Can methods based on spot urine samples be used to estimate average population 24 h sodium excretion? Results from the Isfahan Salt Study

2019 ◽  
Vol 23 (2) ◽  
pp. 202-213 ◽  
Author(s):  
Noushin Mohammadifard ◽  
Hamidreza Marateb ◽  
Marjan Mansourian ◽  
Alireza Khosravi ◽  
Zahra Abdollahi ◽  
...  
Keyword(s):  
Healthy Volunteer ◽  
Validation Study ◽  
Salt Intake ◽  
Population Characteristics ◽  
Urine Samples ◽  
Urine Collection ◽  
Group Level ◽  
Spot Urine ◽  
Larger Sample ◽  
Urine Specimens

AbstractObjective:To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples.Design:A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics.Setting:Iranian adults recruited in 2014–2015.Participants:Healthy volunteer adults aged ≥18 years.Results:With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (−469 to −708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (–151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50).Conclusions:In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.

scholarly journals Estimating mean population salt intake in Fiji and Samoa using spot urine samples

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Joseph Alvin Santos ◽  
Emalie Rosewarne ◽  
Martyna Hogendorf ◽  
Kathy Trieu ◽  
Arti Pillay ◽  
...  
Keyword(s):  
Developing Countries ◽  
Salt Intake ◽  
Intraclass Correlation ◽  
Population Level ◽  
Urine Samples ◽  
Urine Collection ◽  
Cross Sectional ◽  
Spot Urine ◽  
Paired Samples ◽  
Secondary Analyses

Abstract Background There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa. Methods The study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses. Results A total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of − 0.92 g/day, 95% CI − 1.67 to − 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation. Conclusion These data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.

scholarly journals Estimating salt intake in a Caucasian population: can spot urine substitute 24-hour urine samples?

2013 ◽  
Vol 21 (10) ◽  
pp. 1300-1307 ◽  
Author(s):  
Ulla Toft ◽  
Charlotte Cerqueira ◽  
Anne Helms Andreasen ◽  
Betina Heinsbæk Thuesen ◽  
Peter Laurberg ◽  
...  
Keyword(s):  
Salt Intake ◽  
Caucasian Population ◽  
Urine Samples ◽  
Spot Urine

scholarly journals Correcting for Intra-Individual Variability in Sodium Excretion in Spot Urine Samples Does Not Improve the Ability to Predict 24 h Urinary Sodium Excretion

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2026
Author(s):  
Karen Elizabeth Charlton ◽  
Aletta Elisabeth Schutte ◽  
Leanda Wepener ◽  
Barbara Corso ◽  
Paul Kowal ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Individual Variation ◽  
Sodium Excretion ◽  
Distribution Curve ◽  
Salt Intake ◽  
Individual Variability ◽  
Urinary Sodium ◽  
Urine Samples ◽  
Prediction Equations ◽  
Spot Urine

Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.

A13673 Estimating mean population salt intake in Fiji and Samoa using spot urine samples

2018 ◽  
Vol 36 ◽  
pp. e322
Author(s):  
Joseph Alvin Santos ◽  
Kathy Trieu ◽  
Merina Ieremia ◽  
Arti Pillay ◽  
Leausa Toleafoa Take Naseri ◽  
...  
Keyword(s):  
Salt Intake ◽  
Urine Samples ◽  
Spot Urine

scholarly journals Mean Dietary Salt Intake in Vanuatu: A Population Survey of 755 Participants on Efate Island

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 916
Author(s):  
Katherine Paterson ◽  
Nerida Hinge ◽  
Emalie Sparks ◽  
Kathy Trieu ◽  
Joseph Alvin Santos ◽  
...  
Keyword(s):  
Salt Intake ◽  
Urine Samples ◽  
World Health ◽  
Dietary Salt ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Dietary Salt Intake ◽  
Spot Urine ◽  
Salt Consumption

