Dietary reference values for sodium

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. 2019 Sep 4;17(9):e05778. doi: 10.2903/j.efsa.2019.5778

References (country)	Design	Baseline characteristics	Na intake assessment method	UNa (mmol/24 h)	Outcomes assessed	Confounders adjusted for	Results
Shi et al. (2014) (Germany) DONALD	Prospective cohort N = 1,107 DONALD initial cohort N = 435 included in the analyses (included: at least 3 BP measurements with three parallel 24‐h UNa and 3‐day weighed dietary records; excluded: preterm children, birth weight and breast‐feeding data missing; taking BP‐lowering treatment; implausible SBP/DBP values) Mean duration: 10 years	Male (%) 51.0 Age (median (p25–p75), years) b 6 (4–8) g 6 (4–7) BMI (median (p25–p75), kg/m ² ) b 15.7 (15.0–16.8) g 15.3 (14.7–16.4) SBP (median (p25–p75), mm Hg) b 97.1 (90.8–104.0) g 97.0 (90.0–102.0) DBP (median (p25–p75), mm Hg) b 57.0 (50.0–65.0) g 55.0 (49.6–64.1) 24‐h UK (median (p25–p75), mmol) b 39.1 (29.7–47.8) g 32.4 (26.2–38.9) 24‐h UK UCr (median (p25–p75), mmol/kg bw) b 0.16 (0.14–0.18) g 0.15 (0.13–0.17) Energy intake (median (p25–p75), MJ/day) b 6.1 (5.3–7.2) g 5.3 (4.8–6.3)	Single 24‐h urine sample at yearly intervals	Median (p25–p75) First assessment b 67.4 (50.6–89.9) g 58.7 (45.9–74.5) Last assessment b 131.0 (96.9–176.0) g 108.0 (81.7–133.0)	Longitudinal change in SBP and DBP BP measured every 2 years (2 BP readings averaged at each visit)	Age, age 2, age 3, sex, pubertal group, intraindividual change in Na excretion × pubertal group, person‐specific mean‐Na excretion × pubertal group, TEI, TEI × pubertal group, BMI‐SDS, height‐SDS, birth weight, full breast‐feeding status, maternal SBP, FVI, FVI × pubertal group	Change in SBP (mm Hg)/1 mmol/MJ increase in Na excretion (β (95% CI)): Prepubertal group Between person effect −0.2 (−0.4, 0.04) p = 0.1 Within person effect −0.03 (−0.2, 0.09) p = 0.6 Pubertal group Between person effect 0.1 (−0.1, 0.4) p = 0.3 Within person effect 0.1 (−0.004, 0.2) p = 0.06
Age, age 2, age 3, sex, pubertal group, intraindividual change in Na excretion × pubertal group, person‐specific mean‐Na excretion × pubertal group, TEI, TEI × pubertal group, BMI‐SDS, height‐SDS, growth velocity, full breast‐feeding status, maternal SBP, FVI, FVI × pubertal group and Ca intake	Change in DBP (mm Hg)/1 mmol/MJ increase in Na excretion (β (95% CI)): Prepubertal group Between person effect −0.1 (−0.4,0.07) p = 0.2 Within person effect −0.1 (−0.2, 0.03) p = 0.1 Pubertal group Between person effect −0.2 (−0.4, 0.04) p = 0.1 Within person effect 0.1 (−0.02, 0.2) p = 0.09
Krupp et al. (2015) (Germany) DONALD	Prospective cohort N = NR N = 206 included in the analyses (‘included: reached adult age, had a BP measurement and assessed in parallel anthropometrical data between 18 and 25 years, had ≥ 3 parallel plausible dietary records 24 h UNa and ≥ 3 BP measurements during adolescence (11–16 years); excluded: preterm, missing data on birth weight and gestational age, implausible BP data) Mean duration: 7 years	Male (%) 52.0 Age (median (p25–p75), years) b 12.4 (12.1–13.0) g 12.3 (12.0–13.0) BMI (mean (SD), kg/m ² ) b 18.9 (2.3) g 18.7 (2.7) SBP (mean (SD), mm Hg) b 104 (7) g 103 (8) DBP (mean (SD), mm Hg) b 62 (6) g 61 (6) 24‐h UK (mean (SD), mmol) b 56 (14) g 51 (13) 24‐h UK UCr (mean (SD), mmol/kg bw) b 0.18 (0.02) g 0.17 (0.02) Energy intake (mean (SD), MJ/day) b 9.1 (1.5) g 7.9 (0.9)	Single 24‐h urine sample at yearly intervals Samples with UCr < 0.1 mmol/kg BW excluded from the analysis	NaCl (mean (SD)) b 116 (27) g 105 (32) calculated as (Na (mmol/day) + Cl (mmol/day))/2	Longitudinal change in SBP and DBP BP measured every 2 years (2 blood pressure readings averaged at each examination)	Mean pubertal SBP SDS, adult age, standardised energy intake, intake of saturated fat, height‐SDS, maternal education, maternal BP, FVI, adult BMI	Change in SBP (mm Hg)/1 mmol increase in NaCl excretion (ß (95% CI)): b 0.1 (0.03, 0.18) p = 0.01 g ‐0.05 (−0.11, 0.02) p = 0.1
Mean pubertal SBP SDS, adult age, standardised energy intake, calcium intake, birth weight, smoking in the household, maternal BP, FVI, adult BMI	Change in DBP (mm Hg)/1 mmol increase in NaCl excretion (ß (95% CI)): b 0.02 (−0.08, 0.04) p = 0.6 g 0.02 (−0.03, 0.08) p = 0.4

