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Güzel R, Erïhan İB, Özaydin İ, Aydin U, Bağcioğlu M, Kocaaslan R, Yildirim Ü, Sarica K. Dose-dependant preventive effect of a herbal compound on crystal formation in rat model. Arch Ital Urol Androl 2023; 95:11114. [PMID: 36971199 DOI: 10.4081/aiua.2023.11114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION To analyze the dose-dependent preventive effect of a plant-based herbal product on the new crystal formation in a rat model. MATERIALS AND METHODS A total of 42 rats were divided into 7 groups and zinc discs were placed into the bladder of rats to provide a nidus for the development of new crystal formation: Group 1: control, Group 2: 0.75 percent ethylene glycol (EG); Group 3: 0.75 percent EG plus 0.051 ml of the compound; Group 4: 0.75 percent EG plus 0.179 ml of the compound; Group 5: 0.75 percent EG plus 0.217 ml of the compound; Group 6: 0.75 percent EG plus 0.255 ml of the compound; Group 7 0.75 percent EG plus 0.332 of the compound). The analysis and comparison focused on the disc weights, changes in urinary oxalate and calcium levels, urinary pH, and the histopathologic evaluation of the inflammatory changes in the bladder after 14 days. RESULTS According to the evaluation of discs placed in the bladders of the animals, animals receiving the herbal compound on a dose-dependent basis showed a limited increase in the disc weights values after 14 days, despite a considerable increase in animals receiving EG alone (p = 0.001). Further evaluation of the increase in disc weights on a dose-dependent basis in different subgroups (from Groups 3 to 7) demonstrated that the limitation of crystal deposition began to be more prominent as the dose of herbal compound increased. This effect was more evident particularly in comparisons between group 7 and others, according to LSD multiple comparison tests (p = 0.001). As anticipated, there has been no discernible change in the weight of the discs in the control group. Although urinary calcium levels in animals of Groups 2, 6, and 7 were significantly higher than the other groups, we were not able to demonstrate a close correlation between urinary oxalate levels and the increasing dose levels. Even though mean urine pH levels were statistically considerably higher in Group 3, there was no statistically significant correlation between the oxalate and calcium levels between all groups, and no association was seen with the administration of herbal agents. The transitional epithelium between the three groups of animals' bladder samples did not exhibit any appreciable difference according to pathological analysis. CONCLUSIONS In this animal model, the treatment of the compound was successful in lowering the amount of crystal deposition surrounding the zinc discs, most noticeably at a dosage of 0.332 ml, three times per day.
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Affiliation(s)
| | | | - İsa Özaydin
- Kafkas University, Veterinary Faculty, Department of Surgery, Kars.
| | - Uğur Aydin
- Kafkas University, Veterinary Faculty, Department of Surgery, Kars.
| | - Murat Bağcioğlu
- Bahçes ̧ehir University, Medical School, Departments of Urology, Istanbul.
| | | | - Ümit Yildirim
- Kafkas University, Medical School, Departments of Urology, Kars.
| | - Kemal Sarica
- Biruni University, Medical School, Department of Urology, Istanbul.
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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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Li J, Ma H, Lei Y, Wan Q. Diagnostic value of parameters from a spot urine sample for renal potassium loss in hypokalemia. Clin Chim Acta 2020; 511:221-226. [PMID: 33096028 DOI: 10.1016/j.cca.2020.10.024] [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] [Received: 07/20/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND We assessed the value of 1) a spot urine test for diagnosing hypokalemia caused by renal potassium loss, and 2) actual 24-hour urine potassium excretion (24 hUK-actual) for diagnosing hypokalemia caused by renal potassium loss in patients treated with potassium supplementation. The study population was from Southwest China. METHODS Patients with hypokalemia were divided into 2 groups: hypokalemia caused by renal potassium loss (n = 67) and hypokalemia caused by extrarenal potassium loss (n = 63). Urine potassium concentration (UK), urine creatinine concentration (UCr), urine potassium-creatinine ratio (UK/UCr), fractional excretion of potassium (FEK), transtubular potassium concentration gradient (TTKG), and 24-h urine potassium excretion (24 hUK-calculated) were derived from spot urine samples collected on admission, before initiation of therapy. Patients received intravenous potassium chloride 0.4 or 0.6 g/h. 24 hUK-actual was detected in patients whose serum potassium did not return to normal after 24 h of therapy. RESULTS Patients with hypokalemia caused by renal potassium loss had significantly higher UK, UK/UCr, FEK, TTKG and 24 hUK-calculated compared to patients with hypokalemia caused by extrarenal potassium loss (P < 0.05). FEK predicted renal potassium loss in hypokalemia with high accuracy at a cut-off of 9.29% (sensitivity, 80.6%; specificity, 85.7%). The area under the curve for 24 hUK-actual in predicting renal potassium loss in patients with hypokalemia treated with low or high-dose potassium chloride infusion were 0.939 or 0.956, respectively. On the spot urine test, FEK showed the highest correlation with 24 hUK-actual during low or high dose potassium chloride infusion (r = 0.831, p < 0.001 or r = 0.764, p < 0.001). CONCLUSIONS FEK from a spot urine sample represents a convenient and reliable parameter to predict renal potassium loss in patients with hypokalemia.
