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Wang C, Lu Z, Zhang J, Chen X, Xu J, Zhang B, Dong J, Ren J, Xu C, Gao C, Guo X, Wu J, Ma J. The Relationship between Low-Sodium Salt Intake and Both Blood Pressure Level and Hypertension in Chinese Residents. Nutrients 2024; 16:1909. [PMID: 38931264 PMCID: PMC11206867 DOI: 10.3390/nu16121909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Compared to common salt, low-sodium salt can reduce blood pressure to varying degrees. However, the exact dosage relationship remains unclear. We aimed to investigate the dose-response relationships between low-sodium salt intake and systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as the risk of hypertension, and to determine the optimal range for low-sodium salt intake. We investigated the basic characteristics and dietary profile of 350 individuals who consumed low-sodium salt. The samples were divided into three groups according to the 33.3rd and 66.6th percentiles of low-sodium salt intake in condiments (Q1: <4.72 g/d, Q2: ≥4.72 g/d, and <6.88 g/d, and Q3: ≥6.88 g/d). The restricted cubic spline results indicated that low-sodium salt intake decreased linearly with SBP and DBP, while low-sodium intake demonstrated a non-linear, L-shaped relationship with the risk of hypertension, with a safe range of 5.81 g to 7.66 g. The multiple linear regression analysis revealed that compared with group Q1, the DBP in group Q2 decreased by 2.843 mmHg (95%CI: -5.552, -0.133), and the SBP in group Q3 decreased by 4.997 mmHg (95%CI: -9.136, -0.858). Exploratory subgroup analyses indicated that low-sodium salt intake had a significant impact on reducing SBP in males, DBP in females, SBP in rural populations, and DBP in urban populations. The intake of low-sodium salt adheres to the principle of moderation, with 5.81-7.66 g potentially serving as a pivotal threshold.
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Affiliation(s)
- Cuicui Wang
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250100, China;
| | - Zilong Lu
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Jiyu Zhang
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Xiaorong Chen
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.C.); (J.X.)
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.C.); (J.X.)
| | - Bingyin Zhang
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Jing Dong
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Jie Ren
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Chunxiao Xu
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Congcong Gao
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Xiaolei Guo
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China; (Z.L.); (J.Z.); (B.Z.); (J.D.); (J.R.); (C.X.); (C.G.)
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.C.); (J.X.)
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, Jinan 250014, China
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Zhang W, Neupane D, Zhao Z, Jiang B, Zhang M, Zhang X, Huang Z, Li C, Sharman JE, Hu C, Ye P, Wang L. Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey. J Hum Hypertens 2024; 38:155-167. [PMID: 37857758 PMCID: PMC10844095 DOI: 10.1038/s41371-023-00861-7] [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: 08/30/2022] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.
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Affiliation(s)
- Wenrong Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Jiang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Caihong Hu
- Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Pengpeng Ye
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Zhang Q, Shen Y, Yu M, Yang Z, Huang Z, Ding J, Zhu X. Associations between estimation of salt intake and salt-restriction spoons and hypertension status in patients with poorly controlled hypertension: a community-based study from Huzhou City, Eastern China. Nutr J 2024; 23:9. [PMID: 38225607 PMCID: PMC10789056 DOI: 10.1186/s12937-024-00912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND As the prevalence of hypertension increases in China, it is advised to use salt-restriction spoons (SRS) as a lifestyle modification. This study aimed to examine the associations between estimated salt consumption, SRS usage, and the hypertension status in individuals with poorly controlled hypertension. METHODS Data was collected in Huzhou City, Zhejiang Province, in 2021 using convenience sampling. The analysis involved ordinal logistic regression and restricted cubic splines to assess the relevant factors. RESULTS The study found that 73.34% of the 1215 patients had uncontrolled blood pressure (BP). Urinary excretion was assessed through the utilization of the Kawasaki, INTERSALT, and Tanaka formulas. The outcomes of these three methodologies revealed average daily sodium excretion values of 208.70 (65.65), 154.78 (33.91), and 162.61 (40.87) mmol, respectively. The prevalence of utilizing SRS was found to be 37.78% in this study. Despite the acknowledgment among SRS users of the potential hazards associated with excessive salt consumption, there exists a contradictory pattern of attitudes and behaviors concerning salt reduction. Among individuals with different levels of salt intake (quartiles 1-4, Q1 vs Q4), there was a positive association between limiting salt and hypertension status when controlling for other variables (Kawasaki adjusted OR = 0.58, 95% CI = 0.43-0.79; INTERSALT adjusted OR = 0.62, 95% CI = 0.41-0.92; Tanaka adjusted OR = 0.61, 95% CI = 0.45-0.92, p < 0.05). Our research also revealed that using or used SRS was a protective factor for blood BP control (adjusted OR = 0.79, 95% CI = 0.64-0.99, P < 0.05). The restricted cubic spline plots illustrated a monotonic upward relationship between estimated 24-h urinary Na and BP (P-overall association < 0.05; P-non-linear association > 0.05). CONCLUSIONS The use of dietary SRS could result in decrease in daily salt intake for BP control in patients with poorly controlled hypertension. To reduce the impact of high BP in China, additional studies are required to create interventions that can enhance the results for patients.
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Affiliation(s)
- Qi Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Yimei Shen
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China.
| | - Meihua Yu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Zhongrong Yang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Zheng Huang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Jingying Ding
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Xinfeng Zhu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
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Alinaitwe B, Amanya C, A Muwanguzi P, Ngabirano TD. Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda. Integr Blood Press Control 2024; 17:1-11. [PMID: 38196839 PMCID: PMC10773241 DOI: 10.2147/ibpc.s440972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024] Open
Abstract
Purpose Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. Methods This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. Results A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). Conclusion The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.
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Affiliation(s)
- Businge Alinaitwe
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Nursing, Mount Kenya University, Thika, Kenya
| | - Charles Amanya
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Research, Hoima Regional Referral Hospital, Hoima, Uganda
| | - Patience A Muwanguzi
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda
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Aung K, Ream-Winnick S, Lane M, Akinlusi I, Shi T, Htay T. Sodium Homeostasis and Hypertension. Curr Cardiol Rep 2023; 25:1123-1129. [PMID: 37578690 DOI: 10.1007/s11886-023-01931-5] [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] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize and discuss the relationship between sodium homeostasis and hypertension, including emerging concepts of factors outside cardiovascular and renal systems influencing sodium homeostasis and hypertension. RECENT FINDINGS Recent studies support the dose-response association between higher sodium and lower potassium intakes and a higher cardiovascular risk in addition to the dose-response relationship between sodium restriction and blood pressure lowering. The growing body of evidence suggests the role of genetic determinants, immune system, and gut microbiota in sodium homeostasis and hypertension. Although higher sodium and lower potassium intakes increase cardiovascular risk, salt restriction is beneficial only to a certain limit. The immune system contributes to hypertension through pro-inflammatory effects. Sodium can affect the gut microbiome and induce pro-inflammatory and immune responses that contribute to salt-sensitive hypertension.
