Dietary sodium intake and incidence of congestive heart failure in overweight US men and women: first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.

BACKGROUND Cross-sectional epidemiologic studies suggest that a higher intake of dietary sodium is associated with an increased risk of left ventricular hypertrophy. We studied the relationship between dietary sodium intake and incidence of congestive heart failure (CHF) in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study participants. PARTICIPANTS AND METHODS The study sample consisted of 5233 nonoverweight and 5129 overweight men and women without a history of CHF at their baseline examination. Dietary sodium and other nutrient intake estimates were obtained by a 24-hour dietary recall method at the baseline examination, conducted from 1971 to 1975. The incidence of CHF was assessed using medical records and death certificates obtained in 1982 to 1984, 1986, 1987, and 1992. RESULTS During an average of 19 years of follow-up, we documented 413 cases of CHF in nonoverweight and 679 cases of CHF in overweight participants. After adjustment for known CHF risk factors, the relative risk of CHF among overweight participants was 1.43 (95% confidence interval, 1.07-1.91) for those whose sodium intake was greater than 113.6 mmol/d compared with those whose intake was less than 50.2 mmol/d. The relative risks of CHF for a 100-mmol/d higher intake of sodium or per 1743 kcal (average energy intake in the study population) were 1.26 (95% confidence interval, 1.03-1.53) and 1.21 (95% confidence interval, 1.04-1.40), respectively. CONCLUSIONS A higher intake of dietary sodium is a strong independent risk factor for CHF in overweight persons. A reduction in sodium intake may play an important role in the prevention of CHF in overweight individuals and populations.

[1]  P. Whelton,et al.  Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. , 2001, Archives of internal medicine.

[2]  J. Tuomilehto,et al.  Urinary sodium excretion and cardiovascular mortality in Finland: a prospective study , 2001, The Lancet.

[3]  G. Bray,et al.  Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet , 2001 .

[4]  A. Chobanian,et al.  National Heart, Lung, and Blood Institute Workshop on Sodium and Blood Pressure : a critical review of current scientific evidence. , 2000, Hypertension.

[5]  P. Whelton,et al.  Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults. , 1999, JAMA.

[6]  T. Andreoli Pathogenesis of Renal Sodium Retention in Congestive Heart Failure , 1999, Mineral and Electrolyte Metabolism.

[7]  T. Iwamoto,et al.  Effects of renin-angiotensin system blockade and dietary salt intake on left ventricular hypertrophy in Dahl salt-sensitive rats. , 1998, Hypertension research : official journal of the Japanese Society of Hypertension.

[8]  M. Carroll,et al.  Overweight and obesity in the United States: prevalence and trends, 1960–1994 , 1998, International Journal of Obesity.

[9]  J. Feldman,et al.  Plan and operation of the NHANES I Epidemiologic Followup Study, 1992. , 1997, Vital and health statistics. Ser. 1, Programs and collection procedures.

[10]  R. Schmieder,et al.  Salt. A perpetrator of hypertensive target organ disease? , 1997, Archives of internal medicine.

[11]  J. Hall,et al.  Mechanisms of abnormal renal sodium handling in obesity hypertension. , 1997, American journal of hypertension.

[12]  F. Luft,et al.  Heterogeneous responses to changes in dietary salt intake: the salt-sensitivity paradigm. , 1997, The American journal of clinical nutrition.

[13]  J. Cutler,et al.  Randomized trials of sodium reduction: an overview. , 1997, The American journal of clinical nutrition.

[14]  E L Korn,et al.  Time-to-event analysis of longitudinal follow-up of a survey: choice of the time-scale. , 1997, American journal of epidemiology.

[15]  P. Elliott,et al.  Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations , 1996 .

[16]  R. Klesges,et al.  Who underreports dietary intake in a dietary recall? Evidence from the Second National Health and Nutrition Examination Survey. , 1995, Journal of consulting and clinical psychology.

[17]  J. Madans,et al.  Differences in morbidity measures and risk factor identification using multiple data sources: the case of coronary heart disease. , 1995, Statistics in medicine.

[18]  M. Kupari,et al.  Correlates of left ventricular mass in a population sample aged 36 to 37 years. Focus on lifestyle and salt intake. , 1994, Circulation.

[19]  J. Cutler,et al.  Hemodynamic Correlates of the Third Heart Sound During the Evolution of Chronic Heart Failure , 1993, Circulation.

[20]  E. Frohlich,et al.  Relationship between dietary sodium intake, hemodynamics, and cardiac mass in SHR and WKY rats. , 1993, The American journal of physiology.

[21]  J. Feldman,et al.  Plan and operation of the NHANES I Epidemiologic Followup Study, 1987. , 1992, Vital and health statistics. Ser. 1, Programs and collection procedures.

[22]  G. Tell,et al.  Relation of Electrolytes to Blood Pressure in Men The Yi People Study , 1991, Hypertension.

[23]  E. Reisin Sodium and obesity in the pathogenesis of hypertension. , 1990, American journal of hypertension.

[24]  J. Feldman,et al.  Plan and operation of the NHANES I Epidemiologic Followup Study, 1986. , 1990, Vital and health statistics. Ser. 1, Programs and collection procedures.

[25]  V. Katch,et al.  The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. , 1989, The New England journal of medicine.

[26]  J. Madans,et al.  Validity of mortality analysis based on retrospective smoking information. , 1989, Statistics in medicine.

[27]  R. Schmieder,et al.  Dietary salt intake. A determinant of cardiac involvement in essential hypertension. , 1988, Circulation.

[28]  J. Mclaughlin,et al.  Reliability of surrogate information on cigarette smoking by type of informant. , 1987, American journal of epidemiology.

[29]  W. James,et al.  THE DOMINANCE OF SALT IN MANUFACTURED FOOD IN THE SODIUM INTAKE OF AFFLUENT SOCIETIES , 1987, The Lancet.

[30]  J. Feldman,et al.  Plan and operation of the NHANES I Epidemiologic Followup Study: 1982-84. , 1987, Vital and health statistics. Ser. 1, Programs and collection procedures.

[31]  M. Fregly Estimates of sodium and potassium intake. , 1983, Annals of internal medicine.

[32]  J. Feldman,et al.  Plan and operation of the HANES I augmentation survey of adults 25-74 years United States, 1974-1975. , 1978, Vital and health statistics. Ser. 1, Programs and collection procedures.

[33]  R. Tarone,et al.  Tests for trend in life table analysis , 1975 .

[34]  Director,et al.  Plan and operation of the health and nutrition examination survey: United States-1971-1973. , 1973, Vital and health statistics. Ser. 1, Programs and collection procedures.

[35]  David R. Cox,et al.  Regression models and life tables (with discussion , 1972 .

[36]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .