The Relationship between Daily Sodium Intake and Obesity in Korean Adults

Jung-hoon Kim; Gyeong Eun Lim; Sunyoung Kang; Kayoung Lee; Tae-jin Park; Jinseung Kim

doi:10.15384/kjhp.2015.15.4.175

Korean J Health Promot > Volume 15(4); 2015 > Article

Kim, Lim, Kang, Lee, Park, and Kim: The Relationship between Daily Sodium Intake and Obesity in Korean Adults

Original Article

Korean Journal of Health Promotion 2015;15(4):175-184.

Published online: December 19, 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.4.175

The Relationship between Daily Sodium Intake and Obesity in Korean Adults

Jung-hoon Kim, Gyeong Eun Lim, Sunyoung Kang, Kayoung Lee, Tae-jin Park, Jinseung Kim

Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

￭ Corresponding author：Jinseung Kim, MD Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea
Tel: +82-51-890-6729, Fax: +82-51-894-7554 E-mail: jinseungkim@inje.ac.kr, jinseungkim@hanmail.net

Received September 16, 2015 Accepted November 06, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background

World health organization (WHO) recommended daily sodium intake less than 2 g. To assess the validity of WHO recommendation, we investigated the relationship between daily sodium intake and obesity.

Methods

A total of 14,694 participants aged ≥19 years who had no missing data for nutrition, chronic disease, health behavior, economic status and laboratory findings from the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V), which was performed from 2010 to 2012. Obesity was defined as having a body mass index of 25 kg/m² or higher. Daily sodium intake was calculated from 24 hour recall and divided into five categories (< 2 g, 2-4 g, 4-6 g, 6-8 g, ≥8 g). The association between daily sodium intake and obesity was analyzed using multiple logistic regressions.

Results

Higher sodium intake in men had an increased risk of obesity with odds ratios (ORs) of 1.27 for 2-4 g intake (95% confidence interval [CI], 0.97-1.67), 1.40 for 4-6 g intake (95% CI, 1.07-1.85), 1.41 for 6-8 g intake (95% CI, 1.05-1.89), and 1.61 for ≥8 g intake (95% CI, 1.19-2.18), compared to men with less than 2 g intake, after adjusting for confounding factors. The P value for trend of ORs in each group for men was 0.020. In women, compared to the lesser than 2 g intake, only ≥8 g intake group had an OR of 1.28 (95% CI, 1.02-1.62) without showing significant P for trend (P value for trend＝0.221)

Conclusions

We found that sodium intake more than 2 g per day was independently related to the increased risk of obesity in men. Therefore, to minimize the risk of obesity, we suggest taking sodium less than 2 g per day.

Keywords: Sodium, Obesity, Energy intake, World Health Organization

Figure 1.

Flow chart of subjects’ selection.

Figure 2.

Trend of odds ratio for obesity according to daily sodium intake in men.

Table 1.

