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Tartière J, Roubille F, Salvat M, Damy T, Beauvais F, Berthelot E, Lamblin N, Kesri‐Tartière L. Salt substitute recommendations for heart failure patients may influence guideline-directed medical therapies titration. ESC Heart Fail 2024; 11:2455-2459. [PMID: 38783593 PMCID: PMC11287297 DOI: 10.1002/ehf2.14706] [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: 01/16/2023] [Revised: 12/28/2023] [Accepted: 01/18/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS Reducing sodium intake is necessary for patients with chronic heart failure (CHF). Salt substitutes (saltSubs) have become increasingly popular as recommendations by healthcare professionals (HCPs) as well as options for patients and their caregivers. However, their consumption is generally potassium based and remains poorly evaluated in CHF management. Their impact on guideline-directed medical therapies (GDMTs) also remains unknown. The primary objective of this study was to provide a description and estimate of HCP recommendations and reported use of saltSubs in France. Secondary objectives were to identify if there was an association between these recommendations by HCPs and the use of GDMTs. METHODS AND RESULTS A nationwide, questionnaire-based, cross-sectional, epidemiological study was conducted from September 2020 to July 2021. Data collection included baseline characteristics, the use and recommendations of saltSubs, and the use of GDMTs, which included (i) angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNis), (ii) mineralocorticoid receptor antagonists (MRAs), and/or (iii) beta-blockers (BBs). In total, 13% of HCPs advised saltSubs and 17% of patients and 22% of caregivers reported their consumption. CHF patients advised to take saltSubs did not differ in terms of left ventricular ejection fraction (EF) <40%, ischaemic origin, and New York Heart Association III-IV class, but were more recently hospitalized for acute HF (P = 0.004). HCPs who recommended saltSubs to patients were more likely to advise an anti-diabetic diet (P < 0.001), cholesterol-lowering diet (P < 0.001), and exercise (P = 0.018). In the overall population, ACEi/ARB/ARNi use was less frequent in case of saltSub recommendations (74% vs. 82%, P = 0.012). The concomitant prescription of none, one, two, or three GDMTs was less favourable in case of saltSub recommendations (P = 0.046). There was no significant difference for the presence of MRA (56% vs. 58%) and/or BB (78% vs. 82%). The under-prescription of ACEi/ARB/ARNi was found when patients had EF < 40% (P = 0.029) and/or EF ≥ 40% (P = 0.043). In the subgroup with left ventricular EF ≥ 40%, we found a higher thiazide use (P = 0.014) and a less frequent use of low EF GDMTs (P = 0.044) in case of being recommended saltSubs. CONCLUSIONS Beyond the well-established risk for hyperkalaemia, our preliminary results suggest a potentially negative impact of saltSubs on GDMT use, especially for ACEis/ARBs/ARNis in CHF management. saltSub recommendations and their availability from open sale outlets should be considered to avoid possible misuse or deference from GDMTs in the future. Informed advice to consumers should also be considered from HCPs or pharmacists.
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Affiliation(s)
| | - François Roubille
- University of Montpellier, INSERM, CNRS, CHU de MontpellierMontpellierFrance
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Aminde LN, Nugraheni WP, Mubasyiroh R, Rachmawati T, Dwirahmadi F, Martini S, Kusumawardani N, Veerman JL. Cost-effectiveness analysis of low-sodium potassium-rich salt substitutes in Indonesia: an equity modelling study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100432. [PMID: 39081840 PMCID: PMC11287158 DOI: 10.1016/j.lansea.2024.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 03/30/2024] [Accepted: 05/22/2024] [Indexed: 08/02/2024]
Abstract
Background Evidence suggests low-sodium potassium-rich salt substitutes (LSSS) are effective in reducing blood pressure (BP). However, the health and economic impacts of LSSS in Indonesia are currently unknown. Methods We developed a proportional multistate lifetable Markov model to assess a government-led strategy implementing the use of LSSS compared to current regular salt consumption. BP data were derived from the Indonesian Basic Health Research Survey (RISKESDAS 2018), while epidemiological data were from the Global Burden of Disease 2019 study. We estimated implementation costs and the impact of changes in BP on disease events and healthcare costs, and incremental cost-effectiveness ratios. Outcomes were simulated over different time horizons for the 2019 Indonesian population overall, and by income quintiles. Probabilistic sensitivity analysis was done to capture uncertainty. Findings Over the first 10 years, LSSS could prevent 1.5 million non-fatal cardiovascular disease (CVD) events (8.3%-19.4% reduction) and 643,000 incident chronic kidney disease (CKD) cases (8.2% reduction), while averting over 200,000 CVD and CKD deaths (0.2%-5.2% reduction). This translated to over 24.6 million health-adjusted life years (HALYs) gained over the lifetime of the population, and reduced CVD-related health inequalities (concentration index, -0.075, 95% CI: -0.088 to -0.062). Implementation cost (US$ 1.2 billion [IDR 17.2 trillion] total; US$ 4.5 [IDR 63,665] per capita, as of July 2019) was outweighed by the net health expenditure savings (∼US$ 2 billion [IDR 27.7 trillion] total; US$ 7.3 [IDR 103,300] per capita) in the first 10 years. LSSS were cost-saving over the lifetime, and very cost-effective even with a high LSSS price. Interpretation Scaling the use of LSSS nationally could be a cost-saving strategy to prevent substantial cardiovascular and kidney disease burden in Indonesia. Funding Griffith University Postdoctoral Fellowship.
