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Shimoyama M, Kawamoto S, Nakatani Y, Banba N, Nagashima Y, Tomoe T, Sugiyama T, Ueno A, Kitahara K, Kawabe A, Otani N, Sugimura H, Yasu T. Effects of salt intake reduction by urinary sodium to potassium ratio self-monitoring method. Hypertens Res 2024; 47:1852-1860. [PMID: 38600280 DOI: 10.1038/s41440-024-01655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
Effective and feasible educational methods are needed to control salt intake. We performed a single-center, non-randomized controlled study to investigate the effectiveness and feasibility of self-monitoring using a urinary sodium/potassium (Na/K) ratio-measuring device in patients with difficulty in reducing salt intake. This study included 160 patients with hypertension, chronic kidney disease, or heart disease who were followed up in the outpatient clinic of the Dokkyo Medical University Nikko Medical Center. Urinary Na/K ratio measuring Na/K ratio meter were loaned for 2-6 weeks to the treatment (T) group (n = 80) and not to the patients in the control (C) group (n = 80). In the T group, patients were instructed to measure the urinary Na/K ratio at least three times a day and maintain a Na/K ratio below 2.0. Salt reduction education and home blood pressure measurement guidance continued in both groups. The mean device loan period in the T group was 25.1 days, the mean number of measurements was 3.0 times/day, and the proportion of patients achieving three measurements per day was 48.8% (39/80). Self-monitoring using the urinary Na/K ratio meter successfully reduced salt intake by -1.9 g/day at the second visit (p < 0.001) in the T group. In contrast, no change was observed over time in the C group. Self-monitoring using the urinary Na/K ratio meter successfully reduced salt intake in patients with difficulty reducing salt intake.
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Affiliation(s)
- Masahiro Shimoyama
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
| | - Shinya Kawamoto
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan.
| | - Yuki Nakatani
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Nobuyuki Banba
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Yasuko Nagashima
- Department of Diabetes and Endocrinology, Dokkyo Medical University Nikko Medical Center, Nikko, Tochigi, Japan
| | - Takashi Tomoe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
| | - Takushi Sugiyama
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
| | - Asuka Ueno
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
| | - Keijiro Kitahara
- Department of Cardiology, Dokkyo Medical University, Nikko Medical Center, Nikko, Tochigi, Japan
| | - Atsuhiko Kawabe
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
| | - Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University, Nikko Medical Center, Nikko, Tochigi, Japan
| | - Hiroyuki Sugimura
- Department of Cardiology, Dokkyo Medical University, Nikko Medical Center, Nikko, Tochigi, Japan
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center, 145-1 Moritomo, Nikko, Tochigi, 321 -1298, Japan
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Fresh Beef and Lamb Consumption in Relation to Nutrient Intakes and Markers of Nutrition and Health Status among the Population Aged 5-90 Years in Ireland. Nutrients 2023; 15:nu15020313. [PMID: 36678183 PMCID: PMC9863121 DOI: 10.3390/nu15020313] [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: 11/01/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
The dietary role of meat is under scrutiny for health and environmental reasons, yet a growing body of evidence proposes that advice to limit red meat consumption is unnecessarily restrictive. The aim of this study was to investigate the role of 'fresh beef and lamb' in the diet of the population (5-90 years) in Ireland and its association with markers of nutrition and health status. Analyses are based on data from three nationally representative dietary surveys in the Republic of Ireland. Dietary intake data were estimated using food records, and nutrient intakes were estimated based on UK and Irish food composition tables. Biochemical samples were collected and analysed using standard procedures. 'Fresh beef and lamb' (defined as beef/lamb that had not undergone any preserving process other than chilling/freezing/quick-freezing) was consumed by 68-84% of the population and intakes ranged from 19 to 43 g/d across age groups. It made important contributions to intakes of protein, monounsaturated fat, vitamins D, B12, niacin, iron and zinc while also contributing relatively small proportions of total fat, saturated fat and salt. Higher consumption of 'fresh beef and lamb' was associated with higher intakes of protein, niacin, vitamins B6, B12, zinc and potassium (but also total fat) and lower intakes of carbohydrate and total sugars (but also dietary fibre). In adults, older adults and WCBA, higher consumption of 'fresh beef and lamb' was not associated with increased risk factors of cardio-metabolic diseases nor was it associated with better or poorer nutritional status for vitamins D, B12 or iron. This study adds to the evidence base on the contribution of 'fresh beef and lamb' in the diet and may be useful to policymakers updating guidance for healthy diets from sustainable food systems.
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Hattori M, Rahman A, Kidoguchi S, Jahan N, Fujisawa Y, Morisawa N, Ohsaki H, Kobara H, Masaki T, Hossain A, Steeve A, Nishiyama A. Association of Antihypertensive Effects of Esaxerenone with the Internal Sodium Balance in Dahl Salt-Sensitive Hypertensive Rats. Int J Mol Sci 2022; 23:ijms23168915. [PMID: 36012182 PMCID: PMC9408866 DOI: 10.3390/ijms23168915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background: The nonsteroidal mineralocorticoid receptor blocker esaxerenone is effective in reducing blood pressure (BP). Objective: In this study, we investigated esaxerenone-driven sodium homeostasis and its association with changes in BP in Dahl salt-sensitive (DSS) hypertensive rats. Methods: In the different experimental setups, we evaluated BP by a radiotelemetry system, and sodium homeostasis was determined by an approach of sodium intake (food intake) and excretion (urinary excretion) in DSS rats with a low-salt diet (0.3% NaCl), high-salt diet (HSD, 8% NaCl), HSD plus 0.001% esaxerenone (w/w), and HSD plus 0.05% furosemide. Results: HSD-fed DSS rats showed a dramatic increase in BP with a non-dipper pattern, while esaxerenone treatment, but not furosemide, significantly reduced BP with a dipper pattern. The cumulative sodium excretion in the active period was significantly elevated in esaxerenone- and furosemide-treated rats compared with their HSD-fed counterparts. Sodium content in the skin, skinned carcass, and total body tended to be lower in esaxerenone-treated rats than in their HSD-fed counterparts, while these values were unchanged in furosemide-treated rats. Consistently, sodium balance tended to be reduced in esaxerenone-treated rats during the active period. Histological evaluation showed that esaxerenone, but not furosemide, treatment attenuated glomerulosclerosis, tubulointerstitial fibrosis, and urinary protein excretion induced by high salt loading. Conclusions: Collectively, these findings suggest that an esaxerenone treatment-induced reduction in BP and renoprotection are associated with body sodium homeostasis in salt-loaded DSS rats.
