1
|
Fujii R, Hishida A, Nakatochi M, Okumiyama H, Takashima N, Tsuboi Y, Suzuki K, Ikezaki H, Shimanoe C, Kato Y, Tamura T, Ito H, Michihata N, Tanoue S, Suzuki S, Kuriki K, Kadota A, Watanabe T, Momozawa Y, Wakai K, Matsuo K. Polygenic risk score for blood pressure and lifestyle factors with overall and CVD mortality: a prospective cohort study in a Japanese population. Hypertens Res 2024:10.1038/s41440-024-01766-9. [PMID: 38961281 DOI: 10.1038/s41440-024-01766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 07/05/2024]
Abstract
Although previous polygenic risk score (PRS) studies for cardiovascular disease (CVD) focused on incidence, few studies addressed CVD mortality and quantified risks by environmental exposures in different genetic liability groups. This prospective study aimed to examine the associations of blood pressure PRS with all-cause and CVD mortality and to quantify the attributable risk by modifiable lifestyles across different PRS strata. 9,296 participants in the Japan Multi-Institutional Collaborative Cohort Study without hypertension at baseline were analyzed in this analysis. PRS for systolic blood pressure and diastolic blood pressure (PRSSBP and PRSDBP) were developed using publicly available Biobank Japan GWAS summary statistics. CVD-related mortality was defined by the International Classification of Diseases 10th version (I00-I99). Cox-proportional hazard model was used to examine associations of PRSs and lifestyle variables (smoking, drinking, and dietary sodium intake) with mortality. During a median 12.6-year follow-up period, we observed 273 all-cause and 41 CVD mortality cases. Compared to the middle PRS group (20-80th percentile), adjusted hazard ratios for CVD mortality at the top PRS group ( > 90th percentile) were 3.67 for PRSSBP and 2.92 for PRSDBP. Attributable risks of CVD mortality by modifiable lifestyles were higher in the high PRS group ( > 80th percentile) compared with the low PRS group (0-80th percentile). In summary, blood pressure PRS is associated with CVD mortality in the general Japanese population. Our study implies that integrating PRS with lifestyle could contribute to identify target populations for lifestyle intervention even though improvement of discriminatory ability by PRS alone is limited.
Collapse
Affiliation(s)
- Ryosuke Fujii
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan.
- Institute for Biomedicine, Eurac Research, Via A.Volta 21, Bolzano/Bozen, 39100, Italy.
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Asahi Hishida
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daikominami, Higashi-ku, Nagoya, 461-8673, Japan
| | - Hiroshi Okumiyama
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Naoyuki Takashima
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
- NCD Epidemiology Research Center, Shiga University of Medical Science, Tsukiwacho, Seta, Otsu, 520-2192, Japan
| | - Yoshiki Tsuboi
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-1192, Japan
| | - Hiroaki Ikezaki
- Department of Comprehensive General Internal Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Chisato Shimanoe
- Department of Pharmacy, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasufumi Kato
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Tamura
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
- Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuaki Michihata
- Cancer Prevention Center, Chiba Cancer Center Research Institute, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Shiroh Tanoue
- Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Sadao Suzuki
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kiyonori Kuriki
- Laboratory of Public Health, Division of Nutritional Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Tsukiwacho, Seta, Otsu, 520-2192, Japan
- Faculty of Nursing Science, Tsuruga Nursing University, 78-2 Kizaki, Tsuruga, 914-0814, Japan
| | - Takeshi Watanabe
- Department of Preventive Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa, 230-0045, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keitaro Matsuo
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan
- Division of Descriptive Cancer Epidemiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
2
|
Okuda N, Higashiyama A, Tanno K, Yonekura Y, Miura M, Kuno H, Nakajima T, Nagahata T, Taniguchi H, Kosami K, Kojima K, Okayama A. Na and K Intake from Lunches Served in a Japanese Company Cafeteria and the Estimated Improvement in the Dietary Na/K Ratio Using Low-Na/K Seasonings and Dairy to Prevent Hypertension. Nutrients 2024; 16:1433. [PMID: 38794671 PMCID: PMC11123906 DOI: 10.3390/nu16101433] [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: 04/01/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
The excessive intake of sodium (Na) and insufficient intake of potassium (K) are major concerns in the prevention of hypertension. Using low-Na/K seasonings (reducing 25% of the NaCl and adding K salt) may improve the dietary Na/K ratio and help prevent hypertension. To devise an intervention study using low-Na/K seasonings at a company cafeteria, we calculated the Na and K contents of the meals served at the cafeteria and estimated changes in the intakes when suitable low-Na/K seasonings were used. We also considered using milk as a good source of K. We used an ingredient list of a company cafeteria and calculated Na and K contents in each dish. The average amounts of NaCl and K per use were 5.04 g and 718 mg, respectively. Seasonings contributed 70.9% of the NaCl. With the use of low-Na/K seasonings, an estimated reduction in NaCl of 0.8 g/day and an estimated increase in K of 308 mg/day was achieved. With an additional serving (200 mL) of milk, NaCl was reduced by 0.57 g/day and K was increased by 610 mg/day, with an overall decrease in the dietary Na/K ratio from 3.20 to 2.40. The use of low-Na/K seasonings and dairy may improve the dietary Na/K ratio among cafeteria users and help prevent hypertension.
Collapse
Affiliation(s)
- Nagako Okuda
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto 606-8522, Japan; (T.N.); (H.T.)
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama 641-8509, Japan;
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Yahaba 028-3694, Japan;
| | - Yuki Yonekura
- Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, Tokyo 104-0044, Japan;
| | - Makoto Miura
- Collaborative Research Programs of SynCrest Inc., Iwate University, Morioka 020-8550, Japan;
| | - Hiroshi Kuno
- Nichinan Kogyo, Co., Ltd., Nikaho 018-0411, Japan;
- Research and Development Division, Shoda Shoyu, Co., Ltd., Tatebayashi 374-8510, Japan
| | - Toru Nakajima
- Research and Development Division, Shoda Shoyu, Co., Ltd., Tatebayashi 374-8510, Japan
| | - Tomomi Nagahata
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto 606-8522, Japan; (T.N.); (H.T.)
| | - Hirokazu Taniguchi
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto 606-8522, Japan; (T.N.); (H.T.)
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan;
| | - Kyoko Kojima
- The Research Institute of Strategy for Prevention, Tokyo 103-0006, Japan (A.O.)
| | - Akira Okayama
- The Research Institute of Strategy for Prevention, Tokyo 103-0006, Japan (A.O.)
| |
Collapse
|
3
|
Sadanaga T, Hirota S. Association between sodium-to-potassium ratio in spot urine and hospitalization due to heart failure in high-risk Japanese patients. IJC HEART & VASCULATURE 2024; 50:101334. [PMID: 38234681 PMCID: PMC10792732 DOI: 10.1016/j.ijcha.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Background In Japanese cardiovascular (CV) high-risk patients, the ESPRIT (Evaluation of Sodium Intake for the Prediction of Cardiovascular Events in Japanese High-risk Patients) study showed that high sodium excretion (≥4.0 g/day) was associated with a composite CV events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and CV deaths. In this context, the sodium-to-creatinine (Na/Cr) ratio in spot urine was found to be significantly associated with HF hospitalizations. Since a stable potassium balance plays a particularly relevant role for CV patients, this post-hoc study was designed to investigate the extent to which consideration of the sodium-to-potassium (Na/K) ratio represents a better predictor of HF hospitalizations in the ESPRIT study population. Methods This is a post-hoc analysis of a previously reported ESPRIT study (n = 520, 60 HF hospitalizations). Results Receiver operating curve analysis yielded optimal Na/K ratio cut-off value of 2.9 for detecting HF hospitalization. Kaplan-Meier curve showed that high Na/K ratio in spot urine was associated with increased HF hospitalization (p < 0.001). Cox proportional hazards model analysis revealed that high Na/K ratio was associated with HF hospitalization with a hazard ratio of 2.97 (confidence interval: 1.67-5.61). An association between high Na/K ratio and HF hospitalization remained after adjustments for Na/Cr ratio in spot urine or the use of diuretics. Conclusion The Na/K ratio in spot urine is associated with HF hospitalization in high-risk Japanese patients.
Collapse
|
4
|
Liu D, Tian Y, Wang R, Zhang T, Shen S, Zeng P, Zou T. Sodium, potassium intake, and all-cause mortality: confusion and new findings. BMC Public Health 2024; 24:180. [PMID: 38225648 PMCID: PMC10789005 DOI: 10.1186/s12889-023-17582-8] [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: 06/21/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) has established recommended daily intakes for sodium and potassium. However, there is currently some controversy regarding the association between sodium intake, potassium intake, the sodium-to-potassium ratio, and overall mortality. To assess the correlations between sodium intake, potassium intake, the sodium-to-potassium ratio, and overall mortality, as well as the potential differences in sodium and potassium intake thresholds among different population groups, we analyzed data from NHANES 2003-2018. METHODS NHANES is an observational cohort study that estimates sodium and potassium intake through one or two 24-h dietary recalls. Hazard ratios (HR) for overall mortality were calculated using multivariable adjusted Cox models accounting for sampling design. A total of 13855 out of 26288 participants were included in the final analysis. Restricted cubic spline analyses were used to examine the relationship between sodium intake, potassium intake, and overall mortality. If non-linearity was detected, we employed a recursive algorithm to calculate inflection points. RESULTS Based on one or two 24-h dietary recalls, the sample consisted of 13,855 participants, representing a non-institutionalized population aged 40-80 years, totaling 11,348,771 person-months of mean follow-up 99.395 months. Daily sodium intake and daily potassium intake were inversely associated with all-cause mortality. Restrictive cubic spline analysis showed non-linear relationships between daily sodium intake, potassium intake, sodium-potassium ratio, and total mortality. The inflection point for daily sodium intake was 3133 mg/d, and the inflection point for daily potassium intake was 3501 mg/d, and the inflection point for daily sodium-potassium ratio intake was 1.203 mg/mg/d. In subgroup analyses, a significant interaction was found between age and high sodium intake, which was further confirmed by the smooth curves that showed a U-shaped relationship between sodium intake and all-cause mortality in the elderly population, with a inflection point of 3634 mg/d. CONCLUSION Nonlinear associations of daily sodium intake, daily potassium intake and daily sodium-potassium ratio intake with all-cause mortality were observed in American individuals. The inflection point for daily sodium intake was 3133 mg/d. And the inflection point for daily sodium intake was 3634 mg/d in elderly population. The inflection point for daily potassium intake was 3501 mg/d. The inflection point for daily sodium-potassium ratio intake was 1.203 mg/mg/d, respectively, A healthy diet should be based on reasonable sodium intake and include an appropriate sodium-to-potassium ratio.
Collapse
Affiliation(s)
- Donghao Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology: Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
- Beijing Hospital, Institute of Geriatric Medicine, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Yuqing Tian
- Department of Cardiology, Beijing Hospital, National Center of Gerontology: Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Rui Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology: Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Tianyue Zhang
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Shuhui Shen
- Department of Cardiology, Beijing Hospital, National Center of Gerontology: Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Ping Zeng
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
| | - Tong Zou
- Department of Cardiology, Beijing Hospital, National Center of Gerontology: Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
- Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
- Beijing Hospital, Institute of Geriatric Medicine, Peking University Fifth School of Clinical Medicine, Beijing, China.
| |
Collapse
|
5
|
Shinozaki N, Murakami K, Masayasu S, Sasaki S. Usual Nutrient Intake Distribution and Prevalence of Nutrient Intake Inadequacy among Japanese Children and Adults: A Nationwide Study Based on 8-Day Dietary Records. Nutrients 2023; 15:5113. [PMID: 38140372 PMCID: PMC10746136 DOI: 10.3390/nu15245113] [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: 11/27/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
In this cross-sectional study, we evaluated nutrient intake adequacy in 4450 Japanese people aged 1-79 years. Dietary data was collected through non-consecutive 8-day weighed dietary records. Usual nutrient intakes from foods and beverages were estimated using the Multiple Source Method. Participant proportions with intakes below and above the Japanese Dietary Reference Intakes (2020) were calculated. Usual intakes of most nutrients were below the Estimated Average Requirement; calcium showed a high percentage of inadequacy across all sex and age groups (29-88%), and iron showed a high inadequacy among females aged 12-64 years (79-95%). The percentages of energy from protein and carbohydrates, dietary fibre, and potassium were typically below the lower limit of the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). Furthermore, over 20% of the participants exceeded the upper limit of the DG for the percentages of energy from total and saturated fats, and over 88% exceeded the upper limit of the DG for sodium. Japanese children and adults could improve their nutrient intake by increasing calcium, iron, dietary fibre, and potassium and reducing total and saturated fats and sodium. These findings can inform policies and interventions to improve nutrient intake in Japan.
