Abstract
Hypertension is the greatest and the most preventable risk factor for cardiovascular disease. Excessive sodium (Na) intake and insufficient potassium (K) intake have been identified as risk factors for hypertension. Socioeconomic status (SES) may be related to diet quality. In Japan, few studies have examined the relationship between urinary Na and K excretion and SES in adults, and there are no studies in children. In 2014, 1944 children (1382 households) in all public elementary schools in Yaese town, Okinawa, Japan were recruited to participate in a study. Casual urine specimens were collected to estimate 24-h urinary Na and K excretion and urinary Na/K ratio. Mother’s educational background and household incomes were assessed and used as indicators of SES. A total of 236 pairs of children and their mothers were analyzed in this study. Urinary Na and K excretion were not significantly related to educational levels of mothers and household incomes in children. On the other hand, in mothers, lower household income group had higher 24-h estimated urinary Na excretion and urinary Na/K ratio than other groups. There was no significant difference between urinary excretion and educational levels in mothers. Household income disparities in urinary levels seen in mothers were not seen in children. There may be some factors that moderate the dietary inequalities in children.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
The Japanese Society of Hypertension (eds). The Japanese Society of Hypertension guidelines for the management of hypertension 2019. Tokyo, Japan: Lifescience Co.; 2019 (in Japanese).
Aliasgharzadeh S, Tabrizi JS, Nikniaz L, Ebrahimi-Mameghani M, Yagin NL. Effect of salt reduction interventions in lowering blood pressure: a comprehensive systematic review and meta-analysis of controlled clinical trials. PLoS ONE. 2022;17:e0277929 https://doi.org/10.1371/journal.pone.0277929.
Adrogué HJ, Madias NE. The impact of sodium and potassium on hypertension risk. Semin Nephrol. 2014;34:257–72.
Cook NR, Obarzanek E, Cutler JA, Buring JE, Rexrode KM, Kumanyika SK, et al. Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study. Arch Intern Med. 2009;169:32–40.
Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 2013;346:f1378 https://doi.org/10.1136/bmj.f1378.
Lobitz CA, Yamaguchi I. Lifestyle interventions for elevated blood pressure in childhood - approaches and outcomes. Curr Hypertens Rep. 2022;24:589–98.
World Health Organization. WHO Guideline: sodium intake for adults and children. https://www.who.int/publications/i/item/9789241504836. Accessed 17 Aug 2023.
World Health Organization. WHO Guideline: potassium intake for adults and children. https://www.who.int/publications/i/item/9789241504829. Accessed 17 Aug 2023.
Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, et al. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 h) timed urine collections to assess dietary sodium intake. J Clin Hypertens. 2019;21:700–9.
Ginos BNR, Engberink RHGO. Estimation of sodium and potassium intake: current limitations and future perspectives. Nutrients. 2020;12:3275. https://doi.org/10.3390/nu12113275.
McLean RM. Measuring population sodium intake: a review of methods. Nutrients. 2014;6:4651–62.
Psaltopoulou T, Hatzis G, Papageorgiou N, Androulakis E, Briasoulis A, Tousoulis D. Socioeconomic status and risk factors for cardiovascular disease: impact of dietary mediators. Hellenic J Cardiol. 2017;58:32–42.
Thompson C. Dietary health in the context of poverty and uncertainty around the social determinants of health. Proc Nutr Soc. 2022;81:134–40.
Novaković R, Cavelaars A, Geelen A, Nikolić M, Altaba II, Viñas BR, et al. Socio-economic determinants of micronutrient intake and status in Europe: a systematic review. Public Health Nutr. 2014;17:1031–45.
Murayama N. Effects of socioeconomic status on nutrition and nutrition policy studies in Asia. J Nutr Sci Vitaminol. 2022;68:S92–4.
Miyagawa N, Okuda N, Nakagawa H, Takezaki T, Nishi N, Takashima N, et al. Socioeconomic status associated with urinary sodium and potassium excretion in Japan: NIPPON DATA2010. J Epidemiol. 2018;28:S29–34.
