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Wang NX, Arcand J, Campbell NRC, Johnson C, Malta D, Petersen K, Rae S, Santos JA, Sivakumar B, Thout SR, McLean R. The World Hypertension League Science of Salt: a regularly updated systematic review of salt and health outcomes studies (Sept 2019 to Dec 2020). J Hum Hypertens 2022; 36:1048-1058. [PMID: 35688876 PMCID: PMC9734047 DOI: 10.1038/s41371-022-00710-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/05/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023]
Abstract
The World Hypertension League Science of Salt health outcomes review series highlights high-quality publications relating to salt intake and health outcomes. This review uses a standardised method, outlined in previous reviews and based on methods developed by WHO, to identify and critically appraise published articles on dietary salt intake and health outcomes. We identified 41 articles published between September 2019 to December 2020. Amongst these, two studies met the pre-specified methodological quality criteria for critical appraisal. They were prospective cohort studies and examined physical performance and composite renal outcomes as health outcomes. Both found an association between increased/higher sodium intake and poorer health outcomes. Few studies meet criteria for high-quality methods. This review adds further evidence that dietary salt reduction has health benefits and strengthens evidence relating to health outcomes other than blood pressure and cardiovascular disease. We observe that most studies on dietary sodium do not have adequate methodology to reliably assess sodium intake and its association with health outcomes.
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Affiliation(s)
- Nan Xin Wang
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand
| | - JoAnne Arcand
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Daniela Malta
- School of Nutrition, Ryerson University, Toronto, ON, Canada
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah Rae
- Department of Nutritional Sceinces, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Bridve Sivakumar
- Faculty of Health Science, Ontario Tech University, Oshawa, ON, Canada
| | | | - Rachael McLean
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9016, New Zealand.
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Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Johnson E, Crandall CG. Six months of unsupervised exercise training lowers blood pressure during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries. J Appl Physiol (1985) 2022; 133:742-754. [PMID: 35952345 PMCID: PMC9484988 DOI: 10.1152/japplphysiol.00181.2022] [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: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Exercise training reduces cardiovascular disease risk, partly due to arterial blood pressure (BP) lowering at rest and during fixed-load exercise. However, it is unclear whether exercise training can reduce BP at rest and during exercise in adults with well-healed burn injuries. Therefore, the purpose of this investigation was to test the hypothesis that 6 mo of unsupervised exercise training reduces BP at rest and during lower-body cycle ergometry in adults with well-healed burn injuries. Thirty-nine adults (28 with well-healed burn injuries and 11 controls) completed 6 mo of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we measured BP at rest, during fixed-load submaximal exercise (50 and 75 W), during fixed-intensity submaximal exercise (40% and 70% of V̇o2peak), and during maximal exercise on a lower-body cycle ergometer. We compared cardiovascular variables using two-way ANOVA (group × pre/postexercise training [repeated factor]). Adults with well-healed burn injuries had higher diastolic BP at rest (P = 0.04), which was unchanged by exercise training (P = 0.26). Exercise training reduced systolic, mean, and diastolic BP during fixed-load cycling exercise at 75 W in adults with well-healed burn injuries (P ≤ 0.03 for all), but not controls (P ≥ 0.67 for all). Exercise training also reduced mean and diastolic BP during exercise at 40% (P ≤ 0.02 for both), but not at 70% (P ≥ 0.18 for both), of V̇o2peak. These data suggest that a 6-mo unsupervised exercise training program lowers BP during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries.NEW & NOTEWORTHY Adults with well-healed burn injuries have greater cardiovascular disease morbidity and all-cause mortality compared with nonburn-injured adults. We found that exercise training reduced blood pressure (BP) during fixed-load cycling at 75 W and during moderate, but not vigorous, intensity cycling exercise in adults with well-healed burn injuries. These data suggest that 6 mo of unsupervised exercise training provides some degree of cardioprotection by reducing BP responses during submaximal exercise in well-healed burn-injured adults.