Collapse
Affiliation(s)
- Nana Shinozaki
- Department of Nutritional Epidemiology and Behavioural Nutrition, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, 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, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| |
Collapse
|
6
|
Bhagavathula AS, Refaat SA, Bentley BL, Rahmani J. Association between intake of sodium, potassium, sodium-to-potassium ratio, and blood pressure among US adults. INT J VITAM NUTR RES 2023; 93:392-400. [PMID: 34935397 DOI: 10.1024/0300-9831/a000740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
High dietary sodium and low potassium intake is associated with high blood pressure (BP). The current study aimed to determine if the sodium-to-potassium ratio is more strongly associated with low (130-139/80-89 mm Hg) and high (≥140/90 mm Hg) BP thresholds among US adults than either sodium or potassium alone. A total of 30,776 patients aged ≥20 years with complete blood pressure participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Demographic information and health characteristics were compared between men and women using the chi-square test for categorical variables and independent samples t-test for continuous variables. Logistic regression was performed to investigate the association of the odds ratios (OR) of different levels of sodium, potassium, and sodium-to-potassium ratio. After multivariable adjustment (age, gender, Body mass index, Smoking, education, Race, Alcohol, total energy intake, and physical activity), no relationship has been observed between high versus low sodium-to-potassium ratio and BP threshold of 130-139/80-89 mm Hg (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.92-1.12). Higher sodium-to-potassium ratio (OR=1.24; CI: 1.11-1.38) and dietary intake of potassium (OR=0.66; CI: 0.55-0.80) showed significant association in reducing the BP threshold of ≥140/90 mm Hg. In dose-response analysis, higher BP ≥140/90 mm Hg was inversely associated with higher potassium intake. Furthermore, the sodium-to-potassium ratio showed higher odds in predicting the BP of patients aged ≤60 years, underweight, nonsmokers, and non-alcohol users. The study confirms an inverse association between higher potassium intake and higher BP threshold. The Doses-response analyses showed sodium-to-potassium ratio is a better predictor of BP thresholds than sodium or potassium alone.
Collapse
Affiliation(s)
| | | | - Barry L Bentley
- Cardiff School of Technologies, Cardiff Metropolitan University, UK
- Collaboration for the Advancement of Sustainable Medical Innovation, University College London, UK
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Raphadu TT, Mphekgwana PM, Matshipi M, Monyeki KD. A Longitudinal Investigation on the Effects of Sodium and Potassium Intake on the Development of Hypertension and Abdominal Obesity from Childhood to Young Adulthood amongst Ellisras Rural Population, South Africa. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1330. [PMID: 37628329 PMCID: PMC10453195 DOI: 10.3390/children10081330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Hypertension (HT) and obesity have both been on the rise in children. Each is associated with an increase in cardiovascular disease risk, and both track into adulthood. OBJECTIVES This study aimed to identify the association of sodium intake (Na), potassium (K) intake, and sodium-to-potassium (Na/K) ratio with the development of HT and abdominal obesity amongst the Ellisras rural population over time. METHODS In this longitudinal study, data on dietary intake of Na and K were collected using a 24 h recall questionnaire from a total of 325 participants tracked from 1999 (5-12 years), 2001 (7-14 years), and 2015 (18-30 years). The averages of Na and K intake were analysed using local food tables and the South African Food Composition Database System (SAFOODS). In addition, blood pressure (BP) and anthropometric measurements (waist circumference (WC) and height) were also examined. Parametric (independent t-test) and Chi-square/Fishers exact tests were conducted to determine the difference between the years for numerical data and categorical variables. A generalised estimating equation (GEE) was used to assess the association of Na intake, K intake and their ratio on BP, WC, and waist-to-height ratio (WHtR). RESULTS Our results indicate a significant positive association between K intake and WHtR, and even though the model was adjusted for age and sex, there was still an association with WHtR. The Na/K ratio was associated with both BP measurements and abdominal obesity, respectively. Furthermore, Na/K was shown to be associated with an increased risk of developing HT and abdominal obesity. CONCLUSIONS In our study, we observed that an increase in the Na/K ratio is a predictor of HT and abdominal obesity over time compared to Na and K alone. However, more studies are required to further prove this.
Collapse
Affiliation(s)
- Thato Tshepo Raphadu
- 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;
| | - Moloko Matshipi
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| | - Kotsedi Daniel Monyeki
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa; (T.T.R.); (M.M.)
| |
Collapse
|
8
|
Shima H, Okamoto T, Tashiro M, Inoue T, Wariishi S, Okada K, Doi T, Nishiuchi T, Minakuchi J. Reducing the Sodium Intake of Patients With Chronic Kidney Disease Through Education and Estimating Salt Excretion: A Propensity Score Matching Analysis. Cureus 2023; 15:e43510. [PMID: 37727178 PMCID: PMC10506658 DOI: 10.7759/cureus.43510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Japanese people traditionally consume high quantities of salt. This study aimed to investigate the effects of educating patients with chronic kidney disease (CKD) on simple methods for reducing their daily dietary salt intake. METHODS This single-center, retrospective observational study included 115 outpatients with CKD at Kawashima Hospital (Tokushima, Japan). One physician routinely recommended that patients should reduce their salt intake and provided tips for salt restriction. The physician estimated the patients' daily salt intake using spot urine samples at each medical examination (education group; n = 61). The other physicians' outpatients only received dietary guidance on recommended salt intake (control group; n = 54). The estimated 24-hour urinary sodium excretion (24hUNaV) and 24-hour potassium excretion (24hUKV) were calculated using Tanaka's equation. RESULTS Estimated 24hUNaV was positively correlated with body mass index (BMI), estimated 24hUKV, and urinary Na/K ratio. The patients in the education group were younger and had a lower BMI, higher estimated glomerular filtration rate, and lower systolic blood pressure (SBP). Using 38 pairs of patients obtained by propensity score matching with these variables, estimated 24hUNaV, estimated 24hUKV, and diastolic blood pressure (DBP) after one year were significantly reduced in the education group. CONCLUSION A simple salt reduction education may reduce salt intake in outpatients with CKD.
Collapse
Affiliation(s)
- Hisato Shima
- Kidney Disease, Kawashima Hospital, Tokushima, JPN
| | | | | | - Tomoko Inoue
- Kidney Disease, Kawashima Hospital, Tokushima, JPN
| | | | | | - Toshio Doi
- Kidney Disease, Kawashima Hospital, Tokushima, JPN
| | | | | |
Collapse
|
9
|
Mosallanezhad Z, Jalali M, Bahadoran Z, Mirmiran P, Azizi F. Dietary sodium to potassium ratio is an independent predictor of cardiovascular events: a longitudinal follow-up study. BMC Public Health 2023; 23:705. [PMID: 37072769 PMCID: PMC10111692 DOI: 10.1186/s12889-023-15618-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults. METHODS The participants of the Tehran Lipid and Glucose Study (men and women aged 30-84 years, n = 2050), free of CVD at baseline (2006-2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events. RESULTS During a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus < 3049 mg/d) was significantly related to the increased risk of CVD (HR = 1.99, 95% CI = 1.06-3.74). Independent of the well-known risk factors, a 56% reduced risk of CVD was observed in the participants with a higher dietary K intake (HR = 0.44, 95% CI = 0.20-0.94). A Higher Na-to-K ratio was associated with an increased risk of CVD (HR = 1.99, 95% CI = 1.13-3.52). CONCLUSION Our study showed that the Na-to-K ratio might independently predict future risk of CVD events in adults.
Collapse
Affiliation(s)
- Zahra Mosallanezhad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran
| | - Mohammad Jalali
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Shahid-Erabi St., Yeman St, P.O.Box: 19395-4763, Velenjak, Tehran, Iran.
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Zhuang P, Wu F, Liu X, Zhu F, Li Y, Jiao J, Zhang Y. Preserved vegetable consumption and its association with mortality among 440,415 people in the China Kadoorie Biobank. BMC Med 2023; 21:135. [PMID: 37020268 PMCID: PMC10077626 DOI: 10.1186/s12916-023-02829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Fresh vegetable consumption has been associated with lower incidence of cardiovascular disease (CVD). However, whether preserved vegetable consumption is linked with CVD and mortality remains unclear. This study aimed to assess the associations of preserved vegetable consumption with all-cause and cause-specific mortality. METHODS A total of 440,415 participants free of major chronic diseases, aged 30-79 years, were enrolled from 10 diverse regions in China between 2004 and 2008 and were followed up for an average of 10 years. Preserved vegetable consumption was assessed using a validated food frequency questionnaire. Cause-specific hazard models with the consideration of competing risk from various deaths were performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality. RESULTS During 4,415,784 person-years of follow-up, we documented 28,625 deaths. After adjustment for major risk factors, preserved vegetable consumption was marginally associated with higher CVD mortality (P = 0.041 for trend and P = 0.025 for non-linearity) but not associated with cancer mortality and total mortality. For specific causes of death, consuming preserved vegetables was associated with higher hemorrhagic stroke mortality. The multivariable-adjusted HRs (95% CIs) of hemorrhagic stroke mortality compared with non-consumers were 1.32 (1.17-1.50) for 1-3 days/week and 1.15 (1.00-1.31) for regular consumers (≥4 days/week) (P = 0.006 for trend and P < 0.001 for non-linearity). In addition, regular preserved vegetable consumption was associated with increased risk of digestive tract cancer mortality [HR (95% CI): 1.13 (1.00-1.28); P = 0.053 for trend] and esophageal cancer mortality [HR (95% CI): 1.45 (1.17-1.81); P = 0.002 for trend]. CONCLUSIONS Frequent consumption of preserved vegetables was associated with higher risk of mortality from hemorrhagic stroke and esophageal cancer in China. Our findings suggest limiting preserved vegetable consumption might be protective for premature death from hemorrhagic stroke and digestive tract cancer.
Collapse
Affiliation(s)
- Pan Zhuang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Zhejiang Key Laboratory for Agro-Food Processing, College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Fei Wu
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Xiaohui Liu
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Fanghuan Zhu
- Zhejiang Key Laboratory for Agro-Food Processing, College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Yin Li
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Jingjing Jiao
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
- Zhejiang Key Laboratory for Agro-Food Processing, College of Biosystems Engineering and Food Science, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
| |
Collapse
|
11
|
Kondo K, Miura K, Okamura T, Okayama A, Ueshima H. Dietary Factors, Dietary Patterns, and Cardiovascular Disease Risk in Representative Japanese Cohorts: NIPPON DATA80/90. J Atheroscler Thromb 2023; 30:207-219. [PMID: 36436878 PMCID: PMC9981349 DOI: 10.5551/jat.rv22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Diet is one of the most important factors affecting healthy life expectancy through the onset of cardiovascular disease (CVD) risk as well as various chronic diseases. Because dietary habits and disease structure differ depending on the country, region, and/or race, evidence from each population is required. NIPPON DATA80/90 is a long-term cohort study of a representative Japanese population that participated in national nutrition surveys. Among the many findings of this cohort study, a dietary pattern with higher intake of fruits, vegetables, fish (n-3 polyunsaturated fatty acids), and dietary fiber and lower intake of salt as well as sodium-to-potassium ratio was found to be associated with a lower risk of CVD mortality. The results from our cohort study would be useful for effectively preventing CVD. This article reviews the published studies from the NIPPON DATA80/90 to highlight the significant findings that may be used to develop risk prevention strategies for CVD.
