Dietary potassium: a key mediator of the cardiovascular response to dietary sodium chloride

Modifying Dietary Sodium and Potassium Intake: An End to the 'Salt Wars'?

Excessive salt intake raises blood pressure, but the implications of this observation for human health have remained contentious. It has also been recognized for many years that potassium intake may mitigate the effects of salt intake on blood pressure and possibly on outcomes such as stroke. Recent large randomized intervention trials have provided strong support for the benefits of replacing salt (NaCl) with salt substitute (75% NaCl, 25% KCl) on hard outcomes, including stroke. During the same period of time, major advances have been made in understanding how the body senses and tastes salt, and how these sensations drive intake. Additionally, new insights into the complex interactions between systems that control sodium and potassium excretion by the kidneys, and the brain have highlighted the existence of a potassium switch in the kidney distal nephron. This switch seems to contribute importantly to the blood pressure-lowering effects of potassium intake. In recognition of these evolving data, the United States Food and Drug Administration is moving to permit potassium-containing salt substitutes in food manufacturing. Given that previous attempts to reduce salt consumption have not been successful, this new approach has a chance of improving health and ending the 'Salt Wars'.

Partial Replacement of NaCl with KCl in Cooked Meat Could Reduce the Liver Damage Through Renin-Angiotensin System in Mice

SCOPE

Dietary salt (sodium chloride, NaCl) is necessary for processed meat products, but intake of a high-sodium diet carries serious health risks. Considerable studies indicate that the partial substitution of NaCl with potassium chloride (KCl) can produce sodium-reduced cooked meat. However, most studies of sodium-reduced cooked meat focus on the production process in vitro, and the effect of cooked meat on health has not been well clarified in vivo.

METHODS AND RESULTS

This study finds that compared to the high-sodium group (HS), serum renin, angiotensin-converting enzyme (ACE), angiotensin (Ang) II, and the levels of some indicators of dyslipidemia are decreased in the reduced salt by partial substitution of NaCl with KCl group (RS + K). Furthermore, RS + K increases the antioxidation abilities, inhibits the renin-angiotensin system (RAS) through ACE/Ang II/Ang II type 1 receptor axis pathway, reduces synthesis of triglyceride and cholesterol and protein expressions of inflammatory factors interleukin-17A and nuclear factor-kappa B in the liver.

CONCLUSION

Partial substitution of NaCl with KCl in cooked meat can be a feasible approach for improving the health benefits and developing novel functional meat products for nutritional health interventions.

Potassium intake: the Cinderella electrolyte

Dietary guidelines recommend intake targets for some essential minerals, based on observational and experimental evidence relating mineral intake levels to health outcomes. For prevention of cardiovascular disease, reducing sodium intake and increasing potassium intake are the principal tools. While reducing sodium intake has received greatest public health priority, emerging evidence suggests that increasing potassium intake may be a more important target for cardiovascular prevention. Increased potassium intake reduces blood pressure and mitigates the hypertensive effects of excess sodium intake, and the recent large Phase III SSaSS trial reported that increasing potassium intake (and reducing sodium intake) in populations with low potassium intake and high sodium intake, through salt substitution (25% KCl, 75%NaCl), reduces the risk of stroke in patients at increased cardiovascular risk. As key sources of potassium intake include fruit, vegetables, nuts, and legumes, higher potassium intake may be associated with healthy dietary patterns. The current review makes the case that increasing potassium intake might represent a more advantageous dietary strategy for prevention of cardiovascular disease. Future research should focus on addressing the independent effect of potassium supplementation in populations with low or moderate potassium intake, and determine effective strategies to increase potassium intake from diet.

Omega-3 long-chain polyunsaturated fatty acids: Metabolism and health implications

Recently, omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have gained substantial interest due to their specific structure and biological functions. Humans cannot naturally produce these fatty acids (FAs), making it crucial to obtain them from our diet. This comprehensive review details n-3 LC-PUFAs and their role in promoting and maintaining optimal health. The article thoroughly analyses several sources of n-3 LC-PUFAs and their respective bioavailability, covering marine, microbial and plant-based sources. Furthermore, we provide an in-depth analysis of the biological impacts of n-3 LC-PUFAs on health conditions, with particular emphasis on cardiovascular disease (CVD), gastrointestinal (GI) cancer, diabetes, depression, arthritis, and cognition. In addition, we highlight the significance of fortification and supplementation of n-3 LC-PUFAs in both functional foods and dietary supplements. Additionally, we conducted a detailed analysis of the several kinds of n-3 LC-PUFAs supplements currently available in the market, including an assessment of their recommended intake, safety, and effectiveness. The dietary guidelines associated with n-3 LC-PUFAs are also highlighted, focusing on the significance of maintaining a well-balanced intake of n-3 PUFAs to enhance health benefits. Lastly, we highlight future directions for further research in this area and their potential implications for public health.

