Iodized Salt and Urinary Iodine Status among School-Aged Children: A Structured Narrative Review

Authors

Juan Maolidi

DOI:

10.29303/jbt.v26i3.12217

Published:

2026-08-19

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Abstract

Iodine is essential for thyroid hormone synthesis, growth, and neurocognitive development in school-aged children. This review aimed to synthesize empirical evidence on the relationship between iodized salt exposure and urinary iodine concentration (UIC) among school-aged children and to identify factors affecting this relationship. A structured narrative review with a systematic literature search was conducted using Scopus and PubMed. The search identified 75 records, of which 23 studies were included after duplicate removal, title and abstract screening, and full-text assessment. Study quality was appraised using a JBI-based framework, and findings were synthesized narratively because of methodological heterogeneity. Overall, studies measuring household salt iodine content and UIC in the same population generally showed that adequate salt iodization was associated with better population iodine status. However, the relationship was modified by dietary iodine sources, salt storage and cooking practices, geographical context, and differences in exposure and UIC measurement. Evidence from population surveillance also supported the effectiveness of universal salt iodization while highlighting the risk of both insufficient and excessive iodine exposure. UIC should primarily be interpreted as a population-level indicator, as a single spot urine sample is insufficient for individual diagnosis. Comprehensive iodine monitoring should therefore combine salt iodine assessment, population UIC distribution, and relevant dietary and household factors.

Keywords:

Iodized salt Iodine status Urinary iodine concentration School-aged children Salt iodization

References

Abizari, A.-R., Dold, S., Kupka, R., & Zimmermann, M. B. (2017). More than two-thirds of dietary iodine in children in northern Ghana is obtained from bouillon cubes containing iodized salt. Public Health Nutrition, 20(6), 1107–1113. https://doi.org/10.1017/S1368980016003098

Al-Thani, M. H. J. T., Alyafei, S. A. S. A., Al-Motawaa, K. A. K. M., Khalifa, S. A., Shah, S. H. B. U., Vinodson, B., Kokku, S., & Mishra, A. (2023). Excessive iodine status among school-aged children in the State of Qatar: Results of the National Iodine Deficiency Disorder Survey. Public Health Challenges, 2(1), e60. https://doi.org/10.1002/puh2.60

Ategbo, E.-A., Sankar, R., Schultink, W., van der Haar, F., & Pandav, C. S. (2008). An assessment of progress toward universal salt iodization in Rajasthan, India, using iodine nutrition indicators in school-aged children and pregnant women from the same households. Asia Pacific Journal of Clinical Nutrition, 17(1), 56–62.

Ayalew, B. S., Hassen, S. L., Marefiyaw, T. A., Yesuf, M. S., Abebe, D. D., & Temesgen, M. M. (2021). Prevalence of urinary iodine concentration among school children: In Dessie City, Ethiopia. BMC Pediatrics, 21, 423. https://doi.org/10.1186/s12887-021-02887-7

Badan Kebijakan Pembangunan Kesehatan. (2024). Survei Kesehatan Indonesia (SKI) dalam angka. Badan Kebijakan Pembangunan Kesehatan. https://repository.badankebijakan.kemkes.go.id/id/eprint/5539/

Baladastian, S., Bahreini, F., Nouri, A., Morvaridi, M., & Tavakoli, H. (2026). Iodine deficiency and excess in children and related factors in Alborz Province: A cross-sectional study. BMC Nutrition, 12, 47. https://doi.org/10.1186/s40795-026-01272-w

Carvalho, R., Moniz, C. S., Mendes, I., Mendes, A., & Sousa, I. (2022). Iodine status, dietary iodine intake and iodized salt in school-aged children in São Miguel Island, Azores, Portugal. Nutrition, 99–100, 111681. https://doi.org/10.1016/j.nut.2022.111681

Delshad, H., Mirmiran, P., Abdollahi, Z., Salehi, F., & Azizi, F. (2018). Continuously sustained elimination of iodine deficiency: A quarter of a century success in the Islamic Republic of Iran. Journal of Endocrinological Investigation, 41(9), 1089–1095. https://doi.org/10.1007/s40618-018-0838-8

