A Naturally Occurring Source of Iodine Can Be Found in: Vegetables. Poultry. Seafood. Fruit. Beef.
Nutrients. 2021 February; xiii(two): 513.
Is At that place an Ideal Nutrition to Protect against Iodine Deficiency?
Agata Czarnywojtek
2Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; lp.prisoner of war@tar.ataga (A.C.); lp.ude.pmu@alahcurm (Thou.R.)
3Section of Pharmacology, Poznan University of Medical Sciences, threescore-806 Poznan, Poland
Marek Ruchała
2Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; lp.pw@tar.ataga (A.C.); lp.ude.pmu@alahcurm (Yard.R.)
Lutz Schomburg, Academic Editor
Received 2020 Dec 13; Accustomed 2021 Feb 1.
Abstruse
Iodine deficiency is a global issue and affects around 2 billion people worldwide, with meaning women equally a high-chance group. Iodine-deficiency prevention began in the 20th century and started with global salt iodination programmes, which aimed to improve the iodine intake status globally. Although it resulted in the effective eradication of the endemic goitre, it seems that common salt iodination did not resolve all the issues. Currently, it is recommended to limit the consumption of salt, which is the main source of iodine, equally a preventive measure of not-communicable diseases, such equally hypertension or cancer the prevalence of which is increasing. In spite of the fact that there are other sources of iodine, such equally fish, seafood, dairy products, water, and vegetables, the loftier consumption of candy food with a high content of unionised salt, alternative diets or limited common salt intake can nevertheless lead to iodine deficiency. Thus, iodine deficiency remains a relevant event, with new, preventive solutions necessary. However, it appears that there is no diet which would fully encompass the iodine requirements, and iodine food supplementation is still required.
Keywords: iodine deficiency, diet, iodine, vegetarian diet, culling diet
i. Introduction
Iodine is absorbed in the stomach and the minor intestine where it is transported via sodium/iodide symporter (NIS) and pendrin to the thyroid gland, and then stored in the follicular cells. Later on, in the presence of hydrogen peroxide (H2O2), iodine ions (I−) are oxidised by thyroid peroxidase. Then, the tyrosine residues are iodinated—beginning, at position three, which forms monoiodotyrosine (MIT), and then at position 5 to course diiodotyrosine (DIT). MIT and DIT in a coupling reaction class thyroxine (T4) and triiodothyronine (Tiii) hormones [1,ii]. As a trace chemical element, iodine is essential in man nutrition, generally due to its office in the thyroid hormone synthesis. Moreover, both Tiv and Tiii are involved in the regulation of metabolic processes in the human trunk and are responsible for the optimal growth of the central nervous system and encephalon [three,4]. Iodine also serves as an antioxidant and exhibits the protective effects of inflammatory states and cancer [v]. Iodine deficiency constitutes a global effect, and is reflected past urinary iodine concentration (UIC) < 100 µg/24-hour interval [3]. It is prevalent in the eastern Mediterranean, Asia, Eastern Europe, and Africa. Additionally, mild iodine deficiency is observed in Commonwealth of australia, Great Uk, and New Zealand, as well as in specific groups, such as vegans or vegetarians [6]. In fact, proper iodine intake is crucial among pregnant women, as iodine deficiency is the leading cause of mental retardation in children [seven]. Since 1993, World Wellness Organization (WHO) and United Nations Children'southward Fund (UNICEF) recommend a universal table salt iodisation. Currently, around 70% of households in over 120 countries take admission to iodised salt—in 1990, only less than 10% had this advantage [8]. Iodine is captivated in 90% by stomach and duodenum and is mostly delivered from the fortified salt, and other sources such as fish, seafood, dairy, water, eggs, broccoli, peas, or spinach [4,9]. Still, it is vital to notice that unlike concentrations of iodine in nutrient products have been noticed, which is presumably associated with different growth environments [10]. Both the deficiency and excess of iodine can atomic number 82 to an impaired thyroid gland function and, after, to an impaired functioning of the entire organism (Figure ane) [9]. A diet deficient in iodine can lead to mental retardation, hypothyroidism, built anomalies, goitre or depression IQ, whereas the iodine excess can result in iodine-induced hyperthyroidism [six]. Therefore, an adequate iodine intake—150 mg/day for adults, 120 mg/day for children, and 250 mg/day for meaning women—is essential for the proper thyroid gland function [iii]. The aim of the study is to evaluate and review diets in search of the best diet to protect confronting iodine deficiency. Moreover, in this paper we wanted to assess which populations are at adventure of iodine deficiency or excess. In club to collect the literature related to the presented topic, the PubMed database (www.pubmed.ncbi.nlm.nih.gov, accessed on 20 January 2021) was explored with reference to the terms "iodine", "diet", "deficiency". Iodine Global Network materials and reports were besides analyzed. Nosotros accept focused on popular diets—for instance; paleolithic, gluten free or vegan diets—and investigated if individuals following them may be at risk of iodine deficiency. The take chances of iodine deficiency may be increased due to the type of products that are eliminated, for example dairy. Still, we also discussed if in that location are any food substitutes, which could subtract this chance. Further, salt-restrictive and plant-based diets may be associated with iodine deficiency due to reduction or emptying of salt and animal derived foods, respectively. We also mentioned depression-salicylate diet, gluten-free diet and parenteral nutrition that are associated with many nutritional deficiencies.
