Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study

  • Pedro Moreira
  • Ana S. Sousa
  • Rita S. Guerra
  • Alejandro Santos
  • Nuno Borges
  • Cláudia Afonso
  • Teresa F. Amaral
  • Patrícia Padrão
Keywords: Sodium, potassium, sodium-to-potassium ratio, elderly, urinary excretion

Abstract

Background: We aimed to describe urinary sodium and potassium excretion and their ratio in a representative
sample of Portuguese elderly population, according to sociodemographic characteristics and weight status.

Methods: A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according
to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day,
inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio
was defined as >1, according to the World Health Organization cutoffs.

Results: The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in
men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with
lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the
younger elderly, married, and with higher income.

Conclusion: The majority of the Portuguese elderly population was classified as having inadequate sodium,
potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing
sodium and increasing potassium intake are priorities in the Portuguese elderly population.

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References

  1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA 2017; 317(2): 165–82. doi: 10.1001/jama.2016.19043. PubMed PMID:28097354.

  2. Providencia R, Goncalves L, Ferreira MJ. [Cerebrovascular mortality in Portugal: are we overemphasizing hypertension and neglecting atrial fibrillation?]. Rev Port Cardiol 2013; 32(11): 905–13. doi: 10.1016/j.repc.2013.04.010. PubMed PMID:24246719.

  3. Bordalo A. A Saúde dos Portugueses. Perspetiva 2015 (The health of Portuguese. Perspective 2015). Direção Geral da Saúde, Lisboa; 2015.

  4. Pereira M, Peleteiro B, Capewell S, Bennett K, Azevedo A, Lunet N. Changing patterns of cardiovascular diseases and cancer mortality in Portugal, 1980–2010. BMC Public Health 2012; 12: 1126. doi: 10.1186/1471-2458-12-1126. PubMed PMID:23273040 PubMed Central PMCID: PMCPMC3560231. eng.

  5. WHO. Guideline: sodium intake for adults and children. Geneva: WHO; 2012.

  6. World Cancer Research Fund International. Cancer prevention and survival. London: World Cancer Research Fund International; 2017.

  7. Hu G, Jousilahti P, Peltonen M, et al. Urinary sodium and potassium excretion and the risk of type 2 diabetes: a prospective study in Finland. Diabetologia 2005; 48(8): 1477–83. doi: 10.1007/s00125-005-1824-1. PubMed PMID:15971060.

  8. McDonough AA, Veiras LC, Guevara CA, Ralph DL. Cardiovascular benefits associated with higher dietary K+ vs. lower dietary Na+: evidence from population and mechanistic studies. Am J Physiol Endocrinol Metab 2017; 312(4): E348–56. doi: 10.1152/ajpendo.00453.2016. PubMed PMID:28174181 PubMed Central PMCID: PMCPMC5406991.

  9. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013; 346: f1378. doi: 10.1136/bmj.f1378.

  10. Bailey RL, Parker EA, Rhodes DG, Goldman JD, Clemens JC, Moshfegh AJ, et al. Estimating sodium and potassium intakes and their ratio in the American diet: data from the 2011–2012 NHANES. J Nutr 2016; 146: 745–750. doi: 10.3945/jn.115.221184.

  11. Okayama A, Okuda N, Miura K, Okamura T, Hayakawa T, Akasaka H, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open 2016; 6(7): e011632. doi: 10.1136/bmjopen-2016-011632. PubMed PMID:27412107 PubMed Central PMCID: PMCPMC4947715.

  12. WHO. Guideline: potassium intake for adults and children. Geneva: WHO; 2012.

  13. Chang H-Y, Hu Y-W, Yue C-SJ, et al. Effect of potassium-enriched salt on cardiovascular mortality and medical expenses of elderly men. Am J Clin Nutr 2006; 83(6): 1289–96.

  14. Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study. J Hypertens 2014; 32(6): 1211–21. doi: 10.1097/HJH.0000000000000162. PubMed PMID:24675681.

  15. Santana P. Ageing in Portugal: regional iniquities in health and health care. Soc Sci Med 2000; 50(7–8): 11.

  16. Santos FFMd. Esperança de vida à nascença: total e por sexo (base: triénio a partir de 2001): PORDATA. Base de Dados de Portugal Contemporâneo; 1/9/2017. Available from: http://www.pordata.pt/Portugal/Esperan%C3%A7a+de+vida+%C3%A0+nascen%C3%A7a+total+e+por+sexo+(base+tri%C3%A9nio+a+partir+de+2001)-418

  17. Amaral TS, Santos A, Guerra RS, Sousa AS, Álvares L, Valdiviesso R, et al. Nutritional strategies facing an older demographic: the nutrition UP 65 study protocol. JMIR Res Protoc. 2016; 5(3): e184.

