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Iqbal S, Klammer N, Ekmekcioglu C. The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses. Nutrients 2019; 11:nu11061362. [PMID: 31212974 PMCID: PMC6627949 DOI: 10.3390/nu11061362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Nutrition is known to exert an undeniable impact on blood pressure with especially salt (sodium chloride), but also potassium, playing a prominent role. The aim of this review was to summarize meta-analyses studying the effect of different electrolytes on blood pressure or risk for hypertension, respectively. Overall, 32 meta-analyses evaluating the effect of sodium, potassium, calcium and magnesium on human blood pressure or hypertension risk were included after literature search. Most of the meta-analyses showed beneficial blood pressure lowering effects with the extent of systolic blood pressure reduction ranging between -0.7 (95% confidence interval: -2.6 to 1.2) to -8.9 (-14.1 to -3.7) mmHg for sodium/salt reduction, -3.5 (-5.2 to -1.8) to -9.5 (-10.8 to -8.1) mmHg for potassium, and -0.2 (-0.4 to -0.03) to -18.7 (-22.5 to -15.0) mmHg for magnesium. The range for diastolic blood pressure reduction was 0.03 (-0.4 to 0.4) to -5.9 (-9.7 to -2.1) mmHg for sodium/salt reduction, -2 (-3.1 to -0.9) to -6.4 (-7.3 to -5.6) mmHg for potassium, and -0.3 (-0.5 to -0.03) to -10.9 (-13.1 to -8.7) mmHg for magnesium. Moreover, sufficient calcium intake was found to reduce the risk of gestational hypertension.
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Affiliation(s)
- Sehar Iqbal
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Norbert Klammer
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Cem Ekmekcioglu
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
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Va P, Dodd KW, Zhao L, Thompson-Paul AM, Mercado CI, Terry AL, Jackson SL, Wang CY, Loria CM, Moshfegh AJ, Rhodes DG, Cogswell ME. Evaluation of measurement error in 24-hour dietary recall for assessing sodium and potassium intake among US adults - National Health and Nutrition Examination Survey (NHANES), 2014. Am J Clin Nutr 2019; 109:1672-1682. [PMID: 31136657 PMCID: PMC6537943 DOI: 10.1093/ajcn/nqz044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Understanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes. OBJECTIVE The aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE). DESIGN Data were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. RESULTS Overall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32). CONCLUSIONS Compared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.
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Affiliation(s)
- Puthiery Va
- Epidemic Intelligence Service,Division for Heart Disease and Stroke Prevention,Address correspondence to PV (e-mail: )
| | | | - Lixia Zhao
- Division for Heart Disease and Stroke Prevention,IHRC, Inc., Atlanta, GA
| | | | | | - Ana L Terry
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Chia-Yih Wang
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia
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103
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Gandola AE, Dainelli L, Zimmermann D, Dahlui M, Detzel P. Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis. Nutrients 2019; 11:E1235. [PMID: 31151244 PMCID: PMC6627836 DOI: 10.3390/nu11061235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35-75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.
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Affiliation(s)
- Anita E Gandola
- Nestlé Research Center, 1000 Lausanne, Switzerland.
- Università della Svizzera Italiana, 6900 Lugano, Switzerland.
| | | | | | - Maznah Dahlui
- Centre of Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia.
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104
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Gupta K, Kumar A, Tomer V, Kumar V, Saini M. Potential of Colocasia leaves in human nutrition: Review on nutritional and phytochemical properties. J Food Biochem 2019; 43:e12878. [PMID: 31353694 DOI: 10.1111/jfbc.12878] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/06/2019] [Accepted: 04/11/2019] [Indexed: 12/28/2022]
Abstract
Colocasia esculenta leaves possess vital nutritive and nonnutritive components in significant amounts, but are underutilized, and lesser explored. The chemical composition varies significantly depending upon climatic conditions and other agronomical factors of the location of cultivation and variety. Micronutrients, viz. iron (3.4-11.7 mg 100 g-1 ), copper (0.29-0.8 mg 100 g-1 ), magnesium (170-752 mg 100 g-1 ), potassium (0.4-2.4 g 100 g-1 ), and zinc (0.6-4.2 mg 100 g-1 ) are present in high amounts. The ratio of sodium to potassium (1:40) in the leaves add specifically to the antihypertensive properties. Preclinical and clinical studies provide evidence of its antidiabetic, antihemorrhagic, neuropharmacological properties, and as a remedy for stomach and liver ailments. Assessment of phytochemical compounds like chlorogenic acid, anthraquinones, cinnamic acid derivatives, and other phenolics validates these biological properties. The major limiting factor of this plant is oxalate that can be suppressed through food processing strategies. Colocasia leaves are promising green leafy vegetables with nutritional and clinical potential. PRACTICAL APPLICATIONS: Colocasia leaves have demonstrated the ability of antidiabetic, antihypertensive, immunoprotective, neuroprotective, and anticarcinogenic activities. The detailed assessment of phytochemical compounds present in various extracts of the leaves shows the presence of active chemical compounds like anthraquinones, apigenin, catechins, cinnamic acid derivatives, vitexin, and isovitexin which are possibly responsible for the exhibited biological properties. Colocasia leaves are rich sources of micronutrients; however, the presence of oxalates can prohibit proper utilization of these nutrients. Various food processing strategies like soaking, cooking, and so on can significantly reduce the antinutritional content and make these nutrients available for utilization. Documentation of traditional uses and food products from Colocasia leaves show that these leaves have immense potential in the functional food product as well as drug development.
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Affiliation(s)
- Kritika Gupta
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Ashwani Kumar
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Vidisha Tomer
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Vikas Kumar
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
| | - Mona Saini
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara, India
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105
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Abstract
PURPOSE OF REVIEW Excess sodium from dietary salt (NaCl) is linked to elevations in blood pressure (BP). However, salt sensitivity of BP varies widely between individuals and there are data suggesting that salt adversely affects target organs, irrespective of BP. RECENT FINDINGS High dietary salt has been shown to adversely affect the vasculature, heart, kidneys, skin, brain, and bone. Common mediators of the target organ dysfunction include heightened inflammation and oxidative stress. These physiological alterations may contribute to disease development over time. Despite the adverse effects of salt on BP and several organ systems, there is controversy surrounding lower salt intakes and cardiovascular outcomes. Our goal here is to review the physiology contributing to BP-independent effects of salt and address the controversy around lower salt intakes and cardiovascular outcomes. We will also address the importance of background diet in modulating the effects of dietary salt.
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Affiliation(s)
- Austin T Robinson
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, 201M, Newark, DE, 19713, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, 201M, Newark, DE, 19713, USA
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, 540 South College Avenue, 201M, Newark, DE, 19713, USA.
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O'Donnell M, Mente A, Rangarajan S, McQueen MJ, O'Leary N, Yin L, Liu X, Swaminathan S, Khatib R, Rosengren A, Ferguson J, Smyth A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Ismail N, Yusoff K, Dans A, Iqbal R, Szuba A, Mohammadifard N, Oguz A, Yusufali AH, Alhabib KF, Kruger IM, Yusuf R, Chifamba J, Yeates K, Dagenais G, Wielgosz A, Lear SA, Teo K, Yusuf S. Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study. BMJ 2019; 364:l772. [PMID: 30867146 PMCID: PMC6415648 DOI: 10.1136/bmj.l772] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. DESIGN International prospective cohort study. SETTING 18 high, middle, and low income countries, sampled from urban and rural communities. PARTICIPANTS 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.
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Affiliation(s)
- Martin O'Donnell
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Mente
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Matthew J McQueen
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Neil O'Leary
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Lu Yin
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Xiaoyun Liu
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Sumathi Swaminathan
- Division of Nutrition, St John's Research Institute, Bangalore, Karnataka, India
| | - Rasha Khatib
- Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Ferguson
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Smyth
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | - Noorhassim Ismail
- Department of Community Health. University Kebangsaan Malaysia Medical Centre, Malaysia
| | - Khalid Yusoff
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio Dans
- University of the Philippines-Manila, Ermita, Manila, Philippines
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atyekin Oguz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Afzal Hussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority. Dubai, United Arab Emirates
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University. Riyadh, Saudi Arabia
| | - Iolanthe M Kruger
- Faculty of Health Science, North-West University, Potchefstroom campus, Potchefstroom, South Africa
| | - Rita Yusuf
- School of Life Sciences and The Centre for Health, Population and Development. Independent University, Bangladesh, Dhaka, Bangladesh
| | - Jephat Chifamba
- University of Zimbabwe, College of Health Sciences, Physiology Department, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queen's University, Kingston, Canada
| | - Gilles Dagenais
- Laval University Heart and Lungs Institute, Quebec City, QC, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, and Division of Cardiology, Providence Health Care, BC, Canada
| | - Koon Teo
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
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107
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Identification of 22 novel loci associated with urinary biomarkers of albumin, sodium, and potassium excretion. Kidney Int 2019; 95:1197-1208. [PMID: 30910378 DOI: 10.1016/j.kint.2018.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 02/01/2023]
Abstract
Urine biomarkers reflecting kidney function and handling of dietary sodium and potassium are strongly associated with several common diseases including chronic kidney disease, cardiovascular disease, and diabetes mellitus. Knowledge about the genetic determinants of these biomarkers may shed light on pathophysiological mechanisms underlying the development of these diseases. We performed genome-wide association studies of urinary albumin: creatinine ratio (UACR), urinary potassium: creatinine ratio (UK/UCr), urinary sodium: creatinine ratio (UNa/UCr) and urinary sodium: potassium ratio (UNa/UK) in up to 218,450 (discovery) and 109,166 (replication) unrelated individuals of European ancestry from the UK Biobank. Further, we explored genetic correlations, tissue-specific gene expression, and possible genes implicated in the regulation of these biomarkers. After replication, we identified 19 genome-wide significant independent loci associated with UACR, 6 each with UK/UCr and UNa/UCr, and 4 with UNa/UK. In addition to 22 novel associations, we confirmed several established associations, including between the CUBN locus and microalbuminuria. We detected high pairwise genetic correlation across the urinary biomarkers, and between their levels and several physiological measurements. We highlight GIPR, a potential diabetes drug target, as possibly implicated in the genetic control of urinary potassium excretion, and NRBP1, a locus associated with gout, as plausibly involved in sodium and albumin excretion. Overall, we identified 22 novel genome-wide significant associations with urinary biomarkers and confirmed several previously established associations, providing new insights into the genetic basis of these traits and their connection to chronic diseases.
