Skip to main content
Erschienen in: European Journal of Nutrition 2/2017

09.12.2015 | Original Contribution

Lebanese children are iodine deficient and urinary sodium and fluoride excretion are weak positive predictors of urinary iodine

verfasst von: Hala Ghattas, Sirine Francis, Carla El Mallah, Dareen Shatila, Karina Merhi, Sani Hlais, Michael Zimmermann, Omar Obeid

Erschienen in: European Journal of Nutrition | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To assess iodine and fluoride status among Lebanese children.

Methods

A nationally representative cross-sectional study of 6- to 10-year-old schoolchildren was conducted using multistage cluster sampling. Spot urine samples were collected from 1403 children, and urinary iodine, fluoride, creatinine and sodium levels were measured. Salt samples from markets (n = 30) were tested for iodine concentration by titration.

Results

Median urinary iodine concentration was 66.0 µg/l, indicating mild deficiency, and almost 75 % of Lebanese children had a urinary iodine concentration (UIC) <100 µg/l. UIC was higher among children from private schools and in areas of higher socioeconomic status. Most salt samples were fortified at levels far below the legislated requirement, and 56 % of samples contained less than 15 ppm iodine. Fluoride-to-creatinine ratio (F/Cr) was 0.250 (0.159–0.448) mg/g. There were weak positive correlations between UIC and urinary sodium (r 2 = 0.039, P value <0.001) and UIC and urinary fluoride (r 2 = 0.009, P value <0.001).

