Overview of IDD
st
in the 21 century
An International Challenge in Nutrition
H. Delshad M.D
Endocrinologist
Research Institute for Endocrine Sciences
What is Iodine ?
● Iodine is a chemical element
(as are Oxygen,Hydrogen,Iron)
● Iodine is an essential trace element for the
human
● Iodine is an essential part
of the chemical structure of
thyroid hormones
Total quantity present in body is
(15-20 mg) Mostly in thyroid gland
Source of Iodine
4
Discovery of Iodine
● Bernard Courtois discovered Iodine in 1811
● Like most other discoveries, the discovery of Iodine
was a fortuitous
accident.
● While most scientists discovered something when
trying to help people
to save their lives, Courtois discovered Iodine when
he was trying to kill people.
5
Recommended daily intake
of iodine
Preschool children
90 g
Schoolchildren (6-12 y)
120 g
Adult (>12 y)
150 g
Pregnant
women
&
Lactating
250 g
6
The spectrum of IDD
Fetus
Abortions
Stillbirths
Congenital anomalies
Increased perinatal mortality
Neurologic creatinism
Psychomotor defects
Neonate
Neonatal goiter
Neonatal hypothyroidims
Child & adolescent
Goitrous juvenile hypothyroidism
Impaired mental function
Retarded physical development
Adult
Goiter with its complications
Hypothyroidism
Impaired mental function
7
IDD: Iodine Deficiency Disorders
 The
world’s most common
endocrine problem
 The most preventable cause
of mental retardation
 The easiest of the major
nutritional deficiencies to
correct
8
IDD : Spectrum of Disorders
Cretinism, Tip of the Iceberg
1% - 10%
Cretinism
5% - 30%
Some brain damage
30% - 70%
Loss of energy due to hypothyroidism
10
Endemic Cretinism (Neurologic Form)
11
An adult male from the Congo,
with three women of the same
Myxedematous Cretinism
age (17-20 years), all of whom
are myxedematous cretins.
12
History
•Awareness regarding goiter goes back to
thousands years ago.
•David Marine in 1915 declared that Endemic
goiter is the easiest known disease to prevent.
•In 1915,for the first time, Hunziger proposed
that iodized salt be used for goiter in
Switzerland.
•The first large-scale trials with iodized salt
carried out over the period 1916-1920 by
Marine and Kimbal in Ohio, USA.
13
History
1960
WHO presents the first comprehensive review of goiter
on world scale, however in spite of the successful
elimination of IDD in a number of industrialized
countries, only very slow progress is made in developing
countries during the next 15 years.
1983
The concept of iodine deficiency disorders (IDD) is
introduced with emphasis on the effects of iodine
deficiency on brain function.
14
History
1985
With support from UNICEF, WHO & Australian government
the ICCIDD is founded in order to bridge the gap between
available knowledge and its application
1987
The United Nations Sub-Committee on Nutrition establishes
an IDD Working Group to receive an Annual Report of
Progress.
15
History
1990
The UNICEF, established the goal of eliminating iodine
deficiency worldwide.
2010
ICCIDD celebrates 25 years of work and creates Basil Hetzel
International Award for Communications on iodine nutrition.
16
Global
Iodine Nutrition
17
Epidemiological criteria for assessing iodine nutrition
based on median urinary iodine concentration in
school-aged children
Median Urinary
Iodine (g/L)
<20
Iodine Nutrition
Sever iodine deficiency
20-49
Moderate iodine deficiency
50-99
Mild iodine deficiency
>200
More than adequate
18
Update on iodine status worldwide
◙ Iodine sufficient countries before 1990:
●Switzerland
●Scandinavian countries
●Australia
●United States
●Canada
◙ The new global estimate of iodine status data
on the 193 WHO Member States.
19
SAC with insufficient iodine intake, by WHO region, 2011
WHO Region
Countries (n)
Proportion (%)
Total(millions)
Africa
10
39.3
57.9
Americas
2
13.7
14.6
South-East Asia
0
31.8
76
Europe
11
43.9
30.5
Eastern
Mediterranean
4
38.6
30.7
Western Pacific
5
18.6
31.2
Global total
32
29.8
240.9
5.2%: severely deficient, 8.1%: moderately deficient, 15.9%: mildly deficient
20
The top10 iodine deficient countries with the greatest
number of SAC with insufficient iodine intake in 2011
21
The global prevalence of low iodine intakes has fallen over the past
decade, from 36.5% in 2003, to 31.5% in 2007 and to 29.8% in 2011
22
Number of iodine deficient countries
in 2003, 2007, and 2011
Over the past decade, the number of countries
that are iodine deficient has fallen from 54 to
30
23
Countries (number) by iodine status over the period 2003-2011
IODINE INTAKE
2003
2007
2011
Insufficient : Sever iodine deficiency
1
0
0
Insufficient : Moderate iodine deficiency
13
10
9
Insufficient : Mild iodine deficiency
40
37
23
Adequate
43
49
69
More than adequate
24
27
36
Excessive
5
7
11
Countries with data
126
130
148
The number of countries
192
193
193
The number iodine-sufficient countries has increased from 67 to 106, while
the number with excessive iodine intake has increased from 5 to 11.
24
Where do we
stand in 2013?
25
Overall results
About 70% of households worldwide have
access to iodized salt.
 Out of 128 countries with data, at least
90% of households in 37 countries
consume adequately iodized salt, but in 39
countries, coverage rates are below 50%.
 Tow billion of the global population,
including 241 million school children,
still have insufficient dietary iodine intakes.

26
27
Acknowledgment
28
John Stanbury
In 1950, John Stanbury was a young physician at Massachusetts General
Hospital. A surgeon from Argentina brought him photographs of patients
suffering from enlarged thyroid glands, or goiters, and, like his colleagues,
Stanbury had never seen cases like the ones the Argentine displayed.
