Salt, blood pressure and cardiovascular disease

Effects of drinking saline water on carcass traits and meat quality of growing and mature Blackhead Ogaden sheep and Somali goats

Water salinity has a significant impact on water quality, posing challenges for livestock production and productivity, particularly in arid regions where climate change affects freshwater availability. This study aimed to determine the effect of drinking saline water on the carcass and meat quality traits of sheep and goats in Ethiopia. A total of 100 males with an average initial body weight of growing (18.17 ± 0.51) and mature (22.22 ± 0.52 kg) Blackhead Ogaden sheep and growing (17.99 ± 0.50) and mature (21.99 ± 0.54) kg) Somali goats were used. The design of the experiment was a three-way factorial RCBD with three-factor combinations (5 treatment levels, 2 species, and 2 age groups).Water treatments were natural water (Lake Basaka water (control), low saline water (L-SW), moderate saline water (M-SW), high saline water (H-SW), and very high saline water (VH-SW); that is, NaCl was added to natural water at concentrations of 7.95, 11.93, 15.90, and 19.88 g TDS/L, respectively. The finding showed that increasing salinity levels in drinking water reduced slaughter body weight (SBW), carcass weight (CW), dressing percentage (DP), rib eye area (RAE), total edible components (TEC), and increased total non-edible components (TNEC) (P < 0.05). Similarly, sheep and mature animals had higher (P < 0.001) SBW, CW, DP, RAE, and TEC than goats and growing animals. Sensory evaluation, shear force, and proximate analysis were affected by water salinity, species, and age groups (P < 0.05). Overall, the study revealed that consuming saline water above 11 g TDS/L affected carcass traits and meat quality in Somali goats and Blackhead Ogaden sheep.

Iodine and selenium: Dietary sources and nutritional status of the population of the Kurdistan Region in Northern Iraq

AIM

The primary aim of this study was to determine the selenium (Se) and iodine (I) food concentrations and dietary intake of the population living in the Kurdish controlled region of northern Iraq. We also assessed the extent to which iodised salt contributes to dietary iodine intake.

METHODOLOGY

Foods and samples of salt and drinking water were analysed, including 300 crops samples from 40 local farms. The results, supplemented by food composition data, were used to assess dietary Se and I intake for 410 volunteers using a semi-quantitative food questionnaire. To directly investigate the nutritional status of individuals, urine samples were also collected from participants.

RESULTS

Selenium intake was mainly supplied by protein and cereal sources. Calculated median dietary intake of Se was 62.7 µg d-1 (mean = 66.3 µg d-1) with c. 72 % of participants meeting or exceeding dietary reference intake recommendations for age. Median dietary intake of I, excluding salt consumption, was 94.6 µg d-1 (mean 100.2 µg d-1), increasing to 607.2 µg d-1 when salt (of which >90 % was iodized) was included. Salt intake was estimated to be c.13.5 g d-1 (5400 mg Na d-1) which greatly exceeds WHO recommended intake (< 2000 mg d-1 of Na). Urine iodine concentrations indicated that 98 % of school aged children had excessive iodine intake (≥300 µg L-1) and 80-90 % of all study participants had above average or excessive iodine intake (≥200 µg L-1).

CONCLUSIONS

Poultry and rice are the main sources of dietary Se to this population but around a third of children receive an inadequate Se intake. Fresh fruit and vegetables are the main sources of dietary I, but consumption of local foods cannot supply adequate I without iodised salt supplementation. Consumption of iodized salt well above recommended amounts is supplying this population with substantial iodine intake. Interventions to reduce salt intake would help to limit excessive iodine intake whilst also reducing cardio-vascular risks from Na consumption.

Salt intake across the hypertension care cascade in the Bangladeshi adult population: a nationally representative cross-sectional study

OBJECTIVES

This study aimed to examine the distribution of daily salt intake across the hypertension care cascade and assess the proportional distribution of these care cascade categories across various salt consumption level.

DESIGN

A population-based national cross-sectional study.

SETTINGS

Data from the Bangladesh STEPS 2018 survey were used, encompassing both urban and rural strata within all eight divisions. National estimates were generated from weighted data.

PARTICIPANTS

A diverse population of 6754 men and women aged 18-69 years was included in the study.

OUTCOME MEASURES

Daily salt consumption was estimated using the spot urine sodium concentration following Tanaka equation. Distribution of salt intake among different categories of hypertension care cascade, including hypertensives, aware of hypertension status, on treatment and under control, was assessed.

RESULTS

Individuals with hypertension consume more salt on average (9.18 g/day, 95% CI 9.02 to 9.33) than those without hypertension (8.95 g/day, 95% CI 8.84 to 9.05) (p<0.02). No significant differences were found in salt intake when comparing aware versus unaware, treated versus untreated and controlled versus uncontrolled hypertension. In the overall population, 2.7% (95% CI 2.1% to 3.6%) of individuals without hypertension adhered to the recommended salt intake (<5 g/day) while 1.6% (95% CI 1.0% to 2.4%) with hypertension did so (p<0.03). Among individuals with hypertension, 2.4% (95% CI 1.4% to 4.0%) of those aware followed the guideline while only 0.8% (95% CI 0.4% to 1.9%) of those unaware adhered (p<0.03). Additionally, no significant differences were observed in adherence between the treated versus untreated and controlled versus uncontrolled hypertension.

CONCLUSIONS

Individuals with hypertension consume significantly more salt than those without, with no significant variations in salt intake based on aware, treated and controlled hypertension. Adhering to WHO salt intake guidelines aids better blood pressure management. By addressing salt consumption across hypertension care cascade, substantial progress can be made in better blood pressure control.

Is there a relationship between 24-hour urinary sodium and potassium and mental health in migraine patients?: A cross-sectional study

There is a lack of evidence and consensus in terms of the association between dietary intake of sodium (Na) and potassium (K) with mental health. By using 24-hours urinary samples as the gold standard method, we conducted a study to explore the association between dietary intake of Na and K with parameters of mental health including depression, anxiety, and stress among an Iranian population diagnosed with migraine. In the present study, 262 subjects (20-50 years old), with a confirmed diagnosis of migraine were enrolled. Mental health was investigated by the Depression, Anxiety, and Stress Scales (DASS-21) questionnaire. Dietary intake of Na and K was estimated by means of a 24-hour urine sample. Multinomial logistic regression analysis was implemented and odds ratio (OR) with 95% confidence interval (CI) was stated. After controlling for potential confounders, the 24-hour urinary Na was associated significantly with the risk of depression (OR = 0.55, 95% CI: 0.30, 1.00; P = .053). After adjustment for confounders, those in the highest tertile of the 24-hour urinary Na/K ratio had lower odds for having depression (OR = 0.54, 95% CI: 0.31, 0.93; P = .027), and marginally significantly lower risk of anxiety (OR = 0.58, 95% CI: 0.31, 1.06; P = .079) and stress (OR = 0.56, 95% CI: 0.31, 1.02; P = .061). In conclusion, higher 24-hour urine Na was associated with a significantly lower risk of depression. Moreover, the 24-hour Na/K ratio was significantly associated with lower risk of depression, anxiety, and stress.

