Associations of Usual 24-Hour Sodium and Potassium Intakes with Blood Pressure and Risk of Hypertension among Adults in China's Shandong and Jiangsu Provinces.

BACKGROUND/AIMS: High sodium intake and low intake of potassium can increase blood pressure (BP) and risk of developing hypertension. Few studies have examined the association between 24-h urinary sodium and potassium excretion and BP or risk of hypertension in China, and most used only a single 24-h urinary sample. METHODS: We analyzed data on 2281 participants aged 18-69 years by using two 24-h urinary sodium and potassium excretions from the supplemental baseline survey of the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their association with B P, and logistic regression to estimate the risk of hypertension. RESULTS: The average usual intakes of sodium and potassium, and the mean sodium-potassium ratio, were 166.9 mmol/day, 25.3 mmol/day, and 6.8, respectively. All three measures were significantly associated with systolic BP (SBP) and diastolic BP (DBP), with an increase of 1.39 mmHg (95% confidence interval [CI] 0.44─2.34) in SBP and 0.94 mmHg (95% CI 0.34─1.55) in DBP for a 1-standard deviation (SD) (25.6mmol/day) increase in sodium intake, a decrease of 1.42 mmHg (95% CI -2.37─ -0.47) in SBP and 0.91 mmHg (95% CI -1.52─ -0.30) in DBP for a 1-SD (3.4 mmol/day) increase in potassium intake, and an increase of 0.97 mmHg (95% CI 0.36─1.58) in SBP and of 0.65 mmHg (95% CI 0.26─1.04) in DBP per unit increase in the sodium-to-potassium ratio. The adjusted odds ratios comparing the risk of hypertension among adults in the highest with those in the lowest quintile differ significantly for potassium (0.51; 95% CI 0.29─0.88) and sodium-to-potassium ratio (1.40; 95% CI 1.01─1.94). CONCLUSIONS: Our results suggested that higher sodium and lower potassium intakes are associated with increased BP and risk of hypertension in the Shandong and Jiangsu adults.

Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults?

OBJECTIVE: To examine the association of 24 h urinary Na excretion and Na:K with obesity in Chinese adults. DESIGN: Population-based cross-sectional study using a four-stage stratified sampling strategy. SETTING: Shandong Province, China. SUBJECTS: Chinese adults (n 1906) aged 18-69 years who provided complete 24 h urine samples. RESULTS: Odds of obesity increased significantly across increasing quartiles of urinary Na excretion (1·00, 1·54, 1·69 and 2·52, respectively, for overweight; 1·00, 1·20, 1·50, and 2·03, respectively, for obesity; 1·00, 1·44, 1·85 and 2·53, respectively, for abdominal obesity (assessed by waist circumference); and 1·00, 1·28, 1·44 and 1·75, respectively, for abdominal obesity (assessed by waist-to-height ratio); P for linear trend <0·001 for all). In addition, odds of abdominal obesity, but not odds of overweight and obesity, increased significantly with successive Na:K quartiles. Additionally, for each increment in urinary Na excretion of 100 mmol, odds of overweight, obesity, abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 46 %, 39 %, 55 % and 33 %, respectively. Similarly, with a 1 sd increase in Na:K, odds of abdominal obesity (by waist circumference) and abdominal obesity (by waist-to-height ratio) increased significantly by 12 % and 15 %, respectively. CONCLUSIONS: These findings suggest that 24 h urinary Na excretion and Na:K might be important risk factors for obesity in Chinese adults.

Association between 24 h urinary sodium and potassium excretion and the metabolic syndrome in Chinese adults: the Shandong and Ministry of Health Action on Salt and Hypertension (SMASH) study.

The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults.

Urinary albumin excretion and prevalence of microalbuminuria in a general Chinese population: a cross-sectional study.

BACKGROUND: Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population. METHODS: This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria. RESULTS: The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria. CONCLUSIONS: Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.

Prevalence of overweight and obesity and their associations with blood pressure among children and adolescents in Shandong, China.

