Inadequate iodine status among women of childbearing age in Northern Norway: a cross-sectional study

Maren Johnsen; Guri Skeie; Tonje Braaten; Marianne Hope Abel; Sandra Huber; Marian Kjellevold; Elin Evensen; Margaret Rayman; Solrunn Hansen

doi:10.29219/fnr.v69.10802

Maren Johnsen Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
Guri Skeie Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
Tonje Braaten Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
Marianne Hope Abel Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
Sandra Huber Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
Marian Kjellevold Institute of Marine Research (IMR), Bergen, Norway
Elin Evensen Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
Margaret Rayman Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
Solrunn Hansen Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

DOI: https://doi.org/10.29219/fnr.v69.10802

Keywords: iodine status, iodine intake, pregnancy, women, nutrition

Abstract

Background: Iodine is crucial for thyroid hormones, normal metabolism, growth and development in the foetal period. Low iodine status in women of childbearing age is particularly worrying since iodine deficiency continues into pregnancy.

Objective: This study aimed to measure iodine status in non-pregnant and pregnant women in Northern Norway and investigate group differences and determinants of urine iodine concentrations (UICs) based on dietary factors and participants’ knowledge about iodine.

Methods: This cross-sectional study included pregnant (n = 131) and non-pregnant (n = 493) women from the Northern Norway Mother-and-Child Contaminant Cohort Study 2 study (2017–2021) and the Fit Futures 3 study (2020–2021). UIC was measured in spot urine, and dietary iodine intake was calculated from food frequency questionnaires. Group differences in median UIC were explored using non-parametric tests. Associations between independent variables and median UIC were estimated through quantile regression, adjusting for relevant covariates.

Results: Median UIC was 91 μg/L in non-pregnant and 134 μg/L in pregnant women, thus below the World Health Organization definition of insufficient iodine status of < 100 μg/L and 150 μg/L, respectively. Dairy products and lean fish were the most important dietary iodine sources, but the median estimated intake did not reach the recommended intake. Taking iodine supplements was the strongest determinant of UIC in both groups (P < 0.01), and users had adequate iodine status at a group level. A high proportion of the non-pregnant women (84%) were not taking iodine supplements. Poor knowledge about iodine in the participant groups was observed but was not associated with UIC.

Conclusion: Pregnant and non-pregnant women not using iodine supplements had inadequate iodine status and insufficient iodine intake. Supplement use or interventions at the societal level are essential to ensure adequate status in these vulnerable groups.

Downloads

Download data is not yet available.

References

1.
Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr 2016; 104 (Suppl 3): 918s–23s. doi: 10.3945/ajcn.115.110429

2.
Zimmermann MB, Gizak M, Abbott K, Andersson M, Lazarus JH. Iodine deficiency in pregnant women in Europe. Lancet Diabetes Endocrinol 2015; 3(9): 672–4. doi: 10.1016/S2213-8587(15)00263-6

3.
World Health Organization, United Nations Children’s Fund, International Council for Control of Iodine Deficiency Disorders. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. Geneva: World Health Organization; 2007. Available from: https://www.who.int/publications/i/item/9789241595827 [cited 28 May 2024].

4.
Toloza FJK, Motahari H, Maraka S. Consequences of severe iodine deficiency in pregnancy: evidence in humans. Front Endocrinol (Lausanne) 2020; 11: 409. doi: 10.3389/fendo.2020.00409

5.
Markhus MW, Dahl L, Moe V, Abel MH, Brantsæter AL, Øyen J, et al. Maternal iodine status is associated with offspring lan-guage skills in infancy and toddlerhood. Nutrients 2018; 10: 9. doi: 10.3390/nu10091270

6.
WHO/UNICEF. Reaching optimal iodine nutrition in pregnant and lactating women and young children. Joint Statement of the World Health Organization and the United Nations Children’s Fund. Geneva: World Health Organization; 2007. Available from: https://www.who.int/publications/m/item/WHO-statement-IDD-pregnantwomen-children [cited 28 May 2024].

7.
Patriota ESO, Lima ICC, Nilson EAF, Franceschini SCC, Gonçalves VSS, Pizato N. Prevalence of insufficient iodine intake in pregnancy worldwide: a systematic review and meta-analysis. Eur J Clin Nutr 2022; 76(5): 703–15. doi: 10.1038/s41430-021-01006-0

8.
Brantsæter A, Abel M, Haugen M, Meltzer H. Risk of suboptimal iodine intake in pregnant Norwegian women. Nutrients 2013; 5(2): 424–40. doi: 10.3390/nu5020424

9.
Meltzer HM, Torheim LE, Brantsæter AL, Madar A, Abel MH, Dahl L. Risiko for jodmangel i Norge – identifisering av et akutt behov for tiltak. Oslo: Nasjonalt råd for ernæring; 2016. Available from: http://www.ernaeringsradet.no/wp-content/ [cited 28 May 2024].

10.
Berg V, Nøst TH, Skeie G, Thomassen Y, Berlinger B, Veyhe AS, et al. Thyroid homeostasis in mother-child pairs in relation to maternal iodine status: the MISA study. Eur J Clin Nutr 2017; 71(8): 1002–7. doi: 10.1038/ejcn.2017.83

11.
Dahl L, Wik Markhus M, Sanchez PVR, Moe V, Smith L, Meltzer HM, et al. Iodine deficiency in a study population of Norwegian pregnant women – results from the Little in Norway Study (LiN). Nutrients 2018; 10(4): 513. doi: 10.3390/nu10040513

12.
Henjum S, Brantsaeter AL, Kurniasari A, Dahl L, Aadland EK, Gjengedal ELF, et al. Suboptimal iodine status and low iodine knowledge in young Norwegian women. Nutrients 2018; 10: 7. doi: 10.3390/nu10070941

13.
Næss S, Markhus MW, Strand TA, Kjellevold M, Dahl L, Stokland AM, et al. Iodine nutrition and iodine supplement initiation in association with thyroid function in mildly-to-moderately iodine-deficient pregnant and postpartum women. J Nutr 2021; 151(10): 3187–96. doi: 10.1093/jn/nxab224

14.
Medin AC, Carlsen MH, Andersen LF. Iodine intake among children and adolescents in Norway: estimates from the national dietary survey Ungkost 3 (2015–2016). J Trace Elem Med Biol 2020; 58: 126427. doi: 10.1016/j.jtemb.2019.126427

15.
Brantsæter A, Knutsen H, Johansen N, Nyheim K, Erlund I, Meltzer H, et al. Inadequate iodine intake in population groups defined by age, life stage and vegetarian dietary practice in a Norwegian convenience sample. Nutrients 2018; 10(2): 230. doi: 10.3390/nu10020230

16.
Mullan K, Hamill L, Doolan K, Young I, Smyth P, Flynn A, et al. Iodine status of teenage girls on the island of Ireland. Eur J Nutr 2020; 59(5): 1859–67. doi: 10.1007/s00394-019-02037-x

17.
Watutantrige Fernando S, Cavedon E, Nacamulli D, Pozza D, Ermolao A, Zaccaria M, et al. Iodine status from childhood to adulthood in females living in North-East Italy: iodine deficiency is still an issue. Eur J Nutr 2016; 55(1): 335–40. doi: 10.1007/s00394-015-0853-x

18.
Lampropoulou M, Lean MEJ, Combet E. Iodine status of women of childbearing age in Scotland. Proc Nutr Soc 2012; 71(OCE2): E143. doi: 10.1017/S0029665112002005

19.
Garnweidner-Holme L, Aakre I, Lilleengen A, Brantsæter A, Henjum S. Knowledge about Iodine in pregnant and lactating women in the Oslo area, Norway. Nutrients 2017; 9(5): 493. doi: 10.3390/nu9050493

20.
Kayes L, Mullan KR, Woodside JV. A review of current knowledge about the importance of iodine among women of child-bearing age and healthcare professionals. J Nutr Sci 2022; 11: e56. doi: 10.1017/jns.2022.50

21.
Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev 2012; 70(10): 553–70. doi: 10.1111/j.1753-4887.2012.00528.x

22.
Gunnarsdóttir I, Brantsæter AL. Iodine: a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67: 10369. doi: 10.29219/fnr.v67.10369

23.
Norwegian Directorate of Health. [Helsedirektoratet] Utviklingen i norsk kosthold 2022. Oslo; 2023. Available from: https://www.helsedirektoratet.no/rapporter/utviklingen-i-norsk-kosthold/Utviklingen%20i%20norsk%20kosthold%202022%20-%20Kortversjon.pdf/_/attachment/inline/b8079b0a-fefe-4627-8e96-bd979c061555:e22da8590506739c4d215cfdd628cfaaa3b2dbc8/Utviklingen%20i%20norsk%20kosthold%202022%20-%20Kortversjon.pdf [cited 28 May 2024].

24.
Veyhe AS, Hansen S, Sandanger TM, Nieboer E, Odland JØ. The Northern Norway mother-and-child contaminant cohort study: implementation, population characteristics and summary of dietary findings. Int J Circumpolar Health 2012; 71(1): 18644. doi: 10.3402/ijch.v71i0.18644

25.
Fit Futures 3. UiT The Arctic University of Norway. Available from: https://uit.no/research/fitfutures_en [cited 28 May 2024].

