title: Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China.
abstract: BACKGROUND
  Recent studies have shown inconsistent effects of sodium reduction, potassium intake, and the ratio of sodium to potassium (Na/K ratio) on hypertension and other cardiovascular diseases. Major gaps exist in knowledge regarding these issues in China.
  
  
  OBJECTIVE
  We analyzed the patterns and trends of dietary sodium intake, potassium intake, and the Na/K ratio and their relations with incident hypertension in China.
  
  
  METHODS
  The China Health and Nutrition Survey cohort includes 16,869 adults aged 20-60 y from 1991 to 2009. Three consecutive 24-h dietary recalls and condiment and food weights provided detailed dietary data. Multinomial logistic regression models determined trends and patterns of sodium and potassium intake and the Na/K ratio. Models for survival-time data estimated the hazard of incident hypertension.
  
  
  RESULTS
  Sodium intake is decreasing but remains double the Institute of Medicine recommendations. Most sodium comes from added condiments. Adults in the central provinces have the highest sodium intake and the most rapid increase in hypertension. Potassium intake has increased slightly but is below half of the recommended amount. The Na/K ratio is significantly higher than the recommended amounts. Recent measurements of high sodium intake, low potassium intake, and high Na/K ratio have strong independent dose-response associations with incident hypertension.
  
  
  CONCLUSIONS
  Reducing sodium in processed foods, the major public health strategy in Western countries, may be less effective in China, where salt intake remains high. Replacing sodium with potassium in salt to control and prevent hypertension in China should be considered along with other public health and clinical prevention options.
authors.affiliation: Department of Nutrition and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC (SD, CB, and BMP); the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA (AN); and the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing, China (HW, BZ, and JZ).
authors.forename: Shufa
authors.initials: S
authors.lastname: Du
authors.forename: Andrea
authors.initials: A
authors.lastname: Neiman
authors.forename: Carolina
authors.initials: C
authors.lastname: Batis
authors.forename: Huijun
authors.initials: H
authors.lastname: Wang
authors.forename: Bing
authors.initials: B
authors.lastname: Zhang
authors.forename: Jiguo
authors.initials: J
authors.lastname: Zhang
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D017419:Potassium, Dietary / Q000008:administration & dosage / Q000009:adverse effects*; D011634:Public Health; D012982:Sodium, Dietary / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D017419:Potassium, Dietary; D012982:Sodium, Dietary