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Mansouri K, Greupner T, Hahn A. Blood Pressure Stability and Plasma Aldosterone Reduction: The Effects of a Sodium and Bicarbonate-Rich Water - A Randomized Controlled Intervention Study. Blood Press 2024; 33:2291411. [PMID: 38124675 DOI: 10.1080/08037051.2023.2291411] [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: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Objective: Hypertension is a recognized risk factor for cardiovascular disease (CVD), and dietary sodium intake has been linked to its development. However, mineral water high in bicarbonate and sodium does not appear to have adverse effects on blood pressure.This study examines the effects of consuming a mineral water high in bicarbonate and sodium (HBS) compared to a low bicarbonate and sodium (LBS) mineral water on blood pressure and related factors.Methods: A randomized controlled intervention was conducted with 94 healthy participants, consuming 1,500 - 2,000 mL daily of either mineral water high in bicarbonate and sodium (HBS water, n = 49) or low in bicarbonate and sodium (LBS water, n = 45). Blood pressure, anthropometrics, and urinary calcium and sodium excretion were assessed at baseline and after 28 days. 3-day food protocols were assessed to evaluate possible dietary changes.Results: Blood pressure changes did not differ between the groups. Both normotensive and hypertensive subjects showed similar changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in response to the different test waters. Serum aldosterone decreased significantly in both groups, with a greater reduction in the HBS group. Urinary calcium excretion significantly decreased (p = 0.002) and sodium excretion increased in the HBS group. Multiple linear regression analyses indicated no association between urinary sodium excretion and systolic blood pressure increase in the HBS group (B = 0.046, p = 0.170). Changes in urinary sodium excretion did not correlate with changes in serum aldosterone in the same group (r=-0.146, p = 0.350).Conclusions: The study revealed no significant differences in blood pressure changes between individuals consuming HBS water and LBS water. Notably, the additional sodium intake from the test water was effectively excreted.Trial registration: This trial was registered in the German Clinical Trials Register (DRKS00025341, https://drks.de/search/en).
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Affiliation(s)
- Katharina Mansouri
- Institute of Food Science and Human Nutrition, Leibniz University Hanover, 30159, Hanover, Germany
| | - Theresa Greupner
- Institute of Food Science and Human Nutrition, Leibniz University Hanover, 30159, Hanover, Germany
| | - Andreas Hahn
- Institute of Food Science and Human Nutrition, Leibniz University Hanover, 30159, Hanover, Germany
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Campos Nonato I, Mendoza K, Vargas Meza J, Flores Aldana M, Barquera S. Sodium and potassium excretion and its association with cardiovascular disorders in Mexican adults. Front Nutr 2024; 11:1395016. [PMID: 38978698 PMCID: PMC11228292 DOI: 10.3389/fnut.2024.1395016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/06/2024] [Indexed: 07/10/2024] Open
Abstract
Worldwide, as well as in Mexico, the leading cause of death is cardiovascular disease (CVD). Hypertension is the main risk factor for CVD; about 50% of the adult population suffers from this condition. High sodium (Na) intake combined with low potassium (K) intake can trigger cardiovascular disorders such as high blood pressure (BP). The aim of this study was to estimate the mean excretion of Na and K in Mexican adults using a spot urine sample, and its association with cardiovascular disorders. Information on 2,778 adults, 20-59 years of age, who participated in ENSANUT-2016 was analyzed. Na and K were estimated using Tanaka formulae. Biomarkers such as glucose, total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, and anthropometry were measured. Mean Na was 3,354 mg/day (95%CI: 3,278, 3,429), 1,440 mg/day of K (95%CI: 1,412, 1,469), and the Na-K ratio was 2.4. The excretion of Na was greater in adults with high BP (3,542 mg/day) compared to those with normal BP (3,296 mg/day). In adults with hypertension, excretion of K was 10% greater (1,534 mg/day) than in adults with normal BP (1,357 mg/day). In adults with moderate reduction of renal function, Na excretion was 22% less (2,772 mg/day) than in adults with normal kidney function (3,382 mg/day). The results of this study show that the cardiovascular health of Mexican adults is at risk, as they showed high Na excretion and low K excretion.
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Affiliation(s)
- Ismael Campos Nonato
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Kenny Mendoza
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Jorge Vargas Meza
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
- El Poder del Consumidor A.C., Mexico City, Mexico
| | - Mario Flores Aldana
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Simón Barquera
- Research Center of Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
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3
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Baker MB, Binda DD, Nozari A, Baker WE. The Silent Threat of Hypokalemia after High Voltage Electrical Injuries: A Case Study and Review of the Literature. J Clin Med 2024; 13:2852. [PMID: 38792394 PMCID: PMC11122100 DOI: 10.3390/jcm13102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
High-voltage electrical injuries, especially from lightning strikes, can cause life-threatening complications due to extreme temperature and voltage exposure. While burns and cardiac complications have been widely described, the documentation of metabolic imbalances, particularly hypokalemia, has not been as prevalent. This report focuses on a patient with profound transient hypokalemia following a lightning strike, alongside a review of three similar cases of transient hypokalemia from the literature. Our patient, a previously healthy young man, was struck by lightning and subsequently suffered transient hypokalemia with lower extremity sensory changes, which resolved after the normalization of serum potassium levels. While the exact underlying mechanisms of transient hypokalemia following high-voltage electrical injuries are unknown, we propose a multifactorial mechanism, which includes massive intracellular shifts of potassium due to elevated epinephrine levels and the prevention of potassium efflux through the electrical disruption of voltage-gated potassium channels. Our report underscores the importance of recognizing hypokalemia in patients with high-voltage electrical injuries and contributes to the understanding of the complex mechanisms involved. Further research is necessary to understand the connection between cellular changes induced by high-voltage exposure and their effects on metabolism, particularly in relation to hypokalemia.
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Affiliation(s)
- Maxwell B. Baker
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - Dhanesh D. Binda
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - Ala Nozari
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA; (M.B.B.); (D.D.B.)
| | - William E. Baker
- Department of Emergency Medicine, University of Vermont Robert Larner College of Medicine, Burlington, VT 05401, USA;
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Ito S, Asakura K, Sugiyama K, Takakura M, Todoriki H. Association between sodium and potassium excretion estimated from spot urine and socioeconomic status among primary school children and their mothers in Okinawa, Japan. Hypertens Res 2024; 47:1175-1183. [PMID: 38177286 DOI: 10.1038/s41440-023-01564-9] [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: 08/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024]
Abstract
Hypertension is the greatest and the most preventable risk factor for cardiovascular disease. Excessive sodium (Na) intake and insufficient potassium (K) intake have been identified as risk factors for hypertension. Socioeconomic status (SES) may be related to diet quality. In Japan, few studies have examined the relationship between urinary Na and K excretion and SES in adults, and there are no studies in children. In 2014, 1944 children (1382 households) in all public elementary schools in Yaese town, Okinawa, Japan were recruited to participate in a study. Casual urine specimens were collected to estimate 24-h urinary Na and K excretion and urinary Na/K ratio. Mother's educational background and household incomes were assessed and used as indicators of SES. A total of 236 pairs of children and their mothers were analyzed in this study. Urinary Na and K excretion were not significantly related to educational levels of mothers and household incomes in children. On the other hand, in mothers, lower household income group had higher 24-h estimated urinary Na excretion and urinary Na/K ratio than other groups. There was no significant difference between urinary excretion and educational levels in mothers. Household income disparities in urinary levels seen in mothers were not seen in children. There may be some factors that moderate the dietary inequalities in children.
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Affiliation(s)
- Sanae Ito
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan.
| | - Keiko Asakura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Omorinishi 5-21-16, Ota-ku, Tokyo, 143-8540, Japan
| | - Kemmyo Sugiyama
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Seiryo-machi 4-1, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Minoru Takakura
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan
| | - Hidemi Todoriki
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Uehara 207, Nishihara, Okinawa, 903-0215, Japan
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Charles JA, Habibullah NK, Bautista S, Davis B, Joshi S, Hull SC. Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension. Curr Cardiol Rep 2024; 26:121-134. [PMID: 38526748 PMCID: PMC10990999 DOI: 10.1007/s11886-023-02008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. RECENT FINDINGS DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.
