Overcoming the Hydrophobic Nature of Zinc Phenylacetate Through Co-Crystallization with Isonicotinamide

Zinc phenylacetate (Zn-PA), a substitute for sodium phenylacetate as an ammonia-scavenging drug is hydrophobic, which poses problems for drug dissolution and solubility. We were able to co-crystallize the zinc phenylacetate with isonicotinamide (INAM) and produce a novel crystalline compound (Zn-PA-INAM). The single crystal of this new crystal was obtained, and its structure is reported here for the first time. Zn-PA-INAM was characterized computationally by ab initio, Hirshfeld calculations, CLP-PIXEL lattice energy calculation, and BFDH morphology analysis, and experimentally by PXRD, Sc-XRD, FTIR, DSC, and TGA analyses. Structural and vibrational analyses showed a major modification in intermolecular interaction of Zn-PA-INAM compared to Zn-PA. The dispersion-based pi-stacking in Zn-PA is replaced by coulomb-polarization effect of hydrogen bonds. As a result, Zn-PA-INAM is hydrophilic, improving the wettability and powder dissolution of the target compound in an aqueous solution. Morphology analysis revealed, unlike Zn-PA, Zn-PA-INAM has polar groups exposed on its prominent crystalline faces, reducing the hydrophobicity of the crystal. The shift in average water droplet contact angle from 128.1° (Zn-PA) to 27.1° (Zn-PA-INAM) is strong evidence of a marked decrease in hydrophobicity of the target compound. Finally, HPLC was used to obtain the dissolution profile and solubility of Zn-PA-INAM compared to Zn-PA.

Evaluating the association between dietary salt intake and the risk of atrial fibrillation using Mendelian randomization

Background

Previous studies have suggested that dietary salt intake affects atrial fibrillation (AF); however, the causal association between them still remains unclear. Thus, we conducted this Mendelian randomization (MR) study to explore the correlation between them.

Methods

Genetic instruments for dietary salt intake were from a genome-wide association study (GWAS), which included 462,630 European individuals. Summary-level data for AF were obtained from another published GWAS (22,068 cases and 116,926 controls). The inverse-variance weighting (IVW) method was performed as the primary MR analysis. Multiple MR methods, including Robust Adjusted Profile Score (MR-RAPS), maximum likelihood estimation, and Mendelian randomization pleiotropy residual sum and outlier test (MR-PRESSO) were conducted as complementary analyses. The MR-Egger regression intercept and MR-PRESSO global test were conducted to test potential horizontal pleiotropy. The IVW (Q) method and MR-Egger were performed to detect heterogeneity.

Results

Our results suggested that high dietary salt intake was significantly correlated with increased risk of AF [IVW: odds ratio (OR), 1.36; 95% confidence interval (CI), 1.04–1.77; p = 2.25E-02]. The maximum likelihood estimation (OR, 1.37; 95% CI, 1.05–1.78; p = 2.09E-02), MR-RAPS (OR, 1.37; 95% CI, 1.03–1.81; p = 2.79E-02), and MR-PRESSO method (OR, 1.36; 95% CI, 1.05–1.76; p = 2.37E-02) also showed that dietary salt intake was significantly correlated with the risk of AF.

Conclusion

The findings of this study provide robust evidence supporting the correlation between dietary salt intake and the risk of AF. Future studies are required to further clarify this relationship and translate the findings into clinical and public health practice.

Association of 24-h urinary sodium excretion with microalbuminuria in a Chinese population

To assess the relationship of sodium, potassium and the ratio of sodium to potassium (Na/K) with albuminuria, a cross-sectional study was carried out in China in 2017. Sodium, potassium and albumin excretions were examined in a 24-h (h) urine sample collected from 1486 participants. Microalbuminuria was defined as 24-h urinary albumin excretion between 30 and 300 mg/24 h. The participants had an average age of 46.2 ± 14.1 years old, and 48.9% were men. The proportion of patients with microalbuminuria was 9.0%. As illustrated by the adjusted generalized linear mixed model, sodium concentration increased significantly with the increase in 24-h urinary albumin (β = 1.16, 95% confidence interval (CI) 0.38-1.93; P = 0.003). Multivariable-adjusted logistic regression analyses demonstrated that the odds ratio (OR) of microalbuminuria increased with the quartiles of sodium [OR = 2.20, 95% CI 1.26-3.84 (the maximum quartile vs. the minimum quartile), P_{for trend} = 0.006]. Potassium and the Na/K ratio did not have any association with outcome indicators. A high amount of sodium intake was potentially correlated with early renal function impairment.