Nutrition, Body Composition, and Blood Pressure in Children and Adolescents from the Korea National Health and Nutrition Examination Survey

We aimed to investigate the association between nutrition and blood pressure and the role that body composition plays in this relationship. Korea National Health and Nutrition Examination Survey data from the years 2008-2020 were reviewed. A total of 11,234 subjects (5974 boys and 5260 girls) aged 10-18 years of age were selected. We analyzed the correlation between nutrition (intakes of energy, protein, fat, carbohydrate, sodium, saturated fatty acid (SFA), unsaturated fatty acid (USFA), and dietary fiber (DF)) and body composition (height, weight, waist circumference (WC), body mass index (BMI), and waist to height ratio (WHtR)), and performed multiple regression analysis to find the independent correlation between body composition and blood pressure (BP). We then compared the correlation between nutrition and BP, with or without adjustment for body composition. The intakes of energy, protein, fat, carbohydrate, sodium, and USFA had positive associations with height, weight, WC, and BMI. Systolic BP (SBP) and diastolic BP (DBP) were independently positively correlated with height and BMI. The intakes of energy, protein, fat, carbohydrate, sodium, and SFA had positive correlations with SBP and DBP, which disappeared when additionally adjusted for BMI and height. In conclusion, nutrition seems to affect BP via height and BMI in Korean children and adolescents.

Changes in the salt content of packaged foods sold in supermarkets between 2015-2020 in the United Kingdom: A repeated cross-sectional study

BACKGROUND

Excess consumption of salt is linked to an increased risk of hypertension and cardiovascular disease. The United Kingdom has had a comprehensive salt reduction programme since 2003, setting a series of progressively lower, product-specific reformulation targets for the food industry, combined with advice to consumers to reduce salt. The aim of this study was to assess the changes in the sales-weighted mean salt content of grocery foods sold through retail between 2015 and 2020 by category and company.

METHODS AND FINDINGS

Information for products, including salt content (g/100 g), was collected online from retailer websites for 6 consecutive years (2015 to 2020) and was matched with brand-level retail sales data from Euromonitor for 395 brands. The sales-weighted mean salt content and total volume of salt sold were calculated by category and company. The mean salt content of included foods fell by 0.05 g/100 g, from 1.04 g/100 g in 2015 to 0.90 g/100 g in 2020, equivalent to -4.2% (p = 0.13). The categories with the highest salt content in 2020 were savoury snacks (1.6 g/100 g) and cheese (1.6 g/100 g), and the categories that saw the greatest reductions in mean salt content over time were breakfast cereals (-16.0%, p = 0.65); processed beans, potatoes, and vegetables (-10.6%, p = 0.11); and meat, seafood, and alternatives (-9.2%, p = 0.56). The total volume of salt sold fell from 2.41 g per person per day to 2.25 g per person per day, a reduction of 0.16 g or 6.7% (p = 0.54). The majority (63%) of this decrease was attributable to changes in mean salt content, with the remaining 37% accounted for by reductions in sales. Across the top 5 companies in each of 9 categories, the volume of salt sold decreased in 26 and increased in 19 cases. This study is limited by its exclusion of foods purchased out of the home, including at restaurants, cafes, and takeaways. It also does not include salt added at the table, or that naturally occurring in foods, meaning the findings underrepresent the population's total salt intake. The assumption was also made that the products matched with the sales data were entirely representative of the brand, which may not be the case if products are sold exclusively in convenience stores or markets, which are not included in this database.

CONCLUSIONS

There has been a small decline in the salt content of foods and total volume of salt sold between 2015 and 2020, but observed changes were not statistically significant so could be due to random variations over time. We suggest that mandatory reporting of salt sales by large food companies would increase the transparency of how individual businesses are progressing towards the salt reduction targets.

Impact of drinking of saline water on hemato-biochemical parameters of Black Bengal goats in the selected areas of Bangladesh

Global climatic changes are contaminating ground and surface water sources around the world, resulting in increased salinity. Knowing the animals' typical physiological capability for salinity tolerance without compromising their health is a necessity. The research was undertaken to determine the impacts of drinking water salinity on hemato-biochemical parameters of Black Bengal goats. A total of 40 Black Bengal goats (20 male and 20 female), age ranging from 1 to 5 years, were randomly selected and divided into 2 groups. The animals of group 1 received higher saline water (12 ppt) and those in group 2 received lower saline water (1 ppt) as regular drinking water. Blood parameters of all selected goats were measured. Serum creatinine, uric acid, urea, potassium, sodium, and chloride were significantly higher (P< 0.05) in the animals of group 1 compared with group 2, although serum phosphorous was significantly lower (P < 0.05) in group 1 compared with group 2. There were no significant differences in serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, magnesium, and calcium between the animals of group 1 and 2. AST and magnesium differed significantly (P < 0.05) between young and adult goats in group 1. Glucose and urea levels were slightly higher (P < 0.05) in young goats. In both groups, male goats had significantly higher (P < 0.05) serum potassium and urea levels than female goats. The results suggest that Black Bengal goats of the coastal areas have different salt tolerance capacities based on their age and sex, and adapt to higher salinity by changing kidney functions.

The association between low carbohydrate diet scores and cardiometabolic risk factors in Chinese adults

Epidemiological studies on the association between the low carbohydrate diet (LCD) score and cardiovascular disease risk factors have limited and inconsistent results. Data are from the baseline survey of Community-based Cohort Study on Nervous System Diseases. A total of 4609 adults aged ≥18 years were included in the study. Dietary data were assessed using a validated semi-quantitative Food Frequency Questionnaire. Multivariable logistic regression analyses were used to estimate relationships of three LCD scores with low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol (LDL-C), hypercholesterolemia, hypertriglyceridemia, impaired fasting glucose (IFG), high blood pressure, and hyperuricemia after adjusting for potential confounders. A higher LCD score was negatively associated with low HDL-C [OR (95%CI): 0.65 (0.50, 0.83), P=0.0001] and IFG [OR (95%CI): 0.65 (0.51, 0.81), P=0.001] after the final adjustment. However, there are gender differences in this result. Males in the highest quintile of the animal-based or plant-based LCD scores showed a decreased risk of low HDL-C, and females in the highest quintile of the animal-based or plant-based LCD scores showed a decreased risk of IFG than those in the lowest quintile of the LCD scores. These results suggest that gender differences should be considered when using LCD to treat dyslipidemia and reduce fasting blood glucose.

Stage 2 Hypertension and Electrocardiogram Abnormality: Evaluating the Risk Factors of Cardiovascular Diseases in Nigeria

INTRODUCTION

This study evaluated the status of stage 2 hypertension, abnormal ECG and their co-occurrence as possible risk factors of cardiovascular disease and their predictors in a Nigerian University population.

METHODS

A total of 717 subjects participated in this study. Blood pressure (BP), resting electrocardiogram (ECG) and other clinical parameters were measured and categorised according to standard organisational guidelines. Bivariate correlation and multivariate logistic regression model were used to determine covariates and clinical parameter association at a 95 % significant level.

