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Kinuta M, Hisamatsu T, Fukuda M, Taniguchi K, Nakahata N, Kanda H. Home blood pressure measurement days and changes in urinary sodium-to-potassium ratio, estimated salt and potassium intakes and blood pressure: 1-year prospective study. Blood Press Monit 2024; 29:188-194. [PMID: 38946332 DOI: 10.1097/mbp.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVE Current international guidelines recommend home blood pressure (BP) measurement and low sodium and high potassium intakes for the management of hypertension. We hypothesized that increased home BP measurement may result in more effective management of sodium and potassium intakes and BP. METHODS We examined associations of home BP measurement days with changes in the urinary sodium-to-potassium (Na/K) ratio, estimated salt and potassium intakes and BP. We included 209 healthy participants (mean age, 55.9 years; 56.5% women) from a prospective cohort study. We examined 1-year data on self-measured home BP and spot urine samples. RESULTS Median (interquartile range) days of home BP measurement was 324 (225-358) over 1-year. Baseline mean (SD) Na/K ratio, salt and potassium intakes, morning and evening SBP, and morning and evening DBP were 3.8 (2.3), 8.5 (1.9) g/day, 1833.5 (416.5) mg/day, 120.4 (14.0) mmHg, 118.2 (14.2) mmHg, 79.2 (10.1) mmHg, and 76.2 (10.1) mmHg, respectively. In multivariable-adjusted linear regression , β (standard error) per 10 days increase in number of home BP measurement were -0.031 (0.017) for Na/K ratio, -0.036 (0.015) for salt intake, -1.357 (2.797) for potassium intake, -0.178 (0.064) for morning SBP, -0.079 (0.041) for morning DBP, -0.109 (0.067) for evening SBP and -0.099 (0.045) for evening DBP. Additionally, relationships persisted for men and women, but changes in salt intake were more pronounced among participants taking antihypertensive medication (interaction P = 0.002). CONCLUSION Continuous measurement of home BP may lead not only to self-monitoring of BP, but also to declines in salt intakes and some BP indices.
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Affiliation(s)
- Minako Kinuta
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Mari Fukuda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Kaori Taniguchi
- Department of Environmental Medicine and Public Health, Izumo, Shimane University Faculty of Medicine
| | - Noriko Nakahata
- Department of Health and Nutrition, The University of Shimane Faculty of Nursing and Nutrition, Izumo, Japan
| | - Hideyuki Kanda
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
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Morimoto N, Jamil H, Alakkari M, Joyama Y, Anzai T, Takahashi K, Iimori S. Associations between dietary potassium intake and urinary potassium excretion: a protocol for systematic review and meta-analysis. Syst Rev 2024; 13:185. [PMID: 39020425 PMCID: PMC11253472 DOI: 10.1186/s13643-024-02603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/07/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND While numerous studies have reported associations between low dietary potassium intake and adverse clinical outcomes, methods to estimate potassium intake, mainly self-reported dietary measures and urinary potassium excretion, entail certain limitations. Self-reported measures are subject to underreporting and overreporting. Urinary potassium excretion is affected by multiple factors including renal function. Revealing the degree of bias inherent in these measures would help accurately assess potassium intake and its association with disease risk. We aim to summarize evidence on the strength of the associations between potassium intake estimated from 24-h urinary potassium excretion and potassium intake estimated from self-reported dietary measures or objective quantification methods in populations with different kidney function levels and age groups. We also aim to identify factors that affect the association strength. METHODS We will search for potentially eligible studies that examined associations between self-reported potassium intake, 24-h urinary potassium excretion, and objectively quantified potassium intake, using MEDLINE (PubMed), Embase, Web of Science, and Scopus. Studies on children, adolescents, adults, and the elderly are eligible. Studies of patients on dialysis will be excluded. Collective study results, including a meta-analysis, will be synthesized if an adequate number of studies examining similar dietary potassium intake estimation methods are found. Analyses will be performed separately according to age groups and renal function. For the meta-analysis, fixed-effects or random-effect models will be employed depending on the degree of study heterogeneity to combine across studies the correlation coefficient, ratio, or standardized mean difference for potassium intake, comparing dietary potassium intake based on self-reported or objectively quantified methods and intake based on 24-h urinary potassium excretion. The degree of heterogeneity among included studies will be examined by calculating I2 statistics. To investigate sources of study heterogeneity, random-effects meta-regression analyses will be performed. DISCUSSION Revealing the strength of the association between dietary and urinary measures in populations with different levels of kidney function and age groups will enhance researchers' and clinicians' ability to interpret studies that utilize these measures and help establish a more solid evidence base for the role of potassium intake in changing chronic disease risk. Identifying factors that modify the associations between these measures may aid in developing predictive models to estimate actual potassium intake. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022357847.
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Affiliation(s)
- Nobuhisa Morimoto
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan.
| | - Hasan Jamil
- St. Luke's International University, Tokyo, Japan
| | | | - Yuki Joyama
- Columbia University Mailman School of Public Health, New York, USA
| | - Tatsuhiko Anzai
- Department of Biostatistics, Tokyo Medical and Dental University, M&D Data Science Center, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Tokyo Medical and Dental University, M&D Data Science Center, Tokyo, Japan
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
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Wang H, Iwama N, Yuwaki K, Nakamichi Y, Hamada H, Tomita H, Tagami K, Kudo R, Kumagai N, Metoki H, Nakaya N, Hozawa A, Kuriyama S, Yaegashi N, Saito M. Relationship between parity and the prevalence of chronic kidney disease in Japan considering hypertensive disorders of pregnancy and body mass index. BMC Nephrol 2024; 25:166. [PMID: 38755546 PMCID: PMC11100170 DOI: 10.1186/s12882-024-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Global studies exploring the relationship between parity and chronic kidney disease (CKD) are scarce. Furthermore, no study has examined the relationship between parity and CKD in Japan. Therefore, this study aimed to examine the relationship between parity and the prevalence of CKD in a Japanese population, considering the clinical history of hypertensive disorders of pregnancy (HDP) and current body mass index (BMI) based on menopausal status. METHODS This cross-sectional study included 26,945 Japanese multiparous women (5,006 premenopausal and 21,939 postmenopausal women) and 3,247 nulliparous women (1,599 premenopausal and 1,648 postmenopausal women). Participants were divided into two groups based on their menopausal status (premenopausal and postmenopausal women). The relationship between parity and the prevalence of CKD was evaluated using a multiple logistic regression model adjusted for several covariates, including a clinical history of HDP and current BMI. RESULTS The relationship between parity and the prevalence of CKD was not statistically significant in either premenopausal or postmenopausal multiparous women. A clinical history of HDP was significantly associated with an increased risk of CKD in premenopausal and postmenopausal multiparous women. However, the relationship between a clinical history of HDP and CKD in premenopausal women was weakened after adjusting for current BMI. Furthermore, the current BMI was significantly associated with an increased risk of CKD in both premenopausal and postmenopausal women. CONCLUSIONS Parity is not significantly associated with the prevalence of CKD in premenopausal and postmenopausal multiparous women. A clinical history of HDP is a risk factor for CKD in both premenopausal and postmenopausal women. Current BMI is also associated with an increased risk of CKD in premenopausal and postmenopausal women. Therefore, continuous surveillance and preventive measures against CKD should be provided to women with a clinical history of HDP. In addition, maintaining an appropriate body weight is beneficial in reducing the risk of CKD.
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Affiliation(s)
- Hongxin Wang
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Noriyuki Iwama
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan.
- Women's Health Care Medical Science, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan.
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai, Miyagi, 980-8573, Japan.
| | - Keiichi Yuwaki
- Underwriting and Medical Department, The Dai-ichi Life Insurance Company, Limited, Koto-ku, Tokyo, Japan
| | - You Nakamichi
- Underwriting and Medical Department, The Dai-ichi Life Insurance Company, Limited, Koto-ku, Tokyo, Japan
| | - Hirotaka Hamada
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Hasumi Tomita
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Kazuma Tagami
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Rie Kudo
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Natsumi Kumagai
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai, Miyagi, 980-8573, Japan
- Division of Public Health, Hygiene and Epidemiology, Tohoku Medical Pharmaceutical University, 1-15-1 Fukumuro, Sendai, Miyagi, 983-8536, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai, Miyagi, 980-8573, Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai, Miyagi, 980-8573, Japan
| | - Shinichi Kuriyama
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
- International Research Institute of Disaster Science, Tohoku University, 468-1, Aramaki, Sendai, Miyagi, 980-8572, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai, Japan Sendai, Miyagi, 980-8575, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
- Women's Health Care Medical Science, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
- Tohoku Medical Megabank Organization, Tohoku University, 2-1, Seiryomachi, Sendai, Miyagi, 980-8573, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryomachi, Sendai, Japan Sendai, Miyagi, 980-8575, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
- Women's Health Care Medical Science, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, 1-1, Seiryomachi, Sendai, Miyagi, 980-8574, Japan
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Ito S, Asakura K, Sugiyama K, Takakura M, Todoriki H. Association between sodium and potassium excretion estimated from spot urine and socioeconomic status among primary school children and their mothers in Okinawa, Japan. Hypertens Res 2024; 47:1175-1183. [PMID: 38177286 DOI: 10.1038/s41440-023-01564-9] [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: 08/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
Hypertension is the greatest and the most preventable risk factor for cardiovascular disease. Excessive sodium (Na) intake and insufficient potassium (K) intake have been identified as risk factors for hypertension. Socioeconomic status (SES) may be related to diet quality. In Japan, few studies have examined the relationship between urinary Na and K excretion and SES in adults, and there are no studies in children. In 2014, 1944 children (1382 households) in all public elementary schools in Yaese town, Okinawa, Japan were recruited to participate in a study. Casual urine specimens were collected to estimate 24-h urinary Na and K excretion and urinary Na/K ratio. Mother's educational background and household incomes were assessed and used as indicators of SES. A total of 236 pairs of children and their mothers were analyzed in this study. Urinary Na and K excretion were not significantly related to educational levels of mothers and household incomes in children. On the other hand, in mothers, lower household income group had higher 24-h estimated urinary Na excretion and urinary Na/K ratio than other groups. There was no significant difference between urinary excretion and educational levels in mothers. Household income disparities in urinary levels seen in mothers were not seen in children. There may be some factors that moderate the dietary inequalities in children.
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Affiliation(s)
- Sanae Ito
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan.
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Omorinishi 5-21-16, Ota-ku, Tokyo, 143-8540, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Seiryo-machi 4-1, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Minoru Takakura
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan
| | - Hidemi Todoriki
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan
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Wang H, Iwama N, Yuwaki K, Nakamichi Y, Hamada H, Tomita H, Tagami K, Kudo R, Kumagai N, Metoki H, Nakaya N, Hozawa A, Kuriyama S, Yaegashi N, Saito M. Association of parity with the prevalence of hypertension in Japan: The Tohoku Medical Megabank Community-based cohort study. J Clin Hypertens (Greenwich) 2024; 26:102-121. [PMID: 38192049 PMCID: PMC10857469 DOI: 10.1111/jch.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
This study investigated the association of parity with hypertension prevalence in Japanese women while considering a clinical history of hypertensive disorders of pregnancy (HDP) and menopausal status. This cross-sectional study included 30,530 Japanese women (6700 premenopausal; 23 830 postmenopausal). The association between parity and the prevalence of hypertension was evaluated using a multiple logistic regression model with possible confounders. In premenopausal women, no statistically significant association between parity and hypertension prevalence was found. When not adjusted for current body mass index (BMI), a linear graded association was observed between parity and the prevalence of hypertension in postmenopausal women. However, the association between parity and hypertension prevalence in postmenopausal women was attenuated after adjustment for current BMI. Both current BMI and a clinical history of HDP were significantly associated with a high risk of hypertension in both premenopausal and postmenopausal women. Our results also suggest that continuous surveillance and preventive measures for hypertension should be provided for women with HDP and high parity.
