Casual Urine Samples Research Articles

Does casual urine Na/K ratio predict 24 h urine Na/K ratio in treated hypertensive patients? Comparison between casual urine voided in the morning vs. 24 h urine collected on the previous day.

The urine sodium-to-potassium (Na/K) ratio is associated with blood pressure and cardiovascular diseases. A single urine sample is preferable for determining the Na/K ratio in clinical practice. We evaluated whether the Na/K ratio measured using morning casual urine samples predicts the ratio measured using the preceding 24 h urine sample in patients with hypertension. The study included 187 hypertensive patients (mean age 66.1 years, 52.4% female) whose Na and K concentrations were measured both in 24 h (24Na/K) and casual urine the next morning (CNa/K). The Na/K ratios were 3.54 ± 1.5 in 24NaK and 2.63 ± 1.9 in CNa/K. The two estimates showed a significant positive correlation (r = 0.49, p < 0.0001), and (CNa/K-24Na/K)/24Na/K was -23.5 ± 44.4%. In the Bland-Altman plot, the mean difference was -0.91. When CNa/K was divided into three groups, <2 (low), 2-4 (medium), and ≥4 (high), the overall agreement with 24Na/K was 46.0% (86 of 187). The low group had 24.4% agreement and 75.6% underestimation (24Na/K > CNa/K); the medium group had 60.8% agreement, 30.5% underestimation, and 8.7% overestimation (24Na/K < CNa/K); and the high group had 71.8% agreement and 28.2% overestimation. These results indicate that CNa/K and 24Na/K were significantly correlated; however, CNa/K was generally lower than 24Na/K, particularly at Na/K levels < 2. Further efforts should be made to address the validity of using casual urine Na/K ratios in hypertension management practices.

Validation of spot urine in estimating 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets in healthy adults

Purpose To evaluate the validity of spot urine assay methods in estimating the 24-h urinary sodium, potassium and sodium-to-potassium ratio during three different sodium diets. Materials and methods Twelve healthy volunteers were asked to adhere to 3 dietary sodium targets (3.3–5.0g/day,<3.3 g/day and >5.0 g/day) for three consecutive weeks and to measure salt excretion daily in spot urine samples using a self-monitoring device. On day 7 of each week, 24-h urine was collected to compare measured with estimated 24-h salt excretion (by the Kawasaki, Tanaka and INTERSALT equations). Results Correlation coefficients relating measured and estimated 24-h sodium excretion were low and not significant for Kawasaki and INTERSALT and moderate for the Tanaka equation (τ 0.56–0.64,p<.05). Bland–Altman plots showed considerable differences between estimated and measured sodium excretion across all salt diets. Over 40% of the participants showed an absolute difference between measured and estimated 24-h sodium of more than 1000 mg/day. The correlation coefficients between 24-h and spot Na/K ratio were 0.67, 0.94 and 0.85(p<.05), and mean differences were 0.59, 0.06 and 0.48 for the intermediate, low and high sodium diets, respectively. Conclusion These findings do not support estimation of individual 24-h salt excretion from spot urine by the Kawasaki, Tanaka, or INTERSALT formula.

Assessment of the iodine status of children of pre‐school age (6 months–5 years) in Rivers State, Nigeria

AbstractThe study was to determine the iodine status of preschool children in Rivers State, Nigeria. A cross‐sectional study design and an experimental design were employed in the study. The population comprised all preschool children in Rivers State. A multistage sampling procedure was used to draw a sample size of 330 preschool children. Early morning casual urine samples were collected from the pupils for the analysis of urinary iodine concentration (UIC) using the sensitive colorimetric method of the Sandell–Kelthoff reaction. The result revealed that none of the children were severely deficient, 2.41% were moderately deficient, and 36.14% were mildly deficient; 53.01% were adequate, while 4.82% were more than adequate. The study population was found to have adequate iodine based on the median UIC of 143.3 µg/L, and within the optimal (100–199 µg/L) range of iodine, strongly suggesting that iodine deficiency seems not to be a public health problem among the preschool children.