In vitro digestibility of proteins, peptidomic analysis and antioxidant ability of sodium-reduced pork sausage with partial substitution of NaCl by KCl

High salt (NaCl) consumption can impact on human health, and KCl is the most widely used replacement salt in meat products. This study investigated the effects of 0% NaCl (NS), 3% NaCl (HS), 1.95% NaCl (RS), 1.95% NaCl+1.05% KCl (RS + K) on protein digestibility of pork sausage in vitro. The results indicated that RS + K showed the highest gastrointestinal digestibility (GID) because of the structure of looser cross-linked strands and uniform cavities, while HS exhibited the lowest GID. RS + K released more peptides (2499) during gastrointestinal than NS (2301), RS (2130) and HS (2235), with a higher proportion of peptides with molecular weights <1000 Da, and more unique peptides. Meanwhile, the digestion product of RS + K exhibited excellent radical scavenging activity and improved the antioxidant abilities to reduce oxidative injury which was induced by H₂O₂ in HepG2 cells. These results demonstrated that partial substitution with KCl can be an effective strategy for improving the digestibility of sodium-reduced gel-type meat products.

Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort

BACKGROUND AND AIMS

Studies have revealed a positive relationship between milk consumption and hypertension. However, few researchers have investigated the association between milk consumption and changes in blood pressure (BP) in South Korean adults. Therefore, we examined the association between milk intake and the management and risk of hypertension in South Korean adults.

METHODS AND RESULTS

Participants were selected from the Health Examinees study. The definition of hypertension was based on the guidelines of the Korean Society of Hypertension. The participants were divided into three groups according to changes between baseline and follow-up BP data. Milk consumption was assessed using food frequency questionnaires. In both men and women, the higher milk consumption group had increased odds of trends of BP improvement (OR: 1.249, 95% CI: 1.043-1.496, p for trend: 0.2271 in men; OR: 1.147, 95% CI: 1.014-1.297, p for trend: 0.0293 in women) and decreased odds of trends of worsening (OR: 0.861, 95% CI: 0.756-0.980, p for trend: <0.0001 in men, OR: 0.866, 95% CI: 0.794-0.943, p for trend: 0.0010 in women) compared to those of the non-consumption group. In the prospective study, milk intake was inversely associated with hypertension risk (HR: 0.900, 95% CI: 0.811-0.999, p for trend: 0.0076 in men; HR: 0.879, 95% CI: 0.814-0.949, p for trend: 0.0002 in women).

CONCLUSION

Increased intake of milk was inversely related to the risk of increased BP, with a decreased risk of hypertension events.

Key nutrients important in the management of canine myxomatous mitral valve disease and heart failure

The most common cause of heart failure in dogs is myxomatous mitral valve disease (MMVD), which accounts for approximately 75% of canine heart disease cases and is especially common in smaller dogs. Although low-sodium diets have been recommended for humans with heart diseases for decades, there is little evidence to support this practice in dogs. In recent years, however, it has become clear that other nutrients are important to heart health. Dogs with heart disease secondary to MMVD experience patterns of metabolic changes that include decreased mitochondrial energy metabolism and ATP availability, with increased oxidative stress and inflammation. These changes occur early in disease and progress with worsening heart disease. Key nutrients that may support normal function and address these changes include omega-3 fatty acids, medium-chain triglycerides, magnesium, antioxidants including vitamin E and taurine, and the amino acids methionine and lysine. The long-chain omega-3 fatty acids provide anti-inflammatory, antithrombotic, and other benefits. Medium-chain fatty acids and ketones derived from medium-chain triglycerides provide an alternative energy source for cardiac mitochondria and help reduce free radical production. Magnesium supports mitochondrial function, normal cardiac rhythm, and provides other benefits. Both vitamin E and taurine counter oxidative stress, and taurine also has direct cardiac benefits. Dogs with MMVD have reduced plasma methionine. Methionine and lysine are important for carnitine production as well as other functions. This article reviews the evidence supporting the functions and benefits of these and other nutrients in MMVD and other cardiac conditions.

Changes in the Urinary Sodium-to-Potassium Ratio Are Associated with Blood Pressure Change in Older Japanese Adults: A 7-Year Longitudinal Study

Studies on the association between sodium-to-potassium (Na/K) ratio changes and blood pressure (BP) changes among older adults are limited. This 7-year longitudinal study examined the association between Na/K ratio changes (evaluated using spot urine tests) and BP changes among older Japanese adults. Data were collected from 432 participants (mean age: 70.3±4.4; range: 65−84 years) in 2012 and 2019. Changes in BP and the Na/K ratio over 7 years were calculated by subtracting baseline values from values noted during a follow-up survey. The median systolic and diastolic BP (SBP) and (DBP) changes after 7 years were 4 (IQR, −7, 14) and −1 (IQR, −9, 5) mmHg, respectively. The median Na/K ratio was changed during the follow-up period by −0.2 (IQR, −1.3, 0.7). A generalized linear model indicated that Na/K ratio changes were positively associated with SBP (B = 2.03, p < 0.001) and DBP (B = 0.62, p = 0.021) changes. In the non-antihypertensive medication-using group, urinary Na/K ratio changes were associated with SBP and DBP changes (B = 2.39, p = 0.001; B = 0.99, p = 0.033). In the antihypertensive medication user group, urinary Na/K ratio changes were associated with SBP changes (B = 1.62, p = 0.015). We confirmed the association between changes in the Na/K ratio and changes in BP.

