Association between 24-hour urinary sodium excretion and obesity in general population aged from 18 to 69 years old
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摘要:
目的 分析18~69岁普通人群24 h尿钠与肥胖的相关性。 方法 2013-2014年在山东省和江苏省4个项目县，采用多阶段整群随机抽样的方法，选取2 400名18~69岁调查对象进行问卷调查、体格测量和24 h尿液收集。采用多因素线性回归和Logistic回归模型分析尿钠和肥胖的关系。 结果 最终纳入分析的2 275名研究对象肥胖率19.1%(95%CI：17.4%~20.6%)，24 h尿钠为(166.4±71.5)mmol/d。肥胖、按腰围身高比(waist-to-height ratio，WHtR)计算的向心性肥胖人群24 h尿钠水平高于非肥胖人群，差异均有统计学意义(均有P < 0.05)。多元线性回归分析调整相关因素后，24 h尿钠与体重指数(body mass index，BMI)、腰围(waist circumference，WC)和WHtR呈正相关关系。多因素Logistic回归分析结果显示，调整年龄、性别、教育程度、吸烟、饮酒、身体活动、高血压和糖尿病后，与尿钠水平最低组相比，尿钠水平最高组患肥胖、向心性肥胖(按WC计算)、向心性肥胖(按WHtR计算)风险的OR(95%CI)值分别为1.61(1.18~2.20)、2.01(1.39~2.89)和1.47(1.15~1.89)。 结论 24 h尿钠与肥胖呈正相关，高钠摄入是肥胖的重要危险因素。 Abstract:Objective To analyze the association between 24-hour urinary sodium excretion and obesity in a general Chinese population aged from 18 to 69 years old. Methods 2 400 from 18 to 69 year-old subjects were selected from four counties in Shandong Province and Jiangsu Province from 2013 to 2014 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24-hour urine collection were conducted. The relationship between urinary sodium and obesity was analyzed by multivariate linear regression and Logistic regression analysis. Results 2 275 subjects were finally included in the analysis. Obesity rate of the subjects was 19.1%(95% CI: 17.4%-20.6%)and 24-hour urinary sodium was (166.4±71.5) mmol/d. The urinary sodium in obese, and central obesity population calculated according to waist-to-height ratio (WHtR) were higher than the normal population, respectively (All P < 0.05). Multivariate linear regression analysis showed that after adjusting for relevant factors, 24-hour urinary sodium was positively correlated with body mass index (BMI), waist circumference (WC) and WHtR. Multivariate Logistic regression analysis showed that compared to population in the lowest quantile, population in highest quantile had an increased risk of being the obesity, abdominal obesity(calculated according to WC) and abdominal obesity(calculated according to WHtR) with OR(95% CI) of 1.61(1.18-2.20), 2.01(1.39-2.89) and 1.47(1.15-1.89), respectively, after adjusting for age, gender, education, smoking, alcohol consumption, physical activity, hypertension and diabetes. Conclusions High sodium is independently associated with obesity. Sodium intake is a potential and important risk factor for obesity. -
Key words:
- Urinary sodium /
- Obesity /
- 24-hour urine
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表 1 不同尿钠组人群基本特征比较
Table 1. Baseline characteristics of participants of different 24 h urinary sodium level groups
变量 24小时尿钠(mmol/d) F/χ2值 P值 Q1(n=570) Q2(n=568) Q3(n=569) Q4(n=568) 年龄(x±s, 岁) 43.8±13.5 42.1±13.3 41.8±13.4 40.8±13.8 4.87 0.002 BMI(x±s, kg/m2) 24.5±3.7 24.6±3.9 25.1±3.8 25.4±4.1 7.31 < 0.001 WC (x±s, cm) 82.2±9.7 82.4±9.8 84.3±9.9 84.2±10.9 7.11 < 0.001 WHtR 0.50±0.06 0.51±0.06 0.51±0.06 0.51±0.07 2.92 0.033 SBP(x±s, mmHg) 130.1±20.2 131.2±19.6 132.6±19.5 131.5±20.1 1.61 0.184 DBP(x±s, mmHg) 82.8±11.6 83.3±11.7 84.4±11.9 84.0±12.4 2.05 0.106 FPG(x±s, mmol/L) 5.9±1.5 5.6±1.1 5.8±1.4 5.8±1.5 4.94 0.002 吸烟[n(%)] 153(26.8) 152(26.8) 187(32.9) 173(30.5) 7.29 0.063 饮酒[n(%)] 136(23.9) 128(22.5) 164(28.8) 171(30.1) 12.00 0.007 身体活动[n(%)] 148(26.0) 99(17.4) 96(16.9) 126(22.2) 19.22 < 0.001 高血压[n(%)] 208(36.5) 191(33.6) 229(40.3) 211(37.1) 5.41 0.144 糖尿病[n(%)] 47(8.2) 39(6.9) 46(8.1) 46(8.1) 0.98 0.807 尿量(x±s, ml/d) 1 192±467 1 265±418 1 437±420 1 753±477 177.66 < 0.001 尿钠(x±s, mmol/d) 83.9±21.8 136.6±12.5 181.9±15.0 263.3±47.7 4 206.42 < 0.001 尿钾(x±s, mmol/d) 16.9±6.6 23.1±6.0 27.3±6.9 33.9±9.0 558.19 < 0.001 尿钠钾比(x±s) 5.5±2.1 6.3±1.7 7.1±1.8 8.2±2.5 177.99 < 0.001 
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表 2 24 h尿钠与肥胖的单因素分析
Table 2. Univariate analysis of 24-hour urine sodium and obesity
变量 人数(人) 24 h尿钠(x±s, mmol/d) t值 P值 肥胖 -2.75 0.006 是 434 174.8±70.2 否 1 841 164.4±71.7 向心性肥胖(WC) -0.82 0.413 是 618 168.4±68.3 否 1 657 165.6±72.7 向心性肥胖(WHtR) -2.53 0.012 是 1 238 169.8±71.1 否 1 037 162.2±71.8
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表 3 尿钠与不同肥胖指标的多元线性回归分析
Table 3. Multiple linear regression analysis of urinary sodium and obesity
β值 sx t值 P值 BMI 1.94 0.41 4.71 < 0.001 WC 15.07 4.38 3.44 < 0.001 WHtR 80.49 26.40 3.05 0.002
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表 4 尿钠与肥胖关系的Logistic回归模型分析
Table 4. Logistic regression analysis of relationship between urinary sodium and obesity
24 h尿钠OR (95% CI)值 P值 Q1 Q2 Q3 Q4 肥胖 模型1 1.00 0.96 (0.70~1.33) 1.52 (1.12~2.04) 1.57 (1.16~2.12) < 0.001 模型2 1.00 1.00 (0.72~1.40) 1.52 (1.11~2.07) 1.61(1.18~2.20) 0.001 向心性肥胖(WC) 模型1 1.00 1.28 (0.93~1.78) 1.58 (1.12~2.22) 1.94 (1.37~2.74) 0.002 模型2 1.00 1.28 (0.91~1.81) 1.40 (0.97~2.01) 2.01 (1.39~2.89) 0.003 向心性肥胖(WHtR) 模型1 1.00 1.38 (1.09~1.75) 1.58 (1.25~2.01) 1.49 (1.17~1.89) < 0.001 模型2 1.00 1.40 (1.09~1.80) 1.54 (1.20~1.98) 1.47 (1.15~1.89) 0.003 注：模型1调整年龄(＜50岁=0，50岁=1)、性别(男=0，女=1)；模型2调整年龄、性别、教育程度(初中及以下=0，高中及以上=1)、吸烟(不吸烟=0，吸烟=1)、饮酒(不饮酒=0，饮酒=1)、身体活动(无体育锻炼=0，有体育锻炼=1)、高血压(非高血压=0，高血压=1)和糖尿病(非糖尿病=0，糖尿病=1)。
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