Conclusions

Lebanese elementary school children are iodine deficient due to inadequately iodized salt. The weak correlation between UIC and urinary sodium suggests most dietary iodine does not come from iodized salt. The poor correlation between UIC and urinary fluoride suggests that fluoride intake is not affecting iodine metabolism. Efforts are needed in Lebanon to improve industry compliance with salt fortification through improved monitoring and enforcement of legislation.
Literatur
1.
Zurück zum Zitat Andersson M, Karumbunathan V, Zimmermann MB (2012) Global iodine status in 2011 and trends over the past decade. J Nutr 142:744–750CrossRef Andersson M, Karumbunathan V, Zimmermann MB (2012) Global iodine status in 2011 and trends over the past decade. J Nutr 142:744–750CrossRef
2.
Zurück zum Zitat World Health Organization (2007) Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. World Health Organization, United Nations Children’s Fund, International Council for Control of Iodine Deficiency definition, Geneva World Health Organization (2007) Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. World Health Organization, United Nations Children’s Fund, International Council for Control of Iodine Deficiency definition, Geneva
3.
Zurück zum Zitat Aburto N, Abudou M, Candeias V, Wu T, World Health Organization (2014) Effect and safety of salt iodisation to prevent iodine deficiency disorders: a systematic review with meta-analyses. World Health Organization, Geneva Aburto N, Abudou M, Candeias V, Wu T, World Health Organization (2014) Effect and safety of salt iodisation to prevent iodine deficiency disorders: a systematic review with meta-analyses. World Health Organization, Geneva
4.
Zurück zum Zitat Bougma K, Aboud FE, Harding KB, Marquis GS (2013) Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients 5:1384–1416CrossRef Bougma K, Aboud FE, Harding KB, Marquis GS (2013) Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients 5:1384–1416CrossRef
5.
Zurück zum Zitat Zimmermann MB, Boelaert K (2015) Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol 3:286–295CrossRef Zimmermann MB, Boelaert K (2015) Iodine deficiency and thyroid disorders. Lancet Diabetes Endocrinol 3:286–295CrossRef
6.
Zurück zum Zitat Herter-Aeberli I, Cherkaoui M, El Ansari N, Rohner R, Stinca S, Chabaa L, Von Eckardstein A, Aboussad A, Zimmermann MB (2015) Iodine supplementation decreases hypercholesterolemia in iodine-deficient, overweight women: a randomized controlled trial. J Nutr 145:2067–2075CrossRef Herter-Aeberli I, Cherkaoui M, El Ansari N, Rohner R, Stinca S, Chabaa L, Von Eckardstein A, Aboussad A, Zimmermann MB (2015) Iodine supplementation decreases hypercholesterolemia in iodine-deficient, overweight women: a randomized controlled trial. J Nutr 145:2067–2075CrossRef
7.
Zurück zum Zitat World Health Organization (2004) Iodine status worldwide: WHO global database on iodine deficiency. World Health Organization, Geneva World Health Organization (2004) Iodine status worldwide: WHO global database on iodine deficiency. World Health Organization, Geneva
8.
Zurück zum Zitat Cowan J, Najjar S, Sabry Z, Tannous R, Simaan F (1965) Some further observations on goiter in Lebanon. Am J Clin Nutr 17:164–170 Cowan J, Najjar S, Sabry Z, Tannous R, Simaan F (1965) Some further observations on goiter in Lebanon. Am J Clin Nutr 17:164–170
9.
Zurück zum Zitat Cowan J, Kassab G, Silahian A, Shadarevian S (1966) Iodine intake and excretion in three different areas of Lebanon. J Med Liban 19:213–223 Cowan J, Kassab G, Silahian A, Shadarevian S (1966) Iodine intake and excretion in three different areas of Lebanon. J Med Liban 19:213–223
10.
Zurück zum Zitat Najjar SS, Woodruff CW (1963) Some observations on goiter in Lebanon. Am J Clin Nutr 13:46–54 Najjar SS, Woodruff CW (1963) Some observations on goiter in Lebanon. Am J Clin Nutr 13:46–54
11.
Zurück zum Zitat Ministry of Public Health of Lebanon (1997) UNICEF. Evaluation studies of the IDD programme in Lebanon. Ministry of Public Health, Beirut (Ref 3222) Ministry of Public Health of Lebanon (1997) UNICEF. Evaluation studies of the IDD programme in Lebanon. Ministry of Public Health, Beirut (Ref 3222)
