scholarly journals Estimating 24-Hour Sodium Excretion from Spot Urine Samples in Chinese Adults: Can Spot Urine Substitute 24-Hour Urine Samples?

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 798
Author(s):  
Jianwei Xu ◽  
Jiyu Zhang ◽  
Min Liu ◽  
Yamin Bai ◽  
Xiaolei Guo ◽  
...  
Keyword(s):  
Sodium Excretion ◽  
Population Level ◽  
Relative Difference ◽  
Urine Samples ◽  
Misclassification Rate ◽  
Absolute Difference ◽  
Sample Collection ◽  
Spot Urine ◽  
Individual Level ◽  
Chinese Populations

Several estimating equations for predicting 24-h urinary sodium (24-hUNa) excretion using spot urine (SU) samples have been developed, but have not been readily available to Chinese populations. We aimed to compare and validate the six existing methods at population level and individual level. We extracted 1671 adults eligible for both 24-h urine and SU sample collection. Mean biases (95% CI) of predicting 24-hUNa excretion using six formulas were 58.6 (54.7, 62.5) mmol for Kawasaki, −2.7 (−6.2, 0.9) mmol for Tanaka, −24.5 (−28.0, −21.0) mmol for the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT) with potassium, –26.8 (−30.1, −23.3) mmol for INTERSALT without potassium, 5.9 (2.3, 9.6) mmol for Toft, and −24.2 (−27.7, −20.6) mmol for Whitton. The proportions of relative difference >40% with the six methods were nearly a third, and the proportions of absolute difference >51.3 mmol/24-h (3 g/day salt) were more than 40%. The misclassification rate were all >55% for the six methods at the individual level. Although the Tanaka method could offer a plausible estimation for surveillance of the population sodium excretion in Shandong province, caution remains when using the Tanaka formula for other provincial populations in China. However, these predictive methods were inadequate to evaluate individual sodium excretion.

Accuracy of equations for predicting 24-h urinary potassium excretion from spot urine samples in Chinese children

2021 ◽  
pp. 1-9
Author(s):  
Xiaolu Nie ◽  
Yaguang Peng ◽  
Siyu Cai ◽  
Zehao Wu ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Urine Samples ◽  
Misclassification Rate ◽  
Accurate Estimation ◽  
Potassium Excretion ◽  
Spot Urine ◽  
Individual Level ◽  
Potassium Intake ◽  
Urinary Potassium ◽  
The Mean ◽  
The Individual

Abstract Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5–18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, −14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.

scholarly journals Estimating Usual Sodium Intake and Sodium-to-Potassium Molar Ratios From Urine Excretion Among Canadian Adults: An Analysis of the Canadian Health Measures Survey

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1020-1020
Author(s):  
Anthea Christoforou ◽  
Alena (Praneet) Ng ◽  
Jodi Bernstein ◽  
Mary L'Abbe
Keyword(s):  
Sodium Excretion ◽  
Sodium Intake ◽  
Population Level ◽  
Urine Samples ◽  
Dietary Sodium ◽  
Dietary Salt ◽  
Salt Reduction ◽  
Men And Women ◽  
Spot Urine ◽  
Molar Ratios

Abstract Objectives High dietary sodium is now well established to be a major risk factor for hypertension, cardiovascular disease and mortality. Monitoring population sodium intakes is critical for evaluating progress towards Health Canada's dietary salt reduction targets. Given that approximately 90% of ingested sodium is excreted in the urine, accurate estimations of average daily urinary sodium is critical for determining population sodium intake. However, until recently, nationally representative surveys from Canada have only collected a single “spot” (casual) urine sample which are prone to bias due to large day-to-day variation amongst individuals. The aim of this study was to estimate average population sodium intake using the latest version of the Canadian Heath Measures Survey, Cycle 5 (2016–2017) which, for the first time includes 2 non-consecutive days of spot urine samples from a representative sample of the Canadian population. Methods The INTERSALT equations, validated for western populations, was used to estimate 24hr intakes of sodium amongst adults ≥19 years of age, excluding pregnant women (n = 3032). Individual sodium-to-potassium molar ratios (Na: K) were also calculated, given their importance in predicting hypertension risk. The second day of spot urines was used to control for within-person variation in both sodium excretion and NA: K molar ratios, using the National Cancer Institute method for estimating usual dietary intake, adjusting for respondents’ fasting status. Results Mean sodium excretion was 3142 ± 30 mg/day and 3154 ± 30 mg/dayin men and women, respectively. In both men and women only 14% of participants consumed less than the recommended 2300 mg of sodium/day. The Na: K was approximately 1.4 in both men and women with only 15–20%, at or below, an optimal Na: K of 1. Conclusions This is the first study from Canada to estimate sodium and NA: K at the population level, using two days of spot urine samples, providing robust baseline data for continued monitoring. Our findings reveal a need for ongoing efforts to reduce population sodium and improve potassium intakes in order to reduce cardiovascular risk. Funding Sources Canadian Institutes of Health Research.

