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Andrade EDDO, Rebouças ADS, Filho JQ, Ambikapathi R, Caulfield LE, Lima AÂM, Maciel BLL. Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL‐ED study. MATERNAL & CHILD NUTRITION 2022; 18:e13413. [PMID: 35971636 PMCID: PMC9480934 DOI: 10.1111/mcn.13413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods. Data showed a reduction in the quality of infant feeding practices over the first 2 years of life. Breastfeeding decreased over the studied period. There was an increase in the consumption of ultra‐processed and unhealthy foods, which occurred concomitantly to the increase of no consumption of fruits/vegetables. Breastfeeding was an important protective factor against a greater consumption of ultra‐processed food. National nutrition policy should consider promoting breastfeeding and increasing fresh and minimally processed food consumption in children under 2 years.
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Affiliation(s)
| | | | - José Q. Filho
- Institute of Biomedicine for Brazilian Semiarid, Faculty of Medicine Federal University of Ceará Fortaleza Brazil
| | - Ramya Ambikapathi
- Department of Public Health Purdue University West Lafayette Indiana USA
| | - Laura E. Caulfield
- Department of International Health, Center for Human Nutrition The Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Aldo Ângelo Moreira Lima
- Institute of Biomedicine for Brazilian Semiarid, Faculty of Medicine Federal University of Ceará Fortaleza Brazil
| | - Bruna Leal Lima Maciel
- Graduate Progam in Nutrition Federal University of Rio Grande do Norte Natal Brazil
- Department of Nutrition Federal University of Rio Grande do Norte Natal Brazil
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Could salt intake directly affect the cerebral microvasculature in hypertension? J Stroke Cerebrovasc Dis 2022; 31:106632. [PMID: 35870266 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106632] [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: 04/08/2022] [Revised: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Excess dietary salt and chronic kidney disease (CKD) are acknowledged stroke risk factors. The development of small vessel disease, similarly affecting the cerebral and renal microvasculatures, may be an important mechanistic link underlying this interaction. Therefore, we aimed to evaluate if the dietary salt intake and markers of CKD (estimated glomerular filtration rate, albuminuria) relate to transcranial Doppler (TCD) markers of cerebral small vessel disease (CSVD) in hypertensive patients. MATERIALS AND METHODS Fifty-six hypertensive patients (57% with diabetes) underwent TCD monitoring in the middle (MCA) and posterior (PCA) cerebral arteries for evaluating neurovascular coupling (NVC), dynamic cerebral autoregulation (dCA), and vasoreactivity to carbon dioxide (VRCO2). We investigated the relation between renal parameters and TCD studies using Pearson's correlation coefficient and linear regression analyses. RESULTS There were no associations between dCA, VRCO2, NVC, and renal function tests. However, there was a negative association between the daily salt intake and the natural frequency during visual stimulation (r2=0.101, ß=-0.340, p=0.035), indicative of increased rigidity of the cerebral resistance vessels that react to cognitive activation. CONCLUSIONS In this cross-sectional study, we found an association between excess dietary salt consumption and CSVD in hypertensive patients. Future research is needed to evaluate whether the natural frequency could be an early, non-invasive, surrogate marker for microvascular dysfunction in hypertension.
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Valero-Morales I, Tan M, Pei Y, He FJ, MacGregor GA. 24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis. Rev Panam Salud Publica 2022; 46:e199. [PMID: 36406293 PMCID: PMC9668047 DOI: 10.26633/rpsp.2022.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.
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Affiliation(s)
- Isabel Valero-Morales
- Wolfson Institute of Population HealthBarts and The London School of Medicine & DentistryQueen Mary University of LondonLondonUnited KingdomWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
- Isabel Valero-Morales,
| | - Monique Tan
- Wolfson Institute of Population HealthBarts and The London School of Medicine & DentistryQueen Mary University of LondonLondonUnited KingdomWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Yu Pei
- Wolfson Institute of Population HealthBarts and The London School of Medicine & DentistryQueen Mary University of LondonLondonUnited KingdomWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Feng J He
- Wolfson Institute of Population HealthBarts and The London School of Medicine & DentistryQueen Mary University of LondonLondonUnited KingdomWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Graham A MacGregor
- Wolfson Institute of Population HealthBarts and The London School of Medicine & DentistryQueen Mary University of LondonLondonUnited KingdomWolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
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Estimation of sodium and potassium intakes assessed by two 24-hour urine collections in a city of Indonesia. Br J Nutr 2021; 126:1537-1548. [PMID: 33494843 PMCID: PMC8524422 DOI: 10.1017/s0007114521000271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Intakes of excess Na and insufficient K are two major contributors of heart diseases and stroke development. However, no precise study has previously been carried out on Na and K intakes among Indonesian adults. The present study aimed to estimate the Na and K intakes using two consecutive 24-h urine collections. Participants were community-dwelling adults aged between 20 and 96 years, randomly selected from a pool of resident registration numbers. Of the 506 participants, 479 (240 men and 239 women) completed urine collections. The mean Na excretion was 102·8 and 100·6 mmol/d, while the mean K excretion was 25·0 and 23·4 mmol/d for men and women, respectively. Na and K excretions were higher in participants with a higher BMI. A higher K excretion was associated only with younger age. More than 80 % of the participants consumed more than 5 g/d of salt (the upper limit recommended by the Indonesian government), whereas none of them consumed more than 3510 mg/d of K (the lower limit). The high Na and low K intakes, especially high Na among participants with high BMI, should be considered when future intervention programmes are planned in this country.
