Comment on: Less sodium and more potassium to reduce cardiovascular risk and the PURE study
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Notice bibliographique
Résumé
The authors response is available at https://doi.org/10.1093/ehjopen/oead097. We read with interest the commentary by Muiesan et al. but are concerned the PURE study was cited to describe the association between dietary sodium and blood pressure (BP).1 The PURE study used 24-h urine sodium estimated from a fasting morning spot urine sample and the Kawasaki equation, a method which has been shown to have a large systematic and random error in estimating 24-h urine sodium.2 Twenty-four-hour sodium estimated from the Kawasaki equation (and other estimating equations) markedly alter the association of sodium to BP relative to measured 24-h. urine sodium and have an association with BP independent of sodium values.2 The PURE study has been variably reported as showing that there is no significant association of dietary sodium with BP below 3000 mg/day, and that the association is curvilinear with less impact at lower levels of dietary sodium. Meta-analyses of randomized controlled trials (RTCs) utilizing 24-h. urine sodium samples show a linear graded association with BP at greater than 800 mg sodium/day.3 The association between sodium and BP occurs in infants, children, and the elderly and in those with normal BP and hypertension.3 Those of older age, with hypertension and Black ancestry have greater changes in BP with changes in dietary sodium.3 Spot urine samples with estimating equations have been recommended by major international and national health organizations not to be used to estimate 24-h. urine sodium in individuals especially in association with health outcomes2 The most recent recommendation clearly states ‘It is strongly recommended to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals’ sodium (salt) intake in association with health outcomes’.2 The recommendations further state ‘Manuscripts reviewing the literature on the health impacts of reducing dietary sodium that include studies that have used spot and short duration timed urine samples with estimating equations to assess individual sodium intake in association with health outcomes need to fully acknowledge the limitations of this method (i.e. that the method is recommended not to be used and that it is associated with spurious associations)’.2 The PURE study provides a good example (case study) that using an inappropriate methodology even with a large sample size can produce spurious results. Randomized controlled trial evidence should be cited to support the association of dietary sodium with BP and cardiovascular disease.3 N.R.C.C. drafted the letter, which was reviewed revised, and approved by F.J.H., R.M.M., F.P.C., and G.M.M. None.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle