Iodine intake in the Swiss population 100 years after the introduction of iodised salt: a cross-sectional national study in children and pregnant women.
Iodine
Iodine deficiency
Pregnant women
Salt iodisation
School-age children
Switzerland
Urinary iodine concentration
Journal
European journal of nutrition
ISSN: 1436-6215
Titre abrégé: Eur J Nutr
Pays: Germany
ID NLM: 100888704
Informations de publication
Date de publication:
23 Dec 2023
23 Dec 2023
Historique:
received:
28
07
2023
accepted:
23
11
2023
medline:
23
12
2023
pubmed:
23
12
2023
entrez:
23
12
2023
Statut:
aheadofprint
Résumé
The Swiss voluntary salt iodisation programme has successfully prevented iodine deficiency for 100 years, but dietary habits are changing and today only one-third of processed foods contain iodised salt. We aimed to monitor the current iodine status in children and pregnant women. We conducted a nationwide cross-sectional study in children (6-12 years) and pregnant women and measured the urinary iodine concentration (UIC) in spot urine samples. We estimated the iodine intake using UIC and urinary creatinine concentration (UCC) and determined the prevalence of intakes below the average requirement (AR) using the SPADE method. We measured dried blood spot (DBS) thyroglobulin (Tg), TSH and total T4 in pregnant women. The median UIC was 127 μg/L (bootstrapped 95% CI 119, 140, n = 362) in children and 97 μg/L (bootstrapped 95% CI 90, 106, n = 473) in pregnant women. The estimated prevalence of inadequate iodine intake (< 65 μg/day) was 5.4% (bootstrapped 95% CI 0.0, 14.6) in children. Half (47%) of the women consumed iodine-containing multivitamin and mineral supplements (≥ 150 μg/day). Compared to non-users, users had higher median UIC (129 vs. 81 μg/L, P < 0.001), lower prevalence of inadequacy (< 160 μg/day; 0.2 vs. 31%) and lower DBS-Tg (23 vs. 29 μg/L, P < 0.001). All women were euthyroid. The Swiss diet and current salt fortification provides adequate iodine intake in children, but not in all pregnant women. Iodine supplements cover the dietary gap in pregnancy but are not universally consumed. Therefore, improved use of iodised salt in processed foods is desired to ensure adequate iodine intake in all population groups. This trial was registered at clinicaltrials.gov as NCT04524013.
Identifiants
pubmed: 38141138
doi: 10.1007/s00394-023-03287-6
pii: 10.1007/s00394-023-03287-6
doi:
Banques de données
ClinicalTrials.gov
['NCT04524013']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Bürgi H, Supersaxo Z, Selz B (1990) Iodine deficiency diseases in Switzerland one hundred years after Theodor Kocher’s survey: a historical review with some new goitre prevalence data. Acta Endocrinol (Copenh) 123(6):577–590. https://doi.org/10.1530/acta.0.1230577
doi: 10.1530/acta.0.1230577
pubmed: 2284884
Zimmermann M, Andersson M (2021) Global endocrinology: global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020. Eur J Endocrinol 185(1):R13-R21. https://doi.org/10.1530/eje-21-0171
doi: 10.1530/eje-21-0171
pubmed: 33989173
pmcid: 8240726
Andersson M, Hunziker S, Fingerhut R, Zimmermann M, Herter-Aeberli I (2019) Effectiveness of increased salt iodine concentration on iodine status: trend analysis of cross-sectional national studies in Switzerland. Eur J Clin Nutr 59(2):581–593. https://doi.org/10.1007/s00394-019-01927-4
doi: 10.1007/s00394-019-01927-4