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Mill JG, Malta DC, Nilson EAF, Machado ÍE, Jaime PC, Bernal RTI, Cardoso LSDM, Szwarcwald CL. Factors associated with salt intake in the Brazilian adult population: National Health Survey. CIENCIA & SAUDE COLETIVA 2021; 26:555-567. [PMID: 33605333 DOI: 10.1590/1413-81232021262.37492020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 01/14/2023] Open
Abstract
This paper aims to identify the factors associated with high salt intake in the Brazilian adult population. This is a cross-sectional study with 8,083 adults participating in the National Health Survey (PNS, 2014/15). Salt intake was based on the estimation of 24-hour urinary sodium calculated from the sodium/creatinine ratio in spot urine samples. The highest quartile of the distribution was considered high salt intake. The relationship between high salt consumption and sociodemographic factors, lifestyles, morbidity, and self-rated health status was analyzed by calculating the crude prevalence ratios and the prevalence ratios adjusted for age and gender. Approximately 28.1% had an estimated salt intake higher than 10.56 g/day. Overweight (Adjusted Prevalence Ratio; 95%CI - PRadj 1.23; 1.09-1.39), obesity (PRadj 1.61; 1.43-1.83), and diabetes (PRadj 1.36; 1.17-1.58) were positively associated with high salt intake. Female gender (PRadj 0.73; 0.66-0.80), high schooling level (PRadj 0.88; 0.79-0.99), living in the North and chronic kidney disease (PRadj 0.71; 0.56-0.90) were protective factors. Salt consumption is elevated nationwide and in all population subgroups, requiring coordinated actions.
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Affiliation(s)
- José Geraldo Mill
- Centro de Ciências da Saúde, Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Ísis Eloah Machado
- Programa de Pós-Graduação em Saúde e Nutrição, Departamento de Medicina de Família, Universidade Federal de Ouro Preto. Ouro Preto MG Brasil
| | - Patrícia Constante Jaime
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Regina Tomie Ivata Bernal
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Aparna P, Salve H, Krishnan A, Lakshmy R, Gupta S, Nongkynrih B. Methods of dietary sodium estimation. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Effects of endogenous H 2S production inhibition on the homeostatic responses induced by acute high-salt diet consumption. Mol Cell Biochem 2020; 476:715-725. [PMID: 33128215 DOI: 10.1007/s11010-020-03938-w] [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: 04/17/2020] [Accepted: 10/09/2020] [Indexed: 12/31/2022]
Abstract
The gaseous modulator hydrogen sulfide (H2S) is synthesized, among other routes, by the action of cystathionine-γ-lyase (CSE) and importantly participates in body fluid homeostasis. Therefore, the present study aimed to evaluate the participation of H2S in behavioral, renal and neuroendocrine homeostatic responses triggered by the acute consumption of a high Na+ diet. After habituation, adult male Wistar rats were randomly distributed and maintained for seven days on a control [CD (0.27% of Na+)] or hypersodic diet [HD (0.81% of Na+)]. CD and HD-fed animals were treated with DL-Propargylglycine (PAG, 25 mg/kg/day, ip) or vehicle (0.9% NaCl in equivalent volume) for the same period. At the end of the experiment, animals were euthanized for blood and tissue collection. We demonstrated that a short-term increase in dietary Na+ intake, in values that mimic the variations in human consumption (two times the recommended) significantly modified hydroelectrolytic homeostasis, with repercussions in the hypothalamic-neurohypophysial system and hypothalamic-pituitary-adrenal axis function. These findings were accompanied by the development of a clear inflammatory response in renal tubular cells and microvascular components. On the other hand, the inhibition of the endogenous production of H2S by CSE provided by PAG treatment prevented the inflammation induced by HD. In the kidney, PAG treatment induced the overexpression of inducible nitric oxide synthase in animals fed with HD. Taken together, these data suggest, therefore, that HD-induced H2S production plays an important proinflammatory role in the kidney, apparently counter regulating nitric oxide actions in renal tissue.
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Faulkner JL, Belin de Chantemèle EJ. Female Sex, a Major Risk Factor for Salt-Sensitive Hypertension. Curr Hypertens Rep 2020; 22:99. [PMID: 33089375 PMCID: PMC7675065 DOI: 10.1007/s11906-020-01113-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW High dietary salt is a significant contributor to essential hypertension in clinical populations. However, although clinical studies indicate a higher prevalence of salt sensitivity in women over men, knowledge of salt-sensitive mechanisms is largely restricted to males, and female-specific mechanisms are presently being elucidated. RECENT FINDINGS Male-specific mechanisms of salt-sensitive hypertension are well published and predominantly appear to involve dysfunctional renal physiology. However, emerging novel evidence indicates that aldosterone production is sex-specifically heightened in salt-sensitive hypertensive women and female rodent models, which may be regulated by intra-adrenal renin-angiotensin system activation and sex hormone receptors. In addition, new evidence that young females endogenously express higher levels of endothelial mineralocorticoid receptors (MRs) and that endothelial MR is a crucial mediator of endothelial dysfunction in females indicates that the aldosterone-endothelial MR activation pathway is a novel mediator of salt-sensitive hypertension. Heightened aldosterone levels and endothelial MR expression provide a 2-fold sex-specific mechanism that may underlie the pathology of salt-sensitive hypertension in women. This hypothesis indicates that MR antagonists may be a preferential treatment for premenopausal women diagnosed with salt-sensitive hypertension.
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Affiliation(s)
- Jessica L Faulkner
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd., Augusta, GA, 30912, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd., Augusta, GA, 30912, USA.
- Department of Medicine (Cardiology), Medical College of Georgia at Augusta University, 1460 Laney Walker Blvd., Augusta, GA, 30912, USA.
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Overwyk KJ, Quader ZS, Maalouf J, Bates M, Webster J, George MG, Merritt RK, Cogswell ME. Dietary Sodium Intake and Health Indicators: A Systematic Review of Published Literature between January 2015 and December 2019. Adv Nutr 2020; 11:1174-1200. [PMID: 32449929 PMCID: PMC7490163 DOI: 10.1093/advances/nmaa049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Abstract
As the science surrounding population sodium reduction evolves, monitoring and evaluating new studies on intake and health can help increase our understanding of the associated benefits and risks. Here we describe a systematic review of recent studies on sodium intake and health, examine the risk of bias (ROB) of selected studies, and provide direction for future research. Seven online databases were searched monthly from January 2015 to December 2019. We selected human studies that met specified population, intervention, comparison, outcome, time, setting/study design (PICOTS) criteria and abstracted attributes related to the study population, design, intervention, exposure, and outcomes, and evaluated ROB for the subset of studies on sodium intake and cardiovascular disease risks or indicators. Of 41,601 abstracts reviewed, 231 studies were identified that met the PICOTS criteria and ROB was assessed for 54 studies. One hundred and fifty-seven (68%) studies were observational and 161 (70%) focused on the general population. Five types of sodium interventions and a variety of urinary and dietary measurement methods were used to establish and quantify sodium intake. Five observational studies used multiple 24-h urine collections to assess sodium intake. Evidence mainly focused on cardiovascular-related indicators (48%) but encompassed an assortment of outcomes. Studies varied in ROB domains and 87% of studies evaluated were missing information on ≥1 domains. Two or more studies on each of 12 outcomes (e.g., cognition) not previously included in systematic reviews and 9 new studies at low ROB suggest the need for ongoing or updated systematic reviews of evidence on sodium intake and health. Summarizing evidence from assessments on sodium and health outcomes was limited by the various methods used to measure sodium intake and outcomes, as well as lack of details related to study design and conduct. In line with research recommendations identified by the National Academies of Science, future research is needed to identify and standardize methods for measuring sodium intake.
