The “National Iodine Deficiency Day” that has just passed has given rise to a renewed concern about whether daily dietary iodine supplementation is needed. Just a few days ago, hundreds of experts and scholars at the conference organized by the Chinese Medical Association of Endemic Diseases Branch, Chinese Nutrition Society, and the Department of Endocrinology of the Chinese Medical Association co-organized the meeting on iodine and thyroid diseases. Reached consensus. Experts set up a platform for the exchange of basic, preventive, and clinical research results for the establishment of iodine and thyroid diseases, establishing information sharing platforms for producers and users of iodine related products such as iodized salt, iodine additives, and iodine detection, and establishing international and domestic prevention and treatment of iodine deficiency disorders. The policy communication platform for strategic measures, as well as in-depth exchanges on prevention and treatment of iodine deficiency disorders, clinical and basic research at home and abroad.
Expert consensus: In 1995, China implemented the universal salt iodization (USI) policy. For more than 20 years, the condition of iodine deficiency disorders has dropped significantly and the iodine intake of residents throughout the country is at an appropriate level. Since the goal of eliminating iodine deficiency disorders was basically achieved in 2000, China has continued to eliminate iodine deficiency disorders.
Interpretation: In the 1960s, the Chinese government implemented a strategy for the prevention and treatment of iodized salt supply in areas with severe iodine deficiency, which led to the initial control of iodine deficiency disorders. In the early 1980s, iodized salt began to be supplied on a large scale in the ward. By the early 1990s, the prevalence of endemic goiter and cretinism was basically contained. In 1993, the State Council convened the "China mobilization meeting to achieve the goal of eliminating iodine deficiency disorders in 2000." At the meeting, a prevention and control strategy based on universal salt and iodine was identified. By the year 2000, China had achieved the goal of eliminating iodine deficiency disorders in general. In 2015, at the provincial level, 28 provinces in China achieved the goal of eradicating iodine deficiency disorders, and they have maintained continuous elimination since 2000.
Expert consensus 2: In 2014, the World Health Organization (WHO) conducted a systematic review and analysis of the effectiveness and safety of iodized salt, and recommended continued use of salt plus iodine as a means to reduce oncofoam, cretinism, and cognitive decline. Safe and effective prevention and control strategies for the risk of iodine deficiency. In most areas of China, the environment is iodine-deficient. If we do not adhere to the salt iodization policy, iodine deficiency disorders may return.
Interpretation: In carrying out the above work, WHO searched nine domestic and foreign databases, including China Knowledge Online and Wanfang, and collected a large number of published articles. All studies compared the differences between individuals who consumed iodized salt and those who did not eat iodized salt. The number of participants totaled more than 5 million from 30 cohort studies to multiple cross-sectional studies. The review results show that iodized salt has a significant effect on reducing goiter, cretinism, cognitive decline and iodine deficiency. In order to ensure the safe and effective dose of iodine intake, the monitoring of iodized salt projects is very important, especially for countries that implement salt reduction projects.
Expert consensus 3: As the iodine intake of the Chinese population mainly comes from iodized salt, the current intake of salt in China is declining, resulting in the gradual reduction in the amount of iodine that people ingested from salt; In addition, the proportion of food intake of people processed With an increase, the proportion of salt intake from processed foods will also increase.
Interpretation: Because of the diversification of dietary forms in China and the increase in the proportion of processed foods, the source and quantity of iodine intake will also change, which will have different degrees of impact on the iodine nutrition status of the population. From the monitoring results of nutrition and health monitoring in China in 1991 and 2009, sodium intake decreased from 6.6 g/day in 1991 to 4.7 g/day in 2009. The main source of sodium intake is salt added during cooking. However, the contribution of table salt to sodium intake decreased from 81% in 1991 to 70% in 2009. At the same time, the contribution of processed foods and condiments to sodium intake has multiplied. When the salt intake decreases, the amount of iodine intake from salt also decreases. Although the proportion of salt intake from processed foods increases, if the proportion of iodized salt used in processed foods decreases, the iodine intake of the overall population increases. The amount will fall further, so it is necessary to pay close attention to the iodine nutrition of different populations. Experts at the meeting suggested to pay attention to the sources of iodine in diets and the contribution of these sources to iodine intake. Based on the understanding of changes in consumption patterns, and the use of iodized salt in processed foods, the emphasis should be placed on processed foods with high consumption (such as staple foods, meat products, convenience foods, etc.).
