Keywords
iodine
thyroid
goiter
autoimmunity
urinary iodine
thyroid
goiter
autoimmunity
urinary iodine
How to Cite
Vargas Uricoechea, H., Murillo Palacios, J., & Ramírez Bejarano, L. E. (2020). Analysis of the population status of iodine in Colombia and the need to modify the levels of universal iodization of salt. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 7(2), 87–98. https://doi.org/10.53853/encr.7.2.608
Abstract
Iodine deficiency and iodine excess have severe consequences on human health, and have been associated with the presence of goiter, hypothyroidism, hyperthyroidism, thyroid cancer, thyroid nodules and thyroid autoimmunity, as well as poor mental and intellectual development. Universal salt iodization programs have been considered one of the most cost-effective interventions for the prevention of iodine deficiency-associated disorders, as evidenced over time since the implementation of such programs. However, these efforts have also led to an excessive use of iodine in certain geographical regions, according to the overuse of salt. As such, the amount of iodine derived from the use of salt exceeds the established limits that are set to strike a balance between salt consumption and health benefits, thereby leading to undesirable health effects. In Colombia, the recommendations and standards for the production and commercialization of iodized salt are fully complied with. Nevertheless, there is a remarkable rate of iodine excess among the country’s population, which, at least hypothetically, represents a higher risk for developing functional and structural disorders of the thyroid gland. This review analyzes universal salt iodization programs, particularly, their impact on the thyroid and with focus on public health data from Colombia in response to the implementation of this strategy.
References
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3. Resolution WHO. WHA58.24. Sustaining the elimination of iodine deficiency disorders. In: Fifty-eighth World Health Assembly, Geneva, 25 May 2005. Geneva: WHO; 2005.
4. Yngve A, Tseng M. Salt: importance in iodine deficiency and sodium excess. Public Health Nutr. 2010;13(5):599-600.
5. Charlton K, Skeaff S. Iodine fortification: why, when, what, how, and who? Curr Opin Clin Nutr Metab Care. 2011;14(6):618-24.
6. Eastman CJ, Zimmermann MB. The Iodine Deficiency Disorders. [Updated 2018 Feb 6]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK285556/
7. Prabhu SR, Kannan S, Mahadevan S. Iodine Deficiency: An under Recognized Problem. Indian J Endocrinol Metab. 2017;21(4):640-1.
8. Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS One. 2017;12(3):e0173722.
9. Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci. 2019;1446(1):44-65.
10. Wang B, He W, Li Q, Jia X, Yao Q, Song R, et al. U-shaped relationship between iodine status and thyroid autoimmunity risk in adults. Eur J Endocrinol. 2019;181(3):255-266.
11. Woeber KA. Iodine and thyroid disease. Med Clin North Am. 1991;75(1):169-78.
12. Calil-Silveira J, Serrano-Nascimento C, Kopp PA, Nunes MT. Iodide excess regulates its own efflux: a possible involvement of pendrin. Am J Physiol Cell Physiol. 2016;310(7):576-82.
13. Markou K, Georgopoulos N, Kyriazopoulou V, Vagenakis AG. Iodine-Induced hypothyroidism. Thyroid. 2001;11(5):501-10.
14. Eng PH, Cardona GR, Fang SL, Previti M, Alex S, Carrasco N, Chin WW, et al. Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein. Endocrinology. 1999;140(8):3404-10.
15. Koukkou EG, Roupas ND, Markou KB. Effect of excess iodine intake on thyroid on human health. Minerva Med. 2017;108(2):136-46.
16. De la Vieja A, Santisteban P. Role of iodide metabolism in physiology and cancer. Endocr Relat Cancer. 2018;25(4):R225-R245.
17. Yildirim Simsir I, Cetinkalp S, Kabalak T. Review of Factors Contributing to Nodular Goitre and Thyroid Carcinoma. Med Princ Pract. 2020;29(1):1-5.
18. Cao LZ, Peng XD, Xie JP, Yang FH, Wen HL, Li S. The relationship between iodine intake and the risk of thyroid cancer: A meta-analysis. Medicine (Baltimore). 2017;96(20):e6734.
19. Kim HJ, Kim NK, Park HK, Byun DW, Suh K, Yoo MH, et al. Strong association of relatively low and extremely excessive iodine intakes with thyroid cancer in an iodine-replete area. Eur J Nutr. 2017;56(3):965-71.
