Association of Urinary Sodium Excretion With Insulin Resistance in Korean Adolescents

Yuan, Chun; Han, Kyungdo; Kim, Do Hoon; Park, Yong Gyu; Cho, Kyung Hwan; Choi, Youn Seon; Kim, Seon Mee; Kim, Yang Hyun; Nam, Ga Eun

doi:10.1097/md.0000000000003447

Cited by 11 publications

(6 citation statements)

References 33 publications

(36 reference statements)

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“…Several studies reported a positive association of high-sodium diet [ 6 7 8 9 ] or low-potassium diet [ 10 11 ] with insulin resistance that cohere with these results. Sodium intake estimated by the urinary sodium to urinary creatinine ratio was positively associated with insulin resistance among Korean children or adolescents [ 30 31 ]. Ames RP et al [ 6 ] investigated the effect of modest sodium restriction on insulin resistance during 4 weeks in a cross-over design, and suggested that sodium restriction was associated with reduced insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

An association of urinary sodium-potassium ratio with insulin resistance among Korean adults

et al. 2018

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BACKGROUND/OBJECTIVESThis study was conducted to investigate the effects of sodium-potassium ratio on insulin resistance and sensitivity in Korean adults.SUBJECTS/METHODSSubjects were 3,722 adults (1,632 men and 2,090 women) aged 40–69 years participating in the Korean genome and epidemiology study_Ansan and Ansung study. Insulin resistance was assessed using homeostasis model assessment of insulin resistance (HoMA-IR) and fasting insulin, and insulin sensitivity was assessed by using the quantitative insulin sensitivity check index (QUICKI). The 24-h urinary sodium and potassium excretion were estimated from spot urinary samples using the Tanaka formula. The generalized linear model was applied to determine the association between urinary sodium-potassium ratio and insulin resistance.RESULTSHoMA-IR (P-value = 0.029, P-trend = 0.008) and fasting insulin (P-value = 0.017, P-trend = 0.005) levels were positively associated with 24-h estimated urinary sodium-potassium ratio in the multivariable model. QUICKI was inversely associated with 24-h estimated urinary sodium-potassium ratio in all models (P-value = 0.0002, P-trend < 0.0001 in the multivariate model).CONCLUSIONThe present study suggests that high sodium-potassium ratio is related to high insulin resistance and low insulin sensitivity. Decreasing sodium intake and increasing potassium intake are important for maintaining insulin sensitivity. Further studies are needed to confirm these findings in longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

An association of urinary sodium-potassium ratio with insulin resistance among Korean adults

et al. 2018

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“…A US study suggested that high sodium intake is independently positively associated with adiposity and inflammation in adolescents after adjusting for total energy intake and sugar-sweetened soft drink consumption [ 34 ]. It has been reported that high sodium intake is independently related to MetS components, including insulin resistance, dyslipidemia, and hypertension, even after adjusting for confounding variables including age, gender, and BMI [ 25 , 35 ]. Alternatively, a low dietary sodium intake reduces insulin secretion in humans independently of insulin resistance [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, no studies have assessed the medical formula using spot urinary sodium to estimate 24-hour urinary sodium for children and adolescents. A Korean study in adolescents showed that the U-Na to U-SG ratio may be used as a surrogate for sodium intake [ 35 ]. In the current study, we utilized the U-Na to U-SG ratio as a surrogate for sodium intake and showed a significant positive association between the U-Na to U-SG ratio and MetS.…”

