The sodium potassium ratio is the amount of sodium divided by the amount of potassium, and its measurement in urine is an excellent measure of dietary intake, dietary quality, and chronic disease risk.
In this post, full of scientific references, we’ll explain what a low and high sodium potassium ratio means, what foods have the best sodium potassium ratio, and how to measure your sodium and potassium ratio on a regular basis.
Sodium and Potassium Ratio and Your Dietary Quality
Maintaining high dietary quality, including high amounts of fruits and vegetables and avoiding excessive salt, is the single most important factor for preventing chronic diseases and maintaining good health [1].
To put it into perspective, poor dietary behaviors are responsible for more deaths than any other behavior, including such serious offenders as smoking, air pollution, and drug abuse [2].
So what constitutes a “healthy diet?”
With few exceptions, a healthier diet should be lower in sodium and higher in potassium.
In fact, lowering dietary sodium intake and increasing potassium intake (resulting in a lower sodium potassium ratio) is an integral strategy of national and international public health goals [3–6].
Thus, a diet with high quality produces a low sodium potassium ratio (generally less than the number 1), while a diet with worse quality results in a high sodium potassium ratio (generally greater than the number 1) [9–12].
The urine sodium potassium ratio is even significantly associated with the U.S. News’ top two healthy diets – the DASH Diet [13–19] and the Mediterranean Diet [20].
Why does this ratio trend so well to overall dietary quality?
First, sodium.
Over 70% of our sodium intake is derived from packaged, preprepared, or restaurant foods [21].
Most health experts agree that eating fewer preprocessed snacks and packaged foods, and more whole foods, is better for overall health and dietary quality [3].
This, in part, explains why the urinary sodium potassium ratio correlates significantly to consumption of processed and ultra-processed foods [22,23].
Second, potassium.
Urinary potassium is a marker that significantly correlates with dietary intake of fruits and vegetables [14,24,25], and it correlates significantly with overall dietary quality itself [26,27].
In fact, urinary potassium is correlated to the Healthy Eating Index (HEI), an index developed by the Center for Nutrition Policy and Promotion based on the USDA’s Dietary Guidelines for Americans [28].
An Ideal Sodium Potassium Ratio for Good Health
The best sodium potassium ratio for good health as suggested by major health institutions tend to fall at or below the number 1. In some cases, your ideal sodium potassium ratio may be even lower, in the 0.6 to 0.8 range.
Obesity & Weight Loss
Urinary sodium, potassium, and the sodium potassium ratio trend with obesity and total body fat percentage [29–33].
Not only do they trend together, but the concentrations of these biomarkers are predictors of weight loss [34].
And when it comes to those who lose weight and maintain their weight loss, successful individuals consistently had higher healthier dietary quality and better HEI (correlated to the sodium potassium ratio), and higher potassium intake [35].
Hypertension (High Blood Pressure), Stroke, and Cardiovascular Disease (CVD)
Decreasing dietary sodium intake and increasing dietary potassium intake is proven to help lower blood pressure [36–39].
Not only has urine sodium, potassium, and the urinary sodium potassium ratio been shown to significantly correlate to blood pressure [40–44], but the sodium potassium ratio has been shown to be a superior metric compared to either sodium or potassium, alone [45–47].
The sodium potassium ratio is also a strong predictor of stroke [48] while also being significantly associated with the risk of CVD and all-cause mortality (again, stronger than either sodium or potassium, alone) [49,50].
It may not come as a surprise now that reducing sodium intake and increasing dietary potassium intake is a proven method for reducing the need for anti-hypertensive medications [51–53].
Chronic Kidney Disease (CKD)
CKD, it should be noted, is often an exception to the rule of desiring higher dietary potassium intake. Dysregulation of kidney function can change the way your body handles these minerals.
Nevertheless, sodium reduction is still recommended and the sodium potassium ratio has been shown to be significantly correlated to CKD [54–56]. Furthermore, among those with CKD, these markers trend with increased risk of CVD [57].
Diabetes
We know poor dietary behaviors and obesity are risk factors for developing diabetes.
But again, urinary sodium and potassium have been found to significantly correlate to impaired insulin response [58–61], metabolic syndrome [62], and type II diabetes [63–69].
Mental Health
As more research accumulates on the link between diet and mental health, dietary quality is increasingly linked to depression, dementia, and Alzheimer’s Disease.
