After 15 years of promoting the use of iodized salt, Italy is 'iodo-sufficient', with a strong reduction in the risks linked to nutritional iodine deficiency, first of all goiter and its evolution into nodular goiter. Some critical issues, however, still remain for iodine nutrition during pregnancy. It was also possible to confirm that the national iodoprophylaxis program is safe. These are the conclusions of a study coordinated by the National Observatory for the monitoring of iodoprophylaxis in Italy (Osnami) of the Higher Institute of Health, just published by the 'Journal of Clinical Endocrinology & Metabolism'.
The study was conducted between 2015 and 2019 on a national scale in collaboration with the Passi surveillance system, again coordinated by the ISS, the regional observatories for the prevention of goiter, the regional neonatal screening laboratories and the medicines observatory ( Osmed) of AIFA: the consumption of iodized salt – explains the ISS – was evaluated on a sample of approximately 165 thousand adults and 1,000 school canteens, while the concentration of iodine was examined on over 4,300 children between 11 and 13 years old in urine, the prevalence of goiter and thyroid nodules and also the presence of thyroid autoimmunity. On approximately 200 thousand newborns, the quantity of the thyroid hormone Tsh was evaluated, a marker used for screening congenital hypothyroidism and useful for evaluating iodine intake during pregnancy, while cases of hyperthyroidism were estimated indirectly on the basis of prescriptions of methimazole, a drug that is used to treat this problem.
Well, despite the progressive reduction in salt consumption, Italy was found to be 'iodo-sufficient', with a prevalence of use of iodized salt of 71.5% in adults and 78% in school canteens. Consumption is higher in the North, in women and in people with a higher socioeconomic status. The prevalence of goiter in school age was 2.2%, much lower than the threshold of 5%, above which this pathology is defined as endemic. The presence of thyroid nodules in the infant population was also low, around 2%. The percentage of newborns with a Tsh value higher than 5 microunits per liter was 5.1%, a significantly lower value than in the past, but still higher than the limit of 3% considered sufficient by the WHO.
The use of iodized salt was found to be safe – highlights the ISS – with a low frequency of thyroid autoimmunity in school age and hyperthyroidism in the entire population.
“The data suggest that fifteen years of promoting the use of iodized salt have significantly improved iodine nutrition in the population, leading to a lower frequency of pathologies related to nutritional iodine deficiency and demonstrating that the iodoprophylaxis program in our country is safe – comments Antonella Olivieri, scientific director of Osnami -. There remains some concern about iodine nutrition during pregnancy, a period of life in which the need for iodine is increased to satisfy fetal needs”.
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