Journal
JOURNAL OF HUMAN HYPERTENSION
Volume 34, Issue 1, Pages 24-33Publisher
SPRINGERNATURE
DOI: 10.1038/s41371-019-0210-2
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Funding
- Partnerships AMP
- Research Development Fund (PRDF) grant from the Australia Africa Universities Network
- CDC Foundation
- Bloomberg Philanthropies
- WHO
- Division of Behavioural and Social Research (BSR) at the National Institute on Aging (NIA), US National Institutes of Health [OGHA 04034785, YA1323-08-CN-0020, Y1-AG-1005-01]
- [R01AG034479]
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Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low-middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine sample have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine samples in a nationally representative sample of South Africans. Spot and 24-hour urine samples were collected in a subsample (n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland-Altman plots. In this subsample (mean age 52.8 +/- 16.4 years; body mass index 30.2 +/- 8.2 kg/m(2); 76% female; 73% black African; 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4-10.5). Although INTERSALT underestimated salt intake (-3.77 g/d; -1.64 to -7.09), the other equations overestimated by 1.28 g/d (-3.52; 1.97), 6.24 g/d (2.22; 9.45), and 17.18 g/d (8.42; 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland-Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine samples in South Africans is not recommended.
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