In reply
My coauthors and I appreciate the interest of Drs Engelman and Mattes in our recent publication on dietary sodium intake and risk of congestive heart failure.1 We agree with them on the limitations of dietary data from the NHANES I Epidemiologic Follow-up Study (NHEFS). However, we do not agree with them on their comments about the impacts of these biases on the study conclusion.
Drs Engelman and Mattes have reemphasized the issues that we have already discussed in our article. In summary, there are 3 major limitations with NHEFS dietary data. First, the dietary sodium intake was estimated by a single 24-hour dietary recall. This might result in misclassification of usual sodium intake at the individual level. In theory, multiple 24-hour urinary excretions of sodium provide the best estimates of dietary intake.2 However, it is not feasible to collect multiple 24-hour urinary specimens in a large population for . . . [Full Text of this Article]
