Europe at Risk for Iodine Deficiency Resurgence

醫(yī)景醫(yī)學(xué)新聞：歐洲面臨地方性甲狀腺腫大復(fù)蘇的風(fēng)險(xiǎn)

Sheena Meredith, MBBS, MPhil

June 28, 2024

Dietary trends away from dairy products, plus the increasing popularity of plant-based alternative milks, have contributed to an increased risk for iodine deficiency across Europe, according to a new report by the World Health Organization (WHO) Regional Office for Europe and the Iodine Global Network (IGN). The report notes that most salt consumption now comes from meals prepared out of the home and processed foods, which may use noniodized salt, and urgently calls for iodine fortification of all salt and plant-based alternatives to dairy products.

"Even mild [iodine] deficiency, which exists throughout Europe, has a major impact on population health and the economy," said Werner Schultink, PhD, executive director of the IGN, in a press release for the report launch.

The report notes that historically, much of the European population was affected by endemic iodine deficiency. A century ago, severe deficiency disorders such as endemic goiter, clinical hypothyroidism, and severe congenital iodine deficiency disorder (previously referred to as cretinism) were widespread. Preventive measures, including salt iodization, mean these are now controlled. However, mild iodine deficiency remains "a widespread problem in the European region," the report said. 

根據(jù)世界衛(wèi)生組織(WHO)歐洲區(qū)域辦事處和碘全球網(wǎng)絡(luò)(IGN)的一份新報(bào)告，遠(yuǎn)離乳制品的飲食趨勢，加上植物替代牛奶的日益流行，已經(jīng)導(dǎo)致了歐洲各地地方性甲狀腺腫大的風(fēng)險(xiǎn)增加。

報(bào)告指出，現(xiàn)在大多數(shù)食鹽消費(fèi)來自家庭準(zhǔn)備的膳食和加工食品，這些食品可能使用非碘鹽，并緊急呼吁所有食鹽和植物性替代品的碘強(qiáng)化奶制品。

IGN 的執(zhí)行董事沃納·舒爾廷克博士在發(fā)布報(bào)告的新聞稿中說: “即使是歐洲各地普遍存在的輕度碘缺乏癥，也會(huì)對人口健康和經(jīng)濟(jì)產(chǎn)生重大影響?！?/span>

報(bào)告指出，從歷史上看，大部分歐洲人口都受到地方性地方性甲狀腺腫大的影響。一個(gè)世紀(jì)以前，地方性甲狀腺腫、臨床甲狀腺功能減退癥和嚴(yán)重的先天性地方性甲狀腺腫大障礙(以前稱為克汀病)等嚴(yán)重缺陷性疾病廣泛存在。包括食鹽加碘在內(nèi)的預(yù)防措施意味著這些問題現(xiàn)在得到了控制。然而，報(bào)告稱，輕微的地方性甲狀腺腫大仍然是“歐洲地區(qū)普遍存在的問題”。

Health Risks Across the Lifespan

終生健康風(fēng)險(xiǎn)

The potential consequences of iodine deficiency include effects on brain development in early life and increased risk for goiter, thyroid nodules, and hyperthyroidism in adults; the risks of untreated hyperthyroidism include cardiac arrhythmia, heart failure, osteoporosis, adverse pregnancy outcomes, and cognitive impairment in older people. 

Yet recent changes in dietary habits have led to a heightening risk for minor iodine deficiency since the last WHO report was published 15 years ago.

"The shift towards plant-based dairy alternatives, particularly among women, who already bear a higher risk of iodine deficiency and thyroid diseases than men, is concerning for their iodine nutrition, especially in countries relying on milk as a source of iodine, as most dairy alternatives do not contain it," said Dr Hans Henri Kluge, WHO's regional director for Europe, in the press release. He warned that the problem could be reemerging in some countries in the region.

