Document Type : Original Article(s)
Authors
1 MSc Student, Food Security Research Center AND Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Associate Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
5 Associate Professor, Food Security Research Center AND Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Emerging evidence suggests a relationship between sodium (Na) intake and obesity risk. The aim of this study was to investigate the link between 24-hour (24-h) urinary Na excretion and adiposity measures in a sample of Iranian children and adolescents. METHODS: This cross-sectional study was performed among 374 healthy individuals aged 11-18 years old. Random cluster sampling method was used to select the participants from 4 districts in Isfahan, Iran. Na excretion was estimated using a 24-h urinary sample. Creatinine (Cr) level was used to confirm the completeness of samples. Anthropometric measures including weight, height and waist circumference (WC) were obtained based on standard protocols. RESULTS: The odds ratio (OR) for overweight/obesity in subjects with the highest tertile of Na excretion compared with the lowest tertile was 8.01 [95% confidence interval (CI) 4.20-15.3] in crude model and 8.33 (95% CI 4.14-16.8) after adjusting for potential confounders. The association was independent of intake of energy and sugar-sweetened beverages (SSBs). The OR for abdominal obesity in the highest tertile of Na excretion compared with the lowest tertile was 9.12 (95% CI 4.78- 17.4) in crude model and 9.75 (95% CI 4.88-19.5) after controlling for potential confounders. The association was independent of energy intake or SSBs consumption. CONCLUSION: Our study showed a positive association between Na excretion and obesity among children and adolescents. Further investigation through longitudinal studies using a more representative sample of children and adolescents is suggested to determine whether this is a causal relationship.
Keywords
- Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 2008; 32(9): 1431-7.
- Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008; 93(11 Suppl 1): S9-30.
- James WP. The epidemiology of obesity: the size of the problem. J Intern Med 2008; 263(4): 336-52.
- Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev 2007; 29: 62-76.
- Azizi F, Ghanbarian A, Momenan AA, Hadaegh F, Mirmiran P, Hedayati M, et al. Prevention of non-communicable disease in a population in nutrition transition: Tehran Lipid and Glucose Study phase II. Trials 2009; 10: 5.
- Esmaili H, Bahreynian M, Qorbani M, Motlagh ME, Ardalan G, Heshmat R, et al. Prevalence of General and Abdominal Obesity in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study. Iran J Pediatr 2015; 25(3): e401.
- Zhu H, Pollock NK, Kotak I, Gutin B, Wang X, Bhagatwala J, et al. Dietary sodium, adiposity, and inflammation in healthy adolescents. Pediatrics 2014; 133(3): e635-e642.
- Yoon YS, Oh SW. Sodium density and obesity; The Korea National Health and Nutrition Examination Survey 2007-2010. Eur J Clin Nutr 2013; 67(2): 141-6.
- Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, et al. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. Intersalt Cooperative Research Group. BMJ 1996; 312(7041): 1249-53.
- Ellison RC, Sosenko JM, Harper GP, Gibbons L, Pratter FE, Miettinen OS. Obesity, sodium intake, and blood pressure in adolescents. Hypertension 1980; 2(4 Pt 2): 78-82.
- Mattes RD, Donnelly D. Relative contributions of dietary sodium sources. J Am Coll Nutr 1991; 10(4): 383-93.
- Khosravi A, Gharipour A, Gharipour M, Khosravi M, Andalib E, Shirani S, et al. Advanced method used for hypertension's risk factors strati fi cation: support vector machines and gravitational search algorithm. ARYA Atheroscler 2015; 11(6): 349-56.
- Mohammadifard N, Fahimi S, Khosravi A, Pouraram H, Sajedinejad S, Pharoah P, et al. Advocacy strategies and action plans for reducing salt intake in Iran. Arch Iran Med 2012; 15(5): 320-4.
- Haghighatdoost F, Sarrafzadegan N, Khosravi A, Noori F, Boshtam M, Mohammadifard N, et al. Is the association between salt intake and blood pressure mediated by body mass index and central adiposity? Arch Iran Med 2013; 16(3): 167-71.
- Hedayati SS, Minhajuddin AT, Ijaz A, Moe OW, Elsayed EF, Reilly RF, et al. Association of urinary sodium/potassium ratio with blood pressure: sex and racial differences. Clin J Am Soc Nephrol 2012; 7(2): 315-22.
- Remer T, Neubert A, Maser-Gluth C. Anthropometry-based reference values for 24-h urinary creatinine excretion during growth and their use in endocrine and nutritional research. Am J Clin Nutr 2002; 75(3): 561-9.
- Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007; 335(7612): 194.
- Lee SK, Kim MK. Relationship of sodium intake with obesity among Korean children and adolescents: Korea National Health and Nutrition Examination Survey. Br J Nutr 2016; 115(5): 834-41.
- Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 1992; 135(10): 1114-26.
- Faghihimani Z, Nourian M, Nikkar AH, Farajzadegan Z, Khavariyan N, Ghatrehsamani S, et al. Validation of the child & adolescent-international physical Activity questionnaires in Iranian children and adolescents. ARYA Atheroscler 2010; 5(4): 1-4.
- Grimes CA, Riddell LJ, Campbell KJ, He FJ, Nowson CA. 24-h urinary sodium excretion is associated with obesity in a cross-sectional sample of Australian schoolchildren. Br J Nutr 2016; 115(6): 1071-9.
- Libuda L, Kersting M, Alexy U. Consumption of dietary salt measured by urinary sodium excretion and its association with body weight status in healthy children and adolescents. Public Health Nutr 2012; 15(3): 433-41.
- Woodruff SJ, Fryer K, Campbell T, Cole M. Associations among blood pressure, salt consumption and body weight status of students from south-western Ontario. Public Health Nutr 2014; 17(5): 1114-9.
- Fonseca-Alaniz MH, Brito LC, Borges-Silva CN, Takada J, Andreotti S, Lima FB. High dietary sodium intake increases white adipose tissue mass and plasma leptin in rats. Obesity (Silver Spring) 2007; 15(9): 2200-8.
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