Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents

Carla Gonçalves, Sandra Abreu, Patrícia Padrão, Olívia Pinho, Pedro Graça, João Breda, Rute Santos, Pedro Moreira, Carla Gonçalves, Sandra Abreu, Patrícia Padrão, Olívia Pinho, Pedro Graça, João Breda, Rute Santos, Pedro Moreira

Abstract

Background: Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone.

Objective: This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents.

Design: A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall.

Results: Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p=0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (p<0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (p<0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%).

Conclusions: Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake.

Keywords: adolescents; intake; salt; urinary potassium; urinary sodium.

Figures

Fig. 1
Fig. 1
Contribution (%) of dietary sources for total sodium intake to total sample of subjects (n = 178). The contribution of each food category is expressed in mean percentage.
Fig. 2
Fig. 2
Contribution (%) of dietary sources for total potassium intake to total sample of subjects (n = 178). The contribution of each food category is expressed in mean percentage.

References

    1. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23(6):363–84.
    1. Poggio R, Gutierrez L, Matta MG, Elorriaga N, Irazola V, Rubinstein A. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr. 2015;18(4):695–704.
    1. Chockalingam A, Campbell NR, Fodor JG. Worldwide epidemic of hypertension. Can J Cardiol. 2006;22(7):553–5.
    1. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38(3):791–813.
    1. World Health Organization. Vienna declaration on nutrition and noncommunicable diseases in the context of health 2020; WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020; Vienna: World Health Organization; 2013.
    1. Webster J, Trieu K, Dunford E, Hawkes C. Target salt 2025: a global overview of national programs to encourage the food industry to reduce salt in foods. Nutrients. 2014;6(8):3274–87.
    1. Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc. 2013;88(9):987–95.
    1. Morris RC, Jr, Schmidlin O, Frassetto LA, Sebastian A. Relationship and interaction between sodium and potassium. J Am Coll Nutr. 2006;25(3 Suppl):262s–70.
    1. Kotchen TA, Kotchen JM. Nutrition, diet, and hypertension. In: ME Shils, M Shike, AC Ross, B Caballero, RJ Cousins., editors. Modern nutrition in health and disease. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. pp. 1095–107.
    1. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ (Clinical research ed) 1988;297(6644):319–28.
    1. Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, et al. Sodium intake and blood pressure among US children and adolescents. Pediatrics. 2012;130(4):611–19.
    1. Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, et al. Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort Study for Evaluation of Cancer Risks. Am J Clin Nutr. 2008;88(1):195–202.
    1. Thornton SN. Salt in health and disease – a delicate balance. N Engl J Med. 2013;368(26):2531.
    1. WHO. Diet, nutrition and the prevention of chronic diseases. World Health Organization technical report series. 2003/05/29 ed. Geneva: World Health Organization (WHO); 2003. pp. i–viii, 1–149, backcover.
    1. World Health Organization. Guideline: sodium intake for adults and children. 2012. Available from: [cited 5 September 2014]
    1. World Health Organization. Guideline: potassium intake for adults and children. 2012. Available from: [cited 5 September 2014]
    1. George F. Causes of deaths in Portugal and challenges in prevention. Acta Med Port. 2012;25(2):61–3.
    1. Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study. J Hypertens. 2014;32(6):1211–21.
    1. McLean RM. Measuring population sodium intake: a review of methods. Nutrients. 2014;6(11):4651–62.
    1. Elliott P, Brown I. Sodium intakes around the world. Geneva, Switzerland: World Health Organization; 2007.
    1. World Health Organization/Pan American Health Organization Regional Expert Group for Cardiovascular Disease Prevention through Population-wide Dietary Salt Reduction. Protocol for population level sodium determination in 24-hour urine samples. 2010. Available from: [cited 5 September 2014]
