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Liu M, Ye Z, He P, Yang S, Zhang Y, Zhou C, Zhang Y, Hou FF, Qin X. Adding salt to foods and hazards of microvascular, cerebrovascular and cardiovascular diseases. Eur J Clin Nutr 2024; 78:141-148. [PMID: 37838806 DOI: 10.1038/s41430-023-01354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND We aimed to examine the association of the frequency of adding salt to foods and the hazards of the incidence and mortality risks for a range of vascular outcomes, including microvascular, cerebrovascular, and cardiovascular diseases. METHODS 438,307 participants from the UK Biobank who completed the questionnaire on the frequency of adding salt to foods and were free of vascular disease at baseline were enrolled. Information on the frequency of adding salt to foods (do not include salt used in cooking) was collected at baseline through a touch-screen questionnaire. The primary outcomes included incident microvascular diseases, cerebrovascular diseases, and cardiovascular diseases, respectively. The secondary outcomes included: (1) each component of these vascular diseases (10 components in total), (2) first occurrence of fatal and non-fatal vascular diseases. RESULTS During a median follow-up of 12.1 years, a total of 17,169 (3.9%), 10,437 (2.4%), and 48,203 (11.0%) participants developed microvascular, cerebrovascular and cardiovascular diseases, respectively. Overall, the hazards of incident microvascular, cerebrovascular and cardiovascular diseases increased with the increasing frequency of adding salt to foods (all P for trend <0.001). Similar trends were found for the secondary outcomes. Moreover, the positive association of always adding salt to foods with hazard of cardiovascular diseases was stronger among current-smokers (P-interaction = 0.010), younger participants (P-interaction <0.001), and those with lower body mass index levels (P-interaction = 0.003). CONCLUSIONS Higher frequency of adding salt to foods was associated with higher hazards of non-fatal and fatal microvascular, cerebrovascular and cardiovascular diseases, and each component of these vascular diseases.
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Affiliation(s)
- Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Fan Fan Hou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
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Tang R, Kou M, Wang X, Ma H, Li X, Heianza Y, Qi L. Self-Reported Frequency of Adding Salt to Food and Risk of Incident Chronic Kidney Disease. JAMA Netw Open 2023; 6:e2349930. [PMID: 38153731 PMCID: PMC10755616 DOI: 10.1001/jamanetworkopen.2023.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Importance The self-reported frequency of adding salt to foods could reflect a person's long-term salt taste preference, and salt intake has been associated with increased risk of cardiovascular diseases (CVD). Whether self-reported adding of salt to foods is associated with increased risk of chronic kidney disease (CKD) remains unknown. Objective To prospectively examine the association of self-reported frequency of adding salt to foods with incident CKD risk in a general population of adults. Design, Setting, and Participants This population-based cohort study evaluated UK Biobank participants aged 37 to 73 years who were free of CKD at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis. Data were analyzed from October 2022 to April 2023. Exposure Self-reported frequency of adding salt to foods, categorized into never or rarely, sometimes, usually, and always. Main Outcome and Measure Incident CKD cases were defined by diagnostic codes. Hazard ratios (HRs) and 95% CIs were calculated by using Cox proportional hazards models. Models were adjusted for several potential confounders including age, sex, race and ethnicity, Townsend Deprivation Index, estimated glomerular filtration rate (eGFR), body mass index, (BMI), smoking status, alcohol drinking status, regular physical activity, high cholesterol, diabetes, CVD, hypertension, infectious disease, immune disease, and nephrotoxic drugs use at baseline. Results Within a cohort of 465 288 individuals (mean [SD] age 56.32 [8.08] years; 255 102 female participants [54.83%]; 210 186 male participants [45.17%]), participants with higher self-reported frequency of adding salt to foods were more likely to have a higher BMI, higher Townsend Deprivation Index score, and diminished baseline eGFR compared with those who reported a lower frequency of adding salt to foods. Participants who added salt to their foods were also more likely than those who did not add salt to their foods to be current smokers and have diabetes or CVD at baseline. During a median (IQR) follow-up of 11.8 (1.4) years, 22 031 incident events of CKD were documented. Higher self-reported frequency of adding salt to foods was significantly associated with a higher CKD risk after adjustment for covariates. Compared with those who reported never or rarely adding salt to foods, those who reported sometimes adding salt to food (adjusted HR [aHR], 1.04; 95% CI, 1.00-1.07), those who reported usually adding salt to food (aHR, 1.07; 95% CI, 1.02-1.11), and those who reported always adding salt to food (aHR, 1.11; 95% CI, 1.05-1.18) had an increased risk of CKD (P for trend < .001). In addition, eGFR, BMI, and physical activity significantly modified the associations, which were more pronounced among participants with a higher eGFR, lower BMI, or lower level of physical activity. Conclusions and Relevance In this cohort study of 465 288 individuals, a higher self-reported frequency of adding salt to foods was associated with a higher risk of CKD in the general population. These findings suggest that reducing the frequency of adding salt to foods at the table might be a valuable strategy to lower CKD risk in the general population.
