Urinary Iodine Concentration and Mortality Among U.S. Adults

Inoue, Kosuke; Leung, Angela M.; Sugiyama, Takehiro; Tsujimoto, Tetsuro; Makita, Noriko; Nangaku, Masaomi; Ritz, Beate

doi:10.1089/thy.2018.0034

Cited by 29 publications

(26 citation statements)

References 37 publications

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“…To the best of our knowledge, there is only one previous epidemiological study assessing the association between iodine status and mortality with a prospective design and interestingly, the results are not concordant with our study (41). participants with excess iodine exposure (UI >400 lg/L) were at a higher risk of all-cause mortality compared with those with adequate iodine nutrition (HR, 1.19; [CI 1.04-1.37]), whereas low UI concentration was not associated with an increased mortality.…”

Section: Discussioncontrasting

confidence: 98%

Iodine Deficiency and Mortality in Spanish Adults: Di@bet.es Study

Maldonado-Araque

Valdés

Badía-Guillén

et al. 2021

Thyroid

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Background: Longitudinal data assessing the impact of iodine deficiency (ID) on mortality are scarce. We aimed to study the association between the state of iodine nutrition and the risk of total and cause-specific mortality in a representative sample of the Spanish adult population. Methods: We performed a longitudinal observational study to estimate mortality risk according to urinary iodine (UI) concentrations using a sample of 4370 subjects >18 years representative of the Spanish adult population participating in the nationwide study Di@bet.es (2008-2010). We used Cox regression to assess the association between UI at the start of the study (<50, 50-99, 100-199, 200-299, and ‡300 lg/L) and mortality during followup (National death registry-end of follow-up December 2016) in raw models, and adjusted for possible confounding variables: age, sex, educational level, hypertension, diabetes, obesity, chronic kidney disease, smoking, hypercholesterolemia, thyroid dysfunction, diagnosis of cardiovascular disease or cancer, area of residence, physical activity, adherence to Mediterranean diet, dairy and iodinated salt intake. Results: A total of 254 deaths were recorded during an average follow-up period of 7.3 years. The causes of death were cardiovascular 71 (28%); cancer 85 (33.5%); and other causes 98 (38.5%). Compared with the reference category with adequate iodine nutrition (UI 100-300 lg/L), the hazard ratios (HRs) of all-cause mortality in the category with UI ‡300 lg/L were 1.04 (95% confidence interval [CI 0.54-1.98]); however, in the categories with 50-99 UI and <50 lg/L, the HRs were 1.29 [CI 0.97-1.70] and 1.71 [1.18-2.48], respectively (p for trend 0.004). Multivariate adjustment did not significantly modify the results. Conclusions: Our data indicate an excess mortality in individuals with moderate-severe ID adjusted for other possible confounding factors.

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Section: Discussioncontrasting

confidence: 98%

Iodine Deficiency and Mortality in Spanish Adults: Di@bet.es Study

Maldonado-Araque

Valdés

Badía-Guillén

et al. 2021

Thyroid

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“…Therefore, the findings of this study are not generalizable to women with thyroid diseases. In addition, we did not have information on iodine intake in the women, and iodine is an essential micronutrient necessary for the synthesis of THs and preventing long-term adverse health outcomes (Inoue et al. 2018; Zimmermann and Boelaert 2015).…”

Section: Discussionmentioning

confidence: 99%

Perfluoroalkyl Substances and Maternal Thyroid Hormones in Early Pregnancy; Findings in the Danish National Birth Cohort