Short-term effects of modest salt reduction combined with DASH diet on changing salt eating habits in hypertensive patients with type II diabetes

ABSTRACT Objective Excessive salt intake is currently the foremost universal risk factor for controllable chronic disease. This study evaluated the short-term effects of a modest salt intake reduction combined with the Chinese Modified Dietary Approaches to Stop Hypertension (CM-DASH) diet on sodium and potassium intake, mean arterial pressure (MAP), and pulse pressure (PP) in hypertensive patients with type II diabetes. Methods Sixty-one participants were randomized to the intervention group (52% low-sodium salt and DASH) and control group (normal salt and DASH). An 8-week dietary intervention was applied. Daily salt intake, blood pressure (BP), and drug use were recorded every week. Twenty-four-hour urine, casual urine, and blood samples were measured at baseline, the 4th week, and the end of the intervention. Results Fifty-nine patients (25 men) completed the entire study. Sodium intake decreased by 1259.66 (792.76, 1726.56)/705.80 (149.21, 1262.39) mg/day after 4 weeks (intervention: P < .001; control: P = .015). Potassium intake increased by 641.14 (73.31, 1208.96)/43.43 (−259.66, 346.53) mg/day (intervention: P = .028); MAP decreased by 9.06 (6.69, 11.43)/7.16 (4.03, 10.28) mmHg (both: P < .001); PP decreased by 7.97 (3.05, 12.88)/5.74 (2.55,8.94) mmHg (intervention: P = .002; control: P = .001) after 8 weeks. However, the difference between the two groups was not statistically significant. Conclusion Modest salt reduction and the CM-DASH diet for hypertensive patients with type II diabetes can achieve short-term salt reduction effects. The effect on changing salt-eating habits needs to be investigated with an extended follow-up.

Salt Consumption Patterns and Iodine Nutrition Status of Pregnant Women in Coastal Region

Background: Maternal Iodine Deficiency Disorder can result in inevitable cretinism as well as miscarriages, stillbirth and low birth-weight babies. Objective: There is a need to find out contributing factors towards urinary iodine concentrations of pregnant women. Methods: Therefore, the cross-sectional, descriptive study was conducted to assess the patterns of salt utilization and iodine status of pregnant women living in coastal areas of Mon State in January and May, 2013. Result: A total of 144 pregnant women from Pa-Nga village and Kalokepi village in Thanbyuzayat township were asked by using structured questionnaires including age, parity, socioeconomic status and patterns of salt and iodine-rich foods (seaweed, fish, prawn) consumption. Casual urine samples were collected from each pregnant woman and urinary iodine concentrations were measured. Three samples each of the iodized salt and non-iodized salt from local markets were collected for determination of iodine content by the iodometric titration method. Only 83.3% of the study population consumed iodized salt and the remaining (16.7%) consumed non-iodized salt. The median urinary iodine concentration of the study population was 105 μg/L. The mean urinary iodine level of pregnant women who consumed iodized salt and that of pregnant women who consumed non-iodizes salt were 110.47 ± 67.34 μg/L and 95.83 ± 70.13 μg/L (P = 0.336). Iodine content of the iodized salt and non-iodized salt was 20.6 ± 9.2 ppm and 5.1 ± 1.2 ppm respectively. In conclusion, the median iodine level of pregnant women was lower than that of the optimal iodine nutrition for pregnant women, i.e., 150 - 250 μg/L and the mean iodine content of salt samples was lower than the permissible level of iodine in iodized salt, i.e., 30 - 40 ppm. Conclusion: Our findings indicate that iodine nutritional status of pregnant women in this area is insufficient and salt iodization needs to be monitored for the optimal iodine content in iodized salt.

Iodine Deficiency during Preconception Period of Adolescent Girls Residing in a District of Rajasthan, India.