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Affiliation(s)
- Rui Tang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Minghao Kou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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3
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Dong J, Yu X, Li X, Xiang S, Qin Y, Zhu S, Zheng J, Yan Y. Consistency between 3 days' dietary records and 24-h urine in estimating salt intake in children and adolescents. Front Public Health 2022; 10:1071473. [PMID: 36620268 PMCID: PMC9822649 DOI: 10.3389/fpubh.2022.1071473] [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: 10/16/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to evaluate the salt intake in boarding school students and the consistency between salt intake measurements based on 24-h urine and weighed dietary records over 3 consecutive days in this population. Methods This was a school-based cross-sectional study. Overweight (including obesity) or hypertensive students aged 6-14 years and their normal counterparts were recruited for this study at three boarding schools in China. Three consecutive 24-h urine samples were collected from all participants. During the collection period of 24-h urine, the weighed diet records were collected in children who had all three meals at the school canteens on weekdays. Incomplete 24-h urine or dietary records were excluded from the analysis. Results The median salt excretion was 6,218 [4,636, 8,290] mg by 24-h urine and 120 (82.2%) consumed excess salt among the participants. The median salt intake was 8,132 [6,348, 9,370] mg by dietary records and 112 (97.4%) participants consumed excess salt than recommended in participants who have all three meals in the school canteens. In children with complete dietary records and 24-h urine, the level of salt intake estimated by 24-h urine accounted for 79.6% of the dietary records. Conclusion Our study showed that boarding school students consumed excessive salt from school canteens. Thus, policies or strategies targeting school canteens are urgently needed. Weighed dietary records are recommended if feasible.
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Affiliation(s)
- Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China,*Correspondence: Jie Dong ✉
| | - Xiaoran Yu
- Department of Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xun Li
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Shiting Xiang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | | | - Shaolun Zhu
- The Middle School of Fengshu, Taoyuan, China
| | - Jie Zheng
- The Primary School of Qinglin, Taoyuan, China
| | - Yinkun Yan
- Department of Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Santos JA, Bolton KA, Rosewarne E, Trieu K, Di Tanna GL, Woodward M, Webster J, Grimes C. Agreement between 24-hour urine and 24-hour food recall in measuring salt intake in primary school children in Australia. Nutr J 2022; 21:68. [PMCID: PMC9664040 DOI: 10.1186/s12937-022-00823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Monitoring salt consumption in children is essential for informing and implementing public health interventions to reduce children’s salt intake. However, collection of 24-hour urines, considered as the most reliable approach, can be especially challenging to school children. This study aimed to assess the agreement between 24-hour urine (24hrU) and 24-hour food recall (24hrFR) in: (1) estimating salt intake in children; (2) classifying salt intakes above the recommended upper level set for children, and; (3) estimating change in mean salt intake over time.
Methods
This study utilised data from two cross-sectional surveys of school children aged 8 to 12 years living in the state of Victoria, Australia. A single 24hrU and 24hrFR were collected from each participant. Suspected inaccurate urine collections and implausible energy intakes were excluded based on pre-defined criteria. The agreement between the two methods was assessed using Bland-Altman methodology, the intraclass correlation coefficient (ICC), and the kappa statistic. The difference between the measured change in salt intake over time using 24hrU and 24hrFR was derived using mixed effects linear regression analysis.
