1
|
Yang S, Wang H. Avoidance of added salt for 6-12-month-old infants: A narrative review. Arch Pediatr 2023; 30:595-599. [PMID: 37805298 DOI: 10.1016/j.arcped.2023.08.009] [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: 05/09/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 10/09/2023]
Abstract
Most nutrition guidelines recommend avoiding foods with added salt for infants aged 6-12 months. However, the reason for no added salt lacks enough and reliable evidence. We re-searched and re-studied the relevant evidence. We searched PubMed and the Cochrane database for English-language studies published from 1904 through 2021. We also searched the databases of the websites of different national institutions. Randomized clinical trials (RCTs), systematic reviews, observational studies, and dietary guidelines were included in this review. The kidneys of infants aged 6-12 months have adequate sodium excretion capacity. There is insufficient evidence that high salt (sodium) intake early in life might lead to hypertension or salty diet preference in adults. Infants aged 6-12 months might be at risk of low sodium intake of only 150-300 mg of sodium/day, which may not meet the body's needs, if their supplementary food is not adequately salted.
Collapse
Affiliation(s)
- Shuling Yang
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Hai Wang
- Pediatric Department, The First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
| |
Collapse
|
2
|
Cheng HL, Garden FL, Skilton MR, Johnson C, Webster J, Grimes CA, Ivers RQ, Steinbeck KS. Impact of growth, gonadal hormones, adiposity and the sodium-to-potassium ratio on longitudinal adolescent measures of blood pressure at puberty. J Hum Hypertens 2023; 37:835-843. [PMID: 36376566 DOI: 10.1038/s41371-022-00774-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) rises rapidly at puberty. While this is partly due to normal development, factors like excess adiposity and a high intake of dietary sodium relative to potassium may contribute to a true increase in hypertension risk. This study aimed to assess the relative impact of growth, gonadal hormones, adiposity and the sodium-to-potassium ratio (Na:K) on longitudinal BP measures at puberty. This study analysed data from a three-year longitudinal cohort study of pubertal adolescents. Anthropometry, body composition (bio-electrical impedance), serum testosterone and oestradiol (mass spectrometry) were measured annually. Na:K was measured from three-monthly urine samples. These variables were used to predict annual BP measures using mixed modelling and ordinal regression. Data from 325 adolescents (11.7 ± 1.0 y; 55% male) were analysed, showing typical growth patterns at puberty. Systolic BP increased over time in both sexes (p < 0.01), with boys exhibiting a significantly steeper rise compared to girls. Adiposity variables (BMI z-score, percent body fat, fat mass, waist-to-height ratio) strongly and consistently predicted systolic and diastolic BP in both sexes (all p < 0.05). Systolic BP was also significantly and positively related to height (p < 0.05). No associations with BP were identified in either sex for gonadal hormones or Na:K. Similar results were obtained when BP was classified into hypertension categories. Relative to other developmental and diet-related variables tested, adiposity was found to be the strongest most consistent predictor of BP in pubertal adolescents. Findings highlight the importance of dedicated youth obesity management interventions and policy measures for reducing long-term hypertension and cardiovascular disease risks.Australian New Zealand Clinical Trials Registry ACTRN12617000964314.
Collapse
Affiliation(s)
- Hoi Lun Cheng
- The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Westmead, NSW, Australia.
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Specialty of Child and Adolescent Health, Westmead, NSW, Australia.
- The University of Sydney, Faculty of Medicine and Health, The Boden Initiative, Charles Perkins Centre, Camperdown, NSW, Australia.
| | - Frances L Garden
- University of New South Wales, School of Clinical Medicine, South West Sydney Clinical Campuses, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Michael R Skilton
- The University of Sydney, Faculty of Medicine and Health, The Boden Initiative, Charles Perkins Centre, Camperdown, NSW, Australia
| | - Claire Johnson
- University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, School of Population Health, Sydney, NSW, Australia
| | - Jacqui Webster
- University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, School of Population Health, Sydney, NSW, Australia
| | - Carley A Grimes
- Deakin University, Institute for Physical Activity and Nutrition, Geelong, VIC, Australia
| | - Rebecca Q Ivers
- University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
- University of New South Wales, School of Population Health, Sydney, NSW, Australia
| | - Katharine S Steinbeck
- The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Westmead, NSW, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Specialty of Child and Adolescent Health, Westmead, NSW, Australia
- The University of Sydney, Faculty of Medicine and Health, The Boden Initiative, Charles Perkins Centre, Camperdown, NSW, Australia
| |
Collapse
|
3
|
Kos M, Nađ T, Stanojević L, Lukić M, Stupin A, Drenjančević I, Pušeljić S, Davidović Cvetko E, Mihaljević Z, Dumančić D, Jukić I. Estimation of Salt Intake in Normotensive and Hypertensive Children: The Role of Body Weight. Nutrients 2023; 15:736. [PMID: 36771442 PMCID: PMC9921955 DOI: 10.3390/nu15030736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The connection between increased dietary salt intake and arterial hypertension has been recognized for a long time, even in children. This study aimed to investigate salt consumption in normotensive and hypertensive children and evaluate their dietary habits. MATERIALS AND METHODS A total of fifty participants were included in this cross-sectional study: twenty-five normotensive children and 25 children of both sexes with essential arterial hypertension from 12-17 years old. Subjects' body mass index, waist-to-hip ratio, body composition and arterial blood pressure were measured, and their daily salt intake was calculated from 24-h urine samples. Using the food frequency questionnaire (FFQ), the data on the average daily total energy and food intakes were collected and analyzed using a suitable program. RESULTS Estimated daily salt intake was significantly higher in hypertensive compared to normotensive children, and this is positively associated with blood pressure and body mass index (BMI). Hypertensive children had significantly higher BMIs, which also positively correlated with blood pressure. Consistently, resting metabolic rate (kcal) is higher in hypertensive children compared to normotensive, and this is also associated with blood pressure. Reported energy intake is also enlarged in hypertensive compared to normotensive children and for both groups, levels are significantly higher than the recommended values. CONCLUSIONS Our study results confirm the relationship between daily salt consumption, blood pressure and body weight. Sodium consumption related to blood pressure and body weight among children. Cardiovascular disease prevention should start in early childhood by reducing salt intake and preventing overweight/obesity since these are two of the most important modifiable risk factors for hypertension.
Collapse
Affiliation(s)
- Martina Kos
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Tihana Nađ
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Lorena Stanojević
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Matea Lukić
- Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Ines Drenjančević
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Silvija Pušeljić
- Clinic of Pediatrics, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Pediatrics, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Erna Davidović Cvetko
- Lavoslav Ružička College of Applied Sciences of Vukovar, Županijska 50, HR-32000 Vukovar, Croatia
| | - Zrinka Mihaljević
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| | - Dijana Dumančić
- Department of Diagnostic and Interventional Radiology, University Hospital Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Department of Radiology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ivana Jukić
- Institute and Department of Physiology and Immunology, Faculty of Medicine Osijek, University Josip Juraj Strossmayer Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, Trg Sv. Trojstva 3, HR-31000 Osijek, Croatia
| |
Collapse
|
4
|
Flieh SM, Miguel-Berges ML, Huybrechts I, Breidenassel C, Grammatikaki E, Donne CL, Manios Y, Widhalm K, Molnár D, Stehle P, Kafatos A, Dallongeville J, Molina-Hidalgo C, Gómez-Martínez S, Gonzalez-Gross M, De Henauw S, Béghin L, Kersting M, Moreno LA, González-Gil EM. Food portion sizes and their relationship with energy, and nutrient intakes in adolescents: The HELENA study. Nutrition 2023; 106:111893. [PMID: 36462317 DOI: 10.1016/j.nut.2022.111893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/19/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study aimed to investigate the associations between portion sizes (PSs) from different food groups and energy, as well as nutrient intakes in European adolescents. METHODS A sample of 1631 adolescents (54.2 % girls) were included from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional (HELENA) study. Mean food PS was calculated by dividing the total intake of the items by the number of eating occasions of these consumed items. To determine the key items for analysis, foods were ranked by frequency of consumption. A one-way between-groups analysis of covariance was used to test for significant differences in means across tertiles. A multivariable linear regression analysis was carried out, adjusting for age, sex, maternal education, body mass index, and using country as a level. RESULTS Energy intake increased with elevated intakes of energy-dense foods. Large portions of rice and other grains, starch roots and potatoes, and meat substitutes, nuts, and pulses were associated with increased carbohydrate and fiber intake. Larger portions of cheese and butter and animal fat were significantly associated with a higher fat intake. Lower intakes of some vitamins and micronutrients were noticed with consumption of larger portions of high energy-dense foods, such as desserts and pudding, margarine and vegetable oil, and butter and animal fat. CONCLUSIONS Large food PSs may be associated with positive energy, as well as macro- and micronutrient intake. Moreover, the findings from this study may help the future development of dietary guidance in general and specific to PSs, and support targeted strategies to address intakes of certain nutrients in European adolescents.