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Affiliation(s)
- Katherine J Overwyk
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Zerleen S Quader
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- IHRC, Inc. Atlanta, GA, USA
| | - Joyce Maalouf
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Marlana Bates
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, GA, USA
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Salt-dependent hypertension and inflammation: targeting the gut-brain axis and the immune system with Brazilian green propolis. Inflammopharmacology 2020; 28:1163-1182. [PMID: 32785827 PMCID: PMC8826348 DOI: 10.1007/s10787-020-00742-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/30/2020] [Indexed: 01/22/2023]
Abstract
Systemic arterial hypertension (SAH) is a major health problem around the world and its development has been associated with exceeding salt consumption by the modern society. The mechanisms by which salt consumption increase blood pressure (BP) involve several homeostatic systems but many details have not yet been fully elucidated. Evidences accumulated over the last 60 decades raised the involvement of the immune system in the hypertension development and opened a range of possibilities for new therapeutic targets. Green propolis is a promising natural product with potent anti-inflammatory properties acting on specific targets, most of them participating in the gut-brain axis of the sodium-dependent hypertension. New anti-hypertensive products reinforce the therapeutic arsenal improving the corollary of choices, especially in those cases where patients are resistant or refractory to conventional therapy. This review sought to bring the newest advances in the field articulating evidences that show a cross-talking between inflammation and the central mechanisms involved with the sodium-dependent hypertension as well as the stablished actions of green propolis and some of its biologically active compounds on the immune cells and cytokines that would be involved with its anti-hypertensive properties.
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Arantes AC, Sousa ALL, Vitorino PVDO, Jardim PCBV, Jardim TDSV, Rezende JM, Lelis EDS, Rodrigues RB, Coca A, Barroso WKS. Effects of added salt reduction on central and peripheral blood pressure. Arq Bras Cardiol 2020; 114:554-561. [PMID: 32267330 PMCID: PMC7792722 DOI: 10.36660/abc.20180426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 04/15/2019] [Accepted: 05/15/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. OBJECTIVE To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. METHODS This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. RESULTS A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. CONCLUSION The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561).
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Affiliation(s)
- Ana Carolina Arantes
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Ana Luiza Lima Sousa
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Priscila Valverde de O. Vitorino
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Paulo Cesar B. Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Thiago de Souza Veiga Jardim
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
| | - Jeeziane Marcelino Rezende
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Ellen de Souza Lelis
- Pontificia Universidade Católica de GoiásEscola de Ciências Sociais e da SaúdeGoiâniaGoiásBrasilPontificia Universidade Católica de Goiás - Escola de Ciências Sociais e da Saúde - Mestrado em Atenção à Saúde, Goiânia, Goiás – Brasil
| | - Rafaela Bernardes Rodrigues
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
| | - Antonio Coca
- Universitat de BarcelonaBarcelonaEspanhaUniversitat de Barcelona, Barcelona – Espanha
| | - Weimar Kunz Sebba Barroso
- Universidade Federal de GoiásFaculdade de MedicinaPrograma de Pós-Graduação em Ciências da SaúdeGoiâniaGOBrasilUniversidade Federal de Goiás - Faculdade de Medicina - Programa de Pós-Graduação em Ciências da Saúde, Goiânia, GO – Brasil
- Universidade Federal de GoiásGoiâniaGOBrasilUniversidade Federal de Goiás - Liga de Hipertensão Arterial, Goiânia, GO – Brasil
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Rhee MY, Jeong YJ. Sodium Intake, Blood Pressure and Cardiovascular Disease. Korean Circ J 2020; 50:555-571. [PMID: 32281323 PMCID: PMC7321755 DOI: 10.4070/kcj.2020.0042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023] Open
Abstract
Sodium intake reduction has been emphasized because sodium adversely impacts health, especially blood pressure (BP), and the cardiovascular (CV) disease risk. However, data obtained from several cohort studies have raised questions regarding the effects of high sodium intake on BP and the CV disease risk. In the present study, we systematically reviewed the literature to evaluate these associations. Studies showing negative associations between urine sodium and BP and CV outcomes relied on estimated 24-hour urine sodium from spot urine that is inappropriate for determining sodium intake at an individual level. Furthermore, controversy about the association between 24-hour urine sodium and BP may have been caused by different characteristics of study populations, such as age distribution, ethnicity, potassium intake and the inclusion of patients with hypertension, the different statistical methods and BP measurement methods. Regarding the association between sodium intake and the CV disease risk, studies showing negative or J- or U-shaped associations used a single baseline measurement of 24-hour urine sodium in their analyses. However, recent studies that employed average of subsequently measured 24-hour urine sodium showed positive, linear associations between sodium intake and CV outcomes, indicating that controversies are caused by the different sodium intake measurement methods and analytic designs. In conclusion, the study shows that positive associations exist between sodium intake and BP, CV outcomes, and mortality, and that the argument that reducing sodium intake is dangerous is invalid. Sodium intake reduction should be recommended to all, and not limited to patients with hypertension or CV disease.