  18. Instituto Nacional de Estatística. Censos 2011 Resultados Definitivos. Instituto Nacional de Estatística, I.P. (Ed.) Lisboa; 2012.

  19. Stewart A, Marfell-Jones M, Olds T, et al. International standards for anthropometric assessment. Potchefstroom, South Africa: International Standards for Anthropometric Assessment; 2011.

  20. Guerra RS, Fonseca I, Pichel F, Restivo MT, Amaral TF. Hand length as an alternative measurement of height. Eur J Clin Nutr 2014; 68(2): 229–33. PubMed PMID: 24169457; Eng.

  21. Chumlea WC, Guo S, Roche AF, Steinbaugh ML.Prediction of body weight for the nonambulatory elderly from anthropometry. J Am Diet Assoc 1988; 88(5): 564–8. PubMed PMID: 3367012; eng.

  22. ARUP Laboratories. Laboratory test directory – creatinine, 24-hour urine 1/9/2017. Available from: http://ltd.aruplab.com/Tests/Pub/0020473 [cited 2016]

  23. Stuver SO, Lyons J, Coviello A, Fredman L. Feasibility of 24-hr urine collection for measurement of biomarkers in community-dwelling older adults. J Appl Gerontol 2016; 36. doi: 10.1177/0733464815624153. PubMed PMID: 26759387; Eng.

  24. Mente A, O’Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, et al. Normal range of human dietary sodium intake: a perspective based on 24-hour urinary sodium excretion worldwide. Am J Hypertens 2013; 26(10): 5.

  25. Graudal NJ, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens 2014; 27(9): 8.

  26. Mente A, O’Donnell M, Rangarajan S, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet 2016; 388(10043): 465–75. doi: 10.1016/s0140-6736(16)30467-6. PubMed PMID: 27216139; eng.

  27. Cappuccio FP, Campbell NR. Population dietary salt reduction and the risk of cardiovascular disease: a commentary on recent evidence. J Clin Hypertens (Greenwich) 2017; 19(1): 4–5. doi: 10.1111/jch.12917. PubMed PMID:27677605; eng.

  28. Alderman MH. Dietary sodium: paradigm shifts from public health to clinical medicine. Lancet 2016; 388(10056): 2110. doi: 10.1016/s0140-6736(16)31914-6. PubMed PMID:27968745; eng.

  29. Cappuccio FP. Pro: reducing salt intake at population level: is it really a public health priority? Nephrol Dial Transplant 2016; 31(9): 1392–6. doi: 10.1093/ndt/gfw279. PubMed PMID:27488355; eng.

  30. Titze J, Dahlmann A, Lerchl K, Kopp C, Rakova N, Schroder A, et al. Spooky sodium balance. Kidney Int 2014; 85(4): 759–67. doi: 10.1038/ki.2013.367. PubMed PMID: 24107854; eng.

  31. Mapping salt reduction initiatives in the WHO European Region. WHO Regional Office for Europe; Copenhagen. 2013.

  32. Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013; 3(12): e003733. doi: 10.1136/bmjopen-2013-003733. PubMed PMID:24366578 PubMed Central PMCID: PMC PMC3884590.

  33. Food and Nutrition Board. Energy. In: A Report of the Panel on Macronutrients SoURLoNaIaUoDRI, The Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, ed. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). The National Academies Press, Washington DC; 2005, pp. 107–264.

  34. Espeland MA, Kumanyika S, Wilson AC, Reboussin DM, Easter L, Self M, et al. Statistical issues in analyzing 24-hour dietary recall and 24-hour urine collection data for sodium and potassium intakes. Am J Epidemiol 2001; 15(153): 996–1006.

  35. Whelton PK, Appel LJ, Sacco RL, Anderson CA, Antman EM, Campbell N, et al. Sodium, blood pressure, and cardiovascular disease: further evidence supporting the American Heart Association sodium reduction recommendations. Circulation 2012; 126(24): 2880–9. doi: 10.1161/CIR.0b013e318279acbf. PubMed PMID:23124030.

  36. Su D, Stimpson JP, Wilson FA. Racial disparities in mortality among middle-aged and older men: does marriage matter? Am J Mens Health 2015; 9(4): 289–300. doi: 10.1177/1557988314540199. PubMed PMID:24963098.

  37. Floud S, Balkwill A, Canoy D, Wright FL, Reeves GK, Green J, et al. Marital status and ischemic heart disease incidence and mortality in women: a large prospective study. BMC Med. 2014; 12: 42. doi: 10.1186/1741-7015-12-42. PubMed PMID:24618083 PubMed Central PMCID: PMCPMC4103700. eng.

