{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:56:42Z","timestamp":1778623002143,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea (NRF)","doi-asserted-by":"publisher","award":["2021R1I1A3046386"],"award-info":[{"award-number":["2021R1I1A3046386"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Occupational Safety and Health Research Institute","award":["2021R1I1A3046386"],"award-info":[{"award-number":["2021R1I1A3046386"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Evidence for the association between high sodium intake and the onset of nonalcoholic fatty liver disease (NAFLD) is insufficient. This study examined the sex-specific association between sodium intake and the risk of NAFLD. This study included 2582 adults (aged 40\u201369 years; 1011 males and 1571 females). The total sodium excreted over 24 h was estimated from spot urine specimens using Tanaka\u2019s equation. Based on these estimates, participants were categorized into three groups according to their 24-h urinary sodium excretion levels: lowest (T1), middle (T2), and highest (T3). In addition, the participants were divided into non-NAFLD (\u226436) and NAFLD (&gt;36) groups based on the hepatic steatosis index. During the follow-up period (14 years), NAFLD was observed in 551 participants. The estimated 24-h urinary sodium excretion levels were positively associated with the incidence of NAFLD in all subjects. Upon sex stratification, females in the T2 and T3 groups exhibited adjusted hazard ratios of 1.35 and 1.51, respectively, compared with the T1 group. However, a significant relationship was not observed in males. High intake of sodium, especially among females, may be an important factor contributing to the development of NAFLD. Individuals with high sodium intake should be appropriately counselled and monitored for the risk of NAFLD.<\/jats:p>","DOI":"10.3390\/nu16040548","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T06:00:25Z","timestamp":1708063225000},"page":"548","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sex-Specific Association between Sodium Intake Estimated by 24-Hour Urinary Sodium Excretion and Nonalcoholic Fatty Liver Disease: The Community-Based Prospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-6698","authenticated-orcid":false,"given":"Jihye","family":"Lee","sequence":"first","affiliation":[{"name":"Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan 44429, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-2052","authenticated-orcid":false,"given":"Ju-Yeon","family":"Lee","sequence":"additional","affiliation":[{"name":"College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-1534","authenticated-orcid":false,"given":"Yun-Jung","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Convergence Science, College of Medicine, Catholic Kwandong University International St. Mary\u2019s Hospital, Incheon 22711, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/14656566.2017.1413346","article-title":"Ipragliflozin and sodium glucose transporter 2 inhibitors to reduce liver fat: Will the prize we sought be won?","volume":"19","author":"Pafili","year":"2018","journal-title":"Expert. Opin. Pharmacother."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1007\/s00125-016-3952-1","article-title":"Treatment of patients with type 2 diabetes and non-alcoholic fatty liver disease: Current approaches and future directions","volume":"59","author":"Cusi","year":"2016","journal-title":"Diabetologia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101122","DOI":"10.1016\/j.molmet.2020.101122","article-title":"Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans","volume":"50","author":"Pafili","year":"2021","journal-title":"Mol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1001\/jama.2015.5370","article-title":"Nonalcoholic fatty liver disease: A systematic review","volume":"313","author":"Rinella","year":"2015","journal-title":"JAMA"},{"key":"ref_6","first-page":"447","article-title":"Non-alcoholic fatty liver disease: Epidemiology, clinical course, investigation, and treatment","volume":"111","author":"Weiss","year":"2014","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5219","DOI":"10.2174\/13816128113199990381","article-title":"Genetic predisposition in NAFLD and NASH: Impact on severity of liver disease and response to treatment","volume":"19","author":"Dongiovanni","year":"2013","journal-title":"Curr. Pharm. Des."