IODINE DEFICIENCY DISORDERS DETAILS OF NUTRITION CHAPTER

NUTRITION

1. IODINE DEFICIENCY DISORDERS

2. Problem Statement

3. Iodine Deficiency Disorders
Data are from the WHO and the International Council for the Control of Iodine Deficiency Disorders

4. BACKGROUND

5. •Normal levels of thyroid hormones are required for optimal
development of the brain. In areas of iodine deficiency, where
thyroid hormone level are low, brain development is impaired.
The result of extreme condition of iodine deficiency is
cretinism.
•The much greater public health importance are the more
subtle degrees of brain damage and reduce cognitive capacity
which affect the entire population.
•The potential of a whole community is reduced by iodine
deficiency
•The most critical period is from the second trimester of
pregnancy to the third year after birth

6. •IDD at critical stages during pregnancy and early
childhood results in impaired of the brain &
consequently in impaired mental function
•People living in areas affected by severe IDD may
have an IQ of up to about 13.5 points below that of
those comparable communities in areas where there is
no IDD
•Most areas of India are in endemic condition.

7. •Elimination of IDD is a most important health &
social goal.
•IDD are among the easiest and cheapest of all
disorders to prevent.
•Doctors are often facing with the condition in their
practice.

8. IODINE DEFICIENCY DISORDERS
•Iodine deficiencies occurs when iodine intake falls below
recommended levels.
•When iodine intake falls below recommended levels, the
thyroid may no longer be able to synthesize sufficient
amount of thyroid hormone.
•The resulting low level of thyroid hormone in the blood
(hypothyroidism) is the principal factor responsible for the
damage done to the developing brain and other harmful
effects known collectively as IDD.
•IDD refer to all of the ill-effect of iodine deficiency in a
population

9. IODINE METABOLISM
120 µg I
-
40 µg I
-
60 µg I
-
Urine: 480
µg I
-
Feces:
20 µg I
-
As T3 & T4:
80 µg I
-
Daily intake: 500 µg I
-
THYROID
LIVER &
OTHER
TISSUES
Extra cell fluid

11. CURRENT MAGNITUDE of IDD by GOITER by
WHO REGION (1999)
WHO Region Population Population affected by
goitre
In millions In millions% of the Region
Africa 612 124 20%
The Americas 788 39 5%
South East Asia 1477 172 12%
Europe 869 130 15%
Eastern
Mediteranian
473 152 32%
Western Pacific 1639 124 8%
TOTAL 5858 741 13%

12. RECOMMENDED DIALY INTAKE of
IODINE (WHO,2001)

13. IODINE TOXICITY
•In the range 0f 150-600 µg/day, does not interact
adversely with any food or drug.
•Too much iodine (>2000 µg/day) can result in
eruption of acne-like skin lesions.
•Iodine excess of 4.5 mg/day produce a metalic
taste and sores in the mouth, swollen salivary
glands, diarrhea, and vomiting

14. ENDEMIC GOITER
•Goiter
–It only takes several months for inadequate iodine
intake for the thyroid gland to begin enlarging into a
goiter (enlarge thyroid gland)
–When dietary iodine is inadequate, the thyroid gland
swells
•Endemic goiter
–An area with iodine deficiency that produce
enlargement of thyroid gland. The TGR is more than
5%

15. SIMPLIFIED CLASSIFICATION of GOITER by PALPATION
GRADE PHYSICAL EXAMINATION
Grade 0 No palpable or visible goiter
Grade 1 A goiter that is palpable but not visible when the neck
is in the normal position
Grade 2 A swelling in the neck that is clearly visible when the
neck is in a normal position and is consistent with an
enlarged thyroid when the neck is palpated
• the specificity & sensitivity of palpation are low in grade 0 & 1
• TGR (total goiter rate) = number with goiters of grades 1 & 2
total examined
• TGR 5% of schoolchildren 6-12 years of age be used to signal
≥
the presence of a public health problem.