FDHA (2022) Verwendung von jodiertem Salz in industriell verarbeiteten Lebensmitteln: Markterhebung. Risikobewertung. Federal Food Safety and Veterinary Office (FSVO), Bern
Andersson M, Aeberli I, Wüst N, Piacenza A, Bucher T, Henschen I, Haldimann M, Zimmermann M (2010) The Swiss iodized salt program provides adequate iodine for school children and pregnant women, but weaning infants not receiving iodine-containing complementary foods as well as their mothers are iodine deficient. J Clin Endocrinol Metab 95(12):5217–5224. https://doi.org/10.1210/jc.2010-0975
doi: 10.1210/jc.2010-0975
pubmed: 20810570
Hess S, Zimmermann M, Torresani T, Bürgi H, Hurrell R (2001) Monitoring the adequacy of salt iodization in Switzerland: a national study of school children and pregnant women. Eur J Clin Nutr 55(3):162–166. https://doi.org/10.1038/sj.ejcn.1601140
doi: 10.1038/sj.ejcn.1601140
pubmed: 11305264
Zimmermann M, Aeberli I, Torresani T, Bürgi H (2005) Increasing the iodine concentration in the Swiss iodized salt program markedly improved iodine status in pregnant women and children: a 5-y prospective national study. Am J Clin Nutr 82(2):388–392. https://doi.org/10.1093/ajcn.82.2.388
doi: 10.1093/ajcn.82.2.388
pubmed: 16087983
WHO (2007) Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers, 3rd edn. World Health Organization, Geneva
Stalder E, Haldimann M, Blanc A, Dudler V, Ponte B, Pruijm M, Ackermann D, Bochud M (2019) Use of day and night urinary iodine excretion to estimate the prevalence of inadequate iodine intakes via the estimated average requirement cut-point method. Swiss Med Wkly 149:w20090. https://doi.org/10.4414/smw.2019.20090
doi: 10.4414/smw.2019.20090
pubmed: 31154659
Zimmermann M, Andersson M (2012) Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 70(10):553–570. https://doi.org/10.1111/j.1753-4887.2012.00528.x
doi: 10.1111/j.1753-4887.2012.00528.x
pubmed: 23035804
Dorey C, Zimmermann M (2008) Reference values for spot urinary iodine concentrations in iodine-sufficient newborns using a new pad collection method. Thyroid 18(3):347–352. https://doi.org/10.1089/thy.2007.0279
doi: 10.1089/thy.2007.0279
pubmed: 18341380
Ittermann T, Albrecht D, Arohonka P, Bilek R, de Castro J, Dahl L, Filipsson Nystrom H, Gaberscek S, Garcia-Fuentes E, Gheorghiu M, Hubalewska-Dydejczyk A, Hunziker S, Jukic T, Karanfilski B, Koskinen S, Kusic Z, Majstorov V, Makris K, Markou K, Meisinger C, Milevska Kostova N, Mullen K, Nagy E, Pirags V, Rojo-Martinez G, Samardzic M, Saranac L, Strele I, Thamm M, Top I, Trofimiuk-Müldner M, Ünal B, Koskinen S, Vila L, Vitti P, Winter B, Woodside J, Zaletel K, Zamrazil V, Zimmermann M, Erlund I, Völzke H (2020) Standardized map of iodine status in Europe. Thyroid 30(9):1346–1354. https://doi.org/10.1089/thy.2019.0353
doi: 10.1089/thy.2019.0353
pubmed: 32460688
EDI (2022) Verordnung des EDI über den Zusatz von Vitaminen, Mineralstoffen und sonstigen Stoffen in Lebensmitteln (VZVM) (817.022.32). vom 16. Dezember 2016 (Stand am 1. Juli 2022). Federal Department of Home Affairs (FDHA), Bern
Haldimann M, Bochud M, Burnier M, Paccaud F, Dudler V (2014) Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt. Public Health Nutr 18(8):1333–1342. https://doi.org/10.1017/s1368980014002018
doi: 10.1017/s1368980014002018
pubmed: 25231207
pmcid: 10271515
Benzi-Schmid C, Haldimann M (2019) Sind Milch und Milchprodukte gute Jodquellen? Schweizer Ernährungsbulletin 2019. BLV, Bundesamt für Lebensmittelsicherheit und Veterinärwesen, Bern. doi: https://doi.org/10.24444/blv-2018-0111