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Affiliation(s)
- Moo Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Korea.
| | - Yun Jeong Jeong
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Carrillo-Larco RM, Bernabe-Ortiz A. Sodium and Salt Consumption in Latin America and the Caribbean: A Systematic-Review and Meta-Analysis of Population-Based Studies and Surveys. Nutrients 2020; 12:nu12020556. [PMID: 32093337 PMCID: PMC7071427 DOI: 10.3390/nu12020556] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
Sodium/salt consumption is a risk factor for cardiovascular diseases. Although global targets to reduce salt intake have been established, current levels and trends of sodium consumption in Latin America and the Caribbean (LAC) are unknown. We conducted a systematic review and meta-analysis of population-based studies in which sodium consumption was analyzed based on urine samples (24 h samples or otherwise). The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. From 2350 results, 53 were studied in detail, of which 15 reports were included, providing evidence for 18 studies. Most studies were from Brazil (7/18) and six collected 24 h urine samples. In the random effects meta-analysis, 12 studies (29,875 people) were analyzed since 2010. The pooled mean 24 h estimated sodium consumption was 4.13 g/day (10.49 g/day of salt). When only national surveys were analyzed, the pooled mean was 3.43 g/day (8.71 g/day of salt); when only community studies were analyzed the pooled mean was 4.39 g/day (11.15 g/day of salt). Studies had low risk of bias. The estimated 24 h sodium consumption is more than twice the World Health Organization recommendations since 2010. Regional organizations and governments should strengthen policies and interventions to measure and reduce sodium consumption in LAC.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Lima 18, Peru
- Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote 02804, Peru
- Correspondence:
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Lima 18, Peru
- Universidad Científica del Sur, Lima 15067, Peru
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How Much Sodium Should We Eat? PROGRESS IN PREVENTIVE MEDICINE 2020. [DOI: 10.1097/pp9.0000000000000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Neupane D, Rijal A, Henry ME, Kallestrup P, Koirala B, Mclachlan CS, Ghimire K, Zhao D, Sharma S, Pokharel Y, Joseph K, Olsen MH, Schutte AE, Appel LJ. Mean dietary salt intake in Nepal: A population survey with 24-hour urine collections. J Clin Hypertens (Greenwich) 2020; 22:273-279. [PMID: 31967732 DOI: 10.1111/jch.13813] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 01/17/2023]
Abstract
High salt (sodium chloride) intake raises blood pressure and increases the risk of developing hypertension, a major risk factor for cardiovascular disease. Little is known about salt intake in Nepal, and no study has estimated salt consumption from 24-hour urinary sodium excretion. Participants (n = 451) were recruited from the Community-Based Management of Non-Communicable Diseases in Nepal (COBIN) cohort in 2018. Salt intake was estimated by analyzing 24-hour urinary sodium excretion. Multivariate linear regression was used to estimate differences in salt intake. The mean (±SD) age and salt intake were 49.6 (±9.8) years and 13.3 (±4.7) g/person/d, respectively. Higher salt intake was significantly associated with male gender (β for female = -2.4; 95% CI: -3.3, -1.4) and younger age (β10 years = -1.4; 95% CI: -1.4, -0.5) and higher BMI (β = 0.1; 95% CI: 0.0, 0.2). A significant association was also found between increase in systolic blood pressure and higher salt intake (β = 0.3; 95% CI: 0.0, 0.7). While 55% reported that they consumed just the right amount of salt, 98% were consuming more than the WHO recommended salt amount (<5 g/person/d). Daily salt intake in this population was over twice the limit recommended by the WHO, suggesting a substantial need to reduce salt intake in this population. It also supports the need of global initiatives such as WHO's Global Hearts Initiative SHAKE technical package and Resolves to Save Lives for sodium reduction in low- and middle-income countries like Nepal.
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Affiliation(s)
- Dinesh Neupane
- Nepal Development Society, Bharatpur, Chitwan, Nepal.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Anupa Rijal
- Nepal Development Society, Bharatpur, Chitwan, Nepal.,Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - Megan E Henry
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Per Kallestrup
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Bhagawan Koirala
- Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Kamal Ghimire
- Nepal Development Society, Bharatpur, Chitwan, Nepal
| | - Di Zhao
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Shailendra Sharma
- Department of Medicine, The George Washington University, Washington, DC, USA
| | - Yashashwi Pokharel
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO, USA
| | - Kristy Joseph
- Global Noncommunicable Disease Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Aletta E Schutte
- Hypertension in Africa Research Team, South African Medical Research Council, North-West University, Potchefstroom, South Africa
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Yilmaz HÖ, Ayhan NY, Meriç ÇS. Buckwheat: A Useful Food and Its Effects on Human Health. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401314666180910140021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
:
Buckwheat is a plant used for many purposes, such as consumed as a food and used in the
treatment of diseases. It is a good source of many vitamins and minerals and has balanced nutritional
value. Because of its nutrient content and many positive effects on human health, buckwheat has become
a functional food, recently. Main effects of buckwheat on human health are its hypotensive,
hypoglycemic, hypocholesterolemic, neuroprotective and antioxidant effects. Thus, it is considered
an alternative food component in dietary treatment for chronic and metabolic diseases, such as diabetes,
hypertension and celiac disease. Also, its rich nutrient content supports daily diet and provides a
better eating profile. As a result, buckwheat is accepted as a functional food, suggested to improve
human health and is used in the treatment of diseases. The aim of this review is to explain some positive
effects of buckwheat on human health.
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Affiliation(s)
- Hacı Ömer Yilmaz
- Department Nutrition and Dietetics, Faculty of Health Science, Gumushane University, Gumushane, Turkey
| | - Nurcan Yabanci Ayhan
- Department Nutrition and Dietetics, Faculty of Health Science, Ankara University, Ankara, Turkey
| | - Çağdaş Salih Meriç
- Department Nutrition and Dietetics, Faculty of Health Science, Ankara University, Ankara, Turkey
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Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234714. [PMID: 31779236 PMCID: PMC6926662 DOI: 10.3390/ijerph16234714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 12/27/2022]
Abstract
Background: Hypertension is a direct cardiovascular disease risk. It causes a heavy burden on the healthcare system globally. We aim to assess hypertension occurrence and its associated factors among women and men in Vietnam. Methods: A cross-sectional study was conducted from January to February 2019 on 2203 community-dwelling women and men aged 18 years or above. Participants’ characteristics, comorbidity, behaviors, and physical measures were evaluated. Hypertension was classified as systolic/diastolic blood pressure ≥140/90 mmHg or using antihypertensive medication. We analyzed data using logistic regression models. Results: The prevalence of hypertension was 24.3% (20.9% in women, 29.1% in men). For women, older age (odds ratio, OR, 6.80–12.41; p < 0.001), income above the poverty line (OR, 0.64; p = 0.008), diabetes comorbid (OR, 2.98; p < 0.001), added salts consumption (OR, 1.80; p < 0.001), overweight/obesity (OR, 1.64; p = 0.005), abdominal obesity (OR, 2.07; p < 0.001) were associated with hypertension. For men, older age (OR, 2.67–5.92; p < 0.001), diabetes comorbid (OR, 2.25; p = 0.010), smoking (OR, 1.38; p = 0.046), and overweight/obesity (OR, 2.18; p < 0.001) were associated with hypertension. Conclusions: Hypertension is prevalent in Vietnamese people. The associated factors of hypertension are varied by gender.
