The role of dietary potassium in hypertension and diabetes

Adherence to a healthful plant-based diet and risk of mortality among individuals with chronic kidney disease: A prospective cohort study

BACKGROUND

Plant-rich dietary patterns may protect against negative health outcomes among individuals with chronic kidney disease (CKD), although aspects of plant-based diet quality have not been studied. This study aimed to examine associations between healthful and unhealthful plant-based dietary patterns with risk of all-cause mortality among CKD patients for the first time.

METHODS

This prospective analysis included 4807 UK Biobank participants with CKD at baseline. We examined associations of adherence to both the healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI), calculated from repeated 24-h dietary assessments, with risk of all-cause mortality using multivariable Cox proportional hazard regression models.

RESULTS

Over a 10-year follow-up, 675 deaths were recorded. Participants with the highest hPDI scores showed a 34% lower risk of mortality [HRQ4vsQ1 (95% CI): 0.66 (0.52-0.83), ptrend <0.001]. Those with the highest uPDI scores had a 52% [1.52 (1.20-1.93), ptrend = 0.002] higher risk of mortality compared to participants with the lowest respective scores. In food group-specific analyses, higher wholegrain intakes were associated with a 29% lower mortality risk, while intakes of refined grains, and sugar-sweetened beverages were associated a 30% and 34% higher risk, respectively.

CONCLUSIONS

In CKD patients, a higher intake of healthy plant-based foods was associated with a lower risk of mortality, while a higher intake of less healthy plant-based foods was associated with a higher risk of mortality. These results underscore the importance of plant food quality and support the potential role of healthy plant food consumption in the treatment and management of CKD to mitigate unfavourable outcomes.

Association between dietary mineral intakes and urine flow rate: data from the 2009-2018 National Health and Nutrition Examination Survey

Background

Minerals play an important role in human health, but their effect on urinary function remains controversial. The aim of this study was to assess the association between dietary intake of minerals (Ca, P, Mg, Fe, Zn, Cu, Na, K, Se) and urine flow rate (UFR).

Methods

We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES, 2009-2018) database. Multivariate regression and smooth curve fitting were used to investigate the association between dietary mineral intakes and UFR. Subgroup analyses and interaction tests were used to investigate whether this association was stable in the population.

Results

Our study involving 10,229 representative adult NHANES participants showed an association between Mg intake and UFR in a linear regression model for continuous variables. And in the model analysis of tertile categorical variables, we observed a positive association between six mineral intakes (Ca, Mg, Zn, Cu, Na, and K) and UFR. Smoothed curve fitting and threshold effect analysis further support the nonlinear relationship between mineral intakes and UFR. Subgroup analyses and interaction tests ensured the reliability and robustness of the findings.

Conclusion

This study examined the effects of nine dietary minerals on UFR and found that intake of Ca, Mg, Zn, Cu, Na, and K were positively correlated with UFR, suggesting that these minerals may have a positive effect on improving urinary function. In particular, Mg showed a more significant positive correlation with UFR in women, while Na showed a stronger positive correlation in diabetics. However, P, Fe and Se did not show significant correlations. In summary, although these findings provide a preliminary understanding of the relationship between dietary minerals and urinary function, further prospective studies are still necessary to validate these relationships and explore the physiologic mechanisms underlying them.

Association between Dietary Potassium Intake and Nonalcoholic Fatty Liver Disease and Advanced Hepatic Fibrosis in U.S. Adults

Introduction

The correlation between potassium and nonalcoholic fatty liver disease (NAFLD) is currently still poorly understood. We conducted this study to explore the correlation between dietary potassium intake and NAFLD, as well as advanced hepatic fibrosis (AHF). The study also sought to identify any potential interactions.

Methods

The data employed in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) program, encompassing a period from 2007 to 2018. Employing the multiple logistic regression analysis, we evaluated the association of dietary potassium intake with NAFLD and AHF. Subsequently, stratification analysis, based on demographic variables, was constructed so as to assess the stability of the results. In addition, potential interaction effects were assessed by interaction tests.

Results

A total of 9443 participants were included in the analysis. The mean age of the participants was 50.4 years, and their daily mean dietary potassium and vitamin C intake was 2556.49 mg and 82.93 mg, respectively. Following comprehensive statistical analyses, the findings indicated a negative correlation between dietary potassium intake and both NAFLD and AHF. Participants in Q4 group with dietary potassium intake exhibited a 31% and 42% reduction in the odds of developing NAFLD and AHF, respectively, in comparison to Q1 group. An interaction effect of dietary vitamin C intake was observed in the association between dietary potassium intake and NAFLD. The results imply that high dietary vitamin C intake augment the inverse relationship between dietary potassium intake and NAFLD.

Conclusion

Dietary potassium intake was found to have an inverse association with the odds of both NAFLD and AHF. The association between dietary potassium intake and NAFLD was amplified by the presence of vitamin C in the diet.

Coordinated Regulation of Renal Glucose Reabsorption and Gluconeogenesis by mTORC2 and Potassium

Background

The kidney proximal tubule is uniquely responsible for reabsorption of filtered glucose and gluconeogenesis (GNG). Insulin stimulates glucose transport and suppresses GNG in the proximal tubule, however, the signaling mechanisms and coordinated regulation of these processes remain poorly understood. The kinase complex mTORC2 is critical for regulation of growth, metabolism, solute transport, and electrolyte homeostasis in response to a wide array of inputs. Here we examined its role in the regulation of renal glucose reabsorption and GNG.

Methods

Rictor, an essential component of mTORC2, was knocked out using the Pax8-LC1 system to generate inducible tubule specific Rictor knockout (TRKO) mice. These animals were subjected to fasting, refeeding, and variation in dietary K + . Metabolic parameters including glucose homeostasis and renal function were assessed in balance cages. Kidneys and livers were also harvested for molecular analysis of gluconeogenic enzymes, mTORC2-regulated targets, and plasma membrane glucose transporters.

Results

On a normal chow diet, TRKO mice had marked glycosuria despite indistinguishable blood glucose relative to WT controls. Kidney plasma membrane showed lower SGLT2 and SGLT1 in the fed state, supporting reduced renal glucose reabsorption. Additional metabolic testing provided evidence for renal insulin resistance with elevated fasting insulin, impaired pyruvate tolerance, elevated hemoglobin A1c, and increased renal gluconeogenic enzymes in the fasted and fed states. These effects were correlated with reduced downstream phosphorylation of Akt and the transcription factor FOXO4, identifying a novel role of FOXO4 in the kidney. Interestingly, high dietary K + prevented glycosuria and excessive GNG in TRKO mice, despite persistent reduction in mTORC2 substrate phosphorylation.

Conclusion

Renal tubule mTORC2 is critical for coordinated regulation of sodium-glucose cotransport by SGLT2 and SGLT1 as well as renal GNG. Dietary K + promotes glucose reabsorption and suppresses GNG independently of insulin signaling and mTORC2, potentially providing an alternative signaling mechanism in states of insulin resistance.

SIGNIFICANCE STATEMENT

The kidney contributes to regulation of blood glucose through reabsorption of filtered glucose and gluconeogenesis. This study shows that mTORC2 and dietary potassium coordinate the regulation of sodium-glucose cotransport and glucose production in the kidney via independent mechanisms. New insights into the regulation of these processes in the kidney offer promising implications for diabetes mellitus management and treatment.

Metals on the Menu-Analyzing the Presence, Importance, and Consequences

Metals are integral components of the natural environment, and their presence in the food supply is inevitable and complex. While essential metals such as sodium, potassium, magnesium, calcium, iron, zinc, and copper are crucial for various physiological functions and must be consumed through the diet, others, like lead, mercury, and cadmium, are toxic even at low concentrations and pose serious health risks. This study comprehensively analyzes the presence, importance, and consequences of metals in the food chain. We explore the pathways through which metals enter the food supply, their distribution across different food types, and the associated health implications. By examining current regulatory standards for maximum allowable levels of various metals, we highlight the importance of ensuring food safety and protecting public health. Furthermore, this research underscores the need for continuous monitoring and management of metal content in food, especially as global agricultural and food production practices evolve. Our findings aim to inform dietary recommendations, food fortification strategies, and regulatory policies, ultimately contributing to safer and more nutritionally balanced diets.

