Low-Sodium Dietary Perceptions and Experiences of African-American Women with Hypertension

African-Americans are disproportionately affected by hypertension with lower rates of blood pressure control in comparison to the general population (Brennan et al., 2010). Low-sodium dietary intake is one of the most important lifestyle changes that can help control hypertension (Zhang et al., 2013). This qualitative study aimed to explore and describe the perceptions and experiences of low-sodium dietary practices among African-American women with hypertension. The study used a single-category focus group design. The findings suggest that African-American women are attempting to follow a low-sodium diet; however, they are influenced by personal and environmental factors and lack a clear understanding of what a low-sodium diet entails. Therefore, nurses must understand the factors that influence African-American women's ability to follow a low-sodium diet so that effective interventions can be implemented to improve adherence in this population.

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

Elevation of Fasting Ghrelin in Healthy Human Subjects Consuming a High-Salt Diet: A Novel Mechanism of Obesity?

Overweight/obesity is a chronic disease that carries an increased risk of hypertension, diabetes mellitus, and premature death. Several epidemiological studies have demonstrated a clear relationship between salt intake and obesity, but the pathophysiologic mechanisms remain unknown. We hypothesized that ghrelin, which regulates appetite, food intake, and fat deposition, becomes elevated when one consumes a high-salt diet, contributing to the progression of obesity. We, therefore, investigated fasting ghrelin concentrations during a high-salt diet. Thirty-eight non-obese and normotensive subjects (aged 25 to 50 years) were selected from a rural community in Northern China. They were sequentially maintained on a normal diet for three days at baseline, a low-salt diet for seven days (3 g/day, NaCl), then a high-salt diet for seven days (18 g/day). The concentration of plasma ghrelin was measured using an immunoenzyme method (ELISA). High-salt intake significantly increased fasting ghrelin levels, which were higher during the high-salt diet (320.7 ± 30.6 pg/mL) than during the low-salt diet (172.9 ± 8.9 pg/mL). The comparison of ghrelin levels between the different salt diets was statistically-significantly different (p < 0.01). A positive correlation between 24-h urinary sodium excretion and fasting ghrelin levels was demonstrated. Our data indicate that a high-salt diet elevates fasting ghrelin in healthy human subjects, which may be a novel underlying mechanism of obesity.

Social problem solving training for African Americans: effects on dietary problem solving skill and DASH diet-related behavior change

OBJECTIVE

Hypertension continues to take its toll on millions of African Americans. Adhering to an eating plan called Dietary Approaches to Stop Hypertension (DASH) can significantly lower blood pressure. This study examined whether problem solving training in addition to education on DASH is more effective than education alone to help African Americans in an urban community college setting solve their own dietary problems and change eating behaviors that could affect blood pressure.

METHODS

A randomized, two groups, multiple post-test design was used. All participants (N=78, 59% female) completed a Problem Solving Instrument immediately post-intervention and a follow-up Telephone Interview 2 weeks later.

RESULTS

Fewer than half had normal blood pressure on screening. The Experimental Group identified and implemented significantly higher quality solutions to the second of their two problems than the Control Group. The intervention effect was the greatest for participants with blood pressure screenings above normal.

CONCLUSION

Problem solving training combined with nutrition information may help African Americans to deal more effectively with dietary problems especially when the problems are complex or less well-defined.

PRACTICE IMPLICATIONS

Dietary interventions that include a focus on everyday problem solving as well as knowledge acquisition can be developed in clinical, community health, school, and worksite settings.

Dietary sodium restriction alters postprandial ghrelin: implications for race differences in obesity

OBJECTIVES

To examine the effect of sodium restriction on the appetite-stimulating hormone, ghrelin, as a function of race, salt sensitivity, and obesity.

DESIGN

PARTICIPANTS completed two 4-day outpatient dietary interventions (moderate vs low sodium), and blood samples were drawn two hours after a controlled test meal under both conditions.

SETTING

A university research laboratory and affiliated General Clinical Research Center.

PARTICIPANTS

37 women (18 Black, 19 White) and 18 men (9 Black, 9 White), aged 36-63 years.

MEASURES

Cardiovascular function (blood pressure, heart rate, impedance-derived indices of cardiac output and peripheral resistance) was measured after a 20-minute rest before each test meal. Blood was drawn by intravenous forearm catheter two hours after each test meal and later assayed for ghrelin, leptin, and norepinephrine.

RESULTS

After four days of sodium restriction, postprandial ghrelin increased in White men and women and Black men but decreased in Black women. Salt sensitivity, but not obesity, was also related to ghrelin response during sodium restriction; postprandial ghrelin tended to increase among salt-sensitive subjects during salt restriction but decrease among salt-resistant subjects during salt restriction.

CONCLUSIONS

Satiety hormone dysregulation may play a role in: 1) the heightened obesity-related morbidity among Black women, in particular; 2) adherence to sodium-restricted diets; and 3) race differences in behavioral weight-loss interventions that include sodium restriction.