Jod trenger vi tilskudd?

Transcription

1 Jod trenger vi tilskudd? Iodine do we need supplementation? Helle Margrete Meltzer Lisbeth Dahl Anne Lise Brantsæter Vitenskapsakademiet, november 2014

2 Iodine deficiency Myxedematous endemic cretinism in the Democratic Republic of Congo : Four inhabitants aged years : a normal male and three females with severe longstanding hypothyroidism with dwarfism, retarded sexual development, puffy features, dry skin and hair and severe mental retardation. From Delange

3 Jodmangelsykdommer Fosteret: aborter, dødfødsler, økt spebarnsdødelighet -> Endemisk KRETINISME Mentalt tilbakestående Døvstumhet Skjeløydhet Dvergvekst Barn og unge: Struma, nedsatt mental og fysisk utvikling, hypotyroidisme Voksne: struma, hypotyroidisme, mentalt tilbakestående, nedsatt fruktbarhet

4 Hedmark, Norway, ca 1910 Woman with goiter Photo taken by Martin Finborud ( ). Mina Lundstein, f. 1885

5 Goiter: widespread in inland Norway before 1950 Modum : 73% of boys and 80% of girls had visible goiter Up till 1950 there was endemic iodine deficiency in inland Norway. 1950: iodine added to the cow fodder

6 Iodine status in Norway (1934 to 1985) Dahl and Meltzer 2009; In Comprehensive Handbook of Iodine, pp

7 Percentile dietary iodine intake (µg/day) in men and women (national data) Men Women Women Johansson & Solvoll 1999 Norkost II report. Totland et al Norkost III report. * Food frequency questionnaire ** 24-h recalls

8 Dietary iodine intake of children (µg/dag) Recommended intake Dahl et al. 2004; Publ Health Nutr 7(4):

9 Iodine sources in adults and children (%) 9

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11 The Norwegian Mother and Child Cohort study (MoBa) Nationwide prospective pregnancy cohort, long time follow up through questionnaires and health registries. Participants were recruited from all over Norway from % of invited women consented to participate. The cohort includes children, mothers and fathers.

12 Assessment of maternal diet during pregnancy Semi-quantitative FFQ that asked about average intake since the start of pregnancy and up to week questions, 40 groups of questions 255 foods and dishes Dietary supplements (1 page), more than 1000 different supplements reported Meltzer et al. Maternal and Child Nutrition; 2008: 4:14-27

13 UIC indicate suboptimal iodine status in pregnancy UIC>150 μg/l defined by WHO as adequate iodine nutrition Brantsæter et al. Nutrients. 2013; 5:

14 Iodine intake in pregnant Norwegian women in MoBa Study, All Iodine supplement user: No Yes n (%) 61,904 42,329 (68.4) 19,575 (31.6) Iodine intake, μg/day n % Cum % n Cum % n Cum % < , ,886 12, , Brantsæter et al. Nutrients. 2013; 5:

15 The contribution (%) to maternal iodine intake from food groups and iodine containing supplements in iodine supplement (n=19 575) and non-supplement users (n=42 329) Brantsæter et al. Nutrients. 2013; 5:

16 Biomonitoring program has started this year!

17 Thank you!

18 Omfanget av jodmangel F.Delange, koordinator av det Europeiske kontoret av International Council for Control of Iodine Deficiency Disorders: 1.5 milliarder mennesker er i risikosonen for å utvikle jod-mangel sykdommer, dvs ca. 29% av jordens befolkning, inkludert 655 milioner (12%) som har struma. I Europa har vi regnet med at bare 7 land har hatt struma og jodmangelsykdommer under kontroll: Norge, Sverige, Finland, Island, Østerrike, Sveits, Danmark