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Affiliation(s)
- KoKo Aung
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA.
| | - Sarah Ream-Winnick
- Washington University School of Medicine in St. Louis, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Mariela Lane
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Idris Akinlusi
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Ted Shi
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
| | - Thwe Htay
- Texas Tech University Health Sciences Center El Paso, 5001 El Paso Dr, El Paso, TX, 79905, USA
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Wang JG, Zhang W, Li Y, Liu L. Hypertension in China: epidemiology and treatment initiatives. Nat Rev Cardiol 2023; 20:531-545. [PMID: 36631532 DOI: 10.1038/s41569-022-00829-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
The past two to three decades have seen a steady increase in the prevalence of hypertension in China, largely owing to increased life expectancy and lifestyle changes (particularly among individuals aged 35-44 years). Data from the China hypertension survey conducted in 2012-2015 revealed a high prevalence of grade 3 hypertension (systolic blood pressure ≥180 mmHg and diastolic blood pressure ≥110 mmHg) in the general population, which increased with age to up to 5% among individuals aged ≥65 years. The risk profile of patients with hypertension in China has also been a subject of intense study in the past 30 years. Dietary sodium and potassium intake have remained largely the same in China in the past three decades, and salt substitution strategies seem to be effective in reducing blood pressure levels and the risk of cardiovascular events and death. However, the number of individuals with risk factors for hypertension and cardiovascular disease in general, such as physical inactivity and obesity, has increased dramatically in the same period. Moreover, even in patients diagnosed with hypertension, their disease is often poorly managed owing to a lack of patient education and poor treatment compliance. In this Review, we summarize the latest epidemiological data on hypertension in China, discuss the risk factors for hypertension that are specific to this population, and describe several ongoing nationwide hypertension control initiatives that target these risk factors, especially in the low-resource rural setting.
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Affiliation(s)
- Ji-Guang Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wei Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China
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Impact of different dietary sodium reduction strategies on blood pressure: a systematic review. Hypertens Res 2022; 45:1701-1712. [DOI: 10.1038/s41440-022-00990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
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Analysis of Sodium Content in 4082 Kinds of Commercial Foods in China. Nutrients 2022; 14:nu14142908. [PMID: 35889865 PMCID: PMC9322708 DOI: 10.3390/nu14142908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
High-sodium intake is associated with the increased risk of hypertension and cardiovascular disease. Monitoring and analyzing the sodium content in commercial food is instructive for reducing sodium intake in the general population. The sodium content of 4082 commercial foods across 12 food groups and 41 food categories was collected and analyzed, including 4030 pre-packaged foods and 52 artisanal foods. The food group with the highest average sodium content (6888.6 mg/100 g) contained sauces, dressings, springs and dips, followed by bean products (1326.1 mg/100 g) and fish, meat and egg products (1302.1 mg/100 g). The average sodium content of all the collected commercial foods was 1018.6 mg/100 g. Meanwhile, the sodium content of non-alcoholic beverages (49.7 mg/100 g), confectionery (111.8 mg/100 g) and dairy products (164.1 mg/100 g) was much lower than the average sodium content of the 12 food groups. The sodium contents of different food groups and categories were significantly different. The proportion of high-sodium food (600 mg/100 g) was more than one-third of all the products. There are a few products marked with salt reduction on the package. Sixteen salt-reduced products were collected, which belong to the food category of soy sauce and account for 16% of all the soy sauce products. The average sodium content in salt-reduced soy sauce is 2022.8 mg/100 g lower than that of non-salt-reduced soy sauce products. These data provide a primary assessment with sodium content in commercial foods and potential improvements for the food industry to achievement the goal of sodium reduction.
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Preliminary Experiment on the Effect of 18% Substitute Salt on Home Blood Pressure Variability in Hypertensives. Int J Hypertens 2021; 2021:9993328. [PMID: 34513088 PMCID: PMC8433016 DOI: 10.1155/2021/9993328] [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: 04/02/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
At present, the effect of substitute salt in reducing sodium intake and blood pressure is relatively clear. The present study is a phase I clinical trial involving 43 hypertensives in which the effect of 18% sodium substitute salt on the home blood pressure variability (BPV) was observed for 8 weeks with weekly follow-up. Finally, 4 patients were lost, and 39 patients completed the intervention and were included in the analysis. Daily home blood pressure and weekly adverse events were collected. The systolic blood pressure (SBP) in the morning (-10.0 mmHg, 95% CI: -16.5 to -3.5, P = 0.003), SBP at night (-10.2 mmHg, 95% CI: -16.1 to -4.3, P = 0.001), and diastolic blood pressure (DBP) at night (-4.0 mmHg, 95% CI: -7.1 to -0.8, P = 0.014) decreased significantly. Also, there was no statistically significant change in morning (F = 1.137, P = 0.352) and night diastolic (F = 0.344, P = 0.481) BPV and morning systolic BPV (F = 0.663, P = 0.930) over time during the intervention period, except for that night systolic BPV had a downward trend (F = 2.778, P = 0.016) and had decreased 2.04 mmHg (95% CI: 0.84 to 3.23, P = 0.001) after intervention. The use of 18% of the substitute salt did not increase BPV during the intervention and even may decrease it, which indicates its control effects on blood pressure. This study is the first one to observe the effect of 18% sodium substitute salt on the home blood pressure variability, providing a basis for further experiments.
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Sun Y, Wang H, Liang H, Yuan Y, Shu C, Zhang Y, Zhu Y, Yu M, Hu S, Sun N. A Method for Estimating 24-Hour Urinary Sodium Excretion by Casual Urine Specimen in Chinese Hypertensive Patients. Am J Hypertens 2021; 34:718-728. [PMID: 33491075 DOI: 10.1093/ajh/hpab020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/31/2020] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High salt intake is a known risk factor of hypertension, which in turn increases the risk of stroke and cardiovascular diseases. The aim of this study was to develop and evaluate a method for predicting 24-hour urinary sodium excretion (UNa24h) using casual urine specimens in Chinese hypertensive patients. METHODS A total of 966 patients with hypertension were included from 8 provinces across China. A UNa24h prediction model (Sun_C method) was developed for males and females using linear regression based on age, weight, sodium concentration in the spot urine (UNaspot), and creatinine concentration in the spot urine (UCrspot). The data were split into the training (70%) and testing (30%) sets to, respectively, develop and evaluate the Sun_C method. RESULTS Compared with the Kawasaki, INTERSALT, and Tanaka methods, Sun_C method achieved a low and consistent mean bias (1.1 mmol/d) within the range from 106 to 212 mmol/d of UNa24h (equivalent to NaCl intake of 6-12 g/d). In addition, the Sun_C method showed no significant difference between the measured and estimated UNa24h in a paired t-test (P = 0.689). At individual level, Sun_C method had 79.8% of individuals at the cutoff under ±30% level. CONCLUSIONS Sun_C method may prove a reasonable method to estimate the daily dietary sodium intakes (particularly in the range of 6-12 g/d of NaCl) in Chinese hypertensive patients using spot urine measurements. As the amount of data increases in the future, the performance of our formulae will be further improved.
