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Alparslan C, Malyszko J, Caskey FJ, Aleckovic-Halilovic M, Hrušková Z, Arruebo S, Bello AK, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Tesar V, Racki S. Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:29-42. [PMID: 38618499 PMCID: PMC11010604 DOI: 10.1016/j.kisu.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle-income and upper-middle-income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.
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Affiliation(s)
- Caner Alparslan
- Department of Pediatric Nephrology, İzmir Democracy University School of Medicine, İzmir, Turkey
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mirna Aleckovic-Halilovic
- Clinic for Internal Diseases, Department of Nephrology, Dialysis and Transplantation, University Hospital Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Sanjin Racki
- Department of Nephrology, Dialysis and Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
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Pehlivan M, Saleki N, Sezer FE, Özyürek F, Delice B, Hızlı Güldemir H. Water and beverage consumption habits of adults in Turkey by gender and BMI: a cross-sectional survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1910-1925. [PMID: 36739539 DOI: 10.1080/09603123.2023.2172385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
The study aims to determine water and beverage consumption status and related factors in daily nutrition of adults living in Turkey. This study was conducted with 6332 adults aged 18-65 years across Turkey. Demographics and anthropometric data of subjects, their daily water and beverage consumption habits were explored using the retrospective 24-hour recall method. Water and black tea were the most consumed beverages (1801.38 ± 11.06 mL/day, 455 ± 6.10 mL/day, respectively). Increased BMI was associated with a significantly decreased rate of insufficient fluid intake among the participants. Underweight individuals were found to be consuming less (by 0.558 times) fluid compared to those with normal BMI, while obese individuals appeared to have greater energy intake from daily fluid consumption (by 1.111 times). This study showed a relationship between water and beverage intake and anthropometric measurements, suggesting that further research on personalized water intake strategies is beneficial in weight management.
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Affiliation(s)
- Merve Pehlivan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Neda Saleki
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatma Elif Sezer
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatmanur Özyürek
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Büşranur Delice
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Hilal Hızlı Güldemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Anadolu University, Eskisehir, Turkey
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Ahmadi M, Ahadi S, Khadembashiri MA, Khadembashiri MM, Mahalleh M, AziziKia H, Zare HR, Rakhshan Khah AS, Hekmat H, Daroudi R, Akbari Sari A. Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019. IJC HEART & VASCULATURE 2024; 50:101316. [PMID: 38419602 PMCID: PMC10899721 DOI: 10.1016/j.ijcha.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/23/2023] [Indexed: 03/02/2024]
Abstract
Introduction Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. Methods This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. Results IHD accounted for approximately 2.55 million (95 % UI 2.29-2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84-675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85-89 years age-group, in 2019. Conclusion The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.
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Affiliation(s)
- Mohammad Ahmadi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shana Ahadi
- School of Medicine, Jondishapour University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mehrdad Mahalleh
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hani AziziKia
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hamid Reza Zare
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamidreza Hekmat
- School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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Sakir NAI, Hwang SB, Park HJ, Lee BH. Associations between food consumption/dietary habits and the risks of obesity, type 2 diabetes, and hypertension: a cross-sectional study in Jakarta, Indonesia. Nutr Res Pract 2024; 18:132-148. [PMID: 38352217 PMCID: PMC10861337 DOI: 10.4162/nrp.2024.18.1.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to assess the current mean daily intake of 10 food groups, analyze the sociodemographic factors associated with food consumption, and determine the associations between food consumption/dietary intake and the prevalence rates of obesity, type 2 diabetes (T2D), and hypertension (HTN) in Jakarta, Indonesia. SUBJECTS/METHODS A total of 600 participants aged 20-85 yrs were included in this cross-sectional study. Food consumption and dietary habits were assessed using a food frequency questionnaire. To determine the association between food consumption/dietary habits and the abovementioned diseases, logistic regression analysis was performed. RESULTS The average vegetable and fruit intake was lower, while sugar and salt consumption were higher than that recommended by Indonesia's national dietary guidelines. A high intake of ultra-processed foods (UPFs) was associated with young age, men, "single" status, a high education level, and employment with a high monthly income. Obesity and T2D were positively correlated with high intakes of cereals and tubers, UPFs, sugars, fats, and oils. Conversely, an inverse association was found between legume, vegetable, and fruit consumption and obesity risk. An inverse correlation was also observed between vegetable consumption and T2D risk. Moreover, a high salt intake was inversely correlated with fruit consumption in terms of HTN risk. Non-indulgence in habitual late-night snacking and refrainment from consuming more than one dish at each meal were also negatively related to the prevalence of obesity, T2D, and HTN. Inverse correlations were also observed between the prevalence rates of T2D and HTN and abstaining from adding sugar to beverages. CONCLUSION Foods high in fat, sugar, and sodium were strongly associated with the risks of obesity, T2D, and HTN. Additionally, poor eating habits were also associated with disease development.
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Affiliation(s)
| | | | - Hyeon Ju Park
- Department of Food and Nutrition, Chung-Ang University, Anseong 17546, Korea
| | - Bog-Hieu Lee
- Department of Food and Nutrition, Chung-Ang University, Anseong 17546, Korea
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Chweya RN, Onyango CA, Saigilu S, Mwangi C, Gachohi JM. Spatial and network mapping of comorbidity with trachoma and visual-impairing NCDs in a pastoralist community in Kenya: implications for SDGs and UHC. Int Health 2024; 16:35-44. [PMID: 37528750 PMCID: PMC10759297 DOI: 10.1093/inthealth/ihad056] [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: 12/14/2022] [Revised: 05/19/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND We explore the spatial distribution of comorbidity with trachoma and potentially visual-impairing non-communicable diseases (NCDs) and their risk factors among Kenyan pastoralists. METHODS Using a cross-sectional study design, we recruited and clinically examined 262 study participants for NCDs (hypertension or diabetes) and trachoma using the World Health Organization grading system. Network models estimated interactions and risks linked with trachoma and NCDs while the Poisson point process determined their spatial distribution. RESULTS Of the 262 participants, 140 (53%) had trachoma, with >71% of these cases identified among females and those >60 y of age. A total of 36 trachoma cases co-occurred with hypertension (26%) and diabetes (0.01%). NCDs were frequent among those with recurring trachoma (21%) and trachomatous trichiasis (14.3%). Trachoma and NCDs clustered together in <1 km distances (R=0.18, p=0.02). In network analysis, age was strongly associated with trachoma and NCDs. Trachoma was linked with geographic location while diabetes was linked with water source distances. Education level became the central risk factor. CONCLUSIONS We demonstrate a twin trachoma-NCD burden that is higher among elderly pastoralists in southern Kenya. Attenuating adverse population-level visual impairment, including integrating the trachoma SAFE strategy with NCD comprehensive care, amplifies the benefits from economies of scale, accelerating realization of Sustainable Development Goal 3 and universal health coverage in hard-to-reach areas.
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Affiliation(s)
- R N Chweya
- Airbel Labs, International Rescue Committee, P.O. Box 62727-00200 Nairobi, Kenya
| | - C A Onyango
- Airbel Labs, International Rescue Committee, P.O. Box 62727-00200 Nairobi, Kenya
| | - S Saigilu
- Public Health Service, Kajiado County Government, P.O. Box 11-01100, Kajiado, Kenya
| | - C Mwangi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 Nairobi, Kenya
| | - J M Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200 Nairobi, Kenya
- Global Health Program, Washington State University, P.O. Box 62000-00200, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University, P.O. Box 62000-00200 Nairobi, Kenya
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Lew SQ, Asci G, Rootjes PA, Ok E, Penne EL, Sam R, Tzamaloukas AH, Ing TS, Raimann JG. The role of intra- and interdialytic sodium balance and restriction in dialysis therapies. Front Med (Lausanne) 2023; 10:1268319. [PMID: 38111694 PMCID: PMC10726136 DOI: 10.3389/fmed.2023.1268319] [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: 07/27/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
The relationship between sodium, blood pressure and extracellular volume could not be more pronounced or complex than in a dialysis patient. We review the patients' sources of sodium exposure in the form of dietary salt intake, medication administration, and the dialysis treatment itself. In addition, the roles dialysis modalities, hemodialysis types, and dialysis fluid sodium concentration have on blood pressure, intradialytic symptoms, and interdialytic weight gain affect patient outcomes are discussed. We review whether sodium restriction (reduced salt intake), alteration in dialysis fluid sodium concentration and the different dialysis types have any impact on blood pressure, intradialytic symptoms, and interdialytic weight gain.