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Affiliation(s)
- Leopold Ndemnge Aminde
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Wahyu Pudji Nugraheni
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Rofingatul Mubasyiroh
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Tety Rachmawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Febi Dwirahmadi
- Centre for Environment and Population Health, School of Medicine & Dentistry, Griffith University, Gold Coast, Australia
| | - Santi Martini
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Nunik Kusumawardani
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - J Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
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Yu J, Houston L, Gianacas C, Lee V, Fletcher RA, Chen AX, Arnott C. Knowledge, attitudes, and behaviors related to dietary salt intake and the acceptability of salt substitute among the Australian culturally and linguistically diverse community: An online survey. J Clin Hypertens (Greenwich) 2024; 26:543-552. [PMID: 38563696 PMCID: PMC11088427 DOI: 10.1111/jch.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
The Australian culturally and linguistically diverse (CALD) communities may be at higher risk of salt intake than recommended given the use of a combination of discretionary sources and exposure to processed foods within a western country. This survey aimed to understand the knowledge, attitudes, and behaviors toward dietary salt and the acceptability of salt substitutes in the CALD communities. An online cross-sectional survey was conducted among adults who self-reported being a part of a CALD community, which was defined as non-Indigenous cultural groups in Australia having cultural or linguistic connections with their overseas place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. A total of 218 respondents opened the survey link. A total of 196 completed the entire survey. The majority of respondents (162, 83%) were aware that high salt intake causes serious health problems. Altogether 134 (69%) respondents were aware that there is a recommended amount for daily salt consumption although only 59 (44%) knew precise recommendations as <5 g salt per day. Around one quarter of the respondents rarely or never looked for ‟low in salt'' or ‟reduced salt'' messages on food labels when shopping. Over half specified they always or often added salt during cooking or preparing foods in the household. Almost 4 in 5 CALD respondents were willing to reduce their salt intake for health and 3 in 4 were open to trying a salt substitute. Further research into the utility of a salt substitute intervention in the Australian CALD community is warranted.
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Affiliation(s)
- Jie Yu
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lauren Houston
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Chris Gianacas
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
- School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Vivian Lee
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Robert A. Fletcher
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Angela Xun‐Nan Chen
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Clare Arnott
- The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
- Faculty of Medicine and HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Sydney Medical SchoolUniversity of SydneySydneyAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
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Xu X, Zeng L, Jha V, Cobb LK, Shibuya K, Appel LJ, Neal B, Schutte AE. Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines. Hypertension 2024; 81:400-414. [PMID: 38284271 PMCID: PMC10863666 DOI: 10.1161/hypertensionaha.123.21343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension-potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.
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Affiliation(s)
- Xiaoyue Xu
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Ling Zeng
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India (V.J.)
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
- Prasanna School of Public Health, Manipal Academy of Higher Education, India (V.J.)
| | | | | | - Lawrence J. Appel
- Department of Epidemiology, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.)
| | - Bruce Neal
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- School of Public Health, Imperial College London, United Kingdom (V.J., B.N.)