19 Results validation study, MoBa FFQ The validation study showed good agreement between estimated intake of iodine by the FFQ and reference measures: FFQ vs FD: Spearman r S =0.48 (95%CI: 0.33, 0.61) FFQ vs UIE: r S =0.42 (95%CI: 0.26, 0.56) The validation study indicated suboptimal iodine status: Median urinary iodine excretion (UIE): 130 μg/24 h Median urinary iodine concentration (UIC): 69 μg/l 106 (89%) had UIC <150 μg/l Brantsæter et al. Maternal and Child Nutrition, 2008 Brantsæter et al. Annals of Nutrition and Metabolism, 2008 Brantsæter et al. Public Health Nutrition, 2007 Brantsæter et al. Eur J Clin Nutr, 2009

20 Andersson M et al. J. Nutr. 2012;142:

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22 Summary of iodine status in urine samples of Norwegians (1934 to 2009) Before there was endemic iodine deficiency in Norway with goiter prevalence of 80% in the Modum area In 1950 iodine was added to the cow fodder Dahl and Meltzer 2009; In Comprehensive Handbook of Iodine, pp Dahl et al Nutr J 10:

23 Iodine status in Norway (1999 to 2009) UIC of men indicate sufficient iodine intake UIC of women indicate mild iodine deficiency Dahl et al 2003 Scand J Nutr 47(4): Dahl et al Nutr J 10:127.

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26 Table 37.2 Summary of iodine intake studies in Norway..continued 26

27 Table 1. Median and 5 th, 95 th percentile for dietary intake of the elements investigated and concentrations in blood and urine. Food intake Blood Urine Urine (µg/d) (µg/l) (µg/g creatinine) (µg/l) n Median (P5, P95) n Median (P5, P95) n Median (P5, P95) n Median (P5, P95) Iodine (78, 349) (26.7, 442) (25, 402) Selenium (39, 115) (63,153) (8.8, 27) (6, 38) Total Arsenic per kg bw Inorganic arsenic per kg bw (183, 1307) 7.4 (2.4, 17.9) 0.21 (0.13, 0.39) a (0.8, 41.0) (7.8, 788) (8, 859) Total Mercury per kg bw (0.001, 0.11) (1.2, 12.6) (0.3, 3.5) (0.3, 5.1) Cadmium per kg bw (8.5, 39.7) 0.22 (0.10, 0.59) (0.11, 1.8) (0.03, 0.62) (0.04, 0.69) Lead (8.6, 65.1) a Using information from NIFES on mean content of inorganic As in seafood (NIFES National Institute of Nutrition and Seafood Research, 2010)

28 Table 5. Rotated factor loadings of the three element factors identified by principal component analysis of the 179 participants Interpreted element pattern First pattern Second pattern Third pattern Element name Factor loadings a Explained variance Cumulative % Arsenic in blood ( g/l) 0.87 Arsenic in urine ( g/g creatinine) 0.85 Mercury in blood ( g/l) 0.84 Selenium in blood ( g/l) 0.69 Selenium in urine ( g/g creatinine) 0.69 Iodine in urine ( g/g creatinine) 0.58 Mercury in urine ( g/g creatinine) Cadmium in urine ( g/g creatinine) 0.85 Cadmium in blood ( g/l) Lead in blood ( g/l) a Factor loadings are the correlation coefficients (r) between the ln of the original variables (element concentrations) and the extracted patterns. Element concentrations are sorted by the size of the loading coefficients. Element concentrations with factor loadings below 0.4 are not listed.

29 Table 3. Median of the elements in blood and/or urine by socio-demographic factors, only including participants with all measurements in blood and urine. Sex Female Male N I in urine a Se in urine a Se in blood b As in urine a As in blood b Hg in urine a Hg in blood b Cd in urine a Cd in blood b Pb in blood b P-value Age, years < > P-value BMI, kg/m 2 Normal weight < 25 Overweight Obese > P-value Education, years (missing 4) Basic studies High school University or college P-value Living conditions Coast Inland P-value Smoking (missing 2) Non-smokers Smoked in the past Daily or occasional P-value