Iodine status of 8 to 10 years old children within 20 years following compulsory salt iodization policy in Shanghai, China

Wang, Zhengyuan; Zang, Jiajie; Shi, Z; Zhu, Z. P.; Song, Jun; Zou, Shurong; Wei, Jin; Jia, Xiaodong; Guo, Changyi; Liu, Shoujun

doi:10.1186/s12937-019-0491-x

Cited by 21 publications

(20 citation statements)

References 20 publications

(18 reference statements)

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“…In addition, for inland children who consumed either iodized salt or non-iodized salt, the median UIC steadily remained between 100 and 199 μg/L. This finding indicates that school-age children remains iodine-sufficient even when they did not use iodized salt at home, which is in line with the study conducted in Shanghai [32]. It is presumed that the major dietary source of iodine may not be from home-salt-prepared foods, but other commercial foods prepared with iodized salt, e.g.…”

Section: Discussionsupporting

confidence: 85%

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China

Lou

Mao

Zhu

et al. 2020

Nutr J

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Background: Pregnant women, neonates, and school-age children are vulnerable to iodine deficiency. The iodine contents in the environment (drinking water and household salt for cooking) vary by geographical location in China. The aim of this study was to assess the iodine status in vulnerable groups from different geographical zones and analyze the iodine content in household salt and drinking water from these zones. Methods: In coastal and inland regions of Zhejiang Province, China, samples of spot urine, drinking water, and household salt for cooking from both pregnant women and school-age children were determined for iodine concentration between 2017 and 2018. Thyroid-stimulating hormone (TSH) levels from neonates born between 2014 and 2015 were acquired from the Newborns Screening Information System. The iodine status of the vulnerable populations was assessed according to the criteria recommended by the World Health Organization. Results: The median UIC of pregnant women was significantly lower in the coastal region (113.0 μg/L) than the inland region (134.9 μg/L; p < 0.001). The median UICs of pregnant women from these two regions were below the lower optimal iodine cutoff level of 150 μg/L. The percentage of neonates with elevated TSH (> 5 mIU/L) was significantly higher in the coastal region (15.8%) than the inland region (10.5%; p < 0.001). The percentage of neonates with elevated TSH from each region decreased within the range of mild iodine deficiency of 3-19.9%. The median UIC of the coastal school-age children was 156.0 μg/L, and the median UIC of inland children was 181.5 μg/ L. Both medians fell within the recommended optimal iodine range of 100-299 μg/L. The iodine concentrations in drinking water varied from 1.0 μg/L in the inland region to 2.0 μg/L in the coastal region. The proportion of households that consumed iodized salt was lower in the coastal region (nearly 65%) than the inland region (approximately 95%). Conclusions: In these two regions with low iodine contents in drinking water, both pregnant women and neonates were iodine-deficient, although school-age children were iodine-sufficient. Urgent efforts are needed to improve the iodine status of pregnant women and neonates.

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Section: Discussionsupporting

confidence: 85%

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China

Lou

Mao

Zhu

et al. 2020

Nutr J

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“…However, the current standard during pregnancy recommended by WHO/ UNICEF/ICCIDD is based on non-pregnant populations: this might lead to overestimation of iodine deficiency during gestation, so the lower limit may be too high (24) . Monitoring by the Shanghai CDC showed that the median UIC in children aged 8-10 years was >100 μg/l after the implementation of the USI policy, indicating that children aged 8-10 years have sufficient iodine intake (12) . Since the median UIC from a representative child's spot urine sample can be used to classify the iodine status of a population (25) .…”

Section: Discussionmentioning

confidence: 99%

“…Monitoring data in Shanghai showed that the percentage of households choosing iodised salt dropped from 94•6 % in 1999 to 76•5 % in 2017 (12) . In theory, with more families opting for non-iodised salt, the median UIC in the population should be on a downwards trend.…”

