title: Iodine Nutritional Status in Schoolchildren from Public Schools in Brazil: A Cross-Sectional Study Exposes Association with Socioeconomic Factors and Food Insecurity.
abstract: National programs of salt iodization were implemented in Brazil to combat iodine deficiency (ID) in children of school age. Currently, there are limited data in Brazil on those still vulnerable to this deficiency and the state of nutritional iodine status in the northeast region of Brazil, where children are vulnerable to malnutrition.
  
  
  
  The aim of this study was to analyze the iodine nutritional status, household food insecurity, socioeconomic and demographic characteristics among schoolchildren from the public school system living in state the state of Bahia, Brazil.
  
  
  
  A cross-sectional study was conducted on 1419 schoolchildren in Bahia between the ages of 6 and 14 years old. Anthropometric parameters, urinary iodine concentrations (UIC), and thyrotropin (TSH) measurements were evaluated from blood spots on filter paper.
  
  
  
  The mean UIC was 206.4 ± 80.5 μg/L, with a median of 221.6 μg/L, indicating sufficient iodine intake in the region. Low urinary iodide concentration (<100 μg/L) was detected in 12.3% of the schoolchildren (n = 174), with 6.2% with mild (<100 μg/L), 3.0% with moderate (20-49 μg/L), and 3.1% with severe ID (<20 μg/L). Moreover, 9.4% (n = 134) had a urinary iodide concentration of >300 μg/L, indicating the coexistence of excessive iodine intake (EII). The mean TSH was 1.0 ± 0.6 mIU/L. The body mass index category "overweight/obesity" was a protective factor against EII (odds ratio [OR] = 0.64 [confidence interval (CI) 0.4-1.0]; p = 0.07). Urban areas (73%) had a mean UIC of 213.1 ± 80 μg/L compared with 176.8 ± 76.1 μg/L in rural areas. The risk for EII increased in children living in a house with more than six people (OR = 1.62 [CI 0.9-2.6]; p < 0.05) and water consumption from shallow wells (OR = 1.70 [CI 0.9-3.1]; p = 0.09). The risk of ID was increased by 70% in schoolchildren who had moderate or severe food insecurity (OR = 1.70 [CI 0.9-3.0]; p > 0.05).
  
  
  
  A significant proportion of schoolchildren still have ID or EII in the northeast region of Brazil, emphasizing the importance of committed public policies to address this problem. Socioeconomic factors and the lack of education about nutritional importance of iodine were important influencing factors in the presence of ID in schoolchildren.
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .|2 Postgraduate Program in Interactive Processes of Organs and Systems, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Renata de Oliveira
authors.initials: Rde O
authors.lastname: Campos
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Sara Cristina Lima
authors.initials: SC
authors.lastname: Reboucas
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Rebeca
authors.initials: R
authors.lastname: Beck
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Lorena Rejane Maia
authors.initials: LR
authors.lastname: de Jesus
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Yanne Rocha
authors.initials: YR
authors.lastname: Ramos
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Iasmin Dos Santos
authors.initials: Idos S
authors.lastname: Barreto
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Tamires Xavier
authors.initials: TX
authors.lastname: Marques
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Taise Lima Oliveira
authors.initials: TL
authors.lastname: Cerqueira
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .|2 Postgraduate Program in Interactive Processes of Organs and Systems, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: William Alves
authors.initials: WA
authors.lastname: Santos
authors.affiliation: 3 Health and Science Center, Federal University Reconcavo of Bahia , Santo Antonio de Jesus, Brazil .
authors.forename: Clotilde Assis
authors.initials: CA
authors.lastname: Oliveira
authors.affiliation: 4 Institute of Chemistry, Federal University of Bahia , Salvador, Brazil .
authors.forename: Leonardo Sena Gomes
authors.initials: LS
authors.lastname: Teixeira
authors.affiliation: 5 Laboratory of Toxicology and Essentiality of Metals, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo , Ribeirão Preto, SP, Brazil .
authors.forename: Vanessa Cristina de Oliveira
authors.initials: VC
authors.lastname: Souza
authors.affiliation: 5 Laboratory of Toxicology and Essentiality of Metals, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo , Ribeirão Preto, SP, Brazil .
authors.forename: Fernando
authors.initials: F
authors.lastname: Barbosa
authors.affiliation: 1 Department of Bioregulation, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .|2 Postgraduate Program in Interactive Processes of Organs and Systems, Health and Science Institute, Federal University of Bahia , Salvador, Brazil .
authors.forename: Helton Estrela
authors.initials: HE
authors.lastname: Ramos
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D060766:Drinking Water; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006801:Humans; D007455:Iodine / Q000652:urine*; D008297:Male; D009752:Nutritional Status; D050177:Overweight / Q000453:epidemiology; D063766:Pediatric Obesity / Q000453:epidemiology; D065840:Protective Factors; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012574:Schools; D012959:Socioeconomic Factors; D013972:Thyrotropin / Q000097:blood*; D014505:Urban Population
chemical_list: D060766:Drinking Water; D013972:Thyrotropin; D007455:Iodine