Iodine can be ingested through the diet and dietary supplements. The chief sources of iodine are table salt, seafood, fish, algae, milk, and dairy. Iodine is taken up past the thyroid gland and used for synthesis MIT (monoiodotyrosine) and DIT (diiodotyrosine), which are used for thyroid hormone (triiodothyronine and thyroxine) biosynthesis. Receptors of thyroid hormones are on the surface of dissimilar organs; thus, thyroid hormones travel in the blood and may bear upon many systems among other reproductive system, skeletal or muscular arrangement.
2. Iodine Deficiency
2.ane. Iodine Deficiency among Diverse Populations
According to the WHO, iodine deficiency is divers by a median urinary iodine concentration < 100 µg/day [11]. On the basis of the Iodine Global Network report from 2019, which included schoolhouse-age children, 115 countries were classified as countries with the optimal level of iodine supply (the United states of america, Canada, French republic, Portugal, Britain) and in 23 countries the iodine intake was too low—Burkina Faso, Burundi, Kingdom of cambodia, Finland, Germany, Israel, Iraq, Lebanon, Madagascar, Morocco, Haiti, Democratic people's republic of korea, Mozambique, Nicaragua, Samoa, Tajikistan, Vanuatu, Norway, Russia, South Sudan, Sudan, and Vietnam. In Angola and Italy, iodine intake was considered to be sufficient (Figure 2) [12]. As it has already been mentioned, around 2 billion are at risk of iodine deficiency, according to the WHO [thirteen]. Even so, it should exist noted that the written report was based on the UIC results of schoolhouse-age children, and thus, it cannot reflect the status of iodine, for instance, among pregnant women. Moreover, the data regarding the status of iodine in different populations remain bereft. [14]. Most of the analyzed articles demonstrate an emerging iodine deficiency in the population of women of childbearing age, which indicates a public health issue concerning the comeback of iodine status of the abovementioned group of women [fifteen,16]. Gizak et al. emphasised that an insufficient intake of iodine among significant women persists, since iodine intake among meaning women is insufficient in 39 out of 72 countries [17].
Insufficient iodine intake is observed in many regions, mainly African and Asian countries. Optimal intake of iodine occurs amongst other in the Us, Canada, and some countries in Europe. Nevertheless, intake of iodine is non acceptable in many European regions.
Pregnant and breastfeeding women are specially exposed to iodine deficiency, and, therefore, iodination of salt could not be sufficient, and additional supplementation should exist considered [18].
2.two. Health Consequences of Iodine Deficiency
Wellness consequences of iodine deficiency can affect all ages—adults, adolescents, children, infants and foetuses. Similarly, goitre formation and susceptibility to the nuclear radiations affect all age groups. In terms of adults, iodine deficiency has been associated with an impaired mental office, reduced work output, goitre and hypothyroidism. In children and adolescents, on the other hand, information technology has been linked to mental and growth retardation. Moreover, an increment in the incidence of papillary thyroid cancer (PTC) compared to follicular thyroid cancer (FTC) has been observed, amounting to 0.xix to ane.7, respectively [19]. Information technology is now believed that the introduction of the iodine supplementation in subjects with a meaning iodine deficiency may lead to an increase in the PTC/FTC ratio [20,21]. The transition from FTC to PTC may exist associated with an elevated rate of the V600E BRAF (B-Raf serine/threonine kinases) mutation over time [22].
