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Sekizuka H, Ishii T, Miyake H. Relationship between the behavior change model and salt intake in hypertensive patients: a single non-specialized hypertension clinic prospective observational study. Blood Press Monit 2024; 29:119-126. [PMID: 38299988 DOI: 10.1097/mbp.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2 ± 23.3 mEq/L at baseline to 56.9 ± 25.5 mEq/L at 12 months; P = 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7 ± 2.9 g/day at baseline to 8.4 ± 2.8 g/day at 12 months; P = 0.045). In addition, they also had significantly lower changes in urine sodium concentration (-13.1 ± 46.1 vs. -6.6 ± 59.7 mEq/L; P = 0.048), significantly increased changes in urine potassium concentration (5.7 ± 20.1 vs. -4.8 ± 28.6 mEq/L; P = 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (-1.3 ± 2.6 vs. -0.1 ± 2.6 g/day; P = 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa, Japan
| | - Toshiya Ishii
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa, Japan
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Vrooman OPJ, van Kerrebroeck PEV, van Balken MR, van Koeveringe GA, Rahnama'i MS. Nocturia and obstructive sleep apnoea. Nat Rev Urol 2024:10.1038/s41585-024-00887-7. [PMID: 38783115 DOI: 10.1038/s41585-024-00887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
Nocturia, the need to urinate at night, is a common symptom in patients with obstructive sleep apnoea (OSA). Continuous positive airway pressure treatment can reduce nocturia in some patients, but the underlying mechanisms are complex and not fully understood. OSA affects the autonomic nervous system, oxidative stress and endothelial damage. Furthermore, the commonly held theory attributing polyuria to a false signal of cardiac overload and response natriuresis has limitations. A comprehensive approach to the management of nocturia in OSA, considering factors such as comorbidities, medication use, alcohol consumption and lifestyle, is needed. Effective management of nocturia in OSA requires a multidisciplinary approach, and urologists should be aware of the potential effect of OSA on physiology and refer patients for further testing at a sleep centre. In addition to continuous positive airway pressure, other interventions such as oral appliances and surgical obstruction treatment could be beneficial for some patients. Overall, understanding the complex interplay between OSA and nocturia is crucial for optimizing patient outcomes.
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Affiliation(s)
- Olaf P J Vrooman
- Department of Urology, Hospital Rijnstate Arnhem, Arnhem, Netherlands.
| | | | | | | | - Mohammad S Rahnama'i
- Department of Urology Nij Smellinghe Hospital, Drachten, Netherlands
- Society of Urological research and education (SURE), Maastricht, Netherlands
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Stuart KV, Biradar MI, Luben RN, Dhaun N, Wagner SK, Warwick AN, Sun Z, Madjedi KM, Pasquale LR, Wiggs JL, Kang JH, Lentjes MAH, Aschard H, Kim J, Foster PJ, Khawaja AP. The Association of Urinary Sodium Excretion with Glaucoma and Related Traits in a Large United Kingdom Population. Ophthalmol Glaucoma 2024:S2589-4196(24)00074-7. [PMID: 38723778 DOI: 10.1016/j.ogla.2024.04.010] [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: 12/12/2023] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and determine whether this relationship is modified by genetic susceptibility to disease. DESIGN Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. PARTICIPANTS Up to 103 634 individuals (mean age: 57 years; 51% women) with complete urinary, ocular, and covariable data. METHODS Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination, and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score comprising 2673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. MAIN OUTCOME MEASURES Corneal-compensated IOP, OCT derived macular retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. RESULTS In maximally adjusted regression models, a 1 standard deviation increase in UNa:Cr was associated with higher IOP (0.14 mmHg; 95% confidence interval [CI], 0.12-0.17; P < 0.001) and greater prevalence of glaucoma (odds ratio, 1.11; 95% CI, 1.07-1.14; P < 0.001) but not macular retinal nerve fiber layer or ganglion cell-inner plexiform layer thickness. Compared with those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45 mmHg; 95% CI, 0.36-0.53, P < 0.001) and prevalence of glaucoma (odds ratio, 1.30; 95% CI, 1.17-1.45; P < 0.001). Stronger associations with glaucoma (P interaction = 0.001) were noted in participants with a higher glaucoma polygenic risk score. CONCLUSIONS Urinary sodium excretion, a biomarker of dietary intake, may represent an important modifiable risk factor for glaucoma, especially in individuals at high underlying genetic risk. These findings warrant further investigation because they may have important clinical and public health implications. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Kelsey V Stuart
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Mahantesh I Biradar
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Robert N Luben
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Neeraj Dhaun
- Edinburgh Kidney, University/BHF Centre of Research Excellence, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Siegfried K Wagner
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Alasdair N Warwick
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Zihan Sun
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Kian M Madjedi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Department of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Janey L Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jae H Kang
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Hugues Aschard
- Department of Computational Biology, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jihye Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Fu Q, Chen R, Ding Y, Xu S, Huang C, He B, Jiang T, Zeng B, Bao M, Li S. Sodium intake and the risk of various types of cardiovascular diseases: a Mendelian randomization study. Front Nutr 2023; 10:1250509. [PMID: 38188872 PMCID: PMC10771828 DOI: 10.3389/fnut.2023.1250509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Background The existing literature on the link between sodium intake and cardiovascular disease (CVD) largely consists of observational studies that have yielded inconsistent conclusions. In this study, our objective is to assess the causal relationship between sodium intake and 50 CVDs using two-sample Mendelian randomization (MR) analysis. Methods MR analyses were performed to investigate the associations between urinary sodium/creatinine ratio (UNa/UCr), an indicator of sodium intake, and 50 CVDs. The genome-wide association study (GWAS) for UNa/UCr was from the UK Biobank (UKBB), and the GWASs for CVDs were from FinnGen. A false discovery rate (FDR) threshold of 5% was applied for multiple comparison correction. Results The inverse-variance weighted method indicated that the genetically predicted UNa/UCr was significantly associated with 7 of 50 CVDs, including "Coronary atherosclerosis" (OR = 2.01; 95% CI: 1.37, 2.95), "Diseases of arteries, arterioles and capillaries" (OR = 1.88; 95% CI: 1.20, 2.94), "Hard cardiovascular diseases" (OR = 1.71; 95% CI: 1.24, 2.35), "Ischemic heart diseases" (OR = 2.06; 95% CI: 1.46, 2.93), "Major coronary heart disease event" (OR = 1.99; 95% CI: 1.36, 2.91), "Myocardial infarction" (OR = 2.03; 95% CI: 1.29, 3.19), and "Peripheral artery disease" (OR = 2.50; 95% CI: 1.35, 4.63). Similar results were obtained with the MR-Egger and weighted median methods. No significant heterogeneity or horizontal pleiotropy was found in this analysis. Conclusion Our study has uncovered a significant positive causal relationship between UNa/UCr and various CVDs. These results offer a new theoretical foundation for advocating the restriction of sodium intake as a preventive measure against CVD.
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Affiliation(s)
- Qingming Fu
- School of Stomatology, Changsha Medical University, Changsha, China
| | - Rumeng Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yining Ding
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Shuling Xu
- The Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Chunxia Huang
- School of Stomatology, Changsha Medical University, Changsha, China
| | - Binsheng He
- The Hunan Provincial Key Laboratory of the TCM Agricultural Biogenomics, Changsha Medical University, Changsha, China
| | - Ting Jiang
- School of Stomatology, Changsha Medical University, Changsha, China
| | - Bin Zeng
- School of Stomatology, Changsha Medical University, Changsha, China
| | - Meihua Bao
- The Hunan Provincial Key Laboratory of the TCM Agricultural Biogenomics, Changsha Medical University, Changsha, China
- Hunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, School of Pharmaceutical Science, Changsha Medical University, Changsha, China
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
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Hariri M, Ramezani AM, Shamshirgaran SM, Gholami A. Is a spot urine sample a good substitution to estimate 24-h urinary sodium excretion in a population ≥ 50 years old? A validation study. Eur J Nutr 2023; 62:3277-3286. [PMID: 37580619 DOI: 10.1007/s00394-023-03217-6] [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: 12/25/2022] [Accepted: 07/18/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE A variety of prediction equations have been able to estimate 24-h urinary sodium excretion from spot urine samples; however, Iranians over the age of 50 have not been compared and verified. Using spot urine samples as a substitute for 24-h urine samples to estimate 24-h urine sodium excretion among the population age 50 and older are the purpose of this study. METHODS A 24-h urinary sodium excretion was studied by well-known Kawasaki, INTERSALT, Tanaka, and World Health Organization/Pan American Health Organization (WHO/PAHO) formulas. On 360 individuals, the mean bias, agreements between estimated and measured values, correlation, absolute and relative differences, and misclassification rates were evaluated for four equations. RESULTS As a result, the mean urinary sodium excretion for a 24-h period was 136.3 ± 52.21 mmol/24-h, which corresponds to a calculated intake of 9.1 ± 3.8 g of salt per day. According to the WHO/PAHO formula, the mean bias between measured values and estimated 24-h urinary sodium excretion is - 21.6 mg/day (95% confidence interval (CI) - 144.8, 101.6 mg/day), which is the smallest difference compared with the other three formulas. The lowest rate of individual misclassification of salt intake was 40% for WHO/PAHO, especially for those who consumed less than 9 g/day, while Kawasaki had the lowest misclassification rate at higher levels of salt intake. CONCLUSION As a result of our research, the WHO/PAHO equations accurately predict 24-h urinary sodium excretion among Iranians aged ≥ 50 more than other equations, both at the population level and at the individual level. However, further study is needed in regard to different ages in Iran.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Amir M Ramezani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Ghimire K, McLachlan CS, Mishra SR, Kallestrup P, Neupane D. Estimating mean population salt intake using spot urine samples in Nepal: a cross-sectional study. J Hypertens 2023; 41:711-722. [PMID: 36723497 DOI: 10.1097/hjh.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the usefulness of spot urine testing compared with 24-h urine samples to estimate salt intake in low-income settings. This is given 24-h urinary collection can be costly, burdensome, and impractical in population surveys. The primary objective of the study was to compare urinary sodium levels (as an estimate of salt intake) of Nepalese population between 24-h urine and spot urine using previously established spot urine-based equations. Additionally, this study explored the 24-h prediction of creatinine and potassium excretion from spot urine samples using available prediction equations. METHODS The sample population was derived from the community-based survey conducted in Nepal in 2018. Mean salt intake was estimated from spot urine samples comparing previously published equations, and this was then contrasted with mean salt intake estimations from 24-h urine samples, using paired t test, Pearson correlation coefficient, intraclass correlation coefficient, and Bland-Altman plots. RESULTS A total of 451 participants provided both complete 24-h and morning spot urine samples. Unweighted mean (±SD) salt intake based on 24-h urine collection was 13.28 ± 4.72 g/day. The corresponding estimates were 15.44 ± 5.92 g/day for the Kawasaki, 11.06 ± 3.17 g/day for the Tanaka, 15.22 ± 16.72 g/day for the Mage, 10.66 ± 3.35 g/day for the Toft, 8.57 ± 1.72 g/day for the INTERSALT with potassium, 8.51 ± 1.73 g/day for the INTERSALT without potassium, 7.88 ± 1.94 g/day for the Whitton, 18.13 ± 19.92 g/day for the Uechi simple-mean and 12.07 ± 1.77 g/day using the Uechi regression. As compared with 24-h urine estimates, all equations showed significant mean differences (biases); the Uechi regression had the least difference with 9% underestimation (-1.21 g/day, P < 0.001).Proportional biases were evident for all equations depending on the level of salt intake in the Bland-Altman plots. CONCLUSION None of the included spot urine-based equations accurately corresponded to 24-h salt intake in the present study. These equations may be useful for longitudinal monitoring of population salt intake in Nepal, our study highlights that there are limitations on using existing equations for estimating mean salt intake in Nepali population. Further studies are warranted for accuracy and validation.
