Iodine environmental availability and human intake in oceanic islands: Azores as a case-study.

Iodine deficiency is the most common cause of preventable mental impairment. Although several studies have established an association between ocean proximity and iodine environmental availability, recent studies revealed an inadequate iodine intake in the Azorean islands. In this study, we aim to understand the underlying causes of iodine environmental availability in oceanic islands and its association with iodine intake in schoolchildren, using the Azores as case-study. Iodine concentration in soil and grass pasture was measured by INAA and in drinking water by spectrophotometry. Urinary iodine concentration (UIC) in schoolchildren was assessed by ICP-MS in a randomized cross-sectional survey with 315 participants from S. Miguel (study group) and Sta. Maria islands (reference group). A validated diet questionnaire assessing sources of iodine was recorded. The iodine concentration in soils of the reference group was significantly higher than in the study group (58.1ppm vs. 14.5ppm, respectively; p=0.001). The prevalence of schoolchildren with inadequate UIC was significantly higher in the study group than in the reference one (63.0% vs. 37.8%, respectively; p<0.001). Chronic exposure to low iodine environmental availability was significantly associated with the exacerbation in iodine deficiency, with a risk 4.94 times higher in the study group. The differences observed in the studied islands are related with each island geomorphology (soil properties and orography) and climate, which can promote or inhibit iodine environmental availability, contributing distinctively to iodine bioavailability and human intake. These findings draw attention to an urgent need for a full investigation of Azores iodine status to apply evidence-based recommendations for iodine supplementation.