Percentage of ingested sodium excreted in 24-hour urine collections: A systematic review and meta-analysis.
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SUBMITTER: Lucko AM
PROVIDER: S-EPMC8030843 | biostudies-literature | 2018 Sep
REPOSITORIES: biostudies-literature
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Percentage of ingested sodium excreted in 24-hour urine collections: A systematic review and meta-analysis.
Lucko Aaron M AM Doktorchik Chelsea C Woodward Mark M Cogswell Mary M Neal Bruce B Rabi Doreen D Anderson Cheryl C He Feng J FJ MacGregor Graham A GA L'Abbe Mary M Arcand JoAnne J Whelton Paul K PK McLean Rachael R Campbell Norm R C NRC
Journal of clinical hypertension (Greenwich, Conn.) 20180812 9
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Project description:This systematic literature review and meta-analysis examined whether 24-hour diet recall is a valid way to measure mean population sodium intake compared with the gold standard 24-hour urinary assessment. The authors searched electronic databases MEDLINE, Embase, and Scopus using pre-defined terms. Studies were eligible for inclusion if they assessed adult humans in free-living settings, and if they included group means for 24-hour diet recall and 24-hour urinary collection of sodium intake in the same participants. Studies that included populations with an active disease state that might interfere with normal sodium metabolism were excluded. Results of 28 studies are included in the meta-analysis. Overall, 24-hour diet recall underestimated population mean sodium intake by an average of 607 mg per day compared to the 24-hour urine collection. The difference between measures from 24-hour urine and 24-hour diet recall was smaller in studies conducted in high-income countries, in studies where multiple-pass methods of 24-hour diet recall were reported and where urine was validated for completeness. Higher quality studies also reported smaller differences between measures than lower quality studies. Monitoring of population sodium intake with 24-hour urinary excretion remains the most accurate method of assessment. Twenty-four-hour diet recall tends to underestimate intake, although high-quality 24-hour diet recall improves accuracy, and may be used if 24-hour urine is not feasible.
| S-EPMC8030385 | biostudies-literature
Project description:Several estimating equations for predicting 24-h urinary sodium (24-hUNa) excretion using spot urine (SU) samples have been developed, but have not been readily available to Chinese populations. We aimed to compare and validate the six existing methods at population level and individual level. We extracted 1671 adults eligible for both 24-h urine and SU sample collection. Mean biases (95% CI) of predicting 24-hUNa excretion using six formulas were 58.6 (54.7, 62.5) mmol for Kawasaki, -2.7 (-6.2, 0.9) mmol for Tanaka, -24.5 (-28.0, -21.0) mmol for the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) with potassium, -26.8 (-30.1, -23.3) mmol for INTERSALT without potassium, 5.9 (2.3, 9.6) mmol for Toft, and -24.2 (-27.7, -20.6) mmol for Whitton. The proportions of relative difference >40% with the six methods were nearly a third, and the proportions of absolute difference >51.3 mmol/24-h (3 g/day salt) were more than 40%. The misclassification rate were all >55% for the six methods at the individual level. Although the Tanaka method could offer a plausible estimation for surveillance of the population sodium excretion in Shandong province, caution remains when using the Tanaka formula for other provincial populations in China. However, these predictive methods were inadequate to evaluate individual sodium excretion.
| S-EPMC7146571 | biostudies-literature
Project description:Intakes of excess Na and insufficient K are two major contributors of heart diseases and stroke development. However, no precise study has previously been carried out on Na and K intakes among Indonesian adults. The present study aimed to estimate the Na and K intakes using two consecutive 24-h urine collections. Participants were community-dwelling adults aged between 20 and 96 years, randomly selected from a pool of resident registration numbers. Of the 506 participants, 479 (240 men and 239 women) completed urine collections. The mean Na excretion was 102·8 and 100·6 mmol/d, while the mean K excretion was 25·0 and 23·4 mmol/d for men and women, respectively. Na and K excretions were higher in participants with a higher BMI. A higher K excretion was associated only with younger age. More than 80 % of the participants consumed more than 5 g/d of salt (the upper limit recommended by the Indonesian government), whereas none of them consumed more than 3510 mg/d of K (the lower limit). The high Na and low K intakes, especially high Na among participants with high BMI, should be considered when future intervention programmes are planned in this country.
| S-EPMC8524422 | biostudies-literature
Project description:The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24-70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24-70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual's 24-HUNa.
