A systematic review and meta-analysis of 24-h urinary output of children and adolescents: impact on the assessment of iodine status using urinary biomarkers

Eur J Nutr. 2020 Oct;59(7):3113-3131. doi: 10.1007/s00394-019-02151-w. Epub 2019 Nov 29.

Abstract

Purpose: Urinary iodine concentration (UIC (μg/ml) from spot urine samples collected from school-aged children is used to determine the iodine status of populations. Some studies further extrapolate UIC to represent daily iodine intake, based on the assumption that children pass approximately 1 L urine over 24-h, but this has never been assessed in population studies. Therefore, the present review aimed to collate and produce an estimate of the average 24-h urine volume of children and adolescents (> 1 year and < 19 years) from published studies.

Methods: EBSCOHOST and EMBASE databases were searched to identify studies which reported the mean 24-h urinary volume of healthy children (> 1 year and < 19 years). The overall mean (95% CI) estimate of 24-h urine volume was determined using a random effects model, broken down by age group.

Results: Of the 44 studies identified, a meta-analysis of 27 studies, with at least one criterion for assessing the completeness of urine collections, indicated that the mean urine volume of 2-19 year olds was 773 (654, 893) (95% CI) mL/24-h. When broken down by age group, mean (95% CI) 24-h urine volume was 531 mL/day (454, 607) for 2-5 year olds, 771 mL/day (734, 808) for 6-12 year olds, and 1067 mL/day (855, 1279) for 13-19 year olds.

Conclusions: These results demonstrate that the average urine volume of children aged 2-12 years is less than 1 L, therefore, misclassification of iodine intakes may occur when urine volumes fall below or above 1 L. Future studies utilizing spot urine samples to assess iodine status should consider this when extrapolating UIC to represent iodine intakes of a population.

Keywords: Adolescents; Assessment; Children; Iodine; Nutrition; Urine; Urine volume.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adolescent
  • Biomarkers / urine*
  • Child
  • Humans
  • Iodine / urine*
  • Nutritional Status
  • Urine Specimen Collection*

Substances

  • Biomarkers
  • Iodine