An iodine balance study to explore the recommended nutrient intake of iodine in Chinese young adults.
Yang Lichen,Wang Jun,Yang Jianjun,Zhang Huidi,Liu Xiaobing,Mao Deqian,Lu Jiaxi,Gu Yunyou,Li Xiuwei,Wang Haiyan,Xu Jing,Tan Hongxing,Zhang Hongmin,Yu Wei,Tao Xiujuan,Fan Yanna,Cai Qian,Liu Xiaoli,Yang Xiaoguang
The British journal of nutrition
Data on average iodine requirements for the Chinese population are limited following implementation of long-term universal salt iodisation. We explored the minimum iodine requirements of young adults in China using a balance experiment and the 'iodine overflow' hypothesis proposed by our team. Sixty healthy young adults were enrolled to consume a sequential experimental diet containing low, medium and high levels of iodine (about 20, 40 and 60 μg/d, respectively). Each dose was consumed for 4 d, and daily iodine intake, excretion and retention were assessed. All participants were in negative iodine balance throughout the study. Iodine intake, excretion and retention differed among the three iodine levels (P < 0·01 for all groups). The zero-iodine balance derived from a random effect model indicated a mean iodine intake of 102 μg/d, but poor correlation coefficients between observed and predicted iodine excretion (r 0·538 for μg/d data) and retention (r 0·304 for μg/d data). As iodine intake increased from medium to high, all of the increased iodine was excreted ('overflow') through urine and faeces by males, and 89·5 % was excreted by females. Although the high iodine level (63·4 μg/d) might be adequate in males, the corresponding level of 61·6 μg/d in females did not meet optimal requirements. Our findings indicate that a daily iodine intake of approximately half the current recommended nutrient intake (120 μg/d) may satisfy the minimum iodine requirements of young male adults in China, while a similar level is insufficient for females based on the 'iodine overflow' hypothesis.
Iodine bioavailability from cow milk: a randomized, crossover balance study in healthy iodine-replete adults.
van der Reijden Olivia L,Galetti Valeria,Bürki Sarah,Zeder Christophe,Krzystek Adam,Haldimann Max,Berard Joel,Zimmermann Michael B,Herter-Aeberli Isabelle
The American journal of clinical nutrition
BACKGROUND:Milk and dairy products are considered important dietary sources of iodine in many countries. However, to our knowledge, iodine bioavailability from milk has not been directly measured in humans. OBJECTIVE:The aim of this study was to compare iodine bioavailability in iodine-replete adults from: 1) cow milk containing a high concentration of native iodine; 2) milk containing a low concentration of native iodine, with the addition of potassium iodide (KI) to assess a potential matrix effect; and 3) an aqueous solution of KI as a comparator; with all 3 containing equal amounts of total iodine (263 µg/250 mL). We also speciated iodine in milk. DESIGN:We conducted a 3-wk, randomized, crossover balance study in adults (n = 12) consuming directly analyzed, standardized diets. During the 3 test conditions - high intrinsic iodine milk (IIM), extrinsically added iodine in milk (EIM), and aqueous iodine solution (AIS) - subjects collected 24-h urine over 3 d and consumed the test drink on the second day, with 3- or 4-d wash-out periods prior to each treatment. Iodine absorption was calculated as the ratio of urinary iodine excretion (UIE) to total iodine intake. Milk iodine speciation was performed using ion chromatography-mass spectrometry. RESULTS:Iodine intake from the standardized diet was 195 ± 6 µg/d for males and 107 ± 6 µg/d for females; the test drinks provided an additional 263 µg. Eleven subjects completed the protocol. There was a linear relation between iodine intake and UIE (β = 0.89, SE = 0.04, P < 0.001). There were no significant differences in UIE among the 3 conditions (P = 0.24). Median (range) fractional iodine absorption across the 3 conditions was 91 (51-145), 72 (48-95), and 98 (51-143)% on days 1, 2, and 3, respectively, with day 2 significantly lower compared with days 1 and 3 (P < 0.001). In milk, 80-93% of the total iodine was inorganic iodide. CONCLUSION:Nearly all of the iodine in cow milk is iodide and although fractional iodine absorption from milk decreases with increasing dose, its bioavailability is high. The trial was registered at clinicaltrials.gov as NCT03590431.