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Affiliation(s)
- Hongxin Wang
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Noriyuki Iwama
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Women's Health Care Medical ScienceTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiMiyagiJapan
| | - Keiichi Yuwaki
- Underwriting and Medical DepartmentThe Dai‐ichi Life Insurance Company, LimitedKoto‐kuTokyoJapan
| | - You Nakamichi
- Underwriting and Medical DepartmentThe Dai‐ichi Life Insurance Company, LimitedKoto‐kuTokyoJapan
| | - Hirotaka Hamada
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Hasumi Tomita
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Kazuma Tagami
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Rie Kudo
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Natsumi Kumagai
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Hirohito Metoki
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiMiyagiJapan
- Division of Public Health, Hygiene and EpidemiologyTohoku Medical Pharmaceutical UniversitySendaiMiyagiJapan
| | - Naoki Nakaya
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiMiyagiJapan
| | - Atsushi Hozawa
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiMiyagiJapan
| | - Shinichi Kuriyama
- Division of Molecular EpidemiologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
- International Research Institute of Disaster ScienceTohoku UniversitySendaiMiyagiJapan
- Environment and Genome Research CenterTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Nobuo Yaegashi
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Women's Health Care Medical ScienceTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Tohoku Medical Megabank OrganizationTohoku UniversitySendaiMiyagiJapan
- Environment and Genome Research CenterTohoku University Graduate School of MedicineSendaiMiyagiJapan
| | - Masatoshi Saito
- Department of Obstetrics and GynecologyTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Women's Health Care Medical ScienceTohoku University Graduate School of MedicineSendaiMiyagiJapan
- Department of Maternal and Fetal TherapeuticsTohoku University Graduate School of MedicineSendaiMiyagiJapan
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Suzuki A, Takachi R, Ishihara J, Maruya S, Ishii Y, Kito K, Nakamura K, Tanaka J, Yamaji T, Iso H, Iwasaki M, Tsugane S, Sawada N. Urinary Biomarkers in Screening for the Usual Intake of Fruit and Vegetables, and Sodium, Potassium, and the Sodium-to-Potassium Ratio: Required Number and Accuracy of Measurements. Nutrients 2024; 16:442. [PMID: 38337726 PMCID: PMC10857367 DOI: 10.3390/nu16030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Because of within-individual variation, surveys to estimate an individual's usual food intake must be conducted over many days, in general. Here, using non-invasive biomarkers, we examined the number of measurements required to screen for the usual intake of fruit and vegetables, in addition to sodium, potassium, and the sodium-to-potassium (Na/K) ratio. Participants were 202 subjects aged 40-74 years from five areas of Japan who completed weighed food records (WFR) and five 24-hour urinary collections (24-h UCs) between 2012 and 2013. The number of 24-h UCs required to screen for intake that deviated from guidelines estimated by the WFR and their accuracies were assessed by the area under the curve (AUC) in a receiver-operating characteristics (ROC) analysis. The single urinary excretion of sodium, potassium, and the Na/K ratio showed moderate performance (AUC value: >0.7) in discriminating deviations from their criteria by respective intake based on the WFR. Urinary potassium excretion also showed moderate performance (AUC value: >0.7) in estimating the intake of vegetables but could not be used to estimate fruit intake even after five collections. The non-invasive measurement of biomarkers in a single 24-h UC showed moderate performance in screening the usual intake of vegetables, as measured based on the 12-day WFR, as well as of sodium, potassium, and the Na/K ratio.
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Affiliation(s)
- Aoi Suzuki
- Department of Food Science and Nutrition, Nara Women’s University Graduate School of Humanities and Sciences, Kitauoyahigashimachi, Nara-shi 630-8506, Nara, Japan; (A.S.); (S.M.)
| | - Ribeka Takachi
- Department of Food Science and Nutrition, Nara Women’s University Graduate School of Humanities and Sciences, Kitauoyahigashimachi, Nara-shi 630-8506, Nara, Japan; (A.S.); (S.M.)
| | - Junko Ishihara
- Graduate School of Environmental Health, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara-shi 252-5201, Kanagawa, Japan;
| | - Sachiko Maruya
- Department of Food Science and Nutrition, Nara Women’s University Graduate School of Humanities and Sciences, Kitauoyahigashimachi, Nara-shi 630-8506, Nara, Japan; (A.S.); (S.M.)
| | - Yuri Ishii
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (Y.I.); (K.K.); (M.I.); (S.T.); (N.S.)
| | - Kumiko Kito
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (Y.I.); (K.K.); (M.I.); (S.T.); (N.S.)
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata 951-8510, Japan;
| | - Junta Tanaka
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachidori, Niigata 951-8510, Japan;
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan;
| | - Motoki Iwasaki
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (Y.I.); (K.K.); (M.I.); (S.T.); (N.S.)
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (Y.I.); (K.K.); (M.I.); (S.T.); (N.S.)
- Graduate School of Public Health, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo 107-8402, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan; (Y.I.); (K.K.); (M.I.); (S.T.); (N.S.)
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7
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Wittig F, Krems C, Engelbert AK, Strassburg A. Validation of the Updated GloboDiet Version by Protein and Potassium Intake for the German National Nutrition Monitoring. Nutrients 2023; 15:4418. [PMID: 37892493 PMCID: PMC10609925 DOI: 10.3390/nu15204418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The German version of GloboDiet, a software for a computer-based assessment of 24 h recalls, was intensively updated. Therefore, validation is required prior to its use in the upcoming data collection within the German National Nutrition Monitoring. (2) Methods: For this purpose, the cross-sectional ErNst study with 109 participants (57 women and 52 men) was conducted. The study provided data on 24 h GloboDiet recalls and 24 h urine samples from the same day. Protein and potassium intake, known as eligible validation markers, were compared to the measured excretion in urine. To assess the agreement between intake and excretion, the following statistical methods were used: Wilcoxon rank tests, confidence intervals, Spearman correlations, and Bland-Altman plots. (3) Results: Overall, the updated German GloboDiet version showed valid estimates of protein intake. Regarding potassium, results were ambiguous and differed depending on the statistical method applied. While the Bland-Altman plot showed a good agreement between 24 h recalls and urine samples for potassium, the correlation was weak, suggesting that 24 h recalls may underestimate true intake. (4) Conclusions: Despite the partly ambiguous results, the updated GloboDiet version linked to the current German Nutrient Database provides valid estimates of nutrient intake.
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Affiliation(s)
- Friederike Wittig
- Department of Nutritional Behaviour, Max Rubner-Institut (MRI)-Federal Research Institute of Nutrition and Food, 76131 Karlsruhe, Germany; (F.W.); (C.K.)
| | - Carolin Krems
- Department of Nutritional Behaviour, Max Rubner-Institut (MRI)-Federal Research Institute of Nutrition and Food, 76131 Karlsruhe, Germany; (F.W.); (C.K.)
| | - Ann Katrin Engelbert
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut (MRI)-Federal Research Institute of Nutrition and Food, 76131 Karlsruhe, Germany;
| | - Andrea Strassburg
- Department of Nutritional Behaviour, Max Rubner-Institut (MRI)-Federal Research Institute of Nutrition and Food, 76131 Karlsruhe, Germany; (F.W.); (C.K.)
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Giannese D, D'Alessandro C, Pellegrino N, Panichi V, Cupisti A. RAASi Therapy Attenuates the Association between 24-h Urinary Potassium Excretion and Dietary Potassium Intake in CKD Patients. Nutrients 2023; 15:nu15112454. [PMID: 37299418 DOI: 10.3390/nu15112454] [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: 03/02/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to evaluate urinary potassium (K) excretion as a reliable marker of dietary K intake, in a cohort of CKD patients with or without Renin-Angiotensin-Aldosterone System (RAAS) inhibitor therapy. One hundred and thirty-eight consecutive out-patients (51 f and 87 m) aged 60 ± 13 years and affected by CKD stage 3-4, who were metabolically and nutritionally stable, entered the study between November 2021 and October 2022. No difference was observed between patients with (n = 85) or without (n = 53) RAAS inhibitor therapy, regarding dietary intakes, blood biochemistry, and 24-h urine excretion parameters. Considering all patients, urinary K showed a weak relationship with eGFR (r = 0.243, p < 0.01), and with dietary K intake (r = 0.184, p < 0.05). Serum K was not associated with dietary K intake, but an inverse relationship was observed with eGFR (r = -0.269, p < 0.01). When patients were examined depending on whether they were receiving RAAS inhibitor therapy, the weak inverse relationship between serum K and eGFR was maintained in both groups. Conversely, urinary K excretion remained positively associated with dietary K intake only in the no RAAS inhibitor group. In conclusion, 24-h urine K excretion may be used as a surrogate of K intake, but RAAS inhibitor therapy reduces the association between 24-h urine K excretion and dietary K intake in CKD patients.
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Affiliation(s)
- Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Nicola Pellegrino
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vincenzo Panichi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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9
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Lucassen DA, Brouwer-Brolsma EM, Boshuizen HC, Mars M, de Vogel-Van den Bosch J, Feskens EJM. Validation of the smartphone-based dietary assessment tool 'Traqq' for assessing actual dietary intake by repeated 2-hour recalls in adults: comparison with 24h recalls and urinary biomarkers. Am J Clin Nutr 2023:S0002-9165(23)46837-2. [PMID: 37054887 DOI: 10.1016/j.ajcnut.2023.04.008] [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: 10/27/2022] [Revised: 02/07/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Conventional dietary assessment methods are affected by measurement error. We developed a smartphone-based 2-hour recall (2hR) methodology to reduce participant burden and memory-related bias. OBJECTIVE Assessing the validity of the 2hR method against traditional 24-hour recalls (24hRs) and objective biomarkers. METHODS Dietary intake was assessed in 215 Dutch adults on six randomly selected non-consecutive days (i.e., three 2hR-days and three 24hRs) during a four-week period. Sixty-three participants provided four 24-hour urine samples, to assess urinary nitrogen and potassium concentrations. RESULTS Intake estimates of energy (2,052±503 kcal vs. 1,976±483 kcal) and nutrients (e.g., protein: 78±23 g vs. 71±19 g; fat: 84±30 g vs. 79±26 g; carbohydrates: 220±60 g vs. 216±60 g) were slightly higher with 2hR-days than 24hRs. Comparing self-reported protein and potassium intakes to urinary nitrogen and potassium concentrations indicated a slightly higher accuracy of 2hR-days than 24hRs (protein: -14% vs. -18%; potassium: -11% vs. -16%). Correlation coefficients between methods ranged from 0.41 to 0.75 for energy and macronutrients and from 0.41 to 0.62 for micronutrients. Generally regularly consumed food groups showed small differences in intake (<10%) and good correlations (>0.60). Intakes of and energy, nutrients and food groups showed similar reproducibility (ICC) for 2hR-days and 24hRs. CONCLUSIONS Comparing 2hR-days with 24hRs showed relatively similar group-level bias for energy, most nutrients, and food groups. Differences were mostly due to higher intake estimates by 2hR-days. Biomarker comparisons showed less underestimation by 2hR-days as compared to 24hRs, suggesting that 2hR-days are a valid approach to assess intake of energy, nutrients and food groups. TRIAL REGISTRATION This trial was registered at the Dutch Central Committee on Research Involving Human Subjects (CCMO) registry as ABR. No. NL69065.081.19.