Non-communicable diseases are responsible for 63% of global deaths, with a higher burden in low- and middle-income countries. Hypertension is the leading cause of cardiovascular-disease-related deaths worldwide, and approximately 1.7 million deaths are directly attributable to excess salt intake annually. There has been little research conducted on the level of salt consumption amongst the population of Vanuatu. Based on data from other Pacific Island countries and knowledge of changing regional diets, it was predicted that salt intake would exceed the World Health Organization’s (WHO) recommended maximum of 5 g per day. The current study aimed to provide Vanuatu with a preliminary baseline assessment of population salt intake on Efate Island. A cross-sectional survey collected demographic, clinical, and urine data from participants aged 18 to 69 years in rural and urban communities on Efate Island in October 2016 and February 2017. Mean salt intake was determined to be 7.2 (SD 2.3) g/day from spot urine samples, and 5.9 (SD 3.6) g/day from 24-h urine samples, both of which exceed the WHO recommended maximum. Based on the spot urine samples, males had significantly higher salt intake than females (7.8 g compared to 6.5 g; p < 0.001) and almost 85% of the population consumed more than the WHO recommended maximum daily amount. A coordinated government strategy is recommended to reduce salt consumption, including fiscal policies, engagement with the food industry, and education and awareness-raising to promote behavior change.

scholarly journals Effectiveness of a Communication for Behavioral Impact ( COMBI ) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples

2016 ◽  
Vol 18 (11) ◽  
pp. 1135-1142 ◽  
Author(s):  
Ha Thi Phuong Do ◽  
Joseph Alvin Santos ◽  
Kathy Trieu ◽  
Kristina Petersen ◽  
Mai Bach Le ◽  
...  
Keyword(s):  
Salt Intake ◽  
Urine Samples ◽  
Spot Urine ◽  
Behavioral Impact

scholarly journals Correlation Between Spot Urine Sodium, 24 Hour Urinary Sodium and Food Frequency Questionnairein Estimation of Salt Intake in Healthy Individuals

2020 ◽  
Vol 5 (1) ◽  
pp. 74
Author(s):  
Jaafar Maryam Kamiliah ◽  
Nordin Nani ◽  
Abdul Rahman Abdul Rashid
Keyword(s):  
Salt Intake ◽  
Sodium Intake ◽  
Cost Effective ◽  
Urinary Sodium ◽  
Urine Samples ◽  
Urine Sodium ◽  
Gold Standard Method ◽  
Food Frequency ◽  
Spot Urine ◽  
Daily Sodium Intake

Background:Salt intake is a known contributor to increased blood pressure. However, it is rarely monitored in clinical practice. 24-hr urinary sodium (24-HrNa) is the gold standard method to estimate salt intake but this method is rather burdensome.Objective: The objective of this study is to correlate between spot urine sodium (SUNa), 24-HrNa and Na intake estimation by food frequency questionnaire (FFQ) (FFQNa).Methods : 430 healthy participants aged between 20-40 years old were recruited. Second morning voided urine samples were obtained from all participants to estimate SUNa. 24-HrNa samples were obtained from 77 out of 430 participants. All participants were required to answer a validated FFQ. Urine samples were analysed for Na using indirect ion-selective electrode (ISE) method. Daily sodium intake was calculated from the FFQ.Results:The mean daily sodium intake from 24-hrNa (n=77) was 155 mmol/day, SUNa (n=430) was 158 mmol/L and FFQNa (n=430) was 271 mmol/day. There was a moderate correlation between SUNa and 24-hrNa (ρ = 0.62, P < 0.000). No correlation was seen between both 24-hrNa and SUNa with FFQNa (ρ = 0.035, P = 0.768 and ρ = 0.026, P = 0.597 respectively).Conclusion: Spot urine Na is a simple cost-effective method to estimate daily Na intake and has the potential to replace 24-hour urinary Na.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 74-80

scholarly journals Diagnostic usefulness of the spot urine sodium/potassium ratio in cirrhotic patients with ascites

