Association Between Dietary Sodium, Potassium Intake and Lung Cancer Risk

Evidence From The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and The Women's Health Initiative

Dongfang You; Mingzhi Zhang; Wenjing He; Danhua Wang; Yang Yu; Zhaolei Yu; Theis Lange; Sheng Yang; Yongyue Wei; Hongxia Ma; Zhibin Hu; Hongbing Shen; Feng Chen; Yang Zhao


Transl Lung Cancer Res. 2021;10(1):45-56. 

In This Article

Abstract and Introduction


Background: Epidemiological studies have reported that dietary mineral intake plays an important role on lung cancer risk, but the association of sodium, potassium intake is still unclear.

Methods: We determined the association between dietary sodium, potassium intake and lung cancer risk based on the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial and the Women's Health Initiative (WHI). Totally 165,409 participants who completed the baseline questionnaire (BQ) and diet history questionnaire (DHQ) were included into the analytical dataset, including 92,984 (44,959 men and 48,025 women) from the PLCO trial and 72,425 (women only) from the WHI cohort. Multivariable Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident lung cancer associated with dietary potassium and sodium intake. The dose-response relationship was also described using the spline smoothed curve after adjusting covariates.

Results: After the median follow-up of 8.55 and 18.56 years, 1,278 and 1,631 new cases of lung cancer were identified in the PLCO trial and WHI cohort, respectively. Intake of sodium was significantly associated with the incidence of lung cancer in the PLCO trial after multivariate adjustment for men (HR: 1.19, 95% CI: 1.05–1.35; P for linear trend =0.044). There was a suggestion that lung cancer risk had a quadratic curve correlation with the increase of potassium intake for women (third vs. lowest quintile: HR: 0.72, 95% CI: 0.54–0.96; P for quadratic trend =0.042). The similar results showing an inverse association between potassium intake and lung cancer risk were also observed in the WHI cohort for women (highest vs. lowest quintile: HR: 0.82, 95% CI: 0.70–0.97; P for linear trend =0.009).

Conclusions: Appropriate intake of potassium has a protective effect against lung cancer, while high consumption of sodium is associated with an increased risk of lung cancer.


Lung cancer is the most frequent malignant cancer and the leading cause of cancer mortality worldwide,[1] with 2.1 million new cases accounting for 11.6% of the total new cancer cases and 1.8 million deaths accounting for 18.4% of the total cancer deaths predicted in 2018.[2] Previous studies have identified the risk factors contributing to the occurrence of lung cancer, such as cigarette smoking, gender and air pollution.[3]

Recently, emerging evidence has suggested that intake of dietary minerals may have an impact on the incidence of lung cancer. It was found that both a higher zinc and iron intake was associated with a reduced risk of lung cancer.[4,5] Similar protective effects of zinc were also reported in three large case-control studies. For the association between calcium intake and lung cancer risk, however, the findings were inconsistent. An increased risk of lung cancer risk on calcium intake was identified in a case-control study by Zhou et al., while an inverse association was found in the National Cancer Institute (NIH)-American Association of Retired Persons Diet and Health study.[6] Moreover, several studies also showed that both copper and selenium may decrease the risk of lung cancer.[7]

Potassium and sodium are two of the necessary trace elements in the human body, which are mainly derived from diet. Previously, several studies reported that high intake of potassium was negatively related to the occurrence of colorectal cancer, and high sodium consumption could increase the risk of renal cell cancer, colorectal cancer, and gastric cancer.[8–11] However, there are few studies on the relationship between potassium, sodium intake and the risk of lung cancer.

In the present study, we aimed to evaluate whether dietary potassium, sodium intake was associated with lung cancer risk using the data from both the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial and the observational study of the Women's Health Initiative (WHI).

The authors present the following article in accordance with the STROBE reporting checklist (available at