地方性甲狀腺腫大的潛在后果包括對早期大腦發(fā)育的影響，增加成年人甲狀腺腫大、甲狀腺結(jié)節(jié)和甲狀腺功能亢進(jìn)的風(fēng)險(xiǎn)，未經(jīng)治療的甲狀腺功能亢進(jìn)的風(fēng)險(xiǎn)包括心律不整、心力衰竭、骨質(zhì)疏松、不良妊娠結(jié)局和老年人的認(rèn)知障礙。然而，自15年前世衛(wèi)組織發(fā)布上一份報(bào)告以來，近期飲食習(xí)慣的變化已導(dǎo)致輕微地方性甲狀腺腫大的風(fēng)險(xiǎn)加大。

世衛(wèi)組織歐洲地區(qū)主任漢斯 · 亨利 · 克魯格博士在新聞發(fā)布會(huì)上說: “轉(zhuǎn)向植物性乳制品替代品的趨勢，特別是在女性中，她們患地方性甲狀腺腫大和甲狀腺疾病的風(fēng)險(xiǎn)已經(jīng)高于男性，這關(guān)系到她們的碘營養(yǎng)，特別是在依賴牛奶作為碘來源的國家，因?yàn)榇蠖鄶?shù)乳制品替代品不含碘?！?。他警告說，這個(gè)問題可能會(huì)在該地區(qū)的一些國家重新出現(xiàn)。

Pre-Prepared Foods Now Large Source of Salt Intake

預(yù)制食品現(xiàn)在是大量的鹽攝入來源

Salt iodization remains the main strategy across Europe to ensure adequate iodine intake, but this too has been affected by dietary and lifestyle changes. Foods produced or cooked outside the home, such as bread, processed meats, or ready-to-eat meals, are now "the main sources of salt in a western diet," the WHO said, comprising 70%-80% of the total. These foods are often prepared using non-iodized salt. For example, surveys have shown that only 34% of salt in processed foods in Switzerland was iodized, and the proportion was as low as 9% in Germany. 

Many countries in Europe already acknowledge the benefits of fortifying certain food staples with iodized salt, such as bread, said Rodrigo Moreno-Reyes, MD, PhD, lecturer on endocrine physiology at the Université Libre de Bruxelles and IGN's regional coordinator for Western and Central Europe, speaking to Medscape Medical News.

"In countries where the use of iodized food-grade salt in households and processed foods is mandatory, particularly in domestic products such as bread, bakery, and processed meats, population iodine status is generally adequate," he said.

Similarly, in countries with more than 80% use of iodized salt in the bakery industry, such as Armenia, Belarus, Belgium, Georgia, Moldova, and the Netherlands, population iodine intake and status are optimal, he explained. 

食鹽加碘仍然是整個(gè)歐洲確保充足碘攝入量的主要戰(zhàn)略，但這也受到飲食和生活方式變化的影響。世界衛(wèi)生組織說，在家庭以外生產(chǎn)或烹飪的食物，如面包、加工肉類或即食餐，現(xiàn)在是“西方飲食中鹽的主要來源”，占總量的70% -80% 。這些食品通常使用非碘鹽制備。例如，調(diào)查顯示，在瑞士，加工食品中只有34% 的鹽含碘，而在德國，這一比例只有9% 。

醫(yī)學(xué)博士、內(nèi)分泌生理學(xué)講師、 IGN 西歐和中歐地區(qū)協(xié)調(diào)員羅德里戈 · 莫雷諾-雷耶斯(Rodrigo Moreno-Reyes)在接受《醫(yī)景醫(yī)學(xué)新聞》(Medscape Medical News)采訪時(shí)表示，許多歐洲國家已經(jīng)認(rèn)識到用面包等加碘鹽強(qiáng)化某些主要食品的益處。他說: “在那些家庭和加工食品必須使用加碘食品級鹽的國家，特別是在面包、烘焙和加工肉制品等國內(nèi)產(chǎn)品中，人口的碘狀況一般是適當(dāng)?shù)??！?。同樣，在面包業(yè)中碘鹽使用率超過80% 的國家，如亞美尼亞、白俄羅斯、比利時(shí)、格魯吉亞、摩爾多瓦和荷蘭，人口碘攝入量和狀況是最佳的，他解釋說。

Salt: The Optimal Fortification Vehicle

鹽: 最佳的防御工具

Salt iodization is a highly cost-effective intervention, he added. The WHO/IGN report notes that salt is "an optimal vehicle for iodine fortification." 

他補(bǔ)充說，食鹽加碘是一種成本效益很高的干預(yù)措施。世界衛(wèi)生組織/IGN 的報(bào)告指出，鹽是“碘強(qiáng)化的最佳工具?！?/span>

Report co-author Maria Andersson, PhD, a dietitian and senior scientist at University Children's Hospital Zürich in Switzerland, explained to Medscape Medical News that compared with wheat flour fortification, salt is a vehicle consumed by everyone in the population in relatively small amounts. "It reaches everyone in the general population," she said, with no risk for excessive intake because the level of iodine in iodized salt is adapted to the current salt intake. 

