Pre-analytical Factors Influence Accuracy of Urine Spot Iodine Assessment in Epidemiological Surveys

  • Radhouene Doggui
  • Myriam El Ati-Hellal
  • Pierre Traissac
  • Jalila El Ati


Urinary iodine concentration (UIC) is commonly used to assess iodine status of subjects in epidemiological surveys. As pre-analytical factors are an important source of measurement error and studies about this phase are scarce, our objective was to assess the influence of urine sampling conditions on UIC, i.e., whether the child ate breakfast or not, urine void rank of the day, and time span between last meal and urine collection. A nationwide, two-stage, stratified, cross-sectional study including 1560 children (6–12 years) was performed in 2012. UIC was determined by the Sandell-Kolthoff method. Pre-analytical factors were assessed from children’s mothers by using a questionnaire. Association between iodine status and pre-analytical factors were adjusted for one another and socio-economic characteristics by multivariate linear and multinomial regression models (RPR: relative prevalence ratios). Skipping breakfast prior to morning urine sampling decreased UIC by 40 to 50 μg/L and the proportion of UIC < 100 μg/L was higher among children having those skipped breakfast (RPR = 3.2[1.0–10.4]). In unadjusted analyses, UIC was less among children sampled more than 5 h from their last meal. UIC decreased with rank of urine void (e.g., first vs. second, P < 0.001); also, the proportion of UIC < 100 μg/L was greater among 4th rank samples (vs. second RPR = 2.1[1.1–4.0]). Subjects’ breakfast status and urine void rank should be accounted for when assessing iodine status. Providing recommendations to standardize pre-analytical factors is a key step toward improving accuracy and comparability of survey results for assessing iodine status from spot urine samples. These recommendations have to be evaluated by future research.


Urinary iodine Pre-analytical step Epidemiological survey Iodine deficiency Breakfast Urine void rank 


Funding Information

The work was supported by the Tunisian National Institute of Nutrition and Food Technology of the Tunisian Ministry of Health and by grants from the United Nations Children’s Fund (UNICEF) Tunisia.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.INNTA (National Institute of Nutrition and Food Technology)SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research LaboratoryTunisTunisia
  2. 2.Center of Urgent Medical Assistance of TunisLaboratory of Toxicology and Environment (LR12SP07)TunisTunisia
  3. 3.IRD (Institut de Recherche pour le Développement), NUTRIPASS UnitIRD-Université de Montpellier-Montpellier SupAgroMontpellier Cedex 5France

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