title: Higher dietary salt intake is associated with microalbuminuria, but not with retinopathy in individuals with type 1 diabetes: the EURODIAB Prospective Complications Study.
abstract: OBJECTIVE
  High dietary salt intake has been associated with elevated BP and may also have a deleterious effect on microvascular complications. We studied the cross-sectional associations between dietary salt intake (estimated from 24 h urinary sodium excretion) and urinary potassium excretion on the one hand, and the prevalence of microvascular complications on the other, in individuals with type 1 diabetes.
  
  
  METHODS
  We measured sodium and potassium concentrations in two 24 h urine samples in 1,212 individuals with type 1 diabetes (40 ± 10 years old, 51% men) who participated in the EURODIAB Prospective Complications Study. We used multiple logistic regression analyses to investigate associations between dietary salt intake and microvascular complications adjusted for age and sex, and additionally for BMI, smoking, urinary potassium excretion, antihypertensive medication and physical activity, and total energy, protein, alcohol, saturated fat and fibre intake.
  
  
  RESULTS
  After full adjustment, 1 g/day higher dietary salt intake was positively associated with the presence of microalbuminuria (OR 1.06 [95% CI 1.01, 1.10]), but not macroalbuminuria (OR 0.99 [95% CI 0.94, 1.05]), non-proliferative retinopathy (OR 1.00 (95% CI 0.96, 1.04]) or proliferative retinopathy (OR 1.02 (95% CI 0.95, 1.08]). After excluding individuals with cardiovascular disease and/or antihypertensive medication (n = 418), we found a non-significant association with microalbuminuria (OR 1.04 [95% CI 0.99, 1.10]) and macroalbuminuria (OR 1.05 [95% CI 0.96, 1.16]). The association between dietary salt intake and microalbuminuria was stronger in individuals with a BMI above 25 kg/m(2) (OR 1.11 [95% CI 1.04, 1.18]) than in those with BMI below 25 kg/m(2) (OR 1.03 [95% CI 0.97, 1.09]). No significant associations were found between urinary potassium excretion and microvascular complications.
  
  
  CONCLUSIONS
  In individuals with type 1 diabetes, higher dietary salt intake, as determined by 24 h urinary sodium excretion, may be positively associated with microalbuminuria, particularly in overweight individuals.
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Centre, Universiteitssingel 50, 6200 MD, Maastricht, the Netherlands, l.engelen@maastrichtuniversity.nl.
authors.forename: Lian
authors.initials: L
authors.lastname: Engelen
authors.forename: Sabita S
authors.initials: SS
authors.lastname: Soedamah-Muthu
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.forename: Monika
authors.initials: M
authors.lastname: Toeller
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
authors.forename: John H
authors.initials: JH
authors.lastname: Fuller
authors.forename: Casper G
authors.initials: CG
authors.lastname: Schalkwijk
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D003930:Diabetic Retinopathy / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000652:urine; D011188:Potassium / Q000652:urine; D011446:Prospective Studies; D012964:Sodium / Q000652:urine; D012982:Sodium, Dietary / Q000009:adverse effects
chemical_list: D012982:Sodium, Dietary; D012964:Sodium; D011188:Potassium