RESULTS

Stage 2 hypertension and abnormal ECG respectively occurred in 264 (37 %) and 217 (39.2 %) subjects, with co-occurrence and abnormal BMI in 85 (11.8 %) and 459 (64.8%) subjects, respectively. Sex (p = 0.001) and occupation (p = 0.022) were independently associated with abnormal BP and ECG, respectively, while age was independently associated (p < 0.001) with abnormal BP, ECG and co-occurrence of these conditions. Predictors of stage 2 hypertension and abnormal ECG were sex (adjusted odds ratio [aOR] = 1.652, 95 % CI 1.097-2.488) and occupation (aOR = 0.411, 95 % CI 0.217-0.779), respectively, while age was a predictor for stage 2 hypertension (aOR = 0.065, 95 % CI 0.015-0.283), abnormal ECG (aOR = 0.137, 95 % CI 0.053-0.351) and their co-occurrence (aOR = 0.039, 95 % CI 0.014-0.113).

CONCLUSIONS

This study shows prevalence rates of these risk factors are on the increase. It also suggests that ECG abnormality is a public health issue among stage 2 hypertensive patients that must be monitored. Therefore, appropriate interventions that prevent and control hypertension and identified risk factors should be put in place in addition to lifestyle changes, regular screening and surveillance.

Study on the Correlation between Urinary Sodium and Potassium Excretion and Blood Pressure in Adult Hypertensive Inpatients of Different Sexes

OBJECTIVE

This study aims to understand the difference in the influence of urinary sodium and potassium excretion on blood pressure in patients of different sexes with hypertension by analyzing the relationship between urinary sodium and potassium excretion and blood pressure.

METHODS

In this cross-sectional study, 606 hospitalized patients with essential hypertension were recruited from 16 hospitals in the Shanxi Province between June 2018 and December 2019. These patients were grouped by sex, with 368 males and 238 females. Basic information and relevant serum biochemical indexes of patients in the two groups were recorded. The 24-hour urinary sodium and potassium excretion were measured, and 24-hour ambulatory blood pressure monitoring was performed simultaneously. This was done to analyze and compare the relationship between urinary sodium and urinary potassium excretion and blood pressure in adult hospitalized patients of different sexes with hypertension.

RESULTS

The 24-hour urinary sodium excretion in male patients with hypertension was significantly higher than that in female patients (P < 0.001). There was no significant difference in 24-hour urinary potassium excretion between male patients with hypertension and female patients. Spearman correlation analysis showed that 24-hour urinary sodium excretion was positively correlated with 24-hour SBP and nSBP in male patients (P < 0.05), while 24-hour urinary potassium excretion was negatively correlated with 24-hour SBP and nSBP in male patients (P < 0.05). The 24-hour urinary sodium in female patients was significantly positively correlated with 24-hour SBP, 24-hour DBP, SBP, dDBP, nSBP, and nDBP (P < 0.01). The 24-hour urinary potassium was significantly negatively correlated with nSBP (P < 0.05). Multiple stepwise linear regression showed that 24-hour urinary sodium excretion was still significantly positively correlated with 24-hour SBP and nSBP in male patients with hypertension after adjusting for various confounding factors.

CONCLUSION

High urinary sodium and low urinary potassium excretion are closely related to elevated blood pressure in adult patients with hypertension, and there are sex differences.

Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method

OBJECTIVE

High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran.

DESIGN

A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country.

SETTING

429 districts of all provinces of Iran, 2016.

PARTICIPANTS

18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey.

RESULTS

All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index.

CONCLUSIONS

Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.

Salt intake and salt-reduction strategies in South Asia: From evidence to action

The World Health Organization recommends salt reduction as a cost-effective intervention to prevent noncommunicable diseases. Salt-reduction interventions are best tailored to the local context, taking into consideration the varying baseline salt-intake levels, population's knowledge, attitude, and behaviors. Fundamental to reduction programs is the source of dietary salt-intake. In South Asian countries, there is a paucity of such baseline evidence around factors that contribute to community salt intake. Upon reviewing the electronic literature databases and government websites through March 31, 2021, we summarized dietary salt intake levels and aimed to identify major sources of sodium in the diet. Information on the current salt reduction strategies in eight South Asian countries were summarized, namely Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. One hundred twelve publications (out of identified 640) met our inclusion-exclusion criteria for full text review. Twenty-one studies were included in the review. Quality of the included studies was assessed using the US National Heart, Lung, and Blood Institute assessment tool. The primary result revealed that mean salt intake of South Asian countries was approximately twice (10 g/day) compared to WHO recommended intake (< 5 g/day). The significant proportion of salt intake is derived from salt additions during cooking and/or discretionary use at table. In most South Asian countries, there is limited data on population sodium intake based on 24-h urinary methods and sources of dietary salt in diet. While salt reduction initiatives have been proposed in these countries, they are yet to be fully implemented and evaluated. Proven salt reduction strategies in high-income countries could possibly be replicated in South Asian countries; however, further community-health promotion studies are necessary to test the effectiveness and scalability of those strategies in the local context.

Sodium Intake as a Cardiovascular Risk Factor: A Narrative Review

While sodium is essential for human homeostasis, current salt consumption far exceeds physiological needs. Strong evidence suggests a direct causal relationship between sodium intake and blood pressure (BP) and a modest reduction in salt consumption is associated with a meaningful reduction in BP in hypertensive as well as normotensive individuals. Moreover, while long-term randomized controlled trials are still lacking, it is reasonable to assume a direct relationship between sodium intake and cardiovascular outcomes. However, a consensus has yet to be reached on the effectiveness, safety and feasibility of sodium intake reduction on an individual level. Beyond indirect BP-mediated effects, detrimental consequences of high sodium intake are manifold and pathways involving vascular damage, oxidative stress, hormonal alterations, the immune system and the gut microbiome have been described. Globally, while individual response to salt intake is variable, sodium should be perceived as a cardiovascular risk factor when consumed in excess. Reduction of sodium intake on a population level thus presents a potential strategy to reduce the burden of cardiovascular disease worldwide. In this review, we provide an update on the consequences of salt intake on human health, focusing on BP and cardiovascular outcomes as well as underlying pathophysiological hypotheses.

Energy Content and Nutrient Profiles of Frequently Consumed Meals in Singapore

Singapore is a multi-ethnic country with a great variety of traditional ethnic cuisines. In this modern society where there is an increasing prevalence of obesity, it is important to know the nutritional content and energy density of our foods. However, there have been little data on the nutritional content of our local foods. The energy density and nutrient content of 45 commonly consumed meals by three ethnic groups in Singapore (Chinese, Malay, and Indian) were assessed in this study. Chinese, Malay, and Indian cuisines had an average energy density of 661, 652, and 723 kJ/100 g, respectively. Moreover, the macronutrient content is different between the different ethnic groups. Compared to Chinese and Malay cuisines, Indian cuisine contained lower protein but higher fat and carbohydrate content (p = 0.03). From the mineral analysis of the ethnic foods, we found out that Chinese cuisines contain significantly higher sodium (average of 238 mg/100 g) than Malay cuisines (p = 0.006) and Indian cuisines (p = 0.03). Knowing the caloric density and nutrition content of local ethnic foods may aid hawkers and government officials in developing healthier options to tackle Singapore's obesity epidemic.

Forecasting disability-adjusted life years for chronic diseases: reference and alternative scenarios of salt intake for 2017-2040 in Japan

BACKGROUND

In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040.