The DASH Diet, the Mediterranean Diet, and the MIND Diet were all associated with lower cognitive decline and lower risk of developing Alzheimer’s Disease [70]. Furthermore, these healthy diets are increasingly linked to risk of depression [71–74].
And as the urinary sodium potassium ratio is a marker for adherence to the DASH and Mediterranean Diets, it may not come as a surprise that it has been shown that this ratio is associated with risk of cognitive decline [75] as well as depression [76].
As mental health is only just starting to get the attention it deserves, expect to see more research emerge on this topic in the future.
Liver Cirrhosis & Ascites
The mainstay treatments of patients with cirrhosis and ascites are a low sodium diet (2000 mg/day) and diuretics, yet objectively managing a low-sodium diet is difficult without urine measurements.
In addition to 24-hour urine sodium measurements, researchers have repeatedly shown that spot urine sodium potassium ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites [77–79].
In fact, several national and private guidelines have included the use of spot urine sodium potassium ratio testing to monitor adherence for patients with liver cirrhosis and ascites [80–82].
Finding Foods with the Best Sodium Potassium Ratio
So the sodium potassium ratio is great.
But what foods help maintain a good ratio?
At a high level, it’s fairly straight forward.
Lower your sodium potassium ratio to improve it. That means, you must lower your sodium intake and/or increase your potassium intake.
To lower your sodium intake, the most straightforward advice is to lower your intake of processed and pre-packaged foods, along with fast foods and excessive restaurant meals.
To increase your potassium intake, you can generally observe the advice to eat more fruits and vegetables.
But what about the specifics? How does these foods compare?
We decided to look into this, ourselves.
After analyzing about 600 foods from the USDA Food Database, we ranked each food by its potassium density (potassium/calorie), sodium density, sodium potassium ratio, and color-coded by food group.
As you can see, fruits and vegetables overwhelmingly top the list.
In fact, it’s interesting to see w
here the sodium potassium ratio of 1 falls on this chart.
The separation of what generally constitutes as good sodium potassium ratio (less than 1) and a poor sodium potassium ratio (greater than 1) lies almost perfectly at the intersection of fruits and vegetables (shown in blue, green, and purple) and fast foods (shown in red).
How to Measure My Sodium Potassium Ratio
You can always track your dietary sodium intake and potassium intake on paper by looking up your food’s nutrient content and tracking it manually or on an app.
You could also mail away a urine sample to a lab.
But the easiest way to track your dietary sodium potassium ratio is to use Intake’s automated urine testing platform because the urinary sodium potassium ratio is a reflective of dietary intake of sodium and potassium [7,8].
We’ll automatically collect and test for your sodium potassium ratio on a regular basis without you needing to do anything! Our research, funded by the National Science Foundation and the National Institutes of Health, is designed to make it easy for you to test and track your dietary quality without the hassle of food journals or cumbersome testing procedures.
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References
[1] G. 2017 D. Collaborators, Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, Lancet. 393 (2019) 1958–1972.
[2] C.J.L. Murray, The State of US Health, 1990-2010 Burden of Diseases, Injuries, and Risk Factors, JAMA. 310 (2013) 591–606.
[3] USDA, Dietary Guidelines for Americans, 2015.
[4] A. Drewnowski, M. Maillot, C. Rehm, Reducing the sodium-potassium ratio in the US diet: a challenge for public health, The American Journal of Clinical Nutrition. 96 (2012) 439–444. https://doi.org/10.3945/ajcn.111.025353.
[5] W.H. Organization, Guideline: Sodium intake for adults and children, World Health Organization, 2012.
[6] W.H. Organization, Guideline: Potassium intake for adults and children, World Healh Organization, 2012.
[7] S.S. Yi, C.J. Curtis, S.Y. Angell, C.A.M. Anderson, M. Jung, S.M. Kansagra, Highlighting the ratio of sodium to potassium in population-level dietary assessments: cross-sectional data from New York City, USA, Public Health Nutrition. 17 (2014) 2484–2488. https://doi.org/DOI: 10.1017/S1368980014001293.
[8] T. Iwahori, K. Miura, H. Ueshima, Q. Chan, A.R. Dyer, P. Elliott, J. Stamler, for the I.R. Group, Estimating 24-h urinary sodium/potassium ratio from casual (‘spot’) urinary sodium/potassium ratio: the INTERSALT Study, International Journal of Epidemiology. 46 (2016) 1564–1572. https://doi.org/10.1093/ije/dyw287.