Results
A total of 588 participants provided a 24hrU and 24hrFR. Overall, there was no meaningful difference in mean estimated salt intake between the two methods (− 0.2 g/day, 95% CI − 0.5 to 0.1). The Bland-Altman plot showed wide 95% limits of agreement (− 7.2 to 6.8). The ICC between the two methods was 0.13 (95% CI 0.05 to 0.21). There was poor interrater reliability in terms of classifying salt intake above the recommended upper level for children, with an observed agreement of 63% and kappa statistic of 0.11. The change in mean salt intake over time was 0.2 g/day (− 0.4 to 0.7) based on 24hrU, and 0.5 g/day (− 0.0 to 1.1) based on 24hrFR, with a difference-in-differences of 0.4 g/day (− 0.3 to 1.1).
Conclusions
24hrFR appears to provide a reasonable estimate of mean salt intake as measured by 24hrU in Australian school children. However, similar to previous observations in adults, and of studies exploring other alternative methods for estimating salt intake, 24hrFR is a poor predictor of individual-level salt intake in children.
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5
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Ma H, Xue Q, Wang X, Li X, Franco OH, Li Y, Heianza Y, Manson JE, Qi L. Adding salt to foods and hazard of premature mortality. Eur Heart J 2022; 43:2878-2888. [PMID: 35808995 PMCID: PMC9890626 DOI: 10.1093/eurheartj/ehac208] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/11/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS We analyzed whether the frequency of adding salt to foods was associated with the hazard of premature mortality and life expectancy. METHODS AND RESULTS A total of 501 379 participants from UK biobank who completed the questionnaire on the frequency of adding salt to foods at baseline. The information on the frequency of adding salt to foods (do not include salt used in cooking) was collected through a touch-screen questionnaire at baseline. We found graded relationships between higher frequency of adding salt to foods and higher concentrations of spot urinary sodium or estimated 24-h sodium excretion. During a median of 9.0 years of follow-up, 18 474 premature deaths were documented. The multivariable hazard ratios [95% confidence interval (CI)] of all-cause premature mortality across the increasing frequency of adding salt to foods were 1.00 (reference), 1.02 (0.99, 1.06), 1.07 (1.02, 1.11), and 1.28 (1.20, 1.35) (P-trend < 0.001). We found that intakes of fruits and vegetables significantly modified the associations between the frequency of adding salt to foods and all-cause premature mortality, which were more pronounced in participants with low intakes than those with high intakes of these foods (P-interaction = 0.02). In addition, compared with the never/rarely group, always adding salt to foods was related to 1.50 (95% CI, 0.72-2.30) and 2.28 (95% CI, 1.66-2.90) years lower life expectancy at the age of 50 years in women and men, respectively. CONCLUSIONS Our findings indicate that higher frequency of adding salt to foods is associated with a higher hazard of all-cause premature mortality and lower life expectancy.
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Affiliation(s)
- Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Yanping Li
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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6
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Appel LJ, Foti K. Extreme Variability in Urinary Sodium Excretion: Time to Stop Use of Spot Urines to Predict Clinical Outcomes. Hypertension 2021; 78:1637-1639. [PMID: 34644168 PMCID: PMC8525899 DOI: 10.1161/hypertensionaha.121.18154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lawrence J. Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD 21205, USA
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kathryn Foti
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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7
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Eliasson J, Hvistendahl MK, Freund N, Bolognani F, Meyer C, Jeppesen PB. Apraglutide, a novel glucagon-like peptide-2 analog, improves fluid absorption in patients with short bowel syndrome intestinal failure: Findings from a placebo-controlled, randomized phase 2 trial. JPEN J Parenter Enteral Nutr 2021; 46:896-904. [PMID: 34287970 PMCID: PMC9292678 DOI: 10.1002/jpen.2223] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Treatment with glucagon‐like peptide‐2 (GLP‐2) analogs improve intestinal adaptation in patients with short bowel syndrome–associated intestinal failure (SBS‐IF) and may reduce parenteral support requirements. Apraglutide is a novel, long‐acting GLP‐2 analog designed for once‐weekly dosing. This trial investigated the safety and efficacy of apraglutide in patients with SBS‐IF. Methods In this placebo‐controlled, double‐blind, randomized, crossover phase 2 trial, eight adults with SBS‐IF were treated with once‐weekly 5‐mg apraglutide doses and placebo for 4 weeks, followed by once‐weekly 10‐mg apraglutide doses for 4 weeks, with a washout period of 6–10 weeks between treatments. Safety was the primary end point. Secondary end points included changes from baseline in urine volume output compared with placebo, collected for 48 h before and after each treatment period. Results Common treatment‐related adverse events (AEs) were mild to moderate and included polyuria, decreased stoma output, stoma complications, decreased thirst, and edema. No serious AEs were considered to be related to apraglutide treatment. The safety profile was comparable for the lower and higher doses. Treatment with once‐weekly 5‐ and 10‐mg apraglutide doses significantly increased urine volume output by an adjusted mean of 714 ml/day (95% CI, 490–939; P < .05) and 795 ml/day (95% CI, 195–1394; P < .05), respectively, compared with placebo, with no significant differences between doses. Conclusions Once‐weekly apraglutide was well tolerated at both tested doses and significantly increased urine volume output, providing evidence for increased intestinal fluid absorption. A phase 3 trial is underway in adults with SBS‐IF.