METHODS

We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases.

RESULTS

In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden.

CONCLUSIONS

The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.

Assessment of groundwater quality for drinking purpose with special emphasis on salinity and nitrate contamination in the shallow aquifer of Guenniche (Northern Tunisia)

Monitoring the groundwater quality situation and identifying the various pollution loads' sources are a prerequisites to finding solutions. In many areas, nitrate and salinity are one of the prime pollutants in the groundwater. This investigation is carried to present the results of a monitoring study focusing on 20 wells samples collected from the shallow groundwater of Guenniche plain (North Tunisia) during the wet season of May 2016, to present its suitability for drinking purposes with emphasis on the assessment of the presence of nitrate and salinity elements. Nitrate levels' results show that 55% of the samples exceeded the National Tunisian standard limit (NT) and the World Health Organization standard limit (WHO). The salinity results, measured as total dissolved solids (TDS), show that 95% of the samples exceed the international standard, and 25% exceed the national standard. A total of 20% of the wells exceeded the nitrite standards. The total hardness levels indicate that 90% of the samples present very hard water. The Guenniche shallow groundwater average concentrations are categorized as follows: Na⁺ > Ca²⁺ > Mg²⁺ > K⁺ for the cations and Cl^- > SO₄^2- > HCO₃^- > NO₃^- for the anions. Nitrate and salinity variations during the period 2006-2015 follow the rainfall fluctuation patterns. The assessment of water quality using Water Quality Index revealed that 95% of the wells' water classes ranged between "poor", "very poor," and "unsuitable for drinking purposes". Therefore, these wells are affected by anthropogenic and/or natural factors and they are inadvisable for drinking purposes, unless the water from these wells undergoes appropriate treatment before use.

Sustainable solutions to mitigate occupational heat strain - an umbrella review of physiological effects and global health perspectives

BACKGROUND

Climate change is set to exacerbate occupational heat strain, the combined effect of environmental and internal heat stress on the body, threatening human health and wellbeing. Therefore, identifying effective, affordable, feasible and sustainable solutions to mitigate the negative effects on worker health and productivity, is an increasingly urgent need.

OBJECTIVES

To systematically identify and evaluate methods that mitigate occupational heat strain in order to provide scientific-based guidance for practitioners.

METHODS

An umbrella review was conducted in biomedical databases employing the following eligibility criteria: 1) ambient temperatures > 28 °C or hypohydrated participants, 2) healthy adults, 3) reported psychophysiological (thermal comfort, heart rate or core temperature) and/or performance (physical or cognitive) outcomes, 4) written in English, and 5) published before November 6, 2019. A second search for original research articles was performed to identify interventions of relevance but lacking systematic reviews. All identified interventions were independently evaluated by all co-authors on four point scales for effectiveness, cost, feasibility and environmental impact.

RESULTS

Following screening, 36 systematic reviews fulfilled the inclusion criteria. The most effective solutions at mitigating occupational heat strain were wearing specialized cooling garments, (physiological) heat acclimation, improving aerobic fitness, cold water immersion, and applying ventilation. Although air-conditioning and cooling garments in ideal settings provide best scores for effectiveness, the limited applicability in certain industrial settings, high economic cost and high environmental impact are drawbacks for these solutions. However, (physiological) acclimatization, planned breaks, shading and optimized clothing properties are attractive alternative solutions when economic and ecological sustainability aspects are included in the overall evaluation.

DISCUSSION

Choosing the most effective solution or combinations of methods to mitigate occupational heat strain will be scenario-specific. However, this paper provides a framework for integrating effectiveness, cost, feasibility (indoors and outdoor) and ecologic sustainability to provide occupational health and safety professionals with evidence-based guidelines.

Energy Density and Nutrient Contents of Selective Chinese New Year Snacks

BACKGROUND

In this study, the energy density and nutrient contents of thirty Chinese New Year (CNY) snacks commonly consumed in the Asian region during the CNY festive season were measured.

METHODS

Calorie Answer™, Gas Chromatography-Mass Spectrometry (GC-MS) and Inductively coupled plasma-mass spectrometry (ICP-MS) were the main methods applied in this study.

RESULTS

All snacks showed high energy density (kJ/100 g) and the nutrient content, including macro-and micronutrients of these snacks were remarkably different. The most abundant minerals in these snacks include sodium, magnesium, potassium, and calcium. Palmitic (C16:0), oleic (C18:1) and linoleic (C18:2) acids were the main fatty acids and trans-fat was only identified in Butter cookies.

CONCLUSIONS

This study provides a large database on macro- and micronutrient contents in CNY snacks consumed in the Asian region that has not been previously reported. Our results indicate that the snacks were generally energy-dense and nutrient-poor. This study provides necessary information to enable the reformulation of snacks with lower saturated fat and sodium content. It is also a source of information for consumers to select healthier snacks.

Alleviation of salt-induced exacerbation of cardiac, renal, and visceral fat pathology in rats with metabolic syndrome by surgical removal of subcutaneous fat

OBJECTIVES

Evidence suggests that visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) should be considered as distinct types of white fat. Although VAT plays a key role in metabolic syndrome (MetS), the role of subcutaneous adipose tissue (SAT) has been unclear. DahlS.Z-Lepr^fa/Lepr^fa (DS/obese) rats, an animal model of MetS, develop adipocyte hypertrophy and inflammation to similar extents in SAT and VAT. We have now investigated the effects of salt loading and SAT removal on cardiac, renal, and VAT pathology in DS/obese rats.

METHODS

DS/obese rats were subjected to surgical removal of inguinal SAT or sham surgery at 8 weeks of age. They were provided with a 0.3% NaCl solution as drinking water or water alone for 4 weeks from 9 weeks of age.

RESULTS

Salt loading exacerbated hypertension, insulin resistance, as well as left ventricular (LV) hypertrophy, inflammation, fibrosis, and diastolic dysfunction in DS/obese rats. It also reduced both SAT and VAT mass but aggravated inflammation only in VAT. Although SAT removal did not affect LV hypertrophy in salt-loaded DS/obese rats, it attenuated hypertension, insulin resistance, and LV injury as well as restored fat mass and alleviated inflammation and the downregulation of adiponectin gene expression in VAT. In addition, whereas salt loading worsened renal injury as well as upregulated the expression of renin-angiotensin-aldosterone system-related genes in the kidney, these effects were suppressed by removal of SAT.

CONCLUSIONS

SAT removal attenuated salt-induced exacerbation of MetS and LV and renal pathology in DS/obese rats. These beneficial effects of SAT removal are likely attributable, at least in part, to inhibition of both VAT and systemic inflammation.

Anthropometric and Biochemical Predictors for Hypertension in a Cross-Sectional Study in Zanzibar, Tanzania

Background: Aim of this study was to describe the proportion of hypertension among Zanzibari of different age-groups and to detect possible correlates of this non-communicable disease.

Methods: In 2013 a cross-sectional survey was conducted in Unguja Island, Zanzibar. A total of 235 randomly selected households, including 1,229 (2 to 95 years) eligible study participants, were examined. Association between objectively assessed obesity markers, salt intake and hypertension were investigated. Estimates of 24 h sodium and potassium excretion from a single morning spot urine specimen were calculated and used as surrogate for salt intake. The association between overweight/obesity and hypertension in different age-groups was assessed in multilevel logistic regression models. Further associations between salt intake and hypertension were analyzed.