BACKGROUND: Obesity and high blood pressure (BP) are public health problems all over the world. Some studies have reported a positive association between them in children and adolescents. The purpose of this study was to assess the prevalence of overweight and obesity and their associations with BP among school children and adolescents in Shandong, an important province in eastern China. METHODS: In 2011, we conducted a cross-sectional population-representative survey in Shandong, China. A total of 4 898 children and adolescents aged 6-17 years were randomly selected from 140 counties/districts using a multistage random cluster sampling. Weight, height and BP were measured by a trained physician or pediatrician, and information about age, gender and place of residence was obtained using questionnaires. Obesity and high BP were defined according to age- and gender-specific Chinese reference data for children. RESULTS: A total of 4 898 (100%) children and adolescents provided complete information. The prevalence of overweight, obesity and overweight plus obesity were 10.9%, 8.7% and 19.6%, respectively. Boys were more likely to be overweight or obese than girls (P < 0.05 for overweight; P < 0.001 for obesity). The prevalence of overweight plus obesity was highest among children aged 6-11 years (22.3%). BP and the prevalence of high BP increased with increasing body mass index (BMI). With age and sex adjusted, odds ratios (ORs) for high BP were [OR 2.2;95% CI 1.7-2.8) in overweight and [OR 3.6;95% CI 2.6-4.9] in obese children. CONCLUSION: The representative survey confirms high prevalence of overweight and obesity among children and adolescents in Shandong. Childhood obesity is a strong risk factor for high BP. Intervention programs should be implemented to combat the growing obesity epidemic.

Hypertension prevalence, awareness, treatment, and control and sodium intake in Shandong Province, China: baseline results from Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011.

INTRODUCTION: In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. METHODS: Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. RESULTS: Overall, 23.4% (95% confidence interval [CI], 20.9%-26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg-6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg-4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg-5,683 mg). CONCLUSION: Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China.

[Investigation on knowledge, attitude and behavior of salt reduction in Chinese adults, 2010].

OBJECTIVE: To explore the knowledge, attitude and behavior of salt reduction among Chinese adults aged over 18 years old in 2010. METHODS: A total of 96 916 adults aged over 18 were recruited from 162 surveillance points in 2010, applying multi-stage stratified cluster random sampling method.Information about subjects salt reduction related knowledge, attitude and behavior were collected by face-to-face interview. After performing complex weighted analysis, the awareness, willingness and behavior rates were compared by different genders, age groups, urban, rural and different regions. RESULTS: The unweighted salt reduction rate of the awareness, willingness and behavior among Chinese adults were 63.0%, 84.5% and 44.5%. After being weighted, the awareness rate was 62.9%, the awareness rate difference was not significant between males (62.4%) and females (63.4%) (χ(2) = 1.66, P > 0.05), but the urban areas (77.1%) were significantly higher than the rural areas (56.3%) (χ(2) = 85.11, P < 0.01) . The difference among different ages was significant (χ(2) = 228.68, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (67.8%, 59.8%, 50.1%, respectively). The difference among different regions was not significant (χ(2) = 9.82, P < 0.01) in eastern, central and western China (68.2%, 61.3%, 57.1%, respectively). After being weighted, the willingness rate was 83.8%, the willingness rate in females (85.8%) was significantly higher than that in males (81.9%) (χ(2) = 61.92, P < 0.01) , and the urban areas (87.1%) were significantly higher than the rural areas (82.3%) (χ(2) = 15.49, P < 0.01) . The difference among different ages was significant (χ(2) = 74.50, P < 0.01) with descending order in 18-44, 45-59 and ≥ 60 years old (85.3%, 83.1%, 79.6%, respectively). The difference was not significant (χ(2) = 0.58, P > 0.05) among eastern, central and western China (84.3%, 84.0%, 82.9%, respectively). After being weighted, the behavior rate of salt reduction was 42.2%, the behavior rate in females (45.6%) was significantly higher than that in males (38.8%) (χ(2) = 107.74, P < 0.01), and urban areas (56.5%) were significantly higher than the rural areas (35.6%) (χ(2) = 74.38, P < 0.01) . The difference was not significant (χ(2) = 4.19, P > 0.05) among 18-44, 45-59 and ≥ 60 years old(41.5%, 43.6%, 42.2%, respectively). The behavior rate of salt reduction difference in eastern China(47.8%) was significantly higher than that in central (38.9%) and western (38.0%) (χ(2) = 7.22, P < 0.05). CONCLUSIONS: The rate of willingness to reduce salt is higher, but the awareness rate and the behavior rate of salt reduction are not high, especially among the population who are from rural area, or who are from central and western China.

