Jod trenger vi tilskudd? Iodine do we need supplementation? Helle Margrete Meltzer Lisbeth Dahl Anne Lise Brantsæter Vitenskapsakademiet, november 2014
Iodine deficiency Myxedematous endemic cretinism in the Democratic Republic of Congo : Four inhabitants aged 15-20 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
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
Hedmark, Norway, ca 1910 Woman with goiter Photo taken by Martin Finborud (1861-1930). Mina Lundstein, f. 1885
Goiter: widespread in inland Norway before 1950 Modum 1934 1935: 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
Iodine status in Norway (1934 to 1985) Dahl and Meltzer 2009; In Comprehensive Handbook of Iodine, pp345-352.
Percentile dietary iodine intake (µg/day) in men and women (national data) Men Women Women Johansson & Solvoll 1999 Norkost II report. Totland et al. 2012 Norkost III report. * Food frequency questionnaire ** 24-h recalls
Dietary iodine intake of children (µg/dag) Recommended intake Dahl et al. 2004; Publ Health Nutr 7(4):569-576 8
Iodine sources in adults and children (%) 9
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 1999-2008. 38.5% of invited women consented to participate. The cohort includes 108 000 children, 90 700 mothers and 71 500 fathers. www.fhi.no
Assessment of maternal diet during pregnancy Semi-quantitative FFQ that asked about average intake since the start of pregnancy and up to week 22 340 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
UIC indicate suboptimal iodine status in pregnancy UIC>150 μg/l defined by WHO as adequate iodine nutrition Brantsæter et al. Nutrients. 2013; 5: 424 440.
Iodine intake in 61 904 pregnant Norwegian women in MoBa Study, 2002-2008 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 % <50 50-70 70-100 100-150 150-175 175-250 250-500 500 674 2272 7006 16,061 7572 14,886 12,663 770 1.1 1.1 3.7 4.8 11.3 16.1 25.9 42.0 12.2 54.3 24.0 78.3 20.5 98.8 1.2 100 667 1.6 2208 6.8 6658 22.5 14,267 56.2 6044 70.5 8970 91.7 3463 99.9 52 100 7 0.0 64 0.4 348 2.1 1794 11.3 1528 19.1 5916 49.3 9200 96.3 718 100 Brantsæter et al. Nutrients. 2013; 5: 424 440.
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: 424 440.
Biomonitoring program has started this year!
Thank you!
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
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
Andersson M et al. J. Nutr. 2012;142:744-750
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, pp345-352. Dahl et al. 2012 Nutr J 10:127. 22
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):170-178. Dahl et al. 2012 Nutr J 10:127.
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Table 37.2 Summary of iodine intake studies in Norway..continued 26
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 187 151 (78, 349) - - 183 81.8 (26.7, 442) 184 111 (25, 402) Selenium 187 65 (39, 115) 184 95 (63,153) 183 14 (8.8, 27) 184 18 (6, 38) Total Arsenic per kg bw Inorganic arsenic per kg bw 187 532 (183, 1307) 7.4 (2.4, 17.9) 0.21 (0.13, 0.39) a 183 5.9 (0.8, 41.0) 183 79.6 (7.8, 788) 184 102 (8, 859) Total Mercury per kg bw 184 0.04 (0.001, 0.11) 184 4.0 (1.2, 12.6) 183 1.0 (0.3, 3.5) 184 1.2 (0.3, 5.1) Cadmium per kg bw 185 15.4 (8.5, 39.7) 0.22 (0.10, 0.59) 184 0.45 (0.11, 1.8) 183 0.16 (0.03, 0.62) 184 0.18 (0.04, 0.69) Lead - - 184 24.5 (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)
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) 0.53 37.6 Cadmium in urine ( g/g creatinine) 0.85 Cadmium in blood ( g/l) 0.84 52.9 Lead in blood ( g/l) 0.96 64.4 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.
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 179 98 81 I in urine a 81 82 Se in urine a 13.3 13.9 Se in blood b 93 100 As in urine a 65 111 As in blood b 4.3 8.3 Hg in urine a 1.1 0.95 Hg in blood b 3.4 5.1 Cd in urine a 0.20 0.14 Cd in blood b 0.49 0.44 Pb in blood b 21.3 28.3 P-value Age, years < 40 40-60 > 60 33 73 73 0.909 58 87 96 0.668 12.2 13.6 14.0 0.096 85 98 98 0.025 28 83 88 0.034 2.4 6.1 9.8 0.113 0.59 1.4 0.93 1.6 4.2 5.9 0.016 0.09 0.15 0.23 0.819 0.33 0.44 0.52 18.2 25.7 25.4 P-value BMI, kg/m 2 Normal weight < 25 Overweight 25.1-30 Obese > 30 100 61 18 80 82 90 0.081 12.9 14.0 14.9 0.002 93 96 98 0.002 62 90 142 4.2 6.9 11.6 0.99 1.0 0.88 3.6 5.1 5.4 0.18 0.15 0.15 0.039 0.38 0.56 0.32 0.028 23.1 24.5 28.6 P-value Education, years (missing 4) Basic studies High school University or college 50 60 65 0.486 97 76 77 0.074 15.3 13.9 12.4 0.452 96 97 95 0.049 131 80 64 0.060 9.8 5.6 4.0 0.956 1.0 1.2 0.88 0.079 5.7 3.9 3.3 0.645 0.22 0.20 0.12 0.041 0.51 0.56 0.34 0.282 23.1 28.0 21.8 P-value Living conditions Coast Inland 84 95 0.209 94 74 0.010 15.8 12.2 0.405 107 87 0.032 139 42 0.019 11.6 3.0 0.199 1.2 0.83 6.3 3.1 0.001 0.20 0.15 0.014 0.51 0.36 0.092 23.7 24.7 P-value Smoking (missing 2) Non-smokers Smoked in the past Daily or occasional 71 62 44 0.019 83 97 63 13.3 13.3 13.9 95 94 96 66 80 89 4.0 5.9 7.9 1.1 1.1 0.88 3.5 4.4 4.4 0.051 0.11 0.18 0.26 0.054 0.31 0.44 1.2 0.504 21.7 26.3 25.8 P-value 0.048 0.696 0.840 0.369 0.688 0.661 0.364 0.030