The Novel AT2 Receptor Agonist β-Pro7-AngIII Exerts Cardiac and Renal Anti-Fibrotic and Anti-Inflammatory Effects in High Salt-Fed Mice

A high salt (HS) diet is associated with an increased risk for cardiovascular diseases (CVDs) and fibrosis is a key contributor to the organ dysfunction involved in CVDs. The activation of the renin angiotensin type 2 receptor (AT₂R) has been considered as organ protective in many CVDs. However, there are limited AT₂R-selective agonists available. Our first reported β-substituted angiotensin III peptide, β-Pro⁷-AngIII, showed high selectivity for the AT₂R. In the current study, we examine the potential anti-fibrotic and anti-inflammatory effects of this novel AT₂R-selective peptide on HS-induced organ damage. FVB/N mice fed with a 5% HS diet for 8 weeks developed cardiac and renal fibrosis and inflammation, which were associated with increased TGF-β1 levels in heart, kidney and plasma. Four weeks' treatment (from weeks 5-8) with β-Pro⁷-AngIII inhibited the HS-induced cardiac and renal fibrosis and inflammation. These protective effects were accompanied by reduced local and systemic TGF-β1 as well as reduced cardiac myofibroblast differentiation. Importantly, the anti-fibrotic and anti-inflammatory effects caused by β-Pro⁷-AngIII were attenuated by the AT₂R antagonist PD123319. These results demonstrate, for the first time, the cardio- and reno-protective roles of the AT₂R-selective β-Pro⁷-AngIII, highlighting it as an important therapeutic that can target the AT₂R to treat end-organ damage.

High-Salt Diet Impairs the Neurons Plasticity and the Neurotransmitters-Related Biological Processes

Salt, commonly known as sodium chloride, is an important ingredient that the body requires in relatively minute quantities. However, consuming too much salt can lead to high blood pressure, heart disease and even disruption of circadian rhythms. The biological process of the circadian rhythm was first studied in Drosophila melanogaster and is well understood. Their locomotor activity gradually increases before the light is switched on and off, a phenomenon called anticipation. In a previous study, we showed that a high-salt diet (HSD) impairs morning anticipation behavior in Drosophila. Here, we found that HSD did not significantly disrupt clock gene oscillation in the heads of flies, nor did it disrupt PERIOD protein oscillation in clock neurons or peripheral tissues. Remarkably, we found that HSD impairs neuronal plasticity in the axonal projections of circadian pacemaker neurons. Interestingly, we showed that increased excitability in PDF neurons mimics HSD, which causes morning anticipation impairment. Moreover, we found that HSD significantly disrupts neurotransmitter-related biological processes in the brain. Taken together, our data show that an HSD affects the multiple functions of neurons and impairs physiological behaviors.

Independent and interactive associations of dietary nitrate and salt intake with blood pressure and cognitive function: a cross-sectional analysis in the InCHIANTI study

Blood pressure (BP) control is a key target for interventions to reduce cognitive decline. This cross-sectional study explored associations between objective (24-hour urine excretion) and subjective (food frequency questionnaire [FFQ]) measures of dietary sodium and nitrate intakes with cognitive function and resting BP in the InCHIANTI cohort. Baseline data from 989 participants aged >50 years were included. In fully adjusted models, participants with concurrent high nitrate and low sodium (Odds Ratio (OR)=0.49, 95%CI 0.32-0.76, p = 0.001) and high nitrate and high sodium (OR = 0.49, 95%CI 0.32-0.77, p = 0.002) 24-hour urinary concentrations had lower odds of high BP than participants with low nitrate and high sodium concentrations. We found no significant associations between sodium and nitrate intakes (24-hour urinary concentrations and FFQ) and poor cognitive performance. Urinary nitrate excretion was associated with lower BP and results appeared to be independent of sodium intake. Further analyses in longitudinal studies are required to substantiate these findings.

Assessment of Sodium Knowledge and Urinary Sodium Excretion among Regions of the United Arab Emirates: A Cross-Sectional Study

Non-communicable diseases (NCDs) such as cardiovascular disease, cancer and diabetes, are increasing worldwide and cause 65% to 78% of deaths in the Gulf Cooperation Council (GCC). A random sample of 477 healthy adults were recruited in the United Arab Emirates (UAE) in the period March-June 2015. Demographic, lifestyle, medical, anthropometric and sodium excretion data were collected. A questionnaire was used to measure knowledge, attitude and practice regarding salt. Mean sodium and potassium excretion were 2713.4 ± 713 mg/day and 1803 ± 618 mg/day, respectively, significantly higher than the World Health Organization (WHO) recommendations for sodium (2300 mg/day) and lower for potassium (3150 mg/day). Two-thirds (67.4%) exceeded sodium guidelines, with males 2.6 times more likely to consume excessively. The majority of the participants add salt during cooking (82.5%) and whilst eating (66%), and 75% identified processed food as high source of salt. Most (69.1%) were aware that excessive salt could cause disease. Most of the UAE population consumes excess sodium and insufficient potassium, likely increasing the risk of NCDs. Despite most participants being aware that high salt intake is associated with adverse health outcomes, this did not translate into salt reduction action. Low-sodium, high-potassium dietary interventions such as the Mediterranean diet are vital in reducing the impact of NCDs in the UAE.

