Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011–2014

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension and cognitive impairment (n=2276). Intervention: Dietary sodium intake (Q4: 3226-3944.5 mg/day) vs. Lowest quintile of dietary sodium intake (Q1: 286-2076 mg/day). Primary outcome: Cognitive impairment assessed by the Digit Symbol Substitution Test (DSST) in participants with hypertension (multivariable-adjusted Model 3) (OR 0.47, 95% CI 0.25-0.86, p=0.02).

Q: What does this research mean for the field?

Dietary sodium intake exhibits a U-shaped relationship with cognitive impairment in older hypertensive patients, where both excessively high and low intake are linked to impaired processing speed and attention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chengkun Kou; Xu Zhao; Xin Fan; Xin Lin; Qiongying Wang; Jing Yu

doi:10.1111/jch.14667

May 15, 2023Journal of Clinical HypertensionOpen Access

Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011–2014

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Key result

Higher dietary sodium linked to ~53% lower odds of cognitive impairment in hypertensive patients.

OR 0.47
95% CI 0.25-0.86
P=0.02
n=2,276

Figures

Why the study?

The relationship between dietary sodium/potassium intake and cognition in elderly individuals with hypertension needed to be assessed.

Is dietary sodium and potassium intake associated with cognitive impairment in older adults with hypertension?

Key Points

To evaluate the relationship between dietary sodium and potassium intake and cognitive performance among older individuals with hypertension.
Cross-sectional analysis of 2276 participants aged ≥60 years (including 1670 with hypertension) from NHANES 2011–2014.
Multivariable logistic regression and restricted cubic spline models assessed linear and non-linear dose-response associations between dietary intake and cognitive test scores (DSST, AFT, and CERAD).
Among hypertensive participants, the lowest multivariable-adjusted risk of cognitive impairment on the DSST occurred in quartile 4 versus quartile 1 of sodium intake (OR = 0.47, 95% CI 0.26–0.84).
Restricted cubic spline analysis confirmed a U-shaped relationship between dietary sodium intake and cognitive impairment risk measured by the DSST (P non-linearity = 0.0067).

Study Design

Type

Cross-Sectional (n=2,276)

Multicenter

Yes

Structured PICO

Is dietary sodium and potassium intake associated with cognitive impairment in older adults with hypertension?

P

Population

2,276 older adults aged ≥60 years in the United States (1,670 with hypertension; mean age 69.79 years, 52.48% female in the hypertensive group) from the cross-sectional NHANES 2011-2014 survey.

E

Exposure

Dietary sodium intake (grouped into quintiles from Q1 [286–2076 mg/day] to Q5 [3944.5–8765 mg/day], specifically Q4 [3226–3944.5 mg/day]) and dietary potassium intake (quintiles from Q1 [108.5–1762 mg/day] to Q5 [3280–22666 mg/day]) assessed via 24-hour dietary recall interviews

C

Comparator

Lowest quintile (Q1) of dietary sodium intake (286–2076 mg/day) or dietary potassium intake (108.5–1762 mg/day)

O

Outcome

Cognitive impairment defined as scoring below the age-stratified 25th percentile on the Digit Symbol Substitution Test (DSST, assessing processing speed, sustained attention, and working memory), Animal Fluency Test (AFT, assessing executive function), and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning and recall testsurrogate

Main Result

Odds Ratio: 0.47 (95% CI 0.25–0.86)

Absolute Event Rate: 20.38% vs 36.2%

p-value: p=0.02

In older US adults with hypertension, dietary sodium intake shows a U-shaped association with cognitive impairment in processing speed, attention, and working memory (DSST), suggesting both excessively high and extremely low sodium intake are associated with worse cognitive performance, whereas dietary potassium intake shows no association.

Limitations

Cross-sectional study design prevents determination of a causal relationship between dietary sodium intake and cognitive performance.
Only the DSST score was associated with dietary sodium intake after full adjustment, limiting the ability to examine overall cognition.
24-h dietary recall may not capture long-term dietary exposures, is subject to recall bias, and is an indirect method compared with 24-h urine sodium excretion.
Cross-sectional study design makes it difficult to determine a causal relationship between dietary sodium intake and cognitive performance
Only the DSST score was associated with dietary sodium intake, limiting the ability to examine the broader association between sodium intake and cognition
24-h dietary recall may not capture long-term dietary exposures, may result in recall bias, and is an indirect method compared with 24-h urine sodium excretion

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Implication

Caution against very low sodium for cognition in older hypertensives; leaves open causal effects and optimal ranges in prospective studies.

Abstract

This study aimed to assess the relationship between dietary sodium/potassium intake and cognition in elderly individuals with hypertension. We designed a cross‐sectional study based on the 2011–2014 National Health and Nutrition Examination Survey (NHANES) 2011–2014. A multivariable‐logistic regression analysis was performed to analyze the relationship between sodium/potassium intake and cognitive impairment. Restricted cubic spline (RCS) based on regression analysis to assess the nonlinear dose‐response relationship between dietary sodium intake and cognitive performance. Out of the 2276 participants included in this study, 1670 patients had hypertension. Compared with the lowest quartile of dietary sodium intake, the lowest weighted odds ratio of cognitive impairment in DSST was observed in Q4 (OR = 0.45, 0.29–0.70), and a similar trend was observed in AFT (OR = 0.34, 0.18–0.65). After adjusting the covariates, the lowest weighted multivariable‐adjusted OR of cognitive impairment in DSST were also observed in Q4 (OR = 0.47, 0.26‐0.84) compared with the lowest quartile of dietary sodium intake. The RCS results showed that dietary sodium intake was U‐shaped and associated with the risk of cognitive impairment in the DSST ( P non–linearity = 0.0067). In addition, no significant association was observed between dietary potassium intake and different dimensions of cognitive performance. In conclusion, excessively high and low low dietary sodium were associated with impairment of specific processing speed, sustained attention, and working memory for elderly patients with hypertension in the United States. However, no association was observed between dietary potassium intake and cognition.

Discussion

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Cite This Study

Kou et al. (2023) conducted a cross-sectional in Hypertension and cognitive impairment (n=2,276). Dietary sodium intake (Q4: 3226-3944.5 mg/day) vs. Lowest quintile of dietary sodium intake (Q1: 286-2076 mg/day) was evaluated on Cognitive impairment assessed by the Digit Symbol Substitution Test (DSST) in participants with hypertension (multivariable-adjusted Model 3) (OR 0.47, 95% CI 0.25-0.86, p=0.02). Dietary sodium intake in Q4 (3226-3944.5 mg/d) was associated with lower odds of DSST cognitive impairment vs Q1 (adjusted OR 0.47, 95% CI 0.25-0.86, p=0.02) in older hypertensive patients.

synapsesocial.com/papers/6a70733b660549caf2c5087b https://doi.org/10.1111/jch.14667

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Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011–2014

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011–2014

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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