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Affiliation(s)
- Johanna Eliasson
- Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark K Hvistendahl
- Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nanna Freund
- Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Palle B Jeppesen
- Department of Intestinal Failure and Liver Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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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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9
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Chen AX, Haas AV, Williams GH, Vaidya A. Dietary sodium intake and cortisol measurements. Clin Endocrinol (Oxf) 2020; 93:539-545. [PMID: 32511774 PMCID: PMC7859973 DOI: 10.1111/cen.14262] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/09/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the influence of a dietary sodium intake intervention on cortisol measurements within the general population. DESIGN Cross-over intervention. PATIENTS Six hundred thirty adults without known Cushing syndrome, cardiovascular or renal disease completed a restricted dietary sodium diet (10 mmol/d, 230 mg/d) followed by cross-over to a liberalized dietary sodium diet (200 mmol/d, 4600 mg/d). Twenty-four-hour urine collection and biochemical investigations were performed at the end of each dietary intervention. RESULTS Mean 24-hour urinary free cortisol increased with liberalized sodium intake when compared with restricted sodium intake (178.0 ± 89.7 vs 121.3 ± 65.6 nmol/d, P < .001). Nearly all participants (84%) had an increase in the urinary free cortisol following liberalized sodium intake. This translated to a substantial difference in the proportion of participants exceeding categorical thresholds of urinary cortisol on liberalized vs restricted sodium intake: 62% vs 27% for 138 nmol/d (50 mcg/d), 46% vs 17% for 166 nmol/d (60 mcg/d), 32% vs 10% for 193 nmol/d (70 mcg/d), 23% vs 6% for 221 nmol/d (80 mcg/d), 17% vs 4% for 248 nmol/d (90 mcg/d). In parallel, there was a small decrease in morning total serum cortisol with liberalized sodium intake (303.0 ± 117.3 vs 326.4 ± 162.5 nmol/L, P < .001). CONCLUSIONS Increased dietary sodium intake increases urinary free cortisol excretion and may increase the risk for false-positive results. Variations in dietary sodium intake may influence the interpretations of cortisol measurements performed to evaluate for hypercortisolism.
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Affiliation(s)
- Angela X Chen
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department Endocrinology, Flinders Medical Centre, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Andrea V. Haas
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gordon H. Williams
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Vaidya
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Bennett J, Deslippe AL, Crosby C, Belles S, Banna J. Electrolytes and Cardiovascular Disease Risk. Am J Lifestyle Med 2020; 14:361-365. [PMID: 33281514 PMCID: PMC7692015 DOI: 10.1177/1559827620915708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The relationship between sodium intake and blood pressure is a well-studied phenomenon; however, the impact of sodium intake on cardiovascular disease risk and mortality is controversial. Recent studies conclude that weak evidence exists to support sodium restriction for the prevention of cardiovascular mortality in normotensive and hypertensive adults, suggesting that sodium restriction may be an ineffective strategy for disease prevention. Further evidence points to the importance of balancing sodium and potassium intake, a balance commonly achieved with a healthier diet containing greater quantities of fruits and vegetables. The purpose of this article is to highlight dietary strategies that may prove to be more effective in reducing cardiovascular disease risk. Limitations of current methods used to estimate nutrient intake are described as they relate to this topic. Further research is needed to advance understanding of various aspects of dietary intake that are health protective and allow for the development of more effective public education strategies.