[9] A.A. McDonough, L.C. Veiras, C.A. Guevara, D.L. Ralph, Cardiovascular benefits associated with higher dietary K(+) vs. lower dietary Na(+): evidence from population and mechanistic studies, American Journal of Physiology. Endocrinology and Metabolism. 312 (2017) E348–E356. https://doi.org/10.1152/ajpendo.00453.2016.
[10] O.K. Kristbjornsdottir, T.I. Halldorsson, I. Thorsdottir, I. Gunnarsdottir, Association between 24-hour urine sodium and potassium excretion and diet quality in six-year-old children: a cross sectional study, Nutrition Journal. 11 (2012) 94. https://doi.org/10.1186/1475-2891-11-94.
[11] Q. Chan, R.L. Loo, T.M.D. Ebbels, L. van Horn, M.L. Daviglus, J. Stamler, J.K. Nicholson, E. Holmes, P. Elliott, Metabolic phenotyping for discovery of urinary biomarkers of diet, xenobiotics and blood pressure in the INTERMAP Study: an overview, Hypertension Research : Official Journal of the Japanese Society of Hypertension. 40 (2017) 336–345. https://doi.org/10.1038/hr.2016.164.
[12] R.N. Ndanuko, L.C. Tapsell, K.E. Charlton, E.P. Neale, M.J. Batterham, Associations between Dietary Patterns and Blood Pressure in a Clinical Sample of Overweight Adults, Journal of the Academy of Nutrition and Dietetics. 117 (2017) 228–239. https://doi.org/10.1016/j.jand.2016.07.019.
[13] C.E. Grim, Potassium and Blood Pressure: How to Test the Effects of DASH Diet in your Patient with Hypertension?, Hypertens J. 3 (2017) 37–41.
[14] P.H. Lin, J.D. Allen, Y.J. Li, M. Yu, L.F. Lien, L.P. Svetkey, Blood pressure-lowering mechanisms of the DASH dietary pattern, Journal of Nutrition and Metabolism. 2012 (2012) 10. https://doi.org/10.1155/2012/472396.
[15] L.J. Appel, T.J. Moore, E. Obarzanek, W.M. Vollmer, L.P. Svetkey, F.M. Sacks, G.A. Bray, T.M. Vogt, J.A. Cutler, M.M. Windhauser, P.-H. Lin, N. Karanja, D. Simons-Morton, M. McCullough, J. Swain, P. Steele, M.A. Evans, E.R. Miller, D.W. Harsha, A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure, New England Journal of Medicine. 336 (1997) 1117–1124. https://doi.org/10.1056/NEJM199704173361601.
[16] C.A. Nowson, N. Wattanapenpaiboon, A. Pachett, Low-sodium Dietary Approaches to Stop Hypertension–type diet including lean red meat lowers blood pressure in postmenopausal women, Nutrition Research. 29 (2009) 8–18. https://doi.org/https://doi.org/10.1016/j.nutres.2008.12.002.
[17] C.A. Nowson, A. Worsley, C. Margerison, M.K. Jorna, A.G. Frame, S.J. Torres, S.J. Godfrey, Blood Pressure Response to Dietary Modifications in Free-Living Individuals, The Journal of Nutrition. 134 (2004) 2322–2329. https://doi.org/10.1093/jn/134.9.2322.
[18] E. Obarzanek, W.M. Vollmer, P.-H. Lin, L.S. Cooper, D.R. Young, J.D. Ard, V.J. Stevens, D.G. Simons-Morton, L.P. Svetkey, D.W. Harsha, P.J. Elmer, L.J. Appel, Effects of Individual Components of Multiple Behavior Changes: The PREMIER Trial, American Journal of Health Behavior. 31 (2007) 545–560.
[19] M.M. WINDHAUSER, M.A. EVANS, M.L. McCULLOUGH, J.F. SWAIN, P.-H. LIN, K.P. HOBEN, C.S. PLAISTED, N.M. KARANJA, W.M. VOLLMER, Dietary Adherence in the Dietary Approaches to Stop Hypertension Trial, Journal of the Academy of Nutrition and Dietetics. 99 (1999) S76–S83. https://doi.org/10.1016/S0002-8223(99)00420-4.
[20] Z.B. Parvin Mirmiran, Zahra Gaeini, Urinary sodium to potassium ratio: A simple and useful indicator of diet quality in population-based studies, Research Square. PREPRINT (2020). https://doi.org/10.21203/rs.2.12332/v1.
