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Background: Mild-to-moderate iodine deficiency is still present in many countries, particularly in pregnant women. Observational studies suggest that mild-to-moderate iodine deficiency during pregnancy may be associated with impaired thyroid function and child neurodevelopment. Randomized-controlled food trials to increase iodine status are scarce. We assessed the impact of an increased intake of cod during pregnancy on maternal iodine status and infant neurodevelopment. Methods: In this randomized-controlled trial, pregnant women in Bergen, Norway, recruited through Haukeland University Hospital, were randomly assigned (1:1) to an intervention of 200 g of cod twice a week for 16 weeks (gestational week 20–36) or to continue with their standard diet (control group). Randomization was done by lottery. Primary outcome was urinary iodine concentration (UIC) (spot samples from six consecutive days) measured postintervention. Secondary outcome was infant neurodevelopment assessed by the cognitive, language, and motor scales of the Bayley Scales of Infant and Toddler Developmental third edition (Bayley-III) at 11 months of age. In addition, maternal thyroid function was measured (thyrotropin [TSH], free triiodothyronine [fT3], free thyroxine [fT4]) at baseline and postintervention. Results: Between January 2016 until February 2017, 137 women were recruited. Postintervention UIC was higher in the intervention group (n = 61) [median (interquartile range, IQR) 98 (64–145) μg/L], compared with control (n = 61) [median (IQR) 73 (52–120) μg/L] (p = 0.028), also after adjusting for baseline UIC (p = 0.048). Infants of mothers in the intervention group had a lower cognitive composite score on the Bayley-III compared with the control group (p = 0.045). There were no group differences in the Bayley III language- or motor composite scores. Maternal thyroid hormones (TSH, fT3, fT4) did not differ between the groups postintervention. Conclusions: Increased cod intake during pregnancy improved the iodine status in women with mild-to-moderate iodine deficiency, however, did not affect thyroid function. The negative effect on cognition should be followed up to assess whether this is a stable effect over time. More studies are warranted to enable good health advice on iodine nutrition in pregnancy. ClinicalTrials.gov NCT02610959. Registered November 20, 2015. publishedVersion

Additional file 1: Figure S1. Overview of methods used in validation of the I-FFQ in Norwegian pregnant women. Table S1. Number of food items specified in the I-FFQ and the food diary, and number of frequency alternatives in the I-FFQ.

Master i samfunnsernæring Background: People in the long-term refugee camps in the Algerian desert are exposed to high iodine intakes from water and animal milk. At the same time the goitre rate is very high, with a goitre prevalence of 18 % for the women and 11 % for school age children. Objectives: The main objective for this thesis was to examine iodine intake among lactating women, their iodine excretion in urine, and if high iodine intake for the women will give high level of iodine in breast-milk. And further how feeding practises and breast milk iodine concentrations is affecting the children’s iodine concentration in urine. Methods: 110 lactating women with their 110 children from 0 up to 7 months of age were included. The women’s iodine intake was assessed by interviewed information of the last 24-hours and 7 days intake of iodine rich foods. To assess the iodine intake, samples of public water (n=24), camel milk (n=34) and goat milk (n=13) were collected from the women, as well as spot-urine and breast milk samples. Spot-urine was collected from the children as well as data on feeding practises. Iodine concentration in water and urine samples was determined by Sandell-Kolthoff reaction, whereas milk samples were determined by the Inductively Coupled Plasma-Mass Spectrometry method. Results: Median (p25-p75) iodine concentrations of camel milk, goat milk and drinking water were 2020 (1502-4137) µg/L, 952 (801-1787) µg/ L and 102 (80-255) µg/L, respectively. Estimated dietary iodine intake for the women was 409 (234-709) µg/day, where water seemed to be the main contributor to the iodine intake. The women had a median urinary iodine concentration (UIC) of 349 (207-526) µg/L, and UIC were positively associated with BMI and camel milk iodine intake which explained 9,3% of the variation in UIC. The median breast milk iodine concentration (BMIC) was 479 (330-702) µg/L, and was positively associated with water- and goat milk iodine intake and UIC, which explained 15,8% of the variation in BMIC. Even though only 6% of the children were exclusively breast fed, no other foods or drinks but breast milk showed any association with the children’s UIC. BMIC explained 9,9% of the variation in children’s UIC. The children had a median urinary iodine concentration of 728 (401-1145) µg/L. Conclusion: The median BMIC was generally higher than the median UIC and seemed to be affected more by dietary iodine intake than UIC. There are no upper levels of UIC or iodine intake for lactating women by the WHO. But 74 % of the women had iodine intakes above their daily recommended intake of 250 µg/day (WHO), indicating a high iodine exposure. The breast milk iodine concentrations were not favourable for children 0-7 months of age, which have a daily recommended intake of 90 µg/day (WHO). The children’s urinary iodine concentrations indicate that the iodine intake from breast milk is very high, with 89% of the children having a urinary iodine concentration ≥ 300 µg/L, which is the upper limit used for an adult population (WHO). It is likely that the high iodine exposure may cause thyroid disorders for the women and their children

Master i samfunnsernæring Background and aim: Poor feeding practices leads to child malnutrition and consequently impaired physical and cognitive development. The objective of this paper is to describe nutritional status, infant and young child feeding practices, and access to health care in children 0-24 months, in urban and rural areas of Nepal, and to explore predictors for nutritional status. Methods: A cross-sectional study was carried out among 111 mother-child pairs, by convenience sampling. Data were collected using the World Health Organizations indicators for infant and young child feeding practices, and the children’s anthropometrics were measured. Correlation tests were used to measure differences between urban and rural areas and predictors for undernourishment were explored in multiple regression models. Results: Underweight, wasting and stunting was found in 12.6%, 9.0% and 20.7% of the children respectively. The rate of exclusive breastfeeding was 80%, early initiation of breastfeeding was reported by 71% of the mothers, and timely introduction to complementary foods was found in 96% of the infants. The minimum dietary diversity was consumed by 47% of the children, and 43% received a minimum acceptable diet. Snack foods such as biscuits, chips, and chocolates, were consumed by 59% of the children in the past 24 hours. No significant differences were found between children in urban and rural areas with respect to access to health care, feeding practices or nutritional status. However, stunting was substantially higher among children in rural areas. Maternal school level; number of children; number of antenatal visits; and number of children were found to be predictor of undernutrition. Conclusions: Findings of this paper indicate that suboptimal feeding practices and undernutrition exist across urban and rural areas. Early childhood nutritional interventions are necessary to prevent child undernutrition

Master i samfunnsernæring Background: Optimal feeding of infants and young children living under difficult conditions are important to secure their development and survival. Refugees are a particularly vulnerable group. A previous study in the refugee camps in the Algerian desert, shows that prevalence of exclusive (11%) and predominant breastfeeding (47 %) was low among children