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Holvik K, Abel MH, Holmen J, Krokstad S, Totland TH, Meyer HE. No change in 24-h sodium intake estimated from spot urine in Norwegian adults from 2006 to 2019: the population-based Trøndelag Health Study (HUNT). Public Health Nutr 2024; 27:e117. [PMID: 38602104 PMCID: PMC11036440 DOI: 10.1017/s136898002400082x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Monitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-h salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-2008 to 2017-2019 and to describe variations by sex, age and educational level. DESIGN Repeated cross-sectional studies. SETTING The population-based Trøndelag Health Study (HUNT). PARTICIPANTS In each of two consecutive waves (HUNT3: 2006-2008 and HUNT4: 2017-2019), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of Na, K and creatinine and age, sex and BMI, we estimated 24-h Na intake using the International Cooperative Study on Salt and Blood Pressure (INTERSALT) equation for the Northern European region. RESULTS Mean (95 % CI) estimated 24-h salt intakes in men were 11·1 (95 % CI 10·8, 11·3) g in HUNT3 and 10·9 (95 % CI 10·6, 11·1) g in HUNT4, P = 0·25. Corresponding values in women were 7·7 (95 % CI 7·5, 7·9) g and 7·7 (95 % CI 7·5, 7·9) g, P = 0·88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. CONCLUSIONS Estimated 24-h salt intake in adult men and women in mid-Norway did not change from 2006-2008 to 2017-2019.
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Affiliation(s)
- Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Marianne Hope Abel
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Jostein Holmen
- HUNT Research Center, Department of Public Health and Nursing,
Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Center, Department of Public Health and Nursing,
Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust,
Levanger, Norway
| | - Torunn Holm Totland
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health
and Society, University of Oslo, Oslo,
Norway
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Zhang Q, Shen Y, Yu M, Yang Z, Huang Z, Ding J, Zhu X. Associations between estimation of salt intake and salt-restriction spoons and hypertension status in patients with poorly controlled hypertension: a community-based study from Huzhou City, Eastern China. Nutr J 2024; 23:9. [PMID: 38225607 PMCID: PMC10789056 DOI: 10.1186/s12937-024-00912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND As the prevalence of hypertension increases in China, it is advised to use salt-restriction spoons (SRS) as a lifestyle modification. This study aimed to examine the associations between estimated salt consumption, SRS usage, and the hypertension status in individuals with poorly controlled hypertension. METHODS Data was collected in Huzhou City, Zhejiang Province, in 2021 using convenience sampling. The analysis involved ordinal logistic regression and restricted cubic splines to assess the relevant factors. RESULTS The study found that 73.34% of the 1215 patients had uncontrolled blood pressure (BP). Urinary excretion was assessed through the utilization of the Kawasaki, INTERSALT, and Tanaka formulas. The outcomes of these three methodologies revealed average daily sodium excretion values of 208.70 (65.65), 154.78 (33.91), and 162.61 (40.87) mmol, respectively. The prevalence of utilizing SRS was found to be 37.78% in this study. Despite the acknowledgment among SRS users of the potential hazards associated with excessive salt consumption, there exists a contradictory pattern of attitudes and behaviors concerning salt reduction. Among individuals with different levels of salt intake (quartiles 1-4, Q1 vs Q4), there was a positive association between limiting salt and hypertension status when controlling for other variables (Kawasaki adjusted OR = 0.58, 95% CI = 0.43-0.79; INTERSALT adjusted OR = 0.62, 95% CI = 0.41-0.92; Tanaka adjusted OR = 0.61, 95% CI = 0.45-0.92, p < 0.05). Our research also revealed that using or used SRS was a protective factor for blood BP control (adjusted OR = 0.79, 95% CI = 0.64-0.99, P < 0.05). The restricted cubic spline plots illustrated a monotonic upward relationship between estimated 24-h urinary Na and BP (P-overall association < 0.05; P-non-linear association > 0.05). CONCLUSIONS The use of dietary SRS could result in decrease in daily salt intake for BP control in patients with poorly controlled hypertension. To reduce the impact of high BP in China, additional studies are required to create interventions that can enhance the results for patients.