Results: Measures of systolic and diastolic blood pressure as well as proportion of overweight/obesity and hypertension both increased with age. Overweight and obesity were significantly associated with hypertension in adults. Moreover, thinness seems to be associated with hypertension as well. We observed a significantly reduced chance of hypertension for higher urinary sodium-to-potassium compared to a lower ratio in children.

Conclusion: Overweight/obesity and hypertension were highly prevalent (>47% of adults >40 years are overweight or obese and >69% are hypertensive in the same age group) in our sample. Weight status was confirmed as a correlate of high blood pressure in our sample from Zanzibar, Tanzania. To early and effectively prevent related severe cardiovascular outcomes, screening strategies but also monitoring strategies are required for this population.

Comparison of Urinary Sodium and Blood Pressure Relationship From the Spot Versus 24-Hour Urine Samples

Background We compared the relationship between sodium (Na) intake and blood pressure when Na intake was estimated from first- and second-morning spot urine samples using the INTERSALT (International Study on Salt and Blood Pressure) formula, versus directly measured 24-hour samples. Methods and Results We collected 24-hour urine and first- and second-morning voids of 383 participants in coastal Bangladesh for 2 visits. We measured participants' blood pressure using an Omron® HEM-907 monitor. To assess the shape of the relationship between urinary Na and blood pressure, we created restricted cubic spline plots adjusted for age, sex, body mass index, smoking and alcohol consumption, physical activities, religion, sleep hours, and household wealth. To assess multicollinearity, we reported variance inflation factors, tolerances, and Leamer's and Klein's statistics following linear regression models. The mean daily urinary Na was 122 (SD 26) mmol/d for the first; 122 (SD 27) mmol/d for the second; and 134 (SD 70) mmol/d for the 24-hour samples. The restricted cubic spline plots illustrated no association between first-morning urinary Na and systolic blood pressure until the 90th percentile distribution followed by a downward relationship; a nonlinear inverse-V-shaped relationship between second-morning urinary Na and systolic blood pressure; and a monotonic upward relationship between 24-hour urinary Na and systolic blood pressure. We found no evidence of multicollinearity for the 24-hour urinary Na model. Conclusions The urinary Na and systolic blood pressure relationship varied for 3 urinary Na measurements. Twenty-four-hour urinary Na captured more variability of Na intake compared with spot urine samples, and its regression models were not affected by multicollinearity.

Trends in Dietary Sodium Intake in the United States and the Impact of USDA Guidelines: NHANES 1999-2016

BACKGROUND

Moderation in sodium consumption is recommended to reduce morbidity and mortality; however, trends in intake and the impact of guidelines have not been examined.

METHODS

Sodium intake data collected from 1999-2016 in the National Health and Nutrition Examination Surveys were analyzed. Trends in sodium intake for individuals aged 18 years or over and in subgroups based on age, sex, race and ethnicity, and sodium-sensitive chronic diseases were examined. Adherence to US Department of Agriculture guidelines was assessed. Multivariable regression analysis was performed to identify predictors of sodium intake from 2011-2016.

RESULTS

A total of 47,509 individuals (median age = 44.0 years, 48.3% male) were included in the study. Median sodium consumption was 3232 mg per day (95% confidence interval [CI], 3210-3255), increasing from 3156 mg per day (95% CI 3,038-3,273) in 1999-2000 to 3273 mg per day (95% CI, 3218-3328) in 2015-2016 (P < .001). Intake declined with age (3427 mg per day for individuals aged 18-50 years, 3101 mg per day for individuals aged 51-70 years, and 2620 mg per day for individuals aged ≥71 years; P < .001) and was greater in males than in females (3827 mg per day vs 2778 mg per day; P < .001). Caucasians, Hispanics, and African Americans consumed 3278, 3117, and 3027 mg of dietary sodium per day respectively (P < .001). Individuals with hypertension, diabetes mellitus, and chronic kidney disease consumed 3073, 3062, and 2658 mg of dietary sodium per day respectively. Population adherence to US Department of Agriculture recommendations declined from 34% to 23% and all high-risk subgroups had < 10% adherence. Daily total calories was the strongest predictor of sodium consumption (overall r² = 0.680).

CONCLUSION

Sodium intake has remained above recommended levels in all segments of the adult population and adherence to guidelines is poor. Novel interventions are needed to reduce sodium intake.

The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka

BACKGROUND

Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults.

METHODS

A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint.

RESULTS

Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group.

CONCLUSIONS

An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka.

TRIAL REGISTRATION

Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.

Frequency of Use of Added Sugar, Salt, and Fat in Infant Foods up to 10 Months in the Nationwide ELFE Cohort Study: Associated Infant Feeding and Caregiving Practices

The consumption of sugar, salt, and fat in infancy may influence later health. The objective of this study was to describe the frequency of use of added sugar, salt, and fat during the complementary feeding period and the associated infant caregiving practices. Data were obtained from a monthly questionnaire filled by parents for 10,907 infants from the French Etude Longitudinale Française depuis l'Enfance (ELFE) cohort. A score of frequency of use (SU) for added sugar, salt, and fat (oil, margarine, butter, and/or cream) was calculated from the age at complementary feeding introduction (CFI) to the 10th month. Associations between the SU of each added ingredient with infant feeding and caregiving practices were studied with multivariable linear regressions adjusted for familial characteristics. Only 28% of the parents followed the recommendation of adding fat and simultaneously not adding sugar or salt. Breastfeeding mothers were more prone to add sugar, salt, and fat than non-breastfeeding mothers. CFI before four months was positively associated with the SU of added sugar and salt and negatively associated with the SU of added fat. The use of commercial baby food was negatively related to the SU of added salt and fat. The use of these added ingredients was mainly related to breastfeeding, age at CFI, and use of commercial food, and it was independent of the household socioeconomic characteristics.

Life style habits, biochemical factors and their interaction in the prediction of incident hypertension during 21-year follow-up

BACKGROUND

Hypertension is a global health threat and major cardiovascular risk. Various risk-prediction models for incident hypertension have been developed but not many of them have studied the risk-predictive value of life style factors in combination with cardiovascular biomarkers during long-term period of over 10 years.

METHODS

We examined differences in several classical variables for 299 subjects in OPERA (Oulu Project Elucidating Risk of Atherosclerosis) cohort in subjects with no or new hypertension during a follow-up period of 21 years. Effect of both various life style habits and biomarkers were investigated.

RESULTS

Baseline blood pressure, being overweight and smoking actively were independent predictors of new hypertension in majority of multivariate models during long-term follow-up of 21 years in subjects without previous hypertension. Increased high-sensitive C-reactive protein (hsCRP) level (> 3 mg/L) was the strongest predictor of incident hypertension in univariate model. Subjects with two or all three of main risk factors (being overweight, smoking actively and having high hsCRP) had 4-fold risk for incident hypertension.

