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Zambrano AK, Cadena-Ullauri S, Ruiz-Pozo VA, Tamayo-Trujillo R, Paz-Cruz E, Guevara-Ramírez P, Frias-Toral E, Simancas-Racines D. Impact of fundamental components of the Mediterranean diet on the microbiota composition in blood pressure regulation. J Transl Med 2024; 22:417. [PMID: 38702795 PMCID: PMC11067105 DOI: 10.1186/s12967-024-05175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The Mediterranean diet (MedDiet) is a widely studied dietary pattern reflecting the culinary traditions of Mediterranean regions. High adherence to MedDiet correlates with reduced blood pressure and lower cardiovascular disease (CVD) incidence and mortality. Furthermore, microbiota, influenced by diet, plays a crucial role in cardiovascular health, and dysbiosis in CVD patients suggests the possible beneficial effects of microbiota modulation on blood pressure. The MedDiet, rich in fiber and polyphenols, shapes a distinct microbiota, associated with higher biodiversity and positive health effects. The review aims to describe how various Mediterranean diet components impact gut microbiota, influencing blood pressure dynamics. MAIN BODY The MedDiet promotes gut health and blood pressure regulation through its various components. For instance, whole grains promote a healthy gut microbiota given that they act as substrates leading to the production of short-chain fatty acids (SCFAs) that can modulate the immune response, preserve gut barrier integrity, and regulate energy metabolism. Other components of the MedDiet, including olive oil, fuits, vegetables, red wine, fish, and lean proteins, have also been associated with blood pressure and gut microbiota regulation. CONCLUSION The MedDiet is a dietary approach that offers several health benefits in terms of cardiovascular disease management and its associated risk factors, including hypertension. Furthermore, the intake of MedDiet components promote a favorable gut microbiota environment, which, in turn, has been shown that aids in other physiological processes like blood pressure regulation.
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Affiliation(s)
- Ana Karina Zambrano
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador.
| | - Santiago Cadena-Ullauri
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Viviana A Ruiz-Pozo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Rafael Tamayo-Trujillo
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Elius Paz-Cruz
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Patricia Guevara-Ramírez
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, 170527, Ecuador
| | - Evelyn Frias-Toral
- Escuela de Medicina, Universidad Espíritu Santo, Samborondón, 0901952, Ecuador
| | - Daniel Simancas-Racines
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, 170527, Ecuador
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Joshi A, Kaur S, Taneja SK, Mandal R. Review Article on Molecular Mechanism of Regulation of Hypertension by Macro-elements (Na, K, Ca and Mg), Micro-elements/Trace Metals (Zn and Cu) and Toxic Elements (Pb and As). Biol Trace Elem Res 2024; 202:1477-1502. [PMID: 37523058 DOI: 10.1007/s12011-023-03784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
Hypertension (HT) is a medical condition arising due to increase in blood pressure (BP) prevalent worldwide. The balanced dietary intakes of macro-elements and micro-elements including Na, K, Ca, Mg, Zn, and Cu have been described to maintain BP in humans by regulating the osmolarity of blood, cells/tissues, prevention of generation of oxidative and nitrosative stress (OANS), and endothelial damage through their functioning as important components of renin-angiotensin-aldosterone system (RAAS), antioxidant enzyme defense system, and maintenance of blood vascular-endothelial and vascular smooth muscle cell (VSMC) functions. However, inadequate/excess dietary intakes of Na/K, Ca/Mg, and Zn/Cu along with higher Pb and As exposures recognized to induce HT through common mechanisms including the followings: endothelial dysfunctions due to impairment of vasodilatation, increased vasoconstriction and arterial stiffness, blood clotting, inflammation, modification of sympathetic activity and higher catecholamine release, increased peripheral vascular resistance, and cardiac output; increased OANS due to reduced and elevated activities of extracellular superoxide dismutase and NAD(P)H oxidase, less nitric oxide bioavailability, decrease in cGMP and guanylate cyclase activity, increase in intracellular Ca2+ ions in VSMCs, and higher pro-inflammatory cytokines; higher parathyroid and calcitriol hormones; activation/suppression of RAAS resulting imbalance in blood Na+, K+, and water regulated by renin, angiotensin II, and aldosterone through affecting natriuresis/kaliuresis/diuresis; elevation in serum cholesterol and LDL cholesterol, decrease in HDL cholesterol due to defect in lipoprotein metabolism. The present study recommends the need to review simple dietary mineral intervention studies/supplementation trials before keeping their individual dietary excess intakes/exposures in consideration because their interactions lead to elevation and fall of their concentrations in body affecting onset of HT.
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Affiliation(s)
- Amit Joshi
- PG Department of Biotechnology and Microbial Biotechnology, Sri Guru Gobind Singh College, Sector-26, Chandigarh, UT, India
| | - Sukhbir Kaur
- Department of Zoology, Panjab University, Sector-14, Chandigarh, UT, India
| | | | - Reshu Mandal
- PG Department of Zoology, Sri Guru Gobind Singh College, Sector-26, Chandigarh, UT, India.
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Sun H, Zhou Y, Jiang S, Zhao D, Li H, Lu Y, Ma B, Zhou B. Association between low-sodium salt intervention and long-term blood pressure changes is modified by ENaC genetic variation: a gene-diet interaction analysis in a randomized controlled trial. Food Funct 2023; 14:9782-9791. [PMID: 37843257 DOI: 10.1039/d3fo02393a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background: Hypertension is closely associated with excessive sodium intake, and low-sodium salt has been shown to lower blood pressure. However, whether low-sodium salt interacts with genetic variation related to salt sensitivity of blood pressure is unclear. Methods: A total of 259 hypertensive patients who completed the previous 3 years of a low-sodium salt vs. normal salt intervention were included in our study. Genetic risk scores (GRSs) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were respectively built for each participant. A general linear regression model and a generalized mixed model were applied to identify the interaction effects between low-sodium salt intervention and ENaC genetic variation on SBP/DBP changes and trajectories over 3 years. Findings: during the 3-year intervention, both SBP and DBP levels showed a significant decline in the low-sodium salt intervention group than those in the normal salt intervention group over 3 years (Psalt intervention group = 0.001 for SBP and Psalt intervention group = 0.006 for DBP). Furthermore, a gene-diet interaction was found for the SBP change trajectory over 3 years (PSBP-GRS×salt intervention group = 0.011); specifically, significant SBP reductions were found between salt intervention groups in the high SBP-GRS group (-18.77 vs. -9.58 mmHg, Psalt intervention group = 0.001), but not in the low SBP-GRS group (-15.71 vs. -14.62 mmHg, Psalt intervention group = 0.791). No interaction effect between low-sodium salt intervention and genetic variation of ENaC was found for changes in DBP. Conclusions: Higher ENaC genetic variation is associated with a greater reduction in SBP in response to a low-sodium salt intervention. Hypertensive patients with higher ENaC genetic variation may experience a greater benefit in SBP reductions by consuming low-sodium salt. (Trial registration: chiCTR-TRC-09000538, https://www.chictr.org.cn).
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Affiliation(s)
- Hao Sun
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
| | - Ying Zhou
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China
| | - Shuyi Jiang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, 110001, Shenyang, Liaoning, China
| | - Dan Zhao
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
| | - Huamin Li
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
| | - Yue Lu
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
| | - Bing Ma
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
| | - Bo Zhou
- Department of Clinical Epidemiology and Evidence-based Medicine, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, 110001, Shenyang, Liaoning, China.
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Cheshire WP. Salt from the autonomic perspective. Auton Neurosci 2022; 239:102970. [DOI: 10.1016/j.autneu.2022.102970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Human Gut Microbes Associated with Systolic Blood Pressure. Int J Hypertens 2022; 2022:2923941. [PMID: 35154822 PMCID: PMC8831042 DOI: 10.1155/2022/2923941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Emerging studies have revealed a strong link between the gut microbiome and several human diseases. Since human gut microbiome mirrors variations in lifestyle and environment, whether associations between disease conditions and gut microbiome are consistent across populations—particularly in communities practicing traditional subsistence strategies whose microbiomes differ markedly from industrialists—remains unknown. Cardiovascular diseases are the leading cause of mortality in India affecting 55 million people, and high blood pressure is one of the primary risk factors for cardiovascular diseases. We examined associations between gut microbiome and blood pressure along with 14 other variables associated with lifestyle, dietary habits, disease conditions, and clinical blood markers in the three Assamese populations. Our analysis reveals a robust link between the gut microbiome diversity and composition and systolic blood pressure. Moreover, several genera previously associated with hypertension in non-Indian populations were also associated with systolic blood pressure in this cohort and these genera were predictors of elevated blood pressure in these populations. These findings confer opportunities to design personalized, preventative, and targeted interventions harnessing the gut microbiome to tackle the burden of cardiovascular diseases in India.
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Abstract
Introduction: Despite the improved treatment protocol of hypertension, the magnitude of the disease and its related burden remains raised. Hypertension makes up the leading cause of stroke, kidney disease, arterial disease, eye disease, and cardiovascular disease (CVD) growth. Areas covered: This review provides the overview of the role of dietary salt and alcohol use reduction in the management of hypertension, a brief history of alcohol, the vascular endothelium functions, the effects of alcohol use on blood pressure (BP), the mechanisms of alcohol, brief history of salt, the effects of dietary salt intake on BP, and the mechanisms of salt. Expert opinion: Studies found that high dietary salt intake and heavy alcohol consumption have a major and huge impact on BP while both of them have been identified to increase BP. Also, they raise the risk of hypertension-related morbidity and mortality in advance. On the other way, the dietary salt and alcohol use reduction in the management of hypertension are significant in the control of BP and its related morbidity and mortality. Further, studies suggested that the dietary salt and alcohol use reductions are the cornerstone in the management of hypertension due to their significance as part of comprehensive lifestyle modifications.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University , Asella, Ethiopia
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Kim SM, Jung JY. Nutritional management in patients with chronic kidney disease. Korean J Intern Med 2020; 35:1279-1290. [PMID: 32872726 PMCID: PMC7652660 DOI: 10.3904/kjim.2020.408] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
The global prevalence of chronic kidney disease (CKD) is increasing with the aging of populations worldwide. As kidney function declines, the accumulation of metabolic waste products and excessive electrolytes can significantly impair the health of patients with CKD. As nutritional management of patients with CKD is thought to control uremic symptoms and provide beneficial effects on the progression of kidney dysfunction, the diet of patients with CKD should be an important consideration in their care. Many guidelines recommend limiting protein intake in these patients, as high-protein diets aggravate kidney dysfunction. Excess sodium may be associated with CKD progression and all-cause mortality and, therefore, limiting salt intake is generally recommended. Low potassium is associated with muscle weakness and hypertension, whereas high potassium is associated with cardiac arrhythmia. Therefore, recent guidelines recommend adjusting dietary potassium intake on an individual basis to maintain serum potassium levels within the normal range. Appropriate dietary calcium intake is recommended to maintain calcium balance in patients with CKD G3, G4. Given the many dietary considerations for patients with CKD, effective nutritional management is challenging. Individualized strategies are needed to ensure the best outcome for patients with CKD.
