Обзор регулирования и практики использования йодсодержащих добавок в странах Восточной/Центральной Европы и Центральной Азии.

Настоящий обзор посвящен вопросам регулирования и практики использования йодных добавок (ЙД) в странах Восточной/Центральной Европы и Центральной Азии (ВЦЕ-ЦА) на основании новых сведений о преимуществах и недостатках использования ЙД в зависимости от ситуации с йодированием соли. Информация об использовании ЙД анализировалась для групп населения, особенно уязвимых к недостаточности йода: беременных и кормящих женщин, младенцев в возрасте от 6 до 36 месяцев, а также детей дошкольного и школьного возрастов. Процесс подготовки обзора включал несколько повторных циклов поиска информации с помощью базы данных PubMed и других источников. В анализ были включены статьи открытого доступа, опубликованные на английском, русском и румынском языках за последние 10–15 лет. Анализ доступных источников информации показал, что в девяти странах ВЦЕ-ЦА были приняты официальные рекомендации по использованию ЙД у разных групп населения, обычно — беременных и кормящих женщин. При этом в пяти из них медианная концентрация йода в моче (КЙМ) у беременных женщин была ниже оптимальной (150 мкг/л). Опыт стран региона ВЦЕ-ЦА показывает, что обязательное йодирование соли обеспечивает достаточное потребление йода для всех групп населения. Дальнейшие усилия следует направить на повышение использования йодированной соли с целью охватить более 90% домохозяйств и расширение использования йодированной соли в пищевой промышленности. Вместе с тем ЙД могут по-прежнему быть необходимы для лиц, подверженных риску дефицита йода, вызванного особенностями питания и образа жизни (веганство/вегетарианство и другие ограничительные диеты). Такое целевое назначение ЙД может потребовать разработки официальных руководств для оценки эффективности такого подхода и методов контроля за его внедрением.

1. World Health Organization. Regional Office for Europe. (2024). Prevention and control of iodine deficiency in the WHO European Region: adapting to changes in diet and lifestyle. Available at: https://iris.who.int/handle/10665/377746

2. UNICEF/WHO. World Summit for Children - Mid-decade goal: Iodine Deficiency Disorders. UNICEF/WHO Joint Committee on Health Policy. Geneva, 1994

3. WHO Statement: Eliminating iodine deficiency disorders safely through iodized salt. 1994. Available at: https://www.who.int/publications/i/item/WHO-NUT-94.4

4. Zimmermann MB, Andersson M. Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020. Eur. J. Endocrinol. 2021;185(1):13–21

5. Gerasimov G. Iodine Deficiency Disorders (IDD) in the Russian Federation: A Review of Policies towards IDD Prevention and Control and Trends in IDD Epidemiology (1950-2002) Moscow, 2002

6. Turcan L, Gerasimov GA, Parvanta I, Timmer A. Progress in Iodine Deficiency Disorders (IDD) Control and Elimination in Europe and Central Asia Region (ECAR) in 2010–2020. Clin Exp Thyroidol. 2021. doi: https://doi.org/10.14341/ket12713

7. WHO/UNICEF. Reaching Optimal Iodine Nutrition in Pregnant and Lactating Women and Young Children. 2007. Available at: https://www.who.int/publications/m/item/WHO-statement-IDD-pregnantwomen-children

8. WHO. Essential nutrition actions: mainstreaming nutrition through the life-course. 2019. Available at: https://www.who.int/publications/i/item/9789241515856

9. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J. 2014;3(2):76-94. doi: https://doi.org/10.1159/000362597

10. FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good clinical practice advice: Micronutrients in the periconceptional period and pregnancy. Int J Gynaecol Obstet. 2019;144(3):317-321. doi: https://doi.org/10.1002/ ijgo.12739

11. International expert consensus on micronutrient supplement use during the early life course. BMC Pregnancy and Childbirth. 2025;25:44 doi: https://doi.org/10.1186/s12884-024-07123-5

12. Croce L, Chiovato L, Tonacchera M, Petrosino E, Tanda ML, et al. Iodine status and supplementation in pregnancy: an overview of the evidence provided by meta-analyses. Rev Endocr Metab Disord. 2023, 24(2):241-250. doi: https://doi.org/10.1007/s11154-022-09760-7

