24-hour Urinary Sodium Excretion Research Articles

Salt-related knowledge, attitudes, and practices and their relationship with 24-hour urinary sodium and potassium excretions among a group of healthy residents in the UAE: A cross-sectional study.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude, and practice (KAP) toward sodium intake among a group of healthy residents in the UAE. A cross-sectional study on a sample of healthy adults in the UAE. In addition to the KAP questionnaire, sodium and potassium excretions, and food records were taken. The United Arab Emirates. A sample of 190 healthy individuals aged between 20-60 years. The mean (± SD) age of the sample was 38.6 (± 12.5) years and 50.5% were females. The mean urinary sodium and potassium intake were 2816.2± 675.7 mg /day and 2533.3± 615 mg/day, respectively. The means were significantly different compared to the World Health Organization (WHO) recommendation of sodium and potassium, (p < 0.001). About 65% of the participants exceeded the WHO recommendations for salt intake, and participants' knowledge classification for health-related issues was fair while food-related knowledge was poor (P=0.001). A two-stage stepwise multiple regression analysis revealed that KAP scores were negatively associated with urinary sodium excretion (r = -0.174; p = 0.017) and those older participants and females had lower urinary sodium excretion (p<0.001). These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasize the need to establish education and public awareness programs focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

Community-level dietary intake of sodium, potassium, and sodium-to-potassium ratio as a global public health problem: a systematic review and meta-analysis

Background: Widespread adoption of a westernized diet represents a major lifestyle change characterized by substantially higher sodium consumption and lower potassium intake, which is related to cardiovascular morbidity. Methods: We performed a systematic review and meta-analysis over published studies in accordance with quantifying the dietary intake of sodium and potassium of the universal population across the world. The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were used to find research that pronounced 24-hour urinary sodium or potassium excretion (reference period: 2014–2021). The effect size was estimated using the fixed-effect model; sub-group analysis become accomplished to determine urinary sodium and potassium excretion disaggregated by geographical location. Publication bias became evaluated the usage of graphical funnel plot. Data analysis was performed using STATA 16. Results: Forty-three studies (n= 62,940) qualified the selection criteria. The mean urinary excretion of sodium and potassium was 156.73 mmol/24h [95% confidence interval (CI), 148.98–164.47] and 48.89 mmol/24 h (95% CI, 43.61–54.17), respectively; the mean urinary sodium/potassium ratio was 3.68 (95% CI, 2.96–4.40). Conclusions: This updated systematic review highlights excessively high dietary intake of sodium and low intake of potassium at the community level in most parts of the world. The urinary Na/K ratio exceeded the level recommended by the WHO guidelines.

Abstract P219: Risk factors for Accelerated Vascular Aging in Resistant Hypertension: Should we screen our patients earlier?

Background: There is an increase in Cardiovascular disease(CVD) mortality rates among young adults worldwide. Patients with resistant hypertension (RHTN) are at particularly high risk for CVD compared to those with more easily controlled hypertension (HTN). RHTN is defined as blood pressure above goal despite using ≥3 antihypertensive medications. The role of accelerated vascular aging (AVA) in this group has not been well investigated. Our study aims to evaluate risk factors for AVA and its role in RHTN. Methods: We conducted a cross-sectional analysis of a large cohort of 965 black and white patients with RHTN referred to the RHTN Clinic at the University of Alabama at Birmingham. Patients with HTN served as a control group. Results: The most compelling data was seen in young patients (age 41-55 yrs). Those with RHTN had significantly higher arterial stiffness than patients with HTN (pulse pressure: 63.3±17.9 vs 51.2 ±11.7 mm Hg, p=&lt;0.001) earlier onset of HTN (34.2 ±7.3 vs 39.4±10.3 yrs, p=0.001) and longer duration (15.5±9.6 vs 10.7±9.0 yrs, p=0.001), higher BMI (35.4±8.3 vs 31.9±6.6 kg/m2), higher Aldosterone Renin Ratio (12.4±13.2 vs 7.9±12.9, p=0.026), and 24-hour urinary sodium excretion (217.2±104.6 vs 182.8±77.2 mmol, p=0.036). Conclusion: Younger patients with RHTN, when compared with HTN, seem to have AVA as evidenced by higher prevalance of obesity, arterial stiffness, overactivation of the renin-angiotensin-aldosterone system, and higher salt intake. Earlier screening, starting at the age of 35 yrs, may help detect AVA quicker and prevent complications associated with RHTN in younger adults