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Affiliation(s)
- Sun Moon Kim
- Division of Nephrology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
- Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
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Safianu R, Plange-Rhule J. An Assessment of Usual Salt Intake among Older Normotensive Adults in Atonsu, a Suburb of Kumasi in the Ashanti Region of Ghana. Int J Hypertens 2020; 2020:7053654. [PMID: 33145108 PMCID: PMC7596423 DOI: 10.1155/2020/7053654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Globally, sodium intake has been found to be far above the normal level required by the body. Within countries, variations in salt intake exist between rural communities and urban communities. Experimental and epidemiological studies as well as studies involving clinical trials show the existence of adverse effect of salt consumption on the blood pressure of adults. The study evaluated salt intake among older normotensive adults in Atonsu, a suburb of Kumasi in the Ashanti region of Ghana. METHODS Participants were randomly selected from five churches which constituted cluster samples. A questionnaire was administered to participants for demographic information and dietary and lifestyle assessments. The study targeted 100 participants, twenty from each of the five churches. Eighty-two individuals gave their informed consent. Out of the 82 who gave their informed consent, 15 withdrew and 67 completed the course. The 67 participants comprised 36 (53.7%) men and 31 (46.3%) women. Systolic and diastolic blood pressure, BMI, urinary sodium, urinary potassium, serum creatinine, serum sodium, and serum potassium concentrations were also measured. RESULTS Participants' mean age was 52.3 ± 8.7 years. Participants had 24 hr urinary sodium excretion of 153.0 ± 26.9 mmol/day. All participants indicated that they consume foods high in salt even though none of them added salt to their diet at table. Mean 24 hr urinary potassium was 52.5 ± 12.9 mmol/day. Mean systolic blood pressure was 119.9 ± 10.8 mmHg and mean diastolic blood pressure was 72.5 ± 7.3 mmHg. Their mean BMI was 23.7 ± 3.5 kg/m2. CONCLUSION The participants who can be described as quite old and normotensive were high salt consumers, indicated by their dietary assessment and urinary sodium excretion, even though they had normal blood pressure.
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Affiliation(s)
- Rufai Safianu
- Department of Basic Medical Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Umair M, Ahmad M, Saeed H, Saleem Z, Tauqeer F. Clinical efficacy of various anti-hypertensive regimens in hypertensive women of Punjab; a longitudinal cohort study. BMC Womens Health 2020; 20:161. [PMID: 32738879 PMCID: PMC7395419 DOI: 10.1186/s12905-020-01033-2] [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: 10/21/2019] [Accepted: 07/26/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Gender wise differences exist in anti-hypertensive treatment outcomes, yet still un-explored in Pakistan. Thus, we aimed to estimate the clinical efficacy of four different anti-hypertensive regimens in hypertensive women of Punjab, Pakistan. METHODS A longitudinal cohort study of 12 months duration was conducted by enrolling 300 hypertensive women on four anti-hypertensive regimens. Chi-square for significance, logistic regression for association and multilevel regression for changes in outcomes were used. RESULTS Majority of subjects were < 60 years of age, weighing > 65 Kg, having family history, married and hailing from urban areas, with diabetes as the most common comorbidity. Hypertension, adjusted for covariates, was significantly associated with salt intake (OR:2.27, p < 0.01) and physical activity (OR;2.16, p < 0.01). High-risk subjects, compared to low-risk, were consuming more fat (OR;1.54), meat (OR; 2), salt (OR; 2.48) and even vegetables/fruits (OR;3.43). Compared to baseline, the maximum reduction in BP was observed with combination therapy, N-GITS+LTN + HCT (SBP; - 50.17, p < 0.01, DBP; - 16.55, p < 0.01), followed by N-GITS alone (SBP; - 28.89, p < 0.01, DBP; - 12.21, p < 0.01). Compared to baseline, adjusted for treatment effects, significant reductions in SBP (low-risk; - 17.92, p < 0.01 high-risk; - 19.48, p < 0.01) and DBP (low-risk; - 17.92, p < 0.01, high-risk; - 19.48, p < 0.01) were observed in low and high risk patients. Among all four cohorts, orthostatic hypotension and edema were common in N-GITS+LTN + HCT only, but variable effects were observed on biochemical values; urea, BSR and creatinine. CONCLUSION In conclusion, compared to a single agent, combination therapy conferred improved BP controls followed by N-GITS alone in low and high risk women with manageable side effects.
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Affiliation(s)
- Muhammad Umair
- Section of Pharmacology, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Mobasher Ahmad
- Section of Pharmacology, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Hamid Saeed
- Section of Pharmacology, University College of Pharmacy, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
- Section of Pharmaceutics, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
| | - Zikria Saleem
- Section of Pharmaceutics, University of the Punjab, Allama Iqbal Campus, Lahore, 54000 Pakistan
- University of Lahore, Lahore, Pakistan
| | - Fatima Tauqeer
- Institute of Health and Society, Department of Medicine, University of Oslo, Oslo, Norway
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Nikonova TV, Sukhareva OY, Pekareva EV, Ibragimova LI, Mikhina MS, Galstyan GR, Tokmakova AY, Surkova EV, Laptev DN, Kononenko IV, Egorova DN, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Gomova IS, Lipatov DV, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Klimontov VV, Mkrtumyan AM, Petunina NA, Suplotova LA, Ushakova OV, Khalimov YS, Ruyatkina LA. Diabetes mellitus type 1 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Vadim V. Klimontov
- Research Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences
| | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Dedov II, Shestakova MV, Mayorov AY, Shamkhalova MS, Sukhareva OY, Galstyan GR, Tokmakova AY, Nikonova TV, Surkova EV, Kononenko IV, Egorova DN, Ibragimova LI, Shestakova EA, Klefortova II, Sklyanik IA, Yarek-Martynova IY, Severina AS, Martynov SA, Vikulova OK, Kalashnikov VY, Bondarenko IZ, Gomova IS, Starostina EG, Ametov AS, Antsiferov MB, Bardymova TP, Bondar IA, Valeeva FV, Demidova TY, Mkrtumyan AM, Petunina NA, Ruyatkina LA, Suplotova LA, Ushakova OV, Khalimov YS. Diabetes mellitus type 2 in adults. DIABETES MELLITUS 2020. [DOI: 10.14341/dm12507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tatiana P. Bardymova
- Irkutsk State Medical Academy of Postgraduate Education – Branch Campus of the Russian Medical Academy of Continuing Professional Education
| | | | | | | | - Ashot M. Mkrtumyan
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
| | - Nina A. Petunina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Paniagua-Avila A, Fort MP, Glasgow RE, Gulayin P, Hernández-Galdamez D, Mansilla K, Palacios E, Peralta AL, Roche D, Rubinstein A, He J, Ramirez-Zea M, Irazola V. Evaluating a multicomponent program to improve hypertension control in Guatemala: study protocol for an effectiveness-implementation cluster randomized trial. Trials 2020; 21:509. [PMID: 32517806 PMCID: PMC7281695 DOI: 10.1186/s13063-020-04345-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback. METHODS Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness. DISCUSSION We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs. TRIAL REGISTRATION ClinicalTrials.gov: NCT03504124. Registered on 20 April 2018.
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Affiliation(s)
- Alejandra Paniagua-Avila
- Mailman School of Public Health, Columbia University, New York, NY, USA
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
| | - Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
- Colorado School of Public Health, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, and Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, USA
| | - Pablo Gulayin
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Diego Hernández-Galdamez
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
| | - Kristyne Mansilla
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
| | - Eduardo Palacios
- Programa Nacional de Enfermedades Crónicas, Ministerio de Salud y Asistencia Social (MSPAS), Guatemala City, Guatemala
| | - Ana Lucia Peralta
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
| | - Dina Roche
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala
| | - Adolfo Rubinstein
- Programa Nacional de Enfermedades Crónicas, Ministerio de Salud y Asistencia Social (MSPAS), Guatemala City, Guatemala
| | - Jiang He
- Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama - INCAP, Calzada Roosevelt 6-25 zona 11, INCAP III, Guatemala City, Guatemala.
| | - Vilma Irazola
- Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, LA, USA
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Zou P, Stinson J, Parry M, Dennis CL, Yang Y, Lu Z. A Smartphone App (mDASHNa-CC) to Support Healthy Diet and Hypertension Control for Chinese Canadian Seniors: Protocol for Design, Usability and Feasibility Testing. JMIR Res Protoc 2020; 9:e15545. [PMID: 32238343 PMCID: PMC7316441 DOI: 10.2196/15545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/12/2019] [Accepted: 12/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This proposed study aims to translate the Dietary Approach to Stop Hypertension with Sodium (Na) Reduction for Chinese Canadians (DASHNa-CC), a classroom-based, antihypertensive, dietary educational intervention, to an innovative smartphone app (mDASHNa-CC). This study will enable Chinese Canadian seniors to access antihypertensive dietary interventions anytime, regardless of where they are. It is hypothesized that senior Chinese Canadians will be satisfied with their experiences using the mDASHNa-CC app and that the use of this app could lead to a decrease in their blood pressure and improvement in their health-related quality of life. OBJECTIVE The goal of this study is to design and test the usability and feasibility of a smartphone-based dietary educational app to support a healthy diet and hypertension control for Chinese Canadian seniors. METHODS A mixed-method two-phase design will be used. The study will be conducted in a Chinese immigrant community in Toronto, Ontario, Canada. Chinese Canadian seniors, who are at least 65 years old, self-identified as Chinese, living in Canada, and with elevated blood pressure, will be recruited. In Phase I, we will design and test the usability of the app using a user-centered approach. In Phase II, we will test the feasibility of the app, including implementation (primary outcomes of accrual and attrition rates, technical issues, acceptability of the app, and adherence to the intervention) and preliminary effectiveness (secondary outcomes of systolic and diastolic blood pressure, weight, waist circumference, health-related quality of life, and health service utilization), using a pilot, two-group, randomized controlled trial with a sample size of 60 participants in a Chinese Canadian community. RESULTS The study is supported by the Startup Research Grant from Nipissing University, Canada. The research ethics application is under review by a university research ethics review board. CONCLUSIONS The study results will make several contributions to the existing literature, including illustrating the rigorous design and testing of smartphone app technology for hypertension self-management in the community, exploring an approach to incorporating traditional medicine into chronic illness management in minority communities and promoting equal access to current technology among minority immigrant senior groups. TRIAL REGISTRATION Clinicaltrials.gov NCT03988894; https://clinicaltrials.gov/ct2/show/NCT03988894. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/15545.
