Spot urine and 24-h diet recall estimates of dietary sodium intake from the 2008/09 New Zealand Adult Nutrition Survey: a comparison



We aimed to test the difference between estimates of dietary sodium intake using 24-h diet recall and spot urine collection in a large sample of New Zealand adults.


We analysed spot urine results, 24-h diet recall, dietary habits questionnaire and anthropometry from a representative sample of 3312 adults aged 15 years and older who participated in the 2008/09 New Zealand Adult Nutrition Survey. Estimates of adult population sodium intake were derived from 24-h diet recall and spot urine sodium using a formula derived from analysis of INTERSALT data. Correlations, limits of agreement and mean difference were calculated for the total sample, and for population subgroups.


Estimated total population 24-h urinary sodium excretion (mean (95% CI)) from spot urine samples was 3035 mg (2990, 3079); 3612 mg (3549, 3674) for men and 2507 mg (2466, 2548) for women. Estimated mean usual daily sodium intake from 24-h diet recall data (excluding salt added at the table) was 2564 mg (2519, 2608); 2849 mg (2779, 2920) for men and 2304 mg (2258, 2350) for women. Correlations between estimates were poor, especially for men, and limits of agreement using Bland–Altman mean difference analysis were wide.


There is a poor agreement between estimates of individual sodium intake from spot urine collection and those from 24-hour diet recall. Although, both 24-hour dietary recall and estimated urinary excretion based on spot urine indicate mean population sodium intake is greater than 2 g, significant differences in mean intake by method deserve further investigation in relation to the gold standard, 24-hour urinary sodium excretion.

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  1. 1.

    Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007;370:2044–53.

    Article  Google Scholar 

  2. 2.

    Bibbins-Domingo K, Chertow GM, Coxson PG, Moran A, Lightwood JM, Pletcher MJ, et al. Projected effect of dietary salt reductions on future cardiovascular disease. New Engl J Med. 2010;362:590–9.

    CAS  Article  Google Scholar 

  3. 3.

    World Health Organization. Guideline: sodium intake for adults and children. Geneva: World Health Organization (WHO); 2012.

    Google Scholar 

  4. 4.

    World Health Organization. Reducing salt in populations: report of a WHO forum and technical meeting 5–7 october 2006. Paris, France, Geneva: World Health Organization; 2006.

    Google Scholar 

  5. 5.

    World Health Organization. Follow-up to the political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases: sixty-sixth world health assembly (WHA66.10). Geneva: World Health Organization; 2013.

    Google Scholar 

  6. 6.

    Cogswell ME, Zhang Z, Carriquiry AL, Gunn JP, Kuklina EV, Saydah SH, et al. Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr. 2012;96:647–57.

    CAS  Article  Google Scholar 

  7. 7.

    University of Otago and Ministry of Health. Methodology report for the 2008/09 New Zealand Adult Nutrition Survey. Wellington: Ministry of Health; 2011.

    Google Scholar 

  8. 8.

    Sanchez-Castillo CP, Branch WJ, James WPT. A test of the validity of the lithium-marker technique for monitoring dietary sources of salt in man. Clin Sci. 1987;72:87–94.

    CAS  Article  Google Scholar 

  9. 9.

    World Health Organization. The SHAKE technical package for salt reduction.. Geneva: World Health Organization; 2016.

    Google Scholar 

  10. 10.

    Joint Health Surveys Unit. A survey of 24 h and spot urinary sodium and potassium excretion in a representative sample of the Scottish population. National Centre for Social Research. 2007. www.food.gov.uk/multimedia/pdfs/scotlandsodiumreport.pdf

  11. 11.

    Hawkes C, Webster J. National approaches to monitoring population salt intake: a trade-off between accuracy and practicality? PLoS ONE. 2012;7:e46727.

    CAS  Article  Google Scholar 

  12. 12.

    Mente A, O’Donnell M, Rangarajan S, Dagenais G, Lear S, McQueen M, et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. Lancet. 2016;388:465–75.

    CAS  Article  Google Scholar 

  13. 13.