Asakura K, Todoriki H, Sasaki S. Relationship between nutrition knowledge and dietary intake among primary school children in Japan: combined effect of children’s and their guardians’ knowledge. J Epidemiol. 2017;27:483–91.
Okuda M, Asakura K, Sasaki S. Estimation of daily sodium and potassium excretion from overnight urine of Japanese children and adolescents. Environ Health Prev Med. 2020;25:74 https://doi.org/10.1186/s12199-020-00911-3.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.
Inokuchi M, Hasegawa T, Anzo M, Matsuo N. Standardized centile curves of body mass index for Japanese children and adolescents based on the 1978-1981 national survey data. Ann Hum Biol. 2006;33:444–53.
Mage DT, Allen RH, Kodali A. Creatinine corrections for estimating children’s and adult’s pesticide intake doses in equilibrium with urinary pesticide and creatinine concentrations. J Expo Sci Environ Epidemiol. 2008;18:360–8.
Tanaka T, Okamura T, Miura K, Kadowaki T, Ueshima H, Nakagawa H, et al. A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen. J Hum Hypertens. 2002;16:97–103.
Kurotani K, Ishikawa-Takata K, Takimoto H. Diet quality of Japanese adults with respect to age, sex, and income level in the National Health and Nutrition Survey, Japan. Public Health Nutr. 2020;23:821–32.
Kurotani K, Shinsugi C, Takimoto H. Diet quality and household income level among students: 2014 National Health and Nutrition Survey Japan. Eur J Clin Nutr. 2021;75:969–75.
Cabinet Officce, Japan. Statistics of prefectural economic calculation (in Japanese). https://www.esri.cao.go.jp/jp/sna/data/data_list/kenmin/files/contents/main_h28.html. Accessed 17 Aug 2023.
Okuda M, Sasaki S. Assessment of foods associated with sodium and potassium intake in Japanese youths using the brief-type self-administered diet history questionnaire. Nutrients. 2021;13:2345 https://doi.org/10.3390/nu13072345.
Putnam J, Allshouse J, Kantor LS. U.S. per capita food supply trends: more calories, refined carbohydrates, and fats. Food Rev. 2002;25:2–15.
Drewnowski A, Darmon N. Food choices and diet costs: an economic analysis. J Nutr. 2005;135:900–4.
Allison A, Fouladkhah A. Adoptable interventions, human health, and food safety considerations for reducing sodium content of processed food products. Foods. 2018;7:16. https://doi.org/10.3390/foods7020016.
Kurotani K. Health disparity and food assistance among children in Japan. J Nutr Sci Vitaminol. 2022;68:S81–3.
Holbrook JT, Patterson KY, Bodner JE, Douglas LW, Veillon C, Kelsay JL, et al. Sodium and potassium intake and balance in adults consuming self-selected diets. Am J Clin Nutr. 1984;40:786–93.
Tasevska N, Runswick SA, Bingham SA. Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals. J Nutr. 2006;136:1334–40.
Acknowledgements
The authors thank the children and their parents who participated in the research. The authors also thank the dietitians, school nurses, and teachers who supported the research in each school, and the staffs of the municipal government of Yaese town in Okinawa for their valuable contribution.
Funding
This work was financially supported by JSPS KAKENHI Grant Number 25460740 from the Japan Society for the Promotion of Science.
Author information
Authors and Affiliations
Contributions
Research conception and design: SI, KA, and HT; conducting the survey; KA, MT, and HT; interpretation of the data; SI, KA, KS, and HT; writing of the manuscript: SI, KS, and HT.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ito, S., Asakura, K., Sugiyama, K. et al. Association between sodium and potassium excretion estimated from spot urine and socioeconomic status among primary school children and their mothers in Okinawa, Japan. Hypertens Res 47, 1175–1183 (2024). https://doi.org/10.1038/s41440-023-01564-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41440-023-01564-9
Keywords
This article is cited by
-
Original article and review highlighted in this month of Hypertension Research
Hypertension Research (2024)