Purpose of reviewThe health effects of dietary sodium and dietary potassium intake in mitigating blood pressure (BP) are a focus of research. This review summarizes recent findings of these health effects and the effectiveness of potassium-enriched salt substitutes on the risk for and recurrence of cardiovascular events.Recent findingsSalt substitution is an emerging sodium reduction strategy that may prove to be more beneficial in lowering BP and reducing risk for recurrent stroke compared with alternative low-sodium diets. However, careful consideration is required for patients with impaired renal function or on specific renal physiology-modulating pharmacotherapies.SummaryLow sodium substitutes have proven to be more efficacious and practical in lowering BP and preventing stroke or recurrence of stroke than alternative low-sodium diets. This salt reduction strategy holds promising value in reducing the risk for cardiovascular disease.

Dietary sodium and potassium intake are key determinants of blood pressure (BP) control in hypertensive patients. However, their associations with longitudinal home BP control in patients with apparent treatment-resistant hypertension (aTRH) remain unclear. In this prospective cohort study, baseline 24-hour urinary sodium and potassium excretion, objective biomarkers of dietary sodium and potassium intake, as well as urinary sodium-to-potassium (Na/K) ratio were evaluated as exposure variables. The primary outcome was longitudinal home BP control during follow-up. Mixed-effects models were used to assess these associations. A total of 172 patients were followed for a median of 39.3 months, contributing 7547 morning and 6640 evening home BP measurements. After multivariable adjustment, each 1-standard deviation (SD) increase in urinary sodium excretion (99.49mmol) was associated with poorer home systolic BP (SBP) control (morning: odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.89; evening: OR 0.65, 95% CI 0.44-0.96). Each 1-SD increase in the urinary Na/K ratio (1.98 units) was associated with poorer morning (OR 0.68, 95% CI 0.48-0.97) and evening home SBP control (OR 0.69, 95% CI 0.51-0.94). A higher Na/K ratio was also associated with poorer overall evening home BP control (OR 0.73, 95% CI 0.54-0.98). Consistent associations were observed when BP was analyzed as a continuous outcome. Urinary potassium excretion alone was not significantly associated with home BP control. Dietary sodium restriction and maintenance of sodium-potassium balance may represent important strategies for improving home BP control in patients with aTRH. Trial Registration: Not applicable. This study was a prospective observational cohort study with no assignment of participants to any intervention; thereby clinical trial registration was not required.

Globally, efforts are underway to evaluate foods and meals by their nutritional value. In Japan, however, there is no comprehensive system for evaluating overall diet quality. The aim of this study is to use the Healthy Eating Index (HEI)-2020, which is based on the American Dietary Guidelines, to evaluate the diet quality of independent elderly Japanese people to consider appropriate methods for evaluating the Japanese diet. The subjects were 71 individuals aged 60 years or older who participated in a health examination. HEI-2020 was used to evaluate diet quality, with 13 components scored based on intake per energy unit. Associations of HEI-2020 scores with nutrient intake, food group intake, and dietary reference intakes (DRIs) for Japanese were analysed using statistical methods. The median HEI-2020 score was 52/100 points. Among the components, the median score was the maximum for Saturated Fats and Added Sugars, but zero for Whole Grains and Refined Grains. The high-score group had significantly lower intake of saturated fatty acids and higher intake of dietary fiber, vitamin K, potassium, and magnesium. In comparison to DRIs, the high-score group had a significantly higher "% meeting the reference value" for several nutrients, including dietary fiber, magnesium, and potassium. This study shows that the HEI-2020 can identify nutrients such as dietary fiber and minerals that are lacking in the Japanese population. However, for more effective assessment, there is a need to adjust the reference values to match the intake of Japanese people.

Dietary potassium and fiber intake, survival, and health-related quality of life, in a prospective multi-center hemodialysis cohort.