Collapse
Affiliation(s)
- Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | | |
Collapse
|
12
|
Choi SS, Kim YA, Kim HJ, Cho YJ, Lee GH. The Relationship between Dietary Na/K Ratio and Bone Mineral Density in Korean Middle-Aged Women. Korean J Fam Med 2023; 44:21-27. [PMID: 36709957 PMCID: PMC9887444 DOI: 10.4082/kjfm.21.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dietary Na+ or Na+/K+ ratio has been reported to be associated with bone mineral density (BMD). However, this remains unclear, and only a few studies have been reported on the Korean population. Therefore, this study aimed to determine the association between dietary Na+, K+, and Na+/K+ ratios and BMD in middle-aged Korean women. METHODS This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011. A total of 3,690 women aged >50 years were included. Study participants were classified into quartiles (lowest quartile Q1-highest quartile Q4) according to dietary Na+, K+, and Na+/K+ ratio, and we examined the association of these parameters with BMD. Total femur and lumbar spine BMD were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed using IBM SPSS ver. 19.0. RESULTS The mean age was 62 years, and a significant negative trend in the β-coefficient regarding dietary Na+ was only observed in the total femur BMD. However, the total femur and lumbar spine BMD decreased from Q1 to Q4 regarding the dietary Na+/K+ ratio (P-value for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). CONCLUSION A significant negative trend in the β-coefficient for both total femur and lumbar spine BMD was observed regarding the Na+/K+ ratio. Therefore, based on the results of this study, a higher dietary Na+/K+ ratio may be associated with a lower BMD.
Collapse
Affiliation(s)
- Seong Su Choi
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun-A Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Ji Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Geon Ho Lee
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea,Corresponding Author: Geon Ho Lee https://orcid.org/0000-0003-0696-3804 Tel: +82-53-650-4696, Fax: +82-53-650-4122, E-mail:
| |
Collapse
|
13
|
Singh H, Lombardo M, Goyal A, Kumar A, Khar A. Genotypic variation in Na, K and their ratio in 45 commercial cultivars of Indian tropical onion: A pressing need to reduce hypertension among the population. Front Nutr 2023; 10:1098320. [PMID: 36895269 PMCID: PMC9988931 DOI: 10.3389/fnut.2023.1098320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
The intake of diets with higher sodium (Na) and lower potassium (K) has been considered a leading factor for the development of hypertension (HTN). Majority of junk, processed and packaged food have higher Na contents. To counter the effects of diet on HTN, the identification of high K/Na ratio plant-based food is needed. Among fruits and vegetables, onion could be the ideal option since it contains high K content. Keeping this in mind, 45 commercially well adapted short day Indian onion cultivars were evaluated for K and Na content and their ratio to isolate suitable cultivars to prevent HTN in the Indian population. The data suggested wide variation among the genotypes for K, Na, and K/Na ratio ranging from 490.2 ± 17.0 to 9160.0 ± 96.7 mg/kg on dry matter basis, 52.7 ± 3.0 to 458.2 ± 61.7 mg/kg on dry matter basis and 3.1 ± 0.7 to 109.5 ± 17.3, respectively. The K content was recorded as significantly highest in the yellow-coloured bulb variety "Arka Pitamber" (9160.1 ± 96.7) followed by Pusa Sona (7933.2 ± 292.8). On the other hand, minimal K was assessed in the white-coloured bulb variety "Agrifound White" (490.3 ± 17.0) followed by Udaipur Local (732.9 ± 93.4). Twelve cultivars exhibited > 7000 mg K content, while nine cultivars recorded < 1500 mg. On the contrary, Na was recorded as significantly highest in the dark-red-coloured bulbs and the lowest in white bulbs. Furthermore, it was determined that there was a more than 35-fold difference observed between the highest (109.5) and lowest (3.1) K/Na ratio in the bulbs of tested cultivars. Cluster analysis revealed three major groups comprising of 23, 13 and 9 genotypes. This information could form the base for public health, food and onion researchers to design suitable cultivars to prevent HTN as a population-wide approach. The next century is going to be food-based for the amelioration of human diseases in a sustainable way without any after-effects on the human body.
Collapse
Affiliation(s)
- Hira Singh
- Department of Vegetable Science, Punjab Agricultural University, Ludhiana, India
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
| | - Abhishek Goyal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, India
| | - Amrender Kumar
- Agricultural Knowledge Management Unit, ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Anil Khar
- Division of Vegetable Science, ICAR-Indian Agricultural Research Institute, New Delhi, India
| |
Collapse
|
14
|
Burka AT, Geiger DW. Geriatric Pharmacotherapy Case Series: Thiazide-Induced Hypokalemia. Sr Care Pharm 2022; 37:605-611. [DOI: 10.4140/tcp.n.2022.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction The patient was a 72-year-old man with a history of hypertension, hyperlipidemia, benign prostatic hyperplasia, and oropharyngeal cancer. His home medications include amlodipine, atorvastatin, hydrochlorothiazide, and tamsulosin. He lives alone and eats a soft,
bland, nutrient-poor diet. During his annual primary care visit, he is found to have a serum potassium level of 3.3 mEq/L (reference range 3.5-5.0). Assessment The use of hydrochlorothiazide, a thiazide diuretic, as well as his low consumption of dietary potassium, have
likely contributed to his mild, asymptomatic hypokalemia. Outcome The patient’s serum potassium normalizes following replenishment with a 10 mEq microencapsulated potassium chloride (KCl) extended release (ER) tablet three times a day with meals for one week. A registered
dietitian was consulted to provide recommendations for a well-balanced diet, consistent with his dietary texture needs. Conclusions Hypokalemia is a commonly encountered electrolyte disorder, occurring in about 3 to 4% of community-dwelling elders.1 Though asymptomatic
hypokalemia is often an incidental finding, it is associated with an increased risk of major adverse cardiovascular events if left untreated and thus should be promptly corrected when discovered.2
Collapse
Affiliation(s)
- Abigail T. Burka
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee
| | - Daniel W. Geiger
- Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee
| |
Collapse
|
15
|
Sekizuka H, Ishii T, Miyake H. Relationship between salt reduction readiness and salt intake in hypertensive patients: a single nonspecialized hypertension clinic case study. Blood Press Monit 2022; 27:391-396. [PMID: 35687035 DOI: 10.1097/mbp.0000000000000610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is the first report about the association of readiness for salt reduction with daily salt intake or the salt check sheet score in hypertensive patients at a nonspecialized hypertension clinic. We investigated whether salt reduction readiness as evaluated based on the transtheoretical model (TTM) is associated with estimated daily salt intake or the salt check sheet score. The TTM allows evaluators to easily assess a subject's level of readiness for health-related according to five stages. There was no significant relationship between the TTM stages and estimated daily salt intake. A significant correlation was found between the TTM stages and salt check sheet scores (ρ = -0.409; P < 0.001). When providing salt reduction guidance to hypertensive patients, it is effective for healthcare professionals to use repeated urine tests and salt check sheets to take a salt reduction approach according to the level of readiness of the patients.
Collapse
Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa Japan
| | - Toshiya Ishii
- Department of Internal Medicine, FUJITSU Clinic
- Health Promotion Unit, FUJITSU LIMITED, Kanagawa Japan
| | | |
Collapse
|
16
|
Vulin M, Magušić L, Metzger AM, Muller A, Drenjančević I, Jukić I, Šijanović S, Lukić M, Stanojević L, Davidović Cvetko E, Stupin A. Sodium-to-Potassium Ratio as an Indicator of Diet Quality in Healthy Pregnant Women. Nutrients 2022; 14:nu14235052. [PMID: 36501082 PMCID: PMC9737568 DOI: 10.3390/nu14235052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to investigate diet quality in healthy pregnant women based on the Na-to-K ratio from 24 h urine sample and food frequency questionnaire (FFQ), to compare dietary micro- and macronutrient intake with current nutritional recommendations (RDA), and to investigate whether gestational weight gain (GWG) is associated with Na-to-K ratio and diet quality during pregnancy in general. Sixty-four healthy pregnant women between 37 and 40 weeks of gestation participated in the study. Participants' GWG, body composition, molar 24 h urine Na-to-K ratio, and FFQ data on average daily total energy, food groups, and micro-/macronutrient intake were obtained. A Na-to-K ratio of 2.68 (1.11-5.24) does not meet nutrition quality and is higher than the WHO recommendations due to excessive sodium and insufficient potassium intake. FFQ Na-to-K ratio was associated with a higher daily intake of soups, sauces, cereals, fats, and oils and a low intake of fruit and non-alcoholic beverages. A total of 49% of pregnant women exhibited excessive GWG, which was attributed to the increase in adipose tissue mass. GWG was not associated with total energy but may be the result of insufficient physical activity during pregnancy. Daily intake of vitamin D, vitamin E, folate, niacin, riboflavin, calcium, iron, and zinc was suboptimal compared to RDA.
Collapse
Affiliation(s)
- Martina Vulin
- Department of Obstetrics and Gynecology, University Hospital Osijek, HR-31000 Osijek, Croatia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Lucija Magušić
- Department of Obstetrics and Gynecology, University Hospital Osijek, HR-31000 Osijek, Croatia
| | - Ana-Maria Metzger
- Department of Obstetrics and Gynecology, University Hospital Osijek, HR-31000 Osijek, Croatia
| | - Andrijana Muller
- Department of Obstetrics and Gynecology, University Hospital Osijek, HR-31000 Osijek, Croatia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Ines Drenjančević
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Ivana Jukić
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Siniša Šijanović
- Department of Obstetrics and Gynecology, University Hospital Osijek, HR-31000 Osijek, Croatia
- Department of Obstetrics and Gynecology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Matea Lukić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Lorena Stanojević
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | | | - Ana Stupin
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
- Correspondence:
| |
Collapse
|
17
|
Kwon YJ, Lee HS, Park G, Lee JW. Association between dietary sodium, potassium, and the sodium-to-potassium ratio and mortality: A 10-year analysis. Front Nutr 2022; 9:1053585. [PMID: 36438773 PMCID: PMC9691953 DOI: 10.3389/fnut.2022.1053585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/25/2022] [Indexed: 10/05/2023] Open
Abstract
There is inconclusive evidence of the association between dietary sodium, potassium, and the sodium-to-potassium ratio and all-cause and cardiovascular disease mortality. To investigate the association between dietary sodium, potassium, and the sodium-to-potassium ratio and all-cause and cardiovascular disease mortality risks. Data from 143,050 adult participants were analyzed from prospective 10-year community-based cohort analysis. Dietary sodium, potassium, and the sodium-to-potassium ratio at baseline were assessed by a food frequency questionnaire. In Cox proportional hazards regression models, the association between dietary sodium, potassium, and their ratio and all-cause and cardiovascular disease mortality was estimated using hazard ratios and 95% confidence intervals, and their predictive ability as mortality predictors was evaluated using Harrell's c-index. During the mean (range) 10.1 (0.2-15.9) years of follow-up, 5,436 participants died, of whom 985 died of cardiovascular causes. After adjustment for age, sex, body mass index, alcohol intake, smoking, regular exercise, total calorie intake, dyslipidemia, hypertension, diabetes, chronic kidney diseases (CKDs), and potassium or sodium intake, respectively, sodium intake was unassociated with all-cause mortality whereas potassium intake was significantly associated inversely with all-cause (Quintile-5 vs. Quintile-1, hazard ratio, 95% confidence interval, 1.09, 0.97-1.22, and 0.79, 0.69-0.91, respectively). The sodium-to-potassium ratio was not significantly associated with all-cause mortality in the adjusted model, and similar trends were observed for cardiovascular disease mortality.
