Abstract
Objective: Many guidelines recommend that patients with type 2 diabetesshould aim to reduce their intake of salt. However, the precise relationshipbetween dietary salt intake and mortality in patients with type 2 diabetes hasnot been previously explored.
Research and Design Methods: Six hundredand thirty-eight patients attending a single diabetes clinic were followed in aprospective cohort study. Baseline sodium excretion was estimated from 24-hurinary collections (24hUNa). The predictors of all-cause and cardiovascularmortality were determined by Cox regression and competing risk modeling,respectively.
Results: The mean baseline 24hUNa was 184 ± 73 mmol/24 h, whichremained consistent throughout the follow-up (intra individual coefficient ofvariation [CV] 23 ± 11%). Over amedian of 9.9 years, there were 175 deaths, 75(43%) of which were secondary to cardiovascular events. All-cause mortality wasinversely associated with 24hUNa, after adjusting for other baseline risk factors(P < 0.001). For every 100 mmol rise in 24hUNa, all-cause mortality was28%lower (95% CI 6–45%, P = 0.02). After adjusting for the competing risk ofnoncardiovascular death and other predictors, 24hUNa was also significantlyassociated with cardiovascular mortality(sub-hazard ratio 0.65 [95% CI0.44–0.95]; P = 0.03).
Conclusions: In patients with type 2 diabetes, lower 24-h urinary sodiumexcretion wasparadoxically associated with increased all-cause andcardiovascular mortality. Interventionalstudies are necessary to determine ifdietary salt has a causative role in determining adverseoutcomes in patientswith type 2 diabetes and the appropriateness of guidelines advocatingsaltrestriction in this setting.
| Original language | English |
|---|---|
| Pages (from-to) | 703-709 |
| Number of pages | 7 |
| Journal | Diabetes Care |
| Volume | 34 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2011 |
| Externally published | Yes |
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Dietary salt intake and mortality in patients with type 2 diabetes. / Ekinci, Elif; Clarke, Sophie; Thomas, Merlin; Moran, John; Cheong, Karey; MacIsaac, Richard; Jerums, George.
In: Diabetes Care, Vol. 34, No. 3, 2011, p. 703-709.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Dietary salt intake and mortality in patients with type 2 diabetes
AU - Ekinci, Elif
AU - Clarke, Sophie
AU - Thomas, Merlin
AU - Moran, John
AU - Cheong, Karey
AU - MacIsaac, Richard
AU - Jerums, George
PY - 2011
Y1 - 2011
N2 - Objective: Many guidelines recommend that patients with type 2 diabetesshould aim to reduce their intake of salt. However, the precise relationshipbetween dietary salt intake and mortality in patients with type 2 diabetes hasnot been previously explored. Research and Design Methods: Six hundredand thirty-eight patients attending a single diabetes clinic were followed in aprospective cohort study. Baseline sodium excretion was estimated from 24-hurinary collections (24hUNa). The predictors of all-cause and cardiovascularmortality were determined by Cox regression and competing risk modeling,respectively. Results: The mean baseline 24hUNa was 184 ± 73 mmol/24 h, whichremained consistent throughout the follow-up (intra individual coefficient ofvariation [CV] 23 ± 11%). Over amedian of 9.9 years, there were 175 deaths, 75(43%) of which were secondary to cardiovascular events. All-cause mortality wasinversely associated with 24hUNa, after adjusting for other baseline risk factors(P < 0.001). For every 100 mmol rise in 24hUNa, all-cause mortality was28%lower (95% CI 6–45%, P = 0.02). After adjusting for the competing risk ofnoncardiovascular death and other predictors, 24hUNa was also significantlyassociated with cardiovascular mortality(sub-hazard ratio 0.65 [95% CI0.44–0.95]; P = 0.03). Conclusions: In patients with type 2 diabetes, lower 24-h urinary sodiumexcretion wasparadoxically associated with increased all-cause andcardiovascular mortality. Interventionalstudies are necessary to determine ifdietary salt has a causative role in determining adverseoutcomes in patientswith type 2 diabetes and the appropriateness of guidelines advocatingsaltrestriction in this setting.
AB - Objective: Many guidelines recommend that patients with type 2 diabetesshould aim to reduce their intake of salt. However, the precise relationshipbetween dietary salt intake and mortality in patients with type 2 diabetes hasnot been previously explored. Research and Design Methods: Six hundredand thirty-eight patients attending a single diabetes clinic were followed in aprospective cohort study. Baseline sodium excretion was estimated from 24-hurinary collections (24hUNa). The predictors of all-cause and cardiovascularmortality were determined by Cox regression and competing risk modeling,respectively. Results: The mean baseline 24hUNa was 184 ± 73 mmol/24 h, whichremained consistent throughout the follow-up (intra individual coefficient ofvariation [CV] 23 ± 11%). Over amedian of 9.9 years, there were 175 deaths, 75(43%) of which were secondary to cardiovascular events. All-cause mortality wasinversely associated with 24hUNa, after adjusting for other baseline risk factors(P < 0.001). For every 100 mmol rise in 24hUNa, all-cause mortality was28%lower (95% CI 6–45%, P = 0.02). After adjusting for the competing risk ofnoncardiovascular death and other predictors, 24hUNa was also significantlyassociated with cardiovascular mortality(sub-hazard ratio 0.65 [95% CI0.44–0.95]; P = 0.03). Conclusions: In patients with type 2 diabetes, lower 24-h urinary sodiumexcretion wasparadoxically associated with increased all-cause andcardiovascular mortality. Interventionalstudies are necessary to determine ifdietary salt has a causative role in determining adverseoutcomes in patientswith type 2 diabetes and the appropriateness of guidelines advocatingsaltrestriction in this setting.
U2 - 10.2337/dc10-1723
DO - 10.2337/dc10-1723
M3 - Article
VL - 34
SP - 703
EP - 709
JO - Diabetes Care
JF - Diabetes Care
SN - 0149-5992
IS - 3
ER -