Few studies have examined the association between dietary nutrients and subjective cognitive complaints (SCCs), which are potential predictors of Alzheimer's disease-related dementia (ADRD). We aimed to examine the association of midlife intake of macronutrients, as well as of a few other nutrients, with SCC development. We included 5119 participants who responded to the 2018 or 2020 follow-up questionnaire of the New York University Women's Health Study. Dietary data were collected using a validated self-administered Block food frequency questionnaire, and nutrient intake were calculated using food lists and food composition tables. SCCs were assessed using a standardized questionnaire. Dietary intakes of fiber, carbohydrates, and potassium were inversely associated with having ≥ 2 SCC (p-trend = 0.0047, 0.026, and 0.0015, respectively), whereas higher intakes of total fat and saturated fat, as well as a higher ratio of fat to carbohydrates, were positively associated with ≥ 2 SCCs (p-trend = < 0.0001, 0.0015, and 0.0025, respectively). The positive associations of total fat intake and the log-ratio of fat to carbohydrates with ≥ 2 SCCs remained significant after controlling for other nutrients (p-trend = 0.008 and 0.036, respectively). The association between total fat intake and SCCs was stronger among participants with lower caloric intake (< median = 1430kcal) compared with those consuming higher intake (≥ 1430kcal) (p-value for interaction = 0.0049). The associations did not differ appreciably by other factors. We observed a positive association between midlife dietary fat intakes and SCCs in later life in a cohort of women.

The Mediterranean dietary pattern (MDP) is recognised as one of the most evidence-based dietary models for the prevention of non-communicable diseases (NCDs). Its plant-rich composition suggests an inherently high potassium intake, yet epidemiological findings on the association between MDP adherence and potassium intake remain heterogeneous. The present review aims to summarise and critically evaluate the available evidence on the association between adherence to the MDP and dietary potassium intake in the adult population. We conducted a narrative review of observational, longitudinal and interventional studies evaluating the relationship between MDP adherence and dietary potassium intake (self-reported assessment and/or 24 h urinary potassium). MEDLINE/PubMed was searched from inception to 30 October 2025, additional studies were identified by reference screening. From a total of 263 studies retrieved, 10 eligible studies (7 cross-sectional, 1 longitudinal, 2 randomised controlled trials) from Europe, Asia and North America were synthesised. Questionnaire-based studies consistently indicated higher potassium intake with greater MDP adherence, whereas biomarker-based findings were more variable and often attenuated, particularly in studies relying on single or unvalidated 24 h urine collections and selected samples. Overall risk of bias was high for most observational studies, while randomised trials were generally rated as having some concerns. Higher MDP adherence is generally associated with higher potassium intake, but estimates vary by how MDP adherence is defined and scored, the potassium assessment method, and population context. Current evidence remains insufficient to quantify potassium's potential contribution as a candidate mediator without formal mediation analyses and robust exposure assessment, including repeated validated 24 h urine collections. Standardised scoring, routine reporting of potassium, sodium, and the Na/K ratio, and triangulation across dietary, biomarker and intervention evidence are key priorities to strengthen inference.

Dietary sodium and potassium intake and risk of diabetes in the Million Veteran Program.

High sodium and low potassium are associated with incident cardiovascular disease among United States Hispanic/Latino adults: prospective results from the Hispanic Community Health Study/Study of Latinos.

Micronutrient intake and status of adults consuming plant-based meat analogues or animal-based meats as primary protein source: An 8-week randomized controlled trial.

