scholarly journals Using Spot Urine Samples to Estimate Sodium and Potassium intake in Healthy vs CKD Patients: Results from a Controlled Feeding Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1822-1822
Author(s):  
Andrea Lobene ◽  
Elizabeth Stremke ◽  
George McCabe ◽  
Sharon Moe ◽  
Ranjani Moorthi ◽  
...  
Keyword(s):  
Urine Sample ◽  
Mixed Model ◽  
Cardiovascular Health ◽  
Linear Mixed Model ◽  
Secondary Analysis ◽  
Urine Samples ◽  
Inpatient Setting ◽  
Spot Urine ◽  
Feeding Study ◽  
Funding Sources

Abstract Objectives Evaluating sodium (Na) and potassium (K) intake is important as both have implications for blood pressure and cardiovascular health, especially in individuals with chronic kidney disease (CKD). Spot urine samples may be used to estimate Na and K intake with several published equations, but the accuracy has not been thoroughly explored. Our objective was to compare estimated 24-hour urinary Na and K excretion (e24hUNa and e24hUK), calculated from a spot urine sample using published equations, to measured 24hUNa and 24hUK and Na and K intake, and to determine if there are differences between healthy and CKD participants. Methods This is a secondary analysis of a controlled feeding study in participants with moderate CKD matched to healthy adults (n = 16). Participants consumed a controlled diet for 9 days, providing ∼2400 mg Na/d and ∼3000 mg K/d. On days 7 and 8, participants collected all urine in an inpatient setting. Urine Na and K were analyzed by ICP and urine creatinine by the Jaffe reaction. The day 7 fasting urine sample was used to calculate e24hUNa using 2 equations and e24huK using 1 equation. Log-transformed Na intake, measured 24hUNa, and e24hUNa were compared using a general linear mixed model and partial correlations, and agreement between Na intake and e24hUNa was assessed using Bland-Altman plots. Similar analyses were run for K. Results Participants were aged 54.6 ± 13.0 y, n = 8 were female, n = 6 were black, and n = 10 were white. In CKD participants, eGFR was 40.7 ± 7.9 mL/min. Average Na intake on day 7 was 2138 ± 302 mg and K intake was 2528 ± 254 mg. Na intake, measured 24hUNa, and e24hUNa were not significantly different (P = 0.17) or correlated with each other (all P > 0.20) and there was no significant interaction with CKD status (P = 0.51). However, both e24hUNa were ∼500 mg higher than Na intake. For K, e24hUK was significantly different from K intake (P < 0.001) and measured 24hUK (P = 0.02), with no interaction with CKD (P = 0.53). K intake, measured 24hUK, and e24hUK were not correlated (all P > 0.05). Bland-Altman plots show poor agreement between both e24hUNa and Na intake and e24hUK and K intake. Conclusions Estimated 24hUNa and estimated 24hUK are poor predictors of Na and K intake, respectively, in both healthy and CKD participants. Results should be confirmed in a larger sample. Funding Sources Indiana CTSI (funded by NCATS CTSA program), NIDDK.

scholarly journals Estimated 24-hour Sodium Excretion from Available Equations Is a Poor Predictor of Intake (OR15-06-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Andrea Lobene ◽  
Berdine Martin ◽  
George McCabe ◽  
Connie Weaver
Keyword(s):  
Intervention Study ◽  
Secondary Analysis ◽  
Urine Samples ◽  
Rank Tests ◽  
Spot Urine ◽  
Funding Sources ◽  
Signed Rank ◽  
Dietary Potassium ◽  
Research And Education ◽  
The Relationship

