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Fatimatuzahroh D, Farapti F, Dhandapani S. The Association Between Potassium Intake and Obesity: A Systematic Review of Observational Studies. JNFS 2025; 10 (4) :594-602
URL: http://jnfs.ssu.ac.ir/article-1-1287-en.html
URL: http://jnfs.ssu.ac.ir/article-1-1287-en.html
Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia
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The Association between Potassium Intake and Obesity: A Systematic Review of Observational Studies
Dewi Fatimatuzahroh; BSc1, Farapti Farapti; MD, MSc, PhD*1 & Shanthi Dhandapani; MSc, PhD 2
Dewi Fatimatuzahroh; BSc1, Farapti Farapti; MD, MSc, PhD*1 & Shanthi Dhandapani; MSc, PhD 2
1 Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia; 2 Department of Nutrition and Dietetic, School of Health Sciences, Kuala Lumpur 57000, Malaysia.
| ARTICLE INFO | ABSTRACT | |
| SYSTEMATIC REVIEW | Background: Obesity is a global health concern across all age groups, primarily influenced by lifestyle and dietary patterns. Potassium, an essential nutrient is involved in various diseases, including hypertension and cardiovascular disorders. It aids insulin secretion, impacting fat accumulation and obesity. However, the role of potassium in obesity remains underexplored, with inconsistent findings. This systematic review aims to assess the association of potassium intake with obesity. Methods: This study is a systematic review using the keywords "obese" or "overweight" and "potassium" or "obesity" and "potassium intake," with a publication time frame of the last ten years (2014-2024). The articles were retrieved from PubMed, Google Scholar, and ResearchGate. Results: Ten articles analyzed potassium's link to obesity. Four articles examined body composition (fat mass and muscle mass). In comparison, six articles examined assessed Body Mass Index (BMI), with two of these also exploring its relationship with abdominal obesity (AO) (waist circumference (WC) and waist-to-hip ratio). Six articles found that increased potassium intake was associated with lower body weight, BMI, WC, waist-to-hip ratio, or fat mass. Meanwhile, the other four articles suggested that higher potassium intake was linked to an increased risk of obesity. Conclusions: The ten articles on potassium's role in reducing obesity presented inconsistent findings. Most assessed potassium intake alongside sodium (Na: K ratio), which showed more consistent results in reducing obesity. It is recommended that obesity outcomes be evaluated through body composition measures (fat mass, muscle mass, WC) in addition to BMI rather than relying on a single measurement. | |
| Article history: Received: 8 Mar 2025 Revised: 10 Jun 2025 Accepted: 10 Jun 2025 |
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| *Corresponding author: farapti@fkm.unair.ac.id Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia. Postal code: 60115 Tel: +62 85163111103 |
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Keywords: Potassium; Intake; Obesity; Systematic review. |
Introduction
Obesity is defined as having a body mass index (BMI) greater than or equal to 30 kg/m2. Several mechanisms lead to obesity. The usual main cause is the excessive accumulation of body fat stored in fat tissue, leading to weight gain and potential health problems. The excess energy is stored in fat cells, thereby developing the characteristic obesity pathology (Lin and Li, 2021).
According to World Obesity data from 2023, middle-to-upper-income countries, including Indonesia, are expected to see an increase in obesity rates from 19% to 28% in women and from 14% to 27% in men between 2020 and 2035 (World Obesity Federation, 2023). The rising obesity rates have become a major concern for society. Obesity increases the risk of various diseases, including type 2 diabetes, fatty liver disease, osteoarthritis, Alzheimer's disease, depression, and several types of cancer (such as breast, ovarian, prostate, liver, kidney, and colon cancer) (Blüher, 2019). In addition, obesity can lower the quality of life, increase the risk of unemployment, reduce productivity, and lead to social disadvantages (World Obesity Federation, 2023).
Obesity can be prevented and managed through healthy lifestyle changes. In the long term, this can be achieved through regular physical activity and guidance from healthcare professionals. In the short term, significant results can be seen by following a controlled-portion diet (Lin and Li, 2021). According to Yuniarti, eating vegetables and fruits plays an important role in weight management (Yuniarti, 2023). These foods not only help with weight loss but also support overall nutritional balance.