Neural Control and Modulation of Thirst, Sodium Appetite, and Hunger

The function of central appetite neurons is instructing animals to ingest specific nutrient factors that the body needs. Emerging evidence suggests that individual appetite circuits for major nutrients-water, sodium, and food-operate on unique driving and quenching mechanisms. This review focuses on two aspects of appetite regulation. First, we describe the temporal relationship between appetite neuron activity and consumption behaviors. Second, we summarize ingestion-related satiation signals that differentially quench individual appetite circuits. We further discuss how distinct appetite and satiation systems for each factor may contribute to nutrient homeostasis from the functional and evolutional perspectives.

A high-salt/high fat diet alters circadian locomotor activity and glucocorticoid synthesis in mice

Salt is an essential nutrient; however, excessive salt intake is a prominent public health concern worldwide. Various physiological functions are associated with circadian rhythms, and disruption of circadian rhythms is a prominent risk factor for cardiovascular diseases, cancer, and immune disease. Certain nutrients are vital regulators of peripheral circadian clocks. However, the role of a high-fat and high-salt (HFS) diet in the regulation of circadian gene expression is unclear. This study aimed to investigate the effect of an HFS diet on rhythms of locomotor activity, caecum glucocorticoid secretion, and clock gene expression in mice. Mice administered an HFS diet displayed reduced locomotor activity under normal light/dark and constant dark conditions in comparison with those administered a normal diet. The diurnal rhythm of caecum glucocorticoid secretion and the expression levels of glucocorticoid-related genes and clock genes in the adrenal gland were disrupted with an HFS diet. These results suggest that an HFS diet alters locomotor activity, disrupts circadian rhythms of glucocorticoid secretion, and downregulates peripheral adrenal gland circadian clock genes.

Sodium Intake and Target Organ Damage in Hypertension-An Update about the Role of a Real Villain

Salt intake is too high for safety nowadays. The main active ion in salt is sodium. The vast majority of scientific evidence points out the importance of sodium restriction for decreasing cardiovascular risk. International Guidelines recommend a large reduction in sodium consumption to help reduce blood pressure, organ damage, and cardiovascular risk. Regulatory authorities across the globe suggest a general restriction of sodium intake to prevent cardiovascular diseases. In spite of this seemingly unanimous consensus, some researchers claim to have evidence of the unhealthy effects of a reduction of sodium intake, and have data to support their claims. Evidence is against dissenting scientists, because prospective, observational, and basic research studies indicate that sodium is the real villain: actual sodium consumption around the globe is far higher than the safe range. Sodium intake is directly related to increased blood pressure, and independently to the enlargement of cardiac mass, with a possible independent role in inducing left ventricular hypertrophy. This may represent the basis of myocardial ischemia, congestive heart failure, and cardiac mortality. Although debated, a high sodium intake may induce initial renal damage and progression in both hypertensive and normotensive subjects. Conversely, there is general agreement about the adverse role of sodium in cerebrovascular disease. These factors point to the possible main role of sodium intake in target organ damage and cardiovascular events including mortality. This review will endeavor to outline the existing evidence.

Serelaxin and the AT2 Receptor Agonist CGP42112 Evoked a Similar, Nonadditive, Cardiac Antifibrotic Effect in High Salt-Fed Mice That Were Refractory to Candesartan Cilexetil

Fibrosis is involved in the majority of cardiovascular diseases and is a key contributor to end-organ dysfunction. In the current study, the antifibrotic effects of recombinant human relaxin-2 (serelaxin; RLX) and/or the AT₂R agonist CGP42112 (CGP) were compared with those of the established AT₁R antagonist, candesartan cilexetil (CAND), in a high salt-induced cardiac fibrosis model. High salt (HS; 5%) for 8 weeks did not increase systolic blood pressure in male FVB/N mice, but CAND treatment alone significantly reduced systolic blood pressure from HS-induced levels. HS significantly increased cardiac interstitial fibrosis, which was reduced by either RLX and/or CGP, which were not additive under the current experimental conditions, while CAND failed to reduce HS-induced cardiac fibrosis. The antifibrotic effects induced by RLX and/or CGP were associated with reduced myofibroblast differentiation. Additionally, all treatments inhibited the HS-induced elevation in tissue inhibitor of matrix metalloproteinases-1, together with trends for increased MMP-13 expression, that collectively would favor collagen degradation. Furthermore, these antifibrotic effects were associated with reduced cardiac inflammation. Collectively, these results highlight that either RXFP1 or AT₂R stimulation represents novel therapeutic strategies to target fibrotic conditions, particularly in HS states that may be refractory to AT₁R blockade.