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Affiliation(s)
- Jia Li
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China.
| | - Hongyan Ma
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
| | - Yi Lei
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
| | - Qin Wan
- Department of Endocriology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000 Sichuan, China
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Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2020; 97:42-61. [DOI: 10.1016/j.kint.2019.09.018] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/13/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
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Santos JA, Rosewarne E, Hogendorf M, Trieu K, Pillay A, Ieremia M, Naseri LTT, Tukana I, Snowdon W, Petersen K, Webster J. Estimating mean population salt intake in Fiji and Samoa using spot urine samples. Nutr J 2019; 18:55. [PMID: 31506072 PMCID: PMC6737719 DOI: 10.1186/s12937-019-0484-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa. METHODS The study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses. RESULTS A total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of - 0.92 g/day, 95% CI - 1.67 to - 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation. CONCLUSION These data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Martyna Hogendorf
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases, Fiji National University, Nasinu, Fiji
| | | | | | - Isimeli Tukana
- National Wellness Centre, Ministry of Health and Medical Services, Suva, Fiji
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, 3216 Australia
| | - Kristina Petersen
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
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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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Tuangratananon T, Wangmo S, Widanapathirana N, Pongutta S, Viriyathorn S, Patcharanarumol W, Thin K, Nagpal S, Nuevo CEL, Padmawati RS, Puyat-Murga ME, Trisnantoro L, Wangmo K, Wellappuli N, Thi PH, Anh TK, Zangmo T, Tangcharoensathien V. Implementation of national action plans on noncommunicable diseases, Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. Bull World Health Organ 2018; 97:129-141. [PMID: 30728619 PMCID: PMC6357573 DOI: 10.2471/blt.18.220483] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/06/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022] Open
Abstract
By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013–2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.
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Affiliation(s)
- Titiporn Tuangratananon
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Sangay Wangmo
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | | | - Suladda Pongutta
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Shaheda Viriyathorn
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
| | - Kouland Thin
- Swiss Agency for Development and Cooperation, Phnom Penh, Cambodia
| | - Somil Nagpal
- Global Practice on Health, Nutrition and Population, World Bank, Phnom Penh, Cambodia
| | | | - Retna Siwi Padmawati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | - Kinzang Wangmo
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | - Nalinda Wellappuli
- Management Development and Planning Unit, Ministry of Health, Colombo, Sri Lanka
| | - Phuong Hoang Thi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Tuan Khuong Anh
- Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Thinley Zangmo
- Health Promotion Division, Ministry of Health, Thimpu, Bhutan
| | - Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tivanond Road, Muang District, Nonthaburi 11000, Thailand
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Mercado CI, Cogswell ME, Loria CM, Liu K, Allen N, Gillespie C, Wang CY, de Boer IH, Wright J. Validity of predictive equations for 24-h urinary potassium excretion based on timing of spot urine collection among adults: the MESA and CARDIA Urinary Sodium Study and NHANES Urinary Sodium Calibration Study. Am J Clin Nutr 2018; 108:532-547. [PMID: 30535091 PMCID: PMC6454816 DOI: 10.1093/ajcn/nqy138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/21/2018] [Indexed: 12/30/2022] Open
Abstract