2.3. Iodine Deficiency and Breast Cancer
The cause–effect relationship between iodine deficiency, dumb function of the thyroid gland, and breast cancer has been observed for over 100 years [23,24,25]. Iodine is absorbed via sodium/iodide symporter in the glandular chest tissue, and its role is to promote the growth of the normal tissue [26]. In fact, research studies have demonstrated the function of iodine every bit an antioxidant agent in the mammary gland [27,28]. Thus, it has been suggested that iodine deficiency tin increment the risk of chest cancer in two mechanisms. The showtime is associated with direct influence on the glandular breast tissue, which could be explained by ways of an increased sensitivity to oestradiol in the instance of iodine deficiency. The other is associated with an impaired thyroid gland role and, therefore, hypothyroidism equally the result of iodine deficiency [26]. Numerous studies demonstrate the clan between hypothyroidism, especially autoimmune, and breast cancer; notwithstanding, this relationship remains controversial [24,29,30,31,32,33,34]. Significantly, an excessive intake of iodine, by stimulating activity of ER-α, negatively affects the take chances of breast cancer [35]. Simultaneously, an dumb thyroid gland function tin can result in a slower tumour growth and in challenging the diagnosis with an increased tumour invasiveness [26]. In Nihon, almost 3-times lower incidence of breast cancer was observed, when compared with the USA; nevertheless, the incidence of chest cancer among Japanese women living in the USA was similar to other women. It suggests that the iodine-rich diet could be preventive in the development of chest cancer. Therefore, diets comprising a depression corporeality of iodine could be associated with an increased risk of breast cancer development, which emphasises the need to decrease iodine deficiency in all historic period groups.
2.4. Iodine Deficiency in Significant Women
The adequate level regarding the requirements of iodine is specially of import in the population of women in the childbearing age. It should be noted that not only astringent maternal iodine deficiency, only also mild to moderate deficiencies, accept been associated with the consequences appearing in the offspring.
Levie et al. conducted a meta-assay with an private participant data from three prospective population-based cohorts in order to investigate the human relationship between the maternal iodine status during pregnancy and the babe IQ in 6180 mother-kid pairs from iii countries. The aim of the study was to identify the sensitive time windows of exposure to the suboptimal iodine availability. The written report demonstrated that mild to moderate iodine deficiencies were associated with a reduction in verbal IQ scores of children, especially in the first trimester of pregnancy [36].
Additionally, the results obtained in the Avon Longitudinal Study of Parents and Children indicate that there is an inverse correlation betwixt the low maternal iodine status in the first trimester and the offspring IQ scores at the age of eight, as well as reading accuracy, comprehension, and reading score at the age of ix years. The study comprised 1040 significant women and their children in the Britain [37].
In the study by Gietka-Czernel et al. [38], which involved 100 pregnant women betwixt the 5th and 38th week of pregnancy with normal thyroid function, only 35% of the subjects took iodine supplements, and 59% were on a diet rich in iodine carriers. Moreover, the presence of goitre was found in 28% of the pregnant women. In fact, iodine deficiency can as well atomic number 82 to a spontaneous ballgame, stillbirth, nascency cretinism, built disabilities, maldevelopment of the foetal brain and an increased gamble of perinatal bloodshed [39,forty].
iii. Iodine Recommended Intake
3.1. Iodine Intake from the Nutrition, Iodine Fortification and Recommendations
Iodine intake correlates with its blood concentration, therefore, the proper iodine intake is essential [41]. Still, information technology seems that iodine fortification is necessary in order to encounter the daily requirements. It has been observed that a higher consumption of iodine-fortified bread was associated with a more frequent consumption of proper iodine amounts [42].
Although salt iodisation is recommended, iodisation of salt is not obligatory in several countries, eastward.g., the U.s.a. [43]. Salt iodination is mandatory in Poland, China or Kingdom of denmark but is voluntary in Holland or Great Uk. Interestingly, in Australia and New Zealand, salt iodination is not mandatory, nevertheless iodised common salt is used in the baking of bread. The level of table salt iodination varies among countries from viii to 100 mg of iodine/kg of salt [44]. Daily recommended allowances (RDA) and adequate intake (AI) are presented in Table one.
