| 1. |
- Eriksson, Janna, 1992, et al.
(författare)
-
The effects of iron and selenium in iodine containing multivitamins on thyroid related compounds during pregnancy in Sweden: a randomized placebo cotrolled trial
- 2017
-
Ingår i: 87th Annual Meeting of the American Thyroid Association. Thyroid, 27(S1), poster 71. - : Mary Ann Liebert Inc. - 1050-7256 .- 1557-9077.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Multivitamins with iodine are advocated to pregnant women to avoid iodine deficiency, as iodine may be beneficial for brain development in the child. Multivitamins also contain iron and selenium that may affect thyroid hormone metabolism. Iron is included in the tyreoperoxidase enzyme promoting the coupling of iodine to thyroglobulin (Tg) and selenium is incorporated in deiodinases that regulates levels of thyroxine (T4) and triiodothyronine (T3). There is no previous studies on the effects of iodine containing multivitamins on iron and selenium levels in pregnant women and the relation to thyroid hormone levels. This was a randomized, double-blinded controlled trial of 200 pregnant women, who were randomized to multivitamins containing 150 lg iodine, 12 mg iron and 50 lg selenium/day or multivitamins without iodine, iron and selenium in pregnancy week 7–12 until delivery, besides iron supplements on usual routines. Thyroid hormones, Tg, selenium (ref 0.7– 1.2 lmol/L) and iron measurements (ferritin (ref 15–150 mg/L), transferrin saturation (ref 0.1–0.5)) were collected in the third trimester. Urinary iodine concentration confirmed mild ID in the control group with a Tg increase. In the third trimester, 139 patients were left for sampling. In the active group (n = 67) median (interquartile range (IQR)) selenium levels were 0.72 (0.16) vs 0.61 (0.14) in the control group (n = 72), p < 0.001. Low selenium values were noted in 70.0% of participants and it was more common in the control group (81.9%), p < 0.001. Median (IQR) Tg levels was higher in those with low selenium 30.0 (30.5) than in those with normal selenium 20.5 (21.5), p = 0.037. Thyroid hormones did not differ between active/control groups or low/normal selenium groups, but FT3/FT4 ratio was higher in the low selenium group than in the normal selenium group (0.35 (0.08) vs 0.33 (0.08)), p= 0.025. Ferritin in the active group was 22.0 (21.0) and 20.0 (21.5) in the control group, p = 0.393 and transferrin saturation 0.20 (0.11) and 0.18 (0.18), p = 0.802, respectively. Multivitamins used during pregnancy to increase iodine levels also increase selenium levels where effects on thyroid metabolism needs further evaluation.
|
|
| 2. |
- Eriksson, Janna, 1992, et al.
(författare)
-
Urinary iodine excretion and optimal time point for sampling when estimating 24-h urinary iodine
- 2023
-
Ingår i: British Journal of Nutrition. - : Cambridge University Press (CUP). - 0007-1145 .- 1475-2662. ; 130:8, s. 1289-97
-
Tidskriftsartikel (refereegranskat)abstract
- Iodine deficiency may cause thyroid dysfunction. The iodine intake in a population is measured by urinary iodine concentration (UIC) in spot samples or 24-h urinary iodine excretion (24UIE). 24UIE is considered the gold standard and may be estimated using an equation including UIC, urinary creatinine concentration, sex and age (e24UIE). The aims of this study were to evaluate the preferable timing of UIC when using this equation and assess the variability of UIE. Sixty healthy non-smoking women (n 31) and men (n 29) were included in Gothenburg, Sweden. Twelve urine samples were collected at six fixed times on two separate days. Variability was calculated for UIC, 24UIE, e24UIE, iodine excretion per hour (iHr) and UIC adjusted for creatinine and specific gravity. Median 24UIE was 156 mu g/24 h and the median UIC (all spot samples) was 104 mu g/l. UIC (P < 0 center dot 001), 24UIE (P = 0 center dot 001) and e24UIE (P < 0 center dot 001) were significantly higher in men. e24UIE was relatively similar to 24UIE. However, when e24UIE was calculated from UIC in the first void, it was about 15 % lower than 24UIE (P < 0 center dot 001). iHr was lowest in the morning and highest in the afternoon. Median iHr was higher in men (7 center dot 4 v. 5 center dot 3 mu g/h, P < 0 center dot 001). The variability of UIE was higher within individuals than between individuals. This study suggests that most time points for estimation of individual 24UIE are appropriate, but they should preferably not be collected in the first void.
|
|
| 3. |
- Manousou, Sofia, 1979, et al.
(författare)
-
A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women.