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Baldo MP, Brant LCC, Cunha RS, Molina MDCB, Griep RH, Barreto SM, Lotufo PA, Bensenor IM, Mill JG. The association between salt intake and arterial stiffness is influenced by a sex‐specific mediating effect through blood pressure in normotensive adults: The ELSA‐Brasil study. J Clin Hypertens (Greenwich) 2019; 21:1771-1779. [DOI: 10.1111/jch.13728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Marcelo P. Baldo
- Department of Pathophysiology Montes Claros State University Montes Claros Brazil
- Department of Medicine Centro Universitário UNIFIPMOC Montes Claros Brazil
| | - Luisa C. C. Brant
- Faculty of Medicine Federal University of Minas Gerais Belo Horizonte Brazil
| | - Roberto S. Cunha
- Department of Physiological Sciences Federal University of Espírito Santo Vitória Brazil
| | | | - Rosane H. Griep
- Laboratory of Health and Environment Education Oswaldo Cruz Institute Rio de Janeiro Brazil
| | - Sandhi M. Barreto
- Faculty of Medicine Federal University of Minas Gerais Belo Horizonte Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiologic Research University of São Paulo São Paulo Brazil
| | - Isabela M. Bensenor
- Center for Clinical and Epidemiologic Research University of São Paulo São Paulo Brazil
| | - José G. Mill
- Department of Physiological Sciences Federal University of Espírito Santo Vitória Brazil
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Mill JG, Malta DC, Machado ÍE, Pate A, Pereira CA, Jaime PC, Szwarcwald CL, Rosenfeld LG. Estimation of salt intake in the Brazilian population: results from the 2013 National Health Survey. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:E190009.SUPL.2. [PMID: 31596380 DOI: 10.1590/1980-549720190009.supl.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the salt intake in the Brazilian population according to their urinary sodium excretion. METHODS The National Health Survey (2013) aimed to gather data on the health of adults (≥ 18 years) through a random selection of households. In each household, one adult was selected to have their biological data collected (anthropometry, blood pressure, and blood and urine tests). The urine sample was sent to a central laboratory to determine sodium (ion-selective electrode) and creatinine (Jaffé method) concentrations. Sodium excretion was estimated with the Tanaka equation. RESULTS Urinary sodium and creatinine concentrations were measured in 8,083individuals (58% women). The mean salt intake was estimated at 9.34 g/day (95% confidence interval - 95%CI 9.27 - 9.41) and was higher in males (9.63 g/day; 95%CI 9.52 - 9.74) than in females (9.08 g/day; 95%CI 8.99 - 9.17). Wefound no significant differences regarding age group, ethnicity, or schooling. Salt intake was higher in the Southeast and South regions and lower in the Northeast and North. Only 2.4% (95%CI 2.0 - 2.8) of the sample consumed less than 5 g/day, and 58.2% (95%CI 56.7 - 59.6) of participants had an estimated intake of 8 to 12 g/day. CONCLUSION The mean salt intake in the Brazilian population is approximately twice the recommended by the World Health Organization (5g/day).Given the association of high salt intake with hypertension and decreased renal function, these data indicate the need to adopt comprehensive public policies to reduce the consumption in the Brazilian population.
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Affiliation(s)
- José Geraldo Mill
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
| | - Deborah Carvalho Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais- Belo Horizonte (MG), Brasil
| | - Ísis Eloah Machado
- Programa de Pós-Graduação de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brasil
| | - Arthur Pate
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
| | - Cimar Azeredo Pereira
- Diretoria de Pesquisas, Instituto Brasileiro de Geografia e Estatística - Rio de Janeiro (RJ), Brasil
| | - Patrícia Constante Jaime
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde , Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Célia Landman Szwarcwald
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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Relationship between Hedonic Hunger and Health Interest on Habit and Sodium Intake Patterns in Food Consumption. INTERNATIONAL JOURNAL OF FOOD SCIENCE 2019; 2019:9517140. [PMID: 31428626 PMCID: PMC6681620 DOI: 10.1155/2019/9517140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/03/2019] [Indexed: 11/17/2022]
Abstract
Many people are motivated to eat healthily but find it difficult to override established and less healthy habits. Habits, by their nature, are unconscious and cued by the environment, thus making them powerful determinants of behavior. This study examined how hedonic hunger and health interest are related to habit and whether sodium consumption is mediated by hedonic hunger, health interest, and habit. A total of 117 students of Universitas Brawijaya took part in the study. Data analysis were done using Partial Least Square (PLS) and a semi-quantitative food frequency questionnaire (SQ-FFQ). PLS was used to analyze the influence of the relationship between independent and dependent variables. SQ-FFQ was used to determine sodium intake in grams/day. The average sodium intake in this study was 2.47 grams/day. This analysis shows that hedonic hunger and health interest had a significant impact on health habits but not on sodium intake.
