Editorial
Eradication of iodine deficiency in Spain. Close, but not there yet
Erradicación de la deficiencia de yodo en España. Cerca, pero no en la meta
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Close, but not there yet" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "471" "paginaFinal" => "473" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Sergio Donnay, Lluís Vila" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Sergio" "apellidos" => "Donnay" "email" => array:1 [ 0 => "sdonnay@fhalcorcon.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Lluís" "apellidos" => "Vila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:2 [ "colaborador" => "on behalf of the task force on disorders related to iodine deficiency and thyroid dysfunction" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición. Hospital Universitario Fundación Alcorcón. Alcorcón, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Endocrinología y Nutrición, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erradicación de la deficiencia de yodo en España. Cerca, pero no en la meta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Iodine deficiency (ID) in Spain, well documented since the 1960s,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> has persisted with different grades of intensity for more than four decades. In 2004, the World Health Organization (WHO) included Spain among the countries with optimum iodine nutrition based on studies conducted during the previous five years on schoolchildren and adults from various regions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is very difficult to summarize the most relevant facts leading to this substantial progress in ID correction in Spain, and one runs the risk of inadvertently omitting some of them. In addition to the prolonged and continuous activity of the working group on disorders related to iodine deficiency (IDDs)<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> of the Spanish Society of Endocrinology and Nutrition, various clinical and epidemiological research findings reported in the international literature during the past decade have confirmed the significance of ID, thus promoting the search for measures to correct it. Thus, the demonstration of deficient psychoneurological development in children born to mothers with low thyroxine levels during pregnancy secondary to maternal hypothyroidism<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> or ID during pregnancy<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> supported the results of basic studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> and led virtually the entire Spanish medical community to assume the significance of optimum nutritional status and thyroid function in pregnant women. The gradual increase in understanding and acceptance by a large number of physicians of the benefits of iodine prophylaxis and adequate transmission of this information to the population through educational health campaigns has significantly contributed to ID correction in Spain. Finally, the availability on the National Health Service of potassium iodide supplements to correct ID in the pregnant population since 2005<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> has not only made it possible to improve the nutritional iodine status of pregnant women, but has very probably induced in a great part of this population group an increased awareness of the need for taking measures aimed at achieving an adequate nutritional iodine status for the whole family.</p><p id="par0015" class="elsevierStylePara elsevierViewall">At the annual meeting of the IDD work group held in Barcelona in December 2011, two studies concerning the current nutritional iodine status of the Spanish population were presented. Both of them were led by group members. Dr. Vila reported that the Tirokid<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> study, conducted on almost 2000 children from all over Spain aged between 6 and 7 years, had found median urinary iodine levels of 173<span class="elsevierStyleHsp" style=""></span>μg/L. Dr. Soriguer, in turn, reported that the Di@betes<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> study, conducted on an adult population recruited from 16 of the 17 Spanish autonomous communities, had found median urinary iodine levels of 117<span class="elsevierStyleHsp" style=""></span>μg/L. The Arena and