Estimating dietary sodium intake using spot urine samples

He, Jiang; Obst, Katherine

doi:10.1097/hjh.0000000000001230

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…For example, Kawasaki equation was created in a high-sodium intake population, and therefore might overestimate sodium intake in other populations. 24 INTERSALT was done in multiple countries in Europe and the Americas. In a study in Brazil, the estimation of salt consumption (difference between the measured and calculated salt consumption <1 g/day) was adequate only when the consumption was between 9 and 12 g/day (Tanaka) and 12 and 18 g/day (Kawasaki).…”

Section: Discussionmentioning

confidence: 99%

Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India

Krishnan

Amarchand

Tarik

et al. 2022

NMJI

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Background Dietary salt intake is an important modifiable risk factor for cardiovascular diseases. Estimation of 24-hour salt intake using morning urine samples needs to be validated in the Indian context. We examined the performance of INTERSALT, Tanaka and Kawasaki equations for the estimation of 24-hour urinary sodium from morning fasting urine (MFU) samples. Methods We enrolled 486 adults aged 18–69 years from four regions of India with equal rural/urban and sex representation to provide 24-hour urine samples. The next day, a MFU sample was obtained. Based on the volume and sodium content of the 24-hour urine sample, 24-hour sodium excretion (reference method) was calculated. Sodium levels in the MFU samples were measured along with other parameters required, and the above equations were used to estimate 24-hour urinary sodium levels. Intraclass correlation coefficient (ICC) was used to assess the degree of agreement between the estimates from the reference method and the three equations. Bland–Altman (BA) plots were used to identify systematic bias and limits of agreement. A difference of 1 g of salt (0.39 g of sodium) between the mean salt intake by 24-hour urine and as estimated by equations was considered acceptable. Results A total of 346 participants provided both the samples. The mean (SD) daily salt intake estimated by the 24-hour urine sample method was 9.9 (5.8) g. ICC was low for all the three equations: highest for Kawasaki (0.16; 95% CI 0.05–0.26) and least for Tanaka (0.12; 0.02–0.22). Only Tanaka equation provided estimates within 1 g of measured 24-hour salt intake (–0.36 g). BA plots showed that as the mean values increased, all the three equations provided lower estimates of salt intake. Conclusion Tanaka equation provided acceptable values of 24-hour salt intake at the population level. However, poor performance of all the equations highlights the need to understand the reasons and develop better methods for the measurement of sodium intake at the population level.

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Section: Discussionmentioning

confidence: 99%

Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India

Krishnan

Amarchand

Tarik

et al. 2022

NMJI

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“…The spot urine samples were collected on only one occasion, and therefore may be subject to random measurement biases related to timing of meals, exercise, the use of medication, and variations in urine sodium or osmolarity during a day or interday. 41 , 42 In addition, methods developed on the basis of spot urine sodium measurements in specific ethnic groups might be associated with systemic errors . 41 Therefore, the use of spot urine samples to estimate 24‐hour USE is controversial.…”

Section: Discussionmentioning

confidence: 99%

“… 41 , 42 In addition, methods developed on the basis of spot urine sodium measurements in specific ethnic groups might be associated with systemic errors . 41 Therefore, the use of spot urine samples to estimate 24‐hour USE is controversial. However, in comparison to the difficulty of collecting 24‐hour urine samples for use in large‐scale epidemic investigations, these spot urine methods are relatively simple, standardized, low‐cost methods, and they can be effective substitutes for the 24‐hour urine sodium method for the monitoring of salt intake.…”

Section: Discussionmentioning

confidence: 99%

Assessment and validation of three spot urine assay methods for the estimation of 24‐hour urinary sodium excretion in Chinese Tibetan adults living in the mountains