[21] L.J. Harnack, M.E. Cogswell, J.M. Shikany, C.D. Gardner, C. Gillespie, C.M. Loria, X. Zhou, K. Yuan, L.M. Steffen, Sources of Sodium in US Adults From 3 Geographic Regions, Circulation. 135 (2017) 1775–1783. https://doi.org/10.1161/CIRCULATIONAHA.116.024446.
[22] L.S. Oliveira, J.S. Coelho, J.H. Siqueira, N.M.T. Santana, T.S.S. Pereira, M.D.C.B. Molina, Sodium/potassium urinary ratio and consumption of processed condiments and ultraprocessed foods, Nutr Hosp. 36 (2019) 125–132.
[23] A. Queiroz, A. Damasceno, N. Jessen, C. Novela, P. Moreira, N. Lunet, P. Padrão, Urinary Sodium and Potassium Excretion and Dietary Sources of Sodium in Maputo, Mozambique, Nutrients . 9 (2017). https://doi.org/10.3390/nu9080830.
[24] F.M. Sacks, L.P. Svetkey, W.M. Vollmer, L.J. Appel, G.A. Bray, D. Harsha, E. Obarzanek, P.R. Conlin, E.R. Miller, D.G. Simons-Morton, N. Karanja, P.-H. Lin, M. Aickin, M.M. Most-Windhauser, T.J. Moore, M.A. Proschan, J.A. Cutler, Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet, New England Journal of Medicine. 344 (2001) 3–10. https://doi.org/10.1056/NEJM200101043440101.
[25] R. Peniamina, S. Skeaff, J.J. Haszard, R. McLean, Comparison of 24-h Diet Records, 24-h Urine, and Duplicate Diets for Estimating Dietary Intakes of Potassium, Sodium, and Iodine in Children, Nutrients. 11 (2019) 2927. https://doi.org/10.3390/nu11122927.
[26] A. Mente, E.J. Irvine, R.J. Honey, A.G. Logan, Urinary potassium is a clinically useful test to detect a poor quality diet., Journal of Nutrition. 139 (2009) 743–9.
[27] C. Margerison, L.J. Riddell, S.A. McNaughton, C.A. Nowson, Associations between dietary patterns and blood pressure in a sample of Australian adults, Nutrition Journal. 19 (2020) 5. https://doi.org/10.1186/s12937-019-0519-2.
[28] E. Rodríguez-Rodríguez, R.M. Ortega, P. Andrés Carvajales, L.G. González-Rodríguez, Relationship between 24 h urinary potassium and diet quality in the adult Spanish population, Public Health Nutrition. 18 (2015) 850–859. https://doi.org/DOI:10.1017/S1368980014001402.
[29] N. Jain, A.T. Minhajuddin, I.J. Neeland, E.F. Elsayed, G.L. Vega, S.S. Hedayati, Association of urinary sodium-to-potassium ratio with obesity in a multiethnic cohort, The American Journal of Clinical Nutrition. 99 (2014) 992–998. https://doi.org/10.3945/ajcn.113.077362.
[30] N. Rafie, S.G. Hamedani, N. Mohammadifard, A. Feizi, S.M. Safavi, 24-h urinary sodium to potassium ratio and its association with obesity in children and adolescents, European Journal of Nutrition. 58 (2019) 947–953. https://doi.org/10.1007/s00394-018-1645-x.
[31] Z. Ge, J. Zhang, X. Chen, L. Yan, X. Guo, Z. Lu, A. Xu, J. Ma, Are 24 h urinary sodium excretion and sodium:potassium independently associated with obesity in Chinese adults?, Public Health Nutrition. 19 (2016) 1074–1080. https://doi.org/DOI:10.1017/S136898001500230X.
[32] S.-K. Lee, M.K. Kim, Relationship of sodium intake with obesity among Korean children and adolescents: Korea National Health and Nutrition Examination Survey, British Journal of Nutrition. 115 (2016) 834–841. https://doi.org/DOI:10.1017/S0007114515005152.
[33] C.A. Grimes, L.J. Riddell, K.J. Campbell, F.J. He, C.A. Nowson, 24-h urinary sodium excretion is associated with obesity in a cross-sectional sample of Australian schoolchildren, British Journal of Nutrition. 115 (2016) 1071–1079. https://doi.org/DOI: 10.1017/S0007114515005243.
