Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Dietary Reference Intakes of sodium for Koreans: focusing on a new DRI component for chronic disease risk reduction

  • Kim, Hyun Ja (Department of Food and Nutrition, Gangneung-Wonju National University) ;
  • Lee, Yeon-Kyung (Department of Food Science and Nutrition, Kyungpook National University) ;
  • Koo, Hoseok (Department of Internal Medicine, Inje University Seoul Paik Hospital) ;
  • Shin, Min-Jeong (School of Biosystems and Biomedical Sciences, College of Health Science, Korea University)
  • Received : 2021.11.10
  • Accepted : 2022.03.02
  • Published : 2022.05.20
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Abstract

Sodium is a physiologically essential nutrient, but excessive intake is linked to the increased risk of various chronic diseases, particularly cardiovascular. It is, therefore, necessary to accomplish an evidence-based approach and establish the Korean Dietary Reference Intakes (KDRIs) index, to identify both the nutritional adequacy and health effects of sodium. This review presents the rationale for and the process of revising the KDRIs for sodium and, more importantly, establishing the sodium Chronic Disease Risk Reduction Intake (CDRR) level, which is a new specific set of values for chronic disease risk reduction. To establish the 2020 KDRIs for dietary sodium, the committee conducted a systematic literature review of the intake-response relationships between the selected indicators for sodium levels and human chronic diseases. In this review, 43 studies published from January 2014 to December 2018, using databases of PubMed and Web of Science, were finally included for evaluating the risk of bias and strength of evidence (SoE). We determined that SoE of the relationship between dietary sodium and cardiovascular diseases, cerebrovascular disease, and hypertension, was moderate to strong. However, due to insufficient scientific evidence, we were unable to establish the estimated average requirement and the recommended nutrient intake for dietary sodium. Therefore, the adequate intake of sodium for adults was established to be 1,500 mg/day, whereas the CDRR for dietary sodium was established at 2,300 mg/day for adults. Intake goal for dietary sodium established in the 2015 KDRIs instead of the tolerable upper intake level was not presented in the 2020 KDRIs. For the next revision of the KDRIs, there is a requirement to pursue further studies on nutritional adequacy and toxicity of dietary sodium, and their associations with chronic disease endpoint in the Korean population.

Keywords

Acknowledgement

This research was supported by the Policy Research Program for Project No. 20180415A13-00, 25193068200, 25203084501, from the Ministry of Health and Welfare in 2018-2020.

References

  1. Hall JE. Guyton and Hall Textbook of Medical Physiology. Amsterdam: Elsevier Health Sciences; 2010.
  2. He FJ, Li J, Macgregor GA. Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev 2013;CD004937.
  3. World Health Organization (WHO). Guideline: Sodium Intake for Adults and Children. Geneva: WHO; 2012.
  4. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013;346:f1326. https://doi.org/10.1136/bmj.f1326
  5. Graudal N, Jurgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens 2014;27:1129-37. https://doi.org/10.1093/ajh/hpu028
  6. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-248. https://doi.org/10.1016/j.jacc.2017.11.006
  7. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, Lim S, Danaei G, Ezzati M, Powles J, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med 2014;371:624-34. https://doi.org/10.1056/NEJMoa1304127
  8. National Academies of Sciences, Engineering, and Medicine. Dietary Reference Intakes for Sodium and Potassium. Washington, D.C.: The National Academies Press; 2019.
  9. Ministry of Health and Welfare (KR). Dietary Reference Intakes for Koreans 2015. Sejong: Ministry of Health and Welfare; 2015.
  10. Newberry SJ, Anderson CA, Chen C, Fu Z, Tang A, Zhao N, Booth M, Marks J, Hollands S, Motala A, et al. Sodium and potassium intake: effects on chronic disease outcomes and risks [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2018 [cited 2021 October 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519328/.