Abstract P331: Simple Instruction and Provision of Literature on Low Salt Diet Ineffective in Reducing Salt Intake in Patients with Hypertension

Objective: Hypertension remains poorly controlled at the population level. Reduction of salt intake via the DASH diet is effective in reducing blood pressure (BP). We enrolled a cohort of patients with hypertension to assess molecular factors that influence BP control over a follow up period of 6 months. Here we report dietary sodium intake and BP control. Methods: 80 non-diabetic patients aged &gt;40 with hypertension were enrolled in the study. Subjects reccieved brief instruction and a handout on the DASH diet from a study coordinator. Medications were titrated to a BP of &lt;130/80 at enrollment, months 1, 2,3 and 6. BP was measured at each visit using an automated cuff following clinical trial methodology. 24-hour urine sodium excretion was collected at enrollment, months 3 and 6. Descriptive variables were summarized and paired t-tests were used to compare sodium excretion and BP. Results: Cohort characteristics are in Table 1. 73 subjects provided 24-hour urine samples and BP at enrollment and month 3 while 67 had samples at enrollment and month 6. Mean BP at enrollment was 129.9/75.3 (SD 16.6/12.5) which reduced 123/71.8 (SD 12.9/10) at month 3, p &lt;0.001and 125.4/73.4 (SD 15.2/10.5), p=0.02. 24-hour sodium excretion was 152 mmol (SD 73.6) at enrollment. There was no difference in sodium excretion at 3- (154 mmol, SD 86.2, p=0.8) or 6 months (139 mmol, SD 60,, p=0.18). Conclusions: According to 24-hour urine collection, participants consumed roughly 3.5 g of sodium per day. Simple instruction and provision of literature regarding a DASH diet was ineffective in reducing sodium intake. Further study is required to determine a more effective educational delivery method and understand any social factors that may inhibit diet implementation in this urban hypertensive cohort.

Abstract P218: Resistant hypertension is associated with elevated 24-hour cortisol to cortisone ratios in black patients.

Background: RHTN is defined as blood pressure above goal despite using ≥3 antihypertensive medications. Patients with RHTN are at an increased risk for cardiovascular (CVD) compared to those with more easily controlled hypertension (HTN). Blacks With RHTN are at a specifically high risk for CVD. Mineralocorticoid receptor activation has been found as an important mechanism of RHTN. However, aldosterone levels are not different in blacks versus whites. The role of 24-hour cortisol-to-cortisone ratios in this group has not been investigated. Methods: We conducted a cross-sectional analysis of a large cohort of 2397 black and white patients with RHTN who were referred to the RHTN Clinic at the University of Alabama at Birmingham and who underwent 24-hour urine collection including cortisol and cortisone. Patients with HTN served as a control group. Results: Black patients with RHTN compared to whites had a trend to higher 24h cortisol levels (17.7±27.6 vs 16.9±14.9, p =0.70, significantly lower 24h cortisone levels (60.45±37.7 vs 75.3±40.0, p 0.000234), and significantly higher 24h cortisol-to-cortisone ratios (0.23±0.14 vs 0.20 ±0.10, p=0.027). They were younger (53.3±11.6 vs 59.4±12.9 years), more obese (BMI 34.9±7.6 vs 30.8±6.1 kg/m2, p&lt;0.001), had earlier onset of HTN (35.6±12.5 vs 41.4±11.6 years of age, p&lt;0.001), higher 24-hour urinary sodium excretion (188.2±92.5 vs 174.9±83.1 mmol, p=0.006) and lower potassium excretion (54.5 ±28.6 vs 65.5 ±30.5 mmol, p&lt;0.001). Furthermore, they had a significantly higher rate of heart failure (p=0.000455) and diabetes (p=0.0006). Conclusion: Cortisol dysregulation and a higher cortisol-to-cortisone ratio as an index of 11beta HSD2 activity may play a role in black patients with RHTN and may be related to adverse outcomes in this population.