- 2018
-
Ingår i: European journal of clinical nutrition. - : Springer Science and Business Media LLC. - 1476-5640 .- 0954-3007. ; 72:1, s. 124-129
-
Tidskriftsartikel (refereegranskat)abstract
- Different diets are used for weight loss. A Paleolithic-type diet (PD) has beneficial metabolic effects, but two of the largest iodine sources, table salt and dairy products, are excluded. The objectives of this study were to compare 24-h urinary iodine concentration (24-UIC) in subjects on PD with 24-UIC in subjects on a diet according to the Nordic Nutrition Recommendations (NNR) and to study if PD results in a higher risk of developing iodine deficiency (ID), than NNR diet.A 2-year prospective randomized trial in a tertiary referral center where healthy postmenopausal overweight or obese women were randomized to either PD (n=35) or NNR diet (n=35). Dietary iodine intake, 24-UIC, 24-h urinary iodine excretion (24-UIE), free thyroxin (FT4), free triiodothyronine (FT3) and thyrotropin (TSH) were measured at baseline, 6 and 24 months. Completeness of urine sampling was monitored by para-aminobenzoic acid and salt intake by urinary sodium.At baseline, median 24-UIC (71.0μg/l) and 24-UIE (134.0μg/d) were similar in the PD and NNR groups. After 6 months, 24-UIC had decreased to 36.0μg/l (P=0.001) and 24-UIE to 77.0μg/d (P=0.001) in the PD group; in the NNR group, levels were unaltered. FT4, TSH and FT3 were similar in both groups, except for FT3 at 6 months being lower in PD than in NNR group.A PD results in a higher risk of developing ID, than a diet according to the NNR. Therefore, we suggest iodine supplementation should be considered when on a PD.European Journal of Clinical Nutrition advance online publication, 13 September 2017; doi:10.1038/ejcn.2017.134.
|
|
| 4. |
- Manousou, Sofia, 1979, et al.
(författare)
-
A randomized, double-blind study of iodine supplementation during pregnancy in Sweden: pilot evaluation of maternal iodine status and thyroid function.
- 2021
-
Ingår i: European journal of nutrition. - : Springer Science and Business Media LLC. - 1436-6215 .- 1436-6207. ; 60, s. 3411-3422
-
Tidskriftsartikel (refereegranskat)abstract
- Pregnant women in Sweden are mildly iodine deficient. We investigated the effect of daily iodine supplementation on the iodine and thyroid status of pregnant women.In this pilot, randomized, double-blind trial, 200 thyroid-healthy pregnant women were recruited at mean (standard deviation) pregnancy week 8.85 (1.62) and assigned (1:1) to daily intake of a multivitamin tablet with or without 150μg of iodine. Urine and serum samples were collected at baseline and once during the second and third trimesters. Urinary iodine concentration (UIC), serum thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOabs) were analyzed. Neonatal TSH data were collected. UIC and Tg were also analyzed in a group of 89 thyroid-healthy non-pregnant women of reproductive age (WRA).At baseline, the intervention and the control groups had similar median UIC (interquartile range (IQR)): 110μg/L (74-119) and 111μg/L (66-168), respectively. The intervention group reached iodine sufficiency with median UIC (IQR) 139μg/L (89-234) and 136μg/L (91-211) in the second and third trimester, respectively, without significant difference from the lower limit of the recommended range, i.e. 150-250μg/L (p=0.42 and p=0.87, respectively). The intervention group had higher median UIC and lower median Tg compared to the control group during the second (p<0.001 and p=0.019, respectively) and third trimester (p<0.001 and p=0.003, respectively), whereas thyroid hormones, serum TPOabs, and neonatal TSH were similar. The WRA group presented median UIC (IQR) 65μg/L (30-98) and median Tg (IQR) 18μg/L (13-27).A daily supplement containing 150μg of iodine to a group of pregnant women with mild iodine deficiency improved the iodine status from mild ID to iodine sufficiency. This improvement seems to have had a positive impact on maternal thyroglobulin. This study is now under extension to investigate the children's neuropsychological development.ClinicalTrials.gov Identifier NCT02378246, May 3, 2015, retrospectively registered.
|
|
| 5. |
- Manousou, Sofia, 1979, et al.
(författare)
-
Correlations of water iodine concentration to earlier goitre frequency in Sweden-an iodine sufficient country with long-term iodination of table salt.