Abstract MP78: Validity of Predictive Equations for 24-Hour Urine Sodium Excretion in Young Black and Other Adults

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Mary Cogswell ◽  
Chia-Yih Wang ◽  
Te-Ching Chen ◽  
Christine Pfeiffer ◽  
Paul Elliott ◽  
...  
Keyword(s):  
Sodium Excretion ◽  
Sodium Intake ◽  
Urine Collection ◽  
Urine Sodium ◽  
Predictive Equations ◽  
Spot Urine ◽  
Individual Level ◽  
Urine Sodium Excretion ◽  
Mean Differences ◽  
The Individual

Introduction: Reducing mean population sodium intake by ~1200 mg is projected to reduce thousands of deaths from heart disease and stroke and save billions of health care dollars annually. Twenty-four hour urine collection is recommended for assessing changes in mean population sodium intake, but can be difficult to implement. Predicting 24-hour urine sodium excretion using spot urines is not recommended due to diurnal variations in excretion. Further, sodium excretion patterns differ between black and white persons. We assessed the validity of previously published prediction equations for 24-hour sodium excretion in black and other young adults by timing of spot urine collection. Design: Of 481 adult volunteers aged 18-39 years (50% Blacks) asked to participate in a 2011 study in the Metropolitan DC area, 407 collected each urine void in a separate container for 24 hours. Four timed voids from the 24-h urine collection were selected (morning, afternoon, evening, and overnight) to use with previously published predictive equations. Predictive equations were based on one of two approaches; 1) an indirect approach using spot urine sodium-to-creatinine concentrations and predicted 24-hour creatinine excretion ( Tanaka, Kawasaki, Mage ), and 2) a direct approach using spot urine sodium, potassium, and creatinine concentrations, and age, and body mass index with separate equations by sex ( Brown ). We assessed mean differences between predicted and measured 24-hour sodium excretion (bias) and individual differences across levels of sodium excretion using Bland-Altman plots. Results: Among participants, mean measured 24-hour sodium excretion was ~3300 mg (SD ~1400 mg). Of the equations evaluated, mean bias in predicted 24-hour sodium excretion was least from Brown equations when using morning (-165 mg, 95% confidence interval [CI], -295, -36 mg), afternoon (-90 mg, 95% CI, -208, 28 mg) or evening ( -120 mg, 95% CI -230, -11 mg) spot urines. When using overnight spot urines, mean bias from Brown equations was greatest and statistically significant (-247 mg, 95% CI, -348, -151 mg). When using overnight spot urines, mean bias from Tanaka (-23 mg) or Mage (-145 mg) equations was not significant, however, when stratified by sex, mean biases were significant and in opposite directions. Among Blacks, mean biases from Brown were not significant (-167 to 122 mg) except using overnight specimens among Black females (-267 mg, 95% CI, -525, -47 mg). Across equations and time periods, Bland-Altman plots indicated significant bias at the individual level. Conclusions: Of the evaluated equations, predicted 24-hour urine sodium excretion using the Brown equations with morning, afternoon, or evening specimens may provide the least biased estimates of group mean sodium intake among young US adults. None of the equations adequately predicted individual 24-hour sodium excretion measured on the same day.

scholarly journals Urine Spot Samples Can Be Used to Estimate 24-Hour Urinary Sodium Excretion in Children

