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Pereira WDS, Lelis DF, Cunha RS, Griep RH, Barreto SM, Molina MDCB, Schmidt MI, Duncan BB, Bensenor I, Lotufo PA, Mill JG, Baldo MP. Fasting Glucose, Glycated Hemoglobin, and 2h Post-load Blood Glucose Are Independently Associated With Arterial Stiffness in Diabetes: The ELSA-Brasil Study. Angiology 2024; 75:635-644. [PMID: 36951393 DOI: 10.1177/00033197231166180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The association of diabetes with increased large artery stiffness is not definitively established. We aimed to describe the carotid-femoral pulse wave velocity (cf-PWV) in participants with and without diabetes and whether the cf-PWV could vary among the different laboratory-based criteria used. A cross-sectional analysis using baseline data from 13,912 adults was used. cf-PWV as well as anthropometric, biochemical, and clinical data were measured. Diabetes was defined by previous medical diagnosis, medication use, fasting glucose, an oral glucose tolerance test (GTT), or glycated hemoglobin (HbA1c). The prevalence of diabetes was 18.7%, higher in men than in women. After adjustment, participants with diabetes showed higher cf-PWV (men: 9.7 ± 1.7 vs 9.4 ± 1.7 m/s, P < .05; women: 9.4 ± 1.6 vs 9.1 ± 1.7 m/s, P < .05). We observed a progressive increase in cf-PWV as >1 laboratory-based criterion for diabetes diagnosis was reached. Also, participants with diabetes with alterations in any laboratory-based criteria had higher cf-PWV than participants without diabetes, regardless of sex. In summary, diabetes is associated with higher cf-PWV as is each laboratory-based parameter used for its diagnosis. These results support the strong consequences of glucose dysregulation on the vascular system and provide evidence to screen all parameters involved in glycemic metabolism to improve vascular health.
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Affiliation(s)
- Wille D S Pereira
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | - Deborah F Lelis
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | - Roberto S Cunha
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- School of Medicine and Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Maria Inês Schmidt
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - José Geraldo Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Marcelo P Baldo
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
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2
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Ribeiro NG, Lelis DF, Griep RH, Barreto SM, Molina MDCB, Schmidt MI, Duncan BB, Bensenor I, Lotufo PA, Mill JG, Baldo MP. Salt Intake in Adults with Diabetes and Hypertension: The Longitudinal Study of Adult Health-Brasil Study. Metab Syndr Relat Disord 2024; 22:356-364. [PMID: 38563778 DOI: 10.1089/met.2023.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Background and Objective: Hypertension and type-2 diabetes are strong risk factors for cardiovascular diseases, and their management requires lifestyle changes, including a shift in dietary habits. The consumption of salt has increased in the last decades in some countries, but its association with type-2 diabetes remains unknown. Thus, we aimed to estimate the amount of salt intake among adults with and without diabetes and to assess whether concomitant hypertension and diabetes are associated with higher salt intake. Methods: Data from 11,982 adults 35-74 years of age enrolled in the baseline of the Longitudinal Study of Adult Health-Brasil study (2008-2010) were studied. A clinical and anthropometric evaluation was performed, and their daily salt intake was estimated by the overnight 12-hr urine sodium excretion. Results: Salt intake (gram per day) was higher in participants with diabetes as compared with those without diabetes, regardless of sex (men: 14.2 ± 6.4 vs. 12.4 ± 5.6, P < 0.05; women: 10.5 ± 4.8 vs. 9.1 ± 4.1, P < 0.05). However, salt intake is high in participants with fasting glucose ≥126 mg/dL or HbA1c ≥6.5%, but not in participants with blood glucose 2 hr after the glucose tolerance test ≥200 mg/dL. When hypertension and diabetes coexisted, salt consumption was higher than among people without these conditions. The prevalence of hypertension increased with increasing salt intake in women with diabetes, but not in men with this condition. Conclusions: Our findings highlight the high consumption of salt in individuals with diabetes and/or hypertension, and the need for effective strategies to reduce salt consumption in these groups of increased risk for major cardiovascular events, especially in women.