Background:In India, iodine deficiency (ID) still remains a serious concern even after five decades of enormous efforts. ID during the preconception period of adolescent girls may negatively affect future neonates, resulting in neonatal hypothyroidism. Hence, the present study was conducted to assess the prevalence of goiter and associated factors among adolescent girls in a poor socioeconomic district of Rajasthan.Methodology:A cross-sectional study was conducted during January–March 2015 in Tonk district of Rajasthan. A total of 1912 adolescent girls were selected from thirty schools using population proportionate to size sampling. Adolescent girls were clinically examined for thyroid using palpation method. Casual urine (n = 344) and salt samples (n = 370) were collected from a subgroup of girls for the estimation of urinary iodine concentration (UIC) and iodine content in salt, respectively.Results:The overall goiter prevalence was 15.3% (95% confidence interval 13.6%–16.9%) and the median UIC was 266 μg/l (interquartile range: 150–300 μg/l) among 1912 adolescent girls (age, 15.7 ± 1.4 years). Around 16.8% of the families of adolescent girls were consuming salt with inadequate iodine (<15 ppm). Goiter prevalence was statistically significantly different with respect to age groups (P = 0.03). There was no statistically significant difference in goiter prevalence with respect to iodine content of salt (P = 0.98) and UIC (P = 0.41). The median UIC increased with an increase in consumption of iodine content of salt from inadequacy to adequacy (P = 0.15).Conclusion:Adolescent girls, residing in an underdeveloped district, are in the transition phase from mild ID (goiter prevalence 15.3%) to iodine sufficiency (median UIC 266 μg/l).

Urine selenium concentration is a useful biomarker for assessing population level selenium status

Plasma selenium (Se) concentration is an established population level biomarker of Se status, especially in Se-deficient populations. Previously observed correlations between dietary Se intake and urinary Se excretion suggest that urine Se concentration is also a potentially viable biomarker of Se status. However, there are only limited data on urine Se concentration among Se-deficient populations. Here, we test if urine is a viable biomarker for assessing Se status among a large sample of women and children in Malawi, most of whom are likely to be Se-deficient based on plasma Se status. Casual (spot) urine samples (n = 1406) were collected from a nationally representative sample of women of reproductive age (WRA, n =741) and school aged children (SAC, n=665) across Malawi as part of the 2015/16 Demographic and Health Survey. Selenium concentration in urine was determined using inductively coupled plasma mass spectrometry (ICP-MS). Urinary dilution corrections for specific gravity, osmolality, and creatinine were applied to adjust for hydration status. Plasma Se status had been measured for the same survey participants. There was between-cluster variation in urine Se concentration that corresponded with variation in plasma Se concentration, but not between households within a cluster, or between individuals within a household. Corrected urine Se concentrations explained more of the between-cluster variation in plasma Se concentration than uncorrected data. These results provide new evidence that urine may be used in the surveillance of Se status at the population level in some groups. This could be a cost-effective option if urine samples are already being collected for other assessments, such as for iodine status analysis as in the Malawi and other national Demographic and Health Surveys.

A Stratified Cross-Sectional Cluster Model Survey of Iodine Nutrition in Armenia After A Decade of Universal Salt Iodization

Objective: Iodine is a necessary nutrient for the synthesis of thyroid hormones and essential in human development. Being naturally deficient in iodine, Armenia launched a national universal salt iodization (USI) strategy in 2004. Although high rates of goiter continued to be reported, iodine status has not been studied since 2005. Therefore, this study sought to assess the current situation of population iodine nutrition in Armenia. Methods: We used a selective cross-sectional model to recruit three groups: school-age children (SAC), pregnant women (PW), and nonpregnant women of reproductive age (WRA) from each province. We collected casual urine and table salt samples from each participant, which were analyzed for iodine concentration. A repeat urine sample was collected in a subset of participants to adjust the results for within-person variation in iodine concentration. Group-wise urinary iodine concentrations (UICs) were compared with international reference criteria for iodine status. Results: Urine samples were collected from 1,125 participants from 13 different towns in Armenia; a total of 1,078 participants were included in the final analysis: 361 SAC (mean age, 10.5 years, 46.6% female), 356 PW (mean age, 26.1 years), and 361 WRA (mean age, 35.5 years). Population and geographically weighted median UIC were: SAC, 242 μg/L ([25th percentile] 203 to [75th percentile] 289 μg/L); PW, 226 μg/L (209 to 247 μg/L); WRA, 311 μg/L (244 to 371 μg/L). A total of 1,041 table salt samples were sufficient for laboratory analysis: 973 (93.4%) of the salt iodine measurements were within the national standard range of 40 ± 15 mg/kg. Conclusion: The results of household salt sampling indicated a successful USI strategy. While the present study did not achieve a truly representative sample of Armenia's population, the UIC results support the conclusion that iodine deficiency has not recurred and is not an underlying factor for any remaining high goiter prevalence in Armenia. Abbreviations: PW = pregnant women; SAC = school-age children; SI = salt iodine; UIC = urinary iodine concentration; USI = universal salt iodization; WHO = World Health Organization; WRA = women of reproductive age.