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Affiliation(s)
- Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Hendriek C Boshuizen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Monica Mars
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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10
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Accuracy of equations for predicting 24-h urinary potassium excretion from spot urine samples in Chinese children. Br J Nutr 2022; 128:444-452. [PMID: 34593059 DOI: 10.1017/s0007114521003354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5-18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, -14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.
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11
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Legay C, Krasniqi T, Bourdet A, Bonny O, Bochud M. Methods for the dietary assessment of adult kidney stone formers: a scoping review. J Nephrol 2022; 35:821-830. [PMID: 35167058 PMCID: PMC8995246 DOI: 10.1007/s40620-022-01259-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Kidney stones are a frequent and potentially severe condition, affecting 5-10% of the European population. Causes are multifactorial, diet in particular plays a major role in the formation and management of kidney stones. The aim of this scoping review is to assess the methods used to study the diet of adult kidney stone formers. METHODS We conducted a systematic search in Medline Ovid SP, Embase, Cinahl, Cochrane (CENTRAL), Web of Sciences databases on June 10th, 2020. Self-report methods (such as food frequency questionnaires or 24-h dietary recalls), objective nutritional biomarkers and controlled diets were considered. We analyzed the selected publications based on the origin of participants, study design and dietary assessment methods used. RESULTS We screened 871 publications and included 162 of them. Most studies included participants from North America and Europe and were observational. Short and cost-effective tools such as food frequency questionnaires and other questionnaires were the most frequently used. Moreover, food diary was a frequently selected method to study the diet of kidney stone formers. New technologies (e.g. online questionnaires, phone applications, connected tools) were rarely used. CONCLUSION Accurate reporting of the methods used in nutritional studies is of key importance to interpret results and build evidence. Assessing long-term dietary intake is still a challenge for nutritional epidemiology. A combination of self-report methods with objective dietary biomarkers and new technologies probably represents the best way forward.
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Affiliation(s)
- Constance Legay
- Department of Biomedical Sciences, University of Lausanne, Switzer Rue du Bugnon 27, 1011, Lausanne, Switzerland.,Department of Epidemiology and Health Systems, Unisanté, Lausanne, Switzerland.,NCCR Kidney.CH, Zürich, Switzerland
| | - Tropoja Krasniqi
- Department of Biomedical Sciences, University of Lausanne, Switzer Rue du Bugnon 27, 1011, Lausanne, Switzerland.,Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alice Bourdet
- Department of Epidemiology and Health Systems, Unisanté, Lausanne, Switzerland
| | - Olivier Bonny
- Department of Biomedical Sciences, University of Lausanne, Switzer Rue du Bugnon 27, 1011, Lausanne, Switzerland. .,Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland. .,NCCR Kidney.CH, Zürich, Switzerland.
| | - Murielle Bochud
- Department of Epidemiology and Health Systems, Unisanté, Lausanne, Switzerland.,NCCR Kidney.CH, Zürich, Switzerland
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12
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Paradis F, Lamarche B, Robitaille J, Couillard C, Lafrenière J, Tremblay AJ, Corneau L, Lemieux S. Validation of an automated self-administered 24-hour dietary recall web application against urinary recovery biomarkers in a sample of French-speaking adults of the province of Québec, Canada. Appl Physiol Nutr Metab 2022; 47:173-182. [PMID: 35057638 DOI: 10.1139/apnm-2021-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to validate an automated self-administered 24-hour dietary recall web application (R24W) against recovery biomarkers for sodium, potassium and protein intakes and to identify individual characteristics associated with misreporting in a sample of 61 men and 69 women aged 20-65 years from Québec City, Canada. Each participant completed 3 dietary recalls using the R24W, provided two 24-hour urinary samples and completed questionnaires to document psychosocial factors. Mean reported intakes were 2.2%, 2.1% and 5.0% lower than the urinary reference values, respectively, for sodium, potassium and proteins (significant difference for proteins only (p = 0.04)). Deattenuated correlations between the self-reported intake and biomarkers were significant for sodium (r = 0.48), potassium (r = 0.56) and proteins (r = 0.68). Cross-classification showed that 39.7% (sodium), 42.9% (potassium) and 42.1% (proteins) of participants were ranked into the same quartile with both methods and only 4.8% (sodium), 3.2% (potassium) and 0.8% (proteins) were ranked in opposite quartiles. Lower body esteem related to appearance was associated with sodium underreporting in women (r = 0.33, p = 0.006). No other individual factor was found to be associated with misreporting. These results suggest that the R24W has a good validity for the assessment of sodium, potassium and protein intakes in a sample of French-speaking adults. Novelty: The validity of an automated self-administered 24-hour dietary recall web application named the R24W was tested using urinary biomarkers. According to 7 criteria, the R24W was found to have a good validity to assess self-reported intakes of sodium, potassium and proteins.
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Affiliation(s)
- Frédérique Paradis
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benoît Lamarche
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Julie Robitaille
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Charles Couillard
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Jacynthe Lafrenière
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - André J Tremblay
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - Louise Corneau
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada
| | - Simone Lemieux
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada.,École de nutrition, Université Laval, Québec, QC G1V 0A6, Canada
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13
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Yuan L, Muli S, Huybrechts I, Nöthlings U, Ahrens W, Scalbert A, Floegel A. Assessment of Fruit and Vegetables Intake with Biomarkers in Children and Adolescents and Their Level of Validation: A Systematic Review. Metabolites 2022; 12:126. [PMID: 35208201 PMCID: PMC8876138 DOI: 10.3390/metabo12020126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 12/10/2022] Open
Abstract
Fruit and vegetables (FV) are part of a healthy diet and should be frequently consumed already at a young age. However, intake of FV is difficult to assess in children and adolescents due to various misreporting aspects. Thus, measurement of dietary biomarkers may be a promising alternative to assess FV intake more objectively at young age. To date, dietary biomarkers have been primarily studied in adults, and research focused on their usefulness in children is scarce. However, clinical studies have revealed important differences between children and adults, most importantly in their gut microbiome composition, resulting in differences in postprandial metabolism, as well as in food choices and meal compositions that may influence individual biomarker levels. Therefore, the present review aimed to identify biomarkers of FV intake (BFVI) currently available in children and adolescents and to explore whether there are any differences in the BFVI profile above between children and adolescents and adults. In addition, the current level of validation of BFVI in children and adolescents was examined. In total, 28 studies were eligible for this review, and 18 compounds were identified as potential biomarkers for FV intake in children and adolescents. Carotenoid concentration in skin was a valuable biomarker for total FV intake for both children and adult populations. Common BFVI in blood in adults (e.g., carotenoids and vitamin C) showed inconsistent results in children and adolescents. Biomarkers particularly useful in children included urinary hippuric acid as a biomarker of polyphenolic compound intake originating from FV and the combination of N-methylnicotinic acid and acetylornithine as a biomarker of bean intake. Further studies are needed to assess their kinetics, dose-response, and other validation aspects. There is limited evidence so far regarding valid BFVI in children and adolescents. Thus, to put BFVI into practice in children and adolescents, further studies, particularly based on metabolomics, are needed to identify and validate BFVI that can be used in future epidemiological studies.
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Affiliation(s)
- Li Yuan
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany; (W.A.); (A.F.)
| | - Samuel Muli
- Unit of Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, 53115 Bonn, Germany; (S.M.); (U.N.)
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC), 69372 Lyon, France; (I.H.); (A.S.)
| | - Ute Nöthlings
- Unit of Nutritional Epidemiology, Department of Nutrition and Food Sciences, Rheinische Friedrich-Wilhelms-University Bonn, 53115 Bonn, Germany; (S.M.); (U.N.)
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany; (W.A.); (A.F.)
| | - Augustin Scalbert
- International Agency for Research on Cancer (IARC), 69372 Lyon, France; (I.H.); (A.S.)
| | - Anna Floegel
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany; (W.A.); (A.F.)
- Section of Dietetics, Faculty of Agriculture and Food Sciences, Hochschule Neubrandenburg—University of Applied Sciences, 17033 Neubrandenburg, Germany
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14
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Salman E, Kadota A, Okami Y, Kondo K, Yoshita K, Okuda N, Nakagawa H, Saitoh S, Sakata K, Okayama A, Chan Q, Elliott P, Stamler J, Ueshima H, Miura K. Investigation of the urinary sodium-to-potassium ratio target level based on the recommended dietary intake goals for the Japanese population: The INTERMAP Japan. Hypertens Res 2022; 45:1850-1860. [PMID: 36344663 PMCID: PMC9659487 DOI: 10.1038/s41440-022-01007-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022]
Abstract
Growing epidemiological evidence has shown an association of the urinary sodium (Na) to potassium (K) ratio (Na/K ratio) with blood pressure and cardiovascular diseases. However, no clear cutoff level has been defined. We investigated the cutoff level of the urinary Na/K ratio under different dietary guidelines for Japanese individuals, especially that endorsed by the 2020 revised Japanese Dietary Reference Intakes (DRIs). A population of 1145 Japanese men and women aged 40 to 59 years from the INTERMAP study was examined. Using high-quality standardized data, the averages of two 24 h urinary collections and four 24 h dietary recalls were used to calculate the 24 h urinary and dietary Na/K ratios, respectively. Associations between the urinary and dietary Na/K ratios were tested by sex- and age-adjusted partial correlation. The optimal urinary Na/K ratio cutoff level was determined by receiver operating characteristic (ROC) curves and sex-specific cross tables for recommended dietary K and salt. Overall, the average molar ratio of 24 h urinary Na/K was 4.3. We found moderate correlations (P < 0.001) of the 24 h urinary Na/K ratio with 24 h urinary Na and K excretion (r = 0.52, r = -0.49, respectively) and the dietary Na/K ratio (r = 0.53). ROC curves showed that a 24 h urinary Na/K ratio of approximately 2 predicted Na and K intake that meets the dietary goals of the Japanese DRIs. The range of urinary Na/K ratios meeting the dietary goals of the Japanese DRIs for both Na and K was 1.6‒2.2 for men and 1.7‒1.9 for women. Accomplishing a urinary Na/K ratio of 2 would be desirable to achieve the DRIs dietary goals for both Na and K simultaneously in middle-aged Japanese men and women accustomed to Japanese dietary habits. This observational study is registered at www.clinicaltrials.gov as NCT00005271.
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Affiliation(s)
- Ebtehal Salman
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan ,grid.471243.70000 0001 0244 1158OMRON Healthcare Co., Ltd, Kyoto, Japan
| | - Aya Kadota
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Yukiko Okami
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- grid.261445.00000 0001 1009 6411Department of Food Science and Nutrition, Graduate School of Human Life Science and Nutrition, Osaka City University, Osaka, Japan
| | - Nagako Okuda
- grid.258797.60000 0001 0697 4728Department of Health Science, Kyoto Prefectural University, Kyoto, Japan
| | - Hideaki Nakagawa
- grid.411998.c0000 0001 0265 5359Medical Research Institute, Kanazawa Medical University, Kanazawa, Japan
| | - Shigeyuki Saitoh
- grid.263171.00000 0001 0691 0855School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kiyomi Sakata
- grid.411790.a0000 0000 9613 6383Department of Hygiene and Public Health, Iwate Medical University, Yahaba, Japan
| | - Akira Okayama
- grid.272242.30000 0001 2168 5385Department of Non-Communicable Diseases, Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Queenie Chan
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Hirotsugu Ueshima
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
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15
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High Adherence to Mediterranean Diet Is Not Associated with an Improved Sodium and Potassium Intake. Nutrients 2021; 13:nu13114151. [PMID: 34836406 PMCID: PMC8623388 DOI: 10.3390/nu13114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Prevention and control of hypertension and cerebro-cardiovascular diseases are associated with adequate sodium and potassium intake and adherence to a Mediterranean dietary pattern. The aim of this study was to assess the association between adherence to a Mediterranean diet (MD) and the excretion of sodium and potassium as surrogate measures of intake. This is a cross-sectional analysis as part of a larger study (the iMC SALT randomized controlled trial) among workers of a public university. A food frequency questionnaire was used to assess the adherence to MD, using the alternative Mediterranean diet (aMED) score; sodium and potassium excretions were estimated by 24-h urine collections. Sociodemographic and other lifestyle characteristics were also obtained. The associations between the adherence to MD and Na and K excretion were calculated by logistic regression, adjusting for confounding variables. From the 109 selected participants, seven were excluded considering urine screening and completeness criteria, leaving a final sample of 102 subjects (48% male, average age 47 years). Mean sodium and potassium excretion were 3216 mg/day and 2646 mg/day, respectively. Sodium and potassium excretion were significantly higher in men, but no differences were found according to different levels of MD adherence. In logistic regression analysis, sodium, potassium, and sodium-to-potassium ratio urinary excretion tertiles were not associated with MD adherence (low/moderate versus high), even after adjustment for confounding variables. A high adherence to MD was thus not associated with a different level of sodium and potassium intake.