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Affiliation(s)
- Natália Gonçalves Ribeiro
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Minas Gerais, Brazil
| | - Deborah F Lelis
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Minas Gerais, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine, Clinical Hospital/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Del Carmen B Molina
- PostgraduateProgram in Public Health, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Maria I Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do SulBrazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do SulBrazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, São Paulo, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Marcelo Perim Baldo
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Minas Gerais, Brazil
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Louçano B, Maletti S, Timóteo H, Figueiredo JP, Osório N, Barroca MJ, da Silva AM, Pereira T, Caseiro A. Assessing Sarcocornia as a Salt Substitute: Effects on Lipid Profile and Gelatinase Activity. Nutrients 2024; 16:929. [PMID: 38612961 PMCID: PMC11013238 DOI: 10.3390/nu16070929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Sodium, although essential for life, is a key factor in changes in vascular function and cardiovascular disease when consumed in excess. Sarcocornia spp., a halophyte plant with many nutritional benefits, presents itself as a promising substitute for the consumption of purified salt. Matrix metalloproteinases (MMPs) 2 and 9 are widely studied due to their action in physiological processes and as biomarkers at the diagnostic level due to their increased expression in inflammatory processes. This study aimed to evaluate whether replacing salt with Sarcocornia perennis (S. perennis) powder in healthy young people leads to an improvement in biochemical profiles and the attenuation of MMP-2 and MMP-9 activity. In the present study, 30 participants were randomized into a control group that consumed salt and an intervention group that replaced salt with powdered S. perennis. The evaluation of the biochemical parameters was carried out by the spectrophotometry method, and the evaluation of MMP activity was carried out by zymography. A significant decrease was observed in the intervention group in total cholesterol, high-density lipoprotein cholesterol (HDL-c), and creatinine (p-value ≤ 0.05), along with lower but not significantly different mean values of triglycerides. Regarding MMP activity after the intervention, a lower mean value was observed for MMP-9 activity, with there being higher mean values for MMP-2 activity, both with p-values ≥ 0.05. The results confirmed that the consumption of S. perennis is a beneficial choice for health regarding the lipid profile. The evaluation of MMP activity indicated the potential of S. perennis in the regulation of MMP-9 activity in healthy individuals, along with the need for the further study of these proteases in individuals with pathologies.
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Affiliation(s)
- Beatriz Louçano
- Polytechnic Institute of Coimbra, Coimbra Health School, Biomedical Laboratory Sciences, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal; (B.L.); (H.T.); (N.O.); (A.C.)
| | - Sara Maletti
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, Faculty of Medicine and Surgery, University of Modena and Reggio Emilia, Policlinico, via del Pozzo, 7141124 Modena, Italy;
| | - Helena Timóteo
- Polytechnic Institute of Coimbra, Coimbra Health School, Biomedical Laboratory Sciences, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal; (B.L.); (H.T.); (N.O.); (A.C.)
| | - João Paulo Figueiredo
- Polytechnic Institute of Coimbra, Coimbra Health School, Medical Sciences, Socials and Humans, Rua 5 de Outubro, 3046-854 Coimbra, Portugal;
| | - Nádia Osório
- Polytechnic Institute of Coimbra, Coimbra Health School, Biomedical Laboratory Sciences, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal; (B.L.); (H.T.); (N.O.); (A.C.)
- LABINSAÚDE-Research Laboratory for Applied Health Sciences, Polytechnic Institute of Coimbra, Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal;
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal;
| | - Maria João Barroca
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal;
- Polytechnic Institute of Coimbra, Agriculture School of Coimbra, Bencanta, 3040-360 Coimbra, Portugal
| | - Aida Moreira da Silva
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal;
- Polytechnic Institute of Coimbra, Agriculture School of Coimbra, Bencanta, 3040-360 Coimbra, Portugal
| | - Telmo Pereira
- LABINSAÚDE-Research Laboratory for Applied Health Sciences, Polytechnic Institute of Coimbra, Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal;
- Polytechnic Institute of Coimbra, Coimbra Health School, Clinical Physiology, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
- Faculty of Sport Science and Physical Education, University of Coimbra, CIDAF—Research Unit for Sport and Physical Activity, 3000-456 Coimbra, Portugal
| | - Armando Caseiro
- Polytechnic Institute of Coimbra, Coimbra Health School, Biomedical Laboratory Sciences, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal; (B.L.); (H.T.); (N.O.); (A.C.)
