Association of Urinary Sodium Excretion With Insulin Resistance in Korean Adolescents Results From the Korea National Health and Nutrition Examination Survey 2009-2010

Abstract

High sodium intake is a well-known risk factor for elevated blood pressure and is responsible for a higher incidence of cardiovascular events. Reports have suggested an association of sodium intake with insulin resistance (IR) and type 2 diabetes mellitus in adults. However, evidence on an association between sodium intake assessed on the basis of urinary sodium excretion and IR in adolescents is scarce. The present study aimed at investigating the association between urinary sodium excretion and IR among South Korean adolescents. This population-based, cross-sectional study analyzed the data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) 2009 to 2010. The data of a total of 1353 adolescents (779 boys and 574 girls) were included in the final analysis. Spot urine samples were collected, and urinary sodium excretion was estimated by using the urinary sodium concentration (U[Na+]), U[Na+] to urinary creatinine ratio (U[Na+]/Cr), and U[Na+] to specific gravity unit (SGU) ratio (U[Na+]/SGU). IR was assessed by using the homeostasis model assessment of IR (HOMA-IR). Hierarchical multivariable logistic regression analysis was performed to assess the risk for a high HOMA-IR according to urinary sodium excretion. The mean levels of U[Na+], U[Na+]/Cr, and U[Na+]/SGU were significantly higher in subjects in the highest HOMA-IR quartile (Q4) than in subjects in the lowest, second, or third quartiles (Q1-3) of HOMA-IR. The mean values of HOMA-IR and several cardiometabolic parameters tended to progressively increase with the U[Na+], U[Na+]/Cr, and U[Na+]/SGU quartiles. Q3 of U[Na+] was at a significantly higher risk than Q1 of U[Na+] of an association with Q4 of HOMA-IR, after adjustment for confounding variables. Q3 and Q4 of U[Na+]/Cr and U[Na+]/SGU, respectively, had significantly higher risks, than the respective Q1s, of an association with Q4 of HOMA-IR. The risk of an association with Q4 of HOMA-IR demonstrated significantly increasing trends with increasing quartiles of U[Na+], U[Na+]/Cr, and U[Na+]/SGU irrespective of confounding factors. Urinary sodium excretion was positively associated with IR in South Korean adolescents. The monitoring and control of urinary sodium excretion may be recommended as an important intervention for the prevention of IR and related diseases in adolescents.