Journal List > Korean J Health Promot > v.15(4) > 1089857

Kim, Lim, Kang, Lee, Park, and Kim: The Relationship between Daily Sodium Intake and Obesity in Korean Adults

Abstract

Background

World health organization (WHO) recommended daily sodium intake less than 2 g. To assess the validity of WHO recommendation, we investigated the relationship between daily sodium intake and obesity.

Methods

A total of 14,694 participants aged ≥19 years who had no missing data for nutrition, chronic disease, health behavior, economic status and laboratory findings from the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V), which was performed from 2010 to 2012. Obesity was defined as having a body mass index of 25 kg/m2 or higher. Daily sodium intake was calculated from 24 hour recall and divided into five categories (< 2 g, 2-4 g, 4-6 g, 6-8 g, ≥8 g). The association between daily sodium intake and obesity was analyzed using multiple logistic regressions.

Results

Higher sodium intake in men had an increased risk of obesity with odds ratios (ORs) of 1.27 for 2-4 g intake (95% confidence interval [CI], 0.97-1.67), 1.40 for 4-6 g intake (95% CI, 1.07-1.85), 1.41 for 6-8 g intake (95% CI, 1.05-1.89), and 1.61 for ≥8 g intake (95% CI, 1.19-2.18), compared to men with less than 2 g intake, after adjusting for confounding factors. The P value for trend of ORs in each group for men was 0.020. In women, compared to the lesser than 2 g intake, only ≥8 g intake group had an OR of 1.28 (95% CI, 1.02-1.62) without showing significant P for trend (P value for trend=0.221)

Conclusions

We found that sodium intake more than 2 g per day was independently related to the increased risk of obesity in men. Therefore, to minimize the risk of obesity, we suggest taking sodium less than 2 g per day.

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Figure 1.
Flow chart of subjects’ selection.
kjhp-15-175-f1.tif
Figure 2.
Trend of odds ratio for obesity according to daily sodium intake in men.
kjhp-15-175-f2.tif
Table 1.
General characteristics of subjects according to sex
Characteristics Total (n=14,694) Men (n=5,969) Women (n=8,725) P-valuea
Age, y 50.78±0.13 51.66±0.21 50.18±0.17 <0.001
Daily energy intake, Kcal 1,977.19±7.05 2,373.70±12.33 1,705.92±7.02 <0.001
Daily sodium intake, mg 4,866.02±27.03 5,874.65±46.18 2,863.04±30.65 <0.001
Systolic blood pressure, mmHg 120.00±0.14 122.82±0.21 118.08±0.19 <0.001
Diastolic blood pressure, mmHg 76.12±0.09 78.86±0.14 74.25±0.12 <0.001
Fasting blood sugar, mg/dL 97.84±0.18 100.79±0.31 95.83±0.22 <0.001
Total cholesterol, mg/dL 189.62±0.30 187.26±0.47 191.23±0.39 <0.001
HDL cholesterol, mg/dL 52.66±0.11 49.32±0.16 54.94±0.14 <0.001
LDL cholesterol, mg/dL 111.66±0.27 108.93±32.02 113.50±0.34 <0.001
Triglyceride, mg/dL 130.09±0.85 152.38±1.62 114.84±0.86 <0.001
Obesity (BMI≥25), % (N) 31.7 (4,659) 34.9 (2,084) 29.5 (2,575) <0.001
Central obesityb, % (N) 25.9 (3,812) 26.3 (1,570) 25.7 (2,242) 0.410
Chronic disease, %
Hypertension 33.9 (4,976) 39.1 (2,236) 30.3 (2,640) <0.001
Dyslipidemia 36.5 (5,369) 42.8 (2,557) 32.2 (2,812) <0.001
Diabetes mellitus 10.8 (1,589) 13.4 (801) 9.0 (788) <0.001
Cerebral vascular disease 2.0 (300) 2.7 (160) 1.6 (140) <0.001
Angina pectoris 2.4 (357) 2.7 (164) 2.2 (193) 0.038
Myocardial infarction 1.0 (140) 1.4 (85) 0.6 (55) <0.001
Health related behavior
Smoking, % (N) <0.001
Non-smoker 60.9 (8,944) 18.6 (1,109) 89.8 (7,835)
Past smoker 20.5 (3,015) 42.8 (2,554) 5.3 (461)
Current smoker 18.6 (2,735) 38.6 (2,306) 4.9 (429)
Alcohol use, % (N) <0.001
Non drinking 14.0 (2,054) 5.3 (317) 19.9 (1,737)
Normal drinking 60.3 (8,856) 46.6 (2,779) 69.7 (6,077)
Problem drinking 16.6 (2,440) 29.1 (1,736) 8.1 (704)
Alcohol use disorder 4.8 (708) 10.0 (595) 1.3 (113)
Alcohol dependence 4.3 (636) 9.1 (542) 1.1 (94)
Physical activity, METs/wk 2,176.68±28.03 2,648.04±48.53 1,854.22±33.12 <0.001
Household income, % (N) 0.022
Low 19.4 (2,848) 18.2 (1,088) 20.2 (1,760)
Low-middle 25.8 (3,794) 25.9 (1,544) 25.8 (2,250)
High-middle 27.4 (4,026) 28.2 (1,684) 26.8 (2,342)
High 27.4 (4,026) 27.7 (1,653) 27.2 (2,373)
Education level, % (N) <0.001
Less than elementary school 25.8 (3,794) 18.3 (1,092) 31.0 (2,702)
Middle school 11.1 (1,633) 12.2 (730) 10.3 (903)
High school 33.3 (4,886) 35.4 (2,115) 31.8 (2,771)
College or higher 29.8 (4,381) 34.0 (2,032) 26.9 (2,349)

