Медицинская литература. Новинки

 

 

 

 

 

 

Рекомендации по мониторингу программ йодирования соли и оценке статуса йодной обеспеченности населения (русскоязычная версия)

Вы можете загрузить полный текст статьи в формате pdf

За последние два десятилетия был достигнут значительный прогресс в устранении нарушений, связанных с дефицитом йода (ЙД). В то же время были получены важные уроки, как лучше отслеживать и совершенствовать программы йодирования соли. Настоящая статья подготовлена на основе руководства “Guidance of the monitoring of salt iodization programmes and determination of population iodine status” и дает рекомендации о том, как следует избегать распространенных ошибок, возможных при интерпретации данных в процессе осуществления мониторинга национальных программ борьбы с ЙД. Так, адекватность потребления йода следует оценивать среди разных сегментов населения (не только школьников), особенно среди групп, наиболее уязвимых к дефициту йода (беременные женщины). Диапазон показателей медианной концентрации йода в моче (мКЙМ), свидетельствующий об адекватном потреблении йода детьми школьного возраста, был увеличен с 100-199 до 100-299 мкг/л, устраняя ранее существовавший диапазон 200-299 мкг/л (“более чем адекватное потребление йода”). Интерпретация мКЙМ ? 300 мкг/л как “чрезмерное потребление йода” осталась неизменной. мКЙМ может использоваться только для определения статуса обеспеченности населения йодом на популяционном уровне, но не для количественной оценки доли населения с дефицитом или избытком йода. Национальные программы йодирования соли должны контролировать использование йодированной соли в промышленно переработанных пищевых продуктах. Если соль, содержащаяся в таких продуктах, адекватно йодирована, то она может быть важным источником йода в питании и обеспечивать достаточное его поступление даже в условиях, когда использование йодированной соли в домашних хозяйствах невелико.

Ключевые слова:
йодный дефицит, профилактика, мониторинг, йодированная соль, пищевые продукты, беременность, школьники, зоб, iodine deficiency, prevention, monitoring, iodized salt, processed foods, pregnancy, school-aged children, goiter