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Affiliation(s)
- Mai Hattori
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Asadur Rahman
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Correspondence: (A.R.); (A.N.); Tel.: +81-87-891-2125 (A.R. & A.N.); Fax: +81-87-891-2126 (A.R. & A.N.)
| | - Satoshi Kidoguchi
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Nourin Jahan
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Yoshihide Fujisawa
- Life Science Research Center, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Norihiko Morisawa
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe 654-0142, Hyogo, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akram Hossain
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akumwami Steeve
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Department of Anesthesiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
- Correspondence: (A.R.); (A.N.); Tel.: +81-87-891-2125 (A.R. & A.N.); Fax: +81-87-891-2126 (A.R. & A.N.)
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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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Consideration of the reference value and number of measurements of the urinary sodium-to-potassium ratio based on the prevalence of untreated home hypertension: TMM Cohort Study. Hypertens Res 2022; 45:866-875. [PMID: 35043014 PMCID: PMC9010298 DOI: 10.1038/s41440-021-00843-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/18/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Abstract
The sodium-to-potassium (Na/K) ratio is known to be associated with blood pressure (BP). However, no reference value has been established since the urinary Na/K (uNa/K) ratio is known to have diurnal and day-to-day variations. Therefore, we investigated the number of days required to yield a better association between the morning uNa/K ratio and home BP (HBP) and determined a morning uNa/K ratio value that can be used as a reference value in participants who are not taking antihypertensive medication. This was a cross-sectional study using data from the Tohoku Medical Megabank Project Cohort Study. A total of 3122 participants borrowed HBP and uNa/K ratio monitors for 10 consecutive days. We assessed the relationship between the morning uNa/K ratio from 1 day to 10 days and home hypertension (HBP ≥ 135/85 mmHg) using multiple logistic regression models. Although a 1-day measurement of the morning uNa/K ratio was positively associated with home hypertension, multiple measurements of the morning uNa/K ratio were strongly related to home hypertension. The average morning uNa/K ratio was relatively stable after 3 days (adjusted odds ratio of home hypertension per unit increase in the uNa/K ratio for more than 3 days: 1.19-1.23). In conclusion, there was no threshold for the uNa/K ratio, and the morning uNa/K ratio was linearly associated with home hypertension. The Na/K ratio 2.0 calculated from the Dietary Reference Intakes for Japanese might be a good indication. Regarding the stability of the association between the morning uNa/K ratio and BP, more than 3 days of measurements is desirable.
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Alwis US, Verbakel I, Pauwaert K, Delanghe J, Dossche L, Van Camp J, Roggeman S, Everaert K. The Influence of Salt Sensitivity Phenotype on Sodium Excretion and Diuresis: A Chrononutrition Pilot Study. Int J Clin Pract 2022; 2022:9608962. [PMID: 35685516 PMCID: PMC9159230 DOI: 10.1155/2022/9608962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chrononutrition studies on interaction of diet/nutrients on endogenous circadian clocks and meal timing on metabolic homeostasis may be of importance in the management of nocturnal polyuria (NP), owing to loss of circadian rhythm in nighttime urination. Dietary salt restriction is an increasingly popular lifestyle recommendation for NP patients. AIM This study aims to evaluate the effect of an acute salt load on diuresis and to study the phenomenon of salt sensitivity. Methodology. Young, healthy men (n = 21, fasted and sober) ingested 500 ml of water on the control day and 8 g and 12 g of salt with water (500 ml) on two other days. Blood and urine samples were collected at 0 hrs, 2 hrs, and 4 hrs and voided volumes were recorded. Diuresis, serum and urine osmolality, sodium, potassium, urea, and creatinine were measured. Salt sensitivity was determined based on the rate of sodium excretion. RESULTS Compared to 8 g, ingestion of 12 g of salt significantly increased diuresis after 4 hrs. Pure water load induced fast diuresis, whereas salt and water load initially reduced diuresis and promoted late increase in diuresis. The total voided volume was significantly lower in the salt sensitive individuals. CONCLUSION Taken together, salt sensitivity profile and type and time of fluid intake are important considerations to build effective personalized lifestyle recommendations for NP patients, which needs further investigation.
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Affiliation(s)
| | - Irina Verbakel
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Kim Pauwaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University, 9000 Ghent, Belgium
| | - John Van Camp
- Department of Food Technology, Safety and Health, Ghent University, 9000 Ghent, Belgium
| | - Saskia Roggeman
- Research and Policy Department, Psychiatric Center Sint-Jan-Baptist, 9060 Zelzate, Belgium
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
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Liabsuetrakul T, Srisook S, Jandee K, Mori R. Reliability of a portable device for measuring spot urinary Na/K ratios among pregnant Thai women: a cross-sectional study. HYPERTENSION RESEARCH IN PREGNANCY 2021. [DOI: 10.14390/jsshp.hrp2021-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Saiphon Srisook
- Clinical Chemistry Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University
| | - Kasemsak Jandee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
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Sumikama Y, Aoyama H, Isu N, Nagata M, Kato T, Tsukahara T. Development of a Method for Estimating Dietary Salt Intake Using the Overnight Urinary Sodium/Potassium Ratio. J Clin Med Res 2021; 13:479-486. [PMID: 34691322 PMCID: PMC8510648 DOI: 10.14740/jocmr4596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background There are many patients who need to restrict and assess salt in their diet. However, it is difficult to estimate daily salt intake accurately and easily. Therefore, a method for estimating dietary salt intake using the overnight urinary sodium (Na)/potassium (K) ratio was developed. Methods The study involved 43 healthy adults (13 males, 30 females). From 2018 to 2020, subjects consumed a salt-adjusted diet for 11 - 30 days continuously, and overnight urine was collected daily. Using the previous day's salt intake as the objective variable, an equation for estimating the salt intake was developed using a general linear model. To verify the accuracy of the estimating equation, the estimated salt intake of the previous day was calculated using our equation and Tanaka's equation, which is an estimating equation from spot urine widely used in clinical practice and epidemiological studies to estimate dietary salt intake, and they were compared with the actual salt intake. Results The results of the analysis showed that model 1 (previous day's salt intake (g) = 3.62 + 0.64 × urinary Na/K ratio + 0.18 × conductivity (mS/cm) - 0.43 × sex (male 0, female 1)) was the optimal model. Then, salt intake was estimated using model 1 and Tanaka's equation, and compared with actual salt intake. The Pearson's product-moment correlation coefficient between the actual and estimated salt intake was r = 0.618 (P < 0.001) and r = 0.573 (P < 0.001) for model 1 estimates and Tanaka's equation estimates, respectively. The percentages of errors within ±30% from the actual salt intake were 64.2% and 58.4% for model 1 and Tanaka's equation, respectively. Conclusion An equation for estimating salt intake was developed using the Na/K ratio and conductivity of overnight urine. Although the applicability of this method to hypertensive patients and the elderly has not been studied and needs to be clarified in the future, the estimating equation developed is simple and may be a useful method for daily monitoring of dietary salt intake.
