Dietary sodium estimation methods: accuracy and limitations of old and new methods in individuals at high cardiovascular risk

Objective: Accurate and easy to use methods for dietary Na intake estimation in population level are lacking. We aimed at (i) estimating the mean Na intake in the group level using a variety of dietary methods (DM) and urinary methods (UM) and correlating them with 24-h urine collection (24UCol) and (ii) improving the accuracy of the existing DM. Design: The most common DM (three 24-h dietary recalls (24DR) and FFQ) and UM (24UCol and spot urine collection using common equations) were applied. To improve the existing: (i) 24DR, discretionary Na was quantified using salt-related questions or adding extra 15 % in total Na intake and (ii) FFQ, food items rich in Na and salt-related questions were added in the standard questionnaire (NaFFQ). Setting: National and Kapodistrian University of Athens, Greece. Participants: Totally, 122 high cardiovascular risk subjects (56 center dot 0 +/- 12 center dot 6 years; 55 center dot 7 % males). Results: Mean 24 h Na excretion (24UNa) was 2810 +/- 1304 mg/d. Spot urine methods overestimated the 24UNa (bias range: -1781 to -492 mg) and were moderately correlated to 24UCol (r = 0 center dot 469-0 center dot 596, P <= 0 center dot 01). DM underestimated the 24UNa (bias range: 877 to 1212 mg) and were weakly correlated with 24UCol. The improved DM underestimated the 24UNa (bias range: 877 to 923 mg). The NaFFQ presented the smallest bias (-290 +/- 1336 mg) and the strongest correlation with 24UCol (r = 0 center dot 497, P <= 0 center dot 01), but wide limits of agreement in Bland-Altman plots (-2909 mg; 2329 mg), like all the other methods did. Conclusions: The existing methods exhibit poor accuracy. Further improvement of the newly developed NaFFQ could be promising for more accurate estimation of mean dietary Na intake in epidemiological studies. Additional validation studies are needed.