Endemic goiter with iodine sufficiency: a possible role for the consumption of pearl millet in the etiology of endemic goiter

Background: Deficiencies of iodine, iron, and vitamin A are the 3 most comm on micronutrient deficiencies in developing countries, although control pro grams, when properly implemented, can be effective. Objective: We investigated these deficiencies and their possible interactio n in preschool children in the southern Blue Nile area of Sudan. Design: Goiter, signs of vitamin A deficiency, and biochemical markers of t hyroid, vitamin A, and iron status were assessed in 984 children aged 1-6 y . Results: The gaiter rate was 22.3%. The median urinary iodine concentration was 0.79 mu mol/L and 19.38 of the children had a concentration >1.57 mu m ol/L. Although serum thyroxine and triiodothyronine concentrations were wit hin reference ranges, the median thyrotropin concentration was 3.78 mIU/L a nd 44% of the children had thyrotropin concentrations above normal. The mea n urinary thiocyanate concentration was high (259 +/- 121 mu mol/L). The pr evalences of Bitot spots and night blindness were 2.94% and 2.64%, respecti vely, and 32% of the subjects had serum retinol binding protein concentrati ons <15 mg/L. A significant positive con elation was observed between thyro tropin and retinol binding protein. Whereas 88% of the children had hemoglo bin concentrations <1.86 mmol/L, only 13.5% had serum ferritin concentratio ns below the cutoff of 12 mu g/L and 95% had serum transferrin concentratio ns above the cutoff of 2.50 g/L. Conclusions: Our results indicate that goiter is endemic in this region of Sudan despite iodine sufficiency and that both anemia and vitamin A deficie ncy are health problems in the area. Moreover, consumption of millet, vitam in A deficiency, and protein energy malnutrition are possible etiologic fac tors in this endemic area.