  11. National Academies of Sciences, Engineering, and Medicine. Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease. Washington, D.C.: The National Academies Press; 2017.
  12. Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, D.C.: The National Academies Press; 2006.
  13. Korea Centers for Disease Control and Prevention (KCDC). Korea Health Statistics 2017: Korea National Health and Nutrition Examination Survey (KNHANES VII-2). Cheongju: KCDC; 2018.
  14. Craddick SR, Elmer PJ, Obarzanek E, Vollmer WM, Svetkey LP, Swain MC. The DASH diet and blood pressure. Curr Atheroscler Rep 2003;5:484-91. https://doi.org/10.1007/s11883-003-0039-5
  15. Sharma AM, Arntz HR, Kribben A, Schattenfroh S, Distler A. Dietary sodium restriction: adverse effect on plasma lipids. Klin Wochenschr 1990;68:664-8. https://doi.org/10.1007/BF01667013
  16. Ruppert M, Diehl J, Kolloch R, Overlack A, Kraft K, Gobel B, Hittel N, Stumpe KO. Short-term dietary sodium restriction increases serum lipids and insulin in salt-sensitive and salt-resistant normotensive adults. Klin Wochenschr 1991;69 Suppl 25:51-7. https://doi.org/10.1007/BF01649060
  17. Grey A, Braatvedt G, Holdaway I. Moderate dietary salt restriction does not alter insulin resistance or serum lipids in normal men. Am J Hypertens 1996;9:317-22. https://doi.org/10.1016/0895-7061(95)00390-8
  18. Allsopp AJ, Sutherland R, Wood P, Wootton SA. The effect of sodium balance on sweat sodium secretion and plasma aldosterone concentration. Eur J Appl Physiol Occup Physiol 1998;78:516-21. https://doi.org/10.1007/s004210050454
  19. Atkinson SA, Koletzko B. Determining life-stage groups and extrapolating nutrient intake values (NIVs). Food Nutr Bull 2007;28:S61-76. https://doi.org/10.1177/15648265070281S107
  20. Jung WJ, Park SM, Park JM, Rhee H, Kim IY, Lee DW, Lee SB, Seong EY, Kwak IS, Song SH. Severe hypernatremia caused by acute exogenous salt intake combined with primary hypothyroidism. Electrolyte Blood Press 2016;14:27-30. https://doi.org/10.5049/EBP.2016.14.2.27
  21. Metheny NA, Krieger MM. Salt toxicity: a systematic review and case reports. J Emerg Nurs 2020;46:428-39. https://doi.org/10.1016/j.jen.2020.02.011
  22. Sakamoto A, Hoshino T, Boku K, Hiraya D, Inoue Y. Fatal acute hypernatremia resulting from a massive intake of seasoning soy sauce. Acute Med Surg 2020;7:e555.
  23. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med 2001;344:3-10. https://doi.org/10.1056/NEJM200101043440101
  24. Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr, Kostis JB, Kumanyika S, Lacy CR, Johnson KC, Folmar S, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA 1998;279:839-46. https://doi.org/10.1001/jama.279.11.839
  25. Amer M, Woodward M, Appel LJ. Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial. BMJ Open 2014;4:e006671. https://doi.org/10.1136/bmjopen-2014-006671
  26. Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, Engell RE, Lim SS, Danaei G, Mozaffarian D, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ Open 2013;3:e003733. https://doi.org/10.1136/bmjopen-2013-003733
  27. Elliott P, Brown I. Sodium Intakes Around the World. Geneva: World Health Organization; 2007.
  28. Korea Disease Control and Prevention Agency. Korea Health Statistics 2019: Korea National Health and Nutritional Examination Survey (KNHANES VIII-1). Cheongju: Korea Disease Control and Prevention Agency; 2020.
