Inadequate Iodine Intake in Population Groups Defined by Age, Life Stage and Vegetarian Dietary Practice in a Norwegian Convenience Sample

Anne Lise Brantsæter, Helle Katrine Knutsen, Nina Cathrine Johansen, Kristine Aastad Nyheim, Iris Erlund, Helle Margrete Meltzer, Sigrun Henjum, Anne Lise Brantsæter, Helle Katrine Knutsen, Nina Cathrine Johansen, Kristine Aastad Nyheim, Iris Erlund, Helle Margrete Meltzer, Sigrun Henjum

Abstract

Inadequate iodine intake has been identified in populations considered iodine replete for decades. The objective of the current study is to evaluate urinary iodine concentration (UIC) and the probability of adequate iodine intake in subgroups of the Norwegian population defined by age, life stage and vegetarian dietary practice. In a cross-sectional survey, we assessed the probability of adequate iodine intake by two 24-h food diaries and UIC from two fasting morning spot urine samples in 276 participants. The participants included children (n = 47), adolescents (n = 46), adults (n = 71), the elderly (n = 23), pregnant women (n = 45), ovo-lacto vegetarians (n = 25), and vegans (n = 19). In all participants combined, the median (95% CI) UIC was 101 (90, 110) µg/L, median (25th, 75th percentile) calculated iodine intake was 112 (77, 175) µg/day and median (25th, 75th percentile) estimated usual iodine intake was 101 (75, 150) µg/day. According to WHOs criteria for evaluation of median UIC, iodine intake was inadequate in the elderly, pregnant women, vegans and non-pregnant women of childbearing age. Children had the highest (82%) and vegans the lowest (14%) probability of adequate iodine intake according to reported food and supplement intakes. This study confirms the need for monitoring iodine intake and status in nationally representative study samples in Norway.

Keywords: adolescents; children; elderly; iodine status; iodine-supplement use; pregnant; probability of adequate iodine intake; urinary iodine concentration; vegans; vegetarians.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Urinary iodine concentration (UIC) µg/L (A) and calculated iodine intake (B) by non-overlapping subgroups defined by age, life stage and dietary practice. Box plot details: the horizontal lines indicate the median; the box indicates the interquartile range (IQR) (25th percentile to 75th percentile); the whiskers represent observations within 1.5 times the IQR. Outliers with values more than 1.5 times the IQR away from the box are not shown. The dashed line in A represents the WHO cut-off for sufficient iodine intake in non-pregnant groups. The corresponding cut-off in pregnant women is 150 µg/L. The dashed line in B represents recommended iodine intake in children >9 years, non-pregnant adults and the elderly. Recommended intakes in the other groups are 90 µg/day for children 2–5 years, 120 µg/day for children 6–9 years, and 175 µg/day for pregnant women [34].
Figure 2
Figure 2
Plot showing the change in median urinary iodine concentration (UIC) µg/L, coefficients and 95% confidence interval for supplement use, sex, smoking, age and vegan dietary practice. N = 276.
Figure 3
Figure 3
The mean contribution to iodine intake (µg/day) from different food groups in children, adolescents, adults, the elderly, pregnant women, ovo-lacto (OL) vegetarians and vegans.
Figure 4
Figure 4
The contribution (%) to total iodine from food groups and dietary supplements in children, adolescents, adults, the elderly, pregnant women, ovo-lacto (OL) vegetarians and vegans.

References

    1. World Health Organization (WHO) Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers. World Health Organization; Geneva, Switzerland: 2007. International Council for Control of Iodine Deficiency Disorders (ICCIDD), United Nations International Children's Emergency Fund (UNICEF)
    1. Dahl L., Meltzer H.M. The Iodine Content of Foods and Diets: Norwegian Perspectives. In: Preedy V.R., Burrow G.N., Watson R.R., editors. Comprehensive Handbook of Iodine. Academic Press; London, UK: 2009. pp. 345–352.
    1. Frey H., Rosenlund B., Try K., Theodorsen L. Urinary excretion of iodine in Norway. In: Delange F., editor. Iodine Deficiency in Europe. Plenum Press; New York, NY, USA: 1993. pp. 297–300.