- LABINSAÚDE-Research Laboratory for Applied Health Sciences, Polytechnic Institute of Coimbra, Coimbra Health School, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal;
- Molecular Physical-Chemistry R&D Unit, Department of Chemistry, University of Coimbra, 3004-535 Coimbra, Portugal;
- Faculty of Sport Science and Physical Education, University of Coimbra, CIDAF—Research Unit for Sport and Physical Activity, 3000-456 Coimbra, Portugal
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Ríos-González BE, Saldaña-Cruz AM, Gallardo-Moya SG, Brambila-Tapia AJL. Sex Differences in the Relationship between Personal, Psychological and Biochemical Factors with Blood Pressure in a Healthy Adult Mexican Population: A Cross-Sectional Study. J Clin Med 2024; 13:378. [PMID: 38256512 PMCID: PMC10816435 DOI: 10.3390/jcm13020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Hypertension is one of the main risk factors related to cardiovascular mortality, being the levels of blood pressure (BP) related to a variety of personal, anthropometric, biochemical and psychological variables; however, the study evaluating the association of all these factors in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in a sample of relatively healthy subjects has not been performed. The aim of the study was to determine the main variables associated with SBP and DPB in a sample of relatively healthy subjects. A total of 171 participants were included, in which personal, anthropometric, positive and negative psychological variables and biochemical variables were measured. We observed that men showed higher levels of SBP and DBP than women, with more differences for SBP. Among the biochemical factors and SBP, we found that albumin and monocytes were positively correlated with it, while potassium, phosphorus and eosinophils were negatively correlated with it. Additionally, schooling was a constant variable negatively correlated with SBP in all samples (global, men and women). Among psychological variables, we observed that emotional perception was negatively correlated with SBP in men's and women's samples, while autonomy was positively correlated with SBP in the men's sample; however, their association was less when compared with the personal and biochemical variables included in the multivariate model. With regard to DBP, we observed that the biochemical variables, hemoglobin, sodium, uric acid and glucose, were positively correlated with DBP in the global sample, while chloride and BUN were negatively correlated with it. In addition, many personal and behavioral variables, including BMI, age and smoking consumption frequency, also correlated with DBP in the global sample. In conclusion, BP is affected by different factors, and these affect each sex differently.
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Affiliation(s)
- Blanca Estela Ríos-González
- Unidad Médico Familiar #92, Instituto Mexicano del Seguro Social (IMSS), Guadalajara 44340, Mexico;
- Especialidad en Medicina Familiar, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ana Míriam Saldaña-Cruz
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Sergio Gabriel Gallardo-Moya
- Programa de Doctorado en Farmacología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, Guadalajara 44340, Mexico;
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5
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Fajardo VC, Barreto SM, Coelho CG, Diniz MDFH, Molina MDCB, Ribeiro ALP, Telles RW. Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Nutr 2024; 154:133-142. [PMID: 37992809 DOI: 10.1016/j.tjnut.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Increased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend. OBJECTIVE The objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up. METHODS Longitudinal analyses using baseline (2008-2010, aged 35-74 y), second (2012-2014), and third (2016-2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders. RESULTS The mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model. CONCLUSION The present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.