Eating vegetables and fruits provides many health benefits, including increasing the intake of essential nutrients such as potassium, fiber, and vitamin C (Farapti et al., 2022). Potassium intake may help with weight loss since its main sources, vegetables and fruits, are known to support a healthy weight (Tal et al., 2019). Additionally, potassium plays a role in insulin secretion, which can influence fat storage and obesity development in the body (Nichols et al., 2022). Previous studies investigating the association between potassium intake and obesity have reported inconsistent and sometimes conflicting results. While some studies suggest that higher potassium intake may be associated with a lower risk of obesity, others have found no significant relationship. Therefore, this systematic review aims to assess the role of potassium intake in obesity to clarify these inconsistencies and provide a clearer understanding of the relationship.
Materials and Methods
Search strategy
This study is a systematic review that analyzes the association between potassium intake and obesity incidence from PubMed, Google Scholar, and ResearchGate with a publication time limit of the last ten years (2014–2024) using the following search terms “obesity” or “obese” or “overweight” and “potassium” or “potassium intake”. The time limitation was applied to focus on the most recent and relevant evidence, considering that dietary patterns, measurement methods, and obesity prevalence may have changed over time.
Eligibility criteria
The inclusion criteria required that studies explicitly examine the relationship between potassium intake and obesity. Only observational studies published in English and with full-text availability were included. Studies were excluded if they involved experimental designs using animal models or did not align with the topic of interest. The PICO framework used in the systematic review is presented in Table 1.
According to World Obesity data from 2023, middle-to-upper-income countries, including Indonesia, are expected to see an increase in obesity rates from 19% to 28% in women and from 14% to 27% in men between 2020 and 2035 (World Obesity Federation, 2023). The rising obesity rates have become a major concern for society. Obesity increases the risk of various diseases, including type 2 diabetes, fatty liver disease, osteoarthritis, Alzheimer's disease, depression, and several types of cancer (such as breast, ovarian, prostate, liver, kidney, and colon cancer) (Blüher, 2019). In addition, obesity can lower the quality of life, increase the risk of unemployment, reduce productivity, and lead to social disadvantages (World Obesity Federation, 2023).
Obesity can be prevented and managed through healthy lifestyle changes. In the long term, this can be achieved through regular physical activity and guidance from healthcare professionals. In the short term, significant results can be seen by following a controlled-portion diet (Lin and Li, 2021). According to Yuniarti, eating vegetables and fruits plays an important role in weight management (Yuniarti, 2023). These foods not only help with weight loss but also support overall nutritional balance.
Eating vegetables and fruits provides many health benefits, including increasing the intake of essential nutrients such as potassium, fiber, and vitamin C (Farapti et al., 2022). Potassium intake may help with weight loss since its main sources, vegetables and fruits, are known to support a healthy weight (Tal et al., 2019). Additionally, potassium plays a role in insulin secretion, which can influence fat storage and obesity development in the body (Nichols et al., 2022). Previous studies investigating the association between potassium intake and obesity have reported inconsistent and sometimes conflicting results. While some studies suggest that higher potassium intake may be associated with a lower risk of obesity, others have found no significant relationship. Therefore, this systematic review aims to assess the role of potassium intake in obesity to clarify these inconsistencies and provide a clearer understanding of the relationship.
Materials and Methods
Search strategy
This study is a systematic review that analyzes the association between potassium intake and obesity incidence from PubMed, Google Scholar, and ResearchGate with a publication time limit of the last ten years (2014–2024) using the following search terms “obesity” or “obese” or “overweight” and “potassium” or “potassium intake”. The time limitation was applied to focus on the most recent and relevant evidence, considering that dietary patterns, measurement methods, and obesity prevalence may have changed over time.
Eligibility criteria
The inclusion criteria required that studies explicitly examine the relationship between potassium intake and obesity. Only observational studies published in English and with full-text availability were included. Studies were excluded if they involved experimental designs using animal models or did not align with the topic of interest. The PICO framework used in the systematic review is presented in Table 1.
| Table 1. PICO component table. | |
| PICO Component | Considerations |
| Patient population | Individuals of any age or sex |
| Intervention/ Exposure |
Potassium intake (dietary and urinary levels) |
| Comparison | Lower or different potassium intake |
| Outcome | Obesity incidence or prevalence |
Data extraction
The characteristics of the selected articles were collected as follows: the first author's name, publication year, country where the study was conducted, participants' age, sample size, number of cases, method of potassium measurement, gender distribution, outcomes of the association between potassium and obesity, and adjustments made for confounding factors.
Quality assessment
The quality of the included studies using the Newcastle-Ottawa Scale, has a maximum score of nine stars. Studies scoring 0–3 stars were considered low quality, 4–6 stars moderate quality, and 7–9 stars were regarded to have high quality (Cai et al., 2016).
Results
Included studies
The initial search identified a total of 2,757 potentially relevant studies. After removing 1,909 duplicate records, 848 studies remained for screening. Of these, 831 were excluded based on their titles and abstracts, leaving 17 articles for full-text review. Among these, two were excluded due to the use of animal models, and five were not relevant to the study theme. The result was a final selection of 10 articles comprising 8 cross-sectional studies (Chu et al., 2023, Elfassy et al., 2018, Ferguson et al., 2023, Ge et al., 2016, Lee et al., 2020, Liu et al., 2023, Rafie et al., 2019, Wang et al., 2023) and 2 cohort studies (Tal et al., 2019, Yeung et al., 2022) for the systematic review, as presented in Figure 1.
The characteristics of the selected articles were collected as follows: the first author's name, publication year, country where the study was conducted, participants' age, sample size, number of cases, method of potassium measurement, gender distribution, outcomes of the association between potassium and obesity, and adjustments made for confounding factors.
Quality assessment
The quality of the included studies using the Newcastle-Ottawa Scale, has a maximum score of nine stars. Studies scoring 0–3 stars were considered low quality, 4–6 stars moderate quality, and 7–9 stars were regarded to have high quality (Cai et al., 2016).
Results
Included studies
The initial search identified a total of 2,757 potentially relevant studies. After removing 1,909 duplicate records, 848 studies remained for screening. Of these, 831 were excluded based on their titles and abstracts, leaving 17 articles for full-text review. Among these, two were excluded due to the use of animal models, and five were not relevant to the study theme. The result was a final selection of 10 articles comprising 8 cross-sectional studies (Chu et al., 2023, Elfassy et al., 2018, Ferguson et al., 2023, Ge et al., 2016, Lee et al., 2020, Liu et al., 2023, Rafie et al., 2019, Wang et al., 2023) and 2 cohort studies (Tal et al., 2019, Yeung et al., 2022) for the systematic review, as presented in Figure 1.
Study characteristics
Some studies assessed multiple outcomes. Among the 10 articles examining the relationship between potassium intake and obesity, four studies evaluated body composition (fat mass and muscle mass). In contrast, six studies assessed BMI, with two of them also exploring its relationship with WC and waist-to-hip ratio. Six studies found that higher potassium intake was associated with lower body weight, BMI, WC, waist-to-hip ratio, or fat mass. Meanwhile, the other four studies suggested that increased potassium intake was linked to a higher risk of obesity. Previous studies assessed potassium intake using a food frequency questionnaire (FFQ), with some studies validating the FFQ data using 24-hour dietary recall. Additionally, some studies relied solely on 24-hour urine samples.
The largest study population included 16,558 participants, while the smallest study comprised 68 participants. In total, 55,980 participants (8,601 from cohort studies and 47,379 from cross-sectional studies) were analyzed, and all articles included both genders. The studies were published between 2014 and 2024 across various countries, including China (Chu et al., 2023, Ge et al., 2016, Liu et al., 2023), the United States (Elfassy et al., 2018, Wang et al., 2023), Israel (Tal et al., 2019), Korea (Lee et al., 2020), Iran (Rafie et al., 2019), the Netherlands (Yeung et al., 2022), and Jamaica (Ferguson et al., 2023). The description studies are presented in Table 2.
Some studies assessed multiple outcomes. Among the 10 articles examining the relationship between potassium intake and obesity, four studies evaluated body composition (fat mass and muscle mass). In contrast, six studies assessed BMI, with two of them also exploring its relationship with WC and waist-to-hip ratio. Six studies found that higher potassium intake was associated with lower body weight, BMI, WC, waist-to-hip ratio, or fat mass. Meanwhile, the other four studies suggested that increased potassium intake was linked to a higher risk of obesity. Previous studies assessed potassium intake using a food frequency questionnaire (FFQ), with some studies validating the FFQ data using 24-hour dietary recall. Additionally, some studies relied solely on 24-hour urine samples.