    1. Lazarus J.H. Iodine status in europe in 2014. Eur. Thyroid J. 2014;3:3–6. doi: 10.1159/000358873.
    1. Manousou S., Dahl L., Heinsbaek Thuesen B., Hulthen L., Nystrom Filipsson H. Iodine deficiency and nutrition in Scandinavia. Minerva Med. 2017;108:147–158. doi: 10.23736/s0026-4806.16.04849-7.
    1. Nystrom H.F., Brantsaeter A.L., Erlund I., Gunnarsdottir I., Hulthen L., Laurberg P., Mattisson I., Rasmussen L.B., Virtanen S., Meltzer H.M. Iodine status in the Nordic countries—Past and present. Food Nutr. Res. 2016;60:31969. doi: 10.3402/fnr.v60.31969.
    1. Brantsaeter A.L., Abel M.H., Haugen M., Meltzer H.M. Risk of suboptimal iodine intake in pregnant norwegian women. Nutrients. 2013;5:424–440. doi: 10.3390/nu5020424.
    1. Henjum S., Lilleengen A.M., Aakre I., Dudareva A., Gjengedal E.L.F., Meltzer H.M., Brantsaeter A.L. Suboptimal Iodine Concentration in Breastmilk and Inadequate Iodine Intake among Lactating Women in Norway. Nutrients. 2017;9 doi: 10.3390/nu9070643.
    1. Bath S.C., Steer C.D., Golding J., Emmett P., Rayman M.P. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: Results from the Avon Longitudinal Study of Parents and Children (ALSPAC) Lancet. 2013;382:331–337. doi: 10.1016/S0140-6736(13)60436-5.
    1. Abel M.H., Caspersen I.H., Meltzer H.M., Haugen M., Brandlistuen R.E., Aase H., Alexander J., Torheim L.E., Brantsaeter A.L. Suboptimal Maternal Iodine Intake Is Associated with Impaired Child Neurodevelopment at 3 Years of Age in the Norwegian Mother and Child Cohort Study. J. Nutr. 2017 doi: 10.3945/jn.117.250456.
    1. Hynes K.L., Otahal P., Hay I., Burgess J.R. Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J. Clin. Endocrinol. Metab. 2013;98:1954–1962. doi: 10.1210/jc.2012-4249.
    1. Pearce E.N., Lazarus J.H., Moreno-Reyes R., Zimmermann M.B. Consequences of iodine deficiency and excess in pregnant women: An overview of current knowns and unknowns. Am. J. Clin. Nutr. 2016;104:918s–923s. doi: 10.3945/ajcn.115.110429.
    1. Zimmermann M.B. Iodine deficiency and excess in children: Worldwide status in 2013. Endocr. Pract. 2013;19:839–846. doi: 10.4158/EP13180.RA.
    1. Ma Z.F., Skeaff S.A. Assessment of Population Iodine Status. In: Pearce E.N., editor. Iodine Dificiency Disorders and Their Elimination. Springer; Cham, Switzerland: 2017. pp. 15–28.
    1. Rasmussen L.B., Carle A., Jorgensen T., Knudsen N., Laurberg P., Pedersen I.B., Perrild H., Vejbjerg P., Ovesen L. Iodine intake before and after mandatory iodization in Denmark: Results from the Danish Investigation of Iodine Intake and Thyroid Diseases (DanThyr) study. Br. J. Nutr. 2008;100:166–173. doi: 10.1017/S0007114507886387.
    1. Gizak M., Gorstein J., Andersson M. Epidemiology of Iodine Deficiency. In: Pearce E.N., editor. Iodine Deficiency Disorders and Their Elimination. Springer International Publishing; Cham, Switzerland: 2017. pp. 29–43.
    1. National Nutrition Council . Risk of Iodine Deficiency in Norway. Identification of an Acute Need for Action; Report in Norwegian. The Norwegian Directorate of Health; Oslo, Norway: 2016. [(accessed on 7 March 2017)]. Technical Report. Available online: .
    1. Bath S.C., Rayman M.P. Iodine deficiency in the U.K.: An overlooked cause of impaired neurodevelopment? Proc. Nutr. Soc. 2013;72:226–235. doi: 10.1017/S0029665113001006.
    1. Jones E., McLean R., Davies B., Hawkins R., Meiklejohn E., Ma Z.F., Skeaff S. Adequate Iodine Status in New Zealand School Children Post-Fortification of Bread with Iodised Salt. Nutrients. 2016;8 doi: 10.3390/nu8050298.
