title: Dietary sodium intake and incidence of diabetes complications in Japanese patients with type 2 diabetes: analysis of the Japan Diabetes Complications Study (JDCS).
abstract: BACKGROUND
  Many guidelines recommend that patients with type 2 diabetes should reduce their dietary sodium intake. However, the relationship between dietary sodium intake and incidence of diabetic complications in patients with type 2 diabetes has not been explored.
  
  
  OBJECTIVE
  Our objective was to investigate the relationship between dietary sodium intake and incidence of diabetes complications.
  
  
  METHODS
  The study was of a nationwide cohort of patients with type 2 diabetes aged 40 to 70 years with hemoglobin A1c (HbA1c) ≥6.5%.
  
  
  METHODS
  After excluding nonresponders to a dietary survey, 1588 patients were analyzed. Baseline dietary intake was assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes were times to cardiovascular disease (CVD), overt nephropathy, diabetic retinopathy, and all-cause mortality.
  
  
  RESULTS
  Mean daily dietary sodium intake in quartiles ranged from 2.8 to 5.9 g. After adjustment for confounders, hazard ratios for CVD in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 1.70 (95% confidence interval, 0.98-2.94), 1.47 (0.82-2.62), and 2.07 (1.21-3.90), respectively (trend P < .01). In addition, among patients who had HbA1c ≥9.0%, the hazard ratio for CVD in patients in the top vs bottom quartile of sodium intake was dramatically elevated compared with patients with HbA1c <9.0% (1.16 [0.56-2.39] and 9.91 [2.66-36.87], interaction P < .01). Overt nephropathy, diabetic retinopathy, and all-cause mortality were not significantly associated with sodium intake.
  
  
  CONCLUSIONS
  Findings suggested that high dietary sodium intake is associated with elevated incidence of CVD in patients with type 2 diabetes and that there is a synergistic effect between HbA1c values and dietary sodium intake for the development of CVD.
authors: Department of Health and Nutrition (C.H.), University of Niigata Prefecture Faculty of Human Life Studies, Niigata 950-8680, Japan; Department of Hematology, Endocrinology, and Metabolism (C.H., O.H., H.S.), Niigata University Faculty of Medicine, Niigata 951-8510, Japan; Department of Endocrinology and Metabolism (C.H., N.Y.), University of Tsukuba Institute of Clinical Medicine, Tsukuba 305-8575, Japan; Training Department of Administrative Dietitians (Y.Y., C.K.), Shikoku University, Tokushima 771-1151, Japan; EBM Research Center (Sh.T.) and Translational Research Center (Sa.T.), Kyoto University School of Medicine, Kyoto 606-8501, Japan; Department of Endocrinology and Metabolism (A.A., H.I.), Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan; Nutrition Clinic (A.T.), Kagawa Nutrition University, Tokyo 170-8481, Japan; Department of Biostatistics, Epidemiology, and Preventive Health Sciences (Y.O.), University of Tokyo, Tokyo 113-0033, Japan; and The Institute for Adult Diseases (Y.A.), Asahi Life Foundation, Tokyo 103-0002, Japan.
authors: Chika
authors: C
authors: Horikawa
authors: Yukio
authors: Y
authors: Yoshimura
authors: Chiemi
authors: C
authors: Kamada
authors: Shiro
authors: S
authors: Tanaka
authors: Sachiko
authors: S
authors: Tanaka
authors: Osamu
authors: O
authors: Hanyu
authors: Atsushi
authors: A
authors: Araki
authors: Hideki
authors: H
authors: Ito
authors: Akira
authors: A
authors: Tanaka
authors: Yasuo
authors: Y
authors: Ohashi
authors: Yasuo
authors: Y
authors: Akanuma
authors: Nobuhiro
authors: N
authors: Yamada
authors: Hirohito
authors: H
authors: Sone
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012982:Sodium, Dietary / Q000008:administration & dosage / Q000009:adverse effects* / Q000652:urine
chemical_list: D006442:Glycated Hemoglobin; D012982:Sodium, Dietary; C517652:hemoglobin A1c protein, human