Control of Iodine Deficiency Disorders Following 10-Year Universal Salt Iodization in Hebei Province of China

Objective To evaluate the effectiveness of universal salt iodization （USI） for the control of IDD in Hebei province since it was implemented in 1995, identify the problems currently encountered in the implementation of USI and provide practical proposals for addressing these problems. Methods Probability proportionate to size sampling （PPS） was employed in the surveillance of IDD, for which a total of 1200 school children aged 8-10 years were randomly selected from 30 counties around the whole province during each IDD survey. The iodine content of salt was determined quantitatively with the titration method. The iodine content of urinary samples was measured by the method of ammonium persulfate oxidation. Results The coverage of iodized salt increased from 65.0% in 1995 to 98.0% in 1999, then decreased to 88.1% in 2005 which was below the national standard of 90%. The median urinary iodine of children aged 8-10 years varied between 160.1 μg/L and 307.4 μg/L, which was above the national standard. The proportion of urinary samples with iodine content above 300 lag/L was over 30% in 2005, implying exorbitant iodine nutrition among the children. The goiter rate （TGR） among children aged 8-10 years dropped from 11.8% in 1995 to 2.7% in 2005, indicating that the spread of endemic goiter was under control. Conclusion Preliminary elimination of IDD was achieved by USI in Hebei province. Nevertheless, some problems still existed in USI such as non-iodized salt competition, over iodization and un-standardized iodization. In order to address these problems, the management and supervision of salt market needs to be strengthened to prevent non-iodized salt from reaching households; updating equipment and modifying techniques are also necessary to ensure the quality of iodized salt; to clarify the causes of excessive urinary iodine content, the various sources of iodine from the diet need to be investigated in the future.

Role of medical resource level in iodine deficiency disorder

Background:Iodine deficiency disorders(IDDs)refer to a series of diseases caused by the human body's insufficient iodine intake.Edible salt became iodized in China in 1996,which yielded remarkable results.We have known that IDDs is associated with iodine in the human body,but it is not clear whether IDDs is related to medical resource level.Methods:We collected the number of IDDs cases and an index for the level of medical resource from 31 provinces,autonomous regions and municipalities directly under the central government in China.All data came from the China Statistical Yearbook of Health and Family Planning issued in 2013 by the Peking Union Medical College Publishing House.Data standardization and linear regression analysis were used.Results:The results showed that IDDs correlated with the number of beds in medical and health institutions,number of medical health personnel,number of medical and health institutions,total health expenditure,average health expenditure per capita,medical insurance for urban resident and new rural cooperative medical rural residents(P<0.01).In a multiple linear regression,IDDs was most significantly associated with the number of beds in hospitals,the number of rural health personnel,the number of basic medical and health institutions and government health expenditure for these institutions. Conclusion:Based on the experimental data,we concluded that IDDs had a positive connection with the medical resource level,and basic and rural areas had a more significant association with IDDs.This analysis provides new and explicit ideas for iodine prevention and control work in China.

Time Series and Spatial Epidemiological Analysis of the Prevalence of Iodine Deficiency Disorders in China

Objective To recognize the spatial and temporal characteristics of iodine deficiency disorders(IDD),China national IDD surveillance data for the years of 1995–2018 were analyzed.Methods Time series analysis was used to describe and predict the IDD related indicators,and spatial analysis was used to analyze the spatial distribution of salt iodine levels.Results In China,the median urinary iodine concentration increased in 1995–1997,then decreased to adequate levels,and are expected to remain appropriate in 2019–2022.The goiter rate continually decreased and is expected to be maintained at a low level.Since 2002,the coverage rates of iodized salt and the consumption rates of qualified iodized salt(the percentage of qualified iodized salt in all tested salt) increased and began to decline in 2012;they are expected to continue to decrease.Spatial epidemiological analysis indicated a positive spatial correlation in 2016–2018 and revealed feature regarding the spatial distribution of salt related indicators in coastal areas and areas near iodine-excess areas.Conclusions Iodine nutrition in China showed gradual improvements.However,a recent decline has been observed in some areas following changes in the iodized salt supply in China.In the future,more regulations regarding salt management should be issued to strengthen IDD control and prevention measures,and avoid the recurrence of IDD.

