Abstract: TH-PO803
Low Sodium Intake, Low Protein Intake, and Excess Mortality: Findings in the Lifelines-MINUTHE Study
Session Information
- Health Maintenance, Nutrition, Metabolism
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance‚ Nutrition‚ and Metabolism
- 1400 Health Maintenance‚ Nutrition‚ and Metabolism
Authors
- Hessels, Niek, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
- Zhu, Yinjie, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
- De Borst, Martin H., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
- Bakker, Stephan J.L., Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
- Navis, Gerjan, Universitair Medisch Centrum Groningen, Groningen, Groningen, Netherlands
- Riphagen, Ineke J., Universitair Medisch Centrum Groningen, Groningen, Netherlands
Background
Several observational studies reported on a U-shaped association between sodium intake and mortality, which raises questions about the safety of low sodium intake and hampers widespread acceptance of public health campaigns and dietary guidelines. We investigated whether concomitant low protein intake explained the lower part of this U-shaped association between sodium intake and all-cause mortality.
Methods
We investigated the associations between sodium intake (24 h sodium excretion) and all-cause mortality, including the interaction with protein intake (Maroni formula), using multivariable Cox regression in a gender and socioeconomic status balanced Lifelines cohort.
Results
A total of 1603 individuals aged between 60 and 75 years was included. After a median follow-up of 8.9 years, 125 (7.8%) deaths occurred. Both the highest (Q4, >4.7 g/day; HR 1.74 [95%CI 1.03-2.95]) and the lowest quartile of sodium intake (Q1, 0.7-2.8 g/day; 2.05 [1.16-3.62]; p=0.01) were associated with increased risk of all-cause mortality compared with the third quartile of sodium intake (Q3, 3.6-4.7 g/day), independent of potential confounders. A significant interaction with protein intake (P-interaction=0.006) was found, with the increased risk of low sodium intake being reversed to reduced risk by concomitant high protein intake, while the increased risk was magnified by concomitant low protein intake (see figure 1).
Conclusion
We found that both high and low levels of sodium intake were associated with increased all-cause mortality. However, higher protein intake annihilated the excess mortality observed in subjects on low sodium intake. A joint low intake of sodium and protein is associated with a particularly high mortality risk, allegedly due to a poor nutritional status. This backs up guidelines advocating to lower sodium intake while also highlighting the importance of recognizing overall nutritional status.