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Affiliation(s)
- Kamal Ghimire
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Craig S McLachlan
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Shiva R Mishra
- World Heart Federation, Salim Yusuf Emerging Leaders Programme, Geneva, Switzerland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Per Kallestrup
- Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Nepal Development Society, Bharatpur, Chitwan, Nepal
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Clermont A, Rouzier V, Pierre JL, Sufra R, Dade E, Preval F, St-Preux S, Deschamps MM, Apollon A, Dupnik K, Metz M, Duffus Y, Sabwa S, Yan LD, Lee MH, Palmer LG, Gerber LM, Pecker MS, Mann SJ, Safford MM, Fitzgerald DW, Pape JW, McNairy ML. High Dietary Sodium, Measured Using Spot Urine Samples, is Associated with Higher Blood Pressure among Young Adults in Haiti. Glob Heart 2023; 18:5. [PMID: 36817226 PMCID: PMC9936908 DOI: 10.5334/gh.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Background Hypertension (HTN) is the leading cardiovascular disease (CVD) risk factor in Haiti and is likely driven by poverty-related social and dietary factors. Salt consumption in Haiti is hypothesized to be high but has never been rigorously quantified. Methods We used spot urine samples from a subset of participants in the population-based Haiti Cardiovascular Disease Cohort to estimate population mean daily sodium intake. We compared three previously validated formulas for estimating dietary sodium intake using urine sodium, urine creatinine, age, sex, height, and weight. We explored the association between dietary sodium intake and blood pressure, stratified by age group. Results A total of 1,240 participants had spot urine samples. Median age was 38 years (range 18-93), and 48% were female. The mean dietary sodium intake was 3.5-5.0 g/day across the three estimation methods, with 94.2%-97.9% of participants consuming above the World Health Organization (WHO) recommended maximum of 2 g/day of sodium. Among young adults aged 18-29, increasing salt intake from the lowest quartile of consumption (<3.73 g/day) to the highest quartile (>5.88 g/day) was associated with a mean 8.71 mmHg higher systolic blood pressure (SBP) (95% confidence interval: 3.35, 14.07; p = 0.001). An association was not seen in older age groups. Among participants under age 40, those with SBP ≥120 mmHg consumed 0.5 g/day more sodium than those with SBP <120 mmHg (95% confidence interval: 0.08, 0.69; p = 0.012). Conclusions Nine out of 10 Haitian adults in our study population consumed more than the WHO recommended maximum for daily sodium intake. In young adults, higher sodium consumption was associated with higher SBP. This represents an inflection point for increased HTN risk early in the life course and points to dietary salt intake as a potential modifiable risk factor for primordial and primary CVD prevention in young adults.
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Affiliation(s)
- Adrienne Clermont
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- MD Program, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Eliezer Dade
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Fabyola Preval
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Stephano St-Preux
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Marie Marcelle Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Kathryn Dupnik
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Miranda Metz
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Yanique Duffus
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Lily D. Yan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Lawrence G. Palmer
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Mark S. Pecker
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Samuel J. Mann
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Monika M. Safford
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Jean W. Pape
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
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Decker KP, Chiu A, Weggen JB, Richardson JW, Hogwood AC, Darling AM, Garten RS. High sodium intake differentially impacts brachial artery dilation when evaluated with reactive versus active hyperemia in salt resistant individuals. J Appl Physiol (1985) 2023; 134:277-287. [PMID: 36548512 DOI: 10.1152/japplphysiol.00461.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study sought to determine if high sodium (HS) intake in salt resistant (SR) individuals attenuates upper limb arterial dilation in response to reactive (occlusion) and active (exercise) hyperemia, two stimuli with varying vasodilatory mechanisms, and the role of oxidative stress in this response. Ten young, SR participants (9 males, 1 female) consumed a 7-day HS (6,900 mg/day) and a 7-day recommended sodium intake (RI: 2,300 mg/day) diet in a randomized order. On the last day of each diet, brachial artery (BA) function was evaluated via reactive (RH-FMD: 5 min of cuff occlusion) and active [handgrip (HG) exercise] hyperemia after consumption of both placebo (PL) and antioxidants (AO). The HS diet significantly elevated sodium excretion (P < 0.05), but mean arterial blood pressure was unchanged. During the PL condition, the HS diet significantly reduced RH-FMD when compared with RI diet (P = 0.01), but this reduction was significantly restored (P = 0.01) when supplemented with AO (HS + PL: 5.9 ± 3.4; HS + AO: 8.2 ± 2.7; RI + PL: 8.9 ± 4.7; RI + AO: 7.0 ± 2.1%). BA shear-to-dilation slopes, evaluated across all HG exercise workloads, were not significantly different across sodium intervention or AO supplementation. In SR individuals, HS intake impaired BA function when assessed via RH-FMD, but was restored with acute AO consumption suggesting oxidative stress as a contributor to this dysfunction. However, exercise-induced BA dilation was unaltered, potentially implicating an inability of HS intake to influence the mechanisms responsible for effectively maintaining skeletal muscle perfusion during exercise.NEW & NOTEWORTHY This study examined if high sodium (HS) intake in salt resistant (SR) individuals attenuates brachial artery (BA) flow-mediated dilation in response to reactive (occlusion) and active (exercise) hyperemia. In SR individuals, HS intake impaired reactive hyperemia-induced BA dilation, but not exercise-induced BA dilation. This finding suggests that although brachial artery nitric oxide bioavailability may be reduced following HS intake, the redundant mechanisms associated with adequate upper limb blood flow regulation during exercise are maintained.
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Affiliation(s)
- Kevin P Decker
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware
| | - Alex Chiu
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer B Weggen
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Jacob W Richardson
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Austin C Hogwood
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Ashley M Darling
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Ryan S Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
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Sekizuka H, Ishii T, Miyake H. Relationship between salt reduction readiness and salt intake in hypertensive patients: a single nonspecialized hypertension clinic case study. Blood Press Monit 2022; 27:391-396. [PMID: 35687035 DOI: 10.1097/mbp.0000000000000610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject's level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = -0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa Japan
| | - Toshiya Ishii
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa Japan
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Patient self-assessment of urine dipsticks to estimate sodium intake in patients with hypertension. Clin Nutr ESPEN 2022; 51:295-300. [DOI: 10.1016/j.clnesp.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/21/2022]
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11
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Validation of salt intake measurements: comparisons of a food record checklist and spot-urine collection to 24-hour-urine collection. Public Health Nutr 2022; 25:2983-2994. [PMID: 35850716 PMCID: PMC7613718 DOI: 10.1017/s1368980022001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U). Design Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant’s use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland−Altman plots. Setting The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland. Participants Seventy women and 71 men, aged 21−61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April−October 2015). Results Mean Na intake estimates varied slightly across methods (3·5-3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95% CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland-Altmann plots more clearly depicted differences by sex and discretionary salt use. Conclusions Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated.
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Choi S, Casey L, Albersheim S, Van Oerle R, Irvine MA, Piper HG. Urine sodium to urine creatinine ratio as a marker of total body sodium in infants with intestinal failure. J Pediatr Surg 2022; 57:937-940. [PMID: 35078592 DOI: 10.1016/j.jpedsurg.2021.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Urine sodium (UNa) is a measure of total body sodium in infants with intestinal failure (IF) but can be misleading as it does not reflect volume status. Urine sodium to urine creatinine ratio (UNa:UCr) may offer a more accurate measure, but is not routinely used. This study compares UNa:UCr to UNa as a maker of sodium status in infants with IF. METHODS A retrospective review of infants with IF, from a single center, from 2018 to 2020 was conducted (REB H20-00,816). IF etiology, intestinal anatomy, nutritional intake, urine electrolytes and anthropometrics were collected. Linear mixed effects models adjusting for repeated measures were used to associate UNa and UNa:UCr with weight gain and sodium intake. RESULTS Twenty-two infants with a median gestational age of 31 weeks were included. IF etiology included gastroschisis (41%), necrotizing enterocolitis (23%), and intestinal perforation (14%). Infants had an average of 3 paired UNa and UNa:UCr measures for a total of 74 paired measurements. UNa:UCr more strongly correlated with sodium intake compared to UNa (R = 0.25, p = 0.032 vs. R = 0.10, p = 0.38). Overall, neither UNa (p = 0.21) nor UNa:UCr (p = 0.16) were significantly correlated with weight gain. However, for infants receiving ≤50% nutrition enterally, weight gain correlated with UNa (p = 0.01) and UNa:UCr (p = 0.01). UNa:UCr >35 predicted adequate growth regardless of enteral intake (92% sensitivity, 59% specificity). CONCLUSION UNa:UCr is a measure of total body sodium that correlates with sodium intake in infants with IF. Our study indicates UNa:UCr >35 is associated with adequate growth and can be used to guide further validation studies.
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Affiliation(s)
- Seungwon Choi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Sadanaga T, Hirota S. Sodium to creatinine ratio in spot urine is associated with heart failure hospitalization in Japanese high‑risk patients. Exp Ther Med 2022; 23:379. [PMID: 35495597 PMCID: PMC9019713 DOI: 10.3892/etm.2022.11306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Shinichi Hirota
- Department of Cardiology, Kumamoto City Ueki Hospital, Kumamoto 861‑0136, Japan
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Tinker LF, Huang Y, Johnson KC, Carbone LD, Snetselaar L, Van Horn L, Manson JE, Liu S, Mossavar-Rahmani Y, Prentice RL, Lampe JW, Neuhouser ML. Estimating 24-Hour Urinary Excretion of Sodium and Potassium Is More Reliable from 24-Hour Urine Than Spot Urine Sample in a Feeding Study of US Older Postmenopausal Women. Curr Dev Nutr 2021; 5:nzab125. [PMID: 34761160 PMCID: PMC8575727 DOI: 10.1093/cdn/nzab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Assessing estimated sodium (Na) and potassium (K) intakes derived from 24-h urinary excretions compared with a spot urine sample, if comparable, could reduce participant burden in epidemiologic and clinical studies. OBJECTIVES In a 2-week controlled-feeding study, Na and K excretions from a 24-h urine collection were compared with a first-void spot urine sample, applying established algorithms and enhanced models to estimate 24-h excretion. Actual and estimated 24-h excretions were evaluated relative to mean daily Na and K intakes in the feeding study. METHODS A total of 153 older postmenopausal women ages 75.4 ± 3.5 y participated in a 2-wk controlled-feeding study with a 4-d repeating menu cycle based on their usual intake (ClinicalTrials.gov Identifier: NCT00000611). Of the 150 participants who provided both a first-void spot urine sample and a 24-h urine collection on the penultimate study day, statistical methods included Pearson correlations for Na and K between intake, 24-h collections, and the 24-h estimated excretions using 4 established algorithms: enhanced biomarker models by regressing ln-transformed intakes on ln-transformed 24-h excretions or ln-transformed 24-h estimated excretions plus participant characteristics and sensitivity analyses for factors potentially influencing Na or K excretion (e.g., possible kidney disease estimated glomerular filtration rate <60 mL/min/1.73 m2 ). RESULTS Pearson correlation coefficients between Na and K intakes and actual 24-h excretions were 0.57 and 0.38-0.44 for estimated 24-h excretions, depending on electrolyte and algorithm used. Enhanced biomarker model cross-validated R 2 (CVR2) for 24-h excretions were 38.5% (Na), 40.2% (K), and 42.0% (Na/K). After excluding participants with possible kidney disease, the CVR2 values were 43.2% (Na), 40.2% (K), and 38.1% (Na/K). CONCLUSIONS Twenty-four-hour urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily White postmenopausal women.