Effect of urinary sodium-to-potassium ratio change on blood pressure in participants of the longitudinal health of adults study - ELSA-Brasil

To assess the effect of changing the sodium to potassium (Na/K) ratio on blood pressure at 4 years of follow-up.The measurements were carried out under identical conditions in two study periods (2008-2010 and 2012-2014). Urinary excretion of sodium and potassium (mmol/L) over 12 nocturnal hours was used to calculate the Na/K ratio and categorized by quintile. The 24-hour sodium and potassium intake was estimated using a validated equation. The mean BP was calculated from 3 measurements after 5 minutes of rest. Of the 15,105 participants at baseline, 14,014 completed the first follow-up. Participants without validated urine collection (n = 5,041), using antihypertensive medication (n = 3,860) at either time points or reporting bariatric surgery during follow-up (n = 45) were excluded. The differences between follow-up and baseline values were calculated for BP and the Na/K ratio. Analyses were stratified by sex and adjusted for confounding variables.Sodium intake did not change from baseline, but potassium intake increased by approximately 150 mg in both sexes (P < .001), with a consequent reduction of the Na/K ratio. The highest quintile of change in the Na/K ratio was associated with greater variation in BP. When adjusted for covariates, it is possible to observe an increase in SBP in women from the third quintile of the Na/K ratio, in men this increase was observed from the fourth quintile. However, for DBP this increase is observed from the third quintile in both men and women.Increase in SBP was observed in women from the third quintile of the Na/K ratio, in men this increase is observed from the fourth quintile. However, for DBP this increase is observed from the third quintile in both men and women. The Na/K ratio demonstrated a greater association in BP.

ST-segment elevation myocardial infarction

ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.

Double Whammy for Older Smokers: Marginalized by Tobacco Control and Valued by the Tobacco Industry

In the last 20 years, the United States has made stunning progress reducing the rate of adult smoking. However, the smallest reduction is among older adults. Compared to younger smokers, older smokers are more likely to be lower socioeconomic status (SES), have several tobacco related comorbidities, and are less likely to be treated for tobacco addiction yet, in tobacco policy, they are not considered a marginalized group. The tobacco industry's interest in older smokers contrasts with the lack of interest shown by tobacco control. A double whammy is a set of two bad events or situations that have an effect at the same time. The purposes of this article are to use the health disparity paradigm to (a) discuss the "double whammy" of marginalization by tobacco control and valuation by the tobacco industry on the health of older smokers and (b) provide strategies to promote health equity for older smokers.

Supplemental Nutrition Assistance Program participation and racial/ethnic disparities in food and beverage purchases

OBJECTIVE

The current study aimed to (i) describe racial/ethnic disparities in household food and beverage purchases among participants and non-participants in the Supplemental Nutrition Assistance Program (SNAP) and (ii) examine longitudinal associations between SNAP participation and purchases by race/ethnicity.

DESIGN

To describe disparities, we estimated sociodemographic-adjusted mean purchases of seven unhealthy food and beverage groups (e.g. junk food, sugar-sweetened beverages) and four nutrients (e.g. sugar, Na) among white, black and Hispanic SNAP-participating and non-participating households. To examine longitudinal associations, we used multivariable linear regression with household fixed effects.

SETTING

USA, 2010-2014.

SUBJECTS

Food and beverage purchases among low-income (≤250 % federal poverty line) US households (n 30 403) participating in the Nielsen Homescan Panel.

RESULTS

Among non-participants, there were significant black-white disparities (i.e. differences favouring white households) in households' adjusted mean purchases of processed meat, sweeteners, sugar-sweetened beverages, energy and Na. These disparities persisted among SNAP participants. In contrast, the only significant Hispanic-white disparity among non-participants was for Na purchases; this disparity was reduced in magnitude and no longer significant among SNAP-participating households. Additionally, Hispanic households purchased less energy from junk foods than white households, regardless of SNAP status. In longitudinal models accounting for household fixed effects, SNAP participation was associated with increased energy purchased among black households. No other significant longitudinal associations between SNAP and purchase outcomes were observed.

CONCLUSIONS

SNAP may not be meeting its potential to improve food and beverage purchases or reduce disparities. Research is needed to identify strategies for ensuring nutritious purchases across all racial/ethnic groups.