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Affiliation(s)
- Qi Zhang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Yimei Shen
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China.
| | - Meihua Yu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Zhongrong Yang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Zheng Huang
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Jingying Ding
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
| | - Xinfeng Zhu
- Huzhou Center for Disease Control and Prevention, Huzhou, Zhejiang Province, China
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Mao GM, Mo Z, Gu SM, Wang YY, Jiang YJ, Li YH, Li XQ, Chen ZJ, Wang XF, Lou XM, Liu CY. [Analysis of iodine nutritional status of children aged 8-10 years in Zhejiang Province from 2016 to 2021]. Zhonghua Yu Fang Yi Xue Za Zhi 2024; 58:11-17. [PMID: 38228544 DOI: 10.3760/cma.j.cn112150-20230707-00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To analyze the iodine nutrition status of children aged 8 to 10 years in Zhejiang Province from 2016 to 2021. Methods: A multi-stage stratified sampling method was used to select non-residential children aged 8 to 10 years from 90 counties in Zhejiang Province. A total of 114 103 children were included in the study from 2016 to 2021. Direct titration method and arsenic-cerium catalytic spectrophotometry were used to detect salt iodine content and urinary iodine level, respectively, to evaluate the iodine nutritional status of children. Ultrasound was used to detect thyroid volume and analyze the current prevalence of goiter in school-age children. Results: The age of 114 103 children was (9.04 ± 0.81) years old, with 50.0% of (57 083) boys. The median of iodine content M (Q1, Q3) in children's household salt was 23.00 (19.80, 25.20) mg/kg, including 17 242 non-iodized salt, 6 173 unqualified iodized salt, and 90 688 qualified iodized salt. The coverage rate of iodized salt was 84.89%, and the coverage rate of qualified iodized salt was 79.48%. The proportion of non-iodized salt increased from 11.85% in 2016 to 16.04% in 2021 (χ2trend=111.427, P<0.001). The median of urinary iodine concentration M (Q1, Q3) in children was 182.50 (121.00, 261.00) μg/L, among which the proportions of iodine deficiency, iodine suitability, iodine over suitability, and iodine excess were 17.25% (19 686 cases), 39.21% (44 745 cases), 26.85% (30 638 cases), and 16.68% (19 034 cases), respectively. The median of urinary iodine concentration in children in inland areas [M (Q1, Q3): 190.90 (128.80, 269.00) μg/L] was significantly higher than that in children in coastal areas [M (Q1, Q3): 173.00 (113.00, 250.30) μg/L] (P<0.001). From 2016 to 2021, a total of 39 134 ultrasound examinations were conducted, and 1 229 cases of thyroid enlargement were detected. The goiter rate was 3.14% (95%CI: 2.97%-3.32%). The incidence of goiter in children in coastal areas [3.45% (95%CI: 3.19%-3.72%), 641/18 604] was higher than that in children in inland areas [2.86% (95%CI: 2.64%-3.10%), 588/20 530] (P=0.001). Conclusion: From 2016 to 2021, the iodine nutrition level of children aged 8-10 years in Zhejiang Province is generally suitable, and the rate of goiter in children meets the limit of iodine deficiency disease elimination standards.
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Affiliation(s)
- G M Mao
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Z Mo
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - S M Gu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Y Y Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Y J Jiang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Y H Li
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - X Q Li
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - Z J Chen
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - X F Wang
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - X M Lou
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
| | - C Y Liu
- Department of Environmental Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
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Afroza U, Abrar AK, Nowar A, Akhtar J, Mamun MAA, Sobhan SMM, Cobb L, Ide N, Choudhury SR. Salt Intake Estimation from Urine Samples in South Asian Population: Scoping Review. Nutrients 2023; 15:4358. [PMID: 37892433 PMCID: PMC10609745 DOI: 10.3390/nu15204358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
The World Health Organization recommended reducing one's salt intake below 5 g/day to prevent disability and death from cardiovascular and other chronic diseases. This review aimed to identify salt estimation at the population level in South Asian countries, namely Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka. We searched electronic databases and government websites for the literature and reports published between January 2011 and October 2021 and also consulted key informants for unpublished reports. We included studies that assessed salt intake from urinary sodium excretion, either spot urine or a 24 h urine sample, on a minimum of 100 samples in South Asian countries. We included 12 studies meeting the criteria after screening 2043 studies, out of which five followed nationally representative methods. This review revealed that salt intake in South Asian countries ranges from 6.7-13.3 g/day. The reported lowest level of salt intake was in Bangladesh and India, and the highest one was in Nepal. The estimated salt intake reported in the nationally representative studies were ranging from 8 g/day (in India) to 12.1 g/day (in Afghanistan). Salt consumption in men (8.9-12.5 g/day) was reported higher than in women (7.1-12.5 g/day). Despite the global target of population salt intake reduction, people in South Asian countries consume a much higher amount of salt than the WHO-recommended level.
