Disruption of maternal thyroid homeostasis during pregnancy is of particular concern. Per- and polyfluoroalkyl substances (PFASs) can interfere with thyroid function, yet evidence in pregnant women and underlying mechanisms remain unclear. Here, we measured emerging and legacy PFASs, together with serum metabolomic profiles, in 540 pregnant women across two trimesters (n = 1180). Using a metabolome-wide association study combined with a meet-in-the-middle approach, we identified 92 key metabolites spanning 12 classes associated with both PFAS exposure and thyroid function. Pairwise mediation analysis revealed that several metabolites, notably cortisol, l-carnitine, and various amino acids, significantly mediated PFAS-thyroid associations. Pathway-level mediation further identified three principal mechanisms: interference with steroid hormone biosynthesis, mitochondrial dysfunction, and oxidative stress. Notably, we prompted a previously underappreciated mechanistic link whereby PFAS-induced alternations in cortisol may modulate the hypothalamic-pituitary-adrenal axis through negative feedback, thereby perturbing thyroid function. Emerging PFASs (PFO5DoDA, C9 HFPO-TA, and 6:2 Cl-PFESA) exhibited more extensive or similar metabolite-mediated effects on thyroid function compared with legacy PFOA and PFOS, suggesting that PFAS alternatives may pose greater risks for thyroid disruption. These findings show that prenatal PFAS exposure can disrupt maternal thyroid function through multiple metabolic pathways and highlight the necessity of PFAS exposure intervention in vulnerable populations.

[Background]Work alienation is a subjectively negative psychological state characterized by de-tachment from one's job and its environment.Due to heavy workloads,high-intensity tasks,low compensation,as well as pressures related to promotion,nurses are particularly susceptible to work alienation. [Objective]To meta-analyze the primary factors affecting work alienation of nurses in China,providing an evidence-based foundation for improving nursing management and nurses'physical and mental health. [Methods]A systematic search was conducted across multiple databases,including PubMed,Embase,the Cochrane Library,Web of Science,CNKI,VIP,Wanfang Data,and DBM,for cross-sectional studies on work alienation and its influencing factors among nurses in China published from inception to December 2024.Two researchers independently conducted literature screen-ing,data extraction,and risk of bias assessment for the included studies.Meta-analysis was per-formed using Stata 15.0 and RevMan 5.4 software.Pooled effect sizes were calculated using either fixed-effects or random-effects models based on the magnitude of heterogeneity. [Results]A total of 27 studies involving 13 028 nurses were included in the meta-analysis,from which 11 influencing factors of work alienation were identified.The pooled score for work alienation among nurses in China was 34.79(95%CI:32.56,37.01).Subgroup analysis revealed that the emergency department reported the highest score(36.81,95%CI:31.64,41.98),followed by the intensive care unit(34.99,95%CI:32.27,37.72)and internal medicine department(33.90,95%CI:29.10,38.71).Significant factors influencing work alienation included length of work experience[standardized mean difference(SMD)=0.32,95%CI:0.02,0.61],professional title(SMD=0.30,95%CI:0.16,0.44),monthly income(SMD=0.38,95%CI:0.14,0.62),psychological capital(SMD=-0.41,95%CI:-0.52,-0.29),work stress(SMD=0.54,95%CI:0.49,0.58),attitude toward aggression and violence management(SMD=-0.38,95%CI:-0.44,-0.32),and organizational climate(SMD=-0.47,95%CI:-0.57,-0.36)(P<0.05).Sensitivity analysis confirmed the robustness of the meta-analysis results,and no significant publication bias was detected. [Conclusion]Nurses in China exhibit a high level of work alienation,particularly in high-acuity settings like emergency and intensive care unit departments compared to general departments.Shorter work experience(<5 years),lower professional title,lower monthly income(<5 000 CNY),and greater work stress are positively correlated with work alienation.In contrast,psychological capital,proactive attitudes toward managing aggression and violence,and a supportive organizational climate are negatively correlated.These findings indicate a need for nursing managers to develop targeted strategies based on these multifaceted factors to mitigate alienation among nursing staff.