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Affiliation(s)
- Susie Q. Lew
- Department of Medicine, George Washington University, Washington, DC, United States
| | - Gulay Asci
- Department of Nephrology, Ege University Medical School, Izmir, Türkiye
| | - Paul A. Rootjes
- Department of Internal Medicine, Gelre Hospitals, Apeldoorn, Netherlands
| | - Ercan Ok
- Department of Nephrology, Ege University Medical School, Izmir, Türkiye
| | - Erik L. Penne
- Department of Nephrology, Northwest Clinics, Alkmaar, Netherlands
| | - Ramin Sam
- Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Antonios H. Tzamaloukas
- Research Service, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Todd S. Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Jochen G. Raimann
- Research Division, Renal Research Institute, New York City, NY, United States
- Katz School of Science and Health at Yeshiva University, New York City, NY, United States
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Tang R, Kou M, Wang X, Ma H, Li X, Heianza Y, Qi L. Self-Reported Frequency of Adding Salt to Food and Risk of Incident Chronic Kidney Disease. JAMA Netw Open 2023; 6:e2349930. [PMID: 38153731 PMCID: PMC10755616 DOI: 10.1001/jamanetworkopen.2023.49930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Importance The self-reported frequency of adding salt to foods could reflect a person's long-term salt taste preference, and salt intake has been associated with increased risk of cardiovascular diseases (CVD). Whether self-reported adding of salt to foods is associated with increased risk of chronic kidney disease (CKD) remains unknown. Objective To prospectively examine the association of self-reported frequency of adding salt to foods with incident CKD risk in a general population of adults. Design, Setting, and Participants This population-based cohort study evaluated UK Biobank participants aged 37 to 73 years who were free of CKD at baseline. Participants were enrolled from 2006 to 2010 and prospectively followed up for disease diagnosis. Data were analyzed from October 2022 to April 2023. Exposure Self-reported frequency of adding salt to foods, categorized into never or rarely, sometimes, usually, and always. Main Outcome and Measure Incident CKD cases were defined by diagnostic codes. Hazard ratios (HRs) and 95% CIs were calculated by using Cox proportional hazards models. Models were adjusted for several potential confounders including age, sex, race and ethnicity, Townsend Deprivation Index, estimated glomerular filtration rate (eGFR), body mass index, (BMI), smoking status, alcohol drinking status, regular physical activity, high cholesterol, diabetes, CVD, hypertension, infectious disease, immune disease, and nephrotoxic drugs use at baseline. Results Within a cohort of 465 288 individuals (mean [SD] age 56.32 [8.08] years; 255 102 female participants [54.83%]; 210 186 male participants [45.17%]), participants with higher self-reported frequency of adding salt to foods were more likely to have a higher BMI, higher Townsend Deprivation Index score, and diminished baseline eGFR compared with those who reported a lower frequency of adding salt to foods. Participants who added salt to their foods were also more likely than those who did not add salt to their foods to be current smokers and have diabetes or CVD at baseline. During a median (IQR) follow-up of 11.8 (1.4) years, 22 031 incident events of CKD were documented. Higher self-reported frequency of adding salt to foods was significantly associated with a higher CKD risk after adjustment for covariates. Compared with those who reported never or rarely adding salt to foods, those who reported sometimes adding salt to food (adjusted HR [aHR], 1.04; 95% CI, 1.00-1.07), those who reported usually adding salt to food (aHR, 1.07; 95% CI, 1.02-1.11), and those who reported always adding salt to food (aHR, 1.11; 95% CI, 1.05-1.18) had an increased risk of CKD (P for trend < .001). In addition, eGFR, BMI, and physical activity significantly modified the associations, which were more pronounced among participants with a higher eGFR, lower BMI, or lower level of physical activity. Conclusions and Relevance In this cohort study of 465 288 individuals, a higher self-reported frequency of adding salt to foods was associated with a higher risk of CKD in the general population. These findings suggest that reducing the frequency of adding salt to foods at the table might be a valuable strategy to lower CKD risk in the general population.
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Affiliation(s)
- Rui Tang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Minghao Kou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Martin K, Toussaint ND, Tan SJ, Hewitson TD. Skin regulation of salt and blood pressure and potential clinical implications. Hypertens Res 2023; 46:408-416. [PMID: 36434290 DOI: 10.1038/s41440-022-01096-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Sodium chloride, as salt, gives rise to hypertension. Nevertheless, individual susceptibility to the ramifications of sodium chloride is heterogeneous. The conventional nephron-centric regulation of sodium with neurohormonal inputs and responses is now expanded to include an intricate extrarenal pathway including the endothelium, skin, lymphatics, and immune cells. An overabundance of sodium is buffered and regulated by the skin interstitium. Excess sodium passes through (and damages) the vascular endothelium and can be dynamically stored in the skin, modulated by skin immune cells and lymphatics. This excess interstitially stored sodium is implicated in hypertension, cardiovascular dysfunction, metabolic disruption, and inflammatory dysregulation. This extrarenal pathway of regulating sodium represents a novel target for better blood pressure management, rebalancing disturbed inflammation, and hence addressing cardiovascular and metabolic disease.
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Affiliation(s)
- Kylie Martin
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. .,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Sven-Jean Tan
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy D Hewitson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Ma H, Xue Q, Wang X, Li X, Franco OH, Li Y, Heianza Y, Manson JE, Qi L. Adding salt to foods and hazard of premature mortality. Eur Heart J 2022; 43:2878-2888. [PMID: 35808995 PMCID: PMC9890626 DOI: 10.1093/eurheartj/ehac208] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/11/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS We analyzed whether the frequency of adding salt to foods was associated with the hazard of premature mortality and life expectancy. METHODS AND RESULTS A total of 501 379 participants from UK biobank who completed the questionnaire on the frequency of adding salt to foods at baseline. The information on the frequency of adding salt to foods (do not include salt used in cooking) was collected through a touch-screen questionnaire at baseline. We found graded relationships between higher frequency of adding salt to foods and higher concentrations of spot urinary sodium or estimated 24-h sodium excretion. During a median of 9.0 years of follow-up, 18 474 premature deaths were documented. The multivariable hazard ratios [95% confidence interval (CI)] of all-cause premature mortality across the increasing frequency of adding salt to foods were 1.00 (reference), 1.02 (0.99, 1.06), 1.07 (1.02, 1.11), and 1.28 (1.20, 1.35) (P-trend < 0.001). We found that intakes of fruits and vegetables significantly modified the associations between the frequency of adding salt to foods and all-cause premature mortality, which were more pronounced in participants with low intakes than those with high intakes of these foods (P-interaction = 0.02). In addition, compared with the never/rarely group, always adding salt to foods was related to 1.50 (95% CI, 0.72-2.30) and 2.28 (95% CI, 1.66-2.90) years lower life expectancy at the age of 50 years in women and men, respectively. CONCLUSIONS Our findings indicate that higher frequency of adding salt to foods is associated with a higher hazard of all-cause premature mortality and lower life expectancy.
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Affiliation(s)
- Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Yanping Li
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Pamukcu B. Profile of hypertension in Turkey: from prevalence to patient awareness and compliance with therapy, and a focus on reasons of increase in hypertension among youths. J Hum Hypertens 2022; 36:437-444. [PMID: 33462387 DOI: 10.1038/s41371-020-00480-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022]
Abstract
Hypertension is one of the most common noncommunicable chronic diseases and is an important risk factor for vascular complications. The prevalence of hypertension is very high worldwide, and it is still increasing in low- and middle-income countries. Although some improvements were reported in high-income countries in recent years, there is still much to do to overcome hypertension and its complications. Identically, hypertension is a severe public health issue in Turkey. Approximately one third of the adult population has got hypertension but almost half is unaware of the disease. Children and youths are also affected by the burden of hypertension. Increased body mass index and obesity frequently accompany hypertension in children and adolescents. Major contributors to the disease burden appears to be consumption of high amounts of dietary sodium, lack of appropriate physical activity, increasing weight and obesity. In the last decades, an improvement at disease awareness has been achieved but blood-pressure control rates are still low in Turkey. Traditional and natural products, including lemon juice and garlic, are very popular among patients with concerns regarding medications' side effects. Patients' adherence to therapy differs between regions and increases in parallel with high education level. Decreasing daily salt intake has been shown to reduce the prevalence of hypertension substantially and to prevent cardiovascular and cerebrovascular deaths in a cost effective manner in projection studies. Finally, improving education of patients, which has positive effects on disease awareness, treatment adherence, and blood-pressure control rates, should be considered.
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Affiliation(s)
- Burak Pamukcu
- Department of Cardiology, Vocational School of Health Services, Acibadem Kozyatagi Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
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11
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Abstract
Patients on chronic hemodialysis are counseled to reduce dietary sodium intake to limit their thirst and consequent interdialytic weight gain (IDWG), chronic volume overload and hypertension. Low-sodium dietary trials in hemodialysis are sparse and mostly indicate that dietary education and behavioral counseling are ineffective in reducing sodium intake and IDWG. Additional nutritional restrictions and numerous barriers further complicate dietary adherence. A low-sodium diet may also reduce tissue sodium, which is positively associated with hypertension and left ventricular hypertrophy. A potential alternative or complementary approach to dietary counseling is home delivery of low-sodium meals. Low-sodium meal delivery has demonstrated benefits in patients with hypertension and congestive heart failure but has not been explored or implemented in patients undergoing hemodialysis. The objective of this review is to summarize current strategies to improve volume overload and provide a rationale for low-sodium meal delivery as a novel method to reduce volume-dependent hypertension and tissue sodium accumulation while improving quality of life and other clinical outcomes in patients undergoing hemodialysis.
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Affiliation(s)
- Luis M Perez
- Division of Renal Disease and Hypertension, University of Colorado Anschutz Medical Campus, Denver, CO, USA
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Annabel Biruete
- Department of Nutrition and Dietetics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Erdemir E. Free amino acids profile and quality properties of Turkish pastırma cured with potassium lactate and sodium chloride combinations. J FOOD PROCESS PRES 2021. [DOI: 10.1111/jfpp.16263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ebru Erdemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences Agri Ibrahim Cecen University Agri Turkey
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13
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Azadnajafabad S, Ebrahimi N, Mohammadi E, Ghasemi E, Saeedi Moghaddam S, Aminorroaya A, Rezaei N, Ghanbari A, Masinaei M, Mohammadi Fateh S, Haghshenas R, Gorgani F, Kazemi A, Dilmaghani-Marand A, Farzadfar F. Disparities and spatial variations of high salt intake in Iran: a subnational study of districts based on the small area estimation method. Public Health Nutr 2021; 24:6281-6291. [PMID: 34261565 PMCID: PMC11148577 DOI: 10.1017/s1368980021002986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High salt intake is one of the leading diet-related risk factors for several non-communicable diseases. We aimed to estimate the prevalence of high salt intake in Iran. DESIGN A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to risk factor Surveillance (STEPS) 2016. The modelling estimated the prevalence of high salt intake, defined as a daily salt intake ≥ 5 g in all districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country. SETTING 429 districts of all provinces of Iran, 2016. PARTICIPANTS 18 635 salt intake measurements from individuals 25 years old and above who participated in the Iran STEPS 2016 survey. RESULTS All districts in Iran had a high prevalence of high salt intake. The estimated prevalence of high salt intake among females of all districts ranged between 72·68 % (95 % UI 58·48, 84·81) and 95·04 % (95 % UI 87·10, 100). Estimated prevalence for males ranged between 88·44 % (95 % UI 80·29, 96·15) and 98·64 % (95 % UI 94·97, 100). In all categorisations, males had a significantly higher prevalence of high salt intake. Among females, the population with the lower economic status had a higher salt consumption than the participants with higher economic status by investigating the concentration index. CONCLUSIONS Findings of this study highlight the high salt intake as a prominent risk factor in all Iran regions, despite some variations in different scales. More suitable population-wide policies are warranted to handle this public health issue in Iran.