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Affiliation(s)
- Yan Sun
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Hongyi Wang
- Institute of Hypertension, People’s Hospital, Peking University, Beijing, China
| | - Hao Liang
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yifang Yuan
- Institute of Hypertension, People’s Hospital, Peking University, Beijing, China
- Department of Cardiology, Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chang Shu
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yanwei Zhang
- Beijing E-seq Medical Technology Co., Ltd, Science and Technology Park, Beijing, China
| | - Yihua Zhu
- Nanjing Agricultural University, Nanjing, China
| | - Mingxin Yu
- Beijing E-seq Medical Technology Co., Ltd, Science and Technology Park, Beijing, China
| | - Songnian Hu
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Ningling Sun
- Institute of Hypertension, People’s Hospital, Peking University, Beijing, China
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Du X, Zhao D, Henry ME, Fang L, Xu J, Chen X, Zhang J, Bai Y, Wu J, Ma J, Zhong J, Yu M, Appel LJ. Use of Salt-Restriction Spoons and Its Associations with Urinary Sodium and Potassium in the Zhejiang Province of China: Results of a Population-Based Survey. Nutrients 2021; 13:1047. [PMID: 33804870 PMCID: PMC8063796 DOI: 10.3390/nu13041047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/20/2021] [Indexed: 01/31/2023] Open
Abstract
In China, a major source of sodium is salt added during cooking. In this context, use of a salt-restriction spoon (SRS) has been promoted in public health campaigns and by health care providers. To describe use of and factors associated with SRS use, knowledge of correct use, and actual correct use. This study is a population-based, representative survey of 7512 residents, aged 18 to 69 years, of China's Zhejiang Province. The survey, which was conducted in 2017 using a multistage random sampling strategy, collected demographic information, SRS use, and physical measurements; a 24-h urine collection was obtained from 1,496 of the participants. The mean age of the participants was 44.8 years, 50.1% were females, and over 1/3 (35.3%) were classified as hypertensive. Mean 24-h urinary sodium and potassium excretions were 167.3(72.2) mmol/24 h and 38.2(18.2) mmol/24 h, respectively. Only 12.0% (899/7512) of participants once used or were currently using SRS; of the 899 users, 73.4% knew how to use the SRS correctly, and just 46.5% actually used it correctly. SRS use was more commonly associated with behavioral factors rather than socio-demographic factors. Initiation of SRS use by health care providers was associated with correct technical knowledge of SRS. Lower sodium-to-potassium ratio was associated with SRS use, while SRS use was not associated with urinary sodium and potassium excretion. Use of SRS was uncommon in Zhejiang Province of China. Given that a common source of sodium in China is salt added during cooking, use of SRS is an appealing strategy, ideally as part of a multi-component campaign.
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Affiliation(s)
- Xiaofu Du
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Di Zhao
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
| | - Megan E. Henry
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
| | - Le Fang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Xiangyu Chen
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Jie Zhang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Beijing 100050, China; (J.X.); (Y.B.); (J.W.)
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, China;
| | - Jieming Zhong
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Min Yu
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China; (X.D.); (L.F.); (X.C.); (J.Z.); (J.Z.)
| | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, No. 2024 E. Monument Street, Baltimore, MD 21287, USA; (D.Z.); (M.E.H.)
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Goldberg E, Aliani M. Sodium: What is the right amount? ADVANCES IN FOOD AND NUTRITION RESEARCH 2021; 96:175-191. [PMID: 34112352 DOI: 10.1016/bs.afnr.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Sodium is an important nutrient for good health, but excessive amounts in the diet are known to cause an array of complications, including hypertension and exacerbating kidney disease. The purpose of this chapter is to analyze the most current evidence as it relates to sodium intake, since there have been some recent reports contradicting current recommended guidelines. Since the majority of people consuming a typical Western diet exceed recommended sodium levels, it is of utmost importance to determine if this is problematic in otherwise healthy populations, or if sodium should only be restricted in those with underlying health conditions. Sodium intake in children is also included in this chapter, as there is little evidence reported in this population. The impact of various dietary interventions, such as the DASH and Mediterranean diets, in terms of their ability to reduce blood pressure is also briefly discussed.
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Affiliation(s)
- Erin Goldberg
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michel Aliani
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada; Canadian Centre for Agri-Food Research in Health and Medicine, (CCARM), St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada.
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Sukhato K, Akksilp K, Dellow A, Vathesatogkit P, Anothaisintawee T. Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review. Am J Clin Nutr 2020; 112:1584-1598. [PMID: 33022695 DOI: 10.1093/ajcn/nqaa252] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. OBJECTIVE This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. METHODS PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. RESULTS Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from -3.20 to -7.62 mmHg for SBP and from -2.50 to -4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. CONCLUSION Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.
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Affiliation(s)
- Kanokporn Sukhato
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Katika Akksilp
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Bangkok, Thailand
| | - Alan Dellow
- Former Postgraduate Tutor, Oxford Deanery, United Kingdom
| | - Prin Vathesatogkit
- Cardiology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Ito K. Review of the health benefits of habitual consumption of miso soup: focus on the effects on sympathetic nerve activity, blood pressure, and heart rate. Environ Health Prev Med 2020; 25:45. [PMID: 32867671 PMCID: PMC7461326 DOI: 10.1186/s12199-020-00883-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/17/2020] [Indexed: 02/07/2023] Open
Abstract
High salt intake increases blood pressure, and dietary salt intake has been clearly demonstrated to be associated with hypertension incidence. Japanese people consume higher amounts of salt than Westerners. It has been reported that miso soup was one of the major sources of daily salt intake in Japanese people. Adding salt is indispensable to make miso, and therefore, in some cases, refraining from miso soup is recommended to reduce dietary salt intake. However, recent studies using salt-sensitive hypertensive models have revealed that miso lessens the effects of salt on blood pressure. In other word, the intake of miso dose not increase the blood pressure compared to the equivalent intake of salt. In addition, many clinical observational studies have demonstrated the absence of a relationship between the frequency of miso soup intake and blood pressure levels or hypertension incidence. The mechanism of this phenomenon seen in the subjects with miso soup intake has not been fully elucidated yet. However, in basic studies, it was found that the ingredients of miso attenuate sympathetic nerve activity, resulting in lowered blood pressure and heart rate. Therefore, this review focused on the differences between the effects of miso intake and those of the equivalent salt intake on sympathetic nerve activity, blood pressure, and heart rate.