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108
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Giovannucci E. Nutritional epidemiology: forest, trees and leaves. Eur J Epidemiol 2019; 34:319-325. [DOI: 10.1007/s10654-019-00488-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
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109
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Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet 2019; 393:447-492. [PMID: 30660336 DOI: 10.1016/s0140-6736(18)31788-4] [Citation(s) in RCA: 3400] [Impact Index Per Article: 680.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/02/2018] [Accepted: 07/27/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Walter Willett
- Harvard T H Chan School of Public Health, Harvard Medical School, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Johan Rockström
- Potsdam Institute for Climate Impact Research, Potsdam, Germany; Stockholm Resilience Centre, Stockholm, Sweden
| | - Brent Loken
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway.
| | - Marco Springmann
- Oxford Martin Programme on the Future of Food and Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tim Lang
- Centre for Food Policy, City, University of London, London, UK
| | - Sonja Vermeulen
- World Wide Fund for Nature International, Gland, Switzerland; Hoffmann Centre for Sustainable Resource Economy, Chatham House, London, UK
| | - Tara Garnett
- Food Climate Research Network, Environmental Change Institute and Oxford Martin School, University of Oxford, Oxford, UK
| | - David Tilman
- Department of Ecology, Evolution and Behavior, University of Minnesota, St Paul, MN, USA; Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
| | - Fabrice DeClerck
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway; Bioversity International, CGIAR, Montpellier, France
| | - Amanda Wood
- Stockholm Resilience Centre, Stockholm, Sweden; EAT, Oslo, Norway
| | | | - Michael Clark
- Natural Resources Science and Management, University of Minnesota, St Paul, MN, USA
| | | | - Jessica Fanzo
- Nitze School of Advanced International Studies, Berman Institute of Bioethics and Bloomberg School of Public Health, Johns Hopkins University, MD, USA
| | - Corinna Hawkes
- Centre for Food Policy, City, University of London, London, UK
| | - Rami Zurayk
- Department of Landscape Design and Ecosystem Management, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Juan A Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Wim De Vries
- Wageningen University and Research, Environmental Systems Analysis Group, Wageningen, Netherlands
| | | | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Abhishek Chaudhary
- Institute of Food, Nutrition and Health, ETH Zurich, Switzerland; Department of Civil Engineering, Indian Institute of Technology, Kanpur, India
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Francesco Branca
- Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Anna Lartey
- Nutrition and Food Systems Division, Economic and Social Development Department, Food and Agriculture Organization of the UN, Rome, Italy
| | - Shenggen Fan
- International Food Policy Research Institute, Washington DC, USA
| | | | - Elizabeth Fox
- Berman Institute of Bioethics, Johns Hopkins University, MD, USA
| | | | - Max Troell
- Stockholm Resilience Centre, Stockholm, Sweden; The Beijer Institute of Ecological Economics, at the Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Therese Lindahl
- Stockholm Resilience Centre, Stockholm, Sweden; The Beijer Institute of Ecological Economics, at the Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Sudhvir Singh
- EAT, Oslo, Norway; University of Auckland, Auckland, New Zealand
| | | | | | - Sunita Narain
- Centre for Science and Environment, New Delhi, India
| | - Sania Nishtar
- Heartfile, Islamabad, Pakistan; WHO High Level Commission on NCDs, Geneva Switzerland; Chairperson Benazir Income Support Program, Islamabad, Pakistan
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110
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Kyung Kim M, Kwon M, Rhee MY, Kim KI, Nah DY, Kim SW, Gu N, Sung KC, Hong KS, Cho EJ, Jo SH. Dose–response association of 24-hour urine sodium and sodium to potassium ratio with nighttime blood pressure at older ages. Eur J Prev Cardiol 2019; 26:952-960. [DOI: 10.1177/2047487318819528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aims We investigated the dose–response association of 24-hour urine sodium and potassium with 24-hour ambulatory blood pressure. Design Cross-sectional community-based study. Methods Among the 1128 participants in the community-based cross-sectional survey, 740 participants (aged 20–70 years) with complete 24-hour urine collection and valid 24-hour ambulatory blood pressure monitoring were included in the study. Participants were grouped into younger (<55 years, n = 523) and older (≥55 years, n = 217). Results In the older population, nighttime blood pressure linearly increased with 24-hour urine sodium and the sodium to potassium ratio. For 24-hour urine sodium, adjusted β was 0.171 (95% confidence interval (CI) 0.036–0.305) for nighttime systolic blood pressure and 0.144 (95% CI 0.012–0.276) for nighttime diastolic blood pressure. For the 24-hour urine sodium to potassium ratio, adjusted β was 0.142 (95% CI 0.013–0.270) for nighttime systolic blood pressure and 0.144 (95% CI 0.018–0.270) for nighttime diastolic blood pressure. The 24-hour blood pressure linearly increased with the 24-hour urine sodium to potassium ratio and adjusted β was 0.133 (95% CI 0.003–0.262) for 24-hour systolic blood pressure and 0.123 (95% CI 0.003–0.244) for 24-hour diastolic blood pressure. Daytime blood pressure and 24-hour systolic blood pressure showed a significant but non-linear association with 24-hour urine sodium among the older population. In the younger population, 24-hour urine sodium, potassium and the sodium to potassium ratio were not associated with ambulatory blood pressure. Conclusion In the older population, 24-hour urine sodium and the sodium to potassium ratio showed a linear and positive association with nighttime blood pressure, and 24-hour urine sodium was associated with 24-hour systolic blood pressure and daytime blood pressure in a non-linear fashion.
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Affiliation(s)
- Mi Kyung Kim
- Cancer Epidemiology Branch, National Cancer Center, South Korea
| | - Minji Kwon
- Cancer Epidemiology Branch, National Cancer Center, South Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Republic of Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Deuk-Young Nah
- Division of Cardiology, Dongguk University Gyeongju Hospital, Republic of Korea
| | - Sun-Woong Kim
- Department of Statistics, Dongguk University, Republic of Korea
| | - Namyi Gu
- Department of Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Republic of Korea
| | - Ki-Chul Sung
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea
| | | | - Eun-Joo Cho
- Division of Cardiology, St Paul’s Hospital, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Sacred Heart Hospital, South Korea
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111
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Assessing whether a spot urine specimen can predict 24-h urinary sodium excretion accurately. J Hypertens 2019; 37:99-108. [DOI: 10.1097/hjh.0000000000001879] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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112
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Rebholz CM, Young BA, Katz R, Tucker KL, Carithers TC, Norwood AF, Correa A. Patterns of Beverages Consumed and Risk of Incident Kidney Disease. Clin J Am Soc Nephrol 2018; 14:49-56. [PMID: 30591520 PMCID: PMC6364540 DOI: 10.2215/cjn.06380518] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/01/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Selected beverages, such as sugar-sweetened beverages, have been reported to influence kidney disease risk, although previous studies have been inconsistent. Further research is necessary to comprehensively evaluate all types of beverages in association with CKD risk to better inform dietary guidelines. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a prospective analysis in the Jackson Heart Study, a cohort of black men and women in Jackson, Mississippi. Beverage intake was assessed using a food frequency questionnaire administered at baseline (2000-2004). Incident CKD was defined as onset of eGFR<60 ml/min per 1.73 m2 and ≥30% eGFR decline at follow-up (2009-13) relative to baseline among those with baseline eGFR ≥60 ml/min per 1.73 m2. Logistic regression was used to estimate the association between the consumption of each individual beverage, beverage patterns, and incident CKD. Beverage patterns were empirically derived using principal components analysis, in which components were created on the basis of the linear combinations of beverages consumed. RESULTS Among 3003 participants, 185 (6%) developed incident CKD over a median follow-up of 8 years. At baseline, mean age was 54 (SD 12) years, 64% were women, and mean eGFR was 98 (SD 18) ml/min per 1.73 m2. After adjusting for total energy intake, age, sex, education, body mass index, smoking, physical activity, hypertension, diabetes, HDL cholesterol, LDL cholesterol, history of cardiovascular disease, and baseline eGFR, a principal components analysis-derived beverage pattern consisting of higher consumption of soda, sweetened fruit drinks, and water was associated with significantly greater odds of incident CKD (odds ratio tertile 3 versus 1 =1.61; 95% confidence interval, 1.07 to 2.41). CONCLUSIONS Higher consumption of sugar-sweetened beverages was associated with an elevated risk of subsequent CKD in this community-based cohort of black Americans.
