ید و سلامتی دکتر حسن مظفری، استاد گروه تغذیه دانشکده بهداشت، دانشگاه علوم پزشکی شهید صدوقی یزد Mozaffari.kh@gmail.com mozaffari.kh@gmail.com

ید ید بطور عمده بصورت یون و بیشتر در غده تیروئید و مقدار کمتری نیز در غدد بزاقی و معده وجود دارد. تمام سلول ها دارای مقدار جزئی ید هستند. Mozaffari_h@hotmail.com

اعمال ید در بدن عمل اصلی ید حضور در دو هورمون تری یدوتیرونین و تیروکسین است که بر بیشتر اندام ها اثر می گذارد و برای تکامل و عملکرد طبیعی : کل بدن مغز و دستگاه عصبی حفظ گرمای بدن و متابولیسم انرژی ضروری می باشد. Mozaffari_h@hotmail.com

Thyroid Hormones Contain 3-4 Atoms of Iodine Mozaffari_h@hotmail.com

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منابع ید مهمترین منبع طبیعی مواد غذایی دریایی ید موجود در مواد غذایی بستگی به ید خاک دارد بعضی از مواد غذایی گواتروژن هستند ولی در اثر حرارت از بین می روند. Mozaffari_h@hotmail.com

Reference intakes for iodine infants,0-59 months 90 μg/day Schoolchildren, 6-12 years 120 Children >12 years and adults 150 pregnant and lactating women 200 Public health nutrition, Michel JG, et al, chap 13 2004 mozaffari.kh@gmail.com

عوارض ناشی از کمبود نازایی سقط جنین تولد نوزاد مرده آنومالی های مادرزادی عقب ماندگی های ذهنی گواتر کرتینیسم Mozaffari_h@hotmail.com

World Iodine Deficiency Distribution Mozaffari_h@hotmail.com

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Iodine Deficiency Disorder (IDD) mozaffari.kh@gmail.com

Frequency distribution of students by goiter grading and cities of Yazd province. City Goiter grading %TGR (n) Total examined students %Grade 1 (n) %Grade 2 (n) Taft 34 (128) 10.3 (39) 44.3 (167) 377 Abarkuh 35.5 (88) 6 (15) 41.5 (103) 248 Khatam 30.2 (98) 2.2 (7) 32.4 (105) 324 Yazd 38.7 (770) 1.5 (30) 40.2 (800) 1989 Bafgh 37.5 (103) 1.1 (3) 38.5 (106) 275 Sadough 52.3 (283) 1.5 (8) 53.8 (291) 541 Mehriz 40.2 (132) 1.5 (5) 41.8 (137) 328 Mybod 37.2 (129) 0.6 (2) 37.8 (131) 347 Ardakan 31.5 (102) 0 (0) 326 1833(38.6) 2.3 (109) 40.9 (1942) 4755 Mozaffari_h@hotmail.com

Frequency distribution of students by age groups and goiter grading)(Yazd province). Age group (year) Goiter grading %TGR (n) %Grade 1 (n) %Grade 2 (n) 6-6.9 39.9(414) 1.3(13) 41.1(427) 7-7.9 36.9(310) 2.5(21) 39.4(331) 8-8.9 38.4(365) 2.5(24) 40.9(389) 9-9.9 39.3(417) 2.3(24) 41.6(441) 10-11 327(37.8) 3.1(27) 40.9(354) Total 1833(38.6) 2.3 (109) 40.9(1942) Mozaffari_h@hotmail.com

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Goiter Mozaffari_h@hotmail.com

Assessment of IDD According WHO, UNCF, ICCIDD Urinary iodine excretion thyriod size by palpation ultrasonography TSH and thyroglobolin other indicators mozaffari.kh@gmail.com

Assessment of IDD According WHO, UNCF, ICCIDD Public health nutrition, Michel JG, et al, chap 12 2004 Urinary iodine excretion Iodine status median ui micro g/l severe iodine deficiency moderate mild ideal iodine intake more than adequate intake excessive iodine intake <20 20-49 50-99 100-199 200-299 >300 mozaffari.kh@gmail.com

Assessment of IDD According WHO, UNCF, ICCIDD thyriod size: by palpation Grade 0: no palpable or no Visible Grade 1: palpable but not Visible Grade 2: Visible when the neck is in a normal position. Public health nutrition, Michel JG, et al, chap 13 2004 mozaffari.kh@gmail.com

Assessment of IDD According WHO, UNCF, ICCIDD Others Cretinism frequency T4 and T3 Public health nutrition, Michel JG, et al, chap 13 2004 mozaffari.kh@gmail.com

Management of ID Strategies decided upon dependent on: The severity of IDD the accessibility of the population The resources available mozaffari.kh@gmail.com

Management of IDD Strategies Use of iodized salt Iodination of drinking water Fortification of infants formulas Fortification of other foods Fortification of foods consumed by farm animals mozaffari.kh@gmail.com

پیشگیری از کمبود ید یددار کردن نمک: باصرفه ترین، مطمئن ترین و سهل الوصول ترین وضع اقتصادی خانواده اثری در میزان مصرف نمک ندارد نظارت بر میزان ید نمک در سطح کارخانه ها و مراکز توزیع به راحتی امکان پذیر است نوع ید، یدات پتاسیم است که هم پایدار تر و هم مقاوم تر است میزان ید اضافه شده به نمک 40 پی پی ام است اکنون 95 درصد مردم تحت پوشش هستند نمک یددار را باید دور از نور و در ظرف دربسته نگهداری و در پایان پخت به غذا استفاده کرد. نباید نمک یددار را به مدت طولانی(بیش از یک سال) نگهداری نمود Mozaffari_h@hotmail.com

