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Оценка эффективности профилактики дефицита йода у взрослого населения Санкт-Петербурга
Оценка эффективности профилактики дефицита йода у взрослого населения Санкт-Петербурга
Соболева Д.Е., Дора С.В., Каронова Т.Л. и др. Оценка эффективности профилактики дефицита йода у взрослого населения Санкт-Петербурга. Consilium Medicum. 2017; 19 (4): 65–69.
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Аннотация
Цель – оценить эффективность профилактики йодного дефицита у взрослого населения Санкт-Петербурга.
Материалы и методы. Были обследованы 542 жителя Санкт-Петербурга в возрасте 18–77 лет. Все участники были разделены на 3 группы согласно возрасту (18–24, 25–44, 45 лет и старше). Беременные женщины были выделены в отдельную группу. У всех участников проведено анкетирование, а также проанализированы значения йодурии.
Результаты. Медиана йодурии (МЙУ) всех участников составила 91,2 мкг/л и соответствовала дефициту йода легкой степени тяжести. Лица моложе 25 лет и старше 44 лет имели нормальное йодное обеспечение, в отличие от лиц 25–44 лет, у которых диагностирован дефицит йода легкой степени тяжести. Значение МЙУ у беременных женщин составило 112,4 мг/л и соответствовало недостаточному потреблению йода. Йодированную соль использовали в пищу только 41,1% всех обследованных и 52,2% беременных женщин. Препараты йода принимали 1/2 беременных женщин. Характер питания, образование, семейное и материальное положение, а также бытовые условия не влияли на приверженность методам профилактики.
Выводы. Взрослое население Санкт-Петербурга имело различное йодное обеспечение. Лица репродуктивного возраста, включая беременных женщин, имели дефицит йода легкой степени тяжести. Профилактика дефицита йода, проводимая в Санкт-Петербурге в 2013–2015 гг., недостаточно эффективна. Не выявлено социальных факторов, влияющих на приверженность методам профилактики дефицита йода.
Ключевые слова: йод, дефицит йода, йодное обеспечение, профилактика, беременные женщины.
Materials and methods. We examined 542 residents of St. Petersburg aged 18–77 years. All participants were divided into 3 groups according to age (18–24, 25–44, 45 years and older). Pregnant women were evaluated separately. All participants were questioned, the values of urinary iodine concentration (UIC) were analyzed.
Results. Median UIС of all participants was 91.2 mg/l and corresponded to mild iodine deficiency. Persons younger 25 years and older 44 years had iodine sufficiency, participants aged 25–44 were diagnosed with mild iodine deficiency. Median UIC in pregnant women was 112.4 mg/l and corresponded to insufficient iodine intake. Iodized salt was used by 41.1% of all surveyed persons and 52.2% of pregnant women. Iodine supplements were taken by half of pregnant women. The type of nutrition, education, family and financial situation as well as living conditions did not affect adherence to methods of prevention.
Conclusions. The adult population of St. Petersburg had a different iodine status. Persons of reproductive age including pregnant women had mild iodine deficiency. Prophylaxis of iodine deficiency held in St. Petersburg in 2013–2015 was not effective enough. No social factors influencing adherence to iodine deficiency prevention methods were revealed.
Key words: iodine, iodine deficiency, iodine status, prevention, pregnant women.
Материалы и методы. Были обследованы 542 жителя Санкт-Петербурга в возрасте 18–77 лет. Все участники были разделены на 3 группы согласно возрасту (18–24, 25–44, 45 лет и старше). Беременные женщины были выделены в отдельную группу. У всех участников проведено анкетирование, а также проанализированы значения йодурии.
Результаты. Медиана йодурии (МЙУ) всех участников составила 91,2 мкг/л и соответствовала дефициту йода легкой степени тяжести. Лица моложе 25 лет и старше 44 лет имели нормальное йодное обеспечение, в отличие от лиц 25–44 лет, у которых диагностирован дефицит йода легкой степени тяжести. Значение МЙУ у беременных женщин составило 112,4 мг/л и соответствовало недостаточному потреблению йода. Йодированную соль использовали в пищу только 41,1% всех обследованных и 52,2% беременных женщин. Препараты йода принимали 1/2 беременных женщин. Характер питания, образование, семейное и материальное положение, а также бытовые условия не влияли на приверженность методам профилактики.
Выводы. Взрослое население Санкт-Петербурга имело различное йодное обеспечение. Лица репродуктивного возраста, включая беременных женщин, имели дефицит йода легкой степени тяжести. Профилактика дефицита йода, проводимая в Санкт-Петербурге в 2013–2015 гг., недостаточно эффективна. Не выявлено социальных факторов, влияющих на приверженность методам профилактики дефицита йода.