26.
Hjartåker A, Andersen LF, Lund E. Comparison of diet measures from a food-frequency questionnaire with measures from repeated 24-hour dietary recalls. The Norwegian Women and Cancer Study. Public Health Nutr 2007; 10(10): 1094–103. doi: 10.1017/S1368980007702872

27.
Dalane J, Bergvatn T, Kielland E, Carlsen M. Mål, vekt og porsjonsstørrelser for matvarer. IS-2286. Oslo: Mattilsynet, Universitetet i Oslo og Helsedirektoratet; 2015.

28.
The Norwegian Food Safety Authority. The Norwegian Food Composition Table. Available from: https://www.matvaretabellen.no/ [cited 28 May 2024].

29.
Henjum S, Aakre I, Lilleengen AM, Garnweidner-Holme L, Borthne S, Pajalic Z, et al. Suboptimal iodine status among pregnant women in the Oslo area, Norway. Nutrients 2018; 10: 3. doi: 10.3390/nu10030280

30.
Lucas C, Charlton KE, Yeatman H. Nutrition advice during pregnancy: do women receive it and can health professionals provide it? Matern Child Health J 2014; 18(10): 2465–78. doi: 10.1007/s10995-014-1485-0

31.
Combet E, Bouga M, Pan B, Lean MEJ, Christopher CO. Iodine and pregnancy – a UK cross-sectional survey of dietary intake, knowledge and awareness. Br J Nutr 2015; 114(1): 108–17. doi: 10.1017/S0007114515001464

32.
Johnsen M, Braaten T, Skeie G, Laholt H, Hansen S. Midwives and public health nurses’ knowledge and clinical practice in securing sufficient iodine status in relation to pregnancy: a cross-sectional study. Nurs Open 2023; 10(7): 4321–35. doi: 10.1002/nop2.1675

33.
Ohira S, Kirk AB, Dyke JV, Dasgupta PK. Creatinine adjustment of spot urine samples and 24 h excretion of iodine, selenium, perchlorate, and thiocyanate. Environ Sci Technol 2008; 42(24): 9419–23. doi: 10.1021/es8020952

34.
Laboratory manual – creatinine in urine [Labratoriehåndbok – kreatinin i urin]. Labratoriemedisin ved UNN Tromsø 2017. Available from: https://labhandbok.unn.no/medisinsk-biokjemi/kreatinin-i-urin-article1921-816.html [cited 28 May 2024].

35.
Aarsland TE, Kaldenbach S, Bakken KS, Solvik BS, Holten-Andersen M, Strand TA. Inadequate iodine intake in mothers of young children in Innlandet County, Norway. Curr Dev Nutr 2023; 7(3): 100047. doi: 10.1016/j.cdnut.2023.100047

36.
Ma ZF, Venn BJ, Manning PJ, Cameron CM, Skeaff SA. Iodine supplementation of mildly iodine-deficient adults lowers thyroglobulin: a randomized controlled trial. J Clin Endocrinol Metab 2016; 101(4): 1737–44. doi: 10.1210/jc.2015-3591

37.
Zimmermann MB, Hess SY, Adou P, Toresanni T, Wegmüller R, Hurrell RF. Thyroid size and goiter prevalence after introduction of iodized salt: a 5-y prospective study in schoolchildren in Côte d’Ivoire. Am J Clin Nutr 2003; 77(3): 663–7. doi: 10.1093/ajcn/77.3.663

38.
Abel MH, Caspersen IH, Sengpiel V, Jacobsson B, Meltzer HM, Magnus P, et al. Insufficient maternal iodine intake is associated with subfecundity, reduced foetal growth, and adverse pregnancy outcomes in the Norwegian Mother, Father and Child Cohort Study. BMC Med 2020; 18(1): 211. doi: 10.1186/s12916-020-01676-w

39.
Miles EA, Vahlberg T, Calder PC, Houttu N, Pajunen L, Koivuniemi E, et al. Iodine status in pregnant women and infants in Finland. Eur J Nutr 2022; 61(6): 2919–27. doi: 10.1007/s00394-022-02852-9

40.
Adalsteinsdottir S, Tryggvadottir EA, Hrolfsdottir L, Halldorsson TI, Birgisdottir BE, Hreidarsdottir IT, et al. Insufficient iodine status in pregnant women as a consequence of dietary changes. Food Nutr Res 2020; 64: 1–8. doi: 10.29219/fnr.v64.3653

41.
Norwegian Directorate of Health [Helsedirektoratet]. The Norwegian dietary guidelines. Oslo; 2014. Available from: https://www.helsenorge.no/kosthold-og-ernaring/kostrad/helsedirektoratets-kostrad/ [cited 28 May 2024].

42.
Markhus MW, Hysing M, Midtbø LK, Nerhus I, Næss S, Aakre I, et al. Effects of two weekly servings of cod for 16 weeks in pregnancy on maternal iodine status and infant neurodevelopment: mommy’s food, a randomized-controlled trial. Thyroid 2021; 31(2): 288–98. doi: 10.1089/thy.2020.0115

43.
Hussain H, Selamat R, Kuay LK, Zain FM, Jalaludin MY. Urinary iodine: biomarker for population iodine nutrition. In: Bobbarala V, Zaman G, Mohd Desa M.N., Md Akim A, editors. Biochemical testing – clinical correlation and diagnosis. Intech Open; 2019; p. 1–16.

44.
Fagerli RA, Nordbotten A, Borgejordet Å, Vesterhus KN, Løken EB, Trygg K, et al. Norwegian national food composition table. Oslo: Mattilsynet; 2008. Available from: https://www.matvaretabellen.no/en/ [cited 28 May 2024].

45.
Norwegian Directorate of Health. [Helsedirektoratet]. Referanseverdier for energi og næringsssoffer. Oslo; 2023. Available from: https://www.helsedirektoratet.no/rapporter/referanseverdier-for-energi-og-naeringsstoffer [cited 28 May 2024].

46.
Abel MH, Caspersen IH, Meltzer HM, Haugen M, Brandlistuen RE, Aase H, et al. Suboptimal maternal iodine intake is associated with impaired child neurodevelopment at 3 years of age in the Norwegian Mother and Child Cohort Study. J Nutr 2017; 147(7): 1314–24. doi: 10.3945/jn.117.250456

47.
Abel MH, Korevaar TIM, Erlund I, Villanger GD, Caspersen IH, Arohonka P, et al. Iodine intake is associated with thyroid function in mild to moderately iodine deficient pregnant women. Thyroid 2018; 28(10): 1359–71. doi: 10.1089/thy.2018.0305

48.
Moleti M, Di Bella B, Giorgianni G, Mancuso A, De Vivo A, Alibrandi A, et al. Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: an observational study. Clin Endocrinol (Oxf) 2011; 74(6): 762–8. doi: 10.1111/j.1365-2265.2011.04007.x

49.
Rebagliato M, Murcia M, Alvarez-Pedrerol M, Espada M, Fernández-Somoano A, Lertxundi N, et al. Iodine supplementation during pregnancy and infant neuropsychological development. INMA Mother and Child Cohort Study. Am J Epidemiol 2013; 177(9): 944–53. doi: 10.1093/aje/kws333

50.
Norwegian Directorate of Health. [Helsedirektoratet]. Nasjonal faglig retningslinje for svangerskapsomsorgen. Oslo; 2018. Available from: https://www.helsedirektoratet.no/retningslinjer/svangerskapsomsorgen [cited 28 May 2024].

51.
Bouga M, Lean MEJ, Combet E. Iodine and pregnancy – a qualitative study focusing on dietary guidance and information. Nutrients 2018; 10(4): 408. doi: 10.3390/nu10040408

52.
Henjum S, Groufh-Jacobsen S, Aakre I, Terragni L. Life-course perspectives of milk consumption among young Norwegian women and their knowledge of milk as a source of iodine: a qual-itative study. Food Nutr Res 2021; 65: 7758. doi: 10.29219/fnr.v65.7758

53.
Norwegian Directorate of Health [Helsedirektoratet]. Anbefaling om beriking med jod for å sikre et tilstrekkelig jodinntak i befolkningen. Oslo; 2021. Available from: https://www.helsedirektoratet.no/om-oss/rad-og-utvalg/nasjonalt-rad-for-ernaering/Anbefaling%20om%20beriking%20med%20jod%20for%20%C3%A5%20sikre%20et%20tilstrekkelig%20jodinntak%20i%20befolkningen,%20Nasjonalt%20r%C3%A5d%20for%20ern%C3%A6ring,%20februar%202021.pdf/_/attachment/inline/bae79a56-041d-4ccf-8b29-eb75b7e69d05:667ba7fee811d9232d4bea9634744de99190b543/Anbefaling%20om%20beriking%20med%20jod%20for%20%C3%A5%20sikre%20et%20tilstrekkelig%20jodinntak%20i%20befolkningen,%20Nasjonalt%20r%C3%A5d%20for%20ern%C3%A6ring,%20februar%202021.pdf [cited 28 May 2024].

Inadequate iodine status among women of childbearing age in Northern Norway: a cross-sectional study

Abstract

Downloads

References

Most read articles by the same author(s)