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The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: a Cross-sectional Study in China

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Abstract

Currently, the removal of iodized salt is carried out in high water iodine regions. The present situation of iodine nutrition and the prevalence of thyroid diseases in such regions have not been clearly elucidated. This study aimed to figure out these problems to help render effective measures for cases of abnormal iodine nutrition status. A cross-sectional study was carried out in four areas of Jining and Heze, Shandong Province, China, with different water iodine concentrations (WIC). In total, 1344 adults were enrolled in this study, and data related to their iodine nutrition, thyroid function, and thyroid ultrasonography were collected. Subjects were grouped according to WIC, urine iodine concentration (UIC), serum iodine concentration (SIC), and combined UIC and SIC for analysis. Iodine levels were in excess in the 100 μg/L ≤ WIC < 300 μg/L and WIC ≥ 300 μg/L areas. Compared with the control WIC group (10–100 μg/L), the WIC ≥ 300 μg/L group had a higher prevalence of thyroid autoimmunity (TAI, 21.25% vs. 13.19%, P <0.05), subclinical hypothyroidism (SH, 20.20% vs. 11.96%, P < 0.05), thyroid nodules (TN, 31.75% vs. 18.71%, P < 0.05), and thyroid dysfunction (23.62% vs. 12.26%, P < 0.05). Compared with the UIC control group (100–300 μg/L), high UIC group (≥ 800 μg/L) had a higher prevalence of TN (33.75% vs. 21.14%, P < 0.05) and thyroid dysfunction (25% vs. 14.47%, P < 0.05). Next, compared with the control SIC group (50–110 μg/L), high SIC group (≥ 110 μg/L) had a higher prevalence of TAI (33.80% vs. 14.47%, P < 0.05), SH (23.94% vs. 14.30%, P < 0.05), and thyroid dysfunction (33.80% vs. 15.29%, P < 0.05). Finally, subjects with the highest UIC and the highest SIC also had a higher prevalence of TAI (25.92% vs. 10.97%, P < 0.05), SH (23.45% vs. 10.97%, P < 0.05), TN (34.56% vs. 15.85%, P < 0.05), and thyroid dysfunction (27.16% vs. 13.41%, P < 0.05) than subjects with middle iodine levels. The iodine nutrition of subjects in the WIC ≥ 300 μg/L areas was still in excess after removing iodized salt from their diets. High levels of iodine also increased the prevalence of TAI, SH, TN, and thyroid dysfunction in those areas. Simply removing iodized salt may not be sufficient for high water iodine regions.

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Data Availability

The datasets generated during the current study are not publicly available due to privacy considerations but are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (81830098), the Natural Science Foundation of Heilongjiang Province (TD2019H001), and the Graduate Research and Practice Innovation Project of Harbin Medical University (YJSKYCX2019-17HYD). We are sincerely grateful to the organizations participating in this study: the Center for Disease Control and Prevention in Heze and Jining District and the Center for Endemic Disease Control in Shandong Province. Thanks to Professor Kewei Wang, who once worked at the University of Illinois, for English language support.

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  1. J. Yao and W. Zhang contributed equally to this work.

Authors and Affiliations

  1. Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China

    J. Yao, W. Zhang, J. Wang, K. Wang, C. Lv, Z. Zhang, X. Chen, Y. Chen, P. Liu & D. Sun

  2. Institute of Endemic Disease Control, Jinan, Shandong Province, China

    W. Jiang

  3. Heze Center for Disease Control and Prevention, Heze, China

    J. Niu

  4. Jining Center for Disease Control and Prevention, Jining, China

    F. Song

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  1. J. Yao
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Contributions

Sun D and Liu P contributed to the study’s conception and design. Material preparation and data collection were performed by Yao J, Zhang W, Lv C, Zhang Z, Chen X, Chen Y, Jiang W, Niu J, and Song F. Data analysis and the first draft of the manuscript was written by Yao J. Previous versions of the manuscript were commented by Wang J, Liu P, and Wang K. All authors read and approved the final manuscript.

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Correspondence to D. Sun.

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The study was conducted in accordance with the 1964 Helsinki Declaration. The study was approved by the Ethics Committee of Harbin Medical University.

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Informed consent was obtained from every subject before the study was carried out.

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The authors declare no competing interests.

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Yao, J., Zhang, W., Wang, J. et al. The Status of Iodine Nutrition after Removing Iodized Salt in High Water Iodine Regions: a Cross-sectional Study in China. Biol Trace Elem Res 200, 1020–1031 (2022). https://doi.org/10.1007/s12011-021-02727-w

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