The largest study population included 16,558 participants, while the smallest study comprised 68 participants. In total, 55,980 participants (8,601 from cohort studies and 47,379 from cross-sectional studies) were analyzed, and all articles included both genders. The studies were published between 2014 and 2024 across various countries, including China (Chu et al., 2023, Ge et al., 2016, Liu et al., 2023), the United States (Elfassy et al., 2018, Wang et al., 2023), Israel (Tal et al., 2019), Korea (Lee et al., 2020), Iran (Rafie et al., 2019), the Netherlands (Yeung et al., 2022), and Jamaica (Ferguson et al., 2023). The description studies are presented in Table 2.
| Table 2. Description studies included in systematic review. | ||||||||
| Study | Study design | Country | Age | Gender | Participants | Measurement of potassium | Measurement of obesity | Outcome |
| (Liu et al., 2023) | Cross-sectional | China | 18–31 | Male and female | 512 | FFQ | BMI, WC, WHR, and Body Composition | Potassium consumption ≥ 2000 mg/day was significantly associated with higher BMI and WC compared to consumption < 2000 mg/day (P<0.05). Increased potassium consumption was associated with a gradual decrease in the odds ratio for skeletal muscle mass index and lean body nass index (P<0.05). |
| (Wang et al., 2023) | Cross-sectional | USA | 2–17 | Male and Female | 10450 | Food recall 2x24 hours | BMI | Potassium intake was positively correlated with an increase in BMI after adjusting for daily intake (β=0.62, 95% CI: 0.19 to 1.05). |
| (Tal et al., 2019) | Cohort | Israel | 18–70 | Male and Female | 68 | Dietary record 7x24 hours | BMI | The increase in potassium density was higher in the group with above-average BMI reduction (2.1±0.4 mg/kcal/day) compared to the group with below-average BMI reduction (1.9±0.6 mg/kcal/day; P<0.001). |
| (Lee et al., 2020) | Cross-sectional | Korea | ≥ 19 | Male and Female | 16558 | Food recall 2x24 hours | BMI and SMI | High potassium intake significantly reduced the risk of low muscle mass in men (P<0.001). Additionally, higher potassium intake was linked to a greater skeletal muscle index (SMI) compared to lower intake (P< 0.001). Nevertheless, increased potassium intake was also correlated with higher BMI (P<0.001). |
| (Chu et al., 2023) | Cross-sectional | China | 63-63 | Male and Female | 155 | Food record 3x24 hours | BMI and percentage of body fat (PBF) | The Na:K ratio was correlated with weight gain (r=0.173, P=0.031), and higher potassium intake was significantly associated with lower body fat after adjusting for age and gender (β=-0.002, P=0.001). |
| (Rafie et al., 2019) | Cross-sectional | Iran | 11–18 | Male and Female | 374 | 24-hour urine sample and FFQ | BMI, WC, WHtR, and PBF | Among girls, a higher urinary sodium-to-potassium ratio was significantly correlated with an increased risk of WC after controlling for caloric intake (OR 2.71, 95% CI 1.14-6.43). Similarly, in boys, the Na:K ratio was associated with percentage body fat after adjusting for sugar-sweetened beverage (SSB) consumption and caloric intake (OR 4.47, 95% CI 1.44-9.87). |
| (Elfassy et al., 2018) | Cross-sectional | USA | Mean 41 | Male and Female | 16415 | 24-hour urine sample and food recall 2x24 hour | BMI, WC, body fat, and percentage of body fat (PBF) | Among immigrants who had lived in the US for 10+ years and native US residents, a higher potassium intake of 500 mg/day was significantly associated with lower BMI and smaller WC (−0.13 kg/m², P<0.01; and −0.36 cm for immigrants, and −0.62 kg/m², P<0.01 for native residents). |
| (Ge et al., 2016) | Cross-sectional | China | 18–69 | Male and Female | 1906 | 24-hour urine sample | BMI, WC, and WHR | For every 1 standard deviation increase in the Na:K ratio, the odds of WC and waist-to-hip ratio increased significantly by 12% and 15%, respectively. |
| (Yeung et al., 2022) | Cohort | Netherlands | 28–75 | Male and Female | 8533 | 24-hour urine sample | BMI and WC | Potassium intake of less than 2100–2500 mg/day increased the risk of all-cause mortality. This was associated with low potassium excretion, which was linked to an increased risk of all-cause mortality across all BMI and WC groups (P=0.001, P=0.002). |
| (Ferguson et al., 2023) | Cross-sectional | Jamaica | ≥ 15 | Male and Female | 1009 | 24-hour urine sample | BMI | There was a significant association between obesity and a 43% higher consumption of potassium (P<0.001). |
Potassium and obesity
Among cohort and cross-sectional studies, increased potassium intake was associated with modest reductions in BMI and WC (Elfassy et al., 2018, Tal et al., 2019, Yeung et al., 2022). However, some cross-sectional studies reported a positive association between potassium intake and BMI (Ferguson et al., 2023, Liu et al., 2023, Wang et al., 2023). Higher urinary sodium-to-potassium ratios were consistently linked to increased risk of abdominal obesity (Ge et al., 2016). Higher potassium intake correlated with lower body fat and improved muscle mass indices in some studies, although findings were inconsistent (Chu et al., 2023, Lee et al., 2020, Rafie et al., 2019).