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Affiliation(s)
- Justin A Charles
- Department of Family Medicine and Public Health, UC San Diego Health, San Diego, CA, USA.
| | | | - Saul Bautista
- Ethos Farm to Health/Ethos Primary Care, Long Valley, NJ, USA
| | - Brenda Davis
- Brenda Davis, Nutrition Consultations, Calgary, AB, Canada
| | - Shivam Joshi
- Department of Veterans Affairs, Orlando, FL, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Program for Biomedical Ethics, Yale School of Medicine, New Haven, CT, USA
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Zhang Z, Zhou X, Mei Y, Bu X, Tang J, Gong T, Liu G, Cai S, Ren Y, Mu L. Novel low-sodium salt formulations combined with Chinese modified DASH diet for reducing blood pressure in patients with hypertension and type 2 diabetes: a clinical trial. Front Nutr 2023; 10:1219381. [PMID: 37743915 PMCID: PMC10512456 DOI: 10.3389/fnut.2023.1219381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background In this study, we aimed to explore the antihypertensive effect of 23 and 52% concentrations of low-sodium salt combined with the Chinese Modified Dietary Approaches to Stop Hypertension (CM-DASH) diet in patients with hypertension and type 2 diabetes. Methods We conducted a randomized controlled single-blind trial with a semi-open design. One hundred and thirty-two participants were randomly assigned into Group A (control group), Group B (52% low-sodium salt group), Group C (23% low-sodium salt group), and Group D (meal pack group) for 8 weeks of dietary intervention. All participants were followed weekly to collect data on blood pressure, salt use, and adverse events. Blood and 24-h urine samples were analyzed at baseline, 4 weeks, and the end of the intervention. Results At the end of the intervention, the mean blood pressure decreased significantly by 10.81/5.03 mmHg, 14.32/6.32 mmHg, 14.20/6.59 mmHg, and 19.06/7.82 mmHg in Groups A-D, respectively, compared with baseline (p < 0.001). Comparison between groups showed that the systolic blood pressure was lower in Groups C and D than in Groups A (-6.54 mmHg, -8.70 mmHg, p < 0.05) and B (-6.60 mmHg, -8.76 mmHg, p < 0.05), and the diastolic blood pressure was lower in Group D than in Group A (-5.17 mmHg, p = 0.006). The 24-h urinary Na+ and Na+/K+ values were significantly decreased in participants using low-sodium salt (p < 0.001). No serious adverse events occurred during the trial. Conclusion Our preliminary results suggest that 23 and 52% concentrations of low-sodium salt combined with the CM-DASH diet can effectively reduce sodium intake and increase potassium intake in patients with hypertension and type 2 diabetes mellitus, thus achieving "salt reduction" and attaining standard, smooth, comprehensive management of patients with hypertension and type 2 diabetes. Clinical trial registration http://www.chictr.org.cn/, ChiCTR2000029017.
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Affiliation(s)
- Ziyan Zhang
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Xiaomeng Zhou
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Center for Disease Control and Prevention, Fengjie County, Chongqing, China
| | - Ying Mei
- Health Management Center of the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Jie Tang
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Tao Gong
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Guowei Liu
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
- Center for Disease Control and Prevention, Nan’an District, Chongqing, China
| | - Shuwen Cai
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Yanni Ren
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
| | - Lihong Mu
- Department of Epidemiology, School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
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7
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Kagawa T, Ohgami N, He T, Tazaki A, Ohnuma S, Naito H, Yajima I, Chen D, Deng Y, Tamura T, Kondo T, Wakai K, Kato M. Elevated arsenic level in fasting serum via ingestion of fish meat increased the risk of hypertension in humans and mice. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead074. [PMID: 37671121 PMCID: PMC10475452 DOI: 10.1093/ehjopen/oead074] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023]
Abstract
Aims There has been a shortage of human studies to elucidate the association between serum arsenic levels and the prevalence of hypertension. This study multidirectionally investigated associations among arsenic exposure, dietary ingestion, and the risk of hypertension by combined human epidemiological and mouse experimental studies. Methods and results This study focused on the total arsenic level in fasting serum, a biomarker of arsenic exposure. Associations among ingestion frequencies of 54 diet items of Japanese food separated into six categories, total arsenic level in fasting serum, and the prevalence of hypertension were investigated in 2709 general people in Japan. Logistic regression analysis demonstrated a dose-dependent association between serum arsenic level and hypertension and a positive association between the ingestion of fish meat and hypertension. Further analysis showed that the latter association was fully mediated by increased fasting serum arsenic levels in humans. Similarly, oral exposure to the putative human-equivalent dose of arsenic species mixture with the same ratios in a common fish meat in Japan increased systolic blood pressure and arsenic levels in fasting serum in mice. Conclusion This interdisciplinary approach suggests that fish-meat ingestion is a potential risk factor for arsenic-mediated hypertension. Because the increased consumption of fish meat is a recent global trend, health risks of the increased ingestion of arsenic via fish meat should be further investigated.
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Affiliation(s)
- Takumi Kagawa
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Nobutaka Ohgami
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Department of Hygiene, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan
| | - Tingchao He
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Department of Hygiene, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan
| | - Akira Tazaki
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Shoko Ohnuma
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Hisao Naito
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Ichiro Yajima
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Dijie Chen
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Yuqi Deng
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Department of Hygiene, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470–1192, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Takaaki Kondo
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
| | - Masashi Kato
- Department of Occupational and Environmental Health, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
- Voluntary Body for International Health Care in Universities, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan
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Mikami T, Tanno K, Sasaki R, Takanashi N, Kotozaki Y, Asahi K, Tanaka F, Omama S, Kogure M, Nakaya N, Nakamura T, Tsuchiya N, Narita A, Hozawa A, Hitomi J, Sakata K, Sasaki M. Association between the extent of house collapse and urine sodium-to-potassium ratio of victims affected by the 2011 Great East Japan Earthquake and Tsunami: a cross-sectional study. Hypertens Res 2023; 46:1247-1256. [PMID: 36806793 PMCID: PMC10164643 DOI: 10.1038/s41440-023-01190-5] [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: 06/01/2022] [Revised: 12/12/2022] [Accepted: 01/05/2023] [Indexed: 02/19/2023]
Abstract
People who experience natural disasters have a high risk of developing cardiovascular diseases. We investigated the association between the extent of house collapse and urine sodium-to-potassium (UNa/K) ratio of 2011 Great East Japan Earthquake victims. We used the baseline survey data of the Tohoku Medical Megabank Project Community-Based Cohort Study of 29 542 individuals (aged 20-74 years) residing in the affected areas. The UNa/K ratio was calculated using spot urinary electrolyte values. Analysis of covariance was used to calculate the multivariate-adjusted geometric means of the UNa/K ratio in the following groups stratified according to the self-reported extent of house collapse: total collapse (TC), half collapse (HC), partial collapse (PC), and no damage (ND). Multivariable-adjusted odds ratios (ORs) for a high UNa/K ratio were calculated using logistic regression. The TC, HC, PC, and ND groups comprised 5 359 (18.1%), 3 576 (12.1%), 7 331 (24.8%), and 13 276 (44.9%) participants, respectively. The TC (3.33; 95% confidence interval [CI], 3.28-3.38), HC (3.37; 3.30-3.43), and PC (3.32; 3.28-3.37) groups had significantly higher multivariate-adjusted geometric means of the UNa/K ratio than the ND (3.24; 3.21-3.27) group. The multivariable-adjusted ORs (95% CIs) for a high UNa/K ratio in the TC, HC, and PC groups vs. the ND group were 1.07 (0.99-1.15), 1.20 (1.11-1.31), and 1.20 (1.12-1.28), respectively. Similar associations between house collapse and UNa/K ratio were observed for both sexes. We report that victims of a natural disaster tend to have a diet with high sodium-to-potassium ratio.