| S-EPMC4073156 | biostudies-literature
Project description:BACKGROUND:Sodium deficiency in patients with an ileostomy is associated with chronic dehydration and may be difficult to detect. We aimed to investigate if the sodium concentration in a single spot urine sample may be used as a proxy for 24-hour urine sodium excretion. METHODS:In a prospective observational study with 8 patients with an ileostomy and 8 volunteers with intact intestines, we investigated the correlations and agreements between spot urine sodium concentrations and 24-hour urine sodium excretions. Spot urine samples were drawn from every micturition during 24 hours, and relevant blood samples were drawn. All participants documented their food and fluid intakes. RESULTS:There was a high and statistically significant correlation between 24-hour natriuresis and urine sodium concentrations in both morning spot samples (n = 8, Spearman's rho [?] = 0.78, P = 0.03) and midday spot samples (n = 8, ? = 0.82, P = 0.02) in the patients with an ileostomy. The agreement between methods was fair (bias = -1.5, limits of agreement = -32.3 to 29.4). There were no statistically significant associations for evening samples or for samples from volunteers with intact intestines independently of time of day. CONCLUSION:A single spot urine sodium sample obtained in the morning or midday may estimate 24-hour urine sodium excretion in patients with an ileostomy and thus help to identify sodium depletion.
| S-EPMC7065244 | biostudies-literature
Project description:BACKGROUND/OBJECTIVES This study aimed to compare 24-h diet recall (DR) and 24-h urine collection (UC) for estimating sodium and potassium intakes and their ratio (Na/K), identifying factors associated with sodium and potassium intakes and Na/K, and identifying those who were likely to underestimate sodium and potassium intakes by DR. SUBJECTS/METHODS A total of 640 healthy adults aged 19–69 yrs completed a questionnaire survey, salty taste assessment, anthropometric measurement, two 24-h DRs, and two 24-h UCs. RESULTS The mean sodium and potassium intakes and Na/K were 3,755 mg/d, 2,737 mg/d, and 1.45 according to DR, and 4,145 mg/d, 2,812 mg/d, and 1.57 according to UC, with percentage differences of −9.4%, −2.7%, and −7.6% in the values between the two methods, respectively. Men, older adults, smokers, obese individuals, those who consumed all the liquid in the soup, and those who were found to be salty in the salty taste assessment consumed significantly more sodium; older adults, the heavy- activity group, and obese individuals consumed more potassium; and men, younger adults, smokers, and obese individuals had a significantly higher Na/K, according to UC. Compared with UC, DR was more likely to underestimate sodium intake in older adults, smokers, obese individuals, those who consumed all the liquid in the soup, and those who consumed eating-out/delivery food at least once a day, and potassium intake in older adults, the heavy-activity group, and obese individuals. CONCLUSIONS The mean sodium and potassium intakes and Na/K estimated by DR were comparable to those measured by UC. However, the association of sodium and potassium intakes with sociodemographic and health-related factors showed inconsistent results when estimated by DR and UC. Factors influencing the underestimation of sodium intake by DR compared to UC should be further investigated.
| S-EPMC10042712 | biostudies-literature
Project description:To address the limitations in existing urinary stone recurrence (USR) models, including failure to account for changes in 24-hour urine (24U) parameters over time and ignoring multiplicity of stone recurrences, we presented a novel statistical method to jointly model temporal trends in 24U parameters and multiple recurrent stone events. The MSTONE database spanning May 2001 to April 2015 was analyzed. A joint recurrent model was employed, combining a linear mixed-effects model for longitudinal 24U parameters and a recurrent event model with a dynamic first-order Autoregressive (AR(1)) structure. A mixture cure component was included to handle patient heterogeneity. Comparisons were made with existing methods, multivariable Cox regression and conditional Prentice-Williams-Peterson regression, both applied to established nomograms. Among 396 patients (median follow-up of 2.93 years; IQR, 1.53-4.36 years), 34.6% remained free of stone recurrence throughout the study period, 30.0% experienced a single recurrence, and 35.4% had multiple recurrences. The joint recurrent model with a mixture cure component identified significant associations between 24U parameters - including urine pH (adjusted HR = 1.991; 95% CI 1.490-2.660; p < 0.001), total volume (adjusted HR = 0.700; 95% CI 0.501-0.977; p = 0.036), potassium (adjusted HR = 0.983; 95% CI 0.974-0.991; p < 0.001), uric acid (adjusted HR = 1.528; 95% CI 1.105-2.113, p = 0.010), calcium (adjusted HR = 1.164; 95% CI 1.052-1.289; p = 0.003), and citrate (adjusted HR = 0.796; 95% CI 0.706-0.897; p < 0.001), and USR, achieving better predictive performance compared to existing methods. 24U parameters play an important role in prevention of USR, and therefore, patients with a history of stones are recommended to closely monitor for future recurrence by regularly conducting 24U tests.
| S-EPMC11530469 | biostudies-literature
Project description:ImportanceSeveral 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.ObjectiveTo 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.MethodForty-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.ResultsThe 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.InterpretationThe 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.
| S-EPMC7984014 | biostudies-literature
Project description:BackgroundAssessing 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.ObjectivesIn 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.MethodsA 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 ).ResultsPearson 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).ConclusionsTwenty-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.
| S-EPMC8575727 | biostudies-literature
Project description:[Figure: see text].
| S-EPMC8115426 | biostudies-literature