文章作者:梅德斯普 发表日期:2024-07-05 浏览次数:467次

Europe at Risk for Iodine Deficiency Resurgence


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. 




IGN 的执行董事沃纳·舒尔廷克博士在发布报告的新闻稿中说: “即使是欧洲各地普遍存在的轻度碘缺乏症,也会对人口健康和经济产生重大影响。”



Health Risks Across the Lifespan


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 failureosteoporosis, 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.



世卫组织欧洲地区主任汉斯 · 亨利 · 克鲁格博士在新闻发布会上说: “转向植物性乳制品替代品的趋势,特别是在女性中,她们患地方性甲状腺肿大和甲状腺疾病的风险已经高于男性,这关系到她们的碘营养,特别是在依赖牛奶作为碘来源的国家,因为大多数乳制品替代品不含碘。”。他警告说,这个问题可能会在该地区的一些国家重新出现。



Pre-Prepared Foods Now Large Source of Salt Intake


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. 


食盐加碘仍然是整个欧洲确保充足碘摄入量的主要战略,但这也受到饮食和生活方式变化的影响。世界卫生组织说,在家庭以外生产或烹饪的食物,如面包、加工肉类或即食餐,现在是“西方饮食中盐的主要来源”,占总量的70% -80% 。这些食品通常使用非碘盐制备。例如,调查显示,在瑞士,加工食品中只有34% 的盐含碘,而在德国,这一比例只有9% 。

医学博士、内分泌生理学讲师、 IGN 西欧和中欧地区协调员罗德里戈 · 莫雷诺-雷耶斯(Rodrigo Moreno-Reyes)在接受《医景医学新闻》(Medscape Medical News)采访时表示,许多欧洲国家已经认识到用面包等加碘盐强化某些主要食品的益处。他说: “在那些家庭和加工食品必须使用加碘食品级盐的国家,特别是在面包、烘焙和加工肉制品等国内产品中,人口的碘状况一般是适当的。”。同样,在面包业中碘盐使用率超过80% 的国家,如亚美尼亚、白俄罗斯、比利时、格鲁吉亚、摩尔多瓦和荷兰,人口碘摄入量和状况是最佳的,他解释说。



Salt: The Optimal Fortification Vehicle

盐: 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." 

他补充说,食盐加碘是一种成本效益很高的干预措施。世界卫生组织/IGN 的报告指出,盐是“碘强化的最佳工具。”


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."

报告的共同作者玛丽亚 · 安德森博士是瑞士苏黎世大学儿童医院的营养学家和资深科学家,他向 Medscape 医学新闻解释说,与强化面粉相比,盐是人们消耗相对较少量的一种工具。她说: “这种情况普遍存在于每个人身上。”由于碘盐中的碘含量适应当前的食盐摄入量,因此不存在过量摄入的风险。



第六条  各地应当向公众宣传碘缺乏危害和甲状腺疾病相关知识,引导群众科学补碘。

第十三条  在碘缺乏地区销售的食盐,应当为符合食用盐碘含量标准的加碘食盐。


第十四条  因疾病等情况不宜食用加碘食盐的,在医师指导下选择未加碘食盐。


第十五条  加工食品应当使用加碘食盐;为满足特定人群需求使用未加碘食盐的需在标签上注明。

第二十一条  市场销售的食盐应当为小包装食盐,并有明显的加碘食盐标识、碘含量水平标注或者未加碘食盐标识,注明适宜人群或不宜人群。

Double Burden: Overfed but Undernourished

双重负担: 营养过剩

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



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.

地方性甲状腺肿大和超重/肥胖并存被称为“营养不良的双重负担”,英国萨里大学公共卫生营养学高级讲师、主要研究碘的注册营养师萨拉•巴斯博士说。这可以适用于个人和群体层面,并涉及营养过剩和营养不足相互重叠。她说: “饮食中的能量含量可能很高,但其他营养素含量却很低,尤其是碘等微量营养素。”。





Lead image: E+/Getty Images

Image 1: Dr Maria Andersson

Image 2: Dr Sarah Bath

Medscape Medical News © 2024 WebMD, LLC

Send comments and news tips to news@medscape.net.

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

引用此文: 欧洲面临地方性甲状腺肿大复苏的风险-梅德斯普-2024年6月28日。


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