  29. Rural Development Administration (KR). Food Composition Database 9.1. Wanju: Rural Development Administration; 2019.
  30. Mente A, O'Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet 2016;388:465-75. https://doi.org/10.1016/S0140-6736(16)30467-6
  31. Teramoto T, Kawamori R, Miyazaki S, Teramukai S; OMEGA Study Group. Sodium intake in men and potassium intake in women determine the prevalence of metabolic syndrome in Japanese hypertensive patients: OMEGA Study. Hypertens Res 2011;34:957-62. https://doi.org/10.1038/hr.2011.63
  32. Geleijnse JM, Witteman JC, Stijnen T, Kloos MW, Hofman A, Grobbee DE. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study. Eur J Epidemiol 2007;22:763-70. https://doi.org/10.1007/s10654-007-9186-2
  33. Yang Q, Liu T, Kuklina EV, Flanders WD, Hong Y, Gillespie C, Chang MH, Gwinn M, Dowling N, Khoury MJ, 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;171:1183-91. https://doi.org/10.1001/archinternmed.2011.257
  34. Perez V, Chang ET. Sodium-to-potassium ratio and blood pressure, hypertension, and related factors. Adv Nutr 2014;5:712-41. https://doi.org/10.3945/an.114.006783
  35. Du S, Batis C, Wang H, Zhang B, Zhang J, Popkin BM, Popkin BM. Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China. Am J Clin Nutr 2014;99:334-43. https://doi.org/10.3945/ajcn.113.059121
  36. Willey J, Gardener H, Cespedes S, Cheung YK, Sacco RL, Elkind MS. Dietary sodium to potassium ratio and risk of stroke in a multiethnic urban population: the Northern Manhattan Study. Stroke 2017;48:2979-83. https://doi.org/10.1161/STROKEAHA.117.017963
  37. Korea Disease Control and Prevention Agency. The Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII-1). Cheongju: Korea Disease Control and Prevention Agency; 2019.
  38. Jenkins DJ, Jones PJ, Frohlich J, Lamarche B, Ireland C, Nishi SK, Srichaikul K, Galange P, Pellini C, Faulkner D, et al. The effect of a dietary portfolio compared to a DASH-type diet on blood pressure. Nutr Metab Cardiovasc Dis 2015;25:1132-9. https://doi.org/10.1016/j.numecd.2015.08.006
  39. Diaz KM, Muntner P, Levitan EB, Brown MD, Babbitt DM, Shimbo D. The effects of weight loss and salt reduction on visit-to-visit blood pressure variability: results from a multicenter randomized controlled trial. J Hypertens 2014;32:840-8. https://doi.org/10.1097/hjh.0000000000000080
  40. Reidlinger DP, Darzi J, Hall WL, Seed PT, Chowienczyk PJ, Sanders TA; Cardiovascular disease risk REduction Study (CRESSIDA) investigators. How effective are current dietary guidelines for cardiovascular disease prevention in healthy middle-aged and older men and women? A randomized controlled trial. Am J Clin Nutr 2015;101:922-30. https://doi.org/10.3945/ajcn.114.097352
  41. Zhou B, Webster J, Fu LY, Wang HL, Wu XM, Wang WL, Shi JP. Intake of low sodium salt substitute for 3years attenuates the increase in blood pressure in a rural population of North China - A randomized controlled trial. Int J Cardiol 2016;215:377-82. https://doi.org/10.1016/j.ijcard.2016.04.073
  42. Juraschek SP, Miller ER 3rd, Weaver CM, Appel LJ. Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. J Am Coll Cardiol 2017;70:2841-8. https://doi.org/10.1016/j.jacc.2017.10.011
  43. Muth BJ, Brian MS, Chirinos JA, Lennon SL, Farquhar WB, Edwards DG. Central systolic blood pressure and aortic stiffness response to dietary sodium in young and middle-aged adults. J Am Soc Hypertens 2017;11:627-34. https://doi.org/10.1016/j.jash.2017.07.010
