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Qi Z, Tang S, Wu B, Li Y, Yang H, Wang K, Li Z. Evaluation of three prediction formulas of 24-hour urinary sodium excretion in Chinese residents: a systematic review and meta-analysis. Public Health Nutr 2024; 27:e71. [PMID: 38305112 DOI: 10.1017/s1368980024000168] [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] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To determine the appropriateness of three widely used formulas estimating 24-h urinary Na (24hUNa) from spot urine samples in the Chinese population. DESIGN Systematic review and meta-analysis. SETTING Literature review was conducted to identify studies for estimating 24hUNa using the Kawasaki, Tanaka and INTERSALT formulas simultaneously in PubMed, Embase and the Cochrane library databases. The mean difference (MD) and correlation coefficients (r) between measures and estimates from different formulas were assessed. PARTICIPANTS Information extraction and quality assessment were performed in thirteen studies involving 8369 subjects. RESULTS Two studies which affected the overall robustness were excluded in the 'leave-one-out' sensitivity analyses. Within the final meta-analysis included eleven studies and 7197 participants, 36·07 mmol/d (95 %CI 16·89, 55·25) of MD was observed in the Kawasaki formula, and -19·62 mmol/d (95 %CI -37·37, -1·87) in the Tanaka formula and -35·78 mmol/d (95 %CI -50·76, -20·80) in the INTERSALT formula; a pooled r-Fisher's Z of 0·39 (95 %CI 0·32, 0·45) in the Kawasaki formula, 0·43 (95 %CI 0·37, 0·49) in the Tanaka formula and 0·36 (95 %CI 0·31, 0·42) in the INTERSALT formula. Subgroup analyses were conducted to explore the possible factors affecting the accuracy of the formula estimation from three mainly aspects: population types, Na intake levels and urine specimen types. CONCLUSIONS The meta-analysis suggested that the Tanaka formula performed a more accurate estimate in Chinese population. Time of collecting spot urine specimens and Na intake level of the sample population might be the main factors affecting the accuracy of the formula estimation.
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Affiliation(s)
- Zijing Qi
- School of Public Health, Shanxi Medical University, Taiyuan031000, China
| | - Shuai Tang
- School of Public Health, Shanxi Medical University, Taiyuan031000, China
| | - Beike Wu
- School of Public Health, Harbin Medical University, Harbin150081, China
| | - Yanxing Li
- School of Public Health, Shanxi Medical University, Taiyuan031000, China
| | - Hongmei Yang
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi046000, China
| | - Kunbo Wang
- CLASS 2202, Xiangya School of Medicine, Central South University, Changsha410000, China
| | - Zhifang Li
- School of Public Health, Shanxi Medical University, Taiyuan031000, China
- Department of Public Health and Preventive Medicine, Changzhi Medical College, Changzhi046000, China
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Hariri M, Ramezani AM, Shamshirgaran SM, Gholami A. Is a spot urine sample a good substitution to estimate 24-h urinary sodium excretion in a population ≥ 50 years old? A validation study. Eur J Nutr 2023; 62:3277-3286. [PMID: 37580619 DOI: 10.1007/s00394-023-03217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/18/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE A variety of prediction equations have been able to estimate 24-h urinary sodium excretion from spot urine samples; however, Iranians over the age of 50 have not been compared and verified. Using spot urine samples as a substitute for 24-h urine samples to estimate 24-h urine sodium excretion among the population age 50 and older are the purpose of this study. METHODS A 24-h urinary sodium excretion was studied by well-known Kawasaki, INTERSALT, Tanaka, and World Health Organization/Pan American Health Organization (WHO/PAHO) formulas. On 360 individuals, the mean bias, agreements between estimated and measured values, correlation, absolute and relative differences, and misclassification rates were evaluated for four equations. RESULTS As a result, the mean urinary sodium excretion for a 24-h period was 136.3 ± 52.21 mmol/24-h, which corresponds to a calculated intake of 9.1 ± 3.8 g of salt per day. According to the WHO/PAHO formula, the mean bias between measured values and estimated 24-h urinary sodium excretion is - 21.6 mg/day (95% confidence interval (CI) - 144.8, 101.6 mg/day), which is the smallest difference compared with the other three formulas. The lowest rate of individual misclassification of salt intake was 40% for WHO/PAHO, especially for those who consumed less than 9 g/day, while Kawasaki had the lowest misclassification rate at higher levels of salt intake. CONCLUSION As a result of our research, the WHO/PAHO equations accurately predict 24-h urinary sodium excretion among Iranians aged ≥ 50 more than other equations, both at the population level and at the individual level. However, further study is needed in regard to different ages in Iran.