Zhang

Liao

et al. 2021

J of Clinical Hypertension

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Twenty‐four‐hour urine collection is the gold standard method for the evaluation of salt intake, but it is often impractical in large‐scale investigations, especially in resource‐poor areas. Methods for the estimation of 24‐hour urinary sodium excretion (USE) using a spot urine sample have been established, but have not been validated in Chinese Tibetans. Therefore, the authors aimed to evaluate the Kawasaki, Tanaka, and the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) formulas for the prediction of 24‐hour USE in Chinese Tibetan adults. The authors analyzed the bias, correlation, agreements between estimated values and measured values, and the relative and absolute differences and misclassification at the individual level for the three methods in 323 Tibetan participants from the Ganzi Tibetan Autonomous Prefecture of Sichuan Province, China. The mean biases between the measured values and the estimated 24‐hour USE using the Kawasaki, Tanaka, and INTERSALT methods were 5.4 mmol/day (95% confidence interval [CI]: 0.8–10.1 mmol/day), −40.8 mmol/day (95% CI: −44.6 to −36.9 mmol/day), and −57.1 mmol/day (95% CI: −61.9 to −52.4 mmol/day), respectively. The Pearson correlation coefficients for the relationships between the measured values and the estimated 24‐hour USE were 0.43 (Kawasaki), 0.38 (Tanaka), and 0.27 (INTERSALT), respectively (all p < .01). The intraclass correlation coefficients showed similar patterns to the correlation data: 0.47 for Kawasaki, 0.40 for Tanaka, and 0.27 for INTERSALT (all p < .01). The upper and lower limits of agreement between the measured values and the estimated 24‐hour USE were −92.6 and 81.8 mmol/day for the Kawasaki method, −28.5 and 110.0 mmol/day for the Tanaka method, and −28.4 and 142.7 mmol/day for the INTERSALT method. Compared with the other two methods, the percentage of individuals that were misclassified by using the Kawasaki method was 48.2%, while those for the Tanaka and INTERSAL methods was 72.1% and 75.5%, respectively. However, when an individual's salt intake was higher than 12.8 g/day, the misclassification rates of the Kawasaki, Tanaka, and INTERSALT methods were 20%, 90%, and 97.5%, respectively. Thus, the authors found that the Kawasaki equation may have performed better than the other equations at Chinese Tibetan population level assessment, but none of these equations are suitable for use or perform well at the individual level. A more accurate method of using a spot urine sample to evaluate individual 24‐hour USE for Tibetans is needed.

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“…The logistics (loss of work, and need for child care, travel, parking, and so on) are complex, and often result in long delays. It is a common misconception that urine collections need to be refrigerated 15 , 19 , 20 , 21 and that spot PCR testing is less expensive than 24-hour PCR testing. Neither is true.…”

Section: Discussionmentioning

confidence: 99%

“… Intended 24-hour urine collections provide valuable information on nutrient management, particularly sodium, potassium, and protein intake, which cannot be reliably obtained by spot urine testing. 19 , 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

Limited Reliability of the Spot Urine Protein/Creatinine Ratio in the Longitudinal Evaluation of Patients With Lupus Nephritis

Shidham

Ayoub

Birmingham

et al. 2018

Kidney International Reports

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IntroductionCross-sectional studies document that the spot protein/creatinine ratio (PCR) is often an inaccurate estimate of proteinuria magnitude compared with the 24-hour PCR, which is the gold standard. However, the extent to which the inaccuracy of the spot PCR varies over time and between individuals has not previously been reported. We address these crucial questions using a unique database, an National Institutes of Health trial in which lupus nephritis (LN) patients (N = 103) provided spot PCR testing each month and 24-hour PCR testing every 3 months for up to 15 months after induction therapy.MethodsA gold standard proteinuria trend line was constructed for each patient by joining the points that represented the serial 24-hour PCR values of the patient. The spot PCR values of the patient were then plotted in relationship to the 24-hour PCR trend line. Using our previous work, which estimated the 95% confidence intervals for the 24-hour PCR at specific levels, we determined in each patient whether the spot PCR values were “reliable,” “problematic,” or “unreliable.” The sequential spot PCR of the patients deviated widely and often from the 24-hour PCR trend line, to the extent that, if the spot PCR results were used in real time for clinical decision-making, it was likely management errors would occur.ResultsSpot PCRs were reliable in 41%, problematic in 24%, and unreliable in 35% of patients. Those with unreliable spot PCRs could not be predicted and were more likely to respond poorly to treatment.ConclusionThe spot PCR should not be used for management of LN, and perhaps, other glomerulopathies.

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Estimating dietary sodium intake using spot urine samples

Cited by 5 publications

References 17 publications

Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India

Performance of equations for estimation of 24-hour urinary sodium from morning fasting urine samples in a multisite study in India

Assessment and validation of three spot urine assay methods for the estimation of 24‐hour urinary sodium excretion in Chinese Tibetan adults living in the mountains

Limited Reliability of the Spot Urine Protein/Creatinine Ratio in the Longitudinal Evaluation of Patients With Lupus Nephritis

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