Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Nutrition and Health (including climate and ecological aspects)

Recent data on iodine intake in Croatian schoolchildren: results of 2014–2019 survey

European Journal of Clinical Nutrition volume 77, pages 959–965 (2023)Cite this article

Subjects

Abstract

Background

Both insufficient and excessive iodine intake can lead to a broad range of disorders. A cross-sectional survey was conducted to assess iodine status in schoolchildren from Croatia.

Design

957 healthy 6 to 12-year-olds were enrolled (381 from northwestern region, 190 from eastern region, 215 from north Adriatic, and 171 from central Dalmatia region). Urinary iodine concentration (UIC) was measured in spot urine samples. Thyroid volume (Tvol) was recorded by ultrasound device. Standard anthropometric measures were taken, and body surface area (BSA) was determined. Tvol medians were calculated as a function of age, sex and BSA and compared with reference values.

Results

Total sample size included 490 boys and 467 girls. Overall median UIC was 250.68 µg/L, with statistically significant variance in geographical regions (median UIC was 244.71 µg/L in northwestern, 208.02 µg/L in eastern, 216.07 µg/L in north Adriatic and 366.43 µg/L in central Dalmatia region). There were 10.08% of samples with UIC < 100 mcg/L while 38.24% of samples had UIC > 300 mcg/L. Age-matched Tvol medians in schoolchildren from all regions of Croatia were at the upper limits of reference values, but in north Adriatic and central Dalmatia exceeded the 97th percentile. BSA-matched Tvol was within the reference range in all regions.

Conclusions

Our results demonstrate sufficient (more than adequate) iodine intake in schoolchildren of Croatia, and excessive iodine intake in central Dalmatia region. Total thyroid volumes in schoolchildren of Croatia were within the normal range, however borderline enlarged age-matched thyroid glands were observed in coastal areas.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Median urinary iodine concentration in school children from four major regions of Croatia.
Fig. 2: Map of Croatia showing regions enrolled in the study.
Fig. 3: Age distribution of total thyroid volume in boys from all regions of Croatia.
Fig. 4: Age distribution of total thyroid volume in girls from all regions of Croatia.
Fig. 5: Body surface area distribution of total thyroid volume in boys from all regions of Croatia.
Fig. 6: Body surface area distribution of total thyroid volume in girls from all regions of Croatia.

Similar content being viewed by others

Data availability

Data described in the manuscript will be made available upon reasonable request from the corresponding author.

References

  1. Laurberg P, Cerqueira C, Ovesen L, Rasmussen LB, Perrild H, Andersen S, et al. Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010;24:13–27. https://doi.org/10.1016/j.beem.2009.08.013.

    Article  CAS  PubMed  Google Scholar 

  2. World Health Organization. United Nations Children’s Fund & International Council for the Control of Iodine Deficiency Disorders. Assessment of iodine deficiency disorders and monitoring their elimination. 3rd ed. Geneva, Switzerland: WHO, 2007.

  3. Hatch-McChesney A, Lieberman HR. Iodine and iodine deficiency: a comprehensive review of a re-emerging issue. Nutrients. 2022;14:3474 https://doi.org/10.3390/nu14173474.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Zimmermann MB. The role of iodine in human growth and development. Semin Cell Dev Biol. 2011;22:645–52. https://doi.org/10.1016/j.semcdb.2011.07.009.

    Article  CAS  PubMed  Google Scholar 

  5. EFSA NDA Panel (EFSA Panel on Panel on Dietetic Products Nutrition and Allergies 2014. Scientific opinion on dietary reference values for iodine. EFSA J. 2014;12:3660. https://doi.org/10.2903/j.efsa.2014.3660.

  6. Kusić Z, Jukić T, Rogan SA, Jureša V, Dabelić N, Staničić J, et al. Current status of iodine intake in Croatia-the results of 2009 survey. Coll Antropol. 2012;36:123–8.

    PubMed  Google Scholar 

  7. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009;30:376–408. https://doi.org/10.1210/er.2009-0011.

    Article  CAS  PubMed  Google Scholar 

  8. Ba DM, Ssentongo P, Na M, Kjerulff KH, Liu G, Du P, et al. Factors associated with urinary iodine concentration among women of reproductive age, 20-49 years old, in Tanzania: a population-based cross-sectional study. Curr Dev Nutr. 2020;4:nzaa079. https://doi.org/10.1093/cdn/nzaa079.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Henjum S, Abel MH, Meltzer HM, Dahl L, Alexander J, Torheim LE, et al. Er inntaket av jod i befolkningen tilstrekkelig? [Is iodine intake adequate in Norway?]. Tidsskr Nor Laegeforen. 2019;139:Norwegian. https://doi.org/10.4045/tidsskr.18.0319.