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Affiliation(s)
- Koji Ito
- Department of Clinical Laboratory, Japan Community Healthcare Organization, Kyushu Hospital, 1-8-1, Kishinoura, Yahatanishi-ku, Kitakyushu, 806-8501, Japan.
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Dong Z, Liu Y, Pan H, Wang H, Wang X, Xu X, Xiao K, Liu M, Xu Z, Li L, Zhang Y. The Effects of High-Salt Gastric Intake on the Composition of the Intestinal Microbiota in Wistar Rats. Med Sci Monit 2020; 26:e922160. [PMID: 32504527 PMCID: PMC7297027 DOI: 10.12659/msm.922160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background A high-salt diet may result in chronic disease and changes in the intestinal microbiota. This pilot study aimed to investigate the microbial composition of the intestine in Wistar rats given intragastric high-salt infusions for four weeks. Material/Methods Six 4-week-old male Wistar rats were fed standard chow and divided into the high-salt group (n=3) and the control study group (n=3). Rats in the high-salt group were given 1 ml of 10% NaCl solution intragastrically three times per week for four weeks. The fecal pellets were collected, and the microbiota was characterized using 16S rRNA gene sequencing that targeted the V4 region. The relative abundance of microbial populations was compared using linear discriminant analysis effect size (LEfSe) statistical analysis for the identification of biomarkers between two or more groups, principal component analysis (PCA), and linear discriminant analysis (LDA). Microbial genome prediction was performed using the phylogenetic investigation of communities by reconstructing the unobserved states (PICRUSt) bioinformatics software. Results There was no significant difference in the alpha diversity of the fecal microbiota between the high-salt group and the control group. However, PCA showed structural segregation between the two groups. Further analysis using LEfSe showed that the intestinal contents in the high-salt group had significantly reduced populations of Lactobacillus and Prevotella NK3B31, and a significant increase in Alloprevotella and Prevotella 9, without physiological or pathological changes. Conclusions A pilot study in Wistar rats showed that high-salt intake was associated with a change in the composition of the intestinal microbiota.
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Affiliation(s)
- Zhaogang Dong
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Yuanbin Liu
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Hongwei Pan
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Hongchun Wang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xin Wang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xiaofei Xu
- Infertility Center, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Ke Xiao
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Min Liu
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Zhiyun Xu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Lanbo Li
- Department of Animal Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Yi Zhang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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16
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Zhang X, Hu X, Ma J, Zhang P, Li Y, Luo R, He FJ, MacGregor GA, Wang J, Yin Z. Cluster randomised controlled trial of home cook intervention to reduce salt intake in China: a protocol study. BMJ Open 2020; 10:e033842. [PMID: 32385058 PMCID: PMC7228508 DOI: 10.1136/bmjopen-2019-033842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Salt intake in China is twice the upper limit recommended by the WHO, and nearly 80% of salt is added during cooking. This study will develop a package of salt reduction interventions targeting home cooks and evaluate its effectiveness and feasibility for scale-up. METHODS AND ANALYSIS A cluster randomised controlled trial design is adopted in this study, which will be conducted in six provinces covering northern, central and southern China. For each province, 10 communities/villages (clusters) with 13 families (one cook and one adult family member) will be selected in each cluster for evaluation. In total, 780 home cooks and 780 adult family members will be recruited. The home cooks in the intervention group will be provided with the intervention package, including community-based standardised offline and online health education and salt intake monitoring. The duration of the intervention will be 1 year. The primary outcome is the difference between the intervention and control group in change in salt intake as measured by 24 hours urinary sodium from baseline to the end of the trial. The secondary outcome is the difference between the two groups in the change in salt-related knowledge, attitude and practice and blood pressure (BP). ETHICS AND DISSEMINATION The study has been approved by The Queen Mary Research Ethics Committee (QMERC2018/13) and Institutional Review Board of the Chinese Center for Disease Control and Prevention (No. 201801). The study findings will be disseminated widely through conference presentations and peer-reviewed publications and the general media. TRIAL REGISTRATION NUMBER ChiCTR1800016804.
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Affiliation(s)
- Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Hu
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinglei Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaoxue Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
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17
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Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NRC, Li Q, Lackland DT, Leung AA, Anderson CAM, MacGregor GA, He FJ. Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ 2020; 368:m315. [PMID: 32094151 PMCID: PMC7190039 DOI: 10.1136/bmj.m315] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine the dose-response relation between reduction in dietary sodium and blood pressure change and to explore the impact of intervention duration. DESIGN Systematic review and meta-analysis following PRISMA guidelines. DATA SOURCES Ovid MEDLINE(R), EMBASE, and Cochrane Central Register of Controlled Trials (Wiley) and reference lists of relevant articles up to 21 January 2019. INCLUSION CRITERIA Randomised trials comparing different levels of sodium intake undertaken among adult populations with estimates of intake made using 24 hour urinary sodium excretion. DATA EXTRACTION AND ANALYSIS Two of three reviewers screened the records independently for eligibility. One reviewer extracted all data and the other two reviewed the data for accuracy. Reviewers performed random effects meta-analyses, subgroup analyses, and meta-regression. RESULTS 133 studies with 12 197 participants were included. The mean reductions (reduced sodium v usual sodium) of 24 hour urinary sodium, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 130 mmol (95% confidence interval 115 to 145, P<0.001), 4.26 mm Hg (3.62 to 4.89, P<0.001), and 2.07 mm Hg (1.67 to 2.48, P<0.001), respectively. Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days' duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction. CONCLUSIONS The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019140812.