The multidimensional ionotropic receptors of Drosophila melanogaster

Ionotropic receptors (IRs), which form ion channels, can be categorized into conserved 'antennal IRs', which define the first olfactory receptor family of insects, and species-specific 'divergent IRs', which are expressed in gustatory receptor neurones. These receptors are located primarily in cell bodies and dendrites, and are highly enriched in the tips of the dendritic terminals that convey sensory information to higher brain centres. Antennal IRs play important roles in odour and thermosensation, whereas divergent IRs are involved in other important biological processes such as taste sensation. Some IRs are known to play specific biological roles in the perception of various molecules; however, many of their functions have not yet been defined. Although progress has been made in this field, many functions and mechanisms of these receptors remain unknown. In this review, we provide a comprehensive summary of the current state of knowledge in this field.

Dietary NaCl affects bleomycin-induced lung fibrosis in mice

PURPOSE

High levels of NaCl in the diet are associated with both cardiac and renal fibrosis, but whether salt intake affects pulmonary fibrosis has not been examined.

AIM OF THE STUDY

To test the hypothesis that salt intake might affect pulmonary fibrosis.

MATERIALS AND METHODS

Mice were fed low, normal, or high salt diets for 2 weeks, and then treated with oropharyngeal bleomycin to induce pulmonary fibrosis, or oropharyngeal saline as a control.

RESULTS

As determined by collagen staining of lung sections, and protein levels and cell numbers in the bronchoalveolar lavage (BAL) fluid at 21 days after bleomycin, the high salt diet did not exacerbate bleomycin-induced fibrosis, while the low salt diet attenuated fibrosis. For the bleomycin-treated mice, staining of the post-BAL lung sections indicated that compared to the regular salt diet, high salt increased the number of Ly6c-positive macrophages and decreased the number of CD11c and CD206-positive macrophages and dendritic cells. The low salt diet caused bleomycin-induced leukocyte numbers to be similar to control saline-treated mice, but reduced numbers of CD45/collagen-VI positive fibrocytes. In the saline controls, low dietary salt decreased CD11b and CD11c positive cells in lung sections, and high dietary salt increased fibrocytes.

CONCLUSIONS

Together, these data suggest the possibility that a low salt diet might attenuate pulmonary fibrosis.

Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease

The CRISP study of polycystic kidney disease (PKD) found that urinary sodium excretion associated with the rate of total kidney volume increase. Whether sodium restriction slows the progression of Autosomal Dominant PKD (ADPKD) is not known. To evaluate this we conducted a post hoc analysis of the HALT-PKD clinical trials of renin-angiotensin blockade in patients with ADPKD. Linear mixed models examined whether dietary sodium affected rates of total kidney volume or change in estimated glomerular filtration rate (eGFR) in patients with an eGFR over 60 ml/min/1.73 m² (Study A) or the risk for a composite endpoint of 50% reduction in eGFR, end-stage renal disease or death, or the rate of eGFR decline in patients with an eGFR 25-60 ml/min/1.73 m² (Study B) all in patients initiated on an under100 mEq sodium diet. During the trial urinary sodium excretion significantly declined by an average of 0.25 and 0.41 mEq/24 hour per month in studies A and B, respectively. In Study A, averaged and time varying urinary sodium excretions were significantly associated with kidney growth (0.43%/year and 0.09%/year, respectively, for each 18 mEq urinary sodium excretion). Averaged urinary sodium excretion was not significantly associated with faster eGFR decline (-0.07 ml/min/1.73m²/year for each 18 mEq urinary sodium excretion). In Study B, the averaged but not time-varying urinary sodium excretion significantly associated with increased risk for the composite endpoint (hazard ratio 1.08 for each 18 mEq urinary sodium excretion) and a significantly faster eGFR decline (-0.09 ml/min/1.73m²/year for each mEq 18 mEq urinary sodium excretion). Thus, sodium restriction is beneficial in the management of ADPKD.

Factors Affecting Hypertension among the Malaysian Elderly

Hypertension is a common chronic disease in the elderly. This study aimed to determine the effects of age, ethnicity, gender, education, marital status, nutritional parameters, and blood elements on the risk of high blood pressure in the Malaysian elderly. This research was conducted on a group of 2322 non-institutionalized Malaysian elderly. The hierarchy binary logistic regression analysis was applied to estimate the risk of hypertension in respondents. Approximately, 45.61% of subjects had hypertension. The findings indicated that the female gender (Odds ratio (OR) = 1.54), an increase in body weight (OR = 1.61), and an increase in the blood levels of albumin (OR = 1.51), glucose (OR = 1.92), and triglycerides (OR = 1.27) significantly increased the risk of hypertension in subjects (p < 0.05). Conversely, an increase in both dietary carbohydrates (OR = 0.74), and blood cholesterol level (OR = 0.42) significantly reduced the risk of hypertension in samples (p < 0.05). Furthermore, the results showed that ethnicity was a non-relevant factor to increase the risk of hypertension in subjects. It was concluded that female gender, an increase in body weight, and an increase in the blood levels of glucose, triglycerides, and albumin enhanced the risk of high blood pressure in the Malaysian elderly. In addition, an increase in both dietary carbohydrates and blood cholesterol level decreased hypertension in subjects.