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Affiliation(s)
- Ping Zou
- School of Nursing, Nipissing University, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada
| | - Monica Parry
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yeqin Yang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
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Doumas M, Imprialos KP, Kallistratos MS, Manolis AJ. Recent advances in understanding and managing resistant/refractory hypertension. F1000Res 2020; 9. [PMID: 32201574 PMCID: PMC7065661 DOI: 10.12688/f1000research.21669.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 12/11/2022] Open
Abstract
The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.
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Affiliation(s)
- Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece.,VAMC and George Washington University, Washington, USA
| | - Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece
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Adolf C, Heinrich DA, Holler F, Lechner B, Nirschl N, Sturm L, Görge V, Riester A, Williams TA, Treitl M, Ladurner R, Beuschlein F, Reincke M. Patients With Primary Aldosteronism Respond to Unilateral Adrenalectomy With Long-Term Reduction in Salt Intake. J Clin Endocrinol Metab 2020; 105:5614720. [PMID: 31702016 PMCID: PMC7010311 DOI: 10.1210/clinem/dgz051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/17/2019] [Indexed: 01/10/2023]
Abstract
CONTEXT High dietary salt intake is known to aggravate arterial hypertension. This effect could be of particular relevance in the setting of primary aldosteronism (PA), which is associated with cardiovascular damage independent of blood pressure levels. The aim of this study was to determine the impact of therapy on salt intake in PA patients. PATIENTS AND METHODS A total of 148 consecutive PA patients (66 with unilateral and 82 with bilateral PA) from the database of the German Conn's Registry were included. Salt intake was quantified by 24-hour urinary sodium excretion before and after initiation of PA treatment. STUDY DESIGN Observational longitudinal cohort study. SETTING Tertiary care hospital. RESULTS At baseline, unilateral PA patients had a significantly higher urinary sodium excretion than patients with bilateral disease (205 vs 178 mmol/d, P = 0.047). Higher urinary sodium excretion correlated with an increased cardiovascular risk profile including proteinuria, impaired lipid, and glucose metabolism and was associated with higher daily doses of antihypertensive drugs to achieve blood pressure control. In unilateral disease, urinary sodium excretion dropped spontaneously to 176 mmol/d (P = 0.012) 1 year after unilateral adrenalectomy and remained low at 3 years of follow-up (174 mmol/d). In contrast, treatment with mineralocorticoid receptor antagonists (MRA) in bilateral PA patients was not associated with a significant change in urinary sodium excretion at follow-up (179 mmol/d vs 183 mmol/d). CONCLUSION PA patients consuming a high-salt diet, estimated based on urinary sodium excretion, respond to adrenalectomy with a significant reduction of salt intake, in contrast to MRA treatment.
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Affiliation(s)
- Christian Adolf
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Daniel A Heinrich
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Finn Holler
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Benjamin Lechner
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Nina Nirschl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Lisa Sturm
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Veronika Görge
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Anna Riester
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
| | - Tracy A Williams
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
- Divis
ion of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marcus Treitl
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Roland Ladurner
- Klinik für Viszeral- und Endokrine Chirurgie, Klinikum der Universität München, LMU München, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zurich, Switzerland
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Ziemssenstraße, Munich, Germany
- Correspondence and Reprint Requests: Martin Reincke, MD, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstr. 1, 80336 Munich, Germany. E-mail:
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Abstract
Resistant hypertension (RHTN) is defined as uncontrolled blood pressure despite the use of ≥3 antihypertensive agents of different classes, including a diuretic, usually thiazide-like, a long-acting calcium channel blocker, and a blocker of the renin- angiotensin system, either an ACE (angiotensin-converting enzyme) inhibitor or an ARB (angiotensin receptor blocker), at maximal or maximally tolerated doses. Antihypertensive medication nonadherence and the white coat effect, defined as elevated blood pressure when measured in clinic but controlled when measured outside of clinic, must be excluded to make the diagnosis. RHTN is a high-risk phenotype, leading to increased all-cause mortality and cardiovascular disease outcomes. Healthy lifestyle habits are associated with reduced cardiovascular risk in patients with RHTN. Aldosterone excess is common in patients with RHTN, and addition of spironolactone or amiloride to the standard 3-drug antihypertensive regimen is effective at getting the blood pressure to goal in most of these patients. Refractory hypertension is defined as uncontrolled blood pressure despite use of ≥5 antihypertensive agents of different classes, including a long-acting thiazide-like diuretic and an MR (mineralocorticoid receptor) antagonist, at maximal or maximally tolerated doses. Fluid retention, mediated largely by aldosterone excess, is the predominant mechanism underlying RHTN, while patients with refractory hypertension typically exhibit increased sympathetic nervous system activity.
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Affiliation(s)
- Maria Czarina Acelajado
- From the Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham
| | - Zachary H Hughes
- From the Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham
| | - Suzanne Oparil
- From the Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham
| | - David A Calhoun
- From the Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham
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17
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Khan MS, Jones DW, Butler J. Salt, No Salt, or Less Salt for Patients With Heart Failure? Am J Med 2020; 133:32-38. [PMID: 31419422 DOI: 10.1016/j.amjmed.2019.07.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 01/11/2023]
Abstract
Restricting dietary sodium is a common recommendation given by clinicians to patients with heart failure and is one supported by current guidelines. However, the quality of evidence for this recommendation is suboptimal, and there is no consensus on the optimal level of sodium intake. Though excessive sodium intake is associated with left ventricular hypertrophy and hypertension, recent data have suggested that very low sodium intake is paradoxically associated with worse outcomes for patients with heart failure. This is possibly explained by the association between low sodium intake and activation of the sympathetic and renin-angiotensin-aldosterone systems. Nevertheless, sodium restriction is routinely recommended and remains a cornerstone of heart failure and blood pressure therapy. In this review we discuss the pros and cons of sodium restriction for patients with heart failure from the current literature.
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Affiliation(s)
| | - Daniel W Jones
- Department of Medicine, University of Mississippi, Jackson
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson.
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18
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Cheikh Ismail L, Hashim M, H Jarrar A, N Mohamad M, T Saleh S, Jawish N, Bekdache M, Albaghli H, Kdsi D, Aldarweesh D, S Al Dhaheri A. Knowledge, Attitude, and Practice on Salt and Assessment of Dietary Salt and Fat Intake among University of Sharjah Students. Nutrients 2019; 11:E941. [PMID: 31027320 PMCID: PMC6566548 DOI: 10.3390/nu11050941] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the main cause of deaths in the United Arab Emirates and reducing dietary salt intake is recommended to improve the population's health. METHODS a cross-sectional survey was given to 401 students from the University of Sharjah to investigate knowledge, attitudes, and practices related to dietary salt intake and a 24-h dietary recall among a subsample of 122 students, to assess the dietary intake of total fat, cholesterol, saturated fat, trans fat, and sodium. RESULTS findings indicated low salt-related knowledge scores among students (17 out of 30), high prevalence of overweight (28%), obesity (14%), hypertension stage 1 (31%), and hypertension stage 2 (20%). The results also revealed a high percentage of students exceeding the recommended intake of total fat (48%), saturated fat (90%), trans fat (64%), and sodium (89%), and all students not meeting potassium recommendations. CONCLUSIONS culture-specific awareness campaigns on salt and fat intake and their association with health are needed.
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Affiliation(s)
- Leila Cheikh Ismail
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Mona Hashim
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Amjad H Jarrar
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain 15551, United Arab Emirates.
| | - Maysm N Mohamad
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain 15551, United Arab Emirates.
| | - Sheima T Saleh
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Nada Jawish
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Mayssaa Bekdache
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Hiba Albaghli
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Dyana Kdsi
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Dina Aldarweesh
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates.
| | - Ayesha S Al Dhaheri
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain 15551, United Arab Emirates.
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19
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Wenner MM, Paul EP, Robinson AT, Rose WC, Farquhar WB. Acute NaCl Loading Reveals a Higher Blood Pressure for a Given Serum Sodium Level in African American Compared to Caucasian Adults. Front Physiol 2018; 9:1354. [PMID: 30327611 PMCID: PMC6174209 DOI: 10.3389/fphys.2018.01354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/07/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose: African American individuals are more prone to salt-sensitive hypertension than Caucasian individuals. Small changes in serum sodium (Na+) result in increased blood pressure (BP). However, it remains unclear if there are racial differences in BP responsiveness to increases in serum Na+. Therefore, the purpose of this investigation was to determine if African American adults have altered BP responsiveness to acute changes in serum Na+ compared to Caucasian adults. Methods: We measured beat-by-beat BP, serum Na+, plasma renin activity (PRA), angiotensin II (Ang II), and aldosterone (Aldo) during a 60-min 3% NaCl infusion (hypertonic saline infusion, HSI) in 39 participants (19 African Americans, age: 23 ± 1, 20 Caucasians, age: 25 ± 1). Data reported as African American vs. Caucasian cohort, mean ± SEM. Results: Baseline BP and serum Na+ were similar between groups and increased during HSI in both African American and Caucasian participants (p < 0.01). However, the peak change in serum Na+ was greater in African American participants (Δ5.8 ± 0.34 vs. Δ4.85 ± 0.38 mmol/L, p = 0.03). There was a significant group effect (p = 0.02) and an interaction between race and serum Na+ on systolic BP (p = 0.02). Larger categorical changes in serum Na+ corresponded to changes in systolic BP (p < 0.01) and African American participants demonstrated greater systolic BP responses for a given categorical serum Na+ increase (p < 0.01). Baseline Aldo was lower in African American adults (7.2 ± 0.6 vs. 12.0 ± 1.9 ng/dL, p = 0.03), there was a trend for lower baseline PRA (0.59 ± 0.9 vs. 1.28 ± 0.34 ng/mL/h, p = 0.07), and baseline Ang II was not different (14.2 ± 1.8 vs. 18.5 ± 1.4 pg/mL, p = 0.17). PRA and Aldo decreased during the HSI (p ≤ 0.01), with a greater decline in PRA (Δ–0.31 ± 0.07 vs. Δ–0.85 ± 0.25 ng/mL/h, p < 0.01) and Aldo (Δ–2.5 ± 0.5 vs. Δ–5.0 ± 1.1 ng/dL, p < 0.01) in Caucasian participants. However, the racial difference in PRA (p = 0.57) and Aldo (p = 0.59) reduction were no longer significant following baseline covariate analysis. Conclusion: African American individuals demonstrate augmented serum Na+ to an acute hypertonic saline load and greater systolic BP responsiveness to a given serum Na+. The altered BP response may be attributable to lower basal PRA and Aldo and a subsequently blunted RAAS response during the HSI.