Background 24-h urine collections are the suggested method to measure daily urinary potassium excretion (uK) but are costly and burdensome to implement. Objective This study tested how well existing equations with the use of spot urine samples can estimate 24-h uK and if accuracy varies by timing of spot urine collection, age, race, or sex. Design This cross-sectional study used data from 407 participants aged 18-39 y from the Washington, DC area in 2011 and 554 participants aged 45-79 y from Chicago in 2013. Spot urine samples were collected in individual containers for 24 h, and 1 for each timed period (morning, afternoon, evening, and overnight) was selected. For each selected timed spot urine, 24-h uK was predicted through the use of published equations. Difference (bias) between predicted and measured 24-h uK was calculated for each timed period and within age, race, and sex subgroups. Individual-level differences were assessed through the use of Bland-Altman plots and correlation tests. Results For all equations, regardless of the timing of spot urine, mean bias was usually significantly different than 0. No one prediction equation was unbiased across all sex, race, and age subgroups. With the use of the Kawasaki and Tanaka equations, 24-h uK was overestimated at low levels and underestimated at high levels, whereas observed differential bias with the Mage equation was in the opposite direction. Depending on prediction equation and timing of urine sample, 61-75% of individual 24-h uKs were misclassified among 500-mg incremental categories from <1500 to ≥3000 mg. Correlations between predicted and measured 24-h uK were poor to moderate (0.19-0.71). Conclusion Because predicted 24-h uK accuracy varies by timing of spot urine collection, published prediction equations, and within age-race-sex subgroups, study results making use of predicted 24-h uK in association with health outcomes should be interpreted with caution. It is possible that a more accurate prediction equation can be developed leading to different results.
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Affiliation(s)
- Carla I Mercado
- Divisions of Diabetes Translation and National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary E Cogswell
- Divisions of National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
| | - Catherine M Loria
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Norrina Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Cathleen Gillespie
- Divisions of National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
| | - Chia-Yih Wang
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ian H de Boer
- Division of Nephrology, University of Washington, Seattle, WA
| | - Jacqueline Wright
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Petersen KS, Wu JHY, Webster J, Grimes C, Woodward M, Nowson CA, Neal B. Estimating mean change in population salt intake using spot urine samples. Int J Epidemiol 2018; 46:1542-1550. [PMID: 28338706 DOI: 10.1093/ije/dyw239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background Spot urine samples are easier to collect than 24-h urine samples and have been used with estimating equations to derive the mean daily salt intake of a population. Whether equations using data from spot urine samples can also be used to estimate change in mean daily population salt intake over time is unknown. We compared estimates of change in mean daily population salt intake based upon 24-h urine collections with estimates derived using equations based on spot urine samples. Methods Paired and unpaired 24-h urine samples and spot urine samples were collected from individuals in two Australian populations, in 2011 and 2014. Estimates of change in daily mean population salt intake between 2011 and 2014 were obtained directly from the 24-h urine samples and by applying established estimating equations (Kawasaki, Tanaka, Mage, Toft, INTERSALT) to the data from spot urine samples. Differences between 2011 and 2014 were calculated using mixed models. Results A total of 1000 participants provided a 24-h urine sample and a spot urine sample in 2011, and 1012 did so in 2014 (paired samples n = 870; unpaired samples n = 1142). The participants were community-dwelling individuals living in the State of Victoria or the town of Lithgow in the State of New South Wales, Australia, with a mean age of 55 years in 2011. The mean (95% confidence interval) difference in population salt intake between 2011 and 2014 determined from the 24-h urine samples was -0.48g/day (-0.74 to -0.21; P < 0.001). The corresponding result estimated from the spot urine samples was -0.24 g/day (-0.42 to -0.06; P = 0.01) using the Tanaka equation, -0.42 g/day (-0.70 to -0.13; p = 0.004) using the Kawasaki equation, -0.51 g/day (-1.00 to -0.01; P = 0.046) using the Mage equation, -0.26 g/day (-0.42 to -0.10; P = 0.001) using the Toft equation, -0.20 g/day (-0.32 to -0.09; P = 0.001) using the INTERSALT equation and -0.27 g/day (-0.39 to -0.15; P < 0.001) using the INTERSALT equation with potassium. There was no evidence that the changes detected by the 24-h collections and estimating equations were different (all P > 0.058). Separate analysis of the unpaired and paired data showed that detection of change by the estimating equations was observed only in the paired data. Conclusions All the estimating equations based upon spot urine samples identified a similar change in daily salt intake to that detected by the 24-h urine samples. Methods based upon spot urine samples may provide an approach to measuring change in mean population salt intake, although further investigation in larger and more diverse population groups is required.
