Abstract
ObjectiveDespite public health bodies advocating for lowering dietary sodium and increasing potassium intake to improve cardiovascular outcomes, people with diabetes are not meeting these targets. We hypothesize that (i) both at an individual level and within the cohort, there will be a low adherence to the guidelines and (ii) sodium and potassium intake will remain stable over time.MethodsWe conducted this prospective study in a cohort of 904 participants with diabetes who provided 24-h urine collections from 2009 to 2015. Dietary sodium and potassium intake were estimated from 24-h urinary sodium (uNa) and potassium (uK) measurements. Additional data were collected for: 24-h urinary volume (uVol), creatinine (uCr),; serum creatinine, urea, estimated glomerular filtration rate (eGFR), glycated haemoglobin (HbA1c), fasting glucose, lipids); clinical characteristics (age, blood pressure (BP), body mass index (BMI) and duration of diabetes). Adherence to recommended dietary sodium (uNa < 2300 mg/24 h (100mmol/24 h)) and potassium (uK > 4680 mg/24 h(120 mmol/24)) intake were the main outcome measures.ResultsParticipants (n = 904) completed 3689 urine collections (average four collections/participant). The mean ± SD (mmol/24 h) for uNa was 181 ± 73 and uK was 76 ± 25. After correcting uNa for uCr, 7% and 5% of participants met dietary sodium and potassium guidelines respectively. Males were less likely to meet sodium guidelines (OR 0.40, p < 0.001) but were more likely to meet potassium guidelines (OR 6.13, p < 0.001). Longer duration of diabetes was associated with higher adherence to sodium and potassium guidelines (OR 1.04, p < 0.001 and OR 0.96, p = 0.006 respectively). Increasing age was significantly associated with adherence to potassium guidelines (OR 0.97, p = 0.007).ConclusionsPeople with diabetes do not follow current dietary sodium and potassium guidelines and are less likely to change their dietary intake of sodium and potassium over time.
Highlights
Cardiovascular related diseases are the leading cause of morbidity and mortality[1], especially in those with diabetes[2]
We have previously demonstrated that a single measurement of 24-h UNa can predict habitual dietary sodium intake in people with type 2 diabetes, with an intra-individual coefficient of variation 21 ± 1% suggesting day-to-day variation of sodium intake is approximately 20%12
Univariate analysis We examined the likelihood of participants meeting the guidelines in relation to eleven explanatory variables (age, sex, duration of diabetes, HbA1c, fasting glucose, estimated glomerular filtration rate (eGFR), serum urea and lipid profile) (Table 2)
Summary
Cardiovascular related diseases are the leading cause of morbidity and mortality[1], especially in those with diabetes[2]. Blood pressure is a modifiable cardiovascular risk factor[1]. Dietary sodium and potassium intake play a pivotal role in blood pressure regulation[1,3]. High dietary salt intake can raise blood pressure[3,4] whereas a diet low in sodium and high in potassium is associated with lower. Worldwide mean sodium intake is almost double the recommended level of intake (3950 mg/24 h (172 mmol/24 h))[9]. A recent meta-analysis of the Australian population found that the mean sodium intake in people with type 1 or type 2 diabetes was 9.66 g/24 h (420 mmol/24 h)[10].
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