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Methods of assessment of iodine status in humans: a systematic review^1,2,3,4,5

¹ From the Institute for Medical Research, the Laboratory for Nutrition and Metabolism, the University of Belgrade, Belgrade, Serbia (DR-M, MP, and MG); the National Institute for Public Health, Brno, Czech Republic (ZP and JR); the School of Medicine, Health Policy and Practice, the University of East Anglia, Norwich, United Kingdom (LH, AC, and KA); and the Peninsula Technology Assessment Group (PenTAG), the Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, United Kingdom (KA).

² Presented at the EURRECA workshop "Biomarkers of Micronutrient Status," held in Sveti Stefan, Montenegro, 9 June 2008.

³ This manuscript does not necessarily reflect the views of the Commission of the European Communities.

⁴ Supported by the Commission of the European Communities, specific RTD Programme "Quality of Life and Management of Living Resources," within the 6th Framework Programme (contract no. FP6-036196-2 EURRECA: EURopean micronutrient RECommendations Aligned).

⁵ Address correspondence to D Ristic-Medic, University of Belgrade, Institute for Medical Research, Department for Nutrition and Metabolism, Dr Subotica 4, PO Box 102, 11000 Belgrade, Serbia. E-mail: dristicmedic{at}gmail.com or danijelar{at}imi.bg.ac.yu.

Background: Biomarkers of iodine status are required to study iodine deficiency disorders in different parts of the world and to evaluate the effects of fortification strategies.

Objective: The objective was to assess the usefulness of biomarkers of iodine status in humans by systematically reviewing intervention studies that altered iodine status.

Design: We performed a structured search for iodine intervention studies on Ovid MEDLINE, EMBASE (Ovid), and the Cochrane Library. Studies were assessed for inclusion and validity, with independent duplication. A random-effects meta-analysis was performed.

Results: Twenty-one intervention studies (12 randomized controlled trials, 3 controlled clinical trials, and 6 before-after studies) were included in the review. Urinary iodine (in children and adolescents and in those with low and moderate baseline iodine status), thyroglobulin (in children and adolescents but not in pregnant and lactating women), serum thyroxine (in children and adolescents, adults, women, and those with moderate baseline thyroxine status but not in pregnant and lactating women), and serum thyroid-stimulating hormone (in pregnant and lactating women but not in children and adolescents or those at moderate baseline status), but not triiodothyronine, proved to be useful biomarkers of iodine status.

Conclusions: Despite the high risk of bias of many of the included studies, the results suggested that urinary iodine, thyroglobin, serum thyroxine, and thyroid-stimulating hormone are useful biomarkers of iodine status, at least in some groups. High-quality controlled studies measuring relevant long-term outcomes are needed to address which biomarker is the most appropriate for assessing iodine intake in some population groups and settings.

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