Intrigued, Stanbury and other researchers traveled to Argentina in June of
1951 to investigate further, and through their research showed the first
physiological link between goiters and iodine deficiency.
In 1985, Stanbury founded the International Council for the Control
of Iodine Deficiency Disorders (ICCIDD).
29
Basil Stuart Hetzel, AC (born 13 June 1922) is an
Australian medical researcher who has made a major
contribution to combating iodine deficiency a major
cause of goiter and cretinism worldwide.
30
François Delange (1935 - June 2007) was a Belgian
physician and researcher who contributed to thyroid
research. He performed field studies on goiter prevalence
worldwide and performed pioneering research in early
screening for congenital hypothyroidism.
31
Back ground
& present state
of IDD in
IRAN
32
The history of IDD in IRAN
1969 (1348)
The first epidemiological assessment of goiter:
High prevalence of goiter in most parts of the
country.
1983 (1362)
The assessment of goiter in Shahryar
Goiter prevalence:
● 54% in male and 66% in female subjects
● MUI: 65 µg/L
Huge
Goiter
34
1984 (1363)
The assessment in Tehran, rural areas near Tehran
and Kohkiloyeh Boyerahmad :
►Goiter prevalence:
● Hyperendemic
● MUI : ≤ 50 µg/l
►Physical examination:
 Mental& physical growth retardation
 Psychomotor disturbances
 Hearing deficits
1989 (1368)
First national survey
(Centers and capital cities of 14 provinces and rural areas of 8 provinces)
Goiter prevalence:
● Endemic in all and
●Hyper endemic in capital cities of 5 provinces
Median Urinary Iodine:
● ≤100 µg/l in all regions
In general
The
estimated population at risk for IDD in the
country based on the findings of the results of
the surveys conducted from 1983 to 1989:
20 millions
Therefore
in 1988 iodine deficiency has been
accepted as a priority health problem.
In
1989 Iranian National Committee for the
Control of Iodine Deficiency ( INCCI) was
established by MOH
1996 (1375)
Second national survey
7 years after the initiation of salt iodization 2 years after the USI
House hold consumption of iodized salt : % 50
Goiter prevalence:
● 58%
● Most have low grade goiter
Median Urinary Iodine:
● 200 µg/l
o%82; UIC ≥ 100 µg/l
o≤%10; UIC ≤50 µg/l
1996 (1375)
2nd national survey
MUI in schoolchildren was over than the at least
standard value set by WHO/ UNICEF /ICCIDD
 Successful
salt iodization program
I.R.IRAN has announced to be IDD free with fulfilling 10
programmatic indicators set by WHO/ UNICEF /ICCIDD in 2000.
39
2001 (1380)
Third national survey
Households consumption of iodized salt: % 95
Goiter prevalence:
● 9.8%
● Significant decrease in goiter prevalence
especially goiter grade 2
Median Urinary Iodine:
● 167 µg/l
• 5.8% : UIC<50 µg/l
• 14% : UIC= 51-99 µg/l
• 80.2% : UIC> 100 µg/l
2007 (1386)
Forth national survey
Households consumption of iodized salt: % 97
Goiter prevalence:
● 5.9%
● most with grade 1 goiter
Median Urinary Iodine:
● 140 µg/l
 % 65 UI >100 µg/l
 % 15 UI < 50 µg/l
Diagram of goiter prevalence in Iran
from 1989 to 2007
100.0%
60.0%
55.0%
50.0%
9.8%
6.5%
0.0%
1368
1375
1380
1386
year
42
Iodine status of Iranian population
Indicator
Goiter
Prevalence
Median UIC
µg/l
% median UIC
< 100µg/l
1996
(1375)
55
205
14
2001
(1380)
9.8
165
20
2007
(1386)
5.7
140
35
Year
43
2007
Provinces
Prevlence Of Goiter In Iran
Yazd
Hamadan
Hormozgan
Markazi
Mozandaran
Lorestan
Golestan
Guilan
Kohkiloyeh- Boyerahmad
Kermanshah
Kerman
Kordestan
Ghazvin
Ghome
Fars
Sistan Balouchestan
Semnan
Zanjan
Khouzestan
South Khorasan
Khorasan Razavi
North Khorasan
Charmahal Bakhtiari
Tehran
Boushehr
Ilam
Isfahan
Ardabil
West Azarbaijan
East Azarbaijan
1996
0
20
40
60
80
100
44
2012 (1390)
Fifth national survey
Conclusion
● The well-monitored salt iodization program in Iran
has ultimately resulted in optimization of UIC, and
drastically decreased the goiter rate 17 years after
universal salt iodization.
● Our last survey indicates a well established
sustainable IDD program in I.R. IRAN.
● Iodized salt programs need to be carefully
monitored to ensure adequate iodine intake while
avoiding iodine excess.
‫کنترل اختالل های ناش ی از کمبود‬
‫ید در ایران وکشورهای منـ ــطقه‬
‫مدیون تالش خس ـتـگی ناپذیـر و‬
‫همت ماندگار دانشمـند فرهیخ ــته‬
‫جناب آ قای دکتر فریدون عزیزی‬
‫است‪.‬‬
‫فروغ شادی چشمان مادرانی که دیگر کودکی با عقب ماندگی ذهنی‬
‫ناش ی از کمبود ید بد نیا نمی آورند را تقدیم شما می نماییم‪.‬‬
‫‪47‬‬
Home message
Henry Richardson Labouisse, Jr
UNICEFF, 1978
Iodine deficiency is so easy to prevent that it is a
crime to let a single child be born mentally
handicapped for that reason.
48
50