Rev Chil Nutr Vol. 43, Nº1, 2016 54 Diabetes gestacional, hipotiroidismo y concentracion urinaria de yodo en embarazadas. Yodurias en escolares en Paraguay. Exceso de yodo en la sal y riesgo de hiper e hipotiroidismo Gestational diabetes, hypothyroidism and iodine urinary concentration in pregnant women. Urinary iodine in schoolage children in Paraguay. Iodine excess in salt and hyper and hypothyroidism risk. Jorge Antonio Jara Yorg (1) Eduardo A. Pretell (2) Elsi Ovelar (3) Sánchez Bernal S. (3) Mendoza L. (3) Jara Mark A. (4) Jessica M. Jara Ruiz (5) Elías Jara Ruiz (6) José Ortellado (7) Vicente Acuña (8) Félix Brizuela (8) Amada Rodriguez (8) Jorge Santos (8) Giuliana Peña (8) Cecilia Arevalos (6) Idirce Collin (8) (1) Cátedra de Patología Médica, Universidad Nacional de Asunción, Centro de Diagnóstico y Tratamiento Nuclear (CEDIN), Representante y Coordinador Nacional de Iodine Global Network en el Paraguay. Asunción, Paraguay. (2) Coordinador Latinoamericano del Iodine Global Network., Universidad Cayetano Heredia, Lima, Perú. (3) MSP y BS, INAN (Instituto Nacional de Alimentación y Nutrición). Asunción, Paraguay (4) University of Buffalo, NY, USA. (5) Universidad Federal de Curitiba, Brasil. (6) Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Paraguay. (7) Programa de Prevención Cardiovascular, MSP y BS, Asunción, Paraguay. (8) Hospital San Pablo, MSP y BS, Asunción, Paraguay. Dirigir la correspondencia a: Profesor Dr. Jorge Antonio Jara Yorg Tel:+595-21-297462, Cel.+595 981976421 e-mail: firstname.lastname@example.org Este trabajo fue recibido el 3 de Marzo de 2015 aceptado con indicaciones el 25 de Agosto de 2015 y aceptado para ser publicado el 28 de Diciembre de 2015. ABSTRACT The main indicator of iodine nutritional status of salt for human consumption is the urinary concentration of iodine, which is useful in monitoring universal levels in salt. Paraguay has suffered deficiency in salt with high prevalence of goiter in the population reaching 48.6%. In 2000, results of the Thyroid Mobile project in Latin America showed a goiter prevalence of 17% but 79.6% of the consumed iodized salt was adequate in paraguayan households (more than 15 ppm of iodine). The average values of iodine urinary concentration in 4487 scholars was 437 μg/L, 30% of the average value was between the ideal of 100 to 199 μg/L and 46.1% were above 300 mg/L, with risk of excess iodine. Urinary concentration of iodine during pregnancy was measure for the first time in Paraguay in 200 women; the average was 484 μg/L but diabetes and hypothyroidism during pregnancy was observe in 50% of them. Objective: Determine iodine concentration in urine of the school population in 17 departments of the country and measure the levels of iodine in urine in 200 pregnant women from 15-37 years of age and their levels of glycaemia, and thyroid TSH. Methods: During the years, 2006 and 2007 were evaluated 4487 school randomized, in a probabilistic sample, 3198 in rural areas and 1,289 in urban areas; casual urine samples was collected to determine iodine content. The urinary concentration of iodine in two hundred pregnant women, concentration of iodine in salt, and levels of glycaemia and TSH were also included in the present study. All candidates agreed with the informed consent under the ethics rules. Results: These data showed by comparing the levels of iodine in urine concentration in more than adequate and excessive level but this last was markedly elevated (93.8%). The median level greater than 300 μg/L was observed in 100% of the 4,487 urine samples, while the median urinary iodine levels of 300-500 μg/L was 91.3% and above 500 was 9.7%. These levels showed the risk of developing thyroid autoimmune diseases. In 200 pregnancy women the average of urine concentration of iodine was 498 μcg/L, subclinical and clinical hypothyroidism and gestational diabetes was 50% of both. Conclusion: To obtain normal median urinary iodine levels is necessary to decrease the amount of iodine in salt. The main recommendation is to insist on adequate monitoring of iodized salt consumption. Also continue surveillance and monitoring in sentinel sites reporting the importance of adequate iodine intake of the population especially in pregnant women that also need to be warm about the diabetes during pregnancy but also a regimen is necessary to keep them within the normal levels of glycemia. The subclinical hypothyroidism has been also studied in the same patients. Key words: iodine nutrition, schoolchildren, salt concentration of iodine. pregnancy, gestational diabetes.
Rev Nutr 43-1
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