Journal of Endocrinological Investigation

, Volume 25, Issue 5, pp 409–413 | Cite as

Sustainable control of iodine deficiency in Iran: Beneficial results of the implementation of the mandatory law on salt iodization

  • F. Azizi
  • R. Sheikholeslam
  • M. Hedayati
  • P. Mirmiran
  • H. Malekafzali
  • M. Kimiagar
  • M. Pajouhi
Original Article

Abstract

Iodine deficiency disorders (IDD) were prevalent in the Islamic Republic (IR) of IRAN before 1989, when the national salt iodization program with 40 mg I/k of salt was initiated. Despite a comprehensive IDD control program, less than 50% of the households in rural areas consumed iodized salt by 1994. A law for the mandatory production of iodized salt for households was passed in 1994. The purpose of this study was to evaluate goiter status and urinary iodine excretion 2 yr after this law was implemented. In each of 26 provinces, 30 groups of 40 schoolchildren, total 36,178, were examined for goiter and classified according to World Health Organization (WHO) classification. Urinary iodine excretion was measured in 2,917 children by digestion method. Goiter was endemic in all provinces, but the majority were small (grade 1) goiter. Median urinary iodine was 20.5 μg/dl 85.1% had urinary iodine ≥10 μg/dl. Median urinary iodine was above 13 μg/dl in all 26 provinces. In all provinces the percentage of schoolchildren with urinary iodine <5 μg/dl was less than 16%. In nine provinces the median urinary iodine was between 13 to 20 μg/dl; urinary iodine of their schoolchildren was <5 μg/dl in 10.8% and <2 μg/dl in 6–9%. No significant difference was observed between boys and girls or children of rural and urban regions in urinary iodine excretion. We conclude that 7 yr after the beginning of salt iodization and 2 yr following mandatory iodized salt consumption, urinary iodine excretion is adequate in schoolchildren; considering the data of the percent of households consuming iodized salt and programmatic setting of the IDD program, The IR of Iran has reached a sustainable control program for iodine deficiency.