2018 ◽  
Vol 148 (12) ◽  
pp. 1946-1953 ◽  
Author(s):  
Magali Rios-Leyvraz ◽  
Pascal Bovet ◽  
René Tabin ◽  
Bernard Genin ◽  
Michel Russo ◽  
...  
Keyword(s):  
Sodium Excretion ◽  
Salt Intake ◽  
Sodium Intake ◽  
Population Level ◽  
Urinary Sodium Excretion ◽  
Cross Sectional Study ◽  
Urinary Sodium ◽  
Cross Sectional ◽  
High Sodium ◽  
Individual Level

ABSTRACT Background The gold standard to assess salt intake is 24-h urine collections. Use of a urine spot sample can be a simpler alternative, especially when the goal is to assess sodium intake at the population level. Several equations to estimate 24-h urinary sodium excretion from urine spot samples have been tested in adults, but not in children. Objective The objective of this study was to assess the ability of several equations and urine spot samples to estimate 24-h urinary sodium excretion in children. Methods A cross-sectional study of children between 6 and 16 y of age was conducted. Each child collected one 24-h urine sample and 3 timed urine spot samples, i.e., evening (last void before going to bed), overnight (first void in the morning), and morning (second void in the morning). Eight equations (i.e., Kawasaki, Tanaka, Remer, Mage, Brown with and without potassium, Toft, and Meng) were used to estimate 24-h urinary sodium excretion. The estimates from the different spot samples and equations were compared with the measured excretion through the use of several statistics. Results Among the 101 children recruited, 86 had a complete 24-h urine collection and were included in the analysis (mean age: 10.5 y). The mean measured 24-h urinary sodium excretion was 2.5 g (range: 0.8–6.4 g). The different spot samples and equations provided highly heterogeneous estimates of the 24-h urinary sodium excretion. The overnight spot samples with the Tanaka and Brown equations provided the most accurate estimates (mean bias: −0.20 to −0.12 g; correlation: 0.48–0.53; precision: 69.7–76.5%; sensitivity: 76.9–81.6%; specificity: 66.7%; and misclassification: 23.0–27.7%). The other equations, irrespective of the timing of the spot, provided less accurate estimates. Conclusions Urine spot samples, with selected equations, might provide accurate estimates of the 24-h sodium excretion in children at a population level. At an individual level, they could be used to identify children with high sodium excretion. This study was registered at clinicaltrials.gov as NCT02900261.

scholarly journals Estimation of 24-Hour Sodium Excretion from Spot Urine Samples

2010 ◽  
Vol 12 (3) ◽  
pp. 174-180 ◽  
Author(s):  
Samuel J. Mann ◽  
Linda M. Gerber
Keyword(s):  
Sodium Excretion ◽  
Urine Samples ◽  
Spot Urine

scholarly journals Correcting for Intra-Individual Variability in Sodium Excretion in Spot Urine Samples Does Not Improve the Ability to Predict 24 h Urinary Sodium Excretion

Nutrients ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 2026
Author(s):  
Karen Elizabeth Charlton ◽  
Aletta Elisabeth Schutte ◽  
Leanda Wepener ◽  
Barbara Corso ◽  
Paul Kowal ◽  
...  
Keyword(s):  
Analysis Of Variance ◽  
Individual Variation ◽  
Sodium Excretion ◽  
Distribution Curve ◽  
Salt Intake ◽  
Individual Variability ◽  
Urinary Sodium ◽  
Urine Samples ◽  
Prediction Equations ◽  
Spot Urine

Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.