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Affiliation(s)
- Mitra Hariri
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Amir M Ramezani
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Seyed Morteza Shamshirgaran
- Healthy Ageing Research Centre, Neyshabur University of Medical Sciences, Neyshabur, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ali Gholami
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
- Department of Epidemiology and Biostatistics, School of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
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Wu B, Yang H, Ren X, Qi Z, Tang S, Yin X, Huang L, Tian M, Wu Y, Feng X, Li Z. A Method for Estimating 24 h Urinary Sodium and Potassium Excretion by Spot Urine Specimen in Stroke Patients. Nutrients 2022; 14:nu14194105. [PMID: 36235755 PMCID: PMC9573759 DOI: 10.3390/nu14194105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Spot urine specimens have been used to estimate 24 h urinary sodium (Na) excretion (24UNaV) and potassium (K) excretion (24UKV). However, the validity is limited for 24UNaV and unknown for 24UKV in stroke patients, using the existing formulas. Herein, we developed and validated a new formula for 24UNaV and 24UKV by spot urine specimens in stroke patients. Spot and 24 h urine samples were collected from 970 stroke patients. The models of 24UNaV and 24UKV were developed using stepwise multivariate linear regression in 689 patients. The performance of different formulas was internally validated in 281 patients at the population and individual levels. The obtained new formulas were: (1) estimated 24UNaV (mmol/day): -0.191 × Age + 4.349 × BMI + 0.229 × SpotNa + 1.744 × SpotNa/Spot creatinine (Cr) + 41.492 (for male); -1.030 × Age + 2.011 × BMI + 0.143 × SpotNa + 1.035 × SpotNa/SpotCr + 147.159 (for female); and (2) estimated 24UKV (mmol/day): -0.052 × Age + 0.410 × BMI + 0.031 × SpotK + 33.280 × Ln (spotK/spot Cr) - 5.789 × Ln (spotNa/spot Cr) - 1.035 (for male); -0.235 × Age + 0.530 × BMI + 0.040 × SpotK + 30.990 × Ln (spot K/spot Cr) - 7.837 × Ln (spotNa/spotCr) + 4.318 (for female). The new formula obtained the lowest mean bias (5.17 mmol/day for 24UNaV and 0.85 mmol/day for 24UKV) and highest proportion at the cutoff under the ±30% level for the estimation of 24UNaV (59.43%) and 24UKV (70.11%). The new formula provides a meaningful exploration to estimate 24UNaV and 24UKV in stroke patients by using spot urine specimens.