Emparanza study,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> which reported median urinary iodine values of 127<span class="elsevierStyleHsp" style=""></span>μg/L in a group of healthy children aged 6 months to 3 years, was published at the beginning of the year. Thus, the results of these recent studies conducted on different groups of the Spanish population, by finding median urinary iodine levels higher than 100<span class="elsevierStyleHsp" style=""></span>μg/L in all cases would appear to confirm that Spain continues to be among the countries with optimum iodine nutrition. However, some data from these same studies should temper our optimism, so that we do not make the false assumption that ID has definitively been eradicated in Spain. The proportions of children of pre-school age<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and adults<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> with urinary iodine levels less than 100<span class="elsevierStyleHsp" style=""></span>μg/L, close to 40%, and the reported use of iodinated salt in less than 50% of households suggest that the eradication of ID is far from being achieved according to the criteria established by the WHO and other international organizations.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> These include, amongst others, the availability and use of iodinated salt in more than 90% of households.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of <span class="elsevierStyleItalic">Endocrinología y Nutrición</span>, Dr. Arrizabalaga et al.,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> in their study on changes over time in the nutritional iodine status of schoolchildren from the Basque Country, found progressive correction of ID, recording an increase in median urinary iodine levels from 65<span class="elsevierStyleHsp" style=""></span>μg/L in the 1992 to 147<span class="elsevierStyleHsp" style=""></span>μg/L in the 2005 Nutrition Survey. The analysis performed by the authors on the factors influencing iodine intake increase in the Basque Country is of particular interest. Careful verification of the type of salt used at households by reading the label or measuring iodine contents of the salt pack available at the surveyed household showed a low percentage for the use of iodinated salt (IS), slightly above 50%, similar to that reported by other studies.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Although urinary iodine levels were higher in schoolchildren taking IS than in those taking unfortified salt, normalization of iodine intake occurred in both groups. The authors therefore suggest that other dietary sources of iodine have contributed to the correction of ID in the Basque Country. The marked seasonal pattern seen in the urinary iodine levels of schoolchildren points to the consumption of iodine-rich milk and dairy products as one of the most important factors implicated in the increased iodine intake recorded in their study. Arena and Emparanza<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> reached similar conclusions after finding an adequate nutritional iodine status in children of pre-school age in their study, despite the fact that IS was routinely used in less than 40% of households.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Various prior studies<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> had already shown a close relationship between the consumption of dairy products and the urinary iodine levels found in school populations. On the other hand, the significant iodine content found in cow's milk consumed in Spain,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> higher than 200<span class="elsevierStyleHsp" style=""></span>μg/L in all cases, supports the idea that milk intake is very probably one of the factors which contributes most significantly to ID correction in our country. Similarly to what happened in the United Kingdom during the 1980s and 1990s, it is likely that another “accidental triumph of public health”<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> has occurred in Spain, with increased iodine intake being achieved through an increase, neither promoted nor controlled, in the consumption of iodine-rich milk and dairy products.