    Article  Google Scholar 

  10. Gärtner R. Recent data on iodine intake in Germany and Europe. J Trace Elem Med Biol. 2016;37:85–89. https://doi.org/10.1016/j.jtemb.2016.06.012.

    Article  CAS  PubMed  Google Scholar 

  11. The Iodine Global Network. Global scorecard of iodine nutrition in 2021 in the general population based on school-age children (SAC). IGN: Ottawa, Canada. 2021. https://www.ign.org/cm_data/IGN_Global_Scorecard_2021_7_May_2021.pdf. Accessed 1 Aug 2022.

  12. Ittermann T, Albrecht D, Arohonka P, Bilek R, de Castro JJ, Dahl L, et al. Standardized map of iodine status in Europe. Thyroid 2020;30:1346–54. https://doi.org/10.1089/thy.2019.0353. Epub 2020 Jul 15. Erratum in: Thyroid. 2022 May;32(5):603.

    Article  CAS  PubMed  Google Scholar 

  13. Jukić T, Zimmermann MB, Granić R, Prpić M, Krilić D, Jureša V, et al. Sufficient Iodine Intake in School children from the Zagreb Area: assessment with dried blood spot thyroglobulin as a new functional biomarker for iodine deficiency. Acta Clin Croat. 2015;54:424–31.

    PubMed  Google Scholar 

  14. Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann NY Acad Sci 2019;1446:44–65. https://doi.org/10.1111/nyas.14041.

    Article  CAS  PubMed  Google Scholar 

  15. Xiu L, Zhong G, Ma X. Urinary iodine concentration (UIC) could be a promising biomarker for predicting goiter among school-age children: a systematic review and meta-analysis. PLoS One 2017;12:e0174095. https://doi.org/10.1371/journal.pone.0174095. Erratum in: PLoS One. 2017 Jul 7;12 (7):e0181286.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zimmermann MB, Aeberli I, Andersson M, Assey V, Yorg JA, Jooste P, et al. Thyroglobulin is a sensitive measure of both deficient and excess iodine intakes in children and indicates no adverse effects on thyroid function in the UIC range of 100-299 μg/L: a UNICEF/ICCIDD study group report. J Clin Endocrinol Metab. 2013;98:1271–80. https://doi.org/10.1210/jc.2012-3952.

    Article  CAS  PubMed  Google Scholar 

  17. Brunn J, Block U, Ruf G, Bos I, Kunze WP, Scriba PC Volumetrie der Schilddrüsenlappen mittels Real-time-Sonographie [Volumetric analysis of thyroid lobes by real-time ultrasound (author’s transl)]. Dtsch Med Wochenschr. 1981;106:1338-40. German. https://doi.org/10.1055/s-2008-1070506.

  18. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317:1098. https://doi.org/10.1056/NEJM198710223171717.

    Article  PubMed  Google Scholar 

  19. Vidranski V, Franceschi M, Krilić D, Jukić T, Mihaljević I, Kusić Z. Analytical evaluation of the new Seal Autoanalyzer 3 High Resolution for urinary iodine determination. Biochem Med (Zagreb) 2019;29:020711. https://doi.org/10.11613/BM.2019.020711. Erratum in: Biochem Med (Zagreb). 2019 Oct 15;29(3):031201.

    Article  PubMed  Google Scholar 

  20. WHO. Urinary iodine concentrations for determining iodine status deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization; 2013. http://www.who.int/nutrition/vmnis/indicators/urinaryiodine, Accessed 1 Aug 2022.

  21. Zimmermann MB, Hess SY, Molinari L, De Benoist B, Delange F, Braverman LE, et al. New reference values for thyroid volume by ultrasound in iodine-sufficient schoolchildren: a World Health Organization/Nutrition for Health and Development Iodine Deficiency Study Group Report. Am J Clin Nutr. 2004;79:231–7. https://doi.org/10.1093/ajcn/79.2.231.

    Article  CAS  PubMed  Google Scholar 

  22. Dold S, Zimmermann MB, Jukić T, Kusić Z, Jia Q, Sang Z, et al. Universal salt iodization provides sufficient dietary iodine to achieve adequate iodine nutrition during the first 1000 days: a cross-sectional multicenter study. J Nutr. 2018;148:587–98. https://doi.org/10.1093/jn/nxy015.