Urinary Iodine Concentration and Mortality Among U.S. Adults.
Inoue Kosuke,Leung Angela M,Sugiyama Takehiro,Tsujimoto Tetsuro,Makita Noriko,Nangaku Masaomi,Ritz Beate R
Thyroid : official journal of the American Thyroid Association
BACKGROUND:Iodine deficiency has long been recognized as an important public health problem. Global approaches such as salt iodization that aim to overcome iodine deficiency have been successful. Meanwhile, they have led to excessive iodine consumption in some populations, thereby increasing the risks of iodine-induced thyroid dysfunction, as well as the comorbidities and mortality associated with hypothyroidism and hyperthyroidism. This study aimed to elucidate whether iodine intake is associated with mortality among U.S. adults. METHODS:This was an observational study to estimate mortality risks according to urinary iodine concentration (UIC) utilizing a nationally representative sample of 12,264 adults aged 20-80 years enrolled in the National Health and Nutrition Examination Survey (NHANES) III. Crude and multivariable Cox proportional hazards regression models were employed to investigate the association between UIC (<50, 50-99, 100-299, 300-399, and ≥400 μg/L) and mortalities (all-cause, cardiovascular, and cancer). In sensitivity analyses, the study adjusted for total sodium intake and fat/calorie ratio in addition to other potential confounders. Stratum-specific analyses were also conducted to estimate the effects of UIC on mortality according to age, sex, race/ethnicity, and estimated glomerular filtration rate category. RESULTS:Over a median follow-up of 19.2 years, there were 3159 deaths from all causes. Participants with excess iodine exposure (UIC ≥400 μg/L) were at higher risk for all-cause mortality compared to those with adequate iodine nutrition (hazard ratio = 1.19 [confidence interval 1.04-1.37]). Elevated hazard ratios of cardiovascular and cancer mortality were also found, but the confidence interval of the effect estimates included the null value for both outcomes. Low UIC was not associated with increased mortality. Restricted cubic spline models showed similar results for all outcomes. The results did not change substantially after adjusting for total sodium intake and fat/calorie ratio. None of the potential interactions were statistically significant on a multiplicative scale. CONCLUSION:Higher all-cause mortality among those with excess iodine intake compared to individuals with adequate iodine intake highlights the importance of monitoring population iodine status. Further studies with longitudinal measures of iodine status are needed to validate these results and to assess the potential risks excess iodine intake may have on long-term health outcomes.
Sex differences in risk factors for subclinical hypothyroidism.
Ha Jeonghoon,Lee Jeongmin,Jo Kwanhoon,Lim Dong-Jun,Kang Moo Il,Cha Bong Yun,Kim Min-Hee
OBJECTIVE:To investigate the prevalence of subclinical hypothyroidism (SCH) in Korean adults and identify the risk factors for the occurrence of SCH by sex. DESIGN AND METHODS:This study used data from the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI), a cross-sectional, nationally representative survey, which comprises a health interview survey, a health examination survey and a nutrition survey. To examine SCH, the reference range of thyroid-stimulating hormone (TSH) was defined using both the range provided by the test kit manufacturer (SCH-M) and a population-based range (SCH-P). We investigated the prevalence of SCH and its risk factors by sex using both reference ranges. RESULTS:The prevalence of SCH in Koreans according to SCH-M (0.35-5.5 µIU/mL) was 5.6%, and 3.3% with SCH-P (0.62-6.68 µIU/mL). For men, smoking significantly reduced the incidence of SCH, positive anti-thyroid peroxidase antibody (TPOAb) significantly increased the risk of SCH, and in an adjusted model, the risk of SCH in all quartiles increased as the urine iodine creatinine ratio (UICR) quartile increased. For women, positive TPOAb was confirmed as a risk factor for SCH, as was the highest UICR quartile. Furthermore, the odds ratio for SCH in urban vs rural residence was 1.78. CONCLUSIONS:The prevalence rates of SCH were similar to those reported in the literature and previously known risk factors were confirmed using both TSH reference ranges. The notable findings from this study are that the increased risk of SCH with increased iodine intake was more marked in men than in women and that residential area may be a risk factor for SCH in women.