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Affiliation(s)
- Joseph C Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida
| | - Steven A Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
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Migdal KU, Robinson AT, Watso JC, Babcock MC, Lennon SL, Martens CR, Serrador JM, Farquhar WB. A high salt meal does not impair cerebrovascular reactivity in healthy young adults. Physiol Rep 2021; 8:e14585. [PMID: 33038066 PMCID: PMC7547584 DOI: 10.14814/phy2.14585] [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: 05/13/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 01/11/2023] Open
Abstract
A high sodium (Na+) meal impairs peripheral vascular function. In rodents, chronic high dietary Na+ impairs cerebral vascular function, and in humans, habitual high dietary Na+ is associated with increased stroke risk. However, the effects of acute high dietary Na+ on the cerebral vasculature in humans are unknown. The purpose of this study was to determine if acute high dietary Na+ impairs cerebrovascular reactivity in healthy adults. Thirty‐seven participants (20F/17M; 25 ± 5 years; blood pressure [BP]: 107 ± 9/61 ± 6 mm Hg) participated in this randomized, cross‐over study. Participants were given a low Na+ meal (LSM; 138 mg Na+) and a high Na+ meal (HSM; 1,495 mg Na+) separated by ≥ one week. Serum Na+, beat‐to‐beat BP, middle cerebral artery velocity (transcranial Doppler), and end‐tidal carbon dioxide (PETCO2) were measured pre‐ (baseline) and 60 min post‐prandial. Cerebrovascular reactivity was assessed by determining the percent change in middle cerebral artery velocity to hypercapnia (via 8% CO2, 21% oxygen, balance nitrogen) and hypocapnia (via mild hyperventilation). Peripheral vascular function was measured using brachial artery flow‐mediated dilation (FMD). Changes in serum Na+ were greater following the HSM (HSM: Δ1.6 ± 1.2 mmol/L vs. LSM: Δ0.7 ± 1.2 mmol/L, p < .01). Cerebrovascular reactivity to hypercapnia (meal effect: p = .41) and to hypocapnia (meal effect: p = .65) were not affected by the HSM. Contrary with previous findings, FMD was not reduced following the HSM (meal effect: p = .74). These data suggest that a single high Na+ meal does not acutely impair cerebrovascular reactivity, and suggests that despite prior findings, a single high Na+ meal does not impair peripheral vascular function in healthy adults.
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Affiliation(s)
- Kamila U Migdal
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Austin T Robinson
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Joseph C Watso
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Matthew C Babcock
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Shannon L Lennon
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Christopher R Martens
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
| | - Jorge M Serrador
- Department of Pharmacology, Physiology & Neuroscience, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - William B Farquhar
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE, USA
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Del Vecchio JJ, Hosick PA, Matthews EL. Oral saline consumption and pressor responses to acute physical stress. Physiol Int 2020; 107:306-318. [PMID: 32667902 DOI: 10.1556/2060.2020.00018] [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: 12/13/2019] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
Sodium induced volume loading may alter pressor responses to physical stress, an early symptom of cardiovascular disease. PURPOSE Study 1: Determine the time point where total blood volume and serum sodium were elevated following saline consumption. Study 2: Examine the BP response to isometric handgrip (HG) and the cold pressor test (CPT) following saline consumption. METHODS Study 1: Eight participants drank 423 mL of normal saline (sodium 154 mmol/L) and had blood draws every 30 min for 3 h. Study 2: Sixteen participants underwent two randomized data collection visits; a control and experimental visit 90 min following saline consumption. Participants underwent 2 min of isometric HG, post exercise ischemia (PEI), and CPT. RESULTS Study 1: Total blood volume (3.8 ± 3.0 Δ%) and serum sodium (3.5 ± 3.6 Δ%) were elevated (P < 0.05) by the 90 min time point. Study 2: There were no differences in mean arterial pressure (MAP) during HG (EXP: 17.4 ± 8.2 ΔmmHg; CON: 19.1 ± 6.0 ΔmmHg), PEI (EXP: 16.9 ± 11.7 ΔmmHg; CON: 16.9 ± 7.8 ΔmmHg), or the CPT (EXP: 20.3 ± 10.8 ΔmmHg; CON: 20.9 ± 11.7 ΔmmHg) between conditions (P > 0.05). MAP recovery from the CPT was slower following saline consumption (1 min recovery: EXP; 15.7 ± 7.9 ΔmmHg, CON; 12.3 ± 8.9 ΔmmHg, P < 0.05). CONCLUSION Data showed no difference in cardiovascular responses during HG or the CPT between conditions. BP recovery was delayed by saline consumption following the CPT.
