The story of the Croatian village of Rude after fifty years of compulsory salt iodination in Croatia

Jukić, Tomislav and Dabelić, Nina and Rogan, Sunčica Andreja and Nöthig-Hus, Dunja and Lukinac, Ljerka and Ljubičić, Mate and Kusić, Zvonko (2008) The story of the Croatian village of Rude after fifty years of compulsory salt iodination in Croatia. Collegium Antropologicum, 32 (4). pp. 1251-1254. ISSN 0350-6134

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Abstract

The village of Rude is situated near Zagreb, the capital of Croatia in the last Alpine valley on Balkan. In the past, the village was well-known area of severe iodine deficiency disorders (IDD). In 1952', distinguished Croatian endocrinologist Professor Josip Matovinovic carried out detailed village survey. Goiter prevalence in school-age children was 85.0% (with 2.3% of cretins in the village). In 1953, the first regulation on compulsory salt iodination with 10 mg of KI/kg of salt was established in former Yugoslavia. Ten years later a dramatic decrease in goiter prevalence was recorded in all endangered areas of the country and no new cretins appeared. However, at the beginning of 1990' mild to moderate iodine deficiency still persisted in Croatia. In 1991, the village of Rude survey demonstrated goiter prevalence in school-age children of 35.0% and median of urinary iodine excretion (UIE) of 7.4 microg/dL. In 1996, the new obligatory regulation with 25 mg of KI/kg of salt was established in Croatia. The study aim was to monitor IDD status in the village after the new law on compulsory salt iodination. Measurements of UIE and thyroid volumes (Tvol) by ultrasound were performed in 7-11-y-old schoolchildren living in the village of Rude. Medians of UIE and body surface area (BSA)-adjusted Tvol in boys and girls were calculated. The study included 84 children in 1997, 132 in 2000, 72 in 2002, 85 in 2003 and 46 in 2004 for UIE measurement. Thyroid volumes were measured in 1999 (43 boys and 26 girls) and in 2005 (22 boys and 26 girls). Data were compared with the new WHO/ICCIDD reference values. Medians of UIE in schoolchildren from the village of Rude demonstrated rising values in microg/dL: 11.4 in 1997, 14.3 in 2000, 17.3 in 2002, 15.4 in 2003 and 19.0 in 2004. Significant decrease in BSA-adjusted Tvol was recorded from 1999-2005 in boys and girls from the village of Rude and in 2005 Tvol were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren. As a result of increased iodine prophylaxis, IDD no longer exist in Croatia. Monitoring of IDD status in the village of Rude after new law on compulsory salt iodination in Croatia demonstrated rising medians of UIE together with significant reduction of Tvol. In 2005, Tvol in schoolchildren from the village of Rude were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren.

Abstract in Croatian

Selo Rude smješteno je nadomak Zagreba u posljednjoj Alpskoj dolini na Balkanu. To je područje u prošlosti bilo poznato po teškom nedostatku joda. Eminentni hrvatski endokrinolog svjetskog ugleda, profesor Josip Matovinović proveo je 1952. u Rudama opsežno epidemiološko istraživanje i utvrdio prevalencija gušavosti u školske djece od 85,0% (uz 2,3% kretena u seoskoj populaciji). Godine 1953. prvi zakon o obveznoj jodiranju soli sa 10 mg KI/kg soli uveden je u bivšoj Jugoslaviji. Deset godina kasnije zabilježeno je dramatično smanjenje prevalencije gušavosti u svim zahvaćenim područjima Hrvatske uz nestanak kretenizma. Međutim, početkom 1990-tih blagi do umjereni nedostatak joda još uvijek je postojao u Hrvatskoj. Godine 1991, epidemiološko istraživanje stanja gušavosti u selu Rude pokazalo je prevalenciju gušavosti u školske djece 35,0% uz medijan izlučivanja joda urinom 7,4 mg/dL. Godine 1996. uveden je u Hrvatskoj novi zakon o obveznom jodiranju soli s 25 mg KI/kg soli. Cilj ovoga istraživanja je praćenje stanja gušavosti i unosa joda u selu Rude nakon uvođenja novog zakona o obveznom jodiranju soli. Provedeno je višestruko mjerenje izlučivanja joda urinom i ultrazvučno mjerenje volumena štitnjače u školske djece u dobi od 7 do 11 godina. Dobivene podaci su prikazani kao medijani izlučivanja joda urinom te volumeni štitnjače u dječaka i djevojčica usklađeni prema površini tijela. U istraživanje izlučivanja joda urinom uključeno je 84 školske djece u 1997. godini, 132 u 2000, 72 u 2002, 85 u 2003 i 46 školske djece u 2004 godini. Ultrazvučno mjerenje volumena štitnjače provedeno je 1999 godine (43 dječaka i 26 djevojčica) i 2005 godine (22 dječaka i 26 djevojčica). Podaci su uspoređeni s novim referentnim vrijednostima WHO/ICCIDD. Medijani izlučivanja joda urinom u školske djece u selu Rude porasli su nakon novog zakona (mg/dL): 11,4 u 1997, 14,3 u 2000, 17,3 u 2002, 15,4 u 2003 i 19,0 u 2004 godini. Značajno smanjenje volumena štitnjače usklađenih prema površini tijela utvrđeno je u dječaka i djevojčica iz sela Rude, a u 2005 godini te vrijednosti bile su granicama normale u odnosu na nove referentne vrijednosti WHO/ICCIDD. Kao rezultat uvođenja novog zakona o obveznom jodiranju soli 1996. godine danas je iskorijenjena gušavost u školske djece u Hrvatskoj i općenito svi poremećaji uzrokovani nedostatkom joda.

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