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Introduction. Iodine plays a key role in human metabolism, growth, and development. During pregnancy and childhood, the demand for this micronutrient increases notably. Increased neonatal thyroid stimulating hormone (nTSH) levels, defined as nTSH ≥ 5 mIU/L, are a marker of iodine deficiency in a population if its prevalence is higher than 3%. Objective. To establish the prevalence of nTSH ≥ 5 in La Pampa in the 2021-2022 period, analyze its correlation with different variables, and compare it with data from a historical cohort. Population and methods. Cross-sectional, descriptive-analytical study in a population of newborn infants born in the 5 health regions of the province of La Pampa in 2021 and 2022. Results. Of the 5778 assessed newborn infants, 9.6% had nTSH levels ≥ 5 mIU/L. It was reported that 70.4% of these measurements were done after the third day of life. No significant differences were observed in the frequency of high nTSH levels by year of birth, birth weight, or days until sample collection. A higher prevalence was observed among male infants (10.6% versus 8.5%; p = 0.007) and term infants (9.8% versus 6.6%; p = 0.02). The prevalence of high TSH levels was superior to that observed in the 2001-2002 cohort. Conclusions. The prevalence of high nTSH levels in La Pampa during 2021 and 2022 was 9.6%, suggesting the presence of mild iodine deficiency in the population of this province, higher that what had been reported 2 decades ago.
Introducción. El yodo desempeña un rol fundamental en el metabolismo, el crecimiento y el desarrollo humano. Durante el embarazo y la infancia, la demanda de este micronutriente aumenta considerablemente. La tirotropinemia neonatal (TSHn) aumentada, definida como TSHn ≥5 mUI/l, es un marcador que señala la deficiencia de yodo en una población cuando su prevalencia supera el 3 %. Objetivo. Determinar la prevalencia de TSHn ≥ 5 en La Pampa durante el período 2021-2022, analizar su correlación con diferentes variables y compararla con datos de una cohorte histórica. Población y métodos. Estudio transversal, de diseño descriptivo-analítico, sobre una población de neonatos nacidos en las cinco zonas sanitarias de la provincia de La Pampa durante los años 2021 y 2022. Resultados. De los 5778 neonatos evaluados, el 9,6 % presentó niveles de TSHn ≥5 mUI/l. El 70,4 % de estas mediciones fueron realizadas después del tercer día de vida. No se observaron diferencias significativas en la frecuencia de niveles elevados de TSHn según el año de nacimiento, peso al nacer o días hasta la extracción. Se registró una mayor prevalencia en el sexo masculino (10,6 % versus 8,5 %; p = 0,007) y entre los neonatos nacidos a término (9,8 % versus 6,6 %; p = 0,02). La prevalencia de hipertirotropinemia fue superior a la observada en una cohorte de 2001-2002. Conclusiones. La prevalencia de hipertirotropinemia neonatal en La Pampa durante los años 2021 y 2022 fue del 9,6 %, lo que indica un estado de deficiencia leve de yodo en la provincia, superior al reportado hace dos décadas.
Assuntos
Iodo , Tireotropina , Humanos , Recém-Nascido , Estudos Transversais , Iodo/deficiência , Masculino , Tireotropina/sangue , Feminino , Prevalência , Biomarcadores/sangueAssuntos
Hipotireoidismo , Iodo , Humanos , História da Medicina , Ohio , Brasil , Nutrição ParenteralRESUMO
El objetivo de este trabajo fue determinar la calidad de yodación de la sal alimentaria a nivel de puestos de venta en los barrios del Gran San Salvador de Jujuy (GSSJ). Para esto se llevó a cabo un estudio descriptivo y transversal. Se adquirió a nivel comercial un envase de sal en cada una de las 47 urbanizaciones del GSSJ, durante el mes de mayo del 2022. El yodo en sal se determinó por titulación con tiosulfato de sodio, con valor referencial establecido por la Ley 17.259/69 (toda sal debe estar yodada en un rango de una parte de yodo en 30.000 de sal ± 25 % = 24,741,2 ppm). Los resultados mostraron que el nivel de yodo en las sales fue de 24,5 ± 9,4 ppm (promedio ± desvío estándar), 26,1 ppm de mediana, 0 a 42,5 ppm (rango) y IC 95 % de 21,827,2 ppm. Solo el 53,2 % de las muestras estaban correctamente yodadas, el 40,4 % contenían yodo, pero de manera insuficiente, el 4,3 % estaban sin yodar y el 2,1 % en exceso marginal, con similar distribución en todas las categorías del NBI/urbanización (p=NS). Solo el 45,0 % de las sales envasadas regionales cumplían con el nivel de yodo adecuado, diferencia altamente significativa respecto a las no regionales (p=0,0077). En conclusión, en el expendio del mercado minorista del GSSJ casi la mitad de los productos necesitan optimizar el nivel de yodación, por lo que se hace necesario aunar los esfuerzos de todos los actores participantes ante la imperiosa necesidad de cumplir no solo con las normativas y parámetros referenciales, sino fundamentalmente con el aporte del nutriente clave para cubrir los requerimientos diarios de la población.