Table 1
Recommended dietary allowances and acceptable Intake for iodine [45,46].
| Grouping | RDA (Recommended Dietary Allowances), (μg) | Adequate Intake (AI), (μg) |
|---|---|---|
| 0–6 months | 110 | |
| 7–12 months | 130 | |
| ane–3 years | 90 | |
| four–8 years | 90 | |
| nine–xiii years | 120 | |
| 14–xviii years | 150 | |
| ≥nineteen years | 150 | |
| Pregnancy | 220 | |
| Breastfeeding women | 290 |
3.2. Food Sources of Iodine
Fish, seafood, milk, dairy, vegetables, and fruits are considered as a good source of iodine. However, fish are usually not consumed frequently enough to comprehend the daily iodine requirements [47]. The amount of iodine in vegetables and fruits depends on the type of soil in which they had been planted [45] and content of iodine in soil is dissimilar in various world regions. Iodine content in marine plants is higher than in terrestrial plants [48] Moreover, the content of iodine in milk and dairy too varies from 200 μg/L even to chiliad μg/50 [49].
There is a number of factors affecting iodine concentration in milk, eastward.g., farm management and brute keeping (outdoor or indoor) which are associated with the iodine intake [50]. Moreover, the concentration of iodine in organic milk is lower, as compared to the conventional milk. It is vital to notice that iodine concentration in milk does not depend on the fat content [51]. Moreover, the content of iodine in milk was significantly higher in winter than in the summer, due to the fact that milk yield is highest in the summertime-autumn months (it tends to be calving time). Therefore, the concentration of microelements is lower [52]. Mullan et al. too reported that concentration of iodine in milk is higher in the winter than in the summer. Additionally, urinary iodine concentration among girls was lower in summertime than wintertime and was positively correlated with milk consumption [53]. In fact, there are differences between iodine concentrations in milk between various regions in the winter and in the summer which propose that iodine concentration is dependent on feeding [54]. Co-ordinate to Hejtmánková et al., the content of iodine in the surroundings affects iodine concentration in milk [55].
Although it is recommended to limit the salt intake, it still remains the primary source of iodine, eastward.grand., in Slovenia iodised salt was the primary source of iodine for adolescents. Yet, information technology should be noted that fifty-fifty though iodine intake was appropriate, the common salt consumption was exceeded, thus, a decrease of the salt intake must have been associated with other nutritional interventions in order to cover daily iodine requirements [56]. Iodine content in the selected food products is presented in Tabular array 2 to summarize and compile data on iodine content in selected products.
Table two
Iodine content in the selected products. [x,57,58,59].
| Product | Iodine Content (μg/100 Grams of Product) |
|---|---|
| Codfish, fresh | 110 |
| Salmon, fresh | 7.seven–44 |
| Pike, fresh | 8 |
| Kefir, 2% of fat | seven.5 |
| Skimmed milk | 19.five–21 |
| Cheese, full-fat | 7.7–xxx |
| Craven eggs | 9.5–57.half-dozen |
| Oat flakes | 0.v–5.9 |
| Vegetable | 1–31 |
| Basics | four–9 |
| Salt, iodized | 2293 |
4. Diets and a Reduced Iodine Intake
4.i. Hypertension and Salt-Restrictive Nutrition
At the stop of the 20th century, an increased prevalence of cardiovascular disease (CVD) was observed mostly in the adult countries. Information technology was associated with such factors every bit lifestyle changes, a decreased physical action and an increased consumption of processed food with a high content of salt, fatty, and energy. Equally an increased mortality due to CVD was observed, prevention programmes were initiated, including a recommendation to reduce table salt intake, since information technology was associated with an increased risk of hypertension, stroke, atherosclerosis, or several types of cancers [10,sixty]. In 2006 and 2007, during WHO expert consultations, a limited intake of salt was recommended which amounted to maximum 5 g of common salt per twenty-four hours (ii one thousand of sodium). In contrast, in Poland about xiii.v g of table salt is consumed daily, which could seem loftier when compared to other European countries. Withal, in other non-European countries, it tin even reach 20 g of common salt per day [vii,10,61]. Information technology seems somewhat ironic that a limited salt consumption is recommended, when it was previously used as a tool aimed at the prevention of iodine deficiency. Nevertheless, the WHO indicates that iodination of salt is economically beneficial, and iodine does non influence the salt taste [62]. Currently, information technology is recommended to fortify 1 kg of salt with 20–40 mg of iodine, depending on the actual table salt consumption in a item country [7]. Moreover, taking Poland every bit an example, 6.5 k of table salt should exist consumed to provide the recommended iodine intake for adults (150 µg/day). Therefore, it could exist easily observed that the consumption of other sources of iodine is essential in social club to meet the iodine and common salt requirements. Additionally, it should be vital amidst individuals who limit their salt consumption, or those who follow any blazon of emptying diet [61].