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Affiliation(s)
- Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arya Aminorroaya
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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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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Wiriyatanakorn S, Mukdadilok A, Kantachuvesiri S, Mekhora C, Yingchoncharoen T. Impact of self-monitoring of salt intake by salt meter in hypertensive patients: A randomized controlled trial (SMAL-SALT). J Clin Hypertens (Greenwich) 2021; 23:1852-1861. [PMID: 34510703 PMCID: PMC8678669 DOI: 10.1111/jch.14344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/16/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022]
Abstract
Salt intake over reference level would result in elevated blood pressure (BP) and long‐term morbidity. Salt meter is a device used to detect sodium content in daily food. This study aimed to evaluate the efficacy of salt‐meter addition to dietary education. The authors conducted a randomized‐controlled trial in hypertensive patients with uncontrolled BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg). Patients were randomized to receive salt meter plus dietary education (group A) or education only (group B), and followed up for 8 weeks. The primary endpoint was change in 24‐h urinary sodium excretion. Changes in BP, salt taste sensitivity, cardio‐ankle vascular index (CAVI) were also analyzed. There were total number of 90 patients who had complete follow‐up, 45 in each group. Mean age was 62.9 years and 53% were females. Mean baseline 24‐h urine sodium was 151.6 mmol/24 h and mean SBP and DBP were 152.8 and 83.4 mmHg, respectively. Baseline characteristics were similar between two groups. At 8 weeks, mean change in urine sodium were –31.83 mmol/24 h and 0.36 mmol/24 h in group A and group B, respectively (p = .006). Mean decrease in BP were SBP, 14.44 versus 8.22 mmHg (p = .030), and DBP 5.53 versus 1.93 mmHg (p = .032). The salt sensitivity was improved more in group A. There was no different between change in CAVI. From this study, salt meter in conjunction with dietary education, for self‐monitoring of salt intake is superior to education alone in hypertensive patients, and provided better blood pressure control. Salt meter should be considered in uncontrolled hypertensive patients.
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Affiliation(s)
- Sirichai Wiriyatanakorn
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Anucha Mukdadilok
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Surasak Kantachuvesiri
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
| | - Chusana Mekhora
- Institute of Food Research and Product Development, Kasetsart University, Thailand
| | - Teerapat Yingchoncharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand
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Stosovic D, Vasiljevic N, Jovanovic V, Cirkovic A, Paunovic K, Davidovic D. Dietary Habits of Older Adults in Serbia: Findings From the National Health Survey. Front Public Health 2021; 9:610873. [PMID: 34497788 PMCID: PMC8419354 DOI: 10.3389/fpubh.2021.610873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action.
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Affiliation(s)
- Dragana Stosovic
- Centre for Hygiene and Human Ecology, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Nadja Vasiljevic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Jovanovic
- Centre for Disease Control, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Andja Cirkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Paunovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Davidovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Factors Affecting Hypertension in the Adult Population of the Marmara Region, Turkey: A Descriptive Field Study. Int J Hypertens 2021; 2020:8869042. [PMID: 33520303 PMCID: PMC7817237 DOI: 10.1155/2020/8869042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/07/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Hypertension is an increasingly prevalent global public health problem. Nutritional culture and lifestyle are among the factors related to hypertension. The aim of this study was to evaluate the prevalence and influential factors of hypertension in the adult population of the Marmara region, Turkey. Methods The study was conducted in 10 provinces in the Marmara region between June 01, 2018, and November 30, 2018. Participants included 2353 patients over 18 years of age diagnosed with hypertension by any of the 30 family physicians working in the Family Health Centers in these provinces. After the participants provided written consent, a survey consisting of 25 questions was administered by their family physicians. SPSS 25.0 (IBM Corporation, Armonk, New York, United States) was used for all statistical analysis calculations. Results The patients included 1449 females (61.6%) and 904 males (38.4%). Among the respondents, 1555 (73.1%) had primary hypertension etiology and 572 (26.9%) had secondary etiology. While 1614 patients (68.6%) did not exercise at all, 739 patients (31.4%) reported exercising; 1026 patients (43.9%) did not restrict salt in their diet; and 1134 patients (48.2%) had a family history of hypertension. Conclusion Since individual and environmental factors affect the etiology of hypertension, it is recommended that family physicians address these factors first as part of a holistic approach for hypertension prevention, diagnosis, treatment, and follow-up.
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The Effect of Cognitive-Behavioral Intervention on Self-Care Behaviors and Blood Pressure Control in Patients with Primary Hypertension. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Akın S, Bölük C. Prevalence of comorbidities in patients with type-2 diabetes mellitus. Prim Care Diabetes 2020; 14:431-434. [PMID: 31902582 DOI: 10.1016/j.pcd.2019.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/23/2019] [Accepted: 12/25/2019] [Indexed: 01/14/2023]
Abstract
AIMS The prevalence of diabetes mellitus is gradually increasing in Turkey and it is becoming a serious public health problem. Other diseases which accompany diabetes becloud its treatment and bring additional problems. Until now, there have been no studies investigating the prevalence of co-morbidities in Turkish diabetic patients. With this study, we aimed to resolve the deficiency on this subject. METHODS This cross-sectional descriptive epidemiological study was conducted between 2018 and 2019. Patients who had been regularly admitted to our diabetes center in the past 3 years were included in this study. Co-morbidities including hypertension, hyperlipidemia, obesity, coronary heart disease, cerebrovascular disease, diabetic retinopathy, and diabetic nephropathy were investigated. Factors relating to these co-morbidities were assessed. RESULTS After exclusion from analysis, 1024 patients were included in the study. The female/male ratio was found to be 1.7. The mean age of these patients was 69.3 ± 9.8. The mean diabetes duration was 22.2 ± 7.0. The most common co-morbidities were hypertension and hyperlipidemia by the rate of 84.9% and 65.6%. Obesity prevalence was 54.4%, nephropathy was 36.6%, coronary heart disease 22.8%, retinopathy 18.5% and stroke prevalence was found to be 4.8%. Age, diabetes duration and insulin usage were found to be significantly related to all co-morbidities. CONCLUSIONS This study is significant in that it is the widest Turkish diabetic co-morbidity analysis study to date. When compared to other worldwide studies, co-morbidities were seen to be a little bit higher in Turkish diabetic patients. Clinicians need to not only focus on anti-diabetic treatment but also on other co-morbidities in terms of decreasing mortality and morbidity.
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Affiliation(s)
- Seydahmet Akın
- University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Diabetes Center, Department of Internal Medicine, Istanbul, Turkey
| | - Cem Bölük
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul, Turkey.
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An Assessment of Turkish Adults' Knowledge Levels About Their Salt and Sugar Consumption, and Their Attitudes Toward Protecting Children from Excessive Salt and Sugar Consumption. J Pediatr Nurs 2020; 54:e17-e22. [PMID: 32471662 DOI: 10.1016/j.pedn.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The study aimed to assess adults' knowledge levels about salt and sugar consumption and their attitudes toward protecting children from excessive consumption of them. DESIGN AND METHODS A cross-sectional, methodological, descriptive, and correlational study design was conducted. The study was carried out at a family health center and included 377 participants. The results were analyzed using descriptive statistics, reliability analysis and multiple regression. RESULTS The participants' knowledge scores accounted for 1.7% of their attitude scores. The participants' socio-demographic characteristics accounted for 13.9% of their knowledge scores, and the model was statistically significant (F = 7.453, p < 0.001). The participants' socio-demographic characteristics accounted for 11% of their attitude scores, and the model was statistically significant (F = 5.672, p < 0.001). CONCLUSIONS Children and adults should be protected from salt and sugar overconsumption, which is a risk factor for many diseases. Therefore, adults' knowledge levels about salt and sugar consumption and their attitudes toward protecting children from excessive consumption of them should be improved. It is also important to teach adults how to choose foods and beverages after checking their labels and how to be role models for children in this regard. PRACTICE IMPLICATIONS The study results will contribute to the planning of experimental studies to protect children from excessive salt and sugar consumption. In addition, the study results will provide an infrastructure for the preparation of training programs about salt and sugar consume according to the needs of different groups (older adults, young adults etc.).
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Perez LM, Burrows BT, Chan LE, Fang HY, Barnes JL, Wilund KR. Pilot feasibility study examining the effects of a comprehensive volume reduction protocol on hydration status and blood pressure in hemodialysis patients. Hemodial Int 2020; 24:414-422. [PMID: 32400085 DOI: 10.1111/hdi.12841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/11/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Chronic volume overload is a persistent problem in hemodialysis (HD) patients. The purpose of this study was to investigate the impacts of comprehensive volume reduction protocol on HD patient's hydration status and blood pressure (BP). METHODS Twenty-three HD patients (age = 55.7 ± 13.3 years) completed a 6-month comprehensive volume control protocol consisting of: reducing postdialysis weight; reducing BP medication prescriptions; and weekly intradialytic counseling to reduce dietary sodium intake and interdialytic weight gain (IDWG). The primary outcome was volume overload (VO) measured by bioelectrical impedance spectroscopy. Secondary outcomes included: IDWG, postdialysis weight, estimated dry weight (EDW), dietary sodium intake, BP and BP medication prescriptions. FINDINGS From baseline (0M) to 6 months (6M), significant improvements were noted in: VO (0M 3.9 ± 3.9 L vs. 6M 2.6 ± 3.4 L, P = 0.003), postdialysis weight (0M 89.4 ± 23.1 kg vs. 6M 87.6 ± 22.2 kg; P = 0.012), and EDW (0M 89.0 ± 23.2 vs. 6M 86.7 ± 22.5 kg., P = 0.009). There was also a trend for a reduction in monthly averaged IDWG (P = 0.053), and sodium intake (0M 2.9 ± 1.6 vs. 6M 2.3 ± 1.1 g/d, P = 0.125). Neither systolic BP (0M 162 ± 27 vs. 6M 157 ± 23 mmHg, P = 0.405) nor diastolic BP (0M 82 ± 21 vs. 6M 82 ± 19 mmHg, P = 0.960) changed, though there was a significant reduction in the total number of BP medications prescribed (0M 3.0 ± 1.0 vs. 6M 1.5 ± 1.0 BP meds; P = 0.004). DISCUSSION Our volume reduction protocol significantly improved HD patient's hydration status. While BP did not change, the reduction in prescribed BP medication number suggests improved BP control. Despite these overall positive findings, the magnitude of change in most variables was modest. Comprehensive changes in HD clinics may be necessary to realize more clinically significant results.