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Affiliation(s)
- Jonathan Bennett
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Alysha L. Deslippe
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Christine Crosby
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Sally Belles
- Department of Nutrition Sciences, University of Hawaii,
Honolulu, Hawaii (JBennett)
- University of Hawaii Cancer Center, Honolulu, Hawaii
(JBennett)
- School of Population and Public Health, University of
British Columbia, Vancouver, British Columbia, Canada (ALD)
- British Columbia Children’s Hospital Research Institute
(BCCHR), Vancouver, British Columbia, Canada (ALD); The Queen’s Medical Center, Honolulu,
Hawaii (SB)
- College of Tropical Agriculture and Human Resources,
Honolulu, Hawaii (JBanna)
| | - Jinan Banna
- Jinan Banna, PhD, RD, CDN, College of Tropical
Agriculture and Human Resources, 1955 East West Road, Honolulu, HI 96822; e-mail:
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11
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Brandstrup B, Møller AM. The Challenge of Perioperative Fluid Management in Elderly Patients. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00349-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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12
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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: 64] [Impact Index Per Article: 12.8] [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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13
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Coyne MD, Lobene A, Neumann C, Lachcik P, Weaver CM, Nie LH. Determination of bone sodium (Na) and Na exchange in pig leg using in vivo neutron activation analysis (IVNAA). Physiol Meas 2019; 40:075009. [PMID: 31226697 DOI: 10.1088/1361-6579/ab2ba5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The locations of sodium (Na) storage and its exchange mechanisms in the body are not well known. Understanding tissue Na storage and exchange is important for understanding the impact of Na intake, absorption, and retention on human health, especially on the risk of developing chronic diseases. The purpose of this study was to investigate the application of a deuterium-deuterium (DD) neutron generator-based IVNAA system in Na nutrition studies. APPROACH The right legs of two live pigs, one on a low Na diet and one on a high Na diet, both for 14 d, were irradiated inside a customized irradiation cave for 10 min (45 mSv dose to the leg) and then measured with a 100% efficient high purity germanium detector (HPGe). The spectra were analyzed to obtain the net Na counts at different time points. Bone Na concentrations were calculated using the calibration created with Na bone phantoms. MAIN RESULTS The results show that the difference in bone Na to calcium between the pigs on high versus low Na diets was 466 ± 137 ppm. The estimated bone Na to calcium concentrations were 1166 ± 80 and 1631 ± 111 ppm for low and high Na diet pigs, respectively. Analysis also shows rapid exchange of Na in the leg during the first 2 h measurements, while the exchange was minimal at the second and third 2 h measurements, taken 7 and 21 h post irradiation. The exchange decay time of Na in the leg was 51 min for the first measurement, and there was no significant change of Na activities between 2-21 h. SIGNIFICANCE With these results, we conclude there is a non or low exchangeable compartment (likely to be bone) for Na storage and that DD neutron generator-based IVNAA is a useful method for determining tissue Na distribution in nutrition studies.
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Affiliation(s)
- Mychaela D Coyne
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
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14
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Leyvraz M, Chatelan A, da Costa BR, Taffé P, Paradis G, Bovet P, Bochud M, Chiolero A. Sodium intake and blood pressure in children and adolescents: a systematic review and meta-analysis of experimental and observational studies. Int J Epidemiol 2019; 47:1796-1810. [PMID: 29955869 DOI: 10.1093/ije/dyy121] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
Background High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically reviewed the evidence from experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents. Methods A systematic search of the Medline, Embase, CINAHL and CENTRAL databases up to March 2017 was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies involving children or adolescents between 0 and 18 years of age were included. Random-effects meta-analyses were performed by pooling data across all studies, separately for experimental and observational studies, and restricting to studies with sodium intake and blood pressure measurement methods of high quality. Subgroup meta-analyses, sensitivity analyses and meta-regressions were conducted to investigate sources of heterogeneity and confounding. The dose-response relationship was also investigated. Results Of the 6572 publications identified, 85 studies (14 experimental; 71 observational, including 60 cross-sectional, 6 cohort and 5 case-control studies) with 58 531 participants were included. In experimental studies, sodium reduction interventions decreased systolic blood pressure by 0.6 mm Hg [95% confidence interval (CI): 0.5, 0.8] and diastolic blood pressure by 1.2 mm Hg (95% CI: 0.4, 1.9). The meta-analysis of 18 experimental and observational studies (including 3406 participants) with sodium intake and blood pressure measurement methods of high quality showed that, for every additional gram of sodium intake per day, systolic blood pressure increased by 0.8 mm Hg (95% CI: 0.4, 1.3) and diastolic blood pressure by 0.7 mm Hg (95% CI: 0.0, 1.4). The association was stronger among children with overweight and with low potassium intake. A quasi-linear relationship was found between sodium intake and blood pressure. Conclusions Sodium intake is positively associated with blood pressure in children and adolescents, with consistent findings in experimental and observational studies. Since blood pressure tracks across the life course, our findings support the reduction of sodium intake during childhood and adolescence to lower blood pressure and prevent the development of hypertension.
