Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
University of Florida Health Cancer Center, University of Florida, Gainesville.
JAMA Netw Open. 2024 Mar 4;7(3):e243802. doi: 10.1001/jamanetworkopen.2024.3802.
Epidemiologic evidence regarding the outcomes of dietary sodium intake on mortality remains limited for low-income individuals, particularly Black people.
To investigate the associations of excessive dietary sodium with all-cause and cause-specific mortality among predominantly low-income Black and White Americans.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants aged 40 to 79 years from the Southern Community Cohort Study who were recruited at Community Health Centers in 12 southeastern states from 2002 to 2009. Analyses were conducted between March 2022 and June 2023.
Dietary sodium intake was assessed using a validated food frequency questionnaire at baseline.
Multivariable-adjusted Cox regression was used to estimate hazard ratios (HRs) and 95% CIs for mortality outcomes (all-cause, cardiovascular disease [CVD], coronary heart disease [CHD], stroke, heart failure, cancer, and other) associated with sodium intake. Nonlinear associations and population-attributable risk (PAR) of the mortality burden associated with excess sodium were further assessed.
Among the 64 329 participants, 46 185 (71.8%) were Black, 18 144 (28.2%) were White, and 39 155 (60.9%) were female. The mean (SD) age at study enrollment was 51.3 (8.6) years for Black participants and 53.3 (9.3) years for White counterparts. Mean (SD) dietary sodium intake was 4512 (2632) mg/d in Black individuals and 4041 (2227) mg/d in White individuals; 37 482 Black individuals (81.2%) and 14 431 White individuals (79.5%) exceeded the current dietary recommendations of 2300 mg/d. During a median (IQR) follow-up of 13.8 (11.3-15.8) years, 17 811 deaths were documented, including 5701 from CVD. After adjustment for potential confounders, in Black individuals, HRs per 1000-mg increase in daily sodium intake were 1.07 (95% CI, 1.03-1.10) and 1.08 (95% CI, 1.02-1.14) for deaths from total CVD and CHD, respectively; while in White individuals, the corresponding HRs were 1.08 (95% CI, 1.02-1.14) and 1.13 (95% CI, 1.03-1.23). No significant associations were found for cancer mortality. PAR estimates suggest that sodium intake above the recommended threshold may account for 10% of total CVD, 13% of CHD, and 30% of heart failure deaths in this low-income southern population.
In this cohort study of 64 329 low-income Americans, nearly 80% of study participants consumed sodium exceeding the current recommended daily amount, which was associated with 10% to 30% of CVD mortality. Public health programs targeted to reduce sodium intake among this underserved population may be beneficial.
关于低收入人群，特别是黑人，饮食钠摄入量对死亡率的影响的流行病学证据仍然有限。
调查在主要为低收入的黑人和白种人中，过量的饮食钠与全因和病因特异性死亡率之间的关联。
设计、地点和参与者：这项队列研究包括来自南方社区队列研究的年龄在 40 至 79 岁的参与者，他们是在 2002 年至 2009 年从 12 个东南部州的社区健康中心招募的。分析于 2022 年 3 月至 2023 年 6 月进行。
在基线时使用经过验证的食物频率问卷评估饮食钠摄入量。
使用多变量调整的 Cox 回归来估计与钠摄入量相关的死亡率结果（全因、心血管疾病[CVD]、冠心病[CHD]、中风、心力衰竭、癌症和其他）的风险比（HR）和 95%置信区间（CI）。进一步评估了与过量钠相关的死亡率负担的非线性关联和人群归因风险（PAR）。
在 64329 名参与者中，46185 名（71.8%）为黑人，18144 名（28.2%）为白人，39155 名（60.9%）为女性。黑人参与者的平均（SD）研究入组年龄为 51.3（8.6）岁，白人参与者的平均（SD）年龄为 53.3（9.3）岁。黑人个体的平均（SD）饮食钠摄入量为 4512（2632）mg/d，而白人个体的摄入量为 4041（2227）mg/d；37482 名黑人个体（81.2%）和 14431 名白人个体（79.5%）超过了目前 2300mg/d 的饮食建议。在中位数（IQR）随访 13.8（11.3-15.8）年期间，记录了 17811 例死亡，其中 5701 例死于 CVD。在调整了潜在混杂因素后，黑人个体中，每日钠摄入量增加 1000mg 与总 CVD 和 CHD 死亡的 HR 分别为 1.07（95%CI，1.03-1.10）和 1.08（95%CI，1.02-1.14）；而在白人个体中，相应的 HR 分别为 1.08（95%CI，1.02-1.14）和 1.13（95%CI，1.03-1.23）。癌症死亡率没有显著关联。PAR 估计表明，在这个低收入的南方人群中，钠摄入量超过推荐阈值可能导致 10%的 CVD 总死亡、13%的 CHD 死亡和 30%的心力衰竭死亡。
在这项对 64329 名低收入美国成年人的队列研究中，近 80%的研究参与者摄入的钠超过了目前推荐的每日摄入量，这与 10%至 30%的 CVD 死亡率有关。针对这一服务不足人群减少钠摄入量的公共卫生计划可能是有益的。