CONCLUSIONS

Smoking, overweight and increased hsCRP level had risk-predictive value in incident hypertension prediction during long-term follow-up of 21 years. Assessment and measurement of these parameters could be used in help of detecting high risk subjects and primary prevention of hypertension very early on. In addition, the study shows that blood pressure at the middle-age should be followed and treated intensively to prevent hypertension in the older age.

KEY MESSAGES

Baseline blood pressure, being overweight and smoking actively are independent predictors of new hypertension during a long-term follow-up of 21 years. Having two or all three risk factors (smoking actively, body mass index over 25 kg/m², high-sensitive C-reactive protein (hsCRP) level over 3 mg/L) indicates a 4-fold risk for incident hypertension within 21-year follow-up.

The Frequency and Healthfulness of Food and Beverages Advertised on Adolescents' Preferred Web Sites in Canada

PURPOSE

The purpose of this study was to document the frequency and healthfulness of pop-up and banner food advertisements displayed on third-party Web sites preferred by adolescents in Canada.

METHODS

Syndicated Internet advertising exposure data licensed from comScore was used to identify adolescents' (ages 12-17) 10 most popular Web sites and determine the frequency of food and beverage display advertisements on these Web sites from June 2015 to May 2016. The nutrition information for all advertised products was collected, and the healthfulness of all food and beverage ads was assessed using the Pan-American Health Organization (PAHO) and the U.K. Nutrient Profile Models (NPM).

RESULTS

In total, there were 14.4 million food advertisements on all 10 Web sites from June 2015 to May 2016. The most frequently advertised food categories were cakes, cookies, and ice cream (32.5%); cold cereal (20.5%); restaurants (18.0%); and sugar-sweetened beverages (12.0%). Most advertised products (93.3%) were categorized as excessive in either fat, sodium, or free sugars according to the PAHO NPM, and 83.5% of ads were categorized as "less healthy" according to the U.K. NPM. Specifically, 81.3% of ads were excessive in free sugars, 22.1% were excessive in sodium, 14.1% were excessive in saturated fat, and 11.8% were excessive in total fat according to the PAHO NPM.

CONCLUSIONS

Canadian adolescents are potentially exposed to a high frequency of unhealthy food and beverage display advertisements on their preferred Web sites. Regulations restricting food and beverage marketing to children need to include digital media and should consider protecting adolescents up to the age of 17.

Should we tax unhealthy food and drink?

The global burden of obesity leads to significant morbidity and has major economic implications. In April 2018, Britain will join a growing number of countries attempting to tackle this using fiscal measures when the UK Soft Drinks Industry Levy is introduced. We review recent evidence from natural experiments of the impact of health-related food and drink taxes on consumer behaviour, and discuss the possible consequences of these approaches on purchases and health. We highlight some of the potential indirect consequences and the importance of robust prospective evaluation.

Sodium Intake, Blood Pressure, and Dietary Sources of Sodium in an Adult South Indian Population

BACKGROUND

The association between prevalence of hypertension and its relationship with dietary sodium intake has never been published from large epidemiological studies in the South Indian population before.

OBJECTIVES

To assess sodium intake and its association with blood pressure, and major dietary sources of sodium in an adult population in southeastern India.

METHODS

This study included a representative population-based sample of 8080 individuals (57% women) >20 years of age. Individuals with previous history of hypertension and outliers for sodium intake were excluded, resulting in a sample size of 6876, with 4269 from semi-urban/urban and 2607 from rural areas. Baseline measurements included evaluation of systolic (SBP) and diastolic (DBP) blood pressures, anthropometric, sociodemographic, and psychosocial parameters. Based on 24-hour recall, we calculated total daily sodium intake and the percentage contributed by each food group to the total sodium intake. Participants were assigned based on quintiles of dietary sodium intake. Mixed-effects multivariable linear regression models assessed the association of SBP and DBP with sodium intake.

FINDINGS

Men had higher mean sodium intake (4.1 ± 2 versus 3.2 ± 1.7 g/day; P < 0.01) with higher mean SBP and DBP (123/77 versus 117/74 mm Hg; P < 0.01), and higher prevalence of hypertension (22.2% versus 12.9%; P < 0.01) compared with women. Mean dietary sodium intake was significantly higher in the hypertensive men (4.2 ± 2 g/day) and women (3.2 ± 1.7 g/day) compared with normotensive men (4 ± 2 g/day), and women (3.2 ± 1.7 g/day; P < 0.05). Significant (P < 0.01) increases in SBP and DBP were evident in men, but not women with increasing quintile of sodium intake. After multivariable adjustments, sodium intake was independently associated with SBP, but not DBP, in both sexes. The predominant source of dietary sodium in both semi-urban/urban and rural populations was from homemade foods where salt is part of the traditional recipe.

CONCLUSION

In a South Indian population, the dietary intake of sodium was higher than recommendations by major dietary guidelines and was an independent predictor of SBP.

Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji

Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3, p = 0.115). Sub-analysis showed a statistically significant reduction in female salt intake in the Central Division but no differential impact in relation to age or ethnicity. Whilst the low response rate means it is not possible to draw firm conclusions about these changes, the population salt intake in Fiji, at 10.3 g/day, is still twice the World Health Organization's (WHO) recommended maximum intake. This project also assessed iodine intake levels in women of child-bearing age and found that they were within recommended guidelines. Existing policies and programs to reduce salt intake and prevent iodine deficiency need to be maintained or strengthened. Monitoring to assess changes in salt intake and to ensure that iodine levels remain adequate should be built into future surveys.

Dietary salt blunts vasodilation by stimulating epithelial sodium channels in endothelial cells from salt-sensitive Dahl rats

BACKGROUND AND PURPOSE

Our recent studies show that the reduced activity of epithelial sodium channels (ENaC) in endothelial cells accounts for the adaptation of vasculature to salt in Sprague-Dawley rats. The present study examines a hypothesis that enhanced ENaC activity mediates the loss of vasorelaxation in Dahl salt-sensitive (SS) rats.

EXPERIMENTAL APPROACH

We used the cell-attached patch-clamp technique to record ENaC activity in split-open mesenteric arteries. Western blot and immunofluorescence staining were used to evaluate the levels of aldosterone, ENaC, eNOS and NO. Blood pressure was measured with the tail-cuff method and the artery relaxation was measured with the wire myograph assay.

KEY RESULTS

High-salt (HS) diet significantly increased plasma aldosterone and ENaC activity in the endothelial cells of Dahl SS rats. The endothelium-dependent artery relaxation was blunted by HS challenge in these rats. Amiloride, a potent blocker of ENaC, increased both phosphorylated eNOS and NO and therefore prevented the HS-induced loss of vasorelaxation. As, in SS rats, endogenous aldosterone was already elevated by HS challenge, exogenous aldosterone did not further elevate ENaC activity in the rats fed with HS. Eplerenone, a mineralocorticoid receptor antagonist, attenuated the effects of HS on both ENaC activity and artery relaxation.

CONCLUSIONS AND IMPLICATIONS

These data suggest that HS diet blunts artery relaxation and causes hypertension via a pathway associated with aldosterone-dependent activation of ENaC in endothelial cells. This pathway provides one of the mechanisms by which HS causes hypertension in Dahl SS rats.

LINKED ARTICLES

This article is part of a themed section on Spotlight on Small Molecules in Cardiovascular Diseases. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.8/issuetoc.