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Affiliation(s)
- Takahiro Mikami
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
- Department of Anatomy, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
| | - Kozo Tanno
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Ryohei Sasaki
- Department of Human Sciences, Center for Liberal Arts and Sciences, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Nobuyuki Takanashi
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Yuka Kotozaki
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Koichi Asahi
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Fumitaka Tanaka
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Shinichi Omama
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Iwate Prefectural Advanced Critical Care and Emergency Center, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Mana Kogure
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Tomohiro Nakamura
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Naho Tsuchiya
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Akira Narita
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Atsushi Hozawa
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai-City, Miyagi, Japan
| | - Jiro Hitomi
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Anatomy, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Kiyomi Sakata
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Department of Hygiene and Preventive Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Makoto Sasaki
- Division of Clinical Research and Epidemiology, Iwate Tohoku Medical Megabank Organization, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
- Institute for Biomedical Sciences, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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9
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Melo L, Torres F, Guimarães J, Cortez M. Development of processed low-sodium Maasdam cheese. ARQ BRAS MED VET ZOO 2022. [DOI: 10.1590/1678-4162-12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT The article assesses the effect of different potassium emulsifying salts concentrations on physicochemical, colorimetric, and texture characteristics of processed cheese manufactured using Maasdam. Except for pH, physicochemical parameters remained unchanged, but the gradual substitution of sodium emulsifying salts with potassium-based salts influenced color and texture. Treatments with at least 50% potassium salts showed a reduction of at least 30% of sodium. The sodium decrease allows the product's classification as processed cheese with low-sodium content (<140mg per 56.7g serving). The data obtained present substantial information that can help the dairy industries develop newly reduced-sodium products.
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10
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Campos-Nonato I, Vargas Meza J, Nieto C, Ariza AC, Barquera S. Reducing Sodium Consumption in Mexico: A Strategy to Decrease the Morbidity and Mortality of Cardiovascular Diseases. Front Public Health 2022; 10:857818. [PMID: 35392467 PMCID: PMC8980680 DOI: 10.3389/fpubh.2022.857818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertension (HTN) and cardiovascular diseases (CVD) are important public health problems in Mexico. High sodium intake is linked to high blood pressure and increased risk of developing CVD. International organizations suggest consuming <2 g of sodium/day; however, the Mexican population consumes amounts above what is recommended: 3.1 g/day. Although efforts have been made to mitigate this problem, interventions are needed to improve cardiovascular health. This policy brief offers a short review of the current sodium consumption situation in Mexico and the importance of why decision makers should consider actions to reduce consumption. Recommendations to reduce sodium/salt intake include: Reformulation of ultra-processed-foods, promote the use warning labels, communication campaign, reduce the use of table salt, and monitor sodium intake.
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11
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Wang Q. The role of dietary potassium and sodium in hypertension and cardiovascular damage and protection: A narrative review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Newman RG, Moon Y, Sams CE, Tou JC, Waterland NL. Biofortification of Sodium Selenate Improves Dietary Mineral Contents and Antioxidant Capacity of Culinary Herb Microgreens. FRONTIERS IN PLANT SCIENCE 2021; 12:716437. [PMID: 34421969 PMCID: PMC8375293 DOI: 10.3389/fpls.2021.716437] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Selenium biofortification of plants has been suggested as a method of enhancing dietary selenium intake to prevent deficiency and chronic disease in humans, while avoiding toxic levels of intake. Popular herbs such as basil (Ocimum basilicum L.), cilantro (Coriandrum sativum L.), and scallions (Allium fistulosum L.) present an opportunity for biofortification as these plants are used for added flavors to meals and are available as microgreens, young plants with increasing popularity in the consumer marketplace. In this study, basil, cilantro, and scallion microgreens were biofortified with sodium selenate under hydroponic conditions at various selenium concentrations to investigate the effects on yield, selenium content, other mineral contents (i.e., sodium, potassium, calcium, magnesium, phosphorus, copper, zinc, iron, manganese, sulfur, and boron), total phenol content, and antioxidant capacity [oxygen radical absorbance capacity (ORAC)]. The results showed that the selenium content increased significantly at all concentrations, with scallions demonstrating the largest increase. The effects on other minerals varied among herb species. Antioxidant capacity and total phenol content increased in all herbs at the highest selenium treatments, but basil and scallions demonstrated a decreased crop yield. Overall, these biofortified culinary herb microgreens are an ideal functional food for enhancing selenium, other dietary minerals, and antioxidants to benefit human health.
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Affiliation(s)
- Rachel G. Newman
- Division of Animal and Nutritional Sciences, West Virginia University, Morgantown, WV, United States
| | - Youyoun Moon
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, United States
| | - Carl E. Sams
- Department of Plant Sciences, The University of Tennessee, Knoxville, TN, United States
| | - Janet C. Tou
- Division of Animal and Nutritional Sciences, West Virginia University, Morgantown, WV, United States
| | - Nicole L. Waterland
- Division of Plant and Soil Sciences, West Virginia University, Morgantown, WV, United States
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13
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Matuszewska E, Klupczynska A, Maciołek K, Kokot ZJ, Matysiak J. Multielemental Analysis of Bee Pollen, Propolis, and Royal Jelly Collected in West-Central Poland. Molecules 2021; 26:2415. [PMID: 33919229 PMCID: PMC8122449 DOI: 10.3390/molecules26092415] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022] Open
Abstract
Beehive products possess nutritional value and health-promoting properties and are recommended as so-called "superfoods". However, because of their natural origin, they may contain relevant elemental contaminants. Therefore, to assess the quality of bee products, we examined concentrations of a broad range of 24 selected elements in propolis, bee pollen, and royal jelly. The quantitative analyses were performed with inductively coupled plasma-mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectrometry (ICP-OES) techniques. The results of our research indicate that bee products contain essential macronutrients (i.e., K, P, and S) and micronutrients (i.e., Zn and Fe) in concentrations depending on the products' type. However, the presence of toxic heavy metals makes it necessary to test the quality of bee products before using them as dietary supplements. Bearing in mind that bee products are highly heterogenous and, depending on the environmental factors, differ in their elemental content, it is necessary to develop standards regulating the acceptable levels of inorganic pollutants. Furthermore, since bees and their products are considered to be an effective biomonitoring tool, our results may reflect the environment's condition in west-central Poland, affecting the health and well-being of both humans and bees.
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Affiliation(s)
- Eliza Matuszewska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
| | - Agnieszka Klupczynska
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
| | | | - Zenon J. Kokot
- Faculty of Health Sciences, Calisia University, 13 Street, 62-800 Kalisz, Poland;
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Grunwaldzka 6 Street, 60-780 Poznań, Poland; (E.M.); (A.K.)