A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

Higher potassium intake is associated with a lower risk of chronic kidney disease: population-based prospective study

BACKGROUND

High-potassium intake is associated with a lower risk of cardiovascular disease. However, the association between potassium intake and the development of chronic kidney disease (CKD) remains unclear.

OBJECTIVE

The objective of this study was to investigate whether potassium intake is associated with outcomes of incident CKD.

METHODS

This is a population-based prospective observational cohort study from the UK Biobank cohort between 2006 and 2010. We included 317,162 participants without CKD from the UK Biobank cohort. The main predictor was spot urine potassium-to-creatinine ratio (KCR). The primary outcome was incident CKD, which was defined by the International Classification of Disease 10 codes or Operating Procedure Codes Supplement 4 codes.

RESULTS

At baseline, individuals with higher KCR had lower blood pressure, body mass index, and inflammation, and were less likely to have diabetes and hypertension. During a median follow-up of 11.9 y, primary outcome events occurred in 15,246 (4.8%) participants. In the cause-specific model, the adjusted hazard ratio (aHR) per 1-standard deviation increase in KCR for incident CKD was 0.90 [95% confidence interval (CI): 0.89, 0.92]. Compared with quartile 1 of KCR, the aHRs (95% CIs) for quartiles 2-4 were 0.98 (0.94, 1.02), 0.90 (0.86, 0.95), and 0.80 (0.76, 0.84), respectively. In sensitivity analysis with different definitions of CKD, the results were similar. In addition, further analysis with dietary potassium intake also showed a negatively graded association with the primary outcome.

CONCLUSIONS

Higher urinary potassium excretion and intake were associated with a lower risk of incident CKD.

Association between circulating micronutrient pattern, glycemic control, and insulin resistance in type 2 diabetes mellitus

The circulating micronutrient pattern in type 2 diabetes mellitus (T2DM) may impact glycemic control and insulin resistance; however, there is a scarcity of studies that have evaluated the circulating micronutrient pattern in the T2DM population. Therefore, our objective was to identify circulating micronutrient pattern and their association with markers of glycemic control and insulin resistance in individuals with T2DM. We developed a cross-sectional observational study involving adults with T2DM in Sergipe, Brazil. We assessed plasma levels of magnesium, zinc, calcium, potassium, and serum 25-hydroxyvitamin D. Additionally, also measured fasting glucose levels, the percentage of glycated hemoglobin (%HbA1c), and calculated the homeostatic model assessment for insulin resistance (HOMA-IR). Patterns of body reserve were established using principal component analysis and categorized into quartiles. Binary logistic regression models were employed. We evaluated 114 individuals (63.7% women), with a median age and body mass index of 49 years and 29.6 kg/m², respectively. Two circulating micronutrient patterns were identified, explaining 62.5% of the variance: Pattern 1 (positive contributions from magnesium, zinc, calcium, and potassium) and Pattern 2 (positive contributions from 25-hydroxyvitamin D and zinc, with a negative contribution from potassium). Lowest quartile for Pattern 1 and Pattern 2 exhibiting a 4.32-fold (p = 0.019) and 3.97-fold (p = 0.038) higher likelihood of increasing HOMA-IR and %HbA1c values, respectively, compared to the larger quartiles. However, no associations were found between these patterns and fasting glucose values. Lowest quartile for both patterns of micronutrients was associated with inadequate metabolic control in individuals with T2DM.

Immunomodulation through Nutrition Should Be a Key Trend in Type 2 Diabetes Treatment

An organism's ability to function properly depends not solely on its diet but also on the intake of nutrients and non-nutritive bioactive compounds that exert immunomodulatory effects. This principle applies both to healthy individuals and, in particular, to those with concomitant chronic conditions, such as type 2 diabetes. However, the current food industry and the widespread use of highly processed foods often lead to nutritional deficiencies. Numerous studies have confirmed the occurrence of immune system dysfunction in patients with type 2 diabetes. This article elucidates the impact of specific nutrients on the immune system function, which maintains homeostasis of the organism, with a particular emphasis on type 2 diabetes. The role of macronutrients, micronutrients, vitamins, and selected substances, such as omega-3 fatty acids, coenzyme Q10, and alpha-lipoic acid, was taken into consideration, which outlined the minimum range of tests that ought to be performed on patients in order to either directly or indirectly determine the severity of malnutrition in this group of patients.

Dietary calcium, phosphorus, and potassium intake associated with erectile dysfunction in the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004

BACKGROUND

Erectile dysfunction is now a common disorder of sexual function, and its relationship to dietary calcium, phosphorus, and potassium has not been well studied. We set out to determine if dietary intakes of calcium, phosphorus, and potassium are related to erectile dysfunction in U.S. men.

METHODS

For this cross-sectional investigation, we used data from NHANES 2001-2004. To investigate the connection of dietary calcium, phosphorus, and potassium intake with erectile dysfunction, we employed multivariate logistic regression, smoothed curve fitting, and subgroup analysis.

RESULTS

This cross-sectional study comprised 3,556 eligible male subjects in total, with a weighted mean age of 49.93±18.13 years. After controlling for race and age, the greatest tertile of calcium consumption was found to have a 34% lower risk of erectile dysfunction than the lowest tertile (OR = 0.66; 95% CI = 0.52-0.84; p = 0.0006). The risk of erectile dysfunction was found to be reduced by 33% (OR = 0.67; 95% CI = 0.52-0.87; p = 0.0024) for the highest tertile of phosphorus intake compared to the lowest tertile of phosphorus intake and by 35% (OR = 0.65; 95% CI = 0.50-0.83; p = 0.0006) for the highest tertile of potassium intake compared to the lowest tertile of potassium intake in the fully adjusted model.

CONCLUSION

Erectile dysfunction and dietary consumption of calcium, phosphorus, and potassium are inversely associated with the U.S. population. To confirm the accuracy of our findings, additional prospective studies are necessary. Furthermore, it is imperative to do further fundamental research at the molecular level to gain a deeper understanding of the underlying mechanisms.

High-throughput characterization of the effect of sodium chloride and potassium chloride on 31 lactic acid bacteria and their co-cultures

Salt (NaCl) is associated with a risk of hypertension and the development of coronary heart disease, so its consumption should be limited. However, salt plays a key role in the quality and safety of food by controlling undesirable microorganisms. Since studies have focused primarily on the effect of salts on the overall counts of the lactic acid bacteria (LAB) group, we have not yet understood how salt stress individually affects the strains and the interactions between them. In this study, we characterized the effect of sodium chloride (NaCl) and potassium chloride (KCl) on the growth and acidification of 31 LAB strains. In addition, we evaluated the effect of salts on a total of 93 random pairwise strain combinations. Strains and co-cultures were tested at 3% NaCl, 5% NaCl, and 3% KCl on solid medium using an automated approach and image analysis. The results showed that the growth of LAB was significantly reduced by up to 68% at 5% NaCl (p < 0.0001). For the co-cultures, a reduction of up to 57% was observed at 5% NaCl (p < 0.0001). However, acidification was less affected by salt stress, whether for monocultures or co-cultures. Furthermore, KCl had a lesser impact on both growth and acidification compared to NaCl. Indeed, some strains showed a significant increase in growth at 3% KCl, such as Lactococcus lactis subsp. lactis 74310 (23%, p = 0.01). More importantly, co-cultures appeared to be more resilient and had more varied responses to salt stress than the monocultures, as several cases of suppression of the significant effect of salts on acidification and growth were detected. Our results highlight that while salts can modulate microbial interactions, these latter can also attenuate the effect of salts on LAB.