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Affiliation(s)
- Luis M Perez
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Brett T Burrows
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Lauren E Chan
- Department of Nutrition, Oregon State University, Corvallis, Oregon, USA
| | - Hsin-Yu Fang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
| | - Jennifer L Barnes
- Department of Family and Consumer Science, Illinois State University, Normal, Illinois, USA
| | - Kenneth R Wilund
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
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Zhao Y, Liu W, Liu S, Li X, Yin T, Liu X, Wang F, Chang X, Zhang T, Tian M, Zhang Y. Estimating 24-h urinary sodium excretion from casual spot urine specimen among hypertensive patients in Northwest China: the Salt Substitute and Stroke Study. Public Health Nutr 2020; 24:1-7. [PMID: 32345383 DOI: 10.1017/s1368980019005019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop an equation that can estimate the 24-h urinary Na excretion by using casual spot urine specimen for older hypertensive participants in rural Ningxia and further to compare with the INTERSALT method, Kawasaki method and Tanaka method. DESIGN Older hypertensive participants in rural Ningxia provided their casual spot urine samples and 24-h urine samples between January 2015 and February 2017. Sex-specific equation was developed using linear forward stepwise regression analysis. Model fit was assessed using adjusted R2. Approximately half of all participants were randomly selected to validate the equation. Mean differences, intraclass correlation coefficients and Bland-Altman plots were used to evaluate the performance of all methods. SETTING Pingluo County and Qingtongxia County in Ningxia Hui Autonomous Region, China. PARTICIPANTS Older hypertensive participants in rural Ningxia. RESULTS Totally, 807 of 1120 invited participants provided qualified 24-h urine samples and spot urine samples. There was no statistical difference comparing the laboratory-based method against the new method and the INTERSALT method, while Kawasaki method had the largest bias with a mean difference of 40·81 g/d (95 % CI 39·27, 42·35 g/d). Bland-Altman plots showed similar pattern of the results. CONCLUSION The INTERSALT method and the new equation have the potential to estimate the 24-h urinary Na excretion in this study population. However, the extrapolation of the results to other population needs to be careful. Future research is required to establish a more reliable method to estimate 24-h urinary Na excretion.
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Affiliation(s)
- Yi Zhao
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Wanlu Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Sha Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiaoxia Li
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Ting Yin
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiuying Liu
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Faxuan Wang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Xiaoyu Chang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
| | - Tianjing Zhang
- The People's Hospital of Anyang City, Anyang City, Henan Province, China
| | - Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Center, Haidian District, Beijing100088, China
- The George Institute for Global Health, University of New South Wales, Newtown, NSW2042, Australia
| | - Yuhong Zhang
- Public Health and Management School of Ningxia Medical University, Yinchuan City, Ningxia, China
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Lin Y, Mei Q, Qian X, He T. Salt consumption and the risk of chronic diseases among Chinese adults in Ningbo city. Nutr J 2020; 19:9. [PMID: 31996216 PMCID: PMC6990556 DOI: 10.1186/s12937-020-0521-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Chronic diseases have become one of essential public health concerns, leading causes of mortality in China. It is related to the changes in dietary pattern and dietary behavior. The objectives are to assess daily salt intake in Chinese people living in Ningbo and to examine its relationship with health outcomes. Methods Our study used data from health and nutrition survey in 2017. This study included 2811 adults aged 18–79 years (48% males) from urban and rural areas in Ningbo. A food frequency questionnaire together with demographic, physical and medical questionnaires was used to collect dietary intake, demographic, lifestyle and medical information. Ordinal logistic regression was used in the statistical analysis. Results The mean daily salt intake (13.0 g/day) of the participants was higher than the Chinese dietary reference intake (DRI, 6 g/d), which was related to higher risk of pre-hypertension and hypertension. Stratified by gender, education and lifestyle factors, daily salt intake was only significant in the blood pressure category (male: P = 0.048; less education: P = 0.003; urban: P = 0.006; no regular physical activity: P = 0.005, no regular smoking: P = 0.006). Ordinal logistic regression model shows that daily salt intake was significantly associated with higher odds of developing hypertension. Conclusion The daily salt intake of the majority of citizens living in Ningbo exceeded Chinese DRI and may increase the risk of hypertension. Moreover, public health intervention of salt restriction is necessarily needed for the prevention and control the ongoing epidemic of chronic diseases.
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Affiliation(s)
- Yi Lin
- Center for Health Economics, School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham, Ningbo China, 199 Taikang East Road, University Park, Ningbo, 315100, China
| | - Qiuhong Mei
- Department of Health and Education, Ningbo Municipal Center for Disease Control and Prevention, 237 Yongfeng Road, Ningbo, 315010, China
| | - Xujun Qian
- Departmentof Health and Management, Ningbo First Hospital, 59 Liuting Street, Ningbo, 315010, China
| | - Tianfeng He
- Department of Health and Education, Ningbo Municipal Center for Disease Control and Prevention, 237 Yongfeng Road, Ningbo, 315010, China.
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Selvam S, Manisha A, Venkatramanan S, Chung SY, Paramasivam CR, Singaraja C. Microplastic presence in commercial marine sea salts: A baseline study along Tuticorin Coastal salt pan stations, Gulf of Mannar, South India. MARINE POLLUTION BULLETIN 2020; 150:110675. [PMID: 31669711 DOI: 10.1016/j.marpolbul.2019.110675] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 05/06/2023]
Abstract
The present baseline research infers that the salts present in the sea may contain microplastics (MPs), as the seawater is contaminated due to a number of anthropogenic activities. Herein, 25 types of sea salt samples were collected from salt pans located in the Tuticorin coastal region. The MPs present in the samples were separated and identified by various methods such as handpicking, visual classification, and micro-Fourier transform infrared spectroscopy (μ-FT-IR) and atomic force microscopy (AFM). The MPs that measured less than 100 μm formed the major part of the salts, accounting to 60% of the MPs among the total pollutants. The MPs that were found in abundance in the sea salts were polypropylene, followed by polyethylene, nylon, and cellulose. This study was conducted in salt pan areas and demarcated the percentage of MPs present in sea salts. Table salt, which is a prime edible commodity, was found to be contaminated with MPs through polluted seawater, which poses a threat to public health.
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Affiliation(s)
- S Selvam
- Department of Geology, V.O. Chidambaram College, Tuticorin, Tamil Nadu, India
| | - A Manisha
- Department of Geology, V.O. Chidambaram College, Tuticorin, Tamil Nadu, India; Affiliated to Manonmaniam Sundaranar University (Registration No: 18212232062029), Abishekapatti, Tirunelveli-12, Tamil Nadu, India
| | - S Venkatramanan
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Viet Nam; Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Viet Nam.
| | - S Y Chung
- Department of Earth and Environmental Sciences, Pukyong National University, Nam-gu, Busan, South Korea
| | - C R Paramasivam
- Department of Remote Sensing, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
| | - C Singaraja
- Department of Geology, Presidency College, Chennai, Tamil Nadu, India
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Abstract
OBJECTIVE In Iran, there has been no national report on salt intake based on laboratory measurements so far. Therefore, this study was conducted to measure salt intake among Iranian population at the national level. METHODS In stepwise approach to conduct a surveillance survey 2016, 18 624 Iranian adults (25 years old and above), as a representative sample of Iranian adult population at national and subnational levels, underwent urine sodium measurement and were included in this study. The participants were recruited through a systematic random sampling from 30 provinces of Iran. For each individual, through a computer-assisted interview, a questionnaire on lifestyle risk factors was completed, all anthropometric indices were measured, and data on sodium of spot urine sample for all individuals and 24-h urine sample for a subsample were collected. To estimate the 24-h salt intake, common equations were used. RESULTS In total, 97.66% of the population consumed at least 5 g of salt per day. In addition, in 41.20% of the population, the level of salt intake was at least two times higher than the level recommended by the WHO for adults. The mean of salt intake among Iranian population was 9.52 g/day (95% confidence interval: 9.48-9.56). CONCLUSION The study showed that the consumption of salt among the Iranian population is higher than the level recommended by WHO. To reduce salt intake, it is necessary to adopt a combination of nationwide policies such as food reformulation and food labelling.
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Projecting burden of hypertension and its management in Turkey, 2015-2030. PLoS One 2019; 14:e0221556. [PMID: 31509548 PMCID: PMC6738591 DOI: 10.1371/journal.pone.0221556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/24/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In Turkey, hypertension was responsible for 13% of total deaths in 2015. We apply existing research finding regarding the impact of a population-wide reduction in sodium consumption on the decrease of the hypertension prevalence rate among 15+ years population and the gender-age specific reduction in total death rates among 30+ years population, and compare hypertension burden, averted deaths, costs and benefits between two scenarios. METHODS The first scenario (i.e. status quo) assumes constant hypertension prevalence rate and the death rates between 2015 and 2030. Based on the Framingham Heart Study and INTERSALT Study findings on the impact of salt-reduction strategies on hypertension prevalence rate, the second scenario (Scenario II) assumes a 17% reduction in the prevalence of hypertension in Turkey in 2030, from its 2015 prevalence level. We project hypertension attributable disability adjusted life years (DALYs) in 2030, monetize DALYs using GDP (and income) per capita, and compare the projected economic benefits of DALYs averted and the additional costs associated with the increases in hypertension treatment through antihypertensive medications and physician consultations. RESULTS The estimated benefits of reducing the economic burden of hypertension deaths outweigh the cost of providing hypertension treatment. A decrease in hypertension prevalence by 17%, attributable to population-wide reduction in salt consumption, is projected to avert 24.3 thousand deaths in 2030. We projected that, compared to status quo, 392 thousand DALYs will be averted in Scenario II in 2030. The economic benefits of reduction in potential hypertension deaths are estimated to be 6.7 to 8.6 folds higher than the additional cost of hypertension treatment. CONCLUSION Population-wide hypertension prevention and management is a win-win situation for public health and the Turkish health care system as the economic benefits of reducing deaths and disabilities associated with hypertension outweigh the costs significantly.
