Skip to main content Accessibility help
×
Home

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children

  • Nidhi Jaiswal (a1) (a2), Alida Melse-Boonstra (a2), Surjeet Kaur Sharma (a3), Krishnamachari Srinivasan (a1) and Michael B Zimmermann (a2) (a4) (a5)...

Abstract

Objective

To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India.

Design

A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound).

Setting

Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population.

Subjects

Healthy pregnant women in all trimesters, aged 18–35 years, who had healthy children aged 3–15 years.

Results

Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2–65·9) ppm and 18·9 (2·2–68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5–1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10–782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008).

Conclusions

In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Email michael.zimmermann@hest.ethz.ch

References

Hide All
1.Timmer, A (2012) Iodine nutrition and universal salt iodization: a landscape analysis in 2012. IDD Newsletter 40, issue 4, 5–9; available at http://www.iccidd.org/newsletter/idd_nov12_iodine_nutrition_landscape_analysis.pdf
2.Bernal, J (2005) Thyroid hormones and brain development. Vitam Horm 71, 95122.
3.Zoeller, RT & Rovet, J (2004) Timing of thyroid hormone action in the developing brain: clinical observations and experimental findings. J Neuroendocrinol 16, 809818.
4.World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders (2007) Assessment of Iodine Deficiency Disorders and Monitoring their Elimination: A Guide for Programme Managers, 3rd ed.Geneva: WHO.
5.Institute of Medicine (2001) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: The National Academy Press.
6.World Health Organization (2008) Salt as a Vehicle for Fortification. Report of a WHO Expert Consultation. Geneva: WHO.
7.Caldwell, KL, Makhmudov, A , Ely, Eet al. (2011) Iodine status of the US population, National Health and Nutrition Examination Survey, 2005–2006 and 2007–2008. Thyroid 21, 419427.
8.Tiwari, BK (2006) Revised Policy Guidelines on National Iodine Deficiency Disorders Control Programme. New Delhi: IDD and Nutrition Cell, Director General of Health Services, Ministry of Health and Family Welfare, Government of India.
9.Longvah, T, Toteja, GS, Upadhyay, Aet al. (2013) Iodine content in bread, milk and the retention of inherent iodine in commonly used Indian recipes. Food Chem 136, 384388.
10.International Institute for Population Sciences & Macro International (2008) National Family Health Survey (NFHS-3) 2005–06. Mumbai: IIPS.
11.UNICEF (2011) 2009 Coverage Evaluation Survey. All India Report. New Delhi: UNICEF.
12.UNICEF (2010) Coverage Evaluation Survey 2009 (CES-2009). New Delhi: UNICEF.
13.Rah, JH, Anas, AM, Chakrabarty, Aet al. (2013) Towards universal salt iodisation in India: achievements, challenges and future actions. Matern Child Nutr (Epublication ahead of print version).
14.Kusić, Z, Jukić, T, Rogan, SAet al. (2012) Current status of iodine intake in Croatia – the results of 2009 survey. Coll Antropol 36, 123128.
15.Wong, EM, Sullivan, KM, Perrine, CGet al. (2011) Comparison of median urinary iodine concentration as an indicator of iodine status among pregnant women, school-age children, and nonpregnant women. Food Nutr Bull 32, 206212.
16.Census Organization of India (not dated) Population Census 2011. http://www.census2011.co.in/census/district/242-bangalore.html (accessed November 2013).
17.Wikipedia (not dated) Bangalore. http://en.wikipedia.org/wiki/Bangalore (accessed November 2013).
18.Office of the Registrar General & Census Commissioner, India (not dated) CensusInfo India 2011. Karnataka profile. http://censusindia.gov.in/2011census/censusinfodashboard/stock/profiles/en/IND029_Karnataka.pdf (accessed November 2013).
19.Jayadevan, PK (2012) Bangalore among the top 10 preferred entrepreneurial locations. The Economic Times, 12 April 2012. http://articles.economictimes.indiatimes.com/2012-04-12/news/31574639_1_startups-venture-capital-early-stage (accessed November 2013).
