Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep 1;12(9):e061348.
doi: 10.1136/bmjopen-2022-061348.

Comparison of three spot urine formulae and their validation using 24-hour urine sodium for estimation of daily salt intake: a cross-sectional study among Bangladeshi adults

Sohel Reza Choudhury  1 , Mohammad Abdullah Al-Mamun  2 , Jubaida Akhtar  2 , Md Noor Nabi Sayem  2 , Zerin Zahed  2 , Mohammad Ataur Rahman  2 , Jasimuddin Ahmed  3 , Mohammad Mostafa Zaman  4
Affiliations

Comparison of three spot urine formulae and their validation using 24-hour urine sodium for estimation of daily salt intake: a cross-sectional study among Bangladeshi adults

Sohel Reza Choudhury et al. BMJ Open. .

Abstract

Objective: This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh.

Design: A population-based cross-sectional survey.

Setting: A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012-2013.

Participants: 418 community living residents aged 40-59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study.

Outcome measures: The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion.

Results: The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67).

Conclusion: Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.

Keywords: CARDIOLOGY; NUTRITION & DIETETICS; PUBLIC HEALTH.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Average of salt (g/day) from 24HUNa and Tanaka method. (B) Average of salt (g/day) from 24HUNa and Kawasaki method. (C) Average of salt (g/day) from 24HUNa and INTERSALT method.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. GBD 2017 Causes of Death Collaborators . Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the global burden of disease study 2017. Lancet 2018;392:1736-1788. 10.1016/S0140-6736(18)32203-7 - DOI - PMC - PubMed
    1. Karar ZA, Alam N, Streatfield PK. Epidemiological transition in rural Bangladesh, 1986-2006. Global Health Action 2009;2. - PMC - PubMed
    1. Institute for Health Metrics and Evaluation (IHME) . Bangladesh profile. Seattle, WA: IHME, University of Washington, 2018. Available: http://www.healthdata.org/Bangladesh [Accessed 20 Jul 202].
    1. Riaz BK, Islam MZ, Islam ANMS, et al. Risk factors for non-communicable diseases in Bangladesh: findings of the population-based cross-sectional national survey 2018. BMJ Open 2020;10:e041334. 10.1136/bmjopen-2020-041334 - DOI - PMC - PubMed
    1. Chowdhury MZI, Rahman M, Akter T, et al. Hypertension prevalence and its trend in Bangladesh: evidence from a systematic review and meta-analysis. Clin Hypertens 2020;26:10. 10.1186/s40885-020-00143-1 - DOI - PMC - PubMed

Publication types