Development and validation of a prediction model for estimating 24-Hour Urinary Sodium Excretion using spot urine samples in adult patients

To assess whether 24-h urinary sodium excretion (24uNa) can be estimated from spot samples in adult patients who attend hospital clinics. Methods: A cross-sectional study with a development (284 patients) and a validation cohort (229 patients) was conducted at our hospital. A multivariate linear regression model was built which was compared with former models. Concordance analyses and comparison of the ability to correctly classify each patient against a prespecified uNa cut-off value of 130 mmol/24h were performed, assessed by the C-statistic. The model was well calibrated (slope [95%CI] in internal validation: 0.965 [0.947-0.987], showing good discrimination, and performed robustly in an external validation cohort (slope: 0.811 [0.675-0.946]). The mean bias between the measured and the estimated 24uNa by NaRYC was 24.85 mmol/24h [17.06-32.63]. The NaRYC had the highest values of Pearson coefficient (0.613 p<0.0001), accuracy (P30): 56.8%, and AUC-ROC: 0.822 [0.766-0.869] as compared to other seven equations. Although the mean bias of the results is quite acceptable, the variability observed in the 95%CI makes not recommend the general use of a spot as a substitute of the 24-hour urine in order to estimate the total urine excretion of Na in a single subject basis.

49827 Estimated 24-hour urinary sodium excretion associated with severity of atopic dermatitis in the UK Biobank

49827 Estimated 24-hour urinary sodium excretion associated with severity of atopic dermatitis in the UK Biobank

Hypertension status and its risk factors in highlanders living in Ganzi Tibetan Plateau: a cross-sectional study

BackgroundThe updated status of hypertension and its risk factors are poorly evaluated in Tibetan highland areas. We initiated a large-scale cross-sectional survey to provide updated status of hypertension and its risk factors (especially salt intake) in the Ganzi Tibetan Plateau, China.MethodsStratified multistage random sampling was performed to obtain a representative sample of 4,036 adult residents from 4 counties in the Ganzi Tibetan area. The whole survey population was used to present the epidemiology and risk factors of hypertension. The participants with blood and urine biochemistry data were used to analyze the relationship between salt intake parameters and hypertension.ResultsStratified multistage random sampling was performed to obtain a representative sample of 4,036 adult residents. The overall prevalence rate of hypertension was 33.5% (the age-adjusted prevalence rate was 28.9%). A total of 50.9% of the hypertensive patients knew their conditions; 30.1% of them received antihypertensive treatment; and 11.2% of them had their blood pressure controlled. Age, male sex, living altitude ≥ 3500 m, overweight and abdominal obesity were positively correlated with hypertension. In addition, the adjusted odds ratio (OR) for hypertension was 1.33 (95% CI: 1.01–1.74) for drinking tea with salt, and 1.51 (95% CI: 1.32–1.72) for per SD increase in the estimation of 24-hour urinary sodium excretion (e24hUSE). Furthermore, per 100mmol/day increase in e24hUSE was associated with elevation of blood pressure (+ 10.16, 95% CI: 8.45–11.87 mmHg for SBP; +3.83, 95% CI: 2.74–4.93 mmHg for DBP) in this population.ConclusionsOur survey suggests a heavy disease burden of hypertension in the Ganzi Tibetan Plateau. Age, male sex, altitude of residence ≥ 3500 m, overweight, abdominal obesity, and excessive salt intake (shown as drinking tea with adding salt and a higher level of e24hUSE) all increased the risk of hypertension in this highland area.