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Affiliation(s)
- Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Angeline Chatelan
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Patrick Taffé
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Murielle Bochud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
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15
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Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, Cogswell ME, McLean R, Arcand J, MacGregor G, Whelton P, Jula A, L'Abbe MR, Cobb LK, Lackland DT. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake. J Clin Hypertens (Greenwich) 2019; 21:700-709. [PMID: 31087778 DOI: 10.1111/jch.13551] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022]
Abstract
The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology, Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, WHO Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bruce Neal
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Rachael McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa Ontario, Canada
| | - Graham MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Paul Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.,Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Antti Jula
- Department of Public Health Solutions, National Institute for Health and Welfare, Turku, Finland
| | - Mary R L'Abbe
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura K Cobb
- Resolve to Save Lives, Vital Strategies, New York, NY
| | - Daniel T Lackland
- Department of Neurology, Division of Translational Neuroscience and Population Studies, Medical University of South Carolina, Charleston, South Carolina
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16
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Jahan Y, Moriyama M, Rahman MM, Rahman A. Self-monitoring urinary salt excretion device can be used for controlling hypertension for developing countries. Clin Hypertens 2019; 25:3. [PMID: 30923632 PMCID: PMC6419439 DOI: 10.1186/s40885-019-0109-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 12/23/2022] Open
Abstract
Restriction of dietary salt is widely recommended in the management of hypertension, but assessment of individual salt intake has drawn little attention. Monitoring nutritional salt intake through sodium excretion has been popular, because the main route for sodium (Na) excretion is through the urine. Nonetheless, direct measurement of dietary salt intake is time consuming and lacks accuracy. To collect a 24-h urine and measure the content is difficult method for most patients. In this review paper, we would like to explore the usefulness of measuring urinary salt excretion by using a self-monitoring device at home. Measuring daily overnight urine by the self-monitoring device at home will be useful for the management of hypertension suitable for each individual. From the recent increase of processed foods, the term “salt intake” would not accurately be equal to “sodium intake”. Devices measuring urinary sodium excretion have been developed and evaluated on their accuracy and correlation with sodium intake. They must be handy, simple and capable of measuring large populations to be useful for monitoring of daily salt intake and to guide salt restriction as well as the long-term effects by dietary salt intake.
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Affiliation(s)
- Yasmin Jahan
- 1Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- 1Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- 1Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atiqur Rahman
- 2Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden
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17
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Lucko AM, Doktorchik C, Woodward M, Cogswell M, Neal B, Rabi D, Anderson C, He FJ, MacGregor GA, L'Abbe M, Arcand J, Whelton PK, McLean R, Campbell NRC. Percentage of ingested sodium excreted in 24-hour urine collections: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2018; 20:1220-1229. [PMID: 30101426 DOI: 10.1111/jch.13353] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/16/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Aaron M Lucko
- Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, AL, Canada
| | - Chelsea Doktorchik
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AL, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,George Institute for Global Health, Newtown, New South Wales, Australia
| | - Mary Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Bruce Neal
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Anderson
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mary L'Abbe
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Rachael McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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18
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D'Elia L, Manfredi M, Strazzullo P, Galletti F. Validation of an easy questionnaire on the assessment of salt habit: the MINISAL-SIIA Study Program. Eur J Clin Nutr 2018; 73:793-800. [PMID: 30089793 DOI: 10.1038/s41430-018-0204-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of the present study was to validate a short questionnaire on habitual dietary salt intake, to quickly and easily identify individuals whose salt consumption exceeds recommended levels. SUBJECTS/METHODS A total of 1131 hypertensive subjects participating in the MINISAL-SIIA study were included in the analysis. Anthropometric indexes, blood pressure, and 24-h urinary sodium excretion (NaU) were measured. A fixed-sequence questionnaire on dietary salt intake was administered. RESULTS NaU was significantly associated with scores, with a linear association across categories (p for trend <0.0001). In addition, participants who achieved a total score above the median value (eight points) had significantly higher NaU than those whose score was below median (p < 0.0001). In the total sample, the prevalence of "high NaU" (NaU > 85 mmol/day) and "very high NaU" (NaU > 170 mmol/day) was 86 and 35%, respectively. The score of the questionnaire had a significant ability to detect both "high NaU"-with a specificity of 95% at the score of 10 points-and "very high NaU"-with a specificity of 99.6% at score of 13 points. CONCLUSIONS The main results of the study indicates that a higher score of this short questionnaire is distinctive of habitual high salt consumption in hypertensive patients.
