Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

Okayama, Akira; Okuda, Nagako; Miura, Katsuyuki; Okamura, Tomonori; Hayakawa, Takehito; Akasaka, Hiroshi; Ohnishi, Hirofumi; Saitoh, Shigeyuki; Arai, Yusuke; Kiyohara, Yutaka; Takashima, Naoyuki; Yoshita, Katsushi; Fujiyoshi, Akira; Zaid, Maryam; Ohkubo, Takayoshi; Ueshima, Hirotsugu

doi:10.1136/bmjopen-2016-011632

Cited by 112 publications

(78 citation statements)

References 33 publications

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“…Vegetable protein intake (continuous value) showed inverse relationships with mortality for almost all CVD subtypes irrespective of the presence of hypertension. We also observed significant relationual in this analysis 28,[30][31][32] . A limited number of nutrients were calculated in the NNSJ 90, and vegetable protein intake was not included 28) .…”

Section: Resultssupporting

confidence: 76%

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population

Kurihara

Okamura

Sugiyama

et al. 2019

J Atheroscler Thromb

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Aim: To examine the relationship between the intake of dietary vegetable protein and CVD mortality in a 15-year follow-up study of a representative sample of the Japanese population.Methods: A total of 7,744 participants aged 30 years or older (3,224 males and 4,520 females) who were free of CVD at baseline were included in this analysis. Vegetable protein intake (% energy) was assessed using a threeday semi-weighed dietary record at baseline. Multivariable-adjusted hazard ratios (HRs) were calculated using Cox's proportional hazards model after adjusting for confounding factors. Results:The total person-years studied were 107,988 with a mean follow-up period of 13.9 years. There were 1,213 deaths during the follow-up period, among which 354 (29.2%) were due to CVD. Vegetable protein intake was associated inversely with CVD and cerebral hemorrhage mortality, with the HRs for a 1% energy increment in vegetable protein intake being 0.86 (95% CI, 0.75 -0.99) and 0.58 (95% CI, 0.35 -0.95), respectively. In the subgroup analysis of participants with or without hypertension, the inverse association between vegetable protein intake and CVD mortality was more evident in the nonhypertensive group, with the HRs for CVD and stroke being 0.68 (95% CI, 0.50 -0.94) and 0.50 (95% CI, 0.30 -0.84), respectively.Conclusions: Vegetable protein intake may prevent future CVD, particularly in nonhypertensive subjects in the Japanese population. However, further studies are necessary to examine the biological mechanisms of this effect.

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Section: Resultssupporting

confidence: 76%

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population

Kurihara

Okamura

Sugiyama

et al. 2019

J Atheroscler Thromb

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“…We recruited healthy and hypertensive individuals in this study, since reducing Na/K ratio is essential for preventing hypertension and CVDs prior to clinical onset. 5 – 18 , 37 The main findings of this first study on self-monitoring Na/K ratio among healthy and hypertensive individuals included a trend towards larger reductions in urinary Na/K ratio observed in the intervention group. However, the effect of the self-monitoring device on the urinary Na/K ratio did not reach the accepted level of statistical significance on the pre-specified effect size (target reduction of 1 unit difference of Na/K ratio between intervention and control groups) under “pure self-management” (ie, without additional professional support) ( P = 0.088).…”

Section: Discussionmentioning

confidence: 89%

“…5 – 13 The Na/K ratio has also been reported to be a superior metric to either Na or K alone in relation to BP and incident hypertension 5 – 7 , 14 , 15 ; studies also report associations between Na/K ratio and CVD. 16 – 18 The World Health Organization (WHO) plans to reduce Na intake and increase K intake in the future. 19 , 20 However, a conventional population approach does not seem sufficient 21 ; fairly large gaps exist between the actual intakes and the recommended target levels among populations.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Self-monitoring Device for Urinary Sodium-to-Potassium Ratio on Dietary Improvement in Free-Living Adults: a Randomized Controlled Trial

Iwahori

Ueshima

Ohgami

et al. 2018

Journal of Epidemiology

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BackgroundReducing the urinary sodium-to-potassium ratio is important for reducing both blood pressure and risk of cardiovascular disease. Among free-living Japanese individuals, we carried out a randomized trial to clarify the effect of lifestyle modification for lowering urinary sodium-to-potassium ratio using a self-monitoring device.MethodsThis was an open, prospective, parallel randomized, controlled trial. Ninety-two individuals were recruited from Japanese volunteers. Participants were randomly allocated into intervention and control groups. A month-long dietary intervention on self-monitoring urinary sodium-to-potassium ratio was carried out using monitors (HEU-001F, OMRON Healthcare Co., Ltd., Kyoto, Japan). All participants had brief dietary education and received a leaflet as usual care. Monitors were handed out to the intervention group, but not to the control group. The intervention group was asked to measure at least one spot urine sodium-to-potassium ratio daily, and advised to lower their sodium-to-potassium ratio toward the target of less than 1. Outcomes included changes in 24-hour urinary sodium-to-potassium ratio, sodium excretion, potassium excretion, blood pressure, and body weight in both groups.ResultsMean measurement frequency of monitoring was 2.8 times/day during the intervention. Changes in urinary sodium-to-potassium ratio were −0.55 in the intervention group and −0.06 in the control group (P = 0.088); respective sodium excretion changes were −18.5 mmol/24 hours and −8.7 mmol/24 hours (P = 0.528); and corresponding potassium excretion was 2.6 mmol/24 hours and −1.5 mmol/24 hours (P = 0.300). No significant reductions were observed in either blood pressure or body weight after the intervention.ConclusionsProviding the device to self-monitor a sodium-to-potassium ratio did not achieve the targeted reduction of the ratio in “pure self-management” settings, indicating further needs to study an effective method to enhance the synergetic effect of dietary programs and self-monitoring practice to achieve the reduction. However, we cannot deny the possibility of reducing sodium-to-potassium ratio using a self-monitoring device.

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“…A higher dietary Na/K ratio is a significant risk factor not only for incidence of hypertension and cardiovascular disease, but also for mortality from total and subtypes of stroke, cardiovascular disease, and all causes (29) . Our study found a greater mean Na/K ratio in total dishes, especially animal food-based dishes and fried rice with egg, prepared in restaurants vs. households, with the greatest difference of 24.8% found in egg fried rice.…”

Section: Discussionmentioning

confidence: 99%

Differences in nutrient and energy contents of commonly consumed dishes prepared in restaurants v. at home in Hunan Province, China

Jia

Liu

Chen

et al. 2018

Public Health Nutr.

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Objective Eating away from home is associated with poor diet quality, in part due to less healthy food choices and larger portions. However, few studies take into account the potential additional contribution of differences in food composition between restaurant- and home-prepared dishes. This study aimed to investigate differences in nutrients of dishes prepared in restaurants vs. at home. Design Eight commonly consumed dishes were collected in 20 of each of the following types of locations: small and large restaurants, and urban and rural households. In addition, two fast-food items were collected from 10 KFC’s, McDonald’s, and food stalls. Five samples per dish were randomly pooled from every location. Nutrients were analyzed and energy was calculated in composite samples. Differences in nutrients of dishes by preparation location were determined. Setting Urban and rural. Subjects Sodium, potassium, protein, total fat, fatty acids, carbohydrate, and energy in dishes. Results On average, both the absolute and relative fat content, saturated fatty acid (SFA) and sodium/potassium ratio were higher in dishes prepared in restaurants than households (P<0.05). Protein was 15% higher in animal food-based dishes prepared in households than restaurants (P <0.05). Quantile regression models found that, at the 90th quantile, restaurant preparation was consistently negatively associated with protein and positively associated with the percentage energy from fat in all dishes. Moreover, restaurant preparation also positively influenced the SFA content in dishes, except at the highest quantiles. Conclusions These findings suggest that compared to home preparation, dishes prepared in restaurants in China may differ in concentrations of total fat, SFA, protein, and sodium/potassium ratio, which may further contribute, beyond food choices, to less healthy nutrient intake linked to eating away from home.

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Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study

Cited by 112 publications

References 33 publications

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population

Vegetable Protein Intake was Inversely Associated with Cardiovascular Mortality in a 15-Year Follow-Up Study of the General Japanese Population

Effectiveness of a Self-monitoring Device for Urinary Sodium-to-Potassium Ratio on Dietary Improvement in Free-Living Adults: a Randomized Controlled Trial

Differences in nutrient and energy contents of commonly consumed dishes prepared in restaurants v. at home in Hunan Province, China

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