[34] B. Tal, J. Sack, M. Yaron, G. Shefer, A. Buch, L. ben Haim, Y. Marcus, G. Shenkerman, Y. Sofer, L. Shefer, M. Margaliot, N. Stern, Increment in Dietary Potassium Predicts Weight Loss in the Treatment of the Metabolic Syndrome, Nutrients. 11 (2019) 1256. https://doi.org/10.3390/nu11061256.
[35] R.W. Pascual, S. Phelan, M.R. la Frano, K.D. Pilolla, Z. Griffiths, G.D. Foster, Diet Quality and Micronutrient Intake among Long-Term Weight Loss Maintainers, Nutrients. 11 (2019) 3046. https://doi.org/10.3390/nu11123046.
[36] G.H. C., R.S. G., V. Viola, A.M. K., Effects of Different Dietary Interventions on Blood Pressure, Hypertension. 67 (2016) 733–739. https://doi.org/10.1161/HYPERTENSIONAHA.115.06853.
[37] F.J. He, J. Li, G.A. MacGregor, Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials, BMJ. 346 (2013) f1325. https://doi.org/10.1136/bmj.f1325.
[38] N.J. Aburto, A. Ziolkovska, L. Hooper, P. Elliott, F.P. Cappuccio, J.J. Meerpohl, Effect of lower sodium intake on health: systematic review and meta-analyses, British Medical Journal. 346 (2013). http://www.bmj.com/content/346/bmj.f1326.abstract.
[39] N.J. Aburto, S. Hanson, H. Gutierrez, L. Hooper, P. Elliott, F.P. Cappuccio, Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses, BMJ : British Medical Journal. 346 (2013) f1378. https://doi.org/10.1136/bmj.f1378.
[40] S.S. Hedayati, A.T. Minhajuddin, A. Ijaz, O.W. Moe, E.F. Elsayed, R.F. Reilly, C.-L. Huang, Association of urinary sodium/potassium ratio with blood pressure: sex and racial differences, Clinical Journal of the American Society of Nephrology : CJASN. 7 (2012) 315–322. https://doi.org/10.2215/CJN.02060311.
[41] S.L. Jackson, M.E. Cogswell, L. Zhao, A.L. Terry, C.-Y. Wang, J. Wright, S.M. Coleman King, B. Bowman, T.-C. Chen, R. Merritt, C.M. Loria, Association Between Urinary Sodium and Potassium Excretion and Blood Pressure Among Adults in the United States: National Health and Nutrition Examination Survey, 2014, Circulation. 137 (2018) 237–246. https://doi.org/10.1161/CIRCULATIONAHA.117.029193.
[42] S.-G. Lee, W. Lee, O.H. Kwon, J.-H. Kim, Association of urinary sodium/creatinine ratio and urinary sodium/specific gravity unit ratio with blood pressure and hypertension: KNHANES 2009–2010, Clinica Chimica Acta. 424 (2013) 168–173. https://doi.org/https://doi.org/10.1016/j.cca.2013.05.027.
[43] A. Mente, M.J. O’Donnell, S. Rangarajan, M.J. McQueen, P. Poirier, A. Wielgosz, H. Morrison, W. Li, X. Wang, C. Di, P. Mony, A. Devanath, A. Rosengren, A. Oguz, K. Zatonska, A.H. Yusufali, P. Lopez-Jaramillo, A. Avezum, N. Ismail, F. Lanas, T. Puoane, R. Diaz, R. Kelishadi, R. Iqbal, R. Yusuf, J. Chifamba, R. Khatib, K. Teo, S. Yusuf, Association of Urinary Sodium and Potassium Excretion with Blood Pressure, New England Journal of Medicine. 371 (2014) 601–611. https://doi.org/10.1056/NEJMoa1311989.
[44] Y. Tabara, Y. Takahashi, K. Kumagai, K. Setoh, T. Kawaguchi, M. Takahashi, Y. Muraoka, A. Tsujikawa, N. Gotoh, C. Terao, R. Yamada, S. Kosugi, A. Sekine, N. Yoshimura, T. Nakayama, F. Matsuda, N. study Group., Descriptive epidemiology of spot urine sodium-to-potassium ratio clarified close relationship with blood pressure level: the Nagahama study., J Hypertens. 33 (2015) 2407–13.
[45] V. Perez, E.T. Chang, Sodium-to-potassium ratio and blood pressure, hypertension, and related factors, Advances in Nutrition (Bethesda, Md.). 5 (2014) 712–741. https://doi.org/10.3945/an.114.006783.