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Affiliation(s)
- Liping Huang
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Sohei Yoshimura
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
- National Cerebral and Cardiovascular Centre, Osaka, Japan
| | - Bruce Neal
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mark Woodward
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Norm R C Campbell
- Departments of Medicine and Community Health Science, University of Calgary, Calgary, AB, Canada
| | - Qiang Li
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Alexander A Leung
- Departments of Medicine and Community Health Science, University of Calgary, Calgary, AB, Canada
| | | | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
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18
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Huang L, Wang H, Wang Z, Wang Y, Zhang B, Ding G. Associations of Dietary Sodium, Potassium, and Sodium to Potassium Ratio with Blood Pressure- Regional Disparities in China. Nutrients 2020; 12:nu12020366. [PMID: 32019173 PMCID: PMC7071283 DOI: 10.3390/nu12020366] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
High dietary sodium and low potassium intake increase blood pressure and risk of hypertension, but whether the relationship between dietary sodium and potassium and risk of hypertension is different in North China and South China remains unclear. We used data from the longitudinal China Health and Nutrition Survey (CHNS) and selected 6705 adults who participated in at least two waves in 2009, 2011, and 2015 and had no hypertension in baseline. We performed multiple linear regression analysis and multiple logistic regressions stratified by area for the present study design. Sodium and potassium intake were higher in North China (4343.4 and 1624.8 mg/day, respectively) than in South China (4107.8 and 1516.1 mg/d, respectively) (p < 0.05). Multiple linear regression revealed that a positive correlation of sodium intake (β = 0.026, p < 0.05) and ratio of sodium to potassium (Na-K) intake (β = 0.041, p < 0.01) with diastolic blood pressure (DBP) was found in North China, and the association of sodium, potassium, and Na-K intake ratio with blood pressure was different in South China. Multiple logistic regressions documented a similar significant inverse association between dietary potassium intake and risk of hypertension in both North China and South China (risk ratio (RR): 0.63, 95%CI: 0.50–0.79; RR: 0.80, 95%CI: 0.66–0.98, respectively). The risk of hypertension increased in the fourth quartile of dietary sodium and Na-K intake ratio (RR: 1.20, 95%CI: 1.00–1.44; RR: 1.35, 95%CI: 1.13–1.62, respectively) in North China but no association was observed in South China. The current study indicates a different association of dietary sodium and Na-K intake ratio with systolic blood pressure (SBP), DBP, and risk of hypertension in North China and South China.
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Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016. Eur J Nutr 2019; 59:3149-3161. [PMID: 31802196 DOI: 10.1007/s00394-019-02153-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population. METHODS The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP. RESULTS After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p < 0.001) and normotensive people (p < 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p < 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people. CONCLUSIONS The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people.
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Aburto TC, Gordon‐Larsen P, Poti JM, Howard AG, Adair LS, Avery CL, Popkin BM. Is a Hypertension Diagnosis Associated With Improved Dietary Outcomes Within 2 to 4 Years? A Fixed-Effects Analysis From the China Health and Nutrition Survey. J Am Heart Assoc 2019; 8:e012703. [PMID: 31657282 PMCID: PMC6898848 DOI: 10.1161/jaha.119.012703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022]
Abstract
Background Evidence shows that dietary factors play an important role in blood pressure. However, there is no clear understanding of whether hypertension diagnosis is associated with dietary modifications. The aim of this study is to estimate the longitudinal association between hypertension diagnosis and subsequent changes (within 2-4 years) in dietary sodium, potassium, and sodium-potassium (Na/K) ratio. Methods and Results We included adults (18-75 years, n=16 264) from up to 9 waves (1991-2015) of the China Health and Nutrition Survey. Diet data were collected using three 24-hour dietary recalls and a household food inventory. We used fixed-effects models to estimate the association between newly self-reported diagnosed hypertension and subsequent within-individual changes in sodium, potassium, and Na/K ratio. We also examined changes among couples and at the household level. Results suggest that on average, men who were diagnosed with hypertension decreased their sodium intake by 251 mg/d and their Na/K ratio by 0.19 within 2 to 4 years after diagnosis (P<0.005). Among spouse pairs, sodium intake and Na/K ratio of women decreased when their husbands were diagnosed (P<0.05). Household average sodium density and Na/K ratio decreased, and household average potassium density increased after a man was diagnosed. In contrast, changes were not statistically significant when women were diagnosed. Conclusions Our findings suggest that hypertension diagnosis for a man may result in modest dietary improvements for him, his wife, and other household members. Yet, diagnosis for a woman does not seem to result in dietary changes for her or her household members.
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Affiliation(s)
- Tania C. Aburto
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Penny Gordon‐Larsen
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
| | - Jennifer M. Poti
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Annie G. Howard
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Linda S. Adair
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
| | - Christy L. Avery
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | - Barry M. Popkin
- Department of NutritionGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
- Gillings School of Global Public Health and Carolina Population CenterUniversity of North Carolina at Chapel HillNC
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21
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Han W, Wang W, Sun N, Li M, Chen L, Jiang S, Chen Y, Han X. Relationship between 24-hour urinary sodium excretion and blood pressure in the adult population in Shandong, China. J Clin Hypertens (Greenwich) 2019; 21:1370-1376. [PMID: 31350809 PMCID: PMC6771517 DOI: 10.1111/jch.13644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 01/12/2023]
Abstract
The main objective of this study was to determine baseline salt intake levels in a sample of the adult population of Shandong province and to establish the relationship between urinary sodium excretion and blood pressure. A total of 512 participants were recruited, and all the participants provided complete 24‐hour urine collections. Physical assessment and socioeconomic status of participants were collected at the same time. The mean 24‐hour urinary sodium excretion of all subjects was 228.0 ± 127.5 mmol/24 hours. Estimated salt intake was higher in obese subjects (17.6 ± 8.8 g/d) compared with overweight subjects (15.6 ± 8.0 g/d) and those with a normal BMI (13.9 ± 6.8 g/d). Likewise, urinary sodium excretion of hypertensive participants was dramatically higher than that of non‐hypertensive ones, the equivalent of 18.2 ± 9.1 g/d vs 13.3 ± 6.8 g/d. Urinary sodium was significantly associated with SBP (β = 1.08, P = .018) after adjustment for potential confounders. In summary, we found significantly high levels of salt intake in Shandong Province, particularly in obese and hypertension subjects. It is quite important to improve public education about reducing salt intake to control blood pressure among Shandong people.
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Affiliation(s)
- Weizhong Han
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Wei Wang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Ningling Sun
- Department of Heart Center, Hypertensive Laboratory, Peking University People's Hospital, Beijing, China
| | - Min Li
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Lianghua Chen
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Shiliang Jiang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, China
| | - Yunchao Chen
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, China
| | - Xiao Han
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Ji'nan, China
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22
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Iqbal S, Klammer N, Ekmekcioglu C. The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses. Nutrients 2019; 11:nu11061362. [PMID: 31212974 PMCID: PMC6627949 DOI: 10.3390/nu11061362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Nutrition is known to exert an undeniable impact on blood pressure with especially salt (sodium chloride), but also potassium, playing a prominent role. The aim of this review was to summarize meta-analyses studying the effect of different electrolytes on blood pressure or risk for hypertension, respectively. Overall, 32 meta-analyses evaluating the effect of sodium, potassium, calcium and magnesium on human blood pressure or hypertension risk were included after literature search. Most of the meta-analyses showed beneficial blood pressure lowering effects with the extent of systolic blood pressure reduction ranging between -0.7 (95% confidence interval: -2.6 to 1.2) to -8.9 (-14.1 to -3.7) mmHg for sodium/salt reduction, -3.5 (-5.2 to -1.8) to -9.5 (-10.8 to -8.1) mmHg for potassium, and -0.2 (-0.4 to -0.03) to -18.7 (-22.5 to -15.0) mmHg for magnesium. The range for diastolic blood pressure reduction was 0.03 (-0.4 to 0.4) to -5.9 (-9.7 to -2.1) mmHg for sodium/salt reduction, -2 (-3.1 to -0.9) to -6.4 (-7.3 to -5.6) mmHg for potassium, and -0.3 (-0.5 to -0.03) to -10.9 (-13.1 to -8.7) mmHg for magnesium. Moreover, sufficient calcium intake was found to reduce the risk of gestational hypertension.