Changes in oxidative stress levels during two weeks of smoking cessation treatment and their association with nutritional characteristics in Japanese smokers.

Although several experimental studies have reported that oxidative stress levels decrease during smoking cessation, how they change among general smokers has yet to be completely elucidated. In the present study, a total of 23 smokers who underwent smoking cessation treatment were observed for two-week changes in their levels of 8-OHdG and 8-isoprostane. Physical and nutritional characteristics were measured at the initial patient visit, and casual urine samples were collected at the initial visit and at a follow-up visit two weeks later. Oxidative stress was measured by a high performance liquid chromatography electrochemical detector, and the two-week difference in the levels of oxidative stress was assessed according to demographic and nutrient factors. Neither the urinary level of 8-OHdG nor that of 8-isoprostane decreased, although the cotinine level was decreased at two weeks. A Two-way repeated ANOVA revealed a significant interaction for fat intake by time for the change in the 8-OHdG level (P=0.03) and significant interactions for α-tocopherol intake (P=0.03), iron intake, and carbohydrate intake (P=0.03), all of which were time-dependent for the change in the 8-isoprostane level. The 8-OHdG level decreased among smokers with a high fat intake and was increased with a low fat intake. The 8-isoprostane levels were decreased among smokers with a high carbohydrate intake and increased with a low carbohydrate intake, decreased with a low iron intake and increased with a high iron intake and decreased with a low α-tocopherol intake and increased with a high α-tocopherol intake. Although the present study failed to observe a decrease in oxidative stress levels during the two-week smoking cessation period, we hypothesize that the intake levels of specific nutrients when initiating smoking cessation treatment may predict any subsequent changes in the oxidative stress levels.

Iodine status, and knowledge about iodine deficiency disorders in adolescent school girls aged 14-19 years, 2016.

Background: Adequate iodine intake by women in child-bearing age affects fetus neurodevelopment during pregnancy. A majority of previous studies has investigated iodine status among children, and there is limited data on female adolescents who are more exposed to consequences of iodine deficiency (ID) in their near-future pregnancies; thus, we aimed to assess iodine status, and knowledge on iodine deficiency disorders (IDDs) among adolescent school girls (14-19 years old) in Shahriar, Iran. Methods: This cross-sectional study was conducted among 223 female students selected through multi-stage cluster sampling from 12 schools. Iodine and creatinine concentrations were measured in casual urine samples. Iodine content of household salts was also assessed.Data on intake of salt and iodine-rich food sources were collected applying a food frequency questionnaire (FFQ), and knowledge about iodine and IDDs were assessed by a questionnaire. Results: Median and Mean (95% CI) concentrations of urinary iodine and creatinine were 129 µg/L, 137.62 µg/L (95% CI: 126.28, 148.95) and 1.72 g/L, 1.86 g/L (95% CI: 0.55-3.17),respectively. The frequency of mild, moderate and severe ID were 22.4%, 14.3% and 0%,respectively; 43.5% had adequate, and 3.1% had excessive urinary iodine levels. Mean saltiodine concentration was 21.69 (SD=10.56) ppm. Mean knowledge score was 12.7 (SD=3.44).About half of the students had a poor (25.1%) or fair (24.2%) knowledge about iodine deficiency.Adjusting for the confounders, no significant positive association was found between knowledge about iodine-rich food sources and goitrogens with urinary iodine excretion. Conclusion: Adolescent girls in Shahriar had relatively poor knowledge of iodine, and about one third of them suffered from ID.

Current state of iodine nutrition in Filipino school-aged children.

