1
|
Soh YC, Fairley A, Alawad M, Lee SS, Su TT, Stephan BCM, Reidpath D, Robinson L, Yasin S, Siervo M, Mohan D. Assessing Sodium Intake in Middle-Aged and Older Adults with Elevated Blood Pressure: Validation of Spot Urine Excretion and Dietary Survey-Derived Estimates. Nutrients 2024; 16:1461. [PMID: 38794699 PMCID: PMC11123951 DOI: 10.3390/nu16101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 05/26/2024] Open
Abstract
This cross-sectional study evaluated the validity of three alternative methods compared to the gold standard 24-h urine collection for estimating dietary sodium intake, a modifiable risk factor for hypertension, among middle-aged and older adults with elevated blood pressure. These included spot urine collection (using Kawasaki, Tanaka, and INTERSALT equations), 24-h dietary recall, and food frequency questionnaire responses, compared to 24-h urine collection in a subset of 65 participants (aged 50-75 years, 58.5% women, 61.6% hypertensive) from the DePEC-Nutrition trial. The validity of the methods was assessed using bias, the Spearman correlation coefficient (SCC), the intraclass correlation coefficient (ICC), and Bland-Altman analysis. Among the alternative methods, spot urine collection using the Kawasaki equation showed the strongest correlation (SCC 0.238; ICC 0.119, 95% CI -0.079 to 0.323), but it exhibited a significant bias (1414 mg/day, p-value < 0.001) relative to 24-h urine collection. Conversely, dietary surveys had a smaller bias but wider limits of agreement. These findings underscore the complexities of accurately estimating dietary sodium intake using spot urine collection or dietary surveys in this specific population, suggesting that a combination or the refinement of existing methodologies might improve accuracy. Further research with larger samples is necessary to develop more reliable methods for assessing sodium intake in this high-risk group.
Collapse
Affiliation(s)
- Yee Chang Soh
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia
| | - Andrea Fairley
- School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne NE2 4DR, UK;
| | - Mawada Alawad
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia
| | - Siew Siew Lee
- School of Biosciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih 43500, Malaysia;
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (Y.C.S.); (M.A.); (T.T.S.)
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 45700, Malaysia
| | - Blossom Christa Maree Stephan
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham NG7 2TU, UK;
- Dementia Centre of Excellence, Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia
| | - Daniel Reidpath
- Institute for Global Health and Development, Queen Margaret University, Musselburgh EH21 6UU, UK;
- School of Social Sciences, Monash University, Melbourne, VIC 3800, Australia
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK;
| | - Shajahan Yasin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia;
| | - Mario Siervo
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6845, Australia;
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway 47500, Malaysia; (Y.C.S.); (M.A.); (T.T.S.)
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| |
Collapse
|
2
|
Gibson R, Aljuraiban GS, Oude Griep LM, Vu TH, Steffen LM, Appel LJ, Rodriguez BL, Daviglus ML, Elliott P, Van Horn L, Chan Q. Relationship of calcium and magnesium intakes with the dietary approaches to stop hypertension score and blood pressure: the International Study of Macro/micronutrients and Blood Pressure. J Hypertens 2024; 42:789-800. [PMID: 38164982 PMCID: PMC10990009 DOI: 10.1097/hjh.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Research investigating calcium and magnesium intakes from the Dietary Approaches to Stop Hypertension (DASH) pattern and other sources in association with blood pressure is limited. We aimed to characterize sources/intake levels of calcium and magnesium in relation to overall diet quality (DASH-score) and determine modification effects with DASH score and blood pressure. METHODS Cross-sectional United States data (average dietary and supplement intake from four 24 h recalls and eight blood pressure measurements) from two separate visits, 2195 men and women (40-59 years) in the International Study of Macro/Micronutrients and Blood Pressure were analysed. Food-based adherence to the DASH diet was estimated. Linear models tested associations between each 1-point DASH score with blood pressure. Participants were stratified by adherence to sex-specific recommended allowance for magnesium and calcium intakes. Effect-modification was tested across DASH-score quintiles and median of urinary sodium. RESULTS DASH-score was inversely associated with SBP in fully adjusted models (-0.27; 95%CI: -0.38 to -0.15 mmHg). SBP was inversely associated with dietary calcium intake from DASH food groups: -1.54 (95% CI: -2.65 to -0.43) mmHg; calcium intake from other non-DASH food groups: -1.62 (95% CI: -2.94 to -0.29) mmHg. Dietary magnesium intake from DASH food groups (-1.59; 95% CI: -2.79, -0.40 mmHg) and from other non-DASH foods (-1.92; 95% CI: -3.31, -0.53 mmHg) was inversely associated with SBP. CONCLUSION A higher DASH score showed a consistent association with lower BP suggesting a relationship between intakes of calcium and Mg with BP regardless of whether the source is part of the DASH diet or not, even when adjusted for supplement intakes.The INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov .
Collapse
Affiliation(s)
- Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- Department of Nutritional Sciences, King's College London, United Kingdom
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Linda M. Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity (DAPA), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Thanh-Huyen Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beatriz L. Rodriguez
- Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| |
Collapse
|
3
|
Kaur P, Yadav AK, Pal A, Jassal RS, Shafiq N, Sahni N, Kumar V, Jha V. Estimation of dietary intake of sodium, potassium, phosphorus and protein in healthy Indian population and patients with chronic kidney disease. Front Nutr 2024; 11:1312581. [PMID: 38487633 PMCID: PMC10937368 DOI: 10.3389/fnut.2024.1312581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Poor nutritious diet is a major risk element for non-communicable diseases (NCD), which are of considerable public health concern. Given the diverse dietary patterns in India, precise determination of nutrient consumption is crucial for disease management. The present study assessed the dietary intake of sodium, potassium, protein, and phosphorus among North Indians. Methods This cross-sectional study included healthy adults and adults with stage 2 to 4 chronic kidney disease (CKD). We analysed sodium, protein, potassium and phosphorus intakes using one-time 24-h urinary excretion. Dietary intake was also analysed in subgroups based on sex, body mass index, blood pressure and abdominal obesity. We evaluated the performance of various equations available to estimate sodium intake using a spot urine sample with respect to the sodium excretion measured in a 24-h urine sample. Descriptive statistics was used along with t-test for statistical significance. Results A total of 404 subjects (182 adult healthy subjects and 222 adults with CKD) with a mean age of 47.01 ± 11.46 years were studied. Mean dietary intakes of sodium, salt, potassium, protein and phosphorus were 2.94 ± 1.68 g/day, 7.42 ± 4.24 g/day, 1.43 ± 0.59 g/day, 47.67 ± 14.73 g/day and 0.86 ± 0.39 g/day, respectively. There were no differences in nutrient consumption between adults who were healthy and those with CKD. Consumption of sodium, salt, protein, potassium, and phosphorus among healthy population vs. those with CKD were 2.81 ± 1.60 vs. 3.05 ± 1.73 g/day (p = 0.152), 7.08 ± 4.04 vs. 7.70 ± 4.37 g/day (p = 0.143), 47.16 ± 14.59 vs. 48.08 ± 14.86 g/day (p = 0.532), 1.38 ± 0.59 vs. 1.48 ± 0.58 g/day (p = 0.087) and 0.86 ± 0.41 vs. 0.87 ± 0.37 g/day (p = 0.738), respectively. Men had higher consumption of these nutrients than women. Compared to non-hypertensives, hypertensive subjects had higher consumption of salt (8.23 ± 4.89 vs. 6.84 ± 3.59 g/day, p = 0.002) and potassium (1.51 ± 0.63 vs. 1.38 ± 0.55 g/day, p = 0.024), however, no difference were found in protein and phosphorus intakes. In terms of performance of equations used to estimate 24-h sodium intake from spot urinary sodium concentration against the measured 24-h urinary sodium excretion, INTERSALT 2 equation exhibited the least bias [1.08 (95% CI, -5.50 to 7.66)]. Conclusion The study shows higher-than-recommended salt and lower-than-recommended potassium intake in the north Indian population compared to those recommended by guidelines. The dietary protein intake is below the recommended dietary allowance. These findings help the development of targeted policies for dietary modification to reduce the risk of the development and progression of CKD.
Collapse
Affiliation(s)
- Prabhjot Kaur
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arnab Pal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravjit Singh Jassal
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nancy Sahni
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- The George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
4
|
Okami Y, Chan Q, Miura K, Kadota A, Elliott P, Masaki K, Okayama A, Okuda N, Yoshita K, Miyagawa N, Okamura T, Sakata K, Saitoh S, Sakurai M, Nakagawa H, Stamler (deceased) J, Ueshima H. Small High-Density Lipoprotein and Omega-3 Fatty Acid Intake Differentiates Japanese and Japanese-Americans: The INTERLIPID Study. J Atheroscler Thromb 2023; 30:884-906. [PMID: 36328528 PMCID: PMC10406687 DOI: 10.5551/jat.63762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/19/2022] [Indexed: 08/04/2023] Open
Abstract
AIM To identify the most differentiated serum lipids, especially concerning particle size and fractions, between Japanese living in Japan and Japanese-Americans in Hawaii, in the absence of possible genetic confounders, and cross-sectionally examine the associated modifiable lifestyle factors. METHODS Overall, 1,241 (aged 40-59 years) Japanese living in Japan and Japanese-Americans in Hawaii were included. We quantified 130 serum lipid profiles (VLDL 1-5, IDL, LDL 1-6, high-density lipoprotein [HDL] 1-4, and their subfractions) using Bruker's 1H-nuclear magnetic resonance spectrometer for the primary outcome. Modifiable lifestyle factors included body mass index (BMI), physical activity, alcohol and smoking habits, and 70 nutrient parameters. We evaluated the different lipids between the groups using partial least squares-discriminant analysis and association between extracted lipids and lifestyle factors using multivariable linear regression analysis. RESULTS Concentrations of HDL4, HDL with the smallest particle size, were lower in Japanese than in Japanese-Americans of both sexes. Higher fish-derived omega-3 fatty acid intake and lower alcohol intake were associated with lower HDL4 concentrations. A 1% higher kcal intake of total omega-3 fatty acids was associated with a 9.8-mg/dL lower HDL4. Fish-derived docosapentaenoic acid, eicosapentaenoic acid, and docosahexaenoic acid intake were inversely associated with HDL4 concentration. There was no relationship between country, sex, age, or BMI. CONCLUSIONS Japanese and Japanese-Americans can be differentiated based on HDL4 concentration. High fish intake among the Japanese may contribute to their lower HDL4 concentration. Thus, HDL particle size may be an important clinical marker for coronary artery diseases or a fish consumption biomarker.
Collapse
Affiliation(s)
- Yukiko Okami
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Nagako Okuda
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Katsushi Yoshita
- Graduate School of Human Life and Ecology Division of Human Life and Ecology, Osaka Metropolitan University, Osaka, Japan
| | - Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan
| | - Shigeyuki Saitoh
- School of Health Sciences, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hideaki Nakagawa
- Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan
| | | | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
5
|
Miyagawa N, Sekikawa A, Miura K, Evans RW, Okuda N, Fujiyoshi A, Yoshita K, Chan Q, Okami Y, Kadota A, Willcox B, Masaki K, Rodriguez B, Sakata K, Nakagawa H, Saitoh S, Okayama A, Kuller LH, Elliott P, Stamler J, Ueshima H. Circulating plasma phospholipid fatty acid levels as a biomarker of habitual dietary fat intake: The INTERMAP/INTERLIPID Study. J Clin Lipidol 2023; 17:131-141. [PMID: 36463085 DOI: 10.1016/j.jacl.2022.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate assessment of fat intake is essential to examine relationships between diet and disease risk. However, estimating individual intakes of fat quantity by dietary assessment is difficult. OBJECTIVE We assessed the association of plasma phospholipid fatty acid levels with dietary intake of fatty acids in the INTERMAP/INTERLIPID study, conducted with a standardized protocol. METHODS The study participants were 1339 men and women ages 40-59 years from five Japanese populations one from Hawaii; four from Japan. Fatty acid intake was estimated from four standardized 24-hour dietary recalls. Plasma phospholipid fatty acid composition was analyzed by gas chromatography. We illustrated the relationship between intake and circulating fatty acid levels using Spearman's rank-correlation coefficients, mean, and median values. RESULTS Spearman's rank-correlation coefficients between intake (g/d) and circulating fatty acid levels (µg/ml) were -0.03 to 0.21 for saturated fatty acids and monounsaturated fatty acids and -0.04 to 0.32 for trans fatty acids. The coefficients for essential n-3 and n-6 fatty acids were moderate to high, especially for eicosapentaenoic acid (EPA), 0.60; docosahexaenoic acid (DHA), 0.41; and EPA+DHA, 0.51. The circulating levels and intake of marine-derived n-3 fatty acids showed a linear association, at least for the intake of EPA+DHA up to 2.1 g/d. CONCLUSION We observed high correlation between intake and circulating levels of marine-derived n-3 fatty acids in participants from Japanese and Japanese-American populations with high and low fish intake. Plasma phospholipid marine-derived n-3 fatty acid measurements are a simple and reliable biomarker for assessing dietary intake.
Collapse
Affiliation(s)
- Naoko Miyagawa
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, 160-8582, Tokyo, Japan; Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan.
| | - Akira Sekikawa
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan; NCD Epidemiology Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan.
| | - Rhobert W Evans
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States.
| | - Nagako Okuda
- Department of Health Science, Kyoto Prefectural University, Sakyo-ku, 602-8566, Kyoto, Japan.
| | - Akira Fujiyoshi
- Department of Hygiene, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, 641-8509, Wakayama, Japan.
| | - Katsushi Yoshita
- Department of Nutrition, Graduate School of Human Life and Ecology, Osaka Metropolitan University, 3-3-138, Sugimoto, Sumiyoshi-ku, 558-8585, Osaka, Japan.
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom.
| | - Yukiko Okami
- NCD Epidemiology Research Center, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan.