Iodine deficiency disorders in Gansu Province in 2014

Objective To master the situation of iodine deficiency disorders(IDD)and the people’s iodine nutritional status after implementation of the new salt iodine standard in Gansu Province in 2012.Methods Totally 30 counties(cities)were selected in Gansu Province by population proportionate to size sampling(PPS)method in 2014,and one primary school was selected in

Iodized salt consumption and iodine deficiency status in China: a cross-sectional study

Objective:To monitor iodized salt consumption and evaluate iodine deficiency status in 2014 in China.Materials and Methods:In 2014,a nationwide cross-sectional survey was conducted in 31 provinces (in this study,provinces,autonomous regions and municipalities in China's Mainland were named as provinces).Probability proportional to size sampling method was adopted to recruit children ages 8-10 and pregnant women.47,467 children's and 18,994 pregnant women's urine samples were collected and 47,706 children's thyroid volumes were examined.Iodine content in salt was determined with 46,900 edible salt samples from children's households;urinary iodine concentration (UIC) was tested from children and pregnant women's urine samples;thyroid volume of children was assessed by ultrasound.Results:The national coverage rate of iodized salt and consumption rate of qualified iodized salt were 96.3％ and 91.5％,respectively.Median iodine content in iodized salt was 25.2 mg/kg.In 22 of 31 provinces,the provincial coverage rates of iodized salt were over 95％.And consumption rates of qualified iodized salt were more than 90％ in 21 provinces.In this study,the national median urinary iodine concentration (MUIC) of children in China was 197.9 μg/L.At the provincial level,MUIC of children in 19 provinces was 100-199 μg/L,which in 12 provinces was 200-299 μg/L.The national MUIC of pregnant women in 2014 was 154.6 μg/L,slightly higher than the lower limit of the WHO criteria for adequate (150-249 μg/L).At the provincial level,MUIC of pregnant women in 18 provinces was 100-149 μg/L,which in 13 provinces was 150-249 μg/L.The national prevalence of goiter among children in 2014 was 2.6％,of which only Shandong province (5.6％) exceeded the national standard (5％).Conclusions:In China,iodine deficiency disorders (IDD) has been eliminated since 2005.And in 2014,the IDD-free status still remained.

Relationship between Iodine Content in Household Iodized Salt and Thyroid Volume Distribution in Children

Objective To assess the effect of different levels of salt iodine content on thyroid volume（ThV） distribution using data from the 1999, 2011, and 2014 Chinese national iodine deficiency disorder（IDD） surveys. Methods Probability proportion to size（PPS） sampling method was used to obtain a representative national sample of 34,547, 38,932, and 47,188 Chinese children aged 8-10 years in 1999, 2011, and 2014 Chinese national IDD surveys, respectively. The iodine content in household iodized salt and urinary iodine concentration were measured and thyroid ultrasound examination was performed. The data were analyzed by SAS software using histograms and box plots. The skewness and kurtosis were calculated for testing the normality of ThV. Results The median iodine content in household iodized salt dropped from 42.30 mg/kg in 1999 to 25.00 mg/kg in 2014. The median urinary iodine concentration of children aged 8-10 years decreased from 306.0 μg/L in 1999 to 197.9 μg/L in 2014. The median and interquartile range（IQR） of ThV in 1999, 2011, and 2014 surveys were 3.44 m L and 1.50 m L, 2.60 m L and 1.37 m L, 2.63 m L and 1.25 m L, respectively. The skewness and kurtosis of ThV distribution in 1999, 2011, and 2014 surveys were 1.34 and 5.84, 0.98 and 3.54, 1.27 and 5.49, respectively. Conclusion With reduced salt iodization levels, the median urinary iodine concentration and median ThV of children decreased significantly, and the symmetry of the ThV distribution improved.