16. THE SPECTRUM of IDD
AGE THE SPECTRUM OF ABNORMALITIES
FETUS 1. abortion
2. stillbirths
3. congenital anomalies
4. increased perinatal mortality
5. increased infant mortality
6. psychomotor defects
1. neurological cretinism
2. mental deficiencies
3. deaf mutism
4. spastic diplegia squint
5. myxoedematous cretinism
6. mental deficiencies,
7. dwartism, hypothyroidism
NEONATE neonatal hypothyroidism
CHILD &
ADOLESCENT
mental retardation physical retardation
ADULT goiter & its complications Iodine induced hyperthyroidism
ALL AGES goiter
hypothyroidism
impaired mental function
increased susceptibility to
nuclear radiation

17. EPIDEMIOLOGICAL CRITERIA for ASSESSING THE SEVERITY
of IDD BASED ON THE PREVALENCE of GOITER IN SCHOOL-
AGED CHILDREN
Degrees of IDD, expressed as percentage of the
total of the number of children surveyed
none mild moderate severe
Total
Goiter
Rate
0.0-4.9%5.0-19.9%20.0-29.9%
≥
30%

18. EPIDEMIOLOGY CRITERI FOR ASSESSING IODINE NUTRITION
BASED ON MEDIAN URINARY IODINE CONCENTRATION in
SCHOOL AGED CHILDREN
MEDIAN URINARY
IODINE (µG/L)
IODINE INTAKE IODINE NUTRITION
< 20 Insufficient Severe iodine deficiency
20 – 4 0 Insufficient Moderate iodine deficiency
50 – 99 Insufficient Mild iodine deficiency
100 – 199 Adequate Optimal
200 – 299More than adequateRisk of iodine-induced hyperthyroidism
within 5-10 years following introduction of
iodized salt in susceptible groups
> 300 Excessive Risk of adverse health consequences (iodine-
induced hyperthyroidism, autoimmune
thyroid diseases)

19. CRITERIA FOR MONITORING PROGRESS TOWARDS
SUSTAINABLE ELIMINATION of IDD AS A PUBLIC
HEALTH PROBLEM
INDICATORS GOALS
Salt iodization
 proportion of household using
adequately iodized salt
> 90%
Urinary iodine
 proportion below 100 µg < 50%
 proportion below 50 µg < 20%
Programmatic indicator
 attainment of the indicators
specified on the opposite page
At least
8 of the 10

20. MAJOR COMPONENTS REQUIRED TO
CONSOLIDATE THE ELIMINATION of IDD
•Political support
•Administrative arrangements
•Assessment and monitoring systems

21. OPTION CORRECTION of IDD
•Administration of iodized oil capsules every 6-18
months
•Direct administration of iodine solutions, Lugol’s
iodine, at regular intervals (once a month is
sufficient)
•Iodization of salt supplies
•Iodization of water supplies by direct addition of
iodine solution
•Via special delivery mechanism

22. SALT IODIZATION PROGRAM
A successful program at national level depends upon the
implementation of a set of activities by various sectors:
–Government ministries (legislation & justice, health,
industry, agriculture, education, communication, and
finance)
–Salt producers, salt importers & distributors, food
manufactures
–Concerned civic groups
–Nutrition, food & medical scientists
–Other key opinion makers

23. RECOMMENDED IODINE CONCENTRATION IN SALT
•Iodine concentration in salt at the point of production
should be within the range of 20-40 mg of iodine per kg
of salt (20-40 ppm)
•The iodine should be added as Na or K iodate
•RDA: 150 µg of iodine/person/day
•By 150 µg iodine intake, median urinary iodine levels
will vary from 100-200 µg/l
•At Production level:30 ppm
•At consumer level: 15 ppm

24. FACTORS THAT DETERMINE SALT IODINE
CONTENT
Variability in the amount of iodine added during the
iodization process
Distribution of the iodized salt
Packaging process
Loss of iodine due to environmental conditions
during storage and distribution
20% lost during distribution
Loss of iodine due to food processing
20% lost during cooking before consumption

25. SUMMARY
•IDD is a world wild problems
•The much greater public health importance are the more
subtle degrees of brain damage and reduce cognitive
capacity which affect the entire population.
•The potential of a whole community is reduced by iodine
deficiency
•It can be prevented.
•A successful program at national level depends upon
the implementation of a set of activities by various
sectors

26. Thank You