    Article  PubMed  Google Scholar 

  23. Mannar MV. Making salt iodization truly universal by 2020. IDD Newsl. 2014;42:12–15.

    Google Scholar 

  24. Kusić Z, Novosel SA, Dabelić N, Punda M, Roncević S, Labar Z, et al. Croatia has reached iodine sufficiency. J Endocrinol Invest. 2003;26:738–42. https://doi.org/10.1007/BF03347356.

    Article  PubMed  Google Scholar 

  25. World Health Organization. Trace elements in human nutrition and health. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Geneva (Switzerland); WHO; 1996.

  26. Hlucny K, Alexander BM, Gerow K, Larson-Meyer DE. Reflection of dietary iodine in the 24 h urinary iodine concentration, serum iodine and thyroglobulin as biomarkers of iodine status: a pilot study. Nutrients 2021;13:2520. https://doi.org/10.3390/nu13082520.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva, Switzerland: World Health Organization; 2013.

  28. Jelaković B, Kaić-Rak A, Milicić D, Premuzić V, Skupnjak B, Reiner Z. Manje soli-vise zdravlja. Hrvatska inicijativaza smanjenje prekomjernog unosa kuhinjske soli (CRASH) [Less salt-more health.Croatian action on salt and health (CRASH)]. Lijec Vjesn.2009;131:87–92. Croatian.

  29. Drenjančević-Perić I, Jelaković B, Lombard JH, Kunert MP, Kibel A, Gros M. High-salt diet and hypertension: focus on the renin-angiotensin system. Kidney Blood Press Res 2011;34:1–11. https://doi.org/10.1159/000320387.

    Article  CAS  PubMed  Google Scholar 

  30. WHO. Guideline: Sodium intake for adults and children. Geneva, World Health Organization (WHO), 2012.

  31. Jelakovic B. Salt Intake in Croatia—EHUH 2 Report. [(accessed on October 24, 2022)]; In 41st Symposium Hypertension Highlights in 2020. Available online: https://kongresi.emed.hr/course/info.php?id=149.

  32. World Health Organization. Multisectoral Action in Food Systems, Nutrition and Food Safety. Universal salt iodization and sodium intake reduction: compatible, cost-effective strategies of great public health benefit. 22 August 2022. https://www.who.int/publications/i/item/9789240053717 [(Accessed 19 May 2023)].

Download references

Acknowledgements

This study was conducted with support of Croatian Science Foundation project IP-2014-09-6499 grant. The research on goiter and iodine intake in Croatia was undertaken between 2014 and 2019.

Author information

Authors and Affiliations

  1. University Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

    Dorotea Filipan, Valentina Vidranski, Marija Bosak Butković, Ivan Blažeković, Matija Romić, Ivan Šamija, Ana Fröbe & Tomislav Jukić

  2. Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, Osijek, Croatia

    Ivan Mihaljević & Tomislav Jukić

  3. Clinical Institute of Nuclear Medicine and Radiation Protection, University Hospital Osijek, Osijek, Croatia

    Ivan Mihaljević

  4. Clinical Department of Nuclear Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia

    Tatjana Bogović Crnčić

  5. University of Rijeka, Faculty of Medicine, Rijeka, Croatia

    Tatjana Bogović Crnčić

  6. Croatian Academy of Sciences and Arts, Zagreb, Croatia

    Zvonko Kusić

  7. School of Dental Medicine, University of Zagreb, Zagreb, Croatia

    Ivan Šamija & Ana Fröbe

  8. School of Medicine, University of Zagreb, Zagreb, Croatia

    Tomislav Jukić

Authors
  1. Dorotea Filipan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valentina Vidranski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marija Bosak Butković
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivan Blažeković
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matija Romić
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ivan Mihaljević
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tatjana Bogović Crnčić
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zvonko Kusić
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ivan Šamija
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ana Fröbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tomislav Jukić
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors’ contributions were as follows: ZK, TJ, AF—study design (project idea, development of the research plan, overall activities oversight). TJ, VV, IB, MR, MBB, IM, TBC—data acquisition and collection. DF, TJ, VV, IM, TBC—analyses of data and statistical analyses. DF, TJ—composition of the manuscript. All authors read and approved the final (submitted) version of the manuscript.

Corresponding author

Correspondence to Tomislav Jukić.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Filipan, D., Vidranski, V., Bosak Butković, M. et al. Recent data on iodine intake in Croatian schoolchildren: results of 2014–2019 survey. Eur J Clin Nutr 77, 959–965 (2023). https://doi.org/10.1038/s41430-023-01301-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-023-01301-y

This article is cited by

Search

Advanced search

Quick links