Collapse
Affiliation(s)
- Sondos M Flieh
- Growth, Exercise, Nutrition and Development Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - María L Miguel-Berges
- Growth, Exercise, Nutrition and Development Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón, Zaragoza, Spain.
| | - Inge Huybrechts
- International Agency for Research on Cancer, Lyon, France; Department of Public Health, Ghent University, Ghent, Belgium
| | - Christina Breidenassel
- Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany; ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport, Universidad Politécnica de Madrid, Madrid, Spain
| | - Evangelia Grammatikaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University Lille, Inserm, Centre Hospitalier Universitarie Lille, Clinical Investigation Center, Lille, France
| | - Cinzia Le Donne
- Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Rome, Italy
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-Food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
| | - Kurt Widhalm
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria; Austrian Academic Institute for Clinical Nutrition, Vienna, Austria
| | - Dénes Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Peter Stehle
- Department of Nutrition and Food Sciences, University of Bonn, Bonn, Germany
| | | | - Jean Dallongeville
- Department of Epidemiology and Public Health, Institut Pasteur de Lille, Lille, France
| | - Cristina Molina-Hidalgo
- Evaluacion funcional y fisiologia del ejercicio, Ciencia y Tecnologia de la Salud Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Sonia Gómez-Martínez
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Madrid, Spain
| | - Marcela Gonzalez-Gross
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport, Universidad Politécnica de Madrid, Madrid, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Stefaan De Henauw
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laurent Béghin
- University Lille, Inserm, Centre Hospitalier Universitarie Lille, Clinical Investigation Center, Lille, France; University Lille, Inserm, Institute for Translational Research in Inflammation, INFINITE, Lille, France
| | - Mathilde Kersting
- Research Department of Child Nutrition, Pediatric University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón, Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Esther M González-Gil
- Growth, Exercise, Nutrition and Development Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain; Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| |
Collapse
|
5
|
Kim ST, Song YH. Nutrition, Body Composition, and Blood Pressure in Children and Adolescents from the Korea National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13272. [PMID: 36293851 PMCID: PMC9603145 DOI: 10.3390/ijerph192013272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
We aimed to investigate the association between nutrition and blood pressure and the role that body composition plays in this relationship. Korea National Health and Nutrition Examination Survey data from the years 2008-2020 were reviewed. A total of 11,234 subjects (5974 boys and 5260 girls) aged 10-18 years of age were selected. We analyzed the correlation between nutrition (intakes of energy, protein, fat, carbohydrate, sodium, saturated fatty acid (SFA), unsaturated fatty acid (USFA), and dietary fiber (DF)) and body composition (height, weight, waist circumference (WC), body mass index (BMI), and waist to height ratio (WHtR)), and performed multiple regression analysis to find the independent correlation between body composition and blood pressure (BP). We then compared the correlation between nutrition and BP, with or without adjustment for body composition. The intakes of energy, protein, fat, carbohydrate, sodium, and USFA had positive associations with height, weight, WC, and BMI. Systolic BP (SBP) and diastolic BP (DBP) were independently positively correlated with height and BMI. The intakes of energy, protein, fat, carbohydrate, sodium, and SFA had positive correlations with SBP and DBP, which disappeared when additionally adjusted for BMI and height. In conclusion, nutrition seems to affect BP via height and BMI in Korean children and adolescents.
Collapse
|
6
|
Accuracy of equations for predicting 24-h urinary potassium excretion from spot urine samples in Chinese children. Br J Nutr 2022; 128:444-452. [PMID: 34593059 DOI: 10.1017/s0007114521003354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5-18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, -14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.
Collapse
|
7
|
Golpour-Hamedani S, Rafie N, Pourmasoumi M, Morteza Safavi S, Mohammadifard N. Sodium and potassium intakes and adiposity among Iranian pre-adolescents and adolescents: a cross-sectional study. Nutr J 2022; 21:23. [PMID: 35477471 PMCID: PMC9047328 DOI: 10.1186/s12937-022-00776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/14/2022] [Indexed: 09/14/2023] Open
Abstract
Background High sodium and low potassium intakes are associated with the early development of chronic diseases (e.g., hypertension, obesity). Taking into account the limited data on sodium and potassium intakes by 24-h excretion in urine in pre-adolescents and adolescents, we wished to determine baseline salt intake in Iranian subjects aged 11–18 years. Methods This was an observational study involving 374 pre-adolescents and adolescents (154 boys and 220 girls). Sodium and potassium intakes were ascertained by measuring sodium and potassium excretion in urine over 24 h. Creatinine level was used to validate the completeness of the urine collections. The association between sodium and potassium intake and adiposity was determined based on body fat percentage. Results The mean 24-h urine sodium concentration was 3130 ± 2200 mg/day, equal to 7.961 ± 5.596 g/day salt intake. Approximately half of the study participants exceeded the upper limit of Na intake. The mean potassium intake was estimated 1480 ± 1050 mg/day. There was a positive association between urinary sodium excretion and adiposity in crude (OR 1.79; 95% CI: 1.08—2.74) and full adjusted model (OR: 3.15; 95% CI: 2.28–4.63). Also, in subsample analysis, there was a positive correlation between urinary sodium and adiposity in both pre-adolescents (OR: 2.71; 95% CI: 2.29—3.93) and adolescents (OR: 3.55; 95% CI: 2.17—4.74). However, no significant association was found between 24-h urinary potassium and adiposity. Conclusion Sodium intake, as estimated by 24-h urinary excretion, was higher than recommended and it was positively associated with adiposity. Also, this study reported low compliance of potassium intake recommendations in 11–18 years’ Iranian pre-adolescents and adolescents. Health promotion interventions are needed in order to broaden public awareness of high sodium intake and potassium inadequacy to reduce chronic diseases.
Collapse
Affiliation(s)
- Sahar Golpour-Hamedani
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Rafie
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Makan Pourmasoumi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sayyed Morteza Safavi
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. .,Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| |
Collapse
|
8
|
Raphadu TT, Matshipi M, Mphekgwana PM, Monyeki KD. Assessing the Association of Sodium, Potassium Intake and Sodium/Potassium Ratio on Blood Pressure and Central Adiposity Measurements amongst Ellisras Undernourished, Rural Children Aged 5–13 Years: South Africa. CHILDREN 2022; 9:children9030422. [PMID: 35327794 PMCID: PMC8947557 DOI: 10.3390/children9030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
Background: Numerous studies have shown how diet, such as sodium (Na) and potassium (K) intake, is an important risk factor for non-communicable diseases (NCDs). This study aimed to assess the relationship between sodium intake, potassium intake; and sodium/potassium ratio with blood pressure (BP) and abdominal obesity amongst Ellisras rural children. Method: In this cross-sectional study, data on dietary intake of sodium and potassium were collected using a 24-h recall questionnaire from a total of 765 participants, aged 5–13 years. Blood pressure and anthropometric measurements were also collected. Generalised linear models and Pearson correlation were conducted to assess the association of sodium intake, potassium intake; and their ratio with BP, waist circumference (WC), and waist-to-height ratio (WHtR). Results: In both age groups, less than 14.9% of males and 19.8% of females consumed above the recommended adequate intake (AI) of sodium. In addition, both age groups had more than 90% of males and females who consumed below the recommended AI of potassium. Moreover, the sodium/potassium ratio was above the WHO recommended level in more than 30% of males and females. The study found a significant, weak positive correlation of sodium intake with systolic BP (SBP), diastolic BP (DBP), and with WHtR. A significant, weak positive correlation was also found between sodium/potassium ratio and WHtR. In addition, a significant association was found between potassium intake and systolic BP. Conclusion: Although our study found a notable low average intake of sodium and potassium as compared to the recommended values. There was positive correlation found between sodium intake and BP. Furthermore, a positive correlation of sodium intake and sodium/potassium ratio with WHtR was also found.
Collapse
Affiliation(s)
- Thato Tshepo Raphadu
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| | - Moloko Matshipi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| | - Peter Modupi Mphekgwana
- Department of Research Administration and Development, University of Limpopo, Sovenga 0727, South Africa;
| | - Kotsedi Daniel Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
- Correspondence: ; Tel.: +27-152682953
| |
Collapse
|
9
|
Wieërs MLAJ, Mulder J, Rotmans JI, Hoorn EJ. Potassium and the kidney: a reciprocal relationship with clinical relevance. Pediatr Nephrol 2022; 37:2245-2254. [PMID: 35195759 PMCID: PMC9395506 DOI: 10.1007/s00467-022-05494-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 10/26/2022]
Abstract
By controlling urinary potassium excretion, the kidneys play a key role in maintaining whole-body potassium homeostasis. Conversely, low urinary potassium excretion (as a proxy for insufficient dietary intake) is increasingly recognized as a risk factor for the progression of kidney disease. Thus, there is a reciprocal relationship between potassium and the kidney: the kidney regulates potassium balance but potassium also affects kidney function. This review explores this relationship by discussing new insights into kidney potassium handling derived from recently characterized tubulopathies and studies on sexual dimorphism. These insights reveal a central but non-exclusive role for the distal convoluted tubule in sensing potassium and subsequently modifying the activity of the sodium-chloride cotransporter. This is another example of reciprocity: activation of the sodium-chloride cotransporter not only reduces distal sodium delivery and therefore potassium secretion but also increases salt sensitivity. This mechanism helps explain the well-known relationship between dietary potassium and blood pressure. Remarkably, in children, blood pressure is related to dietary potassium but not sodium intake. To explore how potassium deficiency can cause kidney injury, we review the mechanisms of hypokalemic nephropathy and discuss if these mechanisms may explain the association between low dietary potassium intake and adverse kidney outcomes. We discuss if potassium should be repleted in patients with kidney disease and what role dietary potassium plays in the risk of hyperkalemia. Supported by data and physiology, we reach the conclusion that we should view potassium not only as a potentially dangerous cation but also as a companion in the battle against kidney disease.