Zinc Absorption from Representative Diet in a Chinese Elderly Population Using Stable Isotope Technique.
Li Ya Jie,Li Min,Liu Xiao Bing,Ren Tong Xiang,Li Wei Dong,Yang Chun,Wu Meng,Yang Lin Li,Ma Yu Xia,Wang Jun,Piao Jian Hua,Yang Li Chen,Yang Xiao Guang
Biomedical and environmental sciences : BES
OBJECTIVE:To determine the dietary zinc absorption in a Chinese elderly population and provide the basic data for the setting of zinc (Zn) recommended nutrient intakes (RNI) for Chinese elderly people. METHODS:A total of 24 elderly people were recruited for this study and were administered oral doses of 3 mg 67Zn and 1.2 mg dysprosium on the fourth day. The primary macronutrients, energy, and phytic acid in the representative diet were examined based on the Chinese National Standard Methods. Fecal samples were collected during the experimental period and analyzed for zinc content, 67Zn isotope ratio, and dysprosium content. RESULTS:The mean (± SD) zinc intake from the representative Chinese diet was 10.6 ± 1.5 mg/d. The phytic acid-to-zinc molar ratio in the diet was 6.4. The absorption rate of 67Zn was 27.9% ± 9.2%. The RNI of zinc, which were calculated by the absorption rate in elderly men and women, were 10.4 and 9.2 mg/d, respectively. CONCLUSION:This study got the dietary Zn absorption in a Chinese elderly population. We found that Zn absorption was higher in elderly men than in elderly women. The current RNI in elderly female is lower than our finding, which indicates that more attention is needed regarding elderly females' zinc status and health.
A dose-response crossover iodine balance study to determine iodine requirements in early infancy.
Dold Susanne,Zimmermann Michael B,Baumgartner Jeannine,Davaz Tabea,Galetti Valeria,Braegger Christian,Andersson Maria
The American journal of clinical nutrition
BACKGROUND:Optimal iodine intake during infancy is critical for brain development, but no estimated average requirement (EAR) is available for this age group. OBJECTIVE:We measured daily iodine intake, excretion, and retention over a range of iodine intakes in early infancy to determine the minimum daily intake required to achieve iodine balance. DESIGN:In a dose-response crossover study, we randomly assigned healthy infants (n = 11; mean ± SD age 13 ± 3 wk) to sequentially consume over 33 d 3 infant formula milks (IFMs) containing 10.5, 19.3, and 38.5 μg I/100 kcal, respectively. Each IFM was consumed for 11 d, consisting of a 6-d run-in period followed by a 4-d balance period and 1 run-out day. RESULTS:Iodine intake (mean ± SD: 54.6 ± 8.1, 142.3 ± 23.1, and 268.4 ± 32.6 μg/d), excretion (55.9 ± 8.6, 121.9 ± 21.7, and 228.7 ± 39.3 μg/d), and retention (-1.6 ± 8.3, 20.6 ± 21.6, and 39.8 ± 34.3 μg/d) differed among the low, middle, and high iodine IFM groups (P < 0.001 for all). There was a linear relation between daily iodine intake and both daily iodine excretion and daily iodine retention. Zero balance (iodine intake = iodine excretion, iodine retention = 0 μg/d) was achieved at a daily iodine intake of 70 μg (95% CI: 60, 80 μg). CONCLUSION:Our data indicate the iodine requirement in 2- to 5-mo-old infants is 70 μg/d. Adding an allowance for accumulation of thyroidal iodine stores would produce an EAR of 72 μg and a recommended dietary allowance of 80 μg. This trial was registered at clinicaltrials.gov as NCT02045784.
Corrigendum to "Undisturbed dust as a metric of long-term indoor insecticide exposure: Residential DDT contamination from indoor residual spraying and its association with serum levels in the VHEMBE cohort" [Environ. Int. 85C (2015) 163-167].
