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Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers--Reply.

the dose-response association between sodium intake and outcomes.1,2 On the other hand, limited precision does dilute regression estimates, and this might have weakened the association with the outcomes of interest in our study. We also agree that statistical power was limited in the high sodium intake group. We categorized sodium intake using cutoff points driven by the current US recommendations to facilitate clinical interpretation. We would have liked to analyze a very high sodium intake subgroup, but the number of participants was too small to provide stable estimates. The small numbers in the very high sodium subgroup are potentially related to underestimation of sodium intake with FFQ. On the other hand, the dose-response association across the range of reported intakes is evident in the spline graph (Figure 1) provided in the main article.3 The point about potassium is important and supported by the recently reported findings from O’Donnell and colleagues.2 To address this comment, we evaluated self-reported potassium intake in our cohort. The median daily intake was 2750 mg (2130-3500 mg/d), which is comparable to other cohorts.2,4 However, we did not observe any significant association (either crude or adjusted) between self-reported potassium intake and risk of mortality, cardiovascular disease, or heart failure in the Health ABC Study (unpublished data). This may have to do with the limitations of self-reporting as discussed above, or with the fact that our cohort consists of considerably older participants compared with the aforementioned cohorts.2,4 Of note, sodium and potassium intakes were estimated using an FFQ in the study by Umesawa and colleagues.4 We agree that changing dietary habits over time could have led to regression dilution in our cohort. Without multiple dietary assessments, we are not able to rule this out. However, after explicit testing, we did not observe any time-dependent effects of baseline dietary sodium intake on study outcomes. Finally, we agree that high sodium intake has important physiologic effects. However, the increase in monocytes observed by Yi and colleagues was evident only in the 12-g/d salt group,5 which corresponds to twice the amount of the currently recommended intake for the general population. Similarly, the high sodium intake group in the study by Zhou and colleagues6 was consuming 15 g/d of salt. These data actually are in concordance with the aforementioned large-scale studies that observed association with harm only at dietary sodium intake levels exceeding 4000 mg/d,1,2 highlighting the need for prospective clinical trials to establish optimal sodium intake levels.