GOITER IN THE COASTAL AREAS (Case Study In Pati Regency) : An Ecological Nutrition Problem ?

Abstract

Iodine deficiency disorders (IDD) including goiter is still considered as one of the major nutritional problems in Indonesia, including in Central Java. Theoritically, IDD is usually and widely reported to be found in high mountain areas, where the iodine content in soil and water usually low. Eventhough iodine supplementation and salt fortification with iodine program have been done widely, the result of the program has not shown to be optimum. But, in fact, it has been reported that endemic goiter areas have spreaded widely into low land and coastal areas. The importance of iodine deficiency in goitrogenesis and the prevention and treatment of endemic goiter by iodine supplementation are firmly established. However, epidemiologic and experimental evidence revealed that environmental phenomenons may be responsible for many goiters. Several categories of naturally occurring and anthropogenic antithyroid agents may enter the water, air, and food exposure pathways, becoming important environmental goitrogenic factors in areas. Their effects may be additive to those of iodine deficiency, making the intensity of the manifestations of iodine deficiency disorders (IDD) more severe. Their presence should be considered particularly in areas where the features of IDD persist despite adequate iodine prophylaxis. The primary objective of this report was to determine and summarize if the prevalence of goiter in low land and coastal areas has changes over the period 1995-1996 to 2003. The prevalence tended to be higher and a new "endemic goiter area" was found. Goiter appears to be a mild to moderate public health problem in low land as well as costal areas. The prevalence and severity of goiter was more severe compared to the previous decade. The change may be due to ecological phenomenon like eroded flood,which may have potentially goitrogenic and adverse effect on the imbalancy of macro-micro elements in soils. In order to have an effective program, the regular monitoring of iodine content and other macro and micronutrient (such as selenium and plumbum) content in the environment (soil, water, food) is essential.