Iodine deficiency and women’s health: Colonialism’s malign effect on health in Oromia region, in Ethiopia

Objectives: Iodine is an essential nutrient needed for the synthesis of hormone thyroxin. Hormone thyroxin is involved in the metabolism of several nutrients, the regulation of enzymes and differentiation of cells, tissues and organs. Iodine deficiency (ID) impairs the development of the brain and nervous system. It affects cognitive capacity, educability, productivity and child mortality. ID hinders physical strength and causes reproductive failure. The objective of this paper is to explore if the health impacts of ID are more common and severe among women. Design: Using primary data (notes from a visit) and secondary data, this paper examines if the effects of ID are more common and severe among Oromo women inEthiopia. Findings: The health impacts of ID are more common and severe among women. Conclusions: ID is an easily preventable nutritional problem. In Oromia, the persistence of ID is explained by the Ethiopian government’s colonial social policies. Preventing ID should be seen as part of the efforts we make to enhance capacity building, promote health, gender equity and social justice. Implications: Iodine deficiency has a wide range of biological, social, economic and cultural impacts. Preventing ID can be instrumental in bringing about gender equity and building the capacity of people.

Iodine Malnutrition and Associated Factors in Schoolchildren Aged 6 to 14 Years in a Municipality Situated in the Semi-Arid Region of the State of Minas Gerais, Brazil, 2008

The objective of this study was to assess the prevalence of iodine deficiency and possible correlated factors among schoolchildren in the municipality of Novo Cruzeiro-MG by means of an evaluation of urinary iodine excretion. Five hundred and forty schoolchildren aged 6 to 14 years selected by stratified sampling, were evaluated. Urine samples were analyzed using the Sandell-Kolthoff method preconized by the WHO and iodine concentrations in the salt were assessed by means of volumetric analysis, in accordance with recommendations from the Ministry of Health. Iodine deficiency was observed in 38.9% of the schoolchildren. Of these, 28.7% of them presented slight deficiency, 6.2% of them were moderately deficient and 4% of them were seriously deficient. Median urinary iodine levels in the urban and rural population were 150.8 and 119.2 μg/L, respectively, with a clear distribution of iodine deficiency among the populations (p < 0.001) being registered. It was also observed that there was a high prevalence of deficient urinary iodine excretion among schoolchildren that consumed salt with an insufficient iodine content. In relation to the quality of the salt consumed by families, in 12.2% of the residences studied the iodine content in salt was below the recommended level (20 mg/kg), while the iodine content was below 15 mg/kg in only 5.3% of them. The results indicated that, although not characterized as a public health issue, according to WHO criteria, iodine deficiency showed very high prevalence among schoolchildren in this region. Regarding the iodine content of salt found in household consumption, our findings indicated the National Program of Salt Iodination was not efficient in the city, since it did not hit the target proposed by the Ministry of Health. Furthermore, low urinary iodine excretion associated with the consumption of salt with low iodine content suggests the need for periodical evaluations in order to provide effective control of the endemic disease.

Association of iodized salt with goiter prevalence in Chinese populations: a continuity analysis over time

Background: Iodine deficiency disorders(IDD) refer to diseases that are caused by insufficient iodine intake, and the best strategy to prevent IDD is the addition of iodine to dietary salt. Because iodine deficiency is a common cause of goiter, the prevalence as effectively controlled after the implementation of universal salt iodization(USI) in China. However, there is substantial controversy as to whether the incidence of thyroid disorders is related to iodized salt intake. Therefore, we aimed to clarify whether the risk of goiter can be promoted by USI.Methods: A longitudinal continuous study based on the national monitoring results of IDD in China was performed for 3 consecutive years. We recorded the following indicators of IDD from 31 provinces: goiter number, two degrees of goiter(the degree of goiter severity) and cretinism(three endemic diseases), iodized salt intake, median urinary iodine concentration(UIC), soil iodine content and coverage rates of iodized salt. One-way Analysis of Variance(ANOVA) and linear regression analyses examined the differences between the three groups and correlations, respectively. Data were collected from the Chinese national IDD surveillance data in 2011-2013, and the background values of Chinese soil elements were published in 1990.Results: A reference male's daily intake of maximum iodine was 378.9μg, 379.2μg and 366.9μg in 2011, 2012, and 2013, respectively. No statistical association between daily iodized salt intake and the three endemic diseases was observed in 2011-2013(P >0.05). No association was observed between daily iodized salt intake and the UIC of children in 2011(P>0.05). Linear regression revealed no significant correlation between the soil iodine content and three endemic diseases. The present study indicated no difference in the daily iodized salt intake in each province during three years(F=0.886, P=0.647). The coverage rate of iodized salt remained above 98.7%, and goiter rates were stable in 2011-2013.Conclusion: There was no significant association between iodized salt intake and the three endemic diseases, suggesting that the current nutrition level of iodized salt did not cause the high goiter prevalence.