Low correlation between morning spot and 24-hour urine samples for estimating sodium intake in an Iranian population: Isfahan Salt Study

2019 ◽  
Vol 89 (3-4) ◽  
pp. 185-191
Author(s):  
Alireza Khosravi ◽  
Noushin Mohammadifard ◽  
Mojagn Gharipour ◽  
Zahra Abdollahi ◽  
Fatemeh Nouri ◽  
...  
Keyword(s):  
Sodium Excretion ◽  
Salt Intake ◽  
Iranian Population ◽  
Urine Samples ◽  
Potassium Excretion ◽  
Urine Sodium ◽  
Gold Standard Method ◽  
Spot Urine ◽  
Sodium And Potassium ◽  
Tanaka Formula

Abstract. Introduction: Although difficult, the 24-hour urine sodium excretion is still considered as the gold standard method to estimate salt intake. The current study aimed to assess the validity of using spot urine samples in comparison with the standard 24-hour urine collection to estimate sodium and potassium intake in healthy Iranian adults. Methods and subjects: This cross-sectional study was performed on 1099 healthy Iranians aged 18–69 years. Samples of 24-hour and fasting morning spot urine were collected to measure sodium and potassium excretions. Tanaka’s formula was utilized to predict the 24-hour sodium and potassium urinary excretions based on the spot values. Results: The difference between measured and estimated sodium excretion values was 4265 mg/day (95% CI: 4106–4424; P < 0.001) and 2242 mg/day in case of potassium excretion (95% CI: 2140–2344; P < 0.001). There was a weak significant correlation between the 24-hour urine sodium and potassium excretion and the predicted values (intraclass correlations: 0.22 and 0.28, respectively; both P < 0.001). Conclusion: The weak association between the predicted and measured values of sodium and potassium along with the marked overestimation of daily sodium and potassium excretions based on the spot urine and using Tanaka formula indicates that Tanaka formula is not practical for the prediction of sodium and potassium or salt intake in Iranian adults. Using other spot urine sampling times and/or adopting a formula designed based on the characteristics of the Iranian population may increase the validity of spot urine tests.

scholarly journals Estimating sodium intake from spot urine samples at population level: a validation and application study in French adults

2019 ◽  
Vol 122 (2) ◽  
pp. 186-194 ◽  
Author(s):  
Elise Emeville ◽  
Camille Lassale ◽  
Katia Castetbon ◽  
Valérie Deschamps ◽  
Benoît Salanave ◽  
...  
Keyword(s):  
Salt Intake ◽  
Sodium Intake ◽  
Adult Population ◽  
Correlation Coefficients ◽  
Population Level ◽  
Urine Samples ◽  
Validation Sample ◽  
Application Study ◽  
Spot Urine ◽  
Calibration Coefficients

AbstractThe aim of this study was to assess the validity of the predictive INTERSALT equation using spot urine samples to estimate 24-h urinary Na (24-hUNa) excretion and daily Na intake among the French adult population. Among 193 French adults (‘validation sample’), we assessed the validity by comparing predicted 24-hUNa excretion from spot urine and measured 24-hUNa excretion from 24-h urine collections. Spearman correlation coefficients and Bland–Altman plots were used and we calculated calibration coefficients. In a nationally representative sample of 1720 French adults (‘application sample’), the calibrated predictive equation was then applied to the spot urine Na values to estimate 24-hUNa excretion and daily Na intake. In that sample, predicted Na intake was compared with that estimated from 24-h dietary recalls. Results were adjusted and corrected using calibration coefficients. In the validation sample, the measured 24-hUNa excretion was on average 14 % higher than the predicted 24-hUNa (+13 % for men and +16 % for women). Correlation between measured and predicted 24-hUNa excretion was moderate (Spearman r 0·42), and the Bland–Altman plots showed underestimation at lower excretion level and overestimation at higher level. In the application study, estimated daily salt intake was 8·0 g/d using dietary recalls, 8·1 g/d using predicted INTERSALT equation and 9·3 g/d after applying calibration coefficients calculated in the validation study. Despite overall underestimation of 24-hUNa excretion by spot urinary Na, the use of predictive INTERSALT equation remains an acceptable alternative in monitoring global Na intake/excreted in the French population but its use is not advised at the individual level.

scholarly journals Development, validation and application of a machine learning model to estimate salt consumption in 54 countries

eLife ◽  
2022 ◽  
Vol 11 ◽  
Author(s):  
Wilmer Cristobal Guzman-Vilca ◽  
Manuel Castillo-Cara ◽  
Rodrigo M Carrillo-Larco
Keyword(s):  
Machine Learning ◽  
Salt Intake ◽  
Population Level ◽  
American Samoa ◽  
Population Based ◽  
Urine Samples ◽  
Spot Urine ◽  
Salt Consumption ◽  
Model Based ◽  
Machine Learning Model