[Comparison of dietary survey, frequency and 24 hour urinary Na methods in evaluation of salt intake in the population].

OBJECTIVE: To compare the difference and correlation between dietary salt intakes assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method. METHODS: All 2 184 subjects aged 18 to 69 were selected by multi stage stratified cluster random sampling method in Shandong province in June to September, 2011. Dietary salt intakes were measured by 24 hours urinary Na method, food weighted record method and food frequency questionnaire method. The information on gender, age, dining locations and labour intensity of members dining at home for 3 days were recorded. And the dietary habits were surveyed by questionnaire. RESULTS: Salt intakes were 14.0, 12.0 and 10.5 g/d assessed by 24 hours urinary Na method, food weighted record method and food frequency questionnaire, respectively. Comparing with 24 hours urinary Na method, salt intakes assessed by food weighted record method and food frequency questionnaire method were 2.0 g (14.3% undervalued) and 3.4 g (24.3% undervalued) less, respectively. Comparing with 24 hours urinary Na method, the proportion of individuals with salt intake over-reported and under-reported were 42.4% (856/2 020) and 55.3% (1 117/2 020) by food weighted record method, and were 20.7% (418/2 020) and 16.3% (329/2 020) by food frequency questionnaire method, respectively; the proportion of individuals with salt intakes within ± 25% of 24 hours urinary Na method were 36.9% (745/2 020) and 28.4% (574/2 020), respectively. Salt intakes assessed by 24 hours urinary method correlated significantly with both salt intakes assessed by food weighted record method and food frequency questionnaire method; the correlation coefficients were 0.13 and 0.07, respectively. With the increasing of salt intakes by subjects' self-judgment, salt intakes were all rising significantly using three survey methods. Salt intakes of three group population of light, moderate and partial taste salty were 13.6, 13.6 and 14.7 g/d by 24 hours urinary Na method (F = 0.47, P < 0.05); 11.0, 12.0 and 12.7 g/d by food weighted record method (F = 5.83, P < 0.05), and 9.3, 10.2 and 11.9 g/d by food frequency questionnaire method (F = 5.83, P < 0.05), respectively. CONCLUSION: Comparing with 24 hours urinary method, food weighted record method and food frequency questionnaire method would undervalue dietary salt intake. Salt intake status can be more accurately assessed by adjusting the underestimation rate.

[The relationship between salt consumption and blood pressure among residents in Shandong province, China].

OBJECTIVE: To study the relationship between salt consumption and blood pressure among residents in Shandong province, and to provide basic information for guiding people to prevent hypertension by reducing salt intake. METHODS: Using multi-stage stratified cluster random sampling method, 2 184 residents aged 18 to 69 were selected as the research subjects, which were extracted randomly from 20 counties in Shandong province in June, 2011. The blood pressure of the subjects were measured and weighted. Based on 72 h dietary recalls and weighing measurement, and according to the distribution of salt intake, the grouping cut-off points were 10, 14 and 18 g. The difference of subjects with different characteristics and systolic blood pressure, diastolic blood pressure and prevalence of hypertension by grouping salt intake and other characteristics were analyzed, and the relationship between salt intake and prevalence of hypertension were analyzed. RESULTS: The total of 2 133 residents were involved finally, the completion rate was 97.7%. After the complex weighted, the systolic and diastolic blood pressure's means (95%CI value) of the subjects were 121.0 (119.5-122.5) mmHg (1 mmHg = 0.133 kPa) and 78.5(77.4-79.6) mmHg respectively, which were all elevated with increasing of salt consumption. The blood pressure of the subjects with salt intake <10 g was the lowest, which were 119.6 (116.9-122.4) mmHg and 77.5(76.2-78.7) mmHg respectively. The blood pressure of the subjects with salt intake ≥ 18 g was the highest, which were 122.3(120.1-124.5) mmHg and 79.6(78.2-80.9) mmHg respectively. The analysis results showed that, among residents with normal waistline, the prevalence of hypertension of people with salt intake ≥ 18 g was 1.70(95%CI:1.04-2.76) times compared to that of people who consumed less than 10 g salt per day. CONCLUSION: The hypertension prevalence of Shandong province is quite high, and there is a relationship between salt consumption and blood pressure.