Collapse
Affiliation(s)
- Michiel L. A. J. Wieërs
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jaap Mulder
- grid.5645.2000000040459992XDepartment of Pediatrics, Division of Pediatric Nephrology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Pediatrics, Division of Pediatric Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I. Rotmans
- grid.10419.3d0000000089452978Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout J. Hoorn
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
10
|
Okuda M, Fujiwara A, Sasaki S. Adherence to the Japanese Food Guide: The Association between Three Scoring Systems and Cardiometabolic Risks in Japanese Adolescents. Nutrients 2021; 14:nu14010043. [PMID: 35010915 PMCID: PMC8746488 DOI: 10.3390/nu14010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
The Japanese Food Guide Spinning Top (JFGST) indicates optimal intake of five food groups (grain, fish and meat, vegetables, milk, and fruits) and sugar and confectionaries. We aimed to investigate whether adherence to the JFGST in 8th grade junior high school students (n = 3162) was associated with cardiometabolic risks and how different scorings of the JFGST influenced the associations. Metabolic risks were assessed from anthropometrics, blood pressure measurements, and blood glucose and lipid profile measurements. Three types of scoring adherent to the JFGST were analyzed (10 points were given for each item with optimal intake; range: 0–60): the original scoring (ORG scoring); first modified scoring, which had no upper limits for vegetables and fruits (MOD1 scoring); and MOD2 scoring without upper limits for five dishes (MOD2 scoring). The MOD2 scoring was positively associated with dietary fiber, potassium, calcium, and vitamins. All types of scorings were associated with low glucose levels (p ≤ 0.001); the MOD2 scoring was associated with low systolic blood pressure (p = 0.001) and low cardiometabolic risk (p = 0.003). Our findings suggest that Japanese adolescents adherent to the JFGST had low cardiometabolic risks and should not fall below lower limits for intake of the abovementioned five food groups.
Collapse
Affiliation(s)
- Masayuki Okuda
- Graduate School of Sciences and Technology for Innovation, Yamaguchi University, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2231
| | - Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, The National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan;
- Department of Social and Preventive Epidemiology, Graduate School of Medicine and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, Graduate School of Medicine and School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| |
Collapse
|
11
|
Wójcik M, Kozioł-Kozakowska A. Obesity, Sodium Homeostasis, and Arterial Hypertension in Children and Adolescents. Nutrients 2021; 13:4032. [PMID: 34836287 PMCID: PMC8622119 DOI: 10.3390/nu13114032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The relationship between obesity, arterial hypertension, and excessive salt intake has been known for a long time; however, the mechanism of this relationship remains not clear. METHODS The paper presents a current literature review on the relationship between salt consumption and the development of arterial hypertension in children and adolescents with obesity. RESULTS In addition to the traditional theory of hypertension development due to the increase in intravascular volume and disturbances of sodium excretion, recent studies indicate the existence of a complex mechanism related to excessive, pathological secretory activity of adipocytes, insulin resistance, and impaired function of the renin-angiotensin-aldosterone axis. That makes obese children and adolescents particularly vulnerable to the development of salt-sensitive arterial hypertension. Studies performed in many countries have shown that children and adolescents consume more sodium than recommended. It is worth noting, however, that the basis for these recommendations was the extrapolation of data from studies conducted on adults. Moreover, more important than sodium intake is the Na/K ratio and water consumption. CONCLUSION Regardless of the population-wide recommendations on reducing salt intake in children, specific recommendations for overweight and obese patients should be developed.
Collapse
Affiliation(s)
- Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 30-663 Kraków, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Institute of Pediatrics, Jagiellonian University Medical College, 30-663 Kraków, Poland;
| |
Collapse
|
12
|
Necessity of salt intake reduction education beginning in youth: a cross-sectional survey of sodium-to-potassium ratios in mothers and their preschool children. Hypertens Res 2021; 44:1307-1315. [PMID: 34285376 DOI: 10.1038/s41440-021-00705-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
Urinary sodium-to-potassium ratios are known to be high in preschoolers, but there are no reports comparing these ratios with those of the children's mothers. The aim of this study was to investigate the association between the urinary sodium-to-potassium ratios of mothers and their preschool children under the hypothesis that the ratio is equivalent between the two. We evaluated 297 preschoolers aged four to five attending six kindergartens (four in northern Japan, two in southern Japan), and we also evaluated the children's mothers. We asked the participants to take morning first urine samples for 2 consecutive days in the spring and autumn of the same year (four samples per participant) and to fill out a dietary questionnaire. There was a correlation between the urinary sodium-to-potassium ratios of preschoolers and those of their mothers. However, in a comparison between the preschoolers and their mothers overall, higher values were found in the preschoolers [preschoolers: 4.6 (3.5-6.3) mmol/L/g·Cr; mothers: 4.3 (3.9-4.7) mmol/L/g·Cr, p = 0.003]. These results correlated with the urinary sodium-to-potassium ratios estimated from the dietary questionnaire. The preschoolers showed high sodium and low potassium intake consumption compared to the mothers. Interestingly, these were found to differ by region and gender. In conclusion, the urinary sodium-to-potassium ratio in Japanese preschoolers is related to and higher than that of their mothers. It is important to educate children, their parents, childcare professionals, and society as a whole about proper salt restriction and potassium supplementation, as well as to improve the food environment.
Collapse
|
13
|
Assessment of Foods Associated with Sodium and Potassium Intake in Japanese Youths Using the Brief-Type Self-Administered Diet History Questionnaire. Nutrients 2021; 13:nu13072345. [PMID: 34371856 PMCID: PMC8308755 DOI: 10.3390/nu13072345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/20/2022] Open
Abstract
The identification of sodium and potassium intake in youths is an important step to preventing the increase of blood pressure in childhood. We examined food intake and estimated mineral intake using a brief-type self-administered diet history questionnaire (BDHQ) to test its validity as a comparison with urinary excretion in Japanese youths. The subjects were 5th and 8th graders (n = 2377), who completed the BDHQ and permitted the use of their overnight urine specimens. Sodium intake was poorly associated with sodium excretion (Rho = 0.048), and the coefficients of dietary potassium and a sodium-to-potassium molar ratio were 0.091–0.130. Higher soybean paste (miso) intake and pickles were significantly associated with higher sodium excretion (p ≤ 0.005). However, these foods were positively associated with potassium excretion (p = 0.002–0.012), and not associated with an excreted sodium-to-potassium ratio. Fruits and dairy products were positively associated (p ≤ 0.048), whereas beverages were negatively associated with potassium excretion (p ≤ 0.004). The association of the sodium-to-potassium ratio was opposite to that of potassium (p ≤ 0.001). The choice of foods, potassium, and the sodium-to-potassium ratio assessed using the BDHQ are available as part of health education for youths, but the assessment of sodium intake in population levels should be carefully conducted.
Collapse
|
14
|
S Machado IB, Tofanelli MR, Saldanha da Silva AA, Simões E Silva AC. Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date. Curr Pediatr Rev 2021; 17:15-37. [PMID: 33430749 DOI: 10.2174/1573396317999210111200222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Arterial hypertension in children is considered a common alteration nowadays, mainly because obesity is a growing worldwide problem closely related to increased blood pressure. Childhood hypertension can be classified as primary or secondary, depending on the etiology. Primary or essential hypertension still has its pathophysiology not fully elucidated, and there is no consensus in the literature on most underlying mechanisms. In this review, genetic and environmental factors, including sodium and potassium intake, socioeconomic status, ethnicity, family structure, obesity, sedentary lifestyle, prematurity and low birth weight, prenatal and postnatal exposures are highlighted. OBJECTIVE The present study aimed to perform an update on primary hypertension in childhood, providing clinicians and researchers an overview of the current state of the literature regarding the influence of genetic and environmental factors. METHODS This integrative review searched for articles on genetic and environmental factors related to primary hypertension in pediatric patients. The databases evaluated were PubMed and Scopus. RESULTS The studies have provided insights regarding many genetic and environmental factors, in addition to their association with the pathophysiology of primary hypertension in childhood. Findings corroborated the idea that primary hypertension is a multifactorial disease. Further studies in the pediatric population are needed to elucidate the underlying mechanisms. CONCLUSION The study of primary hypertension in pediatrics has utmost importance for the adoption of preventive measures and the development of more efficient treatments, therefore reducing childhood morbidity and the incidence of cardiovascular diseases and other health consequences later in life.
Collapse
Affiliation(s)
- Isabella Barreto S Machado
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Matheus Rampinelli Tofanelli
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ariadna A Saldanha da Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| |
Collapse
|
15
|
Burnier M. Should we eat more potassium to better control blood pressure in hypertension? Nephrol Dial Transplant 2020; 34:184-193. [PMID: 29301002 DOI: 10.1093/ndt/gfx340] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Changes in lifestyle and nutrition are recommended as the first-step approach to the management of hypertension by all national and international guidelines. Today, when considering nutritional factors in hypertension, almost all the attention is focused on the reduction of salt intake to improve blood pressure (BP) control. Changes in potassium intake are only briefly evoked in guidelines. Few physicians actually think about proposing to eat more foods that are high in potassium (fruits, vegetables, nuts) to better control BP. Yet, during the last 40 years, increasing evidence has accumulated demonstrating that increasing potassium intake, either with food products or with supplements, is associated with significant reductions of both systolic and diastolic BP. The hypotensive effect of potassium is particularly marked in patients with hypertension and in subjects with a very high sodium intake, suggesting that potassium counterbalances the effects of sodium. In addition, several meta-analyses have now confirmed that high potassium intake reduces the risk of stroke by ∼ 25%. Finally, increasing potassium in the diet may perhaps be beneficial for some renal patients, as post hoc analyses have suggested that a high potassium intake may retard the decline of renal function in patients with early chronic kidney disease (CKD) stages. However, high potassium intake may be risky and sometimes even dangerous in hypertensive patients with CKD stages 3-5, specifically diabetics. In this context, however, as the level of evidence remains low, more prospective clinical studies are needed. The goal of this review is to discuss the actual evidence that supports the recommendation to eat more potassium in order to better control BP in essential hypertension and to review the restrictions in CKD patients with hypertension.