Abstract Objectives Accurate estimates of sodium (Na) intake are critical for advancing our understanding of Na and cardiovascular disease. The aim of this study was to utilize data from a controlled feeding study to assess the agreement between estimated 24hUNa, calculated from several timed spot urine collections, and known Na intake. Methods This secondary analysis used data from the control phase of a potassium intervention study in normotensive men and women (n = 39) to avoid the potential confounding factor of dietary potassium manipulation. Participants followed the controlled diet containing on average 3463 mg Na/d for 3 days. On day 4, participants ate 3 meals in a clinic setting and collected urine every 2 hours starting with a fasting second void. The 24-hour urine collection was completed with the first morning void the following day. Spot urine samples were analyzed for Na and estimated 24hUNa was calculated from all samples using the INTERSALT and Tanaka equations, and from only the fasting second collection using the Kawasaki equation. The relationship between estimated 24hUNa and Na intake was assessed using Spearman correlations, and agreement between estimated 24hUNa and intake was assessed using Wilcoxon Signed Rank Tests and Bland Altman plots. Results For all timed spot urine samples, estimated 24hUNa using INTERSALT and Kawasaki were significantly correlated with Na intake (all P < 0.05), whereas estimates using Tanaka were not significantly correlated with intake (all P > 0.05). For all timed spot urine samples, estimated 24hUNa using INTERSALT was significantly different from Na intake (all P < 0.05). All estimates of 24hUNa using Tanaka were significantly different from Na intake (all P < 0.05) except from estimates from the 2-hour sample (P = 0.172) and the first void at 24 hours (P = 0.102). Estimate of 24hUNa using Kawasaki was not significantly different from intake (P = 0.635). Bland Altman plots showed high levels of bias, especially at higher and lower levels of intake. Conclusions These results suggest that, regardless of timing of collection and choice of equation, estimated 24hUNa is not a valid indicator of actual Na intake. New equations that directly estimate Na intake are needed. Funding Sources The parent study was funded by the Alliance for Potato Research and Education (APRE).

scholarly journals 4438 Twenty-four-hour Urinary Sodium Excretion Estimated from a Spot Urine Sample May Be Used as an Indicator of Intake in CKD Patients

2020 ◽  
Vol 4 (s1) ◽  
pp. 40-41
Author(s):  
Andrea Lobene ◽  
Elizabeth Stremke ◽  
Ranjani Moorthi ◽  
Sharon Moe ◽  
Kathleen M Hill Gallant
Keyword(s):  
Urine Sample ◽  
Repeated Measures ◽  
Inductively Coupled Plasma ◽  
Secondary Analysis ◽  
Optical Emission ◽  
Urinary Sodium Excretion ◽  
Inpatient Setting ◽  
Spot Urine ◽  
Inductively Coupled ◽  
Spot Urine Sample

OBJECTIVES/GOALS: Sodium (Na) intake can elevate blood pressure and is a factor in developing chronic kidney disease (CKD). Twenty-four-hour urinary Na (24hUNa) is the gold standard for assessing Na intake but is burdensome. Validated equations estimate 24hUNa (e24hUNa) from a spot urine sample, but these estimations are not validated against a known Na intake in CKD. METHODS/STUDY POPULATION: The current study is a secondary analysis of a 9-day controlled feeding study in moderate CKD patients matched to healthy adults. Only CKD patients were used for the current analyses (n = 8). Participants consumed a controlled diet for 9 days, providing ~2400 mg Na/d as determined by inductively coupled plasma optical emission spectroscopy (ICP). On days 7 and 8, participants collected all urine in an inpatient setting, beginning with a fasting sample on day 7. Urine sample mineral analyses were performed by ICP and urinary creatinine by the Jaffe reaction. The day 7 fasting urine sample was used to calculate e24hUNa using 6 published equations. Log-transformed Na intake, measured 24hUNa, and e24hUNa were compared by repeated-measures ANOVA with planned contrasts using SAS. RESULTS/ANTICIPATED RESULTS: Fifty percent of the CKD patients (n = 4) were female; 63% (n = 5) were white, and 37% (n = 3) were black. On average, participants were aged 56.6 ± 13.8 y with a BMI of 31.7 ± 9.4 kg/m2 and eGFR of 40.7 ± 7.9 mL/min. Based on actual food intake, average Na intake on day 7 was 2024 ± 388 mg. Average measured 24hUNa was 2529 ± 1334 mg. The main ANOVA was significant (p = 0.02). Results from the planned contrasts found that e24hUNa from the SALTED cohort, an equation developed specifically for CKD patients, was significantly higher than both Na intake (p<0.001) and measured 24hUNa (p = 0.007). For the remaining 5 equations, e24hUNa was not significantly different from measured 24hUNa nor dietary Na intake. DISCUSSION/SIGNIFICANCE OF IMPACT : Our results suggest that e24hUNa calculated using most published equations may provide a reliable and low-burden method of assessing dietary Na intake in moderate CKD patients. These findings should be confirmed in larger samples. Additional studies are needed to validate or dispute the use of the SALTED equation for estimating Na intake.

