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Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study.
BMJ Open. 2016 07 13; 6(7):e011632.BO

Abstract

OBJECTIVES

To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population.

SETTING

Prospective cohort study.

PARTICIPANTS

In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model.

PRIMARY OUTCOME MEASURES

Mortality from total and subtypes of stroke, CVD and all causes.

RESULTS

A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality.

CONCLUSIONS

Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population.

Authors+Show Affiliations

Research Institute of Strategy for Prevention, Tokyo, Japan.Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan.Department of Public Health, Shiga University of Medical Science, Shiga, Otsu, Japan Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Otsu, Japan.Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.Department of Hygiene and Preventive Medicine, Fukushima Medical University, Fukushima, Japan.Second Department of Internal Medicine, Sapporo Medical University, Sapporo, Japan.Second Department of Internal Medicine, Sapporo Medical University, Sapporo, Japan.Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Science, Sapporo, Japan.Department of Nutrition and Health, Chiba Prefectural University of Health Sciences, Chiba, Japan.Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.Department of Public Health, Shiga University of Medical Science, Shiga, Otsu, Japan.Department of Food and Nutrition, Osaka City University, Osaka, Japan.Department of Public Health, Shiga University of Medical Science, Shiga, Otsu, Japan.Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Otsu, Japan.Department of Hygiene and Public Health, Teikyo University, Tokyo, Japan.Department of Public Health, Shiga University of Medical Science, Shiga, Otsu, Japan Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Otsu, Japan.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27412107

Citation

Okayama, Akira, et al. "Dietary Sodium-to-potassium Ratio as a Risk Factor for Stroke, Cardiovascular Disease and All-cause Mortality in Japan: the NIPPON DATA80 Cohort Study." BMJ Open, vol. 6, no. 7, 2016, pp. e011632.
Okayama A, Okuda N, Miura K, et al. Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open. 2016;6(7):e011632.
Okayama, A., Okuda, N., Miura, K., Okamura, T., Hayakawa, T., Akasaka, H., Ohnishi, H., Saitoh, S., Arai, Y., Kiyohara, Y., Takashima, N., Yoshita, K., Fujiyoshi, A., Zaid, M., Ohkubo, T., & Ueshima, H. (2016). Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. BMJ Open, 6(7), e011632. https://doi.org/10.1136/bmjopen-2016-011632
Okayama A, et al. Dietary Sodium-to-potassium Ratio as a Risk Factor for Stroke, Cardiovascular Disease and All-cause Mortality in Japan: the NIPPON DATA80 Cohort Study. BMJ Open. 2016 07 13;6(7):e011632. PubMed PMID: 27412107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary sodium-to-potassium ratio as a risk factor for stroke, cardiovascular disease and all-cause mortality in Japan: the NIPPON DATA80 cohort study. AU - Okayama,Akira, AU - Okuda,Nagako, AU - Miura,Katsuyuki, AU - Okamura,Tomonori, AU - Hayakawa,Takehito, AU - Akasaka,Hiroshi, AU - Ohnishi,Hirofumi, AU - Saitoh,Shigeyuki, AU - Arai,Yusuke, AU - Kiyohara,Yutaka, AU - Takashima,Naoyuki, AU - Yoshita,Katsushi, AU - Fujiyoshi,Akira, AU - Zaid,Maryam, AU - Ohkubo,Takayoshi, AU - Ueshima,Hirotsugu, AU - ,, Y1 - 2016/07/13/ PY - 2016/7/15/entrez PY - 2016/7/15/pubmed PY - 2017/12/5/medline KW - NUTRITION & DIETETICS KW - cardiovascular disease KW - potassium KW - prospective cohort KW - sodium SP - e011632 EP - e011632 JF - BMJ open JO - BMJ Open VL - 6 IS - 7 N2 - OBJECTIVES: To evaluate the impact of dietary sodium and potassium (Na-K) ratio on mortality from total and subtypes of stroke, cardiovascular disease (CVD) and all causes, using 24-year follow-up data of a representative sample of the Japanese population. SETTING: Prospective cohort study. PARTICIPANTS: In the 1980 National Cardiovascular Survey, participants were followed for 24 years (NIPPON DATA80, National Integrated Project for Prospective Observation of Non-communicable Disease And its Trends in the Aged). Men and women aged 30-79 years without hypertensive treatment, history of stroke or acute myocardial infarction (n=8283) were divided into quintiles according to dietary Na-K ratio assessed by a 3-day weighing dietary record at baseline. Age-adjusted and multivariable-adjusted HRs were calculated using the Mantel-Haenszel method and Cox proportional hazards model. PRIMARY OUTCOME MEASURES: Mortality from total and subtypes of stroke, CVD and all causes. RESULTS: A total of 1938 deaths from all causes were observed over 176 926 person-years. Na-K ratio was significantly and non-linearly related to mortality from all stroke (p=0.002), CVD (p=0.005) and total mortality (p=0.001). For stroke subtypes, mortality from haemorrhagic stroke was positively related to Na-K ratio (p=0.024). Similar relationships were observed for men and women. The observed relationships remained significant after adjustment for other risk factors. Quadratic non-linear multivariable-adjusted HRs (95% CI) in the highest quintile versus the lowest quintile of Na-K ratio were 1.42 (1.07 to 1.90) for ischaemic stroke, 1.57 (1.05 to 2.34) for haemorrhagic stroke, 1.43 (1.17 to 1.76) for all stroke, 1.39 (1.20 to 1.61) for CVD and 1.16 (1.06 to 1.27) for all-cause mortality. CONCLUSIONS: Dietary Na-K ratio assessed by a 3-day weighing dietary record was a significant risk factor for mortality from haemorrhagic stroke, all stroke, CVD and all causes among a Japanese population. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/27412107/Dietary_sodium_to_potassium_ratio_as_a_risk_factor_for_stroke_cardiovascular_disease_and_all_cause_mortality_in_Japan:_the_NIPPON_DATA80_cohort_study_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=27412107 DB - PRIME DP - Unbound Medicine ER -