Abbreviations: BMI, body mass index; METs, metabolic equivalents. Values are presented as mean±standard error or percent (number).

a Continuous variables were calculated by general linear model and categorical variables were calculated by chi-square test.

b Central obesity was defined as waist circumference ≥90 cm in men and ≥85 cm in women.

Table 2.
Chronic diseases and health related behaviors according to daily sodium intake in men
Group Group of daily sodium intake (N=5,969)
<2 g (394) 2-4 g (1,581) 4-6 g (1,695) 6-8 g (1,091) ≥ 8 g (1,208) P valuea
Daily energy intake, Kcal 1,449.58±29.15 1,892.89±15.44 2,280.27±16.40 2,675.45±25.12 3,162.92±33.07 <0.001
Total cholesterol, mg/dL 182.95±2.14 185.18±0.87 188.95±0.86 186.85±1.13 189.36±1.00 0.001
HDL cholesterol, mg/dL 48.14±0.61 48.98±0.32 49.59±0.29 49.59±0.35 49.56±0.33 0.019
LDL cholesterol, mg/dL 105.87±1.84 108.96±0.79 110.04±0.79 107.83±0.99 109.33±0.90 0.144
Triglyceride, mg/dL 149.74±6.93 142.52±2.46 154.47±3.05 153.98±4.09 161.79±4.08 0.020
Fasting blood glucose, mg/dL 101.85±1.19 101.15±0.57 101.02±0.60 99.99±0.66 100.38±0.75 0.159
Systolic blood pressure, mmHg 125.46±0.87 123.44±0.41 122.76±0.40 121.98±0.49 122.00±0.44 <0.001
Diastolic blood pressure, mmHg 76.68±0.52 77.94±0.26 79.26±0.26 79.19±0.33 79.91±0.30 <0.001
Obesity (BMI≥25), % (N) 26.1 (101) 31.4 (497) 35.8 (606) 35.7 (389) 40.5 (489) <0.001
Central obesityb, % (N) 23.9 (94) 23.8 (377) 27.7 (469) 25.6 (279) 29.1 (351) 0.005
Chronic disease, % (N)
Hypertension 48.5 (191) 42.9 (679) 38.1 (646) 34.4 (375) 36.8 (445) <0.001
Dyslipidemia 47.2 (186) 41.9 (662) 42.9 (728) 41.5 (453) 43.7 (528) 0.789
Diabetes mellitus 20.8 (82) 15.4 (243) 12.6 (214) 11.3 (968) 11.5 (139) <0.001
Cerebral vascular disease 6.1 (24) 3.5 (56) 2.6 (44) 1.5 (16) 1.7 (20) <0.001
Angina pectoris 4.1 (16) 3.3 (52) 2.8 (47) 2.4 (26) 1.9 (23) 0.005
Myocardial infarction 2.5 (10) 1.5 (23) 1.5 (25) 1.1 (12) 1.2 (15) 0.123
Health related behavior
Smoking, % (N) 0.770
Non-smoker 19.3 (76) 19.6 (310) 19.5 (331) 17.2 (188) 16.9 (204)
Past smoker 43.4 (171) 44.8 (708) 41.4 (701) 42.9 (468) 41.9 (506)
Current smoker 37.3 (147) 35.6 (563) 39.1 (663) 39.9 (435) 41.2 (498)
Alcohol use, % (N) <0.001
Non drinking 6.9 (27) 55.8 (220) 22.3 (88) 6.3 (25) 8.6 (34)
Normal drinking 7.0 (111) 52.7 (833) 25.2 (398) 8.5 (135) 6.6 (104)
Problem drinking 4.8 (81) 45.1 (764) 31.3 (531) 9.9 (168) 8.9 (151)
Alcohol use disorder 4.4 (48) 45.2 (493) 28.7 (313) 12.0 (131) 9.7 (106)
Alcohol dependence 4.1 (50) 38.8 (469) 33.6 (406) 11.3 (136) 12.2 (147)
Physical activity, METs/wk 2,263.81±173.60 2,419.75±92.49 2,530.51±88.26 3,013.61±119.57 2,906.89±111.41 <0.001