General characteristics of subjects according to sex

Characteristics	Total (n＝14,694)	Men (n＝5,969)	Women (n＝8,725)	P-value^a
Age, y	50.78±0.13	51.66±0.21	50.18±0.17	＜0.001
Daily energy intake, Kcal	1,977.19±7.05	2,373.70±12.33	1,705.92±7.02	＜0.001
Daily sodium intake, mg	4,866.02±27.03	5,874.65±46.18	2,863.04±30.65	＜0.001
Systolic blood pressure, mmHg	120.00±0.14	122.82±0.21	118.08±0.19	＜0.001
Diastolic blood pressure, mmHg	76.12±0.09	78.86±0.14	74.25±0.12	＜0.001
Fasting blood sugar, mg/dL	97.84±0.18	100.79±0.31	95.83±0.22	＜0.001
Total cholesterol, mg/dL	189.62±0.30	187.26±0.47	191.23±0.39	＜0.001
HDL cholesterol, mg/dL	52.66±0.11	49.32±0.16	54.94±0.14	＜0.001
LDL cholesterol, mg/dL	111.66±0.27	108.93±32.02	113.50±0.34	＜0.001
Triglyceride, mg/dL	130.09±0.85	152.38±1.62	114.84±0.86	＜0.001
Obesity (BMI≥25), % (N)	31.7 (4,659)	34.9 (2,084)	29.5 (2,575)	＜0.001
Central obesity^b, % (N)	25.9 (3,812)	26.3 (1,570)	25.7 (2,242)	0.410
Chronic disease, %
Hypertension	33.9 (4,976)	39.1 (2,236)	30.3 (2,640)	＜0.001
Dyslipidemia	36.5 (5,369)	42.8 (2,557)	32.2 (2,812)	＜0.001
Diabetes mellitus	10.8 (1,589)	13.4 (801)	9.0 (788)	＜0.001
Cerebral vascular disease	2.0 (300)	2.7 (160)	1.6 (140)	＜0.001
Angina pectoris	2.4 (357)	2.7 (164)	2.2 (193)	0.038
Myocardial infarction	1.0 (140)	1.4 (85)	0.6 (55)	＜0.001
Health related behavior
Smoking, % (N)				＜0.001
Non-smoker	60.9 (8,944)	18.6 (1,109)	89.8 (7,835)
Past smoker	20.5 (3,015)	42.8 (2,554)	5.3 (461)
Current smoker	18.6 (2,735)	38.6 (2,306)	4.9 (429)
Alcohol use, % (N)				＜0.001
Non drinking	14.0 (2,054)	5.3 (317)	19.9 (1,737)
Normal drinking	60.3 (8,856)	46.6 (2,779)	69.7 (6,077)
Problem drinking	16.6 (2,440)	29.1 (1,736)	8.1 (704)
Alcohol use disorder	4.8 (708)	10.0 (595)	1.3 (113)
Alcohol dependence	4.3 (636)	9.1 (542)	1.1 (94)
Physical activity, METs/wk	2,176.68±28.03	2,648.04±48.53	1,854.22±33.12	＜0.001
Household income, % (N)				0.022
Low	19.4 (2,848)	18.2 (1,088)	20.2 (1,760)
Low-middle	25.8 (3,794)	25.9 (1,544)	25.8 (2,250)
High-middle	27.4 (4,026)	28.2 (1,684)	26.8 (2,342)
High	27.4 (4,026)	27.7 (1,653)	27.2 (2,373)
Education level, % (N)				＜0.001
Less than elementary school	25.8 (3,794)	18.3 (1,092)	31.0 (2,702)
Middle school	11.1 (1,633)	12.2 (730)	10.3 (903)
High school	33.3 (4,886)	35.4 (2,115)	31.8 (2,771)
College or higher	29.8 (4,381)	34.0 (2,032)	26.9 (2,349)

Abbreviations: BMI, body mass index; METs, metabolic equivalents. Values are presented as mean±standard error or percent (number).

^aContinuous variables were calculated by general linear model and categorical variables were calculated by chi-square test.

^bCentral obesity was defined as waist circumference ≥90 cm in men and ≥85 cm in women.

Table 2.

Chronic diseases and health related behaviors according to daily sodium intake in men