    Huang L, Crino M, Wu JHY, Woodward M, Barzi F, Land M-A, et al. Mean population salt intake estimated from 24-h urine samples and spot urine samples: a systematic review and meta-analysis. Int J Epidemiol. 2016;45:239–50.

    Article  Google Scholar 

  14. 14.

    Cogswell ME, Wang C-Y, Chen T-C, Pfeiffer CM, Elliott P, Gillespie CD, et al. Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18–39 y. Am J Clin Nutr. 2013;98:1502–13.

    CAS  Article  Google Scholar 

  15. 15.

    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327:307–10.

    Article  Google Scholar 

  16. 16.

    Gemming L, Jiang Y, Swinburn B, Utter J, Ni Mhurchu C. Under-reporting remains a key limitation of self-reported dietary intake: an analysis of the 2008/09 New Zealand Adult Nutrition Survey. Eur J Clin Nutr. 2013;68:259–64.

    Article  Google Scholar 

  17. 17.

    Swinburn B, Ley S, Carmichael H, Plank L. Body size and composition in polynesians. Int J Obes. 1999;23:1178–83.

    CAS  Article  Google Scholar 

  18. 18.

    Swinburn BA, Ley SJ, Carmichael HE, Plank LD. Body size and composition in polynesians. Int J Obes. 1999;23:1178–83.

    CAS  Article  Google Scholar 

  19. 19.

    Bogardus C, Lillioja S, Ravussin E, Abbott W, Zawadzki JK, Young A, et al. Familial dependence of the resting metabolic rate. New Engl J Med. 1986;315:96–100.

    CAS  Article  Google Scholar 

  20. 20.

    Black A. The sensitivity and specificity of the Goldberg cut-off for EI: BMR for identifying diet reports of poor validity. Eur J Clin Nutr. 2000;54:395.

    CAS  Article  Google Scholar 

  21. 21.

    Cogswell ME, Maalouf J, Elliott P, Loria CM, Patel S, Bowman BA. Use of urine biomarkers to assess sodium intake: challenges and opportunities. Annu Rev Nutr. 2015;35:349–87.

    CAS  Article  Google Scholar 

  22. 22.

    Mercado CI, Cogswell ME, Valderrama AL, Wang C-Y, Loria CM, Moshfegh AJ, et al. Difference between 24-h diet recall and urine excretion for assessing population sodium and potassium intake in adults aged 18–39 y. Am J Clin Nutr. 2015;101:376–86.

    CAS  Article  Google Scholar 

  23. 23.

    Sivakumaran S, Huffman L, Sivakumaran S. The New Zealand Food Composition Database: a useful tool for assessing New Zealanders’ nutrient intake. Food Chem. 2016;238:101–10.

    Article  Google Scholar 

  24. 24.

    Dennis B, Stamler J, Buzzard M, Conway R, Elliott P, Moag-Stahlberg A, et al. INTERMAP: the dietary data—process and quality control. J Hum Hypertens. 2003;17:609–22.

    CAS  Article  Google Scholar 

  25. 25.

    De Keyzer W, Dofkova M, Lillegaard ITL, De Maeyer M, Andersen LF, Ruprich J, et al. Reporting accuracy of population dietary sodium intake using duplicate 24 h dietary recalls and a salt questionnaire. Br J Nutr. 2015;113:488–97.

    Article  Google Scholar 

  26. 26.

    Zhou L, Tian Y, Fu J-J, Jiang Y-Y, Bai Y-M, Zhang Z-H, et al. Validation of spot urine in predicting 24-h sodium excretion at the individual level. Am J Clin Nutr. 2017;105:1291–6.

    CAS  PubMed  Google Scholar 

  27. 27.

    McLean R, Williams S, Mann J. Monitoring population sodium intake using spot urine samples: validation in a New Zealand population. J Hum Hypertens. 2014;28:657–62.

    CAS  Article  Google Scholar 

  28. 28.

    Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA, Bingham S, et al. Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol. 2003;158:1–13.

    Article  Google Scholar 

  29. 29.