Glycemic index, glycemic load, and blood pressure: a systematic review and meta-analysis of randomized controlled trials

Background: High blood pressure is a strong risk factor for cardiovascular disease.Objective: The aim of this study was to determine the associations of dietary glycemic index (GI) and glycemic load (GL) with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in healthy individuals.Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out. Databases were searched for eligible RCTs in 2 phases. MEDLINE, Embase, CAB Abstracts, BIOSIS, ISI Web of Science, and the Cochrane Library were searched from January 1990 to December 2009. An updated search was undertaken with the use of MEDLINE and Embase from January 2010 to September 2016. Trials were included if they reported author-defined high- and low-GI or -GL diets and blood pressure, were of ≥6 wk duration, and comprised healthy participants without chronic conditions. Data were extracted and analyzed with the use of Stata statistical software. Pooled estimates and 95% CIs were calculated with the use of weighted mean differences and random-effects models.Results: Data were extracted from 14 trials comprising 1097 participants. Thirteen trials provided information on differences in GI between control and intervention arms. A median reduction in GI of 10 units reduced the overall pooled estimates for SBP and DBP by 1.1 mm Hg (95% CI: -0.3, 2.5 mm Hg; P = 0.11) and 1.3 mm Hg (95% CI: 0.2 mm Hg, 2.3; P = 0.02), respectively. Nine trials reported information on differences in GL between arms. A median reduction in GL of 28 units reduced the overall pooled estimates for SBP and DBP by 2.0 mm Hg (95% CI: 0.2, 3.8 mm Hg; P = 0.03) and 1.4 mm Hg (95% CI: 0.1, 2.6 mm Hg; P = 0.03), respectively.Conclusions: This review of healthy individuals indicated that a lower glycemic diet may lead to important reductions in blood pressure. However, many of the trials included in the analysis reported important sources of bias. This trial was registered at PROSPERO as CRD42016049026.

Knowledge, attitudes and perception on dietary salt reduction of two communities in Grahamstown, South Africa

INTRODUCTION

Dietary salt reduction has been identified as a cost effective way of addressing the global burden of non-communicable diseases (NCDs), particularly cardiovascular diseases. The World Health Organization has recommended three main strategies for achieving population-wide salt reduction in all member states: food reformulation, policies and consumer awareness campaigns. In 2013, the South African Ministry of Health announced the mandatory salt reduction legislation for the food manufacturing sector. These were set to come into effect on 30 June 2016. This decision was influenced by the need to reduce the incidence of NCDs and the fact that processed food is the source of 54% of the salt consumed in the South African diet. However, with discretionary salt also being a significant contributor, there is need for consumer awareness campaigns. The aim of this study was to assess the knowledge, attitudes and practices of guardians and cooks at two non-governmental organisations based in Grahamstown, South Africa, towards dietary salt reduction.

METHOD

Data was collected through observation and explorative, voice-recorded semi-structured interviews and transcribed data was analysed using NVivo®.

RESULTS

At both centres, salt shakers were not placed on the tables during mealtimes. Only 14% the participants perceived their personal salt intake to be a little. No participants were aware of the recommended daily salt intake limit or the relationship between salt and sodium. Only five out of the 19 participants had previously received information on dietary salt reduction from sources such as healthcare professionals and the media.

CONCLUSION

The results from the first phase of this study highlighted gaps in the participants' knowledge, attitudes and practices towards dietary salt reduction. The aim of the second phase of the research is to design and implement a context specific and culturally appropriate educational intervention on dietary salt reduction.

Blood pressure-lowering effects of long chain n-3 fatty acids from meals enriched with liquid fish oil and from microencapsulated powder

BACKGROUND

Diet plays an important role in the etiology of hypertension. Blood pressure (BP)-lowering properties of long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) are promising. The aim was to investigate whether different formulations of fish oil differently affect blood pressure in community-dwelling adults. The hypothesis was that fish oil formulations would improve BP in comparison with a placebo.

METHODS

In this 4-week randomized, placebo-controlled, doubly-blinded dietary intervention study, participants (N = 99, >50 years) from the capital area of Iceland were randomized into three groups. Group 1 (n = 38) received 6 meals/week fortified with a liquid fish oil and placebo powder. Group 2 (n = 30) received conventional (unfortified) meals and microencapsulated powder. Group 3 (n = 31) was the control group which received conventional meals and placebo powder. Calculated on a weekly basis, the amount of EPA + DHA provided was 1.5 g/d. Systolic (SBP) and diastolic BP (DBP) were measured before and after the intervention period.

RESULTS

Seventy-seven subjects finished the study (77.8%). Drop-out rates were not different between groups. According to multivariate statistics, endpoint SBP was lower in Group 1 (-7.0 mmHg, p = 0.037) and in Group 2 (-7.2 mmHg, p = 0.037) as compared with Group 3. There was no significant difference in DBP between the groups.

CONCLUSION

Our study shows that LC n-3 PUFA from microencapsulated powder are equally effective to meaningfully reduce SBP as LC n-3 PUFA from meals enriched with liquid fish oil in comparison with a control group.

Effects of dietary fibre type on blood pressure: a systematic review and meta-analysis of randomized controlled trials of healthy individuals

OBJECTIVE

To determine the effect of different types of dietary fibre on SBP and DBP.

METHODS

A systematic review of the literature and a meta-analysis of randomized controlled trials using random-effects models. Eligibility criteria for studies included randomized controlled trials of at least 6 weeks duration, testing a fibre isolate or fibre-rich diet against a control or placebo published between 1 January 1990 and 1 December 2013.

RESULTS

Twenty-eight trials met the inclusion criteria and reported fibre intake and SBP and/or DBP. Eighteen trials were included in a meta-analysis. Studies were categorized into 1 of 12 fibre-type categories. The pooled estimates for all fibre types were -0.9 mmHg [95% confidence interval (CI) -2.5 to 0.6 mmHg] and -0.7 mmHg (95% CI -1.9 to 0.5 mmHg) for SBP and DBP, respectively. The median difference in total fibre was 6 g. Analyses of specific fibre types concluded that diets rich in beta-glucans reduce SBP by 2.9 mmHg (95% CI 0.9 to 4.9 mmHg) and DBP by 1.5 mmHg (95% CI 0.2 to 2.7 mmHg) for a median difference in beta-glucans of 4 g. Heterogeneity for individual fibre types was generally low.

CONCLUSIONS

Higher consumption of beta-glucan fibre is associated with lower SBP and DBP. The results of this review are consistent with recommendations to increase consumption of foods rich in dietary fibre, but some additional emphasis on sources of beta-glucans, such as oats and barley, may be warranted.

The influence of high versus low sodium intake on blood pressure and haemodynamics in patients with morbid obesity

BACKGROUND

Many patients with morbid obesity (BMI > 40 kg/m) have hypertension. The complex pathophysiological abnormalities linking hypertension to obesity have not been fully clarified, but abnormal sodium handling could be an important mechanism.

METHOD

Therefore, we examined changes in body fluid compartments and haemodynamic responses (at rest and during exercise) after 5 days of a low-sodium diet (90 mmol/day) and 5 days of a high-sodium diet (250 mmol/day) in 12 morbidly obese, hypertensive patients; 12 morbidly obese, normotensive patients and 12 nonobese controls.

