Relations of urinary salt, potassium and sodium-potassium ratio to standardized mortality ratios for cerebrovascular diseases and stomach cancer in Japanese women

To test Joossens and Geboers's hypothesis that salt is a common cause of both cerebrovascular diseases (CVD) and stomach cancer (SC), we examined the relationship between: the CVD and SC standardized mortality ratios (SMRs), and urinary salt (NaCI), potassium (K) excretion, and urinary sodium-p...

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Published inJapanese Journal of Health and Human Ecology Vol. 69; no. 3; pp. 80 - 89
Main Authors MIKAMI, Seiji, NIHIRA, Susumu, TAKEMORI, Koichi
Format Journal Article
LanguageEnglish
Published The Japanese Society of Health and Human Ecology 2003
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ISSN0368-9395
1882-868X
1882-868X
DOI10.3861/jshhe.69.80

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Abstract To test Joossens and Geboers's hypothesis that salt is a common cause of both cerebrovascular diseases (CVD) and stomach cancer (SC), we examined the relationship between: the CVD and SC standardized mortality ratios (SMRs), and urinary salt (NaCI), potassium (K) excretion, and urinary sodium-potassium ratio (Na/K). In 2000, spot urine samples, using the filter paper sampling technique, were taken from 50 female subjects aged 40 to 69, in each of 182 municipalities (95 urban and 87 rural), which covered all prefectures in Japan. While the CVD SMR levels correlated significantly with NaCI (r=0.296, p<0.o01) and Na/K (r=0.228, p=0.002), the SC SMR levels did not correlate with NaCI (r=0.108, p=0.148); instead, they significantly correlated with Na/K (r=0.169, p=0.022). It was concluded that the area-specific intake of NaCI could well account for the area difference in the CVD SMR rather than the SC SMR.
AbstractList To test Joossens and Geboers's hypothesis that salt is a common cause of both cerebrovascular diseases (CVD) and stomach cancer (SC), we examined the relationship between: the CVD and SC standardized mortality ratios (SMRs), and urinary salt (NaCI), potassium (K) excretion, and urinary sodium-potassium ratio (Na/K). In 2000, spot urine samples, using the filter paper sampling technique, were taken from 50 female subjects aged 40 to 69, in each of 182 municipalities (95 urban and 87 rural), which covered all prefectures in Japan. While the CVD SMR levels correlated significantly with NaCI (r=0.296, p<0.o01) and Na/K (r=0.228, p=0.002), the SC SMR levels did not correlate with NaCI (r=0.108, p=0.148); instead, they significantly correlated with Na/K (r=0.169, p=0.022). It was concluded that the area-specific intake of NaCI could well account for the area difference in the CVD SMR rather than the SC SMR.
Author MIKAMI, Seiji
TAKEMORI, Koichi
NIHIRA, Susumu
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  fullname: TAKEMORI, Koichi
  organization: Faculty of Health Sciences, Aomori University of Health and Welfare
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References Sakata S, Moriyama M (1990): Japanese dietary intake of salt and protein-Relating to strategy of salt restriction, Tohoku J Exp Med, 162, 293-302
Gleibermann L (1973): Blood pressure and dietary salt in human populations, Ecol Food Nutr, 2,143-156
Sasaki, N (1964): The relationship of salt intake to hypertension in the Japanese, Geriatrics, 19, 735-744
Takemori K, Yamamoto H, Kadohama H et al. (2001b): Recovery and preservation of urinary minerals, urea nitrogen and creatinine using filter paper absorption method, JJCDP, 36, 3-8 (in Japanese)
Intersalt Cooperative Research Group (1988): Intersalt: an international study of electrolyte excretion and blood pressure, Results for 24 hour urinary sodium and potassium excretion, Br Med J, 297, 319-328
Karvonen MJ, Punsar S (1977): Sodium excretion and blood pressure of west and east Finns, Acta Med Scand, 202, 501-507