Ключевые слова: йод, дефицит йода, йодное обеспечение, профилактика, беременные женщины.
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Materials and methods. We examined 542 residents of St. Petersburg aged 18–77 years. All participants were divided into 3 groups according to age (18–24, 25–44, 45 years and older). Pregnant women were evaluated separately. All participants were questioned, the values of urinary iodine concentration (UIC) were analyzed.
Results. Median UIС of all participants was 91.2 mg/l and corresponded to mild iodine deficiency. Persons younger 25 years and older 44 years had iodine sufficiency, participants aged 25–44 were diagnosed with mild iodine deficiency. Median UIC in pregnant women was 112.4 mg/l and corresponded to insufficient iodine intake. Iodized salt was used by 41.1% of all surveyed persons and 52.2% of pregnant women. Iodine supplements were taken by half of pregnant women. The type of nutrition, education, family and financial situation as well as living conditions did not affect adherence to methods of prevention.
Conclusions. The adult population of St. Petersburg had a different iodine status. Persons of reproductive age including pregnant women had mild iodine deficiency. Prophylaxis of iodine deficiency held in St. Petersburg in 2013–2015 was not effective enough. No social factors influencing adherence to iodine deficiency prevention methods were revealed.
Key words: iodine, iodine deficiency, iodine status, prevention, pregnant women.
Полный текст
Список литературы
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27. Konrade I et al. A cross-sectional survey of urinary iodine status in Latvia. Mеdicina 2014; 50: 124–9.
28. Трошина Е.А. Современные аспекты профилактики и лечения йододефицитных заболеваний. Фокус на группы риска. Мед. совет. 2016; 3: 82–5. / Troshina E.A. Sovremennye aspekty profilaktiki i lecheniia iododefitsitnykh zabolevanii. Fokus na gruppy riska. Med. sovet. 2016; 3: 82–5. [in Russian]
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30. Andersen SL et al. Challenges in the evaluation of urinary iodine status in pregnancy: the importance of iodine supplement intake and time of sampling. Eur Thyroid J 2014; 3: 179–88.
2. Platonova N.M. Iodnyi defitsit: sovremennoe sostoianie problemy. Klin. i eksperim. tireoidologiia. 2015; 11 (1): 12–21. [in Russian]
3. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. 3rd ed. Geneva, 2007.
4. Iodine Deficiency in Europe: A continuing public health problem. WHO, United Nations Children’s Fund. Geneva, Switzerland, 2007.
5. Zimmermann MB. Iodine Deficiency. Endocr Rev 2009; 30: 376–408.
6. Zimmermann MB. Iodine deficiency in industrialised countries. Geographical and geological influences on nutrition. Proc Nutr Soc 2010; 69: 133–43.
7. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. 2nd ed. Geneva, 2001.
8. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. WHO. Geneva, 2014.
9. Indicators for assessing iodine deficiency disorders and their control programmes. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. Geneva, 1993.
10. Vandevijvere S et al. Fortification of Bread with Iodized Salt Corrected Iodine Deficiency in School-Aged Children, But Not in Their Mothers: A National Cross-Sectional Survey in Belgium. Thyroid 2012; 22 (10): 1046–53.
11. Joseph G, Hollowell NW. Iodine Nutrition in the United States. Trends and Public Health Implications: Iodine Excretion Data fr om National Health and Nutrition Examination Surveys I and III (1971–1974 and 1988–1994). J Clin Endocrinol Metab 1998; 83 (10): 3401–8.
12. Als C et al. Age- and gender-dependent urinary iodine concentrations in an area-covering population sample from the Bernese region in Switzerland. Eur J Endocrinol 2000; 143: 629–37.
13. Khattak RM et al. Monitoring the prevalence of thyroid disorders in the adult population of Northeast Germany. Popul Health Metrics 2016; 14: 1–11.
14. Zimmermann MB, Andersson M. Update of iodine status worldwide. Curr Opin Endocrinol Diabetes Obes 2012; 19: 382–7.
15. Platonova N.M. Iododefitsitnye zabolevaniia i reproduktivnaia funktsiia u zhenshchin. Consilium Medicum. 2006; 8 (6): 13–6. [in Russian]
16. Bath SC et al. Iodine deficiency in pregnant women living in the South East of the UK: the influence of diet and nutritional supplements on iodine status. Br J Nutr 2014; 111: 1622–31.
17. Vicki L et al. The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia [Electronic resource]. Nutr J 2013; 32 (12). http://www.nutritionj.com/content/12/1/32
18. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: Wh ere do we stand in 2013? Thyroid 2013; 23 (5): 523–8.