[46] I. Tzoulaki, C.J. Patel, T. Okamura, Q. Chan, I.J. Brown, K. Miura, H. Ueshima, L. Zhao, L. van Horn, M.L. Daviglus, J. Stamler, A.J. Butte, J.P.A. Ioannidis, P. Elliott, A nutrient-wide association study on blood pressure, Circulation. 126 (2012) 2456–2464. https://doi.org/10.1161/CIRCULATIONAHA.112.114058.
[47] J. Stamler, G. Rose, R. Stamler, P. Elliott, A. Dyer, M. Marmot, INTERSALT study findings. Public health and medical care implications., Hypertension. 14 (1989) 570–577. https://doi.org/10.1161/01.HYP.14.5.570.
[48] A.M. M., Y.R. L., W.A. C., K.E. O., K. Holly, S. Lyn, M.R. L., D.J. A., D. Adam, Spot Urine Sodium-to-Potassium Ratio Is a Predictor of Stroke, Stroke. 50 (2019) 321–327. https://doi.org/10.1161/STROKEAHA.118.023099.
[49] N.R. Cook, E. Obarzanek, J.A. Cutler, J.E. Buring, K.M. Rexrode, S.K. Kumanyika, L.J. Appel, P.K. Whelton, T. of H.P.C.R. Group, Joint effects of sodium and potassium intake on subsequent cardiovascular disease: the Trials of Hypertension Prevention follow-up study, Archives of Internal Medicine. 169 (2009) 32–40. https://doi.org/10.1001/archinternmed.2008.523.
[50] M.E. Cogswell, Z. Zhang, A.L. Carriquiry, J.P. Gunn, E. v Kuklina, S.H. Saydah, Q. Yang, A.J. Moshfegh, Sodium and potassium intakes among US adults: NHANES 2003-2008, The American Journal of Clinical Nutrition. 96 (2012) 647–657. https://doi.org/10.3945/ajcn.112.034413.
[51] A. Siani, P. Strazzullo, A. Giacco, D. Pacioni, E. Celentano, M. Mancini, Increasing the Dietary Potassium Intake Reduces the Need for Antihypertensive Medication, Annals of Internal Medicine. 115 (1991) 753–759. https://doi.org/10.7326/0003-4819-115-10-753.
[52] A. ONO, M. SHIBAOKA, J. YANO, Y. ASAI, T. FUJITA, Eating Habits and Intensity of Medication in Elderly Hypertensive Outpatients, Hypertension Research. 23 (2000) 195–200. https://doi.org/10.1291/hypres.23.195.
[53] N. Musso, B. Carloni, M.C. Chiusano, M. Giusti, Simple dietary advice reduces 24-hour urinary sodium excretion, blood pressure, and drug consumption in hypertensive patients, Journal of the American Society of Hypertension. 12 (2018) 652–659. https://doi.org/https://doi.org/10.1016/j.jash.2018.06.012.
[54] J. He, K.T. Mills, L.J. Appel, W. Yang, J. Chen, B.T. Lee, S.E. Rosas, A. Porter, G. Makos, M.R. Weir, L.L. Hamm, J.W. Kusek, Urinary Sodium and Potassium Excretion and CKD Progression, Journal of the American Society of Nephrology. 27 (2016) 1202 LP – 1212. https://doi.org/10.1681/ASN.2015010022.
[55] P. Mirmiran, P. Nazeri, Z. Bahadoran, S. Khalili-Moghadam, F. Azizi, Dietary Sodium to Potassium Ratio and the Incidence of Chronic Kidney Disease in Adults: A Longitudinal Follow-Up Study, Preventive Nutrition and Food Science. 23 (2018) 87–93. https://doi.org/10.3746/pnf.2018.23.2.87.
[56] H. Koo, S. Hwang, T.H. Kim, S.W. Kang, K.-H. Oh, C. Ahn, Y.H. Kim, The ratio of urinary sodium and potassium and chronic kidney disease progression: Results from the KoreaN Cohort Study for Outcomes in Patients with Chronic Kidney Disease (KNOW-CKD), Medicine. 97 (2018). https://journals.lww.com/md-journal/Fulltext/2018/11020/The_ratio_of_urinary_sodium_and_potassium_and.13.aspx.