The Yin-Yang Dynamics in Cardiovascular Pharmacogenomics and Personalized Medicine

Studies of genetic variants and systems biology have indicated that Yin-Yang dynamics are especially meaningful for cardiovascular pharmacogenomics and personalized therapeutic strategies. The comprehensive concepts of Yin-Yang can be used to characterize the dynamical factors in the adaptive microenvironments of the complex cardiovascular systems. The Yin-Yang imbalances in the complex adaptive systems (CAS) at different levels and stages are essential for cardiovascular diseases (CVDs), including atherosclerosis, hypertension, and heart failure (HF). At the molecular and cellular levels, Yin-Yang interconnections have been considered critical for genetic variants and various pathways, mitophagy, cell death, and cholesterol homeostasis. The significance of the adaptive and spatiotemporal factors in the nonlinear Yin-Yang interactions has been identified in different pathophysiological processes such as fibrosis. The Yin-Yang dynamical balances between proinflammatory and anti-inflammatory cytokines have vital roles in the complex reactions to stress and impairments to the heart. Procoagulant and anticoagulant lipids and lipoproteins in plasma have the Yin-Yang roles that increase or decrease thrombin productions and thrombosis. At the systems level, the Yin-Yang type of relationships has been suggested between atrial fibrillation (AF), diastolic dysfunction (DD), and HF. Based on such perceptions, systemic and personalized cardiovascular profiles can be constructed by embracing the features of CAS, especially the microenvironments and the adaptative pathophysiological stages. These features can be integrated into the comprehensive Yin-Yang dynamics framework to identify more accurate biomarkers for better prevention and treatments. The goal of reestablishing ubiquitous Yin-Yang dynamical balances may become the central theme for personalized and systems medicine for cardiovascular diseases.

Associations between diet quality, blood pressure, and glucose levels among pregnant women in the Asian megacity of Jakarta

BACKGROUND

The prevalence of gestational hypertension and diabetes in pregnancy is increasing worldwide. Diet is a modifiable factor that may influence these conditions, but few studies have examined the association between diet quality and blood pressure and glucose profiles among pregnant women. Data are especially scarce for women in low- and middle-income countries (LMICs), where 90% of global pregnancies occur, and in urban settings. We, therefore, assessed these associations among 174 pregnant women in the Asian megacity of Jakarta in a cross-sectional study of the Brain Probiotic and LC-PUFA Intervention for Optimum Early Life (BRAVE) project.

METHODS

Trained field-enumerators collected socio-demographic characteristics, measured Mid-Upper Arm Circumference (MUAC), and assessed diet by two 24-hour recalls, which were used to calculate the Alternate Healthy Eating Index for Pregnancy (AHEI-P). Blood pressure was measured by automated sphygmomanometer, and fasting blood glucose by capillary glucometer. General linear models were used to identify associations.

RESULTS

The median AHEI-P score was 47.4 (IQR 19.1-76.6). The middle tertile of the AHEI-P score (39.59-56.58) was associated with a 0.4 SD (standardized effect size, 95% CI -0.7 to -0.06; p = 0.02) lower diastolic blood pressure compared with the lowest tertile (<39.59), after adjustment for level of education, smoking status, MUAC, gestational age, history of hypertension, and family history of hypertension. However, no associations were found between the AHEI-P score and systolic blood pressure and blood glucose.

CONCLUSION

Higher diet quality was associated with lower diastolic blood pressure among pregnant women in an urban LMIC community, but not with systolic blood pressure and blood glucose. A behavioral change intervention trial would be warranted to confirm the influence of diet quality on blood pressure and glucose levels and among pregnant women, and even before pregnancy.

Activation of the Sympathetic Nervous System Promotes Blood Pressure Salt-Sensitivity in C57BL6/J Mice

Global salt intake averages >8 g/person per day, over twice the limit advocated by the American Heart Association. Dietary salt excess leads to hypertension, and this partly mediates its poor health outcomes. In ≈30% of people, the hypertensive response to salt is exaggerated. This salt-sensitivity increases cardiovascular risk. Mechanistic cardiovascular research relies heavily on rodent models and the C57BL6/J mouse is the most widely used reference strain. We examined the effects of high salt intake on blood pressure, renal, and vascular function in the most commonly used and commercially available C57BL6/J mouse strain. Changing from control (0.3% Na⁺) to high salt (3% Na⁺) diet increased systolic blood pressure in male mice by ≈10 mm Hg within 4 days of dietary switch. This hypertensive response was maintained over the 3-week study period. Returning to control diet gradually reduced blood pressure back to baseline. High-salt diet caused a rapid and sustained downregulation in mRNA encoding renal NHE3 (sodium-hydrogen-exchanger 3) and EnaC (epithelial sodium channel), although we did not observe a suppression in aldosterone until ≈7 days. During the development of salt-sensitivity, the acute pressure natriuresis relationship was augmented and neutral sodium balance was maintained throughout. High-salt diet increased ex vivo sensitivity of the renal artery to phenylephrine and increased urinary excretion of adrenaline, but not noradrenaline. The acute blood pressure-depressor effect of hexamethonium, a ganglionic blocker, was enhanced by high salt. Salt-sensitivity in commercially sourced C57BL6/J mice is attributable to sympathetic overactivity, increased adrenaline, and enhanced vascular sensitivity to alpha-adrenoreceptor activation and not sodium retention or attenuation of the acute pressure natriuresis response.

