IODINE DEFFICIENCY DISORDERS SREERAJ V T JR HEALTH

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 Group Iodine 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 Gradual leaching of iodine from soil due to: Floods Melting of Glaciers Rivers changing course

Iodine deficiency : A disease of the soil SOIL EROSION : Low Availability of iodine Effect on animals Effect on people WATER, SOIL : : : Environmental iodine deficiency PLANTS Iodine poor feeds & fodders, goitrogens LIVESTOCK Clinical & Reproductive disorders, Decreased productivity 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) Goiter in animal Lower work output

Importance of iodine in brain development 50, 000 brain cells produced/second in developing fetal 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 Sufficiency Iodine 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 in brain development 90 % of human brain development occurs between 3 rd month of pregnancy & 3 rd 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 IDD Goiter Cretinism Spontaneous Abortions, Stillbirths, Birth Defects of Speech & Hearing, Squint, Psychomotor defects Loss of 13 IQ points, Leading Cause of Mental handicap

Thyroid Hormones triiodothyronine (T 3) thyroxine (T 4) 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

Goiter 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 must Get their daily supply of iodine

Iodine consumption on daily basis for all times to come Daily requirement of iodine person is 150 µg – fits on the tip of hair ! Lifetime requirement for 70 years is 5 gms – one teaspoonful ! However, this daily requirement has to be met daily, for all times to come “Daily consumption of adequately iodized 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 India 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 17 th 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 took policy 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

Daily consumption of adequately iodized salt is a healthy habit Thank You! For Towards Sustainable Elimination of IDD