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Affiliation(s)
- L D'Elia
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Italy
| | - M Manfredi
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Italy
| | - P Strazzullo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Italy
| | - F Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Naples, Italy.
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19
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Stremke ER, McCabe LD, McCabe GP, Martin BR, Moe SM, Weaver CM, Peacock M, Hill Gallant KM. Twenty-Four-Hour Urine Phosphorus as a Biomarker of Dietary Phosphorus Intake and Absorption in CKD: A Secondary Analysis from a Controlled Diet Balance Study. Clin J Am Soc Nephrol 2018; 13:1002-1012. [PMID: 29921736 PMCID: PMC6032595 DOI: 10.2215/cjn.00390118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/17/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Twenty-four-hour urine phosphorus is commonly used as a surrogate measure for phosphorus intake and absorption in research studies, but its reliability and accuracy are unproven in health or CKD. This secondary analysis sought to determine the reliability and accuracy of 24-hour urine phosphorus as a biomarker of phosphorus intake and absorption in moderate CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Eight patients with stage 3-4 CKD participated in 2-week balance studies with tightly controlled phosphorus and calcium intakes. Thirteen 24-hour urine collections per patient were analyzed for variability and reliability of 24-hour urine phosphorus and phosphorus-to-creatinine ratio. The accuracy of 24-hour urine phosphorus to predict phosphorus intake was determined using a published equation. The relationships of 24-hour urine phosphorus with phosphorus intake, net absorption, and retention were determined. RESULTS There was wide day-to-day variation in 24-hour urine phosphorus within and among subjects (coefficient of variation of 30% and 37%, respectively). Two 24-hour urine measures were needed to achieve ≥75% reliability. Estimating dietary phosphorus intake from a single 24-hour urine resulted in underestimation up to 98% in some patients and overestimation up to 79% in others. Twenty-four-hour urine phosphorus negatively correlated with whole-body retention but was not related to net absorption. CONCLUSIONS From a sample of eight patients with moderate CKD on a tightly controlled dietary intake, 24-hour urine phosphorus was highly variable and did not relate to dietary phosphorus intake or absorption, rather it inversely related to phosphorus retention.
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Affiliation(s)
| | | | | | | | - Sharon M. Moe
- Divisions of Nephrology and
- Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | | | - Munro Peacock
- Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; and
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20
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Coyne MD, Neumann C, Zhang X, Byrne P, Liu Y, Weaver CM, Nie LH. Compact DD generator-based in vivo neutron activation analysis (IVNAA) system to determine sodium concentrations in human bone. Physiol Meas 2018; 39:055004. [PMID: 29658892 DOI: 10.1088/1361-6579/aabe66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study presents the development of a noninvasive method for monitoring Na in human bone. Many diseases, such as hypertension and osteoporosis, are closely associated with sodium (Na) retention in the human body. Na retention is generally evaluated by calculating the difference between dietary intake and excretion. There is currently no method to directly quantify Na retained in the body. Bone is a storage for many elements, including Na, which renders bone Na an ideal biomarker to study Na metabolism and retention. APPROACH A customized compact deuterium-deuterium (DD) neutron generator was used to produce neutrons for in vivo neutron activation analysis (IVNAA), with a moderator/reflector/shielding assembly optimized for human hand irradiation in order to maximize the thermal neutron flux inside the irradiation cave and to limit radiation exposure to the hand and the whole body. MAIN RESULTS The experimental results show that the system is able to detect sodium levels in the bone as low as 16 µg Na g-1 dry bone with an effective dose to the body of about 27 µSv. The simulation results agree with the numbers estimated from the experiment. SIGNIFICANCE This is expected to be a feasible method for measuring the change of Na in bone. The low detection limit indicates this will be a useful system to study the association between Na retention and related diseases.
