Dietary salt intake and mortality in patients with type 2 diabetes

Elif Ekinci, Sophie Clarke, Merlin Thomas, John Moran, Karey Cheong, Richard MacIsaac, George Jerums

Research output: Contribution to journalArticleResearchpeer-review

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 languageEnglish
Pages (from-to)703-709
Number of pages7
JournalDiabetes Care
Volume34
Issue number3
DOIs
Publication statusPublished - 2011
Externally publishedYes

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Type 2 Diabetes Mellitus
Salts
Mortality
Guidelines
Cohort Studies
Research Design
Sodium

Cite this

Ekinci, E., Clarke, S., Thomas, M., Moran, J., Cheong, K., MacIsaac, R., & Jerums, G. (2011). Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care, 34(3), 703-709. https://doi.org/10.2337/dc10-1723
Ekinci, Elif ; Clarke, Sophie ; Thomas, Merlin ; Moran, John ; Cheong, Karey ; MacIsaac, Richard ; Jerums, George. / Dietary salt intake and mortality in patients with type 2 diabetes. In: Diabetes Care. 2011 ; Vol. 34, No. 3. pp. 703-709.
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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.",
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Ekinci, E, Clarke, S, Thomas, M, Moran, J, Cheong, K, MacIsaac, R & Jerums, G 2011, 'Dietary salt intake and mortality in patients with type 2 diabetes', Diabetes Care, vol. 34, no. 3, pp. 703-709. https://doi.org/10.2337/dc10-1723

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 journalArticleResearchpeer-review

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AU - Clarke, Sophie

AU - Thomas, Merlin

AU - Moran, John

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AU - MacIsaac, Richard

AU - Jerums, George

PY - 2011

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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.

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JO - Diabetes Care

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Ekinci E, Clarke S, Thomas M, Moran J, Cheong K, MacIsaac R et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34(3):703-709. https://doi.org/10.2337/dc10-1723