four.2. Vegan and Vegetarian Diets
Currently, vegan and vegetarian diets are gaining greater recognition. A vegetarian diet excludes meat, fish and seafood (the exclusion of dairy and eggs varies depending on the vegetarian diet type). On the other hand, a vegan nutrition, as more than radical blazon, excludes all fauna products. Properly balanced vegan and vegetarian diets are considered prophylactic to follow at every stage of life, even during pregnancy and infancy [63]. However, incorrectly equanimous vegetarian diets can pb to a deficiency of protein, unsaturated omega-three fatty acids, and several vitamins and minerals, such as vitamin B12, vitamin D, calcium, zinc, iron, or iodine [64]. As it has been previously mentioned, milk and dairy products constitute the sources of iodine the elimination of which could lead to iodine deficiency among vegans and vegetarians. In fact, marine algae are the primary source of iodine in vegetarian diets [65]. Vegan and vegetarians who do not include marine algae in diet, or exercise not supplement iodine are more than susceptible to iodine deficiency than individuals following a less restrictive diet [63]. Moreover, a high consumption of soy has been observed amid individuals following vegetarian diets, which is the source of protein, atomic number 26, zinc or grouping B vitamins [66]. In dissimilarity, according to the in vitro studies, soy isoflavones, i.e., genistein and daidzein, can affect the thyroid peroxidase part [65,67]. In improver, soy can likewise negatively affect the thyroid gland office when iodine is deficient [65,66]. Yet, it should exist noted that thermal processing eliminates most of the soy goitrogens, and their consumption should not be discouraged in order to prevent iodine deficiency. Therefore, it would seem that limited consumption of cruciferous vegetables and soy could be considered among the hypothyroid individuals with a depression iodine intake [64,65].
4.three. Gluten-Complimentary Diet
A gluten-free diet needs to be followed by individuals with coeliac illness. Information technology is associated with the elimination of wheat, rye, barley, and oat (in certain cases). On the other hand, it is recommended to consume naturally occurring gluten-complimentary grains, vegetables (including pulses), fruits, meats and fishes, dairy, and the substitutes for traditional gluten products (with gluten content non exceeding 20 mg/kg) [68,69]. Vici et al. noticed that a gluten-free nutrition was usually depression in poly peptide, vitamin D and B12, folic acrid, iron, zinc, magnesium, and calcium [70]. Additionally, information technology was observed that individuals following a gluten-costless diet swallow inadequate amounts of selenium, riboflavin, niacin, and thiamine, with a simultaneous high consumption of fatty, carbohydrates, and sodium [71]. Nevertheless, according to the current studies, a gluten-free diet is not associated with an increased risk of iodine deficiency [69].
4.four. Iodine Intake and Dairy Foods
As it has been mentioned, dairy and milk products, among others, are sources of iodine. Although the consumption of milk and dairy products varies between countries and populations, they remain i of the most important dietary sources of iodine, and can contribute to about 13–64% of the daily requirement [72,73]. In the Great britain, Kingdom of norway, and French republic milk and dairy consumption account for 38%, sixty%, and 40% of the iodine intake, respectively [74,75,76]. Additionally, dairy products should be consumed often, specially in those countries where iodine-fortification of table salt is not mandatory, or where the availability of iodised table salt is limited. Yet, it is worth bearing in heed that the amount of iodine in dairy and milk products differs and depends on seasonality, farming do, milk processing, and the fortification of animal feeds [77].