References (country)

Design

Baseline characteristics

Na intake assessment method

UNa (mmol/24 h)

Outcomes

assessed

Confounders adjusted for

Results

Shi et al. (2014)

(Germany)

DONALD

Prospective cohort

N = 1,107 DONALD initial cohort

N = 435 included in the analyses (included: at least 3 BP measurements with three parallel 24‐h UNa and 3‐day weighed dietary records; excluded: preterm children, birth weight and breast‐feeding data missing; taking BP‐lowering treatment; implausible SBP/DBP values)

Mean duration: 10 years

Male (%)

51.0

Age (median (p25–p75), years)

b 6 (4–8)

g 6 (4–7)

BMI (median (p25–p75), kg/m ² )

b 15.7 (15.0–16.8)

g 15.3 (14.7–16.4)

SBP (median (p25–p75), mm Hg)

b 97.1 (90.8–104.0)

g 97.0 (90.0–102.0)

DBP (median (p25–p75), mm Hg)

b 57.0 (50.0–65.0)

g 55.0 (49.6–64.1)

24‐h UK (median (p25–p75), mmol)

b 39.1 (29.7–47.8)

g 32.4 (26.2–38.9)

24‐h UK UCr (median (p25–p75), mmol/kg bw)

b 0.16 (0.14–0.18)

g 0.15 (0.13–0.17)

Energy intake (median (p25–p75), MJ/day)

b 6.1 (5.3–7.2)

g 5.3 (4.8–6.3)

Single 24‐h urine sample at yearly intervals

Median (p25–p75)

First assessment

b 67.4 (50.6–89.9)

g 58.7 (45.9–74.5)

Last assessment

b 131.0 (96.9–176.0)

g 108.0 (81.7–133.0)

Longitudinal change in SBP and DBP

BP measured every 2 years (2 BP readings averaged at each visit)

Age, age 2, age 3, sex, pubertal group, intraindividual change in Na excretion × pubertal group, person‐specific mean‐Na excretion × pubertal group, TEI, TEI × pubertal group, BMI‐SDS, height‐SDS, birth weight, full breast‐feeding status, maternal SBP, FVI, FVI × pubertal group

Change in SBP (mm Hg)/1 mmol/MJ increase in Na excretion (β (95% CI)):

Prepubertal group

Between person effect

−0.2 (−0.4, 0.04) p = 0.1

Within person effect

−0.03 (−0.2, 0.09) p = 0.6

Pubertal group

Between person effect

0.1 (−0.1, 0.4) p = 0.3

Within person effect

0.1 (−0.004, 0.2) p = 0.06

Age, age 2, age 3, sex, pubertal group, intraindividual change in Na excretion × pubertal group, person‐specific mean‐Na excretion × pubertal group, TEI, TEI × pubertal group, BMI‐SDS, height‐SDS, growth velocity, full breast‐feeding status, maternal SBP, FVI, FVI × pubertal group and Ca intake

Change in DBP (mm Hg)/1 mmol/MJ increase in Na excretion (β (95% CI)):

Prepubertal group

Between person effect

−0.1 (−0.4,0.07) p = 0.2

Within person effect

−0.1 (−0.2, 0.03) p = 0.1

Pubertal group

Between person effect

−0.2 (−0.4, 0.04) p = 0.1

Within person effect

0.1 (−0.02, 0.2) p = 0.09

Krupp et al. (2015)

(Germany)

DONALD

Prospective cohort

N = NR

N = 206 included in the analyses (‘included: reached adult age, had a BP measurement and assessed in parallel anthropometrical data between 18 and 25 years, had ≥ 3 parallel plausible dietary records 24 h UNa and ≥ 3 BP measurements during adolescence (11–16 years); excluded: preterm, missing data on birth weight and gestational age, implausible BP data)

Mean duration: 7 years

Male (%)

52.0

Age (median (p25–p75), years)

b 12.4 (12.1–13.0)

g 12.3 (12.0–13.0)

BMI (mean (SD), kg/m ² )

b 18.9 (2.3)

g 18.7 (2.7)

SBP (mean (SD), mm Hg)

b 104 (7)

g 103 (8)

DBP (mean (SD), mm Hg)

b 62 (6)

g 61 (6)

24‐h UK (mean (SD), mmol)

b 56 (14)

g 51 (13)

24‐h UK UCr (mean (SD), mmol/kg bw)

b 0.18 (0.02)

g 0.17 (0.02)

Energy intake (mean (SD), MJ/day)

b 9.1 (1.5)

g 7.9 (0.9)

Single 24‐h urine sample at yearly intervals

Samples with UCr < 0.1 mmol/kg BW excluded from the analysis

NaCl (mean (SD))

b 116 (27)

g 105 (32)

calculated as (Na (mmol/day) + Cl (mmol/day))/2

Longitudinal change in SBP and DBP

BP measured every 2 years (2 blood pressure readings averaged at each examination)

Mean pubertal SBP SDS, adult age, standardised energy intake, intake of saturated fat, height‐SDS, maternal education, maternal BP, FVI, adult BMI

Change in SBP (mm Hg)/1 mmol increase in NaCl excretion (ß (95% CI)):

b 0.1 (0.03, 0.18) p = 0.01

g ‐0.05 (−0.11, 0.02) p = 0.1

Mean pubertal SBP SDS, adult age, standardised energy intake, calcium intake, birth weight, smoking in the household, maternal BP, FVI, adult BMI

Change in DBP (mm Hg)/1 mmol increase in NaCl excretion (ß (95% CI)):

b 0.02 (−0.08, 0.04) p = 0.6

g 0.02 (−0.03, 0.08) p = 0.4

b: boys; BMI: body mass index; BP: blood pressure; bw: body weight; 95% CI: 95% confidence interval; Cl: chloride; DBP: diastolic blood pressure; DONALD: Dortmund Nutritional and Anthropometrical Longitudinally Designed study FVI: fruit and vegetable intake; g: girls; MJ: megajoule; mm Hg: millimetre of mercury; mmol: millimole; N: number; Na: sodium; NR: not reported; SBP: systolic blood pressure; SD: standard deviation; SDS: standard deviation score; TEI: total energy intake; UCr: creatinine urinary excretion; UK: potassium urinary excretion; UNa: sodium urinary excretion.