Globally, although progress in eliminating iodine deficiency disorders (IDD) has been reported, IDD is still considered to be a global health problem. As school-aged children are the most accessible population group, their urinary iodine (UI) concentration data are accepted and used as an indicator of IDD for the general population. The aim of this study was to reassess the national, regional, and provincial estimates of UI as a measure of IDD among Filipino school-aged children. Casual urine samples were collected from 22 588 children, 6 to 12 y of age, from participating households in the eighth National Nutrition Survey. UI was determined based on the catalytic action of iodine in the Sandell-Kolthoff reaction and IDD was evaluated using criteria from the World Health Organization, United Nations Children's Fund, International Council for Control of Iodine Deficiency Disorders criteria. The median UI level among Filipino school-aged children was 168 μg/L, corresponding to optimal iodine nutrition; whereas 23.2% had UI reflective of excessive iodine intake. Cjildren in the Zamboanga Peninsula Region had median UI level of 68 μg/L and 41.1% of participants had UI values <50 μg/L, which is indicative of mild iodine deficiency. Children from Guimaras and Zamboanga del Norte, or 2.4% of the provinces, had moderate iodine deficiency. Although the median UI level of school-age children was optimal, there are pockets of inadequacy and excessive intake that need special concern for targeted intervention.

Iodine Status and Consumption of Key Iodine Sources in the U.S. Population with Special Attention to Reproductive Age Women.

We estimated iodine status (median urinary iodine concentration (mUIC (µg/L))) for the US population (6 years and over; n = 4613) and women of reproductive age (WRA) (15–44 years; n = 901). We estimated mean intake of key iodine sources by race and Hispanic origin. We present the first national estimates of mUIC for non-Hispanic Asian persons and examine the intake of soy products, a potential source of goitrogens. One-third of National Health and Nutrition Examination Survey (NHANES) participants in 2011–2014 provided casual urine samples; UIC was measured in these samples. We assessed dietary intake with one 24-h recall and created food groups using the USDA’s food/beverage coding scheme. For WRA, mUIC was 110 µg/L. For both non-Hispanic white (106 µg/L) and non-Hispanic Asian (81 µg/L) WRA mUIC was significantly lower than mUIC among Hispanic WRA (133 µg/L). Non-Hispanic black WRA had a mUIC of 124 µg/L. Dairy consumption was significantly higher among non-Hispanic white (162 g) compared to non-Hispanic black WRA (113 g). Soy consumption was also higher among non-Hispanic Asian WRA (18 g compared to non-Hispanic black WRA (1 g). Differences in the consumption pattern of key sources of iodine and goitrogens may put subgroups of individuals at risk of mild iodine deficiency. Continued monitoring of iodine status and variations in consumption patterns is needed.

Association of Salt Intake Estimated from Casual Urine Samples and Blood Pressure in Ningen Dock Examinees

Association of Salt Intake Estimated from Casual Urine Samples and Blood Pressure in Ningen Dock Examinees

Prevalence of goiter and associated factors among pregnant mothers residing in a district with poor socioeconomic status in Rajasthan state, India.

Background:National survey documented that none of the Indian state is free from iodine deficiency (ID). Hence, the study was conducted with the objective to assess prevalence of goiter and associated factors among pregnant mothers (PMs) in a backward district of Indian state, Rajasthan.Methods:A cross-sectional survey was conducted during January to March 2015. Multistage random sampling was utilized to select PMs. A total of 1,183 villages were enlisted with their respective population, and 30 villages were selected using population proportionate to size sampling. Subjects were included from a cluster till the numbers reached to 17. PMs were clinically examined for goiter by palpation method. Casual urine (n = 226) and salt samples (n = 220), were collected from a subgroup of subjects, and iodine concentrations were analyzed by using wet digestion and iodometric titration methods, respectively.Results:The prevalence of goiter was found to be 14.2% (95% CI; 11.2–17.2). Goiter prevalence did not significantly differ with respect to trimesters of pregnancy (P = 0.09), iodine content in salt (P = 0.8), and urinary iodine concentrations (UIC, P = 0.69). The median UIC was 174 μg/L (IQR; 116–300 μg/L), which indicated adequate iodine intake. There was higher prevalence of goiter in PMs consuming salt with inadequate iodine than those with adequate, which was not significant (P = 0.8). Goiter prevalence was also insignificantly higher among PMs with UIC <150 μg/L than those with UIC ≥150 μg/L (P = 0.69).Conclusion:The study population is in transition phase from mild ID (goiter prevalence 14.1%) to sufficiency (median UIC 174 μg/L).