盐业体制改革前后厦门市810岁儿童碘营养状况分析

目的:分析盐业体制改革前后厦门市8~10岁儿童碘营养状况,为碘缺乏病防控策略调整和制定提供科学依据。方法:在盐业体制改革前(2016年)和改革后(2022年),采用横断面调查和分层整群抽样方法,选择厦门市下辖的6个区为调查点。抽样检测8~10岁儿童家中盐碘、随意1次尿碘和甲状腺肿大情况,并对检测结果进行比较分析。结果:盐业体制改革前和改革后,厦门市8~10岁儿童甲状腺肿大率由1.9%(8/423)上升至2.8%(36/1265),但差异无统计学意义(χ^(2)=1.138,P>0.05);8~10岁儿童碘盐覆盖率从98.4%(1213/1233)下降为96.0%(1215/1265),合格碘盐食用率从95.9%(1183/1233)下降为93.3%(1180/1265),改革后均低于改革前,差异均有统计学意义(χ^(2)值分别为17.382、8.669,P<0.05);非碘盐率从1.6%(20/1233)上升至4.0%(50/1265),改革后高于改革前,差异有统计学意义(χ^(2)=17.392,P<0.01);8~10岁儿童尿碘中位数从216.1μg/L下降为183.4μg/L,改革后低于改革前,差异有统计学意义(Z=4.732,P<0.01)。结论:厦门市持续保持消除碘缺乏病目标,但盐业体制改革后合格碘盐食用率降低,非碘盐率上升,碘缺乏危害风险加大。应坚持科学补碘,强化碘缺乏病防治各项干预措施,保障碘营养安全。

何以秦巴山地成为历史上碘缺乏病最严重的地区

长期以来,秦巴山地居民饱受缺碘之害,除了传统关注视域下患有地方性甲状腺肿(瘿病)外,地方性克汀病在当地也非常流行;明清以来的山地开发运动更使得碘缺乏病加剧。秦巴山地碘缺乏病加剧的原因,除了自然因素外,更为直接的因素包括:不合理的开发模式;选择含碘量较低的河水而非富含碘元素的泉水作为水源;以富集碘元素能力弱的玉米为主食;几乎不含有碘的四川宁盐销售进入秦巴山地,并被作为主要食用盐。碘缺乏病是秦巴山地尖锐人地矛盾的真实写照。

2020—2023年青浦地区儿童尿碘结果分析

通过分析2020—2023年上海市青浦区8~10岁儿童的尿碘监测结果,探讨了儿童碘营养状况的变化趋势,为青浦区科学调整碘缺乏病防治干预策略提供科学依据及理论支持.根据《全国碘缺乏病监测方案》的要求进行采样,共收集8~10岁儿童的尿碘监测结果803份,同时采集所有调查对象家中食用盐样检测碘含量,采用B超法测量儿童甲状腺容积.结果显示:2020—2023年上海市青浦区居民户食用盐碘质量分数的中位数为25.65 mg·kg^(-1)(四分位数为7.54~28.55 mg·kg^(-1)),碘盐合格率为88.4%,碘盐覆盖率为65.0%,合格碘盐食用率为57.3%,儿童尿碘质量浓度中位数为199.25µg·L^(-1)(四分位数为129.20~308.22µg·L^(-1)),儿童甲状腺肿大率为1.2%.青浦区8~10岁儿童碘营养水平处于适宜水平,但仍有必要持续开展碘缺乏病监测.

