First Israeli National Iodine Survey Demonstrates Iodine Deficiency Among School-Aged Children and Pregnant Women

Background: National data on iodine status in Israel are lacking. Reliance on iodine-depleted desalinated water, the absence of a salt iodization program, and reports of increased use of thyroid medication in Israel suggest that the population's iodine intake is likely inadequate. The aims of this study were therefore to determine the iodine status of Israeli school-age children (SAC) and pregnant women (PW) in a nationally representative sample obtained by a novel approach of using pre-discard urinalysis samples collected from a centralized national laboratory. Methods: Spot urine samples from 1023 SAC and 1074 PW, representing all regions and major sectors in Israel, were collected during 2016 at the Maccabi Healthcare Services central laboratory. Urinary iodine concentration (UIC) was measured, and the results were analyzed by trimester, sex, region, and sector. Results: SAC were iodine deficient, with a median (interquartile range [IQR]) UIC of 83 mu g/L (52-127 mu g/L); 62% of SAC UICs were below the World Health Organization adequacy range for SAC (100-199 mu g/L). PW were also iodine deficient, with a median (IQR) UIC of 61 mu g/L (36-97 mu g/L); 85% of PW UICs were below the adequacy range for PW (150-249 mu g/L). For both SAC and PW, the median UIC was below the World Health Organization's adequacy range across all sectors, sexes, and districts. Among SAC, the median (IQR) UIC was lower among females (75 mu g/L; 48-119 mu g/L) than males (92 mu g/L; 59-133 mu g/L; p < 0.05). Median UIC values of PW correlated significantly with the median UIC for SAC by sub-district (R 2 = 0.3, p < 0.05). Conclusions: Urine sampling via a centralized national laboratory was efficient and cost-saving. Iodine deficiency in Israeli SAC and PW is a serious public-health concern. A national program of salt iodization and iodine supplementation of PW should be urgently considered.