13. Dineva M, Fishpool H, Rayman MP, Mendis J, Bath SC. Systematic review and meta-analysis of the effects of iodine supplementation on thyroid function and child neurodevelopment in mildly-to-moderately iodine-deficient pregnant women. Am J Clin Nutr. 2020;112(2):389-412. doi: https://doi.org/10.1093/ajcn/nqaa071

14. Ibrahim M, Sinn J, McGuire W. Iodine supplementation for the prevention of mortality and adverse neurodevelopmental outcomes in preterm infants. Cochrane Database Syst Rev. 2006;(2):CD005253. doi: https://doi.org/10.1002/14651858.CD005253.pub2

15. Velasco I, Rueda-Etxebarria M, Trak-Fellermeier MA, Taylor P, Rabassa Bonet M, et al. Iodine supplementation for preventing iodine deficiency disorders in children and adolescents. Cochrane Database Syst. Rev. 2023(4):CD014475. doi: https://doi.org/10.1002/14651858.CD014475

16. Dold S, Zimmermann MB, Jukic T, Kusic Z, Jia Q, 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(4):587-598. doi: https://doi.org/10.1093/jn/nxy015

17. Marinović Glavić M, Bilajac L, Bolješić M, Bubaš M, Capak K, et al. Assessment of Salt, Potassium, and Iodine Intake in the Croatian Adult Population Using 24 h Urinary Collection: The EH-UH 2 Study. Nutrients. 2024; 16(16):2599. doi: https://doi.org/10.3390/nu16162599

18. Hutchings N, Aghajanova E, Baghdasaryan S, et al. A stratified cross-sectional cluster model survey of iodine nutrition in armenia after a decade of universal salt iodization. Endocr Pract. 2019;25(10):987-993. doi: https://doi.org/10.4158/EP-2018-0634

19. Gerasimov G, Sturua L, Ugulava T, van der Haar F. Georgia celebrates sustained optimal iodine nutrition. IDD Newsletter; 2018;46(2): 2-10

20. Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutrition. 2007;10(12A):1606-1611. doi: https://doi.org/10.1017/S1368980007361004

21. BfR. Declining iodine intake in the population: model scenarios to improve iodine intake BfR Opinion no. 005/2021 issued 9 February 2021. DOI doi.org/10.17590/20230113-115339

22. Leung AM, Pearce EN, Braverman LE. Iodine content of prenatal multivitamins in the United States. N Engl J Med. 2009;360(9):939-940. doi: https://doi.org/10.1056/NEJMc0807851

23. Zimmermann M, Delange F. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur J Clin Nutr. 2004;58(7):979-984. doi: https://doi.org/10.1038/sj.ejcn.1601933

24. Gfeller M, Colque G, Kopp PA. Iodine content of frequently used prenatal and adult multivitamins in Switzerland. Front Endocrinol (Lausanne). 2022 3(13):104-123. doi: https://doi.org/10.3389/fendo.2022.1041232

25. Antistrumin iodine poisoning: Health minister admits to children being given iodine overdose. Tashkent Times, 2023. https://tashkenttimes.uz/national/12044-antistrumin-iodine-poisoning-health-minister-admits-to-children-being-given-iodine-overdose#google_vignette

26. Korobitsyna R, Aksenov A, Sorokina T, Trofimova A, Grjibovski AM. Iodine Status of 6-12-Year-Old Children in Russia over the Past 10 Years: A Scoping Review. Nutrients. 2022; 21;14(4):897. doi: https://doi.org/10.3390/nu14040897

27. Working group on clinical practice. Clinical Practice Guideline for Care in Pregnancy and puerperum. Ministry of health, social services and equity of Spain. 2014. At https://portal.guiasalud.es/wp-content/uploads/2018/12/GPC_533_Embarazo_AETSA_compl_en.pdf

28. De Leo S, Pearce EN, Braverman LE. Iodine Supplementation in Women During Preconception, Pregnancy, and Lactation: Current Clinical Practice by U.S. Obstetricians and Midwives. Thyroid. 2017;27(3):434-439. doi: https://doi.org/10.1089/thy.2016.0227

29. Bouga M, Lean MEJ, Combet E. Contemporary challenges to iodine status and nutrition: the role of foods, dietary recommendations, fortification and supplementation. Proceedings of the Nutrition Society. 2018;77(3):302-313. doi: https://doi.org/10.1017/S0029665118000137

30. Güler B, Bilgiç D, Hülya Y, Hande M. An investigation of vitamin and mineral supplement recommendation among first-trimester pregnancies. Journal of Perinatal Medicine. 2019;47 (9):958-962. doi: https://doi.org/10.1515/jpm-2019-0178