- 2019
-
Ingår i: Environmental health and preventive medicine. - : Springer Science and Business Media LLC. - 1347-4715 .- 1342-078X. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Before iodination of Swedish table salt in 1936, iodine deficiency resulting in goitre and hypothyroidism was common. Sweden has become iodine sufficient, as shown in a national survey in 2007, proving its iodination fortification programme effective for the general population. The objective of this study was to collect drinking water from water treatment plants nationally and test if water iodine concentration (WIC) correlated to urinary iodine concentration (UIC) of school-aged children in a national survey 2007 to former goitre frequency in 1929 and to thyroid volume data in 2007.In 2012, 166 treatment plants, located in 57% (166 of 290) of all Swedish municipalities, were asked to collect drinking water samples of approximately 10 ml. In 2007, tap water samples of the same volume were collected from 30 randomly selected schools for the national survey. Analysis of WIC was done in both treatment plants in 2012 (n = 166) and tap water in 2007 (n = 30). The correlation of WIC to the children's UIC and thyroid volume after iodination was tested based on data from the national survey in 2007. The association of WIC to former goitre frequency was tested based on pre-iodination data, derived from a map of goitre frequency drawn in 1929.The median WIC from water treatment plants was 4.0 μg/L (range 0-27 μg/L). WIC was similar in coastal and inland areas, for both ground and surface water. WIC correlated with historical goitre areas and was lower in the goitre areas than in non-goitre areas (p < 0.001). WIC in the same municipalities as the schools correlated with the UIC of children (p < 0.01), but not with their thyroid volume.WIC still contributes to iodine nutrition in Sweden, but iodination overrides the goitre effect.
|
|
| 6. |
- Manousou, Sofia, 1979, et al.
(författare)
-
Inadequate iodine intake in lactating women in Sweden: A pilot 1-year, prospective, observational study
- 2021
-
Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 100:1, s. 48-57
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Breastfed infants depend on breast-milk iodine for growth and brain development, as iodine is a trace element important for thyroid hormone production. Iodine need is higher during lactation; hence, mothers and children are at risk of iodine deficiency. We aimed to explore maternal iodine and thyroidal status during lactation. Material and methods Pregnant women were recruited in Goteborg, southwest Sweden. Maternal urine and serum were collected at pregnancy week 35-37 (n = 84) and 0.5, 4, and 12 months postpartum. Seventy mothers provided breast milk at 0.5 months. Results Median (interquartile range) breast-milk iodine concentration was 90 (66-116) mu g/L. About 58% had breast-milk iodine concentration <100 mu g/L. Iodine supplement users (n = 13) had higher breast-milk iodine concentration than non-users (n = 49) (140 mu g/L vs 71 mu g/L,P = .001). Exclusively breastfeeding women at 4 months postpartum (n = 57) had lower median urinary iodine concentration (85 mu g/L vs 133 mu g/L,P = .004) and higher thyroglobulin serum concentration (22.3 mu g/L vs 11.8 mu g/L,P = .032) than non-exclusively breastfeeding women (n = 25). Concentrations of thyroid hormones were unaffected. Conclusions This pilot study suggests that lactating women in southwest Sweden present mildly inadequate iodine intake, mainly among non-iodine supplement users and exclusively breastfeeding mothers. Studies on the coverage of the iodine fortification program in breastfeeding women are warranted.
|
|
| 7. |
- Manousou, Sofia, 1979, et al.
(författare)
-
Iodine deficiency and nutrition in Scandinavia.
- 2017
-
Ingår i: Minerva medica. - 1827-1669. ; 108:2, s. 147-158
-
Tidskriftsartikel (refereegranskat)abstract
- Iodine nutrition is a result of geological conditions, iodine fortification and monitoring strategies within a country together with the dietary habits of the population. This review summarizes the basis for the current iodine situation in the Scandinavian countries in order to identify gaps in knowledge, determine necessary future steps, highlight landmarks in Scandinavian iodine research and consider ongoing studies in Scandinavian countries with high international impact. Historically, iodine deficiency disorders such as goiter were common in Norway and Sweden, but not in Denmark. Different strategies have been used in Scandinavia to improve iodine nutrition. The major source of iodine is iodized salt in Sweden and from milk and dairy products in Norway. In Denmark, drinking water, milk, dairy products and iodized salt used in commercial production of bread are the important sources of iodine. The current iodine status in Scandinavia is not optimal and action is ongoing to increase iodination in Denmark, where there is mild iodine deficiency in the general population. Data from all three countries indicate insufficient iodine nutrition during pregnancy and there is a need for data from children, adolescents and young women. Monitoring a population's iodine status and dietary iodine sources is necessary to secure iodine nutrition in Scandinavia. Ongoing studies in Scandinavia will contribute significantly to the knowledge about the effects of mild to moderate iodine deficiency.
|
|
| 8. |
|
|
| 9. |
- Manousou, Sofia, 1979, et al.
(författare)
-
Iodine deficiency in pregnant women in Sweden: a national cross-sectional study.