[Dietary sodium intakes and resources among residents in Shandong province].

OBJECTIVE: To describe dietary sodium intakes and resources among residents in Shandong province. METHODS: A total of 2184 subjects were selected by multi-stage stratified cluster random sampling method from 18-69 years old people in Shandong province in June, 2011. A total of 2140 subjects completed the study, the completion rate was 98.0%. Three-day (24-hour per day) dietary recalls and weighting methods were conducted to collect information about all the foods and condiments consumed by the subjects. Individual dietary sodium intake was calculated, the differences of dietary sodium intake among subjects with different characteristics were analyzed, and the proportions of different dietary sodium resources were also analyzed. RESULTS: The amount of individual dietary sodium intake was 5745.0 (95%CI:5427.6-6062.5) mg/d in Shandong; 6147.4 (95%CI: 5823.8-6471.0) mg/d for male residents, 5339.3 (95%CI:5005.8-5672.8) mg/d for female residents. There was a significant difference between males and females (F = 75.22, P < 0.01). The amount of individual dietary sodium intake was 5910.1 (95%CI:5449.3-6370.8) mg/d, 5341.6 (95%CI:5007.0-5676.1) mg/d for rural residents and urban residents respectively, and there was also a significant difference (F = 5.53, P < 0.05). The amount of condiment sodium intake was 4640.3 (95%CI:4360.2-4920.4) mg/d, which was the largest contributor to sodium intake, accounting for 80.8% (95%CI:79.9%-81.6%) of total intake. Sodium intake from cereals was 650.7 (95%CI: 590.5-711.0) mg/d, accounting for 11.3% (95%CI:10.3%-12.3%) of total intake. Sodium intake from eggs was 118.9 (95%CI:95.2-142.6) mg/d, accounting for 2.1% (95%CI:1.6%-2.6%) of total intake. The amount of manufactured food sodium intake was 582.1(95%CI: 497.8-666.4) mg/d, accounting for 10.1% (95%CI:8.9%-11.4%) of total intake. CONCLUSION: Sodium intakes remain high among residents of Shandong province, and sodium from condiments was the largest source of dietary sodium intake, sodium of manufactured food only accounting for small part.

[Status and trend of cardio-cerebral-vascular diseases mortality in China: data from national disease surveillance system between 2004 and 2008].

OBJECTIVE: To report the status and trend of cardio-cerebral-vascular disease (CCVD) mortality in China between 2004 and 2008. METHODS: The mortality data from population-based survey of National Disease Surveillance System in 2004 and 2008 were analyzed. This surveillance system is consisted of 161 disease surveillance points (DSPs) located in 31 provinces of China including 64 urban and 97 rural DSPs. The total population of surveillance is over 73 millions and accounted for around 6% of the whole population of China. CCVD included ischemic heart diseases (ICD-10: I05-I09, I11, I20-I27, I30-I52) and cerebral-vascular disease (ICD-10: I60-I69). The status and trend of cardiovascular disease (CVD), cerebral-vascular disease (CD), ischemic heart disease (IHD) and acute myocardial infarction (AMI) mortalities from 2004 to 2008 were analyzed by age, gender, and urban/rural regions. RESULTS: The mortality of CCVD was higher in 2008 (229/100 000) than in 2004 (223.5/100 000), which was decreased in urban region (-11.7/100 000) while increased in rural region (+16.0/100 000). The mortality of CD decreased from 134.8/100 000 (2004) to 128.3/100 000 (2008). Mortality of IHD and AMI increased from 66.1/100 000 and 40.4/100 000 (2004) to 71/100 000 and 45.7/100 000 (2008), which remained stable in urban region (+0.98/100 000 and -1.96/100 000) while significantly increased in rural region (+6.7/100 000 and +9.2/100 000). The mortality rates for CVD, CD and AMI were higher in rural population than that in urban population. The age-standardized mortality rates of CVD, CD and IHD were lower in 2008 than in 2004. The mortality rates of CD and IHD decreased in 40-, 60-, and over 80 age groups (except for IHD) in 2008 than in 2004. However, IHD mortality was significantly higher in age of 80 and over group from 2004 to 2008. There were a net 5.5/100 000 increase, 6.4/100 000 decrease and 4.9/100 000 increase for CCVD, CD and IHD between 2004 and 2008. The mortality rate rise in CCVD was mainly due to the increased mortality of IHD and CD in rural population. The CCVD mortality increased with age and was significantly higher in male than in female population. CONCLUSIONS: Despite decreased mortality in CD, CCVD mortality increased from 2004 to 2008, mainly due to the increased mortality of IHD and AMI in rural population. Enhanced CCVD primary and secondary prevention, particular for stressing on primary prevention, is necessary in China, especially in rural areas. Meanwhile, they will give the greatest contributions for a raise of the healthy life expectancy in China.