Effect of amlodipine, efonidipine, and trichlormethiazide on home blood pressure and upper-normal microalbuminuria assessed by casual spot urine test in essential hypertensive patients

ABSTRACTThe aim of this study was to assess the effects of irbesartan alone and combined with amlodipine, efonidipine, or trichlormethiazide on blood pressure (BP) and urinary albumin (UA) excretion in hypertensive patients with microalbuminuria (30≤UA/creatinine (Cr) ratio [UACR] <300 mg/g Cr) and upper-normal microalbuminuria (10≤UACR<30 mg/g Cr). This randomized controlled trial enrolled 175 newly diagnosed and untreated hypertensive patients (home systolic blood pressure [SBP]≥135 mmHg; 10≤UACR<300 mg/g Cr of casual spot urine at the first visit to clinic). All patients were treated with irbesartan (week 0). Patients who failed to achieve home SBP ≤125 mmHg on 8-week irbesartan monotherapy (nonresponders, n = 115) were randomized into three additional drug treatment groups: trichlormethiazide (n = 42), efonidipine (n = 39), or amlodipine (n = 34). Irbesartan monotherapy decreased home SBP and first morning urine samples (morning UACR) for 8 weeks (p < 0.0001). At 8 weeks after randomization, all three additional drugs decreased home SBP (p < 0.0002) and trichlormethiazide significantly decreased morning UACR (p = 0.03). Amlodipine decreased morning UACR in patients with microalbuminuria based on casual spot urine samples (p = 0.048). However, multivariate analysis showed that only higher home SBP and UACR at week 8, but not any additional treatments, were significantly associated with UACR reduction between week 8 and week 16. In conclusion, crucial points of the effects of combination therapy on UACR were basal UACR and SBP levels. The effect of trichlormethiazide or amlodipine treatment in combination with irbesartan treatment on microalbuminuria needs to be reexamined based on a larger sample size after considering basal UACR and SBP levels.

Abstract P333: Repeated Measurementof Casual Urine Na/K Ratio May Provide Useful Information to Screen Early Stage Chronic Kidney Disease Patients With Higher Sodium and Lower Potassium Intake

Objective: Lowering sodium-to-potassium ratio has been reported to benefit people for hypertension prevention and control in epidemiological studies. Four to seven repeated measurements of casual urine sodium-to-potassium ratio is known to provide high correlation and good agreement quality with less bias to estimate 7-day 24-hour urinary Na/K ratio in normotensive and hypertensive individuals. However, little is known about urinary Na/K ratio in patients with chronic kidney disease (CKD). The aim of this study was to clarify the relationship of the repeated measurement of casual and 24-hour urinary sodium-to-potassium ratio in patients with CKD. Design and Method: A total of 61 inpatients with CKD, 31 in stage 1-3 (eGFR ≥ 30 ml/min/1.73m 2 ) and 30 in stage 4-5 (eGFR &lt; 30 ml/min/1.73m 2 ), aged 20 to 85 under low-sodium diet (NaCl 6 g/day) were recruited in Okayama University hospital. Sodium-to-potassium ratio in casual urine at 4 points/day (first void after rising, each urine after breakfast, lunch or dinner) for 2 days and 2-day 24-hr urine at the same day were measured. Correlation and the quality of agreement by Bland and Altman between casual urine and 24-hour urine samples were analyzed. Results: Mean 24-hour Na and K excretion was lower in participants in stage 4-5 (Na: 87.5 mmol/24h, K: 18.8 mmol/24h) than in participants in stage 1-3 (Na: 99.0 mmol/24h, K: 26.1 mmol/24h), whereas mean 24-hour urine Na/K ratio was higher in participants in stage 4-5 (5.1) than in participants in stage 1-3 (4.1). Casual urine Na/K ratio was strongly correlated with 2-day 24-hour urinary Na/K ratio by sampling 2 casual urine specimens per day for 2 days in participants in stage 1-3 (r = 0.69-0.78), but not in stage 4-5 (r = 0.12-0.19). The bias for mean Na/K ratio between 2-day 24-hour urine and sampling 2 casual urine per day for 2 days in participants in stage 1-3 ranged from -0.86 to 0.16, and the quality of agreement for the mean of this casual urine sampling was similar to that of all 8 points of casual urine samples for estimating 2-day 24-hour values. Conclusion: Repeated casual urine Na/K ratio measurement may provide good estimate of 24-hour urine Na/K ratio, in stage 1-3 CKD patients as well as normotensive and hypertensive people; however, not in stage 4-5 CKD patients.

