Higher Sodium/Potassium Ratio Associated with Increased Risk of Metabolic Syndrome

by | Sep 5, 2023 | 2023, Blood Pressure, Cardiovascular Health, Metabolic Syndrome, Minerals, Potassium

Written by Taylor Woosley, Staff Writer. Results of the cross-sectional analysis using data from 2016-2018 KHANES shows a positive association between a higher Na/K ratio and an increased risk of metabolic syndrome and an increased risk of hypertension in older adults. 

cardiovascular health - sliderAccording to the World Health Organization (WHO), cardiovascular diseases (CVDs) result in 17.9 million death per year, corresponding to 31% of all deaths globally1. Metabolic Syndrome (MetS) refers to a constellation of inter-related risk factors that place an individual at higher risk of developing CVD2. MetS risk factors cover multiple components, including raised blood pressure, dyslipidemia, elevated fasting blood glucose and obesity3.

A balanced diet of sodium and potassium intake is essential for cardiovascular health4. High sodium consumption, a major cause of hypertension, is considered a leading dietary risk factor for CVD globally5. Numerous studies have shown a linear relationship between high dietary salt intake and the development of arterial hypertension, as well as a negative association between high potassium intake and blood pressure values6.

Baek et al. conducted a study using data from the Korean National Health and Examination Survey (KNHANES) from 2016-2018 to assess the association and identify food groups to analyze a higher or lower dietary sodium (Na)/potassium (K) ratio in adults. KHANES is a cross-sectional survey consisting of health interviews, a health examination, and a 24-hour diet recall. Health interviews included information on sex, age, education, and lifestyle factors such as physical activity levels and alcohol consumption. The health examination provided data on height, weight, and cardiometabolic risk biomarkers, including blood pressure, fasting glucose, cholesterol, and body mass index (BMI). Sodium and potassium intake through diet was estimated using one 24-hour dietary recall data.

Subjects (n = 12966) included in the final analysis were aged 30 years or older, with available 24-hour dietary recall information. Pearson correlation analysis was used to assess the associations between dietary Na/K ratio and cardiometabolic biomarkers. An age-stratified analysis was utilized to investigate cardiometabolic biomarkers and risk factors based on the dietary Na/K ratio. Average daily intake of sodium and potassium of participants was 3324 and 2867 mg, respectively. Significant findings of the study are as follows:

  • The prevalence of hypertension, obesity, and MetS in all subjects was 33.7%, 31.4%, 13.9%, and 29.1%, respectively. A significant difference was noted in the prevalence of hypertension (p = 0.0202), obesity (p = 0.0006), and MetS (p < 0.0001) according to the dietary Na/K ratio level.
  • Those in the higher Na/K ratio group experienced higher diastolic blood pressure, serum triglycerides, and waist circumference but lower HDL cholesterol compared to those in the low Na/K ratio group.
  • A higher Na/K ratio was not associated with a higher risk of hypertension in younger subjects. However, it was associated with a higher hypertension risk in adults aged 65 years or older (OR = 1.38, 95% CI: 1.10-1.72).
  • The food groups positively associated with a lower Na/K ratio were potatoes, nuts fruits, and dairy products (all p < 0.001). The food groups negatively associated with a lower Na/K ratio were cereals, grains, vegetables, meats, eggs, fish, oils, seasonings, and processed foods (p < 0.001 except vegetables with p = 0.0021).

Results of the study show that the average sodium intake of participants was higher than the WHO guideline and daily potassium intake was lower than the suggested guidelines. Findings suggest that a higher Na/K ratio is positively associated with an increased risk of MetS. Study limitations include the inability to infer direct causality between Na/K ratio and cardiometabolic risk factors due to the cross-sectional study design, the potential recall bias of self-reported diet logs, and potential hidden variables such as nutritional supplement use that could affect study results.

Source: Baek, Seo-Young, and Hye-Kyeong Kim. “Association of Dietary Sodium-to-Potassium Ratio with Cardiometabolic Risk Factors in Korean Adults: Findings from the Korean National Health and Nutrition Examination Survey.” Nutrients 15, no. 14 (2023): 3134.

© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license(https://creativecommons.org/licenses/by/4.0/).

Click here to read the full text study.

Posted September 5, 2023.

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Rahman MM, Islam F, Or-Rashid MH, et al. The Gut Microbiota (Microbiome) in Cardiovascular Disease and Its Therapeutic Regulation. Front Cell Infect Microbiol. 2022;12:903570. doi:10.3389/fcimb.2022.903570
  2. Guembe MJ, Fernandez-Lazaro CI, Sayon-Orea C, Toledo E, Moreno-Iribas C. Risk for cardiovascular disease associated with metabolic syndrome and its components: a 13-year prospective study in the RIVANA cohort. Cardiovasc Diabetol. Nov 22 2020;19(1):195. doi:10.1186/s12933-020-01166-6
  3. Shi Z, Tuomilehto J, Kronfeld-Schor N, et al. The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome-The NHANES Survey during 2005-2016. Nutrients. Dec 14 2022;14(24)doi:10.3390/nu14245317
  4. Sun N, Jiang Y, Wang H, et al. Survey on sodium and potassium intake in patients with hypertension in China. J Clin Hypertens (Greenwich). Nov 2021;23(11):1957-1964. doi:10.1111/jch.14355
  5. Ma Y, He FJ, Sun Q, et al. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk. The New England journal of medicine. Jan 20 2022;386(3):252-263. doi:10.1056/NEJMoa2109794
  6. Muiesan ML, Buso G, Agabiti Rosei C. Less sodium and more potassium to reduce cardiovascular risk. Eur Heart J Suppl. Apr 2023;25(Suppl B):B108-b110. doi:10.1093/eurheartjsupp/suad084