20. Lv C, Yang Y, Jiang L, Gao L, Rong S, Darko GM, et al. Association between chronic exposure to different water iodine and thyroid cancer: A retrospective study from 1995 to 2014. Sci Total Environ. 2017;609:735-41.
21. Parra H. Simple goiter in Colombia. Am J Publ Health. 1948;38:820-4.
22. Góngora López J. Bocio simple y sal yodada en Colombia. Revista de Higiene (Bogotá) 1951;4:291-338.
23. Góngora A, López J, Mújica CF. Dos años de tratamiento del bocio simple con sal yodada en el departamento de Caldas. Medicina y Cirugía.1952;16:341-77.
24. Rueda R, Pardo F. La prevención del bocio endémico en Colombia. Boletín de la oficina sanitaria panamericana. 1966:495-503.
25. Carrillo JC. Evaluación de Desórdenes por Deficiencia de Yodo (DDI) en dos poblaciones de Casanare Colombia, 1984-1986. Bogotá: Nestlé, Servicio de información científica; 1988. Universidad Nacional de Colombia, Facultad de Medicina. ISBN-13: 978-8432223662.
26. Prevalencia de los Desórdenes por Deficiencia de Yodo e Ingestión Promedio de Sal. Colombia, 1994-1998. 1.a edición. Bogotá: Ministerio de Salud, Instituto Nacional de Salud, Instituto Colombiano de Bienestar Familiar, Sociedad Colombiana de Endocrinología, UNICEF-OPS/OMS, Colciencias; 2001.
27. Vargas-Uricoechea H, Sierra-Torres CH, Holguín-Betancourt CM, Cristancho-Torres L. Iodine-deficiency disorders. Permanent surveillance of vulnerable zones is poor. Medicina. (Bogotá).2012;34(2):119-44.
28. Control de los Desórdenes por deficiencia de Yodo en Colombia. Evaluación Externa. Ministerio de Salud/OPS/OMS. 1998:3-8.
29. Definición del problema para el análisis de impacto normativo relacionado con sal para consumo humano [internet]. Ministerio de Salud y ProtecReferencias ción Social; 2019 [acceso el 17 de agosto de 2019]. Disponible en:
https://www.minsalud.gov.co/Normativa/PublishingImages/Paginas/analisis-de-impacto-normativo/AIN_Sal.pdf
30. Eliminación sostenible de los desórdenes por deficiencia de yodo en Latinoamérica. Iodine, Unicef, OPS [acceso el 17 de agosto de 2019]. Disponible en:
http://www.ign.org/cm_data/Eliminacion_Sostenible_-_Espaol_Doc.pdf
31. Vargas-Uricoechea H, Pinzón-Fernández MV, Bastidas-Sánchez BE, JojoaTobar E, Ramírez-Bejarano LE, Murillo-Palacios J. Iodine Status in the Colombian Population and the Impact of Universal Salt Iodization: A DoubleEdged Sword? J Nutr Metab. 2019;2019:6239243.
32. Córdoba CA, Carrillo JC, Marín A. Current Status of Endemic Goiter and Salt Iodization in Colombia. En: Dunn JT, Pretell EA, Daza CH, Viteri F (editores). Towards the eradication of Endemic Goiter, Cretinism and Iodine Deficiency. PAHO/WHO; 1986. p. 280.
33. Control de los desórdenes por deficiencia de Yodo en Colombia. Evaluación Externa. Ministerio de Salud/OPS/OMS. 1998:3-8.
34. Vigilancia de concentraciones de yodo en sal, Colombia. Estudios centinela de yodo y flúor-fase I-2001. Semana Epidemiológica. 2001;49.
35. Gallego ML, Loango N, Londoño AL, Landázuri P. Niveles de excreción urinaria de yodo en escolares del Quindío, 2006–2007. Rev Salud Pública. 2009;11(6):952-60.
36. Cuéllar-Cuéllar AA. Desórdenes por deficiencia de yodo: bocio endémico, correlación entre la presencia de bocio y factores de crecimiento [internet]. Universidad Nacional de Colombia; 2010 [acceso el 18 de noviembre de 2017]. Disponible en: https://core.ac.uk/download/pdf/11055934.pdf
37. Londoño AL, Gallego ML, Bayona A, Landázuri P. Hypothyroidism prevalence and its relationship to high levels of thyroid peroxidase antibodies and urinary iodine in a population aged 35 and over from Armenia, 2009- 2010. Rev Salud Pública (Bogotá). 2011;13(6):998-1009.