Sodium and Potassium Intake and Cardiovascular Disease in Older People: A Systematic Review

This review aims to examine the relationship of sodium and potassium intake and cardiovascular disease (CVD) among older people. Methods: We performed a literature search using PubMed and Web of Science (January 2015 to July 2020) without language restriction. Observational and experimental studies that reported the relationship between sodium, potassium, or sodium-to-potassium ratio with CVD among older adults aged higher than 60 years were included. The authors independently screened all identified studies, extracted information, and assessed the quality of included studies. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool (RoB 2 tool) for randomized trials. Results: We included 12 studies (6 prospective cohort studies, 5 cross-sectional studies, and 1 experimental study). Five of the studies reported on sodium-to-potassium ratio (n = 5), and the others on potassium and/or sodium intake. Cardiovascular events (e.g., stroke and heart failure) were the most reported outcome (n = 9). Of the 12 studies included, five observational studies had low bias risk and the randomized controlled trial was judged as uncertain risk of bias. We found inconsistent results for the effect of the reduction of sodium intake in this population for lower risk of CVD. We found that both the increase of potassium intake and the decrease of sodium-to-potassium ratio were associated with lower risk of hypertension and CVD, particularly stroke. Conclusion: The present review suggests that both higher potassium and lower sodium-to-potassium ratio are associated with lower risk of CVD.

Beyond Fish Oil Supplementation: The Effects of Alternative Plant Sources of Omega-3 Polyunsaturated Fatty Acids upon Lipid Indexes and Cardiometabolic Biomarkers-An Overview

Cardiovascular diseases remain a global challenge, and lipid-associated biomarkers can predict cardiovascular events. Extensive research on cardiovascular benefits of omega-3 polyunsaturated fatty acids (n3-PUFAs) is geared towards fish oil supplementation and fish-rich diets. Nevertheless, vegetarianism and veganism are becoming more popular across all segments of society, due to reasons as varied as personal, ethical and religious values, individual preferences and environment-related principles, amongst others. Due to the essentiality of PUFAs, plant sources of n3-PUFAs warrant further consideration. In this review, we have critically appraised the efficacy of plant-derived n3-PUFAs from foodstuffs and supplements upon lipid profile and selected cardiometabolic markers. Walnuts and flaxseed are the most common plant sources of n3-PUFAs, mainly alpha-linolenic acid (ALA), and feature the strongest scientific rationale for applicability into clinical practice. Furthermore, walnuts and flaxseed are sources of fibre, potassium, magnesium, and non-essential substances, including polyphenols and sterols, which in conjunction are known to ameliorate cardiovascular metabolism. ALA levels in rapeseed and soybean oils are only slight when compared to flaxseed oil. Spirulina and Chlorella, biomasses of cyanobacteria and green algae, are important sources of n3-PUFAs; however, their benefits upon cardiometabolic markers are plausibly driven by their antioxidant potential combined with their n3-PUFA content. In humans, ALA is not sufficiently bioconverted into eicosapentaenoic and docosahexaenoic acids. However, evidence suggests that plant sources of ALA are associated with favourable cardiometabolic status. ALA supplementation, or increased consumption of ALA-rich foodstuffs, combined with reduced omega-6 (n6) PUFAs intake, could improve the n3/n6 ratio and improve cardiometabolic and lipid profile.

Nutrients, Bioactive Compounds and Bioactivity: The Health Benefits of Sweet Cherries (Prunus avium L.)

Background:

Sweet cherries are one of the most appreciated fruits worldwide as well as one of the great sources of several active substances, as phytochemical compounds (carotenoids, serotonin, melatonin and phenolic compounds) as well as in nutritive compounds (sugars and organic acids). Accumulating research demonstrate that their supplementation in our daily diet can contradict oxidative stress, mitigating or even attenuating chronic diseases, as cancerous processes, antiinflammatory- related disorders, diabetes, and neurological and cardiovascular pathologies. Therefore, the aims of this review are to present an overview on the effects of sweet cherries as health promotors, giving emphasis to the health benefits of their bioactive compounds, particularly their antimicrobial, antioxidant, antidiabetic, anticancer, anti-neurodegeneration, anti-inflammatory and cardiovascular effects.