In the past decade, understandingof the mechanisms by which the kidneys sense dietary potassium imbalance and affect the cardiorenal system has substantially advanced. These mechanisms explain why low-potassium diets promote salt-sensitive hypertension, whereas potassium-rich diets enhance natriuresis and lower blood pressure. Increasing dietary potassium may therefore be an effective strategy to reduce cardiovascular disease risk. Clinical trials have shown that replacing regular salt with potassium-enriched substitutes lowers blood pressure and reduces cardiovascular events and mortality. Emerging evidence suggests that low dietary potassium intake contributes to kidney injury, and low urinary potassium excretion is associated with accelerated chronic kidney disease (CKD) progression. However, whether the cardiorenal benefits of adequate potassium intake in CKD outweigh the risk of hyperkalaemia remains uncertain. A clearer understanding of the relationship between dietary potassium intake and blood potassium levels, as well as the optimal blood potassium range for kidney and cardiovascular health, is needed to resolve this question. New strategies to mitigate hyperkalaemia, including use of potassium binders and various kidney-protective drugs, could enable people with CKD to safely consume a potassium-rich diet and avoid the need to discontinue use of medications that increase the risk of hyperkalaemia, such as renin-angiotensin-aldosterone inhibitors and mineralocorticoid receptor antagonists.

Dietary sodium and potassium intake play a key role in the regulation of blood pressure (BP). This study investigated whether 24- urinary sodium, potassium and sodium-to-potassium ratio were associated with blood pressure in Australian schoolchildren aged 4-12 years, and if the association between 24-h urinary sodium and blood pressure was moderated by body weight. Twenty-four-hour urine, blood pressure, and anthropometry were collected from 755 schoolchildren (mean age 9.3 (SD 1.8) years). Multiple linear regression with adjustment for covariates was conducted. The mean sodium excretion was 2419 (SD 1052) mg/d. Seventeen percent of children had elevated blood pressure. There were no overall associations between 24-h sodium or potassium excretion and blood pressure in adjusted regression models. However, in adjusted regression analysis stratified by sex, there was a positive association between 24-h urinary sodium and systolic blood pressure z-score among girls (b-coefficient 0.10 [95% CI 0.03, 0.18], pvalue = 0.01, n = 342). No other sex differences were observed. Body weight significantly moderated the association between sodium excretion and SBP (p for interaction = 0.002). In children living with obesity, sodium excretion was positively associated with systolic blood pressure z-score (b-coefficient 0.75 [95% CI 0.00, 1.51], pvalue = 0.05, n = 21). In conclusion, sodium excretion in this sample exceeded recommended levels for healthy development and almost a fifth of children had elevated blood pressure. For optimal health across life, public health interventions aiming to reduce the elevated cardiovascular risk of raised blood pressure in children are likely to be most effective by reducing sodium intake in conjunction with promoting healthy weight.

BackgroundFood insecurity is associated with an increased risk of hypertension.AimThe aim of this study was to evaluate the role of dietary sodium and potassium intake in the setting of food insecurity on hypertension risk.MethodsWe performed a cross-sectional analysis of data from 17,015 adults aged 18-65 years who participated in the National Health and Nutrition Examination Survey (2011-2018). We examined the associations between food insecurity, hypertension, and dietary sodium and potassium levels using multivariable logistic regression. Mediation analysis was conducted to explore the potential influence of dietary sodium and potassium intake on the relationship between food insecurity influenced hypertension.ResultsIndividuals experiencing food insecurity had a significantly lower mean potassium intake (2.5 ± 0.03 g) compared to food-secure counterparts (2.74 ± 0.02 g). Food insecurity status was significantly associated with an increased likelihood of a higher dietary sodium-to-potassium ratio, an established predictor for hypertension.ConclusionAdults with food insecurity and hypertension were more likely to have lower dietary potassium intake. Increasing access to healthy foods, particularly potassium-rich foods, for individuals facing food insecurity may contribute to reducing the hypertension prevalence and improving cardiovascular outcomes.