Benzi-Schmid C (2023) Nahrungsmittelbilanz für die Schweiz: Überblick zum angenäherten Verzehr und zu dessen Entwicklung in den vergangenen acht Jahren. Schweizer Ernährungsbulletin. Federal Food Safety and Veterinary Office (FSVO), Bern, Switzerland. https://doi.org/10.24444/blv-2023-0111
Agristat S, Switzerland Cheese Marketing, TSM Treuhand GMbH, Branchenorganisation Milch (2022) Dairy statistics Switzerland 2021. Branchenorganisation Milch, Brugg
Chatelan A, Beer-Borst S, Randriamiharisoa A, Pasquier J, Blanco J, Siegenthaler S, Paccaud F, Slimani N, Nicolas G, Camenzind-Frey E, Zuberbuehler C, Bochud M (2017) Major differences in diet across three linguistic regions of Switzerland: results from the first national nutrition survey menuCH. Nutrients. https://doi.org/10.3390/nu9111163
doi: 10.3390/nu9111163
pubmed: 29068399
pmcid: 5707635
Bochud M, Chatelan A, Blanco J, Beer-Borst S (2017) Anthropometric characteristics and indicators of eating and physical activity behaviors in the Swiss adult population: Results from menuCH 2014/2015. Federal Office of Public Health and the Food Safety and Veterinary Office. https://doi.org/10.7892/boris.101641
FDHA (2021) Schweizer Ernährungsbulletin 2021. Federal Food Safety and Veterinary Office (FSVO), Bern
FCN (2018) Vegan diets: review of nutritional benefits and risks. Expert report of the FCN. Federal Food Savety and Veterinary Office, Bern
Swissveg (2022) Statistics on vegetarians and vegans in Switzerland. Swissveg, Winterthur
Schüpbach R, Wegmüller R, Berguerand C, Bui M, Herter-Aeberli I (2017) Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. Eur J Nutr 56(1):283–293. https://doi.org/10.1007/s00394-015-1079-7
doi: 10.1007/s00394-015-1079-7
pubmed: 26502280
Walther B, Guggisberg D, Badertscher R, Egger L, Portmann R, Dubois S, Haldimann M, Kopf-Bolanz K, Rhyn P, Zoller O, Veraguth R, Rezzi S (2022) Comparison of nutritional composition between plant-based drinks and cow’s milk. Front Nutr 9:988707. https://doi.org/10.3389/fnut.2022.988707
doi: 10.3389/fnut.2022.988707
pubmed: 36386959
pmcid: 9650290
FSO (2021) Population and households statistics (STATPOP) 2020. Bern
Fraser C, Harris E (1989) Generation and application of data on biological variation in clinical chemistry. Crit Rev Clin Lab Sci 27(5):409–437. https://doi.org/10.3109/10408368909106595
doi: 10.3109/10408368909106595
pubmed: 2679660
König F, Andersson M, Hotz K, Aeberli I, Zimmermann M (2011) Ten repeat collections for urinary iodine from spot samples or 24-hour samples are needed to reliably estimate individual iodine status in women. J Nutr 141(11):2049–2054. https://doi.org/10.3945/jn.111.144071
doi: 10.3945/jn.111.144071
pubmed: 21918061
Arns-Glaser L, Zihlmann R, Gessler S, Verkaik-Kloosterman J, Zandberg L, Assey V, Rigutto-Farebrother J, Braegger C, Zimmermann M, Andersson M (2023) Estimating habitual iodine intake and prevalence of inadequacy from spot urine in cross-sectional studies: a modeling analysis to determine the required sample size. Am J Clin Nutr. https://doi.org/10.1016/j.ajcnut.2023.03.012
doi: 10.1016/j.ajcnut.2023.03.012
pubmed: 37270291
Lachat C, Hawwash D, Ocké M, Berg C, Forsum E, Hörnell A, Larsson C, Sonestedt E, Wirfält E, Åkesson A, Kolsteren P, Byrnes G, De Keyzer W, Van Camp J, Cade J, Slimani N, Cevallos M, Egger M, Huybrechts I (2016) STrengthening the Reporting of OBservational studies in Epidemiology—nutritional epidemiology (STROBE-nut): an extension of the STROBE statement. PLoS Med 13(6):e1002036. https://doi.org/10.1371/journal.pmed.1002036