| | - Aletta E. Schutte
- School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
- Department of Paediatrics, Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (A.E.S)
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Martín-Riobóo E, Turégano-Yedro M, Banegas JR. Evidence on the use of alternative substances and therapies in hypertension. HIPERTENSION Y RIESGO VASCULAR 2024; 41:40-57. [PMID: 38123388 DOI: 10.1016/j.hipert.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Review of some of the best-known biological and non-biological complementary/alternative therapies/medicines (CAM) and their relationship with blood pressure (BP) and hypertension (HT). SEARCH STRATEGY Narrative review assessing a recent series of systematic reviews, meta-analyses, and clinical trials published in recent years, focusing on the effects of CAM on BP and HT. SELECTION OF STUDIES We searched EMBASE, MEDLINE, Cochrane Library and Google Scholar, obtaining a total of 4336 articles, finally limiting the search to 181 after applying filters. SYNTHESIS OF RESULTS Some studies on biological therapies show some usefulness in BP reduction with an adequate benefit-risk balance, although there is a scarcity of high-quality trials that support these results. Some mind-body therapies have shown hypothetical benefit; in contrast, others lack robust evidence. CONCLUSIONS Although some therapies present a reasonable risk-benefit ratio, they should in no case replace pharmacological treatment when indicated.
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Affiliation(s)
- E Martín-Riobóo
- Especialista en Medicina Familiar y Comunitaria, UGC Poniente, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, IMIBIC, Hospital Reina Sofía Córdoba, Spain.
| | - M Turégano-Yedro
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Casar de Cáceres, Cáceres, Spain
| | - J R Banegas
- Especialista en Medicina Preventiva y Salud Pública, Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPaz y CIBERESP, Madrid, Spain
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Wang Q, Schäfer SC, Haefliger JA, Maillard MP, Alonso F. Dietary Potassium Supplementation Reduces Chronic Kidney Lesions Independent of Blood Pressure in Deoxycorticosterone-Acetate and High Sodium Chloride-Treated Mice. Int J Mol Sci 2023; 24:16858. [PMID: 38069178 PMCID: PMC10705941 DOI: 10.3390/ijms242316858] [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: 08/31/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 12/18/2023] Open
Abstract
We have previously shown that an excess of deoxycorticosterone acetate and high sodium chloride intake (DOCA/salt) in one-renin gene mice induces a high urinary Na/K ratio, hypokalemia, and cardiac and renal hypertrophy in the absence of hypertension. Dietary potassium supplementation prevents DOCA/salt-induced pathological processes. In the present study, we further study whether DOCA/salt-treated mice progressively develop chronic inflammation and fibrosis in the kidney and whether dietary potassium supplementation can reduce the DOCA/salt-induced renal pathological process. Results showed that (1) long-term DOCA/salt-treated one-renin gene mice developed severe kidney injuries including tubular/vascular hypertrophy, mesangial/interstitial/perivascular fibrosis, inflammation (lymphocyte's immigration), proteinuria, and high serum creatinine in the absence of hypertension; (2) there were over-expressed mRNAs of plasminogen activator inhibitor-1 (PAI-1), fibronectin, collagen type I and III, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP1), transforming growth factor-β (TGF-β), tumor necrosis factor-alpha (TNF-α), osteopontin, Nuclear factor kappa B (NF-κB)/P65, and intercellular adhesion molecule (ICAM)-1; and (3) dietary potassium supplementation normalized urinary Na/K ratio, hypokalemia, proteinuria, and serum creatinine, reduced renal hypertrophy, inflammations, and fibrosis, and down-regulated mRNA expression of fibronectin, Col-I and III, TGF-β, TNF-α, osteopontin, and ICAM without changes in the blood pressure. The results provide new evidence that potassium and sodium may modulate proinflammatory and fibrotic genes, leading to chronic renal lesions independent of blood pressure.
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Affiliation(s)
- Qing Wang
- Division of Nephrology and Hypertension, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland;
| | - Stephan C. Schäfer
- Institute for Pathology, Uniklink Köln, Kerpener Strasse 62, 50937 Köln, Germany;
| | - Jacques-Antoine Haefliger
- Department of Biomedical Sciences, Faculty of Biology and Medicine, Lausanne University, Bugnon 7a, 1005 Lausanne, Switzerland;
| | - Marc P. Maillard
- Division of Nephrology and Hypertension, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland;
| | - Florian Alonso
- BioTis, Université de Bordeaux, INSERM U1026, 146 Rue Léo Saignat, 33076 Bordeaux, Cedex, France;
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Kettritz R, Loffing J. Potassium homeostasis - Physiology and pharmacology in a clinical context. Pharmacol Ther 2023; 249:108489. [PMID: 37454737 DOI: 10.1016/j.pharmthera.2023.108489] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Membrane voltage controls the function of excitable cells and is mainly a consequence of the ratio between the extra- and intracellular potassium concentration. Potassium homeostasis is safeguarded by balancing the extra-/intracellular distribution and systemic elimination of potassium to the dietary potassium intake. These processes adjust the plasma potassium concentration between 3.5 and 4.5 mmol/L. Several genetic and acquired diseases but also pharmacological interventions cause dyskalemias that are associated with increased morbidity and mortality. The thresholds at which serum K+ not only associates but also causes increased mortality are hotly debated. We discuss physiologic, pathophysiologic, and pharmacologic aspects of potassium regulation and provide informative case vignettes. Our aim is to help clinicians, epidemiologists, and pharmacologists to understand the complexity of the potassium homeostasis in health and disease and to initiate appropriate treatment strategies in dyskalemic patients.