Abstract 015: Critical Periods in Cardiovascular Health Across the Life Course: A Pooled Cohort Analysis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Norrina B Allen ◽  
Amy Krefman ◽  
Darwin Labarthe ◽  
Philip Greenland ◽  
Markus Juonala ◽  
...  
Keyword(s):  
Change Point ◽  
Mixed Model ◽  
Cardiovascular Health ◽  
Linear Mixed Model ◽  
Cohort Analysis ◽  
Change Points ◽  
Rapid Decline ◽  
Critical Periods ◽  
Ideal Cardiovascular Health ◽  
Inflection Points

Background: The prevalence of Ideal Cardiovascular Health (CVH) decreases with age, beginning in childhood. However, more precise estimates of trajectories of CVH across the lifespan are needed to guide intervention. The aims of this analysis are to describe trajectories in CVH from childhood through middle age and examine whether there are critical inflection points in the decline in CVH. Methods: We pooled data from five prospective childhood/early adulthood cohorts including Bogalusa, Young Finns, HB!, CARDIA, and STRIP. Clinical CVH factors—blood pressure, BMI, cholesterol, glucose—were categorized as poor, intermediate and ideal then summed to create a clinical CVH score, ranging from 0 to 8 (higher score= more ideal CVH). The association between clinical CVH score and age in years was modeled using a segmented linear mixed model, with a random participant intercept, fixed slopes, and fixed change points. Change points were estimated using an extension of the R package ‘segmented’ which utilizes a likelihood based approach to iteratively determine one or more change points. All models were adjusted for race, gender and cohort. Results: This study included 18,290 participants (51% female, 67% White, 46% between the ages of 8-11 at baseline). CVH scores decline with age from 8 through 55 years. We found two ages at which the slope of the CVH trajectories change significantly. CVH scores are generally stable from age 8 until the first change point at age 17 (95% CI 16.3-17.4), when they begin to decline more rapidly with a 0.08 CVH unit loss per year from age 17 to 30. The second change point occurs at age 30 (26.7-33.6) when the rate of decline increases by an additional 0.01 units per year. Conclusion: The clinical CVH score declines from favorable levels from childhood through adulthood, with a rapid decline starting at age 17 that becomes slightly steeper from age 30 to 55 years. These inflection points signal that there are critical periods in an individual’s clinical CVH trajectory during which prevention efforts may be targeted.

scholarly journals Influencing cardiovascular health habits in the rural, deep south: results of a cluster randomized trial

2019 ◽  
Vol 34 (2) ◽  
pp. 200-208
Author(s):  
Laurie S Abbott ◽  
Elizabeth H Slate ◽  
Jennifer L Lemacks
Keyword(s):  
Health Program ◽  
Mixed Model ◽  
Cardiovascular Health ◽  
Linear Mixed Model ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Cvd Risk ◽  
Health Habits ◽  
Cluster Randomized

Abstract Cardiovascular disease (CVD) is a major cause of death among people living in the United States. Populations, especially minorities, living in the rural South are disproportionately affected by CVD and have greater CVD risk, morbidity and mortality. Culturally relevant cardiovascular health programs implemented in rural community settings can potentially reduce CVD risk and facilitate health behavior modification. The purpose of this study was to examine the effects of a cardiovascular health promotion intervention on the health habits of a group of rural African American adults. The study had a cluster randomized controlled trial design involving 12 rural churches that served as statistical clusters. From the churches (n = 6) randomized to the intervention group, 115 participants were enrolled, received the 6-week health program and completed pretest–posttest measures. The 114 participants from the control group churches (n = 6) did not receive the health program and completed the same pretest–posttest measures. The linear mixed model was used to compare group differences from pretest to posttest. The educational health intervention positively influenced select dietary and confidence factors that may contribute toward CVD risk reduction.

scholarly journals Novel Fiber Formulation Does Not Alter Cardiometabolic Profiles in Overweight Participants Consuming Low-Fiber Diets

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 757-757
Author(s):  
Jea Woo Kang ◽  
Chenghao Zhu ◽  
Christopher Rhodes ◽  
Hannah Houts ◽  
Jingyuan Zheng ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Statistical Significance ◽  
Rice Flour ◽  
Lipid Profiles ◽  
Funding Sources ◽  
Fiber Diet ◽  
High Interindividual Variability ◽  
Dietary Records ◽  
Fiber Consumption

