1. ید و سلامتی
دکتر حسن مظفری، استاد گروه تغذیه دانشکده بهداشت، دانشگاه علوم پزشکی شهید صدوقی یزد

2. 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.

3. 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.

4. Thyroid Hormones Contain 3-4 Atoms of Iodine

6. 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.

7. Reference intakes for iodine
infants,0-59 months μg/day
Schoolchildren, 6-12 years
Children >12 years and adults
pregnant and lactating women
Public health nutrition, Michel JG, et al, chap

8. عوارض ناشی از کمبود نازایی سقط جنین تولد نوزاد مرده
آنومالی های مادرزادی
عقب ماندگی های ذهنی
گواتر
کرتینیسم

9. World Iodine Deficiency Distribution

11. Iodine Deficiency Disorder (IDD)

12. 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

13. 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)

15. Goiter

16. Assessment of IDD According WHO, UNCF, ICCIDD
Urinary iodine excretion
thyriod size
by palpation
ultrasonography
TSH and thyroglobolin
other indicators

17. Assessment of IDD According WHO, UNCF, ICCIDD
Public health nutrition, Michel JG, et al, chap
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
>300

18. 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

19. Assessment of IDD According WHO, UNCF, ICCIDD
Others
Cretinism frequency
T4 and T3
Public health nutrition, Michel JG, et al, chap

20. Management of ID Strategies decided upon dependent on:
The severity of IDD
the accessibility of the population
The resources available

21. 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

22. 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

24. 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

25. 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

26. ویتامین دی و سلامتی
دکتر حسن مظفری، استاد گروه تغذیه دانشکده بهداشت، دانشگاه علوم پزشکی شهید صدوقی یزد

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

28. 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.

32. 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

35. 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
0.04
0.21
1.75
4.94
0.76
210
5.8-8
trace
Trace
Trace-25

36. 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.

37. Deficiency
Vitamin D deficiency manifests as rickets in children and growing animals and as osteomalacia in adults.

38. 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

39. 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.

40. Bowed legs

41. 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;

43. سپاسگزارم