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan.
| | - Bradley Willcox
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, 347 N. Kuakini Street, HPM-9, Honolulu, HI, 96817, United States.
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, 347 N. Kuakini Street, HPM-9, Honolulu, HI, 96817, United States.
| | - Beatriz Rodriguez
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii, 347 N. Kuakini Street, HPM-9, Honolulu, HI, 96817, United States.
| | - Kiyomi Sakata
- Department of Hygiene and Public Health, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, 028-3694, Iwate, Japan.
| | - Hideaki Nakagawa
- Department of Social and Environmental Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, 920-0293, Ishikawa Kanazawa, Japan.
| | - Shigeyuki Saitoh
- School of Health Sciences, Sapporo Medical University, S1 W17, Chuo-ku, 060-8556, Sapporo, Japan.
| | - Akira Okayama
- Research Institute of Strategy for Prevention, 1-3-9 Shinkawa Chuo-ku, 104-0033, Tokyo, Japan.
| | - Lewis H Kuller
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, W2 1PG, London, United Kingdom.
| | - Jeremiah Stamler
- Feinberg School of Medicine, Northwestern University, Suite 1400, 680 N Lake Shore Drive, Chicago, IL, 60611, United States
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, 520-2192, Shiga, Japan; Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States.
| |
Collapse
|
6
|
Conway R, Heuchan G, Croker H, Esser S, Ireland V, Lally P, Beeken R, Fisher A. Comparison between Self-Completed and Interviewer-Administered 24-Hour Dietary Recalls in Cancer Survivors: Sampling Bias and Differential Reporting. Nutrients 2022; 14:5236. [PMID: 36558396 PMCID: PMC9781276 DOI: 10.3390/nu14245236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
Self-completed 24 h dietary recalls (24-HRs) are increasingly used for research and national dietary surveillance. It is unclear how difficulties with self-completion affect response rates and sample characteristics. This study identified factors associated with being unable to self-complete an online 24-HR but willing to do so with an interviewer. Baseline 24-HRs from the ASCOT Trial were analysed (n = 1224). Adults who had been diagnosed with cancer in the past seven years and completed treatment, were invited to self-complete 24-HRs online using myfood24®. Non-completers were offered an interviewer-administered 24-HR. One third of participants willing to provide dietary data, were unable to self-complete a 24-HR. This was associated with being older, non-white and not educated to degree level. Compared to interviewer-administered 24-HRs, self-completed 24-HRs included 25% fewer items and reported lower intakes of energy, fat, saturated fat and sugar. This study highlights how collection of dietary data via online self-completed 24-HRs, without the provision of an alternative method, contributes to sampling bias. As dietary surveys are used for service and policy planning it is essential to widen inclusion. Optimisation of 24-HR tools might increase usability but interviewer-administered 24-HRs may be the only suitable option for some individuals.
Collapse
Affiliation(s)
- Rana Conway
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Gabriella Heuchan
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Helen Croker
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Sara Esser
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Victoria Ireland
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Phillippa Lally
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | | | - Abigail Fisher
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| |
Collapse
|
7
|
Levy J, Silva AM, De Carli E, Cacau LT, de Alvarenga JFR, Fiamoncini J, Benseñor IM, Lotufo PA, Marchioni DM. Biomarkers of Fruit Intake Using a Targeted Metabolomics Approach: an Observational Cross-Sectional Analysis of the ELSA-Brasil Study. J Nutr 2022; 152:2023-2030. [PMID: 35641174 DOI: 10.1093/jn/nxac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/11/2022] [Accepted: 05/24/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Advances in technology have led to the identification of a greater number of metabolites related to diet. Although fruit intake biomarkers have been reported in some studies, these findings require further replication, considering the relevance of fruits for diet quality and health. OBJECTIVES The aim of this study was to explore the associations of a set of potential urinary biomarkers of diet, assessed using a targeted metabolomics approach, with self-reported fruit intake data in participants of a computer-assisted 24-h dietary recall (GloboDiet software) validation study. METHODS A total of 93 individuals aged 43-72 y, 54% female, participated in this study. The subjects were a subsample of the Longitudinal Study of Adult Health (ELSA-Brasil). A 24-h dietary recall was obtained with the aid of GloboDiet software matching a 24-h urine sample from each participant. Candidate biomarkers were selected in a literature search and identified in urine by LC coupled to high-resolution MS. Spearman correlation analyses were performed between fruit intake and each biomarker. RESULTS Spearman correlation analysis showed that total fruits intake was significantly correlated with citric acid (ρ = 0.213, P = 0.041), ferulic acid sulfate I (ρ = 0.240, P = 0.020), hesperetin glucuronide/homoeriodictyol glucuronide (ρ = 0.303, P = 0.003), hydroxyhippuric acid (ρ = 0.239, P = 0.021), homovanillic alcohol sulfate (ρ = 0.339, P = 0.001), methylgallic acid sulfate (ρ = 0.268, P = 0.009), naringenin glucuronide (NG; ρ = 0.278, P = 0.007), proline betaine (PB; ρ = 0.305, P = 0.003), syringic acid sulfate (ρ = 0.210, P = 0.044), and sinapic acid sulfate (ρ = 0.412, P < 0.001). Among them, 3 have been described in literature as promising biomarkers for intake of total fruit, oranges, and citrus fruit: NG, hesperetin glucuronide, and PB. CONCLUSIONS Associations of total fruits intake with urinary measurements indicate the potential usefulness of dietary biomarkers in the Brazilian population as a complement to self-reported dietary assessments.
Collapse
Affiliation(s)
- Jessica Levy
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Alexsandro Macedo Silva
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Eduardo De Carli
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Leandro Teixeira Cacau
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - José Fernando Rinaldi de Alvarenga
- Food Research Center (FoRC), Department of Food and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jarlei Fiamoncini
- Food Research Center (FoRC), Department of Food and Experimental Nutrition, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Isabela Martins Benseñor
- Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Clinical and Epidemiological Research Center, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Du X, Fang L, Xu J, Chen X, Bai Y, Wu J, Wu L, Zhong J. The association of knowledge, attitudes and behaviors related to salt with 24-h urinary sodium, potassium excretion and hypertensive status. Sci Rep 2022; 12:13901. [PMID: 35974077 PMCID: PMC9381520 DOI: 10.1038/s41598-022-18087-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
To understand the association between sodium and potassium consumption levels, hypertension and knowledge, attitudes and behaviors (KAB) toward salt and the commitment to effective sodium reduction and potassium supplementation to achieve the purpose of suppressing hypertension. A stratified multistage random sampling method was used to obtain a representative provincial sample of 7512 residents aged 18-69 years through a cross-sectional survey by the Salt Reduction and Hypertension Prevention Project (SRHPP) in Zhejiang Province of China in 2017-2018. A screening including demographic, anthropometric, salt-related KAB and physical measurements was implemented, and 24-h urine of approximately 1/5 of the participants was collected and tested. The mean age was 44.8 years, 50.1% were women, 44.0% lived in urban areas, and hypertension or prehypertension accounted for approximately 35.0%. The mean 24-h urinary sodium and potassium excretion were 3848.5 (1661.1) mg/d and 1491.1 (710.9) mg/d, respectively. KAB in urban areas was generally more favorable than in rural areas, women were better than men, and the optimal blood pressure group was better than the other two groups (P < 0.05). However, the awareness and correct use rate of salt-restricted spoons, low-sodium salt and nutrition labeling were lower. A multivariable linear regression model indicated that KAB had a smaller effect on sodium (two indicators effective for promoting sodium reduction) and a greater effect on potassium (six indicators effective for promoting potassium supplementation) and mainly focused on knowledge and behavior indicators. A multivariable logistic regression model indicated that mastering more knowledge and taking active measures could effectively reduce the transition to hypertension, even if the individual was already in prehypertension. There is much room for improvement of salt-related KAB in the Chinese population. A clear association indicates that KAB can help to reduce sodium and supplement potassium, especially potassium, and help to suppress the development of hypertension. The role of beliefs in KAB should be fully valued and improved, similar to knowledge and behaviors. This study provides important evidence and insight into China's efforts to meet the targets of salt reduction and hypertension prevention.
Collapse
Affiliation(s)
- Xiaofu Du
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Lin Wu
- Department of Medical College, Jinhua Polytechnic, No. 888 Haitang West Road, JinHua, 321017, China
| | - Jieming Zhong
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China.
| |
Collapse
|
9
|
Fujiwara A, Omura Y, Oono F, Sugimoto M, Sasaki S, Takimoto H. A Scoping Review of Epidemiological Studies on Intake of Sugars in Geographically Dispersed Asian Countries: Comparison of Dietary Assessment Methodology. Adv Nutr 2022; 13:1947-1973. [PMID: 35641021 PMCID: PMC9526866 DOI: 10.1093/advances/nmac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/10/2022] [Accepted: 05/26/2022] [Indexed: 01/28/2023] Open
Abstract
Previous systematic reviews, which focused on sugar intake and its relation with health issues, were mainly conducted in Western countries, not Asian countries characterized by differences in dietary habits and disease prevalence. The scarcity of Asian studies may be attributed to the lack of assessment tools for estimating sugar intake. To provide an overview of the epidemiological studies on sugar intake in Asian countries, with a primary focus on dietary assessment methodology for estimating sugar intake, we conducted a scoping review of the epidemiological studies estimating sugar intake in Asian countries (the United Nations' definition) and Taiwan using PubMed and Web of Science. Study quality was evaluated based on its assessment of sugar intake in the whole diet, dietary assessment methods, and data sources used for estimating sugar content. We identified 143 studies from 136 publications from Eastern (n = 63), Southern (n = 30), South-Eastern (n = 26), and Western (n = 24) Asia. Total sugars were investigated in 95 studies, while 23-30 studies investigated sucrose, fructose, added sugars, and free sugars. The main aim of the selected studies was assessment of diet-disease relations (n = 85) and estimation of dietary intake (n = 40), and 62 studies assessed sugars as the primary exposure/outcome. A total of 120 studies assessed sugar intake in the whole diet, and 62 studies used validated FFQs or multiple-day dietary assessment methods. Only 41 studies used country-specific comprehensive food-composition databases or directly measured sugar content. Only 17 studies reported high-quality data. This review elucidated a sufficient number of epidemiological studies estimating sugar intake across Asian countries; however, most studies reported low-quality data. The results from our review showed that both feasible and validated dietary assessment methods, as well as comprehensive country-specific sugar-composition databases, are essential for producing high-quality studies with accurate sugar intake to examine its association with health outcomes.
Collapse
Affiliation(s)
- Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan,Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Yuka Omura
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumi Oono
- Department of Social and Preventive Epidemiology, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Minami Sugimoto
- Institute for Future Initiatives, University of Tokyo, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Tokyo, Japan
| | | |
Collapse
|
10
|
Emamat H, Zahedmehr A, Asadian S, Nasrollahzadeh J. The effect of purple-black barberry (Berberis integerrima) on blood pressure in subjects with cardiovascular risk factors: a randomized controlled trial. JOURNAL OF ETHNOPHARMACOLOGY 2022; 289:115097. [PMID: 35150818 DOI: 10.1016/j.jep.2022.115097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/27/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Berberis integerrima commonly known as "barberry" belongs to the Berberidaceae family and has been used as a medicinal plant in Iranian traditional medicine. AIM OF THE STUDY Our aim in this study was to investigate the effects of barberry consumption on blood pressure (BP). MATERIALS AND METHODS Eighty-four medicated hypertensive patients were selected and randomly allocated to barberry and placebo groups. The barberry group received 10 g/day dried purple-black barberry powder, once daily, for 2-months. Systolic, diastolic, and mean arterial BP was assessed through 24-h ambulatory BP monitoring before and after 2-month treatment. The estimation of sodium and potassium intake was done through measurement of sodium and potassium in 24-h urinary samples. Plasma and urinary nitrite, and nitrate (NOx) levels, as well as plasma angiotensin-converting enzyme (ACE) activity, were also determined. RESULTS Seventy-eight participants with an average age of 54.12 ± 10.32 years and BMI of 27.93 ± 2.22 kg/m2 completed the study. There was no significant difference in body weight, physical activity, and the 24-h urinary sodium and potassium excretion between the two groups before and after the study. After adjusting for baseline values and changes in sodium intake, systolic, and mean arterial BP decreased significantly in the barberry group compared to the placebo group (p = 0.015 and p = 0.008, respectively). Plasma NOx levels and ACE activity were not different between the two groups, but urinary NOx was increased significantly in the barberry group compared to the placebo group (p = 0.008). CONCLUSIONS In patients treated with antihypertensive drugs, daily consumption of purple-black barberry can be effective in improving systolic BP control.