12.
Zurück zum Zitat Ministry of Health of Lebanon, UNICEF, WHO, American University of Beirut (1994) IDD survey in Lebanon, 1993-final report. Ministry of Health, Beirut (Ref 485) Ministry of Health of Lebanon, UNICEF, WHO, American University of Beirut (1994) IDD survey in Lebanon, 1993-final report. Ministry of Health, Beirut (Ref 485)
13.
Zurück zum Zitat Doumit M, Doughan B (2002) La santé bucco-dentaire des écoliers au Liban. Cahiers d’études et de recherches francophones. Santé 12:223–228 Doumit M, Doughan B (2002) La santé bucco-dentaire des écoliers au Liban. Cahiers d’études et de recherches francophones. Santé 12:223–228
14.
Zurück zum Zitat Ge Y, Ning H, Wang S, Wang J (2005) Comet assay of DNA damage in brain cells of adult rats exposed to high fluoride and low iodine. Fluoride 38:209 Ge Y, Ning H, Wang S, Wang J (2005) Comet assay of DNA damage in brain cells of adult rats exposed to high fluoride and low iodine. Fluoride 38:209
15.
Zurück zum Zitat Jooste P, Weight M, Kriek J, Louw A (1999) Endemic goitre in the absence of iodine deficiency in schoolchildren of the Northern Cape Province of South Africa. Eur J Clin Nutr 53:8–12CrossRef Jooste P, Weight M, Kriek J, Louw A (1999) Endemic goitre in the absence of iodine deficiency in schoolchildren of the Northern Cape Province of South Africa. Eur J Clin Nutr 53:8–12CrossRef
16.
Zurück zum Zitat Trivedi M, Verma R, Chinoy N, Patel R, Sathawara N (2007) Effect of high fluoride water on intelligence of school children in India. Fluoride 40:178–183 Trivedi M, Verma R, Chinoy N, Patel R, Sathawara N (2007) Effect of high fluoride water on intelligence of school children in India. Fluoride 40:178–183
17.
Zurück zum Zitat El Mallah C, Ghattas H, Shatila D, Francis S, Merhi K, Hlais S, Toufeili I, Obeid O (2015) Urinary magnesium, calcium, and phosphorus to creatinine ratios of healthy elementary school Lebanese children. Biol Trace Elem Res 1–7. doi:10.1007/s12011-015-0484-3 El Mallah C, Ghattas H, Shatila D, Francis S, Merhi K, Hlais S, Toufeili I, Obeid O (2015) Urinary magnesium, calcium, and phosphorus to creatinine ratios of healthy elementary school Lebanese children. Biol Trace Elem Res 1–7. doi:10.​1007/​s12011-015-0484-3
18.
Zurück zum Zitat Wang G, Zhou R, Wang Z, Shi L, Sun M (1999) Effects of storage and cooking on the iodine content in iodized salt and study on monitoring iodine content in iodized salt. Biomed Environ Sci 12:1–9 Wang G, Zhou R, Wang Z, Shi L, Sun M (1999) Effects of storage and cooking on the iodine content in iodized salt and study on monitoring iodine content in iodized salt. Biomed Environ Sci 12:1–9
19.
Zurück zum Zitat Skeaff S, Thomson C, Gibson R (2002) Mild iodine deficiency in a sample of New Zealand school children. Eur J Clin Nutr 56:1169–1175CrossRef Skeaff S, Thomson C, Gibson R (2002) Mild iodine deficiency in a sample of New Zealand school children. Eur J Clin Nutr 56:1169–1175CrossRef
20.
Zurück zum Zitat Lee J, Kim JH, Lee S-Y, Lee JH (2014) Iodine status in Korean preschool children as determined by urinary iodine excretion. Eur J Nutr 53:683–688CrossRef Lee J, Kim JH, Lee S-Y, Lee JH (2014) Iodine status in Korean preschool children as determined by urinary iodine excretion. Eur J Nutr 53:683–688CrossRef
21.
Zurück zum Zitat Pardede LV, Hardjowasito W, Gross R, Dillon DH, Totoprajogo OS, Yosoprawoto M, Waskito L, Untoro J (1998) Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level. J Nutr 128:1122–1126 Pardede LV, Hardjowasito W, Gross R, Dillon DH, Totoprajogo OS, Yosoprawoto M, Waskito L, Untoro J (1998) Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level. J Nutr 128:1122–1126
22.
Zurück zum Zitat Andersen S, Karmisholt J, Pedersen KM, Laurberg P (2008) Reliability of studies of iodine intake and recommendations for number of samples in groups and in individuals. Br J Nutr 99:813–818 Andersen S, Karmisholt J, Pedersen KM, Laurberg P (2008) Reliability of studies of iodine intake and recommendations for number of samples in groups and in individuals. Br J Nutr 99:813–818
23.
