Abstract
BackgroundMonitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. The objective of this study was to develop and validate an equation using spot urine concentration to predict 24-h sodium excretion in the Malaysian population.MethodsThis was a Malaysian Community Salt Study (MyCoSS) sub-study, which was conducted from October 2017 to March 2018. Out of 798 participants in the MyCoSS study who completed 24-h urine collection, 768 of them have collected one-time spot urine the following morning. They were randomly assigned into two groups to form separate spot urine equations. The final spot urine equation was derived from the entire data set after confirming the stability of the equation by double cross-validation in both study groups. Newly derived spot urine equation was developed using the coefficients from the multiple linear regression test. A Bland-Altman plot was used to measure the mean bias and limits of agreement between estimated and measured 24-h urine sodium. The estimation of sodium intake using the new equation was compared with other established equations, namely Tanaka and INTERSALT.ResultsThe new equation showed the least mean bias between measured and predicted sodium, − 0.35 (− 72.26, 71.56) mg/day compared to Tanaka, 629.83 (532.19, 727.47) mg/day and INTERSALT, and 360.82 (284.34, 437.29) mg/day. Predicted sodium measured from the new equation showed greater correlation with measured sodium (r = 0.50) compared to Tanaka (r =0.24) and INTERSALT (r = 0.44), P < 0.05.ConclusionOur newly developed equation from spot urine can predict least mean bias of sodium intake among the Malaysian population when 24-h urine sodium collection is not feasible.
Highlights
Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult
A minimum sample size of 692 from the Malaysian Community Salt Study (MyCoSS) participants was required to develop and validate the spot urine sodium equation based on the estimated correlation coefficient of 0.15 between spot urine sodium and 24-h urine sodium [17]
There was no significant difference in anthropometry components and urine test measurements for sodium, potassium, and creatinine from 24-h urine and spot urine in both subgroups study (P > 0.05)
Summary
Monitoring sodium intake through 24-h urine collection sample is recommended, but the implementation of this method can be difficult. Accurate monitoring is essential to support public health efforts to reduce excess intake and its associated diseases. Dietary assessments such as 24-h diet recall and food questionnaire have been used to assess dietary sodium intake. These methods are known to be inaccurate due to errors in recall and recording even though it has a lower subject burden [4, 5]. In the presence of complete urine collection and constant sodium intake for several days, 24-h urine reflects about 90% of sodium intake on that day [7]
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