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Affiliation(s)
- Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
| | - Bessie A Young
- Division of Nephrology, Veterans Affairs Puget Sound Health Care Center, Seattle, Washington.,Kidney Research Institute, University of Washington, Seattle, Washington
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Teresa C Carithers
- Department of Nutrition and Hospitality Management, University of Mississippi, Oxford, Mississippi; and
| | - Arnita F Norwood
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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113
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Moliterno P, Álvarez-Vaz R, Pécora M, Luzardo L, Borgarello L, Olascoaga A, Marino C, Noboa O, Staessen JA, Boggia J. Blood Pressure in relation to 24-Hour Urinary Sodium and Potassium Excretion in a Uruguayan Population Sample. Int J Hypertens 2018; 2018:6956078. [PMID: 30631591 PMCID: PMC6304641 DOI: 10.1155/2018/6956078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
Many public health policies in Latin America target an optimized sodium and potassium intake. The aims of this study were to assess the sodium and potassium intake using 24-hour urinary analysis and to study their association with blood pressure in a Uruguayan population cohort using cluster analysis. A total of 149 participants (aged 20-85 years) were included in the study, and office blood pressure, anthropometric measurements, biochemical parameters in the blood, and 24-hour urine samples were obtained. The overall mean sodium and potassium excretion was 152.9 ± 57.3 mmol/day (8.9 ± 3.4 g/day of salt) and 55.4 ± 19.6 mmol/day, respectively. The average office systolic/diastolic blood pressure was 124.6 ± 16.7/79.3 ± 9.9 mmHg. Three compact spherical clusters were defined in untreated participants based on predetermined attributes, including blood pressure, age, and sodium and potassium excretion. The major characteristics of the three clusters were (1) high systolic blood pressure and moderate sodium excretion, (2) moderate systolic blood pressure and very high sodium excretion, and (3) low systolic blood pressure and low sodium excretion. Participants in cluster three had systolic blood pressure values that were 23.9 mmHg (95% confidence interval: -29.5 to -1.84) lower than those in cluster one. Participants in cluster two had blood pressure levels similar to those in cluster one (P = 0.32) and worse metabolic profiles than those in cluster one and three (P < 0.05). None of the clusters showed high blood pressure levels and high sodium excretion. No linear association was found between blood pressure and urinary sodium excretion (r < 0.14; P > 0.47). An effect of sodium and potassium intake on blood pressure levels was not found at the population level using regression or cluster analysis.
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Affiliation(s)
- Paula Moliterno
- Departamento de Nutrición Clínica, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Ramón Álvarez-Vaz
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay
| | - Matias Pécora
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
| | - Leonella Luzardo
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
| | - Luciana Borgarello
- Laboratorio de Patología Clínica, Universidad de la República, Montevideo, Uruguay
| | - Alicia Olascoaga
- Laboratorio de Patología Clínica, Universidad de la República, Montevideo, Uruguay
| | - Carmen Marino
- Área de Investigación, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Oscar Noboa
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| | - José Boggia
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
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114
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Lu Y, Chen R, Cai J, Huang Z, Yuan H. The management of hypertension in women planning for pregnancy. Br Med Bull 2018; 128:75-84. [PMID: 30371746 PMCID: PMC6289217 DOI: 10.1093/bmb/ldy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION OR BACKGROUND Poorly-controlled hypertension in the first trimester significantly increases maternal and fetal morbidity and mortality. The majority of guidelines and clinical trials focus on the management and treatments for hypertension during pregnancy and breast-feeding, while limited evidence could be applied to the management for hypertension before pregnancy. In this review, we summarized the existing guidelines and treatments of pre-pregnancy treatment of hypertension. SOURCES OF DATA PubMed. AREAS OF AGREEMENT Methyldopa and labetalol are considered the first choice, but angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) need to be withdrawn if a hypertensive woman wishes to become pregnant. In women with chronic hypertension, it is very important to make an assessment before conception to exclude secondary causes of hypertension, evaluate their hypertensive control to ensure that it is optimal, discuss the increased risks of pre-eclampsia, and provide education regarding any drug alterations before they become pregnant. AREAS OF CONTROVERSY There is increasing debate regarding discouraging the use of diuretics. There is also controversy regarding the use of supplementations such as calcium, antioxidants and low-dose aspirin. GROWING POINTS A less restricted blood-pressure goal could be set for hypertensive women planning for pregnancy. A healthy body weight before pregnancy could lower the risk of pregnancy-related hypertensive disorders. Recent guidelines also encourage women with chronic hypertension to keep their dietary sodium intake low, either by reducing or substituting sodium salt before pregnancy. TIMELY AREAS FOR DEVELOPING RESEARCH Large, worldwide, randomized trials should be conducted to see the outcomes for hypertensive women who take antioxidants/physical activity before pregnancy.
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Affiliation(s)
- Yao Lu
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Ruifang Chen
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Jingjing Cai
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Zhijun Huang
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
| | - Hong Yuan
- Center of Clinical Pharmacology, Third Xiangya Hospital, Central South Univeristy, Changsha, China
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115
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Ostan R, Guidarelli G, Giampieri E, Lanzarini C, Berendsen AAM, Januszko O, Jennings A, Lyon N, Caumon E, Gillings R, Sicinska E, Meunier N, Feskens EJM, Pietruszka B, de Groot LCPGM, Fairweather-Tait S, Capri M, Franceschi C, Santoro A. Cross-Sectional Analysis of the Correlation Between Daily Nutrient Intake Assessed by 7-Day Food Records and Biomarkers of Dietary Intake Among Participants of the NU-AGE Study. Front Physiol 2018; 9:1359. [PMID: 30327612 PMCID: PMC6174234 DOI: 10.3389/fphys.2018.01359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022] Open
Abstract
Methods for measuring diet composition and quantifying nutrient intake with sufficient validity are essential to study the association between nutrition and health outcomes and risk of diseases. 7-day food records provides a quantification of food actually and currently consumed and is interesting for its use in intervention studies to monitor diet in a short-term period and to guide participants toward changing their intakes. The objective of this study is to analyze the correlation/association between the daily intake of selected nutrients (collected by a 7-day food records plus a mineral/vitamin supplementation questionnaire) and estimates of energy expenditure as well as blood and urine biomarkers of dietary intakes in 1,140 healthy elderly subjects (65–79 years) at baseline of the NU-AGE intervention study (NCT01754012, clinicaltrials.gov). The results show that: the daily intake of energy correlated significantly with predicted total energy expenditure (pTEE) (ρ = 0.459, p < 0.001, and q < 0.001); protein intake correlated significantly with the ratio of 24 h urinary urea to creatinine excretion (ρ = 0.143 for total protein intake, ρ = 0.296 for animal protein intake, and ρ = 0.359 for protein intake/body weight, p < 0.001 and q < 0.001 for each correlation); vitamin B12 and folate intakes correlated significantly with their serum concentrations (ρ = 0.151 and ρ = 0.363, respectively; p < 0.001 and q < 0.001 for each correlation); sodium and potassium intakes correlated significantly with their 24 h urinary excretion (ρ = 0.298 and ρ = 0.123, respectively; p < 0.001 and q < 0.001 for each correlation); vitamin B12 and folate intakes were negatively associated with plasma homocysteine measure (p = 0.001 and p = 0.004, respectively); stratifying subjects by gender, the correlations between energy intake and pTEE and between potassium intake and its 24 h urinary excretion lost their significance in women. Even if the plasma and urinary levels of these nutrients depend on several factors, the significant correlations between daily reported intake of nutrients (protein, vitamin B12, folate, and sodium) and their blood/urinary markers confirmed that the 7-day food records (plus a supplementation questionnaire) provides reliable data to evaluate short-term current dietary intake in European elderly subjects and it can be exploited to guide and monitor NU-AGE participants through the shift of their diet according NU-AGE recommendations.
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Affiliation(s)
- Rita Ostan
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Interdepartmental Centre "L. Galvani" (CIG), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulia Guidarelli
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Enrico Giampieri
- Department of Physics and Astronomy, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Catia Lanzarini
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Agnes A M Berendsen
- Department of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Olga Januszko
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Amy Jennings
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Noëlle Lyon
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Elodie Caumon
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Rachel Gillings
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Ewa Sicinska
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Nathalie Meunier
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Edith J M Feskens
- Department of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | | | | | - Miriam Capri
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Interdepartmental Centre "L. Galvani" (CIG), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Aurelia Santoro
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Interdepartmental Centre "L. Galvani" (CIG), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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116
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1795] [Impact Index Per Article: 299.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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117
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Weaver CM, Stone MS, Lobene AJ, Cladis DP, Hodges JK. What Is the Evidence Base for a Potassium Requirement? NUTRITION TODAY 2018; 53:184-195. [PMID: 30369637 PMCID: PMC6181280 DOI: 10.1097/nt.0000000000000298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Increased intake of potassium should be promoted to reduce the risk of cardiovascular disease and stroke and to protect against bone loss, but confidence in recommended intakes depends on the strength of the evidence. All public health recommendations are considerably higher than current average intakes. Evidence on which current potassium intake recommendations for the United States, Europe, and globally have limitations. More recent evidence reviewed by the Agency for Healthcare Research and Quality affirms that more evidence is needed to define specific values for optimal potassium intakes. Potassium requirements undoubtedly vary with a number of factors including energy needs, race, and intake of sodium.