Zurück zum Zitat Fuge R (2013) Soils and iodine deficiency. Essentials of Medical Geology. Springer, Berlin, pp 417–432CrossRef Fuge R (2013) Soils and iodine deficiency. Essentials of Medical Geology. Springer, Berlin, pp 417–432CrossRef
24.
Zurück zum Zitat Knudsen N, Bülow I, Laurberg P, Ovesen L, Perrild H, Jørgensen T (2003) Low socio-economic status and familial occurrence of goitre are associated with a high prevalence of goitre. Eur J Epidemiol 18:175–181CrossRef Knudsen N, Bülow I, Laurberg P, Ovesen L, Perrild H, Jørgensen T (2003) Low socio-economic status and familial occurrence of goitre are associated with a high prevalence of goitre. Eur J Epidemiol 18:175–181CrossRef
25.
Zurück zum Zitat Hynes KL, Blizzard CL, Venn AJ, Dwyer T, Burgess JR (2004) Persistent iodine deficiency in a cohort of Tasmanian school children: associations with socio-economic status, geographical location and dietary factors. Aust N Z J Public Health 28:476–481CrossRef Hynes KL, Blizzard CL, Venn AJ, Dwyer T, Burgess JR (2004) Persistent iodine deficiency in a cohort of Tasmanian school children: associations with socio-economic status, geographical location and dietary factors. Aust N Z J Public Health 28:476–481CrossRef
26.
Zurück zum Zitat Poland PAII (1999) Issues of IDD Newsletter. Young 15(4):105 Poland PAII (1999) Issues of IDD Newsletter. Young 15(4):105
27.
Zurück zum Zitat Section UN, Division UP, Communications UDo (2008) Sustainable elimination of iodine deficiency: progress since the 1990 World summit for children. UNICEF Section UN, Division UP, Communications UDo (2008) Sustainable elimination of iodine deficiency: progress since the 1990 World summit for children. UNICEF
28.
Zurück zum Zitat Zimmermann MB, Wegmüller R, Zeder C, Torresani T, Chaouki N (2004) Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization. Am J Clin Nutr 79:642–645 Zimmermann MB, Wegmüller R, Zeder C, Torresani T, Chaouki N (2004) Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization. Am J Clin Nutr 79:642–645
29.
Zurück zum Zitat Azizi F, Mehran L, Sheikholeslam R, Ordookhani A, Naghavi M, Hedayati M, Padyab M, Mirmiran P (2008) Sustainability of a well-monitored salt iodization program in Iran: marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt. J Endocrinol Invest 31:422–431CrossRef Azizi F, Mehran L, Sheikholeslam R, Ordookhani A, Naghavi M, Hedayati M, Padyab M, Mirmiran P (2008) Sustainability of a well-monitored salt iodization program in Iran: marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations without alteration in iodine content of salt. J Endocrinol Invest 31:422–431CrossRef
30.
Zurück zum Zitat Alsanosy RMA, Gaffar AM, Khalafalla HE, Mahfouz MS, Zaid AN, Bani IA (2012) Current iodine nutrition status and progress toward elimination of iodine deficiency disorders in Jazan, Saudi Arabia. BMC Public Health 12:1006CrossRef Alsanosy RMA, Gaffar AM, Khalafalla HE, Mahfouz MS, Zaid AN, Bani IA (2012) Current iodine nutrition status and progress toward elimination of iodine deficiency disorders in Jazan, Saudi Arabia. BMC Public Health 12:1006CrossRef
31.
Zurück zum Zitat Carvalho AL, de Souza Meirelles CJC, Oliveira LA, Costa TMB, Navarro AM (2012) Excessive iodine intake in school children. Eur J Nutr 51:557–562CrossRef Carvalho AL, de Souza Meirelles CJC, Oliveira LA, Costa TMB, Navarro AM (2012) Excessive iodine intake in school children. Eur J Nutr 51:557–562CrossRef
32.
Zurück zum Zitat Andersson M, de Benoist B, Rogers L (2010) Epidemiology of iodine deficiency: salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab 24:1–11CrossRef Andersson M, de Benoist B, Rogers L (2010) Epidemiology of iodine deficiency: salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab 24:1–11CrossRef
33.
Zurück zum Zitat Bürgi H, Siebenhüner L, Miloni E (1984) Fluorine and thyroid gland function: a review of the literature. Klin Wochenschr 62:564–569CrossRef Bürgi H, Siebenhüner L, Miloni E (1984) Fluorine and thyroid gland function: a review of the literature. Klin Wochenschr 62:564–569CrossRef
34.