Nagai M, Hashimoto T, Yanagawa H et al. (1982): Relationship of diet to the incidence of esophageal and stomach cancer in Japan, Nutr Cancer, 3, 257-268
Kono S, Ikeda M, Ogata M (1983): Salt and geographical mortality of gastric cancer and stroke in Japan, J Epidemiol community Health, 37, 43-46
McCarron DA, Morris CD, Henry HJ et al. (1984): Blood pressure and nutrient intake in the United States, Science, 224,1392-1398
Katsura S, Nakaji S, Sugawara K (1994): A comparison of dietary style in population samples from two areas of Aomori and Iwate with 5-fold variation in gastric cancer mortality, Hirosaki Med J, 46, 79-89 (in Japanese)
Takemori K, Nihira S, Mikami S et al. (1988); Geographical distribution of urinary sodium and potassium excretion and the relation with blood pressure in Japanese middle-aged female adults, Jpn J Health Hum Ecol, 54,131-142 (in Japanese)
Correa P (1985): Mechanisms of gastric carcinogenesis, Joossens JV, Hill MJ, Geboers J eds., Diet and Human Carcinogenesis, 109-115, Elsevier (Amsterdam)
Kamiyama S, Michioka O (1983): Mutagenic components of diets in high-and low-risk areas for stomach cancer, Stich HF ed. Carcinogens and Mutagens in the Environment, vol. 3, 29-42, CRC Press (Boca Raton)
Keida Y, Omoto K, Kinjou M et al. (1997): Clinicoepidemiological analysis on chronic gastritis, Ten-year comparative study on stomach cancer and chronic gastritis in Okinawa, Bulletin of Okinawa Chubu Hospital, 23, 10-15 (in Japanese)
Takemori K (1981): Recovery of sodium, potassium and creatinine by filter paper method, In case of flame spectrophotometry by internal standardization technique, Hirosaki Med J, 33, 549-551 (in Japanese)
Ministry of Health, Labour and Welfare (2002c): The National Nutrition Survey in Japan, 2000, DAI-ICHI SHUPPAN PUBLISHING. Co. LTD (Tokyo), 166
Haenszel W, Kurihara M, Segi M et al. (1972): Stomach cancer among Japanese in Hawaii, J Natl Cancer Inst, 49, 969-988
Takemori K, Mikami S, Nihira S et al. (2001a): Estimation of minerals and protein intake in Japan by filter paper method and the relation with blood pressure, Kobayasi T et al. ed., Thesis collection by Kyoei Health Control Foundation X VII, 59-70, Kyoei Health Control Corporation (Tokyo) (in Japanese)
Tuyns AJ (1988): Salt and gastrointestinal cancer, Nutr Cancer, 11, 229-232
Kawasaki T, Uezono K, Utsunomiya H et al. (1986): Studies on estimation of 24-hour urinary sodium excretion from predicted creatinine excretion and fractional urine sodium/creatinine ratio, J Health Sci, 8, 57-63 (in Japanese)
Kannel WB, Wolf PA, Verter J et al. (1970): Epidemiologic assessment of the role of blood pressure in stroke, JAMA, 214, 301-310
Kolonel LN, Nomura AMY, Hirohata T et al. (1981): Association of diet and place of birth with stomach cancer incidence in Hawaii Japanese and Caucasians, Am J Clin Nutr, 34, 2478-2485
Kawasaki T, Uezono K, Kikkawa K (1985): Studies on estimation of 24-hour urinary sodium excretion from predicted creatinine excretion and fractional urine sodium/creatinine ratio, Jpn J Hypertens, 8, 42 (in Japanese)
Staessen J, Fagard R, Lijnen P et al. (1981): Salt and blood pressure in Belgium, J Epidemiol Community Health, 35, 256-261
Kesteloot H, Park BC, Lee CS et al. (1980): A comparative study of blood pressure and sodium intake In Belgium and in Korea. Kesteloot H, Joossens JV ed. Epidemiology of Arterial Blood Pressure, 453-470,Martinus Nijhoff publishers (Hague-Boston-London)
Ministry of Health, Labor and Welfare (2002b): http://graph-sys.health-net.or.jp/ken-map/index.html
Hirohata T, Tokunaga S, Sugawara K et al. (1991): The relationship between dietary intake and gastric cancer: A cooperative study of five universities in Japan, Jpn J Hyg, 46, 589. (in Japanese)
Kamiyama S (1988): Epidemiological and experimental studies on the regional difference of stomach cancer in Japan, Jpn J Hyg, 43, 82-97 (in Japanese)
Joossens JV, Geboers J (1981): Nutrition and gastric cancer, Nutr Cancer, 2, 250-261