Switching the World's Salt Supply-Learning from Iodization to Achieve Potassium Enrichment

Sodium is an essential dietary component, but excess sodium intake can lead to high blood pressure and an increased risk of cardiovascular disease. Many national and international bodies, including the World Health Organization, have advocated for population-wide sodium reduction interventions. Most have been unsuccessful due to inadequate sodium reduction by food industry and difficulties in persuading consumers to add less salt to food. Recent research highlights potassium-enriched salt as a new, feasible, acceptable, and scalable approach to reducing the harms caused by excess sodium and inadequate potassium consumption. Modeling shows that a global switch from regular salt to potassium-enriched salt has the potential to avert millions of strokes, heart attacks, and premature deaths worldwide each year. There will be many challenges in switching the world's salt supply to potassium-enriched salt, but the success of universal salt iodization shows that making a global change to the manufacture and use of salt is a tractable proposition. This in-depth review of universal salt iodization identified the importance of a multisectoral effort with strong global leadership, the support of multilateral organizations, engagement with the salt industry, empowered incountry teams, strong participation of national governments, understanding the salt supply chain, and a strategic advocacy and communication plan. Key challenges to the implementation of the iodization program were costs to government, industry, and consumers, industry concerns about consumer acceptability, variance in the size and capabilities of salt producers, inconsistent quality control, ineffective regulation, and trade-related regulatory issues. Many of the opportunities and challenges to universal salt iodization will likely also be applicable to switching the global salt supply to iodized and potassium-enriched salt.

Association of cholesterol with hepatorenal markers and quality of life in diabetic patients before and after magnesium and potassium supplements

Background

Magnesium and potassium are two critical minerals that have been linked to the treatment of diabetes and its consequences. A lack of magnesium has been linked to insulin resistance and diabetes, whereas potassium has been found to promote insulin sensitivity and glucose metabolism. The study aimed to determine the relationship between cholesterol, liver and kidney markers, and quality of life in diabetic patients before and after magnesium and potassium supplementation.

Methods

It was a single-blind randomized controlled study at Lahore Garrison University and Lahore Medical Research Centre (LMRC). The study included 200 diabetes participants. Four groups were made based on supplements. Blood samples of all diabetes patients were obtained to assess their quality of life before and after using Mg + and K + supplements, as well as the association between cholesterol, liver, and kidney markers.

Results

The participants' average age was 51.0 ± 11.08. 139 (69.5 %) of the 200 participants were female, whereas 26 (30.5 %) were male. There was no correlation between the quality of life measure and the patients' cholesterol levels before and after the magnesium and potassium supplementation. Furthermore, the kidney and liver indicators were not dependent on the diabetes individuals' cholesterol levels.

Conclusions

The study concluded that none of the four groups noticed a significant effect of magnesium and potassium therapies on the patient's quality of life or cholesterol levels. However, more research is needed to determine if liver and kidney problems are linked to cholesterol levels before and after medication, as the current study found no significant correlation between the two parameters.

Potassium Magnesium Citrate Is Superior to Potassium Chloride in Reversing Metabolic Side Effects of Chlorthalidone

BACKGROUND

Thiazide diuretics (TD) are the first-line treatment of hypertension because of its consistent benefit in lowering blood pressure and cardiovascular risk. TD is also known to cause an excess risk of diabetes, which may limit long-term use. Although potassium (K) depletion was thought to be the main mechanism of TD-induced hyperglycemia, TD also triggers magnesium (Mg) depletion. However, the role of Mg supplementation in modulating metabolic side effects of TD has not been investigated. Therefore, we aim to determine the effect of potassium magnesium citrate (KMgCit) on fasting plasma glucose and liver fat by magnetic resonance imaging during TD therapy.

METHODS

Accordingly, we conducted a double-blinded RCT in 60 nondiabetic hypertension patients to compare the effects of KCl versus KMgCit during chlorthalidone treatment. Each patient received chlorthalidone alone for 3 weeks before randomization. Primary end point was the change in fasting plasma glucose after 16 weeks of KCl or KMgCit supplementation from chlorthalidone alone.

RESULTS

The mean age of subjects was 59±11 years (30% Black participants). Chlorthalidone alone induced a significant rise in fasting plasma glucose, and a significant fall in serum K, serum Mg, and 24-hour urinary citrate excretion (all P<0.05). KMgCit attenuated the rise in fasting plasma glucose by 7.9 mg/dL versus KCl (P<0.05), which was not observed with KCl. There were no significant differences in liver fat between the 2 groups.

CONCLUSIONS

KMgCit is superior to KCl, the common form of K supplement used in clinical practice, in preventing TD-induced hyperglycemia. This action may improve tolerability and cardiovascular safety in patients with hypertension treated with this drug class.

Association between dietary potassium intake and severe headache or migraine in US adults: a population-based analysis

Background

Migraine is a prevalent neurovascular headache disorder. The link between dietary potassium and blood pressure has been established. We sought to delineate the relationship between dietary potassium intake and the prevalence of migraines.

Methods

We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2004, comprising 10,254 participants aged ≥20 years. Participants who reported severe headaches or migraine in the self-report questionnaire were identified as migraineurs. A 24-h dietary recall methodology was used to assess dietary potassium intake. Multivariate regression analysis and restricted cubic spline (RCS) modeling were utilized to elucidate the relationship between dietary potassium and migraines.

Results

Among the 10,254 participants, 20.1% were identified with migraine or severe headaches. The adjusted odds ratio (OR) for migraine occurrence in the Q2 dietary potassium intake (1771-2,476 mg/d) was 0.84 (95% CI: 0.73-0.97, p = 0.021) compared to the lowest quartile (Q1, ≤ 1771 mg/d). The relationship between dietary potassium and migraine exhibited an L-shaped pattern (non-linear, p = 0.016) with an inflection at approximately 1439.3 mg/d. In the subgroup analysis, when compared to Q1, who had the lowest dietary potassium intake, the adjusted OR for Q2 in females, those in the medium-high household income group, and with a Body Mass Index (BMI) ≥ 25 kg/m2 were as follows: (OR, 0.82; 95% CI, 0.69-0.98), (OR, 0.79; 95% CI, 0.66-0.95), and (OR, 0.78; 95% CI, 0.66-0.93), respectively. No significant interaction was observed across groups after adjusting for all possible covariates.

Conclusion

The relationship between dietary potassium intake and migraine prevalence among US adults appears to follow an L-shaped curve.

Codonopsis lanceolata Extract Restores Smooth Muscle Vasorelaxation in Rat Carotid Arteries Even under High Extracellular K+ Concentrations

Recent studies showed that Codonopsis lanceolata (CL) has antihypertensive effects. However, to date, no study has examined the effects of CL on vascular tone under a high extracellular K+ concentration ([K+]o). Thus, the present study examined the effect of an extract of Codonopsis lanceolata (ECL) on the vascular tension of rat carotid arteries exposed to high [K+]o. We used myography to investigate the effect of an ECL on the vascular tension of rat carotid arteries exposed to high [K+]o and the underlying mechanism of action. In arteries with intact endothelia, the ECL (250 μg/mL) had no effect on vascular tension in arteries exposed to normal or high [K+]o. In contrast, the ECL significantly increased vasorelaxation in endothelium-impaired arteries exposed to a physiologically normal or high [K+]o compared with control arteries exposed to the same [K+]o conditions in the absence of ECL. This vasorelaxing action was unaffected by a broad-spectrum K+ channel blocker and an ATP-sensitive K+ channel blocker. The ECL significantly inhibited the vasoconstriction induced by Ca2+ influx through voltage-dependent Ca2+ channels (VDCCs) but not Ca2+ influx induced via receptor-operated Ca2+ channels or the release of Ca2+ from the sarcoplasmic reticulum in the vascular smooth muscle. In summary, our study reveals that the ECL acts through VDCCs in vascular smooth muscle to promote the recovery of vasorelaxation even in arteries exposed to high [K+]o in the context of endothelial dysfunction and provides further evidence of the vascular-protective effects of ECL.

Scientific characterization methods for better utilization of cattle dung and urine: a concise review

Cattle are usually raised for food, manure, leather, therapeutic, and draught purposes. Biowastes from cattle, such as dung and urine, harbor a diverse group of crucial compounds, metabolites/chemicals, and microorganisms that may benefit humans for agriculture, nutrition, therapeutics, industrial, and other utility products. Several bioactive compounds have been identified in cattle dung and urine, which possess unique properties and may vary based on agro-climatic zones and feeding practices. Therefore, cattle dung and urine have great significance, and a balanced nutritional diet may be a key to improved quality of these products/by-products. This review primarily focuses on the scientific aspects of biochemical and microbial characterization of cattle biowastes. Various methods including genomics for analyzing cattle dung and gas chromatography-mass spectroscopy for cattle urine have been reviewed. The presented information might open doors for the further characterization of cattle resources for heterogeneous applications in the production of utility items and addressing research gaps. Methods for cattle's dung and urine characterization.