Section: Discussionmentioning

confidence: 99%

Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013

Jeong

Shim

2017

PLoS ONE

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ObjectivesThis study aimed to evaluate the association between sodium intake and metabolic syndrome (MetS) in Korean boys.MethodsA total of 1,738 boys aged 10–18 years were included in this study from the Korea National Health and Nutrition Examination Survey (KNHANES) during the years 2010–2013. Sodium intake was assessed using the urinary sodium excretion to urinary specific gravity ratio (U-Na to U-SG ratio).ResultsThe median U-Na to U-SG ratio was 133.27 mmol/L (interquartile range: 95.66–178.50 mmol/L). Significant positive associations were found between the U-Na to U-SG ratio and the TG (P = 0.001 for trend) and TG concentrations, and these concentrations were significantly higher in boys with a U-Na to U-SG ratio in the highest quartile compared with those with a ratio in the lowest (P = 0.001) and second (P = 0.033) quartiles, as demonstrated through analysis of covariance (ANCOVA) after adjustment for possible confounders, including age, BMI standard deviation score, ferritin, vitamin D, house income, smoking, alcohol intake, physical activity, season, total intake, total energy intake, protein intake, fat intake, carbohydrate intake, and water intake. Significant inverse associations were found for the U-Na to U-SG ratio with the HDL-C (P = 0.033 for trend) and HDL-C levels, and these values were significantly lower in boys with a ratio in the highest quartile compared with those with a ratio in the second quartile (P = 0.020), as demonstrated through an ANCOVA. Although the trends did not reach statistical significance, a higher U-Na to U-SG ratio tended to be associated with higher SBP (P = 0.086 for trend), DBP (P = 0.063 for trend), and glucose levels (P = 0.099 for trend), as illustrated through ANCOVA. Boys with a ratio in the highest quartile exhibited a 1.73-fold increased risk for elevated TG (95% CI, 1.19–2.51) and a 2.66-fold increased risk for MetS (95% CI, 1.11–6.35) compared with those with a ratio in the lowest quartile, as demonstrated through multivariate logistic regression analyses after adjusting for confounders.ConclusionsOur results suggest that high sodium intake may be significantly independently associated with MetS in Korean boys aged 10–18 years.

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“…Furthermore, an applicable formula for estimating 24-h urinary sodium excretion in children is unavailable. Based on other studies, we used the U-Na-to-SGU ratio as a surrogate marker of sodium intake [21,36,37].…”

Section: Discussionmentioning

confidence: 99%

“…However, a 24-h urine sample is difficult to collect, and the cost is relatively expensive. One method for measuring sodium intake is a spot urine sodium level calculated from the urinary sodium (U-Na) levels corrected by specific gravity (SG) or the urinary creatinine level [21,36,37]. In the present study, we used the calculated parameter (SG − 1) × 100 as an SG unit (SGU) [21,36,37].…”

Section: Nutritional Intake Assessmentmentioning

confidence: 99%

Analysis of the dietary factors associated with suspected pediatric nonalcoholic fatty liver disease and potential liver fibrosis: Korean National Health and Nutrition Examination Survey 2014-2017

Kim

Lee

2020

BMC Pediatr

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Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased as the obese pediatric population has increased. NAFLD causes progressive liver injury and the only effective treatment is lifestyle modifications. However, few studies have examined the dietary risk factors for pediatric NAFLD or liver fibrosis. Here, we evaluated the dietary factors associated with suspected NAFLD and potential liver fibrosis in Korean children. Methods: Data collected from 1674 children and adolescents aged 10-18 years during the 2014-2017 Korean National Health and Nutrition Examination Surveys analyzed. The 24-h recall method measured the food consumed 1 day before the survey. The "suspected NAFLD" group included excessive body mass index (BMI) subjects ≥ 85th percentile) with alanine aminotransferase (ALT) levels exceeding the upper normal limit (24.1 U/L for boys and 17.7 U/L for girls); the "healthy control" group included subjects with a BMI and ALT level below these thresholds. Sodium intake was assessed by the urinary sodium-to-urinary specific gravity unit ratio (U-Na-to-SGU ratio). A pediatric NAFLD index (PNFI) higher than 3 indicated potential liver fibrosis. Results: The overall prevalence of suspected NAFLD and potential liver fibrosis was 8.2 and 4.5%, respectively. The suspected NAFLD group had a larger proportion of males and subject with a greater height, BMI standard deviation score (BMI-SDS), systolic and diastolic blood pressure SDS, waist circumference, hemoglobin A1c, and levels of total cholesterol, triglycerides, aspartate aminotransferase (AST) and ALT than the control group. The suspected NAFLD group presented significantly higher U-Na-to-SGU ratios and cholesterol intake. The PNFI > 3 subgroup included a significantly larger proportion of males and subjects with higher BMI-SDS, AST and ALT values, and intake of water, carbohydrate, protein, calcium, phosphorus, iron and vitamin B2. After adjusting for confounders, male, BMI-SDS, AST, and protein and carbohydrate intake were independent risk factors for potential liver fibrosis. Niacin intake was an independent protective factor for potential liver fibrosis.

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Association of Urinary Sodium Excretion With Insulin Resistance in Korean Adolescents

Cited by 11 publications

References 33 publications

An association of urinary sodium-potassium ratio with insulin resistance among Korean adults

An association of urinary sodium-potassium ratio with insulin resistance among Korean adults

Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013

Analysis of the dietary factors associated with suspected pediatric nonalcoholic fatty liver disease and potential liver fibrosis: Korean National Health and Nutrition Examination Survey 2014-2017

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