Collapse
Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, Seoul, Gyeonggi, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Goeun Park
- Biomedical Statistics Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul, South Korea
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
18
|
Xie Y, Qi H, Peng W, Li B, Wen F, Zhang F, Zhang L. Higher Potassium Intake and Lower Sodium Intake May Help in Reducing CVD Risk by Lowering Salt Sensitivity of Blood Pressure in the Han Chinese Population. Nutrients 2022; 14:nu14204436. [PMID: 36297119 PMCID: PMC9607620 DOI: 10.3390/nu14204436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 03/10/2023] Open
Abstract
Sodium (Na) reduction with a parallel supplemental potassium (K) intake can prevent cardiovascular diseases (CVDs). The relationship of the urinary Na/K ratio and salt sensitivity of blood pressure (SSBP) with CVDs is not clearly explained. We assumed that the SSBP mediates the relationship between the Na/K ratio and CVDs. In total, 2055 subjects who had 24 h urine collected and SSBP determined were included in this study. CVD risk was estimated using the China-PAR equation. MediationMultivariate logistic regression was used to explore the associations between the Na/K ratio or SSBP with CVD risk. Mediation analysis using a logistic regression model was performed. Both the urinary Na/K ratio and SSBP were related to the estimated CVD risk (p < 0.05). The mediation analysis found that SSBP mediated approximately 12% of the association between Na/K ratio and CVD risk. Our findings indicate that higher K intake and lower Na intake may help in preventing CVD risk by reducing SSBP risk in individuals with normotension or stage-one hypertension.
Collapse
Affiliation(s)
- Yunyi Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Han Qi
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Wenjuan Peng
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Bingxiao Li
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Fengxu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China
- Correspondence: ; Tel.: +86-10-83911777
| |
Collapse
|
19
|
Zakauskiene U, Macioniene E, Zabuliene L, Sukackiene D, Linkeviciute-Dumce A, Banys V, Bratcikoviene N, Karosiene D, Slekiene V, Kontrimas V, Simanauskas K, Utkus A, Brazdziunaite D, Migline V, Makarskiene I, Zurlyte I, Rakovac I, Breda J, Cappuccio FP, Miglinas M. Sodium, Potassium and Iodine Intake in an Adult Population of Lithuania. Nutrients 2022; 14:nu14183817. [PMID: 36145201 PMCID: PMC9504939 DOI: 10.3390/nu14183817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Hypertension is a leading risk factor for cardiovascular events and death. A reduction in salt intake is among the most cost-effective strategies to reduce blood pressure and the risk of cardiovascular diseases. Increasing potassium lowers blood pressure and is associated with lower cardiovascular risk. Adequate iodine intake is important to prevent iodine deficiency disorders. Salt iodization is a key strategy to prevent such deficiency. In Lithuania, no surveys have been performed to directly assess sodium, potassium and iodine consumption. The aim of the present study was to measure sodium, potassium and iodine intake in a randomly selected adult Lithuanian adult population using 24 h urine collections, and to assess knowledge, attitudes and behavior towards salt consumption. Salt and potassium intakes were estimated in 888 randomly selected participants by 24 h urine sodium and potassium excretion and 679 individuals provided suitable 24 h urine samples for the analysis of iodine excretion. Average salt intake was 10.0 (SD 5.3) g/24 h and average potassium intake was 3.3 (SD 1.3) g/24 h. Only 12.5% of participants consumed less than 5 g/24 h of salt. The median value of urinary iodine concentration (UIC) was 95.5 μg/L. Our study showed that average salt intake is twice as high as the maximum level recommended by the World Health Organization while potassium and iodine intakes in Lithuania are below the recommended levels.
Collapse
Affiliation(s)
- Urte Zakauskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
- Correspondence:
| | - Ernesta Macioniene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Lina Zabuliene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Diana Sukackiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Ausra Linkeviciute-Dumce
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Valdas Banys
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nomeda Bratcikoviene
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Faculty of Fundamental Sciences, Vilnius Gediminas Technical University, LT-10223 Vilnius, Lithuania
| | - Dovile Karosiene
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | | | | | - Kazys Simanauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Algirdas Utkus
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Deimante Brazdziunaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Vilma Migline
- Community Well-Being Center, Mykolas Romeris University, LT-08303 Vilnius, Lithuania
| | | | | | - Ivo Rakovac
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Joao Breda
- WHO Athens Quality of Care Office, 10675 Athens, Greece
| | - Francesco P. Cappuccio
- World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| |
Collapse
|
20
|
Changes in the Urinary Sodium-to-Potassium Ratio Are Associated with Blood Pressure Change in Older Japanese Adults: A 7-Year Longitudinal Study. J Clin Med 2022; 11:jcm11175093. [PMID: 36079021 PMCID: PMC9456574 DOI: 10.3390/jcm11175093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/28/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022] Open
Abstract
Studies on the association between sodium-to-potassium (Na/K) ratio changes and blood pressure (BP) changes among older adults are limited. This 7-year longitudinal study examined the association between Na/K ratio changes (evaluated using spot urine tests) and BP changes among older Japanese adults. Data were collected from 432 participants (mean age: 70.3±4.4; range: 65−84 years) in 2012 and 2019. Changes in BP and the Na/K ratio over 7 years were calculated by subtracting baseline values from values noted during a follow-up survey. The median systolic and diastolic BP (SBP) and (DBP) changes after 7 years were 4 (IQR, −7, 14) and −1 (IQR, −9, 5) mmHg, respectively. The median Na/K ratio was changed during the follow-up period by −0.2 (IQR, −1.3, 0.7). A generalized linear model indicated that Na/K ratio changes were positively associated with SBP (B = 2.03, p < 0.001) and DBP (B = 0.62, p = 0.021) changes. In the non-antihypertensive medication-using group, urinary Na/K ratio changes were associated with SBP and DBP changes (B = 2.39, p = 0.001; B = 0.99, p = 0.033). In the antihypertensive medication user group, urinary Na/K ratio changes were associated with SBP changes (B = 1.62, p = 0.015). We confirmed the association between changes in the Na/K ratio and changes in BP.
Collapse
|
21
|
Minatoguchi S. Lower urinary potassium excretion was associated with higher risk of cerebro-cardiovascular- and renal events in patients with hypertension under treatment with anti-hypertensive drugs. J Cardiol 2022; 80:537-544. [PMID: 35989214 DOI: 10.1016/j.jjcc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hypertension is one of the risk factors for cerebro-cardiovascular and renal (CCR) diseases. High blood pressure is affected by the amount of salt (NaCl) and potassium (K) intake. There are many studies reporting the relationship between urinary sodium or potassium excretion and CCR events or all-cause mortality in general populations. Thus, it is necessary to investigate the relationship between urinary NaCl or K excretion and CCR events or all-cause mortality in hypertensive patients under control with anti-hypertensive drugs. METHODS A prospective, multi-center cohort study was performed in 3210 hypertensives under treatment with anti-hypertensive drugs for 5 years. The primary outcome was the CCR events, and the secondary outcome was all-cause mortality. A time-dependent Cox proportional hazards regression analysis was performed to assess the association between outcomes and urinary NaCl and K excretion, blood pressure, or heart rate. RESULTS During the follow-up period, 61 CCR events and 110 all-cause deaths occurred. There was no association between urinary NaCl excretion and CCR events or all-cause mortality. Lower urinary K excretion and higher Na/K ratio were associated with higher risk of CCR events or all-cause mortality. The CCR events were not associated with systolic, diastolic blood pressure, or heart rate. CONCLUSION Lower urinary K excretion was associated with higher risk of CCR events or all-cause mortality in hypertensive patients under treatment with anti-hypertensive drugs.
Collapse
Affiliation(s)
- Shinya Minatoguchi
- Heart Failure Center, Gifu Municipal Hospital, Gifu, Japan.; Department of Circulatory and Respiratory Advanced Medicine, Gifu University Graduate School of Medicine, Gifu, Japan..
| |
Collapse
|
22
|
Sari DW, Noguchi-Watanabe M, Sasaki S, Yamamoto-Mitani N. Dietary Patterns of 479 Indonesian Adults and Their Associations with Sodium and Potassium Intakes Estimated by Two 24-h Urine Collections. Nutrients 2022; 14:nu14142905. [PMID: 35889861 PMCID: PMC9318011 DOI: 10.3390/nu14142905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023] Open
Abstract
The excess sodium (Na) intake and insufficient potassium (K) intake are frequently observed all over the world, including Indonesia. This study explored the dietary patterns of Indonesian people and evaluated their associations with Na and K intakes. Na and K intakes were assessed by repeated 24-h urine collection. The dietary patterns of the previous month were extracted by factor analysis using the Indonesian Food Frequency Questionnaire. The participants were community-dwelling Indonesian men and women (n = 479) aged 20 years and over. We identified four dietary patterns in each sex. After controlling for confounding factors, the high quantile of ‘Noodle, oil, and salty sea products’ pattern was associated with the high Na intake in both men and women (p = 0.02 and <0.001, respectively). The ‘Meat, vegetable, oil, and fruit’ pattern statistically significantly contributed to the high K intake in men (p = 0.04), but not in women (p = 0.26). The ‘Vegetable, non-oil, and milk’ pattern in men and ‘Meat, vegetable, and fruit’ pattern in women were associated with low Na:K ratios (p = 0.03 and 0.01, respectively). Neither ‘bread’ nor ‘fish’ appeared as a major determinant of any dietary patterns in this population. The ‘Noodle, oil, and salty sea products’ pattern should be avoided to reduce sodium intake.
Collapse
Affiliation(s)
- Dianis Wulan Sari
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Faculty of Nursing, Universitas Airlangga, Jln. Mulyorejo, Surabaya, East Java 60115, Indonesia
- Correspondence: or (D.W.S.); (N.Y.-M.); Tel.: +62-31-5913754 (D.W.S.); +81-3-5841-3508 (N.Y.-M.); Fax: +62-31-5913752 (D.W.S.); +81-3-5841-3502 (N.Y.-M.)
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Department of Home Care Nursing Science, School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan;
- Correspondence: or (D.W.S.); (N.Y.-M.); Tel.: +62-31-5913754 (D.W.S.); +81-3-5841-3508 (N.Y.-M.); Fax: +62-31-5913752 (D.W.S.); +81-3-5841-3502 (N.Y.-M.)
| |
Collapse
|
23
|
Santangelo C, Mandracchia F, Bondi D, Piccinelli R, Catasta G, Llauradó E, Tarro L, Verratti V, Cichelli A, Sette S, Pietrangelo T. Traditional dishes, online tools, and public engagement: a feasible and scalable method to evaluate local recipes on nutritional content, sustainability, and health risks. Insight from Abruzzo, Italy. J Food Compost Anal 2022. [DOI: 10.1016/j.jfca.2022.104797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Arafa A, Kokubo Y, Kashima R, Teramoto M, Sakai Y, Nosaka S, Nakao YM, Watanabe E. The Lifelong Health Support 10: a Japanese prescription for a long and healthy life. Environ Health Prev Med 2022; 27:23. [PMID: 35675977 PMCID: PMC9251624 DOI: 10.1265/ehpm.22-00085] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Although the age-adjusted incidence and mortality of cancer and cardiovascular disease (CVD) have been decreasing steadily in Japan, both diseases remain major contributors to morbidity and mortality along with the aging society. Herein, we aim to provide a prescription of 10 health tips for long and healthy life named the “Lifelong Health Support 10 (LHS10).” Method The LHS10 was developed by the preventive medicine specialists at the National Cerebral and Cardiovascular Center in Suita, where it has been used for health guidance to prevent CVD, cancer, and cognitive decline in addition to their major risk factors such as hypertension, diabetes, and obesity. It consisted of the lifestyle modification recommendations of the 2014 Japanese Society of Hypertension guidelines and the 2017 Japan Atherosclerosis Society Guidelines for preventing atherosclerotic CVD. Further, it came in line with other international lifestyle modification guidelines. In this narrative review, we summarized the results of several Japanese epidemiological studies investigating the association between the LHS10 items and the risk of cancer, CVD, and other chronic diseases including dementia, diabetes, and chronic kidney disease. Results The LHS10 included avoiding smoking and secondhand smoke exposure, engaging in physical activity, refraining from excessive alcohol drinking, reducing fried foods and sugary soft drinks, cutting salt in food, consuming more vegetables, fruits, fish, soy foods, and fibers, and maintaining proper body weight. All items of the LHS10 were shown to reduce the risk of cancer, CVD, and other chronic diseases. Conclusions The LHS10 can be a helpful tool for health guidance. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.22-00085.
