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Background: Adequate iodine intake during pregnancy is essential for optimal maternal thyroid function and fetal neurodevelopment. Although universal salt iodization has been implemented in Turkey, pregnant women may remain vulnerable to iodine insufficiency. This study aimed to evaluate maternal thyroid function in relation to iodine status, and to comprehensively compare the diagnostic performance of spot urinary indices and creatinine-adjusted measures against measured 24 h urinary iodine excretion (24h-UIE) in pregnant women. Methods: A total of 227 pregnant women attending family health centers in Afyonkarahisar, Turkey, provided both spot urine samples and complete 24 h urine collections. Urinary iodine concentration (UIC), creatinine-corrected UIC (UIC/UCr), and 24h-UIE were measured. Thyroid function tests were interpreted using trimester-specific reference ranges. Correlations between urinary indices were assessed, and ROC analyses were performed using 24h-UIE as the operational reference. A structured questionnaire evaluated iodine-related dietary knowledge and salt-use practices. Results: The median spot UIC was 59.0 µg/L, indicating insufficient recent iodine intake at the population level. Based on 24h-UIE, 70% of participants had excretion levels below the Estimated Average Requirement (EAR) threshold (<144 µg/day). Spot UIC showed a weak correlation with 24h-UIE (rho = 0.270, p < 0.001), whereas UIC/UCr demonstrated a stronger correlation (rho = 0.491, p < 0.001). In ROC analyses, UIC/UCr yielded a significantly higher AUC than spot UIC (0.774 [95% CI: 0.707–0.841] vs. 0.670 [95% CI: 0.593–0.748]; DeLong p = 0.016). Overt hypothyroidism was not observed; subclinical hypothyroidism was present in 16.3% of participants. While no overall association was found between iodine indices and thyroid status, in the first trimester, those with subclinical hypothyroidism had higher 24h-UIE medians than euthyroid peers (134.2 vs. 100.3 µg/day, p = 0.037), although both groups remained below the EAR threshold. Knowledge regarding iodine-rich foods and iodized salt use was limited among the study population. Conclusions: Iodine insufficiency remains highly prevalent among pregnant women in this region despite salt iodization. While spot UIC alone showed limited agreement with 24h-UIE, creatinine-adjusted UIC may offer improved interpretability under conditions of variable urine dilution. Preserved thyroid function in the presence of iodine insufficiency highlights the silent nature of this condition during pregnancy. Strengthened pregnancy-specific iodine surveillance and targeted antenatal education are warranted.

Fortification of food-grade (edible) salt with iodine is recommended as a safe, cost-effective and sustainable strategy for the prevention of iodine-deficiency disorders. The present paper examines the legislative framework for salt iodization in Asian countries. We reviewed salt iodization legislation in thirty-six countries in Asia and the Pacific. We obtained copies of existing and draft legislation for salt iodization from UNICEF country offices and the WHO's Global Database of Implementation of Nutrition Actions. We compiled legislation details by country and report on commonalities and gaps using a standardized form. The association between type of legislation and availability of iodized salt in households was assessed. We identified twenty-one countries with existing salt iodization legislation, of which eighteen were mandatory. A further nine countries have draft legislation. The majority of countries with draft and existing legislation used a mandatory standard or technical regulation for iodized salt under their Food Act/Law. The remainder have developed a 'stand-alone' Law/Act. Available national surveys indicate that the proportion of households consuming adequately iodized salt was lowest in countries with no, draft or voluntary legislation, and highest in those where the legislation was based on mandatory regulations under Food Acts/Laws. Legislation for salt iodization, particularly mandatory legislation under the national food law, facilitates universal salt iodization. However, additional important factors for implementation of salt iodization and maintenance of achievements include the salt industry's structure and capacity to adequately fortify, and official commitment and capacity to enforce national legislation.