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14
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Nan X, Lu H, Wu J, Xue M, Qian Y, Wang W, Wang X. The interactive association between sodium intake, alcohol consumption and hypertension among elderly in northern China: a cross-sectional study. BMC Geriatr 2021; 21:135. [PMID: 33622268 PMCID: PMC7903677 DOI: 10.1186/s12877-021-02090-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Hypertension is a worldwide public health problem. We sought to examine the interactive associations among sodium intake, alcohol consumption and hypertension among older adult residents of Inner Mongolia in northern China. Methods This cross-sectional study used data from the National Survey for Nutrition and Adult Chronic Disease in Inner Mongolia. The prevalence of hypertension was age standardized by the direct method. Sodium intake and alcohol consumption were estimated using a weighing method and 24-h recalls on 3 consecutive days. Hypertension was either self-reported or field-measured. Participants were categorized into six subgroups according to combinations of sodium intake status and drinking level. Logistic regression was used to determine the interactive effect of sodium intake and drinking on hypertension. Results Of the 820 older adults who participated in this study, 523 (63.80%, age-standardized rate = 62.33%) had been diagnosed with hypertension. The mean sodium intake was 4.88 g. Sodium intake and drinking excessively were both independently related to higher risk of hypertension. A formal test for a multiplicative interaction between sodium intake and drinking revealed a significant interaction (p = 0.042), and the multivariable-adjusted odds ratio (95% CI) for the interaction was 1.1 (1.0–1.3). After adjusting for confounders, compared with moderate sodium intake and no drinking group, the risk of hypertension was highest among those with both excessive sodium intake and excessive alcohol consumption, with an odds ratio of 3.6 (95% CI: 1.7–7.9). Conclusions The study highlights the interactive effect of sodium intake and alcohol consumption on hypertension. Primary health care providers should pay special attention to older adults with hypertension—especially those with an unhealthy diet including both excessive sodium and excessive alcohol intake. These findings are applicable for older adults in Inner Mongolia and worldwide.
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Affiliation(s)
- Xi Nan
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, 010110, China
| | - Haiwen Lu
- Department of Medical Imaging, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia Medical University, Hohhot, 010050, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Mingming Xue
- School of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Yonggang Qian
- Department of Chronic Disease Control and Prevention, Inner Mongolia Center for Disease Control and Prevention, Hohhot, 010031, China
| | - Wenrui Wang
- Inner Mongolia Center for Disease Control and Prevention, Hohhot, 010031, China
| | - Xuemei Wang
- Department of Health Statistics, School of Public Health, Inner Mongolia Medical University, Jinshan Development District, Hohhot, 010110, China.
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15
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Mitsopoulou AV, Magriplis E, Michas G, Micha R, Chourdakis M, Chrousos GP, Roma E, Panagiotakos DB, Zampelas A, Karageorgou D, Bakogianni I, Dimakopoulos I, Ntouroupi T, Tsaniklidou SM, Argyri K, Fappa E, Theodoraki EM, Trichia E, Sialvera TE, Varytimiadi A, Spyreli E, Koutelidakis A, Karlis G, Zacharia S, Papageorgiou A, Dedoussis G, Dimitriadis G, Manios I. Micronutrient dietary intakes and their food sources in adults: the Hellenic National Nutrition and Health Survey (HNNHS). J Hum Nutr Diet 2021; 34:616-628. [PMID: 33497494 DOI: 10.1111/jhn.12840] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study aimed to assess micronutrient intake among Greek adults and to identify the main food sources that contribute to it. METHODS Food consumption data from 2389 participants in the Hellenic National Nutrition and Health Survey (HNNHS), collected with 24-h recalls, was used to calculate micronutrient intakes. Usual nutrient intake was estimated according to the National Cancer Institute method. Nutrient adequacy was estimated using the estimated average requirement (EAR) cut-point method, when available, or adequate intake otherwise. The probability approach was used to determine iron intake adequacy in females of reproductive age. Food group contribution for each nutrient assessed was derived to identify their main food sources. RESULTS Almost all individuals had vitamin D intake below EAR, whereas vitamins A, E, K and C, as well as potassium intake, were also insufficient in a considerable percentage of the population (>70% in most age groups). Calcium intake was substantially below the EAR for females aged >50 years and males >70 years; the same for magnesium in males >70 years. Furthermore, 50% of females, including those of reproductive age, had intake of folate below EAR. More than 50% of the population (to 79%) exceeded the upper tolerable limit for sodium (2300 mg day-1 ). Food contribution analysis revealed that most vitamins were derived from low-quality foods (i.e. fast-food). CONCLUSIONS A significant proportion of adults residing in Greece have low nutrient intake and poor food selections. These results provide guidance to public health policy makers for developing strategies to improve the dietary quality in Greece.
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Affiliation(s)
| | - Emmanuela Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Renata Micha
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Michalis Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - George P Chrousos
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Roma
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Dimitra Karageorgou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ioanna Bakogianni
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Ioannis Dimakopoulos
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Triantafyllia Ntouroupi
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Sophia-Maria Tsaniklidou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Konstantina Argyri
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Evangelia Fappa
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eleni-Maria Theodoraki
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eirini Trichia
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Theodora-Eirini Sialvera
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Aggeliki Varytimiadi
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eleni Spyreli
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Antonis Koutelidakis
- Department of Food Science and Nutrition, University of Aegean, Mytilini, Greece
| | - George Karlis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Stauroula Zacharia
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Anna Papageorgiou
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Georgios Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - George Dimitriadis
- Second Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Haidari, Greece
| | - Ioannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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16
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Pechère-Bertschi A, Olivier V, Burnier M, Udwan K, de Seigneux S, Ponte B, Maillard M, Martin PY, Feraille E. Dietary sodium intake does not alter renal potassium handling and blood pressure in healthy young males. Nephrol Dial Transplant 2021; 37:548-557. [PMID: 33492394 PMCID: PMC8875469 DOI: 10.1093/ndt/gfaa381] [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: 10/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background The effects of sodium (Na+) intakes on renal handling of potassium (K+) are insufficiently studied. Methods We assessed the effect of Na+ on renal K+ handling in 16 healthy males assigned to three 7-day periods on low salt diet [LSD, 3 g sodium chloride (NaCl)/day], normal salt diet (NSD, 6 g NaCl/day) and high salt diet (HSD, 15 g NaCl/day), with constant K+ intake. Contributions of distal NaCl co-transporter and epithelial Na+ channel in the collecting system on K+ and Na+ handling were assessed at steady state by acute response to 100 mg oral hydrochlorothiazide and with addition of 10 mg of amiloride to hydrochlorothiazide, respectively. Results Diurnal blood pressure slightly increased from 119.30 ± 7.95 mmHg under LSD to 123.00 ± 7.50 mmHg (P = 0.02) under HSD, while estimated glomerular filtration rate increased from 133.20 ± 34.68 mL/min under LSD to 187.00 ± 49.10 under HSD (P = 0.005). The 24-h K+ excretion remained stable on all Na+ intakes (66.28 ± 19.12 mmol/24 h under LSD; 55.91 ± 21.17 mmol/24 h under NSD; and 66.81 ± 20.72 under HSD, P = 0.9). The hydrochlorothiazide-induced natriuresis was the highest under HSD (30.22 ± 12.53 mmol/h) and the lowest under LSD (15.38 ± 8.94 mmol/h, P = 0.02). Hydrochlorothiazide increased kaliuresis and amiloride decreased kaliuresis similarly on all three diets. Conclusions Neither spontaneous nor diuretic-induced K+ excretion was influenced by Na+ intake in healthy male subjects. However, the respective contribution of the distal convoluted tubule and the collecting duct to renal Na+ handling was dependent on dietary Na+ intake.
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Affiliation(s)
| | - Valérie Olivier
- Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland.,Department of Cell Physiology and Metabolism, University of Geneva, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, CHUV, Lausanne, Switzerland
| | - Khalil Udwan
- Department of Cell Physiology and Metabolism, University of Geneva, Switzerland
| | - Sophie de Seigneux
- Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland.,Department of Cell Physiology and Metabolism, University of Geneva, Switzerland
| | - Belén Ponte
- Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland
| | - Marc Maillard
- Service of Nephrology and Hypertension, CHUV, Lausanne, Switzerland
| | - Pierre-Yves Martin
- Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland.,Department of Cell Physiology and Metabolism, University of Geneva, Switzerland
| | - Eric Feraille
- Service of Nephrology and Hypertension, University Hospital Geneva, Switzerland.,Department of Cell Physiology and Metabolism, University of Geneva, Switzerland
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Khorraminezhad L, Rudkowska I. Effect of Yogurt Consumption on Metabolic Syndrome Risk Factors: a Narrative Review. Curr Nutr Rep 2021; 10:83-92. [PMID: 33405074 DOI: 10.1007/s13668-020-00344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Metabolic syndrome (MetS) comprises risk factors such as obesity, hypertriglyceridemia, hypertension, and hyperglycemia. Here we described the outcome of various yogurt consumption, either conventional, low-fat, high-fat, Greek, or enriched with nutrients or probiotics: (1) on the parameters of MetS risk factors and (2) on the mechanisms of action of the MetS risk factors. RECENT FINDING The majority (25 studies) of clinical trials and meta-analyses of clinical trials reported a beneficial effect of yogurt consumption in the prevention of MetS risk. Yogurt components, such as calcium, vitamin D, proteins, and probiotics, were associated with the multiple beneficial effects on the prevention of MetS. In general, yogurt consumption may be promoted within healthy dietary patterns to prevent MetS. More studies are needed to determine what type of yogurt has the greatest benefits for specific MetS risk factor prevention.