Furthermore, she added, it is relatively easy and cheap to add iodine to salt, and the iodine content is stable if salt is properly packed, which is the case in Europe.

However, the report highlights that mandatory fortification with iodine in many countries applies only or mainly to table salt, and not to that used in food production. At the same time, people are consuming more processed and less home-cooked food, to which they might add table salt, and they are also consuming less iodine-rich food, such as dairy milk and fish. 

Dietary trends such as these have more bearing on the issue than does recent public health advice to reduce salt consumption, Andersson explained. However, "as less salt is consumed, it is even more important that it is iodized."

Although the escalating consumption of processed foods has also been blamed for the obesity epidemic now affecting much of Europe, iodine deficiency is not directly associated with obesity. "If most salt consumed is iodized, the iodine intake will be sufficient."

報(bào)告的共同作者瑪麗亞 · 安德森博士是瑞士蘇黎世大學(xué)兒童醫(yī)院的營養(yǎng)學(xué)家和資深科學(xué)家，他向 Medscape 醫(yī)學(xué)新聞解釋說，與強(qiáng)化面粉相比，鹽是人們消耗相對較少量的一種工具。她說: “這種情況普遍存在于每個(gè)人身上?！庇捎诘恹}中的碘含量適應(yīng)當(dāng)前的食鹽攝入量，因此不存在過量攝入的風(fēng)險(xiǎn)。

此外，她補(bǔ)充說，在食鹽中添加碘相對容易和便宜，而且如果食鹽包裝得當(dāng)，碘的含量是穩(wěn)定的，歐洲就是這種情況。然而，該報(bào)告強(qiáng)調(diào)，在許多國家，強(qiáng)制性碘強(qiáng)化只適用于或主要適用于食鹽，而不適用于食品生產(chǎn)中使用的碘。與此同時(shí)，人們食用的加工食品越來越多，家庭烹飪的食品越來越少，他們可能會(huì)在食品中加入食鹽，而且他們也在食用含碘量較低的食品，如牛奶和魚。（壹佰提示：安德森博士補(bǔ)充說與本地飲食新常態(tài)情形大致類似?。?/span>

安德森解釋說，這樣的飲食趨勢比最近的公共健康建議對減少鹽消費(fèi)有更大的影響。然而，“隨著食鹽消耗量的減少，加碘更為重要?！氨M管加工食品消費(fèi)的不斷增加也被認(rèn)為是目前影響歐洲大部分地區(qū)的肥胖癥流行的原因，但地方性甲狀腺腫大與肥胖癥沒有直接聯(lián)系?！叭绻秤玫拇蟛糠质雏}都加了碘，碘的攝入量就足夠了。”（壹佰提示：修訂中的《食鹽加碘消除碘缺乏危害管理?xiàng)l例》涉及有關(guān)“如果食用的大部分食鹽都加了碘”的針對性細(xì)化措施確可應(yīng)對且有領(lǐng)先，也給歐州方面提供了可借鑒之處。但實(shí)施仍須落實(shí)配套普及科學(xué)補(bǔ)碘的健康教育，到位未加碘食鹽的食品標(biāo)簽標(biāo)識適宜人群等警示語，幫助消費(fèi)者自覺科學(xué)補(bǔ)碘、按需在公布網(wǎng)點(diǎn)選購未加碘食鹽！《食鹽加碘消除碘缺乏危害管理?xiàng)l例》（司法部20200102征求意見稿）相關(guān)內(nèi)容：

第六條  各地應(yīng)當(dāng)向公眾宣傳碘缺乏危害和甲狀腺疾病相關(guān)知識，引導(dǎo)群眾科學(xué)補(bǔ)碘。

第十三條  在碘缺乏地區(qū)銷售的食鹽，應(yīng)當(dāng)為符合食用鹽碘含量標(biāo)準(zhǔn)的加碘食鹽。

在碘缺乏地區(qū)，餐飲服務(wù)提供者以及集中用餐單位的食堂，應(yīng)當(dāng)使用符合食用鹽碘含量標(biāo)準(zhǔn)的加碘食鹽。

第十四條  因疾病等情況不宜食用加碘食鹽的，在醫(yī)師指導(dǎo)下選擇未加碘食鹽。

各地鹽業(yè)主管部門和衛(wèi)生主管部門應(yīng)當(dāng)向社會(huì)公布本轄區(qū)內(nèi)未加碘食鹽銷售網(wǎng)點(diǎn)的相關(guān)信息。

