Nutrition has complex associations with health, including non-communicable disease (NCD). Therefore, dietary modification may prevent or delay NCD. Until now, the primary focus was sodium, where data are inconsistent, and potassium was forgotten. Potassium (diet or supplements) includes salts with multiple anions. Urinary excretion accounts for 70% of intake and ignores sources or indices of potassium, which impact metabolism. It is essential that we better understand the sources, mechanisms, benefits, harms and feasibility of higher potassium intake. Although potassium-based salt substitutes are beneficial in China (where discretionary salt use is high), findings may not translate where discretionary salt use is low). Through SHIP, I will utilise multi-level modelling approaches to determine levels of dietary intake, including predominant sources, at global, regional and economic levels within the Prospective Urban Rural Epidemiology (PURE) study, a large, international cohort study with rich dietary data (country-specific, validated, 95-250 item food frequency questionnaires). Second, I will explore global and regional differences in relative intake (as an index of nutrients or foods). Third, I will generate novel mechanistic insights into the physiology of potassium intake by exploring associations with ~1000 protein biomarkers, using novel analytic approaches including Mendelian Randomisation, in a nested case-cohort study within PURE. Finally, I will estimate the overarching association between potassium and health (cardiovascular disease, kidney disease, hospitalisations, cognition, function and mortality). My programme will provide novel mechanistic insights, inform dietary recommendations and population-level interventions to reduce NCD.