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Affiliation(s)
- Sehar Iqbal
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Norbert Klammer
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
| | - Cem Ekmekcioglu
- Department of Environmental Health, Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria.
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23
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Wen X, Zhou L, Stamler J, Chan Q, Horn LV, Daviglus ML, Dyer AR, Elliott P, Ueshima H, Miura K, Okuda N, Wu Y, Zhao L. Agreement between 24-h dietary recalls and 24-h urine collections for estimating sodium intake in China, Japan, UK, USA: the International Study of Macro- and Micro-nutrients and Blood Pressure. J Hypertens 2019; 37:814-819. [PMID: 30817463 PMCID: PMC6690055 DOI: 10.1097/hjh.0000000000001941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The present study aims to compare 24-h dietary recalls with 24-h urine collections for the estimation of sodium intake at both population and individual levels in China, Japan, the United Kingdom (UK), and the United States of America (USA), using data from the International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP). METHODS Mean differences between 24-h dietary recalls and 24-h urine collections were calculated for their agreement in estimating sodium intake at the population level; relative and absolute differences as well as misclassification of salt intake groups (salt intake <6, 6-8.9, 9-11.9, 12-14.9, and ≥15 g/day) were used to determine the agreement at the individual level. RESULTS The mean differences (95% CI) between dietary recalls and urine collections for China, Japan, UK, and USA were -54.0 (-59.8, -48.3), 3.9 (0.6, 7.2), 2.9 (-1.8, 7.6), and -3.5 (-5.8, -1.1) mmol/day, respectively. The proportions of individual relative differences beyond ±40% were 34.3% for China, 16.9% for Japan, 24.2% for UK, and 21.3% for USA; the proportions of individual absolute differences greater than 51.3 mmol/day (3 g salt) were 58.6% for China, 32.8% for Japan, 25.4% for UK, and 31.9% for USA. The rate for misclassification of salt intake groups at individual level for China, Japan, UK, and USA were 71.4, 60.9, 58.7, and 60.0%, respectively. CONCLUSION The 24-h dietary recalls demonstrate greater agreement with the 24-h urine collections in estimating population sodium intake for Japan, UK, and USA, compared with China. The 24-h dietary recall has poor performance in assessing individual sodium intake in these four countries.
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Affiliation(s)
- Xiaoxiao Wen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Long Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, Illinois, USA
| | - Alan R. Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan and
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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24
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Corlin L, Ball S, Woodin M, Patton AP, Lane K, Durant JL, Brugge D. Relationship of Time-Activity-Adjusted Particle Number Concentration with Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092036. [PMID: 30231494 PMCID: PMC6165221 DOI: 10.3390/ijerph15092036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Abstract
Emerging evidence suggests long-term exposure to ultrafine particulate matter (UFP, aerodynamic diameter < 0.1 µm) is associated with adverse cardiovascular outcomes. We investigated whether annual average UFP exposure was associated with measured systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and hypertension prevalence among 409 adults participating in the cross-sectional Community Assessment of Freeway Exposure and Health (CAFEH) study. We used measurements of particle number concentration (PNC, a proxy for UFP) obtained from mobile monitoring campaigns in three near-highway and three urban background areas in and near Boston, Massachusetts to develop PNC regression models (20-m spatial and hourly temporal resolution). Individual modeled estimates were adjusted for time spent in different micro-environments (time-activity-adjusted PNC, TAA-PNC). Mean TAA-PNC was 22,000 particles/cm3 (sd = 6500). In linear models (logistic for hypertension) adjusted for the minimally sufficient set of covariates indicated by a directed acyclic graph (DAG), we found positive, non-significant associations between natural log-transformed TAA-PNC and SBP (β = 5.23, 95%CI: −0.68, 11.14 mmHg), PP (β = 4.27, 95%CI: −0.79, 9.32 mmHg), and hypertension (OR = 1.81, 95%CI: 0.94, 3.48), but not DBP (β = 0.96, 95%CI: −2.08, 4.00 mmHg). Associations were stronger among non-Hispanic white participants and among diabetics in analyses stratified by race/ethnicity and, separately, by health status.
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Affiliation(s)
- Laura Corlin
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA.
| | - Shannon Ball
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - Mark Woodin
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
| | - Allison P Patton
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Health Effects Institute, 75 Federal Street, Suite 1400, Boston, MA 02110, USA.
| | - Kevin Lane
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.
| | - John L Durant
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
| | - Doug Brugge
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA 02155, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
- Tufts University Jonathan M. Tisch College of Civic Life, 35 Professors Row, Medford, MA 02155, USA.
