Association between Acculturation and Sodium to Potassium Ratio and Disparity in Trends by Race/Ethnicity in the U.S.: NHANES 2011-2020

Abstract

Introduction: Racial disparity in sodium to potassium ratio (Na/K) has been documented. However, we have a limited understanding of the association between culture and diet. The goal of this study is to assess the trends in the Na/K ratio by race/ethnicity and to explore the association between acculturation and Na/K ratio in the U.S.Method: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020 (aged ≥14 years). Trend analyses were conducted for each race/ethnicity group and nativity status. A multivariable linear regression model was used to test the association between the Na/K ratio and acculturation measures, adjusting for race/ethnicity, age, sex, BMI, hypertension, energy intake, and seven social determinants of health (SDoH)-related confounders (employment status, income ratio to poverty, food security, education, access to healthcare, healthcare insurance, and marital status). Results: A nationally representative sample of 23,057 participants was included. The Na/K ratio increased from 2011 to 2020 in the overall study population, especially among the US-born non-Hispanic White and non-Hispanic Black groups. However, a significant decreasing trend for non-Hispanic Asians, especially Asians who were born outside the U.S. was observed. Non-Hispanic Asians had the highest sodium intake, whereas non-Hispanic Blacks had the highest Na/K ratio compared to other race/ethnicity groups. Findings from the multivariable linear regression model indicated that the duration of residency in the U.S. was associated with an increased Na/K ratio (p<0.01). Adjusting for confounders, non-Hispanic Asians had the highest Na/K ratio (p<0.001), followed by non-Hispanic Blacks (p<0.001), other or multi-racial group (p<0.05), and Mexican Americans (p<0.05) compared to the non-Hispanic Whites. A higher Na/K ratio was more likely among women, individuals aged 19-30 years, those with suboptimal weight, those with higher energy intake, and those with marginal or lower food security, as well as those with government healthcare insurance or no healthcare insurance. No other significant associations were found between the Na/K ratio and other variables in the regression models. Conclusion: The Na/K ratio increased in the U.S. from 2011 to 2020. Prolonged exposure to the U.S. food environment has a significant impact on consuming excessive sodium and insufficient potassium. However, the findings also suggest that non-Hispanic Asians might be less prone to adapting their dietary habits compared to other race/ethnicity groups. Multi-faceted interventions that address the disparity in races/ethnicity and acculturation statuses are needed to reduce the Na/K ratio. Supplementary: A supplementary file includes a table summarizing study participants aged 14 years and over by NHANES cycle and acculturation measures.