We assessed dietary intake and sources of sodium and potassium, and salt-related knowledge, attitudes, and behaviours (KAB) among rural adults in four Chinese provinces. This cross-sectional study was conducted in four provinces in China, with two counties per province and eight villages per county purposively selected. Participants (18-69 years) were enrolled using stratified random sampling by sex and age in each village. Sodium and potassium intake were estimated using eligible 24-h urine samples, with a 24-h dietary recall collected from a 25% subsample to assess dietary sources. Salt-related KAB was assessed using an interviewer-administered questionnaire. Data were summarized using sampling weights as means (SE) for continuous variables and weighted proportions for categorical variables. A total of 2,669 participants were recruited between August 2021 and May 2023. Mean sodium and potassium intake was 5.8 g/day (SE 0.1) and 2.39 g/day (SE 0.04), respectively, equivalent to 14.7 g/day of salt (SE 0.2). Overall, 77.7% of participants were aware of the health risks of excessive salt or salty sauce intake, 67.3% recognized the importance of reducing salt in cooking, and 50.1% reported trying to reduce salt intake. We find that 72.1% of sodium intake came from salt added during home cooking, while cereals and tubers were the main sources of potassium. Rural Chinese adults consume excessive sodium and insufficient potassium relative to World Health Organization recommendations, with generally poor attitudes and adoption of salt-reduction behaviours. These findings highlight the need for interventions that strengthen salt-reduction education, provide practical tools, and improve supportive food environments.

The relationships between dietary sodium and potassium intake and hypertension remain controversial, with recent population-based analyses yielding inconsistent findings. This study aimed to evaluate the associations of sodium and potassium intake with hypertension among U.S. adults and to explore potential interactions with demographic and lifestyle factors. We conducted a cross-sectional analysis using data from 5,569 adults aged ≥20 years in the NHANES 2017-2018 cycle. Dietary intake was assessed using 24-hour dietary recall. Hypertension was defined based on self-reported diagnosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic spline models examined nonlinear trends, and subgroup analyses were stratified by sex, age, and BMI. No significant associations were found between sodium or potassium intake and the odds of hypertension after adjusting for covariates (OR ≈ 1.00, P > 0.05) and findings were consistent when including the Na/K ratio. Results remained stable across sensitivity models and spline analysis. A non-significant inverse trend was observed for dietary fiber intake. Subgroup analyses suggested slightly stronger associations among older adults and individuals with obesity, although interaction terms were not statistically significant. In this nationally representative sample, sodium and potassium intake were not independently associated with hypertension risk. These findings highlight the complexity of diet-blood pressure relationships and the importance of considering broader dietary patterns and individual characteristics in hypertension prevention strategies.

BackgroundInterdialytic hyperkalemia is linked to a heightened risk of adverse clinical outcomes among patients undergoing maintenance hemodialysis (MHD). This study aimed to develop and validate a nomogram to assess the risk of interdialytic hyperkalemia in this patient population.MethodsA total of 312 patients undergoing MHD were retrospectively enrolled from two hemodialysis centers between January 2024 and December 2024. The group was randomly divided into a training set and a validation set in a 7:3 ratio. Least absolute shrinkage and selection operator regression was applied to identify independent predictors of hyperkalemia, which were subsequently incorporated into a multivariate logistic regression model. Model performance was assessed using receiver operating characteristic curve analysis, area under the curve (AUC), calibration plots, and decision curve analysis (DCA) to assess both discrimination and clinical utility.ResultsThe overall incidence of interdialytic hyperkalemia was 28.2%. The final nomogram included seven predictors: dietary potassium intake, dietary phosphorus intake, serum albumin concentration, pre-dialysis blood glucose level, interdialytic weight gain rate, time interval since the last dialysis session, and a history of hyperkalemia within the preceding three months. The model demonstrated strong discriminatory ability with an AUC of 0.905 (95% Confidence Interval (CI): 0.883–0.931) in the training set and 0.782 (95% CI: 0.756–0.819) in the validation set. Calibration plots indicated good agreement between predicted and observed outcomes. DCA confirmed the clinical applicability of the model by demonstrating a net benefit across a range of threshold probabilities.ConclusionA nomogram-based risk prediction model for interdialytic hyperkalemia in patients undergoing MHD was developed and externally validated. The model demonstrated robust predictive performance and may assist clinicians in early identification of patients who are at high-risk, thereby supporting timely interventions.