Discussion
The findings of this systematic review indicate that assessing potassium intake alone may be insufficient. Rather, the sodium-to-potassium ratio serves as a more sensitive marker for obesity by accounting for the combined effects of both minerals. Furthermore, the accuracy of potassium intake measurement can be improved by utilizing 24-hour urine samples, which offer a more reliable reflection of actual intake. An increase in potassium intake is a strong predictor of weight loss (Tal et al., 2019). This is because potassium-rich foods play a key role in the relationship between weight loss and potassium intake (Farapti et al., 2022). Potassium is typically obtained from minimally processed foods, such as lean meats and dairy products, as well as through the adoption of healthier dietary patterns emphasizing vegetable and fruit consumption (Liu et al., 2023). The high fiber content of vegetables and fruits slows gastric emptying and promotes satiety. This increased satiety can lead to reduced overall food consumption, thereby lowering the risk of obesity (Zaki et al., 2022).
According to Yeung et al., the risk of death from various causes increases when potassium intake is less than 2,100–2,500 mg per day (Yeung et al., 2022). This is consistent with the recommendation of the World Health Organization (WHO), which suggests a minimum daily potassium intake of 3,150 mg (90 mmol/day) for adults (World Health Organization, 2012). Meanwhile, the United States Department of Agriculture (USDA) has set the Adequate Intake (AI) for adult potassium intake at 4,700 mg per day, with lower AI values established for children depending on age and gender (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010). Based on observations by Cai et al., consuming a potassium intake of 2200 mg/kcal may reduce the risk of obesity and metabolic syndrome (Cai et al., 2016).
Nutritional status
In a cohort study of Hispanic/Latino individuals, increased potassium intake (500 mg/day) was associated with a 0.13 kg/m² lower BMI among immigrants with 10+ years in the US and a 0.62 kg/m² lower BMI in US-born (Elfassy et al., 2018). These findings are supported by research conducted by Tal et al., which showed that participants with above-average BMI reduction increased their potassium intake by 25% compared to their previous intake, while participants with below-average BMI reduction only increased potassium intake by 3% (P=0.033) (Tal et al., 2019). The increase in potassium density was also higher in the above-average BMI reduction group (2.1±0.4 mg/kcal/day) compared to the below-average BMI reduction group (1.9±0.6 mg/kcal/day; P<0.001).
However, a cross-sectional study of 512 students in China showed contrasting results, finding that respondents who consumed potassium ≥2000 mg/day had a higher BMI compared to those who consumed <2000 mg/day (Liu et al., 2023). These results are consistent with the study by Wang et al., which showed that potassium intake was correlated with increased BMI (β = 0.62, 95% CI: 0.19, 0.05) (Wang et al., 2023). Furthermore, obesity was associated with a 43% higher potassium consumption (P<0.001) (Ferguson et al., 2023). This may be because individuals with obesity tend to pay more attention to the quantity of mineral intake but without properly balancing it with control of energy intake (Liu et al., 2023, Wang et al., 2023).
Abdominal obesity
A study on adults in China found that the sodium-to-potassium ratio (Na:K) in urine was significantly and positively associated with an increased risk of abdominal obesity, whether measured by WC or waist-hip ratio (WHR). Each 1 standard deviation (SD) increase in the 24-hour urinary Na:K ratio was associated with a 12% increased risk of abdominal obesity and a 15% increased risk of WHR (Ge et al., 2016) The urinary Na:K ratio reflects a dietary pattern high in sodium and low in potassium, therefore the Na:K ratio can be used as an indicator of diet quality (Murakami et al., 2010). Furthermore, a lower urinary Na:K ratio indicates a protective effect against obesity (Cai et al., 2016).
Consistent with these findings, a cohort study conducted on 16,415 Hispanic/Latino individuals showed that higher potassium intake was associated with a smaller WC of 0.36 cm in immigrants who had lived in the US for 10+ years and 1.42 cm in US-born (Elfassy et al., 2018).