Although the Universal Salt Iodization (USI) program has been highly successful, it remains relevant due to the continued risk of Iodine Deficiency Disorders (IDDs) in vulnerable groups, such as children and pregnant women. This program empowers the relevant authority to continuously monitor iodine levels in iodized salt. Our study reports on the use of a Salt Iodate Micro-Method Reagent (SIMR) detection kit for this purpose. The kit was validated, with a linearity of 5.0–60.0 mg/Kg, at a detection limit of 6.8 mg/Kg, with excellent recovery ranging from 93.0 to 108.3%, whereas the repeatability, intermediate precision, and reproducibility achieved a mean coefficient of variation (CV) of 5.3%, 6.8%, and 5.9%, respectively. The stability of the reagents used in the kit was tested using freshly prepared iodine standard quality control (QC) samples of 20.0 mg/Kg and 40.0 mg/Kg, all of which were observed to be stable, within the range of the mean ± 2 × (standard deviation, SD), for 10 days. The suitability of the kit was proven when no difference was found in the mean results of 70 salt samples, using a paired t-test and the Bland–Altman plot, compared to the reference method, at a 95% confidence interval (CI). Thus, the SIMR detection kit is a highly feasible alternative method for iodine monitoring, with a fast analysis time, as well as being cost effective, and environmentally friendly.

Background and Objective: Globally iodine deficiency disorder (IDD) is a major preventable cause of cognitive impairment in new born. In developing countries, every year 38 million newborn develop cognitive impairment as a result of iodine deficiency. Iodine consumption by pregnant women is affected by many factors. Hence, we conducted this study to identify factors associated with IDD. To know the effects of different factors on use of iodized salt by pregnant women visiting antenatal outpatient department (OPD) at a public sector tertiary care hospital of Karachi. Methods: Pregnant women (n=360) visiting antenatal OPD at public sector tertiary care hospital of Karachi were interviewed using a structured questionnaire. Systematic random sampling method was employed. Data was collected from March 2017 to January 2018. Chi-square test was applied to identify factors associated with IDD. Results: Thirty one (31% ) of pregnant women were consuming iodized salt in their homes. The percentage of participants who heard about iodized salt for the first time was 24%. Twelve percent (12%) reported that price of iodized salt is more than that of normal salt. Ninety eight (98%) of pregnant women replied that they were not informed about the importance of iodine or iodine requirement during pregnancy by their doctor or health care provider. A statistically significant association was observed between educational status (p=0.001) and household income (p<0.001) with the use of iodized salt. Conclusion: Low education, low income of study participants are identified as factors related to limited consumption and incorrect practices related to the use of iodized salt. In order to address iodine deficiency, there is a need to not only sensitize the expectant mothers about the adverse outcome of maternal iodine deficiency for their unborn child but also to introduce an awareness program at the antenatal clinics by the Health Professional for the antenatal care seeking women. There is also an immense need of support from Government side as well to make strategies and policy changes at the national level to ensure the availability, accessibility and affordability of iodized salt. doi: https://doi.org/10.12669/pjms.38.3.4991 How to cite this:Shaikh F, Jafry SIA, Khan AA. Factors affecting the consumption of iodized salt by pregnant women in Karachi. Pak J Med Sci. 2022;38(3):577-582. doi: https://doi.org/10.12669/pjms.38.3.4991 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Potassium iodate and potassium iodide are commonly fortified in iodized table salt, which must be continuously monitored to maintain quality. Our study reported an optimized detection method for total iodine in iodized table salt using 0.5 M sodium bisulfite as the reducing agent. The iodized table salt (0.5 g) was dissolved in 0.5 M sodium bisulfite solution prior to injection in ultra-high-performance liquid chromatography (UHPLC) coupled with a diode array detector using a weak anion-exchange column (2.1 mm × 150 mm, 5 μm). Iodide was eluted at 9.92 ± 0.06 min (λ = 223 nm) when an isocratic mobile phase of 1:1 (v/v) methanol/120 mM phosphate buffer mixed with tetrasodium pyrophosphate (pH 3.0) was running at 0.20 mL/min (15 min). Iodide was detected as total iodine from 10.0 to 50.0 mg/kg with a limit of detection (LOD) of 1.2 mg/kg and a limit of quantification (LOQ) of 3.7 mg/kg. The method was validated with relative standard deviations (RSDs) of 4.2%, 0.4%, 1.6%, and 0.8% for accuracy, repeatability, intermediate precision, and robustness, respectively. The determination of total iodine was successful on six (6) samples (n = 3), which recovered 87.2–106.9% of iodate and iodide spike. Thus, this study provides a validated protocol for the determination of total iodine in iodized table salt using 0.5 M sodium bisulfite.