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Affiliation(s)
- Virgínia C Fajardo
- Universidade Federal de Minas Gerais, PhD Student of Post-graduate Program in Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina G Coelho
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria de Fátima Hs Diniz
- Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Del Carmen B Molina
- Universidade Federal de Ouro Preto, Ouro Preto, Brazil and Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosa W Telles
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Rheumatology Service, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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6
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Taurio J, Koskela J, Sinisalo M, Tikkakoski A, Niemelä O, Hämäläinen M, Moilanen E, Choudhary MK, Mustonen J, Nevalainen P, Pörsti I. Urine sodium excretion is related to extracellular water volume but not to blood pressure in 510 normotensive and never-treated hypertensive subjects. Blood Press 2023; 32:2170869. [PMID: 36708156 DOI: 10.1080/08037051.2023.2170869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE High sodium intake is an accepted risk factor for hypertension, while low Na+ intake has also been associated with increased risk of cardiovascular events. In this cross-sectional study, we examined the association of 24-h urinary Na+ excretion with haemodynamics and volume status. MATERIALS AND METHODS Haemodynamics were recorded in 510 normotensive and never-treated hypertensive subjects using whole-body impedance cardiography and tonometric radial artery pulse wave analysis. The results were examined in sex-specific tertiles of 24-h Na+ excretion, and comparisons between normotensive and hypertensive participants were also performed. Regression analysis was used to investigate factors associated with volume status. The findings were additionally compared to 28 patients with primary aldosteronism. RESULTS The mean values of 24-h urinary Na+ excretion in tertiles of the 510 participants were 94, 148 and 218 mmol, respectively. Average tertile age (43.4-44.7 years), office blood pressure and pulse wave velocity were corresponding in the tertiles. Plasma electrolytes, lipids, vitamin D metabolites, parathyroid hormone, renin activity, aldosterone, creatinine and insulin sensitivity did not differ in the tertiles. In supine laboratory recordings, there were no differences in aortic systolic and diastolic blood pressure, heart rate, cardiac output and systemic vascular resistance. Extracellular water volume was higher in the highest versus lowest tertile of Na+ excretion. In regression analysis, body surface area and 24-h Na+ excretion were independent explanatory variables for extracellular water volume. No differences in urine Na+ excretion and extracellular water volume were found between normotensive and hypertensive participants. When compared with the 510 participants, patients with primary aldosteronism had 6.0% excess in extracellular water (p = .003), and 24-h Na+ excretion was not related with extracellular water volume. CONCLUSION In the absence of mineralocorticoid excess, Na+ intake, as evaluated from 24-h Na+ excretion, predominantly influences extracellular water volume without a clear effect on blood pressure.
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Affiliation(s)
- Jyrki Taurio
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jenni Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Hämäläinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Eeva Moilanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,The Immunopharmacology Research Group, Tampere University and Tampere University Hospital, Tampere, Finland
| | | | - Jukka Mustonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Pasi Nevalainen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka Pörsti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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7
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Wang NX, Arcand J, Campbell NRC, Johnson C, Malta D, Petersen K, Rae S, Santos JA, Sivakumar B, Thout SR, McLean R. The World Hypertension League Science of Salt: a regularly updated systematic review of salt and health outcomes studies (Sept 2019 to Dec 2020). J Hum Hypertens 2022; 36:1048-1058. [PMID: 35688876 PMCID: PMC9734047 DOI: 10.1038/s41371-022-00710-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023]
Abstract
The World Hypertension League Science of Salt health outcomes review series highlights high-quality publications relating to salt intake and health outcomes. This review uses a standardised method, outlined in previous reviews and based on methods developed by WHO, to identify and critically appraise published articles on dietary salt intake and health outcomes. We identified 41 articles published between September 2019 to December 2020. Amongst these, two studies met the pre-specified methodological quality criteria for critical appraisal. They were prospective cohort studies and examined physical performance and composite renal outcomes as health outcomes. Both found an association between increased/higher sodium intake and poorer health outcomes. Few studies meet criteria for high-quality methods. This review adds further evidence that dietary salt reduction has health benefits and strengthens evidence relating to health outcomes other than blood pressure and cardiovascular disease. We observe that most studies on dietary sodium do not have adequate methodology to reliably assess sodium intake and its association with health outcomes.
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Affiliation(s)
- Nan Xin Wang
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand
| | - JoAnne Arcand
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Daniela Malta
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah Rae
- Department of Nutritional Sceinces, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Bridve Sivakumar
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | | | - Rachael McLean
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand.