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Affiliation(s)
- Lesley F Tinker
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ying Huang
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simin Liu
- Departments of Epidemiology, Medicine, and Surgery and Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Othman F, Ambak R, Omar MA, Shahar S, Nor NSM, Ahmad MH, Yusoff MFM, Haron H, Noh MFM, Aris T. Development and double cross-validation of new spot urine sodium equation to predict 24-h urine sodium in the Malaysian population. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:10. [PMID: 34059149 PMCID: PMC8166012 DOI: 10.1186/s41043-021-00232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population. METHODS This was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT. RESULTS The new equation showed the least mean bias between measured and predicted sodium, - 0.35 (- 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium (r = 0.50) compared to Tanaka (r =0.24) and INTERSALT (r = 0.44), P < 0.05. CONCLUSION Our newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.
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Affiliation(s)
- Fatimah Othman
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Rashidah Ambak
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Mohd Azahadi Omar
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Suzana Shahar
- Centre of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noor Safiza Mohd Nor
- Policy and Strategic Planning Section, Allied Health Science Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohamad Hasnan Ahmad
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Muhammad Fadhli Mohd Yusoff
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
| | - Hasnah Haron
- Centre of Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Fairulnizal Md Noh
- Diabetes & Endocrine Unit, Institute for Medical Research, National Institute for Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Tahir Aris
- Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor Malaysia
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Abstract
Urinary Na excretion is a potential risk factor for CVD. However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterise the relative contribution of biological factors to the Na–CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour Na excretion was estimated using a single overnight urine sample. Hypertension, the metabolic syndrome and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary Na excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (sd) of the 2112 participants was 54·5 (sd 12·2) years, and they were followed up for a mean of 14·1 (sd 8·1) years. Compared with those in the lowest quartile, the highest baseline urinary Na excretion (>4·2 g/24 h) was associated with a 43 % higher CVD risk (hazard ratio, 1·43; 95 % CI 1·02, 1·99). Participants with high urinary Na excretion, hypertension or the metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35 % of the Na–CVD association), followed by systolic blood pressure (BP) (33 %), left ventricular mass (28 %) and diastolic BP (14 %). Higher urinary Na excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic BP.
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Martínez MÁ, González N, Martí A, Marquès M, Rovira J, Kumar V, Nadal M. Human biomonitoring of bisphenol A along pregnancy: An exposure reconstruction of the EXHES-Spain cohort. ENVIRONMENTAL RESEARCH 2021; 196:110941. [PMID: 33647302 DOI: 10.1016/j.envres.2021.110941] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
This study was aimed at reconstructing the exposure to bisphenol (BPA) of 60 pregnant women from the EXHES-Spain cohort. A biomonitoring study was conducted by determining BPA levels in urine samples over the three trimesters of pregnancy. Moreover, the correlations between BPA levels and the role of different potential exposure sources, with special emphasis on the dietary intake, were also studied. Urine samples were subjected to dispersive liquid-liquid microextraction and the subsequent analysis via gas chromatography-mass spectrometry. BPA was detected in 76% of the urine samples. A significant decrease of urinary BPA levels was observed along pregnancy, as mean concentrations of creatinine-adjusted BPA were 4.64, 4.84 and 2.51 μg/g in the first, second and third trimester, respectively. This decrease was essentially associated with changes in the dietary habits of the pregnant women, including a lower intake of canned food and drinks. However, the potential role of other pregnancy-related biochemical or physiological factors should not be disregarded. Very interestingly, significant differences in urine BPA levels were found according to the fruit consumption pattern, as women who ate more citrus fruits showed lower BPA concentrations in urine. The reconstructed exposure to BPA was estimated in 0.072, 0.069 and 0.038 μg BPA/kg of body weight/day in the first, second and third trimesters, respectively. These values are far below the temporary tolerable daily intake (t-TDI) established by the EFSA.
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Affiliation(s)
- María Ángeles Martínez
- Environmental Engineering Laboratory, Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain; Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana. Hospital Sant Joan de Reus, Reus, Spain. Institut d'Investigació Pere Virgili (IISPV). Reus, Spain
| | - Neus González
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Anna Martí
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Montse Marquès
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
| | - Joaquim Rovira
- Environmental Engineering Laboratory, Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain.
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain
| | - Martí Nadal
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain
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At-home determination of 24-h urine sodium excretion: Validation of chloride test strips and multiple spot samples. Auton Neurosci 2021; 233:102797. [PMID: 33773398 DOI: 10.1016/j.autneu.2021.102797] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/10/2021] [Accepted: 03/15/2021] [Indexed: 01/10/2023]
Abstract
Sodium intake and compliance with dietary sodium modification are typically assessed using a 24-h urine collection analyzed using flame photometry, but this is inconvenient. Spot urine samples have been investigated as alternatives to 24-h collections, but their accuracy is poor. Since sodium and chloride are present in equal concentrations in dietary salt, chloride test strips may provide a suitable proxy for at-home measurement of urine sodium concentrations. We aimed to determine whether (i) chloride test strips provide a reliable measure of urinary sodium compared to the gold standard flame photometry and (ii) multiple spot samples accurately reflect 24-h urine sodium. We recruited 43 participants (19 males) aged 23.6 ± 0.6 years to complete multiple consecutive spot samples (morning and evening) along with a 24-h urine sodium collection. Urine 24-h sodium estimates using chloride test strips (114.6 ± 7.5 mmol/day) were highly correlated (r = 0.900, p < 0.0001) with flame photometry (121.1 ± 7.7 mmol/day) with a bias of -6.53 ± 22.2 mmol/day. Use of a three-spot sample average (both morning and evening spot samples) with a correction factor applied (122.9 ± 4.1 mmol/day) provided a good approximation of 24-h sodium measured by flame photometry (125.6 ± 9.0 mmol/day), with a bias of -2.55 ± 43.9 mmol/day. Chloride test strips applied to a 24-h urine collection provide a highly accurate measure of urinary sodium excretion, permitting convenient at-home sample collection and analysis. Their application to multiple spot samples provides a reasonable approximation of sodium excretion that can be used to conveniently monitor attempts at dietary sodium manipulation, without the inconvenience of completing a 24-h urine sample.
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Manevitz Z, Leshem M, Heled Y, Epstein Y, Gershon B, Kodesh E. Exertional sodium loss does not increase immediate salt appetite or dietary sodium intake in athletes. Appetite 2021; 162:105181. [PMID: 33667501 DOI: 10.1016/j.appet.2021.105181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
We tested whether salt preference increases immediately after exertion-induced Na+ loss in sweat, and whether this may generalise to an increase in habitual dietary Na+ intake. For the first aim, trained athletes (n = 20) exercised in 2 ambient temperatures and sweat Na+ loss related to immediate salt preference assessed by taste, intake and psychophysical tests. For the second aim, we compared dietary and urinary Na+, and salt preference, seasoning and hedonics in the athletes and sedentary men (n = 20). No relationship was found between sodium loss during exercise and immediate preference for salt or psychophysical responses, and no differences in comparison to sedentary men. However, athlete diet had fewer foods (29.4 ± 1.5 vs 37.8 ± 1.9, p < 0.001), less seasoning (19 vs 32. p = 0.011) and more athletes reported dietary limitations (31 vs 11, p < 0.05), although nutrient content did not differ. Together these might suggest athlete adherence to a healthy diet at the expense of variety and flavour and a dissociation between dietary reports and intake. Athletes, more than controls, liked foods rich in energy and K+ suggesting compensatory-driven hedonics, although overall their intake did not differ. The findings are consistent with the absence of a salt appetite responding to Na+ loss in humans, and specifically that trained athletes do not increase their preference for salt in immediate response to exertion-induced Na+ loss and are not at risk for increased dietary Na+ compared to sedentary men.
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Affiliation(s)
- Zev Manevitz
- Physical Therapy Department, Tel Aviv University, Israel
| | - Micah Leshem
- School of Psychological Sciences, University of Haifa, Israel.
| | - Yuval Heled
- The Faculty of Science, Kibbutzim College of Education, Technology and the Arts, Tel Aviv, Israel
| | - Yoram Epstein
- Physical Therapy Department, Tel Aviv University, Israel
| | - Barak Gershon
- The Ribstein Center for Sport Medicine and Research, Wingate Institute, Israel
| | - Einat Kodesh
- Physical Therapy Department, University of Haifa, Israel
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Martínez MA, Rovira J, Sharma RP, Schuhmacher M, Kumar V. Reconstruction of phthalate exposure and DINCH metabolites from biomonitoring data from the EXHES cohort of Tarragona, Spain: A case study on estimated vs reconstructed DEHP using the PBPK model. ENVIRONMENTAL RESEARCH 2020; 186:109534. [PMID: 32361526 DOI: 10.1016/j.envres.2020.109534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/12/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
Phthalates are known endocrine disruptors (EDs) and are associated with potential diseases, such as obesity and diabetes. In 2002, the plasticizer 1,2-cyclohexane dicarboxylic acid diisononyl ester (DINCH) was introduced as an alternative to phthalates in the European market. The objective of this study was to evaluate the total exposure to phthalate and DINCH metabolites from EXHES Tarragona, Spain cohort of pregnant women. On the one hand, the analytical determination of phthalate and DINCH metabolites in urine was carried out. On the other hand, the reconstructed exposure was calculated for phthalates and DINCH using their metabolites concentration measured in the urine. Thirteen different phthalate metabolites and two metabolites of DINCH were measured and detected in almost all pregnant women's urine samples (n = 60). There were significant correlations between metabolites of the same parent compounds, and also between DEHP and MBzP metabolites, DiNP and BBZP metabolites, and DEHP and DiNP metabolites respectively. The exposure of pregnant women to phthalate and DINCH parent compounds were also back calculated using the levels of each metabolite found in pregnant women urine (reconstructed exposure). Besides, to demonstrate the utility of this approach, the physiologically based pharmacokinetic (PBPK) model was used to predict the cumulative amount of MEHP (a principal metabolite of DEHP in urine). To proceed with that, DEHP reconstructed exposure and estimated exposure from the same cohort (previously studied by the same authors) were simulated using the PBPK model. Results showed that the reconstructed-PBPK simulation was closer to the 24 h biomonitoring data than the estimated PBPK-simulation., This clearly shows that the combination of reconstructed exposure with the PBPK model is a good tool to predict chemicals exposure. However, some discrepancies between simulated and biomonitored values were found. This can be associated with other sources that contribute to the total exposure and emphasises the need to consider multi-routes exposure for the widely distributed chemicals like phthalates and DINCH.