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The WHO and other international organizations<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> recommend universal iodination, i.e. iodination of any salt intended for human and animal use, including salt used by the food industry, as the best way to guarantee adequate iodine provision in the diet. The correction of ID through other dietary sources of iodine, such as milk and dairy products, has the disadvantage of the lack of control of the iodine entering the human food chain.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In this regard, changes in iodine content in milk, secondary to changes in stock practices have resulted in the reappearance of ID in previously iodine-sufficient countries such as Australia.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In the United Kingdom, where iodine provision in milk had allowed for the recommended daily requirements of iodine being achieved<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> despite the lack of salt iodination programs, ID has very recently reappeared,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and this country is currently among the countries with the highest numbers of schoolchildren with inadequate iodine intake.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The evolution of nutritional iodine status in these countries would appear to confirm the lack of sustainability and the risks associated with this “silent” or uncontrolled iodine prophylaxis, which has repeatedly been denounced in Spain.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Although we can congratulate ourselves on the adequate nutritional iodine status achieved by Spanish schoolchildren and adults, other population groups such as pregnant women are very likely to still have ID.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> The increased availability and consumption of iodine-rich foods, mainly milk and dairy products, has made an uncontrolled contribution to the improvement in nutritional iodine status. However, universal iodination and the use of iodinate salt in more than 90% of households, measures that guarantee adequate iodine provision in the diet<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and that have been shown to be of value for controlled and sustained ID eradication in some countries,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> have continuously been dismissed by Spanish healthcare administrations. Regular monitoring of the actual iodine content in table salt in accordance with the regulations and control of the stable iodine content in milk are potential actions by health administrations that would undoubtedly improve the nutritional iodine status of the Spanish population.</p><p id="par0040" class="elsevierStylePara elsevierViewall">At the start of this century, the WHO and other international organizations<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> defined the characteristics or circumstances of areas erroneously reported as not having ID which do in fact have IDDs. These include countries where ID is supposed to have been eradicated by prophylactic programs or general dietary changes. Unfortunately, the possibility that Spain, having no decided and unequivocal political will to eradicate ID, could be included in this category or be added to the list of countries in which the reappearance of ID has recently been shown appears to be high.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara">The composition of the task force on disorders related to iodine deficiency and thyroid dysfunction is included in <a class="elsevierStyleCrossRef" href="#sec0005">Appendix 1</a>.</p>" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Donnay S, Vila L. Erradicación de la deficiencia de yodo en España. Cerca, pero no en la meta. Endocrinol Nutr. 2012;59(8):471–3.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0045" class="elsevierStylePara elsevierViewall">Coordinator: Donnay Candil, Sergio</p> <p id="par0050" class="elsevierStylePara elsevierViewall">Arena, José. Ares, Susana. Arrizabalaga, Juan José. Arrobas, Teresa. Bandrés Nivela, María Orosia.</p> <p id="par0055" class="elsevierStylePara elsevierViewall">Berbel, Pere. Caballero, Ageda. de la Vieja Escolar, Antonio. Espada, Mercedes. García Fuentes, Eduardo. Gentil, Alfonso. Iglesias Reymunde, Teresa. Lucas, Anna. Muñoz Márquez J, Menéndez, Edelmiro. Millón Ramírez, Maria del Carmen. Moll Mascaró, Gracia. Moreno, Jose Carlos.</p> <p id="par0060" class="elsevierStylePara elsevierViewall">Pineda Arrivas, José Javier. Riestra, María. Santiago, Piedad. Santiesteban, Pilar. Soriguer, Federico.</p> <p id="par0065" class="elsevierStylePara elsevierViewall">Torres Costa, María Teresa. Tortosa, Frederic. Vich Sastre, Francisca. Vila, Lluis, Wengrowicz, Silvia.</p>" "etiqueta" => "Appendix 1" "titulo" => "Work group on disorders related to iodine deficiency and thyroid dysfunction" "identificador" => "sec0005" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "100 años de literatura sobre el bocio endémico en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Ferreiro" 1 => "F. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 0 | 10 |
