Measuring Children’s Sodium and Potassium Intakes in NZ: A Pilot Study

Low sodium and high potassium intakes in childhood protect against rises in blood pressure (BP) and risk of cardiovascular disease (CVD) later in life. Our aim was to pilot methods for collection of 24-h urine samples (gold standard) and diet recalls to assess sodium and potassium intakes and their food sources in 30 children aged 8–11 years at one New Zealand primary school. A diverse sample (n = 27) was recruited over a two-week period. All children provided a urine sample (71% complete) and interviewer-assisted 24-h diet recall (Intake24 software). Median (range) sodium intake was 2191 (1087 to 4786) mg/day (salt equivalent 5.5 g), potassium intake was 1776 (800–2981) mg/day, BP was 105 (84–129)/62 (53–89) mmHg, and sodium to potassium molar ratio was 2.0 (1.1–4.8). Frequent use of discretionary salt was uncommon. Major food sources of sodium were bread, pies and pastries, and bread and pasta-based dishes, and potassium were sauces and condiments, dairy products, and non-alcoholic beverages. Most participants provided adequate data and enjoyed taking part. A larger survey is warranted to confirm findings and inform a potential intervention(s). Small improvements to study procedures and resources should improve completeness of urine samples and quality of 24-h diet recall data.

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Assessment of Foods Associated with Sodium and Potassium Intake in Japanese Youths Using the Brief-Type Self-Administered Diet History Questionnaire

Nutrients ◽

10.3390/nu13072345 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2345

Author(s):

Masayuki Okuda ◽

Satoshi Sasaki

Keyword(s):

Sodium Excretion ◽

Sodium Intake ◽

Molar Ratio ◽

Potassium Excretion ◽

Potassium Intake ◽

Soybean Paste ◽

Diet History Questionnaire ◽

Diet History ◽

8Th Graders ◽

Sodium And Potassium

The identification of sodium and potassium intake in youths is an important step to preventing the increase of blood pressure in childhood. We examined food intake and estimated mineral intake using a brief-type self-administered diet history questionnaire (BDHQ) to test its validity as a comparison with urinary excretion in Japanese youths. The subjects were 5th and 8th graders (n = 2377), who completed the BDHQ and permitted the use of their overnight urine specimens. Sodium intake was poorly associated with sodium excretion (Rho = 0.048), and the coefficients of dietary potassium and a sodium-to-potassium molar ratio were 0.091–0.130. Higher soybean paste (miso) intake and pickles were significantly associated with higher sodium excretion (p ≤ 0.005). However, these foods were positively associated with potassium excretion (p = 0.002–0.012), and not associated with an excreted sodium-to-potassium ratio. Fruits and dairy products were positively associated (p ≤ 0.048), whereas beverages were negatively associated with potassium excretion (p ≤ 0.004). The association of the sodium-to-potassium ratio was opposite to that of potassium (p ≤ 0.001). The choice of foods, potassium, and the sodium-to-potassium ratio assessed using the BDHQ are available as part of health education for youths, but the assessment of sodium intake in population levels should be carefully conducted.

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Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study

BMJ Open ◽

10.1136/bmjopen-2017-016639 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016639 ◽

Cited By ~ 19

Author(s):

Carley A Grimes ◽

Lynn J Riddell ◽

Karen J Campbell ◽

Kelsey Beckford ◽

Janet R Baxter ◽

...

Keyword(s):