  38. Heuberger R, Wong H. The association between depression and widowhood and nutritional status in older adults. Geriatr Nurs. 2014; 35(6): 428–33. doi: 10.1016/j.gerinurse.2014.06.011. PubMed PMID:25085716.

  39. Shahar DR, Schultz R, Shahar A, Wing RR. The effect of widowhood on weight change, dietary intake, and eating behavior in the elderly population. J Aging Health. 2001; 13(2): 189–99. PubMed PMID: 11787511; eng.

  40. Kutob RM, Yuan NP, Wertheim BC, Sbarra DA, Loucks EB, Nassir R, et al. Relationship between marital transitions, health behaviors, and health indicators of postmenopausal women: results from the women’s health initiative. J Women’s Health (2002). 2017; 26(4): 313–20. doi: 10.1089/jwh.2016.5925. PubMed PMID:28072926 PubMed Central PMCID: PMCPMC5397241. eng.

  41. Liu H, Umberson DJ. The times they are a changin’: marital status and health differentials from 1972 to 2003. J Health Soc Behav 2008; 49(3): 239–53. doi: 10.1177/002214650804900301. PubMed PMID:18771061 PubMed Central PMCID: PMCPMC3150568. eng.

  42. Vesnaver E, Keller HH, Sutherland O, Maitland SB, Locher JL. Food behavior change in late-life widowhood: a two-stage process. Appetite 2015; 95: 399–407. doi: 10.1016/j.appet.2015.07.027. PubMed PMID:26232138 PubMed Central PMCID: PMCPMC4589507.

  43. Elmstahl S. Energy expenditure, energy intake and body composition in geriatric long-stay patients. Compr Gerontol A 1987; 1(3): 118–25. PubMed PMID: 3134130; eng.

  44. Nikolic M, Glibetic M, Gurinovic M, Milesevic J, Khokhar S, Chillo S, et al. Identifying critical nutrient intake in groups at risk of poverty in Europe: the CHANCE project approach. Nutrients 2014; 6(4): 1374–93. doi: 10.3390/nu6041374. PubMed PMID:24699195 PubMed Central PMCID: PMCPMC4011040.

  45. Hong JW, Noh JH, Kim DJ. Factors associated with high sodium intake based on estimated 24-hour urinary sodium excretion: the 2009–2011 Korea National Health and Nutrition Examination Survey. Medicine (Baltimore) 2016; 95(9): e2864. doi: 10.1097/MD.0000000000002864. PubMed PMID:26945369 PubMed Central PMCID: PMCPMC4782853.

  46. de Mestral C, Mayen AL, Petrovic D, Marques-Vidal P, Bochud M, Stringhini S. Socioeconomic determinants of sodium intake in adult populations of high-income countries: a systematic review and meta-analysis. Am J Public Health 2017; 107(4): 563. doi: 10.2105/AJPH.2016.303629a. PubMed PMID:28272962; eng.

  47. Larsen SC, Angquist L, Sorensen TI, Heitmann BL. 24h urinary sodium excretion and subsequent change in weight, waist circumference and body composition. PLoS One. 2013; 8: e69689. doi: 10.1371/journal.pone.0069689.

  48. Venezia A, Barba G, Russo O, Capasso C, De Luca V, Farinaro E, et al. Dietary sodium intake in a sample of adult male population in southern Italy: results of the Olivetti Heart Study. Eur J Clin Nutr 2010;64(5):518–24. doi: 10.1038/ejcn.2010.22. PubMed PMID:20216559; eng.

  49. Song HJ, Cho YG, Lee HJ. Dietary sodium intake and prevalence of overweight in adults. Metabolism 2013; 62(5): 703–8. doi: 10.1016/j.metabol.2012.11.009. PubMed PMID:23357528; eng.

  50. Kang YJ, Wang HW, Cheon SY, Lee HJ, Hwang KM, Yoon HS. Associations of obesity and dyslipidemia with intake of sodium, fat, and sugar among Koreans: a qualitative systematic review. Clin Nutr Res 2016; 5(4): 290–304. doi: 10.7762/cnr.2016.5.4.290. PubMed PMID:27812518; PubMed Central PMCID: PMCPMC 5093226.

  51. Grimes CA, Riddell LJ, Campbell KJ, Nowson CA. Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics 2013; 131(1): 14–21. doi: 10.1542/peds.2012-1628. PubMed PMID:23230077.

