Accuracy and Usefulness of Select Methods for Assessing Complete Collection of 24‐Hour Urine: A Systematic Review

This systematic literature review aimed to investigate whether 24 hour diet recall and diet records are reliable and valid ways to measure usual dietary sodium intake compared with 24 hour urinary assessment. We searched electronic databases Medline, Embase, Cinahl, Lilacs, Google Scholar and the Cochrane Library using pre‐defined terms Studies were eligible for inclusion if they assessed adult humans in free‐living settings, and if they included dietary assessment and 24 hours urinary collection for assessment of sodium intake in the same participants. Studies that included populations with an active disease state that might interfere with normal sodium metabolism were excluded. Results of 20 studies using 24 hour diet recall recall (including 14 validation studies) and 10 studies using food records (including six validation studies) are included in this review. Correlations between estimates from dietary assessment and urinary excretion ranged from 0.16 to 0.72 for 24 hour diet recall, and 0.11 to 0.49 for food diaries. Bland‐Altman analysis in two studies of 24 hour diet recall showed poor agreement with 24 hours urinary sodium excretion. These results show that 24 hour diet recall and diet records inaccurately measure dietary sodium intake in individuals compared with the gold standard 24 hours urinary excretion. Validation studies of dietary assessment methods should include multiple days of assessment and 24 hours urine collection, use relevant food composition databases and Bland‐Altman methods of analysis.

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Twenty‐Four–Hour Diet recall and Diet records compared with 24‐hour urinary excretion to predict an individual’s sodium consumption: A Systematic Review

McLean

Farmer

Nettleton

et al. 2018

“…Measurement of the 24‐hour urine collection is considered the “gold standard” to estimate dietary salt intake with standard criteria for completeness of the specimens varying from most using urine volume and creatinine and some using PABA . For this review, we therefore decided to include only those studies that had estimated salt intake using 24‐hour urine samples.…”

Section: Discussionmentioning

confidence: 99%

The Science of Salt: Updating the evidence on global estimates of salt intake

Thout

Santos

McKenzie

et al. 2019

The Global Burden of Disease (GBD) 2010 study estimated national salt intake for 187 countries based on data available up to 2010. The purpose of this review was to identify studies that have measured salt intake in a nationally representative population using the 24‐hour urine collection method since 2010, with a view to updating evidence on population salt intake globally. Studies published from January 2011 to September 2018 were searched for from MEDLINE, Scopus, and Embase databases using relevant terms. Studies that provided nationally representative estimates of salt intake among the healthy adult population based on the 24‐hour urine collection were included. Measured salt intake was extracted and compared with the GBD estimates. Of the 115 identified studies assessed for eligibility, 13 studies were included: Four studies were from Europe, and one each from the United States, Canada, Benin, India, Samoa, Fiji, Barbados, Australia, and New Zealand. Mean daily salt intake ranged from 6.75 g/d in Barbados to 10.66 g/d in Portugal. Measured mean population salt intake in Italy, England, Canada, and Barbados was lower, and in Fiji, Samoa, and Benin was higher, in recent surveys compared to the GBD 2010 estimates. Despite global targets to reduce population salt intake, only 13 countries have published nationally representative salt intake data since the GBD 2010 study. In all countries, salt intake levels remain higher than the World Health Organization's recommendation, highlighting the need for additional global efforts to lower salt intake and monitor salt reduction strategies.

“…The equations were validated by comparing the estimated salt excretion levels with the measured 24‐hour salt excretion from the subsample. Given that a number of factors may interfere with the accuracy of 24‐hour urine collection including respondents forgetting to collect some urine or going beyond the 24‐hour collection period, or spillage, 24‐hour urine samples were excluded from the analysis if total urine volume was <500 mL or if total creatinine was <6 mmol or >30 mmol for men or <4 mmol or >25 mmol for women …”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples

Santos

Trieu

et al. 2016

This study evaluated the effectiveness of the Communication for Behavioral Impact (COMBI)–Eat Less Salt intervention conducted in Viet Tri, Vietnam. The behavior change intervention was implemented in four wards and four communes for one year, which included mass media communication, school interventions, community programs, and focus on high‐risk groups. Mean sodium excretion was estimated from spot urine samples using different equations. A subsample provided 24‐hour urine to validate estimates from spot urine. Information about salt‐related knowledge and behaviors was also collected. There were 513 participants at both baseline and follow‐up. Mean sodium excretion estimated from spot urines fell significantly from 8.48 g/d at baseline to 8.05 g/d at follow‐up (P=.001). All spot equations demonstrated a significant reduction in sodium levels; however, the change was smaller than the measured 24‐hour urine. Participants showed improved knowledge and behaviors following the intervention. The COMBI intervention was effective in lowering average population salt intake and improving knowledge and behaviors.