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Affiliation(s)
- Connie M Weaver
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Michael S Stone
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Andrea J Lobene
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Dennis P Cladis
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Joanna K Hodges
- is a distinguished professor in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on potassium effect of health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on sodium effect in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a doctoral student conducting research on nutrient requirements and safety in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
- is a post-doctoral associate conducting research on calcium effect on health in the Department of Nutrition Science, Purdue University, West Lafayette, Indiana
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Montesano D, Rocchetti G, Cossignani L, Lucini L, Simonetti MS, Blasia F. Italian Lycium barbarum L. Berry: Chemical Characterization and Nutraceutical Value. Nat Prod Commun 2018. [DOI: 10.1177/1934578x1801300913] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lycium barbarum L. has received considerable attention in recent years also in western countries because of the interesting healthy value of these berries. In this paper, goji samples cultivated in Southern Italy were analyzed for their chemical composition and nutritional profile in order to characterize fruits of Italian origin and to increase the awareness about their nutraceutical value. Lipid fraction was characterized by high percentages of unsaturated fatty acids, in particular oleic and linoleic acids, and very low values of atherogenic and thrombogenic indexes (0.1 and 0.2, respectively). In addition, goji berry was an interesting source of phytosterols (41.5 mg/100 g), essentially represented by β-sitosterol. Carotenoid analysis showed the presence of zeaxanthin, in esterified form, with high content of zeaxanthin dipalmitate (277.9 mg/100 g). Finally, in vitro antioxidant capacity and phenolic compounds were investigated. The results suggested that goji hydro-alcoholic extract possessed the ability to scavenge free radicals. Phenolic acids were clearly the most abundant compounds followed by flavonols and favanols. The results reported in this study confirm that Italian L. barbarum berry is a rich source of bioactive molecules with nutraceutical properties.
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Affiliation(s)
- Domenico Montesano
- Department of Pharmaceutical Sciences, Section of Food Science and Nutrition, Università di Perugia, Via San Costanzo, 06126, Perugia, Italy
| | - Gabriele Rocchetti
- Department of Animal Science, Food and Nutrition, Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122, Piacenza, Italy
| | - Lina Cossignani
- Department of Pharmaceutical Sciences, Section of Food Science and Nutrition, Università di Perugia, Via San Costanzo, 06126, Perugia, Italy
| | - Luigi Lucini
- Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122, Piacenza, Italy
| | - Maria Stella Simonetti
- Department of Pharmaceutical Sciences, Section of Food Science and Nutrition, Università di Perugia, Via San Costanzo, 06126, Perugia, Italy
| | - Frances Blasia
- Department of Pharmaceutical Sciences, Section of Food Science and Nutrition, Università di Perugia, Via San Costanzo, 06126, Perugia, Italy
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119
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5622] [Impact Index Per Article: 937.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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120
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Murao S, Takata Y, Yasuda M, Osawa H, Kohi F. The Influence of Sodium and Potassium Intake and Insulin Resistance on Blood Pressure in Normotensive Individuals Is More Evident in Women. Am J Hypertens 2018; 31:876-885. [PMID: 29547880 DOI: 10.1093/ajh/hpy041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/13/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Considering sex differences, salt sensitivity, and insulin resistance (IR), the effect of sodium restriction and increased potassium intake on blood pressure remains unclear in normotensive Asian individuals, compared to that in hypertensive patients. METHODS To assess the influence of sodium and potassium intake in normotensive individuals, we evaluated the estimated 24-hour urinary sodium and potassium excretion rate in 3,392 drug-naïve normotensive Japanese individuals (average age: 48.4 years) and analyzed its relation to blood pressure using multivariate regression analysis. RESULTS Multivariate regression analysis revealed that a 10-mmol/day increment in urinary sodium excretion related to an elevation in systolic blood pressure of 0.16 mm Hg in men and 0.37 mm Hg in women, after adjusting for known risk factors to salt sensitivity, including age, body mass index, serum creatinine, homeostasis model assessment of IR, and urinary potassium excretion. For urinary potassium excretion, a 10-mmol/day increment was associated with a decrease in systolic blood pressure, -0.54 mm Hg in men and -1.49 mm Hg in women, respectively. Furthermore, involvement of IR on blood pressure was observed only in women. CONCLUSIONS In drug-naïve normotensive individuals, the effects of a lower-salt and higher-potassium diet, and IR on blood pressure, were more evident in women. These results suggest that to prevent the new onset of hypertension and its complications, the balances of a sodium restriction and an increased potassium intake are important even in normotensive individuals, independent of known risk factors for salt sensitivity, especially in women.
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Affiliation(s)
- Satoshi Murao
- Department of Endocrinology and Metabolism, Takamatsu Hospital, Kagawa, Japan
| | - Yasunori Takata
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Mitsugi Yasuda
- Health Promotion Center, Takamatsu Hospital, Kagawa, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Fumikazu Kohi
- Department of Internal Medicine, Takamatsu Hospital, Kagawa, Japan
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121
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Castiglione D, Platania A, Conti A, Falla M, D'Urso M, Marranzano M. Dietary Micronutrient and Mineral Intake in the Mediterranean Healthy Eating, Ageing, and Lifestyle (MEAL) Study. Antioxidants (Basel) 2018; 7:antiox7070079. [PMID: 29937504 PMCID: PMC6071131 DOI: 10.3390/antiox7070079] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Dietary vitamins and minerals are essential compounds for the proper functioning of metabolic enzymes, regulation of gene transcription, and powering the body’s defense against oxidative stress. The aim of the present study was to investigate micronutrient consumption separately by age and sex, major dietary sources, and percentage of individuals meeting the recommended requirements according to Italian (Livelli di Assunzione di Riferimento di Nutrienti (LARN)) and European (European Food Safety Agency (EFSA)) agencies. METHODS Data were obtained from the Mediterranean Healthy Eating, Ageing, and Lifestyle (MEAL) study, which included a sample of 1838 individuals randomly collected in the city of Catania, southern Italy. A validated food frequency questionnaire was used to collect information on diet. RESULTS Intake of vitamin A, vitamin C, and vitamin B group (except vitamin B9) was in line with other reports and was adequate according to the guidelines, while the percentage of individuals meeting the guidelines for vitamin D, vitamin E, and vitamin B9 was about 3%, 10%, and 40%, respectively. Among minerals, intake of iron, magnesium, and selenium was adequate for most of the sample, while the percentage of individuals meeting the recommendations for calcium, sodium, and potassium intake was about 20%, 8%, and 35%, respectively. CONCLUSIONS An important percentage of the population would benefit from campaigns raising awareness of micronutrient deficiency or excessive consumption potentially affecting their health.
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Affiliation(s)
- Dora Castiglione
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95123, Italy.
| | - Armando Platania
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95123, Italy.
| | - Alessandra Conti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95123, Italy.
| | - Mariagiovanna Falla
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95123, Italy.
| | - Maurizio D'Urso
- Provincial Health Authority of Catania, Catania 95127, Italy.
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania 95123, Italy.
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Dietary sodium, sodium-to-potassium ratio, and risk of stroke: A systematic review and nonlinear dose-response meta-analysis. Clin Nutr 2018; 38:1092-1100. [PMID: 29907351 DOI: 10.1016/j.clnu.2018.05.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/04/2018] [Accepted: 05/24/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS The association of high sodium intake with risk of stroke has been accepted. But considering the proposed J/U-shaped association between sodium intake and risk of all-cause mortality, the shape of the dose-response relationship has not been determined yet. This study aimed to test the dose-response association of dietary sodium and sodium-to-potassium ratio with risk of stroke in adults aged 18 years or older. METHODS We performed a systematic search using PubMed and Scopus, from database inception up to October 2017. Prospective and retrospective observational studies reporting risk estimates of stroke for three or more quantitative categories of dietary sodium or sodium-to-potassium ratio were included. Studies that reported results as continuous were also included. Two independent authors extracted the information and assessed the quality of included studies. Pooled relative risk (RR) was calculated using a random-effects model. Publication bias was tested. Sensitivity and subgroup analyses were done. RESULTS Of initial 20,412 studies identified, 14 prospective cohort studies, one case-cohort study, and one case-control study (total n = 261,732) with 10,150 cases of stroke were included. The Pooled RRs of stroke were 1.06 (95%CI: 1.02, 1.10; I2 = 60%, n = 14 studies) for a 1 gr/d increment in dietary sodium intake, and 1.22 (95%CI: 1.04, 1.41; I2 = 60%, n = 5 studies) for a one-unit increment in dietary sodium-to-potassium ratio (mmol/mmol). The risk of stroke increased linearly with increasing dietary sodium intake, and also along with the increase in dietary sodium-to-potassium ratio. No evidence of a J/U-shaped association was found in the analyses of total stroke, stroke incidence, and stroke mortality. High sodium intake was associated with a somewhat worse prognosis among Asian countries as compared to westerns. CONCLUSION Higher sodium intake and higher dietary sodium-to-potassium ratio were associated with a higher risk of stroke. Reducing dietary sodium-to-potassium ratio can be considered as a supplementary approach in parallel with the decrease in sodium intake in order to decrease stroke risk. The interpretation of the results is limited by observational nature of studies examined.