Dairy intake is usually below recommended levels, although the current dietary guidelines recommend the consumption of 2–4 serving per day of fat-free or low-fat dairy products. However, the recommendations are land-specific and hence may vary [78]. Depression dairy consumption tin can be associated with an inadequate intake of several minerals, such as calcium, magnesium, potassium, iodine or vitamins, such as vitamin D [79]. Although milk and dairy products were rich in iodine in the Israeli study, the population'south intake was bereft due to a low dairy and milk consumption [77]. Furthermore, a lower consumption of dairy products was associated with a lower iodine intake when compared with consuming 2 or more dairy portions per day among pregnant women [80]. In the Little in Norway Study (LiN), dairy consumption was associated with a urinary iodine concentration, or urinary iodine to creatinine ratio among meaning women; nevertheless, the total iodine intake was even so not in accordance with the current recommendations [75]. On the other hand, although pregnant women in Australia were iodine sufficient, less than 50% of them were able to run across the estimated boilerplate requirement (EAR) from food lone without supplementation, with dairy as the master source of dietary iodine [81]. Iodophors (iodine-containing sanitisers) are used in the dairy industry and are associated with the iodine content in milk and dairy. Although iodine-contaminated milk has been a meaning source of iodine in several countries, due east.g., in Commonwealth of australia, the apply of iodophors declined and resulted in lower iodine concentrations in milk, which resulted in a lower overall iodine intake [82]. In fact, milk and its products are more frequently replaced by non-cow'southward milk and plant-based products, which are scarcely fortified in iodine, possibly leading to iodine deficiencies among vegetarian individuals [83]. It is crucial to find that adding seaweed to the plant-based products, in order to fortify them in calcium, tin increment the iodine contents, although the iodine concentration depends on the type of seaweed extract used.
4.5. Parenteral Diet
Although the oral assimilation of iodine is high—around xc%—and efficient, parenteral nutrition (PN) tin can be associated with the chance of iodine deficiency due to the low iodine content in the parenteral formulas [84]. Nonetheless, a routine supplementation of PN formulas with iodine more often than not is not recommended and varies between the guidelines. On the 1 paw, thyroid gland stores enough iodine to meet the needs for less than three months and the long-term patients with PN can consume enough iodine by means of a standard nutrition (bold the proper absorption of iodine in the duodenum) [85,86]. On the other hand, iodine is administered in PN formulas in Europe, although not in the USA; however, the American Society for Parenteral and Enteral Nutrition (ASPEN) recommended changing the commercially available parenteral multivitamin and multi-trace chemical element products, including iodine supplementation [87]. In the study by Willard et al., the investigated PN solutions contained a minor corporeality of iodine (iodine corporeality was not included on the solutions' labels), and the patients receiving the long-term PN would crave about v.6 L/solar day of a formula to run into the recommended daily allowance (RDA), whereas the standard administration of PN formulas is around 1.eight–2.four Fifty/day [88]. All the same, as Navarro et al. study demonstrated, patients with the short bowel syndrome were able to meet the recommended intake of iodine with the standard nutrition and did not present changes in the iodine condition [89]. Furthermore, previously used povidone-iodine solutions for skin cleansing, resulting in the transcutaneous iodine absorption, were replaced by chlorhexidine-based antiseptics [87]. Findik et al. indicated that the use of povidone iodine solutions during the caesarean sections influenced costless triiodothyronine (fT3) thyroid-stimulating hormone (TSH) values in the mother, although it has non statistically significantly influenced urine iodine levels [ninety]. Additionally, it was also reported that employ of iodine-containing antiseptics increased the urinary iodine status, without influencing the TSH status in the neonate [91]. The use of iodine-containing solutions every bit a dermal disinfectant in newborns is strongly discouraged and their exposure to povidone iodine during caesarean procedures should be monitored for possible thyroid disorders [92]. Moreover, in terms of infants, iodinated disinfectants and adventitious iodine content in PN solutions were sufficient and additional supplementation was unnecessary. However, due to the current utilise of not iodinated antiseptics, iodine supplementation should be considered [86,93].