Inoue

Ritz

Andersen

et al. 2019

Environ Health Perspect

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Background:Maternal thyroid hormones are essential for fetal brain development in early gestation. Perfluoroalkyl substances (PFASs)—widespread and persistent pollutants—have been suggested to interfere with maternal thyroid hormones in the second or third trimesters, but evidence for an association in the early pregnancy period is sparse.Objectives:Our goal was to evaluate the gestational-week specific associations of maternal thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels with plasma concentrations of six PFAS chemicals in the first and second pregnancy trimester.Methods:A cross-sectional analysis was conducted using 1,366 maternal blood samples collected between gestational weeks (GWs) 5 and 19 (median, 8 gestational weeks) in the Danish National Birth Cohort (DNBC) during 1996–2002. We estimated the percentage changes of serum TSH and fT4 levels according to concentrations (in nanograms per milliliter) of six PFAS chemicals modeled as per interquartile range (IQR) increase or by exposure quartiles. Moreover, we contrasted the estimated week-specific TSH or fT4 levels by PFAS quartile and estimated ORs for binary high or low TSH and fT4 status based on the week-specific distribution according to IQR increase of PFAS.Results:TSH levels followed a U-curve trend in early pregnancy with a nadir at GW10, whereas fT4 levels were less fluctuated in the samples. There were no apparent associations between any of the PFASs and changes of average TSH or fT4 levels in total samples. In gestational-week–specific analyses, we found that the estimated TSH values were higher among the highest perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS), and perfluoroheptane sulfonate (PFHpS) quartiles compared with the lower quartiles from GW5 to GW10, but the difference became null or even reversed after GW10. For binary outcomes, perfluorodecanoic acid (PFDA) was associated with high fT4 status before GW10 [OR=1.46 (95% CI: 1.04, 2.05)].Conclusions:We observed some gestational-week–specific associations between high exposure to several PFAS and TSH level in early gestations. Further research of the biology and the potential clinical impact regarding thyroid hormones disruptions in early pregnancy is needed. https://doi.org/10.1289/EHP5482

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“…They also documented younger age, lower BMI, and a lower prevalence of diabetes and hypertension in subjects with higher UIC [21]. An observational study involving 12,264 adult participants in the US National Health and Nutritional Examination Survey III (NHANES III, 1988-1994) documented a median UIC of 140 µg/L [22]. Over a follow-up of around 19 years, higher all-cause mortality was recorded in subjects with very high UIC (≥400 µg/L) than in those with normal UIC [22].…”

Section: Discussionmentioning

confidence: 99%

“…An observational study involving 12,264 adult participants in the US National Health and Nutritional Examination Survey III (NHANES III, 1988-1994) documented a median UIC of 140 µg/L [22]. Over a follow-up of around 19 years, higher all-cause mortality was recorded in subjects with very high UIC (≥400 µg/L) than in those with normal UIC [22]. However, in our cohort, UIC values over 300 µg/L were mostly due to iodine contamination (e.g., amiodarone or iodized contrast media) rather than to excessive dietary intake, since the majority of these UIC values in clinical records corresponded to UIC assessed after a diagnostic procedure with iodinated contrast medium.…”

Section: Discussionmentioning

confidence: 99%

Urinary Iodine Concentration in a Cohort of Adult Outpatients with Thyroid Diseases in Liguria 14 Years after the Law on Salt Iodization

et al. 2019

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Italy is considered a mildly iodine-deficient country. The aim of this study was to evaluate the iodine status of a cohort of adults living in Liguria after the 2005 salt iodization program. We searched all medical records of patients examined in two endocrine outpatient clinics in Genoa and Savona for data on urinary iodine. Subjects were under evaluation for thyroid diseases. Information on the type of salt used was found in few clinical records. Iodized salt use was reported in 29%, 20%, and 13% of records of people living in Genoa districts, the Savona district and nearby districts, respectively. The average urinary iodine concentration was 112.9 ± 62.3 µg/L (n = 415, median 101.0 µg/L). Non-significant differences (P > 0.05) were found between subjects with (median 103.5 µg/L) and without (median 97.5 µg/L) a thyroid gland, between the periods 2009–2013 (median 105.0 µg/L) and 2014–2018 (median 97.5 µg/L), and between Genoa (median 94.0 µg/L), Savona (median 105.0 µg/L) and the other districts (median 114.5 µg/L). No correlation with age, body mass index, creatinine, free thyroxine, thyroglobulin, levo-thyroxine dosage, or thyroid volume was observed. These data suggest a borderline status of iodine sufficiency in this cohort.

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Urinary Iodine Concentration and Mortality Among U.S. Adults

Cited by 29 publications

References 37 publications

Iodine Deficiency and Mortality in Spanish Adults: Di@bet.es Study

Iodine Deficiency and Mortality in Spanish Adults: Di@bet.es Study

Perfluoroalkyl Substances and Maternal Thyroid Hormones in Early Pregnancy; Findings in the Danish National Birth Cohort

Urinary Iodine Concentration in a Cohort of Adult Outpatients with Thyroid Diseases in Liguria 14 Years after the Law on Salt Iodization

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