Nazeri Pantea, Mirmiran Parvin, Shiva Niloofar, Mehrabi Yadollah, Mojarrad Mehdi, Azizi Fereidoun
1Nutrition and Endocrine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Thyroid. 2015 Jun;25(6):611-20. doi: 10.1089/thy.2014.0491. Epub 2015 May 14.
The aim of this review is to assess data available on iodine nutrition status in lactating mothers residing in countries with mandatory and voluntary iodine fortification programs and/or iodine supplementation.
A systematic review was conducted by searching articles published between 1964 and 2013 in Pub Med, ISI Web, and Cochrane Library using iodine nutrition, lactation, iodine supplementation, and iodine fortification as keywords for titles and/or abstracts. Relevant articles were included if they reported urinary iodine concentration (UIC) in lactating mothers and, if determined, the type of iodine fortification program and/or iodine supplementation. Forty-two studies met the inclusion criteria. Among these, 21 studies assessed lactating mothers in countries with a mandatory iodine fortification program, 17 studies were from countries with voluntary and/or without iodine fortification programs, and four studies assessed iodine nutrition status in lactating mothers undergoing iodine supplementation. Among countries with mandatory iodine fortification programs, the range of salt iodization level in lactating mothers with a UIC <100 μg/L was between 8 and 40 ppm, whereas among lactating mothers with UIC >100 μg/L, it was between 15 and 60 ppm. Levels of UIC <100 μg/L were observed among lactating women in India, Denmark, Mali, New Zealand, Australia, Slovakia, Sudan, and Turkey, whereas in countries such as Chile, Iran, Mongolia, New Guinea, and Nigeria, the median or mean of UIC was >100 μg/L. There was a median or mean UIC <100 μg/L in nearly all lactating mothers residing in countries where implementation of universal salt iodization program was voluntary, including Switzerland, Australia, New Zealand, Ireland, and Germany. However, in some countries with voluntary iodine fortification programs, such as the United States, Spain, and Japan, a mean or median UIC of >100 μg/L has been reported.
Although universal salt iodization is still the most feasible and cost-effective approach for iodine deficiency control in pregnant and lactating mothers, UIC in lactating mothers of most countries with voluntary programs and in areas with mandatory iodine fortification is still within the iodine deficiency range, indicating that iodine supplementation in daily prenatal vitamin/mineral supplements in lactating mothers is warranted. However, further investigations are still recommended in this regard.
本综述的目的是评估在实施强制性和自愿性碘强化计划及/或碘补充的国家中，哺乳期母亲碘营养状况的现有数据。
通过在PubMed、ISI Web和Cochrane图书馆中检索1964年至2013年间发表的文章进行系统综述，使用碘营养、哺乳、碘补充和碘强化作为标题和/或摘要的关键词。如果文章报告了哺乳期母亲的尿碘浓度（UIC），以及（若已确定）碘强化计划的类型和/或碘补充情况，则纳入相关文章。42项研究符合纳入标准。其中，21项研究评估了实施强制性碘强化计划国家的哺乳期母亲，17项研究来自实施自愿性和/或无碘强化计划的国家，4项研究评估了接受碘补充的哺乳期母亲的碘营养状况。在实施强制性碘强化计划的国家中，UIC<100μg/L的哺乳期母亲的食盐加碘水平范围在8至40ppm之间，而UIC>100μg/L的哺乳期母亲中，该范围在15至60ppm之间。在印度、丹麦、马里、新西兰、澳大利亚、斯洛伐克、苏丹和土耳其的哺乳期妇女中观察到UIC<100μg/L的情况，而在智利、伊朗、蒙古、新几内亚和尼日利亚等国家，UIC的中位数或平均值>100μg/L。在几乎所有实施普遍食盐碘化计划为自愿性的国家中，包括瑞士、澳大利亚、新西兰、爱尔兰和德国，哺乳期母亲的UIC中位数或平均值<100μg/L。然而，在一些实施自愿性碘强化计划的国家，如美国、西班牙和日本，报告的UIC平均值或中位数>100μg/L。
尽管普遍食盐碘化仍然是控制孕妇和哺乳期母亲碘缺乏最可行且最具成本效益的方法，但大多数实施自愿性计划的国家以及实施强制性碘强化地区的哺乳期母亲的UIC仍处于碘缺乏范围内，这表明有必要在哺乳期母亲的每日产前维生素/矿物质补充剂中添加碘。然而，在这方面仍建议进一步开展调查。
