Abstract
The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published.
Highlights
The important caveats to 24-hour urine collec on include that rigorous methods are used to ensure complete urine collec on and to assess completeness of the 24-hour urine collec ons, that the par cipants are representa ve of the popula on being studied, and that the ming of the urine collec ons meets the needs of the research ques on
The TRUE consor um’s systema c reviews indicate that low-quality research has been commonly used in assessing dietary sodium
A regularly updated systema c review of the literature assessing the associa on of sodium intake to clinical outcomes found the majority of studies could not meet even minimum methodologic criteria [69-74]
Summary
The TRUE Consor um recommends 24-hour urine collec ons be retained to assess popula on and individual sodium intake, with a cau ous and currently unclear role for spot and short-term med urine collec ons to assess popula on average sodium intake. The Consor um recommends not to use a spot and short-term med urine collec on to assess individual sodium intake. The TRUE consor um and others have expressed concern that low-quality research methods, including inaccurate assessment of dietary sodium and not accounting for confounding health risks 7. Campbell NR, Appel LJ, Cappuccio FP, et al A call for Quality Research on Salt Intake and Health: From the World Hypertension League and Suppor ng Organiza ons. Ji C, Sykes L, Paul C, et al Systema c review of studies comparing 24-hour and spot urine collec ons for es ma ng popula on salt intake.
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