Iodine Deficiency Disorder Among Filipino School Children, Pregnant and Lactating Women and the Elderly 20 Years After the Act for Salt Iodization Nationwide Law

Background: Iodine deficiency disorder (IDD) is still a public health problem globally. In response to this, universal salt iodization (USI) has been implemented. This is the most cost-effective strategy to prevent and control it. In the Philippines, an Act for Salt Iodization Nationwide (ASIN Law) was passed in 1995, in response to the increasing goiter rates. This paper describes the prevalence and severity of IDD among Filipino school-aged children (SAC), pregnant and lactating women and the elderly, 20 years after the implementation of the ASIN Law. Methods: Casual urine samples were collected from SAC, pregnant and lactating women and elderly of 1998, 2003, 2008 and 2013, of selected households of the National Nutrition Survey (NNS). Urinary iodine (UI) levels were determined using the acid digestion method. UI levels and prevalence of IDD in the 2013 NNS were compared with those in previous NNSs. Results: Iodine nutrition among the SAC has improved from mild deficiency with a median of 71 ug/L in 1998 to 201 ug/L in 2003. It has remained “optimal” till the 2013 NNS, almost 20 years after ASIN Law. UI was 107 ug/L among the elderly in 2008, but decreased to 80 ug/L in 2013, also indicating “mild” iodine deficiency. Among the lactating women, UI was 111 ug/L in 2003, indicating iodine sufficiency, but decreased to 81 and 77 ug/L in 2008 and 2013 NNS, respectively, indicating “mild” iodine deficiency. Median UI among the pregnant women was 142, 105 and 105 ug/L, also indicating the presence of IDD for the 2003, 2008 and 2013 NNS, respectively. Conclusion: Twenty years after ASIN Law, Filipino SAC have achieved optimum iodine status while the pregnant and lactating women and the elderly remain to be iodine deficient. Strict monitoring of iodization of salt at the production site should be implemented, since iodine levels in salt have remained at levels below the standard. J Endocrinol Metab. 2017;7(3):86-93 doi: https://doi.org/10.14740/jem414w

Diurnal variation of urinary sodium-to-potassium ratio in free-living Japanese individuals

High sodium-to-potassium ratios are associated with elevated blood pressure levels and an increased risk of cardiovascular diseases. We aimed to determine whether urinary sodium-to-potassium ratios fluctuate diurnally during the day to understand measured values of casual urinary sodium-to-potassium ratios. A total of 13,277 casual urine specimens were collected under free-living conditions from 122 Japanese normotensive and hypertensive individuals. Participants collected all casual urine samples in aliquot tubes, reported urine volumes and the time at each voiding for 10–22 days. Then, specimens were classified into hourly data. Diurnal patterns of urinary sodium-to-potassium ratios and urinary concentrations of sodium and potassium were evaluated. Overall mean values of hourly urinary sodium-to-potassium ratios were highest (4.1–5.0) in the early morning, lower (3.3–3.8) in the daytime and higher (4.0–4.4) toward evening hours. The mean urinary sodium and potassium concentrations were the lowest (90–110 and 24–32 mmol l−1, respectively) during the early morning and higher (110–140 and 35–43 mmol l−1, respectively) after mid-morning. Diurnal variability of potassium concentrations was larger than for sodium concentrations. Diurnal variations in urinary sodium-to-potassium ratios were comparable between normotensive and hypertensive individuals, between hypertensive individuals with and without antihypertensive medications, and among age and gender-specific subgroups. Overall mean hourly urinary sodium-to-potassium ratios fluctuated diurnally under free-living conditions and were higher during the morning and evening and lower during the daytime compared with 24-h urinary sodium-to-potassium ratios. Diurnal variation in urinary sodium-to-potassium ratios should be considered to understand actual daily dietary levels and avoid over- and under-estimation in clinical practice.