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Affiliation(s)
- M A Martínez
- Environmental Engineering Laboratory, Departament d'Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain.
| | - J Rovira
- Environmental Engineering Laboratory, Departament d'Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain.
| | - R Prasad Sharma
- Environmental Engineering Laboratory, Departament d'Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain
| | - M Schuhmacher
- Environmental Engineering Laboratory, Departament d'Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain; Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Catalonia, Spain.
| | - V Kumar
- Environmental Engineering Laboratory, Departament d'Enginyeria Quimica, Universitat Rovira i Virgili, Av. Països Catalans 26, 43007, Tarragona, Catalonia, Spain; IISPV, Hospital Universitari Sant Joan de Reus, Universitat Rovira I Virgili, Reus, Spain.
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Zhao Y, Liu W, Liu S, Li X, Yin T, Liu X, Wang F, Chang X, Zhang T, Tian M, Zhang Y. Estimating 24-h urinary sodium excretion from casual spot urine specimen among hypertensive patients in Northwest China: the Salt Substitute and Stroke Study. Public Health Nutr 2020; 24:1-7. [PMID: 32345383 DOI: 10.1017/s1368980019005019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop an equation that can estimate the 24-h urinary Na excretion by using casual spot urine specimen for older hypertensive participants in rural Ningxia and further to compare with the INTERSALT method, Kawasaki method and Tanaka method. DESIGN Older hypertensive participants in rural Ningxia provided their casual spot urine samples and 24-h urine samples between January 2015 and February 2017. Sex-specific equation was developed using linear forward stepwise regression analysis. Model fit was assessed using adjusted R2. Approximately half of all participants were randomly selected to validate the equation. Mean differences, intraclass correlation coefficients and Bland-Altman plots were used to evaluate the performance of all methods. SETTING Pingluo County and Qingtongxia County in Ningxia Hui Autonomous Region, China. PARTICIPANTS Older hypertensive participants in rural Ningxia. RESULTS Totally, 807 of 1120 invited participants provided qualified 24-h urine samples and spot urine samples. There was no statistical difference comparing the laboratory-based method against the new method and the INTERSALT method, while Kawasaki method had the largest bias with a mean difference of 40·81 g/d (95 % CI 39·27, 42·35 g/d). Bland-Altman plots showed similar pattern of the results. CONCLUSION The INTERSALT method and the new equation have the potential to estimate the 24-h urinary Na excretion in this study population. However, the extrapolation of the results to other population needs to be careful. Future research is required to establish a more reliable method to estimate 24-h urinary Na excretion.
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Affiliation(s)
- Yi Zhao
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Wanlu Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Sha Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiaoxia Li
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Ting Yin
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiuying Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Faxuan Wang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiaoyu Chang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Tianjing Zhang
- The People's Hospital of Anyang City, Anyang City, Henan Province, China
| | - Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Center, Haidian District, Beijing100088, China
- The George Institute for Global Health, University of New South Wales, Newtown, NSW2042, Australia
| | - Yuhong Zhang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
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23
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Sasaki S, Takada T, Fukuma S, Imamoto M, Hasegawa T, Nishiwaki H, Iida H, Fukuhara S. Screening tool for identifying adults with excessive salt intake among community-dwelling adults: a population-based cohort study. Am J Clin Nutr 2020; 111:814-820. [PMID: 32020161 DOI: 10.1093/ajcn/nqaa003] [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] [Received: 06/19/2019] [Accepted: 01/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Excessive salt intake is widely known to be a cause of hypertension, cardiovascular events, and so on. However, simple tools for screening excessive salt intake are lacking. OBJECTIVE We aimed to develop a simple screening tool to identify community-dwelling adults with excessive salt intake. METHODS The present study involved participants who received health check-ups in Fukushima, Japan, in 2016 and 2017. We defined data from the 2016 check-up as the derivation set, and data from those who received check-ups in 2017 but not 2016 as the validation set. The outcome measure was excessive salt intake, defined as the estimated daily salt intake of 1 SD or more. Candidate predictors associated with the outcome were extracted using the Delphi method by an expert panel and narrowed down with clinical expertise and stepwise backward selection. The screening tool was developed using a coefficient-based multivariable scoring method and externally validated. RESULTS A total of 1101 participants were included in the derivation set and 249 in the validation set. At the conclusion of the deviation process, 8 predictors were selected and scored. The areas under the receiver operating characteristic curve for derivation and external validation were 0.70 (95% CI: 0.67, 0.74) and 0.71 (95% CI: 0.62, 0.80), respectively. The calibration slope and intercept for external validation were 1.16 and -0.03, respectively. CONCLUSION We developed a screening tool to identify adults with excessive salt intake. By extracting groups with excessive salt intake, target populations needing intervention for salt reduction can be highlighted efficiently.
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Affiliation(s)
- Sho Sasaki
- Department of Nephrology/Clinical Research Support Office, Iizuka Hospital, Fukuoka, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
| | - Toshihiko Takada
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan.,Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Miyuki Imamoto
- Department of Foods and Human Nutrition, Faculty of Human Life Sciences, Notre Dame Seishin University, Kurashiki, Japan
| | - Takeshi Hasegawa
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan.,Office for Promoting Medical Research, Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan.,Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroki Nishiwaki
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hidekazu Iida
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,You Home Clinic Ishinomaki, Isinomaki, Japan
| | - Shunichi Fukuhara
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
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24
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Gruber LM, Strajina V, Bancos I, Murad MH, Dy BM, Young WF, Farley DR, Lyden ML, Thompson GB, McKenzie TJ. Not all adrenal incidentalomas require biochemical testing to exclude pheochromocytoma: Mayo clinic experience and a meta-analysis. Gland Surg 2020; 9:362-371. [PMID: 32420260 DOI: 10.21037/gs.2020.03.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Excluding a pheochromocytoma is important when a patient presents with an incidentally discovered adrenal mass. However, biochemical testing for pheochromocytoma can be cumbersome, time consuming, or falsely positive. Our objective was to determine if unenhanced computed tomography (CT) imaging alone can be used to rule out pheochromocytoma. Methods We performed a retrospective study of all patients with a pathologically confirmed pheochromocytoma and unenhanced CT imaging who were treated at the Mayo Clinic between 1998 and 2016. Additionally, we performed a systematic review and meta-analysis of original studies published after 2005 with patients who had adrenal masses, more than 10 patients with pheochromocytomas, and reported attenuation on unenhanced CT imaging in Hounsfield units (HU). Results In the Mayo cohort, we identified 186 patients and 199 pheochromocytomas with unenhanced CT imaging. The mean unenhanced CT attenuation was 35±9 HU (range, 15-62), and only 15 tumors had attenuation ≤20 HU. The systematic review identified 26 studies (1,217 tumors), and 23 studies provided a mean unenhanced CT attenuation. The overall mean unenhanced CT attenuation across the studies was 35.6 HU (95% CI, 22.0-49.1 HU). A cutoff of >10 HU had a 100% sensitivity (95% CI, 1.00-1.00) for pheochromocytoma with low heterogeneity between the 21 qualified studies (I2=0%). Sensitivity for pheochromocytoma was 100% and 99% for an unenhanced CT attenuation cutoff of >15 and >20 HU. Conclusions Biochemical testing may not be required to exclude pheochromocytoma if an incidental adrenal mass has low attenuation (<10 HU) on unenhanced CT images.
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Affiliation(s)
- Lucinda M Gruber
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Veljko Strajina
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Irina Bancos
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Evidence Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Benzon M Dy
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - William F Young
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David R Farley
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Melanie L Lyden
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Geoffrey B Thompson
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Travis J McKenzie
- Department of Surgery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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25
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Kim JG, Han SW, Yi JH, Park HC, Han SY. Development of objective indicators for quantitative analysis of sodium intake: the sodium to potassium ratio of second-void urine is correlated with 24-hour urinary sodium excretion. Nutr Res Pract 2020; 14:25-31. [PMID: 32042371 PMCID: PMC6997146 DOI: 10.4162/nrp.2020.14.1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/19/2019] [Accepted: 08/13/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/OBJECTIVES To date, sodium intake has been evaluated based on spot urine instead of 24-hour (hr) urine collection. Nevertheless, the optimal method for assessing daily sodium intake remains unclear. SUBJECTS/METHODS Fifteen male (age 32.7 ± 6.5 years) participants were offered 3 meals with a total of 9-10 g salt over 24 hours, and 24-hr urine was collected from the second-void urine of the first day to the first-void urine of the second day. Twenty-four-hr urinary sodium (24UNa) was estimated using Tanaka's equation and the Korean formula, and spot urine Na, potassium (K), chloride (Cl), urea nitrogen (UN), creatinine (Cr), specific gravity (SG) and osmolality (Osm) were measured. The ratios of urinary Na to other parameters were calculated, and correlations with total measured 24UNa were identified. RESULTS Average 24-hr urine volume was 1,403 ± 475 mL, and measured 24UNa was 143.9 ± 42.1 mEq (range, 87.1-239.4 mEq). Measured 24UNa was significantly correlated with urinary Na/UN (r = 0.560, P < 0.01), urinary Na/Osm (r = 0.510, P < 0.01), urinary Na/Cr (r = 0.392, P < 0.01), urinary Na/K (r = 0.290, P < 0.01), 24UNa estimated using Tanaka's equation (r = 0.452, P < 0.01) and the Korean formula (r = 0.414, P < 0.01), age (r = 0.548, P < 0.01), weight (r = 0.497, P < 0.01), and height (r = 0.393, P < 0.01) in all spot urine samples. Estimated 24UNa based on the second-void spot urine of the first day tended to be more closely correlated with measured 24UNa than were estimates from the other spot urine samples. The significant parameters correlated with the second-void urine of the first day were urinary Na/K (r = 0.647, P < 0.01), urinary Na/Cr (r = 0.558, P < 0.05), and estimated 24UNa using Tanaka's equation (r = 0.616, P < 0.05) and the Korean formula (r = 0.588, P < 0.05). CONCLUSIONS Second-void urine is more reliable than first-void urine for estimating 24UNa. Urinary Na/K in the second-void urine on the first day is significantly correlated with 24UNa. Further studies are needed to establish the most reliable index and the optimal time of urine sampling for predicting 24UNa.