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Borgo MV, Pimentel EB, Baldo MP, Souza JBD, Malta DC, Mill JG. Prevalence of cardiovascular risk factors in the population of Vitória according to data from VIGITEL and the National Health Interview Survey of 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190015. [PMID: 31038611 DOI: 10.1590/1980-549720190015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/14/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the prevalence of cardiovascular risk factors in the adult population of Vitória, Espírito Santo, Brazil, in two surveys conducted by telephone interview (VIGITEL) or by clinic and laboratory exams during the National Health Interview Survey (NHIS). METHOD Data were collected from adults (≥ 18 years). In VIGITEL, 1,996 subjects (males = 38%) were interviewed. In NHIS, home visit followed by clinical and laboratory tests was made with 318 individuals (males = 48%) selected in 20 census tracts of the city. The prevalence of risk factors was adjusted to the estimated population of the city in 2013. Data are shown as prevalence and 95% confidence interval (95%CI). RESULTS Similar values of prevalence were found in VIGITEL and NHIS, respectively, for smoking (8.2%; 95%CI 6.7-9.7% vs 10.0; 95%CI 6.4 - 13.6%) and hypertension (24.8%; 95%CI 22.6 - 27.0% vs 27.2%; 95%CI 21.8 - 32.5%). Statistical differences between surveys (p < 0.01) were found for diabetes (6.7%; 95%CI 5.6 - 7.9% vs 10.7%; 95%CI 7.1 - 14.5%), obesity (16.8%; 95%CI 14.1 - 18.1% vs 25.7%; 95%CI 20.4 - 30.9%) and high cholesterol (≥ 200mg/dL) (20.6%; 95%CI 18.6- 22.6% vs 42.3%; 95%CI 36.9 - 47.7%). The prevalence of diabetes was also higher (p < 0.01) in NHIS (6.7 vs 10.7%). CONCLUSION Prevalence of smoking and hypertension, but not obesity, was adequately detected in VIGITEL, because there might have been information bias related to body weight during telephone interviews. Datashow the necessity to improve the diagnosis of dyslipidemias in primary care services, as the control of this risk factor is of utmost importance to prevent cardiovascular diseases.
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Affiliation(s)
- Mariana Veronez Borgo
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
| | - Enildo Broetto Pimentel
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
| | - Marcelo Perim Baldo
- Departamento de Fisiopatologia, Centro de Ciências Biológicas e da Saúde, Universidade Estadual de Montes Claros - Montes Claros (MG), Brasil
| | - Juliana Bottoni de Souza
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde, Ministério da Saúde - Brasília (DF), Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
| | - José Geraldo Mill
- Departamento de Ciências Fisiológicas, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo - Vitória (ES), Brasil
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Moliterno P, Álvarez-Vaz R, Pécora M, Luzardo L, Borgarello L, Olascoaga A, Marino C, Noboa O, Staessen JA, Boggia J. Blood Pressure in relation to 24-Hour Urinary Sodium and Potassium Excretion in a Uruguayan Population Sample. Int J Hypertens 2018; 2018:6956078. [PMID: 30631591 PMCID: PMC6304641 DOI: 10.1155/2018/6956078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
Many public health policies in Latin America target an optimized sodium and potassium intake. The aims of this study were to assess the sodium and potassium intake using 24-hour urinary analysis and to study their association with blood pressure in a Uruguayan population cohort using cluster analysis. A total of 149 participants (aged 20-85 years) were included in the study, and office blood pressure, anthropometric measurements, biochemical parameters in the blood, and 24-hour urine samples were obtained. The overall mean sodium and potassium excretion was 152.9 ± 57.3 mmol/day (8.9 ± 3.4 g/day of salt) and 55.4 ± 19.6 mmol/day, respectively. The average office systolic/diastolic blood pressure was 124.6 ± 16.7/79.3 ± 9.9 mmHg. Three compact spherical clusters were defined in untreated participants based on predetermined attributes, including blood pressure, age, and sodium and potassium excretion. The major characteristics of the three clusters were (1) high systolic blood pressure and moderate sodium excretion, (2) moderate systolic blood pressure and very high sodium excretion, and (3) low systolic blood pressure and low sodium excretion. Participants in cluster three had systolic blood pressure values that were 23.9 mmHg (95% confidence interval: -29.5 to -1.84) lower than those in cluster one. Participants in cluster two had blood pressure levels similar to those in cluster one (P = 0.32) and worse metabolic profiles than those in cluster one and three (P < 0.05). None of the clusters showed high blood pressure levels and high sodium excretion. No linear association was found between blood pressure and urinary sodium excretion (r < 0.14; P > 0.47). An effect of sodium and potassium intake on blood pressure levels was not found at the population level using regression or cluster analysis.
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Affiliation(s)
- Paula Moliterno
- Departamento de Nutrición Clínica, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Ramón Álvarez-Vaz
- Instituto de Estadística, Universidad de la República, Montevideo, Uruguay
| | - Matias Pécora
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
| | - Leonella Luzardo
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
| | - Luciana Borgarello
- Laboratorio de Patología Clínica, Universidad de la República, Montevideo, Uruguay
| | - Alicia Olascoaga
- Laboratorio de Patología Clínica, Universidad de la República, Montevideo, Uruguay
| | - Carmen Marino
- Área de Investigación, Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | - Oscar Noboa
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| | - José Boggia
- Departamento de Fisiopatología, Universidad de la República, Montevideo, Uruguay
- Centro de Nefrología, Universidad de la República, Montevideo, Uruguay
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Dietary sources of salt intake in adults and older people: a population-based study in a Brazilian town. Public Health Nutr 2018; 22:1388-1397. [PMID: 30472972 DOI: 10.1017/s1368980018003233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess salt intake and its dietary sources using biochemical and self-report methods and to characterize salt intake according to sociodemographic and disease-related variables in a sample of the Brazilian population. DESIGN Population-based cross-sectional survey. SETTING Salt intake was assessed by biochemical (24 h urinary Na excretion) and self-report methods (sodium FFQ, 24 h dietary recall, seasoned-salt questionnaire, discretionary-salt questionnaire and total reported salt intake).ParticipantsAdults and older people (n 517) aged 20-80 years, living in Artur Nogueira, São Paulo, Brazil. RESULTS Mean salt intake based on 24 h urinary Na excretion and total reported salt intake was 10·5 and 11·0 g/d, respectively; both measures were significantly correlated. Discretionary salt and seasoned salt were the most important sources of salt intake (68·2 %). Men in the study consumed more salt than women as estimated by 24 h urinary Na excretion (11·7 v. 9·6 g salt/d; P<0·0001). Participants known to be hypertensive added more salt to their meals but consumed less salty ultra-processed foods. Waist circumference in both sexes and BMI were positively correlated with salt intake estimated by 24 h urinary Na excretion. In addition, regression analysis revealed that being a young male or having a high waist circumference was a predictor of higher salt intake. CONCLUSIONS Salt intake in this population was well above the recommended amount. The main source of salt intake came from salt added during cooking. Salt intake varied according to sex and waist circumference.
