Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes—Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT)

Abstract

This study investigates the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65–85. Data from 912 individuals regarding their dietary intake at baseline is analyzed and assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes are times to diabetic retinopathy, overt nephropathy, cardiovascular disease (CVD), and all-cause mortality during six years. We find that mean sodium intake in quartiles ranges from 2.5 g to 5.9 g/day. After adjustment for confounders, no significant associations are observed between sodium intake quartiles and incidence of diabetes complications and mortality, except for a significant trend for an increased risk of diabetic retinopathy (p = 0.039). Among patients whose vegetable intake was less than the average of 268.7 g, hazard ratios (HRs) for diabetic retinopathy in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 0.87 (95% CI, 0.31–2.41), 2.61 (1.00–6.83), and 3.70 (1.37–10.02), respectively. Findings indicate that high sodium intake under conditions of low vegetable intake is associated with an elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes.

Dietary Intake and Diabetic Retinopathy: A Systematic Review of the Literature

“…Most observational studies measured the dietary intake using standard dietary methods such as 24 h recall (n = 4) [ 20 , 34 , 35 ], food frequency questionnaires (FFQ) (n = 23) [ 12 , 18 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], or 3-day food records (n = 3) [ 17 , 51 , 52 ]. A general-based interviewer-administered questionnaire was administered in 20 observational studies, and only one study evaluated dietary sodium intake from urinary excretion levels.…”

“…The findings of a prospective study by Horikawa and associates indicated that, among patients who consumed less than an average of 268.7g of vegetables, high sodium intake was associated with a higher incidence of DR in elderly patients with type 2 diabetes (The results of third [4.4g/d], and fourth [5.9g/d] quartiles compared with the first quartile [2.5g/d], HRs were 2.61 [1.00–6.83], and 3.70 [1.37–10.02], respectively, p = 0.010) [ 37 ]. Another prospective study by Roy and colleagues reported increased sodium intake as a risk factor for DME progression (Q4 vs. Q1, OR: 1.43, 95%CI: 1.10–1.86, p = 0.008), but there was no significant association with DR. [ 49 ] The evidence provided by the remaining studies showed no association of sodium intake with DR [ 47 , 53 , 54 ].…”

Alimentação de Idosos Diabéticos e não Diabéticos no Brasil

“…Nonetheless, epidemiological studies, which search for associations between food consumption and DM, are limited. 4 By contrast, eating standards based on the consumption of ultraprocessed foods and the greater intake of fresh fruits and vegetables has proven to be effective in both the prevention and management of chronic non-communicable diseases (NCDs). 5 This diet standard, known as "Mediterranean", is gaining ground, as it promotes healthy lifestyles and a high regard for seasonal foods.…”

“…7 However, epidemiological studies about food consumption are scarce in the literature, and their results are often highly inconsistent. 4,8 One of the challenges to conduct these studies in Brazil is the large territorial size of the country, associated with the population's heterogeneity, as well as its differences in culture and regional eating habits. Some studies are based on data compiled by specific research projects, such as the Household Budget Survey (HBS), the National Diet and Nutrition Survey, and the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Inquiry (VIGITEL).…”

“…Some studies are based on data compiled by specific research projects, such as the Household Budget Survey (HBS), the National Diet and Nutrition Survey, and the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Inquiry (VIGITEL). 4,9,10 In this edition, Francisco et al 11 used Vigitel 2016 as a tool to map the food consumption of the diabetic and non-diabetic elderly population in Brazilian capitals and the Federal District of Brasilia ( 4). This study presents an expressive sample size, with a little over 13,000 interviews conducted with elderly individuals.…”