Body composition
Research has shown that higher potassium intake is significantly associated with lower body fat (P=0.001) (Chu et al., 2023). However, a study by Liu et al., found no association between total percentage body fat and potassium consumption (Liu et al., 2023). Despite this, increased potassium intake was linked to increases in muscle-related indicators, such as fat-free mass index (FFMI), appendicular skeletal muscle index (ASMI), skeletal muscle mass index (SMMI), and lean mass index (LMI) (P<0.05)
Consistent with the research by Elfassy et al., every 0.50 increase in the urinary Na:K ratio was associated with a 0.48 kg increase in body fat (95% CI: 0.15, 0.93) and a 0.34% increase in body fat percentage (Elfassy et al., 2018). In addition, body fat percentage was associated with the urinary Na:K ratio in boys, with an OR of 4.47 (95% CI: 1.44-9.87) after adjusting for Sugar-sweetened beverages (SSB) consumption and 3.87 (95% CI: 1.20-8.48) after adjusting for calorie intake (Rafie et al., 2019).
There are various mechanisms regarding the role of potassium in obesity prevention, one of which is through glucose metabolism. In potassium deficiency, the body stimulates an increase in insulin along with a decrease in serum potassium of 0.5 mM over 90 minutes without an increase in potassium excretion in the urine (McDonough and Fenton, 2022). There are two ATP-sensitive potassium (KATP) channels related to glucose metabolism, namely SUR1 and Kir6.2 channels. When potassium intake is low, the function of these two channels is reduced, resulting in pancreatic beta cells continuously secreting insulin ,leading to hyperinsulinemia (Nichols et al., 2022).
Reduced opening of KATP channels is also associated with increased extracellular glucose, which is related to insulin release. When extracellular glucose levels increase, glucose is transported to the cytosol by glucose transporter 2 (GLUT-2); therefore, ATP production increases. The increase in cytosolic glucose results in gradual depolarization, which causes the closure of KATP channels. After closure of KATP channels, the membrane depolarizes to approximately -50 mV, which triggers a potential action and activates L-type voltage-gated Ca2+ channels (L-Ca2+) and T (T-Ca2+) channels. This can cause Ca2+ influx, leading to an increase in intracellular Ca2+ levels, which triggers exocytosis of insulin-containing granules (Rodríguez-Rivera and Barrera-Oviedo, 2024). When insulin levels in the body continue to rise, lipolysis is inhibited and fat storage is increased through the synthesis and storage of triglycerides in adipocytes, ultimately contributing to sustained fat accumulation and increasing the risk of obesity (Cowen and Bhatnagar, 2020).
This systematic review has several strengths. First, the studies used come from various countries, so the data obtained is more diverse. Second, the determinants of obesity are analyzed using several indicators, such as BMI, WC, and body composition, including body fat percentage and muscle indicators. Third, this review examines the relationship of potassium from different measurements (intake and Na:K ratio). However, this systematic review also has several limitations. This study has three main limitations. First, the reliance on only three databases restricts the scope of included studies. Second, variations in cut-off points across studies may affect comparability. Third, the predominance of cross-sectional designs limits the ability to establish causal relationships.
Conclusion
Among the ten articles examining the role of potassium in reducing obesity incidence, the results remain inconsistent. Most studies investigated potassium intake simultaneously with the sodium-to-potassium ratio, and the results of this ratio were more consistent in relation to obesity reduction. It is recommended to assess obesity outcomes through measurements of body composition, including fat mass, muscle mass, WC, and BMI, rather than relying on a single measurement. Confounding variables such as caloric intake and potassium-rich food sources should be thoroughly evaluated to understand the role of potassium in obesity comprehensively.
Acknowledgments
The authors would like to thank the Faculty of Public Health, Airlangga University, especially the Nutrition Study Program, for providing quality knowledge that facilitated the completion of this systematic review. Deep gratitude is also directed to the faculty advisor for their guidance and assistance throughout the writing process.
Author’s contribution
Fatimatuzahroh D and Farapti F were the design researchers. Fatimatuzahroh D was involved in data curation. Fatimatuzahroh D and Farapti F designed the methodology and supervised the work. Fatimatuzahroh D wrote the original draft and Dhandapani S supervised the manuscript writing. All authors finally read the manuscript and approved it for publishing.
Conflict of interest
The authors declared no conflict of interest.
Funding
This research received no funding.
