title: Dietary salt intake and mortality in patients with type 2 diabetes.
abstract: OBJECTIVE
  Many guidelines recommend that patients with type 2 diabetes should aim to reduce their intake of salt. However, the precise relationship between dietary salt intake and mortality in patients with type 2 diabetes has not been previously explored.
  
  
  METHODS
  Six hundred and thirty-eight patients attending a single diabetes clinic were followed in a prospective cohort study. Baseline sodium excretion was estimated from 24-h urinary collections (24hU(Na)). The predictors of all-cause and cardiovascular mortality were determined by Cox regression and competing risk modeling, respectively.
  
  
  RESULTS
  The mean baseline 24hU(Na) was 184 ± 73 mmol/24 h, which remained consistent throughout the follow-up (intraindividual coefficient of variation [CV] 23 ± 11%). Over a median of 9.9 years, there were 175 deaths, 75 (43%) of which were secondary to cardiovascular events. All-cause mortality was inversely associated with 24hU(Na), after adjusting for other baseline risk factors (P < 0.001). For every 100 mmol rise in 24hU(Na), all-cause mortality was 28% lower (95% CI 6-45%, P = 0.02). After adjusting for the competing risk of noncardiovascular death and other predictors, 24hU(Na) was also significantly associated with cardiovascular mortality (sub-hazard ratio 0.65 [95% CI 0.44-0.95]; P = 0.03).
  
  
  CONCLUSIONS
  In patients with type 2 diabetes, lower 24-h urinary sodium excretion was paradoxically associated with increased all-cause and cardiovascular mortality. Interventional studies are necessary to determine if dietary salt has a causative role in determining adverse outcomes in patients with type 2 diabetes and the appropriateness of guidelines advocating salt restriction in this setting.
authors.affiliation: Endocrine Centre, Austin Health and the University of Melbourne, Victoria, Australia.
authors.forename: Elif I
authors.initials: EI
authors.lastname: Ekinci
authors.forename: Sophie
authors.initials: S
authors.lastname: Clarke
authors.forename: Merlin C
authors.initials: MC
authors.lastname: Thomas
authors.forename: John L
authors.initials: JL
authors.lastname: Moran
authors.forename: Karey
authors.initials: K
authors.lastname: Cheong
authors.forename: Richard J
authors.initials: RJ
authors.lastname: MacIsaac
authors.forename: George
authors.initials: G
authors.lastname: Jerums
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012964:Sodium / Q000652:urine; D017673:Sodium Chloride, Dietary
chemical_list: D017673:Sodium Chloride, Dietary; D012964:Sodium