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Affiliation(s)
- Yuta Sumikama
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| | | | | | | | - Takumi Kato
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
| | - Takayoshi Tsukahara
- Graduate School of Nutritional Sciences, Nagoya University of Arts and Sciences, Aichi, Japan
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Yamazato M, Sakima A, Ishida A, Kohagura K, Matayoshi T, Tana T, Tamashiro M, Hata Y, Naka T, Nakamura Y, Ohya Y. Salt and potassium intake evaluated with spot urine and brief questionnaires in combination with blood pressure control status in hypertensive outpatients in a real-world setting. Hypertens Res 2021; 44:1316-1325. [PMID: 34345011 DOI: 10.1038/s41440-021-00707-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/02/2021] [Accepted: 06/16/2021] [Indexed: 11/09/2022]
Abstract
Reducing salt and increasing potassium intake are recommended lifestyle modifications for patients with hypertension. The estimated 24-h urinary salt excretion value from spot urine using Tanaka's formula and the salt check-sheet scores, questionnaire-based scores of salt intake, are practical indices of daily salt intake. However, few studies have evaluated salt intake with these methods in hypertensive outpatients. We examined salt and potassium intake with the spot urine method and the salt check-sheet scores of hypertensive outpatients in a multi-facility, real-world setting and examined whether the salt or potassium intake evaluated with these methods related to inadequate blood pressure control. Hypertensive outpatients from 12 medical facilities in the Okinawa prefecture were enrolled from November 2011 to April 2014 (n = 1559, mean age 63.9 years, 46% women). The mean blood pressure, urinary salt excretion value, urinary potassium excretion value, and total score on the salt check-sheet were 129/75 mmHg, 8.7 g/day, 1.6 g/day, and 10.4 points, respectively. The urinary salt excretion value and total score on the salt check-sheet but not urinary potassium excretion value were associated with inadequate blood pressure control (≥140/90 mmHg). Higher body mass index, estimated glomerular filtration rate, urinary potassium excretion value, total score on the salt check-sheet, and presence of inadequate blood pressure control were associated with high urinary salt excretion (≥10.2 g/day). In conclusion, hypertensive outpatients with high urinary salt excretion values estimated using Tanaka's formula or with high scores on the salt check sheet may be candidates for more intensive salt reduction guidance.
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Affiliation(s)
- Masanobu Yamazato
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Atsushi Sakima
- Health Administration Center, University of the Ryukyus, Okinawa, Japan
| | - Akio Ishida
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
| | - Tetsutaro Matayoshi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | | | | | | | | | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Naser AM, He FJ, Rahman M, Campbell NR. Spot Urine Formulas to Estimate 24-Hour Urinary Sodium Excretion Alter the Dietary Sodium and Blood Pressure Relationship. Hypertension 2021; 77:2127-2137. [PMID: 33813848 PMCID: PMC8115426 DOI: 10.1161/hypertensionaha.120.16651] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/05/2021] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Abu Mohd Naser
- Hubert Department of Global Health, Emory Global Diabetes Research Center (A.M.N.), Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Epidemiology (A.M.N.), Rollins School of Public Health, Emory University, Atlanta, GA
| | - Feng J. He
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (F.J.H.)
| | - Mahbubur Rahman
- Environmental Interventions Unit, Infectious Diseases Division, International Center for Diarrhoeal Disease Research, Bangladesh, India (M.R.)
| | - Norm R.C. Campbell
- Department of Medicine, O’Brien Institute of Public Health, Libin Cardiovascular Institute of Alberta at the University of Calgary, Canada (N.R.C.C.)
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Potassium Metabolism and Management in Patients with CKD. Nutrients 2021; 13:nu13061751. [PMID: 34063969 PMCID: PMC8224083 DOI: 10.3390/nu13061751] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/20/2023] Open
Abstract
Potassium (K), the main cation inside cells, plays roles in maintaining cellular osmolarity and acid–base equilibrium, as well as nerve stimulation transmission, and regulation of cardiac and muscle functions. It has also recently been shown that K has an antihypertensive effect by promoting sodium excretion, while it is also attracting attention as an important component that can suppress hypertension associated with excessive sodium intake. Since most ingested K is excreted through the kidneys, decreased renal function is a major factor in increased serum levels, and target values for its intake according to the degree of renal dysfunction have been established. In older individuals with impaired renal function, not only hyperkalemia but also hypokalemia due to anorexia, K loss by dialysis, and effects of various drugs are likely to develop. Thus, it is necessary to pay attention to K management tailored to individual conditions. Since abnormalities in K metabolism can also cause lethal arrhythmia or sudden cardiac death, it is extremely important to monitor patients with a high risk of hyper- or hypokalemia and attempt to provide early and appropriate intervention.
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Segawa H, Higashi A, Masuda I, Yoshii K, Iwahori T, Ueshima H. Urinary sodium/potassium ratio as a screening tool for hyperaldosteronism in men with hypertension. Hypertens Res 2021; 44:1129-1137. [PMID: 34002055 PMCID: PMC8418986 DOI: 10.1038/s41440-021-00663-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/09/2022]
Abstract
Among individuals with hypertension, the prevalence of secondary hypertension has been reported to be ≈10%. More than half of individuals with secondary hypertension have associated hyperaldosteronism. However, given the current clinical environment, these patients often remain undiagnosed. We hypothesized that the urinary sodium/potassium ratio (Na/K) could be used as a simple, low-cost method of screening for hyperaldosteronism among individuals with hypertension in primary care and health examination settings. We recruited hypertensive individuals aged 30-69 years old who were not taking any antihypertensive medications from among participants in health examinations. Urinary Na and K were measured using second morning urine samples, and the plasma aldosterone concentration (PAC) was also measured. We evaluated the association of the second morning urine Na/K ratio (SMU Na/K) with a high PAC, defined as ≥90th percentile (24.3 ng/dL), using receiver operating characteristic (ROC) curves. Overall, 160 participants (108 men and 52 women) with a mean age of 54.3 years were eligible for this study. The area under the ROC curve for the relationship between SMU Na/K and high PAC was 0.77 (95% confidence interval [CI]: 0.59-0.95) in men and 0.64 (95% CI: 0.36-0.93) in women. In men, SMU Na/K values <1.0 could detect hyperaldosteronism with a sensitivity of 45.5%, a specificity of 97.9%, a positive predictive value of 71.4%, and a negative predictive value of 94.1%. The use of the urinary Na/K ratio may be appropriate as a method of screening for hyperaldosteronism in hypertensive men.