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Affiliation(s)
- Megan M Wenner
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Erin P Paul
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Austin T Robinson
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - William C Rose
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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20
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Knowledge and Attitudes Are Related to Selected Salt-Specific Behaviours among Australian Parents. Nutrients 2018; 10:nu10060720. [PMID: 29867025 PMCID: PMC6024726 DOI: 10.3390/nu10060720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/25/2022] Open
Abstract
Salt intake in adults and children exceeds recommended levels. Salt-related knowledge, attitudes, and behaviours (KABs) may influence the amount of salt consumed. The aims of this study were to assess salt-related KABs among parents, and investigate whether salt-related knowledge and attitudes are associated with salt-specific behaviours. Parents with children <18 years were recruited from four shopping centers across Victoria, Australia; Facebook; and an online consumer research panel; they then completed an online questionnaire assessing salt-related KABs and salt use in children. Eight hundred and thirty-seven parents (mean age 41.0 (10.0) (SD) years) provided valid responses. Most (77%) parents were aware that eating too much salt damages children’s health and that reducing the amount of salt in their children’s diet was important (70%), and 46% reported adding salt to food prepared for their children. Parents who were aware that eating too much salt damages children’s health were less likely to report that their child added salt at the table (OR = 0.51, p < 0.001), and that they added salt to food prepared for the child (OR = 0.46, p < 0.001). Educational messages that highlight the adverse health effects of salt during childhood are likely to be useful in reducing discretionary salt use in the home environment.
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21
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Andrade GC, da Costa Louzada ML, Azeredo CM, Ricardo CZ, Martins APB, Levy RB. Out-of-Home Food Consumers in Brazil: What do They Eat? Nutrients 2018; 10:nu10020218. [PMID: 29462918 PMCID: PMC5852794 DOI: 10.3390/nu10020218] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022] Open
Abstract
Considering the increased contribution of foods consumed outside home and their potential impact on diet, this study aims to identify eating out patterns and their association with nutritional dietary quality in Brazil. We used the Individual Food Intake Survey 2008–2009, conducted with 34,003 individuals aged 10 and up. We used factor analysis by principal component to identify out-of-home eating patterns and linear regression to explore the association between patterns scores and dietary quality. We identified three food patterns. The “Traditional meal” pattern carried more rice, beans, meat, roots and tubers, pasta, vegetables and eggs. The “typical Brazilian breakfast/tea” pattern carried more fresh bread, margarine, milk, cheese and butter. The “Ultra-processed food” pattern carried more ready-to-eat meals and soft drinks. The “traditional meal” pattern was positively associated with calories from proteins, fiber, iron, potassium and sodium densities, whereas “typical Brazilian breakfast/tea” and “ultra-processed food” patterns were positively associated with energy density, the percentage of calories from lipids or carbohydrates, trans fat and free sugar. Out-of-home eating may have a negative impact on nutritional dietary quality when based on ultra-processed food. However, it is possible to maintain a healthy out-of-home diet with adherence to traditional Brazilian cuisine.
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Affiliation(s)
- Giovanna Calixto Andrade
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Departamento de Medicina Preventiva da, Faculdade de Medicina da, Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Maria Laura da Costa Louzada
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Departamento de Políticas Públicas e Saúde Coletiva, Universidade Federal de São Paulo (UNIFESP), São Paulo 11015-020, Brazil.
| | - Catarina Machado Azeredo
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Curso de Nutrição da, Faculdade de Medicina da, Universidade Federal de Uberlândia (UFU), Uberlândia 38400-902, Brazil.
| | - Camila Zancheta Ricardo
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Departamento de Medicina Preventiva da, Faculdade de Medicina da, Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
| | - Ana Paula Bortolleto Martins
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Instituto de Defesa do Consumidor (IDEC), São Paulo 05002-000, Brazil.
| | - Renata Bertazzi Levy
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde (NUPENS), São Paulo 01246-907, Brazil.
- Departamento de Medicina Preventiva da, Faculdade de Medicina da, Universidade de São Paulo (FMUSP), São Paulo 01246-903, Brazil.
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Identification of differences in health impact modelling of salt reduction. PLoS One 2017; 12:e0186760. [PMID: 29182636 PMCID: PMC5705127 DOI: 10.1371/journal.pone.0186760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/06/2017] [Indexed: 12/04/2022] Open
Abstract
We examined whether specific input data and assumptions explain outcome differences in otherwise comparable health impact assessment models. Seven population health models estimating the impact of salt reduction on morbidity and mortality in western populations were compared on four sets of key features, their underlying assumptions and input data. Next, assumptions and input data were varied one by one in a default approach (the DYNAMO-HIA model) to examine how it influences the estimated health impact. Major differences in outcome were related to the size and shape of the dose-response relation between salt and blood pressure and blood pressure and disease. Modifying the effect sizes in the salt to health association resulted in the largest change in health impact estimates (33% lower), whereas other changes had less influence. Differences in health impact assessment model structure and input data may affect the health impact estimate. Therefore, clearly defined assumptions and transparent reporting for different models is crucial. However, the estimated impact of salt reduction was substantial in all of the models used, emphasizing the need for public health actions.
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23
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Naser AM, Unicomb L, Doza S, Ahmed KM, Rahman M, Uddin MN, Quraishi SB, Selim S, Shamsudduha M, Burgess W, Chang HH, Gribble MO, Clasen TF, Luby SP. Stepped-wedge cluster-randomised controlled trial to assess the cardiovascular health effects of a managed aquifer recharge initiative to reduce drinking water salinity in southwest coastal Bangladesh: study design and rationale. BMJ Open 2017; 7:e015205. [PMID: 28864689 PMCID: PMC5588995 DOI: 10.1136/bmjopen-2016-015205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/16/2017] [Accepted: 07/13/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Saltwater intrusion and salinisation have contributed to drinking water scarcity in many coastal regions globally, leading to dependence on alternative sources for water supply. In southwest coastal Bangladesh, communities have few options but to drink brackish groundwater which has been associated with high blood pressure among the adult population, and pre-eclampsia and gestational hypertension among pregnant women. Managed aquifer recharge (MAR), the purposeful recharge of surface water or rainwater to aquifers to bring hydrological equilibrium, is a potential solution for salinity problem in southwest coastal Bangladesh by creating a freshwater lens within the brackish aquifer. Our study aims to evaluate whether consumption of MAR water improves human health, particularly by reducing blood pressure among communities in coastal Bangladesh. METHODS AND ANALYSIS The study employs a stepped-wedge cluster-randomised controlled community trial design in 16 communities over five monthly visits. During each visit, we will collect data on participants' source of drinking and cooking water and measure the salinity level and electrical conductivity of household stored water. At each visit, we will also measure the blood pressure of participants ≥20 years of age and pregnant women and collect urine samples for urinary sodium and protein measurements. We will use generalised linear mixed models to determine the association of access to MAR water on blood pressure of the participants. ETHICS AND DISSEMINATION The study protocol has been reviewed and approved by the Institutional Review Boards of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Informed written consent will be taken from all the participants. This study is funded by Wellcome Trust, UK. The study findings will be disseminated to the government partners, at research conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02746003; Pre-results.
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Affiliation(s)
- Abu Mohd Naser
- Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Leanne Unicomb
- Environmental Health & Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Solaiman Doza
- Environmental Health & Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Mahbubur Rahman
- Environmental Health & Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mohammad Nasir Uddin
- Environmental Health & Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shamshad B Quraishi
- Analytical Chemistry Laboratory, Atomic Energy Centre, Bangladesh Atomic EnergyCommission, Dhaka, Bangladesh
| | - Shahjada Selim
- Department of Endocrinology & Metabolism, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mohammad Shamsudduha
- Institute for Risk and Disaster Reduction, Departmentof Geography, University College London, London, UK
| | - William Burgess
- Department of Earth Sciences, University College London, London, UK
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Matthew O Gribble
- Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Thomas F Clasen
- Department of Environmental Health Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Stephen P Luby
- Stanford Woods Institute for the Environment & Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
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Rodrigues MP, Dos Santos LKJ, Fuchs FD, Fuchs SC, Moreira LB. The effectiveness of an educational intervention for sodium restriction in patients with hypertension: study protocol for a randomized controlled trial. Trials 2017; 18:347. [PMID: 28732546 PMCID: PMC5521063 DOI: 10.1186/s13063-017-2091-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/06/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The effectiveness of nonpharmacological interventions in blood pressure reduction has been evidenced by several studies. Nevertheless, as adherence to a low-sodium diet is poor, interventions regarding habit changing should be of a motivational nature in order to develop the ability of overcoming obstacles regarding sodium-restriction behavior. The present study aims to describe the protocol and randomization of a clinical trial design in order to evaluate the effectiveness of an educational intervention based on Dietary Sodium Restriction Questionnaire (DSRQ) scores. The effectiveness measures are the DSRQ score variation and reduction in urinary sodium values from baseline to after 2 and 6 months. METHODS/DESIGN This parallel, randomized clinical trial will include 120 participants, recruited and randomized as follows: 60 of them to be allocated to a sodium-restriction educational intervention group whose results are based on the DSRQ application; and the other 60 allocated to a control group with usual care. Educational orientation and usual care sessions will be conducted once a month for a period of 6 months. Both spot urine collection - estimating sodium intake - and the DSRQ will be applied at the baseline, in the eighth week and at the end of the follow-up. There will also be blood collection and 24-h ambulatory blood pressure monitoring (ABPM) at the beginning and end of the follow-up. Anthropometric measurements, blood pressure measurement and 24-h food recall will be collected during follow-up. DISCUSSION The study "The effectiveness of an educational intervention to sodium restriction in patients with hypertension" is based on the results of the DSRQ application, whose objective is to evaluate aspects related to nonadherence to the recommendation of a low-sodium diet, identifying adherence barriers and facilitators, contributing to the planning of interventions for improving the adoption of a low-sodium diet and, consequently, hypertension control. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, Identifier: NCT02848690 . Registered retrospectively on 27 July 2016.
