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Author ’ s response to reviews Title : Maternal iodine status during lactation and infant weight and length in Henan Province , China
| Content Provider | Semantic Scholar |
|---|---|
| Author | Yang, Jin Li, Xiaofeng Zheng, Heming Wang, Zhe Hao, Zongyu |
| Copyright Year | 2017 |
| Abstract | Please indicate the study design (cross-sectional study). Also define the abbreviation used. It would be informative if the number of women and infants with UIC<50 μg/L is also listed. I suggest that the conclusion would be rephrased as the study did not actually measure "growth". The authors‟ answer: We are so sorry for our negligence in the abstract. The sentence "A cross-sectional survey of maternal iodine status and infant anthropometric measures was conducted" has been added into the abstract. All the abbreviation used were given the full name, such as "weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ) and body mass index (BMI) by the World Health Organization (WHO)" . The number of women and infants with UIC<50 μg/L was listed, which were 41 and 20 respectively. The conclusion has been revised as "Our study suggests that maternal iodine status may be related to their infant anthropometric index. Appropriate iodine intake of lactating women is beneficial for their infants. " Introduction: Lines 75-78 discuss the limitation of previous studies, and provide the rationale for the present study. Please be more specific about each of the point brought up by using examples, e.g. what was the sample of the previous studies (small), or what was the potential confounder which was missed in the previous studies. Also, it would be worth mentioning if any trial has addressed the benefit of iodine supplementation in lactating women (and can be extensively reviewed in the discussion too). The authors‟ answer: The examples have been cited in the Line 78-81. "For example, an Argentina study was restricted by a small sample size (n=77) [19]. Another study from Bangladeshi was based on a micronutrient supplementation trial (n=1617) without considering the genetic effect [20]". There are few studies about the benefit of iodine supplementation in lactating women. Some references have been cited in the discussion, Line 209-213 "An iodine supplementation trial from Bangkok [37] reported that BMIC and infant UIC in supplemented group were higher than the values in non-supplemented group, and cord serum TSH of infant had a decline after iodine supplementation. Morse [38] proved that maternal supplementation of vitamin D, DHA, folic acid and iodine during pregnancy and lactation can be beneficial for brain development of their offspring. Methods: UIC measures were not adjusted for the creatinine clearance. It should be mentioned as an important limitation of the study. Also, what was the rationale for adjustment for maternal iodine supplementation? Does it have a direct effect on infant anthropometric measures independent of maternal or child UIC? Another question is, why in the regression models, maternal and infant UIC were entered simultaneously? One suggestion would be to examine the effect of maternal UIC in the group of children who had UIC within the normal range (excluding high infant UIC or infants with UIC <50 μg/l. If any association will be observed between maternal UIC and child anthropometric measures in this group, it will be an indication for the direct effect of maternal UIC on infant anthropometric measures. The authors‟ answer: We are very sorry for not measuring urine creatinine. The ratio of urinary iodine and creatinine can reflect the real iodine intake of individuals by excluding the influence of urinary concentration and dilution. The method has ever been used for our surveillance in China. However, considering the complexity of the method and the difficulty of obtaining different normal values in different populations, determine iodine in urine by the acid digestion method (WS/T107-2006) are recommended as a national standard method developed by the China‟s Ministry of Health. The limitation has been discussed in Line 248-250. The variable of “maternal iodine supplementation” was deleted from the multiple regression, since it has been reflected by maternal UIC. We completely agree with this valuable suggestion by the reviewer. It was inappropriate that maternal and infant UIC were entered simultaneously in the regression models as there is collinearity among them. According to the suggestion, only women whose children had UIC within the normal range (50-299μg/L) were included (n=451) in the multiple regression. The corresponding part has been adjusted. Results: Line 145, additional to the group level measures, please provide what percentage had UIC within the range recommended by WHO. The authors‟ answer: According to the WHO criterion, a median UIC 100μg/L or higher define both mother and infant as iodine sufficient. So, the sentence "the percentages of the mothers and their infants with UIC above 100 μg/L were 81.0% and 92.7%, respectively" has been supplemented. Discussion: an important issue for recommendations on iodine intake is the safe range. A growing body of literature suggests the impact of low levels of iodine as well as high levels in pregnant and lactating women on child health. The authors are suggested to target this issue in their analyses and also comment on it in the discussion. Also, the lack of evidence in lactating women should be discussed further and the existing interventional studies with iodine supplementation in lactating women can be reviewed. The authors‟ answer: We appreciate the reviewer to propose the point. In our study, the highest HAZ, WAZ was in the infants whose mothers had UIC between 50 and 99 μg/L. The highest BMI was in the infants whose mothers had UIC between 200 and 299 μg/L. The highest values were in the middle UIC group, not the highest UIC group. But in our result, the impact of iodine deficiency on infant anthropometric index outweighs the impact of iodine excess. In order to descript more clearly, the according part in the abstract, result and discuss has been revised. The discussion about lactating women has been stated further in Line 228-233. The existing interventional studies with iodine supplementation in lactating women have been reviewed in Line 209-213 and Line 239242. Line 205, I am not sure if this recommendation is in line with the findings. Despite the fact that UIC at the group level was within the WHO recommendation, there was a percentage of women who had UIC below the recommended levels and the children of these women had smaller anthropometric measures compared to the rest. The authors‟ answer: This recommendation in Line 205 has been deleted as it seems to be improper. Reviewer #2: 1. Abstract: 1. Aim of study: '.' The authors‟ answer: The word „impact‟has been replaced with the word „association‟ in the aim. 2. Conclusion the results were not conclusive on the relationship between maternal UIC and infant growth. The authors‟ answer: The conclusion has been modified as „Our study suggests that maternal iodine status may be related to their infant anthropometric index. Appropriate iodine intake of lactating women is beneficial for their infants.‟ |
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| Language | English |
| Access Restriction | Open |
| Content Type | Text |