  44. Nielsen LH, Ovesen P, Hansen MR, Brantlov S, Jespersen B, Bie P, Jensen BL. Changes in the reninangiotensin-aldosterone system in response to dietary salt intake in normal and hypertensive pregnancy. A randomized trial. J Am Soc Hypertens 2016;10:881-890.e4. https://doi.org/10.1016/j.jash.2016.10.001
  45. Merino J, Guasch-Ferre M, Martinez-Gonzalez MA, Corella D, Estruch R, Fito M, Ros E, Aros F, Bullo M, Gomez-Gracia E, et al. Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study. Am J Clin Nutr 2015;101:440-8. https://doi.org/10.3945/ajcn.114.096750
  46. Kalogeropoulos AP, Georgiopoulou VV, Murphy RA, Newman AB, Bauer DC, Harris TB, Yang Z, Applegate WB, Kritchevsky SB. Dietary sodium content, mortality, and risk for cardiovascular events in older adults: the Health, Aging, and Body Composition (Health ABC) Study. JAMA Intern Med 2015;175:410-9. https://doi.org/10.1001/jamainternmed.2014.6278
  47. Okayama A, Okuda N, Miura K, Okamura T, Hayakawa T, Akasaka H, Ohnishi H, Saitoh S, Arai Y, Kiyohara Y, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open 2016;6:e011632. https://doi.org/10.1136/bmjopen-2016-011632
  48. Mente A, O'Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, Lear S, Ah ST, Wei L, Diaz R, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet 2018;392:496-506. https://doi.org/10.1016/S0140-6736(18)31376-X
  49. Cook NR, Appel LJ, Whelton PK. Lower levels of sodium intake and reduced cardiovascular risk. Circulation 2014;129:981-9. https://doi.org/10.1161/CIRCULATIONAHA.113.006032
  50. Prentice RL, Huang Y, Neuhouser ML, Manson JE, Mossavar-Rahmani Y, Thomas F, Tinker LF, Allison M, Johnson KC, Wassertheil-Smoller S, et al. Associations of biomarker-calibrated sodium and potassium intakes with cardiovascular disease risk among postmenopausal women. Am J Epidemiol 2017;186:1035-43. https://doi.org/10.1093/aje/kwx238
  51. Li Y, Huang Z, Jin C, Xing A, Liu Y, Huangfu C, Lichtenstein AH, Tucker KL, Wu S, Gao X. Longitudinal change of perceived salt intake and stroke risk in a chinese population. Stroke 2018;49:1332-9. https://doi.org/10.1161/STROKEAHA.117.020277
  52. Joosten MM, Gansevoort RT, Mukamal KJ, Lambers Heerspink HJ, Geleijnse JM, Feskens EJ, Navis G, Bakker SJ; PREVEND Study Group. Sodium excretion and risk of developing coronary heart disease. Circulation 2014;129:1121-8. https://doi.org/10.1161/CIRCULATIONAHA.113.004290
  53. Voortman T, Kiefte-de Jong JC, Ikram MA, Stricker BH, van Rooij FJ, Lahousse L, Tiemeier H, Brusselle GG, Franco OH, Schoufour JD. Adherence to the 2015 Dutch dietary guidelines and risk of noncommunicable diseases and mortality in the Rotterdam Study. Eur J Epidemiol 2017;32:993-1005. https://doi.org/10.1007/s10654-017-0295-2
  54. Takase H, Sugiura T, Kimura G, Ohte N, Dohi Y. Dietary sodium consumption predicts future blood pressure and incident hypertension in the Japanese normotensive general population. J Am Heart Assoc 2015;4:e001959. https://doi.org/10.1161/JAHA.115.001959
  55. Buendia JR, Bradlee ML, Daniels SR, Singer MR, Moore LL. Longitudinal effects of dietary sodium and potassium on blood pressure in adolescent girls. JAMA Pediatr 2015;169:560-8. https://doi.org/10.1001/jamapediatrics.2015.0411
  56. Timpka S, Stuart JJ, Tanz LJ, Rimm EB, Franks PW, Rich-Edwards JW. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study. BMJ 2017;358:j3024.