    1. Remer T, Neubert A, Maser-Gluth C. Anthropometry-based reference values for 24-h urinary creatinine excretion during growth and their use in endocrine and nutritional research. Am J Clin Nutr. 2002;75(3):561–9.
    1. Marques M, Pinho O, Almeida MVd. Manual de quantificação de alimentos. Porto: Rocha/Artes Gráficas, Lda; 1996.
    1. Martins I. Tabela da Composição de Alimentos. Lisboa: Editorial do Ministério da Educação; 2007.
    1. Marrero NM, He FJ, Whincup P, Macgregor GA. Salt intake of children and adolescents in South London: consumption levels and dietary sources. Hypertension. 2014;63(5):1026–32.
    1. Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39(Suppl 1):5–41.
    1. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr. 1991;45(12):569–81.
    1. Torun B, Davies PS, Livingstone MB, Paolisso M, Sackett R, Spurr GB. Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Eur J Clin Nutr. 1996;50(Suppl 1):S37–80. discussion S-1.
    1. Nelson M, Black AE, Morris JA, Cole TJ. Between- and within-subject variation in nutrient intake from infancy to old age: estimating the number of days required to rank dietary intakes with desired precision. Am J Clin Nutr. 1989;50(1):155–67.
    1. Lohman T, Roache A, Martorell R. Anthropometric standardization reference manual. Med Sci Sports Exerc. 1992;24(8):952.
    1. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–7.
    1. WHO . AnthroPlus for personal computers manual: software for assessing growth of the world's children and adolescents. Geneva: WHO; 2009.
    1. Currie C, Molcho M, Boyce W, Holstein B, Torsheim T, Richter M. Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale. Soc Sci Med. 2008;66(6):1429–36.
    1. Willett W. Nutritional epidemiology. New York: Oxford University Press; 2012.
    1. Cotter J, Cotter MJ, Oliveira P, Cunha P, Polonia J. Salt intake in children 10–12 years old and its modification by active working practices in a school garden. J Hypertens. 2013;31(10):1966–71.
    1. Oliveira AC, Padrao P, Moreira A, Pinto M, Neto M, Santos T, et al. Potassium urinary excretion and dietary intake: a cross-sectional analysis in 8-10 year-old children. BMC Pediatr. 2015;15(1):60.
    1. Campanozzi A, Avallone S, Barbato A, Iacone R, Russo O, De Filippo G, et al. High sodium and low potassium intake among Italian children: relationship with age, body mass and blood pressure. PLoS One. 2015;10(4):e0121183.
    1. Maldonado-Martin A, Garcia-Matarin L, Gil-Extremera B, Avivar-Oyonarte C, Garcia-Granados ME, Gil-Garcia F, et al. Blood pressure and urinary excretion of electrolytes in Spanish schoolchildren. J Hum Hypertens. 2002;16(7):473–8.
    1. Shi L, Krupp D, Remer T. Salt, fruit and vegetable consumption and blood pressure development: a longitudinal investigation in healthy children. Br J Nutr. 2014;111(4):662–71.
    1. Grimes CA, Riddell LJ, Campbell KJ. Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics. 2013;131:14–21.
    1. Meneton P, Lafay L, Tard A, Dufour A, Ireland J, Menard J, et al. Dietary sources and correlates of sodium and potassium intakes in the French general population. Eur J Clin Nutr. 2009;63(10):1169–75.
    1. Lee HS, Duffey KJ, Popkin BM. Sodium and potassium intake patterns and trends in South Korea. J Hum Hypertens. 2013;27(5):298–303.
    1. Geleijnse JM, Grobbee DE, Hofman A. Sodium and potassium intake and blood pressure change in childhood. BMJ (Clinical research ed) 1990;300(6729):899–902.
    1. Adrogue HJ, Madias NE. The impact of sodium and potassium on hypertension risk. Semin Nephrol. 2014;34(3):257–72.
    1. Yi SS, Curtis CJ, Angell SY, Anderson CA, Jung M, Kansagra SM. Highlighting the ratio of sodium to potassium in population-level dietary assessments: cross-sectional data from New York City, USA. Public Health Nutr. 2014;17(11):2484–8.
    1. De Santo NG, Dilorio B, Capasso G, Russo F, Stamler J, Stamler R, et al. The urinary sodium/potassium ratio in children from southern Italy living in Cimitile: a case for concern. Int J Pediatr Nephrol. 1987;8(3):153–8.
    1. Schachter J, Harper PH, Radin ME, Caggiula AW, McDonald RH, Diven WF. Comparison of sodium and potassium intake with excretion. Hypertension. 1980;2(5):695–9.
