Malnutrition

1. IODINE DEFICIENCY
Abdul Rehman Pirzado

2. Iodine Deficiency
Iodine function: component of thyroid hormones (T3 and T4) which
regulate a variety of processes, including:
• Metabolic rate
• Heart rate
• Temperature
• Mental function
Food sources: depends on the iodine content of the soil on which food
was raised; good natural sources are seafood and seaweed, and iodized
salt, processed foods and dairy products are iodine-rich
Abdul Rehman Pirzado

3. Iodine Deficiency
Signs and symptoms of iodine deficiency:
• In adults/children: hypothyroidism and goiter (thyroid gland
hyperplasia due to elevated TSH levels)
• Congenital hypothyroidism (in fetuses of affected mothers):
intellectual impairment, short stature, speech and hearing loss
Risk factors for deficiency:
iodine-poor soil
Abdul Rehman Pirzado

4. In 2014 Iodine Deficiencyremainsa Major Public
HealthProblem Worldwide
A. Strongly Agree
B. Agree
C. Somewhat Agree
D. Neutral
E. Somewhat Disagree
F. Disagree
G. Strongly Disagree
Abdul Rehman Pirzado

5. IodineDeficiencyis an ImportantHealth Issue for
my Clients
A. Strongly Agree
B. Agree
C. Somewhat Agree
D. Neutral
E. Somewhat Disagree
F. Disagree
G. Strongly Disagree
Abdul Rehman Pirzado

6. IodineDeficiencymay impactmy Health
A. Strongly Agree
B. Agree
C. Somewhat Agree
D. Neutral
E. Somewhat Disagree
F. Disagree
G. Strongly Disagree
Abdul Rehman Pirzado

7. Goiter
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8. Himalayas
Goiter
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9. Congenital Hypothyroidism
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10. Congenital Hypothyroidism
Bolivia TanzaniaPakistan
Abdul Rehman Pirzado

11. A brief history of goiter
• 1813 Iodine isolated from seaweed
• Theodor Kocher (1841-1917), who performed over 5000
thyroidectomies for goiter, recognized post-op myxedema in his
patients
• 1873 children in Albi, France treated with 7.5 mg of iodine daily for 75
days with clinical improvement in goiter
• 1893 Thyroid extracts found to be useful in treating myxedema
• 1890s Baumann and Roos isolated “thyroiodine” from the thyroid
finding it contained 10% iodine
• Osler writes in the 1900s that the cause of goiter and the function of
the thyroid are still unknown
J. Nutr. 135: 675–680, 2005 Abdul Rehman Pirzado

12. The Problems:
There is widespread dietary iodine deficiency
• One-half to two-thirds of the world population at risk
In affected populations, goiter and cretinism in
a few coexist with cognitive deficits in all
• In populations where >5% of school children have
goiter, the cognitive performance among apparently
healthy individuals is shifted downward by 10 - 15 IQ
points
Abdul Rehman Pirzado

13. The Solution:
Universal Salt Iodization
Abdul Rehman Pirzado

14. Iodine Needs
Age Daily Requirements (ug/day)
0-6 months 35
6-12 months 45
1-10 years 60-100
≥ 11 years 100-115
Pregnancy / Lactation 125-150
Abdul Rehman Pirzado

15. The Solution:
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16. Key Components of IDD Elimination
Universal Salt Iodization
Strategy
Oversight
Advocacy Evaluation
and and
Social Mobilization Surveillance
Abdul Rehman Pirzado

17. Advocacy & Social Mobilization
• Accepting the magnitude of the problem
• Overcoming some resistance to universal salt iodization
• Establishing the safety of potassium iodate
• Setting adequate and safe salt iodine levels
• Salt is not an unhealthy product
• Iodization is enrichment of a commonly eaten food
• Support large companies also, not only the cottage industry
• Focus first on areas where success is attainable, not the
poorest and most remote
Abdul Rehman Pirzado

18. Evaluation & Surveillance
• WHO 2007 Resolution: Efforts to eliminate IDD require continuous
monitoring and oversight and require Member States to establish
mechanisms for monitoring iodine nutrition and reporting on their
progress.
• UIE trends in school-aged children to be complemented with iodine
status of pregnant and lactating women.
• Monitoring of iodine status should not only check for deficiency but
also highlight excess.
Abdul Rehman Pirzado

19. Source:
de Benoist B et al. Iodine deficiency in 2007: Global progress since 1993.
Food and Nutrition Bulletin, vol 29, no. 3, 195-202, September 2008.
Category of public health significance
(based on median urinary iodine)
Moderate iodine deficiency (20-49 µg/l)
Mild iodine deficiency (50-99 µg/L)
Optimal (100-199 µg/l)
Risk of iodine induced hyperthyroidism (200-299 µg/l)
Risk of adverse health consequences (>300 µg/l)
No data
Degree of public health significance of iodine nutrition based on median urinary iodine: 1993-2006
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever
on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities,
or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2009. All rights reserved
Abdul Rehman Pirzado

20. Abdul Rehman Pirzado

21. Abdul Rehman Pirzado

22. Situation in Pakistan
 Iodine Deficiency Disorder (IDD) is a public health problem in
Pakistan
 More than half of the population estimated to be at risk
 1989 Government of Pakistan initiated National Iodine
Deficiency Disorders (IDD) Control Program in the hilly areas
 2000 USI program with Provincial governments started
 2006 The USI Program was revitalized- piloted in 20 districts -
Nutrition Wing MoH ,MI, UNICEF and WFP - scaled up in
phases to 102 districts.
Abdul Rehman Pirzado

23. Situation in Pakistan
 2011- The National Nutrition Survey -household consumption of
iodized salt as 69 % compared to 17 % in 2001.
 Percentage of children 6-12 years with iodine deficiency by 28
(i.e. NNS 2011- 36 %: NNS 2001- 64 %).
 Percentage of women with iodine deficiency has increased by 30
(i.e. NNS 2011- 52 %: NNS 2001- 24 %)
 Prevalence of goiter among CBA women decreased to one third
as per NNS of 2011 and now stands at only 3 %.
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24. Abdul Rehman Pirzado

25. Conclusions
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26. Abdul Rehman Pirzado

27. Abdul Rehman Pirzado

28. Conclusions
• Iodine Deficiency Disorders are widespread in the world
affecting millions of people with a range of physical and
mental abnormalities.
• Universal Salt Iodization (USI) of all human and animal salt is
the global strategy for elimination of severe iodine deficiency.
• While tremendous progress has been made to make salt
iodization universal, 2 billion people are still at risk in the world
Abdul Rehman Pirzado

29. Conclusions
• Government Commitment is key for USI
• IDD knowledge needs to be embedded into health sector
infrastructure
• Continued advocacy efforts are needed particularly in Europe
• Expand iodization to include salt used in processed foods
• RDA is 150 µg/day for adults; 250 µg/day for pregnant and
nursing mothers
Abdul Rehman Pirzado