Dietary Reference Intakes for Sodium and Potassium (2019) / Chapter Skim
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4 Potassium: Dietary Reference Intakes for Adequacy
4 Potassium: Dietary Reference Intakes for Adequacy
Pages 101-124
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From page 101... ...
, this chapter describes the committee's review of indicators to inform the potassium DRIs for adequacy and presents its approach and determination of updated reference values for the DRI age, sex, and life-stage groups. The committee's decision was informed by its evaluation of evidence on potassium intake requirements in apparently healthy individuals.
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From page 102... ...
. The approach taken in the 2005 DRI Report predated the guidance and recommendations offered in the 2017 National Academies of Sciences, Engineering, and Medicine report Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (Guiding Principles Report)
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From page 103... ...
To explore which additional indicators could potentially be used to characterize the distribution of potassium intake requirements within the apparently healthy population, the committee first considered aspects of potassium physiology, including adaptations of blood potassium concentration to various conditions and hypokalemia.1 In generally healthy individuals with normal kidney function, serum potassium concentrations are typically kept between 3.5 and 5.0 mmol/L. Homeostatic mechanisms that help to maintain this narrow range include shifting potassium between intracellular and extracellular fluid (internal balance)
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From page 104... ...
. For the purposes of determining potassium intake requirements, however, blood potassium concentrations and hypokalemia are not reliable indicators of usual potassium intake or status in the apparently healthy population.
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From page 105... ...
. The 2005 DRI Report noted that heat exposure and physical activity can increase potassium losses through sweat.
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From page 106... ...
106 DIETARY REFERENCE INTAKES FOR SODIUM AND POTASSIUM TABLE 4-1 Potassium Balance Studies Summarized by Completeness of Assessment of Intake and Lossesa Study Population Complete Balance -- Rigorous Assessment of Intake and All Losses Palacios et al., 2010 30 black and 20 white American adolescent females, 11–15 years of age Incomplete Balance -- Limitation on Loss Assessmente Kodama et al., 2005 109 Japanese males and females, 18–28 years of agef Holbrook et al., 1984 12 healthy American adult males and 16 healthy American females, 20–53 years of age Consolazio et al., 3 healthy, young American adult males, ages not reported 1963 Costill et al., 1982 8 American males in daily running training program, 20–41 years of age
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From page 107... ...
or low sodium (1,300 mg/d) intakesd • Potassium intakes rigorously measured • Urinary, fecal, and sweat potassium losses measured 2,034g • Series of 11 mineral balance studies of 5–12 days duration with a 2–4-day adaptation period • Potassium intake directly measured • Urinary and fecal potassium losses measured; only arm sweat losses during physical activity measured 3,300h • Potassium content of self-selected diet assessed 2,400i for a period of 1 week, four times over the course of 1 year, chemically analyzed for duplicate samples of all food and beverages consumed • Urinary and fecal potassium losses measured; no sweat losses were determined 2,493 • Balance determined after a preliminary 8 days at 24°C (75°F)
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From page 108... ...
aOnly studies reporting balance using crossover or sequential designs in the same partici pants at studied intakes for a minimum of 3 days are included. Studies using parallel arm randomized controlled trial designs were not included because intra-individual variability might confound results.
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From page 109... ...
, based on analysis of 1 week's worth of food and beverage samples collected four times over the course of 1 year. jIncomplete balance studies were limited by lack of direct assessment of potassium content in foods consumed and by lack of assessment of one or more sources of potassium losses as noted for each study.
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From page 110... ...
; negative balance was also found at higher potassium intakes, and appears to vary by factors such as exposure to heat, physical activity, and race/ethnicity. DIETARY REFERENCE INTAKES OF POTASSIUM ADEQUACY The committee's review of the evidence on potential indicators to inform the potassium DRIs for adequacy revealed the following: • There is no sensitive biomarker that can be used to characterize the distribution of potassium requirements in the apparently healthy population.
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From page 111... ...
Conversely, loop and thiazide diuretics can cause low blood potassium concentrations, which may lead to prescription of potassium supplements and an increase in dietary intake of potassium. Therefore, individuals on hypertensive medications would not necessarily reflect the nutritional status of potassium in a group of apparently healthy people, and would not be an appropriate population group to use to derive the potassium AIs.
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From page 112... ...
; as such, their simultaneous consideration was deemed appropriate. As described below, the committee defined the "group of apparently healthy people" used to derive the potassium AI values for adults as normotensive males and females without a self-reported history of cardiovascular disease.
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From page 113... ...
Children and Adolescents 1–18 Years of Age Despite having a general approach to establishing the potassium AIs (selecting the highest of the median usual potassium intakes across the two nationally representative surveys) , the committee had two additional TABLE 4-2 Potassium Adequate Intakes, Infants 0–12 Months of Age DRI Age, Sex, and Life-Stage Group Potassium Adequate Intake, mg/d Infants 0–6 months 400 7–12 months 860 NOTES: Intake values are presented in milligrams.
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From page 114... ...
As the majority of children in these age groups were normotensive, the median usual potassium intakes from the normotensive-only data were nearly identical to the estimate for children of all blood pressure statuses; use of normotensive-only data would not have affected the selected potassium AIs for these DRI age, sex, and life-stage groups. NHANES 2009–2014 esti mates presented in this section reflect the estimates of all blood pressure statuses.
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From page 115... ...
NOTES: The figure presents groups as provided in the data source. The green dashed lines are the potassium AIs that were established in the 2005 DRI Report.
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From page 116... ...
DRI = Dietary Reference Intake; mg/d = milligrams per day. females 19 years of age and older, without a self-reported history of cardiovascular disease.
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From page 117... ...
and Canadian adults; for context, the figure shows the potassium AIs that were established in the 2005 DRI Report. The updated potassium AIs for adults were established using the highest median intake across the two nationally representative surveys among the adults, mathematically rounded, stratified by sex.
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From page 118... ...
NOTES: The green dashed lines are the potassium AIs that were established in the 2005 DRI Report. The black dotted line is the highest median potassium intake across two nationally representative surveys for adult males, females, or life-stage group, mathematically rounded, which was used to establish the potassium AI values in this report.
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From page 119... ...
Lactation Little information exists on changes in body potassium content during lactation. Evidence from a study that measured total body potassium content found significantly greater losses in total body potassium content in lactating women, compared to nonlactating women (Butte and Hopkinson, 1998)
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From page 120... ...
The revisions reflect, in part, the expanded DRI model. The potassium AIs established TABLE 4-6 Potassium Adequate Intakes, Lactation DRI Age, Sex, and Life-Stage Group Potassium Adequate Intake, mg/d Lactation 14–18 years 2,500 19–30 years 2,800 31–50 years 2,800 NOTES: Intake values are presented in milligrams.
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From page 121... ...
TABLE 4-7 Comparison of Potassium Adequate Intakes Established in This Report to Potassium Adequate Intakes Established in the 2005 DRI Report DRI Age, Sex, and Potassium AI Established in Updated Potassium AI Life-Stage Group the 2005 DRI Report (mg/d) Values (mg/d)
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From page 122... ...
2003. Composition of gestational weight gain impacts maternal fat retention and infant birth weight.
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From page 123... ...
2017. Guiding prin ciples for developing Dietary Reference Intakes based on chronic disease.
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From page 124... ...
2018. Sodium and potassium intake: Effects on chronic disease outcomes and risks.
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