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Among cohort and cross-sectional studies, increased potassium intake was associated with modest reductions in BMI and WC (Elfassy et al., 2018, Tal et al., 2019, Yeung et al., 2022). However, some cross-sectional studies reported a positive association between potassium intake and BMI (Ferguson et al., 2023, Liu et al., 2023, Wang et al., 2023). Higher urinary sodium-to-potassium ratios were consistently linked to increased risk of abdominal obesity (Ge et al., 2016). Higher potassium intake correlated with lower body fat and improved muscle mass indices in some studies, although findings were inconsistent (Chu et al., 2023, Lee et al., 2020, Rafie et al., 2019).
Discussion
The findings of this systematic review indicate that assessing potassium intake alone may be insufficient. Rather, the sodium-to-potassium ratio serves as a more sensitive marker for obesity by accounting for the combined effects of both minerals. Furthermore, the accuracy of potassium intake measurement can be improved by utilizing 24-hour urine samples, which offer a more reliable reflection of actual intake. An increase in potassium intake is a strong predictor of weight loss (Tal et al., 2019). This is because potassium-rich foods play a key role in the relationship between weight loss and potassium intake (Farapti et al., 2022). Potassium is typically obtained from minimally processed foods, such as lean meats and dairy products, as well as through the adoption of healthier dietary patterns emphasizing vegetable and fruit consumption (Liu et al., 2023). The high fiber content of vegetables and fruits slows gastric emptying and promotes satiety. This increased satiety can lead to reduced overall food consumption, thereby lowering the risk of obesity (Zaki et al., 2022).
According to Yeung et al., the risk of death from various causes increases when potassium intake is less than 2,100–2,500 mg per day (Yeung et al., 2022). This is consistent with the recommendation of the World Health Organization (WHO), which suggests a minimum daily potassium intake of 3,150 mg (90 mmol/day) for adults (World Health Organization, 2012). Meanwhile, the United States Department of Agriculture (USDA) has set the Adequate Intake (AI) for adult potassium intake at 4,700 mg per day, with lower AI values established for children depending on age and gender (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010). Based on observations by Cai et al., consuming a potassium intake of 2200 mg/kcal may reduce the risk of obesity and metabolic syndrome (Cai et al., 2016).
Nutritional status
In a cohort study of Hispanic/Latino individuals, increased potassium intake (500 mg/day) was associated with a 0.13 kg/m² lower BMI among immigrants with 10+ years in the US and a 0.62 kg/m² lower BMI in US-born (Elfassy et al., 2018). These findings are supported by research conducted by Tal et al., which showed that participants with above-average BMI reduction increased their potassium intake by 25% compared to their previous intake, while participants with below-average BMI reduction only increased potassium intake by 3% (P=0.033) (Tal et al., 2019). The increase in potassium density was also higher in the above-average BMI reduction group (2.1±0.4 mg/kcal/day) compared to the below-average BMI reduction group (1.9±0.6 mg/kcal/day; P<0.001).
However, a cross-sectional study of 512 students in China showed contrasting results, finding that respondents who consumed potassium ≥2000 mg/day had a higher BMI compared to those who consumed <2000 mg/day (Liu et al., 2023). These results are consistent with the study by Wang et al., which showed that potassium intake was correlated with increased BMI (β = 0.62, 95% CI: 0.19, 0.05) (Wang et al., 2023). Furthermore, obesity was associated with a 43% higher potassium consumption (P<0.001) (Ferguson et al., 2023). This may be because individuals with obesity tend to pay more attention to the quantity of mineral intake but without properly balancing it with control of energy intake (Liu et al., 2023, Wang et al., 2023).
Abdominal obesity
A study on adults in China found that the sodium-to-potassium ratio (Na:K) in urine was significantly and positively associated with an increased risk of abdominal obesity, whether measured by WC or waist-hip ratio (WHR). Each 1 standard deviation (SD) increase in the 24-hour urinary Na:K ratio was associated with a 12% increased risk of abdominal obesity and a 15% increased risk of WHR (Ge et al., 2016) The urinary Na:K ratio reflects a dietary pattern high in sodium and low in potassium, therefore the Na:K ratio can be used as an indicator of diet quality (Murakami et al., 2010). Furthermore, a lower urinary Na:K ratio indicates a protective effect against obesity (Cai et al., 2016).
Consistent with these findings, a cohort study conducted on 16,415 Hispanic/Latino individuals showed that higher potassium intake was associated with a smaller WC of 0.36 cm in immigrants who had lived in the US for 10+ years and 1.42 cm in US-born (Elfassy et al., 2018).