Collapse
Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Lausanne, Switzerland
| |
Collapse
|
16
|
Zafarmand MH, Spanjer M, Nicolaou M, Wijnhoven HAH, van Schaik BD, Uitterlinden AG, Snieder H, Vrijkotte TG. Influence of Dietary Approaches to Stop Hypertension-Type Diet, Known Genetic Variants and Their Interplay on Blood Pressure in Early Childhood. Hypertension 2020; 75:59-70. [DOI: 10.1161/hypertensionaha.118.12292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
There is limited evidence on association between adherence to the Dietary Approaches to Stop Hypertension (DASH diet) and a lower blood pressure (BP) in children. In a population-based cohort study, among 1068 Dutch children aged 5 to 7, we evaluated the association between a DASH-type diet, 29 known genetic variants incorporated in a genetic risk score, and their interaction on BP. We calculated DASH score based on the food intake data measured through a validated 71-item food frequency questionnaire. In our sample, DASH score ranged from 9 (low adherence to the DASH diet) to 33 (median=21), and genetic score ranged from 18 (low genetic risk on high BP) to 41 (median=29). After adjustment for covariates, each 10 unit increase in DASH score was associated with a lower systolic BP of 0.7 mm Hg (
P
=0.033). DASH score was negatively associated with hypertension (odds ratio=0.96 [0.92–0.99],
P
=0.044). Similarly, each SD increment in genetic score was associated with 0.5 mm Hg higher diastolic BP (
P
=0.002). We found a positive interaction between low DASH score and high genetic score on diastolic BP adjusted for BP risk factors (β=1.52,
P
interaction
=0.019 in additive scale and β=0.03,
P
interaction
=0.021 in multiplicative scale). Our findings show that adherence to the DASH-type diet, as well as a low (adult-derived) genetic risk profile for BP, is associated with lower BP in children and that the genetic basis of BP phenotypes at least partly overlaps between adults and children. In addition, we found evidence of a gene-diet interaction on BP in children.
Collapse
Affiliation(s)
- Mohammad Hadi Zafarmand
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics (M.H.Z.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marit Spanjer
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Mary Nicolaou
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Hanneke A. H. Wijnhoven
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, the Netherlands (H.A.H.W.)
| | - Barbera D.C. van Schaik
- Amsterdam Public Health Research Institute and Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics (B.D.C.v.S.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands (A.G.U.)
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (A.G.U.)
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands (H.S.)
| | - Tanja G.M. Vrijkotte
- From the Department of Public Health (M.H.Z., M.S., M.N., T.G.M.V.), Amsterdam UMC, University of Amsterdam, the Netherlands
| |
Collapse
|
17
|
Association between Parent and Child Dietary Sodium and Potassium Intakes: Aomori Prefectural Health and Nutrition Survey, 2016. Nutrients 2019; 11:nu11061414. [PMID: 31234612 PMCID: PMC6628498 DOI: 10.3390/nu11061414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022] Open
Abstract
This study investigated the association between parent and child sodium and potassium intakes using data from the 2016 Aomori Prefectural Health and Nutrition Survey. We analyzed one day dietary record data of 103 mothers, 94 fathers, 51 children aged 1-3 years, 39 children aged 4-6 years, 91 children aged 7-14 years, and 56 children aged 15-19 years. We also examined the association of sodium and potassium intake between co-habiting grandparents and their grandchildren. After adjusting for covariates, the total daily sodium intake in mothers was positively associated with that in children for every age group. Potassium intakes by the mothers during breakfast and dinner were positively associated with those in children aged 1-3, 4-6, and 7-14 years. The associations in sodium and potassium intakes between fathers and children were weaker. In addition, these associations were similar to those between the sodium intakes of grandchildren and their grandparents. The association between mother and child sodium and potassium intakes at breakfast and dinner was related to the consumption of similar foods, which suggests the importance of home environment in influencing total dietary sodium and potassium intake in Japanese people.
Collapse
|
18
|
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: 85] [Impact Index Per Article: 17.0] [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.
Collapse
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
| |
Collapse
|
19
|
Measuring Children's Sodium and Potassium Intakes in NZ: A Pilot Study. Nutrients 2018; 10:nu10091198. [PMID: 30200423 PMCID: PMC6164957 DOI: 10.3390/nu10091198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 01/03/2023] Open
Abstract
Low sodium and high potassium intakes in childhood protect against rises in blood pressure (BP) and risk of cardiovascular disease (CVD) later in life. Our aim was to pilot methods for collection of 24-h urine samples (gold standard) and diet recalls to assess sodium and potassium intakes and their food sources in 30 children aged 8–11 years at one New Zealand primary school. A diverse sample (n = 27) was recruited over a two-week period. All children provided a urine sample (71% complete) and interviewer-assisted 24-h diet recall (Intake24 software). Median (range) sodium intake was 2191 (1087 to 4786) mg/day (salt equivalent 5.5 g), potassium intake was 1776 (800–2981) mg/day, BP was 105 (84–129)/62 (53–89) mmHg, and sodium to potassium molar ratio was 2.0 (1.1–4.8). Frequent use of discretionary salt was uncommon. Major food sources of sodium were bread, pies and pastries, and bread and pasta-based dishes, and potassium were sauces and condiments, dairy products, and non-alcoholic beverages. Most participants provided adequate data and enjoyed taking part. A larger survey is warranted to confirm findings and inform a potential intervention(s). Small improvements to study procedures and resources should improve completeness of urine samples and quality of 24-h diet recall data.
Collapse
|
20
|
Assessment of Sodium and Potassium Intakes in Children Aged 6 to 18 Years by 24 h Urinary Excretion in City of Rabat, Morocco. J Nutr Metab 2018; 2018:8687192. [PMID: 30155290 PMCID: PMC6092998 DOI: 10.1155/2018/8687192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of noncommunicable diseases (NCDs) has greatly increased, mainly due to high level of dietary sodium. Thus, reduction of sodium intake in population has been recognized as one of the most cost-effective strategies to reduce NCDs. The aim of this study was to estimate sodium and potassium consumption in a sample of Moroccan children as a baseline study to implement national strategy for salt intake reduction. Methods The study was conducted on 131 children aged 6-18 years recruited from Rabat and its region. Sodium excretion and potassium excretion were measured on 24 h urinary collection, and the creatinine excretion was used to validate completeness of urine collections. Results The average of urinary sodium was 2235.3 ± 823.2 mg/day, and 50% of children consume more than 2 g/d of sodium (equivalent to 5 g/day of salt), recommended by the WHO. However, daily urinary excretion of potassium was 1431 ± 636.5 mg/day, and 75% of children consume less than adequate intake. Sodium consumption increased significantly with age. Of particular interest, 46.7% of children aged 6-8 years and 49.3% of children aged 9-13 years consume more than the corresponding upper limits. Conclusions Children have high sodium and low potassium status. There is evidence of the urgent need to implement a strategy for reduction of dietary sodium intake in Morocco.
Collapse
|
21
|
Girişgen İ, Sönmez F. Çocukluk çağı primer hipertansiyonuna etki eden faktörlerin araştırılması. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
22
|
Sodium Content of Lunches and Snacks Provided in Australian Long Day Care Centres: A Cross-Sectional Study. Nutrients 2018; 10:nu10030284. [PMID: 29495628 PMCID: PMC5872702 DOI: 10.3390/nu10030284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/08/2018] [Accepted: 02/26/2018] [Indexed: 11/16/2022] Open
Abstract
We determined the average amount of sodium provided in lunches and snacks and the average amount of sodium consumed at lunch in a convenience sample of Australian preschool children attending Long Day Care (LDC). Sodium content of lunches and snacks was determined from standardised recipes. Individual children's sodium intake was estimated by a validated visual plate waste scale method. Five recipes (lunch n = 35, snacks n = 70) collected from 7 LDC centres; 95 children (50 boys) mean age 3.5 (SD) (0.2) years lunch intakes were assessed. Average total amount of sodium provided from two snacks and one lunch: 590 (146) mg, representing ~59% of the Australian Upper Level (UL) of intake (1000 mg/day sodium). Average total amount of sodium consumed: 541 (98) mg representing ~54% of the UL. Across all centres, the average sodium and energy consumed from lunch: 186 (108) mg (~19% of UL); 948 (437) kJ (38% of energy allowance); morning snacks: 63 (45) mg (6% of UL), 535 (183) kJ (21% of energy allowance); afternoon snacks: 291 (97) mg (29% of UL), 464 (171) kJ energy (46% of energy allowance). Australian LDC centres providing lunches cooked on site resulted in relatively low-sodium lunches.