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Affiliation(s)
- Ralph Kettritz
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Germany.
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Shivashankar R, Sharma M, Sharma M, Bhardwaj S, Ide N, Cobb L, Bhargava B. India's tryst with salt: Dandi march to low sodium salts. Indian J Med Res 2023; 158:233-243. [PMID: 37861622 PMCID: PMC10720971 DOI: 10.4103/ijmr.ijmr_1059_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 10/21/2023] Open
Abstract
Salt plays a critical role in India's past as well as its present, from Dandi March to its role as a vehicle for micronutrient fortification. However, excess salt intake is a risk factor for high blood pressure and cardiovascular diseases (CVDs). Indians consume double the World Health Organization recommended daily salt (<5 g). India has committed to a 30 per cent reduction in sodium intake by 2025. Evidence based strategies for population sodium intake reduction require a moderate reduction in salt in - home cooked foods, packaged foods and outside-home foods. Reducing the sodium content in packaged food includes policy driven interventions such as front-of-package warning labels, food reformulation, marketing restrictions and taxation on high sodium foods. For foods outside of the home, setting standards for foods purchased and served by schemes like mid-day meals can have a moderate impact. For home cooked foods (the major source of sodium), strategies include advocacy for reducing salt intake. In addition to mass media campaigns for awareness generation, substituting regular salt with low sodium salt (LSS) has the potential to reduce salt intake even in the absence of a major shift in consumer behaviour. LSS substitution effectively lowers blood pressure and thus reduces the risk of CVDs. Further research is required on the effect of LSS substitutes on patients with chronic kidney disease. India needs an integrated approach to sodium reduction that uses evidence based strategies and can be implemented sustainably at scale. This will be possible only through scientific research, governmental leadership and a responsive evidence-to-action approach through a multi-stakeholder coalition.
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Affiliation(s)
- Roopa Shivashankar
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Manika Sharma
- Resolve to Save Lives, All India Institute of Medical Sciences, New Delhi, India
| | - Meenakshi Sharma
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Swati Bhardwaj
- Resolve to Save Lives, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Balram Bhargava
- Cardiothoracic Science Centre, All India Institute of Medical Sciences, New Delhi, India
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Perera V, Allen LN, Farrand C, Kwong EJL, Liyanage I, Wickramasinghe K. Evaluating the role of salt intake in achieving WHO NCD targets in the Eurasian Economic Union: A PRIME modeling study. PLoS One 2023; 18:e0289112. [PMID: 37478108 PMCID: PMC10361522 DOI: 10.1371/journal.pone.0289112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
The World Health Organization has set clear global targets in reducing non-communicable disease mortality by 2030 in its sustainable development goals. This study models the number of deaths that could be averted if Eurasian Economic Union (EEU) member states met the target of reducing their population's current mean salt intake by 30% to achieve mortality reduction targets. Using the WHO Preventable Risk Integrated ModEl (PRIME), we modelled the mortality impact of reducing salt consumption by 30%, as well as according to WHO recommended levels (5 g/person/day), for the five member states of the EEU. PRIME models the number of averted deaths from reducing salt intake by applying established risk ratios to a given population. The baseline demographic and mortality data that are required to generate these estimates were obtained from the relevant government statistical bodies, and salt intake data were referenced from surveillance studies. Uncertainty intervals were generated using Monte Carlo simulation. If salt consumption was reduced by 30%, we estimate that there would have been 94,150 (95%UI: 47,329 to 137,131) fewer deaths due to cardiovascular disease in the EEU in the baseline year, with males and the elderly being more affected. If the WHO-recommended maximum salt intake of 5 g/day was achieved, a total of 193,155 (95%UI: 98,548 to 272,536) deaths would have been prevented. These findings underline the importance of incorporating effective policy changes to meet targets in reducing NCD mortality by one-third by 2030.