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Affiliation(s)
- Kristina S Petersen
- George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
| | - Jason H Y Wu
- George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
| | - Jacqui Webster
- George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
| | - Carley Grimes
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia
| | - Mark Woodward
- George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia.,George Institute for Global Health, University of Oxford, Oxford, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Caryl A Nowson
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong, VIC 3220, Australia
| | - Bruce Neal
- George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Imperial College London, London, UK
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Bongers CCWG, Alsady M, Nijenhuis T, Tulp ADM, Eijsvogels TMH, Deen PMT, Hopman MTE. Impact of acute versus prolonged exercise and dehydration on kidney function and injury. Physiol Rep 2018; 6:e13734. [PMID: 29890037 PMCID: PMC5995308 DOI: 10.14814/phy2.13734] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/17/2023] Open
Abstract
Exercise and dehydration may be associated with a compromised kidney function and potential signs of kidney injury. However, the kidney responses to exercise of different durations and hypohydration levels are not yet known. Therefore, we aimed to compare the effects of acute versus prolonged exercise and dehydration on estimated glomerular filtration rate (eGFR) and kidney injury biomarkers in healthy male adults. A total of 35 subjects (23 ± 3 years) were included and invited for two study visits. Visit 1 consisted of a maximal cycling test. On Visit 2, subjects performed a submaximal exercise test at 80% of maximal heart rate until 3% hypohydration. Blood and urine samples were taken at baseline, after 30 min of exercise (acute effects; low level of hypohydration) and after 150 min of exercise or when 3% hypohydration was achieved (prolonged effects, high level of hypohydration). Urinary outcome parameters were corrected for urinary cystatin C, creatinine, and osmolality. Subjects dehydrated on average 0.6 ± 0.3% and 2.9 ± 0.7% after acute and prolonged exercise, respectively (P < 0.001). The eGFRcystatin C did not differ between baseline and acute exercise (118 ± 11 vs. 116 ± 12 mL/min/1.73 m2 , P = 0.12), whereas eGFRcystatin C was significantly lower after prolonged exercise (103 ± 16 mL/min/1.73 m2 , P < 0.001). We found no difference in osmolality corrected uKIM1 concentrations after acute and prolonged exercise (P > 0.05), and elevated osmolality corrected uNGAL concentrations after acute and prolonged exercise (all P-values < 0.05). In conclusion, acute exercise did barely impact on eGFRcystatin C and kidney injury biomarkers, whereas prolonged exercise is associated with a decline in eGFRcystatin C and increased biomarkers for kidney injury.
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Affiliation(s)
- Coen C. W. G. Bongers
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Mohammad Alsady
- Department of PhysiologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Tom Nijenhuis
- Department of NephrologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Anouk D. M. Tulp
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Research Institute for Sports and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Peter M. T. Deen
- Department of PhysiologyRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Maria T. E. Hopman
- Department of PhysiologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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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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Abstract
OBJECTIVE To compare estimates of mean population salt intake in North and South India derived from spot urine samples versus 24-h urine collections. METHODS In a cross-sectional survey, participants were sampled from slum, urban and rural communities in North and in South India. Participants provided 24-h urine collections, and random morning spot urine samples. Salt intake was estimated from the spot urine samples using a series of established estimating equations. Salt intake data from the 24-h urine collections and spot urine equations were weighted to provide estimates of salt intake for Delhi and Haryana, and Andhra Pradesh. RESULTS A total of 957 individuals provided a complete 24-h urine collection and a spot urine sample. Weighted mean salt intake based on the 24-h urine collection, was 8.59 (95% confidence interval 7.73-9.45) and 9.46 g/day (8.95-9.96) in Delhi and Haryana, and Andhra Pradesh, respectively. Corresponding estimates based on the Tanaka equation [9.04 (8.63-9.45) and 9.79 g/day (9.62-9.96) for Delhi and Haryana, and Andhra Pradesh, respectively], the Mage equation [8.80 (7.67-9.94) and 10.19 g/day (95% CI 9.59-10.79)], the INTERSALT equation [7.99 (7.61-8.37) and 8.64 g/day (8.04-9.23)] and the INTERSALT equation with potassium [8.13 (7.74-8.52) and 8.81 g/day (8.16-9.46)] were all within 1 g/day of the estimate based upon 24-h collections. For the Toft equation, estimates were 1-2 g/day higher [9.94 (9.24-10.64) and 10.69 g/day (9.44-11.93)] and for the Kawasaki equation they were 3-4 g/day higher [12.14 (11.30-12.97) and 13.64 g/day (13.15-14.12)]. CONCLUSION In urban and rural areas in North and South India, most spot urine-based equations provided reasonable estimates of mean population salt intake. Equations that did not provide good estimates may have failed because specimen collection was not aligned with the original method.