Previous epidemiological studies have established associations between fine particulate matter (PM2.5) exposure and maternal thyroid hormone suppression. However, as PM2.5 is a complex chemical mixture, the specific contribution of metallic constituents to PM2.5-induced thyroid disruption remains poorly characterized. This study aimed to evaluate the relationship between maternal thyroid function and exposure to metallic and metalloid components of PM2.5 during pregnancy. In a longitudinal study of 847 pregnant women recruited from three maternal and child healthcare hospitals, we collected fasting blood samples at 10, 17, and 32 weeks of gestation for thyroid hormone assessment. Concurrently, ambient PM2.5 monitoring stations near participating hospitals quantified 11 metallic/metalloid elements. Linear mixed-effects regression models assessed individual element associations with thyroid parameters, while weighted quantile sum (WQS) regression evaluated combined effects of metal mixtures. Significant inverse associations were observed between lead (Pb) exposure and serum thyroid stimulating hormone (TSH) levels. Multiple elements - including aluminum (Al), arsenic (As), cadmium (Cd), lead (Pb), antimony (Sb), selenium (Se) and thallium (Tl) - demonstrated negative correlations with free thyroxine (FT4) and free triiodothyronine (FT3) concentrations. WQS analysis revealed that each inter-decile rise in mixed metal exposure was associated with a 0.52% decrease in TSH (95% CI: -3.84%, 2.91%), a 1.52% reduction in FT₄ (95% CI: -1.95%, -1.09%), and a 1.18% decline in FT₃ (95% CI: -1.60%, -0.77%). Tl, Al, and As emerged as primary contributors to these effects, collectively accounting for 86%- 97% of the weighted mixture impact. These findings demonstrate that metallic components of PM2.5, particularly Tl, Al and As are significantly associated with suppressed maternal thyroid function during pregnancy. This highlights the importance of metal-specific toxicity in PM2.5-related endocrine disruption.

The association between tobacco exposure and obesity remains controversial, with the potential modifying role of cadmium (Cd) unclear. Childhood population provide a critical window to assess low-dose tobacco effects. This study aimed to investigate the association between serum cotinine-assessed tobacco exposure and childhood obesity, and further evaluate whether Cd exposure acts as a potential effect modifier in this association. This nationwide cross-sectional study investigated 5,595 school-aged children from 2017 to 2018 China National Human Biomonitoring. Serum cotinine levels were measured to assess tobacco exposure. General obesity was determined using BMI Z-score, and central obesity was assessed via waist circumference, waist-to-height ratio, and body roundness index. Weighted regression and restricted cubic splines (RCS) assessed associations between cotinine and obesity, with interaction analyses for Cd exposure. Compared to the lowest cotinine tertile, individuals with the highest tertile had higher odds of general obesity (OR = 1.485; 95

Per- and polyfluoroalkyl substances (PFAS) are a class of synthetic fluorinated chemicals characterized by high environmental persistence and widespread occurrence, which have attracted increasing attention due to their potential adverse effects on human health. As the global burden of chronic diseases related to lipid and glucose dysregulation rises, identifying environmental contributors is increasingly important. Growing evidence links PFAS exposure to metabolic disorders, particularly those involving lipid and glucose metabolism. This review summarizes current findings on the mechanisms by which PFAS disrupt metabolic balance, with a focus on pathways involved in fatty acid uptake and oxidation, nuclear receptor signaling, oxidative stress, inflammation and insulin signaling. Furthermore, we highlight the convergence of molecular pathways involved in PFAS-induced lipid and glucose metabolic alterations, which may provide a mechanistic basis for understanding the development of metabolic disorders. Finally, we discuss current research limitations and future perspectives, including the potential application of computational approaches and emerging technologies to further elucidate PFAS-related metabolic effects. A comprehensive understanding of these mechanisms may help identify targets for the prevention and treatment of metabolic diseases, including obesity and type 2 diabetes, and provide regulatory policies on PFAS.

