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The prevalence of iodine deficiency in women of reproductive age in the United States of America

  • Joseph G Hollowell (a1) and James E Haddow (a2)

Abstract

Objective: To review the iodine status of women as assessed through National Health and Nutrition Examination Surveys from 1971 to 2002.

Design and Setting: National normative estimates of iodine status of the civilian, non-institutionalized population in the United States of America.

Subjects: Women of reproductive age and pregnant women.

Results: In the United States of America, iodine began to be added to the diet in the 1920s. An excessive iodine intake was documented by the first National Health and Nutrition Examination Survey (NHANES I) in the 1970s which reported a median urinary iodine (UI) concentration of 320 μg l-1. In the NHANES III survey, conducted between 1988 and 1994, the median UI concentration had decreased to 145 μg l-1, while 14.9% of women aged 15-44 years and 6.9% of pregnant women had a UI concentration 50 μg l-1. The concentrations of serum T4 and thyroid-stimulating hormone of women with a low UI concentration did not, however, indicate an iodine deficiency.

Conclusions: Further studies of the association between iodine excretion and biochemical and physiological changes should be undertaken to better understand women's needs for iodine and to develop criteria to monitor them in pregnancy. Because of the potential harm caused by iodine deficiency during pregnancy, we support the use of iodine supplements for all pregnancies while these data are being collected.