Gaspar Fraser W,Chevrier Jonathan,Bornman Riana,Crause Madelein,Obida Muvhulawa,Barr Dana Boyd,Bradman Asa,Bouwman Henk,Eskenazi Brenda
Although approximately 123 million people may be exposed to high levels of insecticides through the use of indoor residual spraying (IRS) for malaria control, few studies exist on indoor insecticide contamination due to IRS and its relationship with human exposure. In the present study, we developed a sampling method to collect undisturbed dust from 50 homes in Limpopo, South Africa, a region where dichlorodiphenyltrichloroethane (DDT) has been used in IRS programs to prevent malaria for ~70years. We quantified DDT and its degradation products, dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyldichloroethane (DDD) in dust samples to determine dust loading levels and compared these levels to paired serum concentrations of p,p'-DDT and p,p'-DDE in women residents. p,p'-DDT and p,p'-DDE had the highest detection frequencies in both dust (58% and 34% detection, respectively) and serum samples (100% detection). Significantly higher detection frequencies for o,p'-DDT, p,p'-DDE, and p,p'-DDD were observed in dust samples collected in buildings that had been previously sprayed for malaria control. We also observed a significant, positive association between dust loading and serum concentrations of p,p'-DDT and p,p'-DDE (Spearman's rho=0.68 and 0.54, respectively). Despite the low detection frequency in dust, our results indicate that undisturbed dust may be a good metric to quantify long-term home exposure to DDT-related compounds and that contamination of the home environment may be an important determinant/source of DDT and DDE exposure.
Cancer statistics in China, 2015.
Chen Wanqing,Zheng Rongshou,Baade Peter D,Zhang Siwei,Zeng Hongmei,Bray Freddie,Jemal Ahmedin,Yu Xue Qin,He Jie
CA: a cancer journal for clinicians
With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.
Prevalence of thyroid dysfunction with adequate and excessive iodine intake in Hebei Province, People's Republic of China.
Tan Long,Sang Zhongna,Shen Jun,Liu Hua,Chen Wen,Zhao Na,Wei Wei,Zhang Guiqin,Zhang Wanqi
Public health nutrition
OBJECTIVE:To explore (i) the prevalence of thyroid dysfunction in populations with adequate and excessive iodine intakes and (ii) the effect of iodine exposure on the prevalence of thyroid dysfunction. DESIGN:Cross-sectional study was conducted in Hebei in 2010. The population was classified as having adequate or excessive iodine intake according to the iodine concentration in drinking water. Demographic information was collected by questionnaire. Levels of serum thyroid hormones, thyroid autoantibodies and iodine in drinking water and urine were measured. SETTING:Villages with adequate or excessive drinking water iodine in Hebei Province, People's Republic of China. SUBJECTS:A total of 854 men and women aged 20-50 years who had lived in the surveyed areas for over 5 years, including 348 from the adequate iodine area (AIA) and 506 from the excessive iodine area (EIA). RESULTS:Median urinary iodine concentration was 185 μg/l in AIA and 1152 μg/l in EIA. The prevalence of thyroid dysfunction in AIA was 10.3%, which included 1.1% with hypothyroidism and 8.1% with subclinical hypothyroidism; and 20.6% in EIA, which included 3.6% with hypothyroidism and 13.6% with subclinical hypothyroidism. The positive rates of thyroglobulin antibody were 16.1% in AIA and 11.9% in EIA; the positive rates of thyroperoxidase antibody were 20.7% in AIA and 16.4% in EIA. CONCLUSIONS:Excessive iodine intake may lead to increased prevalence of biochemical thyroid dysfunction, especially biochemical hypothyroidism. This is not related to an increase in prevalence of thyroid antibodies. Women are more susceptible to iodine excess.
Effects of increased iodine intake on thyroid disorders.
