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Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey.

ABSTRACT: Twenty-four-hour urine sodium excretion is recommended for monitoring population sodium intake. Because of concerns about participation and completion, sodium excretion has not been collected previously in US nationally representative surveys.We assessed the feasibility of implementing 24-h urine collections as part of a nationally representative survey.We selected a random half sample of nonpregnant US adults aged 20-69 y in 3 geographic locations of the 2013 NHANES. Participants received explicit instructions, started and ended the urine collection in a urine study mobile examination center, and answered questions about their collection. Among those with a complete 24-h urine collection, a random one-half were asked to collect a second 24-h urine sample. Sodium, potassium, chloride, and creatinine excretion were analyzed.The final NHANES examination response rate for adults aged 20-69 y in these 3 study locations was 71%. Of those examined (n = 476), 282 (59%) were randomly selected to participate in the 24-h urine collection. Of these, 212 persons [75% of those selected for 24-h urine collection; 53% (equal to 71% × 75% of those selected for the NHANES)] collected a complete initial 24-h specimen and 92 persons (85% of 108 selected) collected a second complete 24-h urine sample. More men than women completed an initial collection (P = 0.04); otherwise, completion did not vary by sociodemographic characteristics, body mass index, education, or employment status for either collection. Mean 24-h urine volume and sodium excretion were 1964 ± 1228 mL and 3657 ± 2003 mg, respectively, for the first 24-h urine sample, and 2048 ± 1288 mL and 3773 ± 1891 mg, respectively, for the second collection.Given the 53% final component response rate and 75% completion rate, 24-h urine collections were deemed feasible and implemented in the NHANES 2014 on a subsample of adults aged 20-69 y to assess population sodium intake. This study was registered at clinicaltrials.gov as NCT02723682.

SUBMITTER: Terry AL

PROVIDER: S-EPMC4962154 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey.

Terry Ana L AL Cogswell Mary E ME Wang Chia-Yih CY Chen Te-Ching TC Loria Catherine M CM Wright Jacqueline D JD Zhang Xinli X Lacher David A DA Merritt Robert K RK Bowman Barbara A BA

The American journal of clinical nutrition 20160713 2

<h4>Background</h4>Twenty-four-hour urine sodium excretion is recommended for monitoring population sodium intake. Because of concerns about participation and completion, sodium excretion has not been collected previously in US nationally representative surveys.<h4>Objective</h4>We assessed the feasibility of implementing 24-h urine collections as part of a nationally representative survey.<h4>Design</h4>We selected a random half sample of nonpregnant US adults aged 20-69 y in 3 geographic locat ...[more]

PMID: 27413136

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Project description:For policy goal setting, efficacy evaluations, and the development of related programs for reducing sodium intake, it is essential to accurately identify the amount of sodium intake in South Korea and constantly monitor its trends. The present study aimed to identify the status of sodium intake in South Korea and to review the methods and their validity for estimating sodium intake in each country; through this, we aim to determine more accurate methods for determining sodium intake and to monitor the trend in sodium intake for Korean citizens in the future. Using 24-hour dietary recall data from the 2012 Korea National Health and Nutrition Examination Survey (KNHANES) to estimate daily sodium intake, the average daily sodium intake among Koreans was 4,546 mg (men, 5,212 mg; women, 3,868 mg). In addition to the nutrition survey that uses the 24-hour dietary recall method, sodium intake can also be calculated from the amount of sodium excreted in 24-hour urine, 8-hour overnight urine, and spot urine samples. Although KNHANES uses the 24-hour dietary recall method to estimate the sodium intake, the 24-hour dietary recall method has the disadvantage of not being able to accurately determine the amount of sodium intake owing to its unique characteristics of the research method and in the processing of data. Although measuring the amount of sodium excreted in 24-hour urine is known to be the most accurate method, because collecting 24-hour urine from the general population is difficult, using spot urine samples to estimate sodium intake has been suggested to be useful for examining the trend of sodium intake in the general population. Therefore, we planned to conduct a study for estimating of 24-hour sodium excretion from spot urine and 8-hour overnight urine samples and testing the validity among subsamples in the KNHANES. Based on this result, we will adopt the most appropriate urine collection method for estimating population sodium intake in South Korea.

Project description:BackgroundUnderstanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes.ObjectiveThe aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE).DesignData were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available.ResultsOverall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32).ConclusionsCompared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.

Project description:High sodium intake is 1 of the modifiable risk factors for cardiovascular disease, but in Korea, daily sodium intake is estimated to be double the level recommended by World Health Organization. We investigated the association between the estimated 24-h urinary sodium excretion (24hUNaE) and metabolic syndrome using nationwide population data. In total, 17,541 individuals (weighted n?=?33,200,054; weighted men, 52.5% [95% confidence interval, CI?=?51.8-53.3]; weighted age, 45.2 years [44.7-45.7]) who participated in the Korean Health and Nutrition Examination Survey 2009 to 2011 were investigated. NCEP-ATP III criteria for metabolic syndrome were used, and sodium intake was estimated by 24hUNaE using Tanaka equation with a spot urine sample. The weighted mean 24hUNaE values were 3964?mg/d (95% CI?=?3885-4044) in men and 4736?mg/d (4654-4817) in women. The weighted age-adjusted prevalence of metabolic syndrome was 22.2% (21.4-23.0), and it increased with 24hUNaE quartile in both men and women (mean?±?standard error of the mean; men: 22.5?±?1.0%, 23.0?±?1.0%, 26.0?±?1.2%, and 26.0?±?1.2%; P?=?0.026; women: 19.4?±?0.8%, 17.7?±?0.8%, 19.8?±?1.0%, and 23.0?±?1.1%; P?=?0.002, for quartiles 1-4, respectively). Even after adjustment for age, daily calorie intake, heavy alcohol drinking, regular exercise, college graduation, and antihypertensive medication, the weighted prevalence of metabolic syndrome increased with the increase in 24hUNaE in men and women. The weighted 24hUNaE was positively associated with the number of metabolic syndrome components after adjustment for confounding factors in men and women. In subjects without antihypertensive medication, the odds ratio for metabolic syndrome in quartile 4 of 24hUNaE compared with quartile 1 was 1.56 (1.33-1.84, P?<?0.001) in the total population, 1.66 (1.34-2.06, P?<?0.001) in men, and 1.94 (1.49-2.53, P?<?0.001) in women. In this nationwide population study, we observed a significant independent association between high sodium intake, estimated by spot urine sodium excretion, and the presence of metabolic syndrome in men and women.

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Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey.

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Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey.

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