• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Potassium and Sodium Intake: Do the WHO Recommendations Have it Right?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • The WHO recommends an extremely low sodium intake but high potassium intake
    • Recommendations: <2.0 g sodium | >3.5 g potassium
    • Current averages: 4 g/day for salt and 2g/day for potassium
  • Sodium and potassium are interdependent
    • Sodium: Many prospective studies demonstrate a ‘J curve’ for sodium where both low and high sodium may be more highly associated with adverse outcomes (in those without hypertension)
    • Potassium: Linear reduction in BP and adverse CVD events with increasing potassium intake
  • O’Donnell et al. (BMJ, 2019) sought to determine the joint association of sodium and potassium with CVD and mortality

METHODS:

  • International prospective cohort study
    • Prospective Urban Rural Epidemiological (PURE) Study
    • High, middle, and low-income countries; urban and rural areas
  • Participants provided morning fasting urine samples
    • 24 hour urinary sodium and potassium excretion (surrogates for intake)
  • Primary outcome: Composite of
    • All cause mortality | Myocardial infarction | Stroke | Heart failure
  • Secondary outcomes
    • Individual components of the composite primary outcome
    • New diagnosis of cancer on follow-up
  • Reference categories
    • Sodium excretion: 4.00 to 4.99 g/day
    • Potassium excretion: <1.5 g/day
  • 6 category variable for joint sodium and potassium
    • sodium excretion
      • low: <3 g/day
      • Moderate:3-5 g/day
      • High: >5 g/day
    • Potassium excretion
      • (1) ≥ or (2) < than median 2.1 g/day for each of the above

RESULTS:

  • 103,570 people participated
  • Mean estimated excretion
    • Sodium excretion: 4.93 g/day
    • Potassium: 2.12 g/day
  • After a median follow-up of 8.2 years
    • 7884 (6.1%) participants had died or experienced a major cardiovascular event
  • A J-shaped association was observed of sodium excretion
  • Increasing potassium excretion inversely associated with death and cardiovascular events
  • The lowest risk of death and CVD
    • Moderate sodium excretion (3-5 g/day) and
    • Higher potassium excretion
  • The highest risk of death and CVD
    • Low potassium and low sodium excretion
      • Hazard ratio (HR) 1.23 (95%CI, 1.11 to 1.37)
    • Low potassium and high sodium excretion
      • HR 1.21 (95%CI, 1.11 to 1.32)
  • Next highest risk was for the following groups with potassium excretion greater than the median
    • Low sodium excretion: HR 1.19 (95% CI, 1.02 to 1.38)
    • High sodium excretion: HR 1.10 (95% CI, 1.02 to 1.18)
  • Higher potassium excretion diminished the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007)

CONCLUSION:

  • Moderate sodium intake (3-5 g/day) with high potassium intake (foods such as fruit, vegetables, nuts) is associated with the lowest risk of mortality and cardiovascular events
  • Authors point out that feasibility of very low salt diets are limited, and that moderate salt intake may not only be more realistic but may be associated with better diet quality
  • Studies which focused on increasing potassium based foods with less focus on low sodium intake, demonstrated a significant reduction in CVD and mortality

Learn more – Primary Sources:

Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

PURE Study Results – Carbs vs Fat Intake to Reduce Cardiovascular Morbidity and Mortality?
More From the PURE Study: Does Type of Exercise Matter When it Comes to Decreasing Mortality and CVD?  
Does Eating a Mediterranean Diet Reduce Risk of Stroke in Both Men and Women?
Can We Lay the Coffee and Mortality Debate to Rest?
What are the ‘Modifiable’ Risk Factors That Could Extend US Life Expectancy?
ACC/AHA Blood Pressure Guideline: Current Classification System and Treatment Targets

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site