The power of TOPMed imputation for the discovery of Latino-enriched rare variants associated with type 2 diabetes

AIMS/HYPOTHESIS

The Latino population has been systematically underrepresented in large-scale genetic analyses, and previous studies have relied on the imputation of ungenotyped variants based on the 1000 Genomes (1000G) imputation panel, which results in suboptimal capture of low-frequency or Latino-enriched variants. The National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) released the largest multi-ancestry genotype reference panel representing a unique opportunity to analyse rare genetic variations in the Latino population. We hypothesise that a more comprehensive analysis of low/rare variation using the TOPMed panel would improve our knowledge of the genetics of type 2 diabetes in the Latino population.

METHODS

We evaluated the TOPMed imputation performance using genotyping array and whole-exome sequence data in six Latino cohorts. To evaluate the ability of TOPMed imputation to increase the number of identified loci, we performed a Latino type 2 diabetes genome-wide association study (GWAS) meta-analysis in 8150 individuals with type 2 diabetes and 10,735 control individuals and replicated the results in six additional cohorts including whole-genome sequence data from the All of Us cohort.

RESULTS

Compared with imputation with 1000G, the TOPMed panel improved the identification of rare and low-frequency variants. We identified 26 genome-wide significant signals including a novel variant (minor allele frequency 1.7%; OR 1.37, p=3.4 × 10-9). A Latino-tailored polygenic score constructed from our data and GWAS data from East Asian and European populations improved the prediction accuracy in a Latino target dataset, explaining up to 7.6% of the type 2 diabetes risk variance.

CONCLUSIONS/INTERPRETATION

Our results demonstrate the utility of TOPMed imputation for identifying low-frequency variants in understudied populations, leading to the discovery of novel disease associations and the improvement of polygenic scores.

DATA AVAILABILITY

Full summary statistics are available through the Common Metabolic Diseases Knowledge Portal ( https://t2d.hugeamp.org/downloads.html ) and through the GWAS catalog ( https://www.ebi.ac.uk/gwas/ , accession ID: GCST90255648). Polygenic score (PS) weights for each ancestry are available via the PGS catalog ( https://www.pgscatalog.org , publication ID: PGP000445, scores IDs: PGS003443, PGS003444 and PGS003445).

A Critical Review on Vasoactive Nutrients for the Management of Endothelial Dysfunction and Arterial Stiffness in Individuals under Cardiovascular Risk

Pathophysiological conditions such as endothelial dysfunction and arterial stiffness, characterized by low nitric oxide bioavailability, deficient endothelium-dependent vasodilation and heart effort, predispose individuals to atherosclerotic lesions and cardiac events. Nitrate (NO₃^-), L-arginine, L-citrulline and potassium (K⁺) can mitigate arterial dysfunction and stiffness by intensifying NO bioavailability. Dietary compounds such as L-arginine, L-citrulline, NO₃^- and K⁺ exert vasoactive effects as demonstrated in clinical interventions by noninvasive flow-mediated vasodilation (FMD) and pulse-wave velocity (PWV) prognostic techniques. Daily L-arginine intakes ranging from 4.5 to 21 g lead to increased FMD and reduced PWV responses. Isolated L-citrulline intake of at least 5.6 g has a better effect compared to watermelon extract, which is only effective on endothelial function when supplemented for longer than 6 weeks and contains at least 6 g of L-citrulline. NO₃^- supplementation employing beetroot at doses greater than 370 mg promotes hemodynamic effects through the NO₃^--NO2-/NO pathway, a well-documented effect. A potassium intake of 1.5 g/day can restore endothelial function and arterial mobility, where decreased vascular tone takes place via ATPase pump/hyperpolarization and natriuresis, leading to muscle relaxation and NO release. These dietary interventions, alone or synergically, can ameliorate endothelial dysfunction and should be considered as adjuvant therapies in cardiovascular diseases.

Trends in Diet Quality and Increasing Inadequacies of Micronutrients Vitamin C, Vitamin B12, Iron and Potassium in US Type 2 Diabetic Adults

BACKGROUND

Prevalence of diabetes was high and rose significantly in the US between 1999 and 2018. A healthy dietary pattern that provides micronutrient adequacy is one of the most important lifestyle choices for battling the progress of diabetes. Yet, the patterns and trends of diet quality of the US type 2 diabetes are understudied.

OBJECTIVES

We aim to examine the patterns and trends of diet quality and major food sources of macronutrients of US type 2 diabetic adults.

METHODS

The 24 h dietary recalls of 7789 type 2 diabetic adults, comprising 94.3% of total adults with diabetes from the US National Health and Nutrition Examination Survey cycles (1999-2018), were analyzed. Diet quality was measured by the total Healthy Eating Index (HEI)-2015 scores and 13 individual components. Trends of usual intakes of vitamin C (VC), vitamin B12 (VB12), iron, and potassium and supplements from two 24 h recalls were also examined for type 2 diabetic population.

RESULTS

Diet quality of type 2 diabetic adults worsened between 1999 and 2018 while that of US adults of general population improved based on the total HEI 2015 scores. For people with type 2 diabetes, consumption of saturated fat and added sugar increased while consumption of vegetables and fruits declined significantly, although consumption of refined grain declined and consumption of seafood and plant protein increased significantly. In addition, usual intakes of micronutrients VC, VB12, iron, and potassium from food sources declined significantly during this period.

CONCLUSIONS

Diet quality generally worsened for US type 2 diabetic adults between 1999 and 2018. Declining consumptions of fruits, vegetables, and non-poultry meat may have contributed to the increasing inadequacies of VC, VB12, iron, and potassium in the US type 2 diabetic adults.

The association of food intake on the development of hearing impairment after middle age among Japanese community dwellers

OBJECTIVES

This study aimed to determine whether food intake modifies the risk of developing hearing impairment (HI) in Japanese adults in their 40s.

METHODS

Data for individuals who were in their 40s with no HI at baseline and had participated in the survey multiple times were extracted from the National Institute for Longevity Sciences, Longitudinal Study of Aging. A total of 1846 samples observed for up to 11.5 years in 421 participants were included in the analyses. The average 3-day food intake was calculated. HI is defined as a pure-tone average of the better ear at frequencies of 0.5, 1, 2, and 4 kHz greater than 25 dB. The risk of developing HI in the 18 food groups was calculated longitudinally using multivariable cumulative data analyses.

RESULTS

Even after adjusting basic confounding factors, food groups, and baseline hearing level, significant associations were found between beverage consumption and risk increments for HI (odds ratio [OR] = 2.374, 95% confidence interval [CI]:1.141-4.940) and also between mushroom intake and risk reduction (OR = 0.215, 95% CI:0.069-0.667). Other foods did not consistently show significant results when the combination of analysis variables were changed.

CONCLUSIONS

Although the effect of food on hearing is modest to the extent that the significance varies with the variables used in the analysis, the intake of beverages and mushrooms could potentially modify the risk of developing HI after middle age.

Non-pharmacological factors for hypertension management: a systematic review of international guidelines

Lifestyle modifications are one of the cornerstones of hypertension prevention and treatment. We aimed to systematically review hypertension guidelines on their recommendations on non-pharmacological factors including lifestyle interventions, to highlight strength of evidence, similarities, and differences. This systematic review was registered with the international Prospective Register of Systematic Reviews (CRD42021288815). Publications in MEDLINE and EMBASE databases over 10 years since January 2010 to June 2020 were identified. We also included the search from websites of organizations responsible for guidelines development. Two reviewers screened the titles and abstracts to identify relevant guidelines. Two reviewers independently assessed rigour of guideline development using the AGREE II instrument, and one reviewer extracted recommendations. Of the identified guidelines, 10 showed good rigour of development (AGREE II ≥ 60%) and were included in the systematic review. The guidelines were consistent in most recommendations (reduced salt intake, weight, dietary patterns, increased physical activity and smoking cessation, and limiting alcohol intake). Some areas of disagreement were identified, regarding recommendations on novel psychological and environmental factors such as stress or air pollution, alcohol intake thresholds, meat, coffee and tea consumption and refined sugars. Current guidelines agree on the importance of lifestyle in the treatment and prevention of hypertension. Consensus on smoking cessation, limited salt intake, increased physical activity support their integration in management of hypertensive patients and in public health measurements in general population as preventative measurements. Further research into the role of environmental and psychological factors may help clarify future recommendations.