Zurück zum Zitat Zohouri F, Swinbank C, Maguire A, Moynihan P (2006) Is the fluoride/creatinine ratio of a spot urine sample indicative of 24-h urinary fluoride? Community Dent Oral Epidemiol 34:130–138CrossRef Zohouri F, Swinbank C, Maguire A, Moynihan P (2006) Is the fluoride/creatinine ratio of a spot urine sample indicative of 24-h urinary fluoride? Community Dent Oral Epidemiol 34:130–138CrossRef
35.
Zurück zum Zitat Petersen PE, Baez R, Marthaler T (2014) Basic methods for assessment of renal fluoride excretion in community prevention programmes for oral health. World Health Organization, Geneva Petersen PE, Baez R, Marthaler T (2014) Basic methods for assessment of renal fluoride excretion in community prevention programmes for oral health. World Health Organization, Geneva
36.
Zurück zum Zitat Rugg-Gunn A, Villa A, Buzalaf M (2011) Contemporary biological markers of exposure to fluoride. Monogr Oral Sci 22:37–51CrossRef Rugg-Gunn A, Villa A, Buzalaf M (2011) Contemporary biological markers of exposure to fluoride. Monogr Oral Sci 22:37–51CrossRef
37.
Zurück zum Zitat Villa A, Anabalon M, Zohouri V, Maguire A, Franco A, Rugg-Gunn A (2010) Relationships between fluoride intake, urinary fluoride excretion and fluoride retention in children and adults: an analysis of available data. Caries Res 44:60–68CrossRef Villa A, Anabalon M, Zohouri V, Maguire A, Franco A, Rugg-Gunn A (2010) Relationships between fluoride intake, urinary fluoride excretion and fluoride retention in children and adults: an analysis of available data. Caries Res 44:60–68CrossRef
38.
Zurück zum Zitat Akpata ES, Behbehani J, Akbar J, Thalib L, Mojiminiyi O (2014) Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non-fluoridated community. Community Dent Oral Epidemiol 42:224–233CrossRef Akpata ES, Behbehani J, Akbar J, Thalib L, Mojiminiyi O (2014) Fluoride intake from fluids and urinary fluoride excretion by young children in Kuwait: a non-fluoridated community. Community Dent Oral Epidemiol 42:224–233CrossRef
39.
Zurück zum Zitat García-Hoyos F, Cardososilva C, Barbería E (2014) Renal excretion of fluoride after fluoride mouth rinses in children. Eur J Paediatr Dent 15:35–38 García-Hoyos F, Cardososilva C, Barbería E (2014) Renal excretion of fluoride after fluoride mouth rinses in children. Eur J Paediatr Dent 15:35–38
40.
Zurück zum Zitat Day T, Powell-Jackson P (1972) Fluoride, water hardness, and endemic goitre. Lancet 299:1135–1138CrossRef Day T, Powell-Jackson P (1972) Fluoride, water hardness, and endemic goitre. Lancet 299:1135–1138CrossRef
41.
Zurück zum Zitat Doumit M, Doughan B, Baez R (2004) Oral health programme in Lebanon: technical resistance provided for development of baseline studies for salt fluoridation. Ministry of Public Health, Lebanese University, World Health Organization, Beirut Doumit M, Doughan B, Baez R (2004) Oral health programme in Lebanon: technical resistance provided for development of baseline studies for salt fluoridation. Ministry of Public Health, Lebanese University, World Health Organization, Beirut
42.
Zurück zum Zitat Hector F, Maria AA, Margaret P, Anthony V, Fatima R-S (2009) Fluoride intake and urinary fluoride excretion in children attending a daycare center in Maracay, Aragua state, Venezuela. J Dent Oral Hyg 1:027–035 Hector F, Maria AA, Margaret P, Anthony V, Fatima R-S (2009) Fluoride intake and urinary fluoride excretion in children attending a daycare center in Maracay, Aragua state, Venezuela. J Dent Oral Hyg 1:027–035
43.
Zurück zum Zitat Republic of Lebanon, Ministry of Foreign Affairs (2001) National report on follow-up to the world summit for children. Beirut Republic of Lebanon, Ministry of Foreign Affairs (2001) National report on follow-up to the world summit for children. Beirut
Metadaten
Titel
Lebanese children are iodine deficient and urinary sodium and fluoride excretion are weak positive predictors of urinary iodine
verfasst von
Hala Ghattas
Sirine Francis
Carla El Mallah
Dareen Shatila
Karina Merhi
Sani Hlais
Michael Zimmermann
Omar Obeid
Publikationsdatum
09.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Nutrition / Ausgabe 2/2017
Print ISSN: 1436-6207
Elektronische ISSN: 1436-6215
DOI
https://doi.org/10.1007/s00394-015-1120-x

Weitere Artikel der Ausgabe 2/2017

European Journal of Nutrition 2/2017 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.