  52. He FJ, Markandu ND, Sagnella GA, et al. Effect of salt intake on renal excretion of water in humans. Hypertension 2001; 38(3): 317–20. PubMed PMID: 11566897; eng.

  53. He FJ, Markandu ND, Sagnella GA, MacGregor GA. High salt intake: independent risk factor for obesity? Hypertension. 2015;66(4):843–9. doi: 10.1161/hypertensionaha.115.05948. eng.

  54. Choi Y, Lee JE, Chang Y, Kim MK, Sung E, Shin H, et al. Dietary sodium and potassium intake in relation to non-alcoholic fatty liver disease. Br J Nutr 2016; 116(8): 1447–56. doi: 10.1017/S0007114516003391. PubMed PMID:27725000.

  55. Drewnowski A, Maillot M, Rehm C. Reducing the sodium-potassium ratio in the US diet: a challenge for public health. Am J Clin Nutr 2012; 96(2): 439–44. doi: 10.3945/ajcn.111.025353. PubMed PMID:22760562 PubMed Central PMCID: PMCPMC3396449.

  56. Hope SF, Webster J, Trieu K, Pillay A, Ieremia M, Bell C, et al. A systematic review of economic evaluations of population-based sodium reduction interventions. PLoS One 2017; 12(3): e0173600. doi: 10.1371/journal.pone.0173600. PubMed PMID:28355231 PubMed Central PMCID: PMCPMC5371286.

  57. Webb M, Fahimi S, Singh GM, Khatibzadeh S, Micha R, Powles J, et al. Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations. BMJ 2017; 356: i6699. doi: 10.1136/bmj.i6699. PubMed PMID:28073749 PubMed Central PMCID: PMCPMC5225236 www.icmje.org/coi_disclosure.pdf and declare: financial support from the National Institutes of Health for the submitted work. DM reports ad hoc honorariums or consulting fees from Boston Heart Diagnostics, Haas Avocado Board, Astra Zeneca, GOED, DSM, and Life Sciences Research Organization, none of which were related to topics of dietary sodium. The other authors report no financial relationships with any organizations that might have an interest in the submitted work in the previous three years.

  58. Institute of Medicine. Strategies to Reduce Sodium Intake in the United States. In: Henney JE, Taylor CL, Boon CS, eds. Washington, DC: The National Academies Press; 2010.

  59. Rodan AR. Potassium: friend or foe? Pediatr Nephrol 2016; 32. doi: 10.1007/s00467-016-3411-8. PubMed PMID: 27194424; PubMed Central PMCID: PMCPMC5115995.

  60. Panel on Dietary Reference Intakes for Electrolytes and Water SCotSEoDRI. Potassium. In: Food and Nutrition Board, ed. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. National Academy of Sciences, 2005, Washington DC. pp. 186–268.

  61. Taylor EN, Stampfer MJ, Mount DB, Curhan GC. DASH-style diet and 24-hour urine composition. Clin J Am Soc Nephrol 2010; 5(12): 2315–22. doi: 10.2215/CJN.04420510. PubMed PMID:20847091 PubMed Central PMCID: PMCPMC2994094.

  62. Feart C, Alles B, Merle B, Samieri C, Barberger-Gateau P. Adherence to a Mediterranean diet and energy, macro-, and micronutrient intakes in older persons. J Physiol Biochem 2012; 68(4): 691–700. doi: 10.1007/s13105-012-0190-y. PubMed PMID:22760695.

  63. Faria AP, Albuquerque G, Moreira P, Rosário R, Araújo A, Teixeira V, et al. Association between energy density and diet cost in children. Porto Biomed J. 2016; 1(3): 106–11. doi: 10.1016/j.pbj.2016.08.005.

  64. Drewnowski A, Rehm CD, Maillot M, Monsivais P. The relation of potassium and sodium intakes to diet cost among U.S. adults. J Hum Hypertens 2015; 29(1): 14–21. doi: 10.1038/jhh.2014.38. PubMed PMID:24871907 PubMed Central PMCID: PMCPMC4247818.

  65. Albuquerque G, Moreira P, Rosário R, Araújoa A, Teixeiraa VH, Lopesf O, et al. Adherence to the Mediterranean diet in children: Is it associated with economic cost? Porto Biomed J 2017; 2(4): 115–19. doi: 0.1016/j.pbj.2017.01.009.

Published
2018-02-27
How to Cite
Moreira P., Sousa A. S., Guerra R. S., Santos A., Borges N., Afonso C., Amaral T. F., & Padrão P. (2018). Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study. Food & Nutrition Research, 62. https://doi.org/10.29219/fnr.v62.1288
Section
Original Articles

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