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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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14
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Bongers CCWG, Alsady M, Nijenhuis T, Hartman YAW, Eijsvogels TMH, Deen PMT, Hopman MTE. Impact of acute versus repetitive moderate intensity endurance exercise on kidney injury markers. Physiol Rep 2017; 5:e13544. [PMID: 29263119 PMCID: PMC5742704 DOI: 10.14814/phy2.13544] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022] Open
Abstract
Exercise may lead to kidney injury through several mechanisms. Urinary Kidney Injury Molecule-1 (uKIM1) and Neutrophil Gelatinase-Associated Lipocalin (uNGAL) are known biomarkers for acute kidney injury, but their response to repetitive exercise remains unknown. We examined the effects of a single versus repetitive bouts of exercise on markers for kidney injury in a middle-aged population. Sixty subjects (aged 29-78 years, 50% male) were included and walked 30, 40 or 50 km for three consecutive days. At baseline and after exercise day 1 and 3, a urine sample was collected to determine uNGAL and uKIM1. Furthermore, urinary cystatin C, creatinine, and osmolality were used to correct for dehydration-related changes in urinary concentration. Baseline uNGAL was 9.2 (5.2-14.7) ng/mL and increased to 20.7 (11.0-37.2) ng/mL and 14.2(8.0-26.3) ng/mL after day 1 and day 3, respectively, (P ≤ 0.001). Baseline uKIM1 concentration was 2.6 (1.4-6.0) ng/mL and increased to 5.2 (2.4-9.1) ng/mL (P = 0.002) after day 1, whereas uKIM1 was not different from baseline at day 3 (2.9 [1.4-6.4] ng/mL (P = 0.52)). Furthermore, both uNGAL and uKIM1 levels were higher after day 1 compared to day 3 (P < 0.01). When corrected for urinary cystatin C, creatinine, and osmolality, uNGAL demonstrated a similar response compared to the uncorrected data, whereas differences in uKIM1 between baseline, day 1 and day 3 (Ptime = 0.63) were no longer observed for cystatin C and creatinine corrected data. A single bout of prolonged exercise significantly increased uNGAL concentration, whereas no changes in uKIM1 were found. Repetitive bouts of exercise show that there is no cumulative effect of kidney injury markers.