Collapse
Affiliation(s)
- Hadi Emamat
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Zahedmehr
- Cardiovascular Intervention Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Sanaz Asadian
- Department of Radiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Javad Nasrollahzadeh
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Chan Q, Wren GM, Lau CHE, Ebbels TMD, Gibson R, Loo RL, Aljuraiban GS, Posma JM, Dyer AR, Steffen LM, Rodriguez BL, Appel LJ, Daviglus ML, Elliott P, Stamler J, Holmes E, Van Horn L. Blood pressure interactions with the DASH dietary pattern, sodium, and potassium: The International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Am J Clin Nutr 2022; 116:216-229. [PMID: 35285859 PMCID: PMC9257466 DOI: 10.1093/ajcn/nqac067] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet enhances potassium intake and reduces sodium intake and blood pressure (BP), but the underlying metabolic pathways are unclear. OBJECTIVES Among free-living populations, we delineated metabolic signatures associated with the DASH diet adherence, 24-hour urinary sodium and potassium excretions, and the potential metabolic pathways involved. METHODS We used 24-hour urinary metabolic profiling by proton nuclear magnetic resonance spectroscopy to characterize the metabolic signatures associated with the DASH dietary pattern score (DASH score) and 24-hour excretion of sodium and potassium among participants in the United States (n = 2164) and United Kingdom (n = 496) enrolled in the International Study of Macro- and Micronutrients and Blood Pressure (INTERMAP). Multiple linear regression and cross-tabulation analyses were used to investigate the DASH-BP relation and its modulation by sodium and potassium. Potential pathways associated with DASH adherence, sodium and potassium excretion, and BP were identified using mediation analyses and metabolic reaction networks. RESULTS Adherence to the DASH diet was associated with urinary potassium excretion (correlation coefficient, r = 0.42; P < 0.0001). In multivariable regression analyses, a 5-point higher DASH score (range, 7 to 35) was associated with a lower systolic BP by 1.35 mmHg (95% CI, -1.95 to -0.80 mmHg; P = 1.2 × 10-5); control of the model for potassium but not sodium attenuated the DASH-BP relation. Two common metabolites (hippurate and citrate) mediated the potassium-BP and DASH-BP relationships, while 5 metabolites (succinate, alanine, S-methyl cysteine sulfoxide, 4-hydroxyhippurate, and phenylacetylglutamine) were found to be specific to the DASH-BP relation. CONCLUSIONS Greater adherence to the DASH diet is associated with lower BP and higher potassium intake across levels of sodium intake. The DASH diet recommends greater intake of fruits, vegetables, and other potassium-rich foods that may replace sodium-rich processed foods and thereby influence BP through overlapping metabolic pathways. Possible DASH-specific pathways are speculated but confirmation requires further study. INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov.
Collapse
Affiliation(s)
| | - Gina M Wren
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Chung-Ho E Lau
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom,Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Timothy M D Ebbels
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom,Department of Nutritional Sciences, King's College London, London, United Kingdom
| | - Ruey Leng Loo
- Australian National Phenome Centre and Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, Western Australia, Australia
| | - Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Joram M Posma
- Section of Bioinformatics, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lyn M Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Beatriz L Rodriguez
- Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins University, Baltimore, MD, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elaine Holmes
- Section of Nutrition, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom,Australian National Phenome Centre and Centre for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, Western Australia, Australia
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
12
|
Paradis F, Lamarche B, Robitaille J, Couillard C, Lafrenière J, Tremblay AJ, Corneau L, Lemieux S. Validation of an automated self-administered 24-hour dietary recall web application against urinary recovery biomarkers in a sample of French-speaking adults of the province of Québec, Canada. Appl Physiol Nutr Metab 2022; 47:173-182. [PMID: 35057638 DOI: 10.1139/apnm-2021-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to validate an automated self-administered 24-hour dietary recall web application (R24W) against recovery biomarkers for sodium, potassium and protein intakes and to identify individual characteristics associated with misreporting in a sample of 61 men and 69 women aged 20-65 years from Québec City, Canada. Each participant completed 3 dietary recalls using the R24W, provided two 24-hour urinary samples and completed questionnaires to document psychosocial factors. Mean reported intakes were 2.2%, 2.1% and 5.0% lower than the urinary reference values, respectively, for sodium, potassium and proteins (significant difference for proteins only (p = 0.04)). Deattenuated correlations between the self-reported intake and biomarkers were significant for sodium (r = 0.48), potassium (r = 0.56) and proteins (r = 0.68). Cross-classification showed that 39.7% (sodium), 42.9% (potassium) and 42.1% (proteins) of participants were ranked into the same quartile with both methods and only 4.8% (sodium), 3.2% (potassium) and 0.8% (proteins) were ranked in opposite quartiles. Lower body esteem related to appearance was associated with sodium underreporting in women (r = 0.33, p = 0.006). No other individual factor was found to be associated with misreporting. These results suggest that the R24W has a good validity for the assessment of sodium, potassium and protein intakes in a sample of French-speaking adults. Novelty: The validity of an automated self-administered 24-hour dietary recall web application named the R24W was tested using urinary biomarkers. According to 7 criteria, the R24W was found to have a good validity to assess self-reported intakes of sodium, potassium and proteins.
Collapse
Affiliation(s)
- Frédérique Paradis
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benoît Lamarche
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Julie Robitaille
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Charles Couillard
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Jacynthe Lafrenière
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - André J Tremblay
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - Louise Corneau
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - Simone Lemieux
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| |
Collapse
|
13
|
Soh YC, Yap KH, McGrattan A, Yasin S, Reidpath D, Siervo M, Mohan D. Protocol for a systematic review assessing the measurement of dietary sodium intake among adults with elevated blood pressure. BMJ Open 2022; 12:e052175. [PMID: 34980615 PMCID: PMC8724716 DOI: 10.1136/bmjopen-2021-052175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Accurate sodium intake estimates in adults with elevated blood pressure are essential for monitoring salt reduction progress and preventing cardiovascular diseases. However, sodium assessments are challenging in this high-risk population because many commonly used antihypertensive drugs alter urinary sodium excretion. Despite the high cost and substantial participant burden of gold-standard 24-hour urine collection, the relative performance of existing spot-urine based equations and dietary self-report instruments have not been well studied in this population, who will benefit from salt restriction. This systematic review aims to describe the current methods of assessing dietary sodium intake in adults with elevated blood pressure and determine what method can provide a valid and accurate estimate of sodium intake compared with the gold standard 24-hour urine collection. METHODS AND ANALYSIS Studies assessing sodium intake in adults aged 18 years and above with reported elevated blood pressure will be included. Five electronic databases (MEDLINE, Embase, Global Health, WoS and Cochrane CENTRAL) will be systematically searched from inception to March 2021. Also, a manual search of bibliographies and grey literature will be conducted. Two reviewers will screen the records independently for eligibility. One reviewer will extract all data, and two others will review the extracted data for accuracy. The methodological quality of included studies will be evaluated based on three scoring systems: (1) National Heart, Lung and Blood Institute for interventional studies; (2) Biomarker-based Cross-sectional Studies for biomarker-based observational studies and (3) European Micronutrient Recommendation Aligned Network of Excellence for validation studies of dietary self-report instruments. ETHICS AND DISSEMINATION As the proposed systematic review will collect and analyse secondary data associated with individuals, there will be no ethical approval requirement. Findings will be disseminated in a peer-reviewed journal or presented at a conference. PROSPERO REGISTRATION NUMBER CRD42020176137.
Collapse
Affiliation(s)
- Yee Chang Soh
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Malaysia
| | - Kwong Hsia Yap
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Andrea McGrattan
- School of Biomedical, Nutritional and Sports Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Shajahan Yasin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Daniel Reidpath
- International Centre for Diarrhoeal Disease Research, ICDDRB, Dhaka, Bangladesh
| | - Mario Siervo
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| |
Collapse
|
14
|
Salman E, Kadota A, Okami Y, Kondo K, Yoshita K, Okuda N, Nakagawa H, Saitoh S, Sakata K, Okayama A, Chan Q, Elliott P, Stamler J, Ueshima H, Miura K. Investigation of the urinary sodium-to-potassium ratio target level based on the recommended dietary intake goals for the Japanese population: The INTERMAP Japan. Hypertens Res 2022; 45:1850-1860. [PMID: 36344663 PMCID: PMC9659487 DOI: 10.1038/s41440-022-01007-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022]
Abstract
Growing epidemiological evidence has shown an association of the urinary sodium (Na) to potassium (K) ratio (Na/K ratio) with blood pressure and cardiovascular diseases. However, no clear cutoff level has been defined. We investigated the cutoff level of the urinary Na/K ratio under different dietary guidelines for Japanese individuals, especially that endorsed by the 2020 revised Japanese Dietary Reference Intakes (DRIs). A population of 1145 Japanese men and women aged 40 to 59 years from the INTERMAP study was examined. Using high-quality standardized data, the averages of two 24 h urinary collections and four 24 h dietary recalls were used to calculate the 24 h urinary and dietary Na/K ratios, respectively. Associations between the urinary and dietary Na/K ratios were tested by sex- and age-adjusted partial correlation. The optimal urinary Na/K ratio cutoff level was determined by receiver operating characteristic (ROC) curves and sex-specific cross tables for recommended dietary K and salt. Overall, the average molar ratio of 24 h urinary Na/K was 4.3. We found moderate correlations (P < 0.001) of the 24 h urinary Na/K ratio with 24 h urinary Na and K excretion (r = 0.52, r = -0.49, respectively) and the dietary Na/K ratio (r = 0.53). ROC curves showed that a 24 h urinary Na/K ratio of approximately 2 predicted Na and K intake that meets the dietary goals of the Japanese DRIs. The range of urinary Na/K ratios meeting the dietary goals of the Japanese DRIs for both Na and K was 1.6‒2.2 for men and 1.7‒1.9 for women. Accomplishing a urinary Na/K ratio of 2 would be desirable to achieve the DRIs dietary goals for both Na and K simultaneously in middle-aged Japanese men and women accustomed to Japanese dietary habits. This observational study is registered at www.clinicaltrials.gov as NCT00005271.
Collapse
Affiliation(s)
- Ebtehal Salman
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan ,grid.471243.70000 0001 0244 1158OMRON Healthcare Co., Ltd, Kyoto, Japan
| | - Aya Kadota
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Yukiko Okami
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- grid.261445.00000 0001 1009 6411Department of Food Science and Nutrition, Graduate School of Human Life Science and Nutrition, Osaka City University, Osaka, Japan
| | - Nagako Okuda
- grid.258797.60000 0001 0697 4728Department of Health Science, Kyoto Prefectural University, Kyoto, Japan
| | - Hideaki Nakagawa
- grid.411998.c0000 0001 0265 5359Medical Research Institute, Kanazawa Medical University, Kanazawa, Japan
| | - Shigeyuki Saitoh
- grid.263171.00000 0001 0691 0855School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kiyomi Sakata
- grid.411790.a0000 0000 9613 6383Department of Hygiene and Public Health, Iwate Medical University, Yahaba, Japan
| | - Akira Okayama
- grid.272242.30000 0001 2168 5385Department of Non-Communicable Diseases, Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Queenie Chan
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Hirotsugu Ueshima
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | | |
Collapse
|
15
|
Li L, Mi Y, Xu M, Ruan L, Sun J, Song Q. Influence of Dietary Salt Intake on T2D Treatment. Front Endocrinol (Lausanne) 2022; 13:926143. [PMID: 35784580 PMCID: PMC9240780 DOI: 10.3389/fendo.2022.926143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUNDS To what extent patients undergoing long-term T2D treatment are affected by dietary salt intake has not been completely investigated. OBJECTIVES We aimed to investigate the influence of dietary salt intakes on T2D treatment, including glucose-lowering effect and indices related to T2D progression. METHODS The study recruited 1090 patients with T2D at Ningbo City First Hospital from January 1, 2018, to December 30, 2021. We compared their one-year follow-up outcomes in terms of fasting blood glucose (FBG), glycated hemoglobin (HbA1c), blood pressure, obesity, and prevalence of retinopathy and neuropathy among groups with different dietary salt intakes. RESULTS The 1090 patients consisted of 287(26.3%) decreasing-, 190(17.4%) increasing-, 175(16.0%) steadily low-, 243(22.3%) steadily medium-, and 195(17.9%) steadily high-dietary salt intake patients. Compared to increasing-, steadily medium-, and steadily high-dietary salt intake patients, decreasing and steadily low salt intake led to lower baseline FBG, HbA1c, systolic blood pressure (SBP), BMI, and visceral fat area (VFA) (all p<0.05), to a larger decrease in FBG, HbA1c, SBP, BMI, and VFA after one-year treatment (all p<0.05), as well as to a slightly lower prevalence of retinopathy and a significantly lower prevalence of neuropathy. The steadily low salt patients had lower urine albumin/creatinine ratio (UAR) both at baseline and after treatment. Notably, the fasting insulin in the steadily low salt group was higher than the remaining groups after treatment (p<0.01). CONCLUSIONS The present study concludes that lowered dietary salt intake benefits T2D treatment in multiple aspects, including main treatment targets such as FBG and HbA1c, and indices reflecting potential complications of T2D, including BMI, VFA, SBP, UAR, retinopathy, and neuropathy. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT03811470.
Collapse
Affiliation(s)
- Li Li
- Endocrinology and Metabolism, Ningbo City First Hospital, Ningbo, China
| | - Yuwei Mi
- Endocrinology and Metabolism, Ningbo City First Hospital, Ningbo, China
| | - Miao Xu
- Endocrinology and Metabolism, Ningbo City First Hospital, Ningbo, China
| | - Liemin Ruan
- Endocrinology and Metabolism, Ningbo City First Hospital, Ningbo, China
- *Correspondence: Jie Sun, ; Liemin Ruan, ; Qifa Song,
| | - Jie Sun
- Endocrinology and Metabolism, Ningbo City First Hospital, Ningbo, China
- *Correspondence: Jie Sun, ; Liemin Ruan, ; Qifa Song,
| | - Qifa Song
- Medical Data Center, Ningbo City First Hospital, Ningbo, China
- *Correspondence: Jie Sun, ; Liemin Ruan, ; Qifa Song,
| |
Collapse
|
16
|
Vu THT, Van Horn L, Daviglus ML, Chan Q, Dyer AR, Zhong VW, Gibson R, Elliott P, Stamler J. Association between egg intake and blood pressure in the USA: the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). Public Health Nutr 2021; 24:6272-6280. [PMID: 34334150 PMCID: PMC11148583 DOI: 10.1017/s1368980021002949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate associations of egg intake with blood pressure (BP) and the role of dietary variables and other macro- and micro-nutrients in the association. DESIGN We used cross-sectional data for the USA as part of the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). INTERMAP was surveyed between 1996 and 1999, including four 24-h dietary recalls, two 24-h urine collections and eight measurements of systolic BP and diastolic BP (SBP, DBP). Average egg intake (g/d) was calculated. Multivariable linear regression models were used to estimate the association between egg intake (per each 50 g/d or per quintile) and BP. The roles of dietary variables and other macro- and micro-nutrients in this association were also investigated. SETTING In the USA. PARTICIPANTS In total, 2195 US INTERMAP men and women aged 40-59 years. RESULTS Participants were 50 % female, 54 % non-Hispanic White and 16 % non-Hispanic Black. Mean egg intake (sd) in men and women was 30·4(29·8) and 21·6(20·5) g/d, respectively. Adjusting for demographics, socio-economics, lifestyle and urinary Na:K excretion ratios, we found non-linear associations with BP in non-obese women (P-quadratic terms: 0·004 for SBP and 0·035 for DBP).The associations remained after adjusting for dietary variables, macro/micro nutrients or minerals. Dietary cholesterol was highly correlated with egg intake and may factor in the association. No association was found in obese women and in obese or non-obese men. CONCLUSION Egg intake was non-linearly associated with SBP and DBP in non-obese women, but not in obese women or men. Underlying mechanisms require additional study regarding the role of obesity and sex.
