Skip to main content

Currently Skimming:

12 Knowledge Gaps and Future Directions
Pages 401-420

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 401...
... Support from federal agencies and research institutions to address these knowledge gaps is expected to facilitate the work of the next DRI committee that reviews the evidence on potassium and sodium. This chapter also includes the committee's suggestions to enhance the DRI process, based on its experience implementing recommendations from the Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (Guiding Principles Report)
From page 402...
... . Spot urine samples have also demonstrated systematic bias as compared to 24-hour urine samples -- underestimating 24-hour urinary sodium excretion at high intake levels, and overestimating 24-hour urinary sodium excretion at low intake levels -- both in the general population and in individuals with chronic kidney disease (Dougher et al., 2016; He et al., 2018; Huang et al., 2016; Mente et al., 2014)
From page 403...
... . Future DRI committees' efforts to derive EARs and RDAs for potassium and sodium would be facilitated by rigorously designed balance studies that assess intake levels of potassium and sodium needed to achieve balance across the lifespan.
From page 404...
... To better characterize the potassium intake needs in these at-risk subpopulations, future research would do the following: • Evaluate the effect of potassium supplementation on balance, serum potassium concentrations, blood pressure, and cardiovas cular disease in individuals taking common medications that influ ence potassium homeostasis (e.g., ACE-Is, ARBs, diuretics) , and in individuals with chronic kidney disease, diabetes, and heart failure.
From page 405...
... to determine the independent effects of each on blood pressure and cardiovas cular disease. Strengthen the Evidence on the Relationship Between Sodium Intake and Chronic Disease Risk The meta-analyses used in this report helped the committee consider the totality of the evidence, but were limited by their ecological nature -- that is, the studies were the unit of analysis rather than pooled individual-level data.
From page 406...
... Although the committee characterized the relationship between sodium intake and chronic disease risk as at least moderate, additional studies are still needed on the effects of sodium intake reductions on chronic disease risk. There are a number of design and execution challenges to such trials, especially those that evaluate long-term effects of behavioral modification of dietary intake on chronic disease endpoints.
From page 407...
... Given current limitations in characterizing sodium sensitivity, future research would do the following: • Characterize how blood pressure response to changes in sodium intake varies by age, sex, race/ethnicity, adiposity, genotype, and clinical conditions such as hypertension, diabetes, and chronic kidney disease. • Identify both rare and common genetic variants that will help iden tify individuals who are predisposed to sodium sensitivity.
From page 408...
... at dif ferent doses of potassium and sodium intake, and assess whether the ratio is a better measure than either nutrient alone. • Identify individual-level attributes that affect the urinary sodium to-potassium ratio (e.g., age, race/ethnicity, body mass index, geno type)
From page 409...
... . Specifically, higher sodium intakes among individuals with lower energy intakes led to a greater increase in blood pressure than higher sodium intakes among individuals with higher energy intakes.
From page 410...
... Given that most sodium comes from foods prepared away from home and that there is a relationship between sodium intake and chronic disease risk, future research would do the following:
From page 411...
... To continue to explore the possible effect of sodium reduction efforts on iodine consumption, future research would do the following: • Determine whether current approaches to reducing sodium intake in the population decrease intake of iodized salt from sources such as table salt, salt used in processed foods, or both, and assess whether decreases in sodium intake affect iodine consumption and status. • Monitor the iodine status of the U.S.
From page 412...
... Integrating an Externally Conducted Systematic Review into the DRI Process To enhance the effectiveness of an externally conducted systematic review, alignment of the needs of the DRI committee (evidence users) with the information from evidence providers (e.g., Agency for Healthcare Research and Quality)
From page 413...
... To create greater efficiency in the process and usability of the final systematic reviews for DRI applications, future DRI reviews would do the following: • Develop a priori protocols for how and when the DRI committee, the sponsors, and those who design and execute the systematic review coordinate at key points in the process, as guided by sys tematic review best practices. As described in Chapter 2 and Appendix C, the committee assessed the Agency for Healthcare Research and Quality systematic review, Sodium and Potassium Intake: Effects on Chronic Disease Outcomes and Risks (AHRQ Systematic Review)
From page 414...
... The AHRQ Systematic Review was limited to a review of potassium and sodium intakes on chronic disease outcomes and related risk factors. This meant that the committee had comprehensive data summaries for chronic disease (with the exception of a few potential chronic disease indicators not included in the review)
From page 415...
... Thus, the committee needed to adapt existing intake–response meta-analysis methods to combine multiple trials with different sodium intake levels for the control and intervention groups. Future DRI committees will likely refine the approaches to assess intake–response relationships, depending on available evidence.
From page 416...
... Providing Additional Guidance on the Expanded DRI Model as Experience Is Gained The Guiding Principles Report provided limited comment on how DRIs based on chronic disease affect or interact with the other DRI categories. The committee's experience clarified that the review of the evidence and the decisions about DRIs based on chronic disease can have implications for the other DRI categories.
From page 417...
... As the first to apply the guidance in the Guiding Principles Report, the committee determined that evidence on the relationship between sodium intake and chronic disease risk was sufficient to introduce a new DRI category. There remains a need to strengthen the evidence on the relationship between potassium and/or sodium intake and chronic disease risk.
From page 418...
... 2016. Spot urine sodium measurements do not accurately estimate dietary sodium intake in chronic kidney disease.
From page 419...
... 1999. Dietary sodium intake and subsequent risk of cardiovascular disease in overweight adults.
From page 420...
... 2018. Relationship of sodium intake and blood pressure varies with energy intake: Secondary analysis of the DASH (Dietary Approaches to Stop Hypertension)


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.