- 2020
-
Ingår i: European journal of nutrition. - : Springer Science and Business Media LLC. - 1436-6215 .- 1436-6207. ; 59:6, s. 2535-2545
-
Tidskriftsartikel (refereegranskat)abstract
- Voluntary salt iodization at 50mg/kg salt ensures adequate iodine nutrition in Swedish school-aged children, but iodine status in pregnant women is uncertain.We conducted a cross-sectional national study of 743 pregnant women, at median gestational age of 23weeks (IQR 9, 38), recruited from maternal health care centers. We measured: urinary iodine concentration (UIC) and urinary creatinine concentration in spot urine samples; thyroglobulin (Tg), thyroid-stimulating hormone (TSH), and total thyroxine (tT4) on dried blood spots (DBS); and thyreoperoxidase antibodies in serum samples. Data on dietary supplement use were obtained, and women were classified as supplement users (consuming multivitamins containing≥150µg iodine/day) and non-supplement users (no supplements or<150µg iodine/day from supplements).Overall median UIC [bootstrapped 95% confidence interval (CI)] was 101µg/L (95, 108; n=737): 149µg/L (132, 164) in supplement users (n=253) and 85µg/L (79, 92) in non-supplement users (n=440) (p<0.001). Overall geometric mean DBS-Tg (95% CI) was 22.1μg/L (20.8, 23.5; n=675) and the prevalence of elevated DBS-Tg was 19%. DBS-Tg was lower in supplement users (n=229) than in non-supplement users (n=405) (19.1 vs 24.4μg/L, p<0.001). DBS-TSH, DBS-tT4, and S-TPOab positivity did not differ between the two groups.Pregnant women in Sweden have inadequate iodine nutrition. Women not taking iodine supplements containing≥150µg iodine/day are affected by mild iodine deficiency and are at higher risk for increased thyroid activity, while maintaining euthyroidism. Iodine intake should be improved in women both before and after conception by promotion of iodized salt instead of non-iodized salt. We urge regular monitoring of iodine status in the general Swedish population, as well as in risk groups.
|
|
| 10. |
- Manousou, Sofia, 1979
(författare)
-
Iodine intake and uptake in populations at risk for iodine deficiency
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Iodine is essential for the production of thyroid hormones. Both iodine deficiency (ID) and iodine excess may be harmful. Iodine intake in Sweden is considered adequate for the general population due to iodization of table salt since 1936 but data on pregnant and breastfeeding women (i.e. groups with increased need for iodine) are scarce in Sweden. Moreover, bariatric surgery is increasingly popular and it is unknown whether it causes ID by decreased iodine intake and/or uptake. Aims: To investigate iodine status and thyroid function in populations that are known to be at risk for ID (i.e. pregnant and breastfeeding women) and in populations that are assumed to be at risk for ID (i.e. patients who have undergone bariatric surgery). Methods: PAPER I is a cross-sectional, observational study on a representative population in Sweden of 743 pregnant women. PAPER II is a pilot, randomized, controlled trial comprising 200 women who received a daily multivitamin either with iodine 150 μg or without iodine followed until delivery. PAPER III is an observational prospective study of 84 women followed from the third trimester of pregnancy until 12 months postpartum with a focus on breastfeeding habits. PAPER IV is an interventional, non-randomized, controlled trial of patients undergoing gastric bypass or vertical-banded gastroplasty derived from the Swedish Obesity Subjects study. They were compared to obese non-operated subjects and to a population-based control group. The outcomes were urinary iodine, thyroid hormones, thyroglobulin (Tg), breastmilk iodine concentration (BMIC), and dietary iodine intake. Results: Pregnant women in Sweden presented mild ID. A daily supplement containing iodine 150 μg increased iodine status from mild ID to borderline iodine sufficiency with a positive influence on maternal Tg. Breastfeeding women in a local population presented mild ID. A minority (~20%) took iodine supplementation and presented BMIC double that of non-supplement users. Exclusively breastfeeding women at 4 months postpartum presented lower urinary iodine and higher Tg compared to the rest of the study population. Obese subjects at baseline presented higher iodine status than the general population. After bariatric surgery, iodine status decreased but remained at an adequate level at 10 years post-operatively. Whether this decrease was due to altered iodine uptake and/or intake is unknown but the patients did not develop ID. Conclusions: In Sweden, pregnant women present mild ID. Breastfeeding women may be mildly iodine deficient, especially those who exclusively breastfeed their children. The main action to be taken is to improve the coverage of the current iodine fortification program – the efficacy and the safety of iodine supplementation to pregnant and breastfeeding women with mild ID is still unclear. Bariatric surgery does not appear to be a risk factor for ID. Regular monitoring of the iodine fortification program for both the general population and risk groups is strongly required
|
|