Gowachirapant, S., Winichagoon, P., Wyss, L., Tong, B., Baumgartner, J., Melse-Boonstra, A., & Zimmermann, M. B. (2009). Urinary iodine concentrations indicate iodine deficiency in pregnant Thai women but iodine sufficiency in their school-aged children. The Journal of Nutrition, 139(6), 1169–1172. https://doi.org/10.3945/jn.108.100438

Hatch-McChesney, A., & Lieberman, H. R. (2022). Iodine and iodine deficiency: A comprehensive review of a re-emerging issue. Nutrients, 14(17), 3474. https://doi.org/10.3390/nu14173474

Hess, S. Y., Ouédraogo, C. T., Young, R. R., Bamba, I. F., Stinca, S., Zimmermann, M. B., & Wessells, K. R. (2017). Urinary iodine concentration identifies pregnant women as iodine deficient yet school-aged children as iodine sufficient in rural Niger. Public Health Nutrition, 20(7), 1154–1161. https://doi.org/10.1017/S1368980016003232

Hooshmand, S., Yousefian, F., Rahimi, H., Mohammadzadeh, M., & Dehghani, R. (2024). Household salt consumption and urinary iodine levels in schoolchildren aged 8–10 in Darab City, Iran: 2022. Scientific Reports, 14(1), 28349. https://doi.org/10.1038/s41598-024-78799-0

Iannuzzo, G., Campanozzi, A., Trevisani, V., Rutigliano, I., Abate, V., Rendina, D., & De Filippo, G. (2022). Iodine requirements in pediatrics: From fetal life to adolescence. Frontiers in Endocrinology, 13, 929176. https://doi.org/10.3389/fendo.2022.929176

Jayatissa, R., Gunathilaka, M. M., & Fernando, D. N. (2005). Iodine nutrition status among schoolchildren after salt iodisation. Ceylon Medical Journal, 50(4), 144–148. https://doi.org/10.4038/cmj.v50i4.1403

Joompa, P., Sukboon, P., Schultink, W., Zimmermann, M. B., & Gowachirapant, S. (2025). A sentinel survey in remote Western Thailand indicates that school-aged children and reproductive-aged women of the Indigenous Pwo Karen community are iodine sufficient. British Journal of Nutrition, 133(3), 357–362. https://doi.org/10.1017/S0007114524003325

Kementerian Kesehatan Republik Indonesia. (2017). Buku surveilans untuk mengatasi masalah gangguan akibat kekurangan iodium. Badan Penelitian dan Pengembangan Kesehatan.

Leite, J. C., Keating, E., Pestana, D., Fernandes, V. C., Maia, M. L., Norberto, S., Pinto, E., Moreira-Rosário, A., Sintra, D., Moreira, B., Costa, A., Silva, S., Costa, V., Martins, I., Mendes, F. C., Queirós, P., Peixoto, B., Caldas, J. C., Guerra, A., … Calhau, C. (2017). Iodine status and iodised salt consumption in Portuguese school-aged children: The Iogeneration study. Nutrients, 9(5), 458. https://doi.org/10.3390/nu9050458

Madukwe, E. U., Ani, P. N., & Maduabuchi, M. (2013). Iodine content of household salt and urinary iodine of primary school pupils in commercial towns in Nsukka senatorial zone, Enugu State, Nigeria. Pakistan Journal of Nutrition, 12(6), 587–593. https://doi.org/10.3923/pjn.2013.587.593

Nouri Saeidlou, S., Babaei, F., Ayremlou, P., & Entezarmahdi, R. (2018). Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study. Public Health Nutrition, 21(3), 489–496. https://doi.org/10.1017/S1368980017002609

Oblak, A., Arohonka, P., Erlund, I., Kuzmanovska, S., Zaletel, K., & Gaberscek, S. (2022). Validation of a spectrophotometric method for urinary iodine determination on microplate based on Sandell–Kolthoff reaction. Laboratory Medicine, 53(4), 376–380. https://doi.org/10.1093/labmed/lmab117