Collapse
Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Public Health, Faculty of Medicine, Beni-Suef University
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Masayuki Teramoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Saya Nosaka
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Youko M Nakao
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Emi Watanabe
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University
| |
Collapse
|
25
|
Shirota M, Watanabe N, Suzuki M, Kobori M. Japanese-Style Diet and Cardiovascular Disease Mortality: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Nutrients 2022; 14:nu14102008. [PMID: 35631146 PMCID: PMC9147868 DOI: 10.3390/nu14102008] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review and meta-analysis elucidate the effects of the Japanese-style diet and characteristic Japanese foods on the mortality risk of cardiovascular disease (CVD), cerebrovascular disease (stroke), and heart disease (HD). This review article followed the PRISMA guidelines. A systematic search in PubMed, The Cochrane Library, JDreamIII, and ICHUSHI Web identified prospective cohort studies on Japanese people published till July 2020. The meta-analysis used a random-effects model, and heterogeneity and publication bias were evaluated with I2 statistic and Egger’s test, respectively. Based on inclusion criteria, we extracted 58 articles, including 9 on the Japanese-style diet (n = 469,190) and 49 (n = 2,668,238) on characteristic Japanese foods. With higher adherence to the Japanese-style diet, the pooled risk ratios (RRs) for CVD, stroke, heart disease/ischemic heart disease combined (HD/IHD) mortality were 0.83 (95% CI, 0.77–0.89, I2 = 58%, Egger’s test: p = 0.625, n = 9 studies), 0.80 (95% CI, 0.69–0.93, I2 = 66%, Egger’s test: p = 0.602, n = 6 studies), and 0.81 (95% CI, 0.75–0.88, I2 = 0%, Egger’s test: p = 0.544, n = 6 studies), respectively. Increased consumption of vegetables, fruits, fish, green tea, and milk and dairy products decreased the RR for CVD, stroke, or HD mortality. Increased salt consumption elevated the RR for CVD and stroke mortality. Increased consumption of dietary fiber and plant-derived protein decreased the RR for CVD, stroke, and HD/IHD mortality. The Japanese-style diet and characteristic Japanese foods may reduce CVD mortality. Most studies conducted diet surveys between 1980 and the 1990s. This meta-analysis used articles that evaluated the same cohort study by a different method. A new large-scale cohort study matching the current Japanese dietary habits is needed to confirm these findings.
Collapse
Affiliation(s)
- Masayuki Shirota
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
| | - Norikazu Watanabe
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masataka Suzuki
- Yakujihou Marketing Jimusho Inc., Level 3, Sanno Park Tower, 2-11-1 Nagata-cho, Chiyoda-ku, Tokyo 100-6162, Japan; (N.W.); (M.S.)
| | - Masuko Kobori
- Institute of Food Research, National Agriculture and Food Research Organization, 2-1-2 Kannondai, Tsukuba-shi 305-8642, Ibaraki, Japan;
- Correspondence: ; Tel.: +81-29-838-8011
| |
Collapse
|
26
|
The Association of Dietary Intake, Oral Health, and Blood Pressure in Older Adults: A Cross-Sectional Observational Study. Nutrients 2022; 14:nu14061279. [PMID: 35334938 PMCID: PMC8950359 DOI: 10.3390/nu14061279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 12/10/2022] Open
Abstract
Hypertension is related to impaired mastication that causes malnutrition, declining the general health of older adults. This study assessed the role of dietary intake in the relationship between oral health and blood pressure. Eight hundred ninety-four adults aged ≥65 years who independently lived in rural regions of Japan participated in this study. Hypertension was classified according to the guidelines of the Japanese Society of Hypertension. The oral condition was evaluated by analyzing the remaining teeth, occlusal force, posterior occlusal support, masticatory performance, oral moisture, and oral bacterial level. Dietary intake was assessed using a brief self-administered dietary history questionnaire. Mann-Whitney U, chi-square, Kruskal-Wallis tests, and logistic regression analyses were used to elucidate the factors related to hypertension. Normotensive, hypertensive, and history of hypertension were observed in 30.9%, 23.8%, and 45.3% of the participants, respectively. The factors significantly associated with the hypertension were age, body mass index, posterior occlusal support condition, and sodium-to-potassium ratio related to salt intake and/or vegetable intake. Participants without posterior occlusion significantly had higher risk of hypertension (odds ratio = 1.72). This study suggested that there was an association between oral health and hypertension, while the loss of occlusal support may influence nutritional intake conditions.
Collapse
|
27
|
Tsuchihashi T. Dietary salt intake in Japan - past, present, and future. Hypertens Res 2022; 45:748-757. [PMID: 35296804 DOI: 10.1038/s41440-022-00888-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/16/2022]
Abstract
Salt reduction is the most important lifestyle modification, especially in Japanese individuals who still consume a significant amount of salt. The Dietary Reference Intakes for Japanese 2020, issued by the Ministry of Health, Labour and Welfare, propose a salt intake goal of <7.5 g/day for men and <6.5 g/day for women. Regarding the goal of salt reduction in hypertensive patients, the hypertension guideline by the Japanese Society of Hypertension 2019 (JSH2019) proposes a goal of <6 g/day. Although the average salt intake in Japan gradually decreased in the early 2000s, the declining trend has not been seen in recent years, and thus, it seems difficult to achieve these target salt intake levels. To overcome this challenge, the JSH announced the 'JSH Tokyo Declaration' and pledged to create a specific action plan to achieve the target salt intake level of <6 g/day. The six strategies to achieve the target salt intake level are as follows: (1) educating citizens on the harms of excessive salt intake and the importance of reducing salt intake; (2) recommending the assessment of the salt intake of individuals or populations and proposing adequate methods to reduce salt intake; (3) promoting salt reduction for children as a part of dietary education at school; (4) promoting salt reduction in takeout food, prepared dishes, canteens, and school lunches; (5) encouraging companies to develop and promote low-salt foods; and (6) encouraging the government to take measures to promote salt reduction. Through these activities, a society with a low salt intake will be expected in the near future.
Collapse
Affiliation(s)
- Takuya Tsuchihashi
- Steel Memorial Yawata Hospital, Harunomachi 1-1-1, Yahata-Higashi-ku, Kitakyushu City, 805-8508, Japan.
| |
Collapse
|
28
|
Wang DD, Li Y, Nguyen XMT, Song RJ, Ho YL, Hu FB, Willett WC, Wilson PWF, Cho K, Gaziano JM, Djoussé L. Dietary Sodium and Potassium Intake and Risk of Non-Fatal Cardiovascular Diseases: The Million Veteran Program. Nutrients 2022; 14:nu14051121. [PMID: 35268096 PMCID: PMC8912456 DOI: 10.3390/nu14051121] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the association between intakes of sodium and potassium and the ratio of sodium to potassium and incident myocardial infarction and stroke. Design, Setting and Participants: Prospective cohort study of 180,156 Veterans aged 19 to 107 years with plausible dietary intake measured by food frequency questionnaire (FFQ) who were free of cardiovascular disease (CVD) and cancer at baseline in the VA Million Veteran Program (MVP). Main outcome measures: CVD defined as non-fatal myocardial infarction (MI) or acute ischemic stroke (AIS) ascertained using high-throughput phenotyping algorithms applied to electronic health records. Results: During up to 8 years of follow-up, we documented 4090 CVD cases (2499 MI and 1712 AIS). After adjustment for confounding factors, a higher sodium intake was associated with a higher risk of CVD, whereas potassium intake was inversely associated with the risk of CVD [hazard ratio (HR) comparing extreme quintiles, 95% confidence interval (CI): 1.09 (95% CI: 0.99−1.21, p trend = 0.01) for sodium and 0.87 (95% CI: 0.79−0.96, p trend = 0.005) for potassium]. In addition, the ratio of sodium to potassium (Na/K ratio) was positively associated with the risk of CVD (HR comparing extreme quintiles = 1.26, 95% CI: 1.14−1.39, p trend < 0.0001). The associations of Na/K ratio were consistent for two subtypes of CVD; one standard deviation increment in the ratio was associated with HRs (95% CI) of 1.12 (1.06−1.19) for MI and 1.11 (1.03−1.19) for AIS. In secondary analyses, the observed associations were consistent across race and status for diabetes, hypertension, and high cholesterol at baseline. Associations appeared to be more pronounced among participants with poor dietary quality. Conclusions: A high sodium intake and a low potassium intake were associated with a higher risk of CVD in this large population of US veterans.
Collapse
Affiliation(s)
- Dong D Wang
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02115, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
| | - Frank B Hu
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Walter C Willett
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Peter W F Wilson
- Atlanta VA Medical Center, Atlanta, GA 30033, USA
- Emory Clinical Cardiovascular Research Institute, Atlanta, GA 30033, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Luc Djoussé
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
29
|
Is the cut off point proper in screening of primary aldosteronism by urinary Na/K ratio. Japanese are still high in Na/K ratio. Hypertens Res 2022; 45:551. [PMID: 35027712 DOI: 10.1038/s41440-021-00787-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
|
30
|
Antihypertensive Effect of Long-Term Monotherapy with Esaxerenone in Patients with Essential Hypertension: Relationship Between Baseline Urinary Sodium Excretion and Its Antihypertensive Effect. Adv Ther 2022; 39:4779-4791. [PMID: 35976603 PMCID: PMC9464726 DOI: 10.1007/s12325-022-02282-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/22/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The blood pressure (BP) control mechanism for mineralocorticoid receptor blockers is unclear, and analysis of their use as a single agent in the clinical setting is required to resolve this uncertainty. There is a paucity of data on esaxerenone monotherapy assessing its long-term antihypertensive effect and urinary biomarkers. METHODS This post hoc exploratory substudy of a long-term phase 3 study evaluated the effect of esaxerenone monotherapy (2.5 or 5 mg/day) in treatment-naïve patients who continued the therapy during the 52-week study period (n = 25). In addition to blood biomarkers, urinary biomarkers were also assessed in 24-h urine collection samples. RESULTS Esaxerenone monotherapy was associated with consistent reductions in systolic/diastolic BP in the substudy population (- 23.5/- 13.1 mmHg at week 52, p < 0.001 vs baseline). Plasma aldosterone concentrations and plasma renin activity significantly increased during esaxerenone monotherapy at all time points. On the basis of the observations that both urine volume and urinary sodium excretion also decreased up to the end of the study, and were significantly lower at 12 weeks, patients were further categorized into higher/lower urinary sodium excretion subgroups according to whether their baseline values were above or below the median. In the group with higher baseline urinary sodium excretion, esaxerenone exhibited a significantly greater decrease in systolic/diastolic BP compared to the lower baseline group. CONCLUSION Esaxerenone exhibited sustained and stable antihypertensive activity even when administered as a single agent for 52 weeks in patients with essential hypertension. The additional urinary biomarker analysis suggests that the BP-lowering effects of esaxerenone may be partly exerted via mechanisms related to salt and water retention, and that the effect is particularly pronounced in patients with hypertension and higher baseline urinary sodium excretion, which may reflect a state of excessive salt intake. TRIAL REGISTRATION NCT02722265.