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Affiliation(s)
- Coen C. W. G. Bongers
- Department of PhysiologyRadboud Institute for Health SciencesRadboud university medical centerNijmegenThe Netherlands
| | - Mohammad Alsady
- Department of PhysiologyRadboud Institute for Molecular Life SciencesRadboud university medical centerNijmegenThe Netherlands
| | - Tom Nijenhuis
- Department of NephrologyRadboud Institute for Molecular Life SciencesRadboud university medical centerNijmegenThe Netherlands
| | - Yvonne A. W. Hartman
- Department of PhysiologyRadboud Institute for Health SciencesRadboud university medical centerNijmegenThe Netherlands
| | - Thijs M. H. Eijsvogels
- Department of PhysiologyRadboud Institute for Health SciencesRadboud university medical centerNijmegenThe Netherlands
- Research Institute for Sports and Exercise SciencesLiverpool John Moores UniversityLiverpoolUnited Kingdom
| | - Peter M. T. Deen
- Department of PhysiologyRadboud Institute for Molecular Life SciencesRadboud university medical centerNijmegenThe Netherlands
| | - Maria T. E. Hopman
- Department of PhysiologyRadboud Institute for Health SciencesRadboud university medical centerNijmegenThe Netherlands
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Strohm D, Ellinger S, Leschik-Bonnet E, Maretzke F, Heseker H. Revised Reference Values for Potassium Intake. ANNALS OF NUTRITION & METABOLISM 2017; 71:118-124. [PMID: 28803230 PMCID: PMC5639605 DOI: 10.1159/000479705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nutrition societies of Germany, Austria and Switzerland have revised the reference values for potassium intake in January 2017. METHODS For adults, the estimated value was based on the 24-h urinary potassium excretion and on preventive considerations regarding hypertension and stroke. The estimated values for children and adolescents were extrapolated from the adult estimated value considering differences in body mass. For infants aged 0 to under 4 months, the estimated value was set based on the potassium intake via breast milk. From this reference value, the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the potassium loss via breast milk. RESULTS The estimated values for potassium intake are set at 400 mg/day for breastfed infants aged 0 to under 4 months, 600 mg/day for infants aged 4 to under 12 months, 1,100-4,000 mg/day for children and adolescents, 4,000 mg/day for adults and pregnant women and 4,400 mg/day for lactating women. CONCLUSIONS The consumption of potassium-rich foods should be generally increased. Supplemental intake beyond the estimated values has no health benefit and is therefore not recommended.
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Affiliation(s)
| | - Sabine Ellinger
- Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Moenchengladbach, Germany
| | | | | | - Helmut Heseker
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
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16
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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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Okita S, Daitoku S, Abe M, Arimura E, Setoyama H, Koriyama C, Ushikai M, Kawaguchi H, Horiuchi M. Potential predictors of susceptibility to occupational stress in Japanese novice nurses - a pilot study. Environ Health Prev Med 2017; 22:20. [PMID: 29165135 PMCID: PMC5664583 DOI: 10.1186/s12199-017-0641-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/30/2017] [Indexed: 01/21/2023] Open
Abstract
Background Occupational stress is a known factor behind employee resignations; thus, early identification of individuals prone to such stress is important. Accordingly, in this pilot study we evaluated potential predictors of susceptibility to occupational stress in Japanese novice nurses. Methods Forty-two female novice nurses at Kagoshima University Hospital were recruited for the study population. Each underwent physical health and urinary examinations, and completed a lifestyle questionnaire at the time of job entry. Each also completed a Brief Job Stress Questionnaire (BJSQ), related to mental health status, at job entry and 5 months post-entry. Psychological stress, somatic symptoms, and combined BJSQ scores were determined for each time point. Results All three stress condition scores had significantly decreased at 5 months post-entry, suggesting occupational stress. Systolic blood pressure (r = −0.324, p < 0.05) and urinary sodium (r = −0.313, p < 0.05) were significantly negatively correlated with combined BJSQ score at 5 months post-entry. Post-entry stress condition scores were significantly low in subjects reporting substantial 1-year body weight change (≤ ± 3 kg) and short times between dinner and bedtimes (≤2 h), though baseline stress condition scores were not. Urinary sodium concentration, 1-year body weight change, and pre-sleep evening meals were then targeted for multivariate analysis, and confirmed as independent explanatory variables for post-entry stress condition scores. Conclusions One-year body weight change, times between dinner and bedtimes, and urinary sodium concentration are promising potential predictors of susceptibility to occupational stress, and should be further investigated in future research. Trial registration ISRCTN ISRCTN17516023. Retrospectively registered 7 December 2016.
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Affiliation(s)
- Shinobu Okita
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan
| | - Satoshi Daitoku
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan
| | - Masaharu Abe
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan
| | - Emi Arimura
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan.,Department of Life and Environmental Science, Kagoshima Prefectural College, Kagoshima, Japan
| | - Hitoshi Setoyama
- Center for Education of Medical Residents, Kagoshima University Hospital, Kagoshima, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Miharu Ushikai
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan
| | - Hiroaki Kawaguchi
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan
| | - Masahisa Horiuchi
- Department of Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan.
