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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)
REFERENCES
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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) |
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 |
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 |
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 |
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.
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