Appropriate Iodine Nutrition in Iran: 20 Years of Success
AbstractIodine is a trace element in the human body, its only known function is the synthesis of thyroid hormones. Effects of iodine deficiency, termed iodine deficiency disorders (IDD), include endemic goiter, hypothyroidism, cretinism, decreased fertility rate, increased infant mortality and mental retardation. 2.2 billion people worldwide are at risk for IDD. Of these, 30-70% have goiter and 1-10% have cretinism. Two decades ago the I.R. Iran was among the countries most severely affected by iodine deficiency, but during the last two decades has made much progress in the development of universal salt iodization strategies and IDD prevention, and since 1996 meets all WHO/UNICEF/ICCIDD criteria for the sustainable elimination of iodine deficiency.
Delange FM, Dunn JT. Iodine deficiency. In: Braverman LE, Utiger RD, editors. The Thyroid: A fundamental and Clinical Text. 9th ed. Philadelphia: Lippincott Williams & Wilkins 2005; p. 264-88.
Hetzel BS, Pandav C. S.O.S for a Billion: the Conquest of Iodine Deficiency Disorders. 2nd ed. New Delhi: Oxford University Press, (ICCIDD); 1996.
Zimmermann MB, Jooste PL, Pandav CS. Iodinedeficiency disorders. Lancet 2008;372(9645):1251-62.
Santiago-Fernandez P, Torres-Barahona R, Muela- Martínez JA, Rojo-Martínez G, García-Fuentes E, Garriga MJ, et al. Intelligence quotient and iodine intake: a crosssectional study in children. J Clin Endocrinol Metab 2004;89(8):3851-7.
Langer P. History of Goitre. In: Endemic Goitre. Geneva: World Health Organization; 1960. p. 9-25.
Courtois B. Dé couverte d'une substance nouvelle dans le Vareck. (Discovery of a new substance in kelp.) Ann Chim (Paris) 1813;88:304-10.
Hetzel BS. The story of iodine deficiency: an international challenge in nutrition. Oxford, England: Oxford University Press, 1989.
Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J Neuroendocrinol 2008;20(6):784-94.
Delange F. Iodine deficiency as a cause of brain damage. Postgrad Med J 2001;77(906):217-20.
de Benoist B, McLean E, Andersson M, Rogers L. Iodine deficiency in 2007: global progress since 2003. Food Nutr Bull 2008;29(3):195-202.
Delange F, de Benoist B, Pretell E, Dunn JT. Iodine deficiency in the world: where do we stand at the turn of the century? Thyroid 2001;11(5):437-47.
Vitti P, Delange F, Pinchera A, Zimmermann M, Dunn JT. Europe is iodine deficient. Lancet 2003;361(9364):1226.
de Benoist B, Andersson M, Egli I, Takkouche B, Allen H, editors. Iodine status worldwide. WHO Global Database on Iodine Deficiency. Geneva: World Health Organization; 2004.
The United Nations Children's Fund (UNICEF). The State of The World’s Children, 2008. Child survival. New York: UNICEF, 2007.
WHO Nutrition. The WHO Global Database on Iodine Deficiency, 2008. WHO website. Accessed 2008. Available from: URL:http://www.who.int/vmnis/en/
Zimmermann MB. Iodine requirements and the risks and benefits of correcting iodine deficiency in populations. J Trace Elem Med Biol 2008;22(2):81-92.
Zimmermann MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. Am J Clin Nutr 2009;89(2):668S-72S.
WHO Secretariat, Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2- years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr 2007;10(12A):1606-11.
Delange F. Optimal iodine nutrition during pregnancy, lactation and neonatal period. Int J Endocrinol Metab 2004;89:3851.
Azizi F, Smyth P. Breastfeeding and maternal and infant iodine nutrition. Clin Endocrinol (Oxf) 2009;70(5):803-9.
Hetzel BS. Eliminating iodine deficiency disorders: the role of the International Council in the global partnership. Bull World Health Organ 2002;80(5):410-3; discussion 413-7.
Dunn JT, Van der Har F. A practical guide to the correction of iodine deficiency. The Netherlands: International Council for Control of Iodine Deficiency Disorders, 1990.
World Health Organization, UNICEF, ICCIDD. Progress towards the elimination of iodine deficiency disorders (IDD). Geneva: World Health Organization, 1999.
Hetzel BS. Progress in the prevention and control of iodine-deficiency disorders. Lancet 1987;2(8553):266.
Caldwell KL, Miller GA, Wang RY, Jain RB, Jones RL. Iodine status of the U.S. population, National Health and Nutrition Examination Survey 2003- 2004. Thyroid 2008;18(11):1207-14.