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Affiliation(s)
- Hiroyoshi Segawa
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Akane Higashi
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan.
| | - Izuru Masuda
- Takeda Hospital Medical Examination Center, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.,Department of Public Health, Shiga University of Medical Science, Shiga, Japan
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Seko C, Yamashiro M, Odani K, Wada S, Yoshii K, Higashi A. Estimated 24-hour urinary sodium excretion and sodium-to-potassium ratio among Japanese elementary school teachers and school lunch cooks. Clin Exp Hypertens 2021; 43:450-461. [PMID: 33870807 DOI: 10.1080/10641963.2021.1901109] [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: 10/21/2022]
Abstract
Background:Dietary salt intake is largely responsible for increase in blood pressure that is commonly seen with aging. In our previous study carried out in 2015, we calculated the 24-hour urinary sodium excretion and sodium-to-potassium (Na/K) ratio among elementary school children. In the present study, we aimed to examine the same items among the school children's teachers and lunch cooks.Methods:Of 153 recruited participants, urine samples were collected from 129 subjects (84.3%), and 124 subjects (81.0%; 37 male teachers, 65 female teachers, and 22 female cooks) whose dietary habits were confirmed were included in the final study analysis.Results: The median estimated 24-hour urinary salt excretion (g/day) was 8.2 in male teachers, 7.4 in female teachers, and 8.9 in cooks. The median urinary Na/K ratio (mEq/mEq) was 4.1 in male teachers, 3.6 in female teachers, and 4.0 in cooks. In both male and female teachers and cooks, no association was found between urinary salt excretion or urinary Na/K ratio and an awareness of the need to restrict salt intake. The proportion of subjects with both a urinary salt excretion and Na/K ratio above the median was high in male teachers and cooks, whereas the proportion of subjects who scored below the median in both tests was high in female teachers.Conclusion:It should be considered that elementary school teachers and cooks who have been provided with the results of their own salt excretion could realize the importance of reducing salt consumption from early childhood and the continuous salt intake reduction education for children.
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Affiliation(s)
- Chikako Seko
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Mikoto Yamashiro
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kiyoko Odani
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Sayori Wada
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akane Higashi
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
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Lee MJ, Sun CY, Lu CC, Chang YS, Pan HC, Lin YH, Wu VC, Chueh JS. Urinary sodium potassium ratio is associated with clinical success after adrenalectomy in patients with unilateral primary aldosteronism. Ther Adv Chronic Dis 2021; 12:2040622321990274. [PMID: 33633824 PMCID: PMC7887682 DOI: 10.1177/2040622321990274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background The urinary sodium potassium (NaK) ratio is associated with dietary sodium and potassium intake and blood pressure, and it also reflects the activity of aldosterone. Herein we evaluated the value of the urinary NaK ratio in predicting the surgical outcomes of patients with unilateral primary aldosteronism (uPA). Methods This non-concurrent prospective cohort study was conducted from 2011 to 2017 and included 241 uPA patients who had undergone adrenalectomy. Predictors of successful clinical outcomes were analyzed using logistic regression. Results Among the 241 uPA patients, 197 (81.7%) achieved clinical complete or partial success. A urinary sodium potassium ratio <3 (odds ratio (OR): 2.5; 95% confidence interval (CI): 1.2-5.4; p = 0.015), body mass index <25 kg/m2 (OR: 2.82; 95% CI: 1.31-6.06; p = 0.008), renin <1 ng/mL/h (OR: 2.51; 95% CI: 1.01-6.21; p = 0.047) and mean preoperative blood pressure >115 mmHg (OR: 5.02; 95% CI: 2.10-11.97; p < 0.001) could predict clinical success after adrenalectomy. Furthermore, higher pre-treatment plasma aldosterone (OR: 1.014; 95% CI 1.005-1.024; p = 0.002) or lower serum potassium (OR: 0.523; 95% CI: 0.328-0.836; p = 0.007) were correlated with lower urinary NaK ratio (<3), and log urinary NaK ratio was positively correlated with serum C-reactive protein (β value 2.326; 95% CI 0.029-4.623; p = 0.047). Conclusions uPA patients with a lower urinary NaK ratio, due to high plasma aldosterone and low serum potassium concentrations, were more likely to have clinical success after adrenalectomy. uPA patients with a higher urinary NaK ratio were associated with more severe inflammatory status, and possibly more resistant hypertension post-operatively.
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Affiliation(s)
- Ming-Jse Lee
- Division of Nephrology, Ten Chen General Hospital, Taoyuan, Taiwan
| | - Chiao-Yin Sun
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Chu Lu
- Division of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Shian Chang
- Department of Internal Medicine, Postal Hospital, Taipei, Taiwan
| | - Heng-Chih Pan
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yen-Hung Lin
- Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Internal Medicine, National Taiwan University Hospital, Taipei TAIPAI Taiwan
| | - Vin-Cent Wu
- Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Internal Medicine, National Taiwan University Hospital, Taipei TAIPAI Taiwan
| | - Jeff S Chueh
- Glickman Urological and Kidney Institute, Cleveland Clinic, and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA Department of Urology, National Taiwan University, Taipei, Taiwan
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15
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Okuda M, Asakura K, Sasaki S. Estimation of daily sodium and potassium excretion from overnight urine of Japanese children and adolescents. Environ Health Prev Med 2020; 25:74. [PMID: 33246400 PMCID: PMC7697364 DOI: 10.1186/s12199-020-00911-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Estimates of daily sodium (Na) and potassium (K) excretion were explicitly biased when using equations for adults. We aimed to develop equations to estimate them using overnight urine from Japanese children and adolescents. METHODS The subjects comprised 70 students aged 10.49-15.76 years: validation group, n = 34; and verification group, n = 36. Each subject performed two operations of overnight spot urine (Um) and 24-h urine (U24) sampling. Concentrations of Na, K, and creatinine (Cr) were measured, and anthropometrics were recorded. In the validation group, Na/Cr, and K/Cr (mEq L-1/mg dL-1) in 24-h urine were predicted from their correspondents in overnight urine. Daily Cr excretion (EstCr24; mg d-1) was estimated according to Mage's method. RESULTS In validation, we formulated Na excretion (mg d-1) = 23 × exp (0.2085) × [(Na/CrUm + 1)1.0148 - 1] × 1.078 × EstCr24/10; and K excretion (mg d-1) = 39 × exp (0.0315) × [(K/CrUm + 1)1.3165 - 1] × 1.078 × EstCr24/10. For verification, we compared estimates with the measured 24-h Na excretion 3596 ± 1058 mg d-1, and K excretion 1743 ± 569 mg d-1. The mean biases and intraclass correlations (3, 1) were -131 mg d-1 and 0.60, respectively for Na excretion; and -152 mg d-1 and 0.55 for K excretion. CONCLUSION We obtained validated equations to estimate daily Na and K excretion with accessible variables such as Na, K, and Cr concentrations of overnight urine, body height and weight, and age for children and adolescents. When using the obtained equations, caution should be paid to small but definite biases and measurement errors.