This study aimed to determine the iodization quality of food-grade salt available at retail outlets in neighborhoods of Gran San Salvador de Jujuy (GSSJ). To do so, a descriptive and cross-sectional study was conducted, involving the acquisition of salt samples from 47 urban areas within the GSSJ during May 2022. The iodine in salt was determined by titration with sodium thiosulfate, following the reference value established by Law 17,259/69 (all salt must be iodized within a range of one part iodine per 30,000 parts of salt ± 25 % = 24.741.2 ppm). The results showed that the iodine level in the salt samples were 24.5 ± 9.4 ppm (mean ± standard deviation), median 26.1 ppm, 0 to 42.5 ppm (range), and 95 % CI of 21.827.2 ppm. Only 53.2 % of the samples were correctly iodinated, 40.4 % contained iodine, but insufficiently, 4.3 % were not iodinated, and 2.1 % were in marginal excess, with similar distribution across all categories of UBN/urbanization (p=NS). Only 45.0 % of the regional packaged salts met the adequate iodine level, a highly significant difference compared to the non-regional ones (p=0.0077). In conclusion, in the GSSJ retail market, almost half of the products need to optimize their level of iodization, which is why it is necessary to combine the efforts of all relevant actors in the face of the imperative need to comply not only with the regulations and reference parameters but, fundamentally, with the contribution of this key nutrient to cover the daily requirements of the population.
Assuntos
Deficiência de Iodo , Saúde Pública , IodoRESUMO
Iodine intake in Haiti has increased in recent years thanks to the "Bon Sel" social enterprise approach to salt fortification and distribution by the market segment. However, it was uncertain whether this salt reached remote communities. This cross-sectional study aimed to assess the iodine status of school-age children (SAC) and women of reproductive age (WRA) in a remote region of the Central Plateau. A total of 400 children (9-13 years) and 322 women (18-44 years) were recruited through schools and churches, respectively. Urinary iodine (UIC) and urinary creatinine (UCC) concentrations were measured in spot samples, and thyroglobulin (Tg) on dried blood spots. Their iodine intake was estimated, and dietary information collected. The median (IQR) UIC in SAC was 130 µg/L (79-204, n = 399), and in WRA, 115 µg/L (73-173, n = 322). The median (IQR) Tg in SAC was 19.7 µg/L (14.0-27.6, n = 370), and in WRA, 12.2 µg/L (7.9-19.0, n = 183); 10% of SAC had Tg > 40 µg/L. Estimated iodine intake was 77 µg/day and 202 µg/day in SAC and WRA, respectively. Iodized table salt was rarely consumed, though bouillon was used daily; this is hypothesized to be a major contributor to dietary iodine intake. Iodine intake in this remote region seems to have improved considerably since the 2018 national survey, though SAC remain at risk. These results point to the potential effectiveness of using social business principles to deliver humanitarian solutions.
Assuntos
Iodo , Criança , Feminino , Humanos , Estudos Transversais , Haiti , Iodo/administração & dosagem , Iodo/urina , Estado Nutricional , Cloreto de Sódio na Dieta , Masculino , Adolescente , Adulto Jovem , AdultoRESUMO
Abstract Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroid-ism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.
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OBJECTIVE: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. METHODS: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. RESULTS: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). CONCLUSIONS: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroidism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.
Assuntos
Hipotireoidismo , Iodo , Humanos , Recém-Nascido , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Unidades de Terapia Intensiva Neonatal , Nutrição Parenteral/efeitos adversos , Prevalência , Estudos Retrospectivos , TireotropinaRESUMO
El objetivo del presente trabajo fue evaluar el efecto de la pandemia COVID-19 sobre la disponibilidad y accesibilidad de sal yodada en la ciudad de Salta a nivel del mercado minorista previo a y en el nuevo contexto. Para llevar a cabo este estudio se realizó un estudio multietápico, descriptivo y comparativo con una muestra estadísticamente representativa y sistemática de los 321 barrios de Salta capital. Se realizó la compra del envase de sal alimentaria en febrero/2020, enero/2021, abril/2022, estos dos últimos bajo protocolos de prevención. Se determinó el yodo por titulación con tiosulfato de sodio, considerando valores referenciales internacionales que la presencia de ">95 % de las sales de grado alimentario deben estar yodadas en el rango establecido por legislación, a nivel de producción y en el mercado" . Los resultados mostraron que las sales regionales son las de mayor oferta en los tres monitoreos. La totalidad de etiquetado presenta la leyenda "Sal enriquecida con yodo según Ley 17259/69" y sus registros normativos con gran variabilidad en la fecha del vencimiento. En el 2020, 2021 y 2022 el nivel de yodo varió tanto en las sales nacionales como regionales, las sales aptas fueron del 59,3 %, 29,2 % (p=0,0003234) y 41,9 % respectivamente. Sin yodo: 5,5 %, 4,2 % y 3,2 %. En 2021 todos los barrios ofrecieron sales no aptas. Una marca regional ocupa mayoritariamente el mercado minorista. En el contexto sanitario COVID-19, los contenidos de yodo en la sal para el consumidor descendieron marcadamente respecto a la situación pre pandémica, indicador de alerta por los efectos para la salud de la población y futuras generaciones.