Primary Schools ◽

Sodium Intake ◽

Food Sources ◽

Secondary Outcome ◽

Socioeconomic Background ◽

Processed Meat ◽

Potassium Excretion ◽

Urine Collection ◽

Cross Sectional ◽

Sodium And Potassium

ObjectivesTo examine sodium and potassium urinary excretion by socioeconomic status (SES), discretionary salt use habits and dietary sources of sodium and potassium in a sample of Australian schoolchildren.DesignCross-sectional study.SettingPrimary schools located in Victoria, Australia.Participants666 of 780 children aged 4–12 years who participated in the Salt and Other Nutrients in Children study returned a complete 24-hour urine collection.Primary and secondary outcome measures24-hour urine collection for the measurement of sodium and potassium excretion and 24-hour dietary recall for the assessment of food sources. Parent and child reported use of discretionary salt. SES defined by parental highest level of education.ResultsParticipants were 9.3 years (95% CI 9.0 to 9.6) of age and 55% were boys. Mean urinary sodium and potassium excretion was 103 (95% CI 99 to 108) mmol/day (salt equivalent 6.1 g/day) and 47 (95% CI 45 to 49) mmol/day, respectively. Mean molar Na:K ratio was 2.4 (95% CI 2.3 to 2.5). 72% of children exceeded the age-specific upper level for sodium intake. After adjustment for age, sex and day of urine collection, children from a low socioeconomic background excreted 10.0 (95% CI 17.8 to 2.1) mmol/day more sodium than those of high socioeconomic background (p=0.04). The major sources of sodium were bread (14.8%), mixed cereal-based dishes (9.9%) and processed meat (8.5%). The major sources of potassium were dairy milk (11.5%), potatoes (7.1%) and fruit/vegetable juice (5.4%). Core foods provided 55.3% of dietary sodium and 75.5% of potassium while discretionary foods provided 44.7% and 24.5%, respectively.ConclusionsFor most children, sodium intake exceeds dietary recommendations and there is some indication that children of lower socioeconomic background have the highest intakes. Children are consuming about two times more sodium than potassium. To improve sodium and potassium intakes in schoolchildren, product reformulation of lower salt core foods combined with strategies that seek to reduce the consumption of discretionary foods are required.

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Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

BMJ ◽

10.1136/bmj.l772 ◽

2019 ◽

pp. l772 ◽

Cited By ~ 25

Author(s):

Martin O’Donnell ◽

Andrew Mente ◽

Sumathy Rangarajan ◽

Matthew J McQueen ◽

Neil O’Leary ◽

...

Keyword(s):

Urinary Excretion ◽

Sodium Excretion ◽

Cardiovascular Events ◽

Sodium Intake ◽

Urinary Sodium ◽

Potassium Excretion ◽

High Potassium ◽

High Sodium ◽

Low Sodium ◽

Sodium And Potassium

AbstractObjectiveTo evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.DesignInternational prospective cohort study.Setting18 high, middle, and low income countries, sampled from urban and rural communities.Participants103 570 people who provided morning fasting urine samples.Main outcome measuresAssociation of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day).ResultsMean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007).ConclusionsThese findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.

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Twenty-Four–Hour Urinary Sodium and Potassium Excretion and Their Associations With Blood Pressure Among Adults in China

Hypertension ◽

10.1161/hypertensionaha.120.15238 ◽

2020 ◽

Vol 76 (5) ◽

pp. 1580-1588

Author(s):

Yuan Li ◽

Puhong Zhang ◽

Jing Wu ◽

Jixiang Ma ◽

Jianwei Xu ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Intake ◽

Molar Ratio ◽

Baseline Survey ◽

Potassium Excretion ◽

Unique Identifier ◽

Potassium Intake ◽

Link Type ◽

Unit Increase ◽

Sodium And Potassium

This study aimed to assess current level of sodium and potassium intake and their associations with blood pressure (BP) using the 24-hour urinary data in a large sample of China. Data from participants aged 18 to 75 years were collected as the baseline survey of Action on Salt China in 2018. Of 5454 adults, 5353 completed 24-hour urine collection. The average sodium, potassium excretion, and sodium-to-potassium molar ratio were 4318.1±1814.1 mg/d (equivalent to 11.0±4.6 g/d of salt), 1573.7±627.1 mg/d, and 5.0±2.1, respectively. After adjusting for potential confounding factors and correcting for regression dilution, each 1000-mg increase in sodium excretion was associated with increased systolic BP (1.32 mm Hg [95% CI, 0.92–1.81]) and diastolic BP (0.34 mm Hg [95% CI, 0.09–0.60]). Each 1000-mg increase in potassium excretion was inversely associated with systolic BP (−3.19 mm Hg [95% CI, −4.38 to −2.20]) and diastolic BP (−1.56 mm Hg [95% CI, −2.29 to −0.90]). Each unit increase in sodium-to-potassium molar ratio was associated with an increase of systolic BP by 1.21 mm Hg (95% CI, 0.91–1.60) and diastolic BP by 0.44 mm Hg (95% CI, 0.24–0.64). The relationships between sodium and BP mostly increase with the rise of BP quantiles. Potassium shows the opposite trend. The current sodium intake in Chinese adults remains high and potassium intake is low. Sodium and sodium-to-potassium ratio were positively associated with BP, whereas potassium was inversely associated with BP. Registration— URL: https://tinyurl.com/vdr8rpr ; Unique identifier: ChiCTR1800017553. URL: https://tinyurl.com/w8c7x3w ; Unique identifier: ChiCTR1800016804. URL: https://tinyurl.com/s3ajldw ; Unique identifier: ChiCTR1800018119.