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How much salt is too much salt? Anatol J Cardiol 2019; 22:2-4. [PMID: 31264656 PMCID: PMC6683217 DOI: 10.14744/anatoljcardiol.2019.37657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tan CH, Chow ZY, Ching SM, Devaraj NK, He FJ, MacGregor GA, Chia YC. Salt content of instant noodles in Malaysia: a cross-sectional study. BMJ Open 2019; 9:e024702. [PMID: 31048428 PMCID: PMC6501963 DOI: 10.1136/bmjopen-2018-024702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine the salt content in instant noodles sold in Malaysia. STUDY DESIGN A cross-sectional survey was done involving 707 different flavours and packaging of instant noodles sold in six hypermarkets and retailer chains in Malaysia and the corresponding brand's official websites in 2017. METHODS The salt content (gram per serving and per 100 g) was collected from the product packaging and corresponding brand's official website. RESULTS Of the 707 different packaging and flavours of instant noodles, only 62.1% (n=439) provided the salt content in their food label.The mean (±SD) salt per 100 g of instant noodles was 4.3±1.5 g and is nearly four times higher than the salt content of food classified in Malaysia as a high salt content (>1.2 g salt per 100 g). The salt content for instant noodle per packaging ranged from 0.7 to 8.5 g. 61.7% of the instant noodles exceeded the Pacific Salt Reduction Target, 11.8% exceeded the WHO recommended daily salt intake of <5.0 per day and 5.50% exceeded Malaysia Salt Action Target. 98% of instant noodles will be considered as high salt food according to the Malaysia Guidelines.The probability of the instant noodles without mixed flavour (n=324) exceeding the Pacific Salt Reduction Target was tested on univariate and multivariate analysis. Instant noodles with soup, Tom Yam flavour, pork flavour and other flavours were found to be predictors of instant noodles with the tendency to exceed Pacific Salt Reduction Target when compared with instant noodles without mixed flavours (p<0.05). CONCLUSION Only 62% of instant noodles displayed the salt content on their food label. Salt content in instant noodles is very high, with 90% exceeding the daily salt intake recommended by WHO. Prompt action from regulatory and health authorities is needed to reduce the salt content in instant noodles.
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Affiliation(s)
- Chun Han Tan
- Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zhen Yee Chow
- Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Gerontology, Universiti Putra Malaysia, Serdang, Malaysia
| | - Navin Kumar Devaraj
- Department of Family Medicine, Universiti Putra Malaysia, Selangor, Selangor, Malaysia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Yook Chin Chia
- Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Aktaç S, Sabuncular G, Kargin D, Gunes FE. Evaluation of Nutrition Knowledge of Pregnant Women before and after Nutrition Education according to Sociodemographic Characteristics. Ecol Food Nutr 2018; 57:441-455. [PMID: 30421984 DOI: 10.1080/03670244.2018.1544561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this cross-sectional study is to evaluate the effect of nutrition education on nutritional knowledge levels of pregnant women. The study was undertaken on a sample of pregnant women (i = 743) attending health centers in Istanbul for prenatal care. Nutrition knowledge scores were significantly higher in posttest (23.0) than pretest (16.0) after receiving nutrition education (p < .001). Significant differences in pretest (p < .05) but not posttest (p > .05) scores were found for factors, such as education level, work status, and the number of pregnancies; significant differences in both test scores were found for age and nutrition information (p < .05). In conclusion, pregnant women need to be given adequate and appropriate nutrition education for maternal and child health according to sociodemographic characteristics.
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Affiliation(s)
- Sule Aktaç
- a Department of Nutrition and Dietetics, Faculty of Health Sciences , Marmara University , Istanbul , Turkey
| | - Guleren Sabuncular
- a Department of Nutrition and Dietetics, Faculty of Health Sciences , Marmara University , Istanbul , Turkey
| | - Dicle Kargin
- b Department of Nutrition and Dietetics, Institute of Health Sciences , Marmara University , Istanbul , Turkey
| | - Fatma Esra Gunes
- a Department of Nutrition and Dietetics, Faculty of Health Sciences , Marmara University , Istanbul , Turkey
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IMPLEMENTATION OF A “BALANCED NUTRITION EDUCATION PROGRAM” AMONG PRIMARY SCHOOL CHILDREN IN TURKEY. Nutrition 2018. [DOI: 10.1016/j.nut.2018.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Barberio AM, Sumar N, Trieu K, Lorenzetti DL, Tarasuk V, Webster J, Campbell NRC, McLaren L. Population-level interventions in government jurisdictions for dietary sodium reduction: a Cochrane Review. Int J Epidemiol 2018; 46:1551-1405. [PMID: 28204481 DOI: 10.1093/ije/dyw361] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Worldwide, excessive salt consumption is common and is a leading cause of high blood pressure. Our objectives were to assess the overall and differential impact (by social and economic indicators) of population-level interventions for dietary sodium reduction in government jurisdictions worldwide. Methods This is a Cochrane systematic review. We searched nine peer-reviewed databases, seven grey literature resources and contacted national programme leaders. We appraised studies using an adapted version of the Cochrane risk of bias tool. To assess impact, we computed the mean change in salt intake (g/day) from before to after intervention. Results Fifteen initiatives met the inclusion criteria and 10 provided sufficient data for quantitative analysis of impact. Of these, five showed a mean decrease in salt intake from before to after intervention including: China, Finland (Kuopio area), France, Ireland and the UK. When the sample was constrained to the seven initiatives that were multicomponent and incorporated activities of a structural nature (e.g. procurement policy), most (4/7) showed a mean decrease in salt intake. A reduction in salt intake was more apparent among men than women. There was insufficient information to assess differential impact by other social and economic axes. Although many initiatives had methodological strengths, all scored as having a high risk of bias reflecting the observational design. Study heterogeneity was high, reflecting different contexts and initiative characteristics. Conclusions Population-level dietary sodium reduction initiatives have the potential to reduce dietary salt intake, especially if they are multicomponent and incorporate intervention activities of a structural nature. It is important to consider data infrastructure to permit monitoring of these initiatives.
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Affiliation(s)
| | - Nureen Sumar
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathy Trieu
- Food Policy, George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
| | - Diane L Lorenzetti
- Department of Community Health Sciences.,Institute of Health Economics, Edmonton, AB, Canada
| | - Valerie Tarasuk
- Department of Nutritional Science, University of Toronto, Toronto, ON, Canada
| | - Jacqui Webster
- Food Policy, George Institute for Global Health, University of Sydney, Camperdown, NSW, Australia
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Akpolat T, Arici M, Sengul S, Derici U, Ulusoy S, Erturk S, Erdem Y. Home sphygmomanometers can help in the control of blood pressure: a nationwide field survey. Hypertens Res 2018; 41:460-468. [PMID: 29556094 PMCID: PMC8075910 DOI: 10.1038/s41440-018-0030-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/16/2017] [Accepted: 11/25/2017] [Indexed: 11/09/2022]
Abstract
Home blood pressure monitoring (HBPM), which integrates patients into their treatment program, is a self-management tool. The prevalence of home sphygmomanometer ownership and patient compliance with HBPM guidelines are not well known, especially in developing and underdeveloped countries. The aims of this study were to measure the prevalence of home sphygmomanometer ownership among hypertensive subjects through a nationwide field survey (PatenT2), to investigate the validation of sphygmomanometers and consistency of the user arm circumference and cuff size of the upper-arm device owned, as well as to compare blood pressure (BP) readings between hypertensive subjects who have or do not have a sphygmomanometer. Sample selection was based on a multistratified proportional sampling procedure to select a nationally representative sample of the adult population (n = 5437). Of 1650 hypertensive subjects, 332 (20.1%) owned a device, but the percentage of patients who owned a sphygmomanometer was 28.8% among patients who were aware of their hypertension (260/902). The usage of wrist devices and nonvalidated devices is common, and selection of an appropriate cuff size is ignored. Linear-regression analysis showed that owning a BP monitor is associated with decreases of 3.7 mmHg and 2.8 mmHg for systolic and diastolic BPs, respectively. Many patients do not own a sphygmomanometer. The decrease of systolic and diastolic BPs among BP monitor owners is a striking finding. The implementation of a hypertension care program consisting of sphygmomanometer reimbursement and training of patients in its use for HBPM might be cost-effective.
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Affiliation(s)
| | - Mustafa Arici
- Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sule Sengul
- Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ulver Derici
- Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sukru Ulusoy
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Yunus Erdem
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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Gündoğdu S. Contamination of table salts from Turkey with microplastics. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2018; 35:1006-1014. [DOI: 10.1080/19440049.2018.1447694] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sedat Gündoğdu
- Faculty of Fisheries, Department of Basic Sciences, Cukurova University, Adana, Turkey
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Kara B. Health Beliefs Related to Salt-Restricted Diet and Associated Factors in Turkish Patients on Hemodialysis. J Transcult Nurs 2018; 29:155-164. [DOI: 10.1177/1043659617691577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine health beliefs related to salt-restricted diet, to investigate their associations with demographic/disease-related characteristics and family support, and to determine the need for tailored interventions in Turkish patients on hemodialysis. Method: A cross-sectional study was conducted among 200 patients on hemodialysis. Data were collected through an information form, the Perceived Social Support from Family Scale and the Beliefs about Dietary Compliance Scale, including two subscales: perceived benefits and barriers. Descriptive statistics, Student’s t test, Pearson’s correlation coefficients, and linear regression analysis were used for data analysis. Results: The item mean perceived benefit score was higher than the item mean perceived barrier score. Limiting salt intake, family support, and the presence of residual urine output were associated with health beliefs. Conclusions/Implications: The likelihood of adherence to salt-restricted diet was high. A better understanding of health beliefs about salt-restricted diet and their related factors may facilitate the implementation of tailored interventions.