Methods:

Research and online content about sweet cherry fruits is reviewed. The information available has been read several times to avoid inconsistencies. In addition, according what we read, original figures were done and added to facilitate understanding and to enrich the paper.

Results:

In this review, a total of 202 original reports were used. In respect to health benefits, it is possible to confirm by several studies that, in fact, the consumption of sweet cherries has positive impacts in human health, owing to their wealthy and vast constitution, particularly in phenolic compounds, vitamins and carotenoids whose health properties were already documented.

Conclusion:

The findings of this review support the evidence that sweet cherries can be applied in pharmaceutical and food formulations, since they are able to diminish free radical species and proinflammatory markers, preventing and/ or ameliorating oxidative-stress disorders.

DASH Dietary Pattern and Cardiometabolic Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses

Background: The Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which emphasizes fruit, vegetables, fat-free/low-fat dairy, whole grains, nuts and legumes, and limits saturated fat, cholesterol, red and processed meats, sweets, added sugars, salt and sugar-sweetened beverages, is widely recommended by international diabetes and heart association guidelines. Objective: To summarize the available evidence for the update of the European Association of the Study of Diabetes (EASD) guidelines, we conducted an umbrella review of existing systematic reviews and meta-analyses using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach of the relation of the DASH dietary pattern with cardiovascular disease and other cardiometabolic outcomes in prospective cohort studies and its effect on blood pressure and other cardiometabolic risk factors in controlled trials in individuals with and without diabetes. Methods: MEDLINE and EMBASE were searched through 3 January 2019. We included systematic reviews and meta-analyses assessing the relation of the DASH dietary pattern with cardiometabolic disease outcomes in prospective cohort studies and the effect on cardiometabolic risk factors in randomized and non-randomized controlled trials. Two independent reviewers extracted relevant data and assessed the risk of bias of individual studies. The primary outcome was incident cardiovascular disease (CVD) in the prospective cohort studies and systolic blood pressure in the controlled trials. Secondary outcomes included incident coronary heart disease, stroke, and diabetes in prospective cohort studies and other established cardiometabolic risk factors in controlled trials. If the search did not identify an existing systematic review and meta-analysis on a pre-specified outcome, then we conducted our own systematic review and meta-analysis. The evidence was summarized as risk ratios (RR) for disease incidence outcomes and mean differences (MDs) for risk factor outcomes with 95% confidence intervals (95% CIs). The certainty of the evidence was assessed using GRADE. Results: We identified three systematic reviews and meta-analyses of 15 unique prospective cohort studies (n = 942,140) and four systematic reviews and meta-analyses of 31 unique controlled trials (n = 4,414) across outcomes. We conducted our own systematic review and meta-analysis of 2 controlled trials (n = 65) for HbA1c. The DASH dietary pattern was associated with decreased incident cardiovascular disease (RR, 0.80 (0.76–0.85)), coronary heart disease (0.79 (0.71–0.88)), stroke (0.81 (0.72–0.92)), and diabetes (0.82 (0.74–0.92)) in prospective cohort studies and decreased systolic (MD, −5.2 mmHg (95% CI, −7.0 to −3.4)) and diastolic (−2.60 mmHg (−3.50 to −1.70)) blood pressure, Total-C (−0.20 mmol/L (−0.31 to −0.10)), LDL-C (−0.10 mmol/L (−0.20 to −0.01)), HbA1c (−0.53% (−0.62, −0.43)), fasting blood insulin (−0.15 μU/mL (−0.22 to −0.08)), and body weight (−1.42 kg (−2.03 to −0.82)) in controlled trials. There was no effect on HDL-C, triglycerides, fasting blood glucose, HOMA-IR, or CRP. The certainty of the evidence was moderate for SBP and low for CVD incidence and ranged from very low to moderate for the secondary outcomes. Conclusions: Current evidence allows for the conclusion that the DASH dietary pattern is associated with decreased incidence of cardiovascular disease and improves blood pressure with evidence of other cardiometabolic advantages in people with and without diabetes. More research is needed to improve the certainty of the estimates.

Postulating the major environmental condition resulting in the expression of essential hypertension and its associated cardiovascular diseases: Dietary imprudence in daily selection of foods in respect of their potassium and sodium content resulting in oxidative stress-induced dysfunction of the vascular endothelium, vascular smooth muscle, and perivascular tissues