The aim of this study was to evaluate the effect of the COVID-19 pandemic on the availability and accessibility of iodized salt in the city of Salta at retail market level prior to and in the new context. To conduct this research, a multistage, descriptive and comparative study was carried out with a statistically representative and systematic sample of the 321 neighbourhoods of the city of Salta. The purchase of food salt containers was made in said neighbourhoods in February/2020, January/2021, and April/2022, the two last ones under prevention protocols. Iodine was determined by sodium thiosulfate titration, under international reference values indicating that the presence of ">95 % of food grade salt must be iodized within the range established by legislation, at the production level and in the market." The results showed that regional salts are the ones with the highest supply in the three monitoring. All the labeling showed the legend "Salt enriched with iodine according to Law 17259/69" as well as its regulatory records with great variability in the expiration date. In 2020, 2021 and 2022 the level of iodine varied in both national and regional salts, the suitable salts were 59.3 %, 29.2 % (p=0.0003234) and 41.9 % respectively. Without iodine: 5.5 %, 4.2 % and 3.2 %. In 2021 all the neighbourhoods offered unsuitable salts. One regional brand takes up the majority of the retail market. In the COVID-19 health context, the iodine content in salt for human consumption decreased significantly compared to the pre-pandemic situation, a warning indicator because of the effects on the health of the population and future generations.
Assuntos
Deficiência de Iodo , Saúde Pública , COVID-19RESUMO
Introdução: O sal rosa do Himalaia tem se destacado no mercado brasileiro por sua coloração atrativa, além dos apelos ao consumidor que o destacam como um produto "mais natural" e com grande diversidade de minerais por ser um sal de rocha. O teor de iodo no sal rosa consumido no país ainda é pouco discutido, mas vital para manter sob controle os distúrbios por deficiência de iodo (DDI). Objetivo: Avaliar amostras de sal rosa do Himalaia quanto aos teores de iodo, à presença de corantes e à rotulagem. Método: Foram analisadas 71 amostras em 13 cidades do estado de São Paulo para determinação de iodo adicionado na forma de iodato, prova qualitativa para corantes artificiais e avaliação da rotulagem com base na legislação brasileira. Resultados: Um elevado índice de insatisfatoriedade dos teores de iodo foi encontrado (56%) e um percentual ainda maior nos sais comercializados a granel (74%). Verificou-se que, dentre as amostras insatisfatórias, o maior percentual de inadequação (28%) foi a ausência de iodo, colocando a população consumidora deste produto em risco para as DDI. A irregularidade de rotulagem mais encontrada foi a ausência da declaração da adição de iodo (46%), com contradições entre a declaração no rótulo e a efetiva presença avaliada analiticamente. Foram verificadas expressões de qualidade não previstas (27%) ou superlativas (14%), assim como alegações não comprovadas por estudos científicos, como a redução de 60% de sódio e a presença de 84 minerais. Nenhuma amostra apresentou adição de corante. Conclusões: O sal rosa do Himalaia analisado apresentou irregularidades importantes para a saúde da população, em especial quanto ao teor de iodo, mas também não conformidades de rotulagem que comprometem o acesso à informação correta sobre o produto.
Introduction: Himalayan pink salt has stood out in the Brazilian market for its attractive colors, in addition to appeals to the consumer that highlight it as a "more natural" product and with a great diversity of minerals as it is a rock salt. The iodine content in pink salt consumed in the country is still little discussed, but vital to keep Iodine Deficiency Disorders (DDIs) under control. Objective: Evaluate Himalayan pink salt samples for iodine contents, presence of artificial colorants and labeling. Method: Seventy-one samples from thirteen cities of the São Paulo State were analyzed for determination of iodine added as iodate, qualitative testing colorants, and labeling evaluation based on Brazilian legislation. Results: A high rate of unsatisfactory iodine content was found (56%), even higher in salts sold in bulk (74%). It was found that among the unsatisfactory samples, the highest percentage of inadequacy (28%) was the absence of iodine, exposing the consumers of this product at risk for DDIs. The most frequent labeling irregularity was the absence of iodine declaration (46%), with contradictions between label declaration and effective presence evaluated analytically. Unforeseen (27%) or superlative (14%) quality expressions were verified, as well as claims not supported by scientific studies, such as 60% reduction in sodium and presence of 84 minerals. No sample showed colorants addition. Conclusions: Himalayan pink salt samples analyzed showed important irregularities for health of the population, especially regarding the iodine content, but also labeling inaccuracies that compromise access to correct information about the product.