PURPOSE:To investigate the relationship between first-trimester maternal serum iodine concentration (SIC) and foetal ultrasound biometric parameters as well as neonatal size at birth in Chinese pregnant women. MATERIALS AND METHODS:A birth cohort study of 1881 women from 2022 to 2024 in Zhejiang Province, China, was conducted. SIC in the first trimester was measured using inductively coupled plasma mass spectrometry. Foetal biometric parameters in mid-pregnancy were measured using ultrasound scanning techniques. Neonatal anthropometric measurements were obtained immediately after delivery. Linear regression models were used to explore the association between maternal SIC and both foetal ultrasound biometric parameters as well as birth size indicators. RESULTS:Log-transformed maternal SIC showed a significant positive association with biparietal diameter (BPD) (β = 0.102, 95% CI: 0.029, 0.174), but significant negative associations with birth length (β = -0.337, 95% CI: -0.608, -0.066) and birth weight (β = -0.091, 95% CI: -0.171, -0.012). Further sex-stratified analysis revealed that among male foetuses, SIC was significantly positively associated with BPD (β = 0.158, 95% CI: 0.053, 0.263), head circumference (HC) (β = 0.414, 95% CI: 0.074, 0.754) and abdominal circumference (AC) (β = 0.490, 95% CI: 0.111, 0.870). but negatively associated with neonatal length (β = -0.402, 95% CI: -0.742, -0.062) and birth weight (β = -0.120, 95% CI: -0.234, -0.005). These associations were attenuated and non-significant in female foetuses. Maternal age stratification showed significantly stronger positive associations between SIC and foetal BPD in women aged <29 years (β = 0.150, 95% CI: 0.036, 0.265) compared to those ≥29 years. CONCLUSIONS:Our findings suggest that first-trimester maternal SIC shows a positive association with foetal BPD but a potential negative association with neonatal anthropometric measures, with these relationships appearing stronger in male foetuses and younger mothers.

Per- and polyfluoroalkyl substances (PFASs) are persistent environmental pollutants with bioaccumulative properties. Emerging evidence indicates that PFAS disrupts thyroid hormone homeostasis, potentially leading to thyroid dysfunction and impairing physiological functions. However, the associations between PFAS exposure, iodine status, and thyroid function during pregnancy remain insufficiently understood. A total of 911 pregnant women from a birth cohort in Zhejiang Province were included. Serum concentrations of 13 PFASs and thyroid function parameters were measured during the first antenatal visit. Linear regression, quantile regression, and restricted cubic spline models were used to explore associations between individual PFAS and thyroid hormones. Quantile g-computation was conducted to evaluate the overall effects of PFAS mixtures, while Bayesian kernel machine regression was applied to capture potential nonlinear and interactive effects. Stratified analyses were further conducted to examine potential effect modification by iodine status and thyroid autoantibody status. PFOS, PFDA, PFNA, PFUnDA, and PFHpS were negatively associated with FT3 and positively associated with the FT4/FT3 ratio (all P < 0.05). The novel PFMOAA showed positive associations with TSH (β = 0.162; 95

Major depressive disorder (MDD) is a kind of mental disorder with high mortality, suicide and relapse rates, and might be the world's leading cause of health burden by 2030. Growing evidence suggests that neuroinflammation is closely linked to depressive pathogenesis and suggests that MDD can be called a microglia disease. And activation of the P2X7R/NLRP3 signaling pathway in microglia is a key mechanism causing nerve damage. In addition, it is recently found that gut microbiota might initiate neuroinflammatory processes underlying MDD, and gut microbiota dysbiosis can be affected by sleep to ameliorate neuroinflammatory processes. In this paper, we reviewed recent advances about gut-brain axis interactions with neuroinflammation, which might shed light on the mechanisms and treatment of depression.

This study aims to investigate associations between PM10, PM2.5, and NO2 and maternal thyroid hormones. We investigated 443 pregnant women in Zhejiang, China with repeated examinations of serum thyroid hormones at 10, 17, and 32 weeks. Individual exposures to ambient air pollution were retrospectively calculated by inverse distance weighting interpolation. Multivariate linear mixed models were applied to estimate the association between air pollutants and thyroid hormones. PM10 exposure was positively associated with TSH (β: 0.077 [95% CI: 0.003, 0.152]), and negatively associated with FT3 (β: -0.041 [-0.057, -0.025]) and FT4 (β: -0.036 [-0.055, -0.017]) during the 0-90 lag days (per IQR). Similarly, increased exposure to PM2.5 was associated with decreased FT3 (β: -0.016 [-0.032, -0.001]), and increased Tg (β: 0.147 [0.025, 0.269]). Evaluated NO2 levels were associated with decreased FT3 (β: -0.026 [-0.039, -0.014]) and FT4 (β: -0.036 [-0.052, -0.020]), as well as increased Tg (β: 0.129 [0.011, 0.247]). The results indicate that exposure to ambient PM10, PM2.5, and NO2 throughout the entire pregnancy adversely affects thyroid hormones, implying potential health implications of air pollution on maternal thyroid function.