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25
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He Y, Huang L, Yan S, Li Y, Lu L, Wang H, Niu W, Zhang P. Awareness, understanding and use of sodium information labelled on pre-packaged food in Beijing:a cross-sectional study. BMC Public Health 2018; 18:509. [PMID: 29665806 PMCID: PMC5905172 DOI: 10.1186/s12889-018-5396-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/03/2018] [Indexed: 01/24/2023] Open
Abstract
Background Nutrition labelling has been mandatory for pre-packaged foods since 2013 in China, and sodium is one of the nutrients required for display on the nutritional information panel (NIP). This study aimed to estimate the awareness, understanding of, and use of sodium labelling information among the population in China. Methods A cross-sectional survey was carried out in urban Beijing in 2016 on pre-packaged foods. The researchers randomly selected 380 residents from four convenient but disconnected communities and 370 shoppers from four supermarkets owned by different companies and conducted face-to-face interviews. Questions on nutritional knowledge, health attitude, understanding and use of nutritional labels as well as other related factors were assessed. Results All of the 380 community residents and 308 of the 370 supermarket shoppers successfully completed the survey. Of those 688 respondents, 91.3% understood that excessive salt intake was harmful, 19.5% were aware that sodium content is listed on the NIP, 5.5% understood the meaning of NRV% (Percentage of Nutrient Reference Values), 47.7% did not know the relationship between sodium and salt, and 12.6% reported they frequently read the label when shopping. Factors for why people were more likely to choose a product because of its low level of salt shown on the label include income level and their level of awareness of the link between salt and diet. Conclusions Although the participants had a good understanding of the harmful effects of salt, the awareness, understanding and use of sodium labels was very low in Beijing, and even worse nationwide. Efforts should be taken to educate the public to understand and use the NIP better and design clearer ways of displaying such information, such as front-of pack (FoP) labelling or health-related smartphone applications to improve health and help people make better food choices. Electronic supplementary material The online version of this article (doi:10.1186/s12889-018-5396-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yao He
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6, Zhichun Road, Haidian District, Beijing, 100088, China.,Department of Social Medicine and Health education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Liping Huang
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6, Zhichun Road, Haidian District, Beijing, 100088, China
| | - Sijin Yan
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6, Zhichun Road, Haidian District, Beijing, 100088, China.,Department of Social Medicine and Health education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6, Zhichun Road, Haidian District, Beijing, 100088, China
| | - Lixin Lu
- Xicheng District Center for Disease Control and Prevention, No. 38, Waidajie, Deshengmen, Xicheng District, Beijing, 100120, China
| | - Hongbo Wang
- Haidian District Administration Center for Community Health Service, No. 12, Ganjiakou community, Haidian District, Beijing, China
| | - Wenyi Niu
- Department of Social Medicine and Health education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6, Zhichun Road, Haidian District, Beijing, 100088, China.
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26
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He L, Liu YJ, Zheng T, Tan ZJ. Effect of high-salt diet on health: Relationship with intestinal microflora. Shijie Huaren Xiaohua Zazhi 2018; 26:143-149. [DOI: 10.11569/wcjd.v26.i3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Salt is the most basic and commonly used seasoning agent in daily diet. It is an important part of all kinds of food and plays a vital role in food preparation and preservation. People are increasingly in pursuit of a healthy diet to reduce the incidence of dietary-related diseases and to improve their health. Salt intake and related diseases have become the focus of research, and salt intake is considered the main factor for a healthy diet. This paper reviews the progress in research of the effect of high-salt diet on health with regard to intestinal microbiota, metabolic pathogenicity, and epidemiological investigation, and other aspects of salt consumption. Cardiovascular, endocrine, and other chronic diseases have been associated with high salt diet. A better understanding of the effect of high salt intake on health can improve the prevention and treatment of chronic diseases and provide new ideas for the development of scientific diet programs.
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Affiliation(s)
- Lu He
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - You-Jia Liu
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Tao Zheng
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Zhou-Jin Tan
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
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27
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Wong MMY, Arcand J, Leung AA, Thout SR, Campbell NRC, Webster J. The science of salt: A regularly updated systematic review of salt and health outcomes (December 2015-March 2016). J Clin Hypertens (Greenwich) 2017; 19:322-332. [PMID: 28266792 DOI: 10.1111/jch.12970] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/10/2017] [Accepted: 12/04/2016] [Indexed: 01/08/2023]
Abstract
The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from December 2015 to March 2016. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 13 studies were included in the review: one study assessed cardiovascular events, nine studies assessed prevalence or incidence of blood pressure or hypertension, one study assessed kidney disease, and two studies assessed other health outcomes (obesity and nonalcoholic fatty liver disease). Four studies were selected for detailed appraisal and commentary. One study met the minimum methodologic criteria and found an increased risk associated with lower sodium intake in patients with heart failure. All other studies identified in this review demonstrated positive associations between dietary salt and adverse health outcomes.
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Affiliation(s)
- Michelle M Y Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | | | | | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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28
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Zhou L, Tian Y, Fu JJ, Jiang YY, Bai YM, Zhang ZH, Hu XH, Lian HW, Guo M, Yang ZX, Zhao LC. Validation of spot urine in predicting 24-h sodium excretion at the individual level. Am J Clin Nutr 2017; 105:1291-1296. [PMID: 28356277 DOI: 10.3945/ajcn.116.147553] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Evidence for the effect of dietary sodium intake on the risk of cardiovascular disease has been controversial. One of the main explanations for the conflicting results lies in the great variability associated with measurement methods for sodium intake. Spot urine collection is a convenient method commonly used for sodium estimation, but its validity for predicting 24-h urinary sodium excretion at the individual level has not been well evaluated among the general population.Objective: The aim of this study was to evaluate the validity of the Kawasaki, the International Cooperative Study on Salt, Other Factors, and Blood Pressure (INTERSALT), and the Tanaka formulas in predicting 24-h urinary sodium excretion by using spot urine samples in Chinese adults.Design: We analyzed the relative and absolute differences and misclassification at the individual level from 3 commonly used methods for estimating sodium intake among 141 Chinese community residents.Results: The mean measured 24-h sodium excretion was 220.8 mmol/d. The median (95% CIs) differences between measured sodium and those estimated from the Kawasaki, INTERSALT, and Tanaka methods were 6.4 mmol/d (-17.5, 36.8 mmol/d), -67.3 mmol/d (-96.5, -46.9 mmol/d), and -42.9 mmol/d (-59.1, -24.8 mmol/d), respectively. The proportions of relative differences >40% with the Kawasaki, INTERSALT, and Tanaka methods were 31.2%, 41.1%, and 22.0%, respectively; and the absolute difference for the 3 methods was >51.3 mmol/d (3 g salt) in approximately half of the participants. The misclassification rate was 63.1% for the Kawasaki method, 78.7% for the INTERSALT method, and 66.0% for the Tanaka method at the individual level.Conclusion: The results from our study do not support the use of spot urine to estimate 24-h urinary sodium excretion at the individual level because of its poor performance with respect to misclassification. This trial was registered at www.chictr.org.cn as ChiCTR-IOR-16010278.