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Affiliation(s)
- Mychaela D Coyne
- School of Health Sciences, Purdue University, West Lafayette, IN, United States of America
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21
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Appel LJ, Jacobs DR. Invited Commentary: Can Estimation of Sodium Intake Be Improved by Borrowing Information From Other Variables? Am J Epidemiol 2017. [PMID: 28633392 DOI: 10.1093/aje/kwx236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Estimation of dietary sodium intake is problematic. The most accurate measure is average sodium excretion from multiple 24-hour urine collections, but such an approach is impractical. Using data from the Women's Health Initiative, Prentice et al. (Am J Epidemiol. 2017;186(9):1035-1043) assessed the relationship of calibrated estimates of sodium and potassium excretion with cardiovascular outcomes. The calibrated estimates were a function of self-reported sodium-to-potassium ratio from a food frequency questionnaire, age, body mass index, race, supplement use, smoking status, educational level, income, and aspirin use. In general, associations with outcomes using the calibrated estimates were in the expected direction: direct for the sodium-to-potassium ratio and sodium intake and indirect for potassium. The unexpected associations were an increased risk of hemorrhagic stroke with lower sodium-to-potassium ratio and sodium intake and increased risk with higher potassium intake, along with a null relationship of sodium intake with ischemic stroke. Overall, our assessment is that the authors have improved the estimation of mean dietary sodium and potassium intakes. However, more work is needed to show that calibrated estimates actually improve estimation of future clinical events. If this methodological issue can be successfully addressed, their approach has the potential to improve estimation of dietary sodium and potassium intakes in observational studies.
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Affiliation(s)
- Lawrence J Appel
- From Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD (L.J.A., K.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (L.J.A., K.F.); and Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.).
| | - Kathryn Foti
- From Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD (L.J.A., K.F.); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (L.J.A., K.F.); and Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (L.J.A.)
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23
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Webster J, Waqanivalu T, Arcand J, Trieu K, Cappuccio FP, Appel LJ, Woodward M, Campbell NRC, McLean R. Understanding the science that supports population-wide salt reduction programs. J Clin Hypertens (Greenwich) 2017; 19:569-576. [DOI: 10.1111/jch.12994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
| | | | - JoAnne Arcand
- Faculty of Health Sciences; University of Ontario Institute of Technology; Oshawa Ontario Canada
| | - Kathy Trieu
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
| | | | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins University; Baltimore MD USA
| | - Mark Woodward
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
- University of Oxford; Oxford UK
- Department of Epidemiology; Johns Hopkins University; Baltimore Maryland USA
| | - Norm R. C. Campbell
- Department of Medicine; Physiology and Pharmacology and Community Health Sciences; O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta; University of Calgary; Calgary Alberta Canada
| | - Rachael McLean
- Departments of Preventive & Social Medicine; University of Otago; Dunedin New Zealand
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Cogswell ME, Mugavero K, Bowman BA, Frieden TR. Dietary Sodium and Cardiovascular Disease Risk--Measurement Matters. N Engl J Med 2016; 375:580-6. [PMID: 27248297 PMCID: PMC5381724 DOI: 10.1056/nejmsb1607161] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Mary E Cogswell
- From the National Center for Chronic Disease Prevention and Health Promotion, the Division for Heart Disease and Stroke Prevention (M.E.C., K.M., B.A.B.), and the Office of the Director (T.R.F.), Centers for Disease Control and Prevention, Atlanta
| | - Kristy Mugavero
- From the National Center for Chronic Disease Prevention and Health Promotion, the Division for Heart Disease and Stroke Prevention (M.E.C., K.M., B.A.B.), and the Office of the Director (T.R.F.), Centers for Disease Control and Prevention, Atlanta
| | - Barbara A Bowman
- From the National Center for Chronic Disease Prevention and Health Promotion, the Division for Heart Disease and Stroke Prevention (M.E.C., K.M., B.A.B.), and the Office of the Director (T.R.F.), Centers for Disease Control and Prevention, Atlanta
| | - Thomas R Frieden
- From the National Center for Chronic Disease Prevention and Health Promotion, the Division for Heart Disease and Stroke Prevention (M.E.C., K.M., B.A.B.), and the Office of the Director (T.R.F.), Centers for Disease Control and Prevention, Atlanta
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