iv.6. Palaeolithic Diet
A palaeolithic-type diet (PtD), typically used for the bodyweight reduction, is based on products consumed earlier the agriculture was introduced; thus, in such a diet foods like processed oils, dairy, grains, legumes, salt or refined sugars are eliminated. On the other manus, the consumption of lean meats, nuts, eggs, fruits, and vegetable is loftier [94]. Even though meat tin constitute a source of iodine, the study of Franke et al. study demonstrated that iodine content in pork was depression, even if the feed was iodine-enhanced [95]. Taking that into consideration the abovementioned fact, individuals following the PtD can be at risk of iodine deficiency. Co-ordinate to Manousou et al., PtD has been associated with the risk of mild iodine deficiency and, as the authors have suggested, iodine supplementation should be considered [96]. Similar results were plant in the study by Genoni al., where a PtD grouping showed a lower intake of several micronutrients, including iodine, than a group following good for you eating recommendations. Nevertheless, as the authors noted, the utilize of salt, or the result of whether information technology was iodised, could be underestimated [94]. As the Churuangsuk et al. systematic review revealed, the intake of iodine decreased later on following any carbohydrate-restricted nutrition (CRD). Since carbohydrate-rich products practice non institute the principal source of iodine, it could be suggested that this observation was associated with a restricted intake of dairy products in CRD [97]. All the same, in view of iodine intake, not only can the number of carbohydrates thing, but besides their quality. As Louie et al. written report showed, Australian children and adolescents, who consumed carbohydrates from high-glycemic-index products, presented a significantly higher adventure of non meeting the iodine requirements [98]. If our ancestors' diet was low in carbohydrates and lower in iodine than the current diets, the question arises concerning how it could influence the current iodine requirements, and whether they are linked to iodine deficiency disorders (IDD). Interestingly, changes in the man nutrition due to the industrial and agricultural development resulted in increased triiodothyronine (T3) levels, and furthermore, an increased T3 production caused an elevated iodine requirements [99]. Thus, following PtD can currently be misleading and associated with an increased chance of IDD.
4.vii. Low-Salicylate Diet
A depression-salicylate diet eliminates salicylates from food products, due to the unfavourable reaction of the human body to acetylsalicylic acid. Several fruits and vegetables, marinated or dried products, equally well as love, near of the spices, apple tree vinegar, nuts, fruit and vegetable juices, and fruit syrups are rich in salicylates [100,101,102]. Therefore, considering the number of food products, which must be eliminated, a depression-salicylate diet could increment the hazard of nutritional deficiencies. Co-ordinate to Szczuko et al., iodine intake was insufficient and lower than the recommended values amid men and women who followed a low-salicylate diet [102]. In fact, the greater the departure betwixt the recommended and actual dose, the smaller the number of calories—52.19 μg, 37.78 μg, and 12.27 for the diet of 1500 kcal, 2000 kcal, and 2500 kcal, respectively. However, the differences could exist explained past the fact that the higher amounts of calories were consumed, the higher the overall food intake, including iodine-rich products. Additionally, the development of the IDD due to the restricted diets was observed in other cases [103,104,105]. Hence, it is essential to assess the nutritional intake, including iodine intake, among individuals post-obit the restricted diets, due to the potential take a chance of nutritional deficiencies.
5. Excessive Intake of Iodine
5.one. Excessive Intake of Iodine among Various Populations
The excessive consumption of iodine is much less oft observed. Notwithstanding, it is mainly witnessed in the Asian countries, such as Japan or Korea, where for over thirteen thousand years, marine algae take been essential in the local cuisine [106,107]. The European Food Safety Authorization (EFSA) and the WHO consider the values adopted past the Scientific Committee on Food (SCF) and the Establish of Medicine (IOM) regarding the tolerable upper limit for iodine uptake, i.e., 600 µg/d and 1100 µg/d respectively [xiii,46,108,109]. Withal, in Japan, the boilerplate intake of iodine is around 500–1000 µg/twenty-four hour period, and in some region it reaches almost 20,000 µg/d [107,110]. Although virtually of the population can tolerate high doses of iodine, due to the internal self-regulation mechanisms in the thyroid gland, cases of iodine-associated impaired thyroid gland function were observed [111]. The risk of excessive iodine intake is mostly associated with the consumption and supplementation of marine algae in which iodine content is highly varied, depending on the type and the geographical origin; it could fluctuate between 0.06 mg/100 m to 624.5 mg/100 thousand of dry out mass [107,112]. Additionally, the lack of iodine content on the product label is also problematic [112]. For example, the boilerplate consumption of marine algae in Japan is around four–seven g per solar day [107]. Moreover, it should be noted that due to the increased salt consumption, a recommended daily intake of iodine can also be exceeded and, therefore, the office of salt iodination and iodine condition in the population should be highlighted [106]. It