Collapse
|
31
|
Wang Q. The role of dietary potassium and sodium in hypertension and cardiovascular damage and protection: A narrative review. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_23_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
32
|
Ma J, Lee YK. Sodium content changes between 2015 and 2019 in restaurant menu items selected for sodium reduction in Daegu. Nutr Res Pract 2022; 16:537-548. [PMID: 35919291 PMCID: PMC9314199 DOI: 10.4162/nrp.2022.16.4.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/17/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVES South Korea has been conducting the Sodium Reduction Restaurant Project since 2015 to reduce sodium contents in restaurant menus. The purpose of this study was to analyze changes in the sodium content of menus as determined by the Daegu Sodium Reduction Restaurant Project between 2015 and 2019. MATERIALS/METHODS Intervention was aimed at reducing the sodium contents of over 10% of menu items in participating restaurants. On-site inspections and evaluations were conducted using a checklist, and reductions in sodium contents were determined by analyzing the salinities and sodium contents of menus after intervention. RESULTS Post-intervention salinities and sodium contents were significantly lower than baseline values in 2016 (P < 0.001), 2017 (P < 0.001), 2018 (P < 0.001), and 2019 (P < 0.001). However, sodium contents and salinities differences before and after intervention were not significant in 2015. Sodium contents of more than 20% of menu items offered by restaurants that participated in the Sodium Reduction Restaurant Project for 2 yrs starting in 2016 declined by 28.9%. On the other hand, the sodium reduction rate achieved by restaurants that participated for 4 yrs from 2015 reached 55.4%. The percentage of restaurants that participated in the project increased annually, though some failed to be designated as Sodium Reduction Restaurants because they did not meet sodium reduction rate requirements. CONCLUSIONS Positive correlations were found between duration of participation in the project and sodium reduction and designation rates. Sustainable long-term support at the national level is required to expand the project to other regions.
Collapse
Affiliation(s)
- Jian Ma
- Department of Food Science & Nutrition, Kyungpook National University, Daegu 41566, Korea
| | - Yeon-Kyung Lee
- Department of Food Science & Nutrition, Kyungpook National University, Daegu 41566, Korea
| |
Collapse
|
33
|
Kim HJ, Lee YK, Koo H, Shin MJ. Dietary Reference Intakes of sodium for Koreans: focusing on a new DRI component for chronic disease risk reduction. Nutr Res Pract 2022; 16:S70-S88. [PMID: 35651840 PMCID: PMC9127518 DOI: 10.4162/nrp.2022.16.s1.s70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Sodium is a physiologically essential nutrient, but excessive intake is linked to the increased risk of various chronic diseases, particularly cardiovascular. It is, therefore, necessary to accomplish an evidence-based approach and establish the Korean Dietary Reference Intakes (KDRIs) index, to identify both the nutritional adequacy and health effects of sodium. This review presents the rationale for and the process of revising the KDRIs for sodium and, more importantly, establishing the sodium Chronic Disease Risk Reduction Intake (CDRR) level, which is a new specific set of values for chronic disease risk reduction. To establish the 2020 KDRIs for dietary sodium, the committee conducted a systematic literature review of the intake–response relationships between the selected indicators for sodium levels and human chronic diseases. In this review, 43 studies published from January 2014 to December 2018, using databases of PubMed and Web of Science, were finally included for evaluating the risk of bias and strength of evidence (SoE). We determined that SoE of the relationship between dietary sodium and cardiovascular diseases, cerebrovascular disease, and hypertension, was moderate to strong. However, due to insufficient scientific evidence, we were unable to establish the estimated average requirement and the recommended nutrient intake for dietary sodium. Therefore, the adequate intake of sodium for adults was established to be 1,500 mg/day, whereas the CDRR for dietary sodium was established at 2,300 mg/day for adults. Intake goal for dietary sodium established in the 2015 KDRIs instead of the tolerable upper intake level was not presented in the 2020 KDRIs. For the next revision of the KDRIs, there is a requirement to pursue further studies on nutritional adequacy and toxicity of dietary sodium, and their associations with chronic disease endpoint in the Korean population.
Collapse
Affiliation(s)
- Hyun Ja Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Yeon-Kyung Lee
- Department of Food Science and Nutrition, Kyungpook National University, Daegu 41566, Korea
| | - Hoseok Koo
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul 04551, Korea
| | - Min-Jeong Shin
- School of Biosystems and Biomedical Sciences, College of Health Science, Korea University, Seoul 02841, Korea
| |
Collapse
|
34
|
|
35
|
Liabsuetrakul T, Srisook S, Jandee K, Mori R. Reliability of a portable device for measuring spot urinary Na/K ratios among pregnant Thai women: a cross-sectional study. HYPERTENSION RESEARCH IN PREGNANCY 2021. [DOI: 10.14390/jsshp.hrp2021-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Saiphon Srisook
- Clinical Chemistry Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University
| | - Kasemsak Jandee
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University
| | | |
Collapse
|
36
|
Estimation of sodium and potassium intakes assessed by two 24-hour urine collections in a city of Indonesia. Br J Nutr 2021; 126:1537-1548. [PMID: 33494843 PMCID: PMC8524422 DOI: 10.1017/s0007114521000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intakes of excess Na and insufficient K are two major contributors of heart diseases and stroke development. However, no precise study has previously been carried out on Na and K intakes among Indonesian adults. The present study aimed to estimate the Na and K intakes using two consecutive 24-h urine collections. Participants were community-dwelling adults aged between 20 and 96 years, randomly selected from a pool of resident registration numbers. Of the 506 participants, 479 (240 men and 239 women) completed urine collections. The mean Na excretion was 102·8 and 100·6 mmol/d, while the mean K excretion was 25·0 and 23·4 mmol/d for men and women, respectively. Na and K excretions were higher in participants with a higher BMI. A higher K excretion was associated only with younger age. More than 80 % of the participants consumed more than 5 g/d of salt (the upper limit recommended by the Indonesian government), whereas none of them consumed more than 3510 mg/d of K (the lower limit). The high Na and low K intakes, especially high Na among participants with high BMI, should be considered when future intervention programmes are planned in this country.
Collapse
|
37
|
High Adherence to Mediterranean Diet Is Not Associated with an Improved Sodium and Potassium Intake. Nutrients 2021; 13:nu13114151. [PMID: 34836406 PMCID: PMC8623388 DOI: 10.3390/nu13114151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
Prevention and control of hypertension and cerebro-cardiovascular diseases are associated with adequate sodium and potassium intake and adherence to a Mediterranean dietary pattern. The aim of this study was to assess the association between adherence to a Mediterranean diet (MD) and the excretion of sodium and potassium as surrogate measures of intake. This is a cross-sectional analysis as part of a larger study (the iMC SALT randomized controlled trial) among workers of a public university. A food frequency questionnaire was used to assess the adherence to MD, using the alternative Mediterranean diet (aMED) score; sodium and potassium excretions were estimated by 24-h urine collections. Sociodemographic and other lifestyle characteristics were also obtained. The associations between the adherence to MD and Na and K excretion were calculated by logistic regression, adjusting for confounding variables. From the 109 selected participants, seven were excluded considering urine screening and completeness criteria, leaving a final sample of 102 subjects (48% male, average age 47 years). Mean sodium and potassium excretion were 3216 mg/day and 2646 mg/day, respectively. Sodium and potassium excretion were significantly higher in men, but no differences were found according to different levels of MD adherence. In logistic regression analysis, sodium, potassium, and sodium-to-potassium ratio urinary excretion tertiles were not associated with MD adherence (low/moderate versus high), even after adjustment for confounding variables. A high adherence to MD was thus not associated with a different level of sodium and potassium intake.
Collapse
|
38
|
Arakawa M, Watanabe T, Suzuki K, Nishino J, Sekizuka H, Iwahori T, Ono SI, Hidaka S. Validation of Self-Monitoring Devices Supporting Sodium Intake Reduction: An Experimental Feeding Study Using Standardized Low-Salt and High-Salt Meals among Healthy Japanese Volunteers. ANNALS OF NUTRITION AND METABOLISM 2021; 77:289-298. [PMID: 34569491 DOI: 10.1159/000519097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although several approaches for approximating daily Na intake and the Na/K ratio using casual urine are available, the most useful method remains unclear during daily practice and at home. METHODS Twenty-seven participants measured their casual urinary Na/K ratio repeatedly using a Na/K ratio monitor and also measured overnight urine once daily using a monitoring device which delivers on-site feedback to estimate their salt intake under unrestricted, low-salt (LS) (6 g/day), and high-salt (HS) (12 g/day) diets. RESULTS The monitoring method utilizing overnight urine to estimate daily Na remained insensitive, resulting in significant overestimation during the LS diet and underestimation during the HS diet periods; estimated salt intake during the LS and HS diet periods plateaued at 7-8 g/day and 9-10 g/day within 3 day; mean estimated salt intake was 11.3 g/day, 7.9 g/day, and 9.8 g/day on the last day of the unrestricted, LS, and HS diets; the coefficient of variation (CV) of the estimated Na intake was 0.23 and 0.17 in the latter half of the low- and high-salt diet periods, respectively. The mean urinary Na/K molar ratio was 5.6, 2.5, and 5.3 on the last day of the unrestricted, LS, and HS diets; the CV of the daily mean Na/K ratio was 0.41 and 0.36 in the latter half of the LS and HS diet periods, respectively. The urinary Na/K ratio during the LS and HS diet periods plateaued within 2 days. The monitoring method based on the daily mean of the casual urinary Na/K ratio reflected the actual change in Na intake, and the estimated value tracked the actual changes in salt intake with smaller difference than the overnight urine estimates when using the estimation coefficient set at 2; estimated salt intake during the LS and HS diet periods plateaued at 5-6 g/day and 10-12 g/day within 2-3 day; mean estimated salt intake was 11.0 g/day, 5.7 g/day, and 10.7 g/day on the last day of the unrestricted, LS, and HS diets, respectively. DISCUSSION/CONCLUSION Estimates of daily Na intake derived from overnight urine may remain insensitive during dietary interventions. The urinary Na/K ratio reflects the actual change in Na intake during dietary modification and may serve as a practical marker, particularly during short-term interventions. Conversion from the urinary Na/K ratio to estimated salt intake may be useful, if the coefficient was set appropriate by further investigations.
Collapse
Affiliation(s)
- Motoki Arakawa
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Takayuki Watanabe
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Koya Suzuki
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Junichi Nishino
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | | | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Shin-Ichi Ono
- Laboratory of Clinical Medicine, Faculty of Applied Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| | - Shinji Hidaka
- Laboratory of Pharmaceutical Regulatory Science, Faculty of Practical Pharmaceutical Sciences, School of Pharmacy, Nihon University, Chiba, Japan
| |
Collapse
|
39
|
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
|
40
|
Segawa H, Higashi A, Masuda I, Yoshii K, Iwahori T, Ueshima H. Urinary sodium/potassium ratio as a screening tool for hyperaldosteronism in men with hypertension. Hypertens Res 2021; 44:1129-1137. [PMID: 34002055 PMCID: PMC8418986 DOI: 10.1038/s41440-021-00663-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/09/2022]
Abstract
Among individuals with hypertension, the prevalence of secondary hypertension has been reported to be ≈10%. More than half of individuals with secondary hypertension have associated hyperaldosteronism. However, given the current clinical environment, these patients often remain undiagnosed. We hypothesized that the urinary sodium/potassium ratio (Na/K) could be used as a simple, low-cost method of screening for hyperaldosteronism among individuals with hypertension in primary care and health examination settings. We recruited hypertensive individuals aged 30-69 years old who were not taking any antihypertensive medications from among participants in health examinations. Urinary Na and K were measured using second morning urine samples, and the plasma aldosterone concentration (PAC) was also measured. We evaluated the association of the second morning urine Na/K ratio (SMU Na/K) with a high PAC, defined as ≥90th percentile (24.3 ng/dL), using receiver operating characteristic (ROC) curves. Overall, 160 participants (108 men and 52 women) with a mean age of 54.3 years were eligible for this study. The area under the ROC curve for the relationship between SMU Na/K and high PAC was 0.77 (95% confidence interval [CI]: 0.59-0.95) in men and 0.64 (95% CI: 0.36-0.93) in women. In men, SMU Na/K values <1.0 could detect hyperaldosteronism with a sensitivity of 45.5%, a specificity of 97.9%, a positive predictive value of 71.4%, and a negative predictive value of 94.1%. The use of the urinary Na/K ratio may be appropriate as a method of screening for hyperaldosteronism in hypertensive men.