Collapse
Affiliation(s)
- Thanh-Huyen T Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor W Zhong
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rachel Gibson
- 5Department of Nutritional Sciences, King's College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
17
|
Validity of predictive equations for 24-h urinary sodium excretion at the population and individual levels among Chinese adults aged 18-69 years. Sci Rep 2021; 11:22404. [PMID: 34789756 PMCID: PMC8599737 DOI: 10.1038/s41598-021-00513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022] Open
Abstract
Spot urine (SU) collection is a convenient method commonly used for sodium estimation, but its validity in predicting 24-h urinary sodium (24-hUNa) excretion has not been thoroughly evaluated among the general population. The aim of this study was to comprehensively assess the validity of eight existing methods in predicting 24-hUNa excretion by using SU samples among Chinese adults. We analyzed 1424 representative individuals aged 18 to 69 years. We compared the measured and estimated measurements of 24-hUNa at the population level by examining bias, the correlation, intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC) curves and Bland–Altman plots and analyzed the relative and absolute differences and misclassification at the individual level. The bias for all methods was significant (all p < 0.001), among which the smallest bias was − 7.9 mmol for the Toft formula and the largest bias was − 53.8 mmol for the Mage formula. Correlation coefficients were all less than 0.380, all formulas exhibited an area under the ROC curve below 0.683, and the Bland–Altman plots indicated slightly high dispersion of the estimation biases at higher sodium levels regardless of the formula. The proportions of relative differences > 40% for the eight methods were all over one-third, the proportions of absolute differences > 51.3 mmol/24 h (3 g/day NaCl) were all over 40%, and the misclassification rates (7, 10, and 13 g/day NaCl as cutoff points) were all over 65%. Caution remains due to poor validity between estimated and actual measurements when using the eight formulas to obtain a plausible estimation for surveillance of the Chinese population sodium excretion, and the results do not support the application of SU to estimate sodium intake at the individual level due to its poor performance with respect to classification.
Collapse
|
18
|
Sumikama Y, Aoyama H, Isu N, Nagata M, Kato T, Tsukahara T. Development of a Method for Estimating Dietary Salt Intake Using the Overnight Urinary Sodium/Potassium Ratio. J Clin Med Res 2021; 13:479-486. [PMID: 34691322 PMCID: PMC8510648 DOI: 10.14740/jocmr4596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background There are many patients who need to restrict and assess salt in their diet. However, it is difficult to estimate daily salt intake accurately and easily. Therefore, a method for estimating dietary salt intake using the overnight urinary sodium (Na)/potassium (K) ratio was developed. Methods The study involved 43 healthy adults (13 males, 30 females). From 2018 to 2020, subjects consumed a salt-adjusted diet for 11 - 30 days continuously, and overnight urine was collected daily. Using the previous day's salt intake as the objective variable, an equation for estimating the salt intake was developed using a general linear model. To verify the accuracy of the estimating equation, the estimated salt intake of the previous day was calculated using our equation and Tanaka's equation, which is an estimating equation from spot urine widely used in clinical practice and epidemiological studies to estimate dietary salt intake, and they were compared with the actual salt intake. Results The results of the analysis showed that model 1 (previous day's salt intake (g) = 3.62 + 0.64 × urinary Na/K ratio + 0.18 × conductivity (mS/cm) - 0.43 × sex (male 0, female 1)) was the optimal model. Then, salt intake was estimated using model 1 and Tanaka's equation, and compared with actual salt intake. The Pearson's product-moment correlation coefficient between the actual and estimated salt intake was r = 0.618 (P < 0.001) and r = 0.573 (P < 0.001) for model 1 estimates and Tanaka's equation estimates, respectively. The percentages of errors within ±30% from the actual salt intake were 64.2% and 58.4% for model 1 and Tanaka's equation, respectively. Conclusion An equation for estimating salt intake was developed using the Na/K ratio and conductivity of overnight urine. Although the applicability of this method to hypertensive patients and the elderly has not been studied and needs to be clarified in the future, the estimating equation developed is simple and may be a useful method for daily monitoring of dietary salt intake.
Collapse
Affiliation(s)
- Yuta Sumikama
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| | | | | | | | - Takumi Kato
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Takayoshi Tsukahara
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| |
Collapse
|
19
|
Arakawa M, Watanabe T, Suzuki K, Nishino J, Sekizuka H, Iwahori T, Ono SI, Hidaka S. Validation of Self-Monitoring Devices Supporting Sodium Intake Reduction: An Experimental Feeding Study Using Standardized Low-Salt and High-Salt Meals among Healthy Japanese Volunteers. ANNALS OF NUTRITION AND METABOLISM 2021; 77:289-298. [PMID: 34569491 DOI: 10.1159/000519097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although several approaches for approximating daily Na intake and the Na/K ratio using casual urine are available, the most useful method remains unclear during daily practice and at home. METHODS Twenty-seven participants measured their casual urinary Na/K ratio repeatedly using a Na/K ratio monitor and also measured overnight urine once daily using a monitoring device which delivers on-site feedback to estimate their salt intake under unrestricted, low-salt (LS) (6 g/day), and high-salt (HS) (12 g/day) diets. RESULTS The monitoring method utilizing overnight urine to estimate daily Na remained insensitive, resulting in significant overestimation during the LS diet and underestimation during the HS diet periods; estimated salt intake during the LS and HS diet periods plateaued at 7-8 g/day and 9-10 g/day within 3 day; mean estimated salt intake was 11.3 g/day, 7.9 g/day, and 9.8 g/day on the last day of the unrestricted, LS, and HS diets; the coefficient of variation (CV) of the estimated Na intake was 0.23 and 0.17 in the latter half of the low- and high-salt diet periods, respectively. The mean urinary Na/K molar ratio was 5.6, 2.5, and 5.3 on the last day of the unrestricted, LS, and HS diets; the CV of the daily mean Na/K ratio was 0.41 and 0.36 in the latter half of the LS and HS diet periods, respectively. The urinary Na/K ratio during the LS and HS diet periods plateaued within 2 days. The monitoring method based on the daily mean of the casual urinary Na/K ratio reflected the actual change in Na intake, and the estimated value tracked the actual changes in salt intake with smaller difference than the overnight urine estimates when using the estimation coefficient set at 2; estimated salt intake during the LS and HS diet periods plateaued at 5-6 g/day and 10-12 g/day within 2-3 day; mean estimated salt intake was 11.0 g/day, 5.7 g/day, and 10.7 g/day on the last day of the unrestricted, LS, and HS diets, respectively. DISCUSSION/CONCLUSION Estimates of daily Na intake derived from overnight urine may remain insensitive during dietary interventions. The urinary Na/K ratio reflects the actual change in Na intake during dietary modification and may serve as a practical marker, particularly during short-term interventions. Conversion from the urinary Na/K ratio to estimated salt intake may be useful, if the coefficient was set appropriate by further investigations.
Collapse
Affiliation(s)
- Motoki Arakawa
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Takayuki Watanabe
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Koya Suzuki
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Junichi Nishino
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | | | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Shin-Ichi Ono
- Laboratory of Clinical Medicine, Faculty of Applied Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Shinji Hidaka
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| |
Collapse
|
20
|
Use of Salt-Restriction Spoons and Its Associations with Urinary Sodium and Potassium in the Zhejiang Province of China: Results of a Population-Based Survey. Nutrients 2021; 13:nu13041047. [PMID: 33804870 PMCID: PMC8063796 DOI: 10.3390/nu13041047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 01/31/2023] Open
Abstract
In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China’s Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.
Collapse
|
21
|
Current Management of Hyperkalemia in Non-Dialysis CKD: Longitudinal Study of Patients Receiving Stable Nephrology Care. Nutrients 2021; 13:nu13030942. [PMID: 33804015 PMCID: PMC8000881 DOI: 10.3390/nu13030942] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
Background: No study has explored the limitations of current long-term management of hyperkalemia (HK) in outpatient CKD clinics. Methods: We evaluated the association between current therapeutic options and control of serum K (sK) during 12-month follow up in ND-CKD patients stratified in four groups by HK (sK ≥ 5.0 mEq/L) at baseline and month 12: Absent (no-no), Resolving (yes-no), New Onset (no-yes), Persistent (yes-yes). Results: We studied 562 patients (age 66.2 ± 14.5 y; 61% males; eGFR 39.8 ± 21.8 mL/min/1.73 m2, RAASI 76.2%). HK was “absent” in 50.7%, “resolving” in 15.6%, “new onset” in 16.6%, and “persistent” in 17.1%. Twenty-four hour urinary measurements testified adherence to nutritional recommendations in the four groups at either visit. We detected increased prescription from baseline to month 12 of bicarbonate supplements (from 5.0 to 14.1%, p < 0.0001), K-binders (from 2.0 to 7.7%, p < 0.0001), and non-K sparing diuretics (from 34.3 to 41.5%, p < 0.001); these changes were consistent across groups. Similar results were obtained when using higher sK level (≥5.5 mEq/L) to stratify patients. Mixed-effects regression analysis showed that higher sK over time was associated with eGFR < 60, diabetes, lower serum bicarbonate, lower use of non-K sparing diuretics, bicarbonate supplementation, and K-binder use. Treatment-by-time interaction showed that sK decreased in HK patients given bicarbonate (p = 0.003) and K-binders (p = 0.005). Conclusions: This observational study discloses that one-third of ND-CKD patients under nephrology care remain with or develop HK during a 12-month period despite low K intake and increased use of sK-lowering drugs.
Collapse
|
22
|
Du X, Fang L, Xu J, Chen X, Bai Y, Zhong J. Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18-69 years. Sci Rep 2021; 11:3474. [PMID: 33568767 PMCID: PMC7876040 DOI: 10.1038/s41598-021-83049-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/27/2021] [Indexed: 01/03/2023] Open
Abstract
The direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05-1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08-0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (- 3.07 mm Hg; 95% CI - 4.57 to - 1.57) and diastolic BP (- 0.94 mm Hg; 95% CI - 1.87 to - 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42-1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10-0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35-0.84) for potassium and 1.71 (95% CI 1.16-2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83-1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.
Collapse
Affiliation(s)
- Xiaofu Du
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China.
| |
Collapse
|
23
|
Matsumoto-Yamauchi H, Kondo K, Miura K, Tanaka-Mizuno S, Segawa H, Ohno S, Miyagawa N, Zaid M, Okami Y, Okuda N, Nakagawa H, Sakata K, Saitoh S, Okayama A, Yoshita K, Chan Q, Masaki K, Elliott P, Stamler J, Ueshima H. Relationships of Alcohol Consumption with Coronary Risk Factors and Macro- and Micro-Nutrient Intake in Japanese People: The INTERLIPID Study. J Nutr Sci Vitaminol (Tokyo) 2021; 67:28-38. [PMID: 33642462 DOI: 10.3177/jnsv.67.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Several studies have reported a J-shaped relationship between alcohol consumption and coronary heart disease (CHD) risk. However, the mechanisms of this relationship remain unclear. This study aimed to evaluate the relationships of alcohol consumption with established CHD risk factors and with macro-/micro-nutrient intake among Japanese people. Participants were 1,090 Japanese men and women aged 40-59 y enrolled in the INTERLIPID study, excluding former drinkers. Based on two 7-d alcohol records, participants were classified as non-drinkers (0 g/wk), light-drinkers (<100 g/wk), moderate-drinkers (100-299 g/wk), or heavy-drinkers (≥300 g/wk). Detailed macro-/micro-nutrient intake was evaluated using four in-depth 24-h dietary recalls and adjusted for total energy intake excluding alcohol. We analyzed the associations of CHD risk factors and nutrient intake with alcohol consumption. Serum high-density lipoprotein cholesterol and blood pressure were higher and low-density lipoprotein cholesterol was lower among those with higher alcohol consumption. J-shaped relationships with alcohol consumption were observed for the proportion of current smokers, number of cigarettes smoked, and prevalence of hypertension; these risk factors were lowest among light-drinkers. Carbohydrate and total fiber intakes were lower and protein and dietary cholesterol intakes were higher among those with higher alcohol consumption. These associations were similar for men and women. Alcohol consumption was related to nutrient intake as well as established CHD risk factors. Non-drinkers were higher on some CHD risk factors than were light-drinkers. These findings may influence the J-shaped relationship between alcohol consumption and CHD risk.
Collapse
Affiliation(s)
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | | | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center Research Institute
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science.,International Center for Nutrition and Information, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Epidemiology, School of Public Health, Fudan University
| | - Yukiko Okami
- Department of Public Health, Shiga University of Medical Science
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences
| | - Hideaki Nakagawa
- Department of Social and Environmental Medicine, Kanazawa Medical University
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University
| | - Shigeyuki Saitoh
- School of Health Sciences, School of Medicine, Sapporo Medical University
| | | | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University, Graduate School of Human Life Science
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii and Kuakini Medical Center
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | | |
Collapse
|
24
|
Aljuraiban G, Chan Q, Gibson R, Stamler J, Daviglus ML, Dyer AR, Miura K, Wu Y, Ueshima H, Zhao L, Van Horn L, Elliott P, Oude Griep LM. Association between plant-based diets and blood pressure in the INTERMAP study. BMJ Nutr Prev Health 2020; 3:133-142. [PMID: 33521522 PMCID: PMC7841826 DOI: 10.1136/bmjnph-2020-000077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/14/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Plant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns - and assessed their associations with BP. DESIGN We used cross-sectional data including 4,680 men and women ages 40-59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders. RESULTS Modified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat. CONCLUSION An hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components. TRIAL REGISTRATION NUMBER The observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.
