Diabetes Metab J.  2016 Aug;40(4):290-296. 10.4093/dmj.2016.40.4.290.

Dietary Sodium Intake in People with Diabetes in Korea: The Korean National Health and Nutrition Examination Survey for 2008 to 2010

• Kang MS
• Kim CH
• Jeong SJ
• Park TS

• KMID: 2368516
• DOI: http://doi.org/10.4093/dmj.2016.40.4.290

Abstract

BACKGROUND
Diabetics are likely to receive advice from their physicians concerning lifestyle changes. To understand how much sodium is consumed by diabetics in Korea, we compared the average daily sodium intake between diabetics and non-diabetics after controlling for confounding factors.
METHODS
We obtained the sodium intake data for 13,957 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES), 2008 to 2010, which consisted of a health interview and behavioral and nutritional surveys. The KNHANES uses a stratified, multistage, probability-sampling design, and weighting adjustments were conducted to represent the entire population.
RESULTS
Our analysis revealed that, overall, diabetics tended to have lower sodium intake (4,910.2 mg) than healthy individuals (5,188.2 mg). However, both diabetic and healthy individuals reported higher sodium intake than is recommended by the World Health Organization (WHO). Stratified subgroup analyses revealed that the sodium intake (4,314.2 mg) among newly diagnosed diabetics was higher among women when compared to patients with known diabetes (3,812.5 mg, P=0.035). Female diabetics with cardiovascular disease had lower average sodium intake compared to those without cardiovascular disease after adjusting for sex, age, body mass index, and total energy intake (P=0.058). Sodium intake among male diabetics with hypercholesterolemia (P=0.011) and female diabetics with hypertriglyceridemia (P=0.067) tended to be higher than that among those who without dyslipidemia.
CONCLUSION
The average sodium intake of diabetics in Korea was higher than the WHO recommends. Sodium intake in newly diagnosed diabetics was significantly higher than that in non-diabetics and previously diagnosed diabetics among females. Prospective studies are needed to identify the exact sodium intake.

Keyword

Cardiovascular diseases; Diabetes mellitus, type 2; Hypercholesterolemia; Hypertriglyceridemia; Sodium, dietary

MeSH Terms

Body Mass Index
Cardiovascular Diseases
Diabetes Mellitus, Type 2
Dyslipidemias
Energy Intake
Female
Humans
Hypercholesterolemia
Hypertriglyceridemia
Korea*
Life Style
Male
Nutrition Surveys*
Prospective Studies
Sodium
Sodium, Dietary*
World Health Organization
Sodium
Sodium, Dietary

Figure

• 

  Fig. 1 (A) Comparison of sodium intake in male with known diabetes mellitus (DM) and newly diagnosed DM. (B) Comparison of sodium intake in female with known DM and newly diagnosed DM. P value was obtained from PROC SURVEYREG after adjustment for (sex), age group, education, income, body mass index, smoking, alcohol use, physical activity, and total energy intake. aNormal vs. diabetes, bNormal vs. formerly diagnosed, cNormal vs. newly diagnosed, dFormerly vs. newly, e,fStatistically significant P value.

Reference

1. Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ. 1988; 297:319–328.

2. Midgley JP, Matthew AG, Greenwood CM, Logan AG. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA. 1996; 275:1590–1597.

3. He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002; 16:761–770.

4. Cutler JA, Follmann D, Allender PS. Randomized trials of sodium reduction: an overview. Am J Clin Nutr. 1997; 65:2 Suppl. 643S–651S.

5. Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III. Analysis of data from trials of salt reduction. BMJ. 1991; 302:819–824.

6. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study. N Engl J Med. 2000; 342:905–912.

7. Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010; (12):CD006763.

8. Uzu T, Nakao K, Kume S, Araki H, Isshiki K, Araki S, Kawai H, Ugi S, Kashiwagi A, Maegawa H. High sodium intake is associated with masked hypertension in Japanese patients with type 2 diabetes and treated hypertension. Am J Hypertens. 2012; 25:1170–1174.

9. Ekinci EI, Clarke S, Thomas MC, Moran JL, Cheong K, MacIsaac RJ, Jerums G. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011; 34:703–709.

10. Huh KY, Suh I, Kim KR, Nam CM, Oh KW. The relationship between salt perception and salt intake in diabetic patients. J Korean Diabetes Assoc. 1998; 22:74–83.

11. Lee SE, Kim JH. Comparison of dietary intakes and plasma lipid levels in diabetes and control elderly. Korean J Community Nutr. 2004; 9:98–112.

12. Lim HJ, Woo MH, Moon SK, Choue R. Comparative study of diabetes mellitus patients with cerebral infarction or without cerebral infarction: focused on nutrient intakes and dietary quality. Korean J Nutr. 2008; 41:621–633.

13. Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, Yang Q, Moshfegh AJ. Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr. 2012; 96:647–657.

14. Franz MJ. Lifestyle modifications for diabetes management. Endocrinol Metab Clin North Am. 1997; 26:499–510.

15. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344:1343–1350.

16. Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, Fonseca V, Gerstein HC, Grundy S, Nesto RW, Pignone MP, Plutzky J, Porte D, Redberg R, Stitzel KF, Stone NJ. American Heart Association. American Diabetes Association. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007; 115:114–126.

17. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS Jr. American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013; 36:3821–3842.

18. McCarty MF. High-salt, low-potassium diets may increase risk for type 2 diabetes via marinobufagenin-mediated potentiation of glucolipotoxicity in pancreatic beta cells. Available from: http://catalyticlongevity.org/prepub_archive/salt-DM[1].pdf.

19. Kabakov E, Norymberg C, Osher E, Koffler M, Tordjman K, Greenman Y, Stern N. Prevalence of hypertension in type 2 diabetes mellitus: impact of the tightening definition of high blood pressure and association with confounding risk factors. J Cardiometab Syndr. 2006; 1:95–101.

20. Marin R, Gorostidi M, Tranche S, Rodriguez-Manas L, Abellan J. Hypertension prevalence and control in type 2 diabetes: a primary care-based study. Am J Hypertens. 2002; 15:Suppl 3. 192A.

21. Moore WV, Fredrickson D, Brenner A, Childs B, Tatpati O, Hoffman JM, Guthrie R. Prevalence of hypertension in patients with type II diabetes in referral versus primary care clinics. J Diabetes Complications. 1998; 12:302–306.

22. Suh DC, Kim CM, Choi IS, Plauschinat CA, Barone JA. Trends in blood pressure control and treatment among type 2 diabetes with comorbid hypertension in the United States: 1988-2004. J Hypertens. 2009; 27:1908–1916.

23. Forte JG, Miguel JM, Miguel MJ, de Padua F, Rose G. Salt and blood pressure: a community trial. J Hum Hypertens. 1989; 3:179–184.

24. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH. ASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001; 344:3–10.

25. Feldstein CA. Salt intake, hypertension and diabetes mellitus. J Hum Hypertens. 2002; 16:Suppl 1. S48–S51.

26. Shin EK, Lee HJ, Lee JJ, Ann MY, Son SM, Lee YK. Estimation of sodium intake of adult female by 24-hour urine analysis, dietary records and dish frequency questionnaire (DFQ 55). Korean J Nutr. 2010; 43:79–85.

27. Provenzano LF, Stark S, Steenkiste A, Piraino B, Sevick MA. Dietary sodium intake in type 2 diabetes. Clin Diabetes. 2014; 32:106–112.

28. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998; 280:2001–2007.

29. Harsha DW, Sacks FM, Obarzanek E, Svetkey LP, Lin PH, Bray GA, Aickin M, Conlin PR, Miller ER 3rd, Appel LJ. Effect of dietary sodium intake on blood lipids: results from the DASH-sodium trial. Hypertension. 2004; 43:393–398.