We hypothesize that the major environmental determinant of the expression of essential hypertension in America and other Westernized countries is dietary imprudence in respect of the consumption of daily combinations of foods containing suboptimal amounts of potassium and blood pressure-lowering phytochemicals, and supraphysiological amounts of sodium. We offer as premise that Americans on average consume suboptimal amounts of potassium and blood pressure-lowering phytochemicals, and physiologically excessive amounts of sodium, and that such dietary imprudence leads to essential hypertension through oxidative stress-induced vascular endothelial and smooth muscle dysfunction. Such dysfunctions restrict nitric oxide bioavailability, impairing endothelial cell-mediated relaxation of the underlying vascular smooth muscle, initiating and maintaining inappropriately increased peripheral and renal vascular resistance. The biochemical steps from oxidative stress to vascular endothelial dysfunction and its pernicious cardiovascular consequences are well established and generally accepted. The unique aspect of our hypothesis resides in the contention that Americans' habitual consumption of foods resulting in suboptimal dietary intake of potassium and supraphysiological intake of sodium result in oxidative stress, the degree of which, we suggest, will correlate with the degree of deviation of potassium and sodium intake from optimal. Because suboptimal intakes of potassium reflect suboptimal intakes of fruits and vegetables, associated contributors to oxidative stress include suboptimal intakes of magnesium, nitrate, polyphenols, carotenoids, and other phytochemical antioxidants for which fruits and vegetables contain abundant amounts. Currently Americans consume potassium-to-sodium in molar ratios of less than or close to 1.0 and the Institute of Medicine (IOM) recommends a molar ratio of 1.2. Ancestral diets to which we are physiologically adapted range from molar ratios of 5.0 to 10.0 or higher. Accordingly, we suggest that the average American is usually afflicted with oxidative stress-induced vascular endothelial dysfunction, and therefore the standards for normal blood pressure and pre-hypertension often reflect a degree of clinically significant hypertension. In this article, we provide support for those contentions, and indicate the findings that the hypothesis predicts.

School meals' centesimal and mineral composition and their nutritional value for Brazilian children

The assessment of meals served under the Brazilian National School Meal Program (PNAE) is an important tool to verify its adequacy to the proposed parameters and the nutritional needs of school-aged children. The aim of this study was to evaluate the centesimal and mineral composition of the meals offered by the program and adequacy to the nutritional recommendations in three municipalities of the state of Bahia, Brazil. Centesimal composition of meals was determined according to the reference guidelines and mineral composition was analyzed by atomic absorption spectrometry. Non-parametric analysis of variance was used to test the differences of the medians among the municipalities and Student-t test to compare the means between the two sampling periods. There were inadequacies in the carbohydrate, lipid and protein contents, and none of the municipalities reached the recommendation of 20%. Mineral concentration, especially Fe, Se, Cu and K were much lower than expected. Sodium levels were three-folds higher than the recommended, being worrisome due to higher risk of elevated blood pressure. There were inadequacies with regard to the PNAE guidelines, and there is a need to reevaluate the meals that are being offered to better meet childreńs needs and to form healthy habits from childhood.

Dietary sodium, sodium-to-potassium ratio, and risk of stroke: A systematic review and nonlinear dose-response meta-analysis

BACKGROUND & AIMS

The association of high sodium intake with risk of stroke has been accepted. But considering the proposed J/U-shaped association between sodium intake and risk of all-cause mortality, the shape of the dose-response relationship has not been determined yet. This study aimed to test the dose-response association of dietary sodium and sodium-to-potassium ratio with risk of stroke in adults aged 18 years or older.

METHODS

We performed a systematic search using PubMed and Scopus, from database inception up to October 2017. Prospective and retrospective observational studies reporting risk estimates of stroke for three or more quantitative categories of dietary sodium or sodium-to-potassium ratio were included. Studies that reported results as continuous were also included. Two independent authors extracted the information and assessed the quality of included studies. Pooled relative risk (RR) was calculated using a random-effects model. Publication bias was tested. Sensitivity and subgroup analyses were done.

RESULTS

Of initial 20,412 studies identified, 14 prospective cohort studies, one case-cohort study, and one case-control study (total n = 261,732) with 10,150 cases of stroke were included. The Pooled RRs of stroke were 1.06 (95%CI: 1.02, 1.10; I² = 60%, n = 14 studies) for a 1 gr/d increment in dietary sodium intake, and 1.22 (95%CI: 1.04, 1.41; I² = 60%, n = 5 studies) for a one-unit increment in dietary sodium-to-potassium ratio (mmol/mmol). The risk of stroke increased linearly with increasing dietary sodium intake, and also along with the increase in dietary sodium-to-potassium ratio. No evidence of a J/U-shaped association was found in the analyses of total stroke, stroke incidence, and stroke mortality. High sodium intake was associated with a somewhat worse prognosis among Asian countries as compared to westerns.

CONCLUSION

Higher sodium intake and higher dietary sodium-to-potassium ratio were associated with a higher risk of stroke. Reducing dietary sodium-to-potassium ratio can be considered as a supplementary approach in parallel with the decrease in sodium intake in order to decrease stroke risk. The interpretation of the results is limited by observational nature of studies examined.

Short-Term High-Salt Diet Increases Corin Level to Regulate the Salt-Water Balance in Humans and Rodents

BACKGROUND

Dietary sodium and potassium affect the fluctuation in blood pressure (BP) and renal function. Corin, with its enzymatic activity to convert pro-atrial natriuretic peptide (pro-ANP) to biologically active ANP, regulates BP, cardiac, and renal functions. We investigated whether corin expression responds to a high-salt (HS) diet to regulate salt and water balance.