doi: 10.1371/journal.pmed.1002036
pubmed: 27270749
pmcid: 4896435
WHO (1995) Physical status: the use and interpretation of anthropometry—report of a WHO expert committee. World Health Organization, Geneva
Pino S, Fang S, Braverman L (1996) Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 42(2):239–243
doi: 10.1093/clinchem/42.2.239
pubmed: 8595717
Vasiliades J (1976) Reaction of alkaline sodium picrate with creatinine: kinetics and mechanism of formation of the mono-creatinine picric acid complex. Clin Chem 22(10):1664–1671
doi: 10.1093/clinchem/22.10.1664
pubmed: 10095
Stinca S, Andersson M, Erhardt J, Zimmermann M (2015) Development and validation of a new low-cost enzyme-linked immunoassay for serum and dried blood spot thyroglobulin. Thyroid 25(12):1297–1305. https://doi.org/10.1089/thy.2015.0428
doi: 10.1089/thy.2015.0428
pubmed: 26528830
Stinca S, Andersson M, Weibel S, Herter-Aeberli I, Fingerhut R, Gowachirapant S, Hess S, Jaiswal N, Jukic T, Kusic Z, Mabapa N, Nepal A, San Luis T, Zhen J, Zimmermann M (2017) Dried blood spot thyroglobulin as a biomarker of iodine status in pregnant women. J Clin Endocrinol Metab 102(1):23–32. https://doi.org/10.1210/jc.2016-2829
doi: 10.1210/jc.2016-2829
pubmed: 27732337
Alexander E, Pearce E, Brent G, Brown R, Chen H, Dosiou C, Grobman W, Laurberg P, Lazarus J, Mandel S, Peeters R, Sullivan S (2017) 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27(3):315–389. https://doi.org/10.1089/thy.2016.0457
doi: 10.1089/thy.2016.0457
pubmed: 28056690
R Development Core Team (2021) R: a language and environment for statistical computing. 4.1.2. edn. R Foundation for Statistical Computing, Vienna
Pearce E, Lazarus J, Smyth P, He X, Smith D, Pino S, Braverman L (2009) Urine test strips as a source of iodine contamination. Thyroid 19(8):919. https://doi.org/10.1089/thy.2009.0120
doi: 10.1089/thy.2009.0120
pubmed: 19534621
Montenegro-Bethancourt G, Johner S, Stehle P, Neubert A, Remer T (2015) Iodine status assessment in children: spot urine iodine concentration reasonably reflects true twenty-four-hour iodine excretion only when scaled to creatinine. Thyroid 25(6):688–697. https://doi.org/10.1089/thy.2015.0006
doi: 10.1089/thy.2015.0006
pubmed: 25781006
Remer T, Neubert A, Maser-Gluth C (2002) Anthropometry-based reference values for 24-h urinary creatinine excretion during growth and their use in endocrine and nutritional research. Am J Clin Nutr 75:561
doi: 10.1093/ajcn/75.3.561
pubmed: 11864864
Forni Ogna V, Ogna A, Vuistiner P, Pruijm M, Ponte B, Ackermann D, Gabutti L, Vakilzadeh N, Mohaupt M, Martin P, Guessous I, Péchère-Bertschi A, Paccaud F, Bochud M, Burnier M (2015) New anthropometry-based age- and sex-specific reference values for urinary 24-hour creatinine excretion based on the adult Swiss population. BMC Med 13(1):40. https://doi.org/10.1186/s12916-015-0275-x
doi: 10.1186/s12916-015-0275-x
pubmed: 25858764
pmcid: 4354997
Jahreis G, Hausmann W, Kiessling G, Franke K, Leiterer M (2001) Bioavailability of iodine from normal diets rich in dairy products—results of balance studies in women. Exp Clin Endocrinol Diabetes 109(3):163–167. https://doi.org/10.1055/s-2001-14840
doi: 10.1055/s-2001-14840
pubmed: 11409299
IOM (2001) Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc, vol Iodine, vol 8. National Academies Press (US), Washington (DC)