19. Travers CA et al. Iodine status in pregnant women and their newborns: are our babies at risk of iodine deficiency? Med J Aust 2006; 184: 617–20.
20. Vandevijvere S et al. Neonatal Thyroid-Stimulating Hormone Concentrations in Belgium: A Useful Indicator for Detecting Mild Iodine Deficiency? PLoS One 2012; 7 (10): e47770.
21. Alexander EK et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27 (3): 315–89.
22. Lazarus J et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014; 3: 76–94.
23. Герасимов Г.А. Как достичь цели устранения йододефицитных заболеваний в России: проблемы и решения. М., 2008. [in Russian]
24. Melnichenko G.A. i dr. Osvedomlennost naseleniia Rossii o iododefitsitnykh zabolevaniiakh i sposobakh ikh profilaktiki. Klin. i eksperim. tireoidologiia. 2016; 12 (3): 25–30. [in Russian]
25. Gerasimov G.A. i dr. Polnoe ustranenie defitsita ioda v pitanii naseleniia Armenii putem vseobshchego iodirovaniia pishchevoi povarennoi soli. Klin. i eksperim. tireoidologiia. 2006; 2 (3): 51–5. [in Russian]
26. Sekhniashvili Z.Sh., Suchdev P., Gerasimov G.A. Ustranenie defitsita ioda v pitanii naseleniia Gruzii: rezultaty natsionalnogo issledovaniia v 2005 godu. Klin. i eksperim. tireoidologiia. 2008; 4 (2): 48–51. [in Russian]
27. Konrade I et al. A cross-sectional survey of urinary iodine status in Latvia. Mеdicina 2014; 50: 124–9.
28. Troshina E.A. Sovremennye aspekty profilaktiki i lecheniia iododefitsitnykh zabolevanii. Fokus na gruppy riska. Med. sovet. 2016; 3: 82–5. [in Russian]
29. Soboleva D.E. i dr. Iodobespechenie beremennykh zhenshchin Sankt-Peterburga. Effektivnost profilaktiki razvitiia iododefitsitnykh zabolevanii v gruppe riska. Problemy zhenskogo zdorovia. 2015; 10 (2): 25–31. [in Russian]
30. Andersen SL et al. Challenges in the evaluation of urinary iodine status in pregnancy: the importance of iodine supplement intake and time of sampling. Eur Thyroid J 2014; 3: 179–88.
2. Платонова Н.М. Йодный дефицит: современное состояние проблемы. Клин. и эксперим. тиреоидология. 2015; 11 (1): 12–21. / Platonova N.M. Iodnyi defitsit: sovremennoe sostoianie problemy. Klin. i eksperim. tireoidologiia. 2015; 11 (1): 12–21. [in Russian]
3. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. 3rd ed. Geneva, 2007.
4. Iodine Deficiency in Europe: A continuing public health problem. WHO, United Nations Children’s Fund. Geneva, Switzerland, 2007.
5. Zimmermann MB. Iodine Deficiency. Endocr Rev 2009; 30: 376–408.
6. Zimmermann MB. Iodine deficiency in industrialised countries. Geographical and geological influences on nutrition. Proc Nutr Soc 2010; 69: 133–43.
7. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. 2nd ed. Geneva, 2001.
8. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. WHO. Geneva, 2014.
9. Indicators for assessing iodine deficiency disorders and their control programmes. WHO, United Nations Children’s Fund, International Council for the Control of Iodine Deficiency Disorders. Geneva, 1993.
10. Vandevijvere S et al. Fortification of Bread with Iodized Salt Corrected Iodine Deficiency in School-Aged Children, But Not in Their Mothers: A National Cross-Sectional Survey in Belgium. Thyroid 2012; 22 (10): 1046–53.
11. Joseph G, Hollowell NW. Iodine Nutrition in the United States. Trends and Public Health Implications: Iodine Excretion Data fr om National Health and Nutrition Examination Surveys I and III (1971–1974 and 1988–1994). J Clin Endocrinol Metab 1998; 83 (10): 3401–8.
12. Als C et al. Age- and gender-dependent urinary iodine concentrations in an area-covering population sample from the Bernese region in Switzerland. Eur J Endocrinol 2000; 143: 629–37.
13. Khattak RM et al. Monitoring the prevalence of thyroid disorders in the adult population of Northeast Germany. Popul Health Metrics 2016; 14: 1–11.