METHODS

Forty-two volunteers followed 3 sequential diets for 7 days each: a low-salt (LS) diet (3.0 g/day NaCl), a HS diet (18.0 g/day NaCl), followed by an HS diet with K+ supplementation (HS + K+) (18.0 g/day NaCl and 4.5 g/day KCl).

RESULTS

Corin level was higher with the HS diet than the LS and HS + K+ diets and was positively correlated with systolic BP (SBP) and 24-hour urinary Na+ and microalbumin (U-mALB) excretion. In rodents, serum and renal levels of corin were transiently increased with the HS diet and were decreased if the HS diet was continued for up to 7 days. HS loading increased SBP, 24-hour urinary Na+, U-mALB excretion, and the expression of proprotein convertase subtilisin/kexin-6 (PCSK6), a corin activator. Knockdown of PCSK6 or corin in high salt-treated M1-cortical collecting duct (M1-CCD) cells increased the expression of aquaporin 2 (AQP2) and β-epithelial Na+ channel (β-ENaC).

CONCLUSIONS

Short-term HS may induce the PCSK6-corin-ANP-AQP2/β-ENaC pathway in the kidney. Enhanced serum corin level in humans and rodents is positively correlated with HS-induced SBP and 24-hour urinary Na+ and U-mALB excretion, which suggests that corin is involved in the salt-water balance in response to HS intake.

CLINICAL TRIALS REGISTRATION

Public Trials Registry Number NCT02915315.

Relationship between indirect blood pressure and various stages of chronic kidney disease in cats

Chronic kidney disease (CKD) is a common cause of secondary systemic hypertension in cats. We investigated the relationship between indirect blood pressure and the prevalence of systemic hypertension in various CKD stages in cats. Client-owned cats (24 control cats and 77 cats with CKD) were included. Biochemical examinations of plasma were conducted by a commercial laboratory. Diseased cats were divided into two groups based on the International Renal Interest Society (IRIS) guidelines (II and III–IV). Indirect blood pressure was measured using an oscillometric technique. Severe hypertension was diagnosed if systolic blood pressure (SBP) was ≥180 mmHg. Indirect blood pressures were significantly higher in IRIS stage III–IV than in the control cats. Of 77 cats with CKD, 25 (32.5%) had severe hypertension. The frequency of severe hypertension increased with an increase in IRIS stage; 0% in the controls, 27.6% in the IRIS stage II, and 47.4% in the IRIS stage III–IV, respectively. The indirect SBP was weakly correlated with urea nitrogen (r=0.27) and creatinine (r=0.23) concentrations in plasma. Binary logistic regression analysis showed that if plasma creatinine concentration is >3.7 mg/dl, cats with CKD had an increased risk for developing severe hypertension (P<0.001). Our results suggest that indirect blood pressure was correlated with the severity of CKD, and the prevalence of severe hypertension increased in cats with severe CKD. The risk of severe hypertension may be high in cats with severe CKD.

Dietary sodium, dietary potassium, and systolic blood pressure in US adolescents

Both high sodium and low potassium diets are associated with hypertension, but whether these risk factors are distinct or overlapping has not been thoroughly investigated. The authors evaluated the relationship between dietary sodium, potassium, and high systolic blood pressure among 4716 adolescents aged 12 to 14 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2012. There was no association with blood pressure across most values of sodium or potassium intake. However, participants who reported sodium intake ≥7500 mg/d, potassium <700 mg/d, or sodium-potassium ratio ≥2.5 had increased odds for high systolic blood pressure (≥95th percentile for age, sex, and height). Although the high sodium and low potassium groups did not overlap, 49.2% of these adolescents also had a sodium-potassium ratio ≥2.5. In young adolescents, both excessive sodium and limited potassium are associated with high systolic blood pressure, but the balance between sodium and potassium intake may be more useful in explaining blood pressure in this population.

Contributions of Various Radiological Sources to Background in a Suburban Environment

This work is a brief overview and comparison of dose rates stemming from both indoor and outdoor natural background radiation and household objects within a suburban environment in North Carolina. Combined gamma and beta dose rates were taken from indoor objects that ranged from the potassium in fruit to the americium in smoke detectors. For outdoor measurements, various height and time data samples were collected to show fluctuations in dose rate due to temperature inversion and geometric attenuation. Although each sample tested proved to have a statistically significant increase over background using Students t-test, no sample proved to be more than a minor increase in natural radiation dose. The relative contributions from natural radioactivity such as potassium in foods and common household items are shown to be easily distinguished from background using standard handheld instrumentation when applied in a systematic, methodological manner.

