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Elevated urinary Na/K ratio among Lebanese elementary school children is attributable to low K intake

European Journal of Nutrition volume 56, pages 1149–1156 (2017)Cite this article

Abstract

Purpose

To estimate total sodium (Na) and potassium (K) intake using non-fasting morning urine specimens among Lebanese elementary (6–10 year old) schoolchildren.

Method

A national cross-sectional study was conducted. A multistage cluster sampling procedure was used to select a representative sample of 1403 healthy children from the eight districts of Lebanon. Age, anthropometric measurements, and urine samples were collected and analyzed for Na, K, and creatinine (Cr).

Results

The ratios of Na and K to Cr were 23.93 ± 15.54 mM/mM (4.86 ± 3.16 mg/mg) and 11.48 ± 5.82 mM/mM (3.97 ± 2.01 mg/mg), respectively, and showed differences (P value <0.001) between age groups. No differences were found between boys and girls in all the measured Na and K parameters. The estimated mean Na intake was 96.57 ± 61.67 mM/day (2.220 ± 1.418 g/day or 5.69 ± 3.64 g NaCl/day) and exceeded the upper limit of intake in half the children. Estimated K intake was 46.6 ± 23.02 mM/day (1.822 ± 0.900 g/day), and almost all children failed to meet the recommended daily K intake. The high Na/K ratio (2.361 ± 1.67 mM/mM or 1.39 ± 0.98 mg/mg) resulted from a combination of high Na and low K intake but was mostly affected by K intake.

Conclusions

About 50 % of children exceeded the recommended daily upper intake for Na, while the majority was below K adequate intake. This unfavorable Na/K ratio is indicative of potentially negative health effects at later stages in life. Interventions aimed at reducing salt intake and increasing consumption of fruits and vegetables are warranted.

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Acknowledgments

This work was funded by the University Research Board (URB) which had no direct or indirect involvements in this project.

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Author notes

    Affiliations

    1. Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Beirut, Lebanon

      Carla El Mallah, Karina Merhi, Dareen Shatila, Sirine Francis, Imad Toufeili & Omar Obeid

    2. Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

      Hala Ghattas

    3. Faculty of Medicine, American University of Beirut, Beirut, Lebanon

      Sani Hlais

    Authors
    1. Carla El Mallah
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    2. Karina Merhi
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    3. Hala Ghattas
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    Correspondence to Omar Obeid.

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    All subjects gave their informed consent prior to their inclusion in the study.

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    The study protocol was approved by the Institutional Review Board of the American University of Beirut.

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    Carla El Mallah and Karina Merhi have contributed equally to the work, and the first listed authors made the greatest contribution to the paper.

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    El Mallah, C., Merhi, K., Ghattas, H. et al. Elevated urinary Na/K ratio among Lebanese elementary school children is attributable to low K intake. Eur J Nutr 56, 1149–1156 (2017). https://doi.org/10.1007/s00394-016-1164-6

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    • DOI: https://doi.org/10.1007/s00394-016-1164-6

    Keywords

    • Lebanese children
    • Potassium intake
    • Sodium intake
    • Urinary potassium-to-creatinine ratio
    • Urinary sodium-to-creatinine ratio