Body composition
Research has shown that higher potassium intake is significantly associated with lower body fat (P=0.001) (Chu et al., 2023). However, a study by Liu et al., found no association between total percentage body fat and potassium consumption (Liu et al., 2023). Despite this, increased potassium intake was linked to increases in muscle-related indicators, such as fat-free mass index (FFMI), appendicular skeletal muscle index (ASMI), skeletal muscle mass index (SMMI), and lean mass index (LMI) (P<0.05)
Consistent with the research by Elfassy et al., every 0.50 increase in the urinary Na:K ratio was associated with a 0.48 kg increase in body fat (95% CI: 0.15, 0.93) and a 0.34% increase in body fat percentage (Elfassy et al., 2018). In addition, body fat percentage was associated with the urinary Na:K ratio in boys, with an OR of 4.47 (95% CI: 1.44-9.87) after adjusting for Sugar-sweetened beverages (SSB) consumption and 3.87 (95% CI: 1.20-8.48) after adjusting for calorie intake (Rafie et al., 2019).
There are various mechanisms regarding the role of potassium in obesity prevention, one of which is through glucose metabolism. In potassium deficiency, the body stimulates an increase in insulin along with a decrease in serum potassium of 0.5 mM over 90 minutes without an increase in potassium excretion in the urine (McDonough and Fenton, 2022). There are two ATP-sensitive potassium (KATP) channels related to glucose metabolism, namely SUR1 and Kir6.2 channels. When potassium intake is low, the function of these two channels is reduced, resulting in pancreatic beta cells continuously secreting insulin ,leading to hyperinsulinemia (Nichols et al., 2022).
Reduced opening of KATP channels is also associated with increased extracellular glucose, which is related to insulin release. When extracellular glucose levels increase, glucose is transported to the cytosol by glucose transporter 2 (GLUT-2); therefore, ATP production increases. The increase in cytosolic glucose results in gradual depolarization, which causes the closure of KATP channels. After closure of KATP channels, the membrane depolarizes to approximately -50 mV, which triggers a potential action and activates L-type voltage-gated Ca2+ channels (L-Ca2+) and T (T-Ca2+) channels. This can cause Ca2+ influx, leading to an increase in intracellular Ca2+ levels, which triggers exocytosis of insulin-containing granules (Rodríguez-Rivera and Barrera-Oviedo, 2024). When insulin levels in the body continue to rise, lipolysis is inhibited and fat storage is increased through the synthesis and storage of triglycerides in adipocytes, ultimately contributing to sustained fat accumulation and increasing the risk of obesity (Cowen and Bhatnagar, 2020).
This systematic review has several strengths. First, the studies used come from various countries, so the data obtained is more diverse. Second, the determinants of obesity are analyzed using several indicators, such as BMI, WC, and body composition, including body fat percentage and muscle indicators. Third, this review examines the relationship of potassium from different measurements (intake and Na:K ratio). However, this systematic review also has several limitations. This study has three main limitations. First, the reliance on only three databases restricts the scope of included studies. Second, variations in cut-off points across studies may affect comparability. Third, the predominance of cross-sectional designs limits the ability to establish causal relationships.
Conclusion
Among the ten articles examining the role of potassium in reducing obesity incidence, the results remain inconsistent. Most studies investigated potassium intake simultaneously with the sodium-to-potassium ratio, and the results of this ratio were more consistent in relation to obesity reduction. It is recommended to assess obesity outcomes through measurements of body composition, including fat mass, muscle mass, WC, and BMI, rather than relying on a single measurement. Confounding variables such as caloric intake and potassium-rich food sources should be thoroughly evaluated to understand the role of potassium in obesity comprehensively.
Acknowledgments
The authors would like to thank the Faculty of Public Health, Airlangga University, especially the Nutrition Study Program, for providing quality knowledge that facilitated the completion of this systematic review. Deep gratitude is also directed to the faculty advisor for their guidance and assistance throughout the writing process.
Author’s contribution
Fatimatuzahroh D and Farapti F were the design researchers. Fatimatuzahroh D was involved in data curation. Fatimatuzahroh D and Farapti F designed the methodology and supervised the work. Fatimatuzahroh D wrote the original draft and Dhandapani S supervised the manuscript writing. All authors finally read the manuscript and approved it for publishing.
Conflict of interest
The authors declared no conflict of interest.
Funding
This research received no funding.
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Received: 2025/03/8 | Published: 2025/11/19 | ePublished: 2025/11/19
Received: 2025/03/8 | Published: 2025/11/19 | ePublished: 2025/11/19
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