2022年云南省德宏州孕妇和儿童碘缺乏病监测结果分析

目的:分析2022年云南省德宏州孕妇和儿童碘缺乏病监测结果,掌握各项指标控制情况,以便及时提出调整干预策略。方法:将德宏州5个县(市)划分成5个抽样片区,每个片区随机抽取1个乡镇,每个乡镇随机抽取1所小学,每个小学随机抽取8~10岁非寄宿学生40人;所抽取的每个乡镇里随机抽取20名孕妇。采集两类人群家中食盐及尿液,儿童还需检查甲状腺容积。结果:共收集了1609份家庭盐样,其中儿童家庭1073份,孕妇家庭536份。1609份样品的合格碘盐食用率为96.89%,碘盐合格率为97.07%,盐碘中位数为23.27 mg/kg。德宏州各县(市)居民合格碘盐食用率比较,差异有统计学意义(χ^(2)=28.491,P<0.01)。儿童尿碘中位数为257.50μg/L,各县(市)儿童尿碘中位数比较,差异有统计学意义(H=259.399,P<0.01)。孕妇尿碘中位数为203.05μg/L,各县(市)孕妇尿碘中位数比较,差异有统计学意义(H=44.743,P<0.01)。1073名儿童甲状腺肿大率为0.56%。结论:2022年德宏州各县(市)均维持了国家碘缺乏病消除标准,部分县(市)有碘营养过量的风险,需持续进行碘监测工作,找出碘过量原因,进一步加强精准化和差异化干预。

山东省学龄儿童尿碘监测结果分析

目的了解山东省现阶段学龄儿童碘营养状况,通过这一目标人群,对全省居民碘营养状况作一客观评价,提出相应的防治措施。方法对1995、1997、1999、2000及2002年5次山东省碘缺乏病抽样监测中的1685名学龄儿童尿碘进行了测定分析。结果5次监测学龄儿童尿碘中位数分别为234.1、453.0、276.3、165.6和200.0 μg/L;尿碘> 100 μg /L的百分比分别为75.8%、96.7%、86.5%、79.3%、82.5%。尿碘< 20 μg/L的样本占总样本的1.2%,尿碘< 50 μg/L的占5.8%,尿碘< 100 μg/L的占15.5%。不同年龄、不同性别学龄儿童尿碘水平比较差异无显著意义(P> 0.05)。结论目前山东省人群碘摄入量可以满足机体需要,机体碘营养状况良好。坚持食用合格碘盐,完全可以达到防治碘缺乏病的目的。

2002年广东省碘缺乏病防治监测结果分析

目的 了解广东省实现消除碘缺乏病阶段目标后各地防治工作进展情况及存在问题。方法 按卫生部下发的《关于全国第 4次碘缺乏病监测方案的实施意见》要求进行监测。结果 盐碘中位数为 33.4 mg/ kg,居民户合格碘盐食用率为 88.6 % ,碘盐覆盖率为 93.2 3% ;8～ 10岁儿童甲状腺肿大率为 4 .70 % ;儿童尿碘中位数为 184 .5 0 μg/ L,尿碘 <5 0 μg/ L 的儿童占 5 .9% ;水碘中位数为 6 .4 1μg/ L。结论 虽然全省碘盐供应及病情基本稳定 ,人群尿碘水平下降至更理想的水平 ,但在珠江三角洲及沿海地区仍然存在非碘盐冲销现象 。

2002年广西自治区碘缺乏病监测结果分析

目的 了解广西自治区实现消除碘缺乏病阶段目标后的防治现状。方法 每个地 (市 )随机抽取 2～ 3个县 (市 ) ,对盐碘、儿童尿碘、水碘、儿童甲状腺肿大率、儿童智商水平、健康教育等指标进行监测分析。结果 合格碘盐食用率为 90 .7% ;8～ 10岁儿童甲状腺肿大率为 3.1% ;儿童尿碘中位数为 2 5 1.6 μg/ L;儿童智商水平平均为 95 .6 ,智商 <6 9的占 4 .8%。结论 90 %以上的广西居民食用合格碘盐 。