Coggon D, Barker DJP, Cole RB et al. (1989): Stomach cancer and food Storage, J Natl Cancer Inst, 81,1178-1182
Kono, S (1998): Stomach Cancer, Japan Epidemiological Association ed., Handbook of epidemiology, 17-21, Nankodo (Tokyo)
You WC, Blot WJ, Chang YS et al. (1988): Diet and high risk of stomach cancer in Shandong, China, Cancer Res, 48, 3518-3523
Takemori K, Mikami S, Nihira S et al. (1993): Relationship of urinary sodium and potassium and of urinary sodium/creatinine, potassium/ creatinine and sodium/potassium ratios to stomach cancer and cerebrovascular disease mortalities in Japanese women, Tohoku J Exp Med, 171, 185-194
Katsuki S, Hirota, Y (1966): Current concept of the frequency of cerebral hemorrhage and cerebral infarction in Japan, Siekert RG, Whis-nant JP ed. Cerebral Vascular Diseases, 99-111, Grune & Stratton (New York and London)
Hirayama T (1984): Epidemiology of stomach cancer in Japan with special reference to the strategy for the primary prevention, Jpn J Clin Oncol, 14,159-168
Mirvish SS (1983): The etiology of gastric cancer, J Natl Cancer Inst, 71, 629-647
Ikeda M, Nakatsuka H, Watanabe T (1988): The absence of correlation between Na in diet duplicates and stomach cancer mortality in Japan, Tohoku J Exp Med, 155, 285-294
Joossens JV, Geboers J (1987): Dietary salt and risks to health Am J Clin Nutr, 45,1277-1288
Ministry of Health, Labor and Welfare (2002a): Statistical Database, http://wwwdbtk.mhlw.go.jp/toukei/index.html
Tanaka, H (1998): Japanese blood pressure value, Japan Epidemiological Association ed., Handbook of epidemiology, 104-106, Nankodo (Tokyo)
Takemori K, Mikami S, Nihira S et al. (1989): Relationship of blood pressure to sodium and potassium excretion in Japanese women, Tohoku J Exp Med, 158, 269-281
Correa P (1975): A model for gastric cancer epidemiology, Lancet, 2, 58-60
Takemori K (1996): Choice of food reported in the annual report on the family income and expenditure survey in Japan. Especially annual changes and regional features of the choice of salty food, Journal of Health and Welfare Statistics, 43(4), 32-37 (in Japanese)
Hirata K, Fushimi T, Ishii H et al. (1985): A method of estimating urinary potassium excretion by morning spot urine sampling, at the 39th annual meeting of Japanese Society of Nutrition and Food Sciences, Tokyo, April, 129. (in Japanese)
Kesteloot H, Huang DX, Li YL et al. (1987): The relationship between cations and blood pressure in the People's Republic of China, Hypertension, 9, 654-659
Simpson FO (1985): Blood pressure and sodium intake. Bulpitt CJ ed., Handbook of Hypertension, vol. 6: Epidemiology of Hypertension, 175-190, Elsevier (Amsterdam, New York, Oxford)
Takemori K (1980): Collection and transport of urine samples by filter paper absorption method, The method of the determination of sodium, potassium and creatinine concentration in urine, Jpn J Hyg, 35, 721-727 (in Japanese)
Buiatti E, Palli D, Decarli A et al. (1989): A casecontrol study of gastric cancer and diet in Italy, Int J Cancer, 44, 611-616
References_xml – reference: Intersalt Cooperative Research Group (1988): Intersalt: an international study of electrolyte excretion and blood pressure, Results for 24 hour urinary sodium and potassium excretion, Br Med J, 297, 319-328
– reference: Joossens JV, Geboers J (1987): Dietary salt and risks to health Am J Clin Nutr, 45,1277-1288
– reference: Takemori K, Nihira S, Mikami S et al. (1988); Geographical distribution of urinary sodium and potassium excretion and the relation with blood pressure in Japanese middle-aged female adults, Jpn J Health Hum Ecol, 54,131-142 (in Japanese)
– reference: Hirohata T, Tokunaga S, Sugawara K et al. (1991): The relationship between dietary intake and gastric cancer: A cooperative study of five universities in Japan, Jpn J Hyg, 46, 589. (in Japanese)
– reference: Kono S, Ikeda M, Ogata M (1983): Salt and geographical mortality of gastric cancer and stroke in Japan, J Epidemiol community Health, 37, 43-46