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8
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Vatner SF, Zhang J, Vyzas C, Mishra K, Graham RM, Vatner DE. Vascular Stiffness in Aging and Disease. Front Physiol 2021; 12:762437. [PMID: 34950048 PMCID: PMC8688960 DOI: 10.3389/fphys.2021.762437] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/26/2021] [Indexed: 01/01/2023] Open
Abstract
The goal of this review is to provide further understanding of increased vascular stiffness with aging, and how it contributes to the adverse effects of major human diseases. Differences in stiffness down the aortic tree are discussed, a topic requiring further research, because most prior work only examined one location in the aorta. It is also important to understand the divergent effects of increased aortic stiffness between males and females, principally due to the protective role of female sex hormones prior to menopause. Another goal is to review human and non-human primate data and contrast them with data in rodents. This is particularly important for understanding sex differences in vascular stiffness with aging as well as the changes in vascular stiffness before and after menopause in females, as this is controversial. This area of research necessitates studies in humans and non-human primates, since rodents do not go through menopause. The most important mechanism studied as a cause of age-related increases in vascular stiffness is an alteration in the vascular extracellular matrix resulting from an increase in collagen and decrease in elastin. However, there are other mechanisms mediating increased vascular stiffness, such as collagen and elastin disarray, calcium deposition, endothelial dysfunction, and the number of vascular smooth muscle cells (VSMCs). Populations with increased longevity, who live in areas called “Blue Zones,” are also discussed as they provide additional insights into mechanisms that protect against age-related increases in vascular stiffness. Such increases in vascular stiffness are important in mediating the adverse effects of major cardiovascular diseases, including atherosclerosis, hypertension and diabetes, but require further research into their mechanisms and treatment.
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Affiliation(s)
- Stephen F Vatner
- Department of Cell Biology and Molecular Medicine, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Jie Zhang
- Department of Cell Biology and Molecular Medicine, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Christina Vyzas
- Department of Cell Biology and Molecular Medicine, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Kalee Mishra
- Department of Cell Biology and Molecular Medicine, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Robert M Graham
- Victor Chang Cardiac Research Institute, University of New South Wales, Darlinghurst, NSW, Australia
| | - Dorothy E Vatner
- Department of Cell Biology and Molecular Medicine, Rutgers University - New Jersey Medical School, Newark, NJ, United States
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9
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Takeda R, Stickford ASL, Best SA, Yoo JK, Hissen SL, Liu YL, Fu Q. Impact of high-salt versus low-salt intake on the response of sympathetic baroreflex sensitivity to orthostasis in women with a history of normal pregnancy. Am J Physiol Regul Integr Comp Physiol 2021; 321:R260-R270. [PMID: 34231375 DOI: 10.1152/ajpregu.00069.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies have demonstrated that sympathetic baroreflex sensitivity (BRS) increases during orthostatic stress in humans. We recently showed that dietary salt intake affects sympathetic neural control in healthy premenopausal women. This study aimed to determine whether salt loading versus salt reduction would impact sympathetic BRS during orthostasis in premenopausal women with a history of normal pregnancy. Nine healthy women [42 ± 3 (SD) yr] were given a standardized isocaloric high-salt (250 mEq sodium/day) or low-salt (50 mEq sodium/day) diet for 1 wk each (∼2 mo apart with the order randomized), whereas water intake was ad libitum. Laboratory testing was performed following each high- and low-salt period in the midluteal phase of the menstrual cycle. Hemodynamics and muscle sympathetic nerve activity (MSNA) were measured at baseline (supine; 2 min) and during a graded head-up tilt (30° for 5 min and 60° for 20 min). Sympathetic BRS was assessed during baseline and head-up tilt. Hemodynamics were not different between salt conditions during baseline or tilt. Both supine and upright MSNA indices were lower in high salt than low salt (all P < 0.05), however, there was no interaction effect (P = 0.507-0.996). On moving from supine to upright, sympathetic BRS remained unchanged in high salt but increased in low salt (P = 0.028 for interaction). Thus, salt loading diminishes the responsiveness of sympathetic BRS during orthostasis compared with salt reduction in healthy premenopausal women with prior normal pregnancy. Whether this is one underlying mechanism for salt-induced development of hypertension during ambulation remains to be determined.