Background An abrupt increase of thyroid cancer has been witnessed paralleling the supplemented iodine intake in formerly iodine-deficient countries. And increased iodine intake has been linked to the rising incidence rate of papillary thyroid cancer (PTC). However, the correlation between iodine and clinicopathological features of PTC has not been well-characterized. This study aimed to investigate the associations between iodine intake and the clinicopathological features of PTC patients. Methods Three hundred and fifty-nine PTC patients who received surgical treatment in Peking Union Medical College Hospital from May 2015 to November 2020 were retrospectively reviewed. The associations between urinary iodine (UI), urinary iodine/creatinine ratio (UI/U-Cr), and the clinicopathological features of PTC were analyzed. Univariate and multivariate analysis were performed to investigate the relationship between UI level and central lymph node metastasis (CLNM). Results There were no significant differences in UI in different groups according to the variables studied, except that patients with CLNM had higher UI level than CLNM(−) patients. No associations were found between UI/U-Cr and clinicopathological features except variant subtypes (classic/follicular). After dividing patients into high-iodine group and low-iodine group, more patients were found to have CLNM in the high-iodine group (p = 0.02). In addition, younger age, larger tumor size, and classic variant were positively correlated with CLNM (p < 0.05). Univariate analysis showed that insufficient iodine intake (≤ 99 μg/L) was associated with decreased CLNM risk in PTC. And after defining insufficient iodine intake as ≤ 109 μg/L and above requirements as ≥ 190 μg/L, multivariate analysis showed that lower iodine was associated with CLNM in total population of PTC (OR 0.53, 95% CI 0.31–0.91) and in PTC < 1 cm (papillary thyroid microcarcinoma, PTMC) (OR 0.43, 95% CI 0.21–0.87). Conclusions Low iodine was a protective factor for CLNM in papillary thyroid cancer, particularly in those < 1 cm. These results indicated that iodine may not only be an initiator of tumorigenesis, but also a promoter of the development of PTC.

The main indicator adopted to track universal salt iodization has been the coverage of adequately iodized salt in households. Rapid test kits (RTK) have been included in household surveys to test the iodine content in salt. However, laboratory studies of their performance have concluded that RTK are reliable only to distinguish between the presence and absence of iodine in salt, but not to determine whether salt is adequately iodized. The aim of the current paper was to examine the performance of RTK under field conditions and to recommend their most appropriate use in household surveys. Standard performance characteristics of the ability of RTK to detect the iodine content in salt at 0 mg/kg (salt with no iodine), 5 mg/kg (salt with any added iodine) and 15 mg/kg ('adequately' iodized salt) were calculated. Our analysis employed the agreement rate (AR) as a preferred metric of RTK performance. Setting/Subjects Twenty-five data sets from eighteen population surveys which assessed household iodized salt by both the RTK and a quantitative method (i.e. titration or WYD Checker) were obtained from Asian (nineteen data sets), African (five) and European (one) countries. In detecting iodine in salt at 0 mg/kg, the RTK had an AR>90 % in eight of twenty-three surveys, while eight surveys had an AR90 %. The RTK is not suited for assessment of adequately iodized salt coverage. Quantitative assessment, such as by titration or WYD Checker, is necessary for estimates of adequately iodized salt coverage.