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Affiliation(s)
- J J Del Vecchio
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ, USA
| | - P A Hosick
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ, USA
| | - E L Matthews
- Department of Exercise Science and Physical Education, Montclair State University, Montclair, NJ, USA
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Smiljanec K, Mbakwe AU, Ramos-Gonzalez M, Pohlig RT, Lennon SL. Antioxidant cocktail following a high-sodium meal does not affect vascular function in young, healthy adult humans: a randomized controlled crossover trial. Nutr Res 2020; 79:13-22. [PMID: 32610254 DOI: 10.1016/j.nutres.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
Chronic high sodium intake is a risk factor for cardiovascular disease as it impairs vascular function through an increase in oxidative stress. The objective of this study was to investigate the acute effects of a high-sodium meal (HSM) and antioxidant (AO) cocktail on vascular function. We hypothesized that a HSM would impair endothelial function, and increase arterial stiffness and wave reflection, while ingestion of the AO cocktail would mitigate this response. Healthy adults ingested either an AO cocktail (vitamin C, E, alpha-lipoic acid) or placebo (PLA) followed by a HSM (1500 mg) in a randomized crossover blinded design. Blood pressure (BP), endothelial function (flow-mediated dilation; FMD) and measures of arterial stiffness (pulse wave velocity; PWV) and wave reflection (augmentation index; AIx) were made at baseline and 30, 60, 90, and 120 min after meal consumption. Forty-one participants (20M/21W; 24 ± 1 years; BMI 23.4 ± 0.4 kg/m2) completed the study. Mean BP increased at 120 min relative to 60 min (60 min: 79 ± 1; 120 min: 81 ± 1 mmHg; time effect P = .01) but was not different between treatments (treatment × time interaction P = .32). AIx decreased from baseline (time effect P < .001) but was not different between treatments (treatment × time interaction P = .31). PWV (treatment × time interaction, P = .91) and FMD (treatment × time interaction P = .65) were also not different between treatments. In conclusion, a HSM does not acutely impair vascular function suggesting young healthy adults can withstand the acute impact of sodium on the vasculature and therefore, the AO cocktail is not necessary to mitigate the response.
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Affiliation(s)
- Katarina Smiljanec
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | - Alexis U Mbakwe
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
| | | | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, STAR, Newark, DE.
| | - Shannon L Lennon
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE.
