Can methods based on spot urine samples be used to estimate average population 24 h sodium excretion? Results from the Isfahan Salt Study

Mohammadifard, Noushin; Marateb, Hamid Reza; Mansourian, Marjan; Khosravi, Alireza; Abdollahi, Zahra; Campbell, Norman R.C.; Webster, Jacqui; Petersen, Kristina S.; Sarrafzadegan, Nizal

doi:10.1017/s136898001900257x

Cited by 6 publications

(9 citation statements)

References 36 publications

(63 reference statements)

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“…He and colleagues report further evidence that estimates of sodium intake from methods based on spot urine samples are inaccurate and biased by systematic error, 23 which is consistent with previous findings in diverse populations 56‐60 . Furthermore, for the first time, He et al 23 provide novel data suggesting that the use of the Kawasaki equation, a spot urine‐based estimate, changes the linearity of the sodium‐mortality association.…”

Section: Discussionmentioning

confidence: 54%

Further evidence that methods based on spot urine samples should not be used to examine sodium‐disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

Petersen

Malta

Rae

et al. 2020

J of Clinical Hypertension

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The aim of this eighth Science of Salt outcomes review is to identify, summarize, and critically appraise studies on dietary sodium and health outcomes published between November 1, 2018, and August 31, 2019, to extend this series published in the Journal since 2016. The standardized Science of Salt search strategy was conducted. Studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisal. The search strategy resulted in 2621 citations with 27 studies on dietary sodium and health outcomes identified. Two studies met the

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Section: Discussionmentioning

confidence: 54%

Further evidence that methods based on spot urine samples should not be used to examine sodium‐disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

Petersen

Malta

Rae

et al. 2020

J of Clinical Hypertension

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“…Several studies have more recently reported results using the Kawasaki, Tanaka, INTERSALT, and other spot urine algorithms in a variety of populations. In an Iranian study of 79 adults, Mohammadifard et al ( 33 ) reported that the Tanaka algorithm Na estimate was not significantly different from the study 24-h urine Na, although 2 newly proposed algorithms including self-assessment of discretionary salt and participant characteristics of BMI, sex, age, and physical activity were less biased than the Tanaka algorithm. Two large studies, one in France ( 34 ) and one in the Shandong province of China ( 35 ), ruled out the Kawasaki, Tanaka, and INTERSALT algorithms for estimating individual Na intake, while not ruling out their use for group estimation.…”

Section: Discussionmentioning

confidence: 97%

Estimating 24-Hour Urinary Excretion of Sodium and Potassium Is More Reliable from 24-Hour Urine Than Spot Urine Sample in a Feeding Study of US Older Postmenopausal Women

Tinker

Huang

Johnson

et al. 2021

Current Developments in Nutrition

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Background Assessing estimated sodium (Na) and potassium (K) intakes derived from 24-h urinary excretions versus a spot urine sample if comparable could reduce participant burden in epidemiologic and clinical studies. Objectives In a two-week controlled feeding study, Na and K excretion from a 24-h urine collection were compared with a first void spot urine sample, applying established algorithms and enhanced models to estimate 24-h excretion. Actual and estimated 24-h excretions were evaluated relative to mean daily Na and K intakes in the feeding study. Methods 153 older postmenopausal women ages 75.4 ± 3.5 years participated in a 2-week controlled feeding study with a 4-day repeating menu cycle based on their usual intake (ClinicalTrials.gov Identifier: NCT00000611). Of the 150 participants who provided both a first void spot urine sample and a 24-h urine collection on the penultimate study day, statistical methods included Pearson correlations for Na and K between intake, 24-h collections and the 24-h estimated excretions using four established algorithms; enhanced biomarker models by regressing ln-transformed intakes on ln-transformed 24-h excretions or ln-transformed 24-h estimated excretions plus participant characteristics; and sensitivity analyses for factors potentially influencing Na or K excretion, e.g., possible kidney disease estimated eGFR < 60 mL/min/1.73m). Results Pearson correlation coefficients between Na and K intakes and actual 24-h excretions were 0.57 and 0.38–0.44 for estimated 24-h excretions, depending on electrolyte and algorithm used. Enhanced biomarker model cross-validated R2 (CVR2s) for 24-h excretions were 38.5% (Na), 40.2% (K) and 42.0% (Na/K). After excluding participants with possible kidney disease, the CVR2s were 43.2% (Na), 40.2% (K) and 38.1% (Na/K). Conclusions 24-h urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily white postmenopausal women. Summary 24-h urine excretion measurement performs better than estimated 24-h excretion from a spot urine as a biomarker for Na and K intake among a sample of primarily white postmenopausal women.