38. Mora Thiriez S. Situación nutricional de yodo, presencia de bocio y función tiroidea en una población de mujeres embarazadas en la ciudad de Bogotá (Colombia) [internet]. Bogotá: Universidad Nacional de Colombia; 2015 [acceso el 17 de noviembre de 2017]. Disponible en:
http://www.bdigital.unal.edu.co/46629/1/05599139.2015.pdf
39. Vargas-Uricoechea H, Bastidas-Sánchez B, Perdomo-Cabrera M, Vargas-Sierra H. Estado nutricional del yodo. Implicación en la positividad de anticuerpos antitiroideos y posible autoinmunidad tiroidea en una población escolar declarada “libre de desórdenes por deficiencia de yodo”. Medicina (Bogotá). 2015;37(2):122-39.
40. WHO/UNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization [internet]. Geneva: World Health Organization; 1994 [acceso el 12 de agosto de 2017]. Disponible en: http://whqlibdoc.who.int/hq/1994/WHO_NUT_94.6.pdf
41. Endemic goitre [internet]. Geneva: World Health Organization; 1960 [acceso el 5 de agosto de 2017]. Disponible en:
http://whqlibdoc.who.int/monograph/WHO_MONO_44.pdf
42. WHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers [actualizado el 1 de septiembre de 2008]. 3.a edición. Génova: World Health Organization; 2007.
43. Dunn JT. Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Proceedings of the V Meeting of the PAHO/WHO Technical Group on Endemic Goiter, Cretinism and Iodine Deficiency. Washington DC: Pan American Health Organization; 1986.
44. Lyn Patrick ND. Iodine: Deficiency and Therapeutic Considerations. Altern Med Rev. 2008;13(2):116-27.
45. Andersson M, de Benoist B, Rogers L. Epidemiology of iodine deficiency: Salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab. 2010;24(1):1-11.
46. Zimmermann MB, Andersson M. Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):382-7.
47. Andersson M, Karumbunathan V, Zimmermann MB. Global iodine status in 2011 and trends over the past decade. J Nutr. 2012;142(4):744-50.
48. Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev. 2012;70(10):553-70.
49. Iodine Global Network. Global Scorecard of Iodine Nutrition in 2017 in the general population and in pregnant women (PW). IGN: Zurich: 2017.
50. Guideline: Sodium intake for adults and children. Geneva: World Health Organization (WHO); 2012.
51. Salt reduction and iodine fortification strategies in public health [internet]. Geneva: World Health Organization; 2014 [acceso el 12 de septiembre de 2019].
http://apps.who.int/iris/bitstream/10665/101509/1/9789241506694_eng.pdf?ua=1
52. MacGregor GA, He FJ, Pombo-Rodrigues S. Food and the responsibility deal: how the salt reduction strategy was derailed. BMJ. 2015;350:h1936.
53. Bhattacharya U, Chandra AK. Socioeconomic status of the population – a prime determinant in evaluating iodine nutritional status even in a post salt iodization scenario. J Pediatr Endocrinol Metab. 2019;32(2):143-9.
54. Santos JAR, Christoforou A, Trieu K, McKenzie BL, Downs S, Billot L, et al. Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders. Cochrane Database Syst Rev. 2019;2:CD010734.
55. Cappuccio FP, Beer M, Strazzullo P; European Salt Action Network. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis. 2018;29(2):107-14.
56. He FJ, MacGregor GA. Role of salt intake in prevention of cardiovascular disease: controversies and challenges. Nat Rev Cardiol. 2018;15(6):371-7.
57. Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings. Public health and medical care implications. Hypertension. 1989;14(5):570-7.
58. Sun J, Teng D, Li C, Peng S, Mao J, Wang W, et al. Association between iodine intake and thyroid autoantibodies: a cross-sectional study of 7073 early pregnant women in an iodine-adequate region. J Endocrinol Invest. 2020;43(1):43-51.
59. Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Iodine and the Thyroid. En: Imam S, Ahmad S (editores) Thyroid disorders: Basic science and clinical practice. Springer; 2016. p. 27-48.