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Egeland GM, Skurtveit S, Staff AC, Eide GE, Daltveit AK, Klungsøyr K, Trogstad L, Magnus PM, Brantsæter AL, Haugen M. Pregnancy-Related Risk Factors Are Associated With a Significant Burden of Treated Hypertension Within 10 Years of Delivery: Findings From a Population-Based Norwegian Cohort. J Am Heart Assoc 2018; 7:e008318. [PMID: 29755036 PMCID: PMC6015329 DOI: 10.1161/jaha.117.008318] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The association between pregnancy complications and women's later cardiovascular disease has, primarily, been evaluated in studies lacking information on important covariates. This report evaluates the prospective associations between pregnancy-related risk factors (preeclampsia/eclampsia, gestational hypertension, pregestational and gestational diabetes mellitus, preterm delivery, and fetal growth restriction) and pharmacologically treated hypertension within 10 years after pregnancy, while adjusting for a wide range of covariates. METHODS AND RESULTS Prepregnancy normotensive women participating in the MoBa (Norwegian Mother and Child Cohort Study) from January 2004 through July 2009 were linked to the Norwegian Prescription Database to identify women with pharmacologically treated hypertension beyond the postpartum period of 3 months. The burden of hypertension associated with pregnancy-related risk factors was evaluated using an attributable fraction method. A total of 1480 women developed pharmacologically treated hypertension within the follow-up among 60 027 women (rate of hypertension, 3.6/1000 person-years). The proportion of hypertension associated with a history of preeclampsia/eclampsia, gestational hypertension, preterm delivery, and pregestational or gestational diabetes mellitus was 28.6% (95% confidence interval, 25.5%-31.6%) on the basis of multivariable analyses adjusting for numerous covariates. The proportion was similar for women with a healthy prepregnancy body mass index (18.5-24.9 kg/m2; attributable fraction (AF)% 25.9%; 95% confidence interval, 21.3%-30.3%), but considerably higher for nulliparous women at baseline within the first 5 years of follow-up. Small-for-gestational age, however, did not increase subsequent hypertension risk in multivariable analyses. CONCLUSIONS A structured postpartum follow-up of high-risk women identified through pregnancy-related risk factors would facilitate personalized preventive strategies to postpone or avoid onset of premature cardiovascular events.
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Affiliation(s)
- Grace M Egeland
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Svetlana Skurtveit
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Anne Cathrine Staff
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Anne-Kjersti Daltveit
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Kari Klungsøyr
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Lill Trogstad
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Per M Magnus
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Anne Lise Brantsæter
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
| | - Margaretha Haugen
- Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Bergen and Oslo, Norway
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Marinangeli CPF, Curran J, Barr SI, Slavin J, Puri S, Swaminathan S, Tapsell L, Patterson CA. Enhancing nutrition with pulses: defining a recommended serving size for adults. Nutr Rev 2018; 75:990-1006. [PMID: 29202192 PMCID: PMC5914352 DOI: 10.1093/nutrit/nux058] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pulses, defined as dry-harvested leguminous crops, include several varieties of beans, peas, lentils, and chickpeas. There is no consensus around a recommended serving size of pulses within a balanced diet, which prevents the development of transregional strategies that rely on consistent messaging to drive increases in consumption. The purpose of this review is to define and disseminate an appropriate target for a minimum serving size of pulses on any given day that can be used in international or collaborative strategies to promote the consumption of pulses. Relevant data were reviewed to examine dietary guidelines across jurisdictions, determine consumption levels of pulses across the globe, evaluate the nutritional composition of pulses in the context of dietary nutrient insufficiency, and assess the impact of pulses on dietary quality. Across a variety of pulses, 100 g of cooked pulses aligned with most regional serving sizes for pulses and provides significant levels of nutrients that are underconsumed by specific age-sex groups. Moreover, 100 g of pulses provides a number of nutrients that qualify for nutrient content claims under regional regulatory frameworks. The data demonstrate that 100 g or 125 mL (0.5 metric cup) of cooked pulses is a reasonable target for aligning strategies that promote the dietary and nutritional attributes of these legumes.
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Affiliation(s)
| | | | - Susan I Barr
- Department of Food, Nutrition & Health and the Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
| | - Seema Puri
- Institute of Home Economics, University of Delhi, New Delhi, India
| | - Sumathi Swaminathan
- St Johns Research Institute, Division of Nutrition, Bangalore, Karnataka, India
| | - Linda Tapsell
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Mahmassani HA, Avendano EE, Raman G, Johnson EJ. Avocado consumption and risk factors for heart disease: a systematic review and meta-analysis. Am J Clin Nutr 2018; 107:523-536. [PMID: 29635493 DOI: 10.1093/ajcn/nqx078] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background Nutrients in avocados are associated with cardiovascular benefits. Objective The aim of this study was to determine the effect of avocado intake on cardiovascular disease (CVD) risk with the use of a systematic review and meta-analysis. Design MEDLINE, Cochrane Central, and Commonwealth Agricultural Bureau abstracts were searched from 1946 through September 2017 for publications on avocado intake and CVD risk. All designs except for cross-sectional studies that evaluated avocado intake were included. Two investigators independently screened citations and extracted data. Random-effects models meta-analysis was used when ≥3 studies reported the same outcome. Results Of 18 eligible studies (481 subjects), 7 studies compared avocado intake with no intake, 3 studies compared avocado plus monounsaturated fat intake with a control, and 8 studies reported data for qualitative synthesis. In 7 studies, avocado intake significantly increased HDL cholesterol (summary net change: 2.84 mg/dL; 95% CI: 0.18, 5.49 mg/dL), with significant heterogeneity. This remained consistent in sensitivity and subgroup analyses. There was no significant difference between avocado intake and the control for the outcomes of serum total cholesterol (TC), LDL cholesterol, triglycerides (TGs), ratios of TC to HDL cholesterol and LDL cholesterol to HDL cholesterol, and body weight. In qualitative synthesis, there was no significant difference between groups for blood glucose (2 studies), homeostasis model assessment (1 of 2 studies), oxidized LDL (2 studies), high-sensitivity C-reactive protein (2 studies), or apolipoprotein B (2 studies) or, in 1 study each, for body mass index, systolic and diastolic blood pressure, arterial compliance, fibrinogen, interleukin 6, tumor necrosis factor α, and serum nitric oxide. No studies reported incident clinical outcomes of CVD, including myocardial infarction, stroke, and other clinical endpoints. Conclusions Avocado intake resulted in no difference in serum TC, LDL-cholesterol, and TG concentrations, but it did increase serum HDL-cholesterol concentrations, with significant heterogeneity. The association between avocado intake and CVD risk should be confirmed by well-conducted prospective observational studies or long-term trials.
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Affiliation(s)
- Hiya A Mahmassani
- Dorothy J and Gerald R Friedman School of Nutrition and Science Policy at Tufts University
| | | | - Gowri Raman
- Tufts Clinical Evidence Synthesis Center, Tufts Medical Center
| | - Elizabeth J Johnson
- Jean Mayer USDA Human Nutrition, Research Center on Aging at Tufts University, Boston, MA
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4503] [Impact Index Per Article: 750.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
PURPOSE OF REVIEW Hyperkalemia develops in a patient with systemic arterial hypertension (HTN) if one or more risk factors are present, namely chronic kidney disease (CKD) (especially severe stage 4-5 CKD), diabetes mellitus (DM), heart failure (HF), or pharmacological therapies that interfere with potassium homeostasis, mainly through renin-angiotensin-aldosterone inhibition (RAASi). Hyperkalemia is a considerable reason of morbidity (emergency department (ED) visits and hospitalizations) and portends a higher mortality risk in patients at risk; for instance, hyperkalemia increases the risk of mortality within 1 day of a hyperkalemic event. This review aims to identify the risk factors for high-serum potassium, highlight the risk versus benefit of RAASi in certain patient populations, and outline preventive as well as therapeutic strategies for hyperkalemia. RECENT FINDINGS A growing body of evidence supports the safety and efficacy of cation-exchange resins, patiromer, or sodium zirconium cyclosilicate, in patients with a compelling indication for RAASi, yet in whom such therapy was complicated by hyperkalemia, allowing these patients to benefit from continued RAASi therapy. In summary, novel cation exchange polymers present the clinician with a new and safe strategy to address hyperkalemia in patients with a compelling indication for ongoing RAASi therapy instead of withdrawal of such therapy.
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Affiliation(s)
- Jay Ian Lakkis
- University of Hawaii John A. Burns School of Medicine, 95 Maui Lani Pkwy, Wailuku, HI, 96793-2416, USA
| | - Matthew R Weir
- Division of Nephrology, University of Maryland School of Medicine, 22 S. Greene St., Room N3W143, Baltimore, MD, 21201, USA.
