Relationship between urinary sodium excretion and bone mineral density in pediatrics: population-based study from KNHANES V 2010–2011

In Kyung Lee; Yoo Mi Kim; Han Hyuk Lim

doi:10.1515/jpem-2023-0520

Article

Relationship between urinary sodium excretion and bone mineral density in pediatrics: population-based study from KNHANES V 2010–2011

In Kyung Lee , Yoo Mi Kim and Han Hyuk Lim

Published/Copyright: May 17, 2024

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 37 Issue 6

Abstract

Objectives

Osteoporosis poses a growing public health challenge worldwide. While calcium and vitamin D may influence bone mineral density (BMD), the effect of sodium (Na) intake, particularly in pediatrics, remains unexplored. This study aimed to evaluate the relationship between urinary Na excretion and BMD in a Korean pediatric population.

Methods

A total of 2,018 participants (1,084 males and 934 females) aged 10–18 years were included from the data obtained from Korea National Health and Nutrition Examination Survey V (2010–2011).

Results

Daily Na intake was about 4,560 mg and 3,600 mg in boys and girls, respectively. The mean intake of Na per day was positively correlated with the increment of urine Na/Cr ratio quartile (p<0.001). The BMD z-score [lumbar spine (LS), femur neck (FN), and whole body except head (WB)] in the group with high Na/Cr ratio (4th quartile, 4Q) was significantly less than in those with low Na/Cr ratio (1st quartile, 1Q) (p<0.001). Moreover, the LS (p=0.028), FN (p=0.002) and WB (p=0.056) in the 4Q group showed 2.0 times, 2.8 times, and 1.9 times greater risk of low BMD z-scores than in the 1Q group, even after adjusting for other confounding factors, such as age, sex, BMI, vitamin D, moderate activity, and household incomes.

Conclusions

Our findings suggest a strong negative association between urine Na excretion and BMD among Korean children and adolescents. The results underscore the importance of public health interventions targeting Na intake. Further longitudinal studies are recommended to clarify the long-term effects of Na on bone health in younger populations.

Keywords: bone density; osteoporosis; children; sodium

Corresponding author: Han Hyuk Lim, MD, PhD, A Professor, Department of Pediatrics, Chungnam National University College of Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea; and Department of Pediatrics, Chungnam National University Hospital, Daejeon, South Korea, Phone: 82 42 280 7825, E-mail: damus@cnu.ac.kr

Research ethics: This study is a retrospective study that used and analyzed the data from the KNHANES survey; therefore, approval from IRB was not required.
Informed consent: Not applicable.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission. Study concept and design: Han Hyuk Lim and Yoo Mi Kim. Data collection: In Kyung Lee and Han Hyuk Lim. Data analysis: Han Hyuk Lim. Interpretation of data: In Kyung Lee and Han Hyuk Lim. Drafting and revising the manuscript: In Kyung Lee. All authors read and approved the final manuscript.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The datasets generated during and / or analysed during the current study are available from the corresponding author on reasonable request.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2023-0520).

Received: 2023-11-22

Accepted: 2024-04-13

Published Online: 2024-05-17

Published in Print: 2024-06-25

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Keywords for this article

bone density; osteoporosis; children; sodium