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Affiliation(s)
- Masayuki Okuda
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube, 755-8505, Japan.
| | - Keiko Asakura
- Department of Social Medicine, Faculty of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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16
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Ginos BN, Engberink RHO. Estimation of Sodium and Potassium Intake: Current Limitations and Future Perspectives. Nutrients 2020; 12:nu12113275. [PMID: 33114577 PMCID: PMC7692368 DOI: 10.3390/nu12113275] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/24/2022] Open
Abstract
Globally, average dietary sodium intake is double the recommended amount, whereas potassium is often consumed in suboptimal amounts. High sodium diets are associated with increased cardiovascular and renal disease risk, while potassium may have protective properties. Consequently, patients at risk of cardiovascular and renal disease are urged to follow these recommendations, but dietary adherence is often low due to high sodium and low potassium content in processed foods. Adequate monitoring of intake is essential to guide dietary advice in clinical practice and can be used to investigate the relationship between intake and health outcomes. Daily sodium and potassium intake is often estimated with 24-h sodium and potassium excretion, but long-term balance studies demonstrate that this method lacks accuracy on an individual level. Dietary assessment tools and spot urine collections also exhibit poor performance when estimating individual sodium and potassium intake. Collection of multiple consecutive 24-h urines increases accuracy, but also patient burden. In this narrative review, we discuss current approaches to estimating dietary sodium and potassium intake. Additionally, we explore alternative methods that may improve test accuracy without increasing burden.
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Affiliation(s)
- Bigina N.R. Ginos
- Department of Nephrology, Amsterdam University Medical Centres, Academic Medical Centre, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
| | - Rik H.G. Olde Engberink
- Amsterdam Cardiovascular Sciences, VU University Medical Center, 1081 HV Amsterdam, The Netherlands;
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17
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Sodium/potassium ratio change was associated with blood pressure change: possibility of population approach for sodium/potassium ratio reduction in health checkup. Hypertens Res 2020; 44:225-231. [PMID: 32801312 PMCID: PMC7815510 DOI: 10.1038/s41440-020-00536-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 11/09/2022]
Abstract
Recently, the sodium (Na)/potassium (K) ratio was reported to be associated with blood pressure (BP). A Na/K ratio self-monitoring device using spot urine was established recently. Here, we assessed whether the urinary Na/K ratio change measured using the Na/K device was associated with BP change in a health checkup setting. We targeted 12,890 participants who attended the health checkup in Tome City, Miyagi between 2017 and 2018. Tome City introduced urinary Na/K ratio measurements during health checkups since 2017. For each year, we compared the baseline characteristics according to the urinary Na/K ratio and BP level. We assessed the relationship between change in urinary Na/K ratio and BP change using multiple regression analyses adjusted for age, sex, and change in body mass index (BMI) and alcohol intake. The average urinary Na/K ratio was significantly lower in 2018 than in 2017 (5.4 ± 3.0 to 4.9 ± 2.2, P < 0.01). The systolic BP of the participants in 2018 (130.9 ± 17.4 mmHg) was lower than that in 2017 (132.1 ± 17.9 mmHg). Moreover, the change in systolic BP and diastolic BP was positively associated with the change in urinary Na/K ratio. In conclusion, the association of the change in urinary Na/K ratio with hypertension and changes in systolic and diastolic BP can be explained by a change in alcohol intake, BMI, and urinary Na/K ratio. Therefore, measuring the urinary Na/K ratio in community settings is a potential population approach for counteracting hypertension.
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18
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Morrissey E, Giltinan M, Kehoe L, Nugent AP, McNulty BA, Flynn A, Walton J. Sodium and Potassium Intakes and Their Ratio in Adults (18-90 y): Findings from the Irish National Adult Nutrition Survey. Nutrients 2020; 12:E938. [PMID: 32231006 PMCID: PMC7231049 DOI: 10.3390/nu12040938] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 01/26/2023] Open
Abstract
An individual's sodium to potassium intake ratio (Na:K) has been shown to be an important predictor of hypertension. The aim of this study was to estimate the mean 24 h urinary Na, K and Na:K of Irish adults and to identify the foods that determine Na:K in a nationally representative sample of Irish adults. This study was based on data from the Irish National Adult Nutrition Survey (2008-2010) (NANS), which collected spot urine samples and dietary data in a nationally representative sample of Irish adults aged 18+ years. The mean urinary molar Na:K of Irish men and women was 1.90 and 2.15, respectively, which exceed target molar ratios of ≤1.0 and ≤2.0. The mean estimated 24-h urinary excretion of Na was 4631 mg for men and 3525 mg for women, which exceed target maximum population intakes for all gender and age groups. The mean estimated 24-h urinary excretion of K was 3894 mg for men and 2686 mg for women, with intakes in women of all ages and older men (65+ years) below current recommendations. The key foods positively associated with a lower Na:K were fruits, vegetables, potatoes, breakfast cereals, milk, yogurt and fresh meat, while the foods negatively associated with a lower Na:K were breads, cured and processed meats and butters and fat spreads. Strategies to reduce sodium and increase potassium intakes are necessary to lower population Na:K, which may help to reduce the burden of hypertension-related diseases in the Irish population.