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Mirmiran P, Bahadoran Z, Nazeri P, Azizi F. Dietary sodium to potassium ratio and the incidence of hypertension and cardiovascular disease: A population-based longitudinal study. Clin Exp Hypertens 2018; 40:772-779. [PMID: 29381403 DOI: 10.1080/10641963.2018.1431261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE There is an interaction between dietary sodium/potassium intake in the pathogenesis of hypertension (HTN) and cardiovascular disease (CVD). The aim of this study was to investigate the association of dietary sodium to potassium (Na/K) ratio and the risk of HTN and CVD in a general population of Iranian adults. METHODS In this prospective cohort study, adults men and women with complete baseline data were selected from among participants of the Tehran Lipid and Glucose Study and were followed up for 6.3 years for incidence of HTN and CVD outcomes. Dietary sodium and potassium were assessed using a valid and reliable 168-item food frequency questionnaire. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between dietary sodium, potassium and their ratio and risk of outcomes. RESULTS During the study follow-up, 291 (15.1%) and 79 (5.0%) new cases of HTN and CVD were identified, respectively. No significant association was observed between usual intakes of sodium, potassium and dietary Na/K ratio with the incidence of HTN. There was no significant association between dietary intakes of sodium and potassium per se and the risk of CVD, whereas when dietary sodium to potassium ratio was considered as exposure in the fully-adjusted Cox regression model, and participants in the highest compared to lowest tertile had a significantly increased risk of CVD (HR = 2.19, 95% CI = 1.16-4.14). CONCLUSIONS Our findings suggest that high dietary Na/K ratio could contribute to increased risk of CVD events.
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Affiliation(s)
- Parvin Mirmiran
- a Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology , National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Zahra Bahadoran
- b Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Pantea Nazeri
- b Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Fereidoun Azizi
- c Endocrine Research Center , Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Sodium and potassium content of 24 h urinary collections: a comparison between field- and laboratory-based analysers. Public Health Nutr 2018; 21:1036-1042. [PMID: 29306343 DOI: 10.1017/s1368980017003731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Measurement of mean population Na and K intakes typically uses laboratory-based assays, which can add significant logistical burden and costs. A valid field-based measurement method would be a significant advance. In the current study, we used 24 h urine samples to compare estimates of Na, K and Na:K ratio based upon assays done using the field-based Horiba twin meter v. laboratory-based methods. DESIGN The performance of the Horiba twin meter was determined by comparing field-based estimates of mean Na and K against those obtained using laboratory-based methods. The reported 95 % limits of agreement of Bland-Altman plots were calculated based on a regression approach for non-uniform differences. SETTING The 24 h urine samples were collected as part of an ongoing study being done in rural China. SUBJECTS One hundred and sixty-six complete 24 h urine samples were qualified for estimating 24 h urinary Na and K excretion. RESULTS Mean Na and K excretion were estimated as 170·4 and 37·4 mmol/d, respectively, using the meter-based assays; and 193·4 and 43·8 mmol/d, respectively, using the laboratory-based assays. There was excellent relative reliability (intraclass correlation coefficient) for both Na (0·986) and K (0·986). Bland-Altman plots showed moderate-to-good agreement between the two methods. CONCLUSIONS Na and K intake estimations were moderately underestimated using assays based upon the Horiba twin meter. Compared with standard laboratory-based methods, the portable device was more practical and convenient.
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Steffensen IL, Frølich W, Dahl KH, Iversen PO, Lyche JL, Lillegaard ITL, Alexander J. Benefit and risk assessment of increasing potassium intake by replacement of sodium chloride with potassium chloride in industrial food products in Norway. Food Chem Toxicol 2018; 111:329-340. [DOI: 10.1016/j.fct.2017.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/20/2017] [Accepted: 11/20/2017] [Indexed: 12/28/2022]
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Miyazaki H, Nakamura T, Ohki K, Nagai K. Effects of the bioactive peptides Ile-Pro-Pro and Val-Pro-Pro upon autonomic neurotransmission and blood pressure in spontaneously hypertensive rats. Auton Neurosci 2017; 208:88-92. [DOI: 10.1016/j.autneu.2017.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022]
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Eating occasions and the contribution of foods to sodium and potassium intakes in adults. Public Health Nutr 2017; 21:317-324. [PMID: 29108531 DOI: 10.1017/s1368980017002968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions. DESIGN Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). SETTING Nationally representative survey in Australia. SUBJECTS Male and female Australians aged 18-84 years (n 7818). RESULTS Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. CONCLUSIONS Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.
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Zhao X, Zhang Y, Zhang X, Kang Y, Tian X, Wang X, Peng J, Zhu Z, Han Y. Associations of urinary sodium and sodium to potassium ratio with hypertension prevalence and the risk of cardiovascular events in patients with prehypertension. J Clin Hypertens (Greenwich) 2017; 19:1231-1239. [PMID: 29087023 DOI: 10.1111/jch.13104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/07/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the effects of urinary sodium and sodium to potassium ratio on inflammatory cytokines, hypertension, and cardiovascular disease in patients with prehypertension. The authors observed 627 patients with prehypertension in the General Hospital of Shenyang Military Region. Rank correlation analysis revealed that interleukin 6 expression exhibited significant positive correlations with urinary sodium (R = .13) and sodium to potassium ratio (R = .13). The multivariate-adjusted hazard ratio of 24-hour urinary sodium was 1.01 (95% confidence interval, 1.00 - 1.01) for hypertension and 1.01 (95% confidence interval, 1.00 - 1.02) for cardiovascular disease, whereas the hazard ratio for 24-hour urinary sodium to potassium ratio was 1.13 (95% confidence interval, 1.08 - 1.19) for hypertension and 1.10 (95% confidence interval, 1.04 - 1.17) for cardiovascular disease. The study suggests that a high-salt diet may lead to increased interleukin 6 levels and may contribute to hypertension. In addition, a high sodium to potassium ratio and high sodium levels are associated with increased risks of cardiovascular disease and hypertension in patients with prehypertension.
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Affiliation(s)
- Xin Zhao
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Yan Zhang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China.,Jinzhou Medical University, Jinzhou, China
| | - Xiaolin Zhang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Yi Kang
- Liaoning Traditional Chinese Medicine University, Shenyang, China
| | - Xiaoxiang Tian
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Xiaozeng Wang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Junyin Peng
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China.,Jinzhou Medical University, Jinzhou, China
| | - Zhiming Zhu
- Chongqing Institute of Hypertension, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yaling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
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Abstract
Whereas primary prevention seeks to forestall development of disease in individuals with elevated risk, primordial prevention seeks to preempt the development of risk factors. Health behaviors-characterized as "lifestyle" factors-are key interventional targets in primordial prevention of cardiovascular disease. Appropriate dietary intake, including limiting salt and saturated fat consumption, can reduce the risk of developing hypertension and dyslipidemias. Regular physical activity is associated with lower blood pressure and healthier lipid profiles. Diet and exercise are critical to maintaining weight conducive to cardiovascular health. Behavioral factors such as stress management, sleep duration, portion control, and meal timing may play a role in weight management and offer additional routes of intervention. Any smoking elevates cardiovascular risk. Although lifestyle modification programs can be instrumental in reaching public health goals, maintaining cardiovascular health should not be a matter solely of willpower. Ideally, structural and social forces should make healthy lifestyles the default option.
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Affiliation(s)
- Steven A Claas
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donna K Arnett
- Dean's Office, College of Public Health, University of Kentucky, Lexington, KY, USA.
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Rossier BC, Bochud M, Devuyst O. The Hypertension Pandemic: An Evolutionary Perspective. Physiology (Bethesda) 2017; 32:112-125. [PMID: 28202622 DOI: 10.1152/physiol.00026.2016] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hypertension affects over 1.2 billion individuals worldwide and has become the most critical and expensive public health problem. Hypertension is a multifactorial disease involving environmental and genetic factors together with risk-conferring behaviors. The cause of the disease is identified in ∼10% of the cases (secondary hypertension), but in 90% of the cases no etiology is found (primary or essential hypertension). For this reason, a better understanding of the mechanisms controlling blood pressure in normal and hypertensive patients is the aim of very active experimental and clinical research. In this article, we review the importance of the renin-angiotensin-aldosterone system (RAAS) for the control of blood pressure, focusing on the evolution of the system and its critical importance for adaptation of vertebrates to a terrestrial and dry environment. The evolution of blood pressure control during the evolution of primates, hominins, and humans is discussed, together with the role of common genetic factors and the possible causes of the current hypertension pandemic in the light of evolutionary medicine.
