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Published on: February 2, 2017
Obesity and Monitoring Iodine Nutritional Status in Schoolchildren: is Body Mass Index a Factor to Consider?
Simona De Angelis1, Marcello Bagnasco2, Mariacarla Moleti3
1Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Italian National Institute of Health, Rome, Italy.
Insights
Rising childhood overweight and obesity rates may impact iodine status assessments. Body Mass Index (BMI) is a factor to consider in global salt iodization programs.
Area of Science:
- Pediatric Endocrinology
- Nutritional Science
- Public Health
Background:
- Global increase in childhood overweight (OW) and obesity (OB) raises concerns about its impact on population health metrics.
- No prior studies have investigated the influence of increasing OW and OB prevalence on the evaluation of iodine nutritional status in schoolchildren.
- This research addresses a critical gap in understanding potential confounding factors in nutritional monitoring.
Purpose of the Study:
- To determine if Body Mass Index (BMI) affects key indicators of iodine status: urinary iodine concentration (UIC), thyroid volume (TV), and thyroid hypoechogenicity in schoolchildren.
- To assess the interplay between weight status (OW, OB, adequate weight - AW) and iodine status markers across different iodine intake areas.
- To inform public health strategies for accurate iodine status assessment in the context of rising childhood obesity.
Main Methods:
- A cross-sectional study involving 1665 schoolchildren (aged 11-13 years) from iodine-sufficient (IS) and mildly iodine-deficient (ID) areas in Italy (2015-2019).
- Measurements included spot urinary iodine concentration (UIC), thyroid ultrasound for thyroid volume (TV), and assessment of thyroid hypoechogenicity.
- Statistical analyses, including regression, were performed adjusting for sex and age to evaluate the association between BMI categories (AW, OW, OB) and iodine status indicators.
Main Results:
- Lower UIC values were observed in obese children compared to adequate weight children in the iodine-sufficient group after adjusting for covariates (beta = -34.09).
- Thyroid volume was significantly larger in obese children compared to adequate weight children in both IS and ID groups (p < 0.001 and p = 0.012, respectively).
- Thyroid hypoechogenicity was more frequent in the iodine-deficient group and significantly higher in obese children compared to adequate weight children in both groups (p < 0.01).
Conclusions:
- Body Mass Index (BMI) is a significant confounding factor in the assessment of iodine nutritional status in schoolchildren.
- The rising prevalence of overweight and obesity necessitates consideration of BMI in the monitoring of salt iodization programs, particularly in Western countries.
- Accurate iodine status evaluation requires accounting for weight status to ensure effective public health interventions.
Abstract:
The frequency of overweight (OW) and obese (OB) children has increased worldwide, particularly in economically developed countries. No studies have been conducted to verify whether the increasing frequency of OW and obesity in schoolchildren may affect the evaluation of iodine nutritional status in populations. The aim of this study was to verify whether urinary iodine concentration (UIC), thyroid volume (TV), and thyroid hypoechoic pattern may be affected by body mass index (BMI) in schoolchildren. The children included in this study (aged 11-13 years) were a part of the schoolchildren recruited in the second nationwide survey (period 2015-2019) conducted in Italy to monitor by law (Atto di Intesa Stato-Regioni February 26, 2009) the nationwide iodine prophylaxis program. Specifically, 1281 schoolchildren residing in iodine-sufficient areas (IS group) and 384 children residing in a still mildly iodine-deficient area (ID group) were recruited between January and March 2015 in the first-degree secondary state schools. In all the children, spot UIC was measured, thyroid ultrasound was performed to evaluate TV, and hypoechogenicity was assessed to indirectly evaluate iodine-associated thyroid autoimmunity. The frequency of OW, OB, and adequate weight (AW) children was similar in the IS and ID groups at any age. After adjusting for sex and age, the regression analysis showed lower UIC values in OB children than in AW children of the IS group (beta coefficient = -34.09 [95% confidence interval -65.3 to -2.8]), whereas no significant differences were observed in the ID group. In both the IS and ID groups, the distribution of TV in AW children was significantly shifted toward lower values in comparison to the distribution of OB children (p < 0.001 in the IS group; p = 0.012 in the ID group). Furthermore, the frequency of thyroid hypoechogenicity was higher in the ID group than in the IS group (10.9% vs. 6.6%, p = 0.005); however, in both groups, it was significantly lower in AW children than in OB children (p < 0.01). This study for the first time demonstrates that BMI may be a confounding factor in monitoring iodine nutritional status in schoolchildren. Since in Italy as in other Western countries the number of OW and OB children is high, BMI is a factor to consider in monitoring salt iodization programs worldwide.
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