Abstract
24-h urinary sodium excretion is the gold standard for evaluating dietary sodium intake, but it is often not feasible in large epidemiological studies due to high participant burden and cost. Three methods—Kawasaki, INTERSALT, and Tanaka—have been proposed to estimate 24-h urinary sodium excretion from a spot urine sample, but these methods have not been validated in the general Chinese population. This aim of this study was to assess the validity of three methods for estimating 24-h urinary sodium excretion using spot urine samples against measured 24-h urinary sodium excretion in a Chinese sample population. Data are from a substudy of the Prospective Urban Rural Epidemiology (PURE) study that enrolled 120 participants aged 35 to 70 years and collected their morning fasting urine and 24-h urine specimens. Bias calculations (estimated values minus measured values) and Bland-Altman plots were used to assess the validity of the three estimation methods. 116 participants were included in the final analysis. Mean bias for the Kawasaki method was -740 mg/day (95% CI: -1219, 262 mg/day), and was the lowest among the three methods. Mean bias for the Tanaka method was -2305 mg/day (95% CI: -2735, 1875 mg/day). Mean bias for the INTERSALT method was -2797 mg/day (95% CI: -3245, 2349 mg/day), and was the highest of the three methods. Bland-Altman plots indicated that all three methods underestimated 24-h urinary sodium excretion. The Kawasaki, INTERSALT and Tanaka methods for estimation of 24-h urinary sodium excretion using spot urines all underestimated true 24-h urinary sodium excretion in this sample of Chinese adults. Among the three methods, the Kawasaki method was least biased, but was still relatively inaccurate. A more accurate method is needed to estimate the 24-h urinary sodium excretion from spot urine for assessment of dietary sodium intake in China.
Highlights
Dietary sodium intake is positively associated with high blood pressure [1]
A total of 116 participants were included in the final analysis
The mean difference for the Kawasaki method was -740 mg/day, and was the smallest difference of the three estimation methods
Summary
Dietary sodium intake is positively associated with high blood pressure [1]. Several studies have supported this association including animal studies [2], randomized controlled trials [3, 4], observational studies [5,6,7], and meta-analyses [8, 9]. Collecting 24-h urine samples is time-intensive, expensive, and has a high participant burden, so methods for estimating 24-h urinary sodium excretion from spot urine samples have been developed. These include the Kawasaki method [16], the INTERSALT method [17], and the Tanaka method [18], which were mostly common used at the present. The objective of this study was to assess the validity of these three estimation methods against the gold standard 24-h urinary sodium excretion in a sample of Chinese adults
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