The global rise in obesity and its associated metabolic disorders underscores the need for a deeper investigation into their underlying molecular mechanisms. While genetic factors are well-established contributors, recent research has increasingly focused on epigenetic regulators, particularly N6-methyladenosine (m6A)—the most prevalent internal RNA modification in eukaryotes. This post-transcriptional modification plays a crucial role in RNA metabolism by regulating mRNA stability, splicing, nuclear export, and translation efficiency. Notably, emerging evidence implicates m6A in both adipogenesis and metabolic dysregulation. In this review, we systematically examine three key dimensions: (1) the molecular mechanisms of m6A modification, including writers, erasers, and readers, in obesity; (2) dysregulated m6A patterns in obesity-related pathologies, such as type 2 diabetes (T2D), insulin resistance, metabolic dysfunction-associated steatotic liver disease (MASLD), and the glycolysis in cancer cells; and (3) the therapeutic potential of targeting m6A and the regulators. By critically assessing recent advancements, we highlight m6A’s dual role as both a metabolic sensor and a disease modulator, offering novel insights into potential strategies for combating obesity-related metabolic syndromes.

Per- and polyfluoroalkyl substances (PFAS) have been recognized as potential disruptors of thyroid function, but the health implications of their increasingly used emerging alternatives, particularly during pregnancy, remain poorly understood. To address this, we conducted a cross-sectional study involving 492 pregnant women in Zhejiang, China, quantifying thirty PFAS and three thyroid hormones and employing advanced statistical models to assess their associations. The study findings revealed that exposure to perfluorododecanoic acid (PFDoDA) was associated with a 6.37 % decrease in free 3,5,3',5'-tetraiodothyronine (FT4), exposure to perfluoro-2-methoxyacetic acid (PFMOAA) resulted in a 32.52 % increase in thyroid stimulating hormone (TSH) and a 2.33 % decrease in FT4, and exposure to 8:2 Chlorinated polyfluorinated ether sulfonic acid (8:2 Cl-PFESA) led to a 28.46 % increase in TSH. Quantile g-computation (Qgcomp) models demonstrated a significant 21.04 % increase in TSH (95 % CI: 3.11 %, 42.09 %) association with PFAS mixtures, with 8:2 Cl-PFESA (0.25) and PFMOAA (0.23) showing the highest positive weights. These findings were further corroborated by the adaptive elastic net (AENET) models, which confirmed the positive correlation between PFAS mixtures and TSH. Bayesian statistics-based benchmark dose (BBMD) analyses indicated that 8:2 Cl-PFESA (0.01 ng/mL), PFMOAA (0.02 ng/mL), and PFDoDA (0.42 ng/mL) might possess lower safety margin levels for thyroid disruption, warranting more stringent regulatory standards. These findings highlight the necessity of conducting routine biomonitoring and further exploration into the toxicological mechanisms of the emerging PFAS alternatives to address the potential health risks.