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Affiliation(s)
- Leila Khorraminezhad
- Endocrinology and Nephrology Unit, CHU de Québec-Laval University Research Center, CHUL - 2705, Boulevard. Laurier, Québec, Québec, G1V 4G2, Canada
| | - Iwona Rudkowska
- Endocrinology and Nephrology Unit, CHU de Québec-Laval University Research Center, CHUL - 2705, Boulevard. Laurier, Québec, Québec, G1V 4G2, Canada. .,Department of Kinesiology, Laval University, Québec, QC, Canada.
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18
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Nutrition and Exercise Performance in Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:750-758. [PMID: 32847769 DOI: 10.1016/j.jcjd.2020.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022]
Abstract
The best nutritional practices for exercise and sports performance are largely activity specific. The presence of type 1 diabetes undeniably bestows additional factors to consider to manage exercise and ensure adequate nutrients and fuels are available for optimal performance. Whether participating in sports or physical activity on a recreational basis or striving to achieve a high level of athletic performance, individuals with type 1 diabetes must pay attention to their nutritional and dietary patterns, including intake of macronutrients, micronutrients, fluids and supplements, such as caffeine to maintain metabolic and glycemic balance. Performance aside, nutritional recommendations may also differ on an individual basis relative to exercise, glycemic management and body weight goals. Balancing all these dietary factors can be challenging for individuals with type 1 diabetes, and many related aspects have yet to be fully researched in this population.
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ITO S, ASAKURA K, SUGIYAMA K, TAKAKURA M, TODORIKI H. Salt and potassium intake estimated from spot urine in elementary school children and their mothers in Okinawa. ACTA ACUST UNITED AC 2020. [DOI: 10.3861/kenko.86.2_76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sanae ITO
- Tropical Biosphere Research Center, University of the Ryukyus
| | | | | | | | - Hidemi TODORIKI
- Tropical Biosphere Research Center, University of the Ryukyus
- Okinawa Study Center, the Open University of Japan
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20
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Dietary Intake and Sources of Potassium in a Cross-Sectional Study of Australian Adults. Nutrients 2019; 11:nu11122996. [PMID: 31817767 PMCID: PMC6949933 DOI: 10.3390/nu11122996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
A diet rich in potassium is important to reduce the risk of cardiovascular disease. This study assessed potassium intake; food sources of potassium (including NOVA level of processing, purchase origin of these foods); and sodium-to-potassium ratio (Na:K) in a cross-section of Australian adults. Data collection included 24-h urines (n = 338) and a 24-h diet recall (subsample n = 142). The mean (SD) age of participants was 41.2 (13.9) years and 56% were females. Mean potassium (95%CI) 24-h urinary excretion was 76.8 (73.0–80.5) mmol/day compared to 92.9 (86.6–99.1) by 24-h diet recall. Na:K was 1.9 (1.8–2.0) from the urine excretion and 1.4 (1.2–1.7) from diet recall. Foods contributing most to potassium were potatoes (8%), dairy milk (6%), dishes where cereal is the main ingredient (6%) and coffee/coffee substitutes (5%). Over half of potassium (56%) came from minimally processed foods, with 22% from processed and 22% from ultraprocessed foods. Almost two-thirds of potassium consumed was from foods purchased from food stores (58%), then food service sector (15%), and fresh food markets (13%). Overall, potassium levels were lower than recommended to reduce chronic disease risk. Multifaceted efforts are required for population-wide intervention—aimed at increasing fruit, vegetable, and other key sources of potassium intake; reducing consumption of processed foods; and working in supermarket/food service sector settings to improve the healthiness of foods available.
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Folz J, Oh YT, Blaženović I, Richey J, Fiehn O, Youn JH. Interaction of Gut Microbiota and High-Sodium, Low-Potassium Diet in Altering Plasma Triglyceride Profiles Revealed by Lipidomics Analysis. Mol Nutr Food Res 2019; 63:e1900752. [PMID: 31675161 DOI: 10.1002/mnfr.201900752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/09/2019] [Indexed: 01/07/2023]
Abstract
SCOPE High sodium and low potassium (HNaLK) intake increases the risk of cardiovascular disease (CVD) and metabolic syndrome. The authors investigate if the dietary minerals interact with the gut microbiota to alter circulating lipid profiles, implicated in CVD and metabolic syndrome. METHODS AND RESULTS Plasma samples from Wistar rats fed a control or HNaLK diet with or without antibiotic treatment (n = 7 each, a total of 28) are subjected to lipidomics analysis. Lipidomic data are then analyzed using statistical and bioinformatics tools, which detect numerous lipid species altered by the treatments, and consistently demonstrated interactions between the gut microbiota and the HNaLK diet in altering circulating lipids, mainly triglycerides (TGs). Two distinct TG groups differentially regulated by antibiotic treatment are identified. One group (cluster 1), representing the majority of TG species detected, is downregulated, whereas the other group (cluster 2) is upregulated by antibiotic treatment. Interestingly, cluster 2 TGs are also regulated by the diet. Cluster 2 TGs exhibit greater carbon-chain length and double-bond content and include TGs composed of very-long-chain polyunsaturated fatty acids, associated with reduced diabetes risk. CONCLUSION The HNaLK diet interacts with gut bacteria to alter plasma lipid profiles, which may be related to its health effects.
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Affiliation(s)
- Jacob Folz
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, 95616, USA
| | - Young Taek Oh
- Department of Physiology and Neuroscience, Keck School of Medicine of USC, Los Angeles, CA, 90089, USA
| | - Ivana Blaženović
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, 95616, USA
| | - Joyce Richey
- Department of Physiology and Neuroscience, Keck School of Medicine of USC, Los Angeles, CA, 90089, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA, 95616, USA
| | - Jang H Youn
- Department of Physiology and Neuroscience, Keck School of Medicine of USC, Los Angeles, CA, 90089, USA
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Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Aggett P, Fairweather-Tait S, Martin A, Przyrembel H, Ciccolallo L, de Sesmaisons-Lecarré A, Valtueña Martinez S, Martino L, Naska A. Dietary reference values for sodium. EFSA J 2019; 17:e05778. [PMID: 32626425 PMCID: PMC7009309 DOI: 10.2903/j.efsa.2019.5778] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel considers that a sodium intake of 2.0 g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0 g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel considers that 2.0 g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1 g/day for children aged 1-3 years, 1.3 g/day for children aged 4-6 years, 1.7 g/day for children aged 7-10 years and 2.0 g/day for children aged 11-17 years, respectively. For infants aged 7-11 months, an Adequate Intake (AI) of 0.2 g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0-6 months.
