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SHORT COMMUNICATION
Year : 2014  |  Volume : 1  |  Issue : 2  |  Page : 119-122

Iodine deficiency disorders: Public health measures to mitigate the global burden


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Date of Web Publication11-Jun-2014

Correspondence Address:
Saurabh Ram Bihari Lal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur Guduvancherry Main Road, Sembakkam, Kancheepuram 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.134280

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  Abstract 

Iodine is an essential micronutrient required for the synthesis of the hormones - thyroxine and triiodothyronine. Iodine insufficiency is prevalent throughout the world, and is rated as one of the most significant public health concern in more than 125 countries. An optimal intake of dietary iodine during pregnancy, lactation and early childhood period is crucial for ensuring proper development of the brain of the fetus/newborn. During the course of implementation of the strategy of universal administration of the iodized salt, a wide gamut of challenges has been identified. In order to combat the same and simultaneously enhance the coverage of universal administration of the iodized salt, many measures have been proposed, namely formulating clear plan with time-based targets; encouraging coordination amongst all stakeholders; strengthening of the existing infrastructure; and increasing consumer awareness and demand for adequately iodized salt. To conclude, iodine has a crucial role in ensuring the normal growth and development of the child. However, to expand the coverage of the universal iodized salt to the vulnerable population, sustained political commitment and transparent monitoring and evaluation mechanism is the need of the hour.

Keywords: Goiter, iodine, iodized salt, pregnancy, public health, world


How to cite this article:
Lal Shrivastava SR, Shrivastava PS, Ramasamy J. Iodine deficiency disorders: Public health measures to mitigate the global burden. CHRISMED J Health Res 2014;1:119-22

How to cite this URL:
Lal Shrivastava SR, Shrivastava PS, Ramasamy J. Iodine deficiency disorders: Public health measures to mitigate the global burden. CHRISMED J Health Res [serial online] 2014 [cited 2017 May 25];1:119-22. Available from: http://www.cjhr.org/text.asp?2014/1/2/119/134280


  Introduction Top


Food security is considered as a fundamental right at both the individual and population levels. [1] Malnutrition (viz. under and over nutrition) has been acknowledged as one of the major public health concern affecting all the regions of the world. [2],[3] Much has been said about protein-energy malnutrition over the years, but even micronutrient deficiencies (also known as "hidden hunger"), represent an important component of the burden of malnutrition worldwide, especially in developing countries or poor resource settings. [4]


  Iodine: The micronutrient Top


Iodine is an essential micronutrient required for the synthesis of the hormones-thyroxine and triiodothyronine. [5] It is also an indispensable component to facilitate normal growth, brain development, and well being. [6] The adult human body contains a storage of about 50 mg of iodine. [5] The daily recommended dietary allowance for iodine in adults and in pregnancy is 150 and 250 μg, respectively. [5] Seafoods, cod liver oil, milk, and meat are a few of the rich sources of iodine. [5],[7] Occurrence of iodine deficiency disorders (IDDs) are indirectly attributed to the crops that are cultivated in the iodine deficient soil. [7],[8] Further, it has been estimated that almost 30% of the world's population live in areas with deficient levels of iodine in soil and water. [4],[7]

Iodine deficiency disorders

An optimal intake of dietary iodine during pregnancy, lactation and early childhood period is crucial for ensuring proper development of the brain of the fetus/newborn. [9] Although, the most obvious consequence of iodine deficiency is goiter, recent studies have revealed that there is a much wider spectrum of disorders commencing with the intrauterine life and extending through childhood into adult life with serious health and social consequences, collectively known as IDDs. [8] This spectrum includes disorders such as goiter, subnormal intelligence, delayed motor milestones, strabismus, nystagmus, neuromuscular weakness, endemic cretinism, still birth, hypothyroidism, defect in vision, hearing, and speech, spasticity, mental retardation, and intrauterine death. [5],[8] Majority of the consequences of IDDs is invisible and irreversible, but at the same time preventable. [6],[9] Norms have been proposed to classify the extent of iodine deficiency in a specified population on the basis of the median urinary iodine concentration (UIC) as mild (UIC 50-99 μg/l), moderate (UIC 20-49 μg/l) or severe (UIC <20 μg/l). [7],[10] Further, out of the proposed eight Millennium Development Goals, IDDs is directly or indirectly associated with six of them. [11]