RESULTS

High sodium intake as compared to low sodium intake was associated with an increase in plasma volume (obese, hypertensive patients: 5 ± 4%; obese, normotensive patients: 10 ± 11%; nonobese controls: 7 ± 6%), cardiac output (CO) (obese, hypertensive patients: 17 ± 12%; obese, normotensive patients: 20 ± 16%; nonobese controls: 13 ± 14%) and stroke volume (SV) (obese, hypertensive patients: 27 ± 26%; obese, normotensive patients: 27 ± 24%; nonobese controls: 18 ± 27%) in all three groups with no differences between the groups. Despite an increase in CO during high salt intake, 24-h blood pressure (BP) was unchanged in patients and controls as a result of a reduction in total peripheral resistance (obese, hypertensive patients: -11 ± 11%; obese, normotensive patients: -10 ± 12%; nonobese controls: -5 ± 14%). Similar changes were observed during an incremental bicycle exercise test wherein CO and SV were higher, whereas mean arterial BP was unchanged at each exercise level during high sodium intake.

CONCLUSION

Despite substantial increases in CO and SV, we did not observe any significant change in BP during high sodium intake, neither in morbid obese patients nor in lean individuals.

High salt-diet reduces SLC14A1 gene expression in the choroid plexus of Dahl salt sensitive rats

Elevated Na(+) concentration ([Na(+)]) in the cerebrospinal fluid (CSF) contributes to the development of salt-sensitive hypertension. CSF is formed by the choroid plexus (CP) in cerebral ventricles, and [Na(+)] in CSF is controlled by transporters in CP. Here, we examined the effect of high salt diet on the expression of urea transporters (UTs) in the CP of Dahl S vs Dahl R rats using real time PCR. High salt intake (8%, for 2 weeks) did not alter the mRNA levels of UT-A (encoded by SLC14A2 gene) in the CP of either Dahl S or Dahl R rats. In contrast, the mRNA levels of UT-B (encoded by SLC14A1 gene) were significantly reduced in the CP of Dahl S rats on high salt diet as compared with Dahl R rats or Dahl S rats on normal salt diet. Reduced UT-B expression was associated with increased [Na(+)] in the CSF and elevated mean arterial pressure (MAP) in Dahl S rats treated with high salt diet, as measured by radiotelemetry. High salt diet-induced reduction in UT-B protein expression in the CP of Dahl S rats was confirmed by Western blot. Immunohistochemistry using UT-B specific antibodies demonstrated that UT-B protein was expressed on the epithelial cells in the CP. These data indicate that high salt diet induces elevations in CSF [Na(+)] and in MAP, both of which are associated with reduced UT-B expression in the CP of Dahl S rats, as compared with Dahl R rats. The results suggest that altered UT-B expression in the CP may contribute to an imbalance of water and electrolytes in the CSF of Dahl S rats on high salt diet, thereby leading to alterations in MAP.

High sodium intake: review of recent issues on its association with cardiovascular events and measurement methods

There has been a long-known association between high dietary sodium intake and hypertension, as well as the increased risk of cardiovascular disease. Reduction of sodium intake is a major challenge for public health. Recently, there have been several controversial large population-based studies regarding the current recommendation for dietary sodium intake. Although these studies were performed in a large population, they aroused controversies because they had a flaw in the study design and methods. In addition, knowledge of the advantages and disadvantages of the methods is essential in order to obtain an accurate estimation of sodium intake. I have reviewed the current literatures on the association between sodium intake and cardiovascular events, as well as the methods for the estimation of sodium intake.

Determination of iodine and sodium content in fermented meat products purchased in the Czech Republic– a pilot study

Iodine deficiency is still one of acute global public health problems. The best strategy to ensure its required amount in human population is salt fortification with potassium iodate or iodide. Food industry plays an important role in supporting good health status of consumers. Using iodized salt in meat production is not mandatory in the Czech Republic. The aim of this pilot study was to evaluate a group of salty meat products - fermented meats purchased in the Czech Republic in terms of iodine and sodium content. Totally 36 samples purchased in 9 major retail chains, produced in 9 different European countries were analyzed by spectrophotometric methods. As the results show, the use of iodinated salt was obvious only among Czech producers. The application of iodinated and marine salt does not mean that those products are a good source of iodine. Consumers should be more informed about iodine and sodium content in food. They should also be more aware about the health impact of high sodium intake. This pilot study compares iodine and sodium content in this type of meat products produced in different European countries but purchased in the Czech Republic.

Dietary salt intake and hypertension

Over the past century, salt has been the subject of intense scientific research related to blood pressure elevation and cardiovascular mortalities. Moderate reduction of dietary salt intake is generally an effective measure to reduce blood pressure. However, recently some in the academic society and lay media dispute the benefits of salt restriction, pointing to inconsistent outcomes noted in some observational studies. A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypertension, cardiovascular disease and stroke. However, some scientists still advocate the possibility of increased risk of CVD morbidity and mortality at extremes of low salt intake. Future research may inform the optimal sodium reduction strategies and intake targets for general populations. Until then, we have to continue to build consensus around the greatest benefits of salt reduction for CVD prevention, and dietary salt intake reduction strategies must remain at the top of the public health agenda.

[Factors associated with the addition of salt to prepared food]

The scope of this research was to investigate the potential differences between men and women in the addition of salt to prepared food. The study included 47,557 individuals aged 18 to 64 participating in the Risk and Protection Factors for Chronic Disease Surveillance System by Telephone Interview carried out in 26 Brazilian state capitals and the Federal District in 2006. Differences between men and women were tested by the chi-square test and the association magnitudes between the dependent and independent variables were estimated by the Odds Ratio obtained by Multiple Logistic Regression analysis. The prevalence of the addition of salt to prepared food was 8.3%, being higher among men (9,8% vs 6,9%, p < 0.01). After adjustment, the addition of salt to prepared food was higher in individuals with self-rated fair to poor health, reporting cardiovascular disease and living in the North of Brazil. Hypertensive individuals reported addition of less salt to prepared food. Educational level was not associated with salt usage. Men add more salt than women. Public health policies aimed at reducing salt intake by the population should take into account the gender differences in salt intake and the factors that contribute to such differences.

Reducing the modifiable risks of cardiovascular disease in Turkish patients with type 2 diabetes: the effectiveness of training

Our goal was to reduce the number of modifiable risk factors for cardiovascular disease (CVD) through providing lifestyle adjustment training and counseling to patients with type 2 diabetes. In this pre-post intervention study, 139 patients with diabetes were provided with training to reduce the modifiable risks of CVD. One hundred three patients attended the post-training evaluation. Two phone counseling sessions were provided with 1-month intervals. Consumption of red meat and processed food decreased and water consumption, carrying on the recommended diet, and the frequency of exercise increased (p = .000), A1C decreased (p = .05), and the use of aspirin increased (p = .03). Thus, a contribution to the reduction of CVD risk factors in patients with type 2 diabetes was achieved. The training program for reducing CVD risk factors in patients with type 2 diabetes was effective in improving nutrition and lifestyle behaviors and decreasing glycemic control.