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Affiliation(s)
- Jung Gon Kim
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Gyeonggi 10380, Korea
| | - Sang-Woong Han
- Department of Internal Medicine, Hanyang University Guri Hospital, Gyeonggi 11923, Korea
| | - Joo Hark Yi
- Department of Internal Medicine, Hanyang University Guri Hospital, Gyeonggi 11923, Korea
| | - Hyeong Cheon Park
- Department of Internal Medicine, Yonsei University Gangnam Hospital, Seoul 06273, Korea
| | - Sang Youb Han
- Department of Internal Medicine, Inje University Ilsan-Paik Hospital, Gyeonggi 10380, Korea
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26
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Pedersen AKN, Rud C, Wilkens TL, Borre M, Andersen JR, Dahlerup JF, Hvas CL. A Single Urine Sodium Measurement May Validly Estimate 24-hour Urine Sodium Excretion in Patients With an Ileostomy. JPEN J Parenter Enteral Nutr 2020; 44:246-255. [PMID: 30985012 PMCID: PMC7065244 DOI: 10.1002/jpen.1593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sodium deficiency in patients with an ileostomy is associated with chronic dehydration and may be difficult to detect. We aimed to investigate if the sodium concentration in a single spot urine sample may be used as a proxy for 24-hour urine sodium excretion. METHODS In a prospective observational study with 8 patients with an ileostomy and 8 volunteers with intact intestines, we investigated the correlations and agreements between spot urine sodium concentrations and 24-hour urine sodium excretions. Spot urine samples were drawn from every micturition during 24 hours, and relevant blood samples were drawn. All participants documented their food and fluid intakes. RESULTS There was a high and statistically significant correlation between 24-hour natriuresis and urine sodium concentrations in both morning spot samples (n = 8, Spearman's rho [ρ] = 0.78, P = 0.03) and midday spot samples (n = 8, ρ = 0.82, P = 0.02) in the patients with an ileostomy. The agreement between methods was fair (bias = -1.5, limits of agreement = -32.3 to 29.4). There were no statistically significant associations for evening samples or for samples from volunteers with intact intestines independently of time of day. CONCLUSION A single spot urine sodium sample obtained in the morning or midday may estimate 24-hour urine sodium excretion in patients with an ileostomy and thus help to identify sodium depletion.
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Affiliation(s)
- Anne Kathrine Nissen Pedersen
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Charlotte Rud
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Trine Levring Wilkens
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
| | - Mette Borre
- Department of Hepatology and GastroenterologyAarhus University HospitalAarhusDenmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
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27
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Jiménez Rodríguez A, Palomo Cobos L, Novalbos Ruiz JP, Rodríguez Martín A. Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal. Aten Primaria 2019; 51:645-653. [PMID: 31296350 PMCID: PMC6930942 DOI: 10.1016/j.aprim.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/08/2019] [Accepted: 05/14/2019] [Indexed: 12/02/2022] Open
Abstract
La hipertensión arterial (HTA) es el principal factor de riesgo cardiovascular modificable. La HTA se puede relacionar con el consumo elevado de sal. Para medir la ingesta no todas las encuestas de alimentación son comparables y válidas. El procedimiento de referencia para valorar la ingesta de sal consiste en medir la excreción urinaria de sodio en orina recolectada durante 24 h, aunque se han propuesto métodos alternativos, como las recolecciones de muestras de orina puntuales y cronometradas. En esta revisión analizamos qué instrumentos permiten valorar la ingesta de sal y cuáles de ellos han aportado una mayor validez y fiabilidad a través de los estudios de concordancia con la eliminación de sodio en orina. Las encuestas actuales de consumo de alimentos son inadecuados debido a su amplia variabilidad y relativamente baja correlación con la eliminación de sodio en orina de 24 h. Su principal limitación es la necesidad de validación en diferentes grupos poblacionales. En Atención Primaria se debería valorar la ingesta de sal mediante la utilización de cuestionarios de frecuencia de consumo que recojan alimentos con elevado contenido en sal, el consumo de platos preelaborados y preguntas que cuantifiquen la adición de sal en la preparación de alimentos o en la mesa. Para la validación de estos cuestionarios debe emplearse como gold standard la eliminación de sodio en orina de 24 h ajustada según el aclaramiento de creatinina.
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28
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Suzuki I, Ogawa M, Seino K, Nogawa M, Naito H, Yamakoshi KI, Tanaka S. NIR spectroscopic determination of urine components in spot urine: preliminary investigation towards optical point-of-care test. Med Biol Eng Comput 2019; 58:67-74. [PMID: 31745837 DOI: 10.1007/s11517-019-02063-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
Presently, there is no convenient method to measure 24-h urinary Na excretion, which is an important index of daily Na intake, and 24-h urine collection involves a complex process. However, the Na-to-creatinine ratio (NCR) in spot urine has the potential to evaluate 24-h Na excretion and is useful for point-of-care testing. Thus, this study aimed to realize a near-infrared spectroscopic system to assess NCR in spot urine: (1) We attempted to estimate Na concentration using fewer than 10 wavelengths; (2) we calculated NCR using creatinine concentrations from our previous report and verified the NCR predictability. A calibration model was created using multi-linear regression analysis using 10 selected wavelengths in the range of Fourier-transform infrared spectrometer. Spot urine samples were obtained from healthy adults, and glucose powder was added to them to simulate diabetic samples. NCR was calculated using only six wavelengths, and the results confirmed the high accuracy of the estimated Na concentration even though inorganic components do not absorb near-infrared light. Our method enables to optically estimate NCR in spot urine, and it will be useful for point-of-care testing. Graphical abstract.
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Affiliation(s)
- Ikuto Suzuki
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan.
| | - Mitsuhiro Ogawa
- Department of Information and Electronic Engineering, Faculty of Science and Engineering, Teikyo University, Utsunomiya, 320-8551, Japan
| | - Kimihiro Seino
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Masamichi Nogawa
- Department of Clinical Engineering, Faculty of Health Sciences, Komatsu University, Komatsu, 923-0961, Japan
| | - Hisashi Naito
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Ken-Ichi Yamakoshi
- Graduate School of Natural Science & Technology, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Shinobu Tanaka
- Faculty of Frontier Engineering, Institute of Science & Engineering, Kanazawa University, Kanazawa, 920-1192, Japan
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29
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Nowson CA, Lim K, Campbell NRC, O'Connell SL, He FJ, Daly RM. Impact of fractional excretion of sodium on a single morning void urine collection as an estimate of 24-hour urine sodium. J Clin Hypertens (Greenwich) 2019; 21:1763-1770. [PMID: 31693299 DOI: 10.1111/jch.13725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023]
Abstract
The standard for assessing dietary sodium intake is to measure 24-hour urine sodium. On average, 93% of daily sodium intake is excreted over 24-hours. Expense and difficulties in obtaining complete 24-hour collections have led to the measurement of sodium concentration in spot and single-void urine samples, using predictive equations to estimate 24-hour urine sodium. Although multiple predictive equations have been developed, in addition to having an average bias, all the equations overestimate 24-hour sodium at lower levels of 24-hour sodium and underestimate 24-hour urine sodium at higher levels of 24-hour sodium. One of the least biased estimating equations is the INTERSALT equation, which incorporates a spot urine creatinine concentration. The authors hypothesized that differential fractional excretion of sodium (FeNa)(derived from a morning void collection) relative to creatinine would impact on the accuracy of the INTERSALT equation in estimating 24-hour urine sodium. In a prospective study of 139 adults aged 65 years and over, three sequential morning void and 24-hour urine samples were examined. There was a significant correlation between increasing FENa and the difference between estimated and measured 24-hours urine sodium (r = 0.358, P < .01). In the lowest quartile of FENa, the INTERSALT equation overestimated 24-hour urine sodium, but underestimated 24-hour urine sodium with greater magnitude in each of the subsequent quartiles of FENa. Differential excretion of sodium relative to creatinine, potentially impacted by renal blood flow and hydration, among other factors, affected the accuracy of the INTERSALT equation. Additional research may refine the INTERSALT and other predictive equations to increase their accuracy.
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Affiliation(s)
- Caryl A Nowson
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Waurn Ponds Campus, Geelong, Vic., Australia
| | - Karen Lim
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Waurn Ponds Campus, Geelong, Vic., Australia
| | - Norm R C Campbell
- Departments of Medicine, Community Health Sciences, and Physiology and Pharmacology, O'Brien Institute of Public Health, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Stella L O'Connell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Waurn Ponds Campus, Geelong, Vic., Australia
| | - Feng J He
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Robin M Daly
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Waurn Ponds Campus, Geelong, Vic., Australia
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30
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Wilson T, Garcia-Perez I, Posma JM, Lloyd AJ, Chambers ES, Tailliart K, Zubair H, Beckmann M, Mathers JC, Holmes E, Frost G, Draper J. Spot and Cumulative Urine Samples Are Suitable Replacements for 24-Hour Urine Collections for Objective Measures of Dietary Exposure in Adults Using Metabolite Biomarkers. J Nutr 2019; 149:1692-1700. [PMID: 31240300 DOI: 10.1093/jn/nxz138] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/17/2019] [Accepted: 05/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measurement of multiple food intake exposure biomarkers in urine may offer an objective method for monitoring diet. The potential of spot and cumulative urine samples that have reduced burden on participants as replacements for 24-h urine collections has not been evaluated. OBJECTIVE The aim of this study was to determine the utility of spot and cumulative urine samples for classifying the metabolic profiles of people according to dietary intake when compared with 24-h urine collections in a controlled dietary intervention study. METHODS Nineteen healthy individuals (10 male, 9 female, aged 21-65 y, BMI 20-35 kg/m2) each consumed 4 distinctly different diets, each for 1 wk. Spot urine samples were collected ∼2 h post meals on 3 intervention days/wk. Cumulative urine samples were collected daily over 3 separate temporal periods. A 24-h urine collection was created by combining the 3 cumulative urine samples. Urine samples were analyzed with metabolite fingerprinting by both high-resolution flow infusion electrospray mass spectrometry (FIE-HRMS) and proton nuclear magnetic resonance spectroscopy (1H-NMR). Concentrations of dietary intake biomarkers were measured with liquid chromatography triple quadrupole mass spectrometry and by integration of 1H-NMR data. RESULTS Cross-validation modeling with 1H-NMR and FIE-HRMS data demonstrated the power of spot and cumulative urine samples in predicting dietary patterns in 24-h urine collections. Particularly, there was no significant loss of information when post-dinner (PD) spot or overnight cumulative samples were substituted for 24-h urine collections (classification accuracies of 0.891 and 0.938, respectively). Quantitative analysis of urine samples also demonstrated the relation between PD spot samples and 24-h urines for dietary exposure biomarkers. CONCLUSIONS We conclude that PD spot urine samples are suitable replacements for 24-h urine collections. Alternatively, cumulative samples collected overnight predict similarly to 24-h urine samples and have a lower collection burden for participants.