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Affiliation(s)
- Beike Wu
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Hongmei Yang
- School of Public Health, Changzhi Medical College, Changzhi 046000, China
| | - Xinyu Ren
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Zijing Qi
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Shuai Tang
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
| | - Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
- School of Public Health, Harbin Medical University, Harbin 150081, China
| | - Yangfeng Wu
- Clinical Research Center, Peking University, Beijing 100088, China
| | - Xiangxian Feng
- School of Public Health, Changzhi Medical College, Changzhi 046000, China
| | - Zhifang Li
- School of Public Health, Shanxi Medical University, Taiyuan 030001, China
- School of Public Health, Changzhi Medical College, Changzhi 046000, China
- Correspondence: ; Tel.: +86-18636517556
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4
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Campbell NRC, He FJ, McLean RM, Cappuccio FP, Woodward M, MacGregor GA, Guichon J, Mitchell I. Dietary sodium and cardiovascular disease in China: addressing the authors' response, statements and claims. J Hypertens 2022; 40:1831-1836. [PMID: 35943106 DOI: 10.1097/hjh.0000000000003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Norman R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Rachael M McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Mark Woodward
- The George Institute for Global Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Juliet Guichon
- Departments of Community Health Sciences and Pediatrics, Cumming School of Medicine
| | - Ian Mitchell
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gong W, Ma Y, Zhang Z, Liang J, Zhang J, Ding G. Validation of 4 Estimating Methods to Evaluate 24-h Urinary Sodium Excretion: Summer and Winter Seasons for College Students in China. Nutrients 2022; 14:nu14132736. [PMID: 35807918 PMCID: PMC9269089 DOI: 10.3390/nu14132736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Twenty-four-hour urine sample collection is regarded as the gold standard for sodium intake evaluation, but the implementation can be difficult. The objective was to validate and evaluate the accuracy and feasibility of estimating sodium intake by four methods. A group of 268 healthy volunteers aged 18–25 years was enrolled in this study. Twenty-four-hour urine samples as well as timed (morning, afternoon, evening, and overnight) urine samples were randomly collected in summer and winter. The sodium intake was estimated by four published methods—Kawasaki, INTERSALT, Tanaka, and Sun’s. The consistencies between estimated sodium intake and real measured values of 24-h urinary sodium excretion were compared by Bland–Altman plots in each of the methods. The 24-h urinary sodium analysis result indicated that average daily sodium intake was 3048.4 ± 1225.9 mg in summer and 3564.7 ± 1369.9 mg in winter. At the population level, the bias (estimated value-measured value) was the least with the INTERSALT method with afternoon (−39.7 mg; 95%CI: −164.7, 85.3 mg) and evening (−43.5 mg; 95%CI: −166.4, 79.5 mg) samples in summer. In winter, the Kawasaki method (162.1 mg; 95%CI: 13.5, 310.7 mg) was superior to others. Estimation of sodium intake using the four methods is affected by the time and temperature. In summer, the INTERSALT method provides the best estimation of the population’s mean sodium intake. The Kawasaki method is superior to other methods in winter.
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Affiliation(s)
- Weiyi Gong
- Key Laboratory of Trace Elements Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
| | - Yuxia Ma
- Hebei Key Laboratory of Environment and Human Health, Department of Nutrition and Food Hygiene, School of Public Health, Hebei Medical University, Shijiazhuang 050017, China; (Y.M.); (Z.Z.); (J.L.)
| | - Zechen Zhang
- Hebei Key Laboratory of Environment and Human Health, Department of Nutrition and Food Hygiene, School of Public Health, Hebei Medical University, Shijiazhuang 050017, China; (Y.M.); (Z.Z.); (J.L.)
| | - Jufeng Liang
- Hebei Key Laboratory of Environment and Human Health, Department of Nutrition and Food Hygiene, School of Public Health, Hebei Medical University, Shijiazhuang 050017, China; (Y.M.); (Z.Z.); (J.L.)
| | - Jiguo Zhang
- Key Laboratory of Trace Elements Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
- Correspondence: (J.Z.); (G.D.); Tel.: +86-010-6623-7094 (J.Z.); +86-010-6623-7001 (G.D.)
| | - Gangqiang Ding
- Key Laboratory of Trace Elements Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China;
- Correspondence: (J.Z.); (G.D.); Tel.: +86-010-6623-7094 (J.Z.); +86-010-6623-7001 (G.D.)
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Guo X, Zhang M, Li C, Zhang X, Zhao Z, Huang Z, Deng X, Wang L. Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Non-Hypertensive Adults — China, 2018−2019. China CDC Wkly 2022; 4:522-526. [PMID: 35812699 PMCID: PMC9257692 DOI: 10.46234/ccdcw2022.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/29/2022] [Indexed: 11/14/2022] Open
Abstract
What is already known about this topic? High sodium and low potassium in 24 h urinary excretion were associated with elevated blood pressure. What is added by this report? With increasing body mass index levels, decreasing unit urinary sodium excretion was more effective in reducing systolic and diastolic blood pressure, and increasing unit urinary potassium excretion was more effective in reducing diastolic blood pressure. What are the implications for public health practice? Reducing sodium and increasing potassium intake was more effective in reducing blood pressure in overweight and obese non-hypertensive adults compared to underweight and normal weight adults.