| 2024 October | 61 | 1 | 62 |
| 2024 September | 71 | 5 | 76 |
| 2024 August | 48 | 6 | 54 |
| 2024 July | 65 | 6 | 71 |
| 2024 June | 53 | 5 | 58 |
| 2024 May | 62 | 5 | 67 |
| 2024 April | 47 | 4 | 51 |
| 2024 March | 59 | 4 | 63 |
| 2024 February | 34 | 3 | 37 |
| 2024 January | 79 | 4 | 83 |
| 2023 December | 111 | 10 | 121 |
| 2023 November | 86 | 15 | 101 |
| 2023 October | 92 | 7 | 99 |
| 2023 September | 50 | 11 | 61 |
| 2023 August | 38 | 3 | 41 |
| 2023 July | 52 | 19 | 71 |
| 2023 June | 64 | 4 | 68 |
| 2023 May | 66 | 6 | 72 |
| 2023 April | 30 | 0 | 30 |
| 2023 March | 52 | 5 | 57 |
| 2023 February | 49 | 4 | 53 |
| 2023 January | 63 | 7 | 70 |
| 2022 December | 58 | 12 | 70 |
| 2022 November | 81 | 10 | 91 |
| 2022 October | 83 | 11 | 94 |
| 2022 September | 71 | 13 | 84 |
| 2022 August | 48 | 5 | 53 |
| 2022 July | 44 | 11 | 55 |
| 2022 June | 33 | 9 | 42 |
| 2022 May | 31 | 9 | 40 |
| 2022 April | 37 | 10 | 47 |
| 2022 March | 78 | 4 | 82 |
| 2022 February | 53 | 7 | 60 |
| 2022 January | 64 | 6 | 70 |
| 2021 December | 41 | 6 | 47 |
| 2021 November | 55 | 16 | 71 |
| 2021 October | 64 | 12 | 76 |
| 2021 September | 66 | 14 | 80 |
| 2021 August | 45 | 8 | 53 |
| 2021 July | 57 | 8 | 65 |
| 2021 June | 49 | 10 | 59 |
| 2021 May | 80 | 11 | 91 |
| 2021 April | 97 | 32 | 129 |
| 2021 March | 48 | 11 | 59 |
| 2021 February | 45 | 11 | 56 |
| 2021 January | 43 | 17 | 60 |
| 2020 December | 57 | 6 | 63 |
| 2020 November | 53 | 6 | 59 |
| 2020 October | 27 | 13 | 40 |
| 2020 September | 44 | 13 | 57 |
| 2020 August | 30 | 7 | 37 |
| 2020 July | 37 | 9 | 46 |
| 2020 June | 28 | 14 | 42 |
| 2020 May | 33 | 11 | 44 |
| 2020 April | 60 | 10 | 70 |
| 2020 March | 52 | 9 | 61 |
| 2020 February | 38 | 6 | 44 |
| 2020 January | 31 | 5 | 36 |
| 2019 December | 42 | 23 | 65 |
| 2019 November | 33 | 11 | 44 |
| 2019 October | 32 | 9 | 41 |
| 2019 September | 44 | 15 | 59 |
| 2019 August | 31 | 6 | 37 |
| 2019 July | 38 | 7 | 45 |
| 2019 June | 83 | 15 | 98 |
| 2019 May | 206 | 57 | 263 |
| 2019 April | 54 | 34 | 88 |
| 2019 March | 22 | 5 | 27 |
| 2019 February | 27 | 9 | 36 |
| 2019 January | 16 | 4 | 20 |
| 2018 December | 20 | 5 | 25 |
| 2018 November | 41 | 5 | 46 |
| 2018 October | 39 | 5 | 44 |
| 2018 September | 26 | 6 | 32 |
| 2018 August | 11 | 5 | 16 |
| 2018 July | 6 | 6 | 12 |
| 2018 June | 5 | 3 | 8 |
| 2018 May | 26 | 2 | 28 |
| 2018 April | 17 | 6 | 23 |
| 2018 March | 16 | 3 | 19 |
| 2018 February | 16 | 2 | 18 |
| 2018 January | 13 | 0 | 13 |
| 2017 December | 2 | 0 | 2 |
| 2017 November | 11 | 1 | 12 |
| 2017 October | 13 | 1 | 14 |
| 2017 September | 21 | 4 | 25 |
| 2017 August | 23 | 3 | 26 |
| 2017 July | 21 | 2 | 23 |
| 2017 June | 24 | 3 | 27 |
| 2017 May | 32 | 6 | 38 |
| 2017 April | 24 | 2 | 26 |
| 2017 March | 56 | 29 | 85 |
| 2017 February | 51 | 5 | 56 |
| 2017 January | 19 | 3 | 22 |
| 2016 December | 32 | 5 | 37 |
| 2016 November | 25 | 4 | 29 |
| 2016 October | 34 | 6 | 40 |
| 2016 September | 27 | 10 | 37 |
| 2016 August | 14 | 1 | 15 |
| 2016 July | 12 | 1 | 13 |
| 2016 June | 20 | 14 | 34 |
| 2016 May | 15 | 13 | 28 |
| 2016 April | 12 | 29 | 41 |
| 2016 March | 29 | 22 | 51 |
| 2016 February | 20 | 19 | 39 |
| 2016 January | 16 | 12 | 28 |
| 2015 December | 18 | 18 | 36 |
| 2015 November | 22 | 14 | 36 |
| 2015 October | 32 | 15 | 47 |
| 2015 September | 24 | 7 | 31 |
| 2015 August | 22 | 5 | 27 |
| 2015 July | 13 | 6 | 19 |
| 2015 June | 8 | 1 | 9 |
| 2015 May | 20 | 9 | 29 |
| 2015 April | 27 | 17 | 44 |
| 2015 March | 23 | 11 | 34 |
| 2015 February | 13 | 2 | 15 |
| 2015 January | 33 | 5 | 38 |
| 2014 December | 38 | 8 | 46 |
| 2014 November | 27 | 1 | 28 |
| 2014 October | 28 | 3 | 31 |
| 2014 January | 1 | 0 | 1 |
| 2013 December | 1 | 0 | 1 |
| 2013 November | 0 | 1 | 1 |
Show all