Литература:
1.Iodine Global Network. Global Scorecard of Iodine Nutrition 2017. Zurich: IGN; 2017.
2.UNICEF. Meeting Report. Technical Working Group Meeting on Research Priorities for the Monitoring of Salt Iodization Programs and Determination of Population Iodine Status 17-18 December 2015. New York: UNICEF; 2016.
3.UNICEF. Guidance of the monitoring of salt iodization programmes and determination of population iodine status [Internet]. UNICEF; 2018 [cited 2018 Jun 20]. Avaliable from: https://www.unicef.org/nutrition/files/Monitoring-of-Salt-Iodization.pdf.
4.World Health Organization. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. Geneva: WHO; 2007.
5.World Health Organization. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. Geneva: WHO; 2014.
6.Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38(3):791-813. doi: 10.1093/ije/dyp139.
7.Spohrer R, Garrett GS, Timmer A, et al. Processed foods as an integral part of universal salt iodization programs: a review of global experience and analyses of Bangladesh and Pakistan. Food Nutr Bull. 2012;33(4 Suppl):S272-280. doi: 10.1177/15648265120334S303.
8.Spohrer R, Larson M, Maurin C, et al. The growing importance of staple foods and condiments used as ingredients in the food industry and implications for large-scale food fortification programs in Southeast Asia. Food Nutr Bull. 2013;34(2 Suppl):S50-61. doi: 10.1177/15648265130342S107.
9.Gorstein J, van der Haar F, Codling K, et al. Performance of rapid test kits to assess household coverage of iodized salt. Public Health Nutr. 2016;19(15):2712-2724. doi: 10.1017/S1368980016000938.
10.Jooste PL, Strydom E. Methods for determination of iodine in urine and salt. Best Pract Res Clin Endocrinol Metab. 2010;24(1): 77-88. doi: 10.1016/j.beem.2009.08.006.
11.Pandav CS, Arora NK, Krishnan A, et al. Validation of spot-testing kits to determine iodine content in salt. Bull World Health Organ. 2000;78(8):975-980.
12.Rohner F, Kangambega MO, Khan N, et al. Comparative validation of five quantitative rapid test kits for the analysis of salt iodine content: laboratory performance, user- and field-friendliness. PLoS One. 2015;10(9):e0138530. doi: 10.1371/journal.pone.0138530.
13.Zimmermann MB, Aeberli I, Andersson M, et al. Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100-299 mug/L: a UNICEF/ICCIDD study group report. J Clin Endocrinol Metab. 2013;98(3):1271-1280. doi: 10.1210/jc.2012-3952.
14.Knowles J, van der Haar F, Shehata M, et al. Iodine intake through processed food: case studies from Egypt, Indonesia, the Philippines, the Russian Federation and Ukraine, 2010-2015. Nutrients. 2017;9(8). doi: 10.3390/nu9080797.
15.Abizari AR, Dold S, Kupka R, Zimmermann MB. More than two-thirds of dietary iodine in children in northern Ghana is obtained from bouillon cubes containing iodized salt. Public Health Nutr. 2017;20(6):1107-1113. doi: 10.1017/S1368980016003098.
16.Gorstein J, Sullivan KM, Parvanta I, Begin F. Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations. Ottawa: The Micronutrient Initiative, Atlanta: The Centers for Disease Control and Prevention; 2007.
17.Wong EM, Sullivan KM, Perrine CG, et al. Comparison of median urinary iodine concentration as an indicator of iodine status among pregnant women, school-age children, and nonpregnant women. Food Nutr Bull. 2011;32(3):206-212. doi: 10.1177/156482651103200304.
18.Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev. 2012;70(10): 553-570. doi: 10.1111/j.1753-4887.2012.00528.x.
19.Sullivan KM, May S, Maberly G. Urinary Iodine Assessment: A Manual on Survey and Laboratory Methods. Atlanta: PAMM; 2000.
20.Dold S, Zimmermann MB, Jukic T, et al. Universal salt iodization provides sufficient dietary iodine to achieve adequate iodine nutrition during the first 1000 days: a cross-sectional multicenter study. J Nutr. 2018;148(4):587-598. doi: 10.1093/jn/nxy015.
21.Karmisholt J, Laurberg P, Andersen S. Recommended number of participants in iodine nutrition studies is similar before and after an iodine fortification programme. Eur J Nutr. 2014;53(2):487-492. doi: 10.1007/s00394-013-0551-5.
22.Gorstein J. Goiter assessment: help or hindrance in tracking progress in iodine deficiency disorders control program? Thyroid. 2001;11(12):1201-1202. doi: 10.1089/10507250152741082.
23.Cogswell ME, Wang CY, Chen TC, et al. Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18-39 y. Am J Clin Nutr. 2013;98(6):1502-1513. doi: 10.3945/ajcn.113.059436.
24.Zimmermann MB, Hussein I, Al Ghannami S, et al. Estimation of the prevalence of inadequate and excessive iodine intakes in school-age children from the adjusted distribution of urinary iodine concentrations from population surveys. J Nutr. 2016;146(6): 1204-1211. doi: 10.3945/jn.115.229005.

Guidance on the monitoring of salt iodization programmes and determination of population iodine status: Russian language version

Over the last two decades, there has been remarkable progress towards eliminating iodine deficiency (ID). While there has been remarkable success, there have been several notable changes in the way that salt iodization programs have been designed and monitored, as well as the general landscape in which salt iodization is being implemented. This article is based on the “Guidance on the monitoring of salt iodization programmes and determination of population iodine status”. It summarizes important lessons learned on how to better track the performance of and refine salt iodization programs. The adequacy of iodine intakes should be examined among different subsets of the population (not only school-aged children), especially among groups vulnerable to deficiency (such as pregnant women). The acceptable range of ‘adequate’ iodine intake among school-age children can be widened from 100-199 µg/L to 100-299 µg/L eliminating the range of 200-299 µg/L that previously indicates ‘more than adequate’ iodine intake. The interpretation of mUIC of ? 300 µg/L as ‘excessive iodine intake’ remains unchanged. With currently available methods, the mUIC can only be used to define population iodine status and not to quantify the proportion of the population with iodine deficiency or iodine excess. National salt iodization programmes should monitor the use of iodized salt in processed foods. If the salt contained in such foods is well iodized, it can be an important source of iodine and may help explain iodine sufficiency in settings where household iodized salt coverage is low.

Keywords:
йодный дефицит, профилактика, мониторинг, йодированная соль, пищевые продукты, беременность, школьники, зоб, iodine deficiency, prevention, monitoring, iodized salt, processed foods, pregnancy, school-aged children, goiter