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Affiliation(s)
- Xiaohui Guo
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
- Tianjin Nankai District Center for Disease Control and Prevention, Tianjin, China
| | - Mei Zhang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Chun Li
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Xiao Zhang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Zhenping Zhao
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Zhengjing Huang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Xiaoqing Deng
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
| | - Limin Wang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, China CDC, Beijing, China
- Limin Wang,
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Li Y, Su J, Luo D, Duan Y, Huang Z, He M, Tao J, Xiao S, Xiao Y, Chen X, Shen M. Processed Food and Atopic Dermatitis: A Pooled Analysis of Three Cross-Sectional Studies in Chinese Adults. Front Nutr 2021; 8:754663. [PMID: 34938758 PMCID: PMC8685501 DOI: 10.3389/fnut.2021.754663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/17/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: The effect of processed foods on atopic dermatitis (AD) in adults is unclear. This study was to evaluate the association between processed foods and AD in the Chinese adult population. Design: This study included three population-based cross-sectional studies using cluster sampling by villages, institutions, or factories. Participants underwent dermatological examinations by certificated dermatologists and a food frequency questionnaire survey. A spot urine sample was collected to estimate the daily sodium intake. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were presented as the effect size. Setting: Shiyan city of Hubei province, and Huayuan, Shimen, Hengyang, Zhuzhou, and Changsha of Hunan province. Participants: Automobile manufacture workers from Shiyan of Hubei province, and rural residents and civil servants from Hunan. Results: A total of 15,062 participants, including 3,781 rural residents, 5,111 civil servants, and 6,170 workers, completed all evaluations. Compared to those hardly consumed pickles, consumption of pickles 1–3 times per week was significantly associated with AD (aOR: 1.35; 95% CI: 1.06–1.70). The intake of processed meats 1–3 times per month (aOR: 1.29; 95% CI: 1.05–1.58) and 1–3 times per week (aOR: 1.44; 95% CI: 1.11–1.87) were associated with AD dose-dependently when compared with those who rarely ate processed meats. Compared with non-consumers, the consumption of any processed foods 1–3 times per week (aOR: 1.39; 95% CI: 1.08–1.80) and ≥4 times per week (aOR: 1.41; 95% CI: 1.05–1.89) showed increased risks of AD. A positive association of estimated sodium intake with AD was also observed. Conclusion: Intake of processed foods is associated with AD in Chinese adults.
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Affiliation(s)
- Yajia Li
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Juan Su
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yanying Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Meian He
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health for Incubating, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Tao
- Department of Dermatology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yi Xiao
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Chen
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
| | - Minxue Shen
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China.,Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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8
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Validity of predictive equations for 24-h urinary sodium excretion at the population and individual levels among Chinese adults aged 18-69 years. Sci Rep 2021; 11:22404. [PMID: 34789756 PMCID: PMC8599737 DOI: 10.1038/s41598-021-00513-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022] Open
Abstract
Spot urine (SU) collection is a convenient method commonly used for sodium estimation, but its validity in predicting 24-h urinary sodium (24-hUNa) excretion has not been thoroughly evaluated among the general population. The aim of this study was to comprehensively assess the validity of eight existing methods in predicting 24-hUNa excretion by using SU samples among Chinese adults. We analyzed 1424 representative individuals aged 18 to 69 years. We compared the measured and estimated measurements of 24-hUNa at the population level by examining bias, the correlation, intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC) curves and Bland–Altman plots and analyzed the relative and absolute differences and misclassification at the individual level. The bias for all methods was significant (all p < 0.001), among which the smallest bias was − 7.9 mmol for the Toft formula and the largest bias was − 53.8 mmol for the Mage formula. Correlation coefficients were all less than 0.380, all formulas exhibited an area under the ROC curve below 0.683, and the Bland–Altman plots indicated slightly high dispersion of the estimation biases at higher sodium levels regardless of the formula. The proportions of relative differences > 40% for the eight methods were all over one-third, the proportions of absolute differences > 51.3 mmol/24 h (3 g/day NaCl) were all over 40%, and the misclassification rates (7, 10, and 13 g/day NaCl as cutoff points) were all over 65%. Caution remains due to poor validity between estimated and actual measurements when using the eight formulas to obtain a plausible estimation for surveillance of the Chinese population sodium excretion, and the results do not support the application of SU to estimate sodium intake at the individual level due to its poor performance with respect to classification.