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Padilha BM, Ferreira RC, Bueno NB, Tassitano RM, Holanda LDS, Vasconcelos SML, Cabral PC. Association between blood cholesterol and sodium intake in hypertensive women with excess weight. Medicine (Baltimore) 2018; 97:e0371. [PMID: 29642188 PMCID: PMC5908596 DOI: 10.1097/md.0000000000010371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Restricted sodium intake has been recommended for more than 1 century for the treatment of hypertension. However, restriction seems to increase blood cholesterol. In women with excess weight, blood cholesterol may increase even more because of insulin resistance and the high lipolytic activity of adipose tissue.The aim of this study was to assess the association between blood cholesterol and sodium intake in hypertensive women with and without excess weight.This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited at the primary healthcare units of Maceio, Alagoas, Brazilian Northeast. Excess weight was defined as body mass index (BMI) ≥25.0 kg/m. Sodium intake was estimated by the 24-hour urinary excretion of sodium. Blood cholesterol was the primary outcome investigated by this study, and its relationship with sodium intake and other variables was assessed by Pearson correlation and multivariate linear regression using a significance level of 5%.This study included 165 hypertensive women. Of these, 135 (81.8%) were with excess weight. The mean sodium intake was 3.7 g (±1.9) and 3.4 g (±2.4) in hypertensive women with and without excess weight, respectively. The multiple normal linear regression models fitted to the "blood cholesterol" in the 2 groups reveal that for the group of hypertensive women without excess weight only 1 independent variable "age" is statistically significant to explain the variability of the blood cholesterol levels. However, for the group of hypertensive women with excess weight, 2 independent variables, age and sodium intake, can statistically explain variations of the blood cholesterol levels.Blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight.
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Affiliation(s)
- Bruna Merten Padilha
- Faculty of Nutrition, Federal University of Alagoas, Av. Lourival Melo Mota, Alagoas
| | | | - Nassib Bezerra Bueno
- Faculty of Nutrition, Federal University of Alagoas, Av. Lourival Melo Mota, Alagoas
| | - Rafael Miranda Tassitano
- Department of Physical Education, Federal Rural University of Pernambuco, R. Dom Manoel de Medeiros
| | - Lidiana de Souza Holanda
- Department of Nutrition, Federal University of Pernambuco, Av. Prof. Moraes Rego, Recife, Pernambuco, Brazil
| | | | - Poliana Coelho Cabral
- Department of Nutrition, Federal University of Pernambuco, Av. Prof. Moraes Rego, Recife, Pernambuco, Brazil
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Molina MDCB, Pereira TSS, Porto AS, Silva RP, Santana NMT, Cade NV, Mill JG. Validation of single measurement of 12-hour urine excretion for estimation of sodium and potassium intake. A longitudinal study. SAO PAULO MED J 2018; 136:150-156. [PMID: 29694492 PMCID: PMC9879545 DOI: 10.1590/1516-3180.2017.0210031117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/03/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Evaluation of sodium and potassium intake can be carried out using different methods. Biological markers are able to capture intra and inter-individual variability and are used as separate measurements of consumption. The aim of this study was to test the validity of a single measurement of urinary sodium and potassium excretion as representative of habitual intake. DESIGN AND SETTING Longitudinal study, federal university. METHODS Food consumption data from a sample of adult university students and public servants (25 to 74 years old) were collected through 24-hour records and 12-hour urinary sodium and potassium excretion at five different times over a one-year period. The dietary data were entered into a nutritional research data software system and the sodium and potassium intakes were estimated. The variables were tested for normal distribution using the Kolmogorov-Smirnov test. One-way analysis of variance or the Kruskal-Wallis test was used to evaluate means. Correlations between measurements using Pearson or Spearman coefficients were calculated. The degree of agreement between the five measurements was given by the intraclass correlation coefficient. RESULTS Satisfactory agreement was found between the five measurements of urinary sodium and potassium excretion over a year, with little variability in consumption. CONCLUSION A single measurement of urinary sodium and potassium accurately estimated the usual average consumption of these electrolytes. This can be used in population-based studies.
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Affiliation(s)
- Maria del Carmen Bisi Molina
- MSc, PhD. Associate Professor, Department of Integrated Health Education, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - Taísa Sabrina Silva Pereira
- MSc. Doctoral Student of Public Health, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - Aline Silva Porto
- BSc. Master’s Student, Nutrition and Health Program, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - Raiane Pereira Silva
- BSc. Nutritionist, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | | | - Nágela Valadão Cade
- MSc, PhD. Associate Professor, Department of Nursing, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - José Geraldo Mill
- MD, PhD. Titular Professor, Department of Physiology, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
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Lotufo PA. Lowering blood pressure is a priority in Brazil and worldwide. SAO PAULO MED J 2017; 135:509-510. [PMID: 29267514 PMCID: PMC10016011 DOI: 10.1590/1516-3180.2017.1356211117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Paulo Andrade Lotufo
- MD, DrPH. Full Professor, Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo (SP), Brazil.
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Chronic high-sodium diet intake after weaning lead to neurogenic hypertension in adult Wistar rats. Sci Rep 2017; 7:5655. [PMID: 28720883 PMCID: PMC5515999 DOI: 10.1038/s41598-017-05984-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
Abstract
In this study, we investigated some mechanisms involved in sodium-dependent hypertension of rats exposed to chronic salt (NaCl) intake from weaning until adult age. Weaned male Wistar rats were placed under high (0.90% w/w, HS) or regular (0.27% w/w, Cont) sodium diets for 12 weeks. Water consumption, urine output and sodium excretion were higher in HS rats compared to control. Blood pressure (BP) was directly measured by the arterial catheter and found 13.8% higher in HS vs Cont rats. Ganglionic blockade with hexamethonium caused greater fall in the BP of HS rats (33%), and central antagonism of AT1 receptors (losartan) microinjected into the lateral ventricle reduced BP level of HS, but not of Cont group. Heart rate variability analysis revealed sympathetic prevalence on modulation of the systolic interval. HS diet did not affect creatinine clearance. Kidney histological analysis revealed no significant change in renal corpuscle structure. Sodium and potassium concentrations in CSF were found higher in HS rats despite no change in plasma concentration of these ions. Taken together, data suggest that animals exposed to chronic salt intake to a level close to that reported for human' diet since weaning lead to hypertension, which appears to rely on sodium-driven neurogenic mechanisms.