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253886
Author(s):  
Jin Wook Lee ◽  
Jae Seok Hwang ◽  
Woo Jin Chung ◽  
Heon Ju Lee ◽  
Jung Gil Park ◽  
...  
Keyword(s):  
Urine Samples ◽  
Urine Collection ◽  
Urine Sodium ◽  
Salt Diet ◽  
Spot Urine ◽  
Number Of Patients ◽  
Low Salt ◽  
Diagnostic Usefulness ◽  
Diet Compliance ◽  
Cirrhotic Patients

Background and aims The low-salt diet is considered important for control of ascites in cirrhotic patients. To validate whether the spot urine sodium (Na)/potassium (K) ratio could replace 24-h urine Na (uNa) excretion in assessing low-salt diet compliance. Methods We prospectively studied 175 patients. 24-h urine collection and spot urine collection were performed. Subsequently, 24-h uNa, urine creatinine (uCr), and spot urine Na and K were assessed. A complete urine collection was confirmed based on 24-h uCr excretion levels of 15mg/kg/day for men and 10mg/kg/day for women. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the feasibility of spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day. Results Out of 175 patients, 24-h urine samples were completely collected in 57 patients only. Moreover, urine samples were not completely collected in 118 patients because their 24-h uCr excretion level was less than the established criteria. In complete urine collection group, AUROC curve for spot urine Na/K ratio in predicting 24-h uNa greater than 78mmol/day was 0.874±0.051 (P<0.001). In the incomplete urine collection group, the AUROC was 0.832±0.039 (P<0.001). In complete urine collection group, the classical cutoff value greater than 1.0 of spot urine Na/K ratio showed 90.9% sensitivity and 56.0% specificity. Conclusions The spot urine Na/K ratio reflects 24-h uNa, but the AUROC value obtained in this study is lower than that of a previous study. Considered the large number of patients with incomplete urine collection, validating 24-h complete urine collection criteria is necessary.

Low correlation between morning spot and 24-hour urine samples for estimating sodium intake in an Iranian population: Isfahan Salt Study

2019 ◽  
Vol 89 (3-4) ◽  
pp. 185-191
Author(s):  
Alireza Khosravi ◽  
Noushin Mohammadifard ◽  
Mojagn Gharipour ◽  
Zahra Abdollahi ◽  
Fatemeh Nouri ◽  
...  
Keyword(s):  
Sodium Excretion ◽  
Salt Intake ◽  
Iranian Population ◽  
Urine Samples ◽  
Potassium Excretion ◽  
Urine Sodium ◽  
Gold Standard Method ◽  
Spot Urine ◽  
Sodium And Potassium ◽  
Tanaka Formula

Abstract. Introduction: Although difficult, the 24-hour urine sodium excretion is still considered as the gold standard method to estimate salt intake. The current study aimed to assess the validity of using spot urine samples in comparison with the standard 24-hour urine collection to estimate sodium and potassium intake in healthy Iranian adults. Methods and subjects: This cross-sectional study was performed on 1099 healthy Iranians aged 18–69 years. Samples of 24-hour and fasting morning spot urine were collected to measure sodium and potassium excretions. Tanaka’s formula was utilized to predict the 24-hour sodium and potassium urinary excretions based on the spot values. Results: The difference between measured and estimated sodium excretion values was 4265 mg/day (95% CI: 4106–4424; P < 0.001) and 2242 mg/day in case of potassium excretion (95% CI: 2140–2344; P < 0.001). There was a weak significant correlation between the 24-hour urine sodium and potassium excretion and the predicted values (intraclass correlations: 0.22 and 0.28, respectively; both P < 0.001). Conclusion: The weak association between the predicted and measured values of sodium and potassium along with the marked overestimation of daily sodium and potassium excretions based on the spot urine and using Tanaka formula indicates that Tanaka formula is not practical for the prediction of sodium and potassium or salt intake in Iranian adults. Using other spot urine sampling times and/or adopting a formula designed based on the characteristics of the Iranian population may increase the validity of spot urine tests.

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