  57. Bertoia ML, Triche EW, Michaud DS, Baylin A, Hogan JW, Neuhouser ML, Tinker LF, Van Horn L, Waring ME, Li W, et al. Mediterranean and Dietary Approaches to Stop Hypertension dietary patterns and risk of sudden cardiac death in postmenopausal women. Am J Clin Nutr 2014;99:344-51. https://doi.org/10.3945/ajcn.112.056135
  58. Horikawa C, Yoshimura Y, Kamada C, Tanaka S, Tanaka S, Hanyu O, Araki A, Ito H, Tanaka A, Ohashi Y, et al. Dietary sodium intake and incidence of diabetes complications in Japanese patients with type 2 diabetes: analysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab 2014;99:3635-43. https://doi.org/10.1210/jc.2013-4315
  59. Umesawa M, Iso H, Fujino Y, Kikuchi S, Tamakoshi A; JACC Study Group. Salty food preference and intake and risk of gastric cancer: the JACC study. J Epidemiol 2016;26:92-7. https://doi.org/10.2188/jea.je20150023
  60. Wang Z, Koh WP, Jin A, Wang R, Yuan JM. Composite protective lifestyle factors and risk of developing gastric adenocarcinoma: the Singapore Chinese Health Study. Br J Cancer 2017;116:679-87. https://doi.org/10.1038/bjc.2017.7
  61. Carbone L, Johnson KC, Huang Y, Pettinger M, Thomas F, Cauley J, Crandall C, Tinker L, LeBoff MS, Wactawski-Wende J, et al. Sodium intake and osteoporosis. J Clin Endocrinol Metab 2016;101:1414-21. https://doi.org/10.1210/jc.2015-4017
  62. Lee H, Lee SE, Park CS, Park JJ, Lee GY, Kim MS, Choi JO, Cho HJ, Lee HY, Choi DJ, et al. Hyponatraemia and its prognosis in acute heart failure is related to right ventricular dysfunction. Heart 2018;104:1670-7. https://doi.org/10.1136/heartjnl-2017-312084
  63. Deckers IA, van den Brandt PA, van Engeland M, Soetekouw PM, Baldewijns MM, Goldbohm RA, Schouten LJ. Long-term dietary sodium, potassium and fluid intake; exploring potential novel risk factors for renal cell cancer in the Netherlands Cohort Study on diet and cancer. Br J Cancer 2014;110:797-801. https://doi.org/10.1038/bjc.2013.771
  64. Deckers IA, van Engeland M, van den Brandt PA, Van Neste L, Soetekouw PM, Aarts MJ, Baldewijns MM, Keszei AP, Schouten LJ. Promoter CpG island methylation in ion transport mechanisms and associated dietary intakes jointly influence the risk of clear-cell renal cell cancer. Int J Epidemiol 2017;46:622-31. https://doi.org/10.1093/ije/dyw266
  65. Kim MK, Kim K, Shin MH, Shin DH, Lee YH, Chun BY, Choi BY. The relationship of dietary sodium, potassium, fruits, and vegetables intake with blood pressure among Korean adults aged 40 and older. Nutr Res Pract 2014;8:453-62. https://doi.org/10.4162/nrp.2014.8.4.453
  66. Tabara Y, Takahashi Y, Kumagai K, Setoh K, Kawaguchi T, Takahashi M, Muraoka Y, Tsujikawa A, Gotoh N, Terao C, et al. Descriptive epidemiology of spot urine sodium-to-potassium ratio clarified close relationship with blood pressure level: the Nagahama study. J Hypertens 2015;33:2407-13. https://doi.org/10.1097/hjh.0000000000000734
  67. Noh HM, Park SY, Lee HS, Oh HY, Paek YJ, Song HJ, Park KH. Association between High blood pressure and intakes of sodium and potassium among Korean adults: Korean National Health and Nutrition Examination Survey, 2007-2012. J Acad Nutr Diet 2015;115:1950-7. https://doi.org/10.1016/j.jand.2015.04.021