Collapse
Affiliation(s)
- Ghadeer Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martha L Daviglus
- College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alan R Dyer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yangfeng Wu
- Clinical Research Institute and School of Public Health, Peking University, Beijing, Beijing, China
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Linda M Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | |
Collapse
|
25
|
Aljuraiban GS, Pertiwi K, Stamler J, Chan Q, Geleijnse JM, Van Horn L, Daviglus ML, Elliott P, Oude Griep LM. Potato consumption, by preparation method and meal quality, with blood pressure and body mass index: The INTERMAP study. Clin Nutr 2020; 39:3042-3048. [PMID: 32037285 PMCID: PMC8219046 DOI: 10.1016/j.clnu.2020.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Previous studies have reported associations between higher potato intake and higher blood pressure (BP) and/or risk of hypertension and obesity. These studies rarely considered preparation methods of potatoes, overall dietary pattern or the nutrient quality of the meals. These factors may affect the association of potato intake with BP and body mass index (BMI). This study investigated potato consumption by amount, type of processing, overall dietary pattern, and nutrient quality of the meals in relation to BP and BMI. METHODS Cross-sectional analyses were conducted among 2696 participants aged 40-59 y in the US and UK samples of the International Study of Macro- and Micro-Nutrients and Blood Pressure (INTERMAP). Nutrient quality of individual food items and the overall diet was assessed with the Nutrient-Rich Foods (NRF) index. RESULTS No associations with BP or BMI were found for total potato intake nor for boiled, mashed, or baked potatoes or potato-based mixed dishes. In US women, higher intake of fried potato was associated with 2.29 mmHg (95% CI: 0.55, 3.83) higher systolic BP and with 1.14 mmHg (95% CI: 0.10, 2.17) higher diastolic BP, independent of BMI. Higher fried potato consumption was directly associated with a +0.86 kg/m2 difference in BMI (95% CI: 0.24, 1.58) in US women. These associations were not found in men. Higher intakes of fried potato meals with a lower nutritional quality (NRF index≤ 2) were positively associated with systolic (3.88 mmHg; 95% CI: 2.63, 5.53) and diastolic BP (1.62 mmHg; 95% CI: 0.48, 2.95) in US women. No associations with BP were observed for fried potato meals with a higher nutritional quality (NRF index> 2). CONCLUSIONS Fried potato was directly related to BP and BMI in women, but non-fried potato was not. Poor-nutrient quality meals were associated with intake of fried potatoes and higher BP, suggesting that accompanied dietary choices are key mediators of these associations.
Collapse
Affiliation(s)
- Ghadeer S Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, UK
| | - Kamalita Pertiwi
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, UK; MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Martha L Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Institute for Minority Health Research, University of Illinois, Chicago, IL, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, UK; MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Linda M Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, UK; NIHR Biomedical Research Centre, Diet, Anthropometry and Physical Activity (DAPA) Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| |
Collapse
|
26
|
Validation of a new software eAT24 used to assess dietary intake in the adult Portuguese population. Public Health Nutr 2020; 23:3093-3103. [PMID: 32611472 DOI: 10.1017/s1368980020001044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the current study was to evaluate the accuracy of the new software eAT24 used to assess dietary intake in the National Food, Nutrition and Physical Activity Survey (IAN-AF) against urinary biomarkers: N (nitrogen), K (potassium) and Na (sodium). DESIGN We conducted a cross-sectional study. Two non-consecutive 24-h dietary recalls (24-HDR) were applied, and a 24-h urine sample was collected. We examined differences between estimates from dietary and urine measures, Pearson correlation coefficients were calculated and the Bland-Altman plots were drawn. Multiple linear regression was used to evaluate the factors associated with the difference between estimates. SETTING Sub-sample from the Portuguese IAN-AF sampling frame. PARTICIPANTS Ninety-five adults (men and women) aged 18-84 years. RESULTS The estimated intake calculated using the dietary recall data was lower than that estimated from urinary excretion for the three biomarkers studied (protein 94·3 v. 100·4 g/d, K 3212 v. 3416 mg/d and Na 3489 v. 4003 mg/d). Considering 2 d of recall, the deattenuated correlation coefficients were 0·33, 0·64 and 0·26 for protein, K and Na, respectively. For protein, differences between dietary and urinary estimates varied according to BMI (β = -1·96, P = 0·017). The energy intake and 24-h urine volume were significantly associated with the difference between estimates for protein (β = 0·03, P < 0·001 and β = -0·02, P = 0·002, respectively), K (β = 0·71, P < 0·001 and β = -0·42, P = 0·040, respectively) and Na (β = 1·55, P < 0·001 and β = -0·81, P = 0·011, respectively). CONCLUSIONS The new software eAT24 performed well in estimating protein and K intakes, but lesser so in estimating Na intake, using two non-consecutive 24-HDR.
Collapse
|
27
|
Posma JM, Garcia-Perez I, Frost G, Aljuraiban GS, Chan Q, Van Horn L, Daviglus M, Stamler J, Holmes E, Elliott P, Nicholson JK. Nutriome-metabolome relationships provide insights into dietary intake and metabolism. ACTA ACUST UNITED AC 2020; 1:426-436. [PMID: 32954362 PMCID: PMC7497842 DOI: 10.1038/s43016-020-0093-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dietary assessment traditionally relies on self-reported data which are often inaccurate and may result in erroneous diet-disease risk associations. We illustrate how urinary metabolic phenotyping can be used as alternative approach for obtaining information on dietary patterns. We used two multi-pass 24-hr dietary recalls, obtained on two occasions on average three weeks apart, paired with two 24-hr urine collections from 1,848 U.S. individuals; 67 nutrients influenced the urinary metabotype measured with 1H-NMR spectroscopy characterized by 46 structurally identified metabolites. We investigated the stability of each metabolite over time and showed that the urinary metabolic profile is more stable within individuals than reported dietary patterns. The 46 metabolites accurately predicted healthy and unhealthy dietary patterns in a free-living U.S. cohort and replicated in an independent U.K. cohort. We mapped these metabolites into a host-microbial metabolic network to identify key pathways and functions. These data can be used in future studies to evaluate how this set of diet-derived, stable, measurable bioanalytical markers are associated with disease risk. This knowledge may give new insights into biological pathways that characterize the shift from a healthy to unhealthy metabolic phenotype and hence give entry points for prevention and intervention strategies.
Collapse
Affiliation(s)
- Joram M Posma
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, South Kensington Campus, Imperial College London, SW7 2AZ, U.K.,Health Data Research UK-London, U.K
| | - Isabel Garcia-Perez
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K
| | - Gary Frost
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K
| | - Ghadeer S Aljuraiban
- The Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, U.S.A
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL 60612
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, U.S.A
| | - Elaine Holmes
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,UK Dementia Research Institute, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,Division of Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia.,The Australian National Phenome Center, Harry Perkins Institute, Murdoch University, WA 6150, Australia
| | - Paul Elliott
- Health Data Research UK-London, U.K.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,UK Dementia Research Institute, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,National Institute for Health Research Imperial Biomedical Research Centre, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,British Heart Foundation Centre of Research Excellence at Imperial, Imperial College London, W2 1PG, U.K
| | - Jeremy K Nicholson
- Division of Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia.,The Australian National Phenome Center, Harry Perkins Institute, Murdoch University, WA 6150, Australia
| |
Collapse
|
28
|
Yan L, Carter E, Fu Y, Guo D, Huang P, Xie G, Xie W, Zhu Y, Kelly F, Elliott P, Zhao L, Yang X, Ezzati M, Wu Y, Baumgartner J, Chan Q. Study protocol: The INTERMAP China Prospective (ICP) study. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15470.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Unfavourable blood pressure (BP) level is an established risk factor for cardiovascular diseases (CVD), while the exact underlying reasons for unfavourable BP are poorly understood. The INTERMAP China Prospective (ICP) Study is a prospective cohort to investigate the relationship of environmental and nutritional risk factors with key indicators of vascular function (BP, arterial stiffness, carotid-intima media thickness) among middle-aged/older men and women. Methods: A total of 839 Chinese participants aged 40-59 years from three diverse regions of China were enrolled in INTERMAP in 1997/98; data collection included repeated BP measurements, 24-hour urine specimens, and 24-hour dietary recalls. In 2015/16, 574 of these 839 persons were re-enrolled along with 208 new participants aged 40-59 years that were randomly selected from the same study villages. Participant’s environmental and dietary exposures and health outcomes were assessed in this open cohort study, including BP, 24-hour dietary recalls, personal exposures to air pollution, grip strength, arterial stiffness, carotid-media thickness and plaques, cognitive function, and sleep patterns. Serum and plasma specimens were collected with 24-hour urine specimens. A follow-up visit has been scheduled for 2020-2021. Discussion: Winter and summer assessments of a comprehensive set of vascular indicators and their environmental and nutritional risk factors were conducted with high precision. We will leverage advances in exposome research to identify biomarkers of exposure to environmental and nutritional risk factors and improve our understanding of the mechanisms and pathways of their hazardous cardiovascular effects. The ICP Study is observational by design, thus subject to several biases including selection bias (e.g., loss to follow-up), information bias (e.g., measurement error), and confounding that we sought to mitigate through our study design and measurements. However, extensive efforts will apply to minimize those limitations (continuous observer training, repeated measurements of BP, standardized methods in data collection and measurements, and on-going quality control).
Collapse
|
29
|
Okuda N, Okayama A, Miura K, Yoshita K, Miyagawa N, Saitoh S, Nakagawa H, Sakata K, Chan Q, Elliott P, Ueshima H, Stamler J. Food Sources of Dietary Potassium in the Adult Japanese Population: The International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Nutrients 2020; 12:nu12030787. [PMID: 32192157 PMCID: PMC7146396 DOI: 10.3390/nu12030787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
A lower-than-recommended potassium intake is a well-established risk factor for increased blood pressure. Although the Japanese diet is associated with higher sodium intake and lower potassium intake, few studies have examined the source foods quantitatively. Studies on dietary patterns in association with potassium intake will be useful to provide dietary advice to increase potassium intake. Twenty-four-hour (hr) dietary recall data and 24-hr urinary potassium excretion data from Japanese participants (574 men and 571 women) in the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP) were used to calculate food sources of potassium and compare food consumption patterns among quartiles of participants categorized according to 24-hr urinary potassium excretion per unit of body weight (UK/BW). The average potassium intake was 2791 mg/day per participant, and the major sources were vegetables and fruits (1262 mg/day), fish (333 mg/day), coffee and tea (206 mg/day), and milk and dairy products (200 mg/day). Participants in the higher UK/BW quartile consumed significantly more vegetables and fruits, fish, and milk and dairy products, and ate less rice and noodles. Conclusion: Advice to increase the intake of vegetables and fruits, fish, and milk may be useful to increase potassium intake in Japan.
Collapse
Affiliation(s)
- Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama 339-8539, Japan
- Correspondence: ; Tel.: +81-48-749-6111; Fax: +81-48-6110
| | - Akira Okayama
- Department of Non-Communicable Diseases, Research Institute of Strategy for Prevention, Tokyo 104-0033, Japan;
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Katsushi Yoshita
- Department of Food Science and Nutrition, Graduate School of Human Life Science and Nutrition, Osaka City University, Osaka 558-8585, Japan;
| | - Naoko Miyagawa
- International Center for Nutrition and Information, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan;
| | - Shigeyuki Saitoh
- School of Health Sciences, Sapporo Medical University, Sapporo 060-8556, Japan;
| | - Hideaki Nakagawa
- Medical Research Institute, Kanazawa Medical University, Kanazawa 920-0265, Japan;
| | - Kiyomi Sakata
- Department of Hygiene and Public Health, Iwate Medical University, Yahaba 028-3694, Japan;
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK; (Q.C.); (P.E.)
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK; (Q.C.); (P.E.)
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Jeremiah Stamler
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| |
Collapse
|
30
|
Gibson R, Lau CHE, Loo RL, Ebbels TMD, Chekmeneva E, Dyer AR, Miura K, Ueshima H, Zhao L, Daviglus ML, Stamler J, Van Horn L, Elliott P, Holmes E, Chan Q. The association of fish consumption and its urinary metabolites with cardiovascular risk factors: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Am J Clin Nutr 2020; 111:280-290. [PMID: 31782492 PMCID: PMC6997096 DOI: 10.1093/ajcn/nqz293] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Results from observational studies regarding associations between fish (including shellfish) intake and cardiovascular disease risk factors, including blood pressure (BP) and BMI, are inconsistent. OBJECTIVE To investigate associations of fish consumption and associated urinary metabolites with BP and BMI in free-living populations. METHODS We used cross-sectional data from the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP), including 4680 men and women (40-59 y) from Japan, China, the United Kingdom, and United States. Dietary intakes were assessed by four 24-h dietary recalls and BP from 8 measurements. Urinary metabolites (2 timed 24-h urinary samples) associated with fish intake acquired from NMR spectroscopy were identified. Linear models were used to estimate BP and BMI differences across categories of intake and per 2 SD higher intake of fish and its biomarkers. RESULTS No significant associations were observed between fish intake and BP. There was a direct association with fish intake and BMI in the Japanese population sample (P trend = 0.03; fully adjusted model). In Japan, trimethylamine-N-oxide (TMAO) and taurine, respectively, demonstrated area under the receiver operating characteristic curve (AUC) values of 0.81 and 0.78 in discriminating high against low fish intake, whereas homarine (a metabolite found in shellfish muscle) demonstrated an AUC of 0.80 for high/nonshellfish intake. Direct associations were observed between urinary TMAO and BMI for all regions except Japan (P < 0.0001) and in Western populations between TMAO and BP (diastolic blood pressure: mean difference 1.28; 95% CI: 0.55, 2.02 mmHg; P = 0.0006, systolic blood pressure: mean difference 1.67; 95% CI: 0.60, 2.73 mmHg; P = 0.002). CONCLUSIONS Urinary TMAO showed a stronger association with fish intake in the Japanese compared with the Western population sample. Urinary TMAO was directly associated with BP in the Western but not the Japanese population sample. Associations between fish intake and its biomarkers and downstream associations with BP/BMI appear to be context specific. INTERMAP is registered at www.clinicaltrials.gov as NCT00005271.