Sun Xin,Shan Zhongyan,Teng Weiping
Endocrinology and metabolism (Seoul, Korea)
Iodine is a micronutrient essential for the production of thyroid hormones. Iodine deficiency is the most common cause of preventable mental impairment worldwide. Universal salt iodization (USI) has been introduced in many countries as a cost-effective and sustainable way to eliminate iodine deficiency disorders for more than 25 years. Currently, the relationship between USI and iodine excess has attracted more attention. Iodine excess can lead to hypothyroidism and autoimmune thyroiditis, especially for susceptible populations with recurring thyroid disease, the elderly, fetuses, and neonates. Nationwide USI was introduced in China in 1996. This review focused on the effects of iodine excess worldwide and particularly in China.
Assessment of iodine status in children, adults, pregnant women and lactating women in iodine-replete areas of China.
Meng Fangang,Zhao Rencheng,Liu Peng,Liu Lixiang,Liu Shoujun
BACKGROUND:Iodine deficiency disorders (IDD) are widespread in China. Presently, IDD have been put under control by Universal Salt Iodisation (USI) in China; however, there is a lack of evidence on whether the iodine status in adults, pregnant women and lactating women is optimal. This study was therefore conducted to assess the iodine nutrition and thyroid function of children, adults, pregnant women and lactating women residing in areas where the USI program is fully established. DESIGN:Six areas were selected according to the geographical regions in China. In each of these areas, we selected 4 distinct groups of subjects (children, adults, pregnant women and lactating women) in regions where the coverage rate of iodised salt was more than 95% and the levels of iodine and fluoride in drinking water were less than or equal to 10 µg/L and 1 mg/L, respectively. We tested the iodine content of salt, urinary iodine (UI), free thyroxin (FT4), thyrotropin (TSH), thyroglobulin (Tg), thyroglobulin antibody (Tg-Ab) and antimicrosomal antibody (TM-Ab) in the 4 groups, and examined the thyroid volume in children. RESULTS:The median urinary iodine (MUI) concentrations were 271.4 μg/L, 260.2 μg/L, 205.9 μg/L and 193.9 μg/L in children, adults, pregnant women and lactating women, respectively; MUI in children and adults were more than adequate. The goitre prevalence (GP) in children was 6.70%. The odds ratios (OR) of subclinical hypothyroidism in the Tg-Ab- or TM-Ab-positive groups were 3.80, 7.65, 2.01 and 7.47 for children, adults, pregnant women and lactating women, respectively, compared with the negative groups. CONCLUSIONS:The iodine status in children and adults is above the requirement, we should reduce their iodine intake. Subclinical hypothyroidism easily occurs in the Tg-Ab or TM-Ab positive groups.
Exploration of the safe upper level of iodine intake in euthyroid Chinese adults: a randomized double-blind trial.
Sang Zhongna,Wang Peizhong Peter,Yao Zhaixiao,Shen Jun,Halfyard Beth,Tan Long,Zhao Na,Wu Yuntang,Gao Shuo,Tan Jian,Liu Jiayu,Chen Zupei,Zhang Wanqi
The American journal of clinical nutrition
BACKGROUND:The beneficial health effects associated with Universal Salt Iodization are well known. Yet, little is known about the possible adverse health effects in people with high iodine intake and the safe daily intake upper limit in the Chinese population. OBJECTIVE:The objective of this study was to explore the safe upper level of total daily iodine intake among adults in China. DESIGN:A 4-wk, double-blind, placebo-controlled, randomized controlled trial was conducted in 256 euthyroid adults. Participants were randomly assigned to 12 intervention groups with various iodine supplement doses ranging from 0 to 2000 μg/d. Total iodine intake included iodine from both supplements and diet. Multiple outcome measures were used to evaluate possible adverse effects, including thyroid function, thyroid size, and urinary iodine. RESULTS:The mean iodine intake from the diets and salt intake of the participants were 105 ± 25 and 258 ± 101 μg/d, respectively. In comparison with the placebo group, all iodide-supplemented groups responded with significant increases in median urinary iodine concentrations (P < 0.05) and in thyroid-stimulating hormone concentration (P < 0.05). Thyroid volume decreased after 4 wk in the high-iodine intervention groups (1500-2000 μg). Subclinical hypothyroidism appeared in the groups that received 400 μg I (5%) and 500-2000 μg I (15-47%). CONCLUSIONS:This study showed that subclinical hypothyroidism appeared in the participants who took the 400-μg I supplement, which provided a total iodine intake of ∼800 μg/d. Thus, we caution against a total daily iodine intake that exceeds 800 μg/d in China and recommend further research to determine a safe daily upper limit.