Salt-sensitive hypertension: mechanisms and effects of dietary and other lifestyle factors

Salt sensitivity, which is an increase in blood pressure in response to high dietary salt intake, is an independent risk factor for cardiovascular disease and mortality. It is associated with physiological, environmental, demographic, and genetic factors. This review focuses on the physiological mechanisms of salt sensitivity in populations at particular risk, along with the associated dietary factors. The interplay of mechanisms such as the renin-angiotensin aldosterone system, endothelial dysfunction, ion transport, and estrogen decrease in women contributes to development of salt sensitivity. Because of their effects on these mechanisms, higher dietary intakes of potassium, calcium, vitamin D, antioxidant vitamins, and proteins rich in L-arginine, as well as adherence to dietary patterns similar to the DASH (Dietary Approaches to Stop Hypertension) diet, can be beneficial to salt-sensitive populations. In contrast, diets similar to the typical Western diet, which is rich in saturated fats, sucrose, and fructose, together with excessive alcohol consumption, may exacerbate salt-sensitive changes in blood pressure. Identifying potential mechanisms of salt sensitivity in susceptible populations and linking them to protective or harmful dietary and lifestyle factors can lead to more specific guidelines for the prevention of hypertension and cardiovascular disease.

Role of Dietary Components in Modulating Hypertension

Hypertension is a major health issue, particularly in medically underserved populations that may suffer from poor health literacy, poverty, and limited access to healthcare resources. Management of the disease reduces the risk of adverse outcomes, such as cardiovascular or cerebrovascular events, vision impairment due to retinal damage, and renal failure. In addition to pharmacological therapy, lifestyle modifications such as diet and exercise are effective in managing hypertension. Current diet guidelines include the DASH diet, a low-fat and low-sodium diet that encourages high consumption of fruits and vegetables. While the diet is effective in controlling hypertension, adherence to the diet is poor and there are few applicable dietary alternatives, which is an issue that can arise from poor health literacy in at-risk populations. The purpose of this review is to outline the effect of specific dietary components, both positive and negative, when formulating a dietary approach to hypertension management that ultimately aims to improve patient adherence to the treatment, and achieve better control of hypertension.

The Circadian Clock in the Regulation of Renal Rhythms

Since the kidney is integral to maintenance of fluid and ion homeostasis, and therefore blood pressure regulation, its proper function is paramount. Circadian fluctuations in blood pressure, renal blood flow, glomerular filtration rate, and sodium and water excretion have been documented for decades, if not longer. Recent studies on the role of circadian clock proteins in the regulation of a variety of renal transport genes suggest that the molecular clock in the kidney controls circadian fluctuations in renal function. The circadian clock appears to be a critical regulator of renal function with important implications for the treatment of renal pathologies, which include chronic kidney disease and hypertension. The development, regulation, and mechanism of the kidney clock are reviewed here.

Use of Urine Biomarkers to Assess Sodium Intake: Challenges and Opportunities

This article summarizes current data and approaches to assess sodium intake in individuals and populations. A review of the literature on sodium excretion and intake estimation supports the continued use of 24-h urine collections for assessing population and individual sodium intake. Since 2000, 29 studies used urine biomarkers to estimate population sodium intake, primarily among adults. More than half used 24-h urine; the rest used a spot/casual, overnight, or 12-h specimen. Associations between individual sodium intake and health outcomes were investigated in 13 prospective cohort studies published since 2000. Only three included an indicator of long-term individual sodium intake, i.e., multiple 24-h urine specimens collected several days apart. Although not insurmountable, logistic challenges of 24-h urine collection remain a barrier for research on the relationship of sodium intake and chronic disease. Newer approaches, including modeling based on shorter collections, offer promise for estimating population sodium intake in some groups.

Tree nut consumption is associated with better nutrient adequacy and diet quality in adults: National Health and Nutrition Examination Survey 2005-2010

Nutrient adequacy of tree nut consumers has not been examined. The National Health and Nutrition Examination Survey 2005–2010 data were used to assess the association of tree nut consumption by adults 19+ years (n = 14,386) with nutrient adequacy and diet quality. Covariate adjusted usual intake was determined using two 24-h dietary recalls and the National Cancer Institute method. Percentages of the consumption groups below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was determined using the Healthy Eating Index-2005 (HEI) score. Usual intake data showed consumers of tree nuts had a lower percentage (p < 0.0001) of the population below the EAR for vitamins A (22 ± 5 vs. 49 ± 1), E (38 ± 4 vs. 94 ± 0.4) and C (17 ± 4 vs. 44 ± 1); folate (2.5 ± 1.5 vs. 12 ± 0.6); calcium (26 ± 3 vs. 44 ± 1); iron (3 ± 0.6 vs. 9 ± 0.4); magnesium (8 ± 1 vs. 60 ± 1); and zinc (1.5 ± 1 vs. 13 ± 1). Tree nut consumers had a higher percentage (p < 0.0001) of the population above the AI for fiber (33 ± 3 vs. 4 ± 0.3) and potassium (12 ± 3 mg vs. 2 ± 0.2 mg). HEI-2005 total score was higher (p < 0.0001) in tree nut consumers (61 ± 0.7 vs. 52 ± 0.3) than non-consumers. Health professionals should encourage the use of tree nuts as part of a dietary approach to healthy eating.