Collapse
|
23
|
Grimes CA, Riddell LJ, Campbell KJ, Beckford K, Baxter JR, He FJ, Nowson CA. Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study. BMJ Open 2017; 7:e016639. [PMID: 29084791 PMCID: PMC5665305 DOI: 10.1136/bmjopen-2017-016639] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine sodium and potassium urinary excretion by socioeconomic status (SES), discretionary salt use habits and dietary sources of sodium and potassium in a sample of Australian schoolchildren. DESIGN Cross-sectional study. SETTING Primary schools located in Victoria, Australia. PARTICIPANTS 666 of 780 children aged 4-12 years who participated in the Salt and Other Nutrients in Children study returned a complete 24-hour urine collection. PRIMARY AND SECONDARY OUTCOME MEASURES 24-hour urine collection for the measurement of sodium and potassium excretion and 24-hour dietary recall for the assessment of food sources. Parent and child reported use of discretionary salt. SES defined by parental highest level of education. RESULTS Participants were 9.3 years (95% CI 9.0 to 9.6) of age and 55% were boys. Mean urinary sodium and potassium excretion was 103 (95% CI 99 to 108) mmol/day (salt equivalent 6.1 g/day) and 47 (95% CI 45 to 49) mmol/day, respectively. Mean molar Na:K ratio was 2.4 (95% CI 2.3 to 2.5). 72% of children exceeded the age-specific upper level for sodium intake. After adjustment for age, sex and day of urine collection, children from a low socioeconomic background excreted 10.0 (95% CI 17.8 to 2.1) mmol/day more sodium than those of high socioeconomic background (p=0.04). The major sources of sodium were bread (14.8%), mixed cereal-based dishes (9.9%) and processed meat (8.5%). The major sources of potassium were dairy milk (11.5%), potatoes (7.1%) and fruit/vegetable juice (5.4%). Core foods provided 55.3% of dietary sodium and 75.5% of potassium while discretionary foods provided 44.7% and 24.5%, respectively. CONCLUSIONS For most children, sodium intake exceeds dietary recommendations and there is some indication that children of lower socioeconomic background have the highest intakes. Children are consuming about two times more sodium than potassium. To improve sodium and potassium intakes in schoolchildren, product reformulation of lower salt core foods combined with strategies that seek to reduce the consumption of discretionary foods are required.
Collapse
Affiliation(s)
- Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Janet R Baxter
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Feng J He
- Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
24
|
Strohm D, Ellinger S, Leschik-Bonnet E, Maretzke F, Heseker H. Revised Reference Values for Potassium Intake. ANNALS OF NUTRITION & METABOLISM 2017; 71:118-124. [PMID: 28803230 PMCID: PMC5639605 DOI: 10.1159/000479705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nutrition societies of Germany, Austria and Switzerland have revised the reference values for potassium intake in January 2017. METHODS For adults, the estimated value was based on the 24-h urinary potassium excretion and on preventive considerations regarding hypertension and stroke. The estimated values for children and adolescents were extrapolated from the adult estimated value considering differences in body mass. For infants aged 0 to under 4 months, the estimated value was set based on the potassium intake via breast milk. From this reference value, the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the potassium loss via breast milk. RESULTS The estimated values for potassium intake are set at 400 mg/day for breastfed infants aged 0 to under 4 months, 600 mg/day for infants aged 4 to under 12 months, 1,100-4,000 mg/day for children and adolescents, 4,000 mg/day for adults and pregnant women and 4,400 mg/day for lactating women. CONCLUSIONS The consumption of potassium-rich foods should be generally increased. Supplemental intake beyond the estimated values has no health benefit and is therefore not recommended.
Collapse
Affiliation(s)
| | - Sabine Ellinger
- Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Moenchengladbach, Germany
| | | | | | - Helmut Heseker
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
| |
Collapse
|
25
|
Abstract
The kidney plays an essential role in maintaining homeostasis of ion concentrations in the blood. Because the concentration gradient of potassium across the cell membrane is a key determinant of the membrane potential of cells, even small deviations in serum potassium level from the normal setpoint can lead to severe muscle dysfunction, resulting in respiratory failure and cardiac arrest. Less severe hypo- and hyperkalemia are also associated with morbidity and mortality across various patient populations. In addition, deficiencies in potassium intake have been associated with hypertension and adverse cardiovascular and renal outcomes, likely due in part to the interrelated handling of sodium and potassium by the kidney. Here, data on the beneficial effects of potassium on blood pressure and cardiovascular and renal outcomes will be reviewed, along with the physiological basis for these effects. In some patient populations, however, potassium excess is deleterious. Risk factors for the development of hyperkalemia will be reviewed, as well as the risks and benefits of existing and emerging therapies for hyperkalemia.
Collapse
Affiliation(s)
- Aylin R. Rodan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
26
|
Does Potassium Deficiency Contribute to Hypertension in Children and Adolescents? Curr Hypertens Rep 2017; 19:37. [DOI: 10.1007/s11906-017-0733-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
27
|
Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
28
|
Leyvraz M, Taffé P, Chatelan A, Paradis G, Tabin R, Bovet P, Bochud M, Chiolero A. Sodium intake and blood pressure in children and adolescents: protocol for a systematic review and meta-analysis. BMJ Open 2016; 6:e012518. [PMID: 27655262 PMCID: PMC5051513 DOI: 10.1136/bmjopen-2016-012518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Hypertension is a major risk factor for cardiovascular diseases. In adults, high sodium intake is associated with elevated blood pressure. In children, experimental studies have shown that reducing sodium intake can reduce blood pressure. However, their external validity is limited, notably because the sodium reduction was substantial and not applicable in a real-life setting. Observational studies, on the other hand, allow assess the association between blood pressure and sodium intake across usual levels of consumption. There is also evidence that the association differs between subgroups of children according to age and body weight. Our objective is to conduct a systematic review and meta-analysis of experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents and to assess whether the association differs according to age and body weight. METHODS AND ANALYSIS A systematic search of the MEDLINE, EMBASE, CINAHL and CENTRAL databases will be 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 will be included. The exposure will be dietary sodium intake, estimated using different methods including urinary sodium excretion. The outcomes will be systolic and diastolic blood pressure, elevated blood pressure and hypertension. If appropriate, meta-analyses will be performed by pooling data across all studies together and separately for experimental and observational studies. Subgroup meta-analyses by age and body weight will be also conducted. Moreover, separate meta-analyses for different sodium intake levels will be conducted to investigate the dose-response relationship. ETHICS AND DISSEMINATION This systematic review and meta-analysis will be published in a peer-reviewed journal. A report will be prepared for national authorities and other stakeholders in the domains of nutrition, public health, and child health in Switzerland. TRIAL REGISTRATION NUMBER CRD42016038245.
Collapse
Affiliation(s)
- Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Patrick Taffé
- 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
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - René Tabin
- Department of Pediatrics, Hospital of Valais, Sion, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - 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
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| |
Collapse
|
29
|
O'Halloran SA, Grimes CA, Lacy KE, Campbell KJ, Nowson CA. Dietary Intake and Sources of Potassium and the Relationship to Dietary Sodium in a Sample of Australian Pre-School Children. Nutrients 2016; 8:E496. [PMID: 27529278 PMCID: PMC4997409 DOI: 10.3390/nu8080496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/09/2016] [Accepted: 08/09/2016] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to determine the intake and food sources of potassium and the molar sodium:potassium (Na:K) ratio in a sample of Australian pre-school children. Mothers provided dietary recalls of their 3.5 years old children (previous participants of Melbourne Infant Feeding Activity and Nutrition Trial). The average daily potassium intake, the contribution of food groups to daily potassium intake, the Na:K ratio, and daily serves of fruit, dairy, and vegetables, were assessed via three unscheduled 24 h dietary recalls. The sample included 251 Australian children (125 male), mean age 3.5 (0.19) (SD) years. Mean potassium intake was 1618 (267) mg/day, the Na:K ratio was 1.47 (0.5) and 54% of children did not meet the Australian recommended adequate intake (AI) of 2000 mg/day for potassium. Main food sources of potassium were milk (27%), fruit (19%), and vegetable (14%) products/dishes. Food groups with the highest Na:K ratio were processed meats (7.8), white bread/rolls (6.0), and savoury sauces and condiments (5.4). Children had a mean intake of 1.4 (0.75) serves of fruit, 1.4 (0.72) dairy, and 0.52 (0.32) serves of vegetables per day. The majority of children had potassium intakes below the recommended AI. The Na:K ratio exceeded the recommended level of 1 and the average intake of vegetables was 2 serves/day below the recommended 2.5 serves/day and only 20% of recommended intake. An increase in vegetable consumption in pre-school children is recommended to increase dietary potassium and has the potential to decrease the Na:K ratio which is likely to have long-term health benefits.
Collapse
Affiliation(s)
- Siobhan A O'Halloran
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, VIC, Australia.
| | - Carley A Grimes
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, VIC, Australia.
| | - Kathleen E Lacy
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, VIC, Australia.
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, VIC, Australia.