[57] K.T. Mills, J. Chen, W. Yang, L.J. Appel, J.W. Kusek, A. Alper, P. Delafontaine, M.G. Keane, E. Mohler, A. Ojo, M. Rahman, A.C. Ricardo, E.Z. Soliman, S. Steigerwalt, R. Townsend, J. He, for the C.R.I.C. (CRIC) S. Investigators, Sodium Excretion and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease, JAMA. 315 (2016) 2200–2210. https://doi.org/10.1001/jama.2016.4447.
[58] Y.M. Park, C.K. Kwock, S. Park, H.A. Eicher-Miller, Y.J. Yang, An association of urinary sodium-potassium ratio with insulin resistance among Korean adults, Nutrition Research and Practice. 12 (2018) 443–448. https://doi.org/10.4162/nrp.2018.12.5.443.
[59] Association of sodium intake with insulin resistance in Korean children and adolescents: the Korea National Health and Nutrition Examination Survey 2010 , Journal of Pediatric Endocrinology and Metabolism . 31 (2018) 117. https://doi.org/10.1515/jpem-2017-0362.
[60] Y.H. Chun, K. Han, D.H. Kim, Y.G. Park, K.H. Cho, Y.S. Choi, S.M. Kim, Y.H. Kim, G.E. Nam, Association of Urinary Sodium Excretion With Insulin Resistance in Korean Adolescents: Results From the Korea National Health and Nutrition Examination Survey 2009-2010, Medicine. 95 (2016) e3447–e3447. https://doi.org/10.1097/MD.0000000000003447.
[61] J.W. Rowe, J.D. Tobin, R.M. Rosa, R. Andres, Effect of experimental potassium deficiency on glucose and insulin metabolism, Metabolism - Clinical and Experimental. 29 (1980) 498–502. https://doi.org/10.1016/0026-0495(80)90074-8.
[62] C.H. So, H.R. Jeong, Y.S. Shim, Association of the urinary sodium to urinary specific gravity ratio with metabolic syndrome in Korean children and adolescents: The Korea National Health and Nutrition Examination Survey 2010-2013, PloS One. 12 (2017) e0189934–e0189934. https://doi.org/10.1371/journal.pone.0189934.
[63] Z. Daniela, B. Helene, B. Stephen, A.T. L., B. Vivek, I. Erik, Urinary Albumin, Sodium, and Potassium and Cardiovascular Outcomes in the UK Biobank, Hypertension. 75 (2020) 714–722. https://doi.org/10.1161/HYPERTENSIONAHA.119.14028.
[64] R. Chatterjee, H.-C. Yeh, T. Shafi, E. Selvin, C. Anderson, J.S. Pankow, E. Miller, F. Brancati, Serum and Dietary Potassium and Risk of Incident Type 2 Diabetes Mellitus: The Atherosclerosis Risk in Communities (ARIC) Study, Archives of Internal Medicine. 170 (2010) 1745–1751. https://doi.org/10.1001/archinternmed.2010.362.
[65] G.A. Colditz, J.E. Manson, M.J. Stampfer, B. Rosner, W.C. Willett, F.E. Speizer, Diet and risk of clinical diabetes in women, The American Journal of Clinical Nutrition. 55 (1992) 1018–1023. https://doi.org/10.1093/ajcn/55.5.1018.
[66] R. Chatterjee, L.A. Colangelo, H.C. Yeh, C.A. Anderson, M.L. Daviglus, K. Liu, F.L. Brancati, Potassium intake and risk of incident type 2 diabetes mellitus: the Coronary Artery Risk Development in Young Adults (CARDIA) Study, Diabetologia. 55 (2012) 1295–1303. https://doi.org/10.1007/s00125-012-2487-3.
[67] S.M. Stone, L. Martyn, M.C. Weaver, Potassium Intake, Bioavailability, Hypertension, and Glucose Control, Nutrients . 8 (2016). https://doi.org/10.3390/nu8070444.
[68] P.N. Brandão-Lima, G.B. de Carvalho, R.K.F. Santos, B. da C. Santos, N.L. Dias-Vasconcelos, V. de S. Rocha, K.B.F. Barbosa, L.V. Pires, Intakes of Zinc, Potassium, Calcium, and Magnesium of Individuals with Type 2 Diabetes Mellitus and the Relationship with Glycemic Control, Nutrients. 10 (2018) 1948. https://doi.org/10.3390/nu10121948.