Emami A, Shahbazi H, Sabzevari M, Gawam Z, Sarkissian N, Hamedi P, et al. Goiter in Iran. Am J Clin Nutr 1969;22(12):1584-8.
Azizi F, Kimiagar M, Bastani J. Goiter survey in Shahryar. J Shaheed Beheshti Uni Med Sci 1985;9:75-84. [Persian]
Azizi F, Nafarabadi M, Azartash P. Goiter survey in East Tehran. J Shaheed Beheshti Uni Med Sci 1990;4(1,2):17- 32. [Persian]
Azizi F, Sarshar A, Nafarabadi M, Ghazi A, Kimiagar M, Noohi S, et al. Impairment of neuromotor and cognitive development in iodine-deficient schoolchildren with normal physical growth. Acta Endocrinol (Copenh) 1993;129(6):501-4.
Azizi F, Kalani H, Kimiagar M. Physical, neuromotor and intellectual impairments in non-cretinous school children with iodine deficiency. Int J Vit Nutr Res 1995;65:199-205.
Kimiagar M, Ghazi A, Nafarabadi M, Yasaie M, Azizi F. Growth retardation, goiter prevalence and hypothyroidism in school children of Tehran suburbs. Daroo Darman J 1993;9(100):6-11. [Persian]
Kalani H, Kimiagar M, Azizi F. Neurological disturbances in school children of northern village in Tehran province. J Shaheed Beheshti Uni Med Sci 1992;16(3,4). [Persian]
Sarshar A, Mohajer M, Kimiagar M, Azizi F. Psychomotor and intellectual disturbances in schoolchildren of Tehran suburbs. J Shaheed Beheshti Uni Med Sci 1991;15(3,4):12. [Persian]
Kimiagar M, Yassai M, Nafarabadi M, Samimi B, Azizi F. Endemic goiter in Boyer Ahmad, Iran. Med J Iran 1989;3:27-9. [Persian]
Rajabian R, Shahbazi H, Parizadeh J. Goiter survey in Mashhad, Iran. J Mashhad Uni Med Sci, 1990. [Persian]
Hedayati Emami M, Farhadfar Z, Barzigar S. Goiter prevalence in Rasht and Sangar (Gilan Province), Iran, 1989. J Gilan Uni Med Sci 1993;1993;2(5):10-26. [Persian]
Rajabian R. Goiter survey in Neishaboor, Iran. J Shaheed Beheshti Uni Med Sci 1990;14(1,2):17-32. [Persian]
Azizi F, Kimiagar M, Nafarabadi M, Yassai M. Current status of iodine deficiency disorders in the Islamic Republic of Iran. EMR Health Serv J 1990;8:23-7.
Azizi F, Shekholeslam R. National programme for control of iodine deficiency in Iran. Teb Tazkieh J 1996;19:18-22.[Persian]
Azizi F, Sheikholeslam R, Hedayati M, Mirmiran P, Malekafzali H, Kimiagar M, et al. Sustainable control of iodinedeficiency in Iran: beneficial results of the implementation of the mandatory law on salt iodization. J Endocrinol Invest 2002;25(5):409-13.
Pardede LV, Hardjowasito W, Gross R, Dillon DH, Totoprajogo OS, Yosoprawoto M, et al. Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level. J Nutr 1998;128(7):1122-6.
World Health Organization. Indicators for assessing iodine deficiency disorders and their control programmes. Geneva: World Health Organization, 1993.
Regional Meeting for the Promotion of Iodized Salt in the Eastern Mediterranean, East and North Africa Region. Dubai: United Arab Emirates, 2000.
Azizi F, Mehran L, Sheikholeslam R, Ordookhani A, Naghavi M, Hedayati M, et al. Sustainability of a wellmonitored 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 2008;31(5):422-31.
Dunn JT. What’s happening to our iodine? J Clin Endocrinol Metab 1998;83(10):3398-400.
Zimmermann MB, Wegmüller R, Zeder C, Torresani T, Chaouki N. Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization. Am J Clin Nutr 2004;79(4):642-5.
Salarkia N, Mirmiran P, Azizi F. Timing of the effect of iodine supplementation on Intelligent Quotients of School children. Int J Endocrinal Metab 2004;2:95-102.
Azizi F, Mirmiran P, Hedayati M, Salarkia N, Noohi S, Rostamian D. Effect of 10 yr of the iodine supplementation on the hearing threshold of iodine deficient schoolchildren. J Endocrinol Invest 2005;28(7):595-8.