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Erdem Y, Akpolat T, Derici Ü, Şengül Ş, Ertürk Ş, Ulusoy Ş, Altun B, Arıcı M. Dietary Sources of High Sodium Intake in Turkey: SALTURK II. Nutrients 2017; 9:nu9090933. [PMID: 28837102 PMCID: PMC5622693 DOI: 10.3390/nu9090933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 01/28/2023] Open
Abstract
Previous research has shown daily salt intakes in Turkey to be far above the recommended limits. Knowing the sources of dietary salt could form a basis for preventive strategies aimed towards salt reduction. This study aimed to investigate dietary sources of salt in Turkey. A sub-group (n = 657) was selected from the PatenT2 study population, which represented the urban and rural areas of 4 major cities (Ankara, Istanbul, Izmir, and Konya). A questionnaire inquiring about sociodemographic characteristics, medical histories, detailed histories of diet, and salt consumption was completed. Participants were asked to collect a 24-h urine sample and to record their food intake (dietary recall) on the same day. Of 925 participants selected, 657 (71%) provided accurate 24-h urine collections, based on creatinine excretion data. The mean daily 24-h urinary sodium excretion was 252.0 ± 92.2 mmol/day, equal to daily salt intake of 14.8 ± 5.4 g. Of the 657 participants with accurate 24-h urine collections, 464 (70%) provided fully completed dietary recalls. Among these 464 participants, there was a significant difference between the 24-h urinary sodium excretion-based salt intake estimation (14.5 ± 5.1 g/day) and the dietary recall-based salt intake estimation (12.0 ± 7.0 g/day) (p < 0.001). On the other hand, a positive correlation was obtained between the dietary recall-based daily salt intake and 24-h urinary sodium excretion-based daily salt intake (r = 0.277, p < 0.001). Bread was the main source of salt (34%) followed by salt added during cooking and preparing food before serving (30%), salt from various processed foods (21%), and salt added at the table during food consumption (11%). Conclusively, this study confirmed a very high salt intake of the adult population in four major cities in Turkey. The present findings support the emerging salt reduction strategy in Turkey by promoting lower salt content in baked bread, and less salt use in habitual food preparation and during food consumption in the home.
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Affiliation(s)
- Yunus Erdem
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
| | - Tekin Akpolat
- Department of Internal Medicine, Division of Nephrology, Istinye University Liv Hospital, Istanbul 34510, Turkey.
| | - Ülver Derici
- Department of Internal Medicine, Division of Nephrology, Gazi University Faculty of Medicine, Ankara 06560, Turkey.
| | - Şule Şengül
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine, Ankara 06100, Turkey.
| | - Şehsuvar Ertürk
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine, Ankara 06100, Turkey.
| | - Şükrü Ulusoy
- Department of Internal Medicine, Karadeniz Teknik University Faculty of Medicine, Trabzon 61080, Turkey.
| | - Bülent Altun
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
| | - Mustafa Arıcı
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
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Abstract
Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.
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Baran AK, Demirci H, Budak E, Candar A, Akpınar Y. What do people with hypertension use to reduce blood pressure in addition to conventional medication – Is this related to adherence? Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yeşiltepe A, Dizdar OS, Gorkem H, Dondurmacı E, Ozkan E, Koç A, Oguz Baktır A, Gunal AI. Maintenance of negative fluid balance can improve endothelial and cardiac functions in primary hypertensive patients. Clin Exp Hypertens 2017; 39:579-586. [PMID: 28613081 DOI: 10.1080/10641963.2017.1291663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.
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Affiliation(s)
- Ali Yeşiltepe
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Oguzhan Sıtkı Dizdar
- b Department of Internal Medicine and Clinical Nutrition , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Hasan Gorkem
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Engin Dondurmacı
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Eyup Ozkan
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Koç
- d Department of Radiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ahmet Oguz Baktır
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Ihsan Gunal
- e Department of Internal Medicine Division of Nephrology , Kayseri Training and Research Hospital , Kayseri , Turkey
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Ok E, Levin NW, Asci G, Chazot C, Toz H, Ozkahya M. Interplay of volume, blood pressure, organ ischemia, residual renal function, and diet: certainties and uncertainties with dialytic management. Semin Dial 2017; 30:420-429. [PMID: 28581677 DOI: 10.1111/sdi.12612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracellular fluid volume overload and its inevitable consequence, hypertension, increases cardiovascular mortality in the long term by leading to left ventricular hypertrophy, heart failure, and ischemic heart disease in dialysis patients. Unlike antihypertensive medications, a strict volume control strategy provides optimal blood pressure control without need for antihypertensive drugs. However, utilization of this strategy has remained limited because of several factors, including the absence of a gold standard method to assess volume status, difficulties in reducing extracellular fluid volume, and safety concerns associated with reduction of extracellular volume. These include intradialytic hypotension; ischemia of heart, brain, and gut; loss of residual renal function; and vascular access thrombosis. Comprehensibly, physicians are hesitant to follow strict volume control policy because of these safety concerns. Current data, however, suggest that a high ultrafiltration rate rather than the reduction in excess volume is related to these complications. Restriction of dietary salt intake, increased frequency, and/or duration of hemodialysis sessions or addition of temporary extra sessions during the process of gradually reducing postdialysis body weight in conventional hemodialysis and discontinuation of antihypertensive medications may prevent these complications. We believe that even if an unwanted effect occurs while gradually reaching euvolemia, this is likely to be counterbalanced by favorable cardiovascular outcomes such as regression of left ventricular hypertrophy, prevention of heart failure, and, ultimately, cardiovascular mortality as a result of the eventual achievement of normal extracellular fluid volume and blood pressure over the long term.
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Affiliation(s)
- Ercan Ok
- Ege University Medical School, Izmir, Turkey
| | - Nathan W Levin
- Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - Gulay Asci
- Ege University Medical School, Izmir, Turkey
| | | | - Huseyin Toz
- Ege University Medical School, Izmir, Turkey
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Unal S, Tanriover MD, Ascioglu S, Demirkazik A, Ertenli I, Eskioglu E, Guler K, Kiraz S, Ozbakkaloglu M, Ozer B, Tukek T, Akyar S, Erdem Y. Turkish doctors' cohort: healthy despite low screening. Postgrad Med 2016; 129:393-398. [PMID: 27960640 DOI: 10.1080/00325481.2017.1272399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. RESULTS A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. CONCLUSION In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors' health behaviors to further improve doctors' and, relatedly, patients' health.