Abstract Objectives The objective of this study was to determine whether a novel fiber formulation improves glucose, insulin, and lipid profiles in overweight men and women consuming a low fiber diet. Methods Twenty individuals were enrolled in this randomized order, placebo-controlled, cross-over study. Participants were young, healthy, overweight (BMI 23.0–32.0) and consumed &lt;15 g/day of fiber. All participants consumed the fiber and placebo supplement for a period of 4 weeks each, with a 4-week washout between intervention arms. Participants recorded their diet for 3 days using dietary records twice during each 4-week segment. They consumed either fiber and/or placebo packet containing a total of 12 g/serving per day. The Fiber and/or Placebo was given out as powder form which include mostly dietary fiber (resistant starch, fructooligosaccharide, sugarcane fiber, and inulin), rice flour, xanthan gum, and fruit powders that was mixed with water for consumption. Questionnaires, anthropometric measurements, blood draws, and stool samples were collected at each study visit. Changes in glucose, insulin, and lipid profile (total cholesterol (TC), triacylglycerols (TG), HDL-C and calculated LDL-C) were assessed using a linear mixed model. Results The mean change in fasted glucose, insulin, and lipid profiles showed a tendency to decrease in response to fiber consumption compared with the placebo but did not meet statistical significance (P = 0.29, 0.42, and 0.61) due to high interindividual variability. This clinical trial was registered at clinicaltrials.gov as NCT03785860. Conclusions Cardiometabolic profiles did not change in response to the fiber supplement. Funding Sources I would like to acknowledge Usana Health Sciences, Inc. for the support in this research.

Comparison of calcium, magnesium, sodium, potassium, zinc, and creatinine concentration in 24-h and spot urine samples in women

2009 ◽  
Vol 47 (2) ◽  
Author(s):  
Jasminka Z. Ilich ◽  
Maja Blanuša ◽  
Željka Crnčević Orlić ◽  
Tatjana Orct ◽  
Krista Kostial
Keyword(s):  
Urine Sample ◽  
Rank Order ◽  
Essential Elements ◽  
Urine Samples ◽  
Emission Spectrometry ◽  
Creatinine Concentration ◽  
Spot Urine ◽  
Flame Atomic Absorption ◽  
Spot Urine Sample ◽  
Calcium Magnesium

Abstract: The 24-h urine sample is considered as the most reliable material for testing many but not necessarily all constituents in urine. However, its collection is tedious for both patients and research participants. The aim of this study was to compare concentrations of essential elements calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), and zinc (Zn) in 24-h and spot urine samples.: Urine samples were collected from 143 generally healthy women, aged 30–79 years. Fasting spot urine was collected immediately after the end of the 24-h collection, therefore being of the same content as the first morning urine which ended the 24-h collection. Elements were analyzed by flame atomic absorption/emission spectrometry and expressed as mg/g and/or mmol/mol of creatinine (Cr). Spearman rank order correlations between 24-h and spot urine were carried out for each element. Ratios of elements in 24-h to spot urine samples were calculated to estimate the element-proportion of spot in the 24-h sample.: All coefficients of correlation between 24-h and spot urine of measured elements and Cr were significant (p<0.05): Zn (0.637), Mg (0.623), Ca (0.603), Na (0.452), K (0.396), and Cr (0.217). Ratios of 24-h to spot urine samples for each element (except K) were similar and close to 2, indicating uniform proportion of elements from spot urine sample in the 24-h sample. In addition, a high correlation between various pairs of elements was obtained in both 24-h and spot urine; the highest being between Na/Ca (0.435) and (0.578), respectively. This is in accordance with theoretical presumptions and previous findings regarding those relationships.: Although replacing burdensome 24-h urine collection with spot urine sampling might not provide the solution in all cases, our results show that for the elements analyzed, spot urine could be a reliable alternative.Clin Chem Lab Med 2009;47:216–21.

scholarly journals The Relationship between Dietary Polyphenol Intakes and Urinary Polyphenol Concentrations in Adults Prescribed a High Vegetable and Fruit Diet

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3431
Author(s):  
Erin D. Clarke ◽  
Megan E. Rollo ◽  
Clare E. Collins ◽  
Lisa Wood ◽  
Robin Callister ◽  
...  
Keyword(s):  
Hippuric Acid ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Total Polyphenol ◽  
Spot Urine ◽  
Dietary Polyphenols ◽  
Polyphenol Intake ◽  
Study Participants ◽  
The Relationship ◽  
Time Point