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Affiliation(s)
- Marcela Perdomo Rodrigues
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Flavio Danni Fuchs
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Costa Fuchs
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Leila Beltrami Moreira
- Postgraduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Zou P, Dennis CL, Lee R, Parry M. Dietary Approach to Stop Hypertension with Sodium Reduction for Chinese Canadians (DASHNa-CC): A Pilot Randomized Controlled Trial. J Nutr Health Aging 2017; 21:1225-1232. [PMID: 29188883 DOI: 10.1007/s12603-016-0861-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is a lack of culturally sensitive dietary interventions targeting Chinese Canadians despite unhealthy dietary behaviours being identified as the most important modifiable risk factor for hypertension in the Chinese population. AIMS To determine the feasibility of a culturally sensitive dietary intervention for hypertension control; to examine the potential effects of the intervention on blood pressure and health-related quality of life among Chinese Canadians in community. METHODS This study was a two-group pilot randomized controlled trial with 8 weeks follow up. Sixty self-identified Chinese Canadians, older than 45 years old and with grade one hypertension but not on antihypertensive medications were recruited in community. The control group received usual care and the intervention group received usual care plus newly developed DASHNa-CC intervention. The DASHNa-CC intervention consisted of a written manual, two classroom sessions, and one telephone booster call to provide healthy dietary and sodium reduction advice, integrated with Traditional Chinese Medicine food therapy recommendations for hypertension control. RESULTS 618 Chinese Canadians participated in blood pressure screening, and 60 eligible participants recruited. Participants were highly satisfied with the intervention and adhered to the trial protocol. The lost to follow-up rate was 5%. At 8 weeks post-randomization, those in the intervention group had greater reductions in systolic blood pressure [3.8mmHg, t (55) = -1.58, p = 0.12] and higher physical health scores [t (55) = 2.13, p = 0.04] compared to those of the control group. There were no group differences in health care utilization. CONCLUSIONS It is feasible to deliver the DASHNa-CC intervention in a Chinese Canadian community. The DASHNa-CC intervention may decrease blood pressure and improve health-related quality of life for Chinese Canadians.
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Affiliation(s)
- P Zou
- Dr. Ping Zou, Assistant Professor, School of Nursing, Nipissing University, 750 Dundas Street West, Toronto, Ontario, Canada, M6J 3S3, Phone: 416-642-7003,
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Zou P, Dennis CL, Lee R, Parry M. Hypertension Prevalence, Health Service Utilization, and Participant Satisfaction: Findings From a Pilot Randomized Controlled Trial in Aged Chinese Canadians. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017724942. [PMID: 28853303 PMCID: PMC5798669 DOI: 10.1177/0046958017724942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Responding to high prevalence of hypertension and patients' preference of integrating traditional Chinese medicine for blood pressure control, the Dietary Approach to Stop Hypertension With Sodium Reduction for Chinese Canadian (DASHNa-CC) intervention was newly designed as a culturally sensitive dietary educational intervention to facilitate middle-aged and senior Chinese Canadians' blood pressure control in community. The aim of this study was to report the hypertension prevalence rate according to the data from blood pressure screening events, to describe the characteristics of health service utilization among aged Chinese Canadians, and to report the evaluation of participant satisfaction to the DASHNa-CC intervention. This study was designed as a pilot randomized controlled trial with a sample size of 60. Among 618 Chinese Canadians participated in blood pressure screening events, 54.5% (n = 337) having various levels of hypertension. Across 2 months, 38 (63.3%) participants made a total of 47 visits to see their family physicians; 20 (33.3%) participants consulted their family members 224 times for lifestyle modifications and hypertension self-management. Various forms of Chinese media were frequently used as sources of health care information, and English media were rarely accessed. Participants highly satisfied with the contents, delivery approaches, and integration of traditional Chinese medicine in the intervention. Results indicated that middle-aged and senior Chinese Canadians have high hypertension prevalence and specific characteristics of health service utilization. It is important to implement interventions, which are culturally tailored, language appropriate, using proper technology and incorporating traditional Chinese medicine, in Chinese Canadian community for hypertension control.
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Affiliation(s)
- Ping Zou
- Nipissing University, Toronto, Ontario, Canada
- Ping Zou, Assistant Professor, School of Nursing, Nipissing University, 750 Dundas Street West, Toronto, Ontario, Canada M6J 3S3.
| | | | - Ruth Lee
- McMaster University, Hamilton, Ontario, Canada
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Björck L, Rosengren A, Winkvist A, Capewell S, Adiels M, Bandosz P, Critchley J, Boman K, Guzman-Castillo M, O’Flaherty M, Johansson I. Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study. PLoS One 2016; 11:e0160474. [PMID: 27490257 PMCID: PMC4973910 DOI: 10.1371/journal.pone.0160474] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/20/2016] [Indexed: 12/05/2022] Open
Abstract
Objective In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. Methods We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. Results In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. Conclusion CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- * E-mail:
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Piotr Bandosz
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Julia Critchley
- St George's, University of London, Population Health Research Institute, Cranmer Terrace, London, United Kingdom
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Martin O’Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
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Zhou B, Webster J, Fu LY, Wang HL, Wu XM, Wang WL, Shi JP. Intake of low sodium salt substitute for 3years attenuates the increase in blood pressure in a rural population of North China — A randomized controlled trial. Int J Cardiol 2016; 215:377-82. [DOI: 10.1016/j.ijcard.2016.04.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
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Shah PT, Martin R, Yan Y, Shapiro JI, Liu J. Carbonylation Modification Regulates Na/K-ATPase Signaling and Salt Sensitivity: A Review and a Hypothesis. Front Physiol 2016; 7:256. [PMID: 27445847 PMCID: PMC4923243 DOI: 10.3389/fphys.2016.00256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/11/2016] [Indexed: 01/01/2023] Open
Abstract
Na/K-ATPase signaling has been implicated in different physiological and pathophysiological conditions. Accumulating evidence indicates that oxidative stress not only regulates the Na/K-ATPase enzymatic activity, but also regulates its signaling and other functions. While cardiotonic steroids (CTS)-induced increase in reactive oxygen species (ROS) generation is an intermediate step in CTS-mediated Na/K-ATPase signaling, increase in ROS alone also stimulates Na/K-ATPase signaling. Based on literature and our observations, we hypothesize that ROS have biphasic effects on Na/K-ATPase signaling, transcellular sodium transport, and urinary sodium excretion. Oxidative modulation, in particular site specific carbonylation of the Na/K-ATPase α1 subunit, is a critical step in proximal tubular Na/K-ATPase signaling and decreased transcellular sodium transport leading to increases in urinary sodium excretion. However, once this system is overstimulated, the signaling, and associated changes in sodium excretion are blunted. This review aims to evaluate ROS-mediated carbonylation of the Na/K-ATPase, and its potential role in the regulation of pump signaling and sodium reabsorption in the renal proximal tubule (RPT).
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Affiliation(s)
- Preeya T Shah
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University Huntington, WV, USA
| | - Rebecca Martin
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University Huntington, WV, USA
| | - Yanling Yan
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University Huntington, WV, USA
| | - Joseph I Shapiro
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University Huntington, WV, USA
| | - Jiang Liu
- Department of Pharmacology, Physiology and Toxicology, Joan C. Edwards School of Medicine, Marshall University Huntington, WV, USA
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Farquhar WB, Edwards DG, Jurkovitz CT, Weintraub WS. Dietary sodium and health: more than just blood pressure. J Am Coll Cardiol 2016; 65:1042-50. [PMID: 25766952 DOI: 10.1016/j.jacc.2014.12.039] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 12/24/2022]
Abstract
Sodium is essential for cellular homeostasis and physiological function. Excess dietary sodium has been linked to elevations in blood pressure (BP). Salt sensitivity of BP varies widely, but certain subgroups tend to be more salt sensitive. The mechanisms underlying sodium-induced increases in BP are not completely understood but may involve alterations in renal function, fluid volume, fluid-regulatory hormones, the vasculature, cardiac function, and the autonomic nervous system. Recent pre-clinical and clinical data support that even in the absence of an increase in BP, excess dietary sodium can adversely affect target organs, including the blood vessels, heart, kidneys, and brain. In this review, the investigators review these issues and the epidemiological research relating dietary sodium to BP and cardiovascular health outcomes, addressing recent controversies. They also provide information and strategies for reducing dietary sodium.
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Affiliation(s)
- William B Farquhar
- Department of Kinesiology & Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware
| | - David G Edwards
- Department of Kinesiology & Applied Physiology, College of Health Sciences, University of Delaware, Newark, Delaware
| | - Claudine T Jurkovitz
- Department of Medicine, Section of Cardiology, Christiana Care Outcomes Research Center, Christiana Care Health System, Newark, Delaware
| | - William S Weintraub
- Department of Medicine, Section of Cardiology, Christiana Care Outcomes Research Center, Christiana Care Health System, Newark, Delaware.
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O'Flaherty M, Bandosz P, Critchley J, Capewell S, Guzman-Castillo M, Aspelund T, Bennett K, Kabir K, Björck L, Bruthans J, Hotchkiss JW, Hughes J, Laatikainen T, Palmieri L, Zdrojewski T. Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach. Int J Cardiol 2016; 207:286-91. [PMID: 26812643 PMCID: PMC4766942 DOI: 10.1016/j.ijcard.2016.01.147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 01/05/2016] [Accepted: 01/06/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. METHODS We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. RESULTS Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%. CONCLUSIONS Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.
