Overview of Overview of IDD IDD

in the 21in the 21stst centurycentury An International An International

Challenge in NutritionChallenge in Nutrition

H. Delshad M.DEndocrinologistResearch Institute for Endocrine Sciences

● ● Iodine is a chemical element (as are Oxygen,Hydrogen,Iron)

●● Iodine is an essential trace element for the human

●● Iodine is an essential part of the chemical structure of thyroid hormones

Total quantity present in body

is (15-20 mg) Mostly in thyroid

gland

What is Iodine ?

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Source of Iodine

● Like most other discoveries, the discovery of Iodine was a fortuitous accident. ● While most scientists discovered something when trying to help people to save their lives, Courtois discovered Iodine when he was trying to kill people.

● Bernard Courtois discovered Iodine in 1811

Discovery of Iodine

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Recommended daily intake of iodine

Preschool children 90 g

Schoolchildren (6-12 y) 120 g

Adult (>12 y) 150 g

Pregnant & Lactating women

250 g

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The spectrum of IDDFetus Abortions

StillbirthsCongenital anomaliesIncreased perinatal mortalityNeurologic creatinismPsychomotor defects

Neonate Neonatal goiterNeonatal hypothyroidims

Child & adolescent Goitrous juvenile hypothyroidism Impaired mental function Retarded physical development

Adult Goiter with its complications HypothyroidismImpaired mental function

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IDDIDD: : Iodine Deficiency Disorders

The world’s most common endocrine problem

The most preventable cause of mental retardation

The easiest of the major nutritional deficiencies to correct

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IDD : Spectrum of Disorders

1% - 10%

Cretinism

5% - 30%

Some brain damage

30% - 70%

Loss of energy due to hypothyroidism

Cretinism, Tip of the Iceberg

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Endemic Cretinism (Neurologic Form)

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An adult male from the Congo,

with three women of the same

age (17-20 years), all of whom

are myxedematous cretins.

Myxedematous Cretinism

HistoryHistory•Awareness regarding goiter goes back to thousands years ago.•David Marine in 1915 declared that Endemic goiter is the easiest known disease to prevent.•In 1915,for the first time, Hunziger proposed that iodized salt be used for goiter in Switzerland.•The first large-scale trials with iodized salt carried out over the period 1916-1920 by Marine and Kimbal in Ohio, USA.

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HistoryHistory1960 WHO presents the first comprehensive review of goiter on world scale, however in spite of the successful elimination of IDD in a number of industrialized countries, only very slow progress is made in developing countries during the next 15 years.

1983The concept of iodine deficiency disorders (IDD) is introduced with emphasis on the effects of iodine deficiency on brain function.

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1985With support from UNICEF, WHO & Australian government the ICCIDD is founded in order to bridge the gap between available knowledge and its application

1987The United Nations Sub-Committee on Nutrition establishes an IDD Working Group to receive an Annual Report of Progress.

HistoryHistory

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2010ICCIDD celebrates 25 years of work and creates Basil Hetzel International Award for Communications on iodine nutrition.

1990The UNICEF, established the goal of eliminating iodine deficiency worldwide.

HistoryHistory

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Global

Iodine Nutrition

Epidemiological criteria for assessing iodine Epidemiological criteria for assessing iodine nutritionnutrition

based on median urinary iodine based on median urinary iodine concentration in school-aged childrenconcentration in school-aged children

Median Urinary Iodine (g/L)

Iodine Nutrition

<20 Sever iodine deficiency

20-49 Moderate iodine deficiency

50-99 Mild iodine deficiency

>200 More than adequate

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◙ Iodine sufficient countries before 1990:

●Switzerland ●Scandinavian countries ●Australia ●United States ●Canada

◙ The new global estimate of iodine status data on the 193 WHO Member States.

Update on iodine status worldwide

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WHO Region Countries (n) Proportion (%)

Total(millions)

Africa 10 39.3 57.9

Americas 2 13.7 14.6

South-East Asia

0 31.8 76

Europe 11 43.9 30.5

Eastern Mediterranean

4 38.6 30.7

Western Pacific

5 18.6 31.2

Global total 32 29.8 240.9

SAC with insufficient iodine intake, by WHO region, 2011

5.2%: severely deficient, 8.1%: moderately deficient, 15.9%: mildly deficient

The top10 iodine deficient countries with the greatest number of SAC with insufficient iodine intake in 2011

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The global prevalence of low iodine intakes has fallen over the past decade, from 36.5% in 2003, to 31.5% in 2007 and to 29.8% in 2011

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Number of iodine deficient countries in 2003, 2007, and 2011

Over the past decade, the number of countries that are iodine deficient has fallen from 54 to 30

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IODINE INTAKE 2003 2007

2011

Insufficient : Sever iodine deficiency

1 0 0

Insufficient : Moderate iodine deficiency

13 10 9

Insufficient : Mild iodine deficiency 40 37 23

Adequate 43 49 69

More than adequate 24 27 36

Excessive 5 7 11

Countries with data 126 130 148

The number of countries 192 193 193

Countries (number) by iodine status over the period 2003-2011

The number iodine-sufficient countries has increased from 67 to 106, while the number with excessive iodine intake has increased from 5 to 11.

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Where do we stand in

2013?

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Overall resultsOverall results

About 70% of households worldwide have access to iodized salt.

