Development of objective indicators for quantitative analysis of sodium intake: the sodium to potassium ratio of second-void urine is correlated with 24-hour urinary sodium excretion
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BACKGROUND/OBJECTIVES: To date, sodium intake has been evaluated based on spot urine instead of 24-hour (hr) urine collection. Nevertheless, the optimal method for assessing daily sodium intake remains unclear. SUBJECTS/METHODS: Fifteen male (age 32.7 ± 6.5 years) participants were offered 3 meals with a total of 9-10 g salt over 24 hours, and 24-hr urine was collected from the second-void urine of the first day to the first-void urine of the second day. Twenty-four-hr urinary sodium (24UNa) was estimated using Tanaka’s equation and the Korean formula, and spot urine Na, potassium (K), chloride (Cl), urea nitrogen (UN), creatinine (Cr), specific gravity (SG) and osmolality (Osm) were measured. The ratios of urinary Na to other parameters were calculated, and correlations with total measured 24UNa were identified. RESULTS: Average 24-hr urine volume was 1,403 ± 475 mL, and measured 24UNa was 143.9 ± 42.1 mEq (range, 87.1-239.4 mEq). Measured 24UNa was significantly correlated with urinary Na/UN (r = 0.560, P < 0.01), urinary Na/Osm (r = 0.510, P < 0.01), urinary Na/Cr (r = 0.392, P < 0.01), urinary Na/K (r = 0.290, P < 0.01), 24UNa estimated using Tanaka’s equation (r = 0.452, P < 0.01) and the Korean formula (r = 0.414, P < 0.01), age (r = 0.548, P < 0.01), weight (r = 0.497, P < 0.01), and height (r = 0.393, P < 0.01) in all spot urine samples. Estimated 24UNa based on the second-void spot urine of the first day tended to be more closely correlated with measured 24UNa than were estimates from the other spot urine samples. The significant parameters correlated with the second-void urine of the first day were urinary Na/K (r = 0.647, P < 0.01), urinary Na/Cr (r = 0.558, P < 0.05), and estimated 24UNa using Tanaka’s equation (r = 0.616, P < 0.05) and the Korean formula (r = 0.588, P < 0.05). CONCLUSIONS: Second-void urine is more reliable than first-void urine for estimating 24UNa. Urinary Na/K in the second-void urine on the first day is significantly correlated with 24UNa. Further studies are needed to establish the most reliable index and the optimal time of urine sampling for predicting 24UNa.
Abstract
BACKGROUND/OBJECTIVES: To date, sodium intake has been evaluated based on spot urine instead of 24-hour (hr) urine collection. Nevertheless, the optimal method for assessing daily sodium intake remains unclear. SUBJECTS/METHODS: Fifteen male (age 32.7 ± 6.5 years) participants were offered 3 meals with a total of 9-10 g salt over 24 hours, and 24-hr urine was collected from the second-void urine of the first day to the first-void urine of the second day. Twenty-four-hr urinary sodium (24UNa) was estimated using Tanaka’s equation and the Korean formula, and spot urine Na, potassium (K), chloride (Cl), urea nitrogen (UN), creatinine (Cr), specific gravity (SG) and osmolality (Osm) were measured. The ratios of urinary Na to other parameters were calculated, and correlations with total measured 24UNa were identified. RESULTS: Average 24-hr urine volume was 1,403 ± 475 mL, and measured 24UNa was 143.9 ± 42.1 mEq (range, 87.1-239.4 mEq). Measured 24UNa was significantly correlated with urinary Na/UN (r = 0.560, P < 0.01), urinary Na/Osm (r = 0.510, P < 0.01), urinary Na/Cr (r = 0.392, P < 0.01), urinary Na/K (r = 0.290, P < 0.01), 24UNa estimated using Tanaka’s equation (r = 0.452, P < 0.01) and the Korean formula (r = 0.414, P < 0.01), age (r = 0.548, P < 0.01), weight (r = 0.497, P < 0.01), and height (r = 0.393, P < 0.01) in all spot urine samples. Estimated 24UNa based on the second-void spot urine of the first day tended to be more closely correlated with measured 24UNa than were estimates from the other spot urine samples. The significant parameters correlated with the second-void urine of the first day were urinary Na/K (r = 0.647, P < 0.01), urinary Na/Cr (r = 0.558, P < 0.05), and estimated 24UNa using Tanaka’s equation (r = 0.616, P < 0.05) and the Korean formula (r = 0.588, P < 0.05). CONCLUSIONS: Second-void urine is more reliable than first-void urine for estimating 24UNa. Urinary Na/K in the second-void urine on the first day is significantly correlated with 24UNa. Further studies are needed to establish the most reliable index and the optimal time of urine sampling for predicting 24UNa.