Urinary polyphenol metabolites are potential biomarkers of dietary polyphenol intake. The current study aims to evaluate associations between total diet, vegetable and fruit polyphenol intakes with urinary polyphenol metabolite concentrations in a sample of adults prescribed a diet rich in vegetables and fruit. Thirty-four participants completed a 10-week pre-post study. Participants were asked to consume Australian recommended daily vegetable and fruit serves and attend measurement sessions at baseline and at weeks 2 and 10. Two 24-h diet recalls were collected at each time-point and polyphenol intakes were calculated using the Phenol-Explorer database. Spot urine samples, collected at each time-point, were analyzed for 15 polyphenol metabolites using liquid chromatography-mass spectroscopy. Spearman’s correlation analyzes assessed the strength of relationships between urinary and dietary polyphenols. Linear mixed models were used to investigate relationships between polyphenol excretion and intake. Total urinary polyphenols were significantly correlated with total polyphenol intakes at week 10 (rs = 0.47) and fruit polyphenols at week 2 (rs = 0.38). Hippuric acid was significantly correlated with vegetable polyphenols at baseline (rs = 0.39). Relationships were identified between individual polyphenol metabolites and vegetable and fruit polyphenols. Linear mixed model analyzes identified that for every 1 mg increase in polyphenol intakes, urinary polyphenol excretion increased by 16.3 nmol/g creatinine. Although the majority of relationships were not sufficiently strong or consistent at different time-points, promising relationships were observed between total urinary polyphenols and total polyphenol intakes, and hippuric acid and vegetable polyphenols.

scholarly journals Monitoring the South African population’s salt intake: spot urine v. 24 h urine

2017 ◽  
Vol 21 (03) ◽  
pp. 480-488 ◽  
Author(s):  
Bianca Swanepoel ◽  
Aletta E Schutte ◽  
Marike Cockeran ◽  
Krisela Steyn ◽  
Edelweiss Wentzel-Viljoen
Keyword(s):  
South Africa ◽  
South African ◽  
Urine Sample ◽  
Salt Intake ◽  
Urine Samples ◽  
The South ◽  
Population Groups ◽  
Spot Urine ◽  
Spot Urine Sample ◽  
African Context

Abstract Objective The present study set out to determine whether morning spot urine samples can be used to monitor Na (and K) intake levels in South Africa, instead of the ‘gold standard’ 24 h urine sample. Design Participants collected one 24 h and one spot urine sample for Na and K analysis, after which estimations using three different formulas (Kawasaki, Tanaka and INTERSALT) were calculated. Setting Between 2013 and 2015, urine samples were collected from different population groups in South Africa. Subjects A total of 681 spot and 24 h urine samples were collected from white (n 259), black (n 315) and Indian (n 107) subgroups, mostly women. Results The Kawasaki and the Tanaka formulas showed significantly higher (P≤0·001) estimated Na values than the measured 24 h excretion in the whole population (5677·79 and 4235·05 v. 3279·19 mg/d). The INTERSALT formula did not differ from the measured 24 h excretion for the whole population. The Kawasaki formula seemed to overestimate Na excretion in all subgroups tested and also showed the highest degree of bias (−2242 mg/d, 95 % CI−10 659, 6175) compared with the INTERSALT formula, which had the lowest bias (161 mg/d, 95 % CI−4038, 4360). Conclusions Estimations of Na excretion by the three formulas should be used with caution when reporting on Na intake levels. More research is needed to validate and develop a specific formula for the South African context with its different population groups. The WHO’s recommendation of using 24 h urine collection until more studies are carried out is still supported.

scholarly journals ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders

2022 ◽  
Vol 11 (1) ◽  
pp. 250
Author(s):  
Martina Haas ◽  
Ewgeni Jakubovski ◽  
Katja Kunert ◽  
Carolin Fremer ◽  
Nadine Buddensiek ◽  
...  
Keyword(s):  
Behavioral Treatment ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Secondary Analysis ◽  
Tic Disorders ◽  
Clear Trend ◽  
First Line Therapy ◽  
Significant Difference ◽  
Chronic Tic Disorders ◽  
The Difference

Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.

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