Poor Iodine Knowledge, Coastal Region, and Non-Iodized Salt Consumption Linked to Low Urinary Iodine Excretion in Zhejiang Pregnant Women

Lou, Xiaoming; Mo, Zhe; Xing, Mingluan; Mao, Guangming; Zhu, Wei; Wang, Yuanyang; Chen, Yuan; Wang, Zhifang

doi:10.3390/nu11020413

Cited by 19 publications

(29 citation statements)

References 24 publications

(31 reference statements)

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“…The geographical variations in the percentage of households using iodized salt may be related to the differences in knowledge and attitude regarding the consumption of iodized salt between coastal and inland inhabitants. Our previous study showed that inhabitants from the coastal areas had a widespread incorrect perception that iodine-rich seafood (e.g., seaweed and marine fish) was more natural and safer than iodized salt when asked why seafood was chosen as the preferred source of iodine [20]. Consequently, costal inhabitants who consume seafood are reluctant to buy iodized salt.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Since more than 90% iodine intake excrete from urine, the disparity in the median UIC between these two regions can be explained by the difference in iodine intake which may be influenced by two factors. First, the coastal population hold widespread misconception that non-iodized salt is one sort of natural salt and more healthy than iodized salt 6 . They are more likely to consume non-iodized salt than those from the inland 6 , as seen from the coverage of household iodized salt, which is usually lower in the coast (61.9–64.3%) when compared with the inland (95.1–95.3%) 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Understanding the causes of thyroid abnormalities plays a critical role on maintaining the implementation of USI for the increasing number of cases with thyroid abnormalities would lose confidence in consumption of iodized salt 6 , which may ultimately result in IDD re-emerging 7 . Previously published studies on the causes of thyroid abnormalities, however, remain inconsistent.…”

Section: Introductionmentioning

confidence: 99%

Geographical influences on thyroid abnormalities in adult population from iodine-replete regions: a cross-sectional study

Mao

Zhu

et al. 2021

Sci Rep

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The studies on the increasing incidence of thyroid abnormalities are scarce. The aim of this current study was to ascertain the effects of geographical region on thyroid abnormalities under the context of universal salt iodization (USI). We randomly selected 1255 participants residing in inland and 1248 in coast, with the determination of urinary iodine concentration (UIC) and functional and morphological abnormalities of thyroid gland. The median UIC was significantly higher for the inland participants (188.5 μg/L) than the coastal participants (128.5 μg/L; p < 0.001), indicating iodine sufficiency in both populations according to the recommended assessment criteria by the World Health Organization. However, the spectrum of thyroid abnormalities varied between regions, with hypothyroidism prevalent in inland and thyroid nodules in coast. The associations between region and thyroid abnormalities via binary logistic regression models showed that the coastal participants were at a higher risk of total thyroid abnormalities than those from the inland (OR 1.216, 95% CI 1.020–1.449), after the adjustment of ten confounders (demographical characteristics, smoking status, metabolism syndrome, and hyperuricemia). These results indicated that further investigations of the adverse effects of hypothyroidism and thyroid nodules on health burden is urgently needed to sustain USI program.

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“…", were also included (Supplementary 1). These validated questions were adapted from previous studies [13,15,16]. In addition, these questions were further validated in our setting and pilot tested in order to check for validity, comprehension, and clarity.…”

Section: Assessment Of Iodine Knowledge Levelmentioning

confidence: 99%

Adequate Iodine Intake among Young Adults in Jiangsu Province, China Despite a Medium Iodine Knowledge Score

Jin

Luo

Feei

et al. 2020

EJIHPE

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Lack of iodine knowledge might be a risk factor for inadequate iodine intake in populations. Therefore, we aimed to determine the relationship between iodine knowledge and intake in young Chinese adults. A cross-sectional study was conducted in Suzhou, China. Iodine intake was assessed using a validated 33-item iodine-specific Chinese food frequency questionnaire (FFQ) and iodine knowledge was determined using a Chinese iodine knowledge questionnaire. A total of 150 participants (mean age 20.3 years) completed the study. The median iodine intake plus iodized salt was 260 μg/d, indicating iodine sufficiency (>150 µg/d). The median iodine knowledge score was 16/24, suggesting a medium level of knowledge. The majority of participants correctly recognized fish and seafood (95%) and iodized salt (83%) as the most important dietary iodine sources. After adjusting for age and sex, studying in the science cluster and having received iodine education were the predictors of having a higher iodine knowledge score, with adjusted odd ratios (OR) of 4.33 (1.49, 12.61) and 2.73 (1.21, 6.14), respectively. In conclusion, young Chinese adults had an adequate iodine intake despite a medium iodine knowledge score. This study provides support that iodine fortification in China has been successful, but further research is required to more fully substantiate this finding.

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Poor Iodine Knowledge, Coastal Region, and Non-Iodized Salt Consumption Linked to Low Urinary Iodine Excretion in Zhejiang Pregnant Women

Cited by 19 publications

References 24 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

Geographical influences on thyroid abnormalities in adult population from iodine-replete regions: a cross-sectional study

Adequate Iodine Intake among Young Adults in Jiangsu Province, China Despite a Medium Iodine Knowledge Score

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