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, VIC, Australia.
| |
Collapse
|
30
|
Gonçalves C, Abreu S, Padrão P, Pinho O, Graça P, Breda J, Santos R, Moreira P. Sodium and potassium urinary excretion and dietary intake: a cross-sectional analysis in adolescents. Food Nutr Res 2016; 60:29442. [PMID: 27072344 PMCID: PMC4829664 DOI: 10.3402/fnr.v60.29442] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 02/23/2016] [Accepted: 03/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background Hypertension is the leading cause for heart disease and stroke, for mortality and morbidity worldwide, and a high sodium-to-potassium intake ratio is considered a stronger risk factor for hypertension than sodium alone. Objective This study aims to evaluate sodium and potassium urinary excretion, and assess the food sources of these nutrients in a sample of Portuguese adolescents. Design A cross-sectional study with a sample of 250 Portuguese adolescents. Sodium and potassium excretion were measured by one 24-h urinary collection, and the coefficient of creatinine was used to validate completeness of urine collections. Dietary sources of sodium and potassium were assessed using a 24-h dietary recall. Results Valid urine collections were provided by 200 adolescents (118 girls) with a median age of 14.0 in both sexes (p=0.295). Regarding sodium, the mean urinary excretion was 3,725 mg/day in boys and 3,062 mg/day in girls (p<0.01), and 9.8% of boys and 22% of girls met the World Health Organization (WHO) recommendations for sodium intake. Concerning potassium, the mean urinary excretion was 2,237 mg/day in boys and 1,904 mg/day in girls (p<0.01), and 6.1% of boys and 1.7% of girls met the WHO recommendations for potassium intake. Major dietary sources for sodium intake were cereal and cereal products (41%), meat products (16%), and milk and milk products (11%); and for potassium intake, main sources were milk and milk products (21%), meat products (17%), and vegetables (15%). Conclusions Adolescents had a high-sodium and low-potassium diet, well above the WHO recommendations. Health promotion interventions are needed in order to decrease sodium and increase potassium intake.
Collapse
Affiliation(s)
- Carla Gonçalves
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal;
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto (ISPUP), EPIUnit-Epidemiology Research Unit, Porto, Portugal
| | - Olívia Pinho
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,LAQV/REQUIMTE, University of Porto, Porto, Portugal
| | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Directorate General of Health, Lisbon, Portugal
| | - João Breda
- Division of Noncommunicable Diseases and Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Denmark
| | - Rute Santos
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Maia University Institute, Maia, Portugal.,Early Start Research Institute, School of Education, Faculty of Social Sciences, University of Wollongong, Australia
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal.,Institute of Public Health, University of Porto (ISPUP), EPIUnit-Epidemiology Research Unit, Porto, Portugal
| |
Collapse
|
31
|
Service C, Grimes C, Riddell L, He F, Campbell K, Nowson C. Association between Parent and Child Dietary Sodium and Potassium Intakes as Assessed by 24-h Urinary Excretion. Nutrients 2016; 8:191. [PMID: 27043620 PMCID: PMC4848660 DOI: 10.3390/nu8040191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/17/2016] [Accepted: 03/28/2016] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to assess the association between parent and child sodium (Na) and potassium (K) intake as assessed by 24-h urinary excretion (24hUE). Primary school children and their parent(s) provided one 24-h urine sample and information on cooking and children's discretionary salt use. Valid urine samples were provided by 108 mothers (mean age 41.8 (5.1) (SD) years, Na 120 (45) mmol/day) (7.0 g/day salt equivalent) and 40 fathers (44.4 (4.9) years, Na 152 (49) mmol/day (8.9 g/day salt), and 168 offspring (51.8% male, age 9.1 (2.0) years, Na 101 (47) mmol/day (5.9 g/day salt). When adjusted for parental age, child age and gender a 17 mmol/day Na (1 g/day salt) increase in mother's 24hUE was associated with a 3.4 mmol/day Na (0.2 g/day salt) increase in child's salt 24hUE (p = 0.04) with no association observed between father and child. Sixty-seven percent of parents added salt during cooking and 37% of children added salt at the table. Children who reported adding table salt had higher urinary excretion than those who did not (p = 0.01). The association between mother and child Na intake may relate to the consumption of similar foods and highlights the importance of the home environment in influencing total dietary sodium intake.
Collapse
Affiliation(s)
- Carrie Service
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Carley Grimes
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Lynn Riddell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Feng He
- Centre for Environmental and Preventative Medicine, Wolfson Institute of Preventative Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - Karen Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| | - Caryl Nowson
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
| |
Collapse
|
32
|
Elevated urinary Na/K ratio among Lebanese elementary school children is attributable to low K intake. Eur J Nutr 2016; 56:1149-1156. [DOI: 10.1007/s00394-016-1164-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/20/2016] [Indexed: 12/26/2022]
|
33
|
Lava SAG, Bianchetti MG, Simonetti GD. Salt intake in children and its consequences on blood pressure. Pediatr Nephrol 2015; 30:1389-96. [PMID: 25127918 DOI: 10.1007/s00467-014-2931-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 02/07/2023]
Abstract
Sodium is the most abundant extracellular cation and therefore pivotal in determining fluid balance. At the beginning of life, a positive sodium balance is needed to grow. Newborns and preterm infants tend to lose sodium via their kidneys and therefore need adequate sodium intake. Among older children and adults, however, excessive salt intake leads to volume expansion and arterial hypertension. Children who are overweight, born preterm, or small for gestational age and African American children are at increased risk of developing high blood pressure due to a high salt intake because they are more likely to be salt sensitive. In the developed world, salt intake is generally above the recommended intake also among children. Although a positive sodium balance is needed for growth during the first year of life, in older children, a sodium-poor diet seems to have the same cardiovascular protective effects as among adults. This is relevant, since: (1) a blood pressure tracking phenomenon was recognized; (2) the development of taste preferences is important during childhood; and (3) salt intake is often associated with the consumption of sugar-sweetened beverages (predisposing children to weight gain).
Collapse
Affiliation(s)
- Sebastiano A G Lava
- Division of Pediatric Nephrology, University Children's Hospital Bern, Bern, Switzerland
| | | | | |
Collapse
|
34
|
Oliveira AC, Padrão P, Moreira A, Pinto M, Neto M, Santos T, Madureira J, Fernandes EDO, Graça P, Breda J, Moreira P. Potassium urinary excretion and dietary intake: a cross-sectional analysis in 8-10 year-old children. BMC Pediatr 2015; 15:60. [PMID: 25982707 PMCID: PMC4448853 DOI: 10.1186/s12887-015-0374-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 05/05/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Data from studies assessing the intake of potassium, and the concomitant sodium-to-potassium ratio are limited. The aim of this study was to evaluate potassium and sodium-to-potassium ratio intake in 8-10 year-old children. METHODS A cross-sectional survey was carried out from January to June 2014 and data from 163 children (81 boys) were included. Potassium intake was estimated by 24-h urine collection and coefficient of creatinine was used to validate completeness of urine collections. Urinary sodium and sodium-to-potassium ratio were also analysed. A 24-h dietary recall was used to provide information on dietary sources of potassium. Height and weight were measured according to international standards. RESULTS The mean urinary potassium excretion was 1701 ± 594 mg/day in boys, and 1682 ± 541 mg/day in girls (p = 0.835); 8.0% of children met the WHO recommendations for potassium intake. The mean sodium excretion was 2935 ± 1075 mg/day in boys and 2381 ± 1045 mg/day in girls (p <0.001) and urinary sodium-to-potassium ratio was 3.2 ± 1.4 in boys, and 2.5 ± 1.1 in girls (p = 0.002). The mean fruit and vegetable intake was 353.1 ± 232.5 g/day in boys, and 290.8 ± 213.1 g/day in girls (p = 0.101). CONCLUSIONS This study reported a low compliance of potassium intake recommendations in 8-10 year-old children. Health promotion interventions are needed in order to broaden public awareness of potassium inadequacy and to increase potassium intake.
Collapse
Affiliation(s)
- Ana Catarina Oliveira
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
- Institute of Public Health - University of Porto (ISPUP), Porto, Portugal.
| | - André Moreira
- Department of Immunology, Faculty of Medicine, University of Porto, Porto, Portugal.
- Department of Immunoallergology, Hospital of São João, Rua Prof. Hernâni Monteiro, Porto, 4200-319, Portugal.
| | - Mariana Pinto
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
| | - Mafalda Neto
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
- Faculty of Sciences, University of Porto, Porto, Portugal.
| | - Tânia Santos
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
- Faculty of Sciences, University of Porto, Porto, Portugal.
| | - Joana Madureira
- Institute of Mechanical Engineering, Faculty of Engineering, University of Porto, Porto, Portugal.
| | | | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
- Directorate General for Health (Direcção Geral de Saúde), Lisbon, Portugal.
| | - João Breda
- Division of Noncommunicable Diseases and Life-course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, R. Dr. Roberto Frias, Porto, 4200-465, Portugal.
