Ao. Akanji et al., URINARY IODINE EXCRETION IN MOTHERS AND THEIR BREAST-FED CHILDREN IN RELATION TO OTHER CHILDHOOD NUTRITIONAL PARAMETERS, European journal of clinical nutrition, 50(3), 1996, pp. 187-191
Objective: There is currently no coordinated policy on the epidemiolog
y and control of iodine deficiency disorders (IDD) in many parts of Af
rica even where these disorders are endemic. Assessment of the urinary
iodine excretion is believed to give the best index of the prevalence
of IDD in the community. This study aimed to establish whether: (i) t
he breast-fed child of an iodine replete mother was protected from IDD
and, (ii) infants at risk of IDD and in need of immediate iodine supp
lementation could easily be identified through simple screening method
s. Design: Randomized, cross-sectional study. Setting: A tertiary care
infant welfare clinic in Ibadan, South-western Nigeria, a geographica
l area recognised to be outside Nigeria's endemic goitre belt (goitre
prevalence < 5.0%). Subjects: 68 healthy mother-child pairs. The child
ren were all aged 9-18 months and breast-fed almost exclusively. Inter
ventions: Nil. Methods: The relationships of anthropometric, iodine st
atus (casual urinary iodine (I) and iodine/creatinine ratio (I/Cr)) an
d nutritional indices (weights, haematocrits) of the mothers with thos
e of their breast-fed children were assessed, as well as how these par
ameters differed between the children classified on the basis of their
mid-upper arm circumference, MUAC, as: (A) borderline malnourished, M
UAC < 13.5 cm and, (B) well nourished, MUAC > 13.5 cm. Results: The ma
ternal values for I and I/Cr were significantly (p < 0.001) greater th
an those of their breast-fed infants, although the respective mother-c
hild pair values correlated positively (I, r 0.47; I/Cr, 0.21; both p
< 0.05). There was thus a gradient in iodine status between the mother
and her breast-fed infant that is unfavourable to the growing child;
the latter may thus require iodine supplementation in spite of the fac
t that the mother is iodine replete. Among the children, those conside
red well nourished (Group B) had similar iodine status parameters as t
hose considered poorly nourished (Group A) suggesting that malnutritio
n alone should not be the determinant of the prioritization (or otherw
ise) of iodine supplementation in a population with coexistent iodine
deficiency and malnutrition. Mean values for (I) in all the children (
9.9 mu g/dl) fell in the iodine deficiency range ( < 10 mu g/dL), alth
ough all the mothers were iodine replete (mean urinary (I) 14.5 mu g/d
L), despite the fact that all resided in a non iodine deficient area.
Conclusion: The study suggests that: (i) the breast-fed child of an io
dine replete mother resident in a non-iodine deficient area may be iod
ine deficient and in need of iodine supplementation; (ii) malnutrition
, as defined by the simple community screening method of measuring the
MUAC, will not accurately identify those infants in immediate need of
iodine supplementation. These observations have important implication
s for planning IDD control programmes in Africa.