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16
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Association between 24 h Urinary Sodium and Potassium Excretion and Dietary Intake in Japanese Male Adolescent Football Players. ADOLESCENTS 2021. [DOI: 10.3390/adolescents1040035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
High urinary sodium-to-potassium ratio is considered a strong risk factor for hypertension. This study aimed to evaluate urinary excretion of sodium and potassium, and we analyzed these levels associated with dietary intake in Japanese adolescent football players. This cross-sectional study included 120 Japanese male adolescent football players. Over 24 h, urine was collected and measured for creatinine, sodium, and potassium levels. A dietary assessment was performed using a self-administered diet history questionnaire. The study analyzed 79 participants. The mean urinary sodium was 143.2 mmol/day, urinary potassium was 42.8 mmol/day, and the mean urinary sodium-to-potassium ratio was 3.6. Compared with the Japanese Dietary Reference Intakes, the estimated salt intake was 73.4% for the participants who exceeded the sodium intake, and the estimated potassium intake was 73.4% for the participants who did not satisfy it. Multiple regression analysis revealed that milk and dairy product intake was independently and positively associated with urinary potassium (β = 0.252) and independently and negatively associated with the urinary sodium-to-potassium ratio (β = −0.254). Adolescent football players had a high-sodium and low-potassium diet, well above the Japanese Dietary Reference Intakes recommendations. Milk and dairy products could be effective for increasing urinary potassium and decreasing the urinary sodium-to-potassium ratio.
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17
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Wouda RD, Waanders F, de Zeeuw D, Navis G, Vogt L. Diminished antiproteinuric effect of the angiotensin receptor blocker losartan during high potassium intake in patients with CKD. Clin Kidney J 2021; 14:2170-2176. [PMID: 34603695 PMCID: PMC8483678 DOI: 10.1093/ckj/sfab031] [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] [Received: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022] Open
Abstract
Background Angiotensin II type 1 receptor blockers (ARBs) lower blood pressure (BP) and proteinuria and reduce renal disease progression in many-but not all-patients. Reduction of dietary sodium intake improves these effects of ARBs. Dietary potassium intake affects BP and proteinuria. We set out to address the effect of potassium intake on BP and proteinuria response to losartan in non-diabetic proteinuric chronic kidney disease (CKD) patients. Methods We performed a post hoc analysis of a placebo-controlled interventional cross-over study in 33 non-diabetic proteinuric patients (baseline mean arterial pressure and proteinuria: 105 mmHg and 3.8 g/day, respectively). Patients were treated for 6 weeks with placebo, losartan and losartan/hydrochlorothiazide (HCT), combined with a habitual (∼200 mmol/day) and low-sodium (LS) diet (<100 mmol/day), in randomized order. To analyse the effects of potassium intake, we categorized patients based on median split of 24-h urinary potassium excretion, reflecting potassium intake. Results Mean potassium intake was stable during all six treatment periods. Losartan and losartan/HCT lowered BP and proteinuria in all treatment groups. Patients with high potassium intake showed no difference in the BP effects compared with patients with low potassium intake. The antiproteinuric response to losartan monotherapy and losartan combined with HCT during the habitual sodium diet was significantly diminished in patients with high potassium intake (20% versus 41%, P = 0.011; and 48% versus 64%, P = 0.036). These differences in antiproteinuric response abolished when shifting to the LS diet. Conclusions In proteinuric CKD patients, the proteinuria, but not BP-lowering response to losartan during a habitual high-sodium diet was hampered during high potassium intake. Differences disappeared after sodium status change by LS diet.
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Affiliation(s)
- Rosa D Wouda
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Dick de Zeeuw
- University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- University Medical Center Groningen, Groningen, The Netherlands
| | - Liffert Vogt
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Koch SAJ, Conrad J, Cade JE, Weinhold L, Alexy U, Nöthlings U. Validation of the web-based self-administered 24-h dietary recall myfood24-Germany: comparison with a weighed dietary record and biomarkers. Eur J Nutr 2021; 60:4069-4082. [PMID: 33974128 PMCID: PMC8437850 DOI: 10.1007/s00394-021-02547-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE We aimed to validate myfood24-Germany, a web-based 24-h dietary recall (24HDR), by comparing its performance with a weighed dietary record (WDR) and biomarkers. METHODS 97 adults (77% female) completed a 3-day WDR with a 24-h urine collection on day 3, followed by at least one 24HDR with myfood24-Germany (corresponding to day 3 of the WDR). Intake of energy and 32 nutrients assessed by myfood24-Germany and the WDR for the same day were compared (method comparison). Intakes of protein and potassium assessed by myfood24-Germany/WDR were compared with intake estimated from urinary biomarkers for protein and potassium (biomarker comparison). RESULTS In the method comparison, significant correlations were found for energy and all tested nutrients (range 0.45-0.87). There was no significant difference between both methods in the assessed mean energy and macronutrient intake. However, myfood24-Germany underestimated mean intake of 15 nutrients. In the biomarker comparison, protein intake reported by myfood24-Germany/WDR was on average 10%/8% lower than estimated by biomarker. There was no significant difference in mean potassium intake assessed by myfood24-Germany/WDR and biomarker. However, a shared bias in the assessment of potassium intake was observed for both instruments. Concordance correlation coefficients (pc) and weighted Kappa coefficients (κ) confirmed good agreement with the biomarker estimates for myfood24-Germany/WDR in case of protein (pc = 0.58/0.66, κ = 0.51/0.53) and moderate agreement in case of potassium (pc = 0.44/0.51; κ = 0.30/0.33). CONCLUSION Our results suggest that myfood24-Germany is of comparable validity to traditional dietary assessment methods.
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Affiliation(s)
- Stefanie A J Koch
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany.
| | - Johanna Conrad
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany.,Science Department, German Nutrition Society, Bonn, Germany
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Leonie Weinhold
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Ute Alexy
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
| | - Ute Nöthlings
- Nutritional Epidemiology, Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
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Rastmanesh R. Is urinary Na/K ratio an independent indicator associated with current hypertension and RA disease activity or just an artifact? Comment on article by Minamino H et al. Arthritis Res Ther 2021; 23:183. [PMID: 34238356 PMCID: PMC8264979 DOI: 10.1186/s13075-021-02571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Reza Rastmanesh
- The Nutrition Society, London, UK. .,Independent Researcher, Private Clinic, Tehran, 1981635555, Iran.
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20
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Donfrancesco C, Lo Noce C, Russo O, Buttari B, Profumo E, Minutoli D, Di Lonardo A, Iacone R, Vespasiano F, Vannucchi S, Onder G, Galletti F, Galeone D, Bellisario P, Di Lenarda A, Giampaoli S, Palmieri L, Strazzullo P. Trend in potassium intake and Na/K ratio in the Italian adult population between the 2008 and 2018 CUORE project surveys. Nutr Metab Cardiovasc Dis 2021; 31:814-826. [PMID: 33546944 DOI: 10.1016/j.numecd.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Low potassium intake, in addition to high sodium, has been associated with higher risk of hypertension and CVD. The Study assessed habitual potassium intake and sodium/potassium ratio of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urine collection, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys. METHODS AND RESULTS Data were from cross-sectional surveys of randomly selected age-and-sex stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian regions. Urinary electrolyte and creatinine measurements were performed in a central laboratory. Analyses considered 942 men and 916 women, examined in 2008-2012, and 967 men and 1010 women, examined in 2018-2019. In 2008-2012, the age-standardized mean of potassium intake (urinary potassium accounts for 70% of potassium intake) was 3147 mg (95% CI 3086-3208) in men and 2784 mg (2727-2841) in women, whereas in 2018-2019, it was 3043 mg (2968-3118) and 2561 mg (2508-2614) respectively. In 2008-2012, age-adjusted prevalence of persons with an adequate potassium intake (i.e. ≥ 3510 mg/day) was 31% (95% CI 28-34%) for men and 18% (16-21%) for women; in 2018-2019, it was 26% (23-29%) and 12% (10-14%) respectively. The sodium/potassium ratio significantly decreased both in men and women. CONCLUSIONS The average daily potassium intake of the Italian general adult population remains lower than the WHO and EFSA recommended level. These results suggest the need of a revision to strengthen initiatives for the promotion of an adequate potassium intake at the population level.
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Affiliation(s)
| | | | - Ornella Russo
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | - Roberto Iacone
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | | | | | - Andrea Di Lenarda
- University Hospital and Health Services of Trieste, Trieste, Italy; National Association of Hospital Cardiologists (ANMCO), Florence, Italy
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21
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Ziaei R, Askari G, Foshati S, Zolfaghari H, Clark CCT, Rouhani MH. Association between urinary potassium excretion and blood pressure: A systematic review and meta-analysis of observational studies. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:116. [PMID: 33912226 PMCID: PMC8067889 DOI: 10.4103/jrms.jrms_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/19/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
Background The evidence base regarding the association between urinary potassium and blood pressure (BP), or risk of hypertension, is inconsistent. Therefore, we sought to conduct a qualitative and quantitative literature review on the association between potassium excretion and BP. Materials and Methods Medline, Scopus, Web of Science, Science Direct, and Google Scholar were searched up to June 2020. All observational studies that reported BP and measured potassium excretion in overnight or 24-h urine samples were included. Correlation coefficients, mean urinary potassium excretion, and odds ratio (ORs) of hypertension were extracted from the included studies. There were no language or publication date restrictions. Results Overall, twelve observational studies, including 16,174 subjects, were identified for inclusion in the present meta-analysis, and 21 effect sizes were extracted. Pooled mean potassium excretion was 3.46 mmol/24 h higher in normotensive individuals compared with hypertensive subjects (95% confidence interval [CI]: 0.61, 6.31). High urinary potassium excretion was not associated with the risk of hypertension (OR: 0.95; 95% CI: 0.79, 1.13). The pooled correlation coefficient between BP and urinary potassium was not significant (ES: 0.01; 95% CI: -0.03, 0.05). However, a subgroup analysis by age indicated a significant positive correlation between urinary potassium and systolic BP in children (ES: 0.12; 95% CI: 0.04, 0.19). Conclusion 24 h urinary potassium excretion was not correlated to BP and risk of hypertension. In contrast, mean urinary potassium excretion was higher in normotensive individuals compared with hypertensive counterparts. Future studies should focus on the association between different sources of dietary potassium and BP.