24-Hour Urinary Sodium Excretion Is Associated With Increased Risk of Pancreatic Cancer: A Prospective Cohort Study.

This study builds on previous research and its limitations, which indicate the need for further investigation in prospective cohorts. Our aim was to explore the association between estimated 24-hour urinary sodium excretion (indicative of daily sodium consumption) and the occurrence of pancreatic cancer in the UK Biobank's large prospective cohort. Using the INTERSALT equation, the study computed estimated 24-hour urinary sodium excretion by analyzing the baseline spot urine sodium measurements of 434,372 individuals enrolled in the UK Biobank. Pancreatic cancer cases were identified through UK cancer registries. Adjusted Cox proportional hazards models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between estimated 24-hour urinary sodium excretion and the risk of pancreatic cancer. Over a median follow-up period of 13.8 years, 1,765 cases of pancreatic cancer were detected. The multivariable adjusted Cox model showed that each 1-gram rise in estimated 24-hour urinary sodium excretion corresponded to a 1.12 HR for incident pancreatic cancer (95% CI: 1.03, 1.22). The estimated HR for 24-hour urinary sodium excretion in binary form was 1.23 (95% CI: 1.05, 1.44). Compared with the lowest group, the group with the highest estimated 24-hour urinary sodium excretion exhibited an HR of 1.38 (95% CI: 1.21, 1.58). These results propose an association between elevated sodium consumption and a heightened risk of pancreatic cancer. Further validation and exploration of potential mechanisms are warranted.

Sodium Intake and Atopic Dermatitis

The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course. To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort. This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024. The primary exposure was 24-hour urinary sodium excretion. The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association. The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47). These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.

Prediction of 24-Hour Urinary Sodium Excretion Using Machine-Learning Algorithms.

Accurate quantification of sodium intake based on self-reported dietary assessments has been a persistent challenge. We aimed to apply machine-learning (ML) algorithms to predict 24-hour urinary sodium excretion from self-reported questionnaire information. We analyzed 3454 participants from the NHS (Nurses' Health Study), NHS-II (Nurses' Health Study II), and HPFS (Health Professionals Follow-Up Study), with repeated measures of 24-hour urinary sodium excretion over 1 year. We used an ensemble approach to predict averaged 24-hour urinary sodium excretion using 36 characteristics. The TOHP-I (Trial of Hypertension Prevention I) was used for the external validation. The final ML algorithms were applied to 167 920 nonhypertensive adults with 30-year follow-up to estimate confounder-adjusted hazard ratio (HR) of incident hypertension for predicted sodium. Averaged 24-hour urinary sodium excretion was better predicted and calibrated with ML compared with the food frequency questionnaire (Spearman correlation coefficient, 0.51 [95% CI, 0.49-0.54] with ML; 0.19 [95% CI, 0.16-0.23] with the food frequency questionnaire; 0.46 [95% CI, 0.42-0.50] in the TOHP-I). However, the prediction heavily depended on body size, and the prediction of energy-adjusted 24-hour sodium excretion was modestly better using ML. ML-predicted sodium was modestly more strongly associated than food frequency questionnaire-based sodium in the NHS-II (HR comparing Q5 versus Q1, 1.48 [95% CI, 1.40-1.56] with ML; 1.04 [95% CI, 0.99-1.08] with the food frequency questionnaire), but no material differences were observed in the NHS or HPFS. The present ML algorithm improved prediction of participants' absolute 24-hour urinary sodium excretion. The present algorithms may be a generalizable approach for predicting absolute sodium intake but do not substantially reduce the bias stemming from measurement error in disease associations.