Nutritional and Phytochemical Composition of Mahewu (a Southern African Fermented Food Product) Derived from White and Yellow Maize (Zea mays) with Different Inocula

Mahweu is an important indigenous beverage for many low-income and undernourished consumers in southern Africa. As a result, the nutritional and phytochemical profile of mahewu samples (obtained using optimized fermentation and boiling conditions from a previous study) as well as their related raw materials (white and yellow maize) were investigated. At these conditions, white and yellow maize mahewu (WM and YM) were prepared utilizing various inocula including sorghum malt, wheat, millet malt, or maize malt, and the pH, titratable acidity (TTA), total soluble solid (TSS), and proximate analysis were determined. The mineral content, amino acid composition, and phenolic compound profile were also investigated using inductive coupled plasma optical emission spectrometry (ICP-OES), high-performance liquid chromatography (HPLC), and ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC/Q-TOF-MS), respectively. Fermentation was observed to have influenced the proximate composition of obtained mahewu samples compared to the raw flour with significant (p ≤ 0.05) improvement in protein from 8.59 to 9.7% (YM) and 8.78 to 9% (WM) as well as carbohydrate from 72.27 to 74.47% (YM) and 71.15 to 72.65% (WM). Sodium, magnesium, phosphorous, potassium, calcium, manganese, iron, copper, and zinc were the minerals detected in the mahewu samples, while potassium was the most abundant mineral, having values ranging from 3051.61 to 3283.38 mg/kg (YM) and 2882.11 to 3129.97 mg/kg (WM). Heavy metals detected in this study were all below the recommended tolerable levels by the Joint FAO/WHO Expert Committee on Food Additives (JECFA). Arginine and leucine with values ranging from 0.47 to 0.52 g/100 g (YM) and 0.48 to 0.53 g/100 g (WM) as well as 0.91 to 1.04 g/100 g (YM) and 0.95 to 1.01 g/100 g (WM), respectively, were the most abundant essential amino acids, whereas for non-essential amino acids, glutamic acid, aspartic acid, alanine, and proline were observed to be abundant. Based on the different inocula, the derived mahewu samples prepared using either white or yellow maize have varying nutritional and health beneficial components and the choice of inocula might still be determined by consumer preference.

Eating more sardines instead of fish oil supplementation: Beyond omega-3 polyunsaturated fatty acids, a matrix of nutrients with cardiovascular benefits

Omega-3 polyunsaturated fatty acids (n-3 PUFA) play a significant role in the prevention and management of cardiometabolic diseases associated with a mild chronic pro-inflammatory background, including type 2 diabetes, hypertension, hypertriglyceridaemia, and fatty liver disease. The effects of n-3 PUFA supplements specifically, remain controversial regarding reducing risks of cardiovascular events. n-3 PUFA supplements come at a cost for the consumer and can result in polypharmacy for patients on pharmacotherapy. Sardines are a well-known, inexpensive source of n-3 PUFA and their consumption could reduce the need for n-3 PUFA supplementation. Moreover, sardines contain other cardioprotective nutrients, although further insights are crucial to translate a recommendation for sardine consumption into clinical practice. The present review discusses the matrix of nutrients contained in sardines which confer health benefits for cardiometabolism, beyond n-3 PUFA. Sardines contain calcium, potassium, magnesium, zinc, iron, taurine, arginine and other nutrients which together modulate mild inflammation and exacerbated oxidative stress observed in cardiovascular disease and in haemodynamic dysfunction. In a common serving of sardines, calcium, potassium, and magnesium are the minerals at higher amounts to elicit clinical benefits, whilst other nutrients are present in lower but valuable amounts. A pragmatic approach towards the consumption of such nutrients in the clinical scenario should be adopted to consider the dose-response relationship effects on physiological interactions. As most recommendations currently available are based on an indirect rationale of the physiological actions of the nutrients found in sardines, randomised clinical trials are warranted to expand the evidence on the benefits of sardine consumption.

Fructose prevents the development of hyperglycemia in WBN/Kob diabetic fatty rats via maintaining high insulin levels

Fructose is considered to negatively affect type 2 diabetes mellitus (T2DM); however, there are contradictory reports. The present study aimed to elucidate the effects of fructose-rich diet (FRD) on glucose metabolism of WBN/Kob fatty diabetic (WBKDF) rats, a spontaneous T2DM model, and Wistar rats. WBKDF and Wistar rats were fed either FRD or standard diet (STD) for 4 weeks. The food intake, body weight, plasma glucose and insulin were measured weekly. After the 4-week challenge, rats were subjected to an intravenous glucose tolerance test (IVGTT). The liver and pancreas were used for histological analysis. The 4-week challenge of FRD in Wistar rats did not cause hyperglycemia, but increased insulin resistance (HOMA-IR). Feeding WBKDF rats with a FRD accelerated obesity but prevented the onset of severe hyperglycemia via maintaining high plasma insulin levels. HOMA-IR in WBKDF rats was not changed by FRD feeding. IVGTT revealed that FRD feeding in Wistar rats did not affect glucose tolerance, but slightly increased the plasma insulin level. In contrast, FRD feeding in WBKDF rats significantly reduced the glucose tolerance, but insulin response was not improved. FRD feeding did not alter the beta cell area in Wistar rats, but significantly increased it in WBKDF rats. In conclusion, FRD caused insulin resistance in Wistar rats, suggesting that fructose overconsumption is a risk factor for T2DM, whereas FRD inhibited severe hyperglycemia by maintaining high insulin levels　in WBKDF rats. Fructose may be a beneficial sugar for T2DM patients with severe obesity-induced insulin resistance.

Fruit and Vegetable Intake Among Older African American and Hispanic Adults With Cardiovascular Risk Factors

African Americans and Hispanics are disproportionately burdened by cardiovascular risk factors including hypertension, diabetes mellitus, and obesity. There is evidence that fruits and vegetables have protective benefits for cardiovascular health. Factors associated with fruit and vegetable intake among older minority adults are not well established. A cross-sectional analysis of African American and Hispanic adults >55 years with diagnosis of hypertension and/or diabetes was conducted. Daily intake of fruits and vegetables was analyzed by socio-demographic, health status, health behaviors, and access to fruits and vegetables. 77% of participants did not meet the United States Department of Agriculture ≥5 a day serving guidelines. Fruit and vegetable consumption was not associated with having hypertension or diabetes. Body mass index >25 and regular exercise were significantly associated with more vegetable intake, but not fruit. African Americans consumed significantly less fruits and vegetables than Hispanics. Among those with access to fruits and vegetables, 78% did not meet the guidelines. Many older African American and Hispanic adults with cardiovascular disease risk factors do not meet the fruit and vegetable intake guidelines. Inadequate intake is worse among African Americans, sedentary, and non-overweight/obese adults. Studies are needed to understand the barriers associated with fruit and vegetable intake in this population.

Vitamin D, Calcium, Magnesium, and Potassium Consumption and Markers of Glucose Metabolism in the Hispanic Community Health Study/Study of Latinos

OBJECTIVE

This was a cross-sectional study associating vitamin D, calcium, magnesium, and potassium intakes with markers of glucose metabolism in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

METHODS

HCHS/SOL is a multicenter, prospective, population-based cohort study on Hispanics/Latinos aged 18-74 years in the US. For this analysis, we included 10,609 participants who were free of diabetes. Analysis of covariance was used to assess associations of a range of micronutrient intake on the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Hemoglobin A1c (HbA1c), and 2-hour post-oral glucose tolerance test (2h-plasma glucose) separately for normoglycemic and with pre-diabetes, after controlling for important confounders. All analyses accounted for the complex sample design and sampling weights.