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3377","DOI":"10.3748\/wjg.v17.i29.3377","article-title":"Nutrition and physical activity in NAFLD: An overview of the epidemiological evidence","volume":"17","author":"Ratziu","year":"2011","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/MCG.0b013e31824cf51e","article-title":"The role of nutrients in the development, progression, and treatment of nonalcoholic fatty liver disease","volume":"46","author":"Mouzaki","year":"2012","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1210\/jc.2014-3678","article-title":"Effect of a High-Fructose Weight-Maintaining Diet on Lipogenesis and Liver Fat","volume":"100","author":"Schwarz","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1093\/qjmed\/hcv172","article-title":"Associations of sugar- and artificially sweetened soda with nonalcoholic fatty liver disease: A systematic review and meta-analysis","volume":"109","author":"Wijarnpreecha","year":"2016","journal-title":"QJM Int. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/1541-4337.12524","article-title":"Reduced-sodium cheeses: Implications of reducing sodium chloride on cheese quality and safety","volume":"19","author":"Bansal","year":"2020","journal-title":"Compr. Rev. Food Sci. Food Saf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1038\/s41371-022-00690-0","article-title":"2022 World Hypertension League, Resolve to Save Lives and International Society of Hypertension dietary sodium (salt) global call to action","volume":"37","author":"Campbell","year":"2023","journal-title":"J. Hum. Hypertens."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"382","DOI":"10.4162\/nrp.2021.15.3.382","article-title":"Trends in sodium intake and major contributing food groups and dishes in Korea: The Korea National Health and Nutrition Examination Survey 2013-2017","volume":"15","author":"Jeong","year":"2021","journal-title":"Nutr. Res. Pract."},{"key":"ref_15","unstructured":"WHO (2012). Guideline: Sodium Intake for Adults and Children, WHO."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/09637486.2016.1239700","article-title":"Salt and obesity: A systematic review and meta-analysis of observational studies","volume":"68","author":"Moosavian","year":"2017","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/cen.12225","article-title":"High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome","volume":"80","author":"Baudrand","year":"2014","journal-title":"Clin. Endocrinol."},{"key":"ref_18","first-page":"402","article-title":"Association between salt and hypertension in rural and urban populations of low to middle income countries: A systematic review and meta-analysis of population based studies","volume":"25","author":"Subasinghe","year":"2016","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s00125-005-1824-1","article-title":"Urinary sodium and potassium excretion and the risk of type 2 diabetes: A prospective study in Finland","volume":"48","author":"Hu","year":"2005","journal-title":"Diabetologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5049\/EBP.2014.12.1.7","article-title":"Dietary salt intake and hypertension","volume":"12","author":"Ha","year":"2014","journal-title":"Electrolyte Blood Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.clnu.2012.01.003","article-title":"Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies","volume":"31","author":"Rossi","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Huh, J.H., Lee, K.J., Lim, J.S., Lee, M.Y., Park, H.J., Kim, M.Y., Kim, J.W., Chung, C.H., Shin, J.Y., and Kim, H.S. (2015). High Dietary Sodium Intake Assessed by Estimated 24-h urinary sodium Excretion Is Associated with NAFLD and Hepatic Fibrosis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143222"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1017\/S0007114516003391","article-title":"Dietary sodium and potassium intake in relation to non-alcoholic fatty liver disease","volume":"116","author":"Choi","year":"2016","journal-title":"Br. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"456","DOI":"10.5009\/gnl220133","article-title":"High Sodium Intake, as Assessed by Urinary sodium Excretion, Is Associated with Nonalcoholic Fatty Liver Disease or Sarcopenia","volume":"17","author":"Han","year":"2023","journal-title":"Gut Liver"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1017\/S136898001900483X","article-title":"Association between dietary sodium intake and non-alcoholic fatty liver disease in the US population","volume":"24","author":"Zhou","year":"2021","journal-title":"Public Health Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1093\/ije\/dyv316","article-title":"Cohort Profile: The Korean Genome and Epidemiology Study (KoGES) Consortium","volume":"46","author":"Kim","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1038\/sj.jhh.1001307","article-title":"A simple method to estimate populational 24-h urinary sodium and potassium excretion using a casual urine specimen","volume":"16","author":"Tanaka","year":"2002","journal-title":"J. Hum. Hypertens."