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Affiliation(s)
- M O'Flaherty
- Department of Public Health, University of Liverpool, L69 3GB, UK, 2.
| | - P Bandosz
- Department of Public Health, University of Liverpool, L69 3GB, UK, 2
| | - J Critchley
- Population Health Research Institute, St Georges, University of London, UK
| | - S Capewell
- Department of Public Health, University of Liverpool, L69 3GB, UK, 2
| | - M Guzman-Castillo
- Department of Public Health, University of Liverpool, L69 3GB, UK, 2
| | | | - K Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | - K Kabir
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - L Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden
| | - J Bruthans
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - J W Hotchkiss
- School of Veterinary Medicine, University of Glasgow, UK
| | - J Hughes
- UKCRC Centre of Excellence for Public Health, Queen's University, Belfast, UK
| | - T Laatikainen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - L Palmieri
- National Center of Epidemiology, Istituto Superiore di Sanità, Rome, Italy
| | - T Zdrojewski
- Medical University of Gdansk, Department of Hypertension and Diabetology, Poland
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Watkins DA, Olson ZD, Verguet S, Nugent RA, Jamison DT. Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis. Health Policy Plan 2016; 31:75-82. [PMID: 25841771 PMCID: PMC4724166 DOI: 10.1093/heapol/czv023] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care.
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Affiliation(s)
- David A Watkins
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA, Department of Medicine, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa,
| | - Zachary D Olson
- School of Public Health, The University of California, Berkeley, CA, USA
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Rachel A Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA and
| | - Dean T Jamison
- Department of Global Health, University of Washington, Seattle, WA, USA and Global Health Sciences, The University of California, San Francisco, CA, USA
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Choi KH, Park MS, Kim JA, Lim JA. Associations Between Excessive Sodium Intake and Smoking and Alcohol Intake Among Korean Men: KNHANES V. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:15540-9. [PMID: 26670236 PMCID: PMC4690937 DOI: 10.3390/ijerph121215001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 12/12/2022]
Abstract
In this study, we evaluated the associations of smoking and alcohol intake, both independently and collectively, with sodium intake in Korean men. Subjects (6340 men) were from the fifth Korean National Health Examination Survey (2010-2012). Smoking-related factors included smoking status, urinary cotinine level, and pack-years of smoking. Food intake was assessed using a 24-h recall. The odds of excessive sodium intake were estimated using survey logistic regression analysis. The smoking rate was 44.1%. The geometric mean of the urinary cotinine level was 0.05 µg/mL, and the median (min-max) pack-years of smoking was 13.2 (0-180). When adjusted for related factors, the odds (95% confidence interval) of excessive sodium intake were 1.54 (1.00, 2.37), 1.55 (1.23, 1.94), 1.44 (1.07, 1.95), and 1.37 (1.11, 1.68) times higher in the group exposed to smoking and drinking than in the group that never smoked nor drank, the group that never smoked and drank <5 times per month, the group that did not currently smoke and never drank, and the group that did not currently smoke or drink <5 times per month, respectively. There was an interaction effect between smoking and alcohol intake (p-interaction = 0.02). The results suggest that simultaneous exposure to smoking and alcohol intake is associated with increased odds of excessive sodium intake.
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Affiliation(s)
- Kyung-Hwa Choi
- Hallym Research Institute of Clinical Epidemiology, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do 200-702, Korea.
| | - Myung-Sook Park
- Taean Institute of Environmental Health Center, 1952-16 Seohaero, Taean-eup, Taean-gun, Chungcheongnam-do 32148, Korea.
| | - Jung Ae Kim
- Department of Social and Preventive Medicine, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do 200-702, Korea.
- College of Nursing, Hanzhong University, 200 Jiyang-gil, Donghae, Gangwon-do, 240-713, Korea.
| | - Ji-Ae Lim
- Department of Preventive Medicine, College of Medicine, Dankook University, 119 Dandae-ro, Cheonan, Chungnam 330-714, Korea.
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Influence of the Lactotripeptides Isoleucine-Proline-Proline and Valine-Proline-Proline on Systolic Blood Pressure in Japanese Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0142235. [PMID: 26536628 PMCID: PMC4633157 DOI: 10.1371/journal.pone.0142235] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/18/2015] [Indexed: 01/23/2023] Open
Abstract
Background The lactotripeptides isoleucine–proline–proline (IPP) and valine–proline–proline (VPP) have been shown to decrease systolic blood pressure (SBP) in several populations, but the size of the effect varies among studies. We performed a meta-analysis including all published studies to evaluate the SBP-lowering effect of IPP/VPP in Japanese subjects more comprehensively. Methods and Findings Eligible randomized controlled trials were searched for within four bibliographic databases, including two Japanese ones. Eighteen studies (including a total of 1194 subjects) were included in the meta-analysis. A random effect model using the restricted maximum likelihood (REML) estimator was used for the analysis. The analysis showed that consumption of IPP/VPP induced a significant reduction in SBP as compared with placebo in Japanese subjects, with an estimated effect of -5.63 mm Hg (95% CI, -6.87 to -4.39, P<0.0001) and no evidence of publication bias. A significant heterogeneity between series was evident, which could be explained by a significant influence of the baseline blood pressure status of the subjects, the effect of IPP/VPP on SBP being stronger in hypertensive subjects (-8.35 mm Hg, P<0.0001) than in non-hypertensive subjects (-3.42mm Hg, P<0.0001). Furthermore, the effect of IPP/VPP on SBP remained significant when limiting the analysis to series that tested the usual doses of IPP/VPP consumed daily (below 5 mg/d), with estimated effects of -6.01 mm Hg in the overall population and -3.32 mm Hg in non-hypertensive subjects. Conclusions Results from this meta-analysis show that IPP/VPP lactotripeptides can significantly reduce office SBP in Japanese subjects with or without overt hypertension, and for doses that can potentially be consumed as an everyday supplement. This suggests that these peptides could play a role in controlling blood pressure in Japanese subjects. The systematic review protocol was published on the PROSPERO register (CRD42014014322).
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Osowski CP, Lindroos AK, Barbieri HE, Becker W. The contribution of school meals to energy and nutrient intake of Swedish children in relation to dietary guidelines. Food Nutr Res 2015; 59:27563. [PMID: 26522664 PMCID: PMC4628944 DOI: 10.3402/fnr.v59.27563] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 12/13/2022] Open
Abstract
Background In Sweden, school meals are served free of charge and Swedish law states that school meals must be nutritious. Nevertheless, data on children's energy and nutrient intake from school meals are scarce. Objective The aim was to describe the contribution of school meals to Swedish children's nutrient and energy intake during weekdays and compare this to the reference values based on the Nordic Nutrition Recommendations (NNR), which have been adopted as the official Swedish recommendations. Design A cross-sectional food consumption survey was performed on 1,840 Swedish children attending Grade 2 (mean age 8.6) and Grade 5 (mean age 11.7). The children's nutrient and energy intake was compared to the reference values based on the NNR. Results The mean intake from school meals of energy, carbohydrates, dietary fiber, polyunsaturated fatty acids (PUFA), and vitamins D and E did not reach the reference values and the intake of saturated fatty acids (SFA) and sodium exceeded the reference values in both age groups (significant differences, all p≤0.001). Additionally, the pupils in Grade 5 did not reach the reference values for folate, potassium, calcium, magnesium, iron, selenium, and zinc (significant differences, all p≤0.001). Standardized for energy, dietary fiber, PUFA, and vitamins D and E did not reach the reference values, whereas the reference values for SFA and sodium were exceeded in both age groups (significant differences, all p≤0.001). Conclusions The study pointed to some central nutrients in need of improvement as regards school meals in Sweden, namely the quality of fat, dietary fiber, sodium, vitamin D, and iron. Some of these results may be attributed to the children not reporting eating the recommended number of calories, the children omitting some components of the meal, or underreporting, as a consequence of which the reference values for several nutrients were not met.
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Chan SH, Van Hee VC, Bergen S, Szpiro AA, DeRoo LA, London SJ, Marshall JD, Kaufman JD, Sandler DP. Long-Term Air Pollution Exposure and Blood Pressure in the Sister Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:951-8. [PMID: 25748169 PMCID: PMC4590742 DOI: 10.1289/ehp.1408125] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/04/2015] [Indexed: 05/03/2023]
Abstract
BACKGROUND Exposure to air pollution has been consistently associated with cardiovascular morbidity and mortality, but mechanisms remain uncertain. Associations with blood pressure (BP) may help to explain the cardiovascular effects of air pollution. OBJECTIVE We examined the cross-sectional relationship between long-term (annual average) residential air pollution exposure and BP in the National Institute of Environmental Health Sciences' Sister Study, a large U.S. cohort study investigating risk factors for breast cancer and other outcomes. METHODS This analysis included 43,629 women 35-76 years of age, enrolled 2003-2009, who had a sister with breast cancer. Geographic information systems contributed to satellite-based nitrogen dioxide (NO2) and fine particulate matter (≤ 2.5 μm; PM2.5) predictions at participant residences at study entry. Generalized additive models were used to examine the relationship between pollutants and measured BP at study entry, adjusting for cardiovascular disease risk factors and including thin plate splines for potential spatial confounding. RESULTS A 10-μg/m(3) increase in PM2.5 was associated with 1.4-mmHg higher systolic BP (95% CI: 0.6, 2.3; p < 0.001), 1.0-mmHg higher pulse pressure (95% CI: 0.4, 1.7; p = 0.001), 0.8-mmHg higher mean arterial pressure (95% CI: 0.2, 1.4; p = 0.01), and no significant association with diastolic BP. A 10-ppb increase in NO2 was associated with a 0.4-mmHg (95% CI: 0.2, 0.6; p < 0.001) higher pulse pressure. CONCLUSIONS Long-term PM2.5 and NO2 exposures were associated with higher blood pressure. On a population scale, such air pollution-related increases in blood pressure could, in part, account for the increases in cardiovascular disease morbidity and mortality seen in prior studies.
