Methods of assessment of iodine status in humans: a systematic review

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. Am J Clin Nutr 2009; 89(suppl): 2052S-69S