Drinking Water Salinity, Urinary Macro-Mineral Excretions, and Blood Pressure in the Southwest Coastal Population of Bangladesh

• Type of Material: Article
• Authors: Abu Mohd Naser, Emory University; Mahbubur Rahman, International Centre for Diarrhoeal Disease Research Bangladesh; Leanne Unicomb, International Centre for Diarrhoeal Disease Research Bangladesh; Solaiman Doza, International Centre for Diarrhoeal Disease Research Bangladesh; Mohammed Shahid Gazi, International Centre for Diarrhoeal Disease Research Bangladesh; Gazi Raisul Alam, International Centre for Diarrhoeal Disease Research Bangladesh; Mohammed Rabiul Karim, International Centre for Diarrhoeal Disease Research Bangladesh; Mohammad Nasir Uddin, International Centre for Diarrhoeal Disease Research Bangladesh; Golam Kibria Khan, International Centre for Diarrhoeal Disease Research Bangladesh; Kazi Matin Ahmed, University of Dhaka; Mohammad Shamsudduha, University College London; Shuchi Anand, Stanford University; Kabayam Venkat Narayan, Emory University; Howard Chang, Emory University; Stephen P. Luby, Stanford University; Matthew Gribble, Emory University; Thomas Clasen, Emory University
• Language: English
• Date: 2019-05-07
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.119.012007
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 8
• Issue: 9
• Start Page: e012007
• End Page: e012007
• Grant/Funding Information: This research was funded by Wellcome Trust, UK, Our Planet, Our Health Award (Grant # 106871/Z/15/Z).
• Keywords: sodium; calcium; drinking water salinity; potassium; water salinity; blood pressure; magnesium
• Research Categories: Health Sciences, Public Health; Health Sciences, Nutrition

Abstract

Background Sodium (Na+) in saline water may increase blood pressure ( BP ), but potassium (K+), calcium (Ca2+), and magnesium (Mg2+) may lower BP . We assessed the association between drinking water salinity and population BP . Methods and Results We pooled 6487 BP measurements from 2 cohorts in coastal Bangladesh. We used multilevel linear models to estimate BP differences across water salinity categories: fresh water (electrical conductivity, <0.7 mS/cm), mild salinity (electrical conductivity ≥0.7 and <2 mS/cm), and moderate salinity (electrical conductivity ≥2 and <10 mS/cm). We assessed whether salinity categories were associated with hypertension using multilevel multinomial logistic models. Models included participant-, household-, and community-level random intercepts. Models were adjusted for age, sex, body mass index ( BMI ), physical activity, smoking, household wealth, alcohol consumption, sleep hours, religion, and salt consumption. We evaluated the 24-hour urinary minerals across salinity categories, and the associations between urinary minerals and BP using multilevel linear models. Compared with fresh water drinkers, mild-salinity water drinkers had lower mean systolic BP (-1.55 [95% CI : -3.22-0.12] mm Hg) and lower mean diastolic BP (-1.26 [95% CI : -2.21--0.32] mm Hg) adjusted models. The adjusted odds ratio among mild-salinity water drinkers for stage 1 hypertension was 0.60 (95% CI : 0.43-0.84) and for stage 2 hypertension was 0.56 (95% CI : 0.46-0.89). Mild-salinity water drinkers had high urinary Ca2+, and Mg2+, and both urinary Ca2+ and Mg2+ were associated with lower BP. Conclusions Drinking mild-salinity water was associated with lower BP , which can be explained by higher intake of Ca2+ and Mg2+ through saline water.