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پیشگیری از کمبود ید(ادامه) محلول روغنی یددار(خوراکی یا تزریقی) جایی که تصحیح فوری کمبود ید نیاز باشد(شیوع گواتر بیش از 70 درصد) جایی که نمک یددار در دسترس نیست یک تزریق داخل عضلانی 5/0 تا یک میلی لیتر به مدت 3 تا 5 سال محافظت میکند تجویز یک دوزخوراکی ، ذخیره 1 تا 2 سال تامین می کند Mozaffari_h@hotmail.com

Assessment and elimination of IDD Process indicators Iodine content of iodized salt at three levels: at the production site, at the retail level and at the household level. Coverage of iodized salt Outcome indicators urinary iodine secretion thyroid size, TSH and thyroglobulin cretinism T4 and T3 levels mozaffari.kh@gmail.com

ویتامین دی و سلامتی دکتر حسن مظفری، استاد گروه تغذیه دانشکده بهداشت، دانشگاه علوم پزشکی شهید صدوقی یزد Mozaffari.kh@gmail.com mozaffari.kh@gmail.com

ِH. Mozaffari-Khosravi, PhD mozaffari.kh@gmail.com Vitamin ِِِِD ِH. Mozaffari-Khosravi, PhD mozaffari.kh@gmail.com Mozaffari_h@hotmail.com

Vitamin D chemistry Ergocalciferol (D2), obtained by irradiating the plant sterol ergosterol, was the major form of vitamin D used for the prevention and treatment of rickets. Vitamin D3 is the form of vitamin D in nature, but it can be irradiating 7-dehydrocholesterol and is more effective in preventing and curing rickets than vitamin D2. Mozaffari_h@hotmail.com

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Mozaffari_h@hotmail.com

Mozaffari_h@hotmail.com

Vitamin D function Intestinal calcium absorption Bone resorption and formation Has Role in body immunity Reproduction Insulin secretion Differentiation of keratocytes Stimulates the active phosphate transport system in the intestine In conjunction with parathyroid hormone, it mobilizes calcium from bone and increases renal tubular reabsorption of calcium and phosphate Mozaffari_h@hotmail.com

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Vitamin D contents of selected food Mg / 100g Cereals Grain, flours, starches Milk and milk products Cow,s milk Human milk Dried milk Cream Cheese Yoghurt Eggs Whole yolk Fats and oils Butter Cod liver oil margarin Meat and meat products Beef Pultry liver Fish and fish products White fish Fatty fish Vegetables 0.01-0.03 0.04 0.21 0.1-0.28 0.03-0.05 1.75 4.94 0.76 210 5.8-8 trace Trace Trace-25 Mozaffari_h@hotmail.com

Dietary sources Vitamin D3 exists naturally in animal products, and the richest sources are fish-liver oils. It is found in only small and highly variable amounts in butter, cream, egg yolk, and liver. Human milk and unfortified cow's milk tend to be poor sources of vitamin D, providing only 0.4 to 1 Mg/L. However, approximately 98% of all fluid milk sold in the United States is fortified with vitamin D2 (usually 10 Mg [400 IUl/qt), as are most dried whole milk and evaporated milk and some margarines, butters, soy milks, certain cereals, and all infant formula products. Mozaffari_h@hotmail.com

Deficiency Vitamin D deficiency manifests as rickets in children and growing animals and as osteomalacia in adults. Mozaffari_h@hotmail.com

Etiology of vitamin D deficiency Primary Low intake of dietary food sources Inadequate sunlight exposure Skin pigmentation Secondary Liver diseases Renal diseases GI diseases Malabsorption syndrome Mozaffari_h@hotmail.com

Rickets Rickets is a disease involving impaired mineralization of growing bones. It can not only result from deprivation of vitamin D but also from deficiencies of calcium and phosphorus. Rickets is characterized by structural abnormalities of the weight-bearing bones(e.g., tibia, ribs, humerus, radius, ulna) and is associated with accompanying bone pain, muscular tenderness, and hypocalcemic tetany, bowed legs, ''knock knees," beaded ribs (the rachitic rosary), pigeon breast, and frontal bossing of the skull. Radiography reveals enlarged epiphyseal growth plates manifested as enlarged wrists and ankles resulting from their failure to mineralize and continue growth. Patients have increased plasma and serum levels of alkaline phosphatase. Mozaffari_h@hotmail.com

Bowed legs Mozaffari_h@hotmail.com

osteomalacia Patients experience muscular weakness and bone tenderness and have a greater risk of fractures, particularly of the wrist and pelvis. Prevention of osteomalacia is usually possible with an adequate consumption of vitamin D, calcium, and phosphorus in the diet. It has been estimated that as little as 10 to 15 minutes of sun exposure on a clear summer day, two or three times a week, is sufficient to prevent osteomalacia among most older adults. Osteomalacia can be treated effectively with vitamin D3 in doses of 25 to 125 Mg/day; Mozaffari_h@hotmail.com

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سپاسگزارم Mozaffari_h@hotmail.com