Dekkers A, Verkaik-Kloosterman J, van Rossum C, Ocké M (2014) SPADE, a new statistical program to estimate habitual dietary intake from multiple food sources and dietary supplements. J Nutr 144(12):2083–2091. https://doi.org/10.3945/jn.114.191288
doi: 10.3945/jn.114.191288
pubmed: 25320187
Allen L, Carriquiry A, Murphy S (2020) Perspective: proposed harmonized nutrient reference values for populations. Adv Nutr 11(3):469–483. https://doi.org/10.1093/advances/nmz096
doi: 10.1093/advances/nmz096
pubmed: 31701998
EFSA (2018) Summary of tolerable upper intake levels—version 4 (September 2018). European Food Safety Authority: Scientific Committee on Food and Scientific Panel on Dietetic Products, Nutrition and Allergies
IOM (2000) DRI dietary reference intakes: applications in dietary assessment. National Academies Press (US), Washington (DC). https://doi.org/10.17226/9956
Murphy S, Yaktine A, Carriquiry A (2021) Planning nutritionally adequate diets for groups: methods used to develop recommendations for a child and adult care food program. Adv Nutr 12(2):452–460. https://doi.org/10.1093/advances/nmaa119
doi: 10.1093/advances/nmaa119
pubmed: 33002149
FSO (2021) Population by migration status 2021. https://www.bfs.admin.ch/bfs/en/home/statistics/population/migration-integration/by-migration-status.html . Accessed 05 May 2023
Dold S, Zimmermann M, Jukic T, Kusic Z, Jia Q, Sang Z, Quirino A, San Luis T, Fingerhut R, Kupka R, Timmer A, Garrett G, Andersson M (2018) Universal salt iodization provides sufficient dietary iodine to achieve adequate iodine nutrition during the first 1000 days: a cross-sectional multicenter study. J Nutr 148(4):587–598. https://doi.org/10.1093/jn/nxy015
doi: 10.1093/jn/nxy015
pubmed: 29659964
FDHA (2017) Swiss nutrition policy 2017–2024. Federal Food Safety and Veterinary Office (FSVO), Bern, Switzerland
WHO (2014) Salt reduction and iodine fortification strategies in public health: report of a joint technical meeting. World Health Organization, Geneva
Strohm D, Bechthold A, Ellinger S, Leschik-Bonnet E, Stehle P, Heseker H (2018) Revised reference values for the intake of sodium and chloride. Ann Nutr Metab 72(1):12–17. https://doi.org/10.1159/000484355
doi: 10.1159/000484355
pubmed: 29232668
WHO (2012) Guideline: sodium intake for adults and children. World Health Organization, Geneva
Rios-Leyvraz M, Bovet P, Bochud M, Genin B, Russo M, Rossier M, Tabin R, Chiolero A (2019) Estimation of salt intake and excretion in children in one region of Switzerland: a cross-sectional study. Eur J Nutr 58(7):2921–2928. https://doi.org/10.1007/s00394-018-1845-4
doi: 10.1007/s00394-018-1845-4
pubmed: 30341681
Chappuis A, Bochud M, Glatz N, Vuistiner P, Paccaud F, Burnier M (2011) Swiss survey on salt intake: main results. Federal Office of Public Health
Bath S, Verkaik-Kloosterman J, Sabatier M, Ter Borg S, Eilander A, Hora K, Aksoy B, Hristozova N, van Lieshout L, Tanju Besler H, Lazarus J (2022) A systematic review of iodine intake in children, adults, and pregnant women in Europe—comparison against dietary recommendations and evaluation of dietary iodine sources. Nutr Rev 80(11):2154–2177. https://doi.org/10.1093/nutrit/nuac032
doi: 10.1093/nutrit/nuac032
pubmed: 35713524
pmcid: 9549594
Haldimann M, Alt A, Blanc A, Blondeau K (2005) Iodine content of food groups. J Food Compost Anal 18(6):461–471. https://doi.org/10.1016/j.jfca.2004.06.003
doi: 10.1016/j.jfca.2004.06.003