  68. Xu J, Wang M, Chen Y, Zhen B, Li J, Luan W, Ning F, Liu H, Ma J, Ma G. Estimation of salt intake by 24-hour urinary sodium excretion: a cross-sectional study in Yantai, China. BMC Public Health 2014;14:136. https://doi.org/10.1186/1471-2458-14-136
  69. Hu Y, Wang Z, Wang Y, Wang L, Han W, Tang Y, Xue F, Hou L, Liang S, Zhang B, et al. Prevalence, awareness, treatment, and control of hypertension among Kazakhs with high salt intake in Xinjiang, China: a community-based cross-sectional study. Sci Rep 2017;7:45547. https://doi.org/10.1038/srep45547
  70. Park J, Kwock CK, Yang YJ. The effect of the sodium to potassium ratio on hypertension prevalence: a propensity score matching approach. Nutrients 2016;8:482. https://doi.org/10.3390/nu8080482
  71. Navia B, Aparicio A, Perea JM, Perez-Farinos N, Villar-Villalba C, Labrado E, Ortega RM. Sodium intake may promote weight gain; results of the FANPE study in a representative sample of the adult Spanish population. Nutr Hosp 2014;29:1283-9.
  72. Ge Z, Zhang J, Chen X, Yan L, Guo X, Lu Z, Xu A, Ma J. Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults? Public Health Nutr 2016;19:1074-80. https://doi.org/10.1017/S136898001500230X
  73. Huh JH, Lim JS, Lee MY, Chung CH, Shin JY. Gender-specific association between urinary sodium excretion and body composition: analysis of the 2008-2010 Korean National Health and Nutrition Examination Surveys. Metabolism 2015;64:837-44. https://doi.org/10.1016/j.metabol.2015.03.010
  74. Murakami K, Livingstone MB, Sasaki S, Uenishi K; Japan Dietetic Students' Study for Nutrition and Biomarkers Group. Ability of self-reported estimates of dietary sodium, potassium and protein to detect an association with general and abdominal obesity: comparison with the estimates derived from 24 h urinary excretion. Br J Nutr 2015;113:1308-18. https://doi.org/10.1017/S0007114515000495
  75. Ma Y, He FJ, MacGregor GA. High salt intake: independent risk factor for obesity? Hypertension 2015;66:843-9. https://doi.org/10.1161/HYPERTENSIONAHA.115.05948
  76. Grimes CA, Riddell LJ, Campbell KJ, He FJ, Nowson CA. 24-h urinary sodium excretion is associated with obesity in a cross-sectional sample of Australian schoolchildren. Br J Nutr 2016;115:1071-9. https://doi.org/10.1017/S0007114515005243
  77. Oh SW, Koo HS, Han KH, Han SY, Chin HJ. Associations of sodium intake with obesity, metabolic disorder, and albuminuria according to age. PLoS One 2017;12:e0188770. https://doi.org/10.1371/journal.pone.0188770
  78. Nam GE, Kim SM, Choi MK, Heo YR, Hyun TS, Lyu ES, Oh SY, Park HR, Ro HK, Han K, et al. Association between 24-h urinary sodium excretion and obesity in Korean adults: a multicenter study. Nutrition 2017;41:113-9. https://doi.org/10.1016/j.nut.2017.04.006
  79. Zhang X, Wang J, Li J, Yu Y, Song Y. A positive association between dietary sodium intake and obesity and central obesity: results from the National Health and Nutrition Examination Survey 1999-2006. Nutr Res 2018;55:33-44. https://doi.org/10.1016/j.nutres.2018.04.008