Can sodium and potassium measured in timed voids be used as reference instruments for validating self-report instruments? Results from a urine calibration study

Abstract

BackgroundSodium and potassium measured in 24-h urine collections are often used as reference measurements to validate self-reported dietary intake instruments. ObjectivesTo evaluate whether collection and analysis of a limited number of urine voids at specified times during the day (“timed voids”) can provide alternative reference measurements, and to identify their optimal number and timing. MethodsWe used data from a urine calibration study among 441 adults aged 18–39 y. Participants collected each urine void in a separate container for 24 h and recorded the collection time. For the same day, they reported dietary intake using a 24-h recall. Urinary sodium and potassium were analyzed in a 24-h composite sample and in 4 timed voids (morning, afternoon, evening, and overnight). Linear regression models were used to develop equations predicting log-transformed 24-h urinary sodium or potassium levels using each of the 4 single timed voids, 6 pairs, and 4 triples. The equations also included age, sex, race, BMI (kg/m2), and log creatinine. Optimal combinations minimizing the mean squared prediction error were selected, and the observed and predicted 24-h levels were then used as reference measures to estimate the group bias and attenuation factors of the 24-h dietary recall. These estimates were compared. ResultsOptimal combinations found were as follows: single voids—evening; paired voids—afternoon + overnight (sodium) and morning + evening (potassium); and triple voids—morning + evening + overnight (sodium) and morning + afternoon + evening (potassium). Predicted 24-h urinary levels estimated 24-h recall group biases and attenuation factors without apparent bias, but with less precision than observed 24-h urinary levels. To recover lost precision, it was estimated that sample sizes need to be increased by ∼2.6–2.7 times for a single void, 1.7–2.1 times for paired voids, and 1.5–1.6 times for triple voids. ConclusionsOur results provide the basis for further development of new reference biomarkers based on timed voids. Clinical Trial Registryclinicaltrials.gov as NCT01631240.