- Research Centre on Physical Activity and Health, University of Porto, Rua Dr. Plácido Costa, 91, Porto, 4200-450, Portugal.
| |
Collapse
|
35
|
Maalouf J, Cogswell ME, Yuan K, Martin C, Gunn JP, Pehrsson P, Merritt R, Bowman B. Top sources of dietary sodium from birth to age 24 mo, United States, 2003-2010. Am J Clin Nutr 2015; 101:1021-8. [PMID: 25762806 PMCID: PMC4607262 DOI: 10.3945/ajcn.114.099770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sodium intake is high in US children. Data are limited on the dietary sources of sodium, especially from birth to age 24 mo. OBJECTIVE We identified top sources of dietary sodium in US children from birth to age 24 mo. DESIGN Data from the NHANES 2003-2010 were used to examine food sources of sodium (population proportions and mean intakes) in 778 participants aged 0-5.9 mo, 914 participants aged 6-11.9 mo, and 1219 participants aged 12-23.9 mo by sociodemographic characteristics. RESULTS Overall, mean dietary sodium intake was low in 0-5.9-mo-old children, and the top contributors were formula (71.7%), human milk (22.9%), and commercial baby foods (2.2%). In infants aged 6-11.9 mo, the top 5 contributors were formula (26.7%), commercial baby foods (8.8%), soups (6.1%), pasta mixed dishes (4.0%), and human milk (3.9%). In children aged 12-23.9 mo, the top contributors were milk (12.2%), soups (5.4%), cheese (5.2%), pasta mixed dishes (5.1%), and frankfurters and sausages (4.6%). Despite significant variation in top food categories across racial/ethnic groups, commercial baby foods were a top food contributor in children aged 6-11.9 mo, and frankfurters and sausages were a top food contributor in children aged 12-23.9 mo. The top 5 food categories that contributed to sodium intake also differed by sex. Most of the sodium consumed (83-90%) came from store foods (e.g., from the supermarket). In children aged 12-23.9 mo, 9% of sodium consumed came from restaurant foods, and 4% of sodium came from childcare center foods. CONCLUSIONS The vast majority of sodium consumed comes from foods other than infant formula or human milk after the age of 6 mo. Although the majority of sodium intake was from store foods, after age 12 mo, restaurant foods contribute significantly to intake. Reducing the sodium content in these settings would reduce sodium intake in the youngest consumers.
Collapse
Affiliation(s)
- Joyce Maalouf
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Mary E Cogswell
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Keming Yuan
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Carrie Martin
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Janelle P Gunn
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Pamela Pehrsson
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Robert Merritt
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| | - Barbara Bowman
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JM, BB, MEC, JPG, RM, and KY); IHRC Inc., Atlanta, Georgia (JM); and the USDA, Agriculture Research Service, Beltsville, MD (CM and PP)
| |
Collapse
|
36
|
Grimes CA, Baxter JR, Campbell KJ, Riddell LJ, Rigo M, Liem DG, Keast RS, He FJ, Nowson CA. Cross-Sectional Study of 24-Hour Urinary Electrolyte Excretion and Associated Health Outcomes in a Convenience Sample of Australian Primary Schoolchildren: The Salt and Other Nutrients in Children (SONIC) Study Protocol. JMIR Res Protoc 2015; 4:e7. [PMID: 25592666 PMCID: PMC4319086 DOI: 10.2196/resprot.3994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/09/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dietary sodium and potassium are involved in the pathogenesis of cardiovascular disease. Data exploring the cardiovascular outcomes associated with these electrolytes within Australian children is sparse. Furthermore, an objective measure of sodium and potassium intake within this group is lacking. OBJECTIVE The primary aim of the Salt and Other Nutrient Intakes in Children ("SONIC") study was to measure sodium and potassium intakes in a sample of primary schoolchildren located in Victoria, Australia, using 24-hour urine collections. Secondary aims were to identify the dietary sources of sodium and potassium, examine the association between these electrolytes and cardiovascular risk factors, and assess children's taste preferences and saltiness perception of manufactured foods. METHODS A cross-sectional study was conducted in a convenience sample of schoolchildren attending primary schools in Victoria, Australia. Participants completed one 24-hour urine collection, which was analyzed for sodium, potassium, and creatinine. Completeness of collections was assessed using collection time, total volume, and urinary creatinine. One 24-hour dietary recall was completed to assess dietary intake. Other data collected included blood pressure, body weight, height, waist and hip circumference. Children were also presented with high and low sodium variants of food products and asked to discriminate salt level and choose their preferred variant. Parents provided demographic information and information on use of discretionary salt. Descriptive statistics will be used to describe sodium and potassium intakes. Linear and logistic regression models with clustered robust standard errors will be used to assess the association between electrolyte intake and health outcomes (blood pressure and body mass index/BMI z-score and waist circumference) and to assess differences in taste preference and discrimination between high and low sodium foods, and correlations between preference, sodium intake, and covariates. RESULTS A total of 780 children across 43 schools participated. The results from this study are expected at the end of 2015. CONCLUSIONS This study will provide the first objective measure of sodium and potassium intake in Australian schoolchildren and improve our understanding of the relationship of these electrolytes to cardiovascular risk factors. Furthermore, this study will provide insight into child taste preferences and explore related factors. Given the cardiovascular implications of consuming too much sodium and too little potassium, monitoring of these nutrients during childhood is an important public health initiative.
Collapse
Affiliation(s)
- Carley A Grimes
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Research Sciences, Deakin University, Melbourne, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Prospective relevance of fruit and vegetable consumption and salt intake during adolescence for blood pressure in young adulthood. Eur J Nutr 2014; 54:1269-79. [DOI: 10.1007/s00394-014-0804-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
|
38
|
Snacking for a cause: nutritional insufficiencies and excesses of U.S. children, a critical review of food consumption patterns and macronutrient and micronutrient intake of U.S. children. Nutrients 2014; 6:4750-9. [PMID: 25360509 PMCID: PMC4245561 DOI: 10.3390/nu6114750] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/04/2014] [Accepted: 10/16/2014] [Indexed: 11/17/2022] Open
Abstract
The objective of this review was to identify dietary insufficiencies and excesses in children aged two to 11 in the United States (U.S.) and eating habits that merit concern in terms of nutrient and energy density to improve overall diet quality. Data from the What We Eat in America (WWEIA) tables from the National Health and Nutrition Examination Survey (NHANES) were examined as well as survey data from the School Nutrition Dietary Assessment Study (SNDA). Analysis of survey data revealed that children consume insufficient Vitamin D, calcium, and potassium and excess energy, carbohydrates, and sodium. Dietary modifications are necessary to prevent serious deficiencies and the development of chronic illness. Snacking has steadily increased in this population since the 1970s, and snacks provide necessary nutrients. However, carbohydrates and added sugars tend to be over-consumed at snacking occasions. Replacement of current snack choices with nutrient-dense foods could lower the risks of nutrient deficiencies and help lower excess nutrient consumption. Increased consumption of low sugar dairy foods, especially yogurt, at snack times could increase intake of important micronutrients without contributing to dietary excesses.
Collapse
|
39
|
Girardet JP. Apports de sel et tension artérielle chez l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Girardet JP, Rieu D, Bocquet A, Bresson JL, Briend A, Chouraqui JP, Darmaun D, Dupont C, Frelut ML, Hankard R, Goulet O, Simeoni U, Turck D, Vidailhet M. Les enfants consomment-ils trop de sel ? Arch Pediatr 2014; 21:521-8. [DOI: 10.1016/j.arcped.2014.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/14/2014] [Indexed: 01/11/2023]
|
41
|
Tian N, Zhang Z, Loustalot F, Yang Q, Cogswell ME. Sodium and potassium intakes among US infants and preschool children, 2003-2010. Am J Clin Nutr 2013; 98:1113-22. [PMID: 23966425 PMCID: PMC4559260 DOI: 10.3945/ajcn.113.060012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data are limited on usual sodium and potassium intakes relative to age-specific recommendations and the sodium:potassium ratio in infants and preschoolers, especially among those aged <2 y, who are black or breastfed. OBJECTIVE The usual sodium intake above the Tolerable Upper Intake Levels (ULs), potassium intakes above Adequate Intakes (AIs), the sodium:potassium ratio, and sodium density (mg/kcal) among US infants and preschoolers by age group, as applicable, were estimated and compared by race-ethnicity and current breastfeeding status. DESIGN Data were analyzed among 3 groups of children (aged 7-11 mo, 1-3 y, and 4-5 y) from the NHANES 2003-2010 by using measurement error models. RESULTS Seventy-nine percent of children aged 1-3 y and 87% of those aged 4-5 y exceeded their sodium UL; among non-Hispanic black children, the estimates were 84% and 97%, respectively. For potassium, 97% of infants, 5% of children aged 1-3 y, and 0.4% aged 4-5 y met their AIs. Compared with non-Hispanic whites and Mexican Americans, non-Hispanic black infants and preschoolers had higher mean sodium density and sodium:potassium ratios. Currently breastfed infants and children consumed, on average, less sodium than those who were not breastfed (382 ± 53 compared with 538 ± 22 mg in those aged 7-11 mo and 1154 ± 88 compared with 1985 ± 24 mg in those aged 1-3 y, respectively), but the sodium:potassium ratio did not differ. CONCLUSIONS Most US preschoolers, particularly non-Hispanic blacks, consume too much sodium, and nearly all do not consume enough potassium. Data that suggest that currently breastfed infants consume less sodium than do those who are not breastfeeding merit further investigation.
Collapse
Affiliation(s)
- Niu Tian
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | |
Collapse
|
42
|
Salt, fruit and vegetable consumption and blood pressure development: a longitudinal investigation in healthy children. Br J Nutr 2013; 111:662-71. [DOI: 10.1017/s0007114513002961] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Low salt intake and high fruit and vegetable intake (FVI) have been shown to reduce blood pressure (BP) in adults. Longitudinal data on the independent effect of both FVI and salt intake on BP in healthy normotensive children are not available yet. In the present study, we aimed to characterise the concomitant influence of salt intake and FVI on BP development throughout childhood and adolescence. We examined 435 healthy subjects, for whom at least three repeated measurements of BP had been taken and who had provided 24 h urine samples and 3 d weighed dietary records between 4 and 18 years of age. BP was measured using a mercury sphygmomanometer (Mercuro 300, WelchAllyn) and salt intake was determined based on 24 h Na excretion. The intra-individual change in salt intake was almost significantly associated with the change in systolic BP (SBP, P= 0·06) and marginally (P= 0·09) with that in diastolic BP (DBP) in puberty, but not in pre-puberty. A 1 g/d increase in salt intake was associated with a 0·2 mmHg increase in SBP. In pre-puberty, but not in puberty, differences in FVI between children predicted between-person variations in SBP and DBP (P= 0·03). Corresponding findings were obtained for 24 h K excretion (a urinary indicator for FVI). A 100 g/d lower FVI was related to a 0·4 mmHg higher BP value. In conclusion, in healthy children and adolescents with BP in the low-normal range, both salt intake and FVI may already start to influence BP, although at a small magnitude. The potential importance of establishing healthy eating habits in childhood for later BP development emphasises the role of higher FVI and lower salt intake in the prevention of hypertension in the long run.