The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management

Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems.

No short-term effects of calorie-controlled Mediterranean or fast food dietary interventions on established biomarkers of vascular or metabolic risk in healthy individuals

BACKGROUND/OBJECTIVES

This study addressed the question whether the composition of supposedly 'healthy' or 'unhealthy' dietary regimes has a calorie-independent short-term effect on biomarkers of metabolic stress and vascular risk in healthy individuals.

SUBJECTS/METHODS

Healthy male volunteers (age 29.5 ± 5.9 years, n = 39) were given a standardized baseline diet for two weeks before randomization into three groups of different dietary regimes: fast food, Mediterranean and German cooking style. Importantly, the amount of calories consumed per day was identical in all three groups. Blood samples were analyzed for biomarkers of cardiovascular risk and metabolic stress after two weeks of the baseline diet and after two weeks of the assigned dietary regime.

RESULTS

No dietary intervention affected the metabolic or cardiovascular risk profile when compared in-between groups or compared to baseline. Subjects applied to the Mediterranean diet showed a statistically significant increase of uric acid compared to baseline and compared to the German diet group. Plasma concentrations of urea were significantly higher in both the fast food group and the Mediterranean group, when compared to baseline and compared to the German diet group. No significant differences were detected for the levels of vitamins, trace elements or metabolic stress markers (8-hydroxy-2-deoxyguanosine, malondialdehyde and methylglyoxal, a potent glycating agent). Established parameters of vascular risk (e.g. LDL-cholesterol, lipoprotein(a), homocysteine) were not significantly changed in-between groups or compared to baseline during the intervention period.

CONCLUSIONS

The calorie-controlled dietary intervention caused neither protective nor harmful short-term effects regarding established biomarkers of vascular or metabolic risk. When avoiding the noxious effects of overfeeding, healthy individuals can possess the metabolic capacity to compensate for a potentially disadvantageous composition of a certain diet.

[Eating habits in the prevention of cardiovascular diseases and associated factors in elderly hypertensive individuals]

Cardiovascular diseases are the leading cause of death and disability in the elderly. In this study, healthy eating habits and associated factors in the prevention of cardiovascular disease in elderly hypertensive individuals were identified. It involved a cross-sectional study gathering primary data in a family health unit in a city in the interior of the state of Rio Grande do Sul and 212 elderly hypertensive individuals participated in the study. A higher prevalence among the lower age bracket of elderly individuals, female, with little schooling and low income was revealed. Healthy eating habits among the elderly hypertensive individuals assessed are below those recommended in the prevention of cardiovascular disease. Social and economic factors, health characteristics and the use of health services influenced the adoption of healthy eating habits. The results of this study suggest that elderly hypertensive individuals find it difficult to adopt healthy eating habits. This contributes further to the definition of strategies for routine prevention and control of cardiovascular diseases in the elderly.

Cardiovascular effects of dietary salt intake in aged healthy cats: a 2-year prospective randomized, blinded, and controlled study

High salt dry expanded diets are commercially available for cats to increase water intake and urine volume, as part of the prevention or treatment of naturally occurring urinary stone formation (calcium oxalates and struvites). However, chronic high salt intake may have potential cardiovascular adverse effects in both humans, especially in aging individuals, and several animal models. The objective of this prospective, randomized, blinded, and controlled study was to assess the long-term cardiovascular effects of high salt intake in healthy aged cats. Twenty healthy neutered cats (10.1±2.4 years) were randomly allocated into 2 matched groups. One group was fed a high salt diet (3.1 g/Mcal sodium, 5.5 g/Mcal chloride) and the other group a control diet of same composition except for salt content (1.0 g/Mcal sodium, 2.2 g/Mcal chloride). Clinical examination, systolic and diastolic arterial blood pressure measurements, standard transthoracic echocardiography and conventional Doppler examinations were repeatedly performed on non-sedated cats by trained observers before and over 24 months after diet implementation. Radial and longitudinal velocities of the left ventricular free wall and the interventricular septum were also assessed in systole and diastole using 2-dimensional color tissue Doppler imaging. Statistics were performed using a general linear model. No significant effect of dietary salt intake was observed on systolic and diastolic arterial blood pressure values. Out of the 33 tested imaging variables, the only one affected by dietary salt intake was the radial early on late diastolic velocity ratio assessed in the endocardium of the left ventricular free wall, statistically lower in the high salt diet group at 12 months only (P = 0.044). In conclusion, in this study involving healthy aged cats, chronic high dietary salt intake was not associated with an increased risk of systemic arterial hypertension and myocardial dysfunction, as observed in some elderly people, salt-sensitive patients and animal models.