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Affiliation(s)
- Serhat Unal
- a Department of Infectious Diseases and Clinical Microbiology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mine Durusu Tanriover
- b Department of Internal Medicine, Division of General Internal Medicine , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Sibel Ascioglu
- a Department of Infectious Diseases and Clinical Microbiology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Ahmet Demirkazik
- c Department of Internal Medicine, Division of Medical Oncology , Ankara University School of Medicine , Ankara , Turkey
| | - Ihsan Ertenli
- d Department of Internal Medicine, Division of Rheumatology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Erdal Eskioglu
- e Department of Internal Medicine , Numune Training and Research Hospital , Ankara , Turkey
| | - Kerim Guler
- f Department of Internal Medicine , Istanbul University Faculty of Medicine , Istanbul , Turkey
| | - Sedat Kiraz
- d Department of Internal Medicine, Division of Rheumatology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mert Ozbakkaloglu
- g Department of Internal Medicine , Tepecik Training and Research Hospital , Izmir , Turkey
| | - Birol Ozer
- h Department of Internal Medicine, Division of Gastroenterology , Başkent University Faculty of Medicine , Adana , Turkey
| | - Tufan Tukek
- f Department of Internal Medicine , Istanbul University Faculty of Medicine , Istanbul , Turkey
| | - Serra Akyar
- i Institute of Population Studies , Hacettepe University , Ankara , Turkey
| | - Yunus Erdem
- j Department of Internal Diseases, Division of Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey
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McLaren L, Sumar N, Barberio AM, Trieu K, Lorenzetti DL, Tarasuk V, Webster J, Campbell NRC. Population-level interventions in government jurisdictions for dietary sodium reduction. Cochrane Database Syst Rev 2016; 9:CD010166. [PMID: 27633834 PMCID: PMC6457806 DOI: 10.1002/14651858.cd010166.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Excess dietary sodium consumption is a risk factor for high blood pressure, stroke and cardiovascular disease. Currently, dietary sodium consumption in almost every country is too high. Excess sodium intake is associated with high blood pressure, which is common and costly and accounts for significant burden of disease. A large number of jurisdictions worldwide have implemented population-level dietary sodium reduction initiatives. No systematic review has examined the impact of these initiatives. OBJECTIVES • To assess the impact of population-level interventions for dietary sodium reduction in government jurisdictions worldwide.• To assess the differential impact of those initiatives by social and economic indicators. SEARCH METHODS We searched the following electronic databases from their start date to 5 January 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); Cochrane Public Health Group Specialised Register; MEDLINE; MEDLINE In Process & Other Non-Indexed Citations; EMBASE; Effective Public Health Practice Project Database; Web of Science; Trials Register of Promoting Health Interventions (TRoPHI) databases; and Latin American Caribbean Health Sciences Literature (LILACS). We also searched grey literature, other national sources and references of included studies.This review was conducted in parallel with a comprehensive review of national sodium reduction efforts under way worldwide (Trieu 2015), through which we gained additional information directly from country contacts.We imposed no restrictions on language or publication status. SELECTION CRITERIA We included population-level initiatives (i.e. interventions that target whole populations, in this case, government jurisdictions, worldwide) for dietary sodium reduction, with at least one pre-intervention data point and at least one post-intervention data point of comparable jurisdiction. We included populations of all ages and the following types of study designs: cluster-randomised, controlled pre-post, interrupted time series and uncontrolled pre-post. We contacted study authors at different points in the review to ask for missing information. DATA COLLECTION AND ANALYSIS Two review authors extracted data, and two review authors assessed risk of bias for each included initiative.We analysed the impact of initiatives by using estimates of sodium consumption from dietary surveys or urine samples. All estimates were converted to a common metric: salt intake in grams per day. We analysed impact by computing the mean change in salt intake (grams per day) from pre-intervention to post-intervention. MAIN RESULTS We reviewed a total of 881 full-text documents. From these, we identified 15 national initiatives, including more than 260,000 people, that met the inclusion criteria. None of the initiatives were provided in lower-middle-income or low-income countries. All initiatives except one used an uncontrolled pre-post study design.Because of high levels of study heterogeneity (I2 > 90%), we focused on individual initiatives rather than on pooled results.Ten initiatives provided sufficient data for quantitative analysis of impact (64,798 participants). As required by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) method, we graded the evidence as very low due to the risk of bias of the included studies, as well as variation in the direction and size of effect across the studies. Five of these showed mean decreases in average daily salt intake per person from pre-intervention to post-intervention, ranging from 1.15 grams/day less (Finland) to 0.35 grams/day less (Ireland). Two initiatives showed mean increase in salt intake from pre-intervention to post-intervention: Canada (1.66) and Switzerland (0.80 grams/day more per person. The remaining initiatives did not show a statistically significant mean change.Seven of the 10 initiatives were multi-component and incorporated intervention activities of a structural nature (e.g. food product reformulation, food procurement policy in specific settings). Of those seven initiatives, four showed a statistically significant mean decrease in salt intake from pre-intervention to post-intervention, ranging from Finland to Ireland (see above), and one showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention (Switzerland; see above).Nine initiatives permitted quantitative analysis of differential impact by sex (men and women separately). For women, three initiatives (China, Finland, France) showed a statistically significant mean decrease, four (Austria, Netherlands, Switzerland, United Kingdom) showed no significant change and two (Canada, United States) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention. For men, five initiatives (Austria, China, Finland, France, United Kingdom) showed a statistically significant mean decrease, three (Netherlands, Switzerland, United States) showed no significant change and one (Canada) showed a statistically significant mean increase in salt intake from pre-intervention to post-intervention.Information was insufficient to indicate whether a differential change in mean salt intake occurred from pre-intervention to post-intervention by other axes of equity included in the PROGRESS framework (e.g. education, place of residence).We identified no adverse effects of these initiatives.The number of initiatives was insufficient to permit other subgroup analyses, including stratification by intervention type, economic status of country and duration (or start year) of the initiative.Many studies had methodological strengths, including large, nationally representative samples of the population and rigorous measurement of dietary sodium intake. However, all studies were scored as having high risk of bias, reflecting the observational nature of the research and the use of an uncontrolled study design. The quality of evidence for the main outcome was low. We could perform a sensitivity analysis only for impact. AUTHORS' CONCLUSIONS Population-level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population-wide reductions in salt intake from pre-intervention to post-intervention, particularly if they are multi-component (more than one intervention activity) and incorporate intervention activities of a structural nature (e.g. food product reformulation), and particularly amongst men. Heterogeneity across studies was significant, reflecting different contexts (population and setting) and initiative characteristics. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects.
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Affiliation(s)
- Lindsay McLaren
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd floor TRW, 3280 Hospital Dr. NWCalgaryAlbertaCanadaT2N 4Z6
| | - Nureen Sumar
- University of CalgaryDepartment of Family Medicine, Faculty of Medicine3330 Hospital Dr. NWCalgaryABCanadaT2N 4N1
| | - Amanda M Barberio
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd floor TRW, 3280 Hospital Dr. NWCalgaryAlbertaCanadaT2N 4Z6
| | - Kathy Trieu
- The George Institute for Global Health, The University of SydneyFood PolicyCamperdownNSWAustralia2050
| | - Diane L Lorenzetti
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd floor TRW, 3280 Hospital Dr. NWCalgaryAlbertaCanadaT2N 4Z6
| | - Valerie Tarasuk
- University of TorontoDepartment of Nutritional Sciences, Faculty of Medicine150 College StreetTorontoONCanadaM5S 3E2
| | - Jacqui Webster
- The George Institute for Global Health, The University of SydneyFood PolicyCamperdownNSWAustralia2050
| | - Norman RC Campbell
- Faculty of Medicine, University of CalgaryDepartments of Medicine; Community Health Sciences; Physiology and PharmacologyTRW Building, 3280 Hospital Dr. NWCalgaryABCanadaT2N 4Z6
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Erkoyun E, Sözmen K, Bennett K, Unal B, Boshuizen HC. Predicting the health impact of lowering salt consumption in Turkey using the DYNAMO health impact assessment tool. Public Health 2016; 140:228-234. [PMID: 27545691 DOI: 10.1016/j.puhe.2016.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/16/2016] [Accepted: 04/26/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool. STUDY DESIGN Statistical disease modelling study. METHODS DYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. TurkSTAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012-2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025. RESULTS The gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively. CONCLUSION This model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit.
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Affiliation(s)
- E Erkoyun
- Department of Public Health, Dokuz Eylul University, Izmir, Turkey.
| | - K Sözmen
- Department of Public Health, Izmir Katip Celebi University, Izmir, Turkey
| | - K Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Dublin, Ireland
| | - B Unal
- Department of Public Health, Dokuz Eylul University, Izmir, Turkey
| | - H C Boshuizen
- Department of Statistics and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Głąbska D, Włodarek D, Kołota A, Czekajło A, Drozdzowska B, Pluskiewicz W. Assessment of mineral intake in the diets of Polish postmenopausal women in relation to their BMI-the RAC-OST-POL study : Mineral intake in relation to BMI. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2016; 35:23. [PMID: 27484324 PMCID: PMC5025999 DOI: 10.1186/s41043-016-0061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/25/2016] [Indexed: 05/08/2023]
Abstract
BACKGROUND The diets of postmenopausal women in Western countries tend to be deficient in minerals, even if the energy value is at the recommended level. The objective of the presented population-based cohort study was to assess the intake of minerals (sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper) in the diets of women aged above 55 years and to analyse the relations between BMI and mineral intake in this group. METHODS The study was conducted in a group of 406 women who were randomly recruited from the general population of those aged above 55 years. The main outcome measures included BMI, reported sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper intake assessed by dietary record (conducted during two typical, non-consecutive days). The distribution was verified with the use of the Shapiro-Wilk test. The comparison between groups was conducted using ANOVA with the LSD post hoc test or Kruskal-Wallis ANOVA with multiple comparisons. A comparison of satisfying nutritional needs was conducted using the chi-square test. RESULTS Normal body weight individuals were characterised by lower sodium intake per 1000 kcal of diet than obese class II and III individuals (BMI ≥ 35.0 kg/m(2)). Overweight individuals were characterised by lower potassium and magnesium intake per 1000 kcal of diet than obese class I individuals (BMIϵ < 30.0; 35.0 kg/m(2)). The majority of individuals was characterised by insufficient potassium, calcium and magnesium intake. No differences in satisfying nutritional needs between BMI groups were observed for all minerals. CONCLUSIONS Following an improperly balanced diet was observed in the group of postmenopausal female individuals analysed. It was stated that the daily intake of all the assessed minerals was not BMI-dependent for the postmenopausal female individuals, but the nutrient density of diet (for sodium, potassium and magnesium) was associated with BMI.
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Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | - Dariusz Włodarek
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | - Aleksandra Kołota
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | | | - Bogna Drozdzowska
- Department of Pathomorphology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Pluskiewicz
- Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
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Ok E, Asci G, Chazot C, Ozkahya M, Mees EJD. Controversies and problems of volume control and hypertension in haemodialysis. Lancet 2016; 388:285-93. [PMID: 27226131 DOI: 10.1016/s0140-6736(16)30389-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracellular volume overload and hypertension are important contributors to the high risk of cardiovascular mortality in patients undergoing haemodialysis. Hypertension is present in more than 90% of patients at the initiation of haemodialysis and persists in more than two-thirds, despite use of several antihypertensive medications. High blood pressure is a risk factor for the development of left ventricular hypertrophy, heart failure, and mortality, although there are controversies with some study findings showing poor survival with low-but not high-blood pressure. The most frequent cause of hypertension in patients undergoing haemodialysis is volume overload, which is associated with poor cardiovascular outcomes itself independent of blood pressure. Although antihypertensive medications might not be successful to control blood pressure, extracellular volume reduction by persistent ultrafiltration and dietary salt restriction can produce favourable results with good blood pressure control. More frequent or longer haemodialysis can facilitate volume and blood pressure control. However, successful volume and blood pressure control is also possible in patients undergoing conventional haemodialysis.
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Affiliation(s)
- Ercan Ok
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey.
| | - Gulay Asci
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
| | | | - Mehmet Ozkahya
- Division of Nephrology, Ege University School of Medicine, Izmir, Turkey
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Sahan C, Sozmen K, Unal B, O'Flaherty M, Critchley J. Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study. BMJ Open 2016; 6:e011217. [PMID: 27388358 PMCID: PMC4947784 DOI: 10.1136/bmjopen-2016-011217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. DESIGN A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. SETTING Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. SUBJECT Projected populations in 2025 (aged 25-84) of 54 million in Turkey. RESULTS Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290-31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780-55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. CONCLUSIONS Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey.