Expert consensus 4: Monitoring the iodine level of the population and thyroid function is very important to ensure prevention of iodine deficiency and iodine excess. Monitoring the iodine nutritional status of children, pregnant women and nursing mothers is an important measure to prevent iodine deficiency disorders, and it is also an important basis for guiding the adjustment of salt iodization policy. The monitoring results in 2014 showed that there were no provinces with iodine deficiency or excessive iodine in the country, including adequate iodine intake for women of childbearing age.
Interpretation: Since monitoring of high-risk areas of iodine deficiency disorders began in 2007, China has begun to include pregnant women in monitoring. In the subsequent 2011 and 2014 national monitoring of iodine deficiency conditions, it was found that according to the standards recommended by international organizations, pregnant women may be in iodine deficiency when their urinary iodine is suitable, and when the urine of pregnant women is suitable, children may be Iodine is greater than the appropriate amount. However, in areas that have long achieved universal salt iodization targets (qualified iodized salt consumption rate >90%), the population including women of childbearing age has sufficient intake of iodine. Therefore, the amount of iodine stored in women during pregnancy is appropriate. It is recommended to gradually establish a county-based iodine deficiency disease surveillance and assessment system, and at the same time further study other indicators that reflect the status of iodine nutrition in pregnant women, children, and other groups. Where necessary, pregnant women should take compensatory intervention measures.
Expert consensus 5: As iodine deficiency related diseases are reduced, like other countries, the spectrum of thyroid disease in our country is also changing. Similar to the world-wide observations, thyroid disease, especially the high incidence of thyroid cancer, is associated with multiple factors, mainly due to improvements in diagnostic techniques and methods. At present, there is no evidence that the rise in thyroid cancer is related to the iodization of salt. Experts in related fields will further explore other causes of the increase in the incidence of thyroid cancer.
Interpretation: In recent years, the incidence of thyroid cancer in the population has been on the rise. There is a consensus that the occurrence of thyroid cancer and the iodization of iodine caused by excessive salt can not be taken off. Domestic scholars analyze that there are two reasons for the increased incidence of thyroid cancer. On the one hand, the occurrence of thyroid cancer is related to changes in ionizing radiation, the environment, diet, lifestyle, and mental stress; on the other hand, the rate of people attending medical examinations and physical examinations has increased significantly, especially in high-resolution ultrasounds and Acupuncture cytological diagnosis technology has been widely used in clinical practice, which has greatly improved the early diagnosis rate of thyroid cancer. At present, there is no evidence that salt iodization is associated with a high incidence of thyroid cancer. The international experience of salt iodization for prevention and treatment of iodine deficiency disorders for nearly 100 years and clinical and epidemiological investigations have confirmed that the incidence of iodine-induced hyperthyroidism increases transiently after salt iodization, but the incidence of thyroid cancer has not increased. Improvement in iodine nutrition does not increase the incidence of thyroid cancer. However, domestic and international survey data show that the type of thyroid cancer has changed before and after salt iodization. When iodine deficiency occurs, the incidence of follicular and undifferentiated cancers in the population is higher than that of thyroid papillary carcinoma; when salt is added to iodide intervention The incidence of post-thyroid papillary carcinoma is increased, while the incidence of follicular and undifferentiated carcinomas is decreasing. Follicular and undifferentiated cancers are cancers with extremely high levels of malignancy and mortality, whereas papillary thyroid cancers have a low degree of malignancy. In view of the outstanding issues that urgently need to be solved in the current prevention and control work, the next step will be to organize and coordinate domestic research forces, do top-level design, and strengthen communication and exchanges in endemic, nutritional and related clinical medicine (endocrinology, oncology, surgery, maternal and child health, etc.) Solve issues of common concern. At the same time, scientific research and data analysis should also be accelerated to provide a scientific basis for responding to social needs. (Author: Su Xiaohui Liu Pengshen Hongmei: China Center for Disease Prevention and Control Center for Endemic Disease Control, clothing Hillsborough finishing)
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