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Sodium and Potassium in the American Diet: Important Food Sources from NHANES 2015–2016 (P18-045-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-045-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Moises Torres-Gonzalez ◽

Christopher Cifelli ◽

Sanjiv Agarwal ◽

Victor Fulgoni

Keyword(s):

Dietary Guidelines ◽

Food Sources ◽

Ratio Method ◽

Dietary Recall ◽

Funding Sources ◽

Major Food ◽

Recall Data ◽

Cured Meat ◽

A Minor ◽

Sodium And Potassium

Abstract Objectives This analysis used data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) to identify major food sources of sodium, potassium, or both in the American diet. Methods Twenty-four-hour dietary recall data (n = 7817) from the dietary component of the 2015–2016 NHANES was used. Data was analyzed separately for children age 2–18 years and for adults age 19 + years using day one sample weights. Percent sodium and potassium contributions from 48 food subgroups of “What We Eat in America” were determined using SAS (PROC SURVEYREG) and the ratio method. Results The top five food sources of sodium for children 2–18 years of age were: mixed dishes – sandwiches (8.9%), mixed dishes – pizza (8.4%), cured meat/poultry (6.7%), mixed dishes – grain based (6.2%), and poultry (6.0%). Major food sources of potassium for children were milk (11.7%), fruits (7.1%), white potatoes (5.6%), mixed dishes – sandwiches (5.2%), and 100% fruit juices (4.8%). In adults, the top five sources of sodium were mixed dishes – sandwiches (7.5%), cured meat/poultry (7.0%), mixed dishes – Mexican (6.1%), poultry (5.5%), and breads, rolls, tortillas (5.4%). Major food sources of potassium for adults were coffee and tea (8.1%), vegetables, excluding potatoes (7.9%), fruits (6.2%), white potatoes (6.1%), and milk (4.9%). Milk was a minor source of sodium for children (2.6%) and in adults (1.2%). While previous research shows cheese as a source of sodium in the U.S. diet, cheese as consumed was not one of the top 5 sources of sodium for adults or children. However, it is a component of several of the mixed dishes identified in this analysis. Conclusions In children, sandwiches was a top food source of both sodium and potassium. There were no other overlaps in sources of sodium and potassium. Mixed dishes were top food sources of sodium in the diets of both children and adults, while milk, fruits, and potatoes were top food sources of potassium for both groups. This information could be used to help Americans move closer to Dietary Guidelines for Americans recommendations for both sodium and potassium. Funding Sources National Dairy Council.

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Sodium and potassium intakes in a sample of students and employees in the University of Jordan aged (20-40 years) using 3-day food diaries

Nutrition & Food Science ◽

10.1108/nfs-06-2015-0067 ◽

2016 ◽

Vol 46 (1) ◽

pp. 43-50 ◽

Cited By ~ 1

Author(s):

Tasnim Al-Wa'l ◽

Hamed Takruri

Keyword(s):

Sodium Intake ◽

Food Sources ◽

Table Salt ◽

Fast Foods ◽

Content Type ◽

Food Diaries ◽

University Of Jordan ◽

The University ◽

Age Range ◽

Sodium And Potassium

Purpose – This study aimed to estimate sodium and potassium intakes in a selected sample of Jordan University students and employees, to determine the main sources of sodium and potassium in their diets and to compare their intakes with adequate intake (AI), as sodium intakes were found to be high by household budget surveys in Jordan. Design/methodology/approach – A convenient sample of 200 subjects (100 students and 100 employees) from the University of Jordan with an age range of (20-40) years were recruited. The nutritional evaluation of sodium and potassium was done using three-day food records. Foods were analyzed for sodium and potassium using a food analysis program. Findings – Findings of the present study indicated that the intakes of sodium (5176 ± 2,841 mg) exceeded that of AI and that the intakes of potassium (2841 ± 990 mg) were below the AI. The main food sources for sodium were table salt, Jordanian bread and fast foods and sandwiches and for potassium were falafel, Kabsa and hummus. Originality/value – It is also clear that table salt, bread, fast foods were among the top food sources of sodium in Jordanian diet and any national strategy to lower sodium intake should take these into consideration together with upgrading of the educational level of the population.

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ALTERATIONS OF ALDOSTERONE BIOSYNTHESIS BY RAT ADRENAL TISSUE DUE TO INCREASED INTAKE OF SODIUM AND POTASSIUM

Acta Endocrinologica ◽

10.1530/acta.0.0580027 ◽

1968 ◽

Vol 58 (1) ◽

pp. 27-37 ◽

Cited By ~ 11

Author(s):

Jürg Müller

Keyword(s):

Adrenal Glands ◽

Sodium Intake ◽

Potassium Ions ◽

High Potassium ◽

High Sodium ◽

Potassium Intake ◽

High Sodium Intake ◽

Test Conditions ◽

Sodium And Potassium

ABSTRACT Three groups of rats received respectively the following drinking fluids for two weeks: sucrose 5%; NaCl 0.154 m + sucrose; KCl 0.154 m+ sucrose. Aldosterone biosynthesis by quartered adrenal glands of these animals was studied under various in vitro conditions. Adrenals from rats drinking sucrose alone produced significantly more aldosterone under all conditions of incubation than adrenals from rats drinking NaCl, which produced more corticosterone and deoxycorticosterone. Tissue from animals drinking NaCl converted less unlabelled progesterone, 11β-hydroxyprogesterone, deoxycorticosterone and corticosterone to aldosterone and incorporated less tritiated pregnenolone, progesterone, deoxycorticosterone and corticosterone into aldosterone. Adrenals from rats drinking KCl produced less aldosterone than adrenals from rats drinking sucrose under basal conditions but not under stimulation by ACTH or potassium ions. In both groups, the production of corticosterone and of deoxycorticosterone was the same under various test conditions. These results indicate that a high sodium intake inactivates one or both enzymes essential for the conversion of corticosterone to aldosterone, whereas a high potassium intake has no significant effect on these later steps of aldosterone biosynthesis.

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Urinary Sodium and Potassium, and Risk of Ischaemic and Haemorrhagic Stroke (INTERSTROKE): a case-control study

American Journal of Hypertension ◽

10.1093/ajh/hpaa176 ◽

2020 ◽

Author(s):

Conor Judge ◽

Martin J O’Donnell ◽

Graeme J Hankey ◽

Sumathy Rangarajan ◽

Siu Lim Chin ◽

...

Keyword(s):

Ischemic Stroke ◽

Sodium Excretion ◽

Stroke Risk ◽

Sodium Intake ◽

Urinary Sodium ◽

Potassium Excretion ◽

High Potassium ◽

Potassium Intake ◽

Low Sodium ◽

Sodium And Potassium

Abstract Background Although low sodium intake (<2g/day) and high potassium intake (>3·5g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke and its subtypes. Methods We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls (8,761 matched pairs for conditional analysis) from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes. Results The mean estimated 24-hour sodium and potassium urinary excretion was 3·29g/day and 1·57g/day, with 0·01% of participants having both low sodium (<2·0g/day) and high potassium excretion (>3·5g/day). There was a moderate positive correlation between sodium and potassium excretion (r=0·4435, P<0.001) and between sodium excretion and blood pressure (P<0.001). Compared with an estimated urinary sodium excretion of 2·8-3·5g/day (second quartile, reference), higher (>4·26g/day) (OR 1.81;95%CI,1.65-2.00) and lower (<2·8g/day) sodium excretion (OR 1.39;95%CI,1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4·26g/day) was significantly greater (P<0.001) for intracerebral haemorrhage (ICH) (OR 2.38;95%CI,1.93-2.92) than for ischemic stroke (OR 1.67;95%CI,1.50-1.87), and greater for large vessel and small vessel ischemic stroke than for cardioembolic ischemic stroke. Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P=0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1·58g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke. Conclusion The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for intracerebral haemorrhage than ischemic stroke. Our data suggest that moderate sodium intake – rather than low sodium intake – combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.

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Genome-Wide Association Meta-Analysis of Individuals of European Ancestry Identifies Suggestive Loci for Sodium Intake, Potassium Intake, and Their Ratio Measured from 24-Hour or Half-Day Urine Samples

Journal of Nutrition ◽

10.1093/jn/nxaa241 ◽

2020 ◽

Vol 150 (10) ◽

pp. 2635-2645

Author(s):

Minjung Kho ◽

Jennifer A Smith ◽

Niek Verweij ◽

Lulu Shang ◽

Kathleen A Ryan ◽

...

Keyword(s):

Sodium Excretion ◽

Sodium Intake ◽

Meta Analysis ◽

Urine Samples ◽

European Ancestry ◽

Potassium Excretion ◽

Potassium Intake ◽

Genome Wide ◽

Genomic Regions ◽

Sodium And Potassium

ABSTRACT Background Excess sodium intake and insufficient potassium intake are risk factors for hypertension, but there is limited knowledge regarding genetic factors that influence intake. Twenty-hour or half-day urine samples provide robust estimates of sodium and potassium intake, outperforming other measures such as spot urine samples and dietary self-reporting. Objective The aim of this study was to investigate genomic regions associated with sodium intake, potassium intake, and sodium-to-potassium ratio measured from 24-h or half-day urine samples. Methods Using samples of European ancestry (mean age: 54.2 y; 52.3% women), we conducted a meta-analysis of genome-wide association studies in 4 cohorts with 24-h or half-day urine samples (n = 6,519), followed by gene-based analysis. Suggestive loci (P < 10−6) were examined in additional European (n = 844), African (n = 1,246), and Asian (n = 2,475) ancestry samples. Results We found suggestive loci (P < 10−6) for all 3 traits, including 7 for 24-h sodium excretion, 4 for 24-h potassium excretion, and 4 for sodium-to-potassium ratio. The most significant locus was rs77958157 near cocaine- and amphetamine-regulated transcript prepropeptide (CARTPT) , a gene involved in eating behavior and appetite regulation (P = 2.3 × 10−8 with sodium-to-potassium ratio). Two suggestive loci were replicated in additional samples: for sodium excretion, rs12094702 near zinc finger SWIM-type containing 5 (ZSWIM5) was replicated in the Asian ancestry sample reaching Bonferroni-corrected significance (P = 0.007), and for potassium excretion rs34473523 near sodium leak channel (NALCN) was associated at a nominal P value with potassium excretion both in European (P = 0.043) and African (P = 0.043) ancestry cohorts. Gene-based tests identified 1 significant gene for sodium excretion, CDC42 small effector 1 (CDC42SE1), which is associated with blood pressure regulation. Conclusions We identified multiple suggestive loci for sodium and potassium intake near genes associated with eating behavior, nervous system development and function, and blood pressure regulation in individuals of European ancestry. Further research is needed to replicate these findings and to provide insight into the underlying genetic mechanisms by which these genomic regions influence sodium and potassium intake.

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Association between 24-h urinary sodium and potassium excretion and blood pressure among Chinese adults aged 18–69 years

Scientific Reports ◽

10.1038/s41598-021-83049-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaofu Du ◽

Le Fang ◽

Jianwei Xu ◽

Xiangyu Chen ◽

Yamin Bai ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Excretion ◽

Sodium Intake ◽

Urinary Sodium Excretion ◽

Urinary Sodium ◽

Inverse Association ◽

Potassium Excretion ◽

Chinese Adults ◽

Potassium Intake ◽

Sodium And Potassium

AbstractThe direction and magnitude of the association between sodium and potassium excretion and blood pressure (BP) may differ depending on the characteristics of the study participant or the intake assessment method. Our objective was to assess the relationship between BP, hypertension and 24-h urinary sodium and potassium excretion among Chinese adults. A total of 1424 provincially representative Chinese residents aged 18 to 69 years participated in a cross-sectional survey in 2017 that included demographic data, physical measurements and 24-h urine collection. In this study, the average 24-h urinary sodium and potassium excretion and sodium-to-potassium ratio were 3811.4 mg/day, 1449.3 mg/day, and 4.9, respectively. After multivariable adjustment, each 1000 mg difference in 24-h urinary sodium excretion was significantly associated with systolic BP (0.64 mm Hg; 95% confidence interval [CI] 0.05–1.24) and diastolic BP (0.45 mm Hg; 95% CI 0.08–0.81), and each 1000 mg difference in 24-h urinary potassium excretion was inversely associated with systolic BP (− 3.07 mm Hg; 95% CI − 4.57 to − 1.57) and diastolic BP (− 0.94 mm Hg; 95% CI − 1.87 to − 0.02). The sodium-to-potassium ratio was significantly associated with systolic BP (0.78 mm Hg; 95% CI 0.42–1.13) and diastolic BP (0.31 mm Hg; 95% CI 0.10–0.53) per 1-unit increase. These associations were mainly driven by the hypertensive group. Those with a sodium intake above about 4900 mg/24 h or with a potassium intake below about 1000 mg/24 h had a higher risk of hypertension. At higher but not lower levels of 24-h urinary sodium excretion, potassium can better blunt the sodium-BP relationship. The adjusted odds ratios (ORs) of hypertension in the highest quartile compared with the lowest quartile of excretion were 0.54 (95% CI 0.35–0.84) for potassium and 1.71 (95% CI 1.16–2.51) for the sodium-to-potassium ratio, while the corresponding OR for sodium was not significant (OR, 1.28; 95% CI 0.83–1.98). Our results showed that the sodium intake was significantly associated with BP among hypertensive patients and the inverse association between potassium intake and BP was stronger and involved a larger fraction of the population, especially those with a potassium intake below 1000 mg/24 h should probably increase their potassium intake.

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