Group	Group of daily sodium intake (N＝5,969)
Group	＜2 g (394)	2-4 g (1,581)	4-6 g (1,695)	6-8 g (1,091)	≥ 8 g (1,208)	P value^a
Daily energy intake, Kcal	1,449.58±29.15	1,892.89±15.44	2,280.27±16.40	2,675.45±25.12	3,162.92±33.07	＜0.001
Total cholesterol, mg/dL	182.95±2.14	185.18±0.87	188.95±0.86	186.85±1.13	189.36±1.00	0.001
HDL cholesterol, mg/dL	48.14±0.61	48.98±0.32	49.59±0.29	49.59±0.35	49.56±0.33	0.019
LDL cholesterol, mg/dL	105.87±1.84	108.96±0.79	110.04±0.79	107.83±0.99	109.33±0.90	0.144
Triglyceride, mg/dL	149.74±6.93	142.52±2.46	154.47±3.05	153.98±4.09	161.79±4.08	0.020
Fasting blood glucose, mg/dL	101.85±1.19	101.15±0.57	101.02±0.60	99.99±0.66	100.38±0.75	0.159
Systolic blood pressure, mmHg	125.46±0.87	123.44±0.41	122.76±0.40	121.98±0.49	122.00±0.44	＜0.001
Diastolic blood pressure, mmHg	76.68±0.52	77.94±0.26	79.26±0.26	79.19±0.33	79.91±0.30	＜0.001
Obesity (BMI≥25), % (N)	26.1 (101)	31.4 (497)	35.8 (606)	35.7 (389)	40.5 (489)	＜0.001
Central obesity^b, % (N)	23.9 (94)	23.8 (377)	27.7 (469)	25.6 (279)	29.1 (351)	0.005
Chronic disease, % (N)
Hypertension	48.5 (191)	42.9 (679)	38.1 (646)	34.4 (375)	36.8 (445)	＜0.001
Dyslipidemia	47.2 (186)	41.9 (662)	42.9 (728)	41.5 (453)	43.7 (528)	0.789
Diabetes mellitus	20.8 (82)	15.4 (243)	12.6 (214)	11.3 (968)	11.5 (139)	＜0.001
Cerebral vascular disease	6.1 (24)	3.5 (56)	2.6 (44)	1.5 (16)	1.7 (20)	＜0.001
Angina pectoris	4.1 (16)	3.3 (52)	2.8 (47)	2.4 (26)	1.9 (23)	0.005
Myocardial infarction	2.5 (10)	1.5 (23)	1.5 (25)	1.1 (12)	1.2 (15)	0.123
Health related behavior
Smoking, % (N)						0.770
Non-smoker	19.3 (76)	19.6 (310)	19.5 (331)	17.2 (188)	16.9 (204)
Past smoker	43.4 (171)	44.8 (708)	41.4 (701)	42.9 (468)	41.9 (506)
Current smoker	37.3 (147)	35.6 (563)	39.1 (663)	39.9 (435)	41.2 (498)
Alcohol use, % (N)						＜0.001
Non drinking	6.9 (27)	55.8 (220)	22.3 (88)	6.3 (25)	8.6 (34)
Normal drinking	7.0 (111)	52.7 (833)	25.2 (398)	8.5 (135)	6.6 (104)
Problem drinking	4.8 (81)	45.1 (764)	31.3 (531)	9.9 (168)	8.9 (151)
Alcohol use disorder	4.4 (48)	45.2 (493)	28.7 (313)	12.0 (131)	9.7 (106)
Alcohol dependence	4.1 (50)	38.8 (469)	33.6 (406)	11.3 (136)	12.2 (147)
Physical activity, METs/wk	2,263.81±173.60	2,419.75±92.49	2,530.51±88.26	3,013.61±119.57	2,906.89±111.41	＜0.001

Abbreviations: HDL, high density lipoprotein; LDL, low density lipoprotein; BMI, body mass index; METs, metabolic equivalents; wk, week. Values are presented as mean±standard error or percent (number).

^aCalculated by general linear model or chi-square test.

^bCentral obesity was defined waist circumference ≥90 cm in men.

Table 3.

Laboratory data, chronic diseases, and health related behaviors according to daily sodium intake in women

Group	Group of daily sodium intake (N＝8725)
Group	＜2 g (1,563)	2-4 g (3,568)	4-6 g (1,990)	6-8 g (914)	≥ 8 g (690)	P value^a
Daily energy intake, Kcal	1,170.77±10.79	1,584.57±9.3	1,906.45±12.56	2,134.37±20.93	2,399.82±32.99	＜0.001
Total cholesterol, mg/dL	194.44±1.00	190.82±0.61	189.79±0.81	190.85±1.17	190.71±1.33	0.041
HDL cholesterol, mg/dL	53.65±0.33	54.85±0.22	55.35±0.28	56.06±0.43	55.68±0.47	＜0.001
LDL cholesterol, mg/dL	115.67±0.86	113.61±0.53	112.21±0.72	112.58±1.04	113.04±1.20	0.047
Triglyceride, mg/dL	127.07±2.75	112.63±1.22	112.19±1.65	111.86±2.34	110.17±2.47	＜0.001
Fasting blood glucose, mg/dL	97.43±0.52	95.65±0.34	95.32±0.48	94.79±0.59	95.95±0.74	0.058
Systolic blood pressure, mmHg	121.52±0.48	117.80±0.31	116.60±0.39	117.48±0.59	116.74±0.67	＜0.001
Diastolic blood pressure, mmHg	74.35±0.25	74.01±0.16	74.17±0.22	74.88±0.33	74.58±0.39	0.176
Obesity (BMI≥25), % (N)	32.0 (500)	28.8 (1,028)	28.4 (566)	28.4 (260)	32.0 (221)	0.571
Central obesity^b, % (N)	30.4 (475)	25.2 (898)	24.0 (477)	24.3 (222)	24.6 (170)	0.001
Chronic disease, % (N)
Hypertension	39.3 (615)	29.9 (1,067)	26.8 (534)	26.9 (246)	25.7 (177)	＜0.001
Dyslipidemia	39.3 (614)	31.2 (1,112)	30.3 (603)	30.1 (275)	30.1 (208)	＜0.001
Diabetes mellitus	12.9 (201)	8.8 (314)	7.6 (151)	6.9 (63)	8.6 (59)	＜0.001
Cerebral vascular disease	2.5 (39)	1.7 (62)	1.1 (22)	1.0 (9)	1.2 (8)	0.001
Angina pectoris	3.1 (48)	2.4 (84)	1.7 (34)	1.6 (15)	1.7 (12)	0.005
Myocardial infarction	1.3 (20)	0.5 (19)	0.6 (11)	0 (0)	0.7 (5)	0.011
Health related behavior
Smoking, % (N)						0.391
Non-smoker	89.5 (1,399)	90.2 (3,219)	89.6 (1,783)	89.5 (818)	89.3 (616)
Past smoker	4.9 (76)	5.2 (186)	5.4 (107)	5.5 (50)	6.1 (42)
Current smoker	5.6 (88)	4.6 (163)	5.0 (100)	5.0 (46)	4.6 (32)
Alcohol use, % (N)						＜0.001
Non drinking	27.1 (423)	19.2 (684)	18.0 (358)	17.2 (157)	16.7 (115)
Normal drinking	64.3 (1,005)	70.7 (2,521)	70.7 (1,407)	71.0 (649)	71.7 (495)
Problem drinking	6.8 (106)	7.9 (282)	8.7 (174)	9.0 (82)	8.7 (60)
Alcohol use disorder	1.0 (16)	1.2 (43)	1.2 (24)	2.0 (18)	1.7 (12)
Alcohol dependence	0.8 (13)	1.1 (38)	1.4 (27)	0.9 (8)	1.2 (8)
Physical activity, METs/wk	1,721.69±75.50	1,840.59±51.07	1,869.91±68.49	1,879.46±99.92	2,146.18±140.48	0.004

