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Ndanuko RN, Ibrahim R, Hapsari RA, Neale EP, Raubenheimer D, Charlton KE. Association between the Urinary Sodium to Potassium Ratio and Blood Pressure in Adults: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1751-1767. [PMID: 34117485 PMCID: PMC8483973 DOI: 10.1093/advances/nmab036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/31/2020] [Accepted: 03/11/2021] [Indexed: 01/03/2023] Open
Abstract
While sodium and potassium are individually important for blood pressure (BP) regulation, the relative contribution of sodium to potassium intake has not been sufficiently investigated. This study aimed to evaluate the association between urinary sodium to potassium ratio (UNa: K) and systolic and diastolic BP in adults. A systematic review (PROSPERO; CRD42016035296) was conducted and was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three scientific databases (MEDLINE, Scopus, Web of Science) were searched to March 2020 while reference lists of included articles were further hand-searched. Randomized controlled trials (RCT), cohort and cross-sectional studies that assessed 24-h urinary excretion in adults were included. Data from eligible studies were extracted and summarized. Random effects meta-analysis was conducted on RCT data to assess standardized mean differences (SMD) in systolic and diastolic BP according to 24-h UNa: K. Thirty-nine studies were included. Meta-analysis of 5 RCTs found a lower UNa: K ratio to be associated with a significantly greater reduction in systolic and diastolic BP compared with a higher UNa: K ratio [SMD: -1.09 (95% CI: -1.91, -0.28) mmHg and -1.42 (95% CI: -2.24, -0.59) mmHg, respectively]. Heterogeneity between RCTs was observed in systolic and diastolic BP (I2 = 97%, P < 0.0001 and I2 = 98%, P < 0.0001, respectively). The current body of evidence demonstrates that a lower 24-h UNa: K ratio is associated with lower BP in adults. Dietary strategies to achieve an increase in potassium while at the same time lowering sodium would be beneficial in lowering BP.
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Affiliation(s)
| | - Rukayat Ibrahim
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia,University of Surrey, Guildford, United Kingdom
| | - Retno A Hapsari
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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Overwyk KJ, Quader ZS, Maalouf J, Bates M, Webster J, George MG, Merritt RK, Cogswell ME. Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019. Adv Nutr 2020; 11:1174-1200. [PMID: 32449929 PMCID: PMC7490163 DOI: 10.1093/advances/nmaa049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.
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Affiliation(s)
- Katherine J Overwyk
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Zerleen S Quader
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Joyce Maalouf
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Marlana Bates
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
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Petersen KS, Rae S, Venos E, Malta D, Trieu K, Santos JA, Thout SR, Webster J, Campbell NRC, Arcand J. Paucity of high-quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018). J Clin Hypertens (Greenwich) 2019; 21:307-323. [PMID: 30589204 PMCID: PMC8030311 DOI: 10.1111/jch.13450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
The purpose of this review is to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from April 2017 to March 2018. The search strategy was adapted from a previous systematic review on dietary salt and health. Identified studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisals. Overall, 6747 citations were identified by the search strategy, and 42 health outcome studies were identified. Three of the 42 studies met the criteria for methodological quality and health outcomes and underwent detailed critical appraisals and commentary. In addition, a systematic review and meta-analysis was critically appraised, although it did not strictly meet our methodological criteria. All four of the studies critically appraised found that sodium reduction improved blood pressure, especially in individuals with hypertension. In addition, sodium reduction reduced albuminuria in patients with stage 1-3 chronic kidney disease. Examination of the time course of blood pressure responses to sodium reduction revealed lowering sodium in the context of an average American diet may not produce maximal blood pressure reductions within a 4-week intervention period. This review provides further evidence of the benefit of sodium reduction for blood pressure lowering and gives insights into the subgroups of the population that may derive the greatest benefit from sodium reduction and the time course required to see benefit. Only three high-quality studies were identified during this 12-month review period, highlighting the critical need for more well-conducted rigorous studies in this area.
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Affiliation(s)
- Kristina S. Petersen
- Department of Nutritional SciencesPennsylvania State UniversityUniversity ParkPennsylvania
- The George Institute for Global HealthSydneyNew South WalesAustralia
| | - Sarah Rae
- Faculty of Health SciencesThe University of Ontario Institute of TechnologyOshawaOntarioCanada
| | - Erik Venos
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Daniela Malta
- Department of Nutritional Science, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Kathy Trieu
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joseph Alvin Santos
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Jacqui Webster
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health SciencesO'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - JoAnne Arcand
- Faculty of Health SciencesThe University of Ontario Institute of TechnologyOshawaOntarioCanada
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Evaluation of sodium intake for the prediction of cardiovascular events in Japanese high-risk patients: the ESPRIT Study. Hypertens Res 2018; 42:233-240. [DOI: 10.1038/s41440-018-0149-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 11/09/2022]
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Yamori Y, Sagara M, Arai Y, Kobayashi H, Kishimoto K, Matsuno I, Mori H, Mori M. Cross-Sectional Inverse Association of Regular Soy Intake with Insulin Resistance in Japanese Elderly. J Nutr Gerontol Geriatr 2018; 37:282-291. [PMID: 30321124 DOI: 10.1080/21551197.2018.1496512] [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: 10/28/2022]
Abstract
Levels of isoflavones, biomarkers of soy intake, in 24-hour urine (24U) were inversely related to coronary heart disease (CHD) mortality in the World Health Organization's Cardiovascular Disease and Alimentary Comparison Study. Considering 24 U isoflavone levels were highest and CHD mortality was lowest in the Japanese, who maintained the world's longest life expectancy, the association of regular soy intake with cardiometabolic risk was investigated in Japanese adults (20-49 years old) and elderly (50-79 years old). In multivariate analysis adjusted for age, sex, and drug treatments, mean 24 U isoflavone excretion was significantly inversely associated with insulin resistance in the elderly and significantly associated with blood folate and potassium in the elderly, but also positively associated with 24 U salt in the elderly. These findings indicate that low-salt soy should be recommended to improve glucose metabolism in elderly Japanese.
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Affiliation(s)
- Y Yamori
- a Institute for World Health Development , Mukogawa Women's University , Nishinomiya City , Japan
| | - M Sagara
- a Institute for World Health Development , Mukogawa Women's University , Nishinomiya City , Japan
| | - Y Arai
- b Hyogo Prefecture Health Promotion Association , Kobe City , Japan
| | - H Kobayashi
- b Hyogo Prefecture Health Promotion Association , Kobe City , Japan
| | - K Kishimoto
- b Hyogo Prefecture Health Promotion Association , Kobe City , Japan
| | - I Matsuno
- b Hyogo Prefecture Health Promotion Association , Kobe City , Japan
| | - H Mori
- a Institute for World Health Development , Mukogawa Women's University , Nishinomiya City , Japan
| | - M Mori
- c Department of Health Management, School of Health Studies, Tokai University , Kanagawa , Japan
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High central blood pressure is associated with incident cardiovascular events in treated hypertensives: the ABC-J II Study. Hypertens Res 2018; 41:947-956. [DOI: 10.1038/s41440-018-0075-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/08/2022]
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