van der Reijden O, Zimmermann M, Galetti V (2017) Iodine in dairy milk: sources, concentrations and importance to human health. Best Pract Res Clin Endocrinol Metab 31(4):385–395. https://doi.org/10.1016/j.beem.2017.10.004
doi: 10.1016/j.beem.2017.10.004
pubmed: 29221567
Stalder U, Haldimann M (2021) Salz im Brot—darf es eine Prise weniger sein? Bundesamt für Lebensmittelsicherheit und Veterinärwesen (BLV), Bern. https://doi.org/10.24444/blv-2021-0111
FDHA (2019) Ernährung in Schwangerschaft und Stillzeit. Federal Food Safety and Veterinary Office (FSVO), Bern, Switzerland
Gfeller M, Colque G, Kopp P (2022) Iodine content of frequently used prenatal and adult multivitamins in Switzerland. Front Endocrinol. https://doi.org/10.3389/fendo.2022.1041232
doi: 10.3389/fendo.2022.1041232
Zimmermann M (2020) Iodine supplements for mildly iodine-deficient pregnant women: are they worthwhile? Am J Clin Nutr 112(2):247–248. https://doi.org/10.1093/ajcn/nqaa116
doi: 10.1093/ajcn/nqaa116
pubmed: 32433724
Dineva M, Fishpool H, Rayman M, Mendis J, Bath S (2020) Systematic review and meta-analysis of the effects of iodine supplementation on thyroid function and child neurodevelopment in mildly-to-moderately iodine-deficient pregnant women. Am J Clin Nutr 112(2):389–412. https://doi.org/10.1093/ajcn/nqaa071
doi: 10.1093/ajcn/nqaa071
pubmed: 32320029
Næss S, Markhus M, Strand T, Kjellevold M, Dahl L, Stokland A, Nedrebø B, Aakre I (2021) Iodine nutrition and iodine supplement initiation in association with thyroid function in mildly-to-moderately iodine-deficient pregnant and postpartum women. J Nutr 151(10):3187–3196. https://doi.org/10.1093/jn/nxab224
doi: 10.1093/jn/nxab224
pubmed: 34255063
pmcid: 8485914
Farebrother J, Zimmermann M, Andersson M (2019) Excess iodine intake: sources, assessment, and effects on thyroid function. Ann NY Acad Sci 1446(1):44–65. https://doi.org/10.1111/nyas.14041
doi: 10.1111/nyas.14041
pubmed: 30891786
Ascoli W, Arroyave G (1970) Epidemiologia el bocio endemico en Centro America. Relacion entre prevalencia y excrecion urinaria de yodo (Epidemiology of endemic goiter in Central America. Association between prevalence and urinary iodine excretion). Arch Latinoamer Nutr 20:309–320
Langer P (1980) Eastern and southeastern Europe. In: Stanbury Hbe JB (ed) Endemic goiter and endemic cretinism. Wiley, New York, pp 141–153
Delange F, Benker G, Caron P, Eber O, Ott W, Peter F, Podoba J, Simescu M, Szybinsky Z, Vertongen F, Vitti P, Wiersinga W, Zamrazil V (1997) Thyroid volume and urinary iodine in European schoolchildren: standardization of values for assessment of iodine deficiency. Eur J Endocrinol 136(2):180–187. https://doi.org/10.1530/eje.0.1360180
doi: 10.1530/eje.0.1360180
pubmed: 9116913
Beckford K, Grimes C, Margerison C, Riddell L, Skeaff S, West M, Nowson C (2020) A systematic review and meta-analysis of 24h urinary output of children and adolescents: impact on the assessment of iodine status using urinary biomarkers. Eur J Nutr 59(7):3113–3131. https://doi.org/10.1007/s00394-019-02151-w
doi: 10.1007/s00394-019-02151-w
pubmed: 31784814
FDHA (2018) Empfehlungen zu Jod. Federal Food Safety and Veterinary Office (FSVO), Bern
Bu Y, Yuan L, Tian C, Zhao C, Ji C, Gao X, Cai Y, Sun D, Liu Y (2021) 24h urinary creatinine excretion during pregnancy and its application in appropriate estimation of 24h urinary iodine excretion. J Trace Elem Med Biol 66:126751. https://doi.org/10.1016/j.jtemb.2021.126751
doi: 10.1016/j.jtemb.2021.126751
pubmed: 33836494