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Affiliation(s)
- Ceyda Sahan
- Faculty of Medicine, Department of Public Health, Dokuz Eylül University, Izmir, Turkey
| | - Kaan Sozmen
- Faculty of Medicine, Department of Public Health, Kâtip Çelebi University, Izmir, Turkey
| | - Belgin Unal
- Faculty of Medicine, Department of Public Health, Dokuz Eylül University, Izmir, Turkey
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Julia Critchley
- Division of Population Health Sciences and Education, St George's, University of London, London, UK
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Determinants of thirst distress in patients on hemodialysis. Int Urol Nephrol 2016; 48:1525-32. [PMID: 27215556 DOI: 10.1007/s11255-016-1327-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Thirst sensation can induce nonadherence with fluid restriction in patients on hemodialysis (HD) and may lead to large interdialytic weight gain (IWG). This study aimed to evaluate thirst distress and its determinants and to explore fluid management strategies used by patients on HD. METHODS A cross-sectional study was conducted in a sample of 203 patients who were followed in three HD centers in Turkey, from January 2015 to June 2015. Data were collected by a personal information form, the Thirst Distress Scale (TDS) and the Visual Analogue Scale (VAS) for thirst and xerostomia. Data analysis was performed using descriptive statistics, Student's t test, the one-way analysis of variance, Pearson's correlation coefficients, and linear regression analysis. RESULTS The mean TDS score was 20.71 ± 8.34, which is a higher than moderate level of thirst distress. The significant determinants of thirst distress of the patients were the VAS thirst score (unstandardized β = 1.73, p < 0.001), the VAS xerostomia score (unstandardized β = 0.42, p < 0.001), and the IWG values (unstandardized β = 1.20, p = 0.003), after controlling for specific variables. The most common strategies used to reduce fluid intake or relieve thirst were avoiding salty foods (70.9 %), limiting salt on food (70.9 %), and spacing liquids over the entire day (57.6 %). CONCLUSIONS Patients with higher levels of thirst and xerostomia and those with a high IWG were more likely to have higher thirst distress. A greater understanding of thirst distress and its related factors could contribute to more effective interventions that improve health and well-being in patients on HD.
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Kilic M, Uzunçakmak T, Ede H. The effect of knowledge about hypertension on the control of high blood pressure. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Critchley J, Capewell S, O'Flaherty M, Abu-Rmeileh N, Rastam S, Saidi O, Sözmen K, Shoaibi A, Husseini A, Fouad F, Ben Mansour N, Aissi W, Ben Romdhane H, Unal B, Bandosz P, Bennett K, Dherani M, Al Ali R, Maziak W, Arık H, Gerçeklioğlu G, Altun DU, Şimşek H, Doganay S, Demiral Y, Aslan Ö, Unwin N, Phillimore P, Achour N, Aissi W, Allani R, Arfa C, Abu-Kteish H, Abu-Rmeileh N, Al Ali R, Altun D, Ahmad B, Arık H, Aslan Ö, Beltaifa L, Ben Mansour N, Bennett K, Ben Romdhane H, Ben Salah N, Collins M, Critchley J, Capewell S, Dherani M, Demiral Y, Doganay S, Elias M, Ergör G, Fadhil I, Fouad F, Gerçeklioğlu G, Ghandour R, Göğen S, Husseini A, Jaber S, Kalaca S, Khatib R, Khatib R, Koudsie S, Kilic B, Lassoued O, Mason H, Maziak W, Mayaleh MA, Mikki N, Moukeh G, Flaherty MO, Phillimore P, Rastam S, Roglic G, Saidi O, Saatli G, Satman I, Shoaibi A, Şimşek H, Soulaiman N, Sözmen K, Tlili F, Unal B, Unwin N, Yardim N, Zaman S. Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments. Int J Cardiol 2016; 208:150-61. [PMID: 26878275 DOI: 10.1016/j.ijcard.2016.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 11/05/2015] [Accepted: 01/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey. METHODS Data on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995-97; 2006-09); integrated and analysed using the IMPACT model. RESULTS Risk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1-2 kg/m(2) and diabetes prevalence increased by 40%-50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria. Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake. CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder. DISCUSSION CHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.
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Affiliation(s)
- Julia Critchley
- Population Health Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, State of Palestine
| | - Samer Rastam
- Syrian Center For Tobacco Studies, Aleppo, Syria
| | - Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | - Kaan Sözmen
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Azza Shoaibi
- Institute of Community and Public Health, Birzeit University, State of Palestine
| | - Abdullatif Husseini
- Public Health Program, Department of Health Sciences, Qatar University, Doha, Qatar
| | - Fouad Fouad
- Syrian Center For Tobacco Studies, Aleppo, Syria; Department of Epidemiology and Public Health, American University of Beirut, Lebanon
| | - Nadia Ben Mansour
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | - Wafa Aissi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunisia
| | | | - Belgin Unal
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, UK
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College, Dublin, Ireland
| | - Mukesh Dherani
- Department of Public Health and Policy, University of Liverpool, UK
| | | | - Wasim Maziak
- Syrian Center For Tobacco Studies, Aleppo, Syria; Robert Stempel College of Public Health And Social Work, Florida International University, Miami, FL, USA
| | - Hale Arık
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Gül Gerçeklioğlu
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Deniz Utku Altun
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Hatice Şimşek
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Sinem Doganay
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Yücel Demiral
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Özgür Aslan
- Dept. of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Nigel Unwin
- The Faculty of Medical Sciences, University of the West Indies, Barbados
| | | | | | | | | | - Waffa Aissi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Riadh Allani
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Chokra Arfa
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | - Niveen Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Deniz Altun
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Balsam Ahmad
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Hale Arık
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Özgür Aslan
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Latifa Beltaifa
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Nadia Ben Mansour
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College, Dublin, Ireland
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | | | - Julia Critchley
- Division of Population Health Sciences and Education, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Mukesh Dherani
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Yücel Demiral
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Sinem Doganay
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Gül Ergör
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Fouad Fouad
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | - Gül Gerçeklioğlu
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Rula Ghandour
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Sibel Göğen
- Primary Health Care General Directorate, Turkish Ministry of Health, Turkey
| | - Abdullatif Husseini
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Samer Jaber
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Rana Khatib
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Rasha Khatib
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Bülent Kilic
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Olfa Lassoued
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | | | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria; Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA
| | | | - Nahed Mikki
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | | | - Martin O Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Peter Phillimore
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Samer Rastam
- Syrian Center for Tobacco Studies, Aleppo, Syria
| | | | - Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Gül Saatli
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Azza Shoaibi
- Institute of Community and Public Health, Birzeit University, Birzeit, State of Palestine
| | - Hatice Şimşek
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | | | - Kaan Sözmen
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Faten Tlili
- Cardiovascular Epidemiology and Prevention Research Laboratory, Tunis, Tunisia
| | - Belgin Unal
- Dept of Public Health, Faculty of Medicine, Dokuz Eylul University, Turkey
| | - Nigel Unwin
- University of the West Indies, Georgetown, Barbados
| | - Nazan Yardim
- Primary Health Care General Directorate, Turkish Ministry of Health, Turkey
| | - Shahaduz Zaman
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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49
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Topbaş E, Kavalalı T, Öztürk F, Can S, Dedekoç Ş, Sapcı Y. THE IMPACT OF CONTROLLED FLUID AND SALT INTAKE TRAINING IN PATIENTS UNDERGOING HAEMODIALYSIS. J Ren Care 2015; 41:247-52. [PMID: 26119772 DOI: 10.1111/jorc.12133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Serious complications can occur when patients have difficulty in adhering to fluid and salt recommendations. OBJECTIVES AND DESIGN This study was designed as an experimental study with the aims of evaluating the effects of controlled fluid and salt intake training on the intra-dialytic process and on the level of patients' knowledge. The factors that had an impact on the training process were also evaluated. The effectiveness of the planned training was evaluated at 0, 1, 3 and 6 months. RESULTS There were no significant differences in salt intake exceeding 3 g per day (p > 0.05) between the preliminary and final test, although a statistically significant change was observed at months 1 and 3. The effectiveness of the training decreased by the end of the 3rd month. A statistically significant change was obtained prior to and after the training at months 0, 1, 3 and 6 with respect to the rates of daily fluid intake exceeding 1,500 ml, hypovolaemia, hypervolaemia, awareness of salt-rich food and correct calculation of daily fluid intake by the patients. Also a significant reduction was observed in the volume of oedema after the training. The patients' age, gender, marital status and educational background did not have a significant effect on daily salt intake of more than 3 g, daily fluid intake of more than 1,500 ml, and level of knowledge regarding fluid and salt control. CONCLUSIONS The training was effective at some time points in decreasing salt and fluid intake. This training should be repeated at certain intervals for the behavioural changes to become permanent.
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Affiliation(s)
- Eylem Topbaş
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Tuğba Kavalalı
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Feyza Öztürk
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Semih Can
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Şule Dedekoç
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
| | - Yasemin Sapcı
- Amasya University, School of Health, Nursing Department, Amasya, Turkey
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50
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Cogswell ME, Maalouf J, Elliott P, Loria CM, Patel S, Bowman BA. Use of Urine Biomarkers to Assess Sodium Intake: Challenges and Opportunities. Annu Rev Nutr 2015; 35:349-87. [PMID: 25974702 PMCID: PMC5497310 DOI: 10.1146/annurev-nutr-071714-034322] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This article summarizes current data and approaches to assess sodium intake in individuals and populations. A review of the literature on sodium excretion and intake estimation supports the continued use of 24-h urine collections for assessing population and individual sodium intake. Since 2000, 29 studies used urine biomarkers to estimate population sodium intake, primarily among adults. More than half used 24-h urine; the rest used a spot/casual, overnight, or 12-h specimen. Associations between individual sodium intake and health outcomes were investigated in 13 prospective cohort studies published since 2000. Only three included an indicator of long-term individual sodium intake, i.e., multiple 24-h urine specimens collected several days apart. Although not insurmountable, logistic challenges of 24-h urine collection remain a barrier for research on the relationship of sodium intake and chronic disease. Newer approaches, including modeling based on shorter collections, offer promise for estimating population sodium intake in some groups.
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Affiliation(s)
- Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30341; , ,
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