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Sodium status is associated with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies

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Abstract

Purpose

The relationship between sodium intake and the risk of developing type 2 diabetes mellitus (T2DM) is inconsistent. We, therefore, aimed to summarize the current evidence by conducting a systematic review and meta-analysis of observational studies.

Methods

We retrieved studies which compared any marker of sodium status between individuals with T2DM and those without diabetes published in any language by searching online databases from inception up to June 2019. Summary effects were derived using random-effects model.

Results

A total of 44 studies with 503,830 participants from 25 countries were included in this study. Sodium status was significantly different between individuals with and without T2DM (Hedges’ g = 0.21; 95% CI 0.02, 0.40; P = 0.029). Individuals with T2DM had higher sodium intake compared to non-diabetic controls (WMD = 621.79 mg/day; 95% CI 321.53, 922.06; P < 0.001) and 24-h urinary excretion was associated with likelihood of developing T2DM (OR = 1.27, 95% CI 1.15, 1.41; P < 0.001). Furthermore, salivary, hair, and platelet sodium were higher in patients with T2DM compared to controls (P < 0.05).

Conclusion

The findings of the current meta-analysis suggest that sodium levels are higher in patients with T2DM compared to non-diabetic controls; however, given that these studies are observational, it is not possible to infer causality.

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Availability of data and material

The study protocol was registered in the PROSPERO (international prospective register of systematic reviews) database under the number CRD42016050627.

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Acknowledgements

We thank Iran University of Medical Sciences for providing facilities to search in electronic databases.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Roya Kolahdouz-Mohammadi

  2. Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Sepideh Soltani

  3. Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA

    Zachary Stephen Clayton

  4. Nutrition and Food Security Research Center, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Amin Salehi-Abargouei

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  1. Roya Kolahdouz-Mohammadi
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  2. Sepideh Soltani
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  4. Amin Salehi-Abargouei
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RKM contributed to protocol design, search, data extraction, quality assessment and writing the manuscript. SS contributed to protocol design, search, data extraction, statistical analysis and revision of the manuscript. ZSC reviewed and edited the manuscript. ASA contributed to protocol design, statistical analysis and revision of the manuscript. All authors have seen and approved the final version.

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Correspondence to Amin Salehi-Abargouei.

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Kolahdouz-Mohammadi, R., Soltani, S., Clayton, Z.S. et al. Sodium status is associated with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies. Eur J Nutr 60, 3543–3565 (2021). https://doi.org/10.1007/s00394-021-02595-z

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