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Babcock MC, Robinson AT, Migdal KU, Watso JC, Martens CR, Edwards DG, Pescatello LS, Farquhar WB. High Salt Intake Augments Blood Pressure Responses During Submaximal Aerobic Exercise. J Am Heart Assoc 2020; 9:e015633. [PMID: 32406312 PMCID: PMC7660875 DOI: 10.1161/jaha.120.015633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background High sodium (Na+) intake is a widespread cardiovascular disease risk factor. High Na+ intake impairs endothelial function and exaggerates sympathetic reflexes, which may augment exercising blood pressure (BP) responses. Therefore, this study examined the influence of high dietary Na+ on BP responses during submaximal aerobic exercise. Methods and Results Twenty adults (8F/12M, age=24±4 years; body mass index 23.0±0.6 kg·m−2; VO2peak=39.7±9.8 mL·min−1·kg−1; systolic BP=111±10 mm Hg; diastolic BP=64±8 mm Hg) participated in this randomized, double‐blind, placebo‐controlled crossover study. Total Na+ intake was manipulated via ingestion of capsules containing either a placebo (dextrose) or table salt (3900 mg Na+/day) for 10 days each, separated by ≥2 weeks. On day 10 of each intervention, endothelial function was assessed via flow‐mediated dilation followed by BP measurement at rest and during 50 minutes of cycling at 60% VO2peak. Throughout exercise, BP was assessed continuously via finger photoplethysmography and every 5 minutes via auscultation. Venous blood samples were collected at rest and during the final 10 minutes of exercise for assessment of norepinephrine. High Na+ intake increased urinary Na+ excretion (placebo=140±68 versus Na+=282±70 mmol·24H−1; P<0.001) and reduced flow‐mediated dilation (placebo=7.2±2.4 versus Na+=4.2±1.7%; P<0.001). Average exercising systolic BP was augmented following high Na+ (placebo=Δ30.0±16.3 versus Na+=Δ38.3±16.2 mm Hg; P=0.03) and correlated to the reduction in flow‐mediated dilation (R=−0.71, P=0.002). Resting norepinephrine concentration was not different between conditions (P=0.82). Norepinephrine increased during exercise (P=0.002), but there was no Na+ effect (P=0.26). Conclusions High dietary Na+ augments BP responses during submaximal aerobic exercise, which may be mediated, in part, by impaired endothelial function.
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Affiliation(s)
- Matthew C Babcock
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE
| | - Austin T Robinson
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE.,School of Kinesiology Auburn University Auburn AL
| | - Kamila U Migdal
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE
| | - Joseph C Watso
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE
| | | | - David G Edwards
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE
| | | | - William B Farquhar
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE
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Caldwell JT, Sutterfield SL, Post HK, Lovoy GM, Banister HR, Turpin VRG, Colburn TD, Hammond SS, Copp SW, Ade CJ. Impact of high sodium intake on blood pressure and functional sympatholysis during rhythmic handgrip exercise. Appl Physiol Nutr Metab 2019; 45:613-620. [PMID: 31725319 DOI: 10.1139/apnm-2019-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High dietary sodium intake is a risk factor for arterial hypertension; given that the ability to overcome sympathetically mediated vasoconstriction (functional sympatholysis) is attenuated in individuals with hypertension, we investigated the cardiovascular responses to high salt (HS) intake in healthy humans. We hypothesized that a HS intake of 15 g/day for 7 days would attenuate functional sympatholysis and augment the blood pressure response to handgrip exercise (HGE). Thirteen participants (6 males, 7 females) underwent 2 individual days of testing. Beat-by-beat blood pressure and heart rate were recorded throughout the trial on the non-exercising limb. Forearm blood flow was derived from ultrasonography on the brachial artery of the exercising limb. Participants then underwent a flow-mediated dilation (FMD) test. Next, a submaximal HGE was performed for 7 min with lower body negative pressure initiated during minutes 5-7. A single spot urine sample revealed a significant increase in sodium excretion during the HS conditions (p < 0.01). FMD was reduced during the HS condition. Mean arterial pressure was significantly higher during HS intake. No alteration to functional sympatholysis was found between conditions (p > 0.05). In summary, HS intake increases blood pressure without impacting functional sympatholysis or blood pressure responsiveness during HGE. These findings indicate that brachial artery dysfunction precedes an inefficient functional sympatholysis. Novelty Functional sympatholysis was not impacted by 1 week of high sodium intake. High sodium intake augmented the rate pressure product during handgrip exercise in healthy humans.
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Affiliation(s)
- Jacob T Caldwell
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Shelbi L Sutterfield
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Hunter K Post
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Garrett M Lovoy
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Heather R Banister
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Vanessa-Rose G Turpin
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Trenton D Colburn
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Stephen S Hammond
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Steven W Copp
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA.,Department of Kinesiology, Kansas State University, Manhattan, KS 66506, USA
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