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Affiliation(s)
- Rahele Ziaei
- Students' Research Committee, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Foshati
- Students' Research Committee, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Clinical Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Zolfaghari
- Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, England
| | - Mohammad Hossein Rouhani
- Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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22
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Lobene AJ, Stremke ER, McCabe GP, Moe SM, Moorthi RN, Hill Gallant KM. Spot Urine Samples to Estimate Na and K Intake in Patients With Chronic Kidney Disease and Healthy Adults: A Secondary Analysis From a Controlled Feeding Study. J Ren Nutr 2020; 31:602-610. [PMID: 33309410 DOI: 10.1053/j.jrn.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/04/2020] [Accepted: 09/26/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the agreement between estimated 24-hour urinary sodium excretion (e24hUNa) and estimated 24-hour urinary potassium excretion (e24hUK), calculated from a spot urine sample using several available equations and actual sodium and potassium intake from a controlled diet in both healthy participants and those with chronic kidney disease (CKD). DESIGN AND METHODS This study is a secondary analysis of a controlled feeding study in CKD patients matched to healthy controls. Participants (n = 16) consumed the controlled diet, which provided ∼2400 mg Na/day and ∼3000 mg K/day, for 8 days. On days 7 and 8, participants consumed all meals and collected all urine in an inpatient research setting, and they were discharged on day 9. The day 7 morning spot urine sample was used to calculate e24hUNa and e24hUK, which was compared with known sodium and potassium intake, respectively. RESULTS Average e24hUNa from the INTERSALT and Tanaka-Na equations were higher than actual sodium intake by 373 mg and 559 mg, respectively, though the differences were not significant. e24hUNa from the Nerbass-SALTED equation in CKD participants was significantly higher than actual sodium intake by ∼2000 mg (P < .001), though e24hUNa from the Nerbass-RRID equation was not different from intake. e24hUK from the Tanaka-K equation was significantly lower than actual potassium intake (P < .001). For both e24hUNa and e24hUK for all participants, agreement with actual intake was poor, and e24hUNa and e24hUK were not correlated with actual sodium or potassium intake, respectively. CONCLUSION e24hUNa and e24hUK are poor indicators of true sodium and potassium intake, respectively, in both healthy and CKD participants. Findings should be confirmed in larger sample sizes with varying levels of dietary sodium and potassium.
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Affiliation(s)
- Andrea J Lobene
- Department of Nutrition Science, Purdue University, West Lafayette, IN; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | - Elizabeth R Stremke
- Department of Nutrition Science, Purdue University, West Lafayette, IN; Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - George P McCabe
- Department of Statistics, Purdue University, West Lafayette, IN
| | - Sharon M Moe
- Department of Medicine/Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN
| | - Ranjani N Moorthi
- Department of Medicine/Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN
| | - Kathleen M Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN; Department of Food Science and Nutrition, University of Minnesota, Minneapolis, MN
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23
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Quarrier S, Li S, Penniston KL, Best SL, Hedican SP, Jhagroo RA, Nakada SY. Lower Socioeconomic Status is Associated With Adverse Urinary Markers and Surgical Complexity in Kidney Stone Patients. Urology 2020; 146:67-71. [PMID: 32991913 DOI: 10.1016/j.urology.2020.09.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine if socioeconomic status (SES) correlates with severity of kidney stone disease and 24-hour urine parameters. MATERIALS AND METHODS An IRB approved prospectively maintained database for nephrolithiasis was retrospectively analyzed for both 24-hour urine results and surgical procedures performed from 2009 to 2019. Severely distressed communities (SDC) were categorized as those with a Distressed Communities Index (DCI), a composite measure of SES, score in the top quartile (lowest for SES). Univariate and multivariate analyses were performed to evaluate the strength of the association of DCI on: stone size at presentation, need for and type of surgical procedure, need for staged surgery and specific stone risk factors in 24-hour urine collections. RESULTS Surgical procedures were performed on 3939 patients (1978 women) who were not from SDC and 200 (97 women) from SDC. Patients from SDC were older (57.1 years vs 54.2 years; P = .009). Patients from SDC were more likely to undergo proportionally more invasive procedures (17.5% vs 11.6%; P = .011) and require staged surgery at a higher rate (13.0% vs 8.5%; P = .028). Men from SDC had larger stones (12.5 mm vs 9.7 mm; P = .001). Among 24-hour urine results from 2454 patients (1187 women), DCI was not correlated with sodium, calcium, magnesium, volume, oxalate, phosphate, and pH levels. Higher DCI (lower SES) correlated with lower urine citrate (P = .001) and lower urine potassium (P = .002). CONCLUSION SES correlates with larger stone burden at the time of urologic intervention, requires proportionally more invasive procedures and more staged procedures. Lower SES correlated with lower urine citrate and potassium.
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Affiliation(s)
- Scott Quarrier
- Department of Urology, University of Wisconsin, Madison, WI.
| | - Shuang Li
- Department of Urology, University of Wisconsin, Madison, WI
| | | | - Sara L Best
- Department of Urology, University of Wisconsin, Madison, WI
| | - Sean P Hedican
- Department of Urology, University of Wisconsin, Madison, WI
| | - Roy A Jhagroo
- Department of Urology, University of Wisconsin, Madison, WI
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24
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Wang Y, Hodge RA, Stevens VL, Hartman TJ, McCullough ML. Identification and Reproducibility of Plasma Metabolomic Biomarkers of Habitual Food Intake in a US Diet Validation Study. Metabolites 2020; 10:metabo10100382. [PMID: 32993181 PMCID: PMC7600452 DOI: 10.3390/metabo10100382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Previous metabolomic studies have identified putative blood biomarkers of dietary intake. These biomarkers need to be replicated in other populations and tested for reproducibility over time for the potential use in future epidemiological studies. We conducted a metabolomics analysis among 671 racially/ethnically diverse men and women included in a diet validation study to examine the correlation between >100 food groups/items (101 by a food frequency questionnaire (FFQ), 105 by 24-h diet recalls (24HRs)) with 1141 metabolites measured in fasting plasma sample replicates, six months apart. Diet–metabolite associations were examined by Pearson’s partial correlation analysis. Biomarker reproducibility was assessed using intraclass correlation coefficients (ICCs). A total of 677 diet–metabolite associations were identified after Bonferroni adjustment for multiple comparisons and restricting absolute correlation coefficients to greater than 0.2 (601 associations using the FFQ and 395 using 24HRs). The median ICCs of the 238 putative biomarkers was 0.56 (interquartile range 0.46–0.68). In this study, with repeated FFQs, 24HRs and plasma metabolic profiles, we identified several potentially novel food biomarkers and replicated others found in our previous study. Our findings contribute to the growing literature on food-based biomarkers and provide important information on biomarker reproducibility which could facilitate their utilization in future nutritional epidemiological studies.
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Affiliation(s)
- Ying Wang
- Department of Population Science, American Cancer Society, Atlanta, GA 30303, USA; (R.A.H.); (V.L.S.); (M.L.M.)
- Correspondence: ; Tel.: +1-404-329-4341
| | - Rebecca A. Hodge
- Department of Population Science, American Cancer Society, Atlanta, GA 30303, USA; (R.A.H.); (V.L.S.); (M.L.M.)
| | - Victoria L. Stevens
- Department of Population Science, American Cancer Society, Atlanta, GA 30303, USA; (R.A.H.); (V.L.S.); (M.L.M.)
| | - Terryl J. Hartman
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | - Marjorie L. McCullough
- Department of Population Science, American Cancer Society, Atlanta, GA 30303, USA; (R.A.H.); (V.L.S.); (M.L.M.)
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25
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Validation of a new software eAT24 used to assess dietary intake in the adult Portuguese population. Public Health Nutr 2020; 23:3093-3103. [PMID: 32611472 DOI: 10.1017/s1368980020001044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the current study was to evaluate the accuracy of the new software eAT24 used to assess dietary intake in the National Food, Nutrition and Physical Activity Survey (IAN-AF) against urinary biomarkers: N (nitrogen), K (potassium) and Na (sodium). DESIGN We conducted a cross-sectional study. Two non-consecutive 24-h dietary recalls (24-HDR) were applied, and a 24-h urine sample was collected. We examined differences between estimates from dietary and urine measures, Pearson correlation coefficients were calculated and the Bland-Altman plots were drawn. Multiple linear regression was used to evaluate the factors associated with the difference between estimates. SETTING Sub-sample from the Portuguese IAN-AF sampling frame. PARTICIPANTS Ninety-five adults (men and women) aged 18-84 years. RESULTS The estimated intake calculated using the dietary recall data was lower than that estimated from urinary excretion for the three biomarkers studied (protein 94·3 v. 100·4 g/d, K 3212 v. 3416 mg/d and Na 3489 v. 4003 mg/d). Considering 2 d of recall, the deattenuated correlation coefficients were 0·33, 0·64 and 0·26 for protein, K and Na, respectively. For protein, differences between dietary and urinary estimates varied according to BMI (β = -1·96, P = 0·017). The energy intake and 24-h urine volume were significantly associated with the difference between estimates for protein (β = 0·03, P < 0·001 and β = -0·02, P = 0·002, respectively), K (β = 0·71, P < 0·001 and β = -0·42, P = 0·040, respectively) and Na (β = 1·55, P < 0·001 and β = -0·81, P = 0·011, respectively). CONCLUSIONS The new software eAT24 performed well in estimating protein and K intakes, but lesser so in estimating Na intake, using two non-consecutive 24-HDR.
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26
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Posma JM, Garcia-Perez I, Frost G, Aljuraiban GS, Chan Q, Van Horn L, Daviglus M, Stamler J, Holmes E, Elliott P, Nicholson JK. Nutriome-metabolome relationships provide insights into dietary intake and metabolism. ACTA ACUST UNITED AC 2020; 1:426-436. [PMID: 32954362 PMCID: PMC7497842 DOI: 10.1038/s43016-020-0093-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dietary assessment traditionally relies on self-reported data which are often inaccurate and may result in erroneous diet-disease risk associations. We illustrate how urinary metabolic phenotyping can be used as alternative approach for obtaining information on dietary patterns. We used two multi-pass 24-hr dietary recalls, obtained on two occasions on average three weeks apart, paired with two 24-hr urine collections from 1,848 U.S. individuals; 67 nutrients influenced the urinary metabotype measured with 1H-NMR spectroscopy characterized by 46 structurally identified metabolites. We investigated the stability of each metabolite over time and showed that the urinary metabolic profile is more stable within individuals than reported dietary patterns. The 46 metabolites accurately predicted healthy and unhealthy dietary patterns in a free-living U.S. cohort and replicated in an independent U.K. cohort. We mapped these metabolites into a host-microbial metabolic network to identify key pathways and functions. These data can be used in future studies to evaluate how this set of diet-derived, stable, measurable bioanalytical markers are associated with disease risk. This knowledge may give new insights into biological pathways that characterize the shift from a healthy to unhealthy metabolic phenotype and hence give entry points for prevention and intervention strategies.