OBJECTIVES:The relationship between iodine status and gestational diabetes mellitus (GDM) is inconclusive. This study aimed to explore the trajectories of urinary iodine concentrations (UIC) in pregnant women before GDM diagnosis and to assess the associations between maternal UIC trajectories and the risk of developing GDM. METHODS:A prospective cohort study was conducted in China. Data from 1076 pregnant women who were recruited between August 2019 and December 2021 were analyzed. GDM screening was performed at the 28th week of pregnancy. Arsenic and cerium catalysis spectrophotometry was used to measure UIC. The latent class model was used to identify distinct UIC trajectories in pregnant women, using multiple urine specimens. We evaluated the association of UIC trajectories with the risk of GDM by logistic regression analysis. RESULTS:Three maternal UIC trajectories were identified: (1) high-stable trajectory (72.12%), (2) high-decreasing trajectory (3.07%), and (3) low-stable trajectory (24.81%). Compared with the pregnant women in high-stable trajectory group, women in the low-stable UIC trajectory group showed an increased risk of GDM before adjustment of covariates (OR: 1.58, 95% CI: 1.08-2.27). After adjusting for different covariates, a statistically significant association was observed only between low-stable trajectory trajectories and GDM. CONCLUSIONS:This study highlights a relationship between UIC and the risk of GDM. To better prevent iodine deficiency and GDM, persistent sufficient iodine status from pregnancy to delivery, should be emphasized.

Sleep constitutes an essential physiological process that is vital for maintaining physical and mental wellbeing. However, the science of sleep focusing on basic questions such as “how” we sleep and “why” we sleep is still not clear. Over the past decade, substantial progress has also been made in elucidating the interactions between sleep and other biological processes, providing insights into the basic questions of sleep. Among these, emerging evidence highlights the microbiota-gut-brain axis (MGBA) as a pivotal bidirectional network that connects gut microorganisms with the central nervous system to regulate sleep architecture and homeostasis. This interaction is inherently bidirectional: sleep deprivation alters gut motility, mucosal integrity, and microbial composition, while microbial metabolites in turn influence neurotransmission (γ-aminobutyric acid, serotonin), immune-endocrine balance, and inflammatory signaling. In this article, we will review recent studies about MGBA-targeted therapeutic strategies for sleep disorders, such as probiotics, prebiotics, and fecal microbiota transplantation, which aim to restore microbial homeostasis and improve sleep quality. Furthermore, we discuss emerging interventions that modulate microbial metabolites and neuroimmune-endocrine signaling, as well as innovative pharmacological approaches targeting MGBA dysfunction. Collectively, we hope this review will contribute to a deeper understanding of MGBA-mediated mechanisms in sleep disorders promises to inform novel preventive and therapeutic strategies, ultimately improving clinical outcomes and quality of life for affected individuals.

Post-traumatic cerebral infarction (PTCI) is a significant complication in polytrauma patients with traumatic brain injury (TBI). Identifying high-risk patients for early intervention is crucial. This study aims to investigate the independent risk factors for PTCI in polytrauma patients with TBI to establish and validate a prediction model. A retrospective analysis was conducted on 511 patients with TBI and multiple injuries admitted between January 2016 and July 2023. The patients were divided into groups based on whether they developed PTCI. Independent risk factors for PTCI were identified using univariable, Lasso, and multivariable logistic regression analysis. A nomogram was established to predict the risk factors for PTCI. The receiver operating characteristic (ROC) area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were used to determine the predictive accuracy, discrimination, and clinical effectiveness of the nomogram, respectively. In addition, the Hosmer-Lemeshow test was used to assess the goodness-of-fit. Clinically significant associations were observed between PTCI and factors such as cerebral hernia, traumatic subarachnoid hemorrhage, basilar skull fracture, shock index, platelets, platelet-lymphocyte ratio (PLR), prothrombin time, international normalized ratio, D-dimer, albumin, injury severity score, and Glasgow coma score (all p < 0.05). These variables screened by Lasso regression were incorporated in multivariate logistic regression. They identified cerebral hernia, basilar skull fracture, PLR, D-dimer, and albumin as independent risk factors for PTCI (all p < 0.05). The analysis results were visually represented using a nomogram. The AUC of the prediction cohort was 0.9 [95% confidence interval (95% confidence intercal (CI)): 0.84, 0.97], and of the validation cohort was 0.87 (95% CI: 0.79, 0.96). The nomogram prediction model demonstrates excellent performance according to the ROC, calibration curve, and DCA, providing valuable insights for the early identification of high-risk PTCI patients.