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Affiliation(s)
- Thomas Wilson
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Isabel Garcia-Perez
- Section of Biomolecular Medicine, Division of Integrative Systems Medicine and Digestive Diseases, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Joram M Posma
- Section of Biomolecular Medicine, Division of Integrative Systems Medicine and Digestive Diseases, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda J Lloyd
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Edward S Chambers
- Nutrition and Dietetic Research Group, Division of Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Kathleen Tailliart
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Hassan Zubair
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - Manfred Beckmann
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elaine Holmes
- Section of Biomolecular Medicine, Division of Integrative Systems Medicine and Digestive Diseases, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gary Frost
- Nutrition and Dietetic Research Group, Division of Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - John Draper
- Institute of Biological, Environmental, and Rural Sciences, Aberystwyth University, Aberystwyth, United Kingdom
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31
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Wan ER, Cross J, Sofat R, Walsh SB. 24-Hour vs. Spot Urinary Sodium and Potassium Measurements in Adult Hypertensive Patients: A Cohort Validation Study. Am J Hypertens 2019; 32:983-991. [PMID: 31247068 DOI: 10.1093/ajh/hpz104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sodium intake is correlated with the development of hypertension. Guyton's principals suggest that the 24-hour urinary sodium excretion reflects sodium ingestion over the same period. 24-hour urine collections are arduous to collect, so many centers use spot urinary measurements instead. We compared spot to matched 24-hour urinary electrolyte measurements. METHODS We examined 419 hypertensive patients from the UCL Complex Hypertension Clinic. 77 had matched and complete 24-hour and spot urinary and serum biochemistry to examine.We compared the spot and 24-hour urinary; sodium concentration, Na/Cr ratio, FENa, Kawasaki and Tanaka estimated sodium excretion as well as the potassium concentration, K/Cr ratio, Kawasaki and Tanaka potassium excretion. RESULTS Our cohort was 58% male and the median age was 41 years. The 24-hour and spot Na concentrations correlated moderately (r = 0.4633, P < 0.0001). The 24-hour and spot Na/creatinine ratios correlated weakly (r = 0.2625, P = 0.0194). The 24-hour and spot FENa results showed a weak negative correlation (r = -0.222, P = ns). The 24-hour sodium excretion and the Kawasaki-derived spot urine sodium excretion correlated moderately (r = 0.3118, P = 0.0052). All Bland-Altman analyses showed poor agreement.The 24-hour and spot potassium concentrations correlated very poorly (r = 0.1158, P = ns). The 24-hour and spot urinary K/creatinine ratios correlated weakly (r = 0.47, P ≤ 0.0001). 24-hour and Kawasaki and Tanaka estimated potassium excretions correlated much better (r = 0.58, P < 0.0001). CONCLUSIONS Spot urinary measurements of sodium give a very poor understanding of the natriuresis occurring over the same 24-hour period. The Kawasaki and Tanaka estimations of the 24-hour sodium excretion showed a much lower correlation than previously reported.
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Affiliation(s)
- Elizabeth R Wan
- Complex Hypertension Service, UCL Department of Renal Medicine, University College London, London, UK
| | - Jennifer Cross
- Complex Hypertension Service, UCL Department of Renal Medicine, University College London, London, UK
| | - Reecha Sofat
- UCL Department of Medicine, University College London, London, UK
| | - Stephen B Walsh
- Complex Hypertension Service, UCL Department of Renal Medicine, University College London, London, UK
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Can methods based on spot urine samples be used to estimate average population 24 h sodium excretion? Results from the Isfahan Salt Study. Public Health Nutr 2019; 23:202-213. [PMID: 31547894 DOI: 10.1017/s136898001900257x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples. DESIGN A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics. SETTING Iranian adults recruited in 2014-2015. PARTICIPANTS Healthy volunteer adults aged ≥18 years. RESULTS With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (-469 to -708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (-151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50). CONCLUSIONS In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.
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Estimating sodium intake from spot urine samples at population level: a validation and application study in French adults. Br J Nutr 2019; 122:186-194. [PMID: 31006386 DOI: 10.1017/s0007114519000886] [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: 12/14/2022]
Abstract
The aim of this study was to assess the validity of the predictive INTERSALT equation using spot urine samples to estimate 24-h urinary Na (24-hUNa) excretion and daily Na intake among the French adult population. Among 193 French adults ('validation sample'), we assessed the validity by comparing predicted 24-hUNa excretion from spot urine and measured 24-hUNa excretion from 24-h urine collections. Spearman correlation coefficients and Bland-Altman plots were used and we calculated calibration coefficients. In a nationally representative sample of 1720 French adults ('application sample'), the calibrated predictive equation was then applied to the spot urine Na values to estimate 24-hUNa excretion and daily Na intake. In that sample, predicted Na intake was compared with that estimated from 24-h dietary recalls. Results were adjusted and corrected using calibration coefficients. In the validation sample, the measured 24-hUNa excretion was on average 14 % higher than the predicted 24-hUNa (+13 % for men and +16 % for women). Correlation between measured and predicted 24-hUNa excretion was moderate (Spearman r 0·42), and the Bland-Altman plots showed underestimation at lower excretion level and overestimation at higher level. In the application study, estimated daily salt intake was 8·0 g/d using dietary recalls, 8·1 g/d using predicted INTERSALT equation and 9·3 g/d after applying calibration coefficients calculated in the validation study. Despite overall underestimation of 24-hUNa excretion by spot urinary Na, the use of predictive INTERSALT equation remains an acceptable alternative in monitoring global Na intake/excreted in the French population but its use is not advised at the individual level.
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Lloyd AJ, Willis ND, Wilson T, Zubair H, Xie L, Chambers E, Garcia‐Perez I, Tailliart K, Beckmann M, Mathers JC, Draper J. Developing a Food Exposure and Urine Sampling Strategy for Dietary Exposure Biomarker Validation in Free-Living Individuals. Mol Nutr Food Res 2019; 63:e1900062. [PMID: 31157514 PMCID: PMC8629115 DOI: 10.1002/mnfr.201900062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/29/2019] [Indexed: 12/30/2022]
Abstract
SCOPE Dietary choices modulate the risk of chronic diseases and improving diet is a central component of public health strategies. Food-derived metabolites present in urine could provide objective biomarkers of dietary exposure. To assist biomarker validation, this work aims to develop a food intervention strategy mimicking a typical annual diet over a short period of time and assesses urine sampling protocols potentially suitable for future deployment of biomarker technology in free-living populations. METHODS AND RESULTS Six different menu plans comprehensively represent a typical UK annual diet that is split into two dietary experimental periods. Free-living adult participants (n = 15 and n = 36, respectively) are provided with all their food, as a series of menu plans, over a period of three consecutive days. Multiple spot urine samples are collected and stored at home. CONCLUSION A successful food exposure strategy is established following a conventional UK eating pattern, which is suitable for biomarker validation in free-living individuals. The urine sampling procedure is acceptable for volunteers and delivered samples suitable for biomarker quantification. The study design provides scope for validation of existing biomarker candidates and potentially for discovery of new biomarker leads, and should help inform the future deployment of biomarker technology for habitual dietary exposure measurement.
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Affiliation(s)
- Amanda J. Lloyd
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
| | - Naomi D. Willis
- Human Nutrition Research CentreInstitute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneNE2 4HHUK
| | - Thomas Wilson
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
| | - Hassan Zubair
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
| | - Long Xie
- Human Nutrition Research CentreInstitute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneNE2 4HHUK
| | - Edward Chambers
- Nutrition and Dietetic Research GroupDivision of DiabetesEndocrinology and MetabolismDepartment of MedicineHammersmith Hospital CampusImperial College LondonW12 0NNUK
| | - Isabel Garcia‐Perez
- Nutrition and Dietetic Research GroupDivision of DiabetesEndocrinology and MetabolismDepartment of MedicineHammersmith Hospital CampusImperial College LondonW12 0NNUK
| | - Kathleen Tailliart
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
| | - Manfred Beckmann
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
| | - John C. Mathers
- Human Nutrition Research CentreInstitute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneNE2 4HHUK
| | - John Draper
- Institute of BiologicalEnvironmental and Rural SciencesAberystwyth UniversityAberystwythSY23 3DAUK
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Prediction of 24-hour sodium excretion from spot urine samples in South African adults: a comparison of four equations. J Hum Hypertens 2019; 34:24-33. [PMID: 31076654 DOI: 10.1038/s41371-019-0210-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 01/29/2023]
Abstract
Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low-middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine sample have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine samples in a nationally representative sample of South Africans. Spot and 24-hour urine samples were collected in a subsample (n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland-Altman plots. In this subsample (mean age 52.8 ± 16.4 years; body mass index 30.2 ± 8.2 kg/m2; 76% female; 73% black African; 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4-10.5). Although INTERSALT underestimated salt intake (-3.77 g/d; -1.64 to -7.09), the other equations overestimated by 1.28 g/d (-3.52; 1.97), 6.24 g/d (2.22; 9.45), and 17.18 g/d (8.42; 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland-Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine samples in South Africans is not recommended.
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Khosravi A, Mohammadifard N, Gharipour M, Abdollahi Z, Nouri F, Feizi A, Jozan M, Sarrafzadegan N. Low correlation between morning spot and 24-hour urine samples for estimating sodium intake in an Iranian population: Isfahan Salt Study. INT J VITAM NUTR RES 2019; 89:185-191. [PMID: 30887904 DOI: 10.1024/0300-9831/a000558] [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: 11/19/2022]
Abstract
Introduction: Although difficult, the 24-hour urine sodium excretion is still considered as the gold standard method to estimate salt intake. The current study aimed to assess the validity of using spot urine samples in comparison with the standard 24-hour urine collection to estimate sodium and potassium intake in healthy Iranian adults. Methods and subjects: This cross-sectional study was performed on 1099 healthy Iranians aged 18-69 years. Samples of 24-hour and fasting morning spot urine were collected to measure sodium and potassium excretions. Tanaka's formula was utilized to predict the 24-hour sodium and potassium urinary excretions based on the spot values. Results: The difference between measured and estimated sodium excretion values was 4265 mg/day (95% CI: 4106-4424; P < 0.001) and 2242 mg/day in case of potassium excretion (95% CI: 2140-2344; P < 0.001). There was a weak significant correlation between the 24-hour urine sodium and potassium excretion and the predicted values (intraclass correlations: 0.22 and 0.28, respectively; both P < 0.001). Conclusion: The weak association between the predicted and measured values of sodium and potassium along with the marked overestimation of daily sodium and potassium excretions based on the spot urine and using Tanaka formula indicates that Tanaka formula is not practical for the prediction of sodium and potassium or salt intake in Iranian adults. Using other spot urine sampling times and/or adopting a formula designed based on the characteristics of the Iranian population may increase the validity of spot urine tests.
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Affiliation(s)
- Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojagn Gharipour
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Abdollahi
- Nutrition Department, The Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Jozan
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Nutrition Department, The Ministry of Health and Medical Education, Tehran, Iran
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Jędrusik P, Symonides B, Gaciong Z. Comparison of three formulas to estimate 24-hour urinary sodium and potassium excretion in patients hospitalized in a hypertension unit. ACTA ACUST UNITED AC 2018; 12:457-469. [DOI: 10.1016/j.jash.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/02/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
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Beer-Borst S, Luta X, Hayoz S, Sommerhalder K, Krause CG, Eisenblätter J, Jent S, Siegenthaler S, Aubert R, Haldimann M, Strazzullo P. Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees. BMC Public Health 2018; 18:421. [PMID: 29606103 PMCID: PMC5879608 DOI: 10.1186/s12889-018-5366-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics. METHODS Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples. DISCUSSION Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees. TRIAL REGISTRATION German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.