Collapse
Affiliation(s)
- Hiroyoshi Segawa
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Akane Higashi
- Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan.
| | - Izuru Masuda
- Takeda Hospital Medical Examination Center, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiyuki Iwahori
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.,Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| |
Collapse
|
41
|
Liu X, Bai Y, Li S, O'Donnell M, Mente A, Yin L, Hu B, Cheng X, Liu W, Bai X, Wang Y, Sun Y, Li X, Liu L, Yusuf S, Li W. Associations of estimated 24-h urinary sodium excretion with mortality and cardiovascular events in Chinese adults: a prospective cohort study. J Hypertens 2021; 39:484-493. [PMID: 33031177 DOI: 10.1097/hjh.0000000000002647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the associations of sodium excretion with blood pressure, mortality and cardiovascular diseases in Chinese population. METHODS We studied 39 366 individuals aged 35-70 years from 115 urban and rural communities in 12 centers across mainland China. Trained research staff conducted face-to-face interview to record baseline information of all participants based on questionnaires, and collected their morning fasting urine samples to estimate 24-h sodium excretion (24hUNaE). Multivariable frailty Cox regression accounting for clustering by centre was performed to examine the association between estimated 24hUNaE and the primary composite outcome of death and major cardiovascular events in a Chinese population. RESULTS Mean 24hUNaE was 5.68 (SD 1.69) g/day. After a median follow-up of 8.8 years, the composite outcome occurred in 3080 (7.8%) participants, of which 1426 (3.5%) died and 2192 (5.4%) suffered from cardiovascular events. 24hUNaE was positively associated with increased SBP and DBP. Using the 24hUNaE level of 4-4.99 g/day as the reference group, a 24hUNaE of either lower (<3 g/day) or higher (≥7 g/day) was associated with an increased risk of the composite outcome with a hazard ratio of 1.22 (95% confidence interval: 1.01-1.49) and 1.15 (95% confidence interval: 1.01-1.30), respectively. A similar trend was observed between 24hUNaE level and risk of death or major cardiovascular events. CONCLUSION These findings support a positive association between estimated urinary sodium excretion and blood pressure, and a possible J-shaped pattern of association between sodium excretion and clinical outcomes, with the lowest risk in participants with sodium excretion between 3 and 5 g/day.
Collapse
Affiliation(s)
- Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
- Phase I Clinical Trial Center Beijing Shijitan Hospital, Capital Medical University, Beijing
| | - Yinxiao Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Sidong Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Martin O'Donnell
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
| | - Andrew Mente
- Department of Health Research Methods, Evidence and Impact, McMaster University
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Bo Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Xiaoru Cheng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Weida Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Yi Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Xiaomeng Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, PR China
| | - Salim Yusuf
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| |
Collapse
|
42
|
Nassir CMNCM, Ghazali MM, Hashim S, Idris NS, Yuen LS, Hui WJ, Norman HH, Gau CH, Jayabalan N, Na Y, Feng L, Ong LK, Abdul Hamid H, Ahamed HN, Mustapha M. Diets and Cellular-Derived Microparticles: Weighing a Plausible Link With Cerebral Small Vessel Disease. Front Cardiovasc Med 2021; 8:632131. [PMID: 33718454 PMCID: PMC7943466 DOI: 10.3389/fcvm.2021.632131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Cerebral small vessel disease (CSVD) represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger neuroinflammation and the subsequent neurodegenerative cascade. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, Alzheimer disease, and Parkinson disease. Despite being the most common neurodegenerative condition with cerebrocardiovascular axis, understanding about it remains poor. Interestingly, modifiable risk factors such as unhealthy diet including high intake of processed food, high-fat foods, and animal by-products are known to influence the non-neural peripheral events, such as in the gastrointestinal tract and cardiovascular stress through cellular inflammation and oxidation. One key outcome from such events, among others, includes the cellular activations that lead to elevated levels of endogenous cellular-derived circulating microparticles (MPs). MPs can be produced from various cellular origins including leukocytes, platelets, endothelial cells, microbiota, and microglia. MPs could act as microthrombogenic procoagulant that served as a plausible culprit for the vulnerable end-artery microcirculation in the brain as the end-organ leading to CSVD manifestations. However, little attention has been paid on the potential role of MPs in the onset and progression of CSVD spectrum. Corroboratively, the formation of MPs is known to be influenced by diet-induced cellular stress. Thus, this review aims to appraise the body of evidence on the dietary-related impacts on circulating MPs from non-neural peripheral origins that could serve as a plausible microthrombosis in CSVD manifestation as a precursor of neurodegeneration. Here, we elaborate on the pathomechanical features of MPs in health and disease states; relevance of dietary patterns on MP release; preclinical studies pertaining to diet-based MPs contribution to disease; MP level as putative surrogates for early disease biomarkers; and lastly, the potential of MPs manipulation with diet-based approach as a novel preventive measure for CSVD in an aging society worldwide.
Collapse
Affiliation(s)
| | - Mazira Mohamad Ghazali
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Sabarisah Hashim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nur Suhaila Idris
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Lee Si Yuen
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wong Jia Hui
- Neurobiology of Aging and Disease Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Haziq Hazman Norman
- Anatomy Unit, International Medical School (IMS), Management and Science University (MSU), Shah Alam, Malaysia
| | - Chuang Huei Gau
- Department of Psychology and Counselling, Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Nanthini Jayabalan
- Translational Neuroscience Lab, University of Queensland (UQ), Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Yuri Na
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Linqing Feng
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Lin Kooi Ong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, National Health and Medical Research Council (NHMRC), Heidelberg, VIC, Australia
| | - Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Haja Nazeer Ahamed
- Crescent School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, India
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Malaysia
| |
Collapse
|
43
|
Dietary sodium:potassium ratio and CVD risk factors among Japanese adults: a retrospective cross-sectional study of pooled data from the National Health and Nutrition Survey, 2003-2017. Br J Nutr 2021; 125:79-91. [PMID: 32674745 DOI: 10.1017/s000711452000269x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few studies have reported associations between the Na:K ratio and risk factors related to CVD among the general population in Asian countries. This study aimed to investigate the dietary Na:K ratio association with CVD risk factors among Japanese adults. This retrospective cross-sectional study included 48 800 Japanese participants (19 386 men and 29 414 women) aged ≥20 years, registered in the 2003-2017 National Health and Nutrition Survey. Multivariate OR and 95 % CI for risk of hypertension, high glycated HbA1c levels, hypercholesterolaemia, low serum levels of HDL-cholesterol and high non-HDL-cholesterol levels according to the Na:K ratio were estimated using logistic regression models. Dietary Na:K ratio decreased for both men and women from 2003 to 2017. Higher Na:K ratio and higher hypertension prevalence were observed (multivariate OR (fifth v. first quintiles) 1·27, 95 % CI 1·15, 1·40; Pfor trend < 0·001 for men and 1·12, 95 % CI 1·01, 1·23; Pfor trend = 0·007 for women). Higher Na:K ratio was associated with higher prevalence of high HbA1c levels in men (multivariate OR 1·56, 95 % CI 1·24, 1·96). Prevalence of low HDL-cholesterol levels was increased with higher Na:K ratio (Pfor trend =0·002 for men and <0·001 for women). No significant associations were found between Na:K ratio and hypercholesterolaemia in men or high non-HDL-cholesterol levels in both men and women. Our findings suggest that dietary Na:K ratio is associated with several CVD risk factors among Japanese adults.
Collapse
|
44
|
Mirmiran P, Gaeini Z, Bahadoran Z, Ghasemi A, Norouzirad R, Tohidi M, Azizi F. Urinary sodium-to-potassium ratio: a simple and useful indicator of diet quality in population-based studies. Eur J Med Res 2021; 26:3. [PMID: 33407860 PMCID: PMC7788983 DOI: 10.1186/s40001-020-00476-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023] Open
Abstract
Background Current evidence regarding the prognostic relevance of urinary sodium-to-potassium ratio (Na-to-K ratio), as an indicator of diet quality is limited. This study was conducted to investigate whether urinary Na-to-K ratio could be related to habitual dietary patterns, in a general population. Methods This study was conducted in the framework of the Tehran Lipid and Glucose Study (2014–2017) on 1864 adult men and women. Urinary Na and K concentrations were measured in the morning spot urine samples. Dietary intakes of the participants were assessed using a validated 147-item Food Frequency Questionnaire (FFQ) and major dietary patterns were obtained using principal component analysis. Mediterranean dietary pattern and Dietary Approaches to Stop Hypertension (DASH) score, were also calculated. Multivariable-adjusted linear regression was used to indicate association of dietary patterns and urinary Na-to-K ratio. Results Mean (± SD) age of participants was 43.7 ± 13.9 years and 47% were men. Mean (± SD) urinary Na, K and the ratio was 139 ± 41.0 and 57.9 ± 18.6 mmol/L, 2.40 ± 0.07, respectively. Higher urinary Na-to-K ratio (> 2.37 vs. < 1.49) was related to lower intakes of vegetables (282 vs. 321 g/day), low-fat dairy (228 vs. 260 g/day) and fruits (440 vs. 370 g/day). Western dietary pattern was related to higher urinary Na-to-K ratio (β = 0.06; 95% CI 0.01, 0.16). Traditional dietary pattern, Mediterranean and DASH diet scores were inversely associated with urinary Na-to-K ratio (β = − 0.14; 95% CI − 0.24, − 0.11, β = − 0.07; 95% CI − 0.09, − 0.01, β = − 0.12; 95% CI − 0.05, − 0.02, respectively). Conclusions Spot urinary Na-to-K ratio may be used as a simple and inexpensive method to monitor diet quality in population-based epidemiological studies.
Collapse
Affiliation(s)
- Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Sahid-Erabi St, Yemen St, Chamran Exp, P.O. Box: 19395-4763, Tehran, Iran
| | - Zahra Gaeini
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Sahid-Erabi St, Yemen St, Chamran Exp, P.O. Box: 19395-4763, Tehran, Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Sahid-Erabi St, Yemen St, Chamran Exp, P.O. Box: 19395-4763, Tehran, Iran.