RESULTS

HOMA-IR levels were significantly lower among adults with intakes in the highest quartile for vitamin D, magnesium, and potassium compared to the respective lowest quartiles, for those with normoglycemia and pre-diabetes, even after adjusting for confounders, such as diet quality (p < 0.05). For those with pre-diabetes, HOMA-IR levels were also significantly lower for those in the highest quartile of calcium intake. However, 2h-plasma glucose was significantly higher in those with intakes higher than quartile 1 for vitamin D and calcium among those with normoglycemia and significantly higher in quartile 3 of potassium intake for those with pre-diabetes, p < 0.05. No significant associations were found for HbA1c in either group.

CONCLUSIONS

Higher consumption of vitamin D, magnesium, and potassium are associated with optimal levels of HOMA-IR among participants with normoglycemia and pre-diabetes.

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.

Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults

Background

Few studies have compared bioelectrical body and visceral fat indices with anthropometric measures, or evaluated their optimal cutoffs in relation to hypertension among Asians. We compared the efficiencies of bioelectrical indices (percentage of body fat, PBF; visceral fat area, VFA) with anthropometric measures (body mass index, BMI; waist-hip ratio, WHR) for hypertension and re-evaluated the optimal cutoffs of each index by age and gender.

Methods

We conducted a cross-sectional survey among 8234 adults for health examination. PBF, VFA, BMI, WHR, and data on hypertension and behaviors were collected. Receiver operating characteristic (ROC) curve and areas under curves (AUCs) were used to analyze the efficiencies of the indices for hypertension, optimal cutoffs were estimated using the Youden index.

Results

A total of 8234 individuals aged 21–91 with median age 44 (interquartile range [IQR] 33–56) years were included and 40.56% were men. The overall prevalence of hypertension was 27.47%. The studied indices were all associated with hypertension in all age-specific groups both among men and women except for WHR in 21–29 years old men and PBF in in 21–29 years old women. Among males, there were no statistical differences in powers of four indices for hypertension in all age-specific groups, except for 40–49 years, in which WHR was better than VFA. Among females, no differences were found among the indices in 30–39 and 70–79 years groups, while WHR was the best in 21–29 years group, VFA was better than PBF in 30–39 and 50–59 years groups, BMI was better than PBF and WHR in 60–69 years group. The optimal cutoffs of PBF, VFA, BMI and WHR ranged from 23.9 to 28.7%, 86.4 to 106.9cm², 23.5 to 27.1 kg/m², 0.92 to 0.96 across the age categories in males, and 32.8 to 36.3%, 75.9 to 130.9cm², 21.9 to 26.4 kg/m², 0.84 to 0.95 across the age categories in females, respectively.

Conclusions

The obesity indices’ efficiencies for hypertension varied by age and gender, and their cutoff values varied across the age categories and gender. Specific indices and cutoffs based on person’s age and gender should be used to identify individuals with hypertension.

FT-IR and GC-MS analyses of potential bioactive compounds of cow urine and its antibacterial activity

The main emphasis of this study was to identify the bioactive compounds responsible for antibacterial activity of Badri cow urine isolated by thin layer chromatography. The most effective bioactive fraction was analysed by FT-IR and GC-MS analyses. Among the four major fractions (EW1, EW2, CA1 and CA2) obtained by TLC profiling, EW1 was found most active against bacterial strains viz., Listeria monocytogenes (MTCC657), Staphylococcus aureus (MTCC7443), Pseudomonas aeruginosa (MTCC424), Klebsiella pneumoniae (MTCC432) and Salmonella typhi (MTCC733). However, Escherichia coli (MTCC118), was found resistant to all the fractions. In FT-IR spectroscopy, functional groups like alcohol, amide, alkene, alkyl halide, polysulfide and phosphate ions were identified. The GC-MS analysis of EW1 fraction exhibited the presence of 12 compounds, of which 1-heneicosanol was found as the major compound. These compounds might be responsible synergistically or individually for antibacterial activity of cow urine. Nine elements namely sodium (Na), calcium (Ca), chromium (Cr), iron (Fe), magnesium (Mg), aluminium (Al), potassium (K) and zinc (Zn), Gold (Au) were measured by ICP-MS analysis.

Preventing the onset of diabetes-induced chronic kidney disease during prediabetes: The effects of oleanolic acid on selected markers of chronic kidney disease in a diet-induced prediabetic rat model

BACKGROUND

The prevalence of prediabetes correlates with increased incidence of chronic kidney disease (CKD). This study was aimed at investigating the effects of oleanolic acid (OA) on markers associated with CKD in the prediabetic rat model.

METHODS

Prediabetes was induced by exposing male Sprague Dawley rats (150-180 g) to high-fat high- carbohydrate (HFHC) diet for 20 weeks. The prediabetic animals were further subdivided according to their treatment and treated for 12 weeks with either OA (80 mg/kg p.o) or metformin (500 mg/kg p.o) both with and without dietary intervention. 24 h fluid intake and urine output were measured every fourth week of the treatment period while the urine samples were also used for podocin quantification through PCR. The animals were then sacrificed with urine, plasma and kidneys being harvested for biochemical analysis including the measurement of aldosterone, kidney-injury-molecule-1(KIM-1), blood and urine electrolytes, estimated glomerular filtration rate (eGFR), and albumin/creatinine (Alb/Cr) ratio.

RESULTS

This study observed that OA could reduce oxidative stress in the kidney while restoring plasma aldosterone and KIM-1 as well as urine electrolytes which were found to be augmented in prediabetic animals. This also correlated with normalization of GFR and Alb/Cr ratio in the OA-treated groups in both the absence and presence of dietary intervention.

CONCLUSIONS

These findings suggest that OA can ameliorate renal complications in a prediabetic rat model. However, more research is needed for the elucidation of molecular mechanisms behind these effects.

Characterization of an Endemic Plant Origanum grosii from Morocco: Trace Element Concentration and Antihyperglycemic Activities

Origanum genus is one of the most widely used herbs in folk medicine for its biological properties. The present investigation aims to characterize, for the first time, endemic Origanum grosii collected from the Taounate region, Morocco. This characterization was realized by determining the concentration of metals in different parts of the plant (flowers, leaves, and stems) by ICP-MS, and the results were studied statistically by Principal Component Analysis (PCA). Phytochemical screening with the dosage of polyphenols and flavonoids has been conducted. To know more about this species, antihyperglycemic tests have been performed to highlight the presence or absence of the antidiabetic effect for this plant. An Oral Glucose Tolerance Test (OGTT) has been performed on normal mice which were divided into two groups of six mice each. Group 1 (control group) was treated with distilled water, and group 2 was treated with an aqueous extract of O. grosii by gavage at 150 mg/kg. Digestive enzyme α-amylase inhibition assay has also been evaluated to study the inhibition effect of the studied extract using acarbose as a control. The results showed that the leaves exhibited a high concentration of trace elements (Ca, Mg, and K) and total absence of heavy metals, which were found in small quantities (Cr, Ni, and B) on the stems, and this makes the plant safe to use. On the other hand, tannins, flavonoids, triterpenes, and steroids were the major families strongly present in this species. The antidiabetic results showed that O. grosii have significantly reduced postprandial hyperglycemia after glucose loading in normal rats. It showed also that this species has a significant antihyperglycemic activity reflected by the inhibition of α-amylase. The one responsible for this property could be the synergy between the trace elements and the nature of the chemical families of O. grosii species, which can make this plant useful in the management of postprandial hyperglycemia.

Evaluation of nutritional and elemental compositions of green and red cultivars of roselle: Hibiscus sabdariffa L

Roselle—Hibiscus sabdariffa L. leaves at different stages of growth, calyces and seeds were analyzed for nutritional and anti-nutritional factors. All the treatments contained a good but varied proportion of carbohydrate in a range of 26.93–54.13%, crude protein from 5.7 to 27.06%, crude fat 1.16–13.09%, crude fibre 15.75–36.10%, energy 631.36–1065 kJ, ash 6.08–13.74% and moisture content 6.00–9.7%. The vitamins A, C and E were also found to be present in all the treatments in a different but substantial amount. The calcium, magnesium and iron contents in all the treatments were higher than the recommended daily allowance of 1250, 350, and 15 mg for adults, while the phosphorus and sodium values in all the treatments were below 1000 and 1500 mg RDA for adults. However, the Na + /K + for all the treatments were lower than 1. The values of anti-nutrients in the samples were small except post-flowering red which had high phytate content of 21.02%, although this can be easily reduced during processes like boiling and cooking. Thus, both cultivars of roselle contain high nutritional, elemental, and vitamins compositions and small content of anti-nutrients.