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Affiliation(s)
- Joram M Posma
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, South Kensington Campus, Imperial College London, SW7 2AZ, U.K.,Health Data Research UK-London, U.K
| | - Isabel Garcia-Perez
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K
| | - Gary Frost
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K
| | - Ghadeer S Aljuraiban
- The Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, U.S.A
| | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL 60612
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, U.S.A
| | - Elaine Holmes
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,UK Dementia Research Institute, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,Division of Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia.,The Australian National Phenome Center, Harry Perkins Institute, Murdoch University, WA 6150, Australia
| | - Paul Elliott
- Health Data Research UK-London, U.K.,Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,MRC Centre for Environment and Health, School of Public Health, Faculty of Medicine, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,UK Dementia Research Institute, Faculty of Medicine, Hammersmith Campus, Imperial College London, W12 0NN, U.K.,National Institute for Health Research Imperial Biomedical Research Centre, St. Mary's Campus, Imperial College London, W2 1PG, U.K.,British Heart Foundation Centre of Research Excellence at Imperial, Imperial College London, W2 1PG, U.K
| | - Jeremy K Nicholson
- Division of Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA 6150, Australia.,The Australian National Phenome Center, Harry Perkins Institute, Murdoch University, WA 6150, Australia
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27
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Sivakumar B, Malta D, Mak S, Dash S, Newton GE, Arcand J. Evaluating the confounding effects of medical therapies on potassium intake assessment in patients with heart failure. Nutr Metab Cardiovasc Dis 2020; 30:1005-1013. [PMID: 32265100 DOI: 10.1016/j.numecd.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Potassium-wasting (loop diuretics [LD]) and potassium-sparing (spironolactone) medications used for heart failure (HF) may alter renal potassium handling and confound the use of twenty-four-hour (24-h) urine collections as a surrogate marker for potassium intake, an effect that has been observed with dietary sodium assessment. The objective was to determine the strength of association between 24-h urine collections and weighed food records in assessing potassium intake in HF patients stratified by LD usage and spironolactone usage. METHODS AND RESULTS Stable outpatients with HF simultaneously completed two 24-h urine collections and two weighed food records on consecutive days. Analyses compared patients stratified by LD and/or spironolactone use. Pearson's correlation and the Bland-Altman method of agreement assessed the relationship between the techniques. Overall, 109 patients (61 ± 11 yrs, 74% male) were included. The mean difference in dietary potassium estimated between 24-h urine collections and food records was -353 ± 1043 mg (p < 0.01) for all patients, with no differences between measures among subgroups. The association between the two methods was r = 0.551 (95% CI, 0.373 to 0.852, p < 0.001) for LD users; r = 0.287 (95% CI, 0.01 to 0.570, p = 0.050) for LD non-users; r = 0.321 (95% CI, 0.13 to 0.798, p = 0.043) for spironolactone users, and; r = 0.534 (95% CI, 0.331 to 0.747, p < 0.001) for spironolactone non-users. There were no significant mean biases identified as part of the Bland-Altman analysis. CONCLUSION Among HF patients, potassium-wasting and potassium-sparing medications do not influence the agreement between the two methods in the assessment of potassium intake.
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Affiliation(s)
- Bridve Sivakumar
- Faculty of Health Science, Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada
| | - Daniela Malta
- The School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - Susanna Mak
- Department of Medicine, University of Toronto, ON, Canada
| | - Sarah Dash
- Faculty of Health Science, Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada
| | | | - JoAnne Arcand
- Faculty of Health Science, Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada.
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28
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Filippini T, Naska A, Kasdagli MI, Torres D, Lopes C, Carvalho C, Moreira P, Malavolti M, Orsini N, Whelton PK, Vinceti M. Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2020; 9:e015719. [PMID: 32500831 PMCID: PMC7429027 DOI: 10.1161/jaha.119.015719] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Methods and Results We performed a meta‐analysis to explore the dose‐response relationship between potassium supplementation and BP in randomized‐controlled trials with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories. We identified 32 eligible trials. Most were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol/d. We observed a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and BP levels, with weakening of the BP reduction effect above differences of 30 mmol/d and a BP increase above differences ≈80 mmol/d. Achieved potassium excretion analysis also identified a U‐shaped relationship. The BP‐lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake. The BP increase with high potassium excretion was noted in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts. Conclusions We identified a nonlinear relationship between potassium intake and both systolic and diastolic BP, although estimates for BP effects of high potassium intakes should be interpreted with caution because of limited availability of trials. Our findings indicate an adequate intake of potassium is desirable to achieve a lower BP level but suggest excessive potassium supplementation should be avoided, particularly in specific subgroups.
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Affiliation(s)
- Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece
| | - Duarte Torres
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Carla Lopes
- EPIUnit-Institute of Public Health University of Porto Portugal.,Unit of Epidemiology Department of Public Health and Forensic Sciences, and Medical Education Faculty of Medicine University of Porto Portugal
| | - Catarina Carvalho
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Pedro Moreira
- EPIUnit-Institute of Public Health University of Porto Portugal.,Faculty of Nutrition and Food Sciences University of Porto Portugal
| | - Marcella Malavolti
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy
| | - Nicola Orsini
- Department of Global Public Health Karolinska Institute Stockholm Sweden
| | - Paul K Whelton
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, and School of Medicine New Orleans LA
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Modena Italy.,Department of Epidemiology Boston University School of Public Health Boston MA
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Dietary Intake and Sources of Potassium in a Cross-Sectional Study of Australian Adults. Nutrients 2019; 11:nu11122996. [PMID: 31817767 PMCID: PMC6949933 DOI: 10.3390/nu11122996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
A diet rich in potassium is important to reduce the risk of cardiovascular disease. This study assessed potassium intake; food sources of potassium (including NOVA level of processing, purchase origin of these foods); and sodium-to-potassium ratio (Na:K) in a cross-section of Australian adults. Data collection included 24-h urines (n = 338) and a 24-h diet recall (subsample n = 142). The mean (SD) age of participants was 41.2 (13.9) years and 56% were females. Mean potassium (95%CI) 24-h urinary excretion was 76.8 (73.0–80.5) mmol/day compared to 92.9 (86.6–99.1) by 24-h diet recall. Na:K was 1.9 (1.8–2.0) from the urine excretion and 1.4 (1.2–1.7) from diet recall. Foods contributing most to potassium were potatoes (8%), dairy milk (6%), dishes where cereal is the main ingredient (6%) and coffee/coffee substitutes (5%). Over half of potassium (56%) came from minimally processed foods, with 22% from processed and 22% from ultraprocessed foods. Almost two-thirds of potassium consumed was from foods purchased from food stores (58%), then food service sector (15%), and fresh food markets (13%). Overall, potassium levels were lower than recommended to reduce chronic disease risk. Multifaceted efforts are required for population-wide intervention—aimed at increasing fruit, vegetable, and other key sources of potassium intake; reducing consumption of processed foods; and working in supermarket/food service sector settings to improve the healthiness of foods available.
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Population biomonitoring of micronutrient intakes in children using urinary spot samples. Eur J Nutr 2019; 59:3059-3068. [PMID: 31745727 DOI: 10.1007/s00394-019-02144-9] [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: 08/06/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Urinary spot samples are a promising method for the biomonitoring of micronutrient intake in children. Our aim was to assess whether urinary spot samples could be used to estimate the 24-h urinary excretion of potassium, phosphate, and iodine at the population level. METHODS A cross-sectional study of 101 children between 6 and 16 years of age was conducted. Each child collected a 24-h urine collection and three urinary spot samples (evening, overnight, and morning). Several equations were used to estimate 24-h excretion based on the urinary concentrations of each micronutrient in the three spot samples. Various equations and spot combinations were compared using several statistics and plots. RESULTS Ninety-four children were included in the analysis (mean age: 10.5 years). The mean measured 24-h urinary excretions of potassium, phosphate, and iodine were 1.76 g, 0.61 g, and 95 µg, respectively. For potassium, the best 24-h estimates were obtained with the Mage equation and morning spot (mean bias: 0.2 g, correlation: 0.27, precision: 56%, and misclassification: 10%). For phosphate, the best 24-h estimates were obtained with the Mage equation and overnight spot (mean bias: - 0.03 g, correlation: 0.54, precision: 72%, and misclassification: 10%). For iodine, the best 24-h estimates were obtained with the Remer equation and overnight spot (mean bias: - 8 µg, correlation: 0.58, precision: 86%, misclassification: 16%). CONCLUSIONS Urinary spot samples could be a good alternative to 24-h urine collection for the population biomonitoring of iodine and phosphate intakes in children. For potassium, spot samples were less reliable.
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31
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Va P, Dodd KW, Zhao L, Thompson-Paul AM, Mercado CI, Terry AL, Jackson SL, Wang CY, Loria CM, Moshfegh AJ, Rhodes DG, Cogswell ME. Evaluation of measurement error in 24-hour dietary recall for assessing sodium and potassium intake among US adults - National Health and Nutrition Examination Survey (NHANES), 2014. Am J Clin Nutr 2019; 109:1672-1682. [PMID: 31136657 PMCID: PMC6537943 DOI: 10.1093/ajcn/nqz044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes. OBJECTIVE The aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE). DESIGN Data were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. RESULTS Overall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32). CONCLUSIONS Compared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.
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Affiliation(s)
- Puthiery Va
- Epidemic Intelligence Service,Division for Heart Disease and Stroke Prevention,Address correspondence to PV (e-mail: )
| | | | - Lixia Zhao
- Division for Heart Disease and Stroke Prevention,IHRC, Inc., Atlanta, GA
| | | | | | - Ana L Terry
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chia-Yih Wang
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
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32
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Fukuwatari T. Egg as a Source of Vitamins Supplies. J JPN SOC FOOD SCI 2018. [DOI: 10.3136/nskkk.65.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Wang Y, Gapstur SM, Carter BD, Hartman TJ, Stevens VL, Gaudet MM, McCullough ML. Untargeted Metabolomics Identifies Novel Potential Biomarkers of Habitual Food Intake in a Cross-Sectional Study of Postmenopausal Women. J Nutr 2018; 148:932-943. [PMID: 29767735 DOI: 10.1093/jn/nxy027] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background Recent studies suggest that untargeted metabolomics is a promising tool to identify novel biomarkers of individual foods. However, few large cross-sectional studies with comprehensive data on habitual diet and circulating metabolites have been conducted. Objective We aimed to identify potential food biomarkers and evaluate their predictive accuracy. Methods We conducted a cross-sectional analysis of consumption of 91 food groups or items, assessed by a 152-item food-frequency questionnaire, in relation to 1186 serum metabolites measured by mass spectrometry-based platforms from 1369 nonsmoking postmenopausal women (mean age = 68.3 y). Diet-metabolite associations were selected by Pearson's partial correlation analysis (P < 4.63 × 10-7, |r| > 0.2). The predictive accuracy of the selected food metabolites was evaluated from the area under the curve (AUC) calculated from receiver operating characteristic analysis conducted among women in the top and bottom quintiles of dietary intake. Results We identified 379 diet-metabolite associations. Forty-two food groups or items were correlated with 199 serum metabolites. We replicated 63 metabolites as biomarkers of habitual food intake reported in previous cross-sectional studies. Among those not previously shown to be associated with habitual diet, several are biologically plausible and were reported in acute feeding studies including: banana and dopamine 3-O-sulfate (r = 0.34, AUC = 76%) and dopamine 4-O-sulfate (r = 0.33, AUC = 74%), garlic and alliin (r = 0.24, AUC = 69%), N-acetylalliin (r = 0.27, AUC = 70%), and S-allylcysteine (r = 0.23, AUC = 69). Two unannotated metabolites were the strongest predictors for dark fish (X-02269, r = 0.51, AUC = 94%) and coffee intake (X-21442, r = 0.62, AUC = 98%). Conclusion In this comprehensive, cross-sectional analysis of habitual food intake and serum metabolites among postmenopausal women, we identified several potentially novel food biomarkers and replicated others. Our findings contribute to the limited literature on food-based biomarkers and highlight the significant and promising role that large cohort studies with archived blood samples could play in this field. This study was registered at clinicaltrials.gov as NCT03282812.
