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Abstract
BackgroundIodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18–72 μg/L) in groundwater used for drinking and cooking, but the relation with iodine intake is not well characterized. ObjectivesWe aimed to investigate the contributions of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration (UIC) and excretion (UIE) over a 24-h period and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38 L/d (hydration adjusted). MethodsThe study sample comprised 118 nonpregnant, healthy women aged 15–69 y. All participants resided in Hargeisa, and 27 were breastfeeding. Data collection consisted of a 24-h urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household water samples using the Sandell-Kolthoff reaction. ResultsWIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P < 0.003). Nonbreastfeeding women were borderline iodine sufficient [hydration-adjusted median urinary iodine concentration (mUIC) 109 μg/L; 95% CI: 97, 121 μg/L], whereas breastfeeding women showed a mild iodine deficiency (73 μg/L; 95% CI: 54, 90 μg/L). There were strong correlations (ρ: 0.50–0.69, P = 0.001) between WIC and UIC, with iodine from household water contributing more than one-half of the total iodine intake. Multivariate regression showed hydration and breastfeeding status to be the main predictors of UIC. ConclusionsIodine from household water is the main contributor to total iodine intake among women in Hargeisa, Somaliland. Variation in female hydration and spatial and temporal WIC may explain diverging mUIC between studies. Water sources at the extremes of low and high iodine concentrations increase the risk of subpopulations with insufficient or more than adequate iodine intake.
Highlights
Iodine is an essential micronutrient necessary for syntheses of the thyroid hormones thyroxine (T4) and triiodothyronine (T3)
We modeled urinary iodine concentration (UIC) (n = 114) with the following independent variables: breastfeeding, age, weight, height, BMI, Total fluid (beverage) intake (TFI), water iodine concentration (WIC), and the 3 hydration measures urine volume (Uvol), Urine creatinine (Ucreat), and Urine color (Ucol)
The median urinary iodine concentration (mUIC) difference related to breastfeeding status could not be explained by the covariates TFI, Uvol, Ucreat, WIC, or iodine intake from HHWB
Summary
Iodine is an essential micronutrient necessary for syntheses of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). A median UIC (mUIC) between 100 and 200 μg/L defines iodine sufficiency in a population of children (age 6–12 y) and nonpregnant adults [2]. This range allows for considerable variation in mean 24-h urine volume (Uvol) and, subsequently, in urinary iodine excretion (UIE) per day [5, 6]. Some reported reviews have suggested an expected mean urine volume of 1.38–1.5 L in an adult population, based on the iodine RDA of 150 μg/d and a urine excretion/intake ratio of 0.92 [5, 6, 10]. The water source supply was described as “reliable” or “mostly reliable” in 96% of the households
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