Hypokalemia and the Prevalence of Primary Aldosteronism

Hypokalemia is closely linked with the pathophysiology of primary aldosteronism (PA). Although hypokalemic PA is less common than the normokalemic course of the disease, hypokalemia is of particular importance for the manifestation and development of comorbidities. Specifically, a growing body of evidence demonstrates that hypokalemia in PA patients is associated with a more severe disease course regarding cardiovascular and metabolic morbidity and mortality. It is also well appreciated that low potassium levels per se can promote or exacerbate hypertension. The spectrum of hypokalemia-related symptoms ranges from asymptomatic courses to life-threatening conditions. Hypokalemia is found in 9-37% of all cases of PA with a predominance in patients with aldosterone producing adenoma. Conversely, hypokalemia resolves in almost 100% of cases after both, specific medical or surgical treatment of the disease. However, to date, high-level evidence about the prevalence of primary aldosteronism in a hypokalemic population is missing. Epidemiological data are expected from the recently launched IPAHK+study ("Incidence of Primary Aldosteronism in Patients with Hypokalemia").

Daily intake of non-fried potato does not affect markers of glycaemia and is associated with better diet quality compared with refined grains: a randomised, crossover study in healthy adults

Epidemiological studies suggest that consumption of potatoes is associated with increased risk of cardiometabolic diseases. However, few clinical trials have empirically tested this. The aim of this single-blind, randomised, crossover study was to evaluate the effect of daily potato consumption, compared with refined grains, on risk factors for cardiometabolic diseases. It was hypothesised that no difference in cardiometabolic endpoints would be detected between conditions, but diet quality would improve with potato consumption. Healthy participants on self-selected diets received one potato-based side dish or one refined grain-based side dish daily, for 4 weeks, separated by a minimum 2-week break. Dishes were isoenergetic, carbohydrate-matched and prepared without excess saturated fat or Na. Participants were instructed to consume the side dish with a meal in place of carbohydrates habitually consumed. Lipids/lipoproteins, markers of glycaemic control, blood pressure, weight and pulse wave velocity were measured at baseline and condition endpoints. Diet quality was calculated, based on 24-h recalls, using the Healthy Eating Index (HEI)-2015. Fifty adults (female n 34; age 40 (sd 13) years; BMI 24·5 (sd 3·6) kg/m²) completed the present study. No between-condition differences were detected for fasting plasma glucose (–0·05 mmol/l, 95 % CI –0·14, 0·04; P = 0·15), the primary outcome or any other outcomes. Compared with refined grains, the HEI-2015 score (3·5, 95 % CI 0·6, 6·4; P = 0·01), K (547 mg, 95 % CI 331, 764, P < 0·001) and fibre (2·4 g, 95 % CI 0·6, 4·2, P = 0·01) were higher following the potato condition. Consuming non-fried potatoes resulted in higher diet quality, K and fibre intake, without adversely affecting cardiometabolic risk.

The Association of Potassium Status with Parameters of Glucose Metabolism is influenced by Age in Adults

BACKGROUND

Potassium status has been found to affect glucose homeostasis.

OBJECTIVE

This study therefore aimed at investigating relationships between potassium status or dietary intake and fasting plasma glucose (FPG) or glycated haemoglobin (HbA1c) in a sample of Austrian adults (18-80 years, n = 421, 61% women) from the Austrian Study on Nutritional Status 2012.

METHODS

Dietary potassium intake was obtained by two 24 h recalls. FPG, plasma K+, and urinary K+ were determined photometrically, HbA1c by HPLC. Associations between the parameters were studied using multiple regression analysis after controlling for confounders and after age stratification of the sample (18-64 y vs. 65-80 y).

RESULTS

Most of the participants had a potassium intake of less than the estimated adequate daily intake of 4000 mg/d. In the multiple regression analyses in the whole sample plasma K+ had a statistically significant positive effect on FPG only in the crude model (ß = 0.128, p < 0.01) and on HbA1c also in the fully adjusted model (ß = 0.129, p < 0.05). The small effects on HbA1c were also detected in the younger age group but were absent in the older population. However, in this latter, a reverse association of urinary K+ on HbA1c was observed as well as of dietary potassium intake on FPG with no effects in the younger sample.

CONCLUSION

We suggest that age dependent differences in the association between parameters of potassium status and blood glucose regulation should also be taken into account.

Nutrient Composition of Popularly Consumed African and Caribbean Foods in The UK

(1) Background: Traditional foods are important in the diets of Black Africans and Caribbeans and, more widely, influence UK food culture. However, little is known about the nutritional status of these ethnic groups and the nutrient composition of their traditional foods. The aim was to identify and analyse African and Caribbean dishes, snacks and beverages popularly consumed in the UK for energy, macronutrients and micronutrients. (2) Methods: Various approaches including focus group discussions and 24-h dietary recalls were used to identify traditional dishes, snacks, and beverages. Defined criteria were used to prioritise and prepare 33 composite samples for nutrient analysis in a UK accredited laboratory. Quality assurance procedures and data verification were undertaken to ensure inclusion in the UK nutrient database. (3) Results: Energy content ranged from 60 kcal in Malta drink to 619 kcal in the shito sauce. Sucrose levels did not exceed the UK recommendation for adults and children. Most of the dishes contained negligible levels of trans fatty acid. The most abundant minerals were Na, K, Ca, Cu, Mn and Se whereas Mg, P, Fe and Zn were present in small amounts. (4) Conclusion: There was wide variation in the energy, macro- and micronutrients composition of the foods analysed.

Association between osteosarcopenic obesity and hypertension among four minority populations in China: a cross-sectional study

OBJECTIVE

Osteosarcopenic obesity (OSO) may be associated with an increased prevalence of hypertension. The aim of this study was to examine the difference in the prevalence of OSO and hypertension among four minority populations in China and explore the relationship between OSO and hypertension by sex.

DESIGN

This study adopted a cross-sectional design.

PARTICIPANTS

In total, 1939 participants aged ≥50 years, including 459 Jing, 514 Maonan, 535 Hmong and 431 Yao participants from Guangxi Province, China, were included using stratified cluster random sampling.

MAIN OUTCOME MEASURES

The body composition, bone mineral density and blood pressure were measured by an MC-180 body composition analyser, Achilles Express ultrasound bone densitometer and OMRON HEM-1000 electronic sphygmomanometer, respectively.

RESULTS

The results showed that 65.77% of Hmong men, 58.79% of Hmong women, 54.82% of Maonan men, 50.00% of Maonan women, 41.92% of Jing men, 45.21% of Jing women, 53.66% of Yao men and 42.32% of Yao women suffered from hypertension. Compared with those among the normal group, the adjusted OR and 95% CI of age among the women with OSO was 3.15 (1.13 to 8.78). After adjusting for age, ethnicity, smoking status, alcohol consumption, physical activity and menopausal status, the women with OSO also had a higher OR (OR=3.18, 95% CI 1.14 to 8.88) for hypertension than those in the normal group. However, the ORs (95% CI) for hypertension in men with one or more components were not significant after adjusting for age and ethnicity.

CONCLUSION

These results suggest that OSO is a risk factor for hypertension, especially in women. Furthermore, the prevalence of OSO and hypertension in the present study displayed sex-specific and ethnic-specific differences among the four minority populations.