14. Zimmermann MB, Andersson M. Update of iodine status worldwide. Curr Opin Endocrinol Diabetes Obes 2012; 19: 382–7.
15. Платонова Н.М. Йододефицитные заболевания и репродуктивная функция у женщин. Consilium Medicum. 2006; 8 (6): 13–16. / Platonova N.M. Iododefitsitnye zabolevaniia i reproduktivnaia funktsiia u zhenshchin. Consilium Medicum. 2006; 8 (6): 13–6. [in Russian]
16. Bath SC et al. Iodine deficiency in pregnant women living in the South East of the UK: the influence of diet and nutritional supplements on iodine status. Br J Nutr 2014; 111: 1622–31.
17. Vicki L et al. The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia [Electronic resource]. Nutr J 2013; 32 (12). http://www.nutritionj.com/content/12/1/32
18. Pearce EN, Andersson M, Zimmermann MB. Global iodine nutrition: Wh ere do we stand in 2013? Thyroid 2013; 23 (5): 523–8.
19. Travers CA et al. Iodine status in pregnant women and their newborns: are our babies at risk of iodine deficiency? Med J Aust 2006; 184: 617–20.
20. Vandevijvere S et al. Neonatal Thyroid-Stimulating Hormone Concentrations in Belgium: A Useful Indicator for Detecting Mild Iodine Deficiency? PLoS One 2012; 7 (10): e47770.
21. Alexander EK et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27 (3): 315–89.
22. Lazarus J et al. European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014; 3: 76–94.
23. Герасимов Г.А. Как достичь цели устранения йододефицитных заболеваний в России: проблемы и решения. М., 2008. / Герасимов Г.А. Как достичь цели устранения йододефицитных заболеваний в России: проблемы и решения. М., 2008. [in Russian]
24. Мельниченко Г.А. и др. Осведомленность населения России о йододефицитных заболеваниях и способах их профилактики. Клин. и эксперим. тиреоидология. 2016; 12 (3): 25–30. / Melnichenko G.A. i dr. Osvedomlennost naseleniia Rossii o iododefitsitnykh zabolevaniiakh i sposobakh ikh profilaktiki. Klin. i eksperim. tireoidologiia. 2016; 12 (3): 25–30. [in Russian]
25. Герасимов Г.А. и др. Полное устранение дефицита йода в питании населения Армении путем всеобщего йодирования пищевой поваренной соли. Клин. и эксперим. тиреоидология. 2006; 2 (3): 51–5. / Gerasimov G.A. i dr. Polnoe ustranenie defitsita ioda v pitanii naseleniia Armenii putem vseobshchego iodirovaniia pishchevoi povarennoi soli. Klin. i eksperim. tireoidologiia. 2006; 2 (3): 51–5. [in Russian]
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27. Konrade I et al. A cross-sectional survey of urinary iodine status in Latvia. Mеdicina 2014; 50: 124–9.
28. Troshina E.A. Sovremennye aspekty profilaktiki i lecheniia iododefitsitnykh zabolevanii. Fokus na gruppy riska. Med. sovet. 2016; 3: 82–5. [in Russian]
29. Soboleva D.E. i dr. Iodobespechenie beremennykh zhenshchin Sankt-Peterburga. Effektivnost profilaktiki razvitiia iododefitsitnykh zabolevanii v gruppe riska. Problemy zhenskogo zdorovia. 2015; 10 (2): 25–31. [in Russian]
30. Andersen SL et al. Challenges in the evaluation of urinary iodine status in pregnancy: the importance of iodine supplement intake and time of sampling. Eur Thyroid J 2014; 3: 179–88.
Авторы
Д.Е.Соболева*1, С.В.Дора1, Т.Л.Каронова1,2, А.Р.Волкова1, Е.Н.Остроухова1, А.А.Быстрова1,2, Е.В.Шляхто1,2
1 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8;
2 ФГБУ «Северо-Западный федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2
*bayonetka@mail.ru
1 I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L'va Tolstogo, d. 6/8;
2 V.A.Almazov North-West federal medical research center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*bayonetka@mail.ru
1 ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П.Павлова» Минздрава России. 197022, Россия, Санкт-Петербург, ул. Льва Толстого, д. 6/8;
2 ФГБУ «Северо-Западный федеральный медицинский исследовательский центр им. В.А.Алмазова» Минздрава России. 197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2
*bayonetka@mail.ru
________________________________________________
1 I.M.Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation. 197022, Russian Federation, Saint Petersburg, ul. L'va Tolstogo, d. 6/8;
2 V.A.Almazov North-West federal medical research center of the Ministry of Health of the Russian Federation. 197341, Russian Federation, Saint Petersburg, ul. Akkuratova, d. 2
*bayonetka@mail.ru
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