[69] G. Hu, P. Jousilahti, M. Peltonen, J. Lindström, J. Tuomilehto, Urinary sodium and potassium excretion and the risk of type 2 diabetes: a prospective study in Finland, Diabetologia. 48 (2005) 1477–1483. https://doi.org/10.1007/s00125-005-1824-1.
[70] A.C. van den Brink, E.M. Brouwer-Brolsma, A.A.M. Berendsen, O. van de Rest, The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer’s Disease—A Review, Advances in Nutrition. 10 (2019) 1040–1065. https://doi.org/10.1093/advances/nmz054.
[71] L. Cherian, Y. Wang, T. Holland, P. Agarwal, N. Aggarwal, M.C. Morris, Dietary Approaches to Stop Hypertension (DASH) Diet Associated with Lower Rates of Depression, in: Dietary Approaches to Stop Hypertension (DASH) Diet Associated with Lower Rates of Depression, AAN 70th Annual Meeting, 2018.
[72] F.N. Jacka, A. O’Neil, R. Opie, C. Itsiopoulos, S. Cotton, M. Mohebbi, D. Castle, S. Dash, C. Mihalopoulos, M. lou Chatterton, L. Brazionis, O.M. Dean, A.M. Hodge, M. Berk, A randomised controlled trial of dietary improvement for adults with major depression (the “SMILES” trial), BMC Medicine. 15 (2017) 23. https://doi.org/10.1186/s12916-017-0791-y.
[73] N. Parletta, D. Zarnowiecki, J. Cho, A. Wilson, S. Bogomolova, A. Villani, C. Itsiopoulos, T. Niyonsenga, S. Blunden, B. Meyer, L. Segal, B.T. Baune, K. O’Dea, A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED), Nutritional Neuroscience. 22 (2019) 474–487. https://doi.org/10.1080/1028415X.2017.1411320.
[74] C. Lassale, G.D. Batty, A. Baghdadli, F. Jacka, A. Sánchez-Villegas, M. Kivimäki, T. Akbaraly, Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies, Molecular Psychiatry. 24 (2019) 965–986. https://doi.org/10.1038/s41380-018-0237-8.
[75] K.L. Nowak, L. Fried, A. Jovanovich, J. Ix, K. Yaffe, Z. You, M. Chonchol, Dietary Sodium/Potassium Intake Does Not Affect Cognitive Function or Brain Imaging Indices, American Journal of Nephrology. 47 (2018) 57–65. https://doi.org/10.1159/000486580.
[76] S. Mrug, C. Orihuela, M. Mrug, P.W. Sanders, Sodium and potassium excretion predict increased depression in urban adolescents, Physiological Reports. 7 (2019) e14213–e14213. https://doi.org/10.14814/phy2.14213.
[77] M.A. El-Bokl, B.E. Senousy, K.Z. El-Karmouty, I.E.K. Mohammed, S.M. Mohammed, S.S. Shabana, H. Shalaby, Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites, World Journal of Gastroenterology. 15 (2009) 3631–3635. https://doi.org/10.3748/wjg.15.3631.
[78] O.M. da Silva, G. Bicca Thiele, L. Fayad, C. Lazzarotto, E. Buzaglo Dantas-Corrêa, L. de Lucca Schiavon, J. Luz Narciso-Schiavon, Comparative study of spot urine Na/K ratio and 24-hour urine sodium in natriuresis evaluation of cirrhotic patients with ascites, GE Jornal Português de Gastrenterologia. 21 (2014) 15–20. https://doi.org/10.1016/j.jpg.2013.04.006.
[79] J.E. Park, C.H. Lee, B.S. Kim, I.H. Shin, Diagnostic usefulness of the random urine Na/K ratio in cirrhotic patients with ascites: a pilot study, Korean J Hepatol. 16 (2010) 66–74.
[80] K.A. for the S. of the L. (KASL), KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications, Clinical and Molecular Hepatology. 24 (2018) 230–277. https://doi.org/10.3350/cmh.2018.1005.
[81] K.B. Cesario, A. Choure, W.D. Carey, Cirrhotic Ascites, 2017. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/complications-of-cirrhosis-ascites/.
[82] B.A. Runyon, Introduction to the Revised American Association for the Study of Liver Diseases Practice Guideline Management of Adult Patients With Ascites Due to Cirrhosis 2012, 2013. https://www.aasld.org/sites/default/files/2019-06/AASLDPracticeGuidelineAsciteDuetoCirrhosisUpdate2012Edition4_.pdf.