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Affiliation(s)
- Stephanie H Chan
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
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Hughes J, Kabir Z, Bennett K, Hotchkiss JW, Kee F, Leyland AH, Davies C, Bandosz P, Guzman-Castillo M, O’Flaherty M, Capewell S, Critchley J. Modelling Future Coronary Heart Disease Mortality to 2030 in the British Isles. PLoS One 2015; 10:e0138044. [PMID: 26422012 PMCID: PMC4589484 DOI: 10.1371/journal.pone.0138044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Despite rapid declines over the last two decades, coronary heart disease (CHD) mortality rates in the British Isles are still amongst the highest in Europe. This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking and physical activity levels, dietary salt and saturated fat intakes on future CHD mortality in three countries: Northern Ireland (NI), Republic of Ireland (RoI) and Scotland. Methods CHD mortality models previously developed and validated in each country were extended to predict potential reductions in CHD mortality from 2010 (baseline year) to 2030. Risk factor trends data from recent surveys at baseline were used to model alternative future risk factor scenarios: Absolute decreases in (i) smoking prevalence and (ii) physical inactivity rates of up to 15% by 2030; relative decreases in (iii) dietary salt intake of up to 30% by 2030 and (iv) dietary saturated fat of up to 6% by 2030. Probabilistic sensitivity analyses were then conducted. Results Projected populations in 2030 were 1.3, 3.4 and 3.9 million in NI, RoI and Scotland respectively (adults aged 25–84). In 2030: assuming recent declining mortality trends continue: 15% absolute reductions in smoking could decrease CHD deaths by 5.8–7.2%. 15% absolute reductions in physical inactivity levels could decrease CHD deaths by 3.1–3.6%. Relative reductions in salt intake of 30% could decrease CHD deaths by 5.2–5.6% and a 6% reduction in saturated fat intake might decrease CHD deaths by some 7.8–9.0%. These projections remained stable under a wide range of sensitivity analyses. Conclusions Feasible reductions in four cardiovascular risk factors (already achieved elsewhere) could substantially reduce future coronary deaths. More aggressive polices are therefore needed in the British Isles to control tobacco, promote healthy food and increase physical activity.
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Affiliation(s)
- John Hughes
- UKCRC Centre of Excellence for Public Health, Queen’s University, Belfast, United Kingdom
- * E-mail:
| | - Zubair Kabir
- Department of Epidemiology &Public Health University College Cork, Cork, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
| | - Joel W. Hotchkiss
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queen’s University, Belfast, United Kingdom
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Carolyn Davies
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Piotr Bandosz
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Maria Guzman-Castillo
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Julia Critchley
- Population Health Research Institute, St Georges University of London, London, United Kingdom
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Afshin A, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, Singh G, Yakoob MY, Abdollahi M, Al-Hooti S, Farzadfar F, Houshiar-rad A, Hwalla N, Koksal E, Musaiger A, Pekcan G, Sibai AM, Zaghloul S, Danaei G, Ezzati M, Mozaffarian D. The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open 2015; 5:e006385. [PMID: 25995236 PMCID: PMC4442236 DOI: 10.1136/bmjopen-2014-006385] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/29/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE/DESIGN We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths. SETTING/POPULATION Adult population in the Middle East by age, sex, country and time. RESULTS Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids. CONCLUSIONS Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.
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Affiliation(s)
- Ashkan Afshin
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Shahab Khatibzadeh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Saman Fahimi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peilin Shi
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
| | - John Powles
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK
| | - Gitanjali Singh
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
| | | | - Morteza Abdollahi
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Suad Al-Hooti
- Kuwait Institute for Scientific Research, Kuwait, Kuwait
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Houshiar-rad
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahla Hwalla
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Eda Koksal
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | | | - Gulden Pekcan
- Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey
| | - Abla Mehio Sibai
- Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Sahar Zaghloul
- Department of Nutrition Requirements and Growth, National Nutrition Institute, Cairo, Egypt
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA
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Health gain by salt reduction in europe: a modelling study. PLoS One 2015; 10:e0118873. [PMID: 25826317 PMCID: PMC4380413 DOI: 10.1371/journal.pone.0118873] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goal, it would reduce the prevalence of stroke from 10.1% in Finland to 23.1% in Poland. Ischemic heart disease would decrease by 6.6% in Finland to 15.5% in Poland. The number of postponed deaths would be 102,100 (0.9%) in France, and 191,300 (2.3%) in Poland. A reduction of salt intake to 5 grams per day is expected to substantially reduce the burden of cardiovascular disease and mortality in several European countries.
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Graudal N, Hubeck-Graudal T, Jürgens G, McCarron DA. The significance of duration and amount of sodium reduction intervention in normotensive and hypertensive individuals: a meta-analysis. Adv Nutr 2015; 6:169-77. [PMID: 25770255 PMCID: PMC4352175 DOI: 10.3945/an.114.007708] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of this meta-analysis was to establish the time for achievement of maximal blood pressure (BP) efficacy of a sodium reduction (SR) intervention and the relation between the amount of SR and the BP response in individuals with hypertension and normal BP. Relevant studies were retrieved from a pool of 167 randomized controlled trials (RCTs) published in the period 1973-2010 and integrated in meta-analyses. Fifteen relevant RCTs were included in the maximal efficacy analysis. After initiation of sodium reduction (range: 55-118 mmol/d), there were no significant differences in systolic blood pressure (SBP) or diastolic blood pressure (DBP) between measurements at weeks 1 and 2 (∆SBP: -0.18 mmHg/∆DBP: 0.12 mmHg), weeks 1 and 4 (∆SBP: -0.50 mmHg/∆DBP: 0.35 mmHg), weeks 2 and 4 (∆SBP: -0.20 mmHg/∆DBP: -0.10 mmHg), weeks 2 and 6 (∆SBP: -0.50 mmHg/∆DBP: -0.42 mmHg), and weeks 4 and 6 (∆SBP: 0.39 mmHg/∆DBP: -0.22 mmHg). Eight relevant RCTs were included in the dose-response analysis, which showed that within the established usual range of sodium intake [<248 mmol/d (5700 mg/d)], there was no relation between the amount of SR (range: 136-188 mmol) and BP outcome in normotensive populations [∆SBP: 0.99 mm Hg (95% CI: -2.12, 4.10 mm Hg), [corrected] P = 0.53; ∆DBP: -0.49 mm Hg (95% CI: -4.0, 3.03), P = 0.79]. In contrast, prehypertensive and hypertensive populations showed a significant dose-response relation (range of sodium reduction: 77-140 mmol/d) [∆SBP: 6.87 mmHg (95% CI: 5.61, 8.12, P < 0.00001); ∆DBP: 3.61 mmHg (95% CI: 2.83, 4.39, P < 0.00001)]. Consequently, the importance of kinetic and dynamic properties of sodium reduction, as well as baseline BP, should probably be considered when establishing a policy of sodium reduction.
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Affiliation(s)
- Niels Graudal
- Department of Infectious Diseases and Rheumatology 4242, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;
| | | | - Gesche Jürgens
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen, Denmark; and
| | - David A McCarron
- Department of Nutrition, University of California–Davis, Davis, CA
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Becarevic M, Salihefendic N, Zildzic M. Effects of salt intake on blood pressure in banovici coal mine workers. Mater Sociomed 2015; 26:385-8. [PMID: 25685083 PMCID: PMC4314172 DOI: 10.5455/msm.2014.26.385-388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/25/2014] [Indexed: 11/04/2022] Open
Abstract
Introduction: High blood pressure is the cause of almost 13 % of all deaths in the world. DASH (Dietary Approaches to Stop Hypertension) is “gold standard” in diet recommended by American Society of Hypertension, American Heart Association and Dietary Guidelines for Americans 2010 for reduction many CV risk factors including hypertension. Non-pharmacological treatment of hypertension through DASH dietary program with reduction of salt intake can significantly reduce high values of blood pressure and decrease general cardiovascular risks. Goal: The aim of this research is to determine the prevalence of hypertension among miners in Banovici coal mine and amount of salt taken in meals during work time. Material and methods: We inspected the medical documentation and registers for all employees in coal mine Banovici in order to provide calculation of hypertension prevalence. Based on reports and company standards on grocery usage and average amount of salt used in preparation of one meal in coal mine kitchen, we have calculated the average consumption of salt of one employee per meal. Results: There are 2700 of employees in coal mine Banovici with average life age of 46 years. From them 694 (25.7%) miners have arterial hypertension. Also 707023 kg of salt is being spent for preparation of meals in coal mine kitchen on yearly basis. Employees take between 4-9 grams of salt per one meal excluding the salt contained in bread. Conclusion: the amount of salt intake per one meal in the coal mine kitchen is larger from daily doses recommended by ACC/AHA.
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Affiliation(s)
- Munevera Becarevic
- Department of Occupational Medicine, Public Health Centre Banovici,Banovici, Bosnia and Herzegovina
| | | | - Muharem Zildzic
- Practice "Medicus-A" Gracanica, Gracanica, Bosnia and Herzegovina
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De Keyzer W, Tilleman K, Ampe J, De Henauw S, Huybrechts I. Effect of sodium restriction on blood pressure of unstable or uncontrolled hypertensive patients in primary care. Nutr Res Pract 2015; 9:180-5. [PMID: 25861425 PMCID: PMC4388950 DOI: 10.4162/nrp.2015.9.2.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES The aims of the present study are: 1) to quantify sodium consumption of patients with unstable or uncontrolled hypertension, 2) to investigate if reduced sodium intake can lower BP in these patients, and 3), to assess the acceptability and feasibility of this approach. SUBJECTS/METHODS This study included 25 adults (age: 50+ years) with frequently elevated BP or patients with uncontrolled, uncomplicated hypertension despite drug treatment in a general practice setting. BP and salt intake (24h urinary excretion and food records) were measured at baseline and after a sodium reduced diet. RESULTS Mean (± SD) systolic (SBP) over diastolic (DBP) blood pressure (mmHg) at baseline was 150.7 (± 9.5)/84.149 (± 5.6). Mean urinary sodium excretion was 146 mmol/24h. A reduction of 28 mmol sodium excretion decreased SBP/DBP to 135.5 (± 13.0)/82.5 (± 12.8) (P < 0.001). After one month of no dietary advice, only in 48%, SBP was still ≤140 mmHg. CONCLUSION Assessment of sodium intake using food records, 24h urine collections and probing questions to identify use of sodium containing supplements or drugs are essential for tailored advice targeted at sodium intake reduction. The results of the present study indicate that reduced sodium intake can lower BP after 4 weeks in unstable or uncontrolled hypertensive patients.