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Estimation of populational 24-h urinary sodium and potassium excretion from spot urine samples: evaluation of four formulas in a large national representative population. J Hypertens 2017; 35:1119-1120. [PMID: 28353550 DOI: 10.1097/hjh.0000000000001317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Vinceti M, Filippini T, Crippa A, de Sesmaisons A, Wise LA, Orsini N. Meta-Analysis of Potassium Intake and the Risk of Stroke. J Am Heart Assoc 2016; 5:JAHA.116.004210. [PMID: 27792643 PMCID: PMC5121516 DOI: 10.1161/jaha.116.004210] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The possibility that lifestyle factors such as diet, specifically potassium intake, may modify the risk of stroke has been suggested by several observational cohort studies, including some recent reports. We performed a systematic review and meta‐analysis of existing studies and assessed the dose–response relation between potassium intake and stroke risk. Methods and Results We reviewed the observational cohort studies addressing the relation between potassium intake, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016. We carried out a meta‐analysis of 16 cohort studies based on the relative risk (RR) of stroke comparing the highest versus lowest intake categories. We also plotted a pooled dose–response curve of RR of stroke according to potassium intake. Analyses were performed with and without adjustment for blood pressure. Relative to the lowest category of potassium intake, the highest category of potassium intake was associated with a 13% reduced risk of stroke (RR=0.87, 95% CI 0.80–0.94) in the blood pressure–adjusted analysis. Summary RRs tended to decrease when original estimates were unadjusted for blood pressure. Analysis for stroke subtypes yielded comparable results. In the spline analysis, the pooled RR was lowest at 90 mmol of potassium daily intake (RRs=0.78, 95% CI 0.70–0.86) in blood pressure–adjusted analysis, and 0.67 (95% CI 0.57–0.78) in unadjusted analysis. Conclusions Overall, this dose–response meta‐analysis confirms the inverse association between potassium intake and stroke risk, with potassium intake of 90 mmol (≈3500 mg)/day associated with the lowest risk of stroke.
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Affiliation(s)
- Marco Vinceti
- CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Tommaso Filippini
- CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Crippa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Elijovich F, Weinberger MH, Anderson CAM, Appel LJ, Bursztyn M, Cook NR, Dart RA, Newton-Cheh CH, Sacks FM, Laffer CL. Salt Sensitivity of Blood Pressure: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e7-e46. [PMID: 27443572 DOI: 10.1161/hyp.0000000000000047] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Klenow S, Thamm M, Mensink GBM. Sodium intake in Germany estimated from sodium excretion measured in spot urine samples. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0075-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Urinary 24-h creatinine excretion in adults and its use as a simple tool for the estimation of daily urinary analyte excretion from analyte/creatinine ratios in populations. Eur J Clin Nutr 2015. [PMID: 26220572 DOI: 10.1038/ejcn.2015.121] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND/OBJECTIVES The assessment of urinary excretion of specific nutrients (e.g. iodine, sodium) is frequently used to monitor a population's nutrient status. However, when only spot urines are available, always a risk of hydration-status-dependent dilution effects and related misinterpretations exists. The aim of the present study was to establish mean values of 24-h creatinine excretion widely applicable for an appropriate estimation of 24-h excretion rates of analytes from spot urines in adults. SUBJECTS/METHODS Twenty-four-hour creatinine excretion from the formerly representative cross-sectional German VERA Study (n=1463, 20-79 years old) was analysed. Linear regression analysis was performed to identify the most important influencing factors of creatinine excretion. In a subsample of the German DONALD Study (n=176, 20-29 years old), the applicability of the 24-h creatinine excretion values of VERA for the estimation of 24-h sodium and iodine excretion from urinary concentration measurements was tested. RESULTS In the VERA Study, mean 24-h creatinine excretion was 15.4 mmol per day in men and 11.1 mmol per day in women, significantly dependent on sex, age, body weight and body mass index. Based on the established 24-h creatinine excretion values, mean 24-h iodine and sodium excretions could be estimated from respective analyte/creatinine concentrations, with average deviations <10% compared with the actual 24-h means. CONCLUSIONS The present mean values of 24-h creatinine excretion are suggested as a useful tool to derive realistic hydration-status-independent average 24-h excretion rates from urinary analyte/creatinine ratios. We propose to apply these creatinine reference means routinely in biomarker-based studies aiming at characterizing the nutrient or metabolite status of adult populations by simply measuring metabolite/creatinine ratios in spot urines.
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