Hong Jae Won, Noh Jung Hyun, Kim Dong-Jun
From the Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea.
Medicine (Baltimore). 2016 Mar;95(9):e2864. doi: 10.1097/MD.0000000000002864.
Although reducing dietary salt consumption is the most cost-effective strategy for preventing progression of cardiovascular and renal disease, policy-based approaches to monitor sodium intake accurately and the understanding factors associated with excessive sodium intake for the improvement of public health are lacking. We investigated factors associated with high sodium intake based on the estimated 24-hour urinary sodium excretion, using data from the 2009 to 2011 Korea National Health and Nutrition Examination Survey (KNHANES). Among 21,199 adults (≥19 years of age) who participated in the 2009 to 2011 KNHANES, 18,000 participants (weighted n = 33,969,783) who completed urinary sodium and creatinine evaluations were analyzed in this study. The 24-hour urinary sodium excretion was estimated using Tanaka equation. The mean estimated 24-hour urinary sodium excretion level was 4349 (4286-4413) mg per day. Only 18.5% (weighted n = 6,298,481/3,396,973, unweighted n = 2898/18,000) of the study participants consumed less the 2000 mg sodium per day. Female gender (P < 0.001), older age (P < 0.001), total energy intake ≥50 percentile (P < 0.005), and obesity (P < 0.001) were associated with high sodium intake, even after adjusting for potential confounders. Senior high school/college graduation in education and managers/professionals in occupation were associated with lower sodium intake (P < 0.001). According to hypertension management status, those who had hypertension without medication consumed more sodium than those who were normotensive. However, those who receiving treatment for hypertension consumed less sodium than those who were normotensive (P < 0.001). The number of family members, household income, and alcohol drinking did not affect 24-hour urinary sodium excretion. The logistic regression analysis for the highest estimated 24-hour urinary sodium excretion quartile (>6033 mg/day) using the abovementioned variables as covariates yielded identical results. Our data suggest that age, sex, education level, occupation, total energy intake, obesity, and hypertension management status are associated with excessive sodium intake in Korean adults using nationally representative data. Factors associated with high sodium intake should be considered in policy-based interventions to reduce dietary salt consumption and prevent cardiovascular disease as a public health target.
尽管减少饮食中的盐摄入量是预防心血管疾病和肾脏疾病进展最具成本效益的策略，但目前缺乏基于政策的准确监测钠摄入量的方法，也缺乏对与过量钠摄入相关因素的了解，以促进公众健康。我们利用2009年至2011年韩国国家健康与营养检查调查（KNHANES）的数据，根据估计的24小时尿钠排泄量，调查了与高钠摄入相关的因素。在参与2009年至2011年KNHANES的21199名成年人（≥19岁）中，本研究分析了18000名完成尿钠和肌酐评估的参与者（加权n = 33969783）。使用田中方程估算24小时尿钠排泄量。估计的24小时尿钠排泄量平均水平为每天4349（4286 - 4413）毫克。只有18.5%（加权n = 6298481/3396973，未加权n = 2898/18000）的研究参与者每天摄入的钠少于2000毫克。即使在调整潜在混杂因素后，女性（P < 0.001）、年龄较大（P < 0.001）、总能量摄入量≥第50百分位数（P < 0.005）和肥胖（P < 0.001）与高钠摄入相关。教育程度为高中/大学毕业以及职业为经理/专业人员与较低的钠摄入量相关（P < 0.001）。根据高血压管理状况，未服药的高血压患者比血压正常者摄入更多的钠。然而，接受高血压治疗的患者比血压正常者摄入更少的钠（P < 0.001）。家庭成员数量、家庭收入和饮酒对24小时尿钠排泄量没有影响。使用上述变量作为协变量对估计的24小时尿钠排泄量最高四分位数（>6033毫克/天）进行逻辑回归分析，得到了相同的结果。我们的数据表明，利用具有全国代表性的数据，年龄、性别、教育水平、职业、总能量摄入量、肥胖和高血压管理状况与韩国成年人过量钠摄入相关。在基于政策的干预措施中，应考虑与高钠摄入相关的因素，以减少饮食中的盐摄入量，并将预防心血管疾病作为公共卫生目标。
