Association between dietary sodium intake and disease burden and mortality in Koreans between 1998 and 2016: The Korea National Health and Nutrition Examination Survey

Abstract

BACKGROUND/OBJECTIVES: Sodium intake is positively associated with blood pressure, which may increase the risk for cardiovascular disease (CVD). Therefore, we assessed the disease burden of CVD attributable to sodium intakes above 2,000 mg/day and prospectively investigated the association between dietary/urinary sodium levels and the risk of all-cause and CVD-mortality using the Korea National Health and Nutrition Examination Survey (KNHNES). SUBJECTS/METHODS: A total of 68,578 and 33,113 participants were included for comparative risk assessment (CRA) analysis and mortality analysis, respectively, and mean follow-up time for mortality was 5.4 years. CRA analysis was used to quantify attributable incidences of stroke, ischemic heart disease (IHD), and deaths attributable to sodium intake between 1998 and 2016. Cox proportional hazard regression model was used to determine the association between sodium intake and all-cause and CVD-mortality. RESULTS: Mean dietary sodium intake decreased over time, reaching 3,647 mg/day in 2016. Similarly, the population attributable fractions of stroke and IHD, and the number of CVDassociated deaths attributable to high sodium intake/excretion also decreased. In terms of association with mortality, when participants were grouped into quartiles (Q) by energyadjusted sodium intake, those in Q2 had a lower risk of all-cause mortality than those in Q1 with lower intakes. The risk of CVD-associated mortality was higher only in females with high sodium intake in Q4 than those in Q1. CONCLUSIONS: This nationwide data indicates that, in line with previous studies of multiple cohorts, both low and high sodium intakes may be associated with an increased risk of mortality; therefore, the optimal sodium intake for Koreans needs to be revised.

Trends in food and nutrient intake over 20 years: findings from the 1998-2018 Korea National Health and Nutrition Examination Survey

“…However, since these studies were based on the data collected prior to 1998, it is necessary to understand the latest changes in the diet. While there are other previous studies [ 10 , 11 ] that analyzed more recent data, it remains difficult to understand the changes in the overall nutritional status, as their results are mainly concerned with particular aspects of nutrients, such as energy and sodium.…”

Association of rheumatoid arthritis and high sodium intake with major adverse cardiovascular events: a cross-sectional study from the seventh Korean National Health and Nutrition Examination Survey

“… 42 Another recently published study using the KNHANES data noted a higher risk of CVD-associated mortality in women with top-quartile sodium intake (energy-adjusted sodium intake >5625 mg/day). 43 In the subgroup analyses, only the coronary artery disease group showed the same results. Hence, our results for MACE may be mainly attributable to those with coronary artery disease.…”

Trends in Diet Quality and Cardiometabolic Risk Factors Among Korean Adults, 2007-2018

“…25 Consistent with our findings, a previous study reported a reduction in sodium intake from 5550 mg/d in 2001 to 3647 mg/d in 2016. 26 Despite this achievement, sodium intake remains above the level recommend by the World Health Organization (<2000 mg/d); thus, continuous actions are needed for further reduction. In the present study, we also observed some unfavorable changes in diet, particularly decreased intake of vegetables and increased intake of sweets and beverages, suggesting that there are remaining targets for dietary improvement in Korea.…”

“…Responding to high sodium intake reported since 1990, the Korean government has implemented an increasing number of sodium reduction policies that encouraged the food industry to voluntarily reformulate their products and required packaged foods to carry nutrition labels with the information on sodium content . Consistent with our findings, a previous study reported a reduction in sodium intake from 5550 mg/d in 2001 to 3647 mg/d in 2016 . Despite this achievement, sodium intake remains above the level recommend by the World Health Organization (<2000 mg/d); thus, continuous actions are needed for further reduction.…”