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Affiliation(s)
- Ryosuke Takeda
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abigail S L Stickford
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stuart A Best
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah L Hissen
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yu-Lun Liu
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas.,The University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Overwyk KJ, Quader ZS, Maalouf J, Bates M, Webster J, George MG, Merritt RK, Cogswell ME. Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019. Adv Nutr 2020; 11:1174-1200. [PMID: 32449929 PMCID: PMC7490163 DOI: 10.1093/advances/nmaa049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.
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Affiliation(s)
- Katherine J Overwyk
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Zerleen S Quader
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Joyce Maalouf
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Marlana Bates
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
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11
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Smiljanec K, Mbakwe AU, Ramos-Gonzalez M, Pohlig RT, Lennon SL. Antioxidant cocktail following a high-sodium meal does not affect vascular function in young, healthy adult humans: a randomized controlled crossover trial. Nutr Res 2020; 79:13-22. [PMID: 32610254 DOI: 10.1016/j.nutres.2020.05.011] [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] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
Chronic high sodium intake is a risk factor for cardiovascular disease as it impairs vascular function through an increase in oxidative stress. The objective of this study was to investigate the acute effects of a high-sodium meal (HSM) and antioxidant (AO) cocktail on vascular function. We hypothesized that a HSM would impair endothelial function, and increase arterial stiffness and wave reflection, while ingestion of the AO cocktail would mitigate this response. Healthy adults ingested either an AO cocktail (vitamin C, E, alpha-lipoic acid) or placebo (PLA) followed by a HSM (1500 mg) in a randomized crossover blinded design. Blood pressure (BP), endothelial function (flow-mediated dilation; FMD) and measures of arterial stiffness (pulse wave velocity; PWV) and wave reflection (augmentation index; AIx) were made at baseline and 30, 60, 90, and 120 min after meal consumption. Forty-one participants (20M/21W; 24 ± 1 years; BMI 23.4 ± 0.4 kg/m2) completed the study. Mean BP increased at 120 min relative to 60 min (60 min: 79 ± 1; 120 min: 81 ± 1 mmHg; time effect P = .01) but was not different between treatments (treatment × time interaction P = .32). AIx decreased from baseline (time effect P < .001) but was not different between treatments (treatment × time interaction P = .31). PWV (treatment × time interaction, P = .91) and FMD (treatment × time interaction P = .65) were also not different between treatments. In conclusion, a HSM does not acutely impair vascular function suggesting young healthy adults can withstand the acute impact of sodium on the vasculature and therefore, the AO cocktail is not necessary to mitigate the response.
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Affiliation(s)
- Katarina Smiljanec
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | - Alexis U Mbakwe
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | | | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, STAR, Newark, DE.
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
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12
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Adherence to the Dietary Approaches to Stop Hypertension (DASH) and hypertension risk: results of the Longitudinal Study of Adult Health (ELSA-Brasil). Br J Nutr 2020; 123:1068-1077. [PMID: 31959262 DOI: 10.1017/s0007114520000124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We investigated whether high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was independently associated with lower risk of incident hypertension. Participants included 5632 adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health, who took part in the second follow-up visit (2012-2014). Adherence to the DASH diet was estimated at baseline using a score based on eight food items (final scores from 8 to 40 points) and was categorised as high adherence (≥30 points, or ≥75 %) and low adherence (<75 %; reference). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, or use of antihypertensive drugs. The association between adherence to the DASH diet and the risk of incident hypertension was estimated using Cox regression models adjusted by covariates. In total, 780 new cases of hypertension (13·8 %) were identified in about 3·8-year follow-up. Participants with high adherence to the DASH diet had 26 % lower risk of hypertension (hazard ratio (HR) 0·74; 95 % CI 0·57, 0·95) after adjustment for socio-demographic characteristics, health-related behaviours, diabetes and family history of hypertension. The HR reduced to 0·81 (95 % CI 0·63, 1·04) and was of borderline statistical significance after adjustment for BMI, suggesting that lower body weight explains about 10 % of the association between high adherence to the DASH diet and hypertension risk reduction. The results indicate that high adherence to the DASH diet lowered the risk of hypertension by one-fourth over a relatively short follow-up period.
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