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      Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide

      research-article
      1 , 1 , 2 , 3 , 2 , 2 , 4 , 5 , 5 , 2 , 6 , 2 , 7 , on behalf of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE)
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      BMJ Open
      BMJ Publishing Group
      Nutrition & Dietetics, Epidemiology, Hypertension < Cardiology, Preventive Medicine

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          Abstract

          Objectives

          To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010.

          Design

          Bayesian hierarchical modelling using all identifiable primary sources.

          Data sources and eligibility

          We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements.

          Modelling methods

          Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies.

          Main outcome measures

          Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses.

          Results

          In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88–10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/North Africa (3.9–4.2 g/day). Regional mean intakes in North America, Western Europe and Australia/New Zealand ranged from 3.4 to 3.8 g/day. Intakes were lower (<3.3 g/day), but more uncertain, in sub-Saharan Africa and Latin America. Between 1990 and 2010, modest, but uncertain, increases in sodium intakes were identified.

          Conclusions

          Sodium intakes exceed the recommended levels in almost all countries with small differences by age and sex. Virtually all populations would benefit from sodium reduction, supported by enhanced surveillance.

          Related collections

          Most cited references15

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          • Article: not found

          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study.

            This paper describes the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000. The purpose of the study was to assess dietary measurement error using two self-reported dietary instruments-the food frequency questionnaire (FFQ) and the 24-hour dietary recall (24HR)-and unbiased biomarkers of energy and protein intakes: doubly labeled water and urinary nitrogen. Participants were 484 men and women aged 40-69 years from Montgomery County, Maryland. Nine percent of men and 7% of women were defined as underreporters of both energy and protein intake on 24HRs; for FFQs, the comparable values were 35% for men and 23% for women. On average, men underreported energy intake compared with total energy expenditure by 12-14% on 24HRs and 31-36% on FFQs and underreported protein intake compared with a protein biomarker by 11-12% on 24HRs and 30-34% on FFQs. Women underreported energy intake on 24HRs by 16-20% and on FFQs by 34-38% and underreported protein intake by 11-15% on 24HRs and 27-32% on FFQs. There was little underreporting of the percentage of energy from protein for men or women. These findings have important implications for nutritional epidemiology and dietary surveillance.
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              • Article: not found

              Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group.

              The relations between 24 hour urinary electrolyte excretion and blood pressure were studied in 10,079 men and women aged 20-59 sampled from 52 centres around the world based on a highly standardised protocol with central training of observers, a central laboratory, and extensive quality control. Relations between electrolyte excretion and blood pressure were studied in individual subjects within each centre and the results of these regression analyses pooled for all 52 centres. Relations between population median electrolyte values and population blood pressure values were also analysed across the 52 centres. Sodium excretion ranged from 0.2 mmol/24 h (Yanomamo Indians, Brazil) to 242 mmol/24 h (north China). In individual subjects (within centres) it was significantly related to blood pressure. Four centres found very low sodium excretion, low blood pressure, and little or no upward slope of blood pressure with age. Across the other 48 centres sodium was significantly related to the slope of blood pressure with age but not to median blood pressure or prevalence of high blood pressure. Potassium excretion was negatively correlated with blood pressure in individual subjects after adjustment for confounding variables. Across centres there was no consistent association. The relation of sodium to potassium ratio to blood pressure followed a pattern similar to that of sodium. Body mass index and heavy alcohol intake had strong, significant independent relations with blood pressure in individual subjects.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2013
                20 December 2013
                : 3
                : 12
                : e003733
                Affiliations
                [1 ]Department of Public Health and Primary Care, Cambridge Institute of Public Health , Cambridge, UK
                [2 ]Department of Epidemiology, Harvard School of Public Health , Boston, Massachusetts, USA
                [3 ]Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
                [4 ]MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
                [5 ]Institute for Health Metrics and Evaluation, University of Washington , Seattle, Washington, USA
                [6 ]Department of Global Health and Population, Harvard School of Public Health , Boston, Massachusetts, USA
                [7 ]Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
                Author notes
                [Correspondence to ] Dr John Powles; jwp11@ 123456cam.ac.uk

                JP and SF contributed equally.

                Article
                bmjopen-2013-003733
                10.1136/bmjopen-2013-003733
                3884590
                24366578
                8c792abd-5eee-490e-8171-dfe0e895cb83
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

                History
                : 5 August 2013
                : 9 October 2013
                : 5 November 2013
                Categories
                Global Health
                Research
                1506
                1699
                1683
                1714
                1724

                Medicine
                nutrition & dietetics,epidemiology,hypertension < cardiology,preventive medicine
                Medicine
                nutrition & dietetics, epidemiology, hypertension < cardiology, preventive medicine

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