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- Title
UNIVERSAL SALT IODIZATION EFFECTS ON ENDEMIC GOITER IN ARGES COUNTY, ROMANIA.
- Authors
Toma, Adriana; Sava, Mariana; Delia, Corina; Simescu, Mihaela; Tomescu, E.; Coculescu, M.
- Abstract
Background. In the Carpathian area of Romania the Iodine Deficiency Disorders (IDD) including endemic goiter are a public health problem. Recently, the legislation imposing salt iodization was strengthened (from 10 to 20 ± 5 mg iodine/kg salt) and enlarged (universal salt iodization, USI, has been applied to bread industry since 2002). Objective. The effect of bread iodization by law upon the characteristics of goiter endemy was assessed in Arges county, Romania. Design. The characteristics of goiter endemy (as defined by WHO/ICCIDD/UNICEF) were determined in children in the years 1999 (control group C) and 2004 (study group S), two years after universal bread iodization. In the control group C there were 1,241 schoolchildren 6-14 years old, living in 5 villages and in Pitesti town. In the study group S there were 408 schoolchildren 6-12 years old, living in 7 villages and in Pitesti town. After universal bread iodization, a neonatal screening for hypothyroidism was also performed on 11,216 newborns in Arges county, between January 2003 and December 2004. The content of KIO3 in the salt was assessed both in samples collected from village shops in the years 1999 (10 samples) and 2004 (17 samples). The iodine content of drinking water in Arges county villages was assessed in 1999. Methods. Three parameters of IDD endemy were evaluated, i.e. the thyroid volume in schoolchildren by palpation or/and ultrasonography, urinary iodine by the Sandell-Kolthoff method, and neonatal blood TSH levels in dry spot by immunoassay. A questionnaire was filled in by 912 schoolchildren in 1999 and by 408 schoolchildren in 2004. Results. The concentration of iodine in the drinking water collected from three villages, located in the North of Arges county, Subcarpathian area, was low, i.e median values 0.11 μg/l (n = 6) - range: 0.09 to 0.14 μg/l, as compared with the iodine water content in villages in the plain of Arges county, showing median iodine 0.46 (n = 6), range: 0.23 to 1.01 μg/l. The median content of KIO3 in 10 iodized salt samples collected in 1999 was 11.6 mg/kg salt and in 17 samples collected in 2004 it was improved at 40 mg/kg salt (target values by legislation = 34 ± 8.5 mg KIO3/kg salt). Iodized salt consumption in households was appreciated by a questionnaire filled in by schoolchildren and increased from 53% (n = 912) in 1999 to 93.4% (n = 408) in 2004. In the North of Arges county, in the control group C assessed before bread iodization, the global prevalence of goiter in schoolchildren (n=1,241) was 51.6%, the median of urinary iodine (n = 685) was 47.5 μg/l (range 10-270 μg/l), suggesting a moderate IDD. In the study group S, two years after bread iodization, the global prevalence of goiter in schoolchildren (n = 397) significantly decreased to 24.7% (ultrasound method); and urinary iodine median value increased to 72 μg/l (range 80-280 μg/l) (p < 0.01, Mann-Whitney test). The TSH levels over 5 mUI/l in the whole blood were found in 4.9% (275 out of 5573) newborns; TSH levels over 20 mUI/l were found in 0.27% (15 out of 5573). All these three parameters showed a mild endemy of IDD two years after bread iodization. If we consider only the visible goiter (grade 2 goiter, 2001 WHO classification), the prevalence decreased from 6% (75 out of 1,241) to 2.2% (9 out of 408), following bread iodization. Conclusions. There is an evident improvement of goiter endemia, according to WHO/ICCIDD/UNICEF criteria, two years after bread iodization in Arges county; a higher iodine content, obtained by the careful supervision of iodized salt, contributes to this efect.
- Subjects
ARGES River (Romania); ROMANIA; ENDEMIC goiter; IODINE deficiency diseases; HYPOTHYROIDISM; IMMUNOASSAY; DISEASE prevalence; THYROID diseases
- Publication
Acta Endocrinologica (1841-0987), 2005, Vol 1, Issue 2, p167
- ISSN
1841-0987
- Publication type
Article
- DOI
10.4183/aeb.2005.167