IODINE DEFFICIENCY DISORDERS

SREERAJ.V.T

JR.HEALTH INSPECTOR

PHC UDAYAGIRI

Iodine deficiency disorders:A public health problem

Worldwide distribution

What is iodine&

what is iodine deficiency?

What is iodine? Nutrient needed in a

minute quantity daily.

Recommended daily

intake:

150 μg (Micronutrient)

Total quantity present in

body is (15-20 mg)

mostly in thyroid gland

What is iodine?

Iodine: Essential component of

thyroid hormones,

which are needed for:

- Optimal mental & physical development

- Regulation of body metabolism

(Generation & utilization of body energy)

Iodine : Daily requirements

Age GroupIodine Requirement

(µg/day)

0 – 11 months 50

12 – 59 months 90

6 – 12 years 120

> 12 years 150

Pregnant & Lactating Women

200

[WHO, UNICEF, ICCIDD: Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO/NUT/96.13.

Geneva. 1996 ]

Sources of iodine

Food is the main source of iodine

Meat, fish & dairy products

Vegetables, cereals

High amounts in sea fish &

seaweeds

Sea salt is a poor source of iodine

Iodine deficiency – Disease of the soil

Melting of Glaciers

Floods

Rivers changing course

Gradual leaching of iodine from soil due to:

Iodine deficiency : A disease of the soil

SOIL EROSION : WATER, SOIL Environmental iodine deficiency

Low Availability : PLANTS Iodine poor feeds &

of iodine fodders, goitrogens

Effect on animals : LIVESTOCK Clinical & Reproductive

disorders, Decreased productivity

Effect on people : HUMANS Health & Socio -

economic impact

What are the consequences of

iodine deficiency?

Effects on humans:Fetus

Mortality

Spontaneous abortions & stillbirths

Increased perinatal mortality

Disability Birth defects Defects of speech & hearing Psychomotor defects Cretinism

Effects on humans:Neonate

Mortality

Increased neonatal mortality

Morbidity

Neonatal Goiter Neonatal Hypothyroidism

(Decreased production of thyroid hormones at birth)

Effects on humans:Children & adolescents

Goiter Hypothyroidism Retarded physical development Impaired mental function (13 IQ

points)

Effects on humans: Adults

Goiter & its complications

Hypothyroidism

Impaired mental function

Iodine induced hyperthyroidism (IIH)

Effects on livestock

Goiter

Hypothyroidism

Reproductive disorders

Decreased productivity

(Milk, meat, wool, eggs)

Lower work outputGoiter in animal

Importance of iodine inbrain development -

50,000 brain cells produced/secondin developingfetal brain

100 billion brain cells in adult

One million billion connections between these brain cells:Determine IQ

100 billion brain cells in adult human

Comparable to the number of stars in the sky

Brain Cell Growth

Iodine Deficiency

Iodine SufficiencyIodine Deficiency is the single most

common cause of preventable mental retardation

Brain cell branching

• Diminished brain cell branching due to iodine deficiency• Diminished branching Less connections Lower IQ

Importance of iodine inbrain development

90 % of human brain development occurs

between 3rd month of pregnancy & 3rd year of

life

(Critical period)

Deficiency of iodine during this critical period of

development results in permanent brain damage

This brain damage can primarily be prevented by

correcting iodine deficiency before & during

pregnancy

This makes it vital

that all expectant

& lactating mothers

get their

daily requirement

of iodine

Iodine deficiency is single most common cause of mental handicap worldwide

It is totally preventable

Spectrum of IDDGoiter

Loss of 13 IQ points,Leading Cause of Mental handicap

Cretinism

Spontaneous Abortions,Stillbirths,

Birth Defects

Defects of Speech & Hearing,Squint,

Psychomotor defects

Thyroid Hormones

triiodothyronine (T3)

thyroxine (T4)

Thyroid-stimulating hormone (TSH or thyrotropin)

Hypothyroidism is a state in which the

thyroid gland does not make

enough thyroid hormone.

Cold intolerance, increased sensitivity to cold Constipation Weight gain and water retention Bradycardia (low heart rate – fewer than sixty

beats per minute) Fatigue Decreased sweating Muscle cramps and joint pain Dry, itchy skin Thin, brittle fingernails Rapid thoughts Depression Poor muscle tone (muscle hypotonia) Female infertility; any kind of problems with

menstrual cycles Hyperprolactinemia and galactorrhea Elevated serum cholesterol

Goiter has been known since the days of Lord Buddha and before

Earliest evidence of goiter: 3000 BC

GoiterGoiter is a swelling of the thyroid

gland

is painless

not a cause of death-

has been perceived as a cosmetic problem only

Cretinism

Iceberg of IDD

1% - 10%

Cretinism

5% - 30%

Some brain damage

30% - 70%

Loss of energy due to hypothyroidism

High risk groups:

- Pregnant & lactating women

- Pre-school children

Our primary concern

Every population should&

Every mother & child mustGet their daily supply of

iodine

Iodine consumption on daily basis for all times to come

Daily requirement of iodine per person is 150 µg – fits on the tip of hair !

Lifetime requirement for 70 years is 5 gms – one teaspoonful !

However, this daily requirementhas to be met daily, for all times to come

“Daily consumption of adequatelyiodized salt is a healthy habit”

Vehicle for iodine : Salt

One food item consumed every day,by everybody in fixed quantities

Rich or poor, urban or rural area,man or woman, child or adult

Average daily consumption in Indiaper person is 10 gm

Iodization of salt is a simple process

Cost of salt iodization is :10 paise/person/year

What is Iodated Salt?

Iodated salt is common salt containing minute quantities of an iodine compound

Iodated salt looks, tastes and smells exactly like ordinary salt.

The Govt. of India has issued notification banning the salt of non iodized salt for direct human consumption with effect from 17th May, 2006.

Iodized salt – The panacea for iodine deficiency

Salt production and iodization(Supply)

Promotion of Iodized Salt Consumption

(Demand)

Universal Salt Iodization

In 1983, Government of India tookpolicy decision to iodize all salt meant for human consumption – Universal Salt Iodization (USI)

Private sector was permitted and encouraged to produce iodized salt

“Elimination of goiter” was included in Prime Minister’s 20-point National Development Program

India & China

Iodized salt coverage <80%

Iodized salt coverage >80%

The Dandi March

Thank You!ForFor

Daily consumption of adequately iodized salt is a

healthy habit

Towards Sustainable

Elimination of IDD