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      Suboptimal Iodine Status among Pregnant Women in the Oslo Area, Norway

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          Abstract

          Norway has been considered iodine replete for decades; however, recent studies indicate reemergence of inadequate iodine status in different population groups. We assessed iodine status in pregnant women based on urinary iodine concentration (UIC), urinary iodine excretion (UIE), and iodine intake from food and supplements. In 804 pregnant women, 24-h iodine intakes from iodine-rich foods and iodine-containing supplements were calculated. In 777 women, iodine concentration was measured in spot urine samples by inductively coupled plasma/mass spectrometry (ICP-MS). In addition, 49 of the women collected a 24-h urine sample for assessment of UIE and iodine intake from food frequency questionnaire (FFQ). Median UIC was 92 µg/L. Fifty-five percent had a calculated iodine intake below estimated average requirement (EAR) (160 µg/day). Iodine intake from food alone did not provide the amount of iodine required to meet maternal and fetal needs during pregnancy. In multiple regression models, hypothyroidism, supplemental iodine and maternal age were positively associated with UIC, while gestational age and smoking were negatively associated, explaining 11% of the variance. This study clearly shows that pregnant women in the Oslo area are mild to moderate iodine deficient and public health strategies are needed to improve and secure adequate iodine status.

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          Global iodine status in 2011 and trends over the past decade.

          Salt iodization has been introduced in many countries to control iodine deficiency. Our aim was to assess global and regional iodine status as of 2011 and compare it to previous WHO estimates from 2003 and 2007. Using the network of national focal points of the International Council for the Control of Iodine Deficiency Disorders as well as a literature search, we compiled new national data on urinary iodine concentration (UIC) to add to the existing data in the WHO Vitamin and Mineral Nutrition Information System Micronutrients Database. The most recent data on UIC, primarily national data in school-age children (SAC), were analyzed. The median UIC was used to classify national iodine status and the UIC distribution to estimate the number of individuals with low iodine intakes by severity categories. Survey data on UIC cover 96.1% of the world's population of SAC, and since 2007, new national data are available for 58 countries, including Canada, Pakistan, the U.K., and the U.S.. At the national level, there has been major progress: from 2003 to 2011, the number of iodine-deficient countries decreased from 54 to 32 and the number of countries with adequate iodine intake increased from 67 to 105. However, globally, 29.8% (95% CI = 29.4, 30.1) of SAC (241 million) are estimated to have insufficient iodine intakes. Sharp regional differences persist; southeast Asia has the largest number of SAC with low iodine intakes (76 million) and there has been little progress in Africa, where 39% (58 million) have inadequate iodine intakes. In summary, although iodine nutrition has been improving since 2003, global progress may be slowing. Intervention programs need to be extended to reach the nearly one-third of the global population that still has inadequate iodine intakes.
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            Assessment of iodine nutrition in populations: past, present, and future.

            Iodine status has been historically assessed by palpation of the thyroid and reported as goiter rates. Goiter is a functional biomarker that can be applied to both individuals and populations, but it is subjective. Iodine status is now assessed using an objective biomarker of exposure, i.e., urinary iodine concentrations (UICs) in spot samples and comparison of the median UIC to UIC cut-offs to categorize population status. This has improved standardization, but inappropriate use of the crude proportion of UICs below the cut-off level of 100 µg/L to estimate the number of iodine-deficient children has led to an overestimation of the prevalence of iodine deficiency. In this review, a new approach is proposed in which UIC data are extrapolated to iodine intakes, adjusted for intraindividual variation, and then interpreted using the estimated average requirement cut-point model. This may allow national programs to define the prevalence of iodine deficiency in the population and to quantify the necessary increase in iodine intakes to ensure sufficiency. In addition, thyroglobulin can be measured on dried blood spots to provide an additional sensitive functional biomarker of iodine status. © 2012 International Life Sciences Institute.
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              Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation.

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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                28 February 2018
                March 2018
                : 10
                : 3
                : 280
                Affiliations
                [1 ]Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet — Oslo Metropolitan University, Oslo 0310, Norway; inger.aakre@ 123456hioa.no (I.A.); annemarie.lilleengen@ 123456hioa.no (A.M.L.); lisa.garnweidner-holme@ 123456hioa.no (L.G.-H.); sborthne@ 123456gmail.com (S.B.); Zada.Pajalic@ 123456hioa.no (Z.P.); Ellen.Blix@ 123456hioa.no (E.B.)
                [2 ]Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, Aas 1433, Norway; elin.gjengedal@ 123456nmbu.no
                [3 ]Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo 0403, Norway; AnneLise.Brantsaeter@ 123456fhi.no
                Author notes
                [* ]Correspondence: sigrun.henjum@ 123456hioa.no ; Tel.: +47-6723-6513
                Author information
                https://orcid.org/0000-0002-0671-2688
                https://orcid.org/0000-0001-9656-1926
                https://orcid.org/0000-0001-6315-7134
                Article
                nutrients-10-00280
                10.3390/nu10030280
                5872698
                29495606
                41811efe-4e97-4bd3-8f06-5f986694243c
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 31 January 2018
                : 22 February 2018
                Categories
                Article

                Nutrition & Dietetics
                iodine status,pregnancy,iodine deficiency,iodine intake,urinary iodine concentration,urinary iodine excretion,norway

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