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.dld.2009.08.002","article-title":"Hepatic steatosis index: A simple screening tool reflecting nonalcoholic fatty liver disease","volume":"42","author":"Lee","year":"2010","journal-title":"Dig. Liver Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.7326\/0003-4819-145-4-200608150-00004","article-title":"Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate","volume":"145","author":"Levey","year":"2006","journal-title":"Ann. Intern. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1038\/s41574-021-00538-6","article-title":"Hepatic sexual dimorphism\u2014Implications for non-alcoholic fatty liver disease","volume":"17","author":"Lefebvre","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1007\/s12325-017-0556-1","article-title":"NAFLD as a Sexual Dimorphic Disease: Role of Gender and Reproductive Status in the Development and Progression of Nonalcoholic Fatty Liver Disease and Inherent Cardiovascular Risk","volume":"34","author":"Ballestri","year":"2017","journal-title":"Adv. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lonardo, A., and Suzuki, A. (2020). Sexual Dimorphism of NAFLD in Adults. Focus on Clinical Aspects and Implications for Practice and Translational Research. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051278"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1038\/jhh.2012.43","article-title":"Sodium and potassium intake patterns and trends in South Korea","volume":"27","author":"Lee","year":"2013","journal-title":"J. Hum. Hypertens."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1111\/jhn.12674","article-title":"Prospective study of perceived dietary salt intake and the risk of non-alcoholic fatty liver disease","volume":"32","author":"Shen","year":"2019","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Van den Berg, E.H., Gruppen, E.G., Blokzijl, H., Bakker, S.J.L., and Dullaart, R.P.F. (2019). Higher Sodium Intake Assessed by 24 Hour Urinary sodium Excretion Is Associated with Non-Alcoholic Fatty Liver Disease: The PREVEND Cohort Study. J. Clin. Med., 8.","DOI":"10.3390\/jcm8122157"},{"key":"ref_37","first-page":"2038","article-title":"Nutritional Status, Diet and Non-Alcoholic Fatty Liver Disease in Elders","volume":"32","year":"2015","journal-title":"Nutr. Hosp."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1440-1746.2005.04086.x","article-title":"Prevalence and risk factors of non-alcoholic fatty liver disease among Korean adults","volume":"21","author":"Park","year":"2006","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s00535-012-0533-z","article-title":"Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: A multicenter large retrospective study","volume":"47","author":"Eguchi","year":"2012","journal-title":"J. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1365-2265.2006.02543.x","article-title":"Effects of HRT on liver enzyme levels in women with type 2 diabetes: A randomized placebo-controlled trial","volume":"65","author":"McKenzie","year":"2006","journal-title":"Clin. Endocrinol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Grillo, A., Salvi, L., Coruzzi, P., Salvi, P., and Parati, G. (2019). Sodium Intake and Hypertension. Nutrients, 11.","DOI":"10.3390\/nu11091970"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1038\/nrcardio.2010.123","article-title":"Salt, aldosterone, and insulin resistance: Impact on the cardiovascular system","volume":"7","author":"Lastra","year":"2010","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Rinaldi, L., Pafundi, P.C., Galiero, R., Caturano, A., Morone, M.V., Silvestri, C., Giordano, M., Salvatore, T., and Sasso, F.C. (2021). Mechanisms of Non-Alcoholic Fatty Liver Disease in the Metabolic Syndrome. A Narrative Review. Antioxidants, 10.","DOI":"10.3390\/antiox10020270"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"5252","DOI":"10.1016\/j.clnu.2021.08.012","article-title":"Dairy protein intake is inversely related to development of non-alcoholic fatty liver disease","volume":"40","author":"Lee","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1093\/alcalc\/agh074","article-title":"High AST\/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking","volume":"39","author":"Nyblom","year":"2004","journal-title":"Alcohol Alcohol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/4\/548\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:00:44Z","timestamp":1760104844000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/4\/548"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,16]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["nu16040548"],"URL":"https:\/\/doi.org\/10.3390\/nu16040548","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,16]]}}}