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Affiliation(s)
- Bernard C Rossier
- Department of Pharmacology and Toxicology, University of Lausanne, Lausanne, Switzerland;
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Olivier Devuyst
- Institute of Physiology, University of Zurich, Zurich, Switzerland
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Dainelli L, Xu T, Li M, Zimmermann D, Fang H, Wu Y, Detzel P. Cost-effectiveness of milk powder fortified with potassium to decrease blood pressure and prevent cardiovascular events among the adult population in China: a Markov model. BMJ Open 2017; 7:e017136. [PMID: 28951410 PMCID: PMC5623478 DOI: 10.1136/bmjopen-2017-017136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To model the long-term cost-effectiveness of consuming milk powder fortified with potassium to decrease systolic blood pressure (SBP) and prevent cardiovascular events. DESIGN A best case scenario analysis using a Markov model was conducted. PARTICIPANTS 8.67% of 50-79 year olds who regularly consume milk in China, including individuals with and without a prior diagnosis of hypertension. INTERVENTION The model simulated the potential impact of a daily intake of two servings of milk powder fortified with potassium (+700 mg/day) vs the consumption of a milk powder without potassium fortification, assuming a market price equal to 0.99 international dollars (intl$; the consumption of a milk powder without potassium fortification, assuming a market price equal to intl$0.99 for the latter and to intl$1.12 for the first (+13.13%). Both deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the results. MAIN OUTCOME MEASURES Estimates of the incidence of cardiovascular events and subsequent mortality in China were derived from the literature as well as the effect of increasing potassium intake on blood pressure. The incremental cost-effectiveness ratio (ICER) was used to determine the cost-effectiveness of a milk powder fortified with potassium taking into consideration the direct medical costs associated with the cardiovascular events, loss of working days and health utilities impact. RESULTS With an ICER equal to int$4711.56 per QALY (quality-adjusted life year) in the best case scenario and assuming 100% compliance, the daily consumption of a milk powder fortified with potassium shown to be a cost-effective approach to decrease SBP and reduce cardiovascular events in China. Healthcare savings due to prevention would amount to intl$8.41 billion. Sensitivity analyses showed the robustness of the results. CONCLUSION Together with other preventive interventions, the consumption of a milk powder fortified with potassium could represent a cost-effective strategy to attenuate the rapid rise in cardiovascular burden among the 50-79 year olds who regularly consume milk in China.
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Affiliation(s)
| | - Tingting Xu
- China Center for Health Development Studies, Peking University, Beijing, China
- Department of Health Policy and Administration, Peking University School of Public Health, Beijing, China
| | - Min Li
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | | | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yangfeng Wu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- The George Institute for Global Health, Peking University Health Science Centre, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
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137
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Clegg DJ, Cody M, Palmer BF. Challenges in Treating Cardiovascular Disease: Restricting Sodium and Managing Hyperkalemia. Mayo Clin Proc 2017; 92:1248-1260. [PMID: 28778258 DOI: 10.1016/j.mayocp.2017.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 02/02/2023]
Abstract
High sodium intake, whether via diet or drugs, augments cardiorenal risk. Regardless of its source, high sodium intake can both lead to hypertension and reduce the efficacy of renin-angiotensin-aldosterone system inhibitors, which are currently guideline-recommended treatments for hypertension, chronic kidney disease, and heart failure. Reducing sodium intake is therefore recommended to reduce the risk of adverse cardiorenal outcomes. An inverse relationship exists between sodium and potassium, with foods high in sodium being lower in potassium. Diets high in potassium have been associated with reducing hypertension and heart failure; however, optimal renin-angiotensin-aldosterone system inhibitor dosing is often limited by hyperkalemia, which can lead to life-threatening cardiac arrhythmias and increased mortality. Potassium binders are effective at reducing potassium levels. Although some use sodium as the potassium exchange ion, thus increasing sodium intake, a new potassium binder uses another exchange ion and therefore does not increase sodium intake. When treatment options require agents that may precipitate hyperkalemia, particularly in patients at high cardiorenal risk, drugs that do not add to the sodium load may be preferred. A literature search was conducted using PubMed; search terms included potassium, sodium, hyperkalemia, potassium binders, and the literature search focused on manuscripts published more recently since 2000.
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Affiliation(s)
- Deborah J Clegg
- Biomedical Research Department, Diabetes and Obesity Research Division, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Michael Cody
- Medical Affairs, Relypsa, Inc. (a Vifor Pharma Group Company), Redwood City, CA
| | - Biff F Palmer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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138
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Iwahori T, Miura K, Ueshima H. Time to Consider Use of the Sodium-to-Potassium Ratio for Practical Sodium Reduction and Potassium Increase. Nutrients 2017; 9:E700. [PMID: 28678188 PMCID: PMC5537815 DOI: 10.3390/nu9070700] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023] Open
Abstract
Pathogenetic studies have demonstrated that the interdependency of sodium and potassium affects blood pressure. Emerging evidences on the sodium-to-potassium ratio show benefits for a reduction in sodium and an increase in potassium compared to sodium and potassium separately. As presently there is no known review, this article examined the practical use of the sodium-to-potassium ratio in daily practice. Epidemiological studies suggest that the urinary sodium-to-potassium ratio may be a superior metric as compared to separate sodium and potassium values for determining the relation to blood pressure and cardiovascular disease risks. Higher correlations and better agreements are seen for the casual urine sodium-to-potassium ratio than for casual urine sodium or potassium alone when compared with the 24-h urine values. Repeated measurements of the casual urine provide reliable estimates of the 7-day 24-h urine value with less bias for the sodium-to-potassium ratio as compared to the common formulas used for estimating the single 24-h urine from the casual urine for sodium and potassium separately. Self-monitoring devices for the urinary sodium-to-potassium ratio measurement makes it possible to provide prompt onsite feedback. Although these devices have been evaluated with a view to support an individual approach for sodium reduction and potassium increase, there has yet to be an accepted recommended guideline for the sodium-to-potassium ratio. This review concludes with a look at the practical use of the sodium-to-potassium ratio for assistance in practical sodium reduction and potassium increase.
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Affiliation(s)
- Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Research and Development Department, OMRON HEALTHCARE Co., Ltd., 53 Kunotsubo Terada-cho, Muko, Kyoto 617-0002, Japan.
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
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139
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Low fruit consumption and omission of daily meals as risk factors for increased blood pressure in adults. Br J Nutr 2017; 116:683-91. [PMID: 27464462 DOI: 10.1017/s0007114516002397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A population-based cross-sectional survey with cluster sampling design and with inverse sampling was conducted in 2010, in a sample of 1590 adults (19-60 years old) exposed to a high prevalence of food insecurity, in the municipality of Duque de Caxias, metropolitan region of Rio de Janeiro, Brazil. The objective of the study was to evaluate the association of socio-demographic factors, the consumption of fruits and vegetables and the number of meals with increased blood pressure (BP). A hierarchical model that considered variables related to the basic, intermediate and immediate determinants of increased BP was adopted. By using Poisson's regression, univariate models were tested to obtain the prevalence ratio (PR) and its respective 95 % CI. After fitting the model, age (age group 50-59 years) (PR 1·62; 95 % CI 1·09, 2·41), low consumption of fruits in a week (PR 1·37; 95 % CI 1·07, 1·74), fewer meals per day (PR 1·72; 95 % CI 1·21, 2·43) and overweight (PR 1·78; 95 % CI 1·31, 2·20) remained significantly associated with increased BP. Therefore, the results found here reinforce the importance of encouraging and developing strategies that ensure access to healthy foods to minimise increased BP in similar populations.
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140
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Vasara E, Marakis G, Breda J, Skepastianos P, Hassapidou M, Kafatos A, Rodopaios N, Koulouri AA, Cappuccio FP. Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area-The Salt Intake in Northern Greece (SING) Study. Nutrients 2017; 9:E417. [PMID: 28441726 PMCID: PMC5409756 DOI: 10.3390/nu9040417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/06/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies for setting targets and monitoring effectiveness within each country, the current level of consumption should be known. Greece lacks data on actual sodium and potassium intake. The aim of the present study was therefore to assess dietary salt (using sodium as biomarker) and potassium intakes in a sample of healthy adults in northern Greece, and to determine whether adherence to a Mediterranean diet is related to different sodium intakes or sodium-to-potassium ratio. A cross-sectional survey was carried out in the Thessaloniki greater metropolitan area (northern Greece) (n = 252, aged 18-75 years, 45.2% males). Participants' dietary sodium and potassium intakes were determined by 24-hour urinary sodium and potassium excretions. In addition, we estimated their adherence to Mediterranean diet by the use of an 11-item MedDietScore (range 0-55). The mean sodium excretion was 175 (SD 72) mmol/day, equivalent to 4220 (1745) mg of sodium or 10.7 (4.4) g of salt per day, and the potassium excretion was 65 (25) mmol/day, equivalent to 3303 (1247) mg per day. Men had higher sodium and potassium excretions compared to women. Only 5.6% of the sample had salt intake <5 g/day, which is the target intake recommended by the World Health Organization. Mean sodium-to-potassium excretion ratio was 2.82 (1.07). There was no significant difference in salt or potassium intake or their ratio across MedDietScore quartiles. No significant relationships were found between salt intake and adherence to a Mediterranean diet, suggesting that the perception of the health benefits of the Mediterranean diet does not hold when referring to salt consumption. These results suggest the need for a larger, nation-wide survey on salt intake in Greece and underline the importance of continuation of salt reduction initiatives in Greece.
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Affiliation(s)
- Eleni Vasara
- Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
| | - Georgios Marakis
- Nutrition Policy and Research Directorate, Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., Athens 11526, Greece.
| | - Joao Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen DK-2100, Denmark.