DOSE-RESPONSE EFFECT OF SODIUM REDUCTION ON BLOOD PRSSURE IN TREATED HYPERTENSIVES: A SYSTEMATIC REVIEW AND INSTRUMENTAL VARIABLE META-ANALYSIS

Objective: To evaluate the dose-response effects of a reduction in dietary sodium intake on blood pressure (BP) in hypertensive individuals who were on antihypertensive treatments. The impact of antihypertensive-drug class was also examined. Design and method: We searched Medline (via Ovid), Embase, Scopus, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles up to 12 November 2023. We included randomised controlled trials (RCTs) comparing the effect on BP between different levels of dietary sodium intake in adults who were diagnosed as primary hypertension and treated with constant antihypertensive medications during the study period. We excluded RCTs with duration &lt; 2 weeks. Dietary sodium intake was measured using 24-hour urinary sodium excretion. Instrumental variable meta-analyses were conducted to evaluate the dose-response effects of sodium reduction on BP. Subgroup analysis and multivariate meta-regression analysis were performed to examine the impact of antihypertensive-drug class. Results: 35 studies with 2885 participants were included. The pooled estimates of mean reduction in 24-hour urinary sodium excretion, systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were 68.74 (95% confidence interval: 62.30-75.19) mmol, 4.33 (3.37-5.29) mmHg, 2.60 mm Hg (2.04-3.17), and 3.19 (2.50-3.87), respectively. For every 100 mmol reduction in 24-hour urinary sodium excretion, SBP, DBP, and MAP decreased by 6.81 (4.96-8.66) mmHg, 3.85 (2.26-5.43) mmHg, and 4.83 (3.22-6.44) mmHg, respectively (Fig 1). The observed dose-response effects differed across class of antihypertensive medication (P-diff = 0.084 for SBP, and P-diff&lt;0.05 for DBP and MAP). In Beta-blockers, Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, and dual therapy groups, significant dose-response effects of sodium on SBP, DBP and MAP were observed. In Calcium Chanel Blockers (CCB) group, the dose-response relationship was only found for SBP. No dose-response effect on BP was observed in diuretics monotherapy group. Conclusions: Pooled evidence of RCTs suggests a dose-response relationship between sodium reduction and BP in treated hypertensives, which is impacted by class of antihypertensive medications.

Evaluation of Drug-Drug Interaction Between Henagliflozin and Hydrochlorothiazide in Healthy Chinese Volunteers.

Henagliflozin is an original, selective sodium-glucose cotransporter 2 (SGLT2) inhibitor. Hydrochlorothiazide (HCTZ) is a common anti-hypertensive drug. This study aimed to evaluate the potential interaction between henagliflozin and HCTZ. This was a single-arm, open-label, multi-dose, three-period study that was conducted in healthy Chinese volunteers. Twelve subjects were treated in three periods, period 1: 25 mg HCTZ for four days, period 2: 10 mg henagliflozin for four days and period 3: 25 mg HCTZ + 10 mg henagliflozin for four days. Blood samples and urine samples were collected before and up to 24 hours after drug administrations on day 4, day 10 and day 14. The plasma concentrations of henagliflozin and HCTZ were analyzed using LC-MS/MS. The urine samples were collected for pharmacodynamic glucose and electrolyte analyses. Tolerability was also evaluated. The 90% CI of the ratio of geometric means (combination: monotherapy) for AUCτ,ss of henagliflozin and HCTZ was within the bioequivalence interval of 0.80-1.25. For henagliflozin, co-administration increased Css, max by 24.32% and the 90% CI of the GMR was (108.34%, 142.65%), and the 24-hour urine volume and glucose excretion decreased by 0.43% and 19.6%, respectively. For HCTZ, co-administration decreased Css, max by 19.41% and the 90% CI of the GMR was (71.60%, 90.72%), and the 24-hour urine volume and urinary calcium, potassium, phosphorus, chloride, and sodium excretion decreased by 11.7%, 20.8%, 11.8%, 11.9%, 22.0% and 15.5%, respectively. All subjects (12/12) reported adverse events (AEs), but the majority of theses AEs were mild and no serious AEs were reported. Although Css,max was affected by the combination of henagliflozin and HCTZ, there was no clinically meaningful safety interaction between them. Given these results, coadministration of HCTZ should not require any adaptation of henagliflozin dosing. ClinicalTrials.gov NCT06083116.

