Abstract
The iodine status of populations is conventionally assessed using spot urinary samples to obtain a median urinary iodine concentration (UIC) value, which is assessed against standard reference cut-offs. The assumption that spot UIC reflects daily iodine intake may be flawed because of high day-to-day variability and variable urinary volume outputs. This study aimed to compare iodine status in a sample of South African adults when determined by different approaches using a spot urine sample (median UIC (MUIC), predicted 24 h urinary iodine excretion (PrUIE) using different prediction equations) against measured 24 h urinary iodine excretion (mUIE). Both 24 h and spot urine samples were collected in a subsample of participants (n = 457; median age 55 year; range 18–90 year) in the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 in South Africa, in 2015. Kawasaki, Tanaka, and Mage equations were applied to assess PrUIE from predicted urinary creatinine (PrCr) and spot UIC values. Adequacy of iodine intake was assessed by comparing PrUIE and mUIE to the Estimated Average Requirement of 95 µg/day, while the MUIC cut-off was <100 µg/L. Bland Altman plots assessed the level of agreement between measured and predicted UIE. Median UIC (130 µg/L) indicated iodine sufficiency. The prediction equations had unacceptable bias for PrUIE compared to measured UIE. In a sample of adult South Africans, the use of spot UIC, presented as a group median value (MUIC) provided similar estimates of inadequate iodine status, overall, when compared to EAR assessed using measured 24 h iodine excretion (mUIE). Continued use of MUIC as a biomarker to assess the adequacy of population iodine intake appears warranted.
Highlights
Iodine deficiency is the largest preventable cause of brain damage and mental impairment worldwide
Respondents were recruited from selected probability sampled enumeration areas (EAs) using a multi-stage cluster sampling strategy, with stratification by province, residence, and race
More women than men were included and the median age was 52 (IQR 24) years, with 65% of the sample being older than 50 years
Summary
Iodine deficiency is the largest preventable cause of brain damage and mental impairment worldwide. Populations that consume diets that contain small amounts of fish and seafood, moderate to low quantities of milk and dairy products, and include locally produced fruits and vegetables grown in iodine-poor soils are likely to be iodine deficient. For this reason, in order to prevent iodine deficiency disorders, the World Health Organization (WHO) recommends universal salt iodization (USI), where all salt for human and animal consumption is iodized [1]. This represents a halving of the number of countries with insufficient iodine intake over five years, from 32 in 2011 [6] to 15 countries in 2016 [4], and reflects continuing progress to improve the coverage of iodized salt at a national level
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