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Affiliation(s)
- Willem De Keyzer
- Department of Bio- and food sciences, University College Ghent, B-9000 Ghent, Belgium. ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium
| | - Katrien Tilleman
- Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium
| | - Jan Ampe
- General practice Vossensteert Sint-Jozef, B-8000 Bruges, Belgium
| | - Stefaan De Henauw
- Department of Bio- and food sciences, University College Ghent, B-9000 Ghent, Belgium. ; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium
| | - Inge Huybrechts
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, B-9000 Ghent, Belgium
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Drewnowski A, Rehm CD, Maillot M, Monsivais P. The relation of potassium and sodium intakes to diet cost among U.S. adults. J Hum Hypertens 2015; 29:14-21. [PMID: 24871907 PMCID: PMC4247818 DOI: 10.1038/jhh.2014.38] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 04/02/2014] [Accepted: 04/11/2014] [Indexed: 12/25/2022]
Abstract
The 2010 Dietary Guidelines recommended that Americans increase potassium and decrease sodium intakes to reduce the burden of hypertension. One reason why so few Americans meet the recommended potassium or sodium goals may be perceived or actual food costs. This study explored the monetary costs associated with potassium and sodium intakes using national food prices and a representative sample of US adults. Dietary intake data from the 2001-2002 National Health and Nutrition Examination Survey were merged with a national food prices database. In a population of 4744 adults, the association between the energy-adjusted sodium and potassium intakes, and the sodium-to-potassium ratio (Na:K) and energy-adjusted diet cost was evaluated. Diets that were more potassium-rich or had lower Na:K ratios were associated with higher diet costs, while sodium intakes were not related to cost. The difference in diet cost between extreme quintiles of potassium intakes was $1.49 (95% confidence interval: 1.29, 1.69). A food-level analysis showed that beans, potatoes, coffee, milk, bananas, citrus juices and carrots are frequently consumed and low-cost sources of potassium. Based on existing dietary data and current American eating habits, a potassium-dense diet was associated with higher diet costs, while sodium was not. Price interventions may be an effective approach to improve potassium intakes and reduce the Na:K ratio of the diet. The present methods helped identify some alternative low-cost foods that were effective in increasing potassium intakes. The identification and promotion of lower-cost foods to help individuals meet targeted dietary recommendations could accompany future dietary guidelines.
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Affiliation(s)
- A Drewnowski
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, USA
| | - C D Rehm
- Center for Public Health Nutrition, School of Public Health, University of Washington, Seattle, WA, USA
| | - M Maillot
- Faculte de Médecine de la Timoine, Université Aix-Marseille, 27 Boulevard Jean Moulin, Marseille, France
| | - P Monsivais
- Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2014; 2014:CD009217. [PMID: 25519688 PMCID: PMC6483405 DOI: 10.1002/14651858.cd009217.pub3] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is an update of a Cochrane review that was first published in 2011 of the effects of reducing dietary salt intake, through advice to reduce salt intake or low-sodium salt substitution, on mortality and cardiovascular events. OBJECTIVES 1. To assess the long-term effects of advice and salt substitution, aimed at reducing dietary salt, on mortality and cardiovascular morbidity.2. To investigate whether a reduction in blood pressure is an explanatory factor in the effect of such dietary interventions on mortality and cardiovascular outcomes. SEARCH METHODS We updated the searches of CENTRAL (2013, Issue 4), MEDLINE (OVID, 1946 to April week 3 2013), EMBASE (OVID, 1947 to 30 April 2013) and CINAHL (EBSCO, inception to 1 April 2013) and last ran these on 1 May 2013. We also checked the references of included studies and reviews. We applied no language restrictions. SELECTION CRITERIA Trials fulfilled the following criteria: (1) randomised, with follow-up of at least six months, (2) the intervention was reduced dietary salt (through advice to reduce salt intake or low-sodium salt substitution), (3) participants were adults and (4) mortality or cardiovascular morbidity data were available. Two review authors independently assessed whether studies met these criteria. DATA COLLECTION AND ANALYSIS A single author extracted data and assessed study validity, and a second author checked this. We contacted trial authors where possible to obtain missing information. We extracted events and calculated risk ratios (RRs) and 95% confidence intervals (CIs). MAIN RESULTS Eight studies met the inclusion criteria: three in normotensives (n = 3518) and five in hypertensives or mixed populations of normo- and hypertensives (n = 3766). End of trial follow-up ranged from six to 36 months and the longest observational follow-up (after trial end) was 12.7 years.The risk ratios (RR) for all-cause mortality in normotensives were imprecise and showed no evidence of reduction (end of trial RR 0.67, 95% confidence interval (CI) 0.40 to 1.12, 60 deaths; longest follow-up RR 0.90, 95% CI 0.58 to 1.40, 79 deaths n=3518) or in hypertensives (end of trial RR 1.00, 95% CI 0.86 to 1.15, 565 deaths; longest follow-up RR 0.99, 95% CI 0.87 to 1.14, 674 deaths n=3085). There was weak evidence of benefit for cardiovascular mortality (hypertensives: end of trial RR 0.67, 95% CI 0.45 to 1.01, 106 events n=2656) and for cardiovascular events (hypertensives: end of trial RR 0.76, 95% CI 0.57 to 1.01, 194 events, four studies, n = 3397; normotensives: at longest follow-up RR 0.71, 95% CI 0.42 to 1.20, 200 events; hypertensives: RR 0.77, 95% CI 0.57 to 1.02, 192 events; pooled analysis of six trials RR 0.77, 95% CI 0.63 to 0.95, n = 5912). These findings were driven by one trial among retirement home residents that reduced salt intake in the kitchens of the homes, thereby not requiring individual behaviour change.Advice to reduce salt showed small reductions in systolic blood pressure (mean difference (MD) -1.15 mmHg, 95% CI -2.32 to 0.02 n=2079) and diastolic blood pressure (MD -0.80 mmHg, 95% CI -1.37 to -0.23 n=2079) in normotensives and greater reductions in systolic blood pressure in hypertensives (MD -4.14 mmHg, 95% CI -5.84 to -2.43 n=675), but no difference in diastolic blood pressure (MD -3.74 mmHg, 95% CI -8.41 to 0.93 n=675).Overall many of the trials failed to report sufficient detail to assess their potential risk of bias. Health-related quality of life was assessed in one trial in normotensives, which reported significant improvements in well-being but no data were presented. AUTHORS' CONCLUSIONS Despite collating more event data than previous systematic reviews of randomised controlled trials, there is insufficient power to confirm clinically important effects of dietary advice and salt substitution on cardiovascular mortality in normotensive or hypertensive populations. Our estimates of the clinical benefits from advice to reduce dietary salt are imprecise, but are larger than would be predicted from the small blood pressure reductions achieved. Further well-powered studies would be needed to obtain more precise estimates. Our findings do not support individual dietary advice as a means of restricting salt intake. It is possible that alternative strategies that do not require individual behaviour change may be effective and merit further trials.
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Affiliation(s)
- Alma J Adler
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Abstract
Stroke prevention is extremely cost-effective. The Ontario Task Force for the Coordinated Stroke Strategy for Ontario received from Dr. Muhammad Mamdani of the Institute for Clinical Evaluative Sciences the estimate that stroke prevention is approximately ten times more cost-effective than treating acute stroke with tPA.1 Hackam and Spence2 have calculated that in the highest-risk patients it would be possible to reduce the risk of stroke by more than 90% by a combination of interventions (including blood pressure control, smoking cessation, diet, treatment of diabetes, lipid-lowering therapy, and for patients in whom it is indicated, anticoagulation for atrial fibrillation or carotid endarterectomy). Dr Mukul Sharma (personal communication) has shown that stroke prevention is a dominant strategy in health economic terms; i.e. that it improves outcomes while reducing net costs. Effective control of hypertension has the potential to reduce stroke by half.3,4 Because hypertension is so prevalent, it accounts for the greatest population attributable risk for stroke, and thus represents the greatest opportunity to reduce stroke.
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Memory processes in the development of reduced-salt foods. Appetite 2014; 83:125-134. [DOI: 10.1016/j.appet.2014.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 07/25/2014] [Accepted: 08/13/2014] [Indexed: 11/24/2022]
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Charlton K, Webster J, Kowal P. To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs. Nutrients 2014; 6:3672-95. [PMID: 25230210 PMCID: PMC4179182 DOI: 10.3390/nu6093672] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.
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Affiliation(s)
- Karen Charlton
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| | - Paul Kowal
- WHO Study on global AGEing and adult health, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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49
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Abstract
Elevated blood pressure arises from a combination of environmental and genetic factors and the interactions of these factors. A substantial body of evidence from animal studies, epidemiologic studies, meta-analyses, and randomized controlled trials has demonstrated that certain dietary patterns and individual dietary elements play a prominent role in the development of hypertension. Changes in diet can lower blood pressure, prevent the development of hypertension, and reduce the risk of hypertension-related complications. Dietary strategies for the prevention of hypertension include reducing sodium intake, limiting alcohol consumption, increasing potassium intake, and adopting an overall dietary pattern such as the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean diet. In order to reduce the burden of blood pressure-related complications, efforts that focus on environmental and individual behavioral changes that encourage and promote healthier food choices are warranted.
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50
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Wang X. Modified generalized method of moments for a robust estimation of polytomous logistic model. PeerJ 2014; 2:e467. [PMID: 25071990 PMCID: PMC4103096 DOI: 10.7717/peerj.467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/13/2014] [Indexed: 11/20/2022] Open
Abstract
The maximum likelihood estimation (MLE) method, typically used for polytomous logistic regression, is prone to bias due to both misclassification in outcome and contamination in the design matrix. Hence, robust estimators are needed. In this study, we propose such a method for nominal response data with continuous covariates. A generalized method of weighted moments (GMWM) approach is developed for dealing with contaminated polytomous response data. In this approach, distances are calculated based on individual sample moments. And Huber weights are applied to those observations with large distances. Mellow-type weights are also used to downplay leverage points. We describe theoretical properties of the proposed approach. Simulations suggest that the GMWM performs very well in correcting contamination-caused biases. An empirical application of the GMWM estimator on data from a survey demonstrates its usefulness.
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Affiliation(s)
- Xiaoshan Wang
- Department of Clinical and Translational Research/Forsyth Institute , Cambridge, MA , USA
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