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“…Spot urine collection is an easily applicable alternative in estimating dietary Na intake. Increasing studies aim to reveal the most accurate formula for converting spot Na to 24UNa, comparing not only those commonly used (17,(44)(45)(46)(47)(48) but also those newly designed (49,50) against the gold-standard 24UCol. The mostly studied formulas are the INTERSALT equation, the Tanaka equation and the Kawasaki equation.…”

Section: Discussionmentioning

confidence: 99%

“…The mostly studied formulas are the INTERSALT equation, the Tanaka equation and the Kawasaki equation. Despite some controversies (50) , a large number of studies support that among the existing equations, the INTERSALT performs better in estimating the 24UNa showing the least bias (44,45,49,51,52) . In our findings, the INTERSALT equation presented the lowest bias among all the other equations; however, it was moderately correlated with 24UNa and also presented consistent bias in Bland-Altman plots by underestimating Na intake at low levels of Na excretion and overestimating at high levels of Na excretion.…”

Section: Discussionmentioning

confidence: 99%

Dietary sodium estimation methods: accuracy and limitations of old and new methods in individuals at high cardiovascular risk

Tsirimiagkou

Karatzi

Basdeki

et al. 2021

Public Health Nutr.

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Objective: Accurate and easy to use methods for dietary sodium (Na) intake estimation in population level are lacking. We aimed at (i) estimating the mean Na intake in the group level using a variety of dietary methods (DMs) and urinary methods (UMs) and correlating them with 24h urine collection (24UCol); (ii) improving the accuracy of the existing DMs. Design: The most common DMs [three 24h dietary recalls (24DR) and food frequency questionnaire (FFQ)] and UMs [24UCol and spot urine collection using common equations] were applied. To improve the existing: (i) 24DR, discretionary Na was quantified using salt-related questions or adding extra 15% in total Na intake; (ii) FFQ, food items rich in Na and salt-related questions were added in the standard questionnaire (NaFFQ). Setting: University Hospital. Participants: 122 high cardiovascular risk subjects (56.0±12.6 years; 55.7% males). Results: Mean 24h Na excretion (24UNa) was 2810±1304 mg/day. Spot urine methods overestimated the 24UNa (bias range:−1781 to −492 mg) and were moderately correlated to 24UCol (r=0.469-0.596, p≤0.01). DMs underestimated the 24UNa (bias range: 877 to 1212mg) and were weakly correlated with 24UCol. The improved DMs underestimated the 24UNa (bias range: 877 to 923mg). The NaFFQ presented the smallest bias (−290±1336mg) and the strongest correlation with 24UCol (r=0.497, p≤0.01), but wide limits of agreement in Bland-Altman plots (−2909mg; 2329mg), like all the other methods did. Conclusions: The existing methods exhibit poor accuracy. Further improvement of the newly developed NaFFQ could be promising for more accurate estimation of mean dietary Na intake in epidemiological studies. Additional validation studies are needed.

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Can methods based on spot urine samples be used to estimate average population 24 h sodium excretion? Results from the Isfahan Salt Study

Cited by 6 publications

References 36 publications

Further evidence that methods based on spot urine samples should not be used to examine sodium‐disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

Further evidence that methods based on spot urine samples should not be used to examine sodium‐disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

Estimating 24-Hour Urinary Excretion of Sodium and Potassium Is More Reliable from 24-Hour Urine Than Spot Urine Sample in a Feeding Study of US Older Postmenopausal Women

Dietary sodium estimation methods: accuracy and limitations of old and new methods in individuals at high cardiovascular risk

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