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9
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Tinker LF, Huang Y, Johnson KC, Carbone LD, Snetselaar L, Van Horn L, Manson JE, Liu S, Mossavar-Rahmani Y, Prentice RL, Lampe JW, Neuhouser ML. Estimating 24-Hour Urinary Excretion of Sodium and Potassium Is More Reliable from 24-Hour Urine Than Spot Urine Sample in a Feeding Study of US Older Postmenopausal Women. Curr Dev Nutr 2021; 5:nzab125. [PMID: 34761160 PMCID: PMC8575727 DOI: 10.1093/cdn/nzab125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Assessing estimated sodium (Na) and potassium (K) intakes derived from 24-h urinary excretions compared with a spot urine sample, if comparable, could reduce participant burden in epidemiologic and clinical studies. OBJECTIVES In a 2-week controlled-feeding study, Na and K excretions from a 24-h urine collection were compared with a first-void spot urine sample, applying established algorithms and enhanced models to estimate 24-h excretion. Actual and estimated 24-h excretions were evaluated relative to mean daily Na and K intakes in the feeding study. METHODS A total of 153 older postmenopausal women ages 75.4 ± 3.5 y participated in a 2-wk controlled-feeding study with a 4-d repeating menu cycle based on their usual intake (ClinicalTrials.gov Identifier: NCT00000611). Of the 150 participants who provided both a first-void spot urine sample and a 24-h urine collection on the penultimate study day, statistical methods included Pearson correlations for Na and K between intake, 24-h collections, and the 24-h estimated excretions using 4 established algorithms: enhanced biomarker models by regressing ln-transformed intakes on ln-transformed 24-h excretions or ln-transformed 24-h estimated excretions plus participant characteristics and sensitivity analyses for factors potentially influencing Na or K excretion (e.g., possible kidney disease estimated glomerular filtration rate <60 mL/min/1.73 m2 ). RESULTS Pearson correlation coefficients between Na and K intakes and actual 24-h excretions were 0.57 and 0.38-0.44 for estimated 24-h excretions, depending on electrolyte and algorithm used. Enhanced biomarker model cross-validated R 2 (CVR2) for 24-h excretions were 38.5% (Na), 40.2% (K), and 42.0% (Na/K). After excluding participants with possible kidney disease, the CVR2 values were 43.2% (Na), 40.2% (K), and 38.1% (Na/K). CONCLUSIONS Twenty-four-hour urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily White postmenopausal women.
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Affiliation(s)
- Lesley F Tinker
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ying Huang
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Laura D Carbone
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simin Liu
- Departments of Epidemiology, Medicine, and Surgery and Center for Global Cardiometabolic Health, Brown University, Providence, RI, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ross L Prentice
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Johanna W Lampe
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Marian L Neuhouser
- Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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10
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Belanger MJ, Lorinsky MK, Pankayatselvan V, Juraschek SP. A New Method to Estimate Dietary Sodium Intake From a Spot Urine Sample: Context and Caution. Am J Hypertens 2021; 34:686-688. [PMID: 33580237 DOI: 10.1093/ajh/hpab036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Matthew J Belanger
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael K Lorinsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Varayini Pankayatselvan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Zhang X, Liao H, Ye R, Li X, Gou Q, Zhang Z, Shi R, Meng Q, Zhuoma Z, Zhang H, Chen X. Assessment and validation of three spot urine assay methods for the estimation of 24-hour urinary sodium excretion in Chinese Tibetan adults living in the mountains. J Clin Hypertens (Greenwich) 2021; 23:1588-1598. [PMID: 34196446 PMCID: PMC8678802 DOI: 10.1111/jch.14312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24‐hour USE were −92.6 and 81.8 mmol/day for the Kawasaki method, −28.5 and 110.0 mmol/day for the Tanaka method, and −28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24‐hour USE for Tibetans is needed.