Key-words

lodine deficiency disorders goiter urinary iodine iodized salt 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hetzel B.S. Iodine deficiency disorders and their eradication. Lancet 1983, 2: 1126–1129.PubMedCrossRefGoogle Scholar
  2. 2.
    WHO/UNICEF/ICCIDD. Global prevalence of iodine deficiency disorders. MDIS Working Paper No. I. Micronutrient Deficiency Information System. Geneva, World Health Organization, 1993.Google Scholar
  3. 3.
    Emami A., Shahbazi H., Sabzevari M., et al. Goiter in Iran. Amer. J. Clin Nutr. 1969, 22: 1584–1588.PubMedGoogle Scholar
  4. 4.
    Azizi F., Kimiagar M., Bastani J., Navai L., Ghazanfari F. Evaluation of goiter in Shariar. J. Beheshti Med. Sch. 1985, 9: 75–80, (Farsi).Google Scholar
  5. 5.
    Azizi F., Kimiagar M., Navai L., Nafarabadi M. Goiter in Tehran and suburbs In: Vjichayanart A., et al. (Eds.), Recent progress in thyroidology. Proceedings of the third Asia and Oceania Thyroid Association meeting. Dec. 4-6 1986, p. 388–391.Google Scholar
  6. 6.
    Kimiagar M., Azizi F., Navai L., Yassai M., Nafarabadi M. Survey of iodine deficiency in a rural area near Tehran: association of food intake and endemic goiter. Eur. J. Clin. Nutr. 1990, 44: 17–22.PubMedGoogle Scholar
  7. 7.
    Kimiagar M., Yassai M., Nafarabadi M., Sammimi B., Azizi F. Endemic goiter in Boyer Ahmad. Med. J. IRI. 1989, 3: 27–29.Google Scholar
  8. 8.
    Azizi F., Kimiagar M., Nafarabadi M., Yasai M. Current status of iodine deficiency disorders in the Islamic Republic of Iran. EMR. Health Serv. J. 1990, 8: 23–27.Google Scholar
  9. 9.
    Azizi F. Monitoring of IDD prevention. Proceedings of the Fifth International Congress of Endocrine Disorders. 6-9 Sept. 1999, Tehran, I.R. Iran, p. 9.Google Scholar
  10. 10.
    WHO/UNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Geneva, WHO/NUT/94.6, 1994Google Scholar
  11. 11.
    Dunn J.T., Crutchfield M.E., Gutekunst R., Dunn A.N. Methods for measuring iodine in urine. Geneva, ICCIDD/ UNICEF/WHO publication, 1993.Google Scholar
  12. 12.
    Azizi F. Iodine Deficiency Disorders in the Republic of Yemen. Assignment Report No. WHO/EMORO/EM/NUT/ 106/E/R/12.91/30. Alexandria, World Health Organization, EMRO.Google Scholar
  13. 13.
    WHO/UNICEF/ICCIDD. IDD in the Middle East. IDD Newsletter. 1993, 9: 13–17.Google Scholar
  14. 14.
    WHO/EMRO. Assessment of monitoring of iodine deficiency disorders in countries of the eastem Mediterranean region. Report of a symposium-workshop, 9-11 Sept. 1999, Tehran, I.R. Iran, 2000.Google Scholar
  15. 15.
    Azizi F., Sarshar A., Nafarabadi M., et al. Impairment of neuromotor and cognitive development in iodine deficient schoolchildren with normal physical growth. Acta End-ocrinol. 1993, 129: 501–504.Google Scholar
  16. 16.
    Azizi F., Kalani H., Kimiagar M., et al. Physical, neuromotor and intellectual impairment in non-cretinous schoolchildren with iodine deficiency. Int. J. Vitam. Nutr. Res. 1995, 65: 199–205.PubMedGoogle Scholar
  17. 17.
    Aghini-Lombardi F., Antonangeli L., Pinchera A., et al. Effect of iodized salt on thyroid volume of children living in an area previously characterized by moderate iodine deficiency. J. Clin. Endocrinol. Metab. 1997, 82: 1136–1139.PubMedGoogle Scholar
  18. 18.
    Azizi F., Delshad H., Mehrabi Y. Thyroid volumes in schoolchildren of Tehran: Comparison with European schoolchildren. J. Endocrinol. Invest. 2001, 24: 756–762.PubMedGoogle Scholar
  19. 19.
    Dunn J.T., Van Der Haar F. A practical guide to the correction of iodine deficiency. WHO/IDDIDD/UNICEF, Wageningen, 1990, p 14.Google Scholar
  20. 20.
    WHO/UNICEF/ICCIDD. Assessment of the Iodine Deficiency Disorders and Monitoring Their Elimination. Report of Consultation, May 4-6, A guide for programme managers 2000, 2nd ed., WHO/NHD/01.1, Geneva, 2001.Google Scholar
  21. 21.
    Stanbury J.B., Ermans A.E., Boudroux P., et al. Iodine-induced hyperthyroidism: Occurrence and epidemiology. Thyroid 1998, 8: 83–100.PubMedCrossRefGoogle Scholar
  22. 22.
    Azizi F., Daftarian N. Side-effects of iodized oil administration in patients wìth simple goiter. J. Endocrinol. Invest. 2001, 24: 72–77.PubMedGoogle Scholar
  23. 23.
    Rahmani M., Allahverdian S., Hedayati M., Azizi F. Evaluation of urinary iodine and thyroid function tests in Rasht and Sari. East. Mediterr. Health J. In press.Google Scholar
  24. 24.
    Rahmani M., Kouhkan A., Allahverdian S., Hedayati M., Azizi F. Comparison of dietary iodine intake and urinary excretion in urban and rural households of Ilam. Iranian J. Endocrinol. Metab. 2000, 2: 31–38, (Farsi).Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2002

Authors and Affiliations

  • F. Azizi
    • 1
  • R. Sheikholeslam
    • 3
  • M. Hedayati
    • 1
  • P. Mirmiran
    • 1
  • H. Malekafzali
    • 4
  • M. Kimiagar
    • 2
  • M. Pajouhi
    • 4
  1. 1.Endocrine Research Center, Shaheed BeheshtiUniversity of Medical SciencesTehranI.R. Iran
  2. 2.Institute of Nutrition, Shaheed BeheshtiUniversity of Medical SciencesTehranI.R. Iran
  3. 3.Nutrition Unit and Deputy Minister for ResearchTehranI.R. Iran
  4. 4.Ministry of Health and Medical EducationTehranI.R. Iran

Personalised recommendations