60. Gaitan E. Goitrogens. Baillieres Clin Endocrinol Metab. 1988;2(3):683- 702.
61. Requena M, López-Villén A, Hernández AF, Parrón T, Navarro Á, Alarcón R. Environmental exposure to pesticides and risk of thyroid diseases. Toxicol Lett. 2019;315:55-63.
2. Velasco I, Bath SC, Rayman MP. Iodine as Essential Nutrient during the First 1000 Days of Life. Nutrients. 2018;10(3). pii: E290.
3. Resolution WHO. WHA58.24. Sustaining the elimination of iodine deficiency disorders. In: Fifty-eighth World Health Assembly, Geneva, 25 May 2005. Geneva: WHO; 2005.
4. Yngve A, Tseng M. Salt: importance in iodine deficiency and sodium excess. Public Health Nutr. 2010;13(5):599-600.
5. Charlton K, Skeaff S. Iodine fortification: why, when, what, how, and who? Curr Opin Clin Nutr Metab Care. 2011;14(6):618-24.
6. Eastman CJ, Zimmermann MB. The Iodine Deficiency Disorders. [Updated 2018 Feb 6]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK285556/
7. Prabhu SR, Kannan S, Mahadevan S. Iodine Deficiency: An under Recognized Problem. Indian J Endocrinol Metab. 2017;21(4):640-1.
8. Katagiri R, Yuan X, Kobayashi S, Sasaki S. Effect of excess iodine intake on thyroid diseases in different populations: A systematic review and meta-analyses including observational studies. PLoS One. 2017;12(3):e0173722.
9. Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci. 2019;1446(1):44-65.
10. Wang B, He W, Li Q, Jia X, Yao Q, Song R, et al. U-shaped relationship between iodine status and thyroid autoimmunity risk in adults. Eur J Endocrinol. 2019;181(3):255-266.
11. Woeber KA. Iodine and thyroid disease. Med Clin North Am. 1991;75(1):169-78.
12. Calil-Silveira J, Serrano-Nascimento C, Kopp PA, Nunes MT. Iodide excess regulates its own efflux: a possible involvement of pendrin. Am J Physiol Cell Physiol. 2016;310(7):576-82.
13. Markou K, Georgopoulos N, Kyriazopoulou V, Vagenakis AG. Iodine-Induced hypothyroidism. Thyroid. 2001;11(5):501-10.
14. Eng PH, Cardona GR, Fang SL, Previti M, Alex S, Carrasco N, Chin WW, et al. Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein. Endocrinology. 1999;140(8):3404-10.
15. Koukkou EG, Roupas ND, Markou KB. Effect of excess iodine intake on thyroid on human health. Minerva Med. 2017;108(2):136-46.
16. De la Vieja A, Santisteban P. Role of iodide metabolism in physiology and cancer. Endocr Relat Cancer. 2018;25(4):R225-R245.
17. Yildirim Simsir I, Cetinkalp S, Kabalak T. Review of Factors Contributing to Nodular Goitre and Thyroid Carcinoma. Med Princ Pract. 2020;29(1):1-5.
18. Cao LZ, Peng XD, Xie JP, Yang FH, Wen HL, Li S. The relationship between iodine intake and the risk of thyroid cancer: A meta-analysis. Medicine (Baltimore). 2017;96(20):e6734.
19. Kim HJ, Kim NK, Park HK, Byun DW, Suh K, Yoo MH, et al. Strong association of relatively low and extremely excessive iodine intakes with thyroid cancer in an iodine-replete area. Eur J Nutr. 2017;56(3):965-71.
20. Lv C, Yang Y, Jiang L, Gao L, Rong S, Darko GM, et al. Association between chronic exposure to different water iodine and thyroid cancer: A retrospective study from 1995 to 2014. Sci Total Environ. 2017;609:735-41.
21. Parra H. Simple goiter in Colombia. Am J Publ Health. 1948;38:820-4.
22. Góngora López J. Bocio simple y sal yodada en Colombia. Revista de Higiene (Bogotá) 1951;4:291-338.
23. Góngora A, López J, Mújica CF. Dos años de tratamiento del bocio simple con sal yodada en el departamento de Caldas. Medicina y Cirugía.1952;16:341-77.
