The relationship between sodium intake and mortality: a case-cohort study in a population-based cohort of 148,000 adults with both 24-hour and spot urine samples

钠摄入量与死亡率之间的关系：一项病例队列研究，研究对象为 148,000 名成年人，其中包括 24 小时尿液样本和点尿样本

• 批准号: 10565524
• 负责人: Pascal Geldsetzer
• 金额: $ 54.57万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10565524
• 关键词: Adult; Affect; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Cessation of life; Cohort Analysis; Cohort Studies; Consumption; Data; Event; Food Supply; Formulation; Health; Hour; Individual; Intake; Measures; Netherlands; Participant; Population; Potassium; Public Health; Reporting; Research; Research Personnel; Risk; Sample Size; Sampling; Shapes; Sodium; Sodium Chloride; Spottings; Testing; Time; Urine; blood pressure reduction; cohort; comparative; design; dietary guidelines; follow-up; healthy aging; high risk; mortality; mortality risk; population based; randomized trial; stem

PROJECT SUMMARY The largest cohort studies on the subject to date have found that adults with a low estimated sodium intake had a higher risk of mortality than those with a sodium intake close to the population’s average. These findings of a “J-shaped” sodium-mortality association have important implications for public health efforts on salt because they suggest that reducing sodium intake at the population level could cause harm among a large proportion of the population. Many investigators have criticized these cohort studies for their use of a spot urine, rather than the gold-standard 24-hour urine sample, to estimate sodium intake. Thus far, however, the debate on the shape of the sodium-mortality association could not be settled convincingly because analyses of cohort studies that collected 24-hour urine samples have suffered from far smaller sample sizes than of those that collected a spot urine. The overall objective of this project is to better understand the association of sodium intake with mortality, particularly at levels of sodium intake below the population average in the US. The central hypothesis is that the J-shape of the sodium-mortality association that has been reported by some investigators is a result of bias from assessing sodium intake through use of a spot rather than a 24-hour urine sample. This central hypothesis will be tested by pursuing three specific aims: 1) Determine the range of sodium intake among adults that is associated with the lowest risk of all-cause mortality; 2) Determine whether the commonly reported increased risk of mortality at low levels of sodium intake stems from using a spot urine (rather than the gold-standard 24-hour urine) to estimate 24-hour sodium intake; and 3) Establish whether the association of sodium intake with cardiovascular causes of death is the main determinant of the shape of the sodium-mortality association. Using a case-cohort design, this project will analyze the sodium and potassium concentration in urine samples collected as part of Lifelines, which is a population-based cohort study focused on healthy aging in the Northern Netherlands. The Lifelines cohort has three unique features that enable the investigators to make an important contribution to resolving the controversy about the J-shaped sodium- mortality association: 1) Lifelines has collected two 24-hour urine samples from its participants; 2) with 147,888 adult participants and over 6,000 deaths (over a 15-year follow-up period), the Lifelines cohort has a far larger sample size and number of deaths than any other cohorts that have collected 24-hour urine samples; and 3) Lifelines has additionally collected a spot urine sample from all participants such that we are able to directly compare the shape of the sodium-mortality association depending on whether a spot or the gold-standard 24- hour urine sample is used. This project is significant because it will inform dietary guidelines on salt, and whether public health efforts should attempt to lower sodium intake among the entire population (e.g., through reformulation of the food supply) or focus instead only on individuals who consume high levels of sodium.

项目概要 迄今为止关于该主题的最大队列研究发现，估计钠摄入量较低的成年人 与钠摄入量接近人群平均水平的人相比，死亡风险更高。 “J 形”钠与死亡率关联对于盐的公共卫生工作具有重要意义 因为他们认为减少人口水平的钠摄入量可能会对大量人群造成伤害 许多研究人员批评这些队列研究使用了一个点。 然而，到目前为止，我们仍然使用尿液，而不是黄金标准的 24 小时尿液样本来估计钠摄入量。 关于钠与死亡率关联的形态的争论无法令人信服地得到解决，因为分析 收集 24 小时尿液样本的队列研究的样本量远小于其他研究的样本量。 该项目的总体目标是更好地了解尿液的关联性。 钠摄入量与死亡率的关系，特别是在钠摄入量低于美国人口平均水平的情况下。 中心假设是一些人报道的钠与死亡率的 J 形关联 研究人员通过使用点尿而不是 24 小时尿液来评估钠摄入量，从而产生了偏差 这个中心假设将通过追求三个具体目标来检验：1）确定范围。 成人的钠摄入量与全因死亡风险最低相关 2) 确定是否； 普遍报道的钠摄入量低时死亡风险增加的原因是使用点尿 （而不是金标准 24 小时尿液）来估计 24 小时钠摄入量；以及 3) 确定是否 钠摄入量与心血管死亡原因的关系是钠摄入量形状的主要决定因素 该项目将采用病例队列设计来分析钠和钾的含量。 作为生命线一部分收集的尿液样本中的浓度，这是一项基于人群的队列研究，重点关注 生命线队列具有三个独特的特征，使荷兰北部的健康老龄化成为可能。 研究人员为解决有关 J 形钠的争议做出了重要贡献 死亡率协会：1) Lifelines 收集了 147,888 名参与者的两份 24 小时尿液样本； 生命线队列有超过 6,000 名成年参与者死亡（超过 15 年的随访期） 样本量和死亡人数高于任何其他收集 24 小时尿液样本的队列；3) 生命线还从所有人那里收集了现场尿液样本，以便我们能够直接 根据点或金标准 24- 比较钠与死亡率关联的形状 使用小时尿液样本该项目意义重大，因为它将为有关盐的饮食指南提供信息，并且 公共卫生工作是否应尝试降低全体人口的钠摄入量（例如，通过 重新制定食品供应）或仅关注钠摄入量高的个体。