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Sanchez A, Chung SC, Mejia A, Ramirez FE, Shavlik GW, Bivens RL, Brown-Fraser S, Gallant RD. Multiple lifestyle interventions reverses hypertension. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1636534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Albert Sanchez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - S. Christine Chung
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Alfredo Mejia
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
| | - Francisco E. Ramirez
- NEWSTART Program, Weimar Institute, Weimar, CA, USA
- Research, Nedley Clinic, Weimar, CA, USA
| | | | | | - Sherine Brown-Fraser
- Department of Public Health Nutrition and Wellness, Andrews University, Berrien Springs, MI, USA
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Guerrero-Romero F, Rodríguez-Morán M. The ratio potassium-to-magnesium intake and high blood pressure. Eur J Clin Invest 2019; 49:e13093. [PMID: 30801694 DOI: 10.1111/eci.13093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/12/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND To analyse whether the weight ratio of potassium-to-magnesium intake is associated with incident high blood pressure, in otherwise healthy individuals. MATERIALS AND METHODS A total of 529 healthy individuals were enrolled in a cross-sectional study and allocated into following groups: group 1) potassium and magnesium intake within Recommended Dietary Allowance; group 2) magnesium intake as recommended and potassium intake below of recommended dietary allowance; group 3) potassium intake as recommended and magnesium intake below of recommended dietary allowance; and group 4) magnesium and potassium intake below recommended dietary allowance. Groups in study were matched by sodium and calcium intake. A "24 hours recall" questionnaire was used to register all intakes of food and drinks for two consecutive days. Multiple logistic regression analysis adjusted by sex, waist circumference, and triglycerides levels was used to compute the odds ratio between intakes of magnesium and potassium with the high blood pressure. RESULTS High blood pressure was identified in 155 (29.3%) individuals. There were no statistical significant differences by obesity and overweight between the groups. As compared with individuals in the group 1, the potassium-to-magnesium ratio (odds ratio 0.88; 95%CI 0.85-0.93) but not the isolated magnesium and potassium intake per se, was inversely associated to high blood pressure in the subjects of group 4; individuals in the groups 2 and 3 showed no association. CONCLUSIONS Our results suggest that, in healthy individuals with magnesium and potassium intake below recommended dietary allowance, the high potassium-to-magnesium ratio is inversely associated with incident high blood pressure.
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Morris RC, Pravenec M, Šilhavý J, DiCarlo SE, Kurtz TW. Small Amounts of Inorganic Nitrate or Beetroot Provide Substantial Protection From Salt-Induced Increases in Blood Pressure. Hypertension 2019; 73:1042-1048. [PMID: 30917704 PMCID: PMC6458074 DOI: 10.1161/hypertensionaha.118.12234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To reduce the risk of salt-induced hypertension, medical authorities have emphasized dietary guidelines promoting high intakes of potassium and low intakes of salt that provide molar ratios of potassium to salt of ≥1:1. However, during the past several decades, relatively few people have changed their eating habits sufficiently to reach the recommended dietary goals for salt and potassium. Thus, new strategies that reduce the risk of salt-induced hypertension without requiring major changes in dietary habits would be of considerable medical interest. In the current studies in a widely used model of salt-induced hypertension, the Dahl salt-sensitive rat, we found that supplemental dietary sodium nitrate confers substantial protection from initiation of salt-induced hypertension when the molar ratio of added nitrate to added salt is only ≈1:170. Provision of a low molar ratio of added nitrate to added salt of ≈1:110 by supplementing the diet with beetroot also conferred substantial protection against salt-induced increases in blood pressure. The results suggest that on a molar basis and a weight basis, dietary nitrate may be ≈100× more potent than dietary potassium with respect to providing substantial resistance to the pressor effects of increased salt intake. Given that leafy green and root vegetables contain large amounts of inorganic nitrate, these findings raise the possibility that fortification of salty food products with small amounts of a nitrate-rich vegetable concentrate may provide a simple method for reducing risk for salt-induced hypertension.
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Affiliation(s)
- R. Curtis Morris
- Department of Medicine, University of California, San Francisco, San Francisco, USA, 94143
| | - Michal Pravenec
- Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic, 14220
| | - Jan Šilhavý
- Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic, 14220
| | - Stephen E. DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, USA, 48824
| | - Theodore W. Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, USA, 94107-0134
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26
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Blaženović I, Oh YT, Li F, Ji J, Nguyen AK, Wancewicz B, Bender JM, Fiehn O, Youn JH. Effects of Gut Bacteria Depletion and High-Na + and Low-K + Intake on Circulating Levels of Biogenic Amines. Mol Nutr Food Res 2018; 63:e1801184. [PMID: 30513547 DOI: 10.1002/mnfr.201801184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/13/2018] [Indexed: 12/18/2022]
Abstract
SCOPE High-sodium and low-potassium (HNaLK) content in Western diets increases the risk of hypertension and cardiovascular disease (CVD). It is investigated if the dietary minerals interact with gut bacteria to modulate circulating levels of biogenic amines, which are implicated in various pathologies, including hypertension and CVD. METHODS AND RESULTS Using a metabolomic approach to target biogenic amines, the effects of gut bacteria depletion and HNaLK intake on circulating levels of biogenic amines in rats are examined. Forty-five metabolites whose plasma levels are significantly altered by gut bacteria depletion (p < 0.05) are found, indicating their regulation by gut bacteria. Many of them are not previously linked to gut bacteria; therefore, these data provide novel insights into physiological or pathological roles of gut bacteria. A number of plasma metabolites that are altered both by gut bacteria and HNaLK intake are also found, suggesting possible interactions of the diet and gut bacteria in the modulation of these metabolites. The diet effects are observed with significant changes in the gut bacterial taxa Porphyromonadaceae and Prevotellaceae (p < 0.05). CONCLUSION The dietary minerals may regulate abundances of certain gut bacteria to alter circulating levels of biogenic amines, which may be linked to host physiology or pathology.
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Affiliation(s)
- Ivana Blaženović
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA 95616, USA
| | - Young Taek Oh
- Department of Physiology and Neuroscience, Keck School of Medicine of USC, Los Angeles, CA 90089, USA
| | - Fan Li
- Single Cell, Sequencing, and CyTOF Core Lab, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Jian Ji
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA 95616, USA.,School of Food Science, State Key Laboratory of Food Science and Technology, National Engineering Research Center for Functional Foods, School of Food Science Synergetic Innovation Center of Food Safety and Nutrition, Jiangnan University, Wuxi, Jiangsu, China
| | - Ahn-Khoi Nguyen
- Department of Exercise Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Benjamin Wancewicz
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA 95616, USA
| | - Jeffrey M Bender
- USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California Davis Genome Center, Davis, CA 95616, USA.,Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jang H Youn
- Department of Physiology and Neuroscience, Keck School of Medicine of USC, Los Angeles, CA 90089, USA
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Harris RM, Rose AMC, Hambleton IR, Howitt C, Forouhi NG, Hennis AJM, Samuels TA, Unwin N. Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease. BMC Public Health 2018; 18:998. [PMID: 30092782 PMCID: PMC6085702 DOI: 10.1186/s12889-018-5694-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults. Methods A sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design. Results Mean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings. Conclusions In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.
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Affiliation(s)
- Rachel M Harris
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Angela M C Rose
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian R Hambleton
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Christina Howitt
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anselm J M Hennis
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - T Alafia Samuels
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Catarino MD, Silva AMS, Cardoso SM. Phycochemical Constituents and Biological Activities of Fucus spp. Mar Drugs 2018; 16:E249. [PMID: 30060505 PMCID: PMC6117670 DOI: 10.3390/md16080249] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/27/2022] Open
Abstract
Seaweeds are known to be a good supply of key nutrients including carbohydrates, protein, minerals, polyunsaturated lipids, as well as several other health-promoting compounds capable of acting on a wide spectrum of disorders and/or diseases. While these marine macroalgae are deeply rooted in the East Asian culture and dietary habits, their major application in Western countries has been in the phycocolloid industry. This scenario has however been gradually changing, since seaweed consumption is becoming more common worldwide. Among the numerous edible seaweeds, members of the genus Fucus have a high nutritional value and are considered good sources of dietary fibers and minerals, especially iodine. Additionally, their wealth of bioactive compounds such as fucoidan, phlorotannins, fucoxanthin and others make them strong candidates for multiple therapeutic applications (e.g., antioxidant, anti-inflammatory, anti-tumor, anti-obesity, anti-coagulant, anti-diabetes and others). This review presents an overview of the nutritional and phytochemical composition of Fucus spp., and their claimed biological activities, as well as the beneficial effects associated to their consumption. Furthermore, the use of Fucus seaweeds and/or their components as functional ingredients for formulation of novel and enhanced foods is also discussed.
