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Iodine Intake and Prevalence of Thyroid Autoimmunity And European Journal of Endocrinology (2012) 167 387–392 ISSN 0804-4643 CLINICAL STUDY Iodine intake and prevalence of thyroid autoimmunity and autoimmune thyroiditis in children and adolescents aged between 1 and 16 years Emilio Garcı´a-Garcı´a, Marı´a A´ ngeles Va´zquez-Lo´pez, Eduardo Garcı´a-Fuentes1, Firma Isabel Rodrı´guez-Sa´nchez2, Francisco Javier Mun˜oz2, Antonio Bonillo-Perales and Federico Soriguer1 Hospital Torreca´rdenas, Unidad de Pediatrı´a, Paraje Torreca´rdenas, s/n, E-04009 Almerı´a, Spain, 1Hospital Carlos Haya, Unidad de Endocrinologı´a y Nutricio´n, Ma´laga, Spain and 2Hospital Torreca´rdenas, Unidad de Biotecnologı´a, Almerı´a, Spain (Correspondence should be addressed to E Garcı´a-Garcı´a; Email: [email protected]) Abstract Objectives: To determine the status of iodine nutrition in children and adolescents in Almerı´a, Spain. To calculate prevalence of thyroid autoimmunity (TA) and autoimmune thyroiditis (AT) in pediatric ages and to research into associated factors. Methods: Cross-sectional epidemiological study. By a multistage probability sampling 1387 children and adolescents aged between 1 and 16 were selected. Physical examination was carried out including neck palpation. Parents were asked about eating habits as well as about social and demographic aspects. Urinary iodine, free thyroxine, TSH, antiperoxidase and antithyroglobulin antibodies were measured. TA was diagnosed when any antibody was positive and AT when autoimmunity was associated with impaired thyroid function or goitre. Results are shown using percentages (and its 95% confidence interval). To study associated factors we used multiple logistic regression, quantifying the relation with odds ratio (OR), and multiple lineal regression. Results: Median urinary iodine concentration was 199.5 mg/l. The prevalences of TA and AT were 3.7% (2.4–5.0) and 1.4% (0.4–2.4). TA is associated with female sex (OR 2.78; P!0.001) and age (OR 1.30; P!0.001). Iodine status is associated with the intake of milk and dairy product (P!0.001) and vegetable (PZ0.021) but not with use of iodized salt at home (PZ0.1). Conclusions: The iodine supply in children and adolescents in our city is optimal. Milk and dairy products are the most important iodine sources. TA and AT are prevalent in pediatric ages in our city mainly in females and older subjects. European Journal of Endocrinology 167 387–392 Introduction exponentially decades after supplying iodine in pre- viously deficient areas (8, 9) and also that areas with Iodine deficit causes high morbidity in pediatric ages good iodine supply present prevalences between three producing psychomotor and growth retardation, goitre and five times higher than those found in deficient areas and hypothyroidism. To optimize this trace element of the same region (10, 11). remains a medical challenge (1). Iodine sufficiency in No study has estimated the prevalence of auto- turn increases the possibilities of suffering from an immune thyroid disorders in children and adolescents autoimmune thyroid disease (2, 3, 4). living in Spain. Our study aims to describe iodine intake Autoimmune thyroiditis (AT) is a destruction of the among children and adolescents in our city, to calculate thyroid gland mediated by lymphocytes and cytokines. the prevalence of thyroid autoimmunity (TA) and AT in Its aetiology shows the importance of predisposing pediatric ages and to analyze the variables associated genetic factors as proved by the fact that a third of cases with iodine status and with the presence of auto- had a family history of autoimmune thyroid diseases immune thyroid disease. and also by the finding of genes that predispose the subjects to them (5, 6). However, the onset of the disease must be triggered by environmental factors, especially Materials and methods iodine supply (2, 3, 4). The iodination of thyroglobulin (TG) stimulates the production of antibodies and the We conducted an observational cross-sectional epide- proliferation of lymphocytes, which are its pathogenic miological study on a population sample. The study was bases (7). We know that the prevalence of AT increases focused on the city of Almerı´a and the subjects were q 2012 European Society of Endocrinology DOI: 10.1530/EJE-12-0267 Online version via www.eje-online.org Downloaded from Bioscientifica.com at 09/25/2021 06:48:38PM via free access 388 E Garcı´a-Garcı´a and others EUROPEAN JOURNAL OF ENDOCRINOLOGY (2012) 167 residents aged between 1 and 16. Almerı´a is a city on Samples of total blood and a urine specimen were the Spanish south coast comprising w180 000 collected. Serum free thyroxine (normal range 0.9– inhabitants. 