Abbreviations: HDL, high density lipoprotein; LDL, low density lipoprotein; BMI, body mass index; METs, metabolic equivalents; wk, week. Values are presented as mean±standard error or percent (number).

a Calculated by general linear model or chi-square test.

b Central obesity was defined waist circumference ≥90 cm in men.

Table 3.
Laboratory data, chronic diseases, and health related behaviors according to daily sodium intake in women
Group Group of daily sodium intake (N=8725)
<2 g (1,563) 2-4 g (3,568) 4-6 g (1,990) 6-8 g (914) ≥ 8 g (690) P valuea
Daily energy intake, Kcal 1,170.77±10.79 1,584.57±9.3 1,906.45±12.56 2,134.37±20.93 2,399.82±32.99 <0.001
Total cholesterol, mg/dL 194.44±1.00 190.82±0.61 189.79±0.81 190.85±1.17 190.71±1.33 0.041
HDL cholesterol, mg/dL 53.65±0.33 54.85±0.22 55.35±0.28 56.06±0.43 55.68±0.47 <0.001
LDL cholesterol, mg/dL 115.67±0.86 113.61±0.53 112.21±0.72 112.58±1.04 113.04±1.20 0.047
Triglyceride, mg/dL 127.07±2.75 112.63±1.22 112.19±1.65 111.86±2.34 110.17±2.47 <0.001
Fasting blood glucose, mg/dL 97.43±0.52 95.65±0.34 95.32±0.48 94.79±0.59 95.95±0.74 0.058
Systolic blood pressure, mmHg 121.52±0.48 117.80±0.31 116.60±0.39 117.48±0.59 116.74±0.67 <0.001
Diastolic blood pressure, mmHg 74.35±0.25 74.01±0.16 74.17±0.22 74.88±0.33 74.58±0.39 0.176
Obesity (BMI≥25), % (N) 32.0 (500) 28.8 (1,028) 28.4 (566) 28.4 (260) 32.0 (221) 0.571
Central obesityb, % (N) 30.4 (475) 25.2 (898) 24.0 (477) 24.3 (222) 24.6 (170) 0.001
Chronic disease, % (N)
Hypertension 39.3 (615) 29.9 (1,067) 26.8 (534) 26.9 (246) 25.7 (177) <0.001
Dyslipidemia 39.3 (614) 31.2 (1,112) 30.3 (603) 30.1 (275) 30.1 (208) <0.001
Diabetes mellitus 12.9 (201) 8.8 (314) 7.6 (151) 6.9 (63) 8.6 (59) <0.001
Cerebral vascular disease 2.5 (39) 1.7 (62) 1.1 (22) 1.0 (9) 1.2 (8) 0.001
Angina pectoris 3.1 (48) 2.4 (84) 1.7 (34) 1.6 (15) 1.7 (12) 0.005
Myocardial infarction 1.3 (20) 0.5 (19) 0.6 (11) 0 (0) 0.7 (5) 0.011
Health related behavior
Smoking, % (N) 0.391
Non-smoker 89.5 (1,399) 90.2 (3,219) 89.6 (1,783) 89.5 (818) 89.3 (616)
Past smoker 4.9 (76) 5.2 (186) 5.4 (107) 5.5 (50) 6.1 (42)
Current smoker 5.6 (88) 4.6 (163) 5.0 (100) 5.0 (46) 4.6 (32)
Alcohol use, % (N) <0.001
Non drinking 27.1 (423) 19.2 (684) 18.0 (358) 17.2 (157) 16.7 (115)
Normal drinking 64.3 (1,005) 70.7 (2,521) 70.7 (1,407) 71.0 (649) 71.7 (495)
Problem drinking 6.8 (106) 7.9 (282) 8.7 (174) 9.0 (82) 8.7 (60)
Alcohol use disorder 1.0 (16) 1.2 (43) 1.2 (24) 2.0 (18) 1.7 (12)
Alcohol dependence 0.8 (13) 1.1 (38) 1.4 (27) 0.9 (8) 1.2 (8)
Physical activity, METs/wk 1,721.69±75.50 1,840.59±51.07 1,869.91±68.49 1,879.46±99.92 2,146.18±140.48 0.004

