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Title: Dietary salt intake and mortality in patients with type 2 diabetes.
Austin Authors: Ekinci, Elif I ;Clarke, Sophie;Thomas, Merlin C;Moran, John L;Cheong, Karey;MacIsaac, Richard J;Jerums, George 
Affiliation: Endocrine Centre, Austin Health and the University of Melbourne, Victoria, Australia
Issue Date: 2-Feb-2011
Publication information: Diabetes Care 2011; 34(3): 703-9
Abstract: Many guidelines recommend that patients with type 2 diabetes should aim to reduce their intake of salt. However, the precise relationship between dietary salt intake and mortality in patients with type 2 diabetes has not been previously explored.Six hundred and thirty-eight patients attending a single diabetes clinic were followed in a prospective cohort study. Baseline sodium excretion was estimated from 24-h urinary collections (24hU(Na)). The predictors of all-cause and cardiovascular mortality were determined by Cox regression and competing risk modeling, respectively.The mean baseline 24hU(Na) was 184 ± 73 mmol/24 h, which remained consistent throughout the follow-up (intraindividual coefficient of variation [CV] 23 ± 11%). Over a median of 9.9 years, there were 175 deaths, 75 (43%) of which were secondary to cardiovascular events. All-cause mortality was inversely associated with 24hU(Na), after adjusting for other baseline risk factors (P < 0.001). For every 100 mmol rise in 24hU(Na), all-cause mortality was 28% lower (95% CI 6-45%, P = 0.02). After adjusting for the competing risk of noncardiovascular death and other predictors, 24hU(Na) was also significantly associated with cardiovascular mortality (sub-hazard ratio 0.65 [95% CI 0.44-0.95]; P = 0.03).In patients with type 2 diabetes, lower 24-h urinary sodium excretion was paradoxically associated with increased all-cause and cardiovascular mortality. Interventional studies are necessary to determine if dietary salt has a causative role in determining adverse outcomes in patients with type 2 diabetes and the appropriateness of guidelines advocating salt restriction in this setting.
Gov't Doc #: 21289228
DOI: 10.2337/dc10-1723
Journal: Diabetes Care
Type: Journal Article
Subjects: Aged
Diabetes Mellitus, Type 2.mortality.urine
Middle Aged
Prospective Studies
Sodium Chloride, Dietary
Appears in Collections:Journal articles

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