Major depressive disorder is a complex psychiatric condition characterized by mood dysregulation, cognitive impairment, and somatic symptoms. Recent studies underscore the pivotal roles of neural regeneration and inflammation in its pathophysiology. This narrative review synthesizes emerging evidence linking neuroinflammatory pathways and impaired neurogenesis in major depressive disorder. We explore mechanisms including microglial activation, kynurenine pathway dysregulation, synaptic remodeling, and gut–brain axis alterations. Special emphasis is placed on recent discoveries highlighting molecular cross-talk between immune responses and neural plasticity. By mapping these interactions, we aim to advance understanding of major depressive disorder subtypes and support the development of inflammation-targeted therapies.

Objective: To analyze the iodine nutrition status and its related factors among adults aged 18 years and above in Zhejiang Province in 2022. Methods: A multistage stratified sampling method was used to select 4 320 adults aged 18 years and above from 16 on-site survey sites in Zhejiang Province for the study. A questionnaire was used to investigate the general demographic information and personal dietary characteristics of the study participants. Household edible salt and urine samples were collected to detect salt iodine content and urinary iodine level by using direct titration and cerium arsenate-catalyzed spectrophotometry, respectively, to evaluate the iodine nutritional status according to the standard. The multiple-ordered logistic regression model was used to analyze the factors influencing the urinary iodine concentration. Results: The age of the 4 320 study participants was (51.19±15.33) years, with males accounting for 44.44% (1 920). About 40.16% of adults (1 735) were from coastal areas and 56.37% (2 435) from urban areas. The salt iodine content, M (Q1, Q3), of the 4 320 household edible salt samples was 21.10 (0.00, 24.16) mg/kg, including 1 662 non-iodized salt samples, 182 unqualified iodized salt samples and 2 476 qualified iodized salt samples. The rate of iodized salt coverage was 61.53%, and the rate of qualified iodized salt consumption was 57.31%. There was a statistically significant difference in the proportion of qualified iodized salt in adult households among different regions (P<0.001), with the proportion of non-iodized salt gradually decreasing from coastal to inland areas (χ2trend=618.458, P<0.001). The urinary iodine concentration M (Q1, Q3) was 137.60 (86.85, 210.60) μg/L in 4 320 adult urine samples, with the urinary iodine levels of<100, 100-199, 200-299, and≥300 μg/L accounting for 31.64% (1 367), 40.56% (1 752), 17.66% (763), and 10.14% (438), respectively. There was a nonlinear positive correlation between household salt iodine content and urinary iodine level in adults aged 18 years and above by using the χ2 test for trend (χ2regression=231.10, P<0.001 and χ2skew=28.81, P<0.001). Urinary iodine concentrations were higher in men than in women (P=0.029) and higher in adults in rural areas than in urban areas (P<0.001). There were statistically significant differences in the distribution of iodine nutritional status among adults of different ages, regions, and urban and rural areas (all P<0.001). The proportion of those with urinary iodine levels<100 μg/L gradually increased with age (χ2trend=37.493, P<0.001), and gradually decreased from coastal areas to inland areas (χ2trend=71.381, P<0.001). The results of the multiple-ordered logistic regression model analysis showed that compared with adults aged 18 to 44 years and male adults, those aged 45 to 59 years and female adults had lower urinary iodine levels, with OR (95%CI) of 0.75 (0.68-0.83) and 0.85 (0.76-0.95), respectively. Compared with adults in coastal and urban adults, those in sub-coastal, inland and rural adults had higher levels of urinary iodine, with OR (95%CI) of 1.89 (1.63-2.19), 2.02 (1.72-2.37) and 1.46 (1.28-1.66), respectively. Conclusion: The overall iodine nutrition level of adults aged 18 years and above in Zhejiang Province in 2022 is generally appropriate. However, there is a potential risk of iodine deficiency among adults in coastal areas.