31. Obreja G, Lozan O. Evaluarea cunoştinţelor, atitudinilor şi practicilor medicilor privind eliminarea tulburărilor prin deficit de iod (Evaluation of knowledges, attitudes and practices about iodine deficiency disorders elimination among medical doctors). Sănătate Publică, Economie şi Management în Medicină. 2014;1(52):26-31

32. Gheorghiu M. Iodine deficiency is still prevalent in pregnant women from Romania after universal salt iodization. Endocrine Abstracts. 2017doi: https://doi.org/10.1530/endoabs.49.EP1364

33. Bundesinstitut für Risikobewertung. Declining iodine intake in the population: model scenarios to improve iodine intake in children and adolescents: BfR Opinion no. 026/2022 issued 17 October 2022, BfR-Stellungnahmen. Bundesinst. für Risikobewertung. doi: https://doi.org/10.17590/20230116-122505

34. McMullan P, Hamill L, Doolan K, et al. Iodine deficiency among pregnant women living in Northern Ireland. Clin Endocrinol (Oxf). 2019;91(5):639-645

35. Clinical recommendations «Iodine deficiency disorders», 2020. (In Russian). At https://www.endocrincentr.ru/sites/default/files/specialists/science/clinic-recomendations/zabolevaniya_i_sostoyaniya_svyazannye_s_deficitom_yoda.pdf

36. The Ministry of Health of the Russian Federation. Clinical recommendations «Normal pregnancy», 2020. (In Russian). At https://congress-med.ru/assets/files/2024/2024-normalnaya-beremennost.pdf

37. Brough L. Improving Iodine Status in Lactating Women: What Works? Curr Nutr Rep. 2022;11(4):592-599. doi: https://doi.org/10.1007/s13668-022-00427-y

38. Barretto JR, Gouveia MADC, Alves C. Use of dietary supplements by children and adolescents. J Pediatr (Rio J). 2024;100, (Suppl 1):S31-S39. doi: https://doi.org/10.1016/j.jped.2023.09.008

39. Linus Paulling Institute. An Evidence-based Approach to Vitamins and Minerals: Health Benefits and Intake Recommendations: Iodine. 2001, updated in 2015. At https://lpi.oregonstate.edu/mic/minerals/iodine

40. Andersson M, de Benoist B, Delange F, Zupan J. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutrition. 2007;10(12A):1606-1611. doi: https://doi.org/10.1017/S1368980007361004

41. BfR. Declining iodine intake in the population: model scenarios to improve iodine intake BfR Opinion no. 005/2021 issued 9 February 2021. doi: https://doi.org/10.17590/20230113-115339

42. Buhling KJ, Scheuer M, Laakmann E. Recommendation and intake of dietary supplements periconceptional and during pregnancy: results of a nationwide survey of gynaecologists. Arch Gynecol Obstet. 2023;308(6):1863-1869. doi: https://doi.org/10.1007/s00404-023-07167-6

43. Gupta PM, Gahche JJ, Herrick KA, Ershow AG, Potischman N, Perrine CG. Use of Iodine-Containing Dietary Supplements Remains Low among Women of Reproductive Age in the United States: NHANES 2011-2014. Nutrients. 2018;10(4):422.

44. Blumberg JB, Frei B, Fulgoni VL, Weaver CM, Zeisel SH. Contribution of dietary supplements to nutritional adequacy by socioeconomic subgroups in adults of the United States. Nutrients. 2017;10:4. doi: https://doi.org/10.3390/nu10010004

45. Verkaik-Kloosterman J, van ‘t Veer P, Ocké MC. Reduction of salt: will iodine intake remain adequate in The Netherlands?. Br J Nutr. 2010;104(11):1712-1718. doi: https://doi.org/10.1017/S0007114510002722

46. Milevska-Kostova N, Karanfilski B, Knowles J, Codling K, Lazarus JH. Modelling the contribution of iodised salt in industrially processed foods to iodine intake in Macedonia. PLoS ONE. 2022,17(1):e0263225. doi: https://doi.org/10.1371/journal.pone.0263225

47. Salaru I, Demiscan D, Turcan L. Strengthening the strategy to sustain optimal iodine status in the Republic of Moldova: Assessing the use of iodized salt in industrially processed foods. PLOS ONE. 2023;18(12):e0296373. doi: https://doi.org/10.1371/journal.pone.0296373