PERSISTENT EFFECT OF SALT REDUCTION IN SCHOOLCHILDREN AND THEIR FAMILIES: ONE-YEAR FOLLOW-UP AFTER A RANDOMISED CONTROLLED TRIAL

Objective: A previous 12-month randomised controlled trial (RCT) demonstrated the effectiveness of an application-based education program, conducted through schoolchildren, in reducing the salt intake and systolic blood pressure of their adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Design and method: As a follow-up survey of a cluster RCT with 54 schools randomly assigned to either the intervention or control group, all participants who completed the baseline survey were contacted again at 24 months, following a 12-month non-intervention period after the RCT. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12-month follow-up, measured by the mean two consecutive 24-hour urinary sodium excretions. The secondary outcome was the difference in blood pressure change. Results: At 24 months, 542 children and 974 adults were followed up, accounting for 91.6% and 82.3% of the participants, respectively. The mean salt intake in adults at baseline, 12 months and 24 months was 10.0 g/day (standard deviation 3.5), 8.9 g/day (standard deviation 3.2) and 9.4 g/day (standard deviation 3.5) in the intervention group and 10.0 g/day (standard deviation 3.6), 9.8 g/day (standard deviation 3.9) and 9.8 g/day (standard deviation 3.9) in the control group. The mean difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors is -0.38 g/day at 24 months versus baseline (95% confidence interval -0.81 to 0.05, P=0.086), and 0.45 g/day at 24 months versus 12 months (95% confidence interval 0.01 to 0.85, P=0.046). The mean difference in systolic blood pressure change after adjusting for confounding factors is -2.19 mm Hg (95% confidence interval -3.63 to -0.76, P=0.003) at 24 months versus baseline and -0.40 mm Hg (95% confidence interval -1.86 to 1.07, P=0.596) at 24 months versus 12 months. Conclusions: The effect of the education program on adults’ salt intake faded, but the systolic blood pressure lowering effect remained 12 months after the RCT. Continuous salt reduction education is recommended to maintain the effect.

Abstract MP09: Population Level 24-Hour Urinary Sodium and Potassium Associations With Blood Pressure Differs by Sex: Findings From the New York City Heart Follow-Up Study 2010 and 2018

Introduction: Hypertension (HTN) is a leading cause of heart disease and stroke amongst New York City (NYC) residents, with notable sex-based disparities in prevalence and cardiovascular (CV) outcomes. While prior 24-hour urinary population-based studies in other populations have shown that the association between sodium and potassium and blood pressure (BP) is primarily driven by hypertensive adults, the studies did not adequately evaluate how these associations may differ by sex. Hypothesis: Our study examined whether the relationship between sodium, potassium, and the sodium/potassium ratio and BP varies significantly by sex assigned at birth, stratified by HTN status, in the NYC population. Methods: The Heart Follow-Up Study (HFUS) is a cross-sectional survey conducted in 2010 and 2018 among NYC residents ages 18 and older. Study data included BP measurements, sodium and potassium urinary analytes, and self-reported information about CV health. Analyses were based on 1,606 and 2,327 participants, respectively, and weighted to the NYC population. HTN was defined as per the National Health and Nutrition Survey criteria: systolic BP≥140, diastolic BP≥90, or current use of HTN medication. We applied t -tests to detect differences in mean age-adjusted electrolyte excretions between hypertensive and normotensive adults, stratified by sex. Furthermore, we used multivariable linear regression models, which included sex as an interaction term, to assess the association between sodium and potassium intake and BP at the two time points, and to evaluate potential effect modifications by sex. Results: In 2018, we observed no substantial difference between the mean age-adjusted 24-hour urinary excretion of sodium, potassium, and sodium/potassium ratio and HTN status among NYC males or females ( p &gt;.05). From multivariable models, we observed a consistent positive association between sodium/potassium ratio and mean BP in normotensive males; the relationship was stronger in 2010 (2.060, 95% CI: 0.865-3.255) compared to 2018 (0.312, 95% CI: 0.101-0.523). However, this association was not evident in normotensive females at both time points. We did not observe a consistent association between sodium, potassium, and sodium/potassium ratio and BP within the HTN group in males or females at either time point. Conclusions: The association between sodium/potassium levels and BP differs by sex. This association was evident exclusively in normotensive males, although we noted that the magnitude of this association was smaller in 2018 than in 2010. This suggests that sodium/potassium excrement may be a stronger indicator for BP variations within this subgroup. Recognizing that sex-based variations exist, our results suggest conducting intra-sex analysis to better understand CV health disparities and develop tailored public health strategies that will reduce adverse CV outcomes.