– reference: Kamiyama S, Michioka O (1983): Mutagenic components of diets in high-and low-risk areas for stomach cancer, Stich HF ed. Carcinogens and Mutagens in the Environment, vol. 3, 29-42, CRC Press (Boca Raton)
– reference: Nagai M, Hashimoto T, Yanagawa H et al. (1982): Relationship of diet to the incidence of esophageal and stomach cancer in Japan, Nutr Cancer, 3, 257-268
– reference: Haenszel W, Kurihara M, Segi M et al. (1972): Stomach cancer among Japanese in Hawaii, J Natl Cancer Inst, 49, 969-988
– reference: Gleibermann L (1973): Blood pressure and dietary salt in human populations, Ecol Food Nutr, 2,143-156
– reference: Takemori K (1996): Choice of food reported in the annual report on the family income and expenditure survey in Japan. Especially annual changes and regional features of the choice of salty food, Journal of Health and Welfare Statistics, 43(4), 32-37 (in Japanese)
– reference: Coggon D, Barker DJP, Cole RB et al. (1989): Stomach cancer and food Storage, J Natl Cancer Inst, 81,1178-1182
– reference: Hirayama T (1984): Epidemiology of stomach cancer in Japan with special reference to the strategy for the primary prevention, Jpn J Clin Oncol, 14,159-168
– reference: Mirvish SS (1983): The etiology of gastric cancer, J Natl Cancer Inst, 71, 629-647
– reference: Kannel WB, Wolf PA, Verter J et al. (1970): Epidemiologic assessment of the role of blood pressure in stroke, JAMA, 214, 301-310
– reference: Ministry of Health, Labor and Welfare (2002b): http://graph-sys.health-net.or.jp/ken-map/index.html
– reference: Tuyns AJ (1988): Salt and gastrointestinal cancer, Nutr Cancer, 11, 229-232
– reference: Ministry of Health, Labor and Welfare (2002a): Statistical Database, http://wwwdbtk.mhlw.go.jp/toukei/index.html
– reference: McCarron DA, Morris CD, Henry HJ et al. (1984): Blood pressure and nutrient intake in the United States, Science, 224,1392-1398
– reference: Kesteloot H, Park BC, Lee CS et al. (1980): A comparative study of blood pressure and sodium intake In Belgium and in Korea. Kesteloot H, Joossens JV ed. Epidemiology of Arterial Blood Pressure, 453-470,Martinus Nijhoff publishers (Hague-Boston-London)
– reference: Kamiyama S (1988): Epidemiological and experimental studies on the regional difference of stomach cancer in Japan, Jpn J Hyg, 43, 82-97 (in Japanese)
– reference: Takemori K (1981): Recovery of sodium, potassium and creatinine by filter paper method, In case of flame spectrophotometry by internal standardization technique, Hirosaki Med J, 33, 549-551 (in Japanese)
– reference: Takemori K, Mikami S, Nihira S et al. (1989): Relationship of blood pressure to sodium and potassium excretion in Japanese women, Tohoku J Exp Med, 158, 269-281
– reference: Buiatti E, Palli D, Decarli A et al. (1989): A casecontrol study of gastric cancer and diet in Italy, Int J Cancer, 44, 611-616
– reference: Takemori K, Mikami S, Nihira S et al. (2001a): Estimation of minerals and protein intake in Japan by filter paper method and the relation with blood pressure, Kobayasi T et al. ed., Thesis collection by Kyoei Health Control Foundation X VII, 59-70, Kyoei Health Control Corporation (Tokyo) (in Japanese)
– reference: Karvonen MJ, Punsar S (1977): Sodium excretion and blood pressure of west and east Finns, Acta Med Scand, 202, 501-507
– reference: Hirata K, Fushimi T, Ishii H et al. (1985): A method of estimating urinary potassium excretion by morning spot urine sampling, at the 39th annual meeting of Japanese Society of Nutrition and Food Sciences, Tokyo, April, 129. (in Japanese)
– reference: Kawasaki T, Uezono K, Utsunomiya H et al. (1986): Studies on estimation of 24-hour urinary sodium excretion from predicted creatinine excretion and fractional urine sodium/creatinine ratio, J Health Sci, 8, 57-63 (in Japanese)
– reference: Takemori K (1980): Collection and transport of urine samples by filter paper absorption method, The method of the determination of sodium, potassium and creatinine concentration in urine, Jpn J Hyg, 35, 721-727 (in Japanese)
– reference: Kawasaki T, Uezono K, Kikkawa K (1985): Studies on estimation of 24-hour urinary sodium excretion from predicted creatinine excretion and fractional urine sodium/creatinine ratio, Jpn J Hypertens, 8, 42 (in Japanese)
– reference: Tanaka, H (1998): Japanese blood pressure value, Japan Epidemiological Association ed., Handbook of epidemiology, 104-106, Nankodo (Tokyo)
– reference: Sakata S, Moriyama M (1990): Japanese dietary intake of salt and protein-Relating to strategy of salt restriction, Tohoku J Exp Med, 162, 293-302
– reference: Staessen J, Fagard R, Lijnen P et al. (1981): Salt and blood pressure in Belgium, J Epidemiol Community Health, 35, 256-261
– reference: Takemori K, Mikami S, Nihira S et al. (1993): Relationship of urinary sodium and potassium and of urinary sodium/creatinine, potassium/ creatinine and sodium/potassium ratios to stomach cancer and cerebrovascular disease mortalities in Japanese women, Tohoku J Exp Med, 171, 185-194
– reference: Correa P (1975): A model for gastric cancer epidemiology, Lancet, 2, 58-60
– reference: You WC, Blot WJ, Chang YS et al. (1988): Diet and high risk of stomach cancer in Shandong, China, Cancer Res, 48, 3518-3523
– reference: Correa P (1985): Mechanisms of gastric carcinogenesis, Joossens JV, Hill MJ, Geboers J eds., Diet and Human Carcinogenesis, 109-115, Elsevier (Amsterdam)
– reference: Sasaki, N (1964): The relationship of salt intake to hypertension in the Japanese, Geriatrics, 19, 735-744
– reference: Kesteloot H, Huang DX, Li YL et al. (1987): The relationship between cations and blood pressure in the People's Republic of China, Hypertension, 9, 654-659
– reference: Keida Y, Omoto K, Kinjou M et al. (1997): Clinicoepidemiological analysis on chronic gastritis, Ten-year comparative study on stomach cancer and chronic gastritis in Okinawa, Bulletin of Okinawa Chubu Hospital, 23, 10-15 (in Japanese)
– reference: Kono, S (1998): Stomach Cancer, Japan Epidemiological Association ed., Handbook of epidemiology, 17-21, Nankodo (Tokyo)
– reference: Takemori K, Yamamoto H, Kadohama H et al. (2001b): Recovery and preservation of urinary minerals, urea nitrogen and creatinine using filter paper absorption method, JJCDP, 36, 3-8 (in Japanese)
– reference: Simpson FO (1985): Blood pressure and sodium intake. Bulpitt CJ ed., Handbook of Hypertension, vol. 6: Epidemiology of Hypertension, 175-190, Elsevier (Amsterdam, New York, Oxford)
– reference: Joossens JV, Geboers J (1981): Nutrition and gastric cancer, Nutr Cancer, 2, 250-261
– reference: Katsuki S, Hirota, Y (1966): Current concept of the frequency of cerebral hemorrhage and cerebral infarction in Japan, Siekert RG, Whis-nant JP ed. Cerebral Vascular Diseases, 99-111, Grune & Stratton (New York and London)
– reference: Kolonel LN, Nomura AMY, Hirohata T et al. (1981): Association of diet and place of birth with stomach cancer incidence in Hawaii Japanese and Caucasians, Am J Clin Nutr, 34, 2478-2485
– reference: Ikeda M, Nakatsuka H, Watanabe T (1988): The absence of correlation between Na in diet duplicates and stomach cancer mortality in Japan, Tohoku J Exp Med, 155, 285-294
– reference: Katsura S, Nakaji S, Sugawara K (1994): A comparison of dietary style in population samples from two areas of Aomori and Iwate with 5-fold variation in gastric cancer mortality, Hirosaki Med J, 46, 79-89 (in Japanese)
– reference: Ministry of Health, Labour and Welfare (2002c): The National Nutrition Survey in Japan, 2000, DAI-ICHI SHUPPAN PUBLISHING. Co. LTD (Tokyo), 166
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SubjectTerms urinary sodium, urinary sodium-potassium ratio, stomach cancer, cerebrovascular diseases, epidemiology
Title Relations of urinary salt, potassium and sodium-potassium ratio to standardized mortality ratios for cerebrovascular diseases and stomach cancer in Japanese women
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