Associations Between Salt-Restriction Spoons and Long-Term Changes in Urinary Na+/K+ Ratios and Blood Pressure: Findings From a Population-Based Cohort.

Background There have been few studies on the relationship between long-term changes in sodium intake and blood pressure. A method of reducing sodium intake in a population that is known for high-sodium intake based on homemade cooking is also needed. Methods and Results Our study was based on a baseline survey of 15 350 individuals aged 18 to 69 years with multistage random sampling and a 3-year salt-restriction campaign across Shandong Province, China. We included 339 individuals from six districts/counties in this cohort study, and the 24-hour urinary sodium-potassium ratio (Na+/K+) served as an indicator of sodium intake. The average change in ratio was 2.39 (95% CI, 2.17-2.61) from 6.81 (95% CI, 6.41-7.21) at baseline to 4.41 (95% CI, 4.18-4.64) during the resurvey. Following a reduction from low to high quartiles of urinary Na+/K+ ratio, the average increases were 10.9 (95% CI, 8.9-12.9), 9.2 (95% CI, 6.9-11.5), 6.3 (95% CI, 4.0-8.6), and 5.3 (95% CI, 2.9-7.7) mm Hg for systolic blood pressure (P for trend=0.019) and 3.8 (95% CI, 2.4-5.2), 2.9 (95% CI, 1.7-4.2), 1.6 (95% CI, 0.4-2.8), and -0.3 (95% CI, -1.4-0.8) mm Hg for diastolic blood pressure (P for trend=0.002), respectively. A reduction in salt intake was evident for people using a 2-g salt-restriction spoon for cooking (-3.49 versus -2.22; P=0.027) after adjustment of confounding factors, compared with nonusers. Similar findings were obtained for other salt-restriction spoon-based indicators. Conclusions Our study indicated that using a salt-restriction spoon for cooking was associated with reduced salt intake that led to a blunting of blood pressure deterioration. This finding further supports the salt-restriction spoon-based strategy for people whose primary salt intake is from homemade cooking.

Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016.

Importance: High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. Objective: To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. Design, Setting, and Participants: This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. Interventions: Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. Main Outcomes and Measures: The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. Results: Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. Conclusions and Relevance: The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.

Association of microalbuminuria and high-normal 24-hour urinary albumin excretion with metabolic syndrome and its components in the general Chinese population: cross-sectional study.

OBJECTIVE: Microalbuminuria (MAU) has been described as a risk factor for metabolic syndrome (MetS). However, the association between MetS components with MAU and 24-hour urinary albumin excretion (UAE) has not been clearly explained in the general Chinese population. We aimed to analyse the associations between MAU and high-normal 24-hour UAE with MetS and its components. DESIGN: Cross-sectional observational study. SETTING: Four selected counties/districts in China's Shandong and Jiangsu Provinces. PARTICIPANTS: A total of 2261 participants aged 18-69 years were included in this study. Participants with missing physical examination data or incomplete urine collection were not included in the analysis. RESULTS: The prevalence of MAU was 9%, and the mean 24-hour UAE was 18 mg/d. The prevalence of MAU was significantly higher for the MetS, high blood pressure (BP), high triglyceride (TG) levels, low high-density lipoprotein cholesterol (HDL-C) and hyperglycaemia groups but not for the central obesity group. Both MAU and mean 24-hour UAE were significantly increased in association with a number of MetS components. The adjusted prevalence OR (POR) for MetS with MAU was 2.95 (95% CI 2.15 to 4.04) compared with those without MAU. MAU was significantly associated with three components of MetS: high BP (POR=1.86, 95% CI 1.31 to 2.64), high TG levels (POR=1.80, 95% CI 1.31 to 2.46) and hyperglycaemia (POR=1.84, 95% CI 1.34 to 2.53). No significant association between MAU and central obesity or low HDL-C was found. The presence of MetS gradually increased according to the normal-range 24-hour UAE quartiles: POR=1.00, POR=1.22, POR=1.14 and POR=2.02, respectively. Hyperglycaemia also increased significantly according to the normal-range 24-hour UAE quartiles. CONCLUSIONS: MAU and elevated 24-hour UAE within the normal range were closely associated with MetS in the Chinese population, which may provide a basis for the development of early interventions to decrease the effects of MetS.