Sex-Specific Association between Sodium Intake Estimated by 24-Hour Urinary Sodium Excretion and Nonalcoholic Fatty Liver Disease: The Community-Based Prospective Cohort Study.

Evidence for the association between high sodium intake and the onset of nonalcoholic fatty liver disease (NAFLD) is insufficient. This study examined the sex-specific association between sodium intake and the risk of NAFLD. This study included 2582 adults (aged 40-69 years; 1011 males and 1571 females). The total sodium excreted over 24 h was estimated from spot urine specimens using Tanaka's equation. Based on these estimates, participants were categorized into three groups according to their 24-h urinary sodium excretion levels: lowest (T1), middle (T2), and highest (T3). In addition, the participants were divided into non-NAFLD (≤36) and NAFLD (>36) groups based on the hepatic steatosis index. During the follow-up period (14 years), NAFLD was observed in 551 participants. The estimated 24-h urinary sodium excretion levels were positively associated with the incidence of NAFLD in all subjects. Upon sex stratification, females in the T2 and T3 groups exhibited adjusted hazard ratios of 1.35 and 1.51, respectively, compared with the T1 group. However, a significant relationship was not observed in males. High intake of sodium, especially among females, may be an important factor contributing to the development of NAFLD. Individuals with high sodium intake should be appropriately counselled and monitored for the risk of NAFLD.

Evaluation of three prediction formulas of 24-hour urinary sodium excretion in Chinese residents: a systematic review and meta-analysis.

To determine the appropriateness of three widely used formulas estimating 24-h urinary Na (24hUNa) from spot urine samples in the Chinese population. Systematic review and meta-analysis. Literature review was conducted to identify studies for estimating 24hUNa using the Kawasaki, Tanaka and INTERSALT formulas simultaneously in PubMed, Embase and the Cochrane library databases. The mean difference (MD) and correlation coefficients (r) between measures and estimates from different formulas were assessed. Information extraction and quality assessment were performed in thirteen studies involving 8369 subjects. Two studies which affected the overall robustness were excluded in the 'leave-one-out' sensitivity analyses. Within the final meta-analysis included eleven studies and 7197 participants, 36·07 mmol/d (95 %CI 16·89, 55·25) of MD was observed in the Kawasaki formula, and -19·62 mmol/d (95 %CI -37·37, -1·87) in the Tanaka formula and -35·78 mmol/d (95 %CI -50·76, -20·80) in the INTERSALT formula; a pooled r-Fisher's Z of 0·39 (95 %CI 0·32, 0·45) in the Kawasaki formula, 0·43 (95 %CI 0·37, 0·49) in the Tanaka formula and 0·36 (95 %CI 0·31, 0·42) in the INTERSALT formula. Subgroup analyses were conducted to explore the possible factors affecting the accuracy of the formula estimation from three mainly aspects: population types, Na intake levels and urine specimen types. The meta-analysis suggested that the Tanaka formula performed a more accurate estimate in Chinese population. Time of collecting spot urine specimens and Na intake level of the sample population might be the main factors affecting the accuracy of the formula estimation.

Estimation of 24-hour urinary sodium and potassium excretion among Chinese adults: a cross-sectional study from the China National Nutrition Survey

BackgroundHigh-sodium intake is one of the most important risk factors for hypertension and cardiovascular disease, yet reliable national estimates of sodium intake in Chinese adults have not been reported. ObjectivesWe estimated 24-h urinary sodium and potassium excretion and population daily sodium and potassium intake of Chinese adults for the first time at a national level. MethodsA nationally representative cross-sectional survey was conducted to collect 24-h urine specimens from Chinese adults aged ≥18 y as part of the China National Nutrition Survey 2015. Finally, 10,114 participants (4932 males and 5182 females) with complete 24-h urine specimens were included in the analysis. Estimates of mean urinary electrolyte excretion and demographic, socioeconomic, and health characteristics were used with weighted coefficients that accounted for sample selection probabilities, poststratification weighting, and nonresponse rates. ResultsThe estimation of overall weighted mean 24-h urinary sodium excretion was 4121 mg (95% confidence interval [CI]: 3993, 4250), 4155 mg (95% CI: 3993, 4317) in males and 4081 mg (95% CI: 3953, 4209) in females (P for sex difference = 0.36). Overall mean 24-h urinary potassium excretion was 1534 mg (95% CI: 1492, 1577), 1468 mg (95% CI: 1424, 1513) in males and 1614 mg (95% CI: 1569–1660) in females (P for sex difference <0.001). Mean 24-h urinary sodium excretion was significantly higher in rural adults (4350 mg; 95% CI: 4217, 4483) than in urban residents (3909 mg; 95% CI: 3739, 4080; P < 0.001), and in northern residents (4388 mg; 95% CI: 4237, 4539) than in southern residents (3998 mg; 95% CI: 3832, 4163; P = 0.002). ConclusionsThe first nationwide survey with 24-h urine collection confirmed that mean sodium intake in Chinese adults was more than twice the upper limit, whereas mean potassium intake was <60% of the lower limit, recommended by the World Health Organization. Urgent measures should be taken to reduce sodium intake and increase potassium intake in China.

24-hour urine sodium excretion among renal donors in India: a cross-sectional study

24-hour urine sodium excretion among renal donors in India: a cross-sectional study

Calcitriol reverses age-related hypertension via downregulating renal AP1/AT1R pathway through regulating mitochondrial function

ABSTRACT Background The vitamin D level in the blood is associated with the incidence of hypertension. The present study investigated whether or not calcitriol, an active form of vitamin D, reverses age-related hypertension. Methods Young (3-month-old) and aged (12-month-old) C57BL/6 male mice were administered with or without calcitriol at 150 ng/kg per day by oral gavage for 8 weeks. Blood pressure was measured by tail-cuff plethysmography and telemetry, and superoxide production in renal tissue was assessed by fluorescence imaging, and the protein expression of AP1/AT1R signaling pathway was examined by Western blot. Results We showed that 24-hour renal sodium excretion was impaired and blood pressure was increased in aged mice, which was related to the enhancement of renal AT1R expression and function. In addition, the expression of transcription factor AP1 (a dimer of c-Fos and c-Jun) and the binding of AP1 to the AT1R promoter region was significantly enhanced, accompanied by decreased nuclear translocation of Nrf2, abnormal mitochondrial function including decreased ATP production, NAD+/NADH ratio and mtDNA copy numbers, and increased reactive oxygen species. Calcitriol increased 24-hour urinary sodium excretion and reduced blood pressure in aged mice. Mechanically, calcitriol increased the nuclear translocation of Nrf2, improved mitochondrial function, reduced AP1 binding ability to AT1R promoter, which reversed enhanced AT1R expression and function, and lowered blood pressure in aged mice. Conclusions Our findings indicated that calcitriol reversed age-related hypertension via downregulating renal AP1/AT1R pathway through regulating mitochondrial function. Thus, calcitriol may be a valuable therapeutic strategy for age-related hypertension.