Magnitude of the iodine deficiency disorders

Iodine insufficiency is prevalent throughout the world, and is rated as one of the most significant public health concern in more than 125 countries. [12],[13] Secondary to the insufficient dietary consumption of iodine, almost two billion individuals are prone to suffer from IDDs worldwide. [12] In fact, the findings of studies done in developed countries such as European countries and Australia have also revealed that decreased UIC, is an inevitable consequence of decreased dietary iodine intake. [14],[15],[16] From the perspective of developing countries, for instance, in India, it has been revealed that the entire population of the country is prone to IDDs due to deficiency of iodine in the soil and consequently the food derived from it. [8],[17]

Impact of iodine supplementation on infants, newborn, children and antenatal outcomes

Owing to the complete dependence of the fetus on maternal thyroxine levels (viz. trans-placental passage) in the first and the second trimester of pregnancy, even a small reduction in maternal serum levels of thyroxine during antenatal period can result in long-term impairment in the psychomotor development of the child. [11],[18] In fact the finding of a meta-analysis revealed that the children living in iodine-deficient regions on an average have a lower intelligence quotient, contrary to the children living in iodine-sufficient areas. [19] Furthermore, confirmatory evidence is available to reveal that administration of iodine during pregnancy, peri-conceptional period, and in school augments the growth and development and reduces the risk of mortality as well. [20],[21],[22],[23] In addition, administration of iodine has also found to be effective for enhancing the survival chances of extremely low birth weight preterm babies and for bringing about an improvement in the hearing ability of the children. [24],[25]

As pregnancy is a state of increased energy demands, on a similar note, even the daily recommended dietary allowance for iodine during pregnancy is augmented by more than 60% in comparison with the pre-pregnancy need. [5],[8] If hypothyroidism precipitates in the initial stages of pregnancy, there is a significant risk of miscarriage, premature labor and neurological damage to the fetus. [26],[27] In fact, it has been revealed that regular supplementation of oral iodine for more than three months during antenatal period can significantly improved the pregnancy outcome. [28],[29] Studies have even revealed that iodine administration during lactation period is also advantageous for the breastfed child. [30],[31],[32]

Current strategy

The universally recommended primary strategy for ensuring the elimination of iodine deficiency is through the administration of the iodized salt. [33] Globally, at present around 145 nations have implemented administration of iodized salt, owing to which over 71% of the world's population are consuming iodized salt as recommended. [34],[35] Some of the factors such as formulation of strategies based on the research findings; sustained political commitment; roping in of the private sector; strict enforcement of legislative measures to ensure iodization of salt; and networking with international agencies, have been attributed to the current progress. [17],[36]

Identified challenges

Although considerable progress has been observed in the past couple of decades, iodine deficiency even now remains a significant health problem worldwide and affects both industrialized and developing nations. [37] During the course of implementation of the strategy of universal administration of the iodized salt, a wide gamut of challenges have been identified, each of which should be tackled efficiently to sustain the success achieved. The identified concerns are insufficient administration of iodized salt during pregnancy and lactation; weak monitoring mechanisms; gaps in the supply and distribution of the salt; minimal awareness activities; poor political will; and occurrence of the adverse side effects secondary to the iodized salt administration (viz. iodine-induced hyperthyroidism in patients with autonomous nodular goiter; iodine induced thyroiditis; and an increased prevalence of occult papillary carcinoma). [38],[39],[40],[41],[42]