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confidence: 99%

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

et al. 2020

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As city residents eat out more frequently, it is unknown that if iodised salt is still required in home cooking. We analysed the relationship of household salt and eating out on urinary iodine concentration (UIC) in pregnant women. A household condiment weighing method was implemented to collect salt data for a week. A household salt sample was collected. A urine sample was taken at the end of the week. Totally, 4640 participants were investigated. The median UIC was 139·1 μg/l in pregnant women and 148·7, 140·0 and 122·9 μg/l in the first, second and third trimesters. Median UIC in the third trimester was lower than in the other trimesters (P < 0·001). The usage rates of iodised (an iodine content ≥ 5·0 mg/kg) and qualified-iodised (an iodine content ≥ 21·0 mg/kg) salt were 73·9 and 59·3 %. The median UIC in the qualified-iodised salt group was higher than in the non-iodised group (P = 0·037). The median UIC in the non-iodised group who did not eat out was lower than in qualified-salt groups who both did and did not eat out (P = 0·007, <0·001). The proportion of qualified-iodised salt used in home cooking is low, but foods eaten out have universal salt iodisation according to the national compulsory policy. Household iodised salt did not play a decisive role in the iodine status of pregnant women. Pregnant women in their third trimester who are not eating out and using non-iodised salt at home require extra iodine.

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“…Shanghai has followed the national compulsive universal salt iodization (USI) policy since 1996; the city began monitoring the iodine status of children 8-10-year old in 1995 and of pregnant women in 2009. According to the monitoring data, the iodine status of Shanghai's 8-10-year-old children has been adequate since 2005, but the MUIC of pregnant women has indicated mild iodine de ciency, with a level of only 135.9 µg/L in 2009, 139.8 µg/L in 2012, and 126.5 µg/L in 2015 [14][15][16]. Furthermore, monitoring in Shanghai has revealed that more and more families choose non-iodized salt as their cooking salt, and the rate of households with iodized salt dropped from 94.6% in 1999 to 76.5% in 2017 [16].…”

Section: Introductionmentioning

confidence: 99%

“…According to the monitoring data, the iodine status of Shanghai’s 8–10‐year‐old children was adequate after 2005, although the MUIC of pregnant women has indicated mild iodine deficiency, with a level of only 135.9 μg L −1 in 2009, 139.8 μg L −1 in 2012 and 126.5 μg L −1 in 2015 ( 13–15 ) . Furthermore, monitoring in Shanghai has revealed that more and more families choose non‐iodised salt as their cooking salt, and the rate of household using iodised salt has dropped from 94.6% in 1999 to 76.5% in 2017 ( 15 ) . Hence, the iodine level in pregnant women has become a concern.…”

Section: Introductionmentioning

confidence: 99%

Association of iodine‐related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency

Wang

Shi

et al. 2020

J Human Nutrition Diet

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Background: China's universal salt-iodization program has all but eliminated iodine de ciency disorders. Concern has shifted to mild iodine de ciency. Our study examined factors with the potential to predict mild iodine de ciency in pregnant women. Methods: A total of 2 400 pregnant women were enrolled using a multistage, strati ed, random-sampling method. Data were collected through face-to-face interviews, a standardized questionnaire, an iodine-related knowledge questionnaire, urine samples, and household cooking salt samples. Results: The median urinary iodine concentration (MUIC) was 148.0 μg/L for all participants, and 155.0 μg/L, 151.0 μg/L, and 139.6 μg/L in the rst, second, and third trimesters, respectively. The third trimester's MUIC was signi cantly lower than that of the rst trimester, and the usage rates of iodized salt and quali ed-iodized salt were 71.5% and 59.4%, respectively. Iodine-related knowledge was signi cantly different between the high and low UIC groups. Participants' MUIC increased signi cantly with increases in iodine-related knowledge. The third trimester was a signi cant risk factor for high UIC, whereas abundant iodine-related knowledge, study the dietary knowledge urgently, and consumption of iodine-rich food within 48 hours of a urine iodine test were signi cant protective factors for high UIC (P<0.05). Conclusions: Iodine levels are adequate among pregnant women in Shanghai during the rst and second trimesters, but insu cient in the third trimester. The use of iodized cooking salt does not determine the iodine status of pregnant women. Abundant iodine-related knowledge is important for pregnant women in the third trimester to maintain adequate urinary iodine.

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Iodine status of 8 to 10 years old children within 20 years following compulsory salt iodization policy in Shanghai, China

Abstract: Background: In 1996, Shanghai implemented universal salt iodization and has became the last provincial unit in China to carry out this intervention. In this study, we summarized achievements in past 20 years, to provide suggestions and evidence for the next stage of iodine supplementation.

Cited by 21 publications

References 20 publications

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China

Geographical influences on the iodine status in pregnant women, neonates, and school-age children in China

Relationship of household cooking salt and eating out on iodine status of pregnant women in environmental iodine-deficient coastal areas of China

Association of iodine‐related knowledge, attitudes and behaviours with urinary iodine excretion in pregnant women with mild iodine deficiency

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