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Affiliation(s)
- Vern Perera
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Luke N. Allen
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Farrand
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Edwin Jit Leung Kwong
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isurujith Liyanage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Kremlin Wickramasinghe
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Moscow, Russian Federation
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Bhattacharya S, Varshney S, Hossain MM, Saleem SM, Gupta P, Singh A. "Taste modification" strategy for prevention and control of hypertension in India: need for robust clinical trials. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 14:100206. [PMID: 37492416 PMCID: PMC10363492 DOI: 10.1016/j.lansea.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 07/27/2023]
Abstract
Hypertension is an important modifiable risk factor for cardiovascular disease (CVD). Among normotensives, excessive dietary salt elevates the blood pressure and thereby increases the risk of CVD events. Despite such solid evidence, there is no effective approach to address excessive salt intake in India. Instead of just encouraging patients to lower their salt intake, we must provide an alternative technique by fostering an environment that facilitates this behaviour change. In this Viewpoint, we propose 'Taste Modification' strategy, i.e., a salt-reduction technique in which individuals are informed that adding spices/herbs to meals will reduce their salt intake. We hypothesise that a gradual reduction in salt intake can aid in the treatment of hypertension over time. The goal is to progressively substitute salt with spices for effective salt reduction. However, the 'Taste Modification' strategy must be first validated using multicentric clinical trials.
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Affiliation(s)
- Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, India
| | - Saurabh Varshney
- Department of ENT (Otorhinolaryngology), All India Institute of Medical Sciences, Deoghar, India
| | - Md Mahbub Hossain
- Department of Decision and Information Sciences, C.T. Bauer College of Business, University of Houston, Houston, TX, USA
| | - Sheikh Mohd Saleem
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | - Pratima Gupta
- Department of Community Medicine, Government Medical College, Srinagar, India
- Department of Microbiology, All India Institute of Medical Sciences, Deoghar, India
| | - Amarjeet Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Kou C, Zhao X, Fan X, Lin X, Wang Q, Yu J. Dietary sodium/potassium intake and cognitive impairment in older patients with hypertension: Data from NHANES 2011-2014. J Clin Hypertens (Greenwich) 2023. [PMID: 37183770 DOI: 10.1111/jch.14667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
This study aimed to assess the relationship between dietary sodium/potassium intake and cognition in elderly individuals with hypertension. We designed a cross-sectional study based on the 2011-2014 National Health and Nutrition Examination Survey (NHANES) 2011-2014. A multivariable-logistic regression analysis was performed to analyze the relationship between sodium/potassium intake and cognitive impairment. Restricted cubic spline (RCS) based on regression analysis to assess the nonlinear dose-response relationship between dietary sodium intake and cognitive performance. Out of the 2276 participants included in this study, 1670 patients had hypertension. Compared with the lowest quartile of dietary sodium intake, the lowest weighted odds ratio of cognitive impairment in DSST was observed in Q4 (OR = 0.45, 0.29-0.70), and a similar trend was observed in AFT (OR = 0.34, 0.18-0.65). After adjusting the covariates, the lowest weighted multivariable-adjusted OR of cognitive impairment in DSST were also observed in Q4 (OR = 0.47, 0.26-0.84) compared with the lowest quartile of dietary sodium intake. The RCS results showed that dietary sodium intake was U-shaped and associated with the risk of cognitive impairment in the DSST (Pnon-linearity = 0.0067). In addition, no significant association was observed between dietary potassium intake and different dimensions of cognitive performance. In conclusion, excessively high and low low dietary sodium were associated with impairment of specific processing speed, sustained attention, and working memory for elderly patients with hypertension in the United States. However, no association was observed between dietary potassium intake and cognition.
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Affiliation(s)
- Chengkun Kou
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xu Zhao
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xin Fan
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xin Lin
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qiongying Wang
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jing Yu
- Hypertension Centre, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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Jhankaria B. Masala. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:71-72. [PMID: 37615132 DOI: 10.25259/nmji_513_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
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13
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Jones DW, Clark D, Morgan TO, He FJ. Potassium-Enriched Salt Substitution as a Population Strategy to Prevent Cardiovascular Disease. Hypertension 2022; 79:2199-2201. [PMID: 36070400 DOI: 10.1161/hypertensionaha.122.19248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel W Jones
- Department pf Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Donald Clark
- Department pf Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Trefor O Morgan
- Department pf Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Feng J He
- Department pf Medicine, University of Mississippi Medical Center, Jackson, MS
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14
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Jeemon P, Harikrishnan S. Systolic blood pressure and cardiovascular health. Nat Med 2022; 28:2003-2004. [PMID: 36216944 DOI: 10.1038/s41591-022-02005-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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