Impact of protein energy malnutrition on thyroid size in an iodine deficient population of Gujarat (India): Is it an aetiological factor for goiter?

Abstract

Objective: To assess the severity of protein energy malnutrition (PEM) in iodine deficient subjects and to assess the impact of PEM on thyroid size. Methods: 1002 subjects (530 school-aged children and 472 adults) were assessed for PEM by direct anthropometric measurements of height, weight, triceps skinfold (TSF) thickness, mid upper arm circumference (MUAC) and thigh circumference (TC), and derived indices of body surface area (BSA), body mass index (BMI), and Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-forheight (WHZ). Severity of PEM was based on the World Health Organization (WHO) criteria and the threshold on the Waterlow classification. Thyroid size was measured by ultrasonography to determine the thyroid volume (TV). Linear regression analysis was performed between TV and anthropometric parameters. Results: Children had severe PEM as evident from the WHO percentage prevalence of stunting HAZ , 22SD 64% (where , 22SD is the Z-score deficit), wasting WHZ , 22SD 43%Y underweight WAZ , 22SD 82% and BMI , 16 kgam 2 90%X Waterlow classification showed that children were either stunted or wasted, or stunted and wasted, or stunted and obese. Nearly 100% (529/530) of the children had goiter as evidenced from enlarged TV-for-BSA when compared with the WHO reference. There was a weak but statistically significant P , 0X05 positive correlation between TV and BSA, weight, height, MUAC, TC and HAZ but a negative correlation between TV and WHZ, BMI and TSF r 20X1±0X2XAdults had PEM as evident from BMI , 18X5 kgam 2 in 54% subjects. Median MUAC 22X7 cm reveals prolonged severe PEM. Eighty-two percent had enlarged TV (.20 ml). There was a significant P 0X01 negative correlation between TV and MUAC. Conclusions: (i) The severity of acute (wasting) and chronic (stunting) PEM is very high in Gujarati children. They are stunted or wasted, or stunted and wasted, or stunted and obese. Gujarati adults are thin with low protein and fat reserves. (ii) Anthropometric parameters showed a significant P , 0X001 correlation r 0X1±0X2 with thyroid size. (iii) Higher prevalence of goiter may be due to macro-nutrient malnutrition (PEM) in the face of micro-nutrient malnutrition (iodine deficiency disorders, IDD).

Iodine nutrition in elementary state schools of Queretaro, Mexico: correlations between urinary iodine concentration with global nutrition status and social gap index

“…This is particularly relevant in places such as Pinal de Amoles, which had the lowest median UIC and the highest SGI and stunting prevalence. This finding is in accordance with previous reports, such as those from Indonesia (19) and India (30). In these studies, iodine deficiency was associated with height SDS and intelligence quotient, and undernutrition and poverty, respectively.…”

Thyroid volume, selenium levels and nutritional habits in a rural region in Albania

“…There are reports which correlate the manifestation of goiter with elements of diet other than iodine, such as low levels of selenium, the consumption of foods rich in thiocyanate, the insufficiency of vitamin A, iron deficiency and low intake of proteins. 7,9,[16][17][18] The countries in which studies were conducted in order to assess the effect of dietary factors in patients with sufficient intake of iodine and which found a correlation with the above-mentioned parameters are mainly developing countries that have serious problems with malnutrition. It is possible that in our study the lower meat intake may have contributed to mild deficiencies in various micronutrients; however, in this population we did not measure iron or vitamin A concentrations.…”

“…Such nutritional factors include iodine, selenium, vitamin A and iron as well as foods containing thiocyanates and proteins. [6][7][8][9][10] The purpose of this paper was to study thyroid status in inhabitants of the region of Gyrocaster in Southwestern Albania, who were attending the outpatients' clinic for routine examination, in relation to their dietary habits and their socioeconomic level.…”

Thyroid disorders in India: An epidemiological perspective

“…However, it is not clear whether these results are applicable to the general Indian population. [16] In the state of Gujarat, the same group had reported that iodine deficiency continues to be a problem, as more than 20% of the population had a very low median urinary iodine of <50 ΅g/l. [17] In the same population, the prevalence of hypothyroidism has been reported to be about 7%.…”