Dietary Salt Intake and Mortality in Patients With Type 2 Diabetes

2型糖尿病患者食盐摄入量与死亡率的关系

OBJECTIVE Many guidelines recommend that patients with type 2 diabetes should aim to reduce their intake of salt. However, the precise relationship between dietary salt intake and mortality in patients with type 2 diabetes has not been previously explored. 海南医学院第一附属医院内分泌科王新军

目的  许多指南建议，2型糖尿病患者应该减少盐的摄入量。然而，2型糖尿病患者中食盐摄入量与死亡率的确切关系尚未见研究。

RESEARCH DESIGN AND METHODS Six hundred and thirty-eight patients attending a single diabetes clinic were followed in a prospective cohort study. Baseline sodium excretion was estimated from 24-h urinary collections (24hUNa). The predictors of all-cause and cardiovascular mortality were determined by Cox regression and competing risk modeling, respectively.
研究设计与方法  本研究为一前瞻性队列研究，对在一个糖尿病门诊就诊的638例糖尿病患者进行随访。收集24小时尿，估计基线钠排泄（24hUNa）。分别用Cox回归和竞争风险模型确定全因死亡和心血管死亡的预测因素。
RESULTS The mean baseline 24hUNa was 184 ± 73 mmol/24 h, which remained consistent throughout the follow-up (intraindividual coefficient of variation [CV] 23 ± 11%). Over a median of 9.9 years, there were 175 deaths, 75 (43%) of which were secondary to cardiovascular events. All-cause mortality was inversely associated with 24hUNa, after adjusting for other baseline risk factors (P < 0.001). For every 100 mmol rise in 24hUNa, all-cause mortality was 28% lower (95% CI 6–45%, P = 0.02). After adjusting for the competing risk of noncardiovascular death and other predictors, 24hUNa was also significantly associated with cardiovascular mortality (sub-hazard ratio 0.65 [95% CI 0.44–0.95]; P = 0.03).

结果  平均基线24hUNa为184 ± 73 mmol/24小时，在后继随访过程中保持一致（个体内变异系数[CV] 23 ± 11％）。经过中位随访时间9.9年后，有175例患者死亡，75例（43％）继发于心血管事件。在校正其他基线危险因素后，全因死亡率与24hUNa呈负相关（P < 0.001）。24hUNa每升高100 mmol，全因死亡率降低28％（95％CI为6-45％，P = 0.02）。在校正非心血管死亡危险因素和其他预测因素后，24hUNa仍与心血管疾病死亡率显著相关（亚危险比为0.65 [95％CI 0.44-0.95]，P = 0.03）。

CONCLUSIONS In patients with type 2 diabetes, lower 24-h urinary sodium excretion was paradoxically associated with increased all-cause and cardiovascular mortality. Interventional studies are necessary to determine if dietary salt has a causative role in determining adverse outcomes in patients with type 2 diabetes and the appropriateness of guidelines advocating salt restriction in this setting.

结论  2型糖尿病患者24 h尿钠低排泄量与全因死亡率和心血管死亡率增加相关。需要进行干预研究，以确定是否食盐在确定2型糖尿病不良结局中具有致病性作用，糖尿病患者是否指南建议限制食盐是合适的。

Diabetes Care March 2011 34:703-709;