Qian, T. T., Sun, R., Liu, L. C., Che, W. J., Zhao, M., Zhang, L., Li, W. D., Jia, Q. Z., Wang, J. H., Li, J. S., Chen, Z. H., Zhang, B. Y., & Liu, P. (2023). Relationship between dining place, iodine source, and iodine nutrition in school-age children: A cross-sectional study in China. Biomedical and Environmental Sciences, 36(1), 10–23. https://doi.org/10.3967/bes2023.002

Rika, U. F., Habib, M. A., Sen, P., Nindrea, R. D., & Ming, L. C. (2026). Universal salt iodization remains insufficient to prevent iodine deficiency without maternal education and improved household salt practices: Insights from structural equation modelling in Noakhali. Human Nutrition and Metabolism, 43, 200359. https://doi.org/10.1016/j.hnm.2025.200359

Shakya, P. R., Gelal, B., Das, B. K. L., Lamsal, M., Pokharel, P. K., Nepal, A. K., Brodie, D. A., Sah, G. S., & Baral, N. (2015). Urinary iodine excretion and thyroid function status in school age children of hilly and plain regions of Eastern Nepal. BMC Research Notes, 8, 374. https://doi.org/10.1186/s13104-015-1359-6

Vandevijvere, S., Mourri, A. B., Amsalkhir, S., Avni, F., Van Oyen, H., & Moreno-Reyes, R. (2012). Fortification of bread with iodized salt corrected iodine deficiency in school-aged children, but not in their mothers: A national cross-sectional survey in Belgium. Thyroid, 22(10), 1046–1053. https://doi.org/10.1089/thy.2012.0016

Wassie, M. M., Abebe, Z., Tariku, A., Gebeye, E., Awoke, T., Gete, A. A., Yesuf, M. E., Kebede, Y., Biks, G. A., & Zhou, S. J. (2018). Iodine status five years after the mandatory salt iodization legislation indicates above requirement: A cross-sectional study in Northwest Ethiopia. BMC Nutrition, 4, 52. https://doi.org/10.1186/s40795-018-0261-8

World Health Organization. (2022). Sustaining the elimination of iodine deficiency disorders. World Health Organization. https://www.who.int/

Yao, N., Zhou, C., Xie, J., Li, X., Zhou, Q., Chen, J., & Zhou, S. (2020). Assessment of the iodine nutritional status among Chinese school-aged children. Endocrine Connections, 9(5), 379–386. https://doi.org/10.1530/EC-19-0568

Zheng, C., Yin, Z., Zhan, B., Xu, W., & Ma, Z. F. (2024). Pregnant women at risk for iodine deficiency but adequate iodine intake in school-aged children of Zhejiang Province, China. Environmental Geochemistry and Health, 46(6), 204. https://doi.org/10.1007/s10653-024-01934-3

Zhou, S., Zhou, C., Xie, J., Luo, F., & Yao, N. (2024). Iodine status of school-aged children in the changing context of universal salt iodization program during 1997–2018 in Chongqing, China. Journal of Trace Elements in Medicine and Biology, 81, 127328. https://doi.org/10.1016/j.jtemb.2023.127328

Zimmermann, M. B. (2009). Iodine deficiency. Endocrine Reviews, 30(4), 376–408. https://doi.org/10.1210/er.2009-0011

Zimmermann, M. B., & Andersson, M. (2021). Global perspectives in endocrinology: Coverage of iodized salt programs and iodine status in 2020. European Journal of Endocrinology, 185(1), R13–R21. https://doi.org/10.1530/EJE-21-0171

Author Biography

Juan Maolidi, Universitas Mataram

Author Origin : Indonesia

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How to Cite

Maolidi, J. (2026). Iodized Salt and Urinary Iodine Status among School-Aged Children: A Structured Narrative Review. Jurnal Biologi Tropis, 26(3), 1430–1440. https://doi.org/10.29303/jbt.v26i3.12217

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