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, Alexander Technological and Educational Institute of Thessaloniki, Sindos, Thessaloniki 57400, Greece.
| | - Maria Hassapidou
- Department of Nutrition and Dietetics, Alexander Technological and Educational Institute of Thessaloniki, Sindos, Thessaloniki 57400, Greece.
| | - Anthony Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Nikolaos Rodopaios
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Alexandra A Koulouri
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
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141
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Poorolajal J, Zeraati F, Soltanian AR, Sheikh V, Hooshmand E, Maleki A. Oral potassium supplementation for management of essential hypertension: A meta-analysis of randomized controlled trials. PLoS One 2017; 12:e0174967. [PMID: 28419159 PMCID: PMC5395164 DOI: 10.1371/journal.pone.0174967] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/17/2017] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Increased dietary potassium intake is thought to be associated with low blood pressure (BP). Whether potassium supplementation may be used as an antihypertensive agent is a question that should be answered. OBJECTIVE To assess the effect of oral potassium supplementation on blood pressure in patients with primary hypertension. SEARCH METHODS We searched Medline, Web of Science, Scopus, Cochrane Central Register of Controlled Trials until October 2016. We also screened reference lists of articles and previous reviews. We applied no language restrictions. SELECTION CRITERIA We included randomized placebo-controlled clinical trials addressing the effect of potassium supplementation on primary hypertension for a minimum of 4 weeks. DATA COLLECTION AND ANALYSIS We extracted data on systolic and diastolic BP (SBP and DBP) at the final follow-up. We explored the heterogeneity across studies using Cochran's test and I2 statistic and assessed the probability of publication bias using Begg's and Egger's tests. We reported the mean difference (MD) of SBP and DBP in a random-effects model. RESULTS We found a total of 9059 articles and included 23 trials with 1213 participants. Compared to placebo, potassium supplementation resulted in modest but significant reductions in both SBP (MD -4.25 mmHg; 95% CI: -5.96 to -2.53; I2 = 41%) and DBP (MD -2.53 mmHg; 95% CI: -4.05 to -1.02; I2 = 65%). According to the change-score analysis, based on 8 out of 23 trials, compared to baseline, the mean changes in SBP (MD -8.89 mmHg; 95% CI: -13.67 to -4.11) and DBP (MD -6.42 mmHg; 95% CI: -10.99 to -1.84) was significantly higher in the intervention group than the control group. CONCLUSIONS Our findings indicated that potassium supplementation is a safe medication with no important adverse effects that has a modest but significant impact BP and may be recommended as an adjuvant antihypertensive agent for patients with essential hypertension.
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Affiliation(s)
- Jalal Poorolajal
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
- Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Zeraati
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Reza Soltanian
- Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Vida Sheikh
- Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elham Hooshmand
- Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Akram Maleki
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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142
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6069] [Impact Index Per Article: 867.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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143
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Interaction between Single Nucleotide Polymorphism and Urinary Sodium, Potassium, and Sodium-Potassium Ratio on the Risk of Hypertension in Korean Adults. Nutrients 2017; 9:nu9030235. [PMID: 28273873 PMCID: PMC5372898 DOI: 10.3390/nu9030235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 01/23/2017] [Accepted: 02/27/2017] [Indexed: 12/31/2022] Open
Abstract
Hypertension is a complex disease explained with diverse factors including environmental factors and genetic factors. The objectives of this study were to determine the interaction effects between gene variants and 24 h estimated urinary sodium and potassium excretion and sodium-potassium excretion ratios on the risk of hypertension. A total of 8839 participants were included in the genome-wide association study (GWAS) to find genetic factors associated with hypertension. Tanaka and Kawasaki formulas were applied to estimate 24 h urinary sodium and potassium excretion. A total of 4414 participants were included in interaction analyses to identify the interaction effects of gene variants according to 24 h estimated urinary factors on the risk of hypertension. CSK rs1378942 and CSK-MIR4513 rs3784789 were significantly modified by urinary sodium-potassium excretion ratio. In addition, MKLN rs1643270 with urinary potassium excretion, LOC101929750 rs7554672 with urinary sodium and potassium excretion, and TENM4 rs10466739 with urinary sodium-potassium excretion ratio showed significant interaction effects. The present study results indicated that the mutant alleles of CSK rs1378942 and CSK-MIR4513 rs3784789 had the strongest protective effects against hypertension in the middle group of 24 h estimated urinary sodium-potassium excretion ratio. Further studies are needed to replicate these analyses in other populations.
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144
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The effect of potassium supplementation on blood pressure in hypertensive subjects: A systematic review and meta-analysis. Int J Cardiol 2017; 230:127-135. [DOI: 10.1016/j.ijcard.2016.12.048] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/24/2016] [Accepted: 12/16/2016] [Indexed: 12/25/2022]
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145
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McDonough AA, Youn JH. Potassium Homeostasis: The Knowns, the Unknowns, and the Health Benefits. Physiology (Bethesda) 2017; 32:100-111. [PMID: 28202621 PMCID: PMC5337831 DOI: 10.1152/physiol.00022.2016] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Potassium homeostasis has a very high priority because of its importance for membrane potential. Although extracellular K+ is only 2% of total body K+, our physiology was evolutionarily tuned for a high-K+, low-Na+ diet. We review how multiple systems interface to accomplish fine K+ balance and the consequences for health and disease.
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Affiliation(s)
- Alicia A McDonough
- Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jang H Youn
- Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California
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146
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Vamvakis A, Gkaliagkousi E, Triantafyllou A, Gavriilaki E, Douma S. Beneficial effects of nonpharmacological interventions in the management of essential hypertension. JRSM Cardiovasc Dis 2017; 6:2048004016683891. [PMID: 28228940 PMCID: PMC5308526 DOI: 10.1177/2048004016683891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/14/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022] Open
Abstract
Essential hypertension is a major health problem causing excess cardiovascular morbidity and mortality. Management of essential hypertension consists of pharmacological and nonpharmacological interventions. In order to prevent and/or treat hypertension, parameters like nutrition, body weight, and physical exercise should be evaluated and taken under consideration for improvement. A large body of evidence clearly support that the role of salt, alcohol, fruits, and vegetables is important for high blood pressure. Furthermore, maintaining a normal body weight should be succeeded along with physical activity few times per week if not daily. Nonpharmacological intervention is rather a dynamic procedure that takes a multilevel approach with repeated training of the hypertensives by a team of expert physicians, rather than a single based guidance. Additionally, it should be based on a profile customization and personalized approach. Intensive interventions aiming at lifestyle changes through educational meetings are considered more effective in lowering high blood pressure. This consists of a lifestyle modification with a permanent basis for patient’s daily schedule and eventually should become a philosophy for a better quality of life through improvement of nutritional and exercise behavior. Further studies are needed so intervention guideline models can be even more effective for patients with essential hypertension.
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Affiliation(s)
- Anastasios Vamvakis
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
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147
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Yılmaz ZV, Akkaş E, Türkmen GG, Kara Ö, Yücel A, Uygur D. Dietary sodium and potassium intake were associated with hypertension, kidney damage and adverse perinatal outcome in pregnant women with preeclampsia. Hypertens Pregnancy 2016; 36:77-83. [DOI: 10.1080/10641955.2016.1239734] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Zehra Vural Yılmaz
- Zekai Tahir Burak Women’s Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey
| | - Elif Akkaş
- Dr. Sami Ulus Women’s and Children’s Health Training and Research Hospital, Department of Obstetrics and Gynaecology, Ankara, Turkey
| | | | - Özgür Kara
- Zekai Tahir Burak Women’s Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey
| | - Aykan Yücel
- Zekai Tahir Burak Women’s Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey
| | - Dilek Uygur
- Zekai Tahir Burak Women’s Health Education and Training Hospital, Department of Perinatology, Ankara, Turkey
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148
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Larsson SC, Wolk A. Potato consumption and risk of cardiovascular disease: 2 prospective cohort studies. Am J Clin Nutr 2016; 104:1245-1252. [PMID: 27680993 DOI: 10.3945/ajcn.116.142422] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/01/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Whether consumption of potatoes, which are rich in potassium and have a high glycemic index and glycemic load, is associated with the risk of cardiovascular disease (CVD) is unknown. OBJECTIVE The aim was to examine the association between potato consumption and risk of total and specific CVD events as well as mortality from CVD in 2 prospective cohorts of Swedish adults, a population with a high consumption of potatoes. DESIGN Information on potato consumption was available from 69,313 men and women, free of CVD and diabetes, in the Cohort of Swedish Men and the Swedish Mammography Cohort. Nonfatal and fatal cases of CVD diagnosed over 13 y of follow-up were identified by linkage with the Swedish National Patient and Cause of Death Registers. Analyses were conducted by using a Cox proportional hazards regression model, controlled for potential confounders. RESULTS We ascertained 10,147 major CVD events [myocardial infarction (MI), heart failure (HF), and stroke] and 4003 deaths due to CVD. Total potato consumption was not associated with the risk of major CVD events, specific CVD endpoints, or CVD mortality in either men or women. Multivariable HRs (95% CIs) per an increment of 3 servings/wk of total potato consumption (boiled potatoes, fried potatoes, and French fries) were 1.00 (0.97, 1.02) for major CVD events, 1.01 (0.97, 1.04) for MI, 0.97 (0.93, 1.02) for HF, 1.01 (0.97, 1.05) for stroke, and 0.99 (0.95, 1.03) for CVD mortality. There were no significant trends between the consumption of boiled potatoes, fried potatoes, or French fries and risk of any CVD outcome. CONCLUSION Potato consumption was not associated with the risk of CVD in this population. The Swedish Mammography Cohort and the Cohort of Swedish Men are registered at clinicaltrials.gov as NCT01127698 and NCT01127711, respectively.
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Affiliation(s)
- Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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149
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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150
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