Iodine Deficiency Disorder Among Filipino School Children, Pregnant and Lactating Women and the Elderly 20 Years After the Act for Salt Iodization Nationwide Law

Background: Iodine deficiency disorder (IDD) is still a public health problem globally. In response to this, universal salt iodization (USI) has been implemented. This is the most cost-effective strategy to prevent and control it. In the Philippines, an Act for Salt Iodization Nationwide (ASIN Law) was passed in 1995, in response to the increasing goiter rates. This paper describes the prevalence and severity of IDD among Filipino school-aged children (SAC), pregnant and lactating women and the elderly, 20 years after the implementation of the ASIN Law. Methods: Casual urine samples were collected from SAC, pregnant and lactating women and elderly of 1998, 2003, 2008 and 2013, of selected households of the National Nutrition Survey (NNS). Urinary iodine (UI) levels were determined using the acid digestion method. UI levels and prevalence of IDD in the 2013 NNS were compared with those in previous NNSs. Results: Iodine nutrition among the SAC has improved from mild deficiency with a median of 71 ug/L in 1998 to 201 ug/L in 2003. It has remained “optimal” till the 2013 NNS, almost 20 years after ASIN Law. UI was 107 ug/L among the elderly in 2008, but decreased to 80 ug/L in 2013, also indicating “mild” iodine deficiency. Among the lactating women, UI was 111 ug/L in 2003, indicating iodine sufficiency, but decreased to 81 and 77 ug/L in 2008 and 2013 NNS, respectively, indicating “mild” iodine deficiency. Median UI among the pregnant women was 142, 105 and 105 ug/L, also indicating the presence of IDD for the 2003, 2008 and 2013 NNS, respectively. Conclusion: Twenty years after ASIN Law, Filipino SAC have achieved optimum iodine status while the pregnant and lactating women and the elderly remain to be iodine deficient. Strict monitoring of iodization of salt at the production site should be implemented, since iodine levels in salt have remained at levels below the standard. J Endocrinol Metab. 2017;7(3):86-93 doi: https://doi.org/10.14740/jem414w

The Use and Interpretation of Sodium Concentrations in Casual (Spot) Urine Collections for Population Surveillance and Partitioning of Dietary Iodine Intake Sources.

In 2013, the World Health Organization (WHO) called for joint surveillance of population salt and iodine intakes using urinary analysis. 24-h urine collection is considered the gold standard for salt intake assessment, but there is an emerging consensus that casual urine sampling can provide comparable information for population-level surveillance. Our review covers the use of the urinary sodium concentration (UNaC) and the urinary iodine concentration (UIC) from casual urine samples to estimate salt intakes and to partition the sources of iodine intakes. We reviewed literature on 24-h urinary sodium excretion (UNaE) and UNaC and documented the use of UNaC for national salt intake monitoring. We combined information from our review of urinary sodium with evidence on urinary iodine to assess the appropriateness of partitioning methods currently being adapted for cross-sectional survey analyses. At least nine countries are using casual urine collection for surveillance of population salt intakes; all these countries used single samples. Time trend analyses indicate that single UNaC can be used for monitoring changes in mean salt intakes. However; single UNaC suffers the same limitation as single UNaE; i.e., an estimate of the proportion excess salt intake can be biased due to high individual variability. There is evidence, albeit limited, that repeat UNaC sampling has good agreement at the population level with repeat UNaE collections; thus permitting an unbiased estimate of the proportion of excess salt intake. High variability of UIC and UNaC in single urine samples may also bias the estimates of dietary iodine intake sources. Our review concludes that repeated collection, in a sub-sample of individuals, of casual UNaC data would provide an immediate practical approach for routine monitoring of salt intake, because it overcomes the bias in estimates of excess salt intake. Thus we recommend more survey research to expand the evidence-base on predicted-UNaE from repeat casual UNaC sampling. We also conclude that the methodology for partitioning the sources of iodine intake based on the combination of UIC and UNaC measurements in casual urine samples can be improved by repeat collections of casual data; which helps to reduce regression dilution bias. We recommend more survey research to determine the effect of regression dilution bias and circadian rhythms on the partitioning of dietary iodine intake sources.