Proposed interventions

In order to combat the challenges and simultaneously enhance the coverage of universal administration of the iodized salt, a series of measure have been proposed, namely increasing the political support; formulating clear plan with time-based targets; encouraging coordination amongst all stakeholders involved in IDDs control activities; regular monitoring and transparent evaluation activities; strengthening of the existing infrastructure; increasing consumer awareness and demand for adequately iodized salt; sensitizing manufacturers to produce iodized salt; conducting large scale community-based surveys to estimate the iodine levels during antenatal period; introducing quality assured iodized salt through public distribution system; intensifying behavioral change communication activities; and empowering community to monitor the quality of iodized salt by using salt testing kits. In addition, iodine induced adverse effects can be completely prevented by maintaining the quality of the iodized salt and by strict monitoring of iodine levels. [5],[28],[29],[36],[40]


  Conclusion Top


To conclude, iodine has a crucial role in ensuring the normal growth and development of the child. However, to expand the coverage of the universal iodized salt to the vulnerable population, sustained political commitment and transparent monitoring and evaluation mechanism is the need of the hour.

 
  References Top

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2.World Health Organization. Joint child malnutrition estimates (UNICEF-WHO-WB): Global and regional trends by WHO Regions, 1990-2012 Underweight; 2013. Available from: http://apps.who.int/gho/data/view.main.NUTWHOUNDERWEIGHTv?lang=en [Last accessed on 2013 Dec 19].  Back to cited text no. 2
    
3.World Health Organization. Obesity and overweight, 2013. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/ [Last accessed on 2013 Dec 19].  Back to cited text no. 3
    
4.UNICEF, World Bank, USAID, Micronutrient initiative. Investing in the future: A united call to action on vitamin and mineral deficiencies. Global report, 2009. Available from: http://www.unitedcalltoaction.org/documents/Investing_in_the_future.pdf [Last accessed on 2014 Jan 22].  Back to cited text no. 4
    
5.Park K. Nutrition and health. In: Park K, editor. Textbook of Preventive and Social Medicine. 20 th ed. Jabalpur: Banarsidas Bhanot; 2009. p. 539-40, 557-8.  Back to cited text no. 5
    
6.Zimmermann MB, Jooste PL, Pandav CS. Iodine-deficiency disorders. Lancet 2008;372:1251-62.  Back to cited text no. 6
    
7.WHO, UNICEF, ICCIDDS. Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers; 2007. Available from: http://www.who.int/nutrition/publications/micronutrients/iodine_deficiency/9789241595827/en/[Last accessed on 2014 Jan 26].  Back to cited text no. 7
    
8.National Institute of Health and Family Welfare. National iodine deficiency disorders control programme. Available from: http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/NATIONALIODINEDEFICIENCYDISORDERS.html [Last accessed on 2014 Jan 22].  Back to cited text no. 8
    
9.Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: A review. Thyroid 2007;17:829-35.  Back to cited text no. 9
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10.World Health Organization. Degree of public health significance of iodine nutrition; 2004. Available from: http://www.who.int/vmnis/database/iodine/iodine_data_status_summary_t4/en/ [Last accessed on 2014 Jan 26].  Back to cited text no. 10
    
11.Murcia M, Rebagliato M, Iniguez C, Lopez-Espinosa MJ, Estarlich M, Plaza B, et al. Effect of iodine supplementation during pregnancy on infant neurodevelopment at 1 year of age. Am J Epidemiol 2011;173:804-12.  Back to cited text no. 11
    
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18.Gavilan E, Jimenez de Gracia L. Overall child development: Beyond pharmacological iodine supplementation. Endocrinol Nutr 2013;60:577-81.  Back to cited text no. 18
    
19.Bleichrodt N, Born MP. A meta-analysis of research on iodine and its relationship to cognitive development. In: Stanbury JB, editor. The damaged brain of iodine deficiency - Cognitive behavioral, neuromotor, educative aspects. New York: Cognizant Communication Corporation; 1994. p. 195-200.  Back to cited text no. 19
    
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