Abbreviations: HDL, High density lipoprotein; LDL, low density lipoprotein; BMI, body mass index; METs, metabolic equivalents; wk, week. Values are presented as mean±standard error or percent (number).

a Calculated by general linear model or chi-square test.

b Central obesity was defined waist circumference ≥ 85 cm in women.

Table 4.
Odds ratios for obesity according to daily sodium intake by logistic regression
Outcome Daily sodium intake Adjusted OR (95% CI)a Adjusted OR (95% CI)b Adjusted OR (95% CI)c
Obesity (BMI≥25 kg/m2)
Men (N=5,969) <2 g (394) 1 1 1
2-4 g (1,581) 1.24 (0.96-1.59) 1.26 (0.97-1.64) 1.27 (0.97-1.67)
4-6 g (1,695) 1.45 (1.13-1.87) 1.44 (1.11-7.88) 1.40 (1.07-1.85)
6-8 g (1,091) 1.42 (1.08-1.86) 1.44 (1.08-1.91) 1.41 (1.05-1.89)
≥8 g (1,208) 1.72 (1.30-2.27) 1.67 (1.25-2.23) 1.61 (1.19-2.18)
P value for trendd 0.001 0.003 0.020
Women (N=8725) <2 g (1,563) 1 1 1
2-4 g (3,568) 1.00 (0.88-1.15) 1.04 (0.90-1.20) 1.01 (0.87-1.17)
4-6 g (1,990) 1.03 (0.88-1.21) 1.07 (0.91-1.26) 1.04 (0.87-1.23)
6-8 g (914) 1.04 (0.86-1.27) 1.08 (0.87-1.32) 1.02 (0.82-1.26)
≥8 g (690) 1.26 (1.01-1.58) 1.28 (1.02-1.62) 1.21 (0.96-1.54)
P value for trendd 0.249 0.221 0.494

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index.

a Logistic regression for obesity with daily sodium intake after adjustment for age and daily energy intake.

b Logistic regression for obesity with daily sodium intake after adjustment for age, daily energy intake, chronic disease, and social behaviors (smoking status, drinking status (AUDIT score), physical activity (METs-min/week)), economic status, and education level.

c Logistic regression for obesity with daily sodium intake after adjustment for daily energy intake, chronic disease, social behaviors, economic status, education level, lipid profile (total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol), fasting blood glucose, and blood pressure.

d Tests for linear trends across categories were conducted by treating the median of each category as a continuous variable.

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