Abbreviations: HDL, High density lipoprotein; LDL, low density lipoprotein; BMI, body mass index; METs, metabolic equivalents; wk, week. Values are presented as mean±standard error or percent (number).

^aCalculated by general linear model or chi-square test.

^bCentral obesity was defined waist circumference ≥ 85 cm in women.

Table 4.

Odds ratios for obesity according to daily sodium intake by logistic regression

Outcome	Daily sodium intake	Adjusted OR (95% CI)^a	Adjusted OR (95% CI)^b	Adjusted OR (95% CI)^c
Obesity (BMI≥25 kg/m²)
Men (N＝5,969)	＜2 g (394)	1	1	1
	2-4 g (1,581)	1.24 (0.96-1.59)	1.26 (0.97-1.64)	1.27 (0.97-1.67)
	4-6 g (1,695)	1.45 (1.13-1.87)	1.44 (1.11-7.88)	1.40 (1.07-1.85)
	6-8 g (1,091)	1.42 (1.08-1.86)	1.44 (1.08-1.91)	1.41 (1.05-1.89)
	≥8 g (1,208)	1.72 (1.30-2.27)	1.67 (1.25-2.23)	1.61 (1.19-2.18)
	P value for trend^d	0.001	0.003	0.020
Women (N＝8725)	＜2 g (1,563)	1	1	1
	2-4 g (3,568)	1.00 (0.88-1.15)	1.04 (0.90-1.20)	1.01 (0.87-1.17)
	4-6 g (1,990)	1.03 (0.88-1.21)	1.07 (0.91-1.26)	1.04 (0.87-1.23)
	6-8 g (914)	1.04 (0.86-1.27)	1.08 (0.87-1.32)	1.02 (0.82-1.26)
	≥8 g (690)	1.26 (1.01-1.58)	1.28 (1.02-1.62)	1.21 (0.96-1.54)
	P value for trend^d	0.249	0.221	0.494

Abbreviations: OR, odds ratio; CI, confidence interval; BMI, body mass index.

^aLogistic regression for obesity with daily sodium intake after adjustment for age and daily energy intake.

^bLogistic regression for obesity with daily sodium intake after adjustment for age, daily energy intake, chronic disease, and social behaviors (smoking status, drinking status (AUDIT score), physical activity (METs-min/week)), economic status, and education level.

^cLogistic regression for obesity with daily sodium intake after adjustment for daily energy intake, chronic disease, social behaviors, economic status, education level, lipid profile (total cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol), fasting blood glucose, and blood pressure.

^dTests for linear trends across categories were conducted by treating the median of each category as a continuous variable.

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