Collapse
|
43
|
Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013; 346:f1378. [PMID: 23558164 PMCID: PMC4816263 DOI: 10.1136/bmj.f1378] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature and meta-analyses to fill the gaps in knowledge on potassium intake and health. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, Latin American and Caribbean Health Science Literature Database, and the reference lists of previous reviews. STUDY SELECTION Randomised controlled trials and cohort studies reporting the effects of potassium intake on blood pressure, renal function, blood lipids, catecholamine concentrations, all cause mortality, cardiovascular disease, stroke, and coronary heart disease were included. DATA EXTRACTION AND SYNTHESIS Potential studies were independently screened in duplicate, and their characteristics and outcomes were extracted. When possible, meta-analysis was done to estimate the effects (mean difference or risk ratio with 95% confidence interval) of higher potassium intake by using the inverse variance method and a random effect model. RESULTS 22 randomised controlled trials (including 1606 participants) reporting blood pressure, blood lipids, catecholamine concentrations, and renal function and 11 cohort studies (127,038 participants) reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease in adults were included in the meta-analyses. Increased potassium intake reduced systolic blood pressure by 3.49 (95% confidence interval 1.82 to 5.15) mm Hg and diastolic blood pressure by 1.96 (0.86 to 3.06) mm Hg in adults, an effect seen in people with hypertension but not in those without hypertension. Systolic blood pressure was reduced by 7.16 (1.91 to 12.41) mm Hg when the higher potassium intake was 90-120 mmol/day, without any dose response. Increased potassium intake had no significant adverse effect on renal function, blood lipids, or catecholamine concentrations in adults. An inverse statistically significant association was seen between potassium intake and risk of incident stroke (risk ratio 0.76, 0.66 to 0.89). Associations between potassium intake and incident cardiovascular disease (risk ratio 0.88, 0.70 to 1.11) or coronary heart disease (0.96, 0.78 to 1.19) were not statistically significant. In children, three controlled trials and one cohort study suggested that increased potassium intake reduced systolic blood pressure by a non-significant 0.28 (-0.49 to 1.05) mm Hg. CONCLUSIONS High quality evidence shows that increased potassium intake reduces blood pressure in people with hypertension and has no adverse effect on blood lipid concentrations, catecholamine concentrations, or renal function in adults. Higher potassium intake was associated with a 24% lower risk of stroke (moderate quality evidence). These results suggest that increased potassium intake is potentially beneficial to most people without impaired renal handling of potassium for the prevention and control of elevated blood pressure and stroke.
Collapse
Affiliation(s)
- Nancy J Aburto
- Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
| | | | | | | | | | | |
Collapse
|
44
|
Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013; 346:f1326. [PMID: 23558163 PMCID: PMC4816261 DOI: 10.1136/bmj.f1326] [Citation(s) in RCA: 814] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews. STUDY SELECTION Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease. STUDY APPRAISAL AND SYNTHESIS Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals. RESULTS We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus ≥ 2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60). CONCLUSIONS High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.
Collapse
Affiliation(s)
- Nancy J Aburto
- Nutrition Policy and Scientific Advice Unit, Department of Nutrition for Health and Development, World Health Organization, 1211 Geneva 27, Switzerland.
| | | | | | | | | | | |
Collapse
|
45
|
Keast DR, Fulgoni III VL, Nicklas TA, O’Neil CE. Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006. Nutrients 2013; 5:283-301. [PMID: 23340318 PMCID: PMC3571649 DOI: 10.3390/nu5010283] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/03/2013] [Accepted: 01/07/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States. METHODS Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003-2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order. RESULTS The two top ranked food/food group sources of energy and nutrients were: energy - milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein - milk (13.2%) and poultry (12.8%); total carbohydrate - soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars - soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars - soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber - fruit (10.4%) and yeast bread/rolls (10.3%); total fat - cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids - cheese (16.3%) and milk (13.3%); cholesterol - eggs (24.2%) and poultry (13.2%); vitamin D - milk (60.4%) and milk drinks (8.3%); calcium - milk (33.2%) and cheese (19.4%); potassium - milk (18.8%) and fruit juice (8.0%); and sodium - salt (18.5%) and yeast bread and rolls (8.4%). CONCLUSIONS Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children's diets.
Collapse
Affiliation(s)
- Debra R. Keast
- Food & Nutrition Database Research, Inc., 1801 Shadywood Lane, Okemos, MI 48864, USA; E-Mail:
| | | | - Theresa A. Nicklas
- Children’s Nutrition Research Center, Baylor College, Department of Pediatrics, 1100 Bates Avenue, Houston, TX 77030, USA; E-Mail:
| | - Carol E. O’Neil
- Didactic Program in Dietetics, 261 Knapp Hall, Louisiana State University AgCenter, Baton Rouge, LA 70803, USA
| |
Collapse
|
46
|
Trends in blood pressure in 9 to 11-year-old children in the United Kingdom 1980-2008: the impact of obesity. J Hypertens 2012; 30:1708-17. [PMID: 22828085 DOI: 10.1097/hjh.0b013e3283562a6b] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES High blood pressure (BP) is a major public health issue, both in the United Kingdom and worldwide. Although BP levels in UK adults are declining, there is little published information on BP trends in children, a particular concern in the context of the rising levels of childhood adiposity. Our aims are to determine whether BP in children has changed over time and whether the change reflected trends in adiposity. METHODS We collated data from seven population-based BP studies conducted in the United Kingdom between 1980 and 2008. Children of white European origin were included (9-11 years, mean 10.3 years). Adjustments were made to account for differences in mean ages, BP devices and cuff sizes used in different studies. RESULTS Mean SBP increased over time both in boys and girls: annual increases were 0.45 mmHg (95% CI: 0.43, 0.48) for boys; 0.51 mmHg (0.49, 0.53) for girls. Mean BMI increased by 0.064 kg/m(2) (0.060, 0.068) per year for boys; 0.070 kg/m(2) (0.065, 0.074) for girls; the prevalence of overweight/obesity increased from 5.7 to 21.1% and from 9.7 to 24.1%, respectively. The SBP trends occurred both in children with low and high BMI, but were more marked in low BMI group; BMI explained only 15.3% (15.1%, 15.6%) of increases in SBP for boys and 14.9% (14.6%, 15.1%) for girls. The BMI/SBP association appeared to become weaker over time (P < 0.001 for negative interaction from 1984). There was only a modest annual increase in DBP (<0.1 mmHg). CONCLUSIONS SBP levels have increased with time, but the increase is not explained by increased BMI. Further research is needed to identify the factors responsible.
Collapse
|
47
|
Food sources and correlates of sodium and potassium intakes in Flemish pre-school children. Public Health Nutr 2011; 15:1039-46. [DOI: 10.1017/s1368980011002497] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AbstractObjectiveThe aim of the present study was to investigate dietary sources of Na and K intakes among Flemish pre-school children using multiple linear regression analyses.DesignThree-day estimated diet records were used to assess dietary intakes. The contribution to Na and K intakes of fifty-seven food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals.SettingA random cluster sampling design at the level of schools, stratified by province and age, was used.SubjectsA representative sample of 696 Flemish pre-school children aged 2·5–6·5 years was recruited.ResultsMean Na intake was above and mean K intake was largely below the recommendation for children. Bread (22 %) and soup (13 %) were main contributors to Na intake followed by cold meat cuts and other meat products (12 % and 11 %, respectively). Sugared milk drinks, fried potatoes, milk and fruit juices were the main K sources (13 %, 12 %, 11 % and 11 %, respectively). Although Na and K intakes were positively correlated, several food categories showed Na:K intake ratio well above one (water, cheeses, soup, butter/margarine, fast foods and light beverages) whereas others presented a ratio well below one (oil & fat, fruits & juices, potatoes, vegetables and hot beverages).ConclusionsFlemish pre-school children had too high Na and too low K intakes. The finding that main dietary sources of Na and K are clearly different indicates the feasibility of simultaneously decreasing Na and increasing K intake among children.
Collapse
|
48
|
Alimentation de l’enfant et facteurs de risque cardiovasculaire. Arch Pediatr 2010; 17:51-9. [DOI: 10.1016/j.arcped.2009.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 10/16/2009] [Indexed: 11/21/2022]
|
49
|
Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol 2009; 38:791-813. [PMID: 19351697 DOI: 10.1093/ije/dyp139] [Citation(s) in RCA: 747] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption. METHODS Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data. RESULTS Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources. CONCLUSIONS Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.
Collapse
Affiliation(s)
- Ian J Brown
- Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, UK
| | | | | | | |
Collapse
|
50
|
|