Collapse
Affiliation(s)
- Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Nutritional Sciences, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Chung-Ho E Lau
- Division of Diabetes Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Ruey Leng Loo
- Institute of Health Futures, Murdoch University, Perth, Western Australia, Australia
| | - Timothy M D Ebbels
- Division of System Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Elena Chekmeneva
- National Institute for Health Research–British Research Council, Clinical Phenotyping Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Liancheng Zhao
- Department of Epidemiology, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Health Data Research UK London, Imperial College London, London, United Kingdom
| | - Elaine Holmes
- Division of Diabetes Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Institute of Health Futures, Murdoch University, Perth, Western Australia, Australia
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
31
|
Yan L, Carter E, Fu Y, Guo D, Huang P, Xie G, Xie W, Zhu Y, Kelly F, Elliott P, Zhao L, Yang X, Ezzati M, Wu Y, Baumgartner J, Chan Q. Study protocol: The INTERMAP China Prospective (ICP) study. Wellcome Open Res 2019. [DOI: 10.12688/wellcomeopenres.15470.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Unfavourable blood pressure (BP) level is an established risk factor for cardiovascular diseases (CVD), while the exact underlying reasons for unfavourable BP are poorly understood. The INTERMAP China Prospective (ICP) Study is a prospective cohort to investigate the relationship of environmental and nutritional risk factors with key indicators of vascular function including BP, arterial stiffness, and carotid-intima media thickness. Methods: A total of 839 Chinese participants aged 40-59 years from three diverse regions of China were enrolled in INTERMAP in 1997/98; data collection included repeated BP measurements, 24-hour urine specimens, and 24-hour dietary recalls. In 2015/16, 574 of these 839 persons were re-enrolled along with 208 new participants aged 40-59 years that were randomly selected from the same study villages. Participant’s environmental and dietary exposures and health outcomes were assessed in this open cohort study, including BP, 24-hour dietary recalls, personal exposures to air pollution, grip strength, arterial stiffness, carotid-media thickness and plaques, cognitive function, and sleep patterns. Serum and plasma specimens were collected with 24-hour urine specimens. Discussion: Winter and summer assessments of a comprehensive set of vascular indicators and their environmental and nutritional risk factors were conducted with high precision. We will leverage advances in exposome research to identify biomarkers of exposure to environmental and nutritional risk factors and improve our understanding of the mechanisms and pathways of their hazardous cardiovascular effects. The ICP Study is observational by design, thus subject to several biases including selection bias (e.g., loss to follow-up), information bias (e.g., measurement error), and confounding that we sought to mitigate through our study design and measurements. However, extensive efforts will apply to minimize those limitations (continuous observer training, repeated measurements of BP, standardized methods in data collection and measurements, and on-going quality control).
Collapse
|
32
|
Guan VX, Probst YC, Neale EP, Tapsell LC. Evaluation of the dietary intake data coding process in a clinical setting: Implications for research practice. PLoS One 2019; 14:e0221047. [PMID: 31404088 PMCID: PMC6690518 DOI: 10.1371/journal.pone.0221047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND High quality dietary intake data is required to support evidence of diet-disease relationships exposed in clinical research. Source data verification may be a useful quality assurance method in this setting. The present pilot study aimed to apply source data verification to evaluate the quality of the data coding process for dietary intake in a clinical trial and to explore potential barriers to data quality in this setting. METHODS Using a sample of 20 cases from a clinical trial, source data verification was conducted between three sets of data derived documents: transcripts of audio-recorded diet history interviews, matched paper-based diet history forms and outputs from nutrition analysis software. The number of cases and rates of discrepancies between documents were calculated. A total of five in-depth interviews with dietitians collecting and coding dietary data were thematically analysed. RESULTS Some 2024 discrepancies were identified. The highest discrepancy rate was 57.49%, and occurred between diet history interviews and nutrition analysis software outputs. Sources of the discrepancies included both quantities and frequencies of food intake. The highest discrepancy rate was for the food group "vegetable products and dishes". In-depth interviews implicated recall bias of trial participants as a cause of discrepancies, but dietitians also acknowledged a possible subconscious influence of having to code reported foods into nutrition analysis software programs. CONCLUSION The accuracy of dietary intake data appeared to depend on the level of detailed food data required. More support for participants on reporting consumption, and incorporating supportive tools to guide estimates of food quantities may facilitate a more consistent coding process and improve data quality. This pilot study offers a novel method and an overview of dietary intake data coding measurement errors. These findings may warrant further investigation in a larger sample.
Collapse
Affiliation(s)
- Vivienne X. Guan
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
| | - Yasmine C. Probst
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth P. Neale
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Linda C. Tapsell
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
33
|
Koyama T, Yoshita K, Okuda N, Saitoh S, Sakata K, Okayama A, Nakagawa H, Miyagawa N, Miura K, Chan Q, Elliott P, Stamler J, Ueshima H. Overall nutrient and total fat intake among Japanese people: The INTERLIPID Study Japan. Asia Pac J Clin Nutr 2019; 26:837-848. [PMID: 28802293 DOI: 10.6133/apjcn.072016.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Total fat intake is linked to the intake of other nutrients. Little data are available on the extent to which total fat affects diet quality in Japanese people. We investigated the relationship between total fat intake and other nutrient intake using INTERLIPID/ INTERMAP data on Japanese people living in Japan. METHODS AND STUDY DESIGN The participants included 371 men and 401 women with a healthy body mass index and between the ages of 40 and 59 from 4 population samples in Japan. Nutrient intake data were based on four in-depth 24-hour dietary recalls per person. RESULTS Analysis of covariance adjusted for age revealed that total fat intake was positively related to intakes of calcium, thiamine, riboflavin, meat, eggs, and milks and dairy products for both sexes. Total fat intake was inversely associated with carbohydrate and cereals intake for both sexes. On average, men with total fat intake between 25.0 and 27.4% of total energy had saturated fatty acids above 7%, which is the upper limit recommended for preventing lifestyle-related diseases. Men with total fat intake less than 20% of total energy had a higher risk of not meeting the Dietary Reference Intakes for Japanese (2015) for some nutrients. CONCLUSIONS Total fat intake was positively associated with calcium, thiamine, and riboflavin intakes and inversely associated with carbohydrate intake. Our results suggest that in 40-59-year-old men with a healthy body mass index, total fat intake between 20 and 27% of total energy may best support adequate intake of other nutrients.
Collapse
Affiliation(s)
- Tatsuya Koyama
- Department of Food and Human Health Science, Graduate School of Human Life Science, Osaka City University, Osaka, Japan. ;
| | - Katsushi Yoshita
- Department of Food and Human Health Science, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, Faculty of Human Science, University of Human Arts and Sciences, Saitama, Japan
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Science, Sapporo, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Hideaki Nakagawa
- Kanazawa Medical University Medical Research Institute, Ishikawa, Japan
| | - Naoko Miyagawa
- Department of Health Science, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- Department of Health Science, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
34
|
Sodium and Potassium Intake Assessed by Spot and 24-h Urine in the Population-Based Tromsø Study 2015-2016. Nutrients 2019; 11:nu11071619. [PMID: 31315306 PMCID: PMC6682958 DOI: 10.3390/nu11071619] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022] Open
Abstract
Reduction of salt intake is a public health priority and necessitates the surveillance of salt intake in the population. The validity of salt intake assessed by dietary surveys is generally low. We, therefore, aimed to estimate salt intake by 24-h urine collection and to assess the usefulness of spot urine collection for surveillance purposes. In the population-based Tromsø Study 2015-2016, 493 men and women aged 40-69 years collected 24-h urine, of whom 475 also collected spot urine. Sodium and potassium excretions were calculated by multiplying respective urinary concentrations by the total volume of urine. Based on the sodium concentration in spot urine, we also estimated 24-h sodium excretion by three different equations. Mean sodium excretion was 4.09 ± 1.60 and 2.98 ± 1.09 g/24-h in men and women, respectively, corresponding to a calculated salt intake of 10.4 and 7.6 g. The sodium to potassium molar (Na/K) ratio was approximately 1.8 in both genders. Of the three equation utilizing spot urine, estimated mean 24-h sodium excretion was closest for the INTERSALT formulae (4.29 and 2.96 g/24-h in men and women, respectively). In this population-based study, the estimated salt intake was higher than the recommended intake. However, urine potassium excretion was rather high resulting in a favorable Na/K ratio. Mean sodium excretion calculated from spot urine by the INTERSALT equation predicted the mean sodium excretion in 24-h urine reasonably well.
Collapse
|
35
|
Zhou L, Stamler J, Chan Q, Van Horn L, Daviglus ML, Dyer AR, Miura K, Okuda N, Wu Y, Ueshima H, Elliott P, Zhao L. Salt intake and prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States: the INTERMAP Study. Am J Clin Nutr 2019; 110:34-40. [PMID: 31111867 PMCID: PMC6599742 DOI: 10.1093/ajcn/nqz067] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several studies have reported that dietary salt intake may be an independent risk factor for overweight/obesity, but results from previous studies are controversial, reflecting study limitations such as use of a single spot urine or dietary recall to estimate daily salt intake rather than 24-h urine collections, and population samples from only a single country or center. OBJECTIVE The aim of this study was to use data from the International Study of Macro-/Micro-nutrients and Blood Pressure (INTERMAP Study) to explore the relation between dietary salt intake estimated from 2 timed 24-h urine collections and body mass index (BMI; in kg/m2) as well as prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States. METHODS Data were from a cross-sectional study of 4680 men and women aged 40-59 y in Japan (n = 1145), China (n = 839), the United Kingdom (n = 501), and the United States (n = 2195). General linear models were used to obtain the regression coefficients (β) of salt intake associated with BMI. Multivariable logistic regression models were used to determine the ORs and 95% CIs of overweight/obesity associated with a 1-g/d higher dietary salt intake. RESULTS After adjustment for potential confounding factors including energy intake, salt intake 1 g/d higher was associated with BMI higher by 0.28 in Japan, 0.10 in China, 0.42 in the United Kingdom, and 0.52 in the United States, all P values < 0.001. Salt intake 1 g/d higher was associated with odds of overweight/obesity 21% higher in Japan, 4% higher in China, 29% higher in the United Kingdom, and 24% higher in the United States, all P values < 0.05. CONCLUSIONS Salt intake is positively associated with BMI and the prevalence of overweight/obesity in Japan, China, the United Kingdom, and the United States. This association needs to be further confirmed in well-designed prospective studies with repeated dietary and BMI measurements.This trial was registered at clinicaltrials.gov as NCT00005271.
Collapse
Affiliation(s)
- Long Zhou
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, IL
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Yangfeng Wu
- School of Public Health and Clinical Research Institute, Peking University, Beijing, China
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | |
Collapse
|
36
|
Wen X, Zhou L, Stamler J, Chan Q, Horn LV, Daviglus ML, Dyer AR, Elliott P, Ueshima H, Miura K, Okuda N, Wu Y, Zhao L. Agreement between 24-h dietary recalls and 24-h urine collections for estimating sodium intake in China, Japan, UK, USA: the International Study of Macro- and Micro-nutrients and Blood Pressure. J Hypertens 2019; 37:814-819. [PMID: 30817463 PMCID: PMC6690055 DOI: 10.1097/hjh.0000000000001941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The present study aims to compare 24-h dietary recalls with 24-h urine collections for the estimation of sodium intake at both population and individual levels in China, Japan, the United Kingdom (UK), and the United States of America (USA), using data from the International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP). METHODS Mean differences between 24-h dietary recalls and 24-h urine collections were calculated for their agreement in estimating sodium intake at the population level; relative and absolute differences as well as misclassification of salt intake groups (salt intake <6, 6-8.9, 9-11.9, 12-14.9, and ≥15 g/day) were used to determine the agreement at the individual level. RESULTS The mean differences (95% CI) between dietary recalls and urine collections for China, Japan, UK, and USA were -54.0 (-59.8, -48.3), 3.9 (0.6, 7.2), 2.9 (-1.8, 7.6), and -3.5 (-5.8, -1.1) mmol/day, respectively. The proportions of individual relative differences beyond ±40% were 34.3% for China, 16.9% for Japan, 24.2% for UK, and 21.3% for USA; the proportions of individual absolute differences greater than 51.3 mmol/day (3 g salt) were 58.6% for China, 32.8% for Japan, 25.4% for UK, and 31.9% for USA. The rate for misclassification of salt intake groups at individual level for China, Japan, UK, and USA were 71.4, 60.9, 58.7, and 60.0%, respectively. CONCLUSION The 24-h dietary recalls demonstrate greater agreement with the 24-h urine collections in estimating population sodium intake for Japan, UK, and USA, compared with China. The 24-h dietary recall has poor performance in assessing individual sodium intake in these four countries.
