Measurement error corrected sodium and potassium intake estimation using 24-hour urinary excretion

Ying Huang, Linda Van Horn, Lesley F. Tinker, Marian L. Neuhouser, Laura Carbone, Yasmin Mossavar-Rahmani, Fridtjof Thomas, Ross L. Prentice

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


: Epidemiological studies of the association of sodium and potassium intake with cardiovascular disease risk have almost exclusively relied on self-reported dietary data. Here, 24-hour urinary excretion assessments are used to correct the dietary self-report data for measurement error under the assumption that 24-hour urine recovery provides a biomarker that differs from usual intake according to a classical measurement model. Under this assumption, dietary self-reports underestimate sodium by 0% to 15%, overestimate potassium by 8% to 15%, and underestimate sodium/potassium ratio by ≈20% using food frequency questionnaires, 4-day food records, or three 24-hour dietary recalls in Women's Health Initiative studies. Calibration equations are developed by linear regression of log-transformed 24-hour urine assessments on corresponding log-transformed self-report assessments and several study subject characteristics. For each self-report method, the calibration equations turned out to depend on race and age and strongly on body mass index. After adjustment for temporal variation, calibration equations using food records or recalls explained 45% to 50% of the variation in (log-transformed) 24-hour urine assessments for sodium, 60% to 70% of the variation for potassium, and 55% to 60% of the variation for sodium/potassium ratio. These equations may be suitable for use in epidemiological disease association studies among postmenopausal women. The corresponding signals from food frequency questionnaire data were weak, but calibration equations for the ratios of sodium and potassium/total energy explained ≈35%, 50%, and 45% of log-biomarker variation for sodium, potassium, and their ratio, respectively, after the adjustment for temporal biomarker variation and may be suitable for cautious use in epidemiological studies. CLINICAL TRIAL REGISTRATION-: URL: Unique identifier: NCT00000611.

Original languageEnglish (US)
Pages (from-to)238-244
Number of pages7
Issue number2
StatePublished - Feb 2014


  • bias (epidemiology)
  • biological markers
  • potassium
  • sodium

ASJC Scopus subject areas

  • Internal Medicine


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