24. Rueda R, Pardo F. La prevención del bocio endémico en Colombia. Boletín de la oficina sanitaria panamericana. 1966:495-503.
25. Carrillo JC. Evaluación de Desórdenes por Deficiencia de Yodo (DDI) en dos poblaciones de Casanare Colombia, 1984-1986. Bogotá: Nestlé, Servicio de información científica; 1988. Universidad Nacional de Colombia, Facultad de Medicina. ISBN-13: 978-8432223662.
26. Prevalencia de los Desórdenes por Deficiencia de Yodo e Ingestión Promedio de Sal. Colombia, 1994-1998. 1.a edición. Bogotá: Ministerio de Salud, Instituto Nacional de Salud, Instituto Colombiano de Bienestar Familiar, Sociedad Colombiana de Endocrinología, UNICEF-OPS/OMS, Colciencias; 2001.
27. Vargas-Uricoechea H, Sierra-Torres CH, Holguín-Betancourt CM, Cristancho-Torres L. Iodine-deficiency disorders. Permanent surveillance of vulnerable zones is poor. Medicina. (Bogotá).2012;34(2):119-44.
28. Control de los Desórdenes por deficiencia de Yodo en Colombia. Evaluación Externa. Ministerio de Salud/OPS/OMS. 1998:3-8.
29. Definición del problema para el análisis de impacto normativo relacionado con sal para consumo humano [internet]. Ministerio de Salud y ProtecReferencias ción Social; 2019 [acceso el 17 de agosto de 2019]. Disponible en:
https://www.minsalud.gov.co/Normativa/PublishingImages/Paginas/analisis-de-impacto-normativo/AIN_Sal.pdf
30. Eliminación sostenible de los desórdenes por deficiencia de yodo en Latinoamérica. Iodine, Unicef, OPS [acceso el 17 de agosto de 2019]. Disponible en:
http://www.ign.org/cm_data/Eliminacion_Sostenible_-_Espaol_Doc.pdf
31. Vargas-Uricoechea H, Pinzón-Fernández MV, Bastidas-Sánchez BE, JojoaTobar E, Ramírez-Bejarano LE, Murillo-Palacios J. Iodine Status in the Colombian Population and the Impact of Universal Salt Iodization: A DoubleEdged Sword? J Nutr Metab. 2019;2019:6239243.
32. Córdoba CA, Carrillo JC, Marín A. Current Status of Endemic Goiter and Salt Iodization in Colombia. En: Dunn JT, Pretell EA, Daza CH, Viteri F (editores). Towards the eradication of Endemic Goiter, Cretinism and Iodine Deficiency. PAHO/WHO; 1986. p. 280.
33. Control de los desórdenes por deficiencia de Yodo en Colombia. Evaluación Externa. Ministerio de Salud/OPS/OMS. 1998:3-8.
34. Vigilancia de concentraciones de yodo en sal, Colombia. Estudios centinela de yodo y flúor-fase I-2001. Semana Epidemiológica. 2001;49.
35. Gallego ML, Loango N, Londoño AL, Landázuri P. Niveles de excreción urinaria de yodo en escolares del Quindío, 2006–2007. Rev Salud Pública. 2009;11(6):952-60.
36. Cuéllar-Cuéllar AA. Desórdenes por deficiencia de yodo: bocio endémico, correlación entre la presencia de bocio y factores de crecimiento [internet]. Universidad Nacional de Colombia; 2010 [acceso el 18 de noviembre de 2017]. Disponible en: https://core.ac.uk/download/pdf/11055934.pdf
37. Londoño AL, Gallego ML, Bayona A, Landázuri P. Hypothyroidism prevalence and its relationship to high levels of thyroid peroxidase antibodies and urinary iodine in a population aged 35 and over from Armenia, 2009- 2010. Rev Salud Pública (Bogotá). 2011;13(6):998-1009.
38. Mora Thiriez S. Situación nutricional de yodo, presencia de bocio y función tiroidea en una población de mujeres embarazadas en la ciudad de Bogotá (Colombia) [internet]. Bogotá: Universidad Nacional de Colombia; 2015 [acceso el 17 de noviembre de 2017]. Disponible en:
http://www.bdigital.unal.edu.co/46629/1/05599139.2015.pdf
39. Vargas-Uricoechea H, Bastidas-Sánchez B, Perdomo-Cabrera M, Vargas-Sierra H. Estado nutricional del yodo. Implicación en la positividad de anticuerpos antitiroideos y posible autoinmunidad tiroidea en una población escolar declarada “libre de desórdenes por deficiencia de yodo”. Medicina (Bogotá). 2015;37(2):122-39.