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Affiliation(s)
- Eoin Morrissey
- Department of Biological Sciences, Cork Institute of Technology, T12928 Cork, Ireland
| | - Miriam Giltinan
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
| | - Laura Kehoe
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
| | - Anne P. Nugent
- UCD Institute of Food and Health, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- Institute for Global Food Security, School of Biological Sciences, Queens University Belfast, Belfast BT7 1NN, Northern Ireland, UK
| | - Breige A. McNulty
- UCD Institute of Food and Health, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Albert Flynn
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
| | - Janette Walton
- Department of Biological Sciences, Cork Institute of Technology, T12928 Cork, Ireland
- School of Food and Nutritional Sciences, University College Cork, T12 K8AF Cork, Ireland
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19
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Xu H, Guo Y, Lu S, Ma Y, Wang X, Zhao L, Sun J. Effect of Steamed Potato Bread Intake on Glucose, Lipids, and Urinary Na + and K +: A Randomized Controlled Trial with Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062096. [PMID: 32235690 PMCID: PMC7143724 DOI: 10.3390/ijerph17062096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 01/01/2023]
Abstract
Although potatoes are highly nutritious, many epidemiological studies have connected their consumption with abnormal lipids, diabetes, and hypertension. Steamed potato bread has recently become one of China's staple foods. A randomized controlled trial was designed to evaluate the effect of steamed potato bread consumption on Chinese adolescents. Four classes from a high school were randomly selected and assigned to the intervention group (two classes) or control group (two classes). The steamed wheat bread (100% raw wheat flour) and potato bread (raw wheat flour to cooked potato flour ratio of 3:7) were provided to the control group and intervention group as staple food once a school day for 8 weeks, respectively. Compared with the control group, the intervention group had significant net changes in systolic blood pressure (4.6 mmHg, p = 0.010), insulin (-4.35 mIU/L, p < 0.001), total cholesterol (-0.13 mmol/L, p = 0.032), and high-density lipoproteins cholesterol (-0.07 mmol/L, p = 0.010). The urinary level of Na+/K+ did not differ between the groups. In conclusion, the intake of steamed potato bread for 8 weeks resulted in positive effects on the total cholesterol and insulin profiles but a negative effect on the systolic blood pressure and high-density lipoproteins cholesterol of adolescents.
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Affiliation(s)
- Haiquan Xu
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
- Correspondence: (H.X.); (J.S.)
| | - Yanzhi Guo
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
| | - Shijun Lu
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
| | - Yunqian Ma
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
| | - Xiuli Wang
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Junmao Sun
- Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing 100081, China; (Y.G.); (S.L.); (Y.M.); (X.W.)
- Correspondence: (H.X.); (J.S.)
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20
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Seko C, Odani K, Wada S, Yoshii K, Segawa H, Kitaoka K, Masumoto T, Higashi A. Characteristic dietary habits associated with high values of estimated 24-hours urinary sodium excretion and sodium-to-potassium ratio assessed by age group among the residents of a rural town in Japan. Clin Exp Hypertens 2019; 42:449-459. [DOI: 10.1080/10641963.2019.1693587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Chikako Seko
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kiyoko Odani
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Sayori Wada
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Kaori Kitaoka
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Taeko Masumoto
- Faculty of Nursing, Doshisha Women’s College of Liberal Arts, Kyoto, Japan
| | - Akane Higashi
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
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21
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Association of the spot urine sodium-to-potassium ratio with blood pressure is independent of urinary Na and K levels: The Nagahama study. Hypertens Res 2019; 42:1624-1630. [DOI: 10.1038/s41440-019-0276-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 11/08/2022]
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22
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Xia L, Sugita-Konishi Y, Gong Y, Routledge M. Dietary Deoxynivalenol Exposure Assessment in University Students from Japan. Food Saf (Tokyo) 2019; 7:48-53. [PMID: 31998586 PMCID: PMC6978884 DOI: 10.14252/foodsafetyfscj.2018021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022] Open
Abstract
This study was conducted to give a preliminary estimation of deoxynivalenol (DON) dietary exposure in Japanese university students (n = 30, aged 22-25 years) using a biomarker approach and to examine the correlation between wheat food intake and DON exposure levels. Spot urine samples were collected from 30 students of Azabu University, Tokyo. Urine samples were treated with enzyme digestion (for total DON measurement) and without (for unconjugated DON analysis) before clean-up using an immuno-affinity column and analysis using an LC-MS method, with a 13C15- DON internal standard used for accurate quantification. The limit of detection for this method is 0.5 ng/mL urine. The geometric mean (95% CI) of DON concentration was 2.03 (1.64 - 6.87) ng per mL urine. Ninety of the urine samples had detectable levels of urinary DON. The DON dietary intake exposure estimation suggested that one out of the 30 subjects had an intake of DON that exceeded Joint FAO/WHO Expert Committee on Food Additives (JECFA) provisional maximum tolerable daily intake (PMTDI) level. Mean ratio of free DON to total DON was determined to be 19%. Wheat intake assessed using a basic food frequent questionnaire method did not show a significant correlation with the urinary DON level.
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Affiliation(s)
- Lei Xia
- School of Food Science & Nutrition, University of Leeds,
Leeds, UK
| | | | - Yunyun Gong
- School of Food Science & Nutrition, University of Leeds,
Leeds, UK
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23
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Iwahori T, Miura K, Ueshima H, Tanaka-Mizuno S, Chan Q, Arima H, Dyer AR, Elliott P, Stamler J. Urinary sodium-to-potassium ratio and intake of sodium and potassium among men and women from multiethnic general populations: the INTERSALT Study. Hypertens Res 2019; 42:1590-1598. [PMID: 30996260 DOI: 10.1038/s41440-019-0263-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/18/2019] [Accepted: 03/24/2019] [Indexed: 11/09/2022]
Abstract
The Na/K ratio may be more strongly related to blood pressure and cardiovascular disease than sodium or potassium. The casual urine Na/K ratio can provide prompt on-site feedback, and with repeated measurements, may provide useful individual estimates of the 24-h ratio. The World Health Organization has published guidelines for sodium and potassium intake, but no generally accepted guideline prevails for the Na/K ratio. We used standardized data on 24 h and casual urinary electrolyte excretion obtained from the INTERSALT Study for 10,065 individuals aged 20-59 years from 32 countries (52 populations). Associations between the casual urinary Na/K ratio and the 24-h sodium and potassium excretion of individuals were assessed by correlation and stratification analyses. The mean 24-h sodium and potassium excretions were 156.0 mmol/24 h and 55.2 mmol/24 h, respectively; the mean 24-h urinary Na/K molar ratio was 3.24. Pearson's correlation coefficients (r) for the casual urinary Na/K ratio with 24-h sodium and potassium excretions were 0.42 and -0.34, respectively, and these were 0.57 and -0.48 for the 24-h ratio. The urinary Na/K ratio predicted a 24-h urine Na excretion of <85 mmol/day (the WHO recommended guidelines) with a sensitivity of 99.7% and 94.0%, specificity of 39.5% and 48.0%, and positive predictive value of 96.3% and 61.1% at the cutoff point of 1 in 24 h and casual urine Na/K ratios, respectively. A urinary Na/K molar ratio <1 may be a useful indicator for adherence to the WHO recommended levels of sodium and, to a lesser extent, the potassium intake across different populations; however, cutoff points for Na/K ratio may be tuned for localization.