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Affiliation(s)
- Marcelo D Catarino
- Department of Chemistry & Organic Chemistry, Natural Products and Food Stuffs Research Unit (QOPNA), University of Aveiro, Aveiro 3810-193, Portugal.
| | - Artur M S Silva
- Department of Chemistry & Organic Chemistry, Natural Products and Food Stuffs Research Unit (QOPNA), University of Aveiro, Aveiro 3810-193, Portugal.
| | - Susana M Cardoso
- Department of Chemistry & Organic Chemistry, Natural Products and Food Stuffs Research Unit (QOPNA), University of Aveiro, Aveiro 3810-193, Portugal.
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Kisioglu B, Nergiz-Unal R. The powerful story against cardiovascular diseases: Dietary factors. FOOD REVIEWS INTERNATIONAL 2017. [DOI: 10.1080/87559129.2017.1410172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Betul Kisioglu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Reyhan Nergiz-Unal
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
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30
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McDonough AA, Veiras LC, Guevara CA, Ralph DL. Cardiovascular benefits associated with higher dietary K + vs. lower dietary Na +: evidence from population and mechanistic studies. Am J Physiol Endocrinol Metab 2017; 312:E348-E356. [PMID: 28174181 PMCID: PMC5406991 DOI: 10.1152/ajpendo.00453.2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/26/2017] [Accepted: 02/03/2017] [Indexed: 12/24/2022]
Abstract
The World Health Organization ranks hypertension the leading global risk factor for disease, specifically, cardiovascular disease. Blood pressure (BP) is higher in Westernized populations consuming Na+-rich processed foods than in isolated societies consuming K+-rich natural foods. Evidence suggests that lowering dietary Na+ is particularly beneficial in hypertensive individuals who consume a high-Na+ diet. Nonetheless, numerous population studies demonstrate a relationship between higher dietary K+, estimated from urinary excretion or dietary recall, and lower BP, regardless of Na+ intake. Interventional studies with K+ supplementation suggest that it provides a direct benefit; K+ may also be a marker for other beneficial components of a "natural" diet. Recent studies in rodent models indicate mechanisms for the K+ benefit: the distal tubule Na+-Cl- cotransporter (NCC) controls Na+ delivery downstream to the collecting duct, where Na+ reabsorbed by epithelial Na+ channels drives K+ secretion and excretion through K+ channels in the same region. High dietary K+ provokes a decrease in NCC activity to drive more K+ secretion (and Na+ excretion, analogous to the actions of a thiazide diuretic) whether Na+ intake is high or low; low dietary K+ provokes an increase in NCC activity and Na+ retention, also independent of dietary Na+ Together, the findings suggest that public health efforts directed toward increasing consumption of K+-rich natural foods would reduce BP and, thus, cardiovascular and kidney disease.
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Affiliation(s)
- Alicia A McDonough
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Luciana C Veiras
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Claire A Guevara
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Donna L Ralph
- Department of Cell and Neurobiology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Dermience M, Mathieu F, Li XW, Vandevijvere S, Claus W, De Maertelaer V, Dufourny G, Bin L, Yangzom D, Lognay G. Minerals and Trace Elements Intakes and Food Consumption Patterns of Young Children Living in Rural Areas of Tibet Autonomous Region, P.R. China: A Cross-Sectional Survey. Healthcare (Basel) 2017; 5:E12. [PMID: 28257043 PMCID: PMC5371918 DOI: 10.3390/healthcare5010012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Several studies revealed clinical signs of stunting and rickets among rural populations of Tibet Autonomous Region (T.A.R.), and especially amid children. Further, these populations are affected by a bone disease named Kashin-Beck disease (KBD). However, little is known about the dietary status of this population. This survey aimed to assess the usual intakes of young Tibetan children living in rural areas around Lhasa for energy, water, and ten minerals and trace elements (Na, K, Ca, P, Mg, Fe, Zn, Cu, Mn, and Se) involved in bone metabolism. DESIGN A cross-sectional survey was designed. Totally, 250 pre-school children aged 3-5 years living in rural areas were enrolled. The 24-h food recall method was used to collect the intakes for two days, during two different seasons (September 2012 and April 2013). Because Tibetan foods are mainly derived from local agriculture and artisanal production, a combination of food composition tables was compiled, including specific and local food composition data. RESULTS The Chinese dietary recommended intakes are not met for most of the elements investigated. Intake of sodium is much too high, while usual intakes are too low for K, Ca, Zn, Cu, and Se. Bioavailability of Ca, Fe, and Zn may be of concern due to the high phytic acid content in the diet. CONCLUSION These nutrient imbalances may impact growth and bone metabolism of young Tibetan children. The advantages of the implementation of food diversification programs are discussed as well as the relevance of supplements distribution.
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Affiliation(s)
- Michael Dermience
- Analytical chemistry, Gembloux Agro Bio Tech-University of Liege, Passage des Deportes, 2, B-5030 Gembloux, Belgium.
| | - Françoise Mathieu
- Kashin-Beck Disease Fund Asbl-Vzw, Rue de l'Aunee, 6, B-6953 Forrieres, Belgium.
| | - Xiao Wei Li
- China National Center for Food Safety Risk Assessment, Panjiayuan Nanli, 7, Chaoyang District, Beijing 100021, China.
| | | | - William Claus
- Kashin-Beck Disease Fund Asbl-Vzw, Rue de l'Aunee, 6, B-6953 Forrieres, Belgium.
| | - Viviane De Maertelaer
- SBIM and Institut de Recherche Interdisciplinaire en Biologie Humaine et Moleculaire, Free University of Brussels, route de Lennik, 808, B-1070 Brussels, Belgium.
| | - Ghislaine Dufourny
- CIRIHA, Haute Ecole Lucia de Brouckere, Avenue Emile Gryzon, 1, B-1070 Brussels, Belgium.
| | - Li Bin
- Center for Disease Control and Prevention-North Lin Kuo Road 21, Lhasa 850000, China.
| | - Dechen Yangzom
- Kashin-Beck Disease Foundation, Gakyiling Hotel, Tuanjie Xincun, Sera Road, Lhasa 850000, China.
| | - Georges Lognay
- Analytical chemistry, Gembloux Agro Bio Tech-University of Liege, Passage des Deportes, 2, B-5030 Gembloux, Belgium.
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McDonough AA, Youn JH. Potassium Homeostasis: The Knowns, the Unknowns, and the Health Benefits. Physiology (Bethesda) 2017; 32:100-111. [PMID: 28202621 PMCID: PMC5337831 DOI: 10.1152/physiol.00022.2016] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Potassium homeostasis has a very high priority because of its importance for membrane potential. Although extracellular K+ is only 2% of total body K+, our physiology was evolutionarily tuned for a high-K+, low-Na+ diet. We review how multiple systems interface to accomplish fine K+ balance and the consequences for health and disease.