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Affiliation(s)
- Sigrid Beer-Borst
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
| | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Stefanie Hayoz
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Kathrin Sommerhalder
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Corinna Gréa Krause
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland
| | - Julia Eisenblätter
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Sandra Jent
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Stefan Siegenthaler
- Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Rafael Aubert
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Max Haldimann
- Federal Food Safety and Veterinary Office, Division of Risk Assessment, Laboratories, Schwarzenburgstrasse 155, 3003, Bern, Switzerland
| | - Pasquale Strazzullo
- Department of Clinical Medicine & Surgery, Federico II University of Naples Medical School, via S. Pansini 5, 80131, Naples, Italy
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External validation and comparison of formulae estimating 24-h sodium intake from a fasting morning urine sample. J Hypertens 2018; 36:785-792. [DOI: 10.1097/hjh.0000000000001609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Han SY, Kim NH, Kim DH, Han K, Kim SM. Relationship between urinary sodium-creatinine ratios and insulin resistance in Korean children and adolescents with obesity. J Pediatr Endocrinol Metab 2018. [PMID: 29543590 DOI: 10.1515/jpem-2017-0447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of childhood obesity has significantly increased in Korea. This study aimed to use data from the 2010 Korea National Health and Nutrition Examination Survey (KNHANES) to investigate the association between sodium (Na) intake and insulin resistance in children and adolescents with obesity. METHODS The study population consisted of 578 adolescents aged 12-18 years who were enrolled in the 2010 KNHANES. Subjects were classified into the following four groups based on their body mass index (BMI) and homeostatic model assessment-insulin resistance (HOMA-IR) values: normal BMI and HOMA-IR (Group 1), normal BMI and ≥75% HOMA-IR (Group 2), ≥85% BMI and normal HOMA-IR (Group 3) and ≥85% BMI and ≥75% HOMA-IR (Group 4). The groups were further divided into four quartiles (Q1-Q4) based on urinary sodium-creatinine ratios (UNa/Cr) to analyze the association between obesity and metabolic abnormality as a result of increased Na intake. RESULTS There were significant differences among the four groups in terms of abdominal obesity (p<0.000), waist circumference (WC) (p<0.000) blood glucose levels (p<0.000), insulin levels (p<0.000) and UNa/Cr, with Groups 2, 3 and 4 having significantly higher UNa/Cr than Group 1 (p=0.002). In addition, there was a significant positive correlation between UNa/Cr and obesity (Q1=1 vs. Q4=3.23, p=0.019) and metabolic abnormality (Q1=1 vs. Q4=2.25, p=0.167). CONCLUSIONS Increased Na intake showed a positive statistical correlation with insulin resistance and is associated with an increased risk of insulin resistance and other metabolic abnormalities in obese children and adolescents.
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Affiliation(s)
- So Yoon Han
- Department of Family Medicine, Korea University College of Medicine, Korea University, Seoul, Republic of Korea
| | - Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Do Hoon Kim
- Department of Family Medicine, Korea University College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Biostatistics, Catholic University College of Medicine, Seoul, South Korea
| | - Seon Mee Kim
- Department of Family Medicine, Korea University College of Medicine, Korea University, Seoul, Republic of Korea
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Kong JS, Lee YK, Kim MK, Choi MK, Heo YR, Hyun T, Kim SM, Lyu ES, Oh SY, Park HR, Rhee MY, Ro HK, Song MK. Estimation model for habitual 24-hour urinary-sodium excretion using simple questionnaires from normotensive Koreans. PLoS One 2018; 13:e0192588. [PMID: 29447201 PMCID: PMC5813954 DOI: 10.1371/journal.pone.0192588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/27/2018] [Indexed: 11/19/2022] Open
Abstract
This study was conducted to develop an equation for estimation of 24-h urinary-sodium excretion that can serve as an alternative to 24-h dietary recall and 24-h urine collection for normotensive Korean adults. In total, data on 640 healthy Korean adults aged 19 to 69 years from 4 regions of the country were collected as a training set. In order to externally validate the equation developed from that training set, 200 subjects were recruited independently as a validation set. Due to heterogeneity by gender, we constructed a gender-specific equation for estimation of 24-h urinary-sodium excretion by using a multivariable linear regression model and assessed the performance of the developed equation in validation set. The best model consisted of age, body weight, dietary behavior (‘eating salty food’, ‘Kimchi consumption’, ‘Korean soup or stew consumption’, ‘soy sauce or red pepper paste consumption’), and smoking status in men, and age, body weight, dietary behavior (‘salt preference’, ‘eating salty food’, ‘checking sodium content for processed foods’, ‘nut consumption’), and smoking status in women, respectively. When this model was tested in the external validation set, the mean bias between the measured and estimated 24-h urinary-sodium excretion from Bland-Altman plots was -1.92 (95% CI: -113, 110) mmol/d for men and -1.51 (95% CI: -90.6, 87.6) mmol/d for women. The cut-points of sodium intake calculated based on the equations were ≥4,000 mg/d for men and ≥3,500 mg/d for women, with 89.8 and 76.6% sensitivity and 29.3 and 64.2% specificity, respectively. In this study, a habitual 24-hour urinary-sodium-excretion-estimation model of normotensive Korean adults based on anthropometric and lifestyle factors was developed and showed feasibility for an asymptomatic population.
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Affiliation(s)
- Ji-Sook Kong
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Gyeonggi, South Korea
| | - Yeon-Kyung Lee
- Department of Food Science and Nutrition, Kyungpook National University, Daegu, South Korea
| | - Mi Kyung Kim
- Division of Cancer Epidemiology and Prevention, National Cancer Center, Goyang, Gyeonggi, South Korea
- * E-mail:
| | - Mi-Kyeong Choi
- Division of Food Science, Kongju National University, Yesan, South Korea
| | - Young-Ran Heo
- Department of Food and Nutrition, Chonnam National University, Gwangju, South Korea
| | - Taisun Hyun
- Department of Food and Nutrition, Chungbuk National University, Cheongju, South Korea
| | - Sun Mee Kim
- Department of Family Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Eun-Soon Lyu
- Department of Food Science and Nutrition, Pukyong National University, Busan, South Korea
| | - Se-Young Oh
- Department of Food and Nutrition, Kyunghee University, Seoul, South Korea
| | - Hae-Ryun Park
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, South Korea
| | - Hee-Kyong Ro
- Department of Food and Nutrition, Dongshin University, Naju, South Korea
| | - Mi Kyung Song
- Biometrics Research Branch and Biostatistics Collaboration Unit, Division of Cancer Epidemiology and Prevention, Research Institute and Hospital, National Cancer Center, Goyang, Korea, National Cancer Center, Goyang, Gyeonggi, South Korea
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Jensen PN, Bao TQ, Huong TTT, Heckbert SR, Fitzpatrick AL, LoGerfo JP, Ngoc TLV, Mokdad AH. The association of estimated salt intake with blood pressure in a Viet Nam national survey. PLoS One 2018; 13:e0191437. [PMID: 29346423 PMCID: PMC5773206 DOI: 10.1371/journal.pone.0191437] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/04/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate the association of salt consumption with blood pressure in Viet Nam, a developing country with a high level of salt consumption. DESIGN AND SETTING Analysis of a nationally representative sample of Vietnamese adults 25-65 years of age who were surveyed using the World Health Organization STEPwise approach to Surveillance protocol. Participants who reported acute illness, pregnancy, or current use of antihypertensive medications were excluded. Daily salt consumption was estimated from fasting mid-morning spot urine samples. Associations of salt consumption with systolic blood pressure and prevalent hypertension were assessed using adjusted linear and generalized linear models. Interaction terms were tested to assess differences by age, smoking, alcohol consumption, and rural/urban status. RESULTS The analysis included 2,333 participants (mean age: 37 years, 46% male, 33% urban). The average estimated salt consumption was 10g/day. No associations of salt consumption with blood pressure or prevalent hypertension were observed at a national scale in men or women. The associations did not differ in subgroups defined by age, smoking, or alcohol consumption; however, associations differed between urban and rural participants (p-value for interaction of urban/rural status with salt consumption, p = 0.02), suggesting that higher salt consumption may be associated with higher systolic blood pressure in urban residents but lower systolic blood pressure in rural residents. CONCLUSIONS Although there was no evidence of an association at a national level, associations of salt consumption with blood pressure differed between urban and rural residents in Viet Nam. The reasons for this differential association are not clear, and given the large rate of rural to urban migration experienced in Viet Nam, this topic warrants further investigation.
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Affiliation(s)
- Paul N. Jensen
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Tran Quoc Bao
- Department of Preventive Medicine, Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Tran Thi Thanh Huong
- Department of Ethics and Social Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - James P. LoGerfo
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Truong Le Van Ngoc
- Department of Preventive Medicine, Viet Nam Ministry of Health, Hanoi, Viet Nam
| | - Ali H. Mokdad
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Lee H, Park JB, Choi SW, Yoon YE, Park HE, Lee SE, Lee SP, Kim HK, Cho HJ, Choi SY, Lee HY, Choi J, Lee YJ, Kim YJ, Cho GY, Choi J, Sohn DW. Impact of a Telehealth Program With Voice Recognition Technology in Patients With Chronic Heart Failure: Feasibility Study. JMIR Mhealth Uhealth 2017; 5:e127. [PMID: 28970189 PMCID: PMC5643844 DOI: 10.2196/mhealth.7058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 12/27/2022] Open
Abstract
Background Despite the advances in the diagnosis and treatment of heart failure (HF), the current hospital-oriented framework for HF management does not appear to be sufficient to maintain the stability of HF patients in the long term. The importance of self-care management is increasingly being emphasized as a promising long-term treatment strategy for patients with chronic HF. Objective The objective of this study was to evaluate whether a new information communication technology (ICT)–based telehealth program with voice recognition technology could improve clinical or laboratory outcomes in HF patients. Methods In this prospective single-arm pilot study, we recruited 31 consecutive patients with chronic HF who were referred to our institute. An ICT-based telehealth program with voice recognition technology was developed and used by patients with HF for 12 weeks. Patients were educated on the use of this program via mobile phone, landline, or the Internet for the purpose of improving communication and data collection. Using these systems, we collected comprehensive data elements related to the risk of HF self-care management such as weight, diet, exercise, medication adherence, overall symptom change, and home blood pressure. The study endpoints were the changes observed in urine sodium concentration (uNa), Minnesota Living with Heart Failure (MLHFQ) scores, 6-min walk test, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) as surrogate markers for appropriate HF management. Results Among the 31 enrolled patients, 27 (87%) patients completed the study, and 10 (10/27, 37%) showed good adherence to ICT-based telehealth program with voice recognition technology, which was defined as the use of the program for 100 times or more during the study period. Nearly three-fourths of the patients had been hospitalized at least once because of HF before the enrollment (20/27, 74%); 14 patients had 1, 2 patients had 2, and 4 patients had 3 or more previous HF hospitalizations. In the total study population, there was no significant interval change in laboratory and functional outcome variables after 12 weeks of ICT-based telehealth program. In patients with good adherence to ICT-based telehealth program, there was a significant improvement in the mean uNa (103.1 to 78.1; P=.01) but not in those without (85.4 to 96.9; P=.49). Similarly, a marginal improvement in MLHFQ scores was only observed in patients with good adherence (27.5 to 21.4; P=.08) but not in their counterparts (19.0 to 19.7; P=.73). The mean 6-min walk distance and NT-proBNP were not significantly increased in patients regardless of their adherence. Conclusions Short-term application of ICT-based telehealth program with voice recognition technology showed the potential to improve uNa values and MLHFQ scores in HF patients, suggesting that better control of sodium intake and greater quality of life can be achieved by this program.