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Affiliation(s)
- Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan. .,Graduate School of Science, Technology and Innovation, Kobe University, Hyogo, Japan. .,Research and Development Department, Omron Healthcare Co., Ltd, Kyoto, Japan.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | | | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Thi Minh Nguyen T, Miura K, Tanaka-Mizuno S, Tanaka T, Nakamura Y, Fujiyoshi A, Kadota A, Tamaki J, Takebayashi T, Okamura T, Ueshima H. Association of blood pressure with estimates of 24-h urinary sodium and potassium excretion from repeated single-spot urine samples. Hypertens Res 2018; 42:411-418. [PMID: 30523292 DOI: 10.1038/s41440-018-0152-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/26/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023]
Abstract
While the association between 24-h urinary sodium and potassium excretion with blood pressure is well established, the relationships of these ions to spot urine measurements are unclear. Our purpose is to assess the association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. Spot urine and blood pressure were collected annually during a 5-year period from 4360 Japanese workers with ages ranging from 19 to 55 years. Estimates of 24-h sodium and potassium excretion were based on Tanaka's formula. Overall, a single standard deviation increase in the estimated sodium excretion (36.5 mmol/day) was associated with a 1.3 mmHg higher systolic blood pressure and a 0.8 mmHg higher diastolic blood pressure (P < 0.001). A single standard deviation increase in estimated potassium excretion (8.9 mmol/day) was associated with a 1.1 mmHg lower systolic blood pressure and a 0.7 mmHg lower diastolic blood pressure (P < 0.001). As a combined measure of the excretion of both electrolytes, the estimated 24-h sodium-to-potassium ratio was positively associated with both blood pressures (P < 0.001). Associations of blood pressure with sodium and the sodium-to-potassium ratio increased with age and were stronger in men compared to women. Associations with potassium and the sodium-to-potassium ratio were stronger in individuals who were overweight. The findings provide evidence for an association between blood pressure and the estimated 24-h sodium and potassium excretion from repeated single-spot urine samples. As convenient measures of dietary intake for each electrolyte, repeated spot urine samples may be useful for assessing hypertension risk, especially in men, older individuals, and overweight individuals.
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Affiliation(s)
- Trang Thi Minh Nguyen
- Department of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan. .,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
| | | | | | - Yasuyuki Nakamura
- Department of Food Science and Human Nutrition, Ryukoku University, Otsu, Japan
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical University, Takatsuki, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
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Okuyama Y, Uchida HA, Iwahori T, Segawa H, Kato A, Takeuchi H, Kakio Y, Umebayashi R, Kitagawa M, Sugiyama H, Miura K, Ueshima H, Wada J. The relationship between repeated measurement of casual and 24-h urinary sodium-to-potassium ratio in patients with chronic kidney disease. J Hum Hypertens 2018; 33:286-297. [PMID: 30443006 DOI: 10.1038/s41371-018-0127-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/22/2018] [Accepted: 10/19/2018] [Indexed: 01/10/2023]
Abstract
This study aimed to clarify the relationship between repeated measurements of casual (spot) and 24-h urinary sodium-to-potassium (Na/K) ratios in patients with chronic kidney disease (CKD). A total of 61 inpatients with CKD, 31 in stage 1-3 (eGFR [estimated glomerular filtration rate] ≥ 30 ml/min/1.73 m2) and 30 in stage 4-5 (eGFR < 30 ml/min/1.73 m2), aged 20-85 consuming a low-sodium diet (NaCl [sodium chloride] 6 g/day) were recruited. Urinary Na, K, and Na/K ratios were measured in both casual urine samples and 2-day, 24 h urine samples, and then analyzed by correlation and Bland-Altman analyses. Mean 24-h urine Na/K ratio was higher in participants in stage 4-5 (5.1) than in participants in stage 1-3 (4.1) CKD. Casual urine Na/K ratio was strongly correlated with 2-day, 24-h urine Na/K ratio by sampling 4 casual urine specimens every morning and evening in participants in stage 1-3 (r = 0.69-0.78), but not in stage 4-5 (r = 0.12-0.19). The bias for mean Na/K ratio between 2-day, 24-h urine, and the 4 casual urine sampling ranged from -0.86 to 0.16 in participants in stage 1-3, and the quality of agreement for the mean of this casual urine sampling was similar to that of sampling 8 casual urine samples for estimating 2-day, 24-h values. Methods using repeated casual urine Na/K ratios may provide a reasonable estimation of 24-h urine Na/K ratio in normotensive and hypertensive as well as individuals with stage 1-3, but not stage 4-5 CKD.
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Affiliation(s)
- Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. .,Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Graduate School of Science, Technology and Innovation, Kobe University, Kobe, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Ayako Kato
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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26
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Yamashita M, Tabara Y, Higo Y, Setoh K, Kawaguchi T, Takahashi Y, Kosugi S, Nakayama T, Matsuda F, Wakamura T. Association between socioeconomic factors and urinary sodium-to-potassium ratio: the Nagahama Study. Hypertens Res 2018; 41:973-980. [DOI: 10.1038/s41440-018-0101-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 12/11/2022]
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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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28
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Seko C, Taguchi Y, Segawa H, Odani K, Aoi W, Wada S, Kitaoka K, Masumoto T, Higashi A. Estimation of salt intake and sodium-to-potassium ratios assessed by urinary excretion among Japanese elementary school children. Clin Exp Hypertens 2017; 40:481-486. [PMID: 29172788 DOI: 10.1080/10641963.2017.1403620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dietary salt intake is largely responsible for the increase in blood pressure with age. It is important to start effective prevention approaches during childhood. In this study, we estimated salt intake and sodium-to-potassium (Na/K) ratios assessed by urinary excretion among elementary school children in Kyoto, Japan. A total of 331 subjects aged 9-11 years participated in school checkups in April 2015. Urinary concentrations of sodium, potassium, and creatinine were measured in first morning urine samples. The subjects' dietary habits were confirmed by questionnaires completed by their parents. The median estimated urinary sodium excretion was 129.0 mmol/day (5.7g/day of salt). In 30.2% of the subjects, their estimated salt intake exceeded their age-specific dietary goal for salt intake recommended by the Dietary Reference Intakes for Japanese 2015. Multivariate linear regression model analysis after adjustment for age revealed a significant positive correlation between seaweeds or fish paste products consumption and the estimated salt intake (p = 0.02 and 0.02, respectively). The median urinary Na/K ratio (mEq/mEq) was 4.5. Multivariate linear regression model analysis revealed a significant negative correlation between fruit consumption and urinary Na/K ratio (p = 0.04). These results suggest that the high sodium intake and the high Na/K ratios occur among Japanese elementary school children, and that the urinary Na/K ratio in children may be reduced by the daily consumption of fruit.