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Abstract Objectives: to evaluate the nutritional status of iodine in pregnant adolescents, taking into account the increase in the demand for iodine during pregnancy and the absence of iodization strategies for this population. Methods: cross-sectional study conducted with 62 pregnant and 71 non-pregnant adolescents assisted in primary care. The nutritional status of iodine was determined by urinary samples. The iodine concentration in the consumed culinary salt was also evaluated. For the comparative analyses of categorical variables, the Chi-square test was used and for the continuous variables, the Kruskal-Wallis test, considering a 95% confidence interval (CI) and significance level of 5%. Results: the mean iodine concentration in household salt was 25.1 mg/kg (CI95%= 11.1-67.5 mg/kg), with higher mean content in culinary salt in the group of pregnant women (p<0.028). Regarding the nutritional status of iodine, 71% of pregnant adolescents were deficient and 29% iodine-sufficient, with significant difference when compared to 38% of deficiency and 62% of sufficiency in the control group (p<0.001). Conclusions: there was an iodic deficiency among pregnant adolescents, even in the face of higher concentrations of iode in household salt, exposing a paradox between higher consumption and lower sufficiency in this group. Thus, it is suggested to consider iodine supplementation during pregnancy, seeking to minimize the effects of this deficiency on maternal and child health.
Resumo Objetivos: avaliar o estado nutricional de iodo em adolescentes gestantes, levando-se em consideração o aumento na demanda de iodo na gestação e a ausência de estratégias de iodização para essa população. Métodos: estudo transversal realizado com 62 adolescentes gestantes e 71 não gestantes assistidas na atenção primária. O estado nutricional de iodo foi determinado pela concentração de iodo em amostras urinárias. O teor de iodo no sal culinário também foi avaliado. Para as análises comparativas das variáveis categóricas utilizou-se o teste de qui-quadrado e para as variáveis contínuas o teste Kruskal-Wallis, considerando intervalo de confiança (IC) de 95% e nível de significância de 5%. Resultados: a média da concentração de iodo no sal domiciliar foi de 25,1 mg/kg (IC95%= 11,1-67,5 mg/kg), com maior teor médio no sal culinário de gestantes (p<0,028). Em relação ao estado nutricional de iodo, 71% das adolescentes gestantes mostraram-se deficientes e 29% iodo-suficientes, com diferença significativa quando comparadas aos 38% de deficiência e 62% de suficiência no grupo controle (p<0,001). Conclusões: observou-se deficiência iódica entre adolescentes gestantes, mesmo diante de maiores concentrações de iodo no sal domiciliar, expondo um paradoxo entre maior consumo e menor suficiência neste grupo. Assim, sugere-se considerar a suplementação de iodo na gestação, buscando-se minimizar os efeitos desta carência sobre a saúde maternoinfantil.
Assuntos
Humanos , Gravidez , Adolescente , Gravidez na Adolescência , Deficiência de Iodo , Estado Nutricional , Estudos Transversais , Iodo/análise , Atenção Primária à Saúde , Brasil , Distribuição de Qui-Quadrado , Saúde Materno-Infantil , Suplementos NutricionaisRESUMO
As pregnant women are susceptible to changes in iodine, which can cause miscarriage, goiter, thyroid nodules, hypothyroidism, in addition to fetal neurological impairment or development. The aim of this study was to verify the implications of the iodine alteration in each gestational trimester and its consequences of physiological justification. The review was based on PRISMA. Searching for articles that took place in March 2020 without delimiting data. As bases consulted were the Clinical Trials, Cochrane Library, Lilacs and Medline (PubMed). The descriptors were combined as follows: "pregnancy" AND "iodine deficiency". Articles that addressed iodine deficiency and its implications were included. The selection followed the steps of reading the titles, abstracts and full articles. To assess the methodological quality of the studies, the STROBE Instruction instrument was used. The research resulted in 1,266 studies and 11 were included. In assessing methodological quality, the lowest score was and the maximum 20. According to studies, the fourth most affected by iodine loss are the second and third, it is possible to increase the volume and pneumatic nodules, subclinical hypothyroidism, pre-eclampsia, among others. The damages caused by iodine deficiency in the first or second trimester are still reversible, therefore, they need to be diagnosed early, to guarantee an iodic homeostasis and prevent damage to the health of the mother-child binomial.