Validation of 4 Estimating Methods to Evaluate 24-h Urinary Sodium Excretion: Summer and Winter Seasons for College Students in China

Twenty-four-hour urine sample collection is regarded as the gold standard for sodium intake evaluation, but the implementation can be difficult. The objective was to validate and evaluate the accuracy and feasibility of estimating sodium intake by four methods. A group of 268 healthy volunteers aged 18-25 years was enrolled in this study. Twenty-four-hour urine samples as well as timed (morning, afternoon, evening, and overnight) urine samples were randomly collected in summer and winter. The sodium intake was estimated by four published methods-Kawasaki, INTERSALT, Tanaka, and Sun's. The consistencies between estimated sodium intake and real measured values of 24-h urinary sodium excretion were compared by Bland-Altman plots in each of the methods. The 24-h urinary sodium analysis result indicated that average daily sodium intake was 3048.4 +/- 1225.9 mg in summer and 3564.7 +/- 1369.9 mg in winter. At the population level, the bias (estimated value-measured value) was the least with the INTERSALT method with afternoon (-39.7 mg; 95%CI: -164.7, 85.3 mg) and evening (-43.5 mg; 95%CI: -166.4, 79.5 mg) samples in summer. In winter, the Kawasaki method (162.1 mg; 95%CI: 13.5, 310.7 mg) was superior to others. Estimation of sodium intake using the four methods is affected by the time and temperature. In summer, the INTERSALT method provides the best estimation of the population's mean sodium intake. The Kawasaki method is superior to other methods in winter.