    •

Copyright

COPYRIGHT: © The Authors 2007

Corresponding author

*Corresponding author: Email jgh3@mindspring.com

References

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1Morreale de Escobar, G, Obregon, MJ, Escobar del Rey, F. Is neuropsychological development related to maternal hypothyroidism or maternal hypothyroxinemia? Journal of Clinical Endocrinology and Metabolism 2000; 85: 3975–87. Google Scholar | PubMed
2Glinoer, D. Pregnancy and iodine. Thyroid 2001; 11: 471–81. CrossRef | Google Scholar | PubMed
3Delange, F. Optimal iodine nutrition during pregnancy, lactation and the neonatal period. International Journal of Endocrinology and Metabolism 2004; 2: 1–12. Google Scholar
4Zimmermann, M, Delange, F. Iodine supplementation of pregnant women in Europe: a review and recommendations. European Journal of Clinical Nutrition 2004; 58: 979–84. CrossRef | Google Scholar | PubMed
5Marine, D, Kimball, OP. The prevention of simple goiter. American Journal of Medical Science 1922; 163: 34–9. Google Scholar
6Kimball, OP. Endemic goiter—a food deficiency disease. Journal of the American Dietetics Association 1949; 25: 112–5. Google Scholar | PubMed
7London, WT, Vought, RL, Brown, FA. Bread—a dietary source of large quantities of iodine. New England Journal of Medicine 1965; 273: 381. CrossRef | Google Scholar
8Markel, H. ‘When it rains it pours’: Endemic goiter, iodized salt, and David Murray Cowie, MD. American Journal of Public Health 1987; 77: 219–29. CrossRef | Google Scholar
9Altland, JK, Brush, BE. Goiter prevention in Michigan. Results of thirty years' voluntary use of iodized salt. Journal of the Michigan State Medical Society 1952; 51: 985–9. Google Scholar | PubMed
10Pittman, JA, Pauley, GE, Beschi, RS. Changing values for thyroidal radioiodine uptake. New England Journal of Medicine 1969; 273: 1331–4. Google Scholar
11Robbins, J. Iodine deficiency, excess, and the use of iodine for protection against radioactive iodine. Thyroid Study 1980; 3: 1. Google Scholar
12Oddie, TH, Fisher, DA, McDonahey, WM, Thompson, CSHCN. Iodine intake in the United States: a reassessment. Journal of Clinical Endocrinology 1970; 30: 659–65. CrossRef | Google Scholar | PubMed
13Braverman, LE. Iodine and the thyroid: 33 years of study. Thyroid 1994; 4: 351–6. CrossRef | Google Scholar
14Trowbridge, FL, Hand, KA, Nichaman, MZ. Findings relating to goiter and iodine in the Ten-State Nutrition Survey. American Journal of Clinical Nutrition 1975; 28: 712–6. CrossRef | Google Scholar | PubMed
15Trowbridge, FL, Matovinovic, J, McLaren, GD, Nichaman, MZ. Iodine and goiter in children. Pediatrics 1975; 56: 82–90. Google Scholar | PubMed
16Hollowell, JG, Staehling, NW, Hannon, WH, Flanders, DW, Gunter, EW, Maberly, GF, Braverman, LE, Pino, S, Miller, DT, Garbe, PL, DeLozier, DM, Jackson, RJ. Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971–1974 and 1988–1994). Journal of Clinical Endocrinology and Metabolism 1998; 83: 3401–8. Google Scholar
17Bureau of Nutritional Sciences. Iodine and Goiter. Nutrition Canada: The Saskatchewan Survey Report. Ottawa, Canada: Department of Health and Welfare, 1975; 125–30. Google Scholar
18Pennington, JAT, Schoen, SA. Total Diet Study: estimated dietary intakes of nutritional elements, 1982–1991. International Journal of Vitamin and Nutrition Research 1996; 66: 350–62. Google Scholar | PubMed
19Pennington, JAT, Schoen, SA. Contributions of food groups to estimated intakes of nutritional elements: results from the FDA Total Diet Studies, 1982–1991. International Journal of Vitamin and Nutrition Research 1996; 66: 342–9. Google Scholar | PubMed
20Personal communication, Richard L. Hanneman, Salt Institute, Alexandria, Virginia. Google Scholar
21WHO, UNICEF, and ICCIDD. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. A Guide for Programme Managers, 2nd edn. Geneva: WHO, 2001 WHO/NHD/01.1. Google Scholar
22Dunn, JT. Editorial: what's happening to our iodine? Journal of Clinical Endocrinolology and Metabolism 1998; 83: 3398–400. Google Scholar | PubMed
23Lee, K, Bradley, R, Dwyer, J, Lee, SL. Too much versus too little: the implications of current iodine intake in the United States. Nutrition Reviews 1999; 57: 177–81. CrossRef | Google Scholar | PubMed
24Utiger, RD. Maternal hypothyroidism and fetal development. New England Journal of Medicine 1999; 341: 601–2. CrossRef | Google Scholar | PubMed
25Haddow, JE, Palomaki, GE, Allan, WC, Williams, JR, Knight, GJ, Gagnon, J, O'Heir, CE, Mitchell, ML, Hermos, RJ, Waisbren, SE, Faix, JD, Klein, RZ. Maternal thyroid deficiency during pregnancy and subsequent psychological development in the child. New England Journal of Medicine 1999; 341: 549–55. CrossRef | Google Scholar
26Caldwell, KL, Maxwell, BC, Makhmudov, AA, Pino, S, Braverman, LE, Jones, RL, Hollowell, JG. Use of inductively coupled plasma mass spectrometry to measure urinary iodine in NHANES 2000: comparison with previous method. Clinical Chemistry 2003; 49: 1019–21. CrossRef | Google Scholar | PubMed
27Caldwell, KL, Jones, R, Hollowell, JG. Urinary Iodine Concentration—United States National Health and Nutrition Examination Survey (2001–2002). Thyroid 2005; 15(7): 692–9. CrossRef | Google Scholar
28National Center for Health Statistics. Plan and operation of the Hispanic Health and Nutrition Examination Survey, 1982–84. Vital Health Statistics 1985; 1: 1–429. Google Scholar
29Gunter, EW, Lewis, BL, Koncikowski, SM. Laboratory methods used for the Third National Health and Nutrition Examination Survey (NHANES III), 1988–1994. CDC 1996: 1–754. Google Scholar
30Delange, F, Burgi, H. Evaluation of the risk of persisting iodine deficiency in members of an iodine replete population. Technical Report, Department of Nutrition for Health and Development, WHO, Geneva: WHO, 2000. Google Scholar
31Food and Nutrition Board. Institute of Medicine. Dietary reference intakes. Washington, DC: National Academy Press, 2001; 258–89. Google Scholar
32Pearce, EN, Bazrafshan, HR, He, X, Pino, S, Braverman, LE. Dietary iodine in pregnant women from the Boston, Massachusetts area. Thyroid 2004; 14: 327–8. CrossRef | Google Scholar
33Bruhn, JC, Franke, AA. Iodine in human milk. Journal of Dairy Science 1983; 66: 1396–8. CrossRef | Google Scholar | PubMed
34Pearce, EN, Braverman, LE. Personal communication—unpublished data, 2004. Google Scholar
35Semba, RD, Delange, F. Iodine in human milk: perspectives for infant health. Nutrition Reviews 2001; 59: 269–78. CrossRef | Google Scholar | PubMed
36Smallridge, RC, Glinoer, D, Hollowell, JG, Brent, G. Thyroid function inside and outside of pregnancy. What do we know and what don't we know? Thyroid 2005; 15: 42–7. CrossRef | Google Scholar | PubMed
37Mitchell, ML, Klein, RZ, Sargent, JD, Meter, RA, Haddow, JE, Waisbren, SE, Faix, JD. Iodine sufficiency and measurements of thyroid function in maternal hypothyroidism. Clinical Endocrinology 2003; 58: 612–6. CrossRef | Google Scholar | PubMed
38Hollowell, JG, Staehling, NW, Flanders, DW, Hannon, WH, Gunter, EW, Spencer, CA, Braverman, LE. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). Journal of Clinical Endocrinolology and Metabolism 2002; 87: 489–99. CrossRef | Google Scholar
39Hollowell, JG, McClain, MR, Palomaki, GE, Haddow, JE. Relationships between urinary iodine and total thyroxine (T4) and thyroid stimulating hormone (TSH) concentration in the U.S. population (Abstract). Program and Abstracts of the 76th Annual Meeting of the American Thyroid Association, Vancouver, Canada. Thyroid 2004; 14: 721. Google Scholar
40Andersen, S, Pedersen, KM, Pedersen, IB, Laurberg, P. Variations in urinary iodine excretion and thyroid function. A 1-year study in healthy men. European Journal of Endocrinology 2001; 144: 461–5. CrossRef | Google Scholar | PubMed

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