    Brown IJ, Dyer AR, Chan Q, Cogswell ME, Ueshima H, Stamler J, et al. Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in western populations: the INTERSALT study. Am J Epidemiol. 2013;177:1180–92.

    Article  Google Scholar 

  30. 30.

    Allen NB, Zhao L, Loria CM, Van Horn L, Wang C-Y, Pfeiffer CM, et al. The validity of predictive equations for 24-hour sodium excretion: the MESA and CARDIA uniary sodium study. Am J Epidemiol. 2017;186:149–59. kwx056

    Article  Google Scholar 

  31. 31.

    Thomson CD, Colls AJ. Twenty-four hour urinary sodium excretion in seven hundred residents of Otago and Waikato. Dunedin: University of Otago; 1998.

    Google Scholar 

  32. 32.

    McLean R, Edmonds J, Williams S, Mann J, Skeaff SA. Balancing sodium and potassium: estimates of intake in a new zealand adult population sample. Nutrients. 2015;7:8930–8.

    CAS  Article  Google Scholar 

  33. 33.

    Freedman LS, Kipnis V, Schatzkin A, Tasevska N, Potischman N. Can we use biomarkers in combination with self-reports to strengthen the analysis of nutritional epidemiologic studies? Epidemiol Perspect Innov. 2010;7:2.

    Article  Google Scholar 

  34. 34.

    Willett WC, Hu FB. Not the time to abandon the food frequency questionnaire: point. Cancer Epidemiol Biomarkers Prev. 2006;15:1757–8.

    Article  Google Scholar 

  35. 35.

    Prentice RL, Huang Y, Neuhouser ML, Manson JE, Mossavar-Rahmani Y, Thomas F, et al. Associations of biomarker-calibrated sodium and potassium intakes with cardiovascular disease risk among postmenopausal women. Am J Epidemiol. 2017;186:1035–43.

    Article  Google Scholar 

  36. 36.

    Huang Y, Van Horn L, Tinker LF, Neuhouser ML, Carbone L, Mossavar-Rahmani Y, et al. Measurement error corrected sodium and potassium intake estimation using 24-hour urinary excretion. Hypertension. 2014;63:238–44.

    CAS  Article  Google Scholar 

  37. 37.

    Mente A, O’Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, et al. Association of urinary sodium and potassium excretion with blood pressure. New Engl J Med. 2014;371:601–11.

    Article  Google Scholar 

  38. 38.

    Terry AL, Cogswell ME, Wang C-Y, Chen T-C, Loria CM, Wright JD, et al. Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey. Am J Clin Nutr. 2016;104:480–8.

    CAS  Article  Google Scholar 

  39. 39.

    Thomson BM, Vannoort RW, Haslemore RM. Dietary exposure and trends of exposure to nutrient elements iodine, iron, selenium and sodium from the 2003-4 New Zealand Total Diet Survey. Br J Nutr. 2008;99:614.

    CAS  Article  Google Scholar 

  40. 40.

    Poslusna K, Ruprich J, de Vries JH, Jakubikova M, van’t Veer P. Misreporting of energy and micronutrient intake estimated by food records and 24 h recalls, control and adjustment methods in practice. Br J Nutr. 2009;101(S2):S73–S85.

    CAS  Article  Google Scholar 

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The New Zealand Ministry of Health funded the 2008/09 New Zealand Adult Nutrition Survey. The New Zealand Crown is the owner of the copyright of the survey data. The results presented in this paper are the work of the authors.

Author contributions

R.M.M. designed the study, analysed the data and wrote the manuscript. S.M.W. advised on study design, data analysis and contributed to the writing of the manuscript. L.A.T.M. analysed the data, advised on study design and contributed to the writing and reviewing of the manuscript. J.I.M. advised on study design reviewed the manuscript.

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Correspondence to Rachael M McLean.

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McLean, R.M., Williams, S.M., Te Morenga, L.A. et al. Spot urine and 24-h diet recall estimates of dietary sodium intake from the 2008/09 New Zealand Adult Nutrition Survey: a comparison. Eur J Clin Nutr 72, 1120–1127 (2018). https://doi.org/10.1038/s41430-018-0176-0

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