Marginal iodide deficiency and thyroid function: dose-response analysis for quantitative pharmacokinetic modeling.
Gilbert M E,McLanahan E D,Hedge J,Crofton K M,Fisher J W,Valentín-Blasini L,Blount B C
Severe iodine deficiency (ID) results in adverse health outcomes and remains a benchmark for understanding the effects of developmental hypothyroidism. The implications of marginal ID, however, remain less well known. The current study examined the relationship between graded levels of ID in rats and serum thyroid hormones, thyroid iodine content, and urinary iodide excretion. The goals of this study were to provide parametric and dose-response information for development of a quantitative model of the thyroid axis. Female Long Evans rats were fed casein-based diets containing varying iodine (I) concentrations for 8 weeks. Diets were created by adding 975, 200, 125, 25, or 0 μg/kg I to the base diet (~25 μg I/kg chow) to produce 5 nominal I levels, ranging from excess (basal+added I, Treatment 1: 1000 μg I/kg chow) to deficient (Treatment 5: 25 μg I/kg chow). Food intake and body weight were monitored throughout and on 2 consecutive days each week over the 8-week exposure period, animals were placed in metabolism cages to capture urine. Food, water intake, and body weight gain did not differ among treatment groups. Serum T4 was dose-dependently reduced relative to Treatment 1 with significant declines (19 and 48%) at the two lowest I groups, and no significant changes in serum T3 or TSH were detected. Increases in thyroid weight and decreases in thyroidal and urinary iodide content were observed as a function of decreasing I in the diet. Data were compared with predictions from a recently published biologically based dose-response (BBDR) model for ID. Relative to model predictions, female Long Evans rats under the conditions of this study appeared more resilient to low I intake. These results challenge existing models and provide essential information for development of quantitative BBDR models for ID during pregnancy and lactation.
Iodine intake as a determinant of thyroid disorders in populations.
Laurberg Peter,Cerqueira Charlotte,Ovesen Lars,Rasmussen Lone Banke,Perrild Hans,Andersen Stig,Pedersen Inge Bülow,Carlé Allan
Best practice & research. Clinical endocrinology & metabolism
UNLABELLED:Depending on the availability of iodine, the thyroid gland is able to enhance or limit the use of iodine for thyroid hormone production. When compensation fails, as in severely iodine-deficient populations, hypothyroidism and developmental brain damage will be the dominating disorders. This is, out of all comparison, the most serious association between disease and the level of iodine intake in a population. In less severe iodine deficiency, the normal thyroid gland is able to adapt and keep thyroid hormone production within the normal range. However, the prolonged thyroid hyperactivity associated with such adaptation leads to thyroid growth, and during follicular cell proliferation there is a tendency to mutations leading to multifocal autonomous growth and function. In populations with mild and moderate iodine deficiency, such multifocal autonomous thyroid function is a common cause of hyperthyroidism in elderly people, and the prevalence of thyroid enlargement and nodularity is high. The average serum TSH tends to decrease with age in such populations caused by the high frequency of autonomous thyroid hormone production. On the other hand, epidemiological studies have shown that hypothyroidism is more prevalent in populations with a high iodine intake. Probably, this is also a complication to thyroid adaptation to iodine intake. Many thyroid processes are inhibited when iodine intake becomes high, and the frequency of apoptosis of follicular cells becomes higher. Abnormal inhibition of thyroid function by high levels of iodine is especially common in people affected by thyroid autoimmunity (Hashimoto's thyroiditis). In populations with high iodine intake, the average serum thyroid-stimulating hormone (TSH) tends to increase with age. This phenomenon is especially pronounced in Caucasian populations with a genetically determined high tendency to thyroid autoimmunity. A small tendency to higher serum TSH may be observed already when iodine intake is brought from mildly deficient to adequate, but there is at present no evidence that slightly elevated serum TSH in elderly people leads to an increase in morbidity and mortality. CONCLUSION:Even minor differences in iodine intake between populations are associated with differences in the occurrence of thyroid disorders. Both iodine intake levels below and above the recommended interval are associated with an increase in the risk of disease in the population. Optimally, iodine intake of a population should be kept within a relatively narrow interval where iodine deficiency disorders are prevented, but not higher. Monitoring and adjusting of iodine intake in a population is an important part of preventive medicine.