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Norouzirad
- Department of Biochemistry, School of Paramedical Sciences, Dezful University of Medical Sciences, Dezful, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
45
|
Sakaguchi K, Takemi Y, Hayashi F, Koiwai K, Nakamura M. Effect of workplace dietary intervention on salt intake and sodium-to-potassium ratio of Japanese employees: A quasi-experimental study. J Occup Health 2021; 63:e12288. [PMID: 34731526 PMCID: PMC8565653 DOI: 10.1002/1348-9585.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Excess salt intake is a major risk factor for hypertension and cardiovascular disease. Modifying workplace environments has been recognized to be important for reducing salt intake. However, studies examining the effects of improving the workplace environment regarding salt reduction are limited. This study aimed to evaluate the effects of workplace dietary intervention on employees' salt intake and sodium-to-potassium (Na/K) ratio. METHODS A quasi-experimental study was conducted. Two small business establishments in Saitama Prefecture, Japan, were allocated as the intervention (n = 69) and comparison (n = 68) workplaces, respectively. The 1-year intervention involving healthy lunch and nutrition education was implemented in the intervention workplace. Spot urine samples, physical assessments, and self-administered questionnaire data were collected at baseline, 6 months, and 1 year after the start of the intervention. Analysis of covariance was conducted to investigate differences in the salt intake or Na/K ratio between the study workplaces at year 1. Educational status and rotating work schedules were included as covariates. RESULTS Salt intake in the intervention workplace decreased significantly from 10.7 to 9.3 g (-1.4 g change; 95% confidence interval [CI]: "-2.4, -0.5"). The adjusted difference in changes in salt intake between workplaces was statistically significant (-3.7 g change; 95% CI: "-5.2, -2.3"). Although no significant change was observed in the Na/K ratio in the intervention workplace (3.37-3.08; -0.29 change; 95% CI: "-0.59, 0.01"), the adjusted difference in changes between the workplaces was statistically significant (-0.60 change; 95% CI: "-1.03, -0.17"). CONCLUSIONS Providing healthy lunch and nutrition education may be effective approaches to reduce employees' salt intake and Na/K ratio.
Collapse
Affiliation(s)
| | - Yukari Takemi
- Nutrition EcologyKagawa Nutrition UniversitySakado‐shiJapan
| | - Fumi Hayashi
- Nutrition EcologyKagawa Nutrition UniversitySakado‐shiJapan
| | - Kaori Koiwai
- Public Health NutritionKagawa Nutrition UniversitySakado‐shiJapan
| | - Masakazu Nakamura
- Health Promotion Research CenterInstitute of Community MedicineJapan Association for Development of Community MedicineChiyoda kuJapan
| |
Collapse
|
46
|
Sun M, Cui H, Liang M, Wang W, Wang Y, Liu X, Liu S, Cao L. Perceived dietary salt intake and the risk of primary liver cancer: a population-based prospective study. J Hum Nutr Diet 2020; 33:833-840. [PMID: 32548912 DOI: 10.1111/jhn.12761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although a high-salt diet is associated with high risk of chronic diseases such as hypertension, stroke and cardiovascular disease, little is known about the relationship between a high-salt diet and the risk of primary liver cancer (PLC). Consequently, we prospectively assessed the association of high perceived salt intake with the risk of PLC in the Kailuan Study. METHODS In total, 97 006 participants who were healthy adults or free living adults at the baseline (2006) were included in the present study. The data of perceived salt intake were collected via questionnaire and classified into three categories: <6 g day-1 for low salt intake, 6-10 g day-1 for intermediate salt intake, >10 g day-1 for high-salt intake. PLC including hepatocellular carcinoma and intrahepatic cholangiocarcinoma (excluding liver metastasis), and was confirmed by review of medical records. We used a Cox proportional hazards model to analyse the association between high perceived salt diet and the risk of PLC after adjusting for possible confounders, including age, gender, body mass index, high sensitivity-C-reactive protein, low-density lipoprotein-cholesterol, total cholesterol, triglycerides, alanine aminotransferase, HbsAg positive, cirrhosis, fatty liver, hypertension, diabetes, drinking status, smoking status and physical exercise. RESULTS During the follow-up period of 1 113 816 person-years, 397 PLC events were diagnosed. After adjusting for most potential confounders, subjects in intermediate salt intake and high salt intake had a multivariable hazard ratio and 95% confidence interval of 1.49 (0.97-2.29) and 1.98 (1.22-3.22) (P for trend = 0.0042), respectively, compared to low salt intake. CONCLUSIONS A higher perceived salt intake was associated with a higher risk of PLC.
Collapse
Affiliation(s)
- M Sun
- Department of Graduate School, North China University of Science and Technology, Tangshan, Hebei, China.,Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - H Cui
- Department of Graduate School, North China University of Science and Technology, Tangshan, Hebei, China.,Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - M Liang
- Department of Graduate School, North China University of Science and Technology, Tangshan, Hebei, China.,Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - W Wang
- Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - Y Wang
- Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - X Liu
- Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - S Liu
- Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| | - L Cao
- Department of Hepatobiliary Surgery, Kailuan General Hospital Affiliated to North China University of Science and Technology, Tangshan, Hebei, China
| |
Collapse
|
47
|
Okuda N, Okayama A, Miura K, Yoshita K, Miyagawa N, Saitoh S, Nakagawa H, Sakata K, Chan Q, Elliott P, Ueshima H, Stamler J. Food Sources of Dietary Potassium in the Adult Japanese Population: The International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Nutrients 2020; 12:nu12030787. [PMID: 32192157 PMCID: PMC7146396 DOI: 10.3390/nu12030787] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023] Open
Abstract
A lower-than-recommended potassium intake is a well-established risk factor for increased blood pressure. Although the Japanese diet is associated with higher sodium intake and lower potassium intake, few studies have examined the source foods quantitatively. Studies on dietary patterns in association with potassium intake will be useful to provide dietary advice to increase potassium intake. Twenty-four-hour (hr) dietary recall data and 24-hr urinary potassium excretion data from Japanese participants (574 men and 571 women) in the International Study of Macro/Micronutrients and Blood Pressure (INTERMAP) were used to calculate food sources of potassium and compare food consumption patterns among quartiles of participants categorized according to 24-hr urinary potassium excretion per unit of body weight (UK/BW). The average potassium intake was 2791 mg/day per participant, and the major sources were vegetables and fruits (1262 mg/day), fish (333 mg/day), coffee and tea (206 mg/day), and milk and dairy products (200 mg/day). Participants in the higher UK/BW quartile consumed significantly more vegetables and fruits, fish, and milk and dairy products, and ate less rice and noodles. Conclusion: Advice to increase the intake of vegetables and fruits, fish, and milk may be useful to increase potassium intake in Japan.
Collapse
Affiliation(s)
- Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama 339-8539, Japan
- Correspondence: ; Tel.: +81-48-749-6111; Fax: +81-48-6110
| | - Akira Okayama
- Department of Non-Communicable Diseases, Research Institute of Strategy for Prevention, Tokyo 104-0033, Japan;
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Katsushi Yoshita
- Department of Food Science and Nutrition, Graduate School of Human Life Science and Nutrition, Osaka City University, Osaka 558-8585, Japan;
| | - Naoko Miyagawa
- International Center for Nutrition and Information, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan;
| | - Shigeyuki Saitoh
- School of Health Sciences, Sapporo Medical University, Sapporo 060-8556, Japan;
| | - Hideaki Nakagawa
- Medical Research Institute, Kanazawa Medical University, Kanazawa 920-0265, Japan;
| | - Kiyomi Sakata
- Department of Hygiene and Public Health, Iwate Medical University, Yahaba 028-3694, Japan;
| | - Queenie Chan
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK; (Q.C.); (P.E.)
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2AZ, UK; (Q.C.); (P.E.)
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.M.); (H.U.)
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Jeremiah Stamler
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| |
Collapse
|
48
|
Siwulski M, Budka A, Rzymski P, Gąsecka M, Kalač P, Budzyńska S, Magdziak Z, Niedzielski P, Mleczek P, Mleczek M. Worldwide basket survey of multielemental composition of white button mushroom Agaricus bisporus. CHEMOSPHERE 2020; 239:124718. [PMID: 31514008 DOI: 10.1016/j.chemosphere.2019.124718] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
Agaricus bisporus is the most commonly cultivated and consumed mushroom species. The aim of this study was to compare the profile of macro- and trace elements in A. bisporus fruit bodies produced commercially in 19 countries in 2018 and distributed worldwide (32 analyzed objects). Trace elements with unknown biological roles were also determined. The content of 36 elements (of 70 taken into account) revealed significant differences among the analyzed objects. Contents of Ca, K, Mg, Na and S varied in wide ranges of 425-2430, 12740-40940, 610-3240, 98-430 and 1030-2650 mg kg-1 dw, respectively. The fruit bodies were characterized by a generally similar content of trace elements with some clear exceptions. Rankings of the objects according to the decreased amount of macroelements, trace elements and all elements jointly, show that mushrooms are significantly diverse as regards the content of particular elements of the mentioned group. The analyzed fruit bodies displayed a relatively high content of Ca, Mo and Se, and a high K/Na ratio. Regardless of origin, A. bisporus did not constitute a source of significant levels of Al, Cd or rare earth elements. An increased level of As and Pb in mushrooms from several producers indicates a need for additional measures to reduce potential dietary exposures to these toxicants.
Collapse
Affiliation(s)
- Marek Siwulski
- Poznan University of Life Sciences, Department of Vegetable Crops, Dąbrowskiego 159, 60-594, Poznań, Poland
| | - Anna Budka
- Poznan University of Life Sciences, Department of Mathematical and Statistical Methods, Wojska Polskiego 28, 60-637, Poznań, Poland
| | - Piotr Rzymski
- Poznan University of Medical Sciences, Department of Environmental Medicine, Rokietnicka 8, 60-806, Poznań, Poland
| | - Monika Gąsecka
- Poznan University of Life Sciences, Department of Chemistry, Wojska Polskiego 75, 60-625, Poznań, Poland
| | - Pavel Kalač
- University of South Bohemia, Faculty of Agriculture, Department of Applied Chemistry, 370 04, České Budějovice, Czech Republic
| | - Sylwia Budzyńska
- Poznan University of Life Sciences, Department of Chemistry, Wojska Polskiego 75, 60-625, Poznań, Poland
| | - Zuzanna Magdziak
- Poznan University of Life Sciences, Department of Chemistry, Wojska Polskiego 75, 60-625, Poznań, Poland
| | - Przemysław Niedzielski
- Adam Mickiewicz University in Poznań, Faculty of Chemistry, Umultowska 89b, 61-614, Poznań, Poland
| | - Patrycja Mleczek
- Poznan University of Life Sciences, Department of Ecology and Environmental Protection, Piątkowska 94c, 60-649, Poznań, Poland
| | - Mirosław Mleczek
- Poznan University of Life Sciences, Department of Chemistry, Wojska Polskiego 75, 60-625, Poznań, Poland.
| |
Collapse
|
49
|
Seko C, Odani K, Wada S, Yoshii K, Segawa H, Kitaoka K, Masumoto T, Higashi A. Characteristic dietary habits associated with high values of estimated 24-hours urinary sodium excretion and sodium-to-potassium ratio assessed by age group among the residents of a rural town in Japan. Clin Exp Hypertens 2019; 42:449-459. [DOI: 10.1080/10641963.2019.1693587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Chikako Seko
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kiyoko Odani
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Sayori Wada
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| | - Kengo Yoshii
- Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Kaori Kitaoka
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Taeko Masumoto
- Faculty of Nursing, Doshisha Women’s College of Liberal Arts, Kyoto, Japan
| | - Akane Higashi
- Division of Applied Life Sciences, Graduate School of Life and Environmental Sciences, Kyoto Prefectural University, Kyoto, Japan
| |
Collapse
|
50
|
Turck D, Castenmiller J, de Henauw S, Hirsch-Ernst KI, Kearney J, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Pelaez C, Pentieva K, Siani A, Thies F, Tsabouri S, Vinceti M, Aggett P, Fairweather-Tait S, Martin A, Przyrembel H, Ciccolallo L, de Sesmaisons-Lecarré A, Valtueña Martinez S, Martino L, Naska A. Dietary reference values for sodium. EFSA J 2019; 17:e05778. [PMID: 32626425 PMCID: PMC7009309 DOI: 10.2903/j.efsa.2019.5778] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel considers that a sodium intake of 2.0 g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0 g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel considers that 2.0 g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1 g/day for children aged 1-3 years, 1.3 g/day for children aged 4-6 years, 1.7 g/day for children aged 7-10 years and 2.0 g/day for children aged 11-17 years, respectively. For infants aged 7-11 months, an Adequate Intake (AI) of 0.2 g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0-6 months.
Collapse
|