Formulas developed based on the ratio of urea nitrogen to creatinine concentrations obtained from multiple spot urine samples are acceptable to predict protein intake at group level but not at individual level

In this study, we hypothesized that spot urine can be used to predict protein intake at both group and individual levels. Participants (n = 369) of this study were recruited from all 47 prefectures in Japan. Sex-specific formulas were developed based on the ratio of urea nitrogen to creatinine concentration obtained from 3 spot urine samples. Validity of the formulas was examined against two 24-hour urine collections for 7 combinations of spot urine (single and means of 2 or 3 samples) using t test (mean estimation), Spearman correlation, and Bland-Altman plot (individual bias). Means of measured protein intake based on 24-hour urinary excretions were 87.3 g/d (standard deviation 19.7) for men and 70.5 g/d (standard deviation 14.7) for women. Irrespective of sex, the predicted intakes were not significantly different (within 2.7% of differences) from those measured by urinary excretions. Predicted intakes were moderately correlated with measured intakes (men, 0.45-0.60; women, 0.35-0.53). Even after using the mean of 3 samples, Bland-Altman plots showed a considerably wide limit of agreement (men, -30 to 33 g/d; women, -27 to 24 g/d). Except for using single spot urine samples in women, the formula tended to overestimate intake at a lower and underestimate at a higher level of protein intake (slope: men, -0.47 [P < .0001]; women, -0.38 [P = .002)). In conclusion, predictive formulas developed in this study can be used to predict protein intake at group level or to rank individuals' intake but not to predict absolute intake at individual level. (C) 2020 Elsevier Inc. All rights reserved.