Hypertension is a risk factor for cardiovascular disease. Low dietary potassium (K+) intake is associated with higher blood pressure (BP) and increased activity of the kidney NaCl cotransporter NCC. Increasing dietary K+ can lower NCC activity and reduce BP, but a threshold for beneficial effects of dietary K+ is apparent, with very high K+ intakes associated with higher BP. Here, we examine in male C57Bl/6J mice if an optimal BP-lowering K+ intake window exists and the molecular basis of K+ driven increases in BP. Telemetric BP recordings are performed in mice receiving diets with normal (0.74%) NaCl content and progressively increasing K+ content (0.75% to 5% K+, as KCl) for 5 days. None of the diets examined reduce BP despite lowering NCC activity and above 1.75% K+ intake systolic BP (SBP) is raised, concurrent with higher aldosterone and sodium channel (αENaC) activity. On a high NaCl diet (1.57% Na+), K+-driven increases in αENaC and SBP are absent and high NaCl does not increase SBP. We conclude that the higher BP subsequent to excess K+ intake is aldosterone and ENaC-dependent, and increased dietary K+ is beneficial when Na+ intake is high.

Dietary intake plays a pivotal role in sustaining optimal melatonin levels, while the relationship between dietary patterns and circulating melatonin levels remains unclear. This study aims to investigate the associations between dietary patterns, nutrient intake, and serum melatonin levels in the Chinese population. This cross-sectional study included 6,521 Chinese adults. Three dietary patterns were identified through principal component analysis. Multivariable linear regression was used to assess the associations between dietary patterns and serum melatonin levels. The covariance analysis and partial least squares regression was used to evaluate the association between micronutrient intake and serum melatonin concentrations. The Dietary pattern 2 (DP2), characterized by high intake of fatty foods and red meat with the lowest Dietary Variety Score (DVS), and DP3 featuring high consumption of red meat, fruits, and vegetables but low intake of white meat and aquatic products with low DVS, were significantly associated with lower serum melatonin levels (DP2: β = - 0.12, P-trend < 0.001; DP3: β = - 0.13, P-trend < 0.001). Insufficient nutrient and quality intake of dietary fiber, potassium, vitamin B2, calcium, and magnesium was found in DP2, whereas DP3 showed inadequate intake of protein, cholesterol, vitamin B2, niacin, calcium, phosphorus, magnesium, selenium, and iron. Specific dietary patterns, low dietary diversity and nutrient deficiencies are associated to reduced melatonin levels. These findings reveal distinct mechanisms linking overall dietary patterns to serum melatonin concentrations, underscoring the importance of appropriate dietary patterns and nutrients intake in sustaining optimal circulating melatonin homeostasis in humans.

Abstract Background and Aims A diet high in potassium (K) and low in sodium (Na) has been associated with lower blood pressure in the general population. With the advent of potassium-rich salt substitutes it is of interest to investigate how dietary Na and K intake interact in the setting of hypertension prevention. For this purpose, the 24-hour urine Na/K-ratio could be of added value. Method We selected adult outpatients of a Dutch tertiary hospital who collected 24-hour urine with Na and K measurements, as a proxy for dietary intake, between 1998–2023. We excluded subjects with a history of renal replacement therapy or hypertension (clinical diagnosis or an office blood pressure of &amp;gt;140/90 mmHg). We used Cox-regression analyses to explore the association between 24-hour urine Na, K or Na/K-ratio and new-onset hypertension. We adjusted for age, sex, diabetes mellitus, history of cardiovascular events and estimated glomerular filtration rate (eGFR). Results We included 2104 patients, of whom 54% were female. The mean age of the patients was 46 ± 15 years, 22% had diabetes mellitus, and 9% a history of CVE. Baseline eGFR was 90 ± 29 ml/min/1.73 m². Mean 24-h urine Na was 155 ± 70 mmol/24 h, K was 69 ± 27 mmol/24h and the Na/K-ratio 2.4 ± 1.2 mmol/mmol. During a median follow-up duration of 12 (2–20) years, hypertension was diagnosed in 32%. Higher 24-hour urine K was associated with a 22% lower risk (HR 0.78 per standard deviation (SD) change, 95% CI 0.95–0.87, p-value &amp;lt; 0.001) for new-onset hypertension, whereas 24-hour urinary Na was not associated with the composite outcome (HR 0.93 per SD change, 95% CI 0.93–1.07, p-value = 0.37). A higher 24-hour urine Na/K ratio was associated with a 19% (HR 1.19 per SD change, 95% CI 1.12–1.28, p-value &amp;lt; 0.001) for new-onset hypertension. Conclusion Higher 24-hour urine K and a lower 24-hour urine Na/K-ratio are associated with a lower incidence of new-onset hypertension. These data support the notion that high potassium intake contributes to the prevention of hypertension in the outpatient setting.