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Salt intake, blood pressure, and socioeconomic disparities among government employees in Sri Lanka: a cross-sectional study. J Public Health Policy 2017; 38:327-344. [PMID: 28596554 DOI: 10.1057/s41271-017-0073-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our study estimated salt intake, examined the association between blood pressure (BP) and salt intake, and explored the socioeconomic variations in salt intake among administrators (government employees). This is a cross-sectional study. We studied 168 randomly selected administrators aged 30-60 years attached to government offices in Colombo, Sri Lanka. Self-administered questionnaire gathered information on socio-demographic, work-related information, lifestyle practices, and medical history. BP, 24-hour urine collection, and anthropometric indices were measured. Mean salt intake levels measured by 24-hour Sodium (Na) excretion in hypertensives and non-hypertensives were 202.56 (SD ± 85.45) mmol/day and 176.79 (SD ± 82.02) mmol/day, respectively. A 100-mmol increase in sodium was associated with an average increase of 3.1 (95 per cent CI 2-4.2) mmHg in systolic BP and 1.8 (95 per cent CI 0.89-2.6) mmHg in diastolic BP. Higher salt intake was found in managerial assistants (12.38 ± 5.0 g) compared with senior officers (10.84 ± 4.9 g). Salt intake among these administrators was alarmingly high. High salt intake was positively associated with hypertension and more prevalent in lower socioeconomic strata.
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Wong MMY, Arcand J, Leung AA, Raj TS, Trieu K, Santos JA, Campbell NRC. The Science of Salt: A Regularly Updated Systematic Review of Salt and Health Outcomes (August to November 2015). J Clin Hypertens (Greenwich) 2016; 18:1054-1062. [PMID: 27461996 PMCID: PMC8031601 DOI: 10.1111/jch.12874] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of this review was to systematically identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from August to November 2015. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 15 studies were included in the review: one study assessed cardiovascular events, five studies assessed blood pressure or hypertension incidence, six studies assessed surrogate outcomes for cardiovascular or kidney diseases, and three studies assessed other outcomes (age-related cataracts, rheumatoid arthritis, and bone mineral density, respectively). Four studies were selected for detailed appraisal and commentary.
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Affiliation(s)
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.
| | - Alexander A Leung
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Kathy Trieu
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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Dietary sodium and potassium intakes: Data from urban and rural areas. Nutrition 2016; 33:35-41. [PMID: 27908548 DOI: 10.1016/j.nut.2016.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/17/2016] [Accepted: 08/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Hypertension is highly prevalent in West African populations, but little data is available on salt and potassium intake in these populations. We assumed in this study that sodium and potassium intake might be high and low, respectively, in the Beninese population in view of the emerging nutritional transition. The aim of this study was to estimate dietary sodium and potassium intakes based on 24-h urine collections. METHODS We selected 420 individuals (ages 25-64 y), representative of the population, from urban and rural areas in Benin. Urine was collected over 24 h, and sodium, potassium, and creatinine were quantified. Blood pressure was measured on the left arm using a validated electronic oscillometric monitor. RESULTS Adequate data were available for 354 participants. Mean dietary intake of sodium and potassium were 4.4 ± 2.1 and 1.8 ± 0.9 g/24 h, respectively. High intake of sodium was associated with urban area, age <44 y, administrative occupation, higher income, body mass index (BMI) ≥25 kg/m2, and a large waist circumference. High potassium intake was associated with male sex, administrative occupation, BMI ≥25 kg/m2, and large waist circumference. Sodium intake was associated with high systolic and diastolic blood pressures. In multivariate analysis, only age <44 y and, marginally, BMI ≥25 kg/m2 were associated with high sodium intake, whereas male sex and a BMI ≥25 kg/m2 were associated with high potassium intake. CONCLUSION Large proportions of the population had sodium intake higher, and potassium intake lower, than dietary recommendations. These results suggest that interventions to reduce salt consumption and promote potassium-rich foods, including fruits and vegetables, are needed in Benin.
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Mill JG, Rodrigues SL, Baldo MP, Malta DC, Szwarcwald CL. Estudo de validação das equações de Tanaka e de Kawasaki para estimar a excreção diária de sódio através da coleta da urina casual. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18 Suppl 2:224-37. [DOI: 10.1590/1980-5497201500060020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Validar as fórmulas de Tanaka e Kawasaki para cálculo do consumo de sal pela relação sódio/creatinina na urina casual. Métodos: Foram estudados 272 adultos (20 - 69 anos, 52,6% de mulheres) com coleta urinária de 24 h e duas coletas casuais no mesmo dia (em jejum - casual 1 - e fora do jejum - casual 2). Antropometria, pressão arterial e coleta de sangue foram obtidos no mesmo dia. A concordância entre o consumo de sal estimado pela urina de 24 h e pela urina casual foi feita por Pearson (r) e Bland & Altman. Resultados: O consumo médio de sal medido pela urina de 24 h foi de 10,4 ± 5,3 g/dia. A correlação entre a excreção de sódio na urina de 24 h e a estimada pela urina casual 1 ou 2, respectivamente, foi apenas moderada, tanto por Tanaka (r = 0,51 e r = 0,55; p < 0,001) como por Kawasaki (r = 0,52 e r = 0,54; p < 0,001). Observa-se subestimação crescente dos valores estimados em relação ao medido com o aumento do consumo de sal pela fórmula de Tanaka e, ao contrário, superestimação ao usar a fórmula de Kawasaki. As fórmulas estimam adequadamente o consumo diário de sal (diferença entre sal medido e estimado de, no máximo, 1 g/dia) somente com consumo entre 9 - 12 g/dia (Tanaka) e 12 - 18 g/dia (Kawasaki). Conclusão: A coleta de urina casual estima adequadamente o consumo de sal apenas nos indivíduos próximos à média populacional.
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