is also recommended to carefully utilise supplements based on marine algae, particularly in pregnant women where the utilise of such supplements should be discouraged [112,113]. Iodine excess can also lead to thyrotoxicosis, eastward.g., the Jod-Basedow phenomenon which occurs in the form of treatment or remission of Graves' disease or the tuberous goitre in people living in the areas of iodine deficiency [114]. Furthermore, the consumption of proper amounts of iodine is significant for a developing foetus. In fact, an increased demand for this mineral in meaning women is caused by an increased product of thyroid hormones by half, the passage of iodine through the blood-placenta bulwark, and an increased renal clearance of this chemical element [xviii,115]. In the case of pregnancy and breastfeeding, the need for iodine in the form of oral supplements should be increased to a dose of 220–290 μg per day. Still, the American Thyroid Association recommends a daily intake of 150 µg of iodine to ensure a normal development of the encephalon and the nervous arrangement of the foetus and the baby [116]. According to the WHO, an excessive iodine intake (UIC > 500 μg/L) may besides accept a detrimental effect on the thyroid function, leading to subclinical hypothyroidism, while UIC of 150–249 μg/L is an adequate iodine intake for significant women, although non for an private patient [117,118]. Moreover, the incidence of thyroid cancer has increased, which is associated with several and diverse factors, for example, increased iodine supplementation or obesity [115,119]
v.2. Pharmacotherapy and Excessive Iodine Intake
Pharmacological doses of iodine—even chiliad times college than a daily requirement—are found in many medical substances, e.g., iodine-containing dissimilarity media (140–400 mg of iodine per 1 mL), disinfectants (10 mg of iodine per 1 mL), amiodarone (one 200 mg tablet contains 75 mg of iodine), or Lugol's solution (127 mg of iodine in xx drops) [120]. The good for you thyroid gland has a defense mechanism confronting the excessive iodine intake, called the Wolff–Chaikoff result, which temporarily inhibits the biosynthesis of thyroid hormones [110,121]. The structural formula of amiodarone, a benzofuran derivative, is similar to the T4. A molecule of this substance contains two atoms of iodine, which represents around 37.v% of its mass, x% of which is deionised daily to the iodine. Therefore, of 200–400 mg of amiodarone daily, 6–12 mg of iodine is supplied, hence, if 150–200 µg of iodine is considered a the daily requirement, the iodine demand is exceeded multiple times [122]. The lack of abovementioned defense force mechanisms tin atomic number 82 to hypothyroidism among individuals treated with amiodarone [121].
half-dozen. Summary
Both the deficiency as well as the excessive intake of iodine can lead to agin health consequences. The grouping which is most at take chances of iodine deficiency, due to the increased requirements, are pregnant women. Information technology should be noted that the increasing prevalence of breast cancer could also exist associated with a lower iodine intake, thus, monitoring of iodine intake should be i of the breast cancer prevention measures. Several diets, such as a vegan, vegetarian, palaeolithic, or depression salicylate nutrition, are too associated with an increased risk of iodine deficiency, all the same in fact, any improperly counterbalanced diet can result in iodine deficiency. Interestingly, several societies recommend limiting the consumption of dairy fat, therefore, possibly affecting dairy consumption overall, which could too have an bear upon on the iodine intake. The global recommendation to iodise table salt resulted in significant improvements in the iodine status globally. For instance, introducing iodised salt resulted in the eliminating of IDD in school-age children in China, or the incidence of goitres in several areas in India [123,124]. Withal, certain issues remain unresolved. Express common salt consumption is recommended as a prevention of various non-communicable diseases, such as hypertension, stroke, or atherosclerosis. Moreover, a consumption of candy foods, which practice not necessarily include iodised salt, also affects the iodine intake and its status. Information technology is worth bearing in listen that achieving an adequate iodine status among pregnant women can outcome in an excessive iodine status among children. Therefore, it seems necessary to discover other alternatives, apart from the iodised salt, in club to forestall iodine deficiency. However, in several countries, particularly those with a lower income, universal common salt iodization programs should be introduced and promoted in guild to prevent goitres and IDD. Furthermore, information technology is vital to think that no perfect diet exists, fully covering the iodine requirements, which suggests that iodine fortification and supplementation is crucial.
Writer Contributions
Conceptualization, I.K.-M., A.C. and M.R.; writing—original typhoon preparation, K.S. and A.M.R.; writing—review and editing—K.S., A.M.R., A.E.R., A.Southward.-T., A.C. and I.Yard.-K.; visualization—A.Due east.R. and I.K.-K.; supervision—I.K.-K.; projection administration—A.D. and M.R.; funding acquisition—A.D. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Lath Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
Statement excluded.
Conflicts of Interest
The authors declare no conflict of involvement.
Footnotes
Publisher'south Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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