[Profile and associations of carotid femoral pulse wave velocity in a community-based Beijing population of middle and old age].

OBJECTIVE: To explore the profile and related factors of carotid femoral pulse wave velocity (CFPWV) in a community-based Beijing population of middle and old age. METHODS: A total of 1519 residents aged 44 - 79 years old from Shijingshan district, Beijing, were recruited for the cardiovascular risk factor survey and CFPWV measurements. One way ANOVA, pearson correlation and partial correlation, stepwise multi-linear regression were used for the data analysis. RESULTS: (1) The age-adjusted mean value of CFPWV was significantly higher in men than that in women (11.4 vs. 11.1 m/s, P = 0.007). CFPWV increased significantly with age both for men and women (all P < 0.01). (2) After adjusting for age and gender, CFPWV was significantly higher in people with hypertension, diabetes and higher heart rate (> 70 beats/min) than people without these factors (P < 0.01). (3) CFPWV significantly correlated with age, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate (correlation coefficient ranged from 0.12 - 0.46, all P < 0.01). In female, CFPWV was positively correlated with total cholesterol and triglycerides (correlation coefficient 0.11 and 0.13, all P < 0.01). Multi-linear regression analysis showed age, gender, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate were independent predictors of CFPWV. CONCLUSION: In this middle and old age Chinese population, age, sex, systolic blood pressure, diastolic blood pressure, fasting blood glucose and heart rate but not HDL-cholesterol and body mass index were associated with CFPWV.

Associations of Domain-Specific Physical Activity With Leisure-Time Sedentary Behaviors in Chinese Professionals.

OBJECTIVE: To understand the association of domain-specific physical activity (PA) with leisure-time sedentary behavior (LTSB) among Chinese professionals. METHODS: Totally, 3326 workers aged 35 to 64 years old from Beijing city and Zhejiang province were asked information on domain-specific PA with a revised Global Physical Activity Questionnaire (GPAQ). The association of domain-specific PA with LTSB-lifestyle (≥4 hours/day spent on LTSB) was examined with a binary logistic regression model. RESULTS: Compared with sedentary occupational activity (OA), light-, moderate-, and vigorous-intensity OA were respectively associated with 55.3% (ORs, 0.447; 95%CI, 0.378 to 0.529), 63.5% (ORs, 0.365; 95%CI, 0.285 to 0.468), and 77.1% (ORs, 0.229; 95%CI, 0.126 to 0.417) less the odds of having LTSB-lifestyle. Those performing domestic activity (DA) are greater than and equal to 19.6 MET-hours/week had 30.1% (ORs, 0.699; 95%CI, 0.576 to 0.848) less the odds. CONCLUSIONS: Both non-sedentary occupations and DA were negatively associated with LTSB-lifestyle in these professionals.

Population-based association between urinary excretion of sodium, potassium and its ratio with albuminuria in Chinese.