1.7 ng/dl), serum TSH (normal range 0.2–4.2 mU/l), Accessible population was obtained from two sources: antiperoxidase antibodies (TPO ab) (normal value the Medical District and the Education Office. Data from !34 U/ml) and anti-TG antibodies (TG ab; normal children aged from 1 to 4 were obtained from the list value !115 U/ml) were assayed by electrochemilumi- given by the Medical District of Almerı´a in which all nescence immunoanalysis (Roche Diagnostics). children living in the city are registered for screening for Urinary excretion of iodine was assayed by Benotti hypothyroidism and phenylketonuria. It virtually method (13) in a sample of urine and expressed as coincides with the target population. The district has micrograms of iodine per litre of urine. Epidemiologic nine community health centres; 5453 children con- criteria for assessing iodine nutrition based on stitute the cohort of children born between January median urinary iodine concentrations of school-age 2003 and December 2004. Subjects older than 4 children and adults are: iodine deficiency, !100 mg/l; correspond to the total number of students registered adequate iodine nutrition, 100–199 mg/l; above require- in November 2004 in the 44 state schools, 26 state- ments, 200–299 mg/l; and excessive, O300 mg/l (12). subsidised and private schools of Nursery (4–5 years old) and Primary (6–12 years old) education as well as in the 18 state schools and ten state-subsidised and Table 1 Characteristics of study participants. private schools of Secondary education (12–16 years old) in our city. A total of 17 934 children between 4 Percentage Mean and 12 years of age and 9823 aged between 12 and 16 Variable (95% CI) (95% CI) S.D. were eligible. Sex A multistage probabilistic sampling was carried out. Females 48.8 (46.2–51.4) The primary units were the community health centres of Males 51.2 (48.6–53.8) the Medical District and the schools of Nursery, Primary Age (years) 8.37 (8.13–8.61) 4.5 Pubertal status and Secondary education. We randomly selected four Prepubertal 63.6 (62.4–64.8) community health centres, six schools of Nursery and Pubertal 36.4 (35.4–37.4) Primary education (four state and two private) and six BMI (kg/m2) 18.7 (18.5–18.9) 3.9 schools of Secondary education (four state and two Ethnicity private). Afterwards, three groups of every academic Spanish 89.7 (88.1–91.3) Maghribian 4.4 (3.4–5.4) level were selected and all the students in the above- Latin American 4.4 (3.4–5.4) mentioned groups were asked to take part in the study. Other 1.5 (0.9–2.1) Assuming a TA prevalence of 10%, a 95% confidence Father’s employment situation interval and a precision of 3%, the minimum sampling Employed 87.7 (86.0–89.3) Unemployed/retired 12.3 (10.6–14.0) size needed was 359 individuals aged between 1 and 6, Mother’s employment situation 376 between 6 and 12, and 370 between 12 and 16. Employed 65.8 (63.3–68.3) We selected 550 individuals in each age group in case Unemployed/housewife 34.2 (31.7–36.7) any of them refused to take part in the study. Father’s education level No education 4.2 (3.1–5.3) Inclusion criteria were that the participants were Primary 43.0 (40.4–45.6) residents of Almerı´a and aged between 1 and 16 years. Higher 52.8 (50.2–55.4) Anybody suffering from any endocrine or systemic Mother’s education level disease was excluded. No education 3.1 (2.2–4.0) Anthropometric and physical examination data were Primary 40.0 (37.4–42.6) Higher 56.9 (54.3–59.5) obtained for each individual. We looked for signs of How often they consume pubertal development (testicular volume of at least 4 ml Fruit (per day) 0.82 (0.78–0.85) 0.58 in males and breast development in females) and presence Vegetables (per day) 0.73 (0.70–0.76) 0.44 of goitre according to the international criteria (12). Milk and dairy products 0.67 (0.65–0.69) 0.25 (l/day) Parents were questioned about the following socio- Meat (per week) 4.07 (3.95–4.20) 1.88 demographic variables: origin (Spanish or immigrant Fish (per week) 2.86 (2.76–2.95) 1.38 and if so of what origin); socio-economic and cultural: Eggs (per week) 2.36 (2.28–2.45) 1.28 employment situation (employed, unemployed, retired/ Pulses (per week) 2.89 (2.79–3.00) 1.53 Baked goods (per week) 2.19 (2.00–2.38) 2.80 disabled, housewife or student); education level Sweets (per week) 2.19 (1.93–2.44) 3.74 (no education, primary or vocational, secondary or Snacks (per week) 1.71 (1.52–1.89) 2.51 university); eating habits: frequency of fruit, vegetables, Type of oil consumed: 89.2 (87.6–90.8) milk and dairy products, meat, fish, eggs and legumes olive intake, and how often they eat unnecessary foods, such Type of salt consumed: 47.3 (46.4–48.2) iodized as baked goods, sweets and snacks; type of salt (iodated or not) and type of oil consumed at home.
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