第十五條  加工食品應(yīng)當(dāng)使用加碘食鹽；為滿足特定人群需求使用未加碘食鹽的需在標(biāo)簽上注明。

第二十一條  市場銷售的食鹽應(yīng)當(dāng)為小包裝食鹽，并有明顯的加碘食鹽標(biāo)識、碘含量水平標(biāo)注或者未加碘食鹽標(biāo)識，注明適宜人群或不宜人群。）

Double Burden: Overfed but Undernourished

雙重負(fù)擔(dān): 營養(yǎng)過剩

The escalating consumption of processed foods has also been blamed for the obesity epidemic now affecting much of Europe. 

加工食品消費(fèi)的不斷增加也被認(rèn)為是目前影響歐洲大部分地區(qū)的肥胖流行病的罪魁禍?zhǔn)住?/span>

The coexistence of iodine deficiency and overweight/obesity is known as the "double burden of malnutrition," said Sarah Bath, PhD, senior lecturer in public health nutrition at the UK's University of Surrey and a registered dietitian with a main research interest in iodine. This can apply within individuals and at the population level and involves overnutrition and undernutrition coinciding with each other. 

"Diets may be high in energy but low in other nutrients, particularly micronutrients including iodine," she said.

The WHO/IGN report stresses that the health risks of minor iodine deficiency are particularly high for women during pregnancy because they have higher iodine needs, and iodine intake is especially important for fetal brain development prior to and during pregnancy. Yet women are more likely to switch away from dairy consumption and favor plant-based milks as an alternative.

The WHO Regional Office for Europe and the IGN issued an urgent joint call for iodine fortification of all salt and plant-based dairy alternatives across the WHO European region. Although policies to reduce sodium intake are important, the report's authors say people should be advised to use less, but always iodized, salt to prevent iodine deficiency.

地方性甲狀腺腫大和超重/肥胖并存被稱為“營養(yǎng)不良的雙重負(fù)擔(dān)”，英國薩里大學(xué)公共衛(wèi)生營養(yǎng)學(xué)高級講師、主要研究碘的注冊營養(yǎng)師薩拉?巴斯博士說。這可以適用于個(gè)人和群體層面，并涉及營養(yǎng)過剩和營養(yǎng)不足相互重疊。她說: “飲食中的能量含量可能很高，但其他營養(yǎng)素含量卻很低，尤其是碘等微量營養(yǎng)素。”。

世界衛(wèi)生組織/國際孕婦研究所的報(bào)告強(qiáng)調(diào)，少量地方性甲狀腺腫大對婦女在懷孕期間的健康風(fēng)險(xiǎn)特別高，因?yàn)樗齻儗Φ獾男枨筝^高，而攝入碘對于懷孕前和懷孕期間胎兒的大腦發(fā)育特別重要。然而，女性更有可能放棄乳制品的消費(fèi)，轉(zhuǎn)而青睞植物性牛奶作為替代品。

世衛(wèi)組織歐洲區(qū)域辦事處和全球營養(yǎng)網(wǎng)絡(luò)發(fā)出緊急聯(lián)合呼吁，要求在世衛(wèi)組織歐洲區(qū)域強(qiáng)化所有鹽和植物性乳制品替代品的碘營養(yǎng)。盡管減少鈉攝入量的政策很重要，但報(bào)告的作者表示，應(yīng)該建議人們少用，但一直都是加碘的鹽來預(yù)防地方性甲狀腺腫大。

Credits:

Lead image: E+/Getty Images

Image 1: Dr Maria Andersson

Image 2: Dr Sarah Bath

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Cite this: Europe at Risk for Iodine Deficiency Resurgence - Medscape - June 28, 2024.

引用此文: 歐洲面臨地方性甲狀腺腫大復(fù)蘇的風(fēng)險(xiǎn)-梅德斯普-2024年6月28日。

——本文參考資料鏈接引自鹽業(yè)部落《WHO/IGN報(bào)告：風(fēng)險(xiǎn)增加！食鹽補(bǔ)碘成關(guān)鍵》，供參考的英翻中內(nèi)容政法欄目管理員使用360翻譯。https://www.medscape.com/viewarticle/europe-risk-iodine-deficiency-resurgence-2024a1000c3k?src=rss&form=fpf