We aim to analyze the changes in dietary iodine intake and the contribution rates of various foods to it after the reduction in salt iodine concentration in Zhejiang. We used data from two cross-sectional nutrition surveillance surveys conducted by the Zhejiang Provincial Center for Disease Control and Prevention in 2010 (9798 residents) and 2022 (5980 residents). In both surveys, multi-stage stratified and systematic sampling were adopted, and uniformly trained investigators conducted the dietary surveys using a 24 h dietary review and weighing record methods for 3 consecutive days. From 2010 to 2022, the median salt iodine concentration and the consumption rate of qualified iodized salt in Zhejiang households dropped from 28.80 to 22.08 mg/kg and from 76.65% to 64.20%, respectively. Moreover, the residents’ median dietary iodine intake decreased from 277.48 to 142.05 μg/d. Significant interregional differences in dietary iodine intake were found in 2010 and 2022 (H = 639.175, p < 0.001; H = 588.592, p < 0.001, respectively); however, no significant differences existed between urban and rural areas (p > 0.05). From 2010 to 2022, the proportion of residents with dietary iodine intake below the estimated average requirement increased from 15.10% to 34.80%, while that of residents with intake above the tolerable upper limit decreased from 15.00% to 2.90%. The contribution rate of salt to dietary iodine intake among residents in Zhejiang decreased from 74.92% to 48.54%, showing an apparent overall downward trend despite the dietary intake being generally adequate (markedly inadequate in coastal regions). The salt iodine concentration and the consumption rate of qualified iodized salt in households in Zhejiang showed downward trends. Salt remained the main source of dietary iodine; however, its contribution decreased significantly. Zhejiang may need to reverse the trend of the continuous decline in the consumption rate of qualified iodized salt to protect the health of its residents.

The biosynthesis of thyroid hormones is essential for brain and neurological development. It requires iodine as a key component but is also influenced by other nutrients. Evidence for the combined nutrient status in relation to thyroid hormones during pregnancy is limited. We aimed to investigate the joint associations of iodine, selenium, zinc, calcium, magnesium and iron with maternal thyroid functions in 489 pregnant women from Hangzhou, China. Serum levels of six essential minerals and thyroid function parameters were measured during the first antenatal visit. Linear regression, quantile g-computation and Bayesian kernel machine regression were used to explore the individual and joint relationships between the six minerals and thyroid hormones. Linear regression analyses revealed that calcium was positively associated with free triiodothyronine (FT3). Zinc was positively associated with free thyroxine (FT4). Iodine was negatively associated with thyroid-stimulating hormone (TSH) and positively associated with FT3 and FT4. The quantile g-computation and BKMR models indicated that the joint nutrient concentration was negatively associated with TSH and positively associated with FT3 and FT4. Among the six minerals, iodine contributed most to thyroid function. The findings suggested that maintaining the appropriate concentration of minerals, either as individuals or a mixture, is important for thyroid health during pregnancy.

We aimed to assess dietary iodine intake and sources in Zhejiang Province a decade after a reduction in iodine concentration in iodized salt. Three-day 24 h dietary recall and household weighing were used, complemented by “Chinese Food Composition” data. Household water and salt samples were collected from 5890 residents and analyzed. Differences in iodized salt consumption rates were observed across the following regions: inland (84.20%), subcoastal (67.80%), and coastal (37.00%) areas. The median (P25, P75) iodine concentration in water and diet were 2.2 (0.9, 4.0) μg/L and 142.05 (58.94, 237.11) μg/d, respectively, with significant regional differences in dietary concentration (inland [185.61 μg/d], subcoastal [153.42 μg/d], and coastal [75.66 μg/d]). Males (149.99 μg/d) and iodized salt consumers (191.98 μg/d) had a significantly higher dietary iodine intake than their counterparts. Regions were ranked as follows based on the proportions of individuals meeting the recommended dietary iodine intake: inland (69.40%), subcoastal (56.50%), and coastal (34.10%) areas. Dietary sources included salt (48.54%), other foods (32.06%), drinking water (8.84%), laver (4.82%), kelp (3.02%), and other seafood (2.32%). The qualified iodized salt consumption rate was significantly lower than the national standard. Zhejiang Province should continue implementing measures to control iodine deficiency through salt iodization, education efforts, and increasing the qualified iodized salt consumption rate.

Objective: To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021. Methods: A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children. Results: The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M (Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 (χ2trend=111.427, P<0.001). The median of urinary iodine concentration M (Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [M (Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [M (Q1, Q3): 173.00 (113.00, 250.30) μg/L] (P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95%CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95%CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95%CI: 2.64%-3.10%), 588/20 530] (P=0.001). Conclusion: From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.