20.Ministry of Human Resource Development, Department of School Education & Literacy, Government of India (2011) Mid Day Meal Scheme. http://mdm.nic.in/ (accessed October 2011).
21.Department of Instruction, Government of Karnataka (not dated) Mid Day Meals. http://schooleducation.kar.nic.in/mms/mms.html (accessed November 2013).
22.Tamil Nadu Salt Corporation Limited (A Government of India Enterprise) (2010) http://www.tn.gov.in/rti/proactive/ind/handbook_salt.pdf (accessed November 2013).
23.World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee. Geneva: WHO.
24.Pino, S, Fang, SL & Braverman, LE (1996) Ammonium persulfate: a safe alternative oxidizing reagent for measuring urinary iodine. Clin Chem 42, 239243.
25.Gowachirapant, S, Winichagoon, P, Wyss, Let al. (2009) Urinary iodine concentrations indicate iodine deficiency in pregnant Thai women but iodine sufficiency in their school-aged children. J Nutr 139, 11691172.
26.Sultanalieva, RB, Mamutova, S & van der Haar, F (2010) The current salt iodization strategy in Kyrgyzstan ensures sufficient iodine nutrition among school-age children but not pregnant women. Public Health Nutr 13, 623630.
27.Gatseva, PD, Bivolarska, AV & Argirova, MD (2011) Results from the National Strategy for Improvement of Iodine Nutrition in Bulgaria. A study of children and pregnant women living in an iodine-deficient area. J Public Health 19, 237240.
28.US Centers for Disease Control and Prevention (2012) Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population 2012. Atlanta, GA: National Center for Environmental Health.
29.Burgess, JR, Seal, JA, Stilwell, GMet al. (2007) A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania. Med J Aust 186, 574576.
30.Vandevijvere, S, Mourri, AB, Amsalkhir, Set al. (2012) Fortification of bread with iodized salt corrected iodine deficiency in school-aged children, but not in their mothers: a national cross-sectional survey in Belgium. Thyroid 22, 10461053.
31.Zou, S, Wu, F, Guo, Cet al. (2012) Iodine nutrition and the prevalence of thyroid disease after salt iodization: a cross-sectional survey in Shanghai, a coastal area in China. PLoS One 7, e40718.
32.Yadav, K, Srivastava, R, Badhal, Set al. (2012) Iodine nutrition of pregnant women in India: evidence of significant iodine deficiency. Indian J Med Special 3, 4954.
33.Lean, MIFA, Lean, MEJ, Yajnik, CSet al. (2013) Iodine status during pregnancy in India and related neonatal and infant outcomes. Public Health Nutr (Epublication ahead of print version).
34.Menon, KC, Skeaff, SA, Thomson, CDet al. (2011) The effect of maternal iodine status on infant outcomes in an iodine-deficient Indian population. Thyroid 21, 13731380.
35.Singh, MB, Fotedar, R & Lakshminarayana, J (2009) Micronutrient deficiency status among women of desert areas of Western Rajasthan, India. Public Health Nutr 12, 624629.
36.World Health Organization (2007) Vitamin and Mineral Nutrition Information System (VMNIS). WHO Global Database on Iodine Deficiency. Geneva: WHO.
37.Micronutrient Initiative (2010) Summary Report: Iodized Salt Coverage Study 2010. New Delhi: Government of India, Office of the Salt Commissioner.
38.Kapil, U (2010) Successful efforts towards elimination of iodine deficiency disorders in India. Indian J Community Med 35, 455468.
39.Andersson, M, Thankachan, P, Muthayya, Set al. (2008) Dual fortification of salt with iodine and iron: a randomized, double-blind, controlled trial of micronized ferric pyrophosphate and encapsulated ferrous fumarate in southern India. Am J Clin Nutr 88, 13781387.
40.Department of Instruction, Government of Karnataka (not dated) Mid Day Meals, Programs_Food and Nutrition. http://schooleducation.kar.nic.in/mms/food.html (accessed November 2013).
41.Orito, Y, Oku, H, Kubota, Set al. (2009) Thyroid function in early pregnancy in Japanese healthy women: relation to urinary iodine excretion, emesis, and fetal and child development. J Clin Endocrinol Metab 94, 16831688.
