背景:钠摄入对心血管疾病(CVD)健康和死亡率的影响已经研究了数十年,包括与血压的既定关联。然而,非线性模式,剂量-反应关联,钠和钾摄入量与总体和特定原因死亡率之间关系的性别差异仍有待阐明,缺乏全面的检查。我们的研究目的是确定钠和钾的摄入量以及钠钾比是否与男性和女性的总体死亡率和特定原因死亡率相关。
方法:我们对美国国立卫生研究院AARP饮食与健康研究的237,036名男性和179,068名女性进行了前瞻性分析。使用多变量校正的Cox比例风险回归模型来计算风险比。还对队列研究进行了系统评价和荟萃分析。
结果:在6,009,748人年的随访中,有77,614人死亡,男子49297人,妇女28317人。调整其他风险因素,我们发现,较高的钠摄入量(≥2,000mg/d)与总体死亡率和CVD死亡率(总体死亡率,第五对最低的五分之一,男性和女性HR=1.06和1.10,P非线性<0.0001;CVD死亡率,第五对最低的五分之一,HRs=1.07和1.21,P非线性=0.0002和0.01)。较高的钾摄入量和较低的钠钾比与死亡率降低有关。女性表现出更强的关联(总死亡率,第五对最低的五分之一,对于男性和女性,钾的HR=0.96和0.82,钠钾比的HR=1.09和1.23,分别;P非线性<0.05,相互作用均P≤0.0006)。总死亡率与钠摄入量有关,不同人群危险因素亚组的钾和钠钾比总体相似,但在体重指数或水果摄入量较低的男性中,钾与死亡率的反向关联更强(P交互作用<0.0004).基于42项风险估计的队列研究的最新荟萃分析,2,085,904名与会者,80,085例CVD事件产生了非常相似的结果(最高钠类别与最低钠类别,心血管事件的汇总相对风险=1.13,95%CI:1.06-1.20;P非线性<0.001)。
结论:我们的研究表明,每日钠摄入量(钠摄入量在2,000至7,500mg/d之间)之间存在显着正相关。钠钾比,心血管疾病和总死亡率的风险,女性的钠钾比死亡率比男性强,荟萃分析为CVD关联提供了令人信服的支持。这些数据可能表明减少钠摄入量和增加钾摄入量是改善健康和长寿的手段。我们的数据表明钾-死亡率和钠-钾比率-死亡率的关系存在性别差异,这提供了与当前一般成年人膳食指南相关的额外证据.
背景:PROSPERO标识符:CRD42022331618。
BACKGROUND: The impact of sodium intake on cardiovascular disease (CVD) health and mortality has been studied for decades, including the well-established association with blood pressure. However, non-linear patterns, dose-response associations, and sex differences in the relationship between sodium and potassium intakes and overall and cause-specific mortality remain to be elucidated and a comprehensive examination is lacking. Our study objective was to determine whether intake of sodium and potassium and the sodium-potassium ratio are associated with overall and cause-specific mortality in men and women.
METHODS: We conducted a prospective analysis of 237,036 men and 179,068 women in the National Institutes of Health-AARP Diet and Health Study. Multivariable-adjusted Cox proportional hazard regression models were utilized to calculate hazard ratios. A systematic review and meta-analysis of cohort studies was also conducted.
RESULTS: During 6,009,748 person-years of follow-up, there were 77,614 deaths, 49,297 among men and 28,317 among women. Adjusting for other risk factors, we found a significant positive association between higher sodium intake (≥ 2,000 mg/d) and increased overall and CVD mortality (overall mortality, fifth versus lowest quintile, men and women HRs = 1.06 and 1.10, Pnonlinearity < 0.0001; CVD mortality, fifth versus lowest quintile, HRs = 1.07 and 1.21, Pnonlinearity = 0.0002 and 0.01). Higher potassium intake and a lower sodium-potassium ratio were associated with a reduced mortality, with women showing stronger associations (overall mortality, fifth versus lowest quintile, HRs for potassium = 0.96 and 0.82, and HRs for the sodium-potassium ratio = 1.09 and 1.23, for men and women, respectively; Pnonlinearity < 0.05 and both P for interaction ≤ 0.0006). The overall mortality associations with intake of sodium, potassium and the sodium-potassium ratio were generally similar across population risk factor subgroups with the exception that the inverse potassium-mortality association was stronger in men with lower body mass index or fruit consumption (Pinteraction < 0.0004). The updated meta-analysis of cohort studies based on 42 risk estimates, 2,085,904 participants, and 80,085 CVD events yielded very similar results (highest versus lowest sodium categories, pooled relative risk for CVD events = 1.13, 95% CI: 1.06-1.20; Pnonlinearity < 0.001).
CONCLUSIONS: Our study demonstrates significant positive associations between daily sodium intake (within the range of sodium intake between 2,000 and 7,500 mg/d), the sodium-potassium ratio, and risk of CVD and overall mortality, with women having stronger sodium-potassium ratio-mortality associations than men, and with the meta-analysis providing compelling support for the CVD associations. These data may suggest decreasing sodium intake and increasing potassium intake as means to improve health and longevity, and our data pointing to a sex difference in the potassium-mortality and sodium-potassium ratio-mortality relationships provide additional evidence relevant to current dietary guidelines for the general adult population.
BACKGROUND: PROSPERO Identifier: CRD42022331618.