[Factors associated with the addition of salt to prepared food]

The scope of this research was to investigate the potential differences between men and women in the addition of salt to prepared food. The study included 47,557 individuals aged 18 to 64 participating in the Risk and Protection Factors for Chronic Disease Surveillance System by Telephone Interview carried out in 26 Brazilian state capitals and the Federal District in 2006. Differences between men and women were tested by the chi-square test and the association magnitudes between the dependent and independent variables were estimated by the Odds Ratio obtained by Multiple Logistic Regression analysis. The prevalence of the addition of salt to prepared food was 8.3%, being higher among men (9,8% vs 6,9%, p < 0.01). After adjustment, the addition of salt to prepared food was higher in individuals with self-rated fair to poor health, reporting cardiovascular disease and living in the North of Brazil. Hypertensive individuals reported addition of less salt to prepared food. Educational level was not associated with salt usage. Men add more salt than women. Public health policies aimed at reducing salt intake by the population should take into account the gender differences in salt intake and the factors that contribute to such differences.

Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

OBJECTIVE

The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.

DESIGN

We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject Eleven prospective studies with 229 785 participants and average follow-up period of 13.37 years (range 5.5-19 years).

RESULTS

Higher Na intake was significantly associated with higher CVD mortality (relative risk=1.12; 95 % CI 1.06, 1.19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1.08; 95 % CI 1.01, 1.15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0.016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.

CONCLUSIONS

Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

Recent economic evaluations of interventions to prevent cardiovascular disease by reducing sodium intake

Excess intake of sodium, a common problem worldwide, is associated with hypertension and cardiovascular disease (CVD), and hypertension is a major risk factor for CVD. Population-wide efforts to reduce sodium intake have been identified as a promising strategy for preventing hypertension and CVD, and such initiatives are currently recommended by a variety of scientific and public health organizations. By reviewing the literature published from January 2011 to March 2013, we summarized recent economic analyses of interventions to reduce sodium intake. The evidence, derived from estimates of resultant blood pressure decreases and thus decreases in the incidence of CVD events, supports population-wide interventions for reducing sodium intake. Both lowering the salt content in manufactured foods and conducting mass media campaigns at the national level are estimated to be cost-effective in preventing CVD. Although better data on the cost of interventions are needed for rigorous economic evaluations, population-wide sodium intake reduction can be a promising approach for containing the growing health and economic burden associated with hypertension and its sequelae.

A review of settings-based health promotion with applications to sports clubs

Sports clubs have a long and traditional history in many countries, yet they remain underdeveloped and underutilized settings for health promotion. Leisure time settings, in general, have been in minor role among settings-based health promotion initiatives. Current health concerns in western countries, such as sedentary lifestyles and obesity, have aroused a need to expand health promotion to include also settings with greater potential to reach and engage children and adolescents in more vigorous activity. To develop these alternative, most often non-institutional, settings to the level of the established ones, it is important to review what has been done, what has been accepted and what is known from research, theory and practice to have contributed to health. Given that settings approaches have been implemented with diverse scope and without close cooperation between different initiatives, the first aim of this paper is, on the basis of a review of commonly used theories and practices, to propose a mutual definition for the settings approach to health promotion. The second is to examine the applicability of the theoretical basis to youth sports club settings. Sports clubs are used as a reflective setting when reviewing the traditional ones.

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

Strong leadership from heads of state is needed to meet national commitments to the UN political declaration on non-communicable diseases (NCDs) and to achieve the goal of a 25% reduction in premature NCD mortality by 2025 (the 25 by 25 goal). A simple, phased, national response to the political declaration is suggested, with three key steps: planning, implementation, and accountability. Planning entails mobilisation of a multisectoral response to develop and support the national action plan, and to build human, financial, and regulatory capacity for change. Implementation of a few priority and feasible cost-effective interventions for the prevention and treatment of NCDs will achieve the 25 by 25 goal and will need only few additional financial resources. Accountability incorporates three dimensions: monitoring of progress, reviewing of progress, and appropriate responses to accelerate progress. A national NCD commission or equivalent, which is independent of government, is needed to ensure that all relevant stakeholders are held accountable for the UN commitments to NCDs.