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Affiliation(s)
- Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qiling Gou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhipeng Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Qingtao Meng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zewong Zhuoma
- Luohuo County Health Bureau, Ganzi Tibetan Autonomous Prefecture, Luhuo, Sichuan Province, People's Republic of China
| | - Hengyu Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Qian N, Jiang Y, Wang Y, Yan P, Yao F, Sun M, Liu X, Zhang Y, Cheng Y, Lu Y, Song W. Validity of five formulas in estimating 24-h urinary sodium via spot urine sampling in hypertensive patients living in Northeast China. J Hypertens 2021; 39:1326-1332. [PMID: 33323909 PMCID: PMC8183493 DOI: 10.1097/hjh.0000000000002769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective was to evaluate the accuracy of five formulas -- the Kawasaki, Tanaka, INTERSALT, Mage, and Uechi methods -- using spot urinary sampling for 24-h urinary sodium (UNa) prediction in hypertensive patients living in northeast China. METHODS There were 1154 hypertensive patients enrolled from multiple centers. Five different formulas were used to predict 24-h UNa excretion via spot morning urinary samples. Actual UNa excretion was measured from 24-h urine samples. The estimated value was compared with the actual value by examining biases, the intraclass correlation coefficients (ICC), and Bland-Altman plots. RESULTS The average excretion of sodium was 2.97 ± 1.26 g/day. The formula-produced mean biases for actual UNa were 0.31 g/day for INTERSALT, 0.80 g/day for Mage, 0.88 g/day for Tanaka, 1.14 g/day for Uechi, and 1.95 g/day for Kawasaki. The ICC was 0.511 for Kawasaki, 0.499 for INTERSALT, 0.468 for Tanaka, 0.402 for Mage, and 0.378 for Uechi. The least mean bias in the lower and moderate salt intake subgroups was 1.22 and 0.07 g/day, respectively, which was calculated using the Mage and INTERSALT methods. The least mean bias in the higher salt intake subgroup was 0.10 g/day for the Uechi method. The INTERSALT method was more efficiency at the individual level, with 17.4% of participants having relative differences within 10%, and 22.3% participants having absolute differences within 393 mg. CONCLUSION The INTERSALT method may exhibit a good performance in estimating 24-h urinary sodium level for the hypertensive population living in northeast China.
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Affiliation(s)
- Ni Qian
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Ying Wang
- Department of General Medicine, The First People's Hospital of Guiyang, Guiyang
| | - Peishi Yan
- Department of Cardiology, The Center Hospital of Dalian
| | - Fumei Yao
- Department of Cardiology, The 2 Hospital of Dalian
| | - Min Sun
- Department of Cardiology, The 3 Hospital of Dalian
| | - Xiaojie Liu
- Department of Cardiology, The Liaoyu Hospital of Dalian, Liaoning, China
| | - Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Yunpeng Cheng
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Yan Lu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
| | - Wei Song
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning
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Abstract
Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.
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Affiliation(s)
- Robert M Carey
- Department of Medicine, University of Virginia Health System, Charlottesville (R.M.C)
| | - Jackson T Wright
- Department of Medicine, Case-Western Reserve University School of Medicine, Cleveland, OH (J.T.W.)
| | - Sandra J Taler
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN (S.J.T.)
| | - Paul K Whelton
- Departments of Epidemiology and Medicine, Tulane University, New Orleans, LA (P.K.W.)