Collapse
Affiliation(s)
- Xiaoxiao Wen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Long Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, Illinois, USA
| | - Alan R. Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan and
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
37
|
Okami Y, Ueshima H, Nakamura Y, Okuda N, Nakagawa H, Sakata K, Saitoh S, Okayama A, Yoshita K, R Choudhury S, Chan Q, Elliott P, Stamler J, Miura K. The Relationship of Dietary Cholesterol with Serum Low-Density Lipoprotein Cholesterol and Confounding by Reverse Causality: The INTERLIPID Study. J Atheroscler Thromb 2019; 26:170-182. [PMID: 29887537 PMCID: PMC6365148 DOI: 10.5551/jat.43075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: The positive relationship between dietary cholesterol and serum cholesterol has been questioned by a set of recent cohort studies. This study aimed to investigate how employment status and education years relate to the association between dietary cholesterol and serum low-density lipoprotein cholesterol (LDL-C) in a Japanese population. Methods: A population-based, random sample, cross-sectional study (INTERLIPID) was performed. Among 1,145 Japanese individuals aged 40–59 years, 106 were excluded because of special diets, use of lipid-lowering drugs, hormone replacement, and missing data, leaving 1,039 individuals (533 men and 506 women). Dietary cholesterol was assessed from four 24-h dietary recalls, and LDL-C was measured enzymatically with an autoanalyzer. A standard questionnaire inquired about employment status and education years. Results: In men, a 1 standard deviation (SD) higher dietary cholesterol was associated with 3.16 mg/dL lower serum LDL-C (P = 0.009; unadjusted model). After adjustment for covariates, higher serum LDL-C was estimated per 1 SD higher intake of dietary cholesterol in nonemployed men [self-employed, homemakers, farmers, fishermen, and retired employees; β = +9.08, 95% confidence interval (CI) = +0.90–+17.27] and less educated men (β = +4.46, 95% CI = −0.97–+9.90), whereas an inverse association was observed in employed men (β = −3.02, 95% CI= −5.49–−0.54) and more educated men (β = −3.66, 95% CI = −6.25–−1.07). Conclusions: In men who were nonemployed and less educated, a higher intake of dietary cholesterol was associated with elevated concentrations of serum LDL-C, whereas an inverse association was observed in men who were employed and more educated.
Collapse
Affiliation(s)
- Yukiko Okami
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | - Yasuyuki Nakamura
- Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences
| | - Hideaki Nakagawa
- Department of Epidemiology and Public Health, Kanazawa Medical University
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University
| | - Shigeyuki Saitoh
- School of Health Sciences, School of Medicine, Sapporo Medical University
| | | | | | - Sohel R Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London
| | | | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | | |
Collapse
|
38
|
Kurihara A, Okamura T, Sugiyama D, Higashiyama A, Watanabe M, Okuda N, Kadota A, Miyagawa N, Fujiyoshi A, Yoshita K, Ohkubo T, Okayama A, Miura K, Ueshima H. Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population. J Atheroscler Thromb 2019; 26:198-206. [PMID: 30089755 PMCID: PMC6365153 DOI: 10.5551/jat.44172] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
AIM To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population. METHODS A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a three-day semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors. RESULTS The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75-0.99) and 0.58 (95% CI, 0.35-0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50-0.94) and 0.50 (95% CI, 0.30-0.84), respectively. CONCLUSIONS Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.
Collapse
Affiliation(s)
- Ayako Kurihara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Aya Higashiyama
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Makoto Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- Department of Food and Nutrition, Osaka City University, Osaka, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - for the NIPPON DATA90 Research Group
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan
- Research Institute of Strategy for Prevention, Tokyo, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Food and Nutrition, Osaka City University, Osaka, Japan
- Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan
| |
Collapse
|
39
|
Thi Minh Nguyen T, Miura K, Tanaka-Mizuno S, Tanaka T, Nakamura Y, Fujiyoshi A, Kadota A, Tamaki J, Takebayashi T, Okamura T, Ueshima H. Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples. Hypertens Res 2018; 42:411-418. [PMID: 30523292 DOI: 10.1038/s41440-018-0152-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/26/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023]
Abstract
While the association between 24-h urinary sodium and potassium excretion with blood pressure is well established, the relationships of these ions to spot urine measurements are unclear. Our purpose is to assess the association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. Spot urine and blood pressure were collected annually during a 5-year period from 4360 Japanese workers with ages ranging from 19 to 55 years. Estimates of 24-h sodium and potassium excretion were based on Tanaka's formula. Overall, a single standard deviation increase in the estimated sodium excretion (36.5 mmol/day) was associated with a 1.3 mmHg higher systolic blood pressure and a 0.8 mmHg higher diastolic blood pressure (P < 0.001). A single standard deviation increase in estimated potassium excretion (8.9 mmol/day) was associated with a 1.1 mmHg lower systolic blood pressure and a 0.7 mmHg lower diastolic blood pressure (P < 0.001). As a combined measure of the excretion of both electrolytes, the estimated 24-h sodium-to-potassium ratio was positively associated with both blood pressures (P < 0.001). Associations of blood pressure with sodium and the sodium-to-potassium ratio increased with age and were stronger in men compared to women. Associations with potassium and the sodium-to-potassium ratio were stronger in individuals who were overweight. The findings provide evidence for an association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. As convenient measures of dietary intake for each electrolyte, repeated spot urine samples may be useful for assessing hypertension risk, especially in men, older individuals, and overweight individuals.
Collapse
Affiliation(s)
- Trang Thi Minh Nguyen
- Department of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan. .,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
| | | | | | - Yasuyuki Nakamura
- Department of Food Science and Human Nutrition, Ryukoku University, Otsu, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical University, Takatsuki, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | | |
Collapse
|
40
|
Okuyama Y, Uchida HA, Iwahori T, Segawa H, Kato A, Takeuchi H, Kakio Y, Umebayashi R, Kitagawa M, Sugiyama H, Miura K, Ueshima H, Wada J. The relationship between repeated measurement of casual and 24-h urinary sodium-to-potassium ratio in patients with chronic kidney disease. J Hum Hypertens 2018; 33:286-297. [PMID: 30443006 DOI: 10.1038/s41371-018-0127-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/22/2018] [Accepted: 10/19/2018] [Indexed: 01/10/2023]
Abstract
This study aimed to clarify the relationship between repeated measurements of casual (spot) and 24-h urinary sodium-to-potassium (Na/K) ratios in patients with chronic kidney disease (CKD). A total of 61 inpatients with CKD, 31 in stage 1-3 (eGFR [estimated glomerular filtration rate] ≥ 30 ml/min/1.73 m2) and 30 in stage 4-5 (eGFR < 30 ml/min/1.73 m2), aged 20-85 consuming a low-sodium diet (NaCl [sodium chloride] 6 g/day) were recruited. Urinary Na, K, and Na/K ratios were measured in both casual urine samples and 2-day, 24 h urine samples, and then analyzed by correlation and Bland-Altman analyses. Mean 24-h urine Na/K ratio was higher in participants in stage 4-5 (5.1) than in participants in stage 1-3 (4.1) CKD. Casual urine Na/K ratio was strongly correlated with 2-day, 24-h urine Na/K ratio by sampling 4 casual urine specimens every morning and evening in participants in stage 1-3 (r = 0.69-0.78), but not in stage 4-5 (r = 0.12-0.19). The bias for mean Na/K ratio between 2-day, 24-h urine, and the 4 casual urine sampling ranged from -0.86 to 0.16 in participants in stage 1-3, and the quality of agreement for the mean of this casual urine sampling was similar to that of sampling 8 casual urine samples for estimating 2-day, 24-h values. Methods using repeated casual urine Na/K ratios may provide a reasonable estimation of 24-h urine Na/K ratio in normotensive and hypertensive as well as individuals with stage 1-3, but not stage 4-5 CKD.
Collapse
Affiliation(s)
- Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. .,Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Graduate School of Science, Technology and Innovation, Kobe University, Kobe, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Ayako Kato
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
41
|
Factors associated with intra-individual visit-to-visit variability of blood pressure in four countries: the INTERMAP study. J Hum Hypertens 2018; 33:229-236. [PMID: 30420643 DOI: 10.1038/s41371-018-0129-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/02/2018] [Accepted: 09/14/2018] [Indexed: 11/08/2022]
Abstract
Several studies demonstrated that visit-to-visit variability of blood pressure (BP) predicted future events of total death, stroke and cardiovascular disease. Little is known about factors associated with visit-to-visit BP variability in different countries. We recruited participants aged 40-59 years from four countries (Japan, the People's Republic of China [PRC], the United Kingdom [UK] and the United States [US]). At each study visit, BP was measured twice by trained observers using random zero sphygmomanometers after five minutes resting. We defined visit-to-visit BP variability as variation independent of mean (VIM) by using average systolic BP of 1st and 2nd measurement across four study visits. Data on 4680 men and women were analyzed. Mean ± standard deviation of VIM values among participants in Japan, the PRC, the UK and the US were 5.44 ± 2.88, 6.85 ± 3.49, 5.65 ± 2.81 and 5.84 ± 3.01, respectively; VIM value in the PRC participants was significantly higher. Sensitivity analyses among participants without antihypertensive treatment or past history of cardiovascular disease yielded similar results. Higher VIM value was associated with older age, female gender, lower pulse rate and urinary sodium excretion and use of antihypertensive agents such as angiotensin converting enzyme inhibitors, beta blockers and calcium channel blockers. The difference of visit-to-visit BP variability between PRC and other countries remained significant after adjustment for possible confounding factors. In this large international study across four countries, visit-to-visit BP variability in the PRC was higher than in the other three countries. Reproducibility and mechanisms of these findings remain to be elucidated.
Collapse
|
42
|
McLean RM, Farmer VL, Nettleton A, Cameron CM, Cook NR, Woodward M, Campbell NRC. Twenty-Four-Hour Diet recall and Diet records compared with 24-hour urinary excretion to predict an individual's sodium consumption: A Systematic Review. J Clin Hypertens (Greenwich) 2018; 20:1360-1376. [PMID: 30298972 DOI: 10.1111/jch.13391] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 11/27/2022]
Abstract
This systematic literature review aimed to investigate whether 24 hour diet recall and diet records are reliable and valid ways to measure usual dietary sodium intake compared with 24 hour urinary assessment. We searched electronic databases Medline, Embase, Cinahl, Lilacs, Google Scholar and the Cochrane Library using pre-defined terms Studies were eligible for inclusion if they assessed adult humans in free-living settings, and if they included dietary assessment and 24 hours urinary collection for assessment of sodium intake in the same participants. Studies that included populations with an active disease state that might interfere with normal sodium metabolism were excluded. Results of 20 studies using 24 hour diet recall recall (including 14 validation studies) and 10 studies using food records (including six validation studies) are included in this review. Correlations between estimates from dietary assessment and urinary excretion ranged from 0.16 to 0.72 for 24 hour diet recall, and 0.11 to 0.49 for food diaries. Bland-Altman analysis in two studies of 24 hour diet recall showed poor agreement with 24 hours urinary sodium excretion. These results show that 24 hour diet recall and diet records inaccurately measure dietary sodium intake in individuals compared with the gold standard 24 hours urinary excretion. Validation studies of dietary assessment methods should include multiple days of assessment and 24 hours urine collection, use relevant food composition databases and Bland-Altman methods of analysis.
Collapse
Affiliation(s)
- Rachael M McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Victoria L Farmer
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Alice Nettleton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Claire M Cameron
- Biostatistics Unit, Dean's Office, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy R Cook
- Department of Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Norman R C Campbell
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
43
|
Aljuraiban GS, Stamler J, Chan Q, Horn LV, Daviglus ML, Elliott P, Oude Griep LM. Relations between dairy product intake and blood pressure: the INTERnational study on MAcro/micronutrients and blood Pressure. J Hypertens 2018; 36:2049-2058. [PMID: 29927842 PMCID: PMC6591711 DOI: 10.1097/hjh.0000000000001779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Epidemiologic evidence suggests that low-fat dairy consumption may lower risk of hypertension. Dairy products may be distinctly linked to health, because of differences in nutritional composition, but little is known about specific nutrients that contribute to the dairy-blood pressure (BP) association, nor to underlying kidney function. METHODS We examined cross-sectional associations to BP of dairy product intakes, total and by type, from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP) including 2694 participants aged 40-59 years from the UK and the USA. Eight BP, four 24-h dietary recalls and two 24-h urine samples were collected during four visits. Linear regression models adjusted for lifestyle/dietary factors to estimate BP differences per 2SD higher intakes of total-and-individual-types of dairy were calculated. RESULTS Multivariable linear regression coefficients were estimated and pooled. In contrast to total and whole-fat dairy, each 195 g/1000 kcal (2SD) greater low-fat dairy intake was associated with a lower SBP -2.31 mmHg and DBP -2.27 mmHg. Significant associations attenuated with adjustment for dietary phosphorus, calcium, and lactose, but strengthened with urinary calcium adjustment. Stratification by median albumin-creatinine ratio (ACR; high ACR indicates impaired kidney function) showed strong associations between low-fat dairy and BP in participants with low ACR (SBP: -3.66; DBP: -2.15 mmHg), with no association in participants with high ACR. CONCLUSION Low-fat dairy consumption was associated with lower BP, especially among participants with low ACR. Dairy-rich nutrients including phosphorus and calcium may have contributed to the beneficial associations with BP.
Collapse
Affiliation(s)
- Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Martha L. Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Chicago, Illinois, USA
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Linda M. Oude Griep
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | | |
Collapse
|
44
|
Zaid M, Miura K, Okayama A, Nakagawa H, Sakata K, Saitoh S, Okuda N, Yoshita K, Choudhury SR, Rodriguez B, Masaki K, Willcox B, Miyagawa N, Okamura T, Chan Q, Elliott P, Stamler J, Ueshima H. Associations of High-Density Lipoprotein Particle and High-Density Lipoprotein Cholesterol With Alcohol Intake, Smoking, and Body Mass Index - The INTERLIPID Study. Circ J 2018; 82:2557-2565. [PMID: 30135319 DOI: 10.1253/circj.cj-18-0341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recently, high-density lipoprotein particles (HDL-P) have been found to be more strongly inversely associated with coronary artery disease (CAD) risk than their counterpart, HDL cholesterol (HDL-C). Given that lifestyle is among the first targets in CAD prevention, we compared the associations of HDL-P and HDL-C with selected lifestyle factors. Methods and Results: We examined 789 Japanese participants of the INTERLIPID Study: men (n=386) and women (n=403) aged 40-59 years in 1996-1998. Participants treated for dyslipidemias were excluded. Lifestyle factors included alcohol intake, smoking amount, and body mass index (BMI). Multivariable linear regression was used for cross-sectional analyses of these factors with HDL-P, HDL-C, HDL-P size subclasses (small, medium and large) and mean HDL-P size. In men, higher alcohol intake was associated with higher HDL-P and higher HDL-C. The associations of alcohol, however, were strongest with HDL-P. A higher smoking amount tended to be associated with lower HDL-P and HDL-C. In contrast, BMI was not associated with HDL-P, but was strongly inversely associated with HDL-C. While alcohol intake favored larger mean HDL-P size, smoking and BMI favored a lipid profile with smaller HDL-P subclasses and overall smaller mean HDL-P size. Similar, but generally weaker results were observed in women. CONCLUSIONS Although both HDL-P and HDL-C are parameters of HDL, they have different associations with alcohol, smoking and BMI.