Sensitivity and specificity of published strategies using urinary creatinine to identify incomplete 24-h urine collection.
Murakami Kentaro,Sasaki Satoshi,Takahashi Yoshiko,Uenishi Kazuhiro,Watanabe Tomoko,Kohri Toshiyuki,Yamasaki Mitsuyo,Watanabe Reiko,Baba Keiko,Shibata Katsumi,Takahashi Toru,Hayabuchi Hitomi,Ohki Kazuko,Suzuki Junko
Nutrition (Burbank, Los Angeles County, Calif.)
OBJECTIVE:Although urinary creatinine has been used to identify incomplete 24-h urine in numerous epidemiologic studies, information on its utility is limited. We examined the sensitivity and specificity of several strategies that use creatinine to identify incomplete urine using the p-aminobenzoic acid (PABA) check method as reference. METHODS:Subjects were 654 female Japanese dietetic students 18-22 y of age. A single 24-h urine sample was collected, with recording of the time of the start and end of the collection period and missing urine volume. Simultaneous administration of PABA was done to assess completeness. The sensitivity and specificity of five strategies derived from the literature that used creatinine to identify incomplete urine were calculated as the proportion of incomplete and complete urine correctly identified, respectively. RESULTS:A total of 7.6% of subjects was identified as having incomplete urine by PABA (PABA recovery <85%). This proportion significantly (P < 0.0001) decreased (to 5.5%) after considering self-reported collection time and missing urine volume in the calculation of total urine volume. The sensitivity and specificity of the strategy of Knuimann et al. (incomplete urine = <0.7 of [mmol urinary creatinine x 113]/[21 x kilograms of body weight]) were 0.47 and 0.99, respectively. The corresponding values of other strategies were 0.11-0.22 and 0.57-1.00, respectively. CONCLUSION:At least in well-motivated populations in which the proportion of incomplete urine is presumed to be small, the strategy of Knuimann et al. and consideration of the self-reported collection time and missing urine volume in the estimation of total volume may be useful.
Effects of low dose oral iodide supplementation on thyroid function in normal men.
Gardner D F,Centor R M,Utiger R D
Previous studies have demonstrated that short-term oral iodide administration, in doses ranging from 1500 micrograms to 250 mg/day, has an inhibitory effect on thyroid hormone secretion in normal men. As iodide intake in the USA may be as high as 800 micrograms/d, we investigated the effects of very low dose iodide supplementation on thyroid function. Thirty normal men aged 22-40 years were randomly assigned to receive 500, 1500, and 4500 micrograms iodide/day for 2 weeks. Blood was obtained on days 1 and 15 for measurement of serum T4, T3, T3-charcoal uptake, TSH, protein-bound iodide (PBI) and total iodide, and 24 h urine samples were collected on these days for measurement of urinary iodide excretion. TRH tests were performed before and at the end of the period of iodide administration. Serum inorganic iodide was calculated by subtracting the PBI from the serum total iodide. We found significant dose-related increases in serum total and inorganic iodide concentrations, as well as urinary iodide excretion. The mean serum T4 concentration and free T4 index values decreased significantly at the 1500 micrograms/day and 4500 micrograms/day doses. No changes in T3-charcoal uptake or serum T3 concentration occurred at any dose. Administration of 500 micrograms iodide/day resulted in a significant increase (P less than 0.005) in the serum TSH response to TRH, and the two larger iodide doses resulted in increases in both basal and TRH-stimulated serum TSH concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)