Mortality benefits from US population-wide reduction in sodium consumption: projections from 3 modeling approaches

Computer simulations have been used to estimate the mortality benefits from population-wide reductions in dietary sodium, although comparisons of these estimates have not been rigorously evaluated. We used 3 different approaches to model the effect of sodium reduction in the US population over the next 10 years, incorporating evidence for direct effects on cardiovascular disease mortality (method 1), indirect effects mediated by blood pressure changes as observed in randomized controlled trials of antihypertension medications (method 2), or epidemiological studies (method 3).The 3 different modeling approaches were used to model the same scenarios: scenario A, gradual uniform reduction totaling 40% over 10 years; scenario B, instantaneous 40% reduction in sodium consumption sustained for 10 years to achieve a population-wide mean of 2200 mg/d; and scenario C, instantaneous reduction to 1500 mg sodium per day sustained for 10 years. All 3 methods consistently show a substantial health benefit for reductions in dietary sodium under each of the 3 scenarios tested. A gradual reduction in dietary sodium over the next decade (scenario A) as might be achieved with a range of proposed public health interventions would yield considerable health benefits over the next decade, with mean effects across the 3 models ranging from 280 000 to 500 000 deaths averted. Projections of instantaneous reductions illustrate the maximum benefits that could be achieved (0.7-1.2 million deaths averted in 10 years). Under 3 different modeling assumptions, the projected health benefits from reductions in dietary sodium are substantial.

Scaling up chronic disease prevention interventions in lower- and middle-income countries

Chronic diseases are increasingly becoming a health burden in lower- and middle-income countries, putting pressure on public health efforts to scale up interventions. This article reviews current efforts in interventions on a population and individual level. Population-level interventions include ongoing efforts to reduce smoking rates, reduce intake of salt and trans-fatty acids, and increase physical activity in increasingly sedentary populations. Individual-level interventions include control and treatment of risk factors for chronic diseases and secondary prevention. This review also discusses the barriers in interventions, particularly those specific to low- and middle-income countries. Continued discussion of proven cost-effective interventions for chronic diseases in the developing world will be useful for improving public health policy.

[Hungarian Diet and Nutritional Status Survey - the OTAP2009 study. IV. Macroelement intake of the Hungarian population]

The adequate intake of minerals is basically important for healthy nutrition.

AIM AND METHOD

The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present publication describes the macroelement intake.

RESULTS

The salt intake is unusually high (17.2 g in men and 12.0 g in women), the potassium intake remains well below the recommendation. These factors substantially increase the risk of cardiovascular diseases including high blood-pressure. The calcium intake stays below the recommendation except in the youngest males, the oldest men and women are at risk from this point of view. While magnesium intake suited the recommendation, the intake of phosphorus exceeded it twice.

CONCLUSIONS

Focusing on marcroelements, high sodium/salt intake represents the highest public health risk. The implementation of STOP SALT! National Salt Reducing Programme, i.e. decrease the salt content of processed food and provide proper information to the population about excessive salt consumption, should result in a beneficial change of salt intake and ameliorate the public health conditions.

The development of salty taste acceptance is related to dietary experience in human infants: a prospective study

BACKGROUND

Sodium intake is related to hypertension and other diseases, but little is known about the early development of salty taste acceptance.

OBJECTIVE

The prospective study asked whether dietary experience with foods containing sodium is associated with development of infant salty taste preference.

DESIGN

Infants (n = 61) were tested at 2 and 6 mo to assess their response to 0.17 and 0.34 mol NaCl/L in water. Intake tests consisted of randomized double-blind 120-s exposure to salt solutions and water. Acceptance, calculated as solution intake relative to water, was examined as a function of exposure to starchy table food-a significant source of sodium. Dietary exposure (yes or no) was defined by maternal report. As a control, similar comparisons were based on exposure to fruit table food. A subset of 26 subjects returned at 36-48 mo for assessment of salty taste hedonics and preference.

RESULTS

Dietary experience was related to salt acceptance, with only those infants previously exposed to starchy table foods (n = 26) preferring the salty solutions at 6 mo (P = 0.007). Fruit exposure was not associated with sodium chloride acceptance. Infants eating starchy table foods at 6 mo were more likely to lick salt from the surface of foods at preschool age (P = 0.007) and tended to be more likely to eat plain salt (P = 0.08).

CONCLUSIONS

The findings suggest an influential role of early dietary experience in shaping salty taste responses of infants and young children.

Cardiovascular disease: rise, fall, and future prospects

Cardiovascular disease (CVD) became the leading cause of chronic disease morbidity and mortality in industrialized countries in the twentieth century. In many nations, it peaked and began to decline, while in developing countries it is rising. The contributions of risk factors, sociocultural changes, and medical care are debated, but all play a role in understanding these disease patterns. Public health approaches such as dietary change along with widespread use of medications such as aspirin, statins, diuretics, and beta-blockers may impact future trends in this chronic disease epidemic.