Global targets to reduce salt intake have been proposed but their monitoring is challenged by the lack of population-based data on salt consumption. We developed a machine learning (ML) model to predict salt consumption at the population level based on simple predictors and applied this model to national surveys in 54 countries. We used 21 surveys with spot urine samples for the ML model derivation and validation; we developed a supervised ML regression model based on: sex, age, weight, height, systolic and diastolic blood pressure. We applied the ML model to 54 new surveys to quantify the mean salt consumption in the population. The pooled dataset in which we developed the ML model included 49,776 people. Overall, there were no substantial differences between the observed and ML-predicted mean salt intake (p<0.001). The pooled dataset where we applied the ML model included 166,677 people; the predicted mean salt consumption ranged from 6.8 g/day (95% CI: 6.8-6.8 g/day) in Eritrea to 10.0 g/day (95% CI: 9.9-10.0 g/day) in American Samoa. The countries with the highest predicted mean salt intake were in Western Pacific. The lowest predicted intake was found in Africa. The country-specific predicted mean salt intake was within reasonable difference from the best available evidence. A ML model based on readily available predictors estimated daily salt consumption with good accuracy. This model could be used to predict mean salt consumption in the general population where urine samples are not available.

scholarly journals Urinary Cannabinoid Disposition in Occasional and Frequent Smokers: Is THC-Glucuronide in Sequential Urine Samples a Marker of Recent Use in Frequent Smokers?

2014 ◽  
Vol 60 (2) ◽  
pp. 361-372 ◽  
Author(s):  
Nathalie A Desrosiers ◽  
Dayong Lee ◽  
Marta Concheiro-Guisan ◽  
Karl B Scheidweiler ◽  
David A Gorelick ◽  
...  
Keyword(s):  
Time Frame ◽  
Research Unit ◽  
Urine Samples ◽  
Absolute Difference ◽  
Sample Collection ◽  
Chromatography Tandem Mass Spectrometry ◽  
Liquid Chromatography Tandem Mass ◽  
World Anti Doping Agency ◽  
Cannabis Smoking ◽  
Normalized Concentration

Abstract BACKGROUND There is extended urinary excretion of Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), and 11-nor-9-carboxy-THC (THCCOOH) in abstinent frequent cannabis smokers. We characterized THC, 11-OH-THC, THCCOOH, cannabidiol, cannabinol, THC-glucuronide, and THCCOOH-glucuronide disposition in urine of frequent and occasional cannabis smokers, and we propose a model to predict recent cannabis smoking. METHODS Frequent and occasional smokers resided on a closed research unit and smoked one 6.8% THC cannabis cigarette ad libitum. Urinary cannabinoids were quantified in each void by liquid chromatography-tandem mass spectrometry within 24 h of collection. RESULTS No urine samples had measureable THC, 11-OH-THC, cannabidiol, or cannabinol. THCCOOH, THC-glucuronide, and THCCOOH-glucuronide were measurable in all frequent smokers' urine and 60%, 100%, and 100% of occasional smokers' urine samples, respectively. Pre- and postdose maximal concentrations (non- and creatinine normalized) and probability of being positive were significantly higher in frequent smokers' samples. THC-glucuronide concentrations peaked 0.6–7.4 h after smoking; THCCOOH and THCCOOH-glucuronide concentrations were highly variable. At the newly adopted THCCOOH 175-μg/L World Anti-Doping Agency decision limit, only 50% of frequent smokers were positive 0–6 h postdose; no occasional smokers' samples were positive. An absolute %difference of ≥50% between 2 consecutive THC-glucuronide–positive samples with a creatinine-normalized concentration of ≥2 μg/g in the first sample predicted cannabis smoking with efficiencies of 93.1% in frequent and 76.9% in occasional smokers within 6 h of first sample collection. CONCLUSIONS These controlled urinary cannabinoid data provide a possible means of identifying recent cannabis intake in cannabis smokers' urine within a short collection time frame after smoking.

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