1. IODINE DEFFICIENCY DISORDERS SREERAJ.V.T JR.HEALTH INSPECTOR PHC UDAYAGIRI

2. Iodine deficiency disorders: A public health problem Worldwide distribution

3. What is iodine & what is iodine deficiency?

4. What is iodine?  Nutrient needed in a minute quantity daily. Recommended daily intake: 150 μg (Micronutrient)  Total quantity present in body is (15-20 mg) mostly in thyroid gland

5. What is iodine?  Iodine: Essential component of thyroid hormones, which are needed for: - Optimal mental & physical development - Regulation of body metabolism (Generation & utilization of body energy)

6. Iodine : Daily requirements Age Group Iodine Requirement (µg/day) 0 – 11 months50 12 – 59 months90 6 – 12 years120 > 12 years150 Pregnant & Lactating Women 200 [WHO, UNICEF, ICCIDD: Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness. WHO/NUT/96.13. Geneva. 1996 ]

7. Sources of iodine  Food is the main source of iodine  Meat, fish & dairy products  Vegetables, cereals  High amounts in sea fish & seaweeds Sea salt is a poor source of iodine

8. Iodine deficiency – Disease of the soil Melting of Glaciers Floods Rivers changing course Gradual leaching of iodine from soil due to:

9. Iodine deficiency : A disease of the soil SOIL EROSION: WATER, SOILEnvironmental iodine deficiency Low Availability : PLANTS Iodine poor feeds & of iodinefodders, goitrogens Effect on animals: LIVESTOCK Clinical & Reproductive disorders, Decreased productivity Effect on people: HUMANSHealth & Socio - economic impact

10. What are the consequences of iodine deficiency?

11. Effects on humans: Fetus Mortality  Spontaneous abortions & stillbirths  Increased perinatal mortality Disability  Birth defects  Defects of speech & hearing  Psychomotor defects  Cretinism

12. Effects on humans: Neonate Mortality  Increased neonatal mortality Morbidity  Neonatal Goiter  Neonatal Hypothyroidism (Decreased production of thyroid hormones at birth)

13. Effects on humans: Children & adolescents  Goiter  Hypothyroidism  Retarded physical development  Impaired mental function (  13 IQ points)

14. Effects on humans: Adults  Goiter & its complications  Hypothyroidism  Impaired mental function  Iodine induced hyperthyroidism (IIH)

15. Effects on livestock  Goiter  Hypothyroidism  Reproductive disorders  Decreased productivity (Milk, meat, wool, eggs)  Lower work output Goiter in animal

16. Importance of iodine in brain development -  50,000 brain cells produced/second in developing fetal brain  100 billion brain cells in adult  One million billion connections between these brain cells: Determine IQ

17. 100 billion brain cells in adult human Comparable to the number of stars in the sky

18. Brain Cell Growth Iodine Deficiency Iodine Sufficiency Iodine Deficiency is the single most common cause of preventable mental retardation

19. Brain cell branching Diminished brain cell branching due to iodine deficiency Diminished branching  Less connections  Lower IQ

20. Importance of iodine in brain development 90 % of human brain development occurs between 3 rd month of pregnancy & 3 rd year of life (Critical period)

21. Deficiency of iodine during this critical period of development results in permanent brain damage  This brain damage can primarily be prevented by correcting iodine deficiency before & during pregnancy  This makes it vital that all expectant & lactating mothers get their daily requirement of iodine

22.  Iodine deficiency is single most common cause of mental handicap worldwide  It is totally preventable

23. Spectrum of IDD Goiter Loss of 13 IQ points, Leading Cause of Mental handicap Cretinism Spontaneous Abortions, Stillbirths, Birth Defects Defects of Speech & Hearing, Squint, Psychomotor defects

25. Thyroid Hormones triiodothyroninetriiodothyronine (T 3 ) thyroxinethyroxine (T 4 ) Thyroid-stimulating hormone (TSH or thyrotropin)

26. Hypothyroidism is a state in which the thyroid gland does not make enough thyroid hormone.thyroid glandthyroid hormone

27.  Cold intolerance, increased sensitivity to cold Cold intolerance  Constipation Constipation  Weight gain and water retention Weight gainwater retention  Bradycardia (low heart rate – fewer than sixty beats per minute) Bradycardia  Fatigue Fatigue  Decreased sweatingsweating  Muscle cramps and joint pain Muscle crampsjoint pain  Dry, itchy skin  Thin, brittle fingernailsbrittle fingernails  Rapid thoughts Rapid thoughts  Depression Depression  Poor muscle tone (muscle hypotonia)muscle hypotonia  Female infertility; any kind of problems with menstrual cycles  Hyperprolactinemia and galactorrhea Hyperprolactinemiagalactorrhea  Elevated serum cholesterol Elevated serum cholesterol

30. Goiter has been known since the days of Lord Buddha and before Earliest evidence of goiter: 3000 BC

31. Goiter Goiter is a swelling of the thyroid glandthyroid gland is painless not a cause of death - has been perceived as a cosmetic problem only

32. Cretinism

33. Iceberg of IDD

34. High risk groups:  - Pregnant & lactating women  - Pre-school children

35. Our primary concern  Every population should &  Every mother & child must Get their daily supply of iodine

36. Iodine consumption on daily basis for all times to come  Daily requirement of iodine per person is 150 µg – fits on the tip of hair !  Lifetime requirement for 70 years is 5 gms – one teaspoonful !  However, this daily requirement has to be met daily, for all times to come  “Daily consumption of adequately iodized salt is a healthy habit”

37. Vehicle for iodine : Salt  One food item consumed every day, by everybody in fixed quantities  Rich or poor, urban or rural area, man or woman, child or adult  Average daily consumption in India per person is 10 gm  Iodization of salt is a simple process  Cost of salt iodization is : 10 paise/person/year

38. What is Iodated Salt?  Iodated salt is common salt containing minute quantities of an iodine compound  Iodated salt looks, tastes and smells exactly like ordinary salt.  The Govt. of India has issued notification banning the salt of non iodized salt for direct human consumption with effect from 17 th May, 2006.

39. Iodized salt – The panacea for iodine deficiency Salt production and iodization (Supply) Promotion of Iodized Salt Consumption (Demand)

40. Universal Salt Iodization  In 1983, Government of India took policy decision to iodize all salt meant for human consumption – Universal Salt Iodization (USI)  Private sector was permitted and encouraged to produce iodized salt  “Elimination of goiter” was included in Prime Minister’s 20-point National Development Program

41. India & China Iodized salt coverage <80% Iodized salt coverage >80%

42. The Dandi March

44. Thank You! For Daily consumption of adequately iodized salt is a healthy habit Towards Sustainable Elimination of IDD