Abstract
Background/Objectives: In a demographic increasingly at risk of obesity and hypertension, whether dietary behaviours associated with hypertension prevention, such as restricting salt intake and consuming potassium-rich fruits and vegetables, contribute to obesity prevention is unclear. Therefore, we aimed to investigate the structural associations of dietary salt restriction practices with body mass index (BMI) and the mediating role of the dietary sodium/potassium (Na/K) ratio in middle-aged and older Japanese adults. Methods: This cross-sectional survey included 418 participants aged 40-69 years, residing in Hyogo, Japan. Simultaneous multi-population analysis according to sex was performed using a hypothetical model to explore associations of dietary salt restriction practices with BMI, mediated by the dietary Na/K ratio, as well as the role of BMI-related eating behaviours. Results: Dietary salt restriction was associated with a low dietary Na/K ratio (standardised estimate: -0.21, p = 0.001 for men; -0.19, p = 0.002 for women) in both sexes. Dietary salt restriction was associated with lower values of BMI in men (0.21, p = 0.004), mediated by the Na/K ratio; a direct but relatively weak association with lower values of BMI was observed in women (-0.16, p = 0.018). In men, eating out frequently was associated with higher values of BMI (0.20, p = 0.005). Conclusions: Dietary salt restriction practices in middle-aged and older adults may contribute to obesity prevention, and dietary Na/K ratio may play a mediating role in men but not in women; additionally, eating out was associated with higher values of BMI in men.