重庆市普供碘盐8年防治碘缺乏病的效果评价

目的评价碘盐措施防治碘缺乏病的效果。方法用直接滴定法检测居民户盐碘;用触诊和B超法检查8～10岁儿童甲状腺,同时检查儿童尿碘和智商。结果1997～2005年,碘盐覆盖率为90.08%～98.17%,合格碘盐食用率为83.00%～92.37%;儿童甲肿率触诊法由18.33%显著下降至10.45%,B超法由17.42%显著下降至9.90%;尿碘中位数稳定在238.75～266.65μg/L,智商值由2002年的103.23显著提高至2005年的106.32,以普供碘盐后出生的8岁儿童为优(107.83)。结论重庆市普供碘盐8年防治碘缺乏病效果显著。

贵州省第4次碘缺乏病监测分析

目的了解贵州省碘缺乏病防治现状,为制定贵州省可持续消除碘缺乏病的防治策略提供依据。方法采用多级随机抽样法。结果居民户盐碘中位数为34.9mg/kg,食用碘盐合格率87.2%,变异系数26.8%,高碘盐比例(>60mg/kg或>50mg/kg)较第3次监测时明显降低;8～10岁儿童尿碘中位数340.4μg/L,<50μg/L的比例为0;甲状腺肿大率触诊法为10.5%,B超法为14.2%。水碘均值<10μg/L;10岁儿童智商(IQ)均值为93.9±19.6,智力低下占9.9%。结论随着盐碘、尿碘中位数水平的降低和碘盐合格率提高,甲肿率明显降低。碘盐浓度还有下调空间。

重庆市基本消除碘缺乏病评估结果分析

目的分析重庆市基本消除碘缺乏病的经验和存在的问题,为进一步巩固成果,实现消除碘缺乏病的目标提供参考资料。方法查阅历年碘盐监测、儿童甲状腺肿和尿碘资料,现场调查居民食用碘盐、8～10岁儿童甲状腺肿和尿碘,分析病情变化特征。结果2001-2007年,碘盐生产批质量合格率除2001年为92.86%外,其余各年均为100%;碘盐批发企业批质量合格率2001年为88.68%,其余年在92.57%～99.34%之间;居民碘盐食用率为94.2%～98.4%,合格碘盐食用率自2003年起,稳定在90%以上,2007年95%的区县在90%以上;儿童甲状腺肿大率2005年触诊法和B超法分别降至10.5%和9.9%,无20%以上的区县;尿碘中位数稳定在250μg/L左右,<50μg/L者占5%以下。市级评估38个区县,合格碘盐食用率均为90%以上,儿童甲状腺肿大率在10.0%～17.3%之间,尿碘中位数均>100μg/L。国家评估碘盐食用率为99.07%,儿童甲状腺肿大率触诊法为7.76%,B超法为7.27%,尿碘中位数为289.17μg/L。结论重庆市达到基本消除碘缺乏病标准,但仍存在非碘盐,儿童甲肿率下降缓慢等问题,与生活水平低和蛋白质营养不足有关。仍需加强碘盐监测,防止非碘盐,同时发展经济,提高居民生活水平,增加蛋白质营养,方能取得更好的效果。

2005年全国居民户层次盐碘监测结果分析

目的了解全民食盐加碘10年后全国消除碘缺乏病工作进展情况，评估全国居民户层次盐碘水平，方法以省为单位，采用人口比例概率抽样法（PPS）进行抽样，对31个省（区、市）及新疆生产建设兵团上报的盐碘定量测定结果，使用Epi Info 2002软件进行汇总分析，结果以2000年第五次人口普查的各省人口数据加权后，全国碘盐覆盖率为94．9％，合格碘盐食用率为90．2％，盐碘中位数为30．8mg／kg、结论以食盐加碘为主的防治碘缺乏病综合措施成效显著。适当降低盐碘质量浓度，提高盐碘均匀度，加强碘盐监测工作，才能确保居民食用合格碘盐，科学防治碘缺乏病：