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Affiliation(s)
- Ying Wang
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Brian D Carter
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA
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Pre-pregnancy BMI, gestational weight gain and body image are associated with dietary under-reporting in pregnant Japanese women. J Nutr Sci 2018; 7:e12. [PMID: 29686861 PMCID: PMC5906558 DOI: 10.1017/jns.2018.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/18/2018] [Accepted: 02/02/2018] [Indexed: 12/21/2022] Open
Abstract
Dietary under-reporting is a common problem when using self-reported dietary assessment tools. However, there are few studies regarding under-reporting during pregnancy. This study aimed to explore the demographic and psychosocial characteristics related to dietary under-reporting in pregnant Japanese women. A cross-sectional study was conducted between 2010 and 2011 at a university hospital in Tokyo, Japan. Nutrient intake was assessed using a self-administered Diet History Questionnaire (DHQ), which had questions about the consumption frequency and portion size of selected food items. The 24-h urinary excretion levels of urea N and K were used as the dietary protein and K intake reference values, respectively. Under-reporting of protein and K was defined as the bottom 25 % of the reporting accuracy (the ratio of reported intake on the DHQ to the estimated intake based on urinary excretion). Under-reporters were defined as participants who under-reported both protein and K intake. Multiple logistic regression analysis was performed to examine the factors associated with under-reporters. Of 271 healthy women at 19-23 weeks of gestation, thirty-five participants (12·9 %) were identified as under-reporters. Under-reporters had a lower pre-pregnancy BMI (adjusted OR (AOR) = 0·81) and lower gestational weight gain (AOR = 0·82); they also reported managing their gestational weight gain with the aim to return to their pre-pregnancy weight soon after childbirth (AOR = 2·99). Healthcare professionals should consider the potential for dietary under-reporting and the possible related factors when assessing the dietary intakes of pregnant Japanese women using self-administered questionnaires.
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Grimes CA, Riddell LJ, Campbell KJ, Beckford K, Baxter JR, He FJ, Nowson CA. Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study. BMJ Open 2017; 7:e016639. [PMID: 29084791 PMCID: PMC5665305 DOI: 10.1136/bmjopen-2017-016639] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine sodium and potassium urinary excretion by socioeconomic status (SES), discretionary salt use habits and dietary sources of sodium and potassium in a sample of Australian schoolchildren. DESIGN Cross-sectional study. SETTING Primary schools located in Victoria, Australia. PARTICIPANTS 666 of 780 children aged 4-12 years who participated in the Salt and Other Nutrients in Children study returned a complete 24-hour urine collection. PRIMARY AND SECONDARY OUTCOME MEASURES 24-hour urine collection for the measurement of sodium and potassium excretion and 24-hour dietary recall for the assessment of food sources. Parent and child reported use of discretionary salt. SES defined by parental highest level of education. RESULTS Participants were 9.3 years (95% CI 9.0 to 9.6) of age and 55% were boys. Mean urinary sodium and potassium excretion was 103 (95% CI 99 to 108) mmol/day (salt equivalent 6.1 g/day) and 47 (95% CI 45 to 49) mmol/day, respectively. Mean molar Na:K ratio was 2.4 (95% CI 2.3 to 2.5). 72% of children exceeded the age-specific upper level for sodium intake. After adjustment for age, sex and day of urine collection, children from a low socioeconomic background excreted 10.0 (95% CI 17.8 to 2.1) mmol/day more sodium than those of high socioeconomic background (p=0.04). The major sources of sodium were bread (14.8%), mixed cereal-based dishes (9.9%) and processed meat (8.5%). The major sources of potassium were dairy milk (11.5%), potatoes (7.1%) and fruit/vegetable juice (5.4%). Core foods provided 55.3% of dietary sodium and 75.5% of potassium while discretionary foods provided 44.7% and 24.5%, respectively. CONCLUSIONS For most children, sodium intake exceeds dietary recommendations and there is some indication that children of lower socioeconomic background have the highest intakes. Children are consuming about two times more sodium than potassium. To improve sodium and potassium intakes in schoolchildren, product reformulation of lower salt core foods combined with strategies that seek to reduce the consumption of discretionary foods are required.
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Affiliation(s)
- Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Janet R Baxter
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Feng J He
- Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Strohm D, Ellinger S, Leschik-Bonnet E, Maretzke F, Heseker H. Revised Reference Values for Potassium Intake. ANNALS OF NUTRITION & METABOLISM 2017; 71:118-124. [PMID: 28803230 PMCID: PMC5639605 DOI: 10.1159/000479705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nutrition societies of Germany, Austria and Switzerland have revised the reference values for potassium intake in January 2017. METHODS For adults, the estimated value was based on the 24-h urinary potassium excretion and on preventive considerations regarding hypertension and stroke. The estimated values for children and adolescents were extrapolated from the adult estimated value considering differences in body mass. For infants aged 0 to under 4 months, the estimated value was set based on the potassium intake via breast milk. From this reference value, the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the potassium loss via breast milk. RESULTS The estimated values for potassium intake are set at 400 mg/day for breastfed infants aged 0 to under 4 months, 600 mg/day for infants aged 4 to under 12 months, 1,100-4,000 mg/day for children and adolescents, 4,000 mg/day for adults and pregnant women and 4,400 mg/day for lactating women. CONCLUSIONS The consumption of potassium-rich foods should be generally increased. Supplemental intake beyond the estimated values has no health benefit and is therefore not recommended.
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Affiliation(s)
| | - Sabine Ellinger
- Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Moenchengladbach, Germany
| | | | | | - Helmut Heseker
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
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Timon CM, Blain RJ, McNulty B, Kehoe L, Evans K, Walton J, Flynn A, Gibney ER. The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population. J Med Internet Res 2017; 19:e158. [PMID: 28495662 PMCID: PMC5445234 DOI: 10.2196/jmir.6407] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/18/2016] [Accepted: 02/11/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region. OBJECTIVE The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool "Foodbook24." METHODS Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire. RESULTS For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary. CONCLUSIONS The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland.
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Affiliation(s)
- Claire M Timon
- UCD, Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Richard J Blain
- UCD, Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Breige McNulty
- UCD, Institute of Food and Health, University College Dublin, Dublin, Ireland
| | - Laura Kehoe
- UCC, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Katie Evans
- UCC, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Janette Walton
- UCC, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Albert Flynn
- UCC, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Eileen R Gibney
- UCD, Institute of Food and Health, University College Dublin, Dublin, Ireland
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Sun Q, Bertrand KA, Franke AA, Rosner B, Curhan GC, Willett WC. Reproducibility of urinary biomarkers in multiple 24-h urine samples. Am J Clin Nutr 2017; 105:159-168. [PMID: 28049663 PMCID: PMC5183728 DOI: 10.3945/ajcn.116.139758] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Limited knowledge regarding the reproducibility of biomarkers in 24-h urine samples has hindered the collection and use of the samples in epidemiologic studies. OBJECTIVE We aimed to evaluate the reproducibility of various markers in repeat 24-h urine samples. DESIGN We calculated intraclass correlation coefficients (ICCs) of biomarkers measured in 24-h urine samples that were collected in 3168 participants in the NHS (Nurses' Health Study), NHSII (Nurses' Health Study II), and Health Professionals Follow-Up Study. RESULTS In 742 women with 4 samples each collected over the course of 1 y, ICCs for sodium were 0.32 in the NHS and 0.34 in the NHSII. In 2439 men and women with 2 samples each collected over 1 wk to ≥1 mo, the ICCs ranged from 0.33 to 0.68 for sodium at various intervals between collections. The urinary excretion of potassium, calcium, magnesium, phosphate, sulfate, and other urinary markers showed generally higher reproducibility (ICCs >0.4). In 47 women with two 24-h urine samples, ICCs ranged from 0.15 (catechin) to 0.75 (enterolactone) for polyphenol metabolites. For phthalates, ICCs were generally ≤0.26 except for monobenzyl phthalate (ICC: 0.55), whereas the ICC was 0.39 for bisphenol A (BPA). We further estimated that, for the large majority of the biomarkers, the mean of three 24-h urine samples could provide a correlation of ≥0.8 with true long-term urinary excretion. CONCLUSIONS These data suggest that the urinary excretion of various biomarkers, such as minerals, electrolytes, most polyphenols, and BPA, is reasonably reproducible in 24-h urine samples that are collected within a few days or ≤1 y. Our findings show that three 24-h samples are sufficient for the measurement of long-term exposure status in epidemiologic studies.
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Affiliation(s)
- Qi Sun
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; .,Departments of Nutrition
| | | | - Adrian A Franke
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI
| | - Bernard Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Biostatistics, and
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Departments of Nutrition.,Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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A review of the design and validation of web- and computer-based 24-h dietary recall tools. Nutr Res Rev 2016; 29:268-280. [DOI: 10.1017/s0954422416000172] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractTechnology-based dietary assessment offers solutions to many of the limitations of traditional dietary assessment methodologies including cost, participation rates and the accuracy of data collected. The 24-h dietary recall (24HDR) method is currently the most utilised method for the collection of dietary intake data at a national level. Recently there have been many developments using web-based platforms to collect food intake data using the principles of the 24HDR method. This review identifies web- and computer-based 24HDR tools that have been developed for both children and adult population groups, and examines common design features and the methods used to investigate the performance and validity of these tools. Overall, there is generally good to strong agreement between web-based 24HDR and respective reference measures for intakes of macro- and micronutrients.
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Vinceti M, Filippini T, Crippa A, de Sesmaisons A, Wise LA, Orsini N. Meta-Analysis of Potassium Intake and the Risk of Stroke. J Am Heart Assoc 2016; 5:JAHA.116.004210. [PMID: 27792643 PMCID: PMC5121516 DOI: 10.1161/jaha.116.004210] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The possibility that lifestyle factors such as diet, specifically potassium intake, may modify the risk of stroke has been suggested by several observational cohort studies, including some recent reports. We performed a systematic review and meta‐analysis of existing studies and assessed the dose–response relation between potassium intake and stroke risk. Methods and Results We reviewed the observational cohort studies addressing the relation between potassium intake, and incidence or mortality of total stroke or stroke subtypes published through August 6, 2016. We carried out a meta‐analysis of 16 cohort studies based on the relative risk (RR) of stroke comparing the highest versus lowest intake categories. We also plotted a pooled dose–response curve of RR of stroke according to potassium intake. Analyses were performed with and without adjustment for blood pressure. Relative to the lowest category of potassium intake, the highest category of potassium intake was associated with a 13% reduced risk of stroke (RR=0.87, 95% CI 0.80–0.94) in the blood pressure–adjusted analysis. Summary RRs tended to decrease when original estimates were unadjusted for blood pressure. Analysis for stroke subtypes yielded comparable results. In the spline analysis, the pooled RR was lowest at 90 mmol of potassium daily intake (RRs=0.78, 95% CI 0.70–0.86) in blood pressure–adjusted analysis, and 0.67 (95% CI 0.57–0.78) in unadjusted analysis. Conclusions Overall, this dose–response meta‐analysis confirms the inverse association between potassium intake and stroke risk, with potassium intake of 90 mmol (≈3500 mg)/day associated with the lowest risk of stroke.
