The Indian Journal of Pediatrics
https://doi.org/10.1007/s12098-017-2581-0
CORRESPONDENCE
Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School
Children: Correspondence
Received: 8 September 2017 / Accepted: 14 December 2017
# Dr. K C Chaudhuri Foundation 2018
To the Editor: The article entitled BAnemia, Iron
Deficiency and Iodine Deficiency among Nepalese
School Children^ recently published in Indian Journal of
Pediatrics was extremely informative and useful [1]. The
authors had collected 759 urine samples and 316 blood
samples from school children. The authors found Urinary
Iodine Excretion (UIE) was low amongst children with
iron deficiency anemia. Also, a significant association
was found between UIE with hemoglobin and iron status.
In the above study the investigators collected Bon the spot^
casual urine samples of children and estimated their UIE levels.
We would like to share with the readers of Indian Journal of
Pediatrics that the individual Iodine Nutrition Status (of
Children), cannot be estimated based on assessment of UIE
in BOn the Spot^ urine samples. The UIE estimation from BOn
the Spot^ urine samples provides estimates of iodine status in
the population as a whole and not of the specific individuals
constituting the population [2].
It may not be scientifically valid to classify the children into
different grades of iodine status as done by the investigators
i.e., i) Iodine Deficient ii) Iodine Sufficient.
For assessment of Individual Iodine Nutritional Status,
we need to assess the UIE in the urine samples collected
for 24 h or alternatively 10 repeat collection of BOn the
Spot^ urine samples should be done and UIE should be
estimated in them [3].
In view of above, the conclusion drawn by the authors that
Blow urinary iodine excretion was associated with anemia and
iron deficiency^ may not be valid and needs to be corrected.
Radhika Kapil1 and Aakriti Gupta2
1
Department of Pathology, Jawaharlal Nehru Medical College,
2
Belgaum, Karnataka; Department of Human Nutrition, All India
Institute of Medical Sciences, New Delhi, India. E-mail: drradhikapatho@
gmail.com
References
1. Khatiwada S, Lamsal M, Gelal B, et al. Anemia, iron deficiency and
iodine deficiency among Nepalese school children. Indian J Pediatr.
2016;83:617–21.
2. World Health Organization. Assessment of Iodine Deficiency
Disorders and Monitoring their Elimination: A guide for
Programme Managers, 3rd ed. Geneva: World Health Organization;
2007. Viii, 99 p.
3. Konig F, Andersson M, Hotz K, Aeberli I, Zimmerman MB. Ten
repeat collections for urinary iodine from spot samples or 24-hour
samples are needed to reliably estimate individual iodine status in
women. J Nutr. 2011;141:2049–54.
Authors' Reply
To the Editor: We would like to thank Kapil et al. for their
view on our paper entitled BAnemia, Iron Deficiency and
Iodine Deficiency among Nepalese School Children^ [1].
We are delighted by the interest of the authors on our paper.
It is well established that median urinary iodine excretion
(UIE) in the spot urine samples is the most convenient marker
of iodine status in the school children population. The median
UIE provides information about the iodine status of the pop-
ulation rather than individual iodine status and spot urine sam-
ple iodine concentration may not be valid marker of individual
iodine status [2].
Though median UIE < 100 μg/L and >100 μg/L are being
considered as iodine deficiency and iodine sufficiency respec-
tively in the population [2], WHO started using spot UIE
<100 μg/L as having low iodine intakes to give prevalence
estimates of iodine deficiency in iodine surveys from across
the globe and to monitor the progress in elimination of iodine
deficiency even though the approach overestimates the true
prevalence of iodine deficiency [3, 4]. This spot UIE cut off of

100 μg/L has been used to estimate the proportions of indi-
viduals having iodine deficiency or sufficiency in the iodine
survey of Nepal [5]. Thus, in the current study also, we ap-
plied spot UIE cut off of 100 μg/L, to get a crude estimation of
the number of children having low iodine intake (iodine defi-
ciency) in the study population.
Even in the light of spot UIE not being a true indicator of
individual iodine status, based on the correlation of urinary
iodine concentration with the hemoglobin and iron status in-
dicators in the study, the conclusion Blow urinary iodine ex-
cretion was associated with anemia and iron deficiency^ is
still valid.
Saroj Khatiwada1, Madhab Lamsal2, Basanta Gelal2,
Sharad Gautam2, Ashwini Kumar Nepal2, David Brodie3
and Nirmal Barall2
1
Department of Pharmacy, Central Institute of Science and
Technology (CIST) College, Pokhara University, Kathmandu, Nepal;
2
Department of Biochemistry, B P Koirala Institute of Health Sciences,
3
Ghopa, Dharan, Nepal; Faculty of Society and Health,
Buckinghamshire University, Buckinghamshire, UK . E-mail :
khatiwadasaroj22@gmail.com
Indian J Pediatr
References
1. Khatiwada S, Lamsal M, Gelal B, et al. Anemia, iron deficiency and
iodine deficiency among Nepalese school children. Indian J Pediatr.
2016;83:617–21.
2. Assessment of Iodine Deficiency Disorders and Monitoring their
Elimination. WHO/UNICEF/ICCIDD. WHO Publication 2007. p.
1–108.
3. Andersson M, Takkouche B, Egli I, Allen HE, de Benoist B. Current
global iodine status and progress over the last decade towards the
elimination of iodine deficiency. Bull World Health Organ.
2005;83:518–25.
4. Andersson M, Karumbunathan V, Zimmermann MB. Global iodine
status in 2011 and trends over the past decade. J Nutr. 2012;142:744–
50.
5. Ministry of Health and Population, Department of Health Services,
Government of India and Alliance Nepal. National Survey and
Impact Study for Iodine Deficiency Disorders (IDD) and Availability
of Iodized Salt in Nepal; 2007.