Background and Objectives: The prevalence of adult thyroid structural abnormalities has increased significantly worldwide. However, no study has examined the thyroid structure and urine iodine levels of adults in Heilongjiang Province in the last decade. Therefore, this study aims to investigate the rate and risk factors of thyroid structural abnormalities among the residents of this province. Methods and Study Design: A probability proportional sampling method was used, and a total of 3,645 individuals in Heilongjiang Province were included. The subjects was asked to complete a thyroid ultrasound and fill out a questionnaire. Furthermore, urine iodine levels and salt iodine content were determined, and multivariate logistic regression was used to identify the independent risk factors for thyroid diseases. Results: The prevalence of thyroid structural abnormalities in Heilongjiang Province was 56.0%. Univariate analysis showed that there were significant differences between the structural abnormalities group and the normal thyroid group in terms of sex, age, body mass index, hypertension, diabetes, smoking, alcohol consumption, frequency of seafood consumption and pickled food consumption, employment status, and urine iodine level (p<0.05). Multivariate analysis showed that the following were independent risk factors of thyroid disease: female, increased age, hypertension, diabetes, cigarette smoking frequent seafood consumption, employment, and urine iodine levels. Conclusions: The prevalence of thyroid structural abnormalities in adults in Heilongjiang Province was relatively high. Therefore, to help prevent the occurrence of thyroid disease in adults in Heilongjiang Province, the risk factors of thyroid structural abnormalities should be better understood.

We sought to assess the universal salt iodization (USI) strategy in Armenia by characterizing dietary iodine intake from naturally occurring iodine, salt-derived iodine in processed foods and salt-derived iodine in household-prepared foods. Using a cross-sectional cluster survey model, we collected urine samples which were analysed for iodine and sodium concentrations (UIC and UNaC) and household salt samples which were analysed for iodine concentration (SI). SI and UNaC data were used as explanatory variables in multiple linear regression analyses with UIC as dependent variable, and the regression parameters were used to estimate the iodine intake sources attributable to native iodine and iodine from salt in processed foods and household salt. Armenia is naturally iodine deficient; in 2004, the government mandated a USI strategy. We recruited school-age children (SAC), pregnant women (PW) and non-pregnant women of reproductive age (WRA). From thirteen sites covering all provinces, sufficient urine and table salt samples were obtained from 312 SAC, 311 PW and 332 WRA. Findings revealed significant differences between groups: contribution of native iodine ranged from 81% in PW to 46% in SAC, while household salt-derived iodine contributed from 19% in SAC to 1% in PW. Differences between groups may reflect differences in diet. In all groups, household and processed food salt constituted a significant part of total iodine intake, highlighting the success and importance of USI in ensuring iodine sufficiency. There appears to be leeway to reduce salt intake without adversely affecting the iodine status of the population in Armenia.

In the framework of a worldwide policy to eliminate iodine deficiency (ID) disorders, universal salt iodization was adopted in Tunisia two decades ago. The present study aims to evaluate this strategy, using both performance and impact indicators. A total of 1560 children, aged 6–12 years, were randomly sampled using a national, two-stage, stratified, cross-sectional cluster survey in 2012. Urinary iodine concentration (UIC) of the subjects, and household salt iodine content, were analyzed. The national median UIC was 220 µg/L (95% confidence interval (CI): 199–241), indicating an acceptable iodine status at the population level. Only 11.4% (95% CI: 8.6–14.9) of the children had UIC <100 µg/L, but with large regional disparities (4.3% to 25.5%, p < 0.01); however, more than a quarter of the subjects were at risk of adverse health consequences due to iodine excess. Children from households of low socio-economic levels were more prone to inadequate UIC. The national median iodine concentration of household salt was 22 mg/kg (95% CI: 21–23). Only half of the households used adequately iodized salt (15–25 ppm), with large regional disparities. National ID rates are now well below the target criteria of WHO (World Health Organization) certification (<20% of children with UIC <50 µg/L and <50% with UIC <100 µg/L). The coverage of adequately iodized salt fell short in meeting the goals of USI (Universal Salt Iodization), i.e., >90% of households. Regular monitoring of iodized salt production lines must be strengthened with involvement by producers.