Background: Increased intake of Mg2+ and K+ are each linked to lower risk of cardiovascular outcomes and death. While studies have shown improved kidney outcomes with increased dietary intake of Mg2+ or K+, data is limited in CKD patients. Methods: Using Chronic Renal Insufficiency Cohort data, we included subjects with baseline dietary surveys and a follow up measure of eGFR (n = 3318). Estimated daily Mg2+ (including supplemental) and K+ intake were examined as predictors for subsequent death or kidney failure*. Our final statistical model^ was repeated and stratified into groups of eGFR < 30 and ≥ 30 ml/min. Results: The median intake (mg/day) was 312 for Mg2+ and 2636 for K+. Higher Mg2+ and K+ intake were associated with a lower risk for death (Fig 1 a&c). Stratified analyses showed a similar relationship regardless of eGFR group (Fig 2 a&c). Mg2+ or K+ intake had no consistent relationship with kidney failure in the total cohort (Fig 1 b&d), but each appeared protective for kidney failure only in the eGFR ≥ 30 ml/min subgroup (Fig 2 b&d). Conclusion: Our data suggest Mg2+ and K+ intake are protective against death in CKD patients, regardless of degree of kidney disease. While not statistically significant in all models, our data also suggest both Mg2+ and K+ intake may be protective against kidney failure, but only in those with an eGFR ≥ 30 ml/min. Future research should study the benefits or potential harms of Mg2+ and/or K+ supplementation in CKD patients.

The distal convoluted tubule (DCT) plays a crucial role in potassium (K+) homeostasis, with electrogenic basolateral K+ flux well established as a regulator of its function. Although the involvement of electroneutral basolateral K+ transport has been hypothesized, its precise role remains unclear. The electroneutral potassium chloride (Cl-) cotransporter, KCC3, is expressed in the kidney, but its role in DCT function has yet to be fully defined. To explore this, we generated a novel animal model with DCT-specific deletion of KCC3. Our results show that KCC3 deletion in DCT cells led to reduced levels of both total and phosphorylated sodium (Na+) Cl- cotransporter (NCC), along with decreased NCC mRNA expression, indicating a regulatory role for KCC3 in NCC expression at the transcript level. Despite these changes, knockout animals maintained normal electrolyte balance under standard dietary conditions. In response to dietary K+ restriction, knockout mice showed no significant differences compared with controls-blood K+ levels, NCC phosphorylation, and with no lysine kinase (WNK) body formation in the DCT remained unchanged. These findings suggest that KCC3 is involved in the basal regulation of NCC expression but is not essential for DCT adaptation to K+ depletion or for overall K+ homeostasis.NEW & NOTEWORTHY Deletion of KCC3 specifically in distal convoluted tubule cells leads to decreased NCC mRNA transcript abundance as well as a reduction in both total and phosphorylated NCC protein levels. Despite these molecular changes, DCT-specific KCC3 deletion does not disrupt overall potassium homeostasis under either standard or low potassium dietary conditions. These findings suggest that other KCC isoforms, such as KCC4, may be involved in regulating the DCT response to reduced dietary potassium intake.