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Affiliation(s)
- Long Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Division of Preventive Oncology, National Center for Tumor Disease, German Cancer Research Center, Heidelberg, Germany
| | - Jun-Jie Fu
- Jiangxi Center for Disease Control and Prevention, Nanchang, China
| | - Ying-Ying Jiang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; and
| | - Ya-Min Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; and
| | - Zi-Hua Zhang
- Dexing Center for Disease Control and Prevention, Dexing, China
| | - Xiao-He Hu
- Dexing Center for Disease Control and Prevention, Dexing, China
| | - Hong-Wu Lian
- Dexing Center for Disease Control and Prevention, Dexing, China
| | - Min Guo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Xiong Yang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; and
| | - Lian-Cheng Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;
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29
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Walsh JL, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma’eel H. Knowledge, attitudes, motivators and salt-related behaviour in a cardiac care unit population: A cross-sectional study in Lebanon. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2017. [DOI: 10.3233/mnm-16129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma’eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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30
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Foss JD, Kirabo A, Harrison DG. Do high-salt microenvironments drive hypertensive inflammation? Am J Physiol Regul Integr Comp Physiol 2017; 312:R1-R4. [PMID: 27903514 PMCID: PMC5283943 DOI: 10.1152/ajpregu.00414.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 01/11/2023]
Abstract
Hypertension is a global epidemic affecting over one billion people worldwide. Despite this, the etiology of most cases of human hypertension remains obscure, and treatment remains suboptimal. Excessive dietary salt and inflammation are known contributors to the pathogenesis of this disease. Recently, it has been recognized that salt can accumulate in the skin and skeletal muscle, producing concentrations of sodium greater than the plasma in hypertensive animals and humans. Such elevated levels of sodium have been shown to alter immune cell function. Here, we propose a model in which tissue salt accumulation causes an immune response leading to renal and vascular inflammation and hypertension.
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Affiliation(s)
- Jason D Foss
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David G Harrison
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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31
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Wang M, Moran AE, Liu J, Coxson PG, Penko J, Goldman L, Bibbins-Domingo K, Zhao D. Projected Impact of Salt Restriction on Prevention of Cardiovascular Disease in China: A Modeling Study. PLoS One 2016; 11:e0146820. [PMID: 26840409 PMCID: PMC4739496 DOI: 10.1371/journal.pone.0146820] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/22/2015] [Indexed: 01/19/2023] Open
Abstract
Objectives To estimate the effects of achieving China’s national goals for dietary salt (NaCl) reduction or implementing culturally-tailored dietary salt restriction strategies on cardiovascular disease (CVD) prevention. Methods The CVD Policy Model was used to project blood pressure lowering and subsequent downstream prevented CVD that could be achieved by population-wide salt restriction in China. Outcomes were annual CVD events prevented, relative reductions in rates of CVD incidence and mortality, quality-adjusted life-years (QALYs) gained, and CVD treatment costs saved. Results Reducing mean dietary salt intake to 9.0 g/day gradually over 10 years could prevent approximately 197 000 incident annual CVD events [95% uncertainty interval (UI): 173 000–219 000], reduce annual CVD mortality by approximately 2.5% (2.2–2.8%), gain 303 000 annual QALYs (278 000–329 000), and save approximately 1.4 billion international dollars (Int$) in annual CVD costs (Int$; 1.2–1.6 billion). Reducing mean salt intake to 6.0 g/day could approximately double these benefits. Implementing cooking salt-restriction spoons could prevent 183 000 fewer incident CVD cases (153 000–215 000) and avoid Int$1.4 billion in CVD treatment costs annually (1.2–1.7 billion). Implementing a cooking salt substitute strategy could lead to approximately three times the health benefits of the salt-restriction spoon program. More than three-quarters of benefits from any dietary salt reduction strategy would be realized in hypertensive adults. Conclusion China could derive substantial health gains from implementation of population-wide dietary salt reduction policies. Most health benefits from any dietary salt reduction program would be realized in adults with hypertension.
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Affiliation(s)
- Miao Wang
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Andrew E. Moran
- Division of General Medicine, Department of Medicine, Columbia University, New York, New York, United States of America
| | - Jing Liu
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Pamela G. Coxson
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, United States of America
| | - Joanne Penko
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, United States of America
| | - Lee Goldman
- Columbia University College of Physicians and Surgeons, New York, New York, United States of America
| | - Kirsten Bibbins-Domingo
- Division of General Internal Medicine, Department of Medicine, University of California at San Francisco, San Francisco, United States of America
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- * E-mail:
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Duraimani S, Schneider RH, Randall OS, Nidich SI, Xu S, Ketete M, Rainforth MA, Gaylord-King C, Salerno JW, Fagan J. Effects of Lifestyle Modification on Telomerase Gene Expression in Hypertensive Patients: A Pilot Trial of Stress Reduction and Health Education Programs in African Americans. PLoS One 2015; 10:e0142689. [PMID: 26571023 PMCID: PMC4646647 DOI: 10.1371/journal.pone.0142689] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 10/25/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African Americans suffer from disproportionately high rates of hypertension and cardiovascular disease. Psychosocial stress, lifestyle and telomere dysfunction contribute to the pathogenesis of hypertension and cardiovascular disease. This study evaluated effects of stress reduction and lifestyle modification on blood pressure, telomerase gene expression and lifestyle factors in African Americans. METHODS Forty-eight African American men and women with stage I hypertension who participated in a larger randomized controlled trial volunteered for this substudy. These subjects participated in either stress reduction with the Transcendental Meditation technique and a basic health education course (SR) or an extensive health education program (EHE) for 16 weeks. Primary outcomes were telomerase gene expression (hTERT and hTR) and clinic blood pressure. Secondary outcomes included lifestyle-related factors. Data were analyzed for within-group and between-group changes. RESULTS Both groups showed increases in the two measures of telomerase gene expression, hTR mRNA levels (SR: p< 0.001; EHE: p< 0.001) and hTERT mRNA levels (SR: p = 0.055; EHE: p< 0.002). However, no statistically significant between-group changes were observed. Both groups showed reductions in systolic BP. Adjusted changes were SR = -5.7 mm Hg, p< 0.01; EHE = -9.0 mm Hg, p < 0.001 with no statistically significant difference between group difference. There was a significant reduction in diastolic BP in the EHE group (-5.3 mm Hg, p< 0.001) but not in SR (-1.2 mm Hg, p = 0.42); the between-group difference was significant (p = 0.04). The EHE group showed a greater number of changes in lifestyle behaviors. CONCLUSION In this pilot trial, both stress reduction (Transcendental Meditation technique plus health education) and extensive health education groups demonstrated increased telomerase gene expression and reduced BP. The association between increased telomerase gene expression and reduced BP observed in this high-risk population suggest hypotheses that telomerase gene expression may either be a biomarker for reduced BP or a mechanism by which stress reduction and lifestyle modification reduces BP. TRIAL REGISTRATION ClinicalTrials.gov NCT00681200.
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Affiliation(s)
- Shanthi Duraimani
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
| | - Robert H. Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Otelio S. Randall
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Sanford I. Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Shichen Xu
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Muluemebet Ketete
- Howard University College of Medicine, Department of Internal Medicine, Division of Cardiology, Washington DC, United States of America
| | - Maxwell A. Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John W. Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, Maharishi Vedic City, Iowa, United States of America
| | - John Fagan
- Department of Physiology and Health, Maharishi University of Management, Fairfield, Iowa, United States of America
- MUM Molecular Biology Laboratory, Maharishi University of Management, Fairfield Iowa, United States of America
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