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Affiliation(s)
- Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Sae Won Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Sang Eun Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic Of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | | | | | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic Of Korea
| | - Jinwook Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic Of Korea
| | - Dae-Won Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic Of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic Of Korea
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The role of dietary sodium intake on the modulation of T helper 17 cells and regulatory T cells in patients with rheumatoid arthritis and systemic lupus erythematosus. PLoS One 2017; 12:e0184449. [PMID: 28877244 PMCID: PMC5587319 DOI: 10.1371/journal.pone.0184449] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/24/2017] [Indexed: 12/30/2022] Open
Abstract
We aimed at investigating whether the frequency and function of T helper 17 (Th17) and regulatory T cells (Treg) are affected by a restriction of dietary sodium intake in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We enrolled RA and SLE patients not receiving drugs known to increase urinary sodium excretion. Patients underwent a dietary regimen starting with a restricted daily sodium intake followed by a normal-sodium daily intake. The timepoints were identified at baseline (T0), after 3 weeks of low-sodium dietary regimen (T3), after 2 weeks of normal-sodium dietary regimen (T5). On these visits, we measured the 24-hour urinary sodium excretion, the frequency and function of Th17 and Treg cells in the peripheral blood, the serum levels of cytokines. Analysis of urinary sodium excretion confirmed adherence to the dietary regimen. In RA patients, a trend toward a reduction in the frequencies of Th17 cells over the low-sodium dietary regimen followed by an increase at T5 was observed, while Treg cells exhibited the opposite trend. SLE patients showed a progressive reduction in the percentage of Th17 cells that reached a significance at T5 compared to T0 (p = 0.01) and an increase in the percentage of Treg cells following the low-sodium dietary regimen at both T1 and T3 compared to T0 (p = 0.04 and p = 0.02, respectively). No significant apoptosis or proliferation modulation was found. In RA patients, we found a reduction at T5 compared to T0 in serum levels of both TGFβ (p = 0.0016) and IL-9 (p = 0.0007); serum IL-9 levels were also reduced in SLE patients at T5 with respect to T0 (p = 0.03). This is the first study investigating the effects of dietary sodium intake on adaptive immunity. Based on the results, we hypothesize that a restricted sodium dietary intake may dampen the inflammatory response in RA and SLE patients.
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Fitzgerald KC, Munger KL, Hartung HP, Freedman MS, Montalbán X, Edan G, Wicklein EM, Radue EW, Kappos L, Pohl C, Ascherio A. Sodium intake and multiple sclerosis activity and progression in BENEFIT. Ann Neurol 2017; 82:20-29. [PMID: 28556498 DOI: 10.1002/ana.24965] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/21/2017] [Accepted: 05/13/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether a high-salt diet, as measured by urinary sodium concentration, is associated with faster conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) and MS activity and disability. METHODS BENEFIT was a randomized clinical trial comparing early versus delayed interferon beta-1b treatment in 465 patients with a CIS. Each patient provided a median of 14 (interquartile range = 13-16) spot urine samples throughout the 5-year follow-up. We estimated 24-hour urine sodium excretion level at each time point using the Tanaka equations, and assessed whether sodium levels estimated from the cumulative average of the repeated measures were associated with clinical (conversion to MS, Expanded Disability Status Scale [EDSS]) and magnetic resonance imaging (MRI) outcomes. RESULTS Average 24-hour urine sodium levels were not associated with conversion to clinically definite MS over the 5-year follow-up (hazard ratio [HR] = 0.91, 95% confidence interval [CI] = 0.67-1.24 per 1g increase in estimated daily sodium intake), nor were they associated with clinical or MRI outcomes (new active lesions after 6 months: HR = 1.05, 95% CI = 0.97-1.13; relative change in T2 lesion volume: -0.11, 95% CI = -0.25 to 0.04; change in EDSS: -0.01, 95% CI = -0.09 to 0.08; relapse rate: HR = 0.78, 95% CI = 0.56-1.07). Results were similar in categorical analyses using quintiles. INTERPRETATION Our results, based on multiple assessments of urine sodium excretion over 5 years and standardized clinical and MRI follow-up, suggest that salt intake does not influence MS disease course or activity. Ann Neurol 2017;82:20-29.
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Affiliation(s)
- Kathryn C Fitzgerald
- Department of Neurology and Neuroimmunology, Johns Hopkins School of Medicine, Baltimore, MA
| | - Kassandra L Munger
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | | | | | - Gilles Edan
- Pontchaillou University Hospital Center, Rennes, France
| | | | - Ernst-Wilhelm Radue
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurological Clinic and Polyclinic, Departments of Medicine, Clinical Research, and Biomedicine and Biomedical Engineering, University Hospital Basel, Basel, Switzerland
| | | | - Alberto Ascherio
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Jędrusik P, Symonides B, Wojciechowska E, Gryglas A, Gaciong Z. Diagnostic value of potassium level in a spot urine sample as an index of 24-hour urinary potassium excretion in unselected patients hospitalized in a hypertension unit. PLoS One 2017; 12:e0180117. [PMID: 28662194 PMCID: PMC5491125 DOI: 10.1371/journal.pone.0180117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary hyperaldosteronism may be associated with elevated 24-hour urinary potassium excretion. We evaluated the diagnostic value of spot urine (SU) potassium as an index of 24-hour urinary potassium excretion. METHODS We measured SU and 24-hour urinary collection potassium and creatinine in 382 patients. Correlations between SU and 24-hour collections were assessed for potassium levels and potassium/creatinine ratios. We used the PAHO formula to estimate 24-hour urinary potassium excretion based on SU potassium level. The agreement between estimated and measured 24-hour urinary potassium excretion was evaluated using the Bland-Altman method. To evaluate diagnostic performance of SU potassium, we calculated areas under the curve (AUC) for SU potassium/creatinine ratio and 24-hour urinary potassium excretion estimated using the PAHO formula. RESULTS Strongest correlation between SU and 24-hour collection was found for potassium/creatinine ratio (r = 0.69, P<0.001). The PAHO formula underestimated 24-hour urinary potassium excretion by mean 8.3±18 mmol/d (95% limits of agreement -28 to +44 mmol/d). Diagnostic performance of SU potassium/creatinine ratio was borderline good only if 24-hour urinary potassium excretion was largely elevated (AUC 0.802 for 120 mmol K+/24 h) but poor with lower values (AUC 0.696 for 100 mmol K+/24 h, 0.636 for 80 mmol K+/24 h, 0.675 for 40 mmol K+/24 h). Diagnostic performance of 24-hour urinary potassium excretion estimated by the PAHO formula was excellent with values above 120 mmol/d and good with lower values (AUC 0.941 for 120 mmol K+/24 h, 0.819 for 100 mmol K+/24 h, 0.823 for 80 mmol K+/24 h, 0.836 for 40 mmol K+/24 h). CONCLUSIONS Spot urine potassium/creatinine ratio might be a marker of increased 24-hour urinary potassium excretion and a potentially useful screening test when reliable 24-hour urine collection is not available. The PAHO formula allowed estimation of the 24-hour urinary potassium excretion based on SU measurements with reasonable clinical accuracy.
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Affiliation(s)
- Piotr Jędrusik
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
| | - Bartosz Symonides
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Wojciechowska
- Student Society at the Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Adam Gryglas
- Student Society at the Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Estimation of populational 24-h urinary sodium and potassium excretion from spot urine samples. J Hypertens 2017; 35:477-486. [DOI: 10.1097/hjh.0000000000001180] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Smartphone technology facilitates dietary change in healthy adults. Nutrition 2017; 33:343-347. [DOI: 10.1016/j.nut.2016.08.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/22/2016] [Accepted: 08/06/2016] [Indexed: 11/18/2022]
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49
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Huang L, Crino M, Wu JH, Woodward M, Land MA, McLean R, Webster J, Enkhtungalag B, Nowson CA, Elliott P, Cogswell M, Toft U, Mill JG, Furlanetto TW, Ilich JZ, Hong YH, Cohall D, Luzardo L, Noboa O, Holm E, Gerbes AL, Senousy B, Pinar Kara S, Brewster LM, Ueshima H, Subramanian S, Teo BW, Allen N, Choudhury SR, Polonia J, Yasuda Y, Campbell NR, Neal B, Petersen KS. Reliable Quantification of the Potential for Equations Based on Spot Urine Samples to Estimate Population Salt Intake: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2016; 5:e190. [PMID: 27655265 PMCID: PMC5052460 DOI: 10.2196/resprot.6282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background Methods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake. Objective The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake. Methods A systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean population salt intake. Results The search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmed as eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participant data will be requested from the authors of eligible studies. Conclusions Many equations for estimating salt intake from spot urine samples have been developed and validated, although most have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broader understanding of the capacity for spot urine samples to estimate population salt intake.
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Affiliation(s)
- Liping Huang
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
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50
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Whitton C, Gay GMW, Lim RBT, Tan LWL, Lim WY, van Dam RM. Evaluation of Equations for Predicting 24-Hour Urinary Sodium Excretion from Casual Urine Samples in Asian Adults. J Nutr 2016; 146:1609-15. [PMID: 27358415 DOI: 10.3945/jn.116.232108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The collection of 24-h urine samples for the estimation of sodium intake is burdensome, and the utility of spot urine samples in Southeast Asian populations is unclear. OBJECTIVE We aimed to assess the validity of prediction equations with the use of spot urine concentrations. METHODS A sample of 144 Singapore residents of Chinese, Malay, and Indian ethnicity aged 18-79 y were recruited from the Singapore Health 2 Study conducted in 2014. Participants collected urine for 24 h in multiple small bottles on a single day. To determine the optimal collection time for a spot urine sample, a 1-mL sample was taken from a random bottle collected in the morning, afternoon, and evening. Published equations and a newly derived equation were used to predict 24-h sodium excretion from spot urine samples. RESULTS The mean ± SD concentration of sodium from the 24-h urine sample was 125 ± 53.4 mmol/d, which is equivalent to 7.2 ± 3.1 g salt. Bland-Altman plots showed good agreement at the group level between estimated and actual 24-h sodium excretion, with biases for the morning period of -3.5 mmol (95% CI: -14.8, 7.8 mmol; new equation) and 1.46 mmol (95% CI: -10.0, 13.0 mmol; Intersalt equation). A larger bias of 25.7 mmol (95% CI: 12.2, 39.3 mmol) was observed for the Tanaka equation in the morning period. The prediction accuracy did not differ significantly for spot urine samples collected at different times of the day or at a random time of day (P = 0.11-0.76). CONCLUSION This study suggests that the application of both our own newly derived equation and the Intersalt equation to spot urine concentrations may be useful in predicting group means for 24-h sodium excretion in urban Asian populations.
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Affiliation(s)
| | | | | | | | | | - Rob M van Dam
- Saw Swee Hock School of Public Health and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore; and Department of Nutrition, Harvard School of Public Health, Boston, MA
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