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Affiliation(s)
- Marco Vinceti
- CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Tommaso Filippini
- CREAGEN, Environmental, Genetic and Nutritional Epidemiology Research Center, Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessio Crippa
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Nybacka S, Lindroos AK, Wirfält E, Leanderson P, Landberg R, Ericson U, Larsson I, Warensjö Lemming E, Bergström G, Hedblad B, Orho-Melander M, Melander O, Winkvist A, Bertéus Forslund H. Carotenoids and alkylresorcinols as objective biomarkers of diet quality when assessing the validity of a web-based food record tool and a food frequency questionnaire in a middle-aged population. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0094-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Sugimoto M, Asakura K, Masayasu S, Sasaki S. Relatively severe misreporting of sodium, potassium, and protein intake among female dietitians compared with nondietitians. Nutr Res 2016; 36:818-26. [DOI: 10.1016/j.nutres.2016.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Potassium Measures and Their Associations with Glucose and Diabetes Risk: The Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One 2016; 11:e0157252. [PMID: 27280455 PMCID: PMC4900670 DOI: 10.1371/journal.pone.0157252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
Background Recent studies have found low-normal potassium (K) to be associated with increased diabetes risk. We sought to verify these associations in a multi-ethnic US cohort; and to determine if these associations extend to US Hispanics and Asian-Americans. Methods We analyzed data from Multi-Ethnic Study of Atherosclerosis (MESA) participants who were free-of-diabetes at baseline. We examined cross-sectional associations between measures of K—serum, dietary, and urine—with fasting glucose and HOMA-IR. We examined longitudinal associations between K and diabetes risk over 8 years. Findings In multivariable models, compared to those with higher serum K (≥4.5mmol/L), those with lower serum K (<4.0mmol/L) had significantly higher fasting glucose [1.3 mg/dL (95%CI 0.2, 2.4), P-value = 0.03]. Incident diabetes developed in 1281 of 5415 at-risk participants. In minimally-adjusted models, we found inverse associations between serum and dietary K and diabetes risk. Compared to those with higher serum K, those with lower serum K had an HR (95% CI) of incident diabetes of 1.23 (1.04, 1.47), P-value = 0.02. However, these associations were attenuated in fully-adjusted models. We found no significant interaction between potassium and ethnicity. Conclusions In this multi-ethnic cohort, we found a significant inverse association between serum K and fasting glucose but no significant association with longer-term diabetes risk. This inverse association between potassium and glucose must be studied further to understand the physiology and its potential impact on chronic health.
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Comparison of approaches to correct intake–health associations for FFQ measurement error using a duplicate recovery biomarker and a duplicate 24 h dietary recall as reference method. Public Health Nutr 2016; 18:226-33. [PMID: 24499731 DOI: 10.1017/s1368980014000032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To illustrate the impact of intake-related bias in FFQ and 24 h recall (24hR), and correlated errors between these methods, on intake-health associations. DESIGN Dietary intake was assessed by a 180-item semi-quantitative FFQ and two 24hR. Urinary N and urinary K were estimated from two 24 h urine samples. We compared four scenarios to correct associations for errors in an FFQ estimating protein and K intakes. SETTING Wageningen, The Netherlands. SUBJECTS Fifty-nine men and fifty-eight women aged 45–65 years. RESULTS For this FFQ, measurement error weakened a true relative risk of 2·0 to 1·4 for protein and 1·5 for K. As compared with calibration to duplicate recovery biomarkers (i.e. the preferred scenario 1), estimating a validity coefficient using this duplicate biomarker resulted in overcorrected associations, caused by intake-related bias in the FFQ (scenario 2). The correction factor based on a triad using biomarkers and 24hR was hampered by this intake-related bias and by correlated errors between FFQ and 24hR, and in this population resulted in a nearly perfect correction for protein but an overcorrection for K (scenario 3). When the 24hR was used for calibration, only a small correction was done, due to correlated errors between the methods and intake-related bias in the 24hR (scenario 4). CONCLUSIONS Calibration to a gold standard reference method is the preferred approach to correct intake-health associations for FFQ measurement error. If it is not possible to do so, using the 24hR as reference method only partly removes the errors, but may result in improved intake-health associations.
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Kieneker LM, Gansevoort RT, de Boer RA, Brouwers FP, Feskens EJ, Geleijnse JM, Navis G, Bakker SJ, Joosten MM. Urinary potassium excretion and risk of cardiovascular events. Am J Clin Nutr 2016; 103:1204-12. [PMID: 26984482 DOI: 10.3945/ajcn.115.106773] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Observational studies on dietary potassium and risk of cardiovascular disease (CVD) have reported weak-to-modest inverse associations. Long-term prospective studies with multiple 24-h urinary samples for accurate estimation of habitual potassium intake, however, are scarce. OBJECTIVE We examined the association between urinary potassium excretion and risk of blood pressure-related cardiovascular outcomes. DESIGN We studied 7795 subjects free of cardiovascular events at baseline in the Prevention of Renal and Vascular End-stage Disease study, a prospective, observational cohort with oversampling of subjects with albuminuria at baseline. Main cardiovascular outcomes were CVD [including ischemic heart disease (IHD), stroke, and vascular interventions], IHD, stroke, and new-onset heart failure (HF). Potassium excretion was measured in two 24-h urine specimens at the start of the study (1997-1998) and midway through follow-up (2001-2003). RESULTS Baseline median urinary potassium excretion was 70 mmol/24 h (IQR: 56-84 mmol/24 h). During a median follow-up of 10.5 y (IQR: 9.9-10.8 y), a total of 641 CVD, 465 IHD, 172 stroke, and 265 HF events occurred. After adjustment for age and sex, inverse associations were observed between potassium excretion and risk [HR per each 26-mmol/24-h (1-g/d) increase; 95% CI] of CVD (0.87; 0.78, 0.97) and IHD (0.86; 0.75, 0.97), as well as nonsignificant inverse associations for risk of stroke (0.85; 0.68, 1.06) and HF (0.94; 0.80, 1.10). After further adjustment for body mass index, smoking, alcohol consumption, education, and urinary sodium and magnesium excretion, urinary potassium excretion was not statistically significantly associated with risk (multivariable-adjusted HR per 1-g/d increment; 95% CI) of CVD (0.96; 0.85, 1.09), IHD (0.90; 0.81, 1.04), stroke (1.09; 0.86, 1.39), or HF (0.99; 0.83, 1.18). No associations were observed between the sodium-to-potassium excretion ratio and risk of CVD, IHD, stroke, or HF. CONCLUSION In this cohort with oversampling of subjects with albuminuria at baseline, urinary potassium excretion was not independently associated with a lower risk of cardiovascular events.
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Affiliation(s)
- Lyanne M Kieneker
- Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and
| | | | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; and
| | - Frank P Brouwers
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; and
| | - Edith Jm Feskens
- Top Institute Food and Nutrition, Wageningen, Netherlands; Wageningen University, Division of Human Nutrition, Wageningen, Netherlands
| | - Johanna M Geleijnse
- Top Institute Food and Nutrition, Wageningen, Netherlands; Wageningen University, Division of Human Nutrition, Wageningen, Netherlands
| | | | - Stephan Jl Bakker
- Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and
| | - Michel M Joosten
- Top Institute Food and Nutrition, Wageningen, Netherlands; Department of Internal Medicine and
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Freedman LS, Commins JM, Moler JE, Willett W, Tinker LF, Subar AF, Spiegelman D, Rhodes D, Potischman N, Neuhouser ML, Moshfegh AJ, Kipnis V, Arab L, Prentice RL. Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for potassium and sodium intake. Am J Epidemiol 2015; 181:473-87. [PMID: 25787264 DOI: 10.1093/aje/kwu325] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We pooled data from 5 large validation studies (1999-2009) of dietary self-report instruments that used recovery biomarkers as referents, to assess food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). Here we report on total potassium and sodium intakes, their densities, and their ratio. Results were similar by sex but were heterogeneous across studies. For potassium, potassium density, sodium, sodium density, and sodium:potassium ratio, average correlation coefficients for the correlation of reported intake with true intake on the FFQs were 0.37, 0.47, 0.16, 0.32, and 0.49, respectively. For the same nutrients measured with a single 24HR, they were 0.47, 0.46, 0.32, 0.31, and 0.46, respectively, rising to 0.56, 0.53, 0.41, 0.38, and 0.60 for the average of three 24HRs. Average underreporting was 5%-6% with an FFQ and 0%-4% with a single 24HR for potassium but was 28%-39% and 4%-13%, respectively, for sodium. Higher body mass index was related to underreporting of sodium. Calibration equations for true intake that included personal characteristics provided improved prediction, except for sodium density. In summary, self-reports capture potassium intake quite well but sodium intake less well. Using densities improves the measurement of potassium and sodium on an FFQ. Sodium:potassium ratio is measured much better than sodium itself on both FFQs and 24HRs.
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Ability of self-reported estimates of dietary sodium, potassium and protein to detect an association with general and abdominal obesity: comparison with the estimates derived from 24 h urinary excretion. Br J Nutr 2015; 113:1308-18. [DOI: 10.1017/s0007114515000495] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As under-reporting of dietary intake, particularly by overweight and obese subjects, is common in dietary surveys, biases inherent in the use of self-reported dietary information may distort true diet–obesity relationships or even create spurious ones. However, empirical evidence of this possibility is limited. The present cross-sectional study compared the relationships of 24 h urine-derived and self-reported intakes of Na, K and protein with obesity. A total of 1043 Japanese women aged 18–22 years completed a 24 h urine collection and a self-administered diet history questionnaire. After adjustment for potential confounders, 24 h urine-derived Na intake was associated with a higher risk of general obesity (BMI ≥ 25 kg/m2) and abdominal obesity (waist circumference ≥ 80 cm; both P for trend = 0·04). For 24 h urine-derived protein intake, positive associations with general and abdominal obesity were observed (P for trend = 0·02 and 0·053, respectively). For 24 h urine-derived K intake, there was an inverse association with abdominal obesity (P for trend = 0·01). Conversely, when self-reported dietary information was used, only inverse associations between K intake and general and abdominal obesity were observed (P for trend = 0·04 and 0·02, respectively), with no associations of Na or protein intake. In conclusion, we found positive associations of Na and protein intakes and inverse associations of K intake with obesity when using 24 h urinary excretion for estimating dietary intakes. However, no association was observed based on using self-reported dietary intakes, except for inverse association of K intake, suggesting that the ability of self-reported dietary information using the diet history questionnaire for investigating diet–obesity relationships is limited.
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Validation of a Web-based, self-administered, non-consecutive-day dietary record tool against urinary biomarkers. Br J Nutr 2015; 113:953-62. [DOI: 10.1017/s0007114515000057] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
New technologies are promising for the use of short-term instruments for dietary data collection; however, innovative tools should be validated against objective biomarkers. The aim of the present study was to investigate the validity of a Web-based, self-administered dietary record (DR) tool using protein, K and Na intakes against 24 h urinary biomarkers (24 h U). Of the total participants, 199 adult volunteers (104 men and 95 women, mean age 50·5 (23–83 years)) of the NutriNet-Santé Study were included in the protocol. They completed three non-consecutive-day DR and two 24 h U on the first and third DR days. Relative differences between reported (DR) and measured (24 h U) intakes were calculated from the log ratio (DR/24 h U) for protein, K and Na intakes: − 14·4,+2·6 and − 2·1 % for men; and − 13·9, − 3·7 and − 8·3 % for women, respectively. The correlations between reported and true intakes were 0·61, 0·78 and 0·47 for men and 0·64, 0·42 and 0·37 for women for protein, K and Na, respectively. Attenuation factors, that represent attenuation of the true diet–disease relationship due to measurement error (a value closer to 1 indicating lower attenuation), ranged from 0·23 (Na, women) to 0·60 (K, men). We showed that the Web-based DR tool used in the NutriNet-Santé cohort study performs well in estimating protein and K intakes and fairly well in estimating Na intake. Furthermore, three non-consecutive-day DR appear to be valid for estimating usual intakes of protein and K, although caution is advised regarding the generalisability of these findings to other nutrients and general population.
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Lakatos O, Györke Z, Sulyok E. Sodium and potassium intake in Hungarian children and adolescents: Comparison of two cross sectional studies. ACTA ALIMENTARIA 2015. [DOI: 10.1556/aalim.44.2015.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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