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Affiliation(s)
- Alicia A McDonough
- Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jang H Youn
- Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, California
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Veiras LC, Han J, Ralph DL, McDonough AA. Potassium Supplementation Prevents Sodium Chloride Cotransporter Stimulation During Angiotensin II Hypertension. Hypertension 2016; 68:904-12. [PMID: 27600183 DOI: 10.1161/hypertensionaha.116.07389] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/27/2016] [Indexed: 01/06/2023]
Abstract
Angiotensin II (AngII) hypertension increases distal tubule Na-Cl cotransporter (NCC) abundance and phosphorylation (NCCp), as well as epithelial Na(+) channel abundance and activating cleavage. Acutely raising plasma [K(+)] by infusion or ingestion provokes a rapid decrease in NCCp that drives a compensatory kaliuresis. The first aim tested whether acutely raising plasma [K(+)] with a single 3-hour 2% potassium meal would lower NCCp in Sprague-Dawley rats after 14 days of AngII (400 ng/kg per minute). The potassium-rich meal neither decreased NCCp nor increased K(+) excretion. AngII-infused rats exhibited lower plasma [K(+)] versus controls (3.6±0.2 versus 4.5±0.1 mmol/L; P<0.05), suggesting that AngII-mediated epithelial Na(+) channel activation provokes K(+) depletion. The second aim tested whether doubling dietary potassium intake from 1% (A1K) to 2% (A2K) would prevent K(+) depletion during AngII infusion and, thus, prevent NCC accumulation. A2K-fed rats exhibited normal plasma [K(+)] and 2-fold higher K(+) excretion and plasma [aldosterone] versus A1K. In A1K rats, NCC, NCCpS71, and NCCpT53 abundance increased 1.5- to 3-fold versus controls (P<0.05). The rise in NCC and NCCp abundance was prevented in the A2K rats, yet blood pressure did not significantly decrease. Epithelial Na(+) channel subunit abundance and cleavage increased 1.5- to 3-fold in both A1K and A2K; ROMK (renal outer medulla K(+) channel abundance) abundance was unaffected by AngII or dietary K(+) In summary, the accumulation and phosphorylation of NCC seen during chronic AngII infusion hypertension is likely secondary to potassium deficiency driven by epithelial Na(+) channel stimulation.
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Affiliation(s)
- Luciana C Veiras
- From the Department of Cell and Neurobiology, Keck School of Medicine of USC, Los Angeles, CA
| | - Jiyang Han
- From the Department of Cell and Neurobiology, Keck School of Medicine of USC, Los Angeles, CA
| | - Donna L Ralph
- From the Department of Cell and Neurobiology, Keck School of Medicine of USC, Los Angeles, CA
| | - Alicia A McDonough
- From the Department of Cell and Neurobiology, Keck School of Medicine of USC, Los Angeles, CA.
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Magnusson M, Carl C, Mata L, de Nys R, Paul NA. Seaweed salt from Ulva: A novel first step in a cascading biorefinery model. ALGAL RES 2016. [DOI: 10.1016/j.algal.2016.03.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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35
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Mazloomy Mahmoodabad SS, Tehrani H, Gholian-aval M, Gholami H, Nematy M. The effect of social class on the amount of salt intake in patients with hypertension. Blood Press 2016; 25:360-363. [DOI: 10.1080/08037051.2016.1179508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Hadi Tehrani
- Department of Health Education & Health Promotion, Health Sciences Research Center, School of Health, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Mahdi Gholian-aval
- Department of Health Education & Health Promotion, Health Sciences Research Center, School of Health, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
| | - Hasan Gholami
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Nematy
- Department of Nutrition School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Gonçalves C, Abreu S, Padrão P, Pinho O, Graça P, Breda J, Santos R, Moreira P. Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents. Food Nutr Res 2016; 60:29442. [PMID: 27072344 PMCID: PMC4829664 DOI: 10.3402/fnr.v60.29442] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone. Objective This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents. Design A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall. Results Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p=0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (p<0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (p<0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%). Conclusions Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake.
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Affiliation(s)
- Carla Gonçalves
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal;
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto (ISPUP), EPIUnit-Epidemiology Research Unit, Porto, Portugal
| | - Olívia Pinho
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,LAQV/REQUIMTE, University of Porto, Porto, Portugal
| | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Directorate General of Health, Lisbon, Portugal
| | - João Breda
- Division of Noncommunicable Diseases and Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Denmark
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Maia University Institute, Maia, Portugal.,Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Australia
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto (ISPUP), EPIUnit-Epidemiology Research Unit, Porto, Portugal
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Okuskhanov E, Assenova B, Rebezov M, Yessimbeko Z, Kulushtaye B, Zinina O, Stuart M. Mineral Composition of Deer Meat Pate. ACTA ACUST UNITED AC 2016. [DOI: 10.3923/pjn.2016.217.222] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Campmans-Kuijpers MJE, Singh-Povel C, Steijns J, Beulens JWJ. The association of dairy intake of children and adolescents with different food and nutrient intakes in the Netherlands. BMC Pediatr 2016; 16:2. [PMID: 26749195 PMCID: PMC4707007 DOI: 10.1186/s12887-015-0524-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
Background Dairy products are nutrient-rich foods that may contribute to adequate nutrient intakes. However, dairy intake might also be associated with other food sources that influence nutrient intakes. Therefore, we studied the association of dairy, milk and cheese intake with intake of foods and nutrients from (non)dairy sources. Methods Dietary intake was assessed from 2007 to 2010 through two non-consecutive 24-h dietary recalls in 1007 children (7–13 years) and 706 adolescents (14–18 years). Participants were divided into non-consumers of a particular dairy product and tertiles according to their dairy intake (lowest, medium and highest intake). P for trend was calculated by linear regression over the median intakes of non-consumers and the tertiles for dairy, milk and cheese. Results In children, higher dairy consumption was associated with higher intakes of fruits (54.8 g ± 22.3; p < 0.0001), vegetables (25.0 g ± 14.6; p = 0.001) and cereals (18.5 g ± 20.7; p = 0.01) and with lower consumption of non-alcoholic beverages (−281 g ± 101; p = 0.01): soft drinks (−159 g ± 28.2; p < 0.0001) and fruit juices (−40.5 ± 14.8; p = 0.01). Results were comparable for milk consumption. In adolescents, similar results were found for milk and dairy consumption, except for the associations with higher fruits and vegetable intake. In children and adolescents, higher cheese consumption was associated with higher vegetable and non-alcoholic beverages consumption; and lower meat consumption (−7.8 g ± 4.8; p = 0.05) in children. Higher cheese consumption was also associated with higher intakes of saturated fat (8.5 g ± 0.9), trans-fatty acids (0.48 g ± 0.06), sodium (614 mg ± 59.3) and several vitamins and minerals . Conclusions Higher milk and dairy consumption were associated with lower non-alcoholic beverages consumption, and higher cereal, fruit and vegetable consumption in children, which was also reflected in the nutrient intakes. These findings confirm that the consumption of milk and dairy products might be a marker for healthier eating habits. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0524-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marjo J E Campmans-Kuijpers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | | | - Jan Steijns
- FrieslandCampina, Amersfoort, The Netherlands.
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Drug therapy of apparent treatment-resistant hypertension: focus on mineralocorticoid receptor antagonists. Drugs 2015; 75:473-85. [PMID: 25787734 DOI: 10.1007/s40265-015-0372-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Apparent treatment-resistant hypertension (aTRH) is defined as blood pressure (BP) >140/90 mmHg despite three different antihypertensive drugs including a diuretic. aTRH is associated with an increased risk of cardiovascular events, including stroke, chronic renal failure, myocardial infarction, congestive heart failure, aortic aneurysm, atrial fibrillation, and sudden death. Preliminary studies of renal nerve ablation as a therapy to control aTRH were encouraging. However, these results were not confirmed by the Symplicity 3 trial. Therefore, attention has refocused on drug therapy. Secondary forms of hypertension and associated conditions such as obesity, sleep apnea, and primary aldosteronism are common in patients with aTRH. The pivotal role of aldosterone in the pathogenesis of aTRH in many cases is well recognized. For patients with aTRH, the Joint National Committee-8, the European Society of Hypertension, and a recent consensus conference recommend that a diuretic, ACE inhibitor, or angiotensin receptor blocker and calcium channel blocker combination be used to maximally tolerated doses before starting a 'fourth-line' drug such as a mineralocorticoid receptor (MR) antagonist. Although the best fourth-line drug for aTRH has not been extensively investigated, a number of studies summarized here show that an MR antagonist is effective in reducing BP when added to the standard multi-drug regimen.
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