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Dong J, Zhao X, Dong H, Yan Y, Mi J. Can spot urine measurement be a substitute for 24-hour urine measurement to estimate sodium intake in adolescents? Pediatr Investig 2021; 5:12-20. [PMID: 33778422 PMCID: PMC7984014 DOI: 10.1002/ped4.12243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE Several methods have been established in recent decades that allow use of spot urine to estimate dietary sodium intake. However, their accuracies have been controversial in children. OBJECTIVE To validate the performance of three commonly used methods-the Kawasaki, Tanaka, and International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) methods. Additionally, this study explored the accuracies of the Tanaka and INTERSALT methods by using spot urine samples taken at four separate times. METHOD Forty-one adolescents aged 14 to 16 years completed two non-consecutive 24-hour urine collections and their mean values were used as reference data. The second-morning urine was used for assessment with the Kawasaki method; a casual spot urine and spot urine samples taken at four separate times (morning, afternoon, evening, and overnight) were used for assessment with the Tanaka and INTERSALT methods. RESULTS The mean differences were 1801 mg, 542 mg, 47 mg, and -31 mg for the Kawasaki, Tanaka, INTERSALT1 (with potassium), and INTERSALT2 (without potassium) methods with their required spot urine, respectively. The proportions of relative difference levels within ± 10% were 4.9% for the Kawasaki method, 19.5% for the Tanaka method, 36.6% for the INTERSALT1 method, and 36.6% for the INTERSALT2 method. INTERPRETATION The INTERSALT method seemed to provide minimally biased estimations of mean population sodium intake with casual spot urine. However, there is a need to be cautious regarding inconsistencies in estimation among different levels of sodium intake. The methods assessed in this study were unable to accurately estimate sodium intake at the individual level.
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Affiliation(s)
- Jie Dong
- Pediatrics Research Institute of Hunan ProvinceHunan Children’s HospitalChangshaHunanChina
| | - Xiaoyuan Zhao
- Department of EpidemiologyCapital Institute of PediatricsBeijingChina
| | - Hongbo Dong
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yinkun Yan
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Jie Mi
- Department of EpidemiologyCapital Institute of PediatricsBeijingChina
- Department of Non‐communicable Disease ManagementBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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Mill JG, Malta DC, Nilson EAF, Machado ÍE, Jaime PC, Bernal RTI, Cardoso LSDM, Szwarcwald CL. Factors associated with salt intake in the Brazilian adult population: National Health Survey. CIENCIA & SAUDE COLETIVA 2021; 26:555-567. [PMID: 33605333 DOI: 10.1590/1413-81232021262.37492020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 01/14/2023] Open
Abstract
This paper aims to identify the factors associated with high salt intake in the Brazilian adult population. This is a cross-sectional study with 8,083 adults participating in the National Health Survey (PNS, 2014/15). Salt intake was based on the estimation of 24-hour urinary sodium calculated from the sodium/creatinine ratio in spot urine samples. The highest quartile of the distribution was considered high salt intake. The relationship between high salt consumption and sociodemographic factors, lifestyles, morbidity, and self-rated health status was analyzed by calculating the crude prevalence ratios and the prevalence ratios adjusted for age and gender. Approximately 28.1% had an estimated salt intake higher than 10.56 g/day. Overweight (Adjusted Prevalence Ratio; 95%CI - PRadj 1.23; 1.09-1.39), obesity (PRadj 1.61; 1.43-1.83), and diabetes (PRadj 1.36; 1.17-1.58) were positively associated with high salt intake. Female gender (PRadj 0.73; 0.66-0.80), high schooling level (PRadj 0.88; 0.79-0.99), living in the North and chronic kidney disease (PRadj 0.71; 0.56-0.90) were protective factors. Salt consumption is elevated nationwide and in all population subgroups, requiring coordinated actions.
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Affiliation(s)
- José Geraldo Mill
- Centro de Ciências da Saúde, Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Ísis Eloah Machado
- Programa de Pós-Graduação em Saúde e Nutrição, Departamento de Medicina de Família, Universidade Federal de Ouro Preto. Ouro Preto MG Brasil
| | - Patrícia Constante Jaime
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Regina Tomie Ivata Bernal
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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