참고문헌 (34)
- Aburto NJ, "Effect of lower sodium intake on health : systematic review and meta-analyses", BMJ, 346, pp.f1326~ (2013)
- Jones-Burton C, "An in-depth review of the evidence linking dietary salt intake and progression of chronic kidney disease", Am J Nephrol, 26, pp.268~275 (2006)
- Swift PA, "Modest salt reduction reduces blood pressure and urine protein excretion in black hypertensives : a randomized control trial", Hypertension, 46, pp.308~312 (2005)
- Intersalt Cooperative Research Group, "Intersalt : an international study of electrolyte excretion and blood pressure. Results for 24hour urinary sodium and potassium excretion", BMJ, 297, pp.319~328 (1988)
- 하성규, "Dietary Salt Intake and Hypertension", Electrolytes & Blood Pressure, 12(1), pp.7~18 (2014), 전해질고혈압연구회[DOI]
- McLean RM, "Measuring population sodium intake : a review of methods", Nutrients, 6, pp.4651~4662 (2014)
- Brown IJ, "Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in Western populations : the INTERSALT study", Am J Epidemiol, 177, pp.1180~1192 (2013)
- Cogswell ME, "Estimated 24-hour urinary sodium and potassium excretion in US adults", JAMA, 319, pp.1209~1220 (2018)
- Komiyama Y, "Prediction of diuretic response to tolvaptan by a simple, readily available spot urine Na", K ratio, 2017, pp.12, e0174649~
- El-Bokl MA, "Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites", World J Gastroenterol, 15, pp.3631~3635 (2009)
- Colin-Ramirez E, "Estimates of dietary sodium consumption in patients with chronic heart failure", J Card Fail, 21, pp.981~988 (2015)
- Mills KT, "Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease", JAMA, 315, pp.2200~2210 (2016)
- Boudville N, "Increased sodium intake correlates with greater use of antihypertensive agents by subjects with chronic kidney disease", Am J Hypertens, 18, pp.1300~1305 (2005)
- Livingstone MB, "Accuracy of weighed dietary records in studies of diet and health", BMJ, 300, pp.708~712 (1990)
- Johnson RK, "Correlates of over-and underreporting of energy intake in healthy older men and women", Am J Clin Nutr, 59, pp.1286~1290 (1994)
- Tanaka T, "A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen", J Hum Hypertens, 16, pp.97~103 (2002)
- Koo HS, "Estimating 24-hour urine sodium level with spot urine sodium and creatinine", J Korean Med Sci, 29(Suppl 2), pp.S97~S102 (2014)
- Mann SJ, "Estimation of 24-hour sodium excretion from spot urine samples", J Clin Hypertens(Greenwich), 12, pp.174~180 (2010)
- Iwahori T, "Estimating 24-h urinary sodium", potassium ratio from casual(‘spot’)urinary sodium, Int J Epidemiol, pp.2017, 46[DOI]
- Tabara Y, "Descriptive epidemiology of spot urine sodium-to-potassium ratio clarified close relationship with blood pressure level : the Nagahama study", J Hypertens, 33, pp.2407~2413 (2015)
- Iwahori T, "Six random specimens of daytime casual urine on different days are sufficient to estimate daily sodium", potassium ratio in comparison to 7-day 24-h urine collections, 2014, pp.37, 765~771
- Iwahori T, "Four to seven random casual urine specimens are sufficient to estimate 24-h urinary sodium", potassium ratio in individuals with high blood pressure, 2016, pp.30, 328~334
- Stamler J, "INTERSALT study findings. Public health and medical care implications", Hypertension, 14, pp.570~577 (1989)
- Huggins CE, "Relationship of urinary sodium and sodium-topotassium ratio to blood pressure in older adults in Australia", Med J Aust, 195, pp.128~132 (2011)
- Hedayati SS, "Association of urinary sodium", potassium ratio with blood pressure : sex and racial differences, 2012, pp.7, 315~322
- Perez V, "Sodium-to-potassium ratio and blood pressure, hypertension, and related factors", Adv Nutr, 5, pp.712~741 (2014)
- Cook NR, "Joint effects of sodium and potassium intake on subsequent cardiovascular disease : the Trials of Hypertension Prevention follow-up study", Arch Intern Med, 169, pp.32~40 (2009)
- da Silva OM, "Comparative study of spot urine Na", K ratio and 24-hour urine sodium in natriuresis evaluation of cirrhotic patients with ascites, 2014, pp.21, 15~20
- Iwahori T, "Time to consider use of the sodium-to-potassium ratio for practical sodium reduction and potassium increase", Nutrients, 9, pp.700~ (2017)
- Wang CY, "Urinary excretion of sodium, potassium, and chloride, but not iodine, varies by timing of collection in a 24-hour calibration study", J Nutr, 143, pp.1276~1282 (2013)
- Kamata K, "Estimation of 24-h urinary sodium excretion using lean body mass and overnight urine collected by a pipe-sampling method", J Hypertens, 20, pp.2191~2197 (2002)
- Korea Health Statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1), "Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention", Korea Centers for Disease Control and Prevention, ~ (2017)
- Dougher CE, "Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease", Am J Clin Nutr, 104, pp.298~305 (2016)
- Arcand J, "Evaluation of 2 methods for sodium intake assessment in cardiac patients with and without heart failure : the confounding effect of loop diuretics", Am J Clin Nutr, 93, pp.535~541 (2011)