BACKGROUND AND OBJECTIVES: Albuminuria is a risk factor for cardiovascular and renal disease. However, little is known about the association of 24 h urinary sodium and potassium excretion with albuminuria in China. The aim of this study was to examine this association by analyzing the data from 1,975 Chinese adults living in north China. METHODS AND STUDY DESIGN: Excretion of urinary sodium, potassium and albumin was assessed in a single 24-h urine sample for each participant. Height, weight, waist circumference and blood pressure were measured and body mass index was determined as weight divided by square height. Fasting blood sample was collected and fasting glucose was measured. RESULTS: The average 24-h urinary sodium and potassium excretion were 232 mmol and 40.8 mmol, resulting a mean sodium to potassium ratio of 6.7. The median (Q1-Q3) 24-h urinary albuminuria excretion was 6.1 mg (4.5-8.7 mg). Overall, urinary sodium excretion was positively associated with albumin excretion (ß=0.029, p<0.001). This association was independent of major cardiovascular risk factors including age, gender, systolic blood pressure, body mass index, fasting glucose, waist circumference, hypertensive drug treatment, and smoking. Moreover, the relation of sodium and albumin was similar in the subgroups stratified by gender, adiposity and diabetic status. No significant associations of potassium excretion or sodium to potassium ratio with urinary albumin excretion were observed. CONCLUSIONS: In cross-sectional analyses, high sodium intake was shown to be associated with increased urinary albuminuria in the general Chinese adult population, supporting salt restriction for renal and cardiovascular health benefit.

[Association between 24 h urinary sodium to potassium ratio and metabolic syndrome in Chinese adults].

OBJECTIVE: To examine the association between 24 h urinary sodium to potassium ratio and metabolic syndrome (MS) in Chinese adults. METHODS: A population-based cross-sectional study was conducted among Chinese adults aged 18-69 years in Shandong province in 2011. Data on 24 h urinary excretion of sodium and potassium and components of MS were examined. Participants were divided into four groups according to the quartile of 24 h urinary sodium to potassium ratio. RESULTS: Of the 1 906 Chinese adults eligible for final data analysis, 471 (24.7%) were with MS. After completion of multivariate logistic regression analysis, when compared to the participants with 24 h urinary sodium to potassium ratio < 4.3, the OR (95% CI) of participants with 24 h urinary sodium to potassium ratio during 4.3-5.6, 5.7-8.1, and ≥ 8.1 were 1.27 (0.93-1.71), 1.06 (0.78-1.46), and 1.45 (1.06-1.97), respectively (P values for linear trend < 0.05). As for the components of MS, the odds of central obesity and elevated blood pressure but not the odds of elevated triglycerides, low high density lipoprotein cholesterol and elevated fasting glucose, had significantly increases with successive 24 h urinary sodium to potassium ratio quartiles (P values for linear trends < 0.05). CONCLUSION: The 24 h urinary sodium to potassium ratio appeared significantly associated with the odds of MS.

Are Microalbuminuria and Elevated 24 H Urinary Microalbumin Excretion within Normal Range Associated with Metabolic Syndrome in Chinese Adults?

The association of microalbuminuria and elevated 24 h urinary microalbumin excretion (UAE) with metabolic syndrome (MetS) has not been well examined in Chinese Adults. In the present study, a population-based cross-sectional study was conducted among Chinese adults aged 18-69 years in Shandong province in 2011 to determine the relationship between them. Data on 24 h UAE and other variables were obtained and components of MetS were examined. The prevalence of MetS and mean 24 h UAE was 24.7% and 6.7 mg, respectively. Compared with participants with normoalbuminuria, the odds of MetS and its components including central obesity, elevated blood pressure and elevated fasting glucose, but not the odds of low HDL cholesterol and elevated triglycerides, significantly increased in those with microalbuminuria. Additionally, the odds of MetS and its three components significantly increased across increasing quartiles of 24 h UAE within normal range (1.00, 1.11, 1.02 and 1.58, respectively, for MetS; 1.00, 1.14, 1.21, and 1.68, respectively, for central obesity; 1.00, 1.35, 1.26 and 1.68, respectively, for elevated blood pressure; and 1.00, 1.32, 1.06 and 1.47, respectively, for elevated triglycerides; p for linear trend ≤0.05 for all). Furthermore, for each increment of 10 mg 24 h UAE within normal range, the odds of MetS and its components including central obesity, elevated blood pressure, and elevated triglycerides significantly increased by 53%, 65%, 55%, and 41%, respectively. These findings suggest that both microalbuminuria and elevated 24 h UAE within normal range might be important risk factors for MetS in Chinese adults.