    1. Dahl L., Johansson L., Julshamn K., Meltzer H.M. The iodine content of Norwegian foods and diets. Public Health Nutr. 2004;7:569–576. doi: 10.1079/PHN2003554.
    1. Norwegian Directorate of Health . Utviklingen i Norsk kosthold 2015; IS-2382. Helsedirektoratet; Oslo, Norway: 2015. (In Norwegian)
    1. Totland T.H., Melnæs B.K., Lundberg-Hallén N., Helland-Kigen K.M., Lund-Blix N.A., Myhre J.B., Johansen A.M.W., Løken E.B., Andersen L.F. Norkost 3, National Dietary Survey in Men and Women in Norway Aged 18–70 Years. The University of Oslo, the Norwegian Food Safety Authority and the Norwegian Directorate of Health; Oslo, Norway: 2012. (In Norwegian)
    1. Troan G., Dahl L., Meltzer H.M., Abel M.H., Indahl U.G., Haug A., Prestlokken E. A model to secure a stable iodine concentration in milk. Food Nutr. Res. 2015;59:29829. doi: 10.3402/fnr.v59.29829.
    1. Zimmermann M.B., Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr. Rev. 2012;70:553–570. doi: 10.1111/j.1753-4887.2012.00528.x.
    1. Rasmussen L.B., Ovesen L., Christiansen E. Day-to-day and within-day variation in urinary iodine excretion. Eur. J. Clin. Nutr. 1999;53:401–407. doi: 10.1038/sj.ejcn.1600762.
    1. Zimmermann M.B., Hussein I., Al Ghannami S., El Badawi S., Al Hamad N.M., Abbas Hajj B., Al-Thani M., Al-Thani A.A., Winichagoon P., Pongcharoen T., et al. Estimation of the Prevalence of Inadequate and Excessive Iodine Intakes in School-Age Children from the Adjusted Distribution of Urinary Iodine Concentrations from Population Surveys. J. Nutr. 2016;146:1204–1211. doi: 10.3945/jn.115.229005.
    1. Ma Z.F., Venn B.J., Manning P.J., Cameron C.M., Skeaff S.A. The sensitivity and specificity of thyroglobulin concentration using repeated measures of urinary iodine excretion. Eur. J. Nutr. 2017 doi: 10.1007/s00394-017-1410-6.
    1. Perrine C.G., Cogswell M.E., Swanson C.A., Sullivan K.M., Chen T.C., Carriquiry A.L., Dodd K.W., Caldwell K.L., Wang C.Y. Comparison of population iodine estimates from 24-hour urine and timed-spot urine samples. Thyroid. 2014;24:748–757. doi: 10.1089/thy.2013.0404.
    1. Vejbjerg P., Knudsen N., Perrild H., Laurberg P., Andersen S., Rasmussen L.B., Ovesen L., Jorgensen T. Estimation of iodine intake from various urinary iodine measurements in population studies. Thyroid. 2009;19:1281–1286. doi: 10.1089/thy.2009.0094.
    1. Juan W., Trumbo P.R., Spungen J.H., Dwyer J.T., Carriquiry A.L., Zimmerman T.P., Swanson C.A., Murphy S.P. Comparison of 2 methods for estimating the prevalences of inadequate and excessive iodine intakes. Am. J. Clin. Nutr. 2016;104:888s–897s. doi: 10.3945/ajcn.115.110346.
    1. Brera C., de Santis B., Debegnach F., Miano B., Moretti G., Lanzone A., Del Sordo G., Buonsenso D., Chiaretti A., Hardie L., et al. Experimental study of deoxynivalenol biomarkers in urine. EFSA Support. Publ. 2015;12 doi: 10.2903/sp.efsa.2015.EN-818.
    1. Norwegian Food Safety Authority Matvaretabellen [The Norwegian Food Database] [(accessed on 10 December 2015)]; Available online:
    1. Lauritsen J. FoodCalc; Data Program from the Project “Diet, Cancer and Health” at the Danish Cancer Society. [(accessed on 1 February 2005)]; Available online: .
    1. NNR12 Project Group . Nordic Nutrition Recommendations 2012 Integrating Nutrition and Physical Activity. 5th ed. Nordic Council of Ministers; Copenhagen, Denmark: 2014. Iodine.
    1. EFSA, NDA Panel (EFSA Panel on Dietetic Products Nutrition and Allergies) Scientific Opinion on Dietary Reference Values for Iodine. EFSA J. 2014;12 doi: 10.2903/j.efsa.2014.3660.
    1. Food and Nutrition Board, Institute of Medicine . Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academies Press; Washington, DC, USA: 2001.
    1. Institute of Medicine . DRI Dietary Reference Intakes: Applications in Dietary Assessment, part III, Chapter 4: Using the Estimated Average Requirement for Nutrient Assessment of Groups. National Academies Press; Washington, DC, USA: 2000. pp. 71–143.
    1. Joseph M.L., Carriquiry A. A measurement error approach to assess the association between dietary diversity, nutrient intake, and mean probability of adequacy. J. Nutr. 2010;140:2094s–2101s. doi: 10.3945/jn.110.123588.
    1. Le Cook B., Manning W.G. Thinking beyond the mean: A practical guide for using quantile regression methods for health services research. Shanghai Arch. Psychiatry. 2013;25:55–59. doi: 10.3969/j.issn.1002-0829.2013.01.011.
    1. Fields C., Borak J. Iodine Deficiency in Vegetarian and Vegan Diets: Evidence-Based Review of the World’s Literature on Iodine Content in Vegetarian Diets. In: Preedy V., Burrow G., Watson R., editors. Comprehensive Handbook of Iodine. Elsevier Inc.; Amsterdam, The Netherlands: 2009.
    1. Li M., Eastman C.J. The changing epidemiology of iodine deficiency. Nat. Rev. Endocrinol. 2012;8:434–440. doi: 10.1038/nrendo.2012.43.
    1. Garnweidner-Holme L., Aakre I., Lilleengen A.M., Brantsaeter A.L., Henjum S. Knowledge about Iodine in Pregnant and Lactating Women in the Oslo Area, Norway. Nutrients. 2017;9 doi: 10.3390/nu9050493.
    1. Abel M.H., Ystrom E., Caspersen I.H., Meltzer H.M., Aase H., Torheim L.E., Askeland R.B., Reichborn-Kjennerud T., Brantsæter A.L. Maternal Iodine Intake and Offspring Attention-Deficit/Hyperactivity Disorder: Results from a Large Prospective Cohort Study. Nutrients. 2017;9 doi: 10.3390/nu9111239.
    1. Andersson M., Berg G., Eggertsen R., Filipsson H., Gramatkovski E., Hansson M., Hulthen L., Milakovic M., Nystrom E. Adequate iodine nutrition in Sweden: A cross-sectional national study of urinary iodine concentration in school-age children. Eur. J. Clin. Nutr. 2009;63:828–834. doi: 10.1038/ejcn.2008.46.
    1. Costa Leite J., Keating E., Pestana D., Cruz Fernandes V., Maia M.L., Norberto S., Pinto E., Moreira-Rosario A., Sintra D., Moreira B., et al. Iodine Status and Iodised Salt Consumption in Portuguese School-Aged Children: The Iogeneration Study. Nutrients. 2017;9 doi: 10.3390/nu9050458.
    1. Beckford K., Grimes C.A., Margerison C., Riddell L.J., Skeaff S.A., Nowson C.A. Iodine Intakes of Victorian Schoolchildren Measured Using 24-h Urinary Iodine Excretion. Nutrients. 2017;9 doi: 10.3390/nu9090961.
    1. Granfors M., Andersson M., Stinca S., Akerud H., Skalkidou A., Poromaa I.S., Wikstrom A.K., Nystrom H.F. Iodine deficiency in a study population of pregnant women in Sweden. Acta Obstet. Gynecol. Scand. 2015;94:1168–1174. doi: 10.1111/aogs.12713.
    1. Travers C.A., Guttikonda K., Norton C.A., Lewis P.R., Mollart L.J., Wiley V., Wilcken B., Eastman C.J., Boyages S.C. Iodine status in pregnant women and their newborns: Are our babies at risk of iodine deficiency? Med. J. Aust. 2006;184:617–620.
    1. Andersen S.L., Sorensen L.K., Krejbjerg A., Moller M., Laurberg P. Iodine deficiency in Danish pregnant women. Dan. Med. J. 2013;60:A4657.
    1. Leitzmann C. Vegetarian nutrition: Past, present, future. Am. J. Clin. Nutr. 2014;100:496s–502s. doi: 10.3945/ajcn.113.071365.
    1. Bath S.C., Hill S., Infante H.G., Elghul S., Nezianya C.J., Rayman M.P. Iodine concentration of milk-alternative drinks available in the UK in comparison with cows' milk. Br. J. Nutr. 2017;118:525–532. doi: 10.1017/S0007114517002136.
    1. Lightowler H.J., Davies G.J. Iodine intake and iodine deficiency in vegans as assessed by the duplicate-portion technique and urinary iodine excretion. Br. J. Nutr. 1998;80:529–535. doi: 10.1017/S0007114598001627.
    1. Krajcovicova-Kudlackova M., Buckova K., Klimes I., Sebokova E. Iodine deficiency in vegetarians and vegans. Ann. Nutr. Metab. 2003;47:183–185. doi: 10.1159/000070483.
    1. Elorinne A.L., Alfthan G., Erlund I., Kivimaki H., Paju A., Salminen I., Turpeinen U., Voutilainen S., Laakso J. Food and Nutrient Intake and Nutritional Status of Finnish Vegans and Non-Vegetarians. PLoS ONE. 2016;11:e0148235. doi: 10.1371/journal.pone.0148235.
    1. Schupbach R., Wegmuller R., Berguerand C., Bui M., Herter-Aeberli I. Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. Eur. J. Nutr. 2015 doi: 10.1007/s00394-015-1079-7.
    1. Leung A.M., Lamar A., He X., Braverman L.E., Pearce E.N. Iodine status and thyroid function of Boston-area vegetarians and vegans. J. Clin. Endocrinol. Metab. 2011;96:E1303–E1307. doi: 10.1210/jc.2011-0256.
    1. Ovesen L., Boeing H. The use of biomarkers in multicentric studies with particular consideration of iodine, sodium, iron, folate and vitamin D. Eur. J. Clin. Nutr. 2002;56:S12–S17. doi: 10.1038/sj.ejcn.1601424.
    1. Als C., Helbling A., Peter K., Haldimann M., Zimmerli B., Gerber H. Urinary iodine concentration follows a circadian rhythm: A study with 3023 spot urine samples in adults and children. J. Clin. Endocrinol. Metab. 2000;85:1367–1369. doi: 10.1210/jc.85.4.1367.
    1. Thomson C.D., Smith T.E., Butler K.A., Packer M.A. An evaluation of urinary measures of iodine and selenium status. J. Trace Elem. Med. Biol. 1996;10:214–222. doi: 10.1016/S0946-672X(96)80038-1.
    1. Andersen S., Karmisholt J., Pedersen K.M., Laurberg P. Reliability of studies of iodine intake and recommendations for number of samples in groups and in individuals. Br. J. Nutr. 2008;99:813–818. doi: 10.1017/S0007114507842292.
    1. Haddow J.E., McClain M.R., Palomaki G.E., Hollowell J.G. Urine iodine measurements, creatinine adjustment, and thyroid deficiency in an adult United States population. J. Clin. Endocrinol. Metab. 2007;92:1019–1022. doi: 10.1210/jc.2006-2156.
    1. Zimmermann M.B., Andersson M. Update on iodine status worldwide. Curr. Opin. Endocrinol. Diabetes Obes. 2012;19:382–387. doi: 10.1097/MED.0b013e328357271a.
    1. Frisoli T.M., Schmieder R.E., Grodzicki T., Messerli F.H. Salt and hypertension: Is salt dietary reduction worth the effort? Am. J. Med. 2012;125:433–439. doi: 10.1016/j.amjmed.2011.10.023.
    1. Charlton K., Probst Y., Kiene G. Dietary Iodine Intake of the Australian Population after Introduction of a Mandatory Iodine Fortification Programme. Nutrients. 2016;8 doi: 10.3390/nu8110701.
    1. Andersson M., de Benoist B., Delange F., Zupan J. 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. Public Health Nutr. 2007;10:1606–1611.
    1. Gowachirapant S., Jaiswal N., Melse-Boonstra A., Galetti V., Stinca S., Mackenzie I., Thomas S., Thomas T., Winichagoon P., Srinivasan K., et al. Effect of iodine supplementation in pregnant women on child neurodevelopment: A randomised, double-blind, placebo-controlled trial. Lancet. 2017;5:853–863. doi: 10.1016/s2213-8587(17)30332-7.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe