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. 2018 Mar 27;319(12):1209-1220.
doi: 10.1001/jama.2018.1156.

Estimated 24-Hour Urinary Sodium and Potassium Excretion in US Adults

Mary E Cogswell  1 , Catherine M Loria  2 , Ana L Terry  3 , Lixia Zhao  1   4 , Chia-Yih Wang  3 , Te-Ching Chen  3 , Jacqueline D Wright  2 , Christine M Pfeiffer  5 , Robert Merritt  1 , Claudia S Moy  6 , Lawrence J Appel  7   8
Affiliations

Estimated 24-Hour Urinary Sodium and Potassium Excretion in US Adults

Mary E Cogswell et al. JAMA. .

Abstract

Importance: In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended collecting 24-hour urine to estimate US sodium intake because previous studies indicated 90% of sodium consumed was excreted in urine.

Objective: To estimate mean population sodium intake and describe urinary potassium excretion among US adults.

Design, setting, and participants: In a nationally representative cross-sectional survey of the US noninstitutionalized population, 827 of 1103 (75%) randomly selected, nonpregnant participants aged 20 to 69 years in the examination component of the National Health and Nutrition Examination Survey (NHANES) collected at least one 24-hour urine specimen in 2014. The overall survey response rate for the 24-hour urine collection was approximately 50% (75% [24-hour urine component response rate] × 66% [examination component response rate]).

Exposures: 24-hour collection of urine.

Main outcomes and measures: Mean 24-hour urinary sodium and potassium excretion. Weighted national estimates of demographic and health characteristics and mean electrolyte excretion accounting for the complex survey design, selection probabilities, and nonresponse.

Results: The study sample (n = 827) represented a population of whom 48.8% were men; 63.7% were non-Hispanic white, 15.8% Hispanic, 11.9% non-Hispanic black, and 5.6% non-Hispanic Asian; 43.5% had hypertension (according to 2017 hypertension guidelines); and 10.0% reported a diagnosis of diabetes. Overall mean 24-hour urinary sodium excretion was 3608 mg (95% CI, 3414-3803). The overall median was 3320 mg (interquartile range, 2308-4524). In secondary analyses by sex, mean sodium excretion was 4205 mg (95% CI, 3959-4452) in men (n = 421) and 3039 mg (95% CI, 2844-3234) in women (n = 406). By age group, mean sodium excretion was 3699 mg (95% CI, 3449-3949) in adults aged 20 to 44 years (n = 432) and 3507 mg (95% CI, 3266-3748) in adults aged 45 to 69 years (n = 395). Overall mean 24-hour urinary potassium excretion was 2155 mg (95% CI, 2030-2280); by sex, 2399 mg (95% CI, 2253-2545) in men and 1922 mg (95% CI, 1757-2086) in women; and by age, 1986 mg (95% CI, 1878-2094) in adults aged 20 to 44 years and 2343 mg (95% CI, 2151-2534) in adults aged 45 to 69 years.

Conclusions and relevance: In cross-sectional data from a 2014 sample of US adults, estimated mean sodium intake was 3608 mg per day. The findings provide a benchmark for future studies.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Cogswell reported an honorarium from Johns Hopkins University for the Inaugural Kruse Research to Policy Alumni Achievement Award in Human Nutrition. Dr Appel reported assisting in the design and implementation of a sodium reduction initiative as part of the Resolve project through a contract with Vital Strategies through his institution and personal fees from Wolters Kluwer for a chapter on sodium reduction in UpToDate. No other disclosures are reported.

Figures

Figure.
Figure.. Flow of Participants Through the Study
NHANES indicates National Health and Nutrition Examination Survey. aParticipants who “missed” urine included those who spilled or missed more than a few drops of urine during the 24-hour collection period as determined from a series of standardized questions with fixed response categories administered at visit 2 for each urine collection. For further details, see the eMethods in the Supplement.
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