42.American Thyroid Association (2013) ATA statement on the potential risks of excess iodine. IDD Newsletter, 41, issue 3, 19; available at http://www.thyroid.org/ata-statement-on-the-potential-risks-of-excess-iodine-ingestion-and-exposure/
43.Stagnaro-Green, A, Abalovich, M, Alexander, Eet al. (2011) The American Thyroid Association taskforce on thyroid disease during pregnancy and postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 21, 10811125.
44. Anon. (2013) In the UK and Australia, poor iodine intake in pregnancy predicts lower child IQ. IDD Newsletter 41, issue 2; available at http://www.iccidd.org/newsletter/idd_may13_pregnancy.pdf
45.Bath, SC, Steer, CD, Golding, Jet al. (2013) 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 382, 331337.
46.Charlton, KE, Yeatman, H & Brock, E (2013) Iodized baking salt improves iodine intakes in Australian pregnant women, but they still need iodine supplements to achieve sufficient intakes. Prev Med 57, 2630.
47.Schiess, S, Cressey, PJ & Thomson, BM (2012) Predictive modelling of interventions to improve iodine intake in New Zealand. Public Health Nutr 15, 19321940.
48.Mallard, SR & Houghton, LA (2013) Public health policy in New Zealand to redress iodine insufficiency in pregnant women may widen sociodemographic disparities. Public Health Nutr (Epublication ahead of print version).
49.Als, C, Haldimann, M, Burgi, Eet al. (2003) Swiss pilot study of individual seasonal fluctuations of urinary iodine concentration over two years: is age-dependency linked to the major source of dietary iodine? Eur J Clin Nutr 57, 636646.
50.Moreno-Reyes, R, Carpentier, YA, Macours, Pet al. (2011) Seasons but not ethnicity influence urinary iodine concentrations in Belgian adults. Eur J Nutr 50, 285290.
51.Rasmussen, LB, Ovesen, L & Christiansen, E (1999) Day-to-day and within-day variation in urinary iodine excretion. Eur J Clin Nutr 53, 401407.
52.Als, C, Helbling, A, Peter, Ket al. (2000) Urinary iodine concentration follows a circadian rhythm: a study with 3023 spot urine samples in adults and children. J Clin Endocrinol Metab 85, 13671369.
53.Remer, T, Fonteyn, N, Alexy, Uet al. (2006) Longitudinal examination of 24-h urinary iodine excretion in schoolchildren as a sensitive, hydration status-independent research tool for studying iodine status. Am J Clin Nutr 83, 639646.
54.Mackerras, DEM, Singh, GR & Eastman, EJ (2011) Iodine status of Aboriginal teenagers in the Darwin region before mandatory iodine fortification of bread. Med J Aust 194, 126130.
55.Zimmermann, MB, Aeberli, I, Andersson, Met al. (2013) Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100–299 g/l: a UNICEF/ICCIDD study group report. J Clin Endocrin Metab 98, 110.
56.Zimmermann, MB, Ito, Y, Hess, SYet al. (2005) High thyroid volume in children with excess dietary iodine intakes. Am J Clin Nutr 81, 840844.
57.Teng, X, Shan, Z, Chen, Yet al. (2011) More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis: a cross-sectional study based on two Chinese communities with different iodine intake levels. Eur J Endocrinol 164, 943950.
58.Ategbo, EA, Sankar, R, Schultink, Wet al. (2008) An assessment of progress toward universal salt iodization in Rajasthan, India, using iodine nutrition indicators in school-aged children and pregnant women from the same households. Asia Pac J Clin Nutr 17, 5662.
59.Wang, Y, Zhang, Z, Ge, Pet al. (2009) Iodine deficiency disorders after a decade of universal salt iodization in a severe iodine deficiency region in China. Indian J Med Res 130, 413417.
60.Andersson, M, Karumbunathan, V & Zimmermann, MB (2012) Global iodine status in 2011 and trends over the past decade. J Nutr 142, 744750.
61.Andersson, M, Benoist, B de & Rogers, L (2010) Epidemiology of iodine deficiency: salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab 24, 111.

Keywords

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children

  • Nidhi Jaiswal (a1) (a2), Alida Melse-Boonstra (a2), Surjeet Kaur Sharma (a3), Krishnamachari Srinivasan (a1) and Michael B Zimmermann (a2) (a4) (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed