Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013

PLOS ONE, Nov 2019

Objectives This study aimed to evaluate the association between sodium intake and metabolic syndrome (MetS) in Korean boys. Methods A total of 1,738 boys aged 10–18 years were included in this study from the Korea National Health and Nutrition Examination Survey (KNHANES) during the years 2010–2013. Sodium intake was assessed using the urinary sodium excretion to urinary specific gravity ratio (U-Na to U-SG ratio). Results The median U-Na to U-SG ratio was 133.27 mmol/L (interquartile range: 95.66–178.50 mmol/L). Significant positive associations were found between the U-Na to U-SG ratio and the TG (P = 0.001 for trend) and TG concentrations, and these concentrations were significantly higher in boys with a U-Na to U-SG ratio in the highest quartile compared with those with a ratio in the lowest (P = 0.001) and second (P = 0.033) quartiles, as demonstrated through analysis of covariance (ANCOVA) after adjustment for possible confounders, including age, BMI standard deviation score, ferritin, vitamin D, house income, smoking, alcohol intake, physical activity, season, total intake, total energy intake, protein intake, fat intake, carbohydrate intake, and water intake. Significant inverse associations were found for the U-Na to U-SG ratio with the HDL-C (P = 0.033 for trend) and HDL-C levels, and these values were significantly lower in boys with a ratio in the highest quartile compared with those with a ratio in the second quartile (P = 0.020), as demonstrated through an ANCOVA. Although the trends did not reach statistical significance, a higher U-Na to U-SG ratio tended to be associated with higher SBP (P = 0.086 for trend), DBP (P = 0.063 for trend), and glucose levels (P = 0.099 for trend), as illustrated through ANCOVA. Boys with a ratio in the highest quartile exhibited a 1.73-fold increased risk for elevated TG (95% CI, 1.19–2.51) and a 2.66-fold increased risk for MetS (95% CI, 1.11–6.35) compared with those with a ratio in the lowest quartile, as demonstrated through multivariate logistic regression analyses after adjusting for confounders. Conclusions Our results suggest that high sodium intake may be significantly independently associated with MetS in Korean boys aged 10–18 years.

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Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013

December Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013 Cheol Hwan So 1 2 Hwal Rim Jeong 0 1 Young Suk Shim 0 1 0 Department of Pediatrics, Hallym University College of Medicine , Seoul , Republic of Korea 1 Editor: Tatsuo Shimosawa, The University of Tokyo , JAPAN 2 Department of Pediatrics, Wonkwang University School of Medicine , Iksan , Republic of Korea - The median U-Na to U-SG ratio was 133.27 mmol/L (interquartile range: 95.66±178.50 mmol/L). Significant positive associations were found between the U-Na to U-SG ratio and the TG (P = 0.001 for trend) and TG concentrations, and these concentrations were significantly higher in boys with a U-Na to U-SG ratio in the highest quartile compared with those with a ratio in the lowest (P = 0.001) and second (P = 0.033) quartiles, as demonstrated through analysis of covariance (ANCOVA) after adjustment for possible confounders, including age, BMI standard deviation score, ferritin, vitamin D, house income, smoking, alcohol intake, physical activity, season, total intake, total energy intake, protein intake, fat intake, carbohydrate intake, and water intake. Significant inverse associations were found for the U-Na to U-SG ratio with the HDL-C (P = 0.033 for trend) and HDL-C levels, and these values were significantly lower in boys with a ratio in the highest quartile compared with those with a ratio in the second quartile (P = 0.020), as demonstrated through an ANCOVA. Although the trends did not reach statistical significance, a higher U-Na to U-SG ratio tended Data Availability Statement: This study used third-party data from the Korean National Health and Nutrition Examination Survey (KNHANES). All relevant data are available from the KNHANES database. which is available to the public via the KNHANES website at the following link: http:// knhanes.cdc.go.kr. Others would be able to access these data in the same manner. The authors did not have any special access privileges that others would not have. Objectives Methods Results Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. to be associated with higher SBP (P = 0.086 for trend), DBP (P = 0.063 for trend), and glucose levels (P = 0.099 for trend), as illustrated through ANCOVA. Boys with a ratio in the highest quartile exhibited a 1.73-fold increased risk for elevated TG (95% CI, 1.19±2.51) and a 2.66-fold increased risk for MetS (95% CI, 1.11±6.35) compared with those with a ratio in the lowest quartile, as demonstrated through multivariate logistic regression analyses after adjusting for confounders. Conclusions Our results suggest that high sodium intake may be significantly independently associated with MetS in Korean boys aged 10±18 years. Introduction According to the 2013 Korea School Health Examination, the prevalence of obesity in Korean children and adolescents increased from 13.2% in 2009 to 15.3% in 2013 [ 1 ]. The high prevalence of childhood and adolescent obesity has been associated with increased adult obesity [ 2 ] and obesity-related complications, such as insulin resistance [ 3 ], hypertension [ 4 ], dyslipidemia [ 5 ], metabolic syndrome (MetS) [ 6 ], and type 2 diabetes mellitus (T2DM) [ 7 ]. According to the modified NCEP-ATP III for children and adolescents, a recent Korean study revealed that the prevalence of MetS is 5.8% and 5.5% in boys and girls aged with 10±18 years, respectively [ 8 ]. MetS is related to cardiovascular disease, cerebrovascular disease, kidney disease, and type 2 diabetes mellitus (T2DM) [ 9 ]. This constellation of cardiometabolic risk factors is considered to be modifiable, and the identification of children and adolescents with MetS is necessary because age-specific interventions can help improve their condition. High sodium intake has become one of the major problems in the healthcare field throughout the world. High sodium intake is associated with increased blood pressure in children [ 10 ], adolescents [ 10 ] and adults [ 11 ], and high sodium intake is thought to be related to MetS because elevated blood pressure is a component of MetS [ 12 ]. However, recent studies have indicated that high sodium intake is associated with other components of MetS [13±15]. There are reports that high sodium intake is related to obesity [13.14], and it has also been suggested that high sodium intake is associated with cardiometabolic risk factors, such as dyslipidemia, insulin resistance, and metabolic syndrome, in adults [ 15 ]. However, no previous study has demonstrated a link between high sodium and insulin resistance-related diseases in children and adolescents. In addition, high salt intake is modifiable as part of a medical intervention. In the current study, we aimed to evaluate (...truncated)


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Cheol Hwan So, Hwal Rim Jeong, Young Suk Shim. Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013, PLOS ONE, 2017, Volume 12, Issue 12, DOI: 10.1371/journal.pone.0189934