The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses

Nutrition is known to exert an undeniable impact on blood pressure with especially salt (sodium chloride), but also potassium, playing a prominent role. The aim of this review was to summarize meta-analyses studying the effect of different electrolytes on blood pressure or risk for hypertension, respectively. Overall, 32 meta-analyses evaluating the effect of sodium, potassium, calcium and magnesium on human blood pressure or hypertension risk were included after literature search. Most of the meta-analyses showed beneficial blood pressure lowering effects with the extent of systolic blood pressure reduction ranging between -0.7 (95% confidence interval: -2.6 to 1.2) to -8.9 (-14.1 to -3.7) mmHg for sodium/salt reduction, -3.5 (-5.2 to -1.8) to -9.5 (-10.8 to -8.1) mmHg for potassium, and -0.2 (-0.4 to -0.03) to -18.7 (-22.5 to -15.0) mmHg for magnesium. The range for diastolic blood pressure reduction was 0.03 (-0.4 to 0.4) to -5.9 (-9.7 to -2.1) mmHg for sodium/salt reduction, -2 (-3.1 to -0.9) to -6.4 (-7.3 to -5.6) mmHg for potassium, and -0.3 (-0.5 to -0.03) to -10.9 (-13.1 to -8.7) mmHg for magnesium. Moreover, sufficient calcium intake was found to reduce the risk of gestational hypertension.

Ion channels and transporters in diabetic kidney disease

Type 1 and 2 diabetes mellitus are major medical epidemics affecting millions of patients worldwide. Diabetes mellitus is the leading cause of diabetic kidney disease (DKD), which is the most common cause of end-stage renal disease (ESRD). DKD is associated with significant changes in renal hemodynamics and electrolyte transport. Alterations in renal ion transport triggered by pathophysiological conditions in diabetes can exacerbate hypertension, accelerate renal injury, and are integral to the development of DKD. Renal ion transporters and electrolyte homeostasis play a fundamental role in functional changes and injury to the kidney during DKD. With the large number of ion transporters involved in DKD, understanding the roles of individual transporters as well as the complex cascades through which they interact is essential in the development of effective treatments for patients suffering from this disease. This chapter aims to gather current knowledge of the major renal ion transporters with altered expression and activity under diabetic conditions, and provide a comprehensive overview of their interactions and collective functions in DKD.

Food Sources of Energy and Nutrients of Public Health Concern and Nutrients to Limit with a Focus on Milk and other Dairy Foods in Children 2 to 18 Years of Age: National Health and Nutrition Examination Survey, 2011⁻2014

Many children are not meeting current nutrient recommendations. The objective of this study was to determine the food sources of energy, nutrients of public health concern, and nutrients to limit with a focus on dairy foods. Twenty-four-hour dietary recall data from children 2–5 (n = 1511), 6–11 (n = 2193), and 12–18 years (n = 2172) participating in NHANES 2011–2014 were analyzed. Energy, fiber, calcium, potassium, vitamin D, added sugars, saturated fatty acids (SFA), and sodium intakes were sample-weighted and ranked on percentage contribution to the diet using specific food group intake and disaggregated data for dairy foods. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and sweetened beverages, respectively were the top food sources of energy, respectively. For calcium, potassium, and vitamin D, milk was the top ranked food source in all age groups. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and pizza, respectively were the top three ranked food sources of SFA; and sugar sweetened beverages and sweet bakery products were to top two food group sources of added sugars. Cured meats/poultry, pizza, and pizza, respectively, were the top ranked food sources of sodium for the three age groups. Identification of food sources of these nutrients can help health professionals implement appropriate dietary recommendations and plan age-appropriate interventions.

Effects of a high-sodium/low-potassium diet on renal calcium, magnesium, and phosphate handling

The distal convoluted tubule (DCT) of the kidney plays an important role in blood pressure regulation by modulating Na⁺ reabsorption via the Na⁺-Cl^- cotransporter (NCC). A diet containing high salt (NaCl) and low K⁺ activates NCC, thereby causing Na⁺ retention and a rise in blood pressure. Since high blood pressure, hypertension, is associated with changes in serum calcium (Ca²⁺) and magnesium (Mg²⁺) levels, we hypothesized that dietary Na⁺ and K⁺ intake affects Ca²⁺ and Mg²⁺ transport in the DCT. Therefore, the present study aimed to investigate the effect of a high-Na⁺/low-K⁺ diet on renal Ca²⁺ and Mg²⁺ handling. Mice were divided in four groups and fed a normal-Na⁺/normal-K⁺, normal-Na⁺/low-K⁺, high-Na⁺/normal-K⁺, or high-Na⁺/low-K⁺ diet for 4 days. Serum and urine were collected for electrolyte and hormone analysis. Gene and protein expression of electrolyte transporters were assessed in kidney and intestine by qPCR and immunoblotting. Whereas Mg²⁺ homeostasis was not affected, the mice had elevated urinary Ca²⁺ and phosphate (P_i) excretion upon high Na⁺ intake, as well as significantly lower serum Ca²⁺ levels in the high-Na⁺/low-K⁺ group. Alterations in the gene and protein expression of players involved in Ca²⁺ and P_i transport indicate that reabsorption in the proximal tubular and TAL is affected, while inducing a compensatory response in the DCT. These effects may contribute to the negative health impact of a high-salt diet, including kidney stone formation, chronic kidney disease, and loss of bone mineral density.

Twenty-four-Hour Urinary Potassium Excretion, But Not Sodium Excretion, Is Associated With All-Cause Mortality in a General Population

Background

Few studies have examined the relationship between accurate monitoring of sodium or potassium consumption and mortality. We aimed to investigate the association between 24‐hour urinary sodium or potassium excretion and ≈30‐year mortality in a Japanese population using 24‐hour urine collection.

Methods and Results

We enrolled a total of 1291 participants, aged 21 to 85 years, who underwent health checkups, including a blood test and 24‐hour urine collection. They were followed up for 27.5±9.9 years by December 31, 2015, and the final follow‐up rate was 95.8%. Cox proportional hazards regression analysis was used to assess the association between 24‐hour urinary sodium or potassium excretion and all‐cause mortality. At baseline, the mean 24‐hour urinary sodium and potassium excretions were 5.80±2.28 g/d and 1.85±0.82 g/d, respectively. There were 631 deaths during the follow‐up. The cumulative survival rate was significantly decreased in the lowest quartile compared with the other higher groups. In the Cox proportional hazard model after adjustment for age and sex, 24‐hour urinary potassium excretion, but not sodium excretion, was inversely associated with all‐cause mortality. We divided the 24‐hour urinary potassium excretion levels into quartiles. After adjustment for confounding factors, the hazard ratio of all‐cause mortality in the highest quartile of 24‐hour urinary potassium excretion versus the lowest was 0.62 (95% confidence interval, 0.48–0.79; P<0.001).

Conclusions

The 24‐hour urinary potassium excretion, but not sodium excretion, was significantly associated with all‐cause mortality in the general population.

Potassium measurements and risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies

Objective

To clarify the relationship between serum, dietary, and urinary potassium and the risk of type 2 diabetes mellitus (T2DM).

Materials and Methods

We searched PubMed and EMBASE through January 6, 2017 for studies reporting risk estimates on the association of potassium measurements and the risk of T2DM. The summary risk estimates were obtained through a random-effects model. Dose-response analysis was conducted.

Results

Eight studies involving 5,053 cases and 119,993 individuals were included. A trend toward significance was found in the highest versus lowest meta-analysis on serum potassium and T2DM risk (RR = 0.79; 95% CI 0.60-1.04); moreover, the RR per 1 mmol/L increase in serum potassium was 0.83 (95% CI 0.73-0.95). A non-significant association of dietary potassium and T2DM risk was detected (RR for the highest versus lowest category: 0.93; 95% CI 0.81-1.06; RR for every 1000mg increase per day: 1.00, 95% CI 0.96-1.05). A similar non-significant association was found for urinary potassium and T2DM risk (RR for the highest versus lowest category: 0.83; 95% CI 0.39-1.75; RR per 10 mmol increase: 1.00; 95% CI 0.95-1.05). Evidence of a linear association between serum, dietary, and urinary potassium and the risk of T2DM was found (all P_{non-linearity} > 0.05).

Conclusions

Low serum potassium increases the risk of T2DM in a linear dose-response manner; nevertheless, neither dietary potassium nor urinary potassium shows any association with the risk of T2DM. However, these findings should be interpreted with caution due to limited studies.