Out of 128 countries with data, at least 90% of households in 37 countries consume adequately iodized salt, but in 39 countries, coverage rates are below 50%.

Tow billion of the global population, including 241 million school children, still have insufficient dietary iodine intakes.

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Acknowledgment

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John Stanbury

In 1985, Stanbury founded the International Council for the Control of Iodine Deficiency Disorders (ICCIDD).

In 1950, John Stanbury was a young physician at Massachusetts General Hospital. A surgeon from Argentina brought him photographs of patients suffering from enlarged thyroid glands, or goiters, and, like his colleagues, Stanbury had never seen cases like the ones the Argentine displayed. Intrigued, Stanbury and other researchers traveled to Argentina in June of 1951 to investigate further, and through their research showed the first physiological link between goiters and iodine deficiency.

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Basil Stuart Hetzel, AC (born 13 June 1922) is an Australian medical researcher who has made a major contribution to combating iodine deficiency a major cause of goiter and cretinism worldwide.

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François Delange (1935 - June 2007) was a Belgian physician and researcher who contributed to thyroid research. He performed field studies on goiter prevalence worldwide and performed pioneering research in early screening for congenital hypothyroidism.

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Back ground & present state

of IDD in

IRAN

The history of IDD in IRAN

 1969 (1348)The first epidemiological assessment of goiter:  High prevalence of goiter in most parts of the country.

1983 (1362)The assessment of goiter in Shahryar  Goiter prevalence: ● 54% in male and 66% in female subjects ● MUI: 65 µg/L

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Huge Goiter

1984 (1363)1984 (1363)

The assessment in Tehran, rural areas The assessment in Tehran, rural areas near Tehran and Kohkiloyeh Boyerahmad :near Tehran and Kohkiloyeh Boyerahmad :

►Goiter prevalence: ● Hyperendemic ● MUI : ≤ 50 µg/l

►Physical examination: Mental& physical growth retardation Psychomotor disturbances Hearing deficits

1989 (1368)1989 (1368)First national surveyFirst national survey(Centers and capital cities of 14 provinces and rural areas of 8 provinces)

Goiter prevalence:

● Endemic in all and ●Hyper endemic in capital cities of 5 provinces

Median Urinary Iodine:

● ≤100 µg/l in all regions

In general  

The estimated population at risk for IDD in the country based on the findings of the results of the surveys conducted from 1983 to 1989:

20 millions

Therefore in 1988 iodine deficiency has been accepted as a priority health problem.

In 1989 Iranian National Committee for the Control of Iodine Deficiency ( INCCI) was established by MOH

1996 (1375)1996 (1375)Second national surveySecond national survey

Goiter prevalence: ● 58% ● Most have low grade goiter

Median Urinary Iodine: ● 200 µg/l

7 years after the initiation of salt iodization 2 years after the USIHouse hold consumption of iodized salt :

% 50

o%82; UIC ≥ 100 µg/lo≤%10; UIC ≤50 µg/l

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1996 (1375)1996 (1375) 22ndnd national survey national survey

MUI in schoolchildren was over than the at least standard value set by WHO/ UNICEF /ICCIDD

Successful salt iodization program

I.R.IRAN has announced to be IDD free with fulfilling 10 programmatic indicators set by WHO/ UNICEF /ICCIDD in 2000.

2001 (1380)2001 (1380)Third national surveyThird national survey

Goiter prevalence: ● 9.8% ● Significant decrease in goiter prevalence especially goiter grade 2

Median Urinary Iodine: ● 167 µg/l • 5.8% : UIC<50 µg/l • 14% : UIC= 51-99 µg/l • 80.2% : UIC> 100 µg/l

Households consumption of iodized salt: % 95

2007 (1386)2007 (1386)Forth national surveyForth national survey

Goiter prevalence: ● 5.9% ● most with grade 1 goiter

Median Urinary Iodine: ● 140 µg/l

% 65 UI >100 µg/l % 15 UI < 50 µg/l

Households consumption of iodized salt: % 97

Diagram of goiter prevalence in Iran from 1989 to 2007

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Indicator Year

Goiter Prevalence

Median UICµg/l

% median UIC

< 100µg/l

1996(1375)

55 205 14

2001(1380)

9.8 165 20

2007(1386)

5.7 140 35

Iodine status of Iranian population

Pre

vlen

ce O

f G

oite

r In

Ira

n

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2012 (1390)2012 (1390)Fifth national surveyFifth national survey

??

Conclusion

● The well-monitored salt iodization program in Iran has ultimately resulted in optimization of UIC, and drastically decreased the goiter rate 17 years after universal salt iodization.

● Our last survey indicates a well established sustainable IDD program in I.R. IRAN.

● Iodized salt programs need to be carefully monitored to ensure adequate iodine intake while avoiding iodine excess.

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کنترل اختالل های ناشی از کمبود

ید در ایران وکشورهای منـــــطقه

مدیون تالش خســتـگی ناپذیـر و

همت ماندگار دانشمـند فرهیخـــته

دکتر فریدون جناب آ قای عزیزی

.است

فروغ شادی چشمان مادرانی که دیگر کودکی با عقب ماندگی ذهنی.ناشی از کمبود ید بد نیا نمی آورند را تقدیم شما می نماییم

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Iodine deficiency is so easy to prevent that it is a crime to let a single child be born mentally

handicapped for that reason.

Henry Richardson Labouisse, Jr

UNICEFF, 1978

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