    1. Witschi JC, Capper AL, Hosmer DW, Jr, Ellison RC. Sources of sodium, potassium, and energy in the diets of adolescents. J Am Diet Assoc. 1987;87(12):1651–5.
    1. Goncalves C, Monteiro S, Padrao P, Rocha A, Abreu S, Pinho O, et al. Salt reduction in vegetable soup does not affect saltiness intensity and liking in the elderly and children. Food Nutr Res. 2014;58 24825, doi: .
    1. Gonçalves C, Silva G, Pinho O, Camelo S, Amaro L, Teixeira V, et al. Sodium content in vegetable soups prepared outside the home: identifying the problem. In: Arezes P, Baptista J, Barroso M, Carneiro P, Cordeiro P, Costa N, et al., editors. Occupational Safety and Hygiene – SHO 2012 – Book of Abstracts. Vila Nova de Gaia: Portuguese Society of Occupational Safety and Hygiene (SPOSHO); 2012. pp. 278–281.
    1. Graça P. Relatório Estratégia para a redução do consumo de sal na alimentação em Portugal. Direção Geral de Saude; 2013.
    1. Assembleia da Republica. Lei n 75/2009 Estabelece normas com vista à redução do teor de sal no pão bem como informação na rotulagem de alimentos embalados destinados ao consumo humano. Diário da República; 2009.
    1. Dunford EK, Eyles H, Mhurchu CN, Webster JL, Neal BC. Changes in the sodium content of bread in Australia and New Zealand between 2007 and 2010: implications for policy. Med J Aust. 2011;195(6):346–9.
    1. Wyness LA, Butriss JL, Stanner SA. Reducing the population's sodium intake: the UK Food Standards Agency's salt reduction programme. Public Health Nutr. 2012;15(2):254–61.
    1. Burton PM, Monro JA, Alvarez L, Gallagher E. Glycemic impact and health: new horizons in white bread formulations. Crit Rev Food Sci Nutr. 2011;51(10):965–82.
    1. D'Alessandro A, De Pergola G. Mediterranean diet pyramid: a proposal for Italian people. Nutrients. 2014;6(10):4302–16.
    1. Belz MC, Ryan LA, Arendt EK. The impact of salt reduction in bread: a review. Crit Rev Food Sci Nutr. 2012;52(6):514–24.
    1. Bolhuis DP, Temme EH, Koeman FT, Noort MW, Kremer S, Janssen AM. A salt reduction of 50% in bread does not decrease bread consumption or increase sodium intake by the choice of sandwich fillings. J Nutr. 2011;141(12):2249–55.
    1. La Croix KW, Fiala SC, Colonna AE, Durham CA, Morrissey MT, Drum DK, et al. Consumer detection and acceptability of reduced-sodium bread. Public Health Nutr. 2015;18(8):1412–18.
    1. Willems AA, van Hout DH, Zijlstra N, Zandstra EH. Effects of salt labelling and repeated in-home consumption on long-term liking of reduced-salt soups. Public Health Nutr. 2014;17(5):1130–7.
    1. World Health Organization. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser. 2003;916(i–viii):1–149.
    1. Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke. 2014;45(6):1613–19.
    1. Rodriguez-Rodriguez E, Ortega RM, Andres Carvajales P, Gonzalez-Rodriguez LG. Relationship between 24 h urinary potassium and diet quality in the adult Spanish population. Public Health Nutr. 2015;18(5):850–9.
    1. Webster JL, Dunford EK, Neal BC. A systematic survey of the sodium contents of processed foods. Am J Clin Nutr. 2010;91(2):413–20.
    1. He FJ, MacGregor GA. Beneficial effects of potassium on human health. Physiol Plant. 2008;133(4):725–35.
    1. Instituto Nacional de Estatística I.P., Instituto Nacional de Saúde Doutor Ricardo Jorge I.P. Inquérito Nacional de Saúde 2005/2006. Portugal, Lisboa: Instituto Nacional de Estatística IP;
    1. Rodrigues SS, Franchini B, Graca P, de Almeida MD. A new food guide for the Portuguese population: development and technical considerations. J Nutr Educ Behav. 2006;38(3):189–95.
    1. Moreira P, Padrao P. Educational, economic and dietary determinants of obesity in Portuguese adults: a cross-sectional study. Eat Behav. 2006;7(3):220–8.
    1. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, et al. Sodium and potassium intake and mortality among us adults: prospective data from the third national health and nutrition examination survey. Arch Intern Med. 2011;171(13):1183–91.
    1. Espeland MA, Kumanyika S, Wilson AC, Reboussin DM, Easter L, Self M, et al. Statistical issues in analyzing 24-hour dietary recall and 24-hour urine collection data for sodium and potassium intakes. Am J Epidemiol. 2001;153(10):996–1006.

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