Collapse
Affiliation(s)
- Maryam Zaid
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | | | - Hideaki Nakagawa
- Department of Epidemiology and Public Health, Kanazawa Medical University
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University
| | - Shigeyuki Saitoh
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences
| | | | | | - Beatriz Rodriguez
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii and Kuakini Medical Center
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii and Kuakini Medical Center
| | - Bradley Willcox
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii and Kuakini Medical Center
| | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science
| | | | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Public Health, Shiga University of Medical Science
| | | |
Collapse
|
45
|
Jung S, Goloubeva O, Hylton N, Klifa C, LeBlanc E, Shepherd J, Snetselaar L, Van Horn L, Dorgan JF. Intake of dietary carbohydrates in early adulthood and adolescence and breast density among young women. Cancer Causes Control 2018; 29:631-642. [PMID: 29802491 PMCID: PMC7365352 DOI: 10.1007/s10552-018-1040-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/16/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Carbohydrate intake increases postprandial insulin secretion and may affect breast density, a strong risk factor for breast cancer, early in life. We examined associations of adolescent and early adulthood intakes of total carbohydrates, glycemic index/load, fiber, and simple sugars with breast density among 182 young women. METHODS Diet was assessed using three 24-h recalls at each of five Dietary Intervention Study in Children (DISC) clinic visits when participants were age 10-19 years and at the DISC06 Follow-Up Study clinic visit when participants were age 25-29 years. Associations between energy-adjusted carbohydrates and MRI-measured percent dense breast volume (%DBV) and absolute dense breast volume (ADBV) at 25-29 years were quantified using multivariable-adjusted mixed-effects linear models. RESULTS Adolescent sucrose intakes and premenarcheal total carbohydrates intakes were modestly associated with higher %DBV (mean %DBVQ1 vs Q4, 16.6 vs 23.5% for sucrose; and 17.2 vs 22.3% for premenarcheal total carbohydrates, all Ptrend ≤ 0.02), but not with ADBV. However, adolescent intakes of fiber and fructose were not associated with %DBV and ADBV. Early adulthood intakes of total carbohydrates, glycemic index/load, fiber, and simple sugars were not associated with %DBV and ADBV. CONCLUSIONS Insulinemic carbohydrate diet during puberty may be associated with adulthood breast density, but our findings need replication in larger studies. Clinical Trials Registration ClinicalTrials.gov Identifier, NCT00458588 April 9, 2007; NCT00000459 October 27, 1999.
Collapse
Affiliation(s)
- Seungyoun Jung
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA
| | - Olga Goloubeva
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA
| | - Nola Hylton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Erin LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John Shepherd
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
- University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Linda Van Horn
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Howard Hall 102E, Baltimore, MD, 21201, USA.
| |
Collapse
|
46
|
McLean RM, Williams SM, Te Morenga LA, Mann JI. Spot urine and 24-h diet recall estimates of dietary sodium intake from the 2008/09 New Zealand Adult Nutrition Survey: a comparison. Eur J Clin Nutr 2018; 72:1120-1127. [PMID: 29786097 DOI: 10.1038/s41430-018-0176-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND We aimed to test the difference between estimates of dietary sodium intake using 24-h diet recall and spot urine collection in a large sample of New Zealand adults. METHODS We analysed spot urine results, 24-h diet recall, dietary habits questionnaire and anthropometry from a representative sample of 3312 adults aged 15 years and older who participated in the 2008/09 New Zealand Adult Nutrition Survey. Estimates of adult population sodium intake were derived from 24-h diet recall and spot urine sodium using a formula derived from analysis of INTERSALT data. Correlations, limits of agreement and mean difference were calculated for the total sample, and for population subgroups. RESULTS Estimated total population 24-h urinary sodium excretion (mean (95% CI)) from spot urine samples was 3035 mg (2990, 3079); 3612 mg (3549, 3674) for men and 2507 mg (2466, 2548) for women. Estimated mean usual daily sodium intake from 24-h diet recall data (excluding salt added at the table) was 2564 mg (2519, 2608); 2849 mg (2779, 2920) for men and 2304 mg (2258, 2350) for women. Correlations between estimates were poor, especially for men, and limits of agreement using Bland-Altman mean difference analysis were wide. CONCLUSIONS There is a poor agreement between estimates of individual sodium intake from spot urine collection and those from 24-hour diet recall. Although, both 24-hour dietary recall and estimated urinary excretion based on spot urine indicate mean population sodium intake is greater than 2 g, significant differences in mean intake by method deserve further investigation in relation to the gold standard, 24-hour urinary sodium excretion.
Collapse
Affiliation(s)
- Rachael M McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | - Sheila M Williams
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lisa A Te Morenga
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Jim I Mann
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
47
|
Duan L, Liu W, Zhang P, Liu S, Liu X, Sang M, Liu L, Lin H, Sang Z. Salt Intake of Lactating Women as Assessed by Modified Food Weighted Records. J Am Coll Nutr 2018; 37:614-619. [PMID: 29667517 DOI: 10.1080/07315724.2018.1454354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE High salt intake among lactating women can increase the risk of hypertension and cardiovascular disease in infants/offspring. However, considering the limited salt intake data in lactating women, the aims of this study were to compare the salt intake assessed by modified food weighted records (FWR) with that estimated by 24-h urinary sodium excretion and to investigate the salt intake of lactating women. METHODS In total, 30 lactating women aged 20-39 years who were 2 to 4 months postpartum were recruited from the cities of Tianjin and Luoyang in China. The household salt intakes of the lactating women were collected by modified FWR for 3 days. Information on the gender, age, eating behaviours and labour intensity of the family members and guests dining at home during the 3 days was recorded. Meanwhile, 24-h urine samples of lactating women were collected. RESULTS The salt intakes of the lactating women estimated by modified FWR and 24-h urinary sodium excretion were 8.50 ± 5.32 g/d and 9.34±3.74 g/d (t=-1.29, P=0.207), respectively, which exceeded the WHO recommendation of 5 g/d. There was a significant correlation (r=0.628, P < 0.001) between the salt intakes assessed by the two methods. A Bland-Altman plot showed no significant mean difference between the two methods (salt intake measured by 24-h urinary sodium excretion-salt intake assessed by modified FWR=0.46 g/d, P=0.207). CONCLUSIONS The modified FWR is a reliable tool to assess the salt intake of lactating women. The salt intake of lactating women in China remains higher than the WHO recommendation and should be restricted through further efforts.
Collapse
Affiliation(s)
- Lijun Duan
- a Department of endocrinology , Tianjin First Center Hospital , Tianjin , China
| | - Wendi Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Peng Zhang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Shiyan Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Xiaotong Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Maocheng Sang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Lu Liu
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Haiyue Lin
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| | - Zhongna Sang
- b Department of Nutrition and Food Hygiene , School of Public Health, Tianjin Medical University , Tianjin , China
| |
Collapse
|
48
|
Stamler J, Chan Q, Daviglus ML, Dyer AR, Van Horn L, Garside DB, Miura K, Wu Y, Ueshima H, Zhao L, Elliott P. Relation of Dietary Sodium (Salt) to Blood Pressure and Its Possible Modulation by Other Dietary Factors: The INTERMAP Study. Hypertension 2018; 71:631-637. [PMID: 29507099 PMCID: PMC5843536 DOI: 10.1161/hypertensionaha.117.09928] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/05/2017] [Accepted: 01/23/2018] [Indexed: 02/07/2023]
Abstract
Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium-BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium-BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium-BP-but not sodium/potassium-BP-relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium-BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005271.
Collapse
Affiliation(s)
| | | | - Martha L. Daviglus
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Alan R. Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Daniel B. Garside
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Katsuyuki Miura
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Yangfeng Wu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Hirotsugu Ueshima
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Liancheng Zhao
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| | - Paul Elliott
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA (JS, MLD, ARD, LVH, DBG); Center for Clinical and Translational Science, University of Illinois, Chicago, IL, USA (MLD, DBG); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (QC, PE); MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK (QC, PE); Department of Public Health, Shiga University of Medical Science, Otsu, Japan (KM, HU); the George Institute for Global Health at Peking University Health Science Center (YW); Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China (LZ)
| |
Collapse
|
49
|
Iwahori T, Ueshima H, Ohgami N, Yamashita H, Miyagawa N, Kondo K, Torii S, Yoshita K, Shiga T, Ohkubo T, Arima H, Miura K. Effectiveness of a Self-monitoring Device for Urinary Sodium-to-Potassium Ratio on Dietary Improvement in Free-Living Adults: a Randomized Controlled Trial. J Epidemiol 2018; 28:41-47. [PMID: 29093302 PMCID: PMC5742378 DOI: 10.2188/jea.je20160144] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 02/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Reducing the urinary sodium-to-potassium ratio is important for reducing both blood pressure and risk of cardiovascular disease. Among free-living Japanese individuals, we carried out a randomized trial to clarify the effect of lifestyle modification for lowering urinary sodium-to-potassium ratio using a self-monitoring device. METHODS This was an open, prospective, parallel randomized, controlled trial. Ninety-two individuals were recruited from Japanese volunteers. Participants were randomly allocated into intervention and control groups. A month-long dietary intervention on self-monitoring urinary sodium-to-potassium ratio was carried out using monitors (HEU-001F, OMRON Healthcare Co., Ltd., Kyoto, Japan). All participants had brief dietary education and received a leaflet as usual care. Monitors were handed out to the intervention group, but not to the control group. The intervention group was asked to measure at least one spot urine sodium-to-potassium ratio daily, and advised to lower their sodium-to-potassium ratio toward the target of less than 1. Outcomes included changes in 24-hour urinary sodium-to-potassium ratio, sodium excretion, potassium excretion, blood pressure, and body weight in both groups. RESULTS Mean measurement frequency of monitoring was 2.8 times/day during the intervention. Changes in urinary sodium-to-potassium ratio were -0.55 in the intervention group and -0.06 in the control group (P = 0.088); respective sodium excretion changes were -18.5 mmol/24 hours and -8.7 mmol/24 hours (P = 0.528); and corresponding potassium excretion was 2.6 mmol/24 hours and -1.5 mmol/24 hours (P = 0.300). No significant reductions were observed in either blood pressure or body weight after the intervention. CONCLUSIONS Providing the device to self-monitor a sodium-to-potassium ratio did not achieve the targeted reduction of the ratio in "pure self-management" settings, indicating further needs to study an effective method to enhance the synergetic effect of dietary programs and self-monitoring practice to achieve the reduction. However, we cannot deny the possibility of reducing sodium-to-potassium ratio using a self-monitoring device.
Collapse
Affiliation(s)
- Toshiyuki Iwahori
- OMRON Healthcare Co., Ltd., Kyoto, Japan
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | | | | | - Naoko Miyagawa
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University, Osaka, Japan
| | | | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University of Medicine, Tokyo, Japan
| | - Hisatomi Arima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
50
|
Iwahori T, Miura K, Ueshima H, Chan Q, Dyer AR, Elliott P, Stamler J. Estimating 24-h urinary sodium/potassium ratio from casual ('spot') urinary sodium/potassium ratio: the INTERSALT Study. Int J Epidemiol 2017; 46:1564-1572. [PMID: 28039381 PMCID: PMC5837629 DOI: 10.1093/ije/dyw287] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 01/20/2023] Open
Abstract
Background Association between casual and 24-h urinary sodium-to-potassium (Na/K) ratio is well recognized, although it has not been validated in diverse demographic groups. Our aim was to assess utility across and within populations of casual urine to estimate 24-h urinary Na/K ratio using data from the INTERSALT Study. Methods The INTERSALT Study collected cross-sectional standardized data on casual urinary sodium and potassium and also on timed 24-h urinary sodium and potassium for 10 065 individuals from 52 population samples in 32 countries (1985-87). Pearson correlation coefficients and agreement were computed for Na/K ratio of casual urine against 24-h urinary Na/K ratio both at population and individual levels. Results Pearson correlation coefficients relating means of 24-h urine and casual urine Na/K ratio were r = 0.96 and r = 0.69 in analyses across populations and individuals, respectively. Correlations of casual urine Na/creatinine and K/creatinine ratios with 24-h urinary Na and K excretion, respectively, were lower than correlation of casual and 24-h urinary Na/K ratio in analyses across populations and individuals. The bias estimate with the Bland-Altman method, defined as the difference between Na/K ratio of 24-h urine and casual urine, was approximately 0.4 across both populations and individuals. Spread around, the mean bias was higher for individuals than populations. Conclusion With appropriate bias correction, casual urine Na/K ratio may be a useful, low-burden alternative method to 24-h urine for estimation of population urinary Na/K ratio. It may also be applicable for assessment of the urinary Na/K ratio of individuals, with use of repeated measurements to reduce measurement error and increase precision.
Collapse
Affiliation(s)
- Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Research and Development Department, OMRON HEALTHCARE Co., Ltd, Kyoto, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | |
Collapse
|