40. WHO/UNICEF/ICCIDD. Indicators for assessing iodine deficiency disorders and their control through salt iodization [internet]. Geneva: World Health Organization; 1994 [acceso el 12 de agosto de 2017]. Disponible en: http://whqlibdoc.who.int/hq/1994/WHO_NUT_94.6.pdf
41. Endemic goitre [internet]. Geneva: World Health Organization; 1960 [acceso el 5 de agosto de 2017]. Disponible en:
http://whqlibdoc.who.int/monograph/WHO_MONO_44.pdf
42. WHO/UNICEF/ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers [actualizado el 1 de septiembre de 2008]. 3.a edición. Génova: World Health Organization; 2007.
43. Dunn JT. Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Proceedings of the V Meeting of the PAHO/WHO Technical Group on Endemic Goiter, Cretinism and Iodine Deficiency. Washington DC: Pan American Health Organization; 1986.
44. Lyn Patrick ND. Iodine: Deficiency and Therapeutic Considerations. Altern Med Rev. 2008;13(2):116-27.
45. Andersson M, de Benoist B, Rogers L. Epidemiology of iodine deficiency: Salt iodisation and iodine status. Best Pract Res Clin Endocrinol Metab. 2010;24(1):1-11.
46. Zimmermann MB, Andersson M. Update on iodine status worldwide. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):382-7.
47. Andersson M, Karumbunathan V, Zimmermann MB. Global iodine status in 2011 and trends over the past decade. J Nutr. 2012;142(4):744-50.
48. Zimmermann MB, Andersson M. Assessment of iodine nutrition in populations: past, present, and future. Nutr Rev. 2012;70(10):553-70.
49. Iodine Global Network. Global Scorecard of Iodine Nutrition in 2017 in the general population and in pregnant women (PW). IGN: Zurich: 2017.
50. Guideline: Sodium intake for adults and children. Geneva: World Health Organization (WHO); 2012.
51. Salt reduction and iodine fortification strategies in public health [internet]. Geneva: World Health Organization; 2014 [acceso el 12 de septiembre de 2019].
http://apps.who.int/iris/bitstream/10665/101509/1/9789241506694_eng.pdf?ua=1
52. MacGregor GA, He FJ, Pombo-Rodrigues S. Food and the responsibility deal: how the salt reduction strategy was derailed. BMJ. 2015;350:h1936.
53. Bhattacharya U, Chandra AK. Socioeconomic status of the population – a prime determinant in evaluating iodine nutritional status even in a post salt iodization scenario. J Pediatr Endocrinol Metab. 2019;32(2):143-9.
54. Santos JAR, Christoforou A, Trieu K, McKenzie BL, Downs S, Billot L, et al. Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders. Cochrane Database Syst Rev. 2019;2:CD010734.
55. Cappuccio FP, Beer M, Strazzullo P; European Salt Action Network. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis. 2018;29(2):107-14.
56. He FJ, MacGregor GA. Role of salt intake in prevention of cardiovascular disease: controversies and challenges. Nat Rev Cardiol. 2018;15(6):371-7.
57. Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot M. INTERSALT study findings. Public health and medical care implications. Hypertension. 1989;14(5):570-7.
58. Sun J, Teng D, Li C, Peng S, Mao J, Wang W, et al. Association between iodine intake and thyroid autoantibodies: a cross-sectional study of 7073 early pregnant women in an iodine-adequate region. J Endocrinol Invest. 2020;43(1):43-51.
59. Vargas-Uricoechea H, Bonelo-Perdomo A, Sierra-Torres CH. Iodine and the Thyroid. En: Imam S, Ahmad S (editores) Thyroid disorders: Basic science and clinical practice. Springer; 2016. p. 27-48.
60. Gaitan E. Goitrogens. Baillieres Clin Endocrinol Metab. 1988;2(3):683- 702.
61. Requena M, López-Villén A, Hernández AF, Parrón T, Navarro Á, Alarcón R. Environmental exposure to pesticides and risk of thyroid diseases. Toxicol Lett. 2019;315:55-63.
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