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Affiliation(s)
- Chikako Seko
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Yuko Taguchi
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Hiroyoshi Segawa
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Kiyoko Odani
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Wataru Aoi
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Sayori Wada
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
| | - Kaori Kitaoka
- b Department of Nutritional Sciences for Well-being, Faculty of Health Sciences for Welfare , Kansai University of Welfare Sciences , Osaka , Japan
| | - Taeko Masumoto
- c Faculty of Nursing , Doshisha Women's College of Liberal Arts , Kyoto , Japan
| | - Akane Higashi
- a Division of Applied Life Sciences , Graduate School of Life and Environmental Sciences, Kyoto Prefectural University , Kyoto , Japan
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29
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Yatabe MS, Iwahori T, Watanabe A, Takano K, Sanada H, Watanabe T, Ichihara A, Felder RA, Miura K, Ueshima H, Kimura J, Yatabe J. Urinary Sodium-to-Potassium Ratio Tracks the Changes in Salt Intake during an Experimental Feeding Study Using Standardized Low-Salt and High-Salt Meals among Healthy Japanese Volunteers. Nutrients 2017; 9:nu9090951. [PMID: 28850062 PMCID: PMC5622711 DOI: 10.3390/nu9090951] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/15/2017] [Accepted: 08/25/2017] [Indexed: 12/03/2022] Open
Abstract
The Na/K ratio is considered to be a useful index, the monitoring of which allows an effective Na reduction and K increase, because practical methods (self-monitoring devices and reliable individual estimates from spot urine) are available for assessing these levels in individuals. An intervention trial for lowering the Na/K ratio has demonstrated that a reduction of the Na/K ratio mainly involved Na reduction, with only a small change in K. The present study aimed to clarify the relationship between dietary Na intake and the urinary Na/K molar ratio, using standardized low- and high-salt diets, with an equal dietary K intake, to determine the corresponding Na/K ratio. Fourteen healthy young adult volunteers ingested low-salt (3 g salt per day) and high-salt (20 g salt per day) meals for seven days each. Using a portable urinary Na/K meter, participants measured their spot urine at each voiding, and 24-h urine was collected on the last day of each diet period. On the last day of the unrestricted, low-salt, and high-salt diet periods, the group averages of the 24-h urine Na/K ratio were 4.2, 1.0, and 6.9, while the group averages of the daily mean spot urine Na/K ratio were 4.2, 1.1, and 6.6, respectively. The urinary Na/K ratio tracked changes in dietary salt intake, and reached a plateau approximately three days after each change in diet. Frequent monitoring of the spot urine Na/K ratio may help individuals adhere to an appropriate dietary Na intake.
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Affiliation(s)
- Midori Sasaki Yatabe
- Department of Pharmacology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.S.Y.); (A.W.); (K.T.)
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (H.S.); (T.W.)
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Toshiyuki Iwahori
- Research and Development Department, Omron Healthcare Co., Ltd., Muko 617-0002, Japan;
- Department of Public Health, Shiga University of Medical Science, Shiga 520-2192, Japan; (K.M.); (H.U.)
| | - Ami Watanabe
- Department of Pharmacology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.S.Y.); (A.W.); (K.T.)
| | - Kozue Takano
- Department of Pharmacology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.S.Y.); (A.W.); (K.T.)
| | - Hironobu Sanada
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (H.S.); (T.W.)
| | - Tsuyoshi Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (H.S.); (T.W.)
| | - Atsuhiro Ichihara
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
| | - Robin A. Felder
- Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908, USA;
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga 520-2192, Japan
| | - Junko Kimura
- Department of Pharmacology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.S.Y.); (A.W.); (K.T.)
| | - Junichi Yatabe
- Department of Pharmacology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (M.S.Y.); (A.W.); (K.T.)
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (H.S.); (T.W.)
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
- Correspondence: ; Tel.: +81-333-538-111
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30
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Iwahori T, Miura K, Ueshima H. Time to Consider Use of the Sodium-to-Potassium Ratio for Practical Sodium Reduction and Potassium Increase. Nutrients 2017; 9:E700. [PMID: 28678188 PMCID: PMC5537815 DOI: 10.3390/nu9070700] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023] Open
Abstract
Pathogenetic studies have demonstrated that the interdependency of sodium and potassium affects blood pressure. Emerging evidences on the sodium-to-potassium ratio show benefits for a reduction in sodium and an increase in potassium compared to sodium and potassium separately. As presently there is no known review, this article examined the practical use of the sodium-to-potassium ratio in daily practice. Epidemiological studies suggest that the urinary sodium-to-potassium ratio may be a superior metric as compared to separate sodium and potassium values for determining the relation to blood pressure and cardiovascular disease risks. Higher correlations and better agreements are seen for the casual urine sodium-to-potassium ratio than for casual urine sodium or potassium alone when compared with the 24-h urine values. Repeated measurements of the casual urine provide reliable estimates of the 7-day 24-h urine value with less bias for the sodium-to-potassium ratio as compared to the common formulas used for estimating the single 24-h urine from the casual urine for sodium and potassium separately. Self-monitoring devices for the urinary sodium-to-potassium ratio measurement makes it possible to provide prompt onsite feedback. Although these devices have been evaluated with a view to support an individual approach for sodium reduction and potassium increase, there has yet to be an accepted recommended guideline for the sodium-to-potassium ratio. This review concludes with a look at the practical use of the sodium-to-potassium ratio for assistance in practical sodium reduction and potassium increase.
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Affiliation(s)
- Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Research and Development Department, OMRON HEALTHCARE Co., Ltd., 53 Kunotsubo Terada-cho, Muko, Kyoto 617-0002, Japan.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
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