Estimating Sodium and Potassium Intakes and Their Ratio in the American Diet: Data from the 2011–2012 NHANES 1 2 3 4

Background: The dietary sodium-to-potassium ratio (Na:K) is shown to be more strongly associated with an increased risk of cardiovascular disease (CVD) and CVD-related mortality than either sodium or potassium intake alone. Objective: The aim was to estimate the Na:K in the diet of US adults. Methods: Among US adults from the 2011–2012 NHANES (≥20 y; 2393 men and 2337 women), the National Cancer Institute method was used to estimate sodium and potassium intakes, Na:K, and the percentage of individuals with Na:K <1.0 utilizing the complex, stratified, multistage probability cluster sampling design. Results: Overall, women had a significantly lower Na:K than men (mean ± SE: 1.32 ± 0.02 compared with 1.45 ± 0.02). Non-Hispanic whites had a significantly lower Na:K than non-Hispanic blacks and non-Hispanic Asians (1.34 ± 0.02 compared with 1.54 ± 0.03 and 1.49 ± 0.04, respectively). Only 12.2% ± 1.5% of US adults had a Na:K < 1.0. The Na:K decreased linearly as age increased. Most adults (90% ± 0.8%) had sodium intakes >2300 mg/d, whereas <3% had potassium intakes >4700 mg/d. Grains and vegetables were among the highest contributors to sodium intakes for adults with Na:K < 1.0, compared with protein foods and grains for those with Na:K ≥ 1.0. Vegetables and milk and dairy products constituted the primary dietary sources of potassium for individuals with Na:K < 1.0, whereas mixed dishes and protein foods contributed the most potassium for individuals with ratios ≥1.0. Individuals with a Na:K < 1.0 were less likely to consume mixed dishes and condiments and were more likely to consume vegetables, milk and dairy products, and fruit than those with a Na:K ≥ 1.0. Conclusion: Only about one-tenth of US adults have a Na:K consistent with the WHO guidelines for reduced risk of mortality. Continued efforts to reduce sodium intake in tandem with novel strategies to increase potassium intake are warranted.