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Affiliation(s)
- Ummay Afroza
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Ahmad Khairul Abrar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Abira Nowar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Jubaida Akhtar
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Sheikh Mohammad Mahbubus Sobhan
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
| | - Laura Cobb
- Resolve To Save Lives (RTSL), New York, NY 10004, USA; (L.C.); (N.I.)
| | - Nicole Ide
- Resolve To Save Lives (RTSL), New York, NY 10004, USA; (L.C.); (N.I.)
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka 1216, Bangladesh; (A.K.A.); (A.N.); (J.A.); (M.A.A.M.); (S.M.M.S.); (S.R.C.)
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Zhang Y, Wang J, Ma W, Li X, Wang H, Xu J. Survey of iodized salt coverage in areas with different water iodine concentrations and the iodine status of local women. Eur J Nutr 2023; 62:2919-2928. [PMID: 37402817 DOI: 10.1007/s00394-023-03198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 06/23/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE There were only two definitions of iodine-deficient (water iodine concentration < 10 μg/L) and iodine-excess areas (water iodine concentration > 100 μg/L) in China before 2020. Areas with water iodine concentration between 10 and 100 μg/L implement the same policy as iodine-deficient areas to provide iodized salt. The definition of iodine-adequate areas was formulated in 2020 for the first time. The paper aims to investigate the coverage rate of iodized salt (CR) in different areas defined according to the latest national standards, evaluate the iodine status of local women, and provide a basis for the revision and improvement of relevant policies. METHODS A total of 1948 women aged 18-60 were recruited from the iodine extra-high areas (IEHA), iodine-excess areas (IEA), iodine-adequate areas (IAA), inland iodine-deficient areas (IIDA), and coastal iodine-deficient areas (CIDA). Information on daily diet was collected with the Food Frequency Questionnaire. Drinking water, salt, food, and urine samples were collected and tested in our laboratory. Based on the recommended daily iodine intake, we assessed whether the subjects' daily iodine intake levels were adequate. RESULTS The CR and the median urinary iodine concentrations (UICs) were 4.02% and 98.03 μg/L in CIDA, 89.74% and 144.93 μg/L in IIDA, 26.55% and 178.60 μg/L in IAA, 8.78% and 446.5 μg/L in IEA, 3.95% and 605.4 μg/L in IEHA, respectively. The differences among these five areas were statistically significant (P < 0.0001). The daily dietary iodine intakes were mainly from drinking water in IAA (63.92%), IEA (92.29%), and IEHA (92.93%), and were mainly from iodized salt in IIDA (59.22%) and food in CIDA (86.6%). CONCLUSION Women in IAA and IIDA were in an adequate iodine state. Women in IEA and IEHA were in an iodine-excess state, and it is necessary to carry out water improvements projects. Women in CIDA were in a slight iodine-deficient state, and health education on scientific iodine fortification should be strengthened to increase iodine intake.
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Affiliation(s)
- Ying Zhang
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China
| | - Jianqiang Wang
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China
| | - Wei Ma
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China
| | - Xiuwei Li
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China
| | - Haiyan Wang
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China
| | - Jing Xu
- National Health Commission Key Laboratory of Trace Element Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 100050, China.
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Bolton KA, Santos JA, Rosewarne E, Trieu K, Reimers J, Nowson C, Neal B, Webster J, Woodward M, Dunford E, Armstrong S, Bolam B, Grimes C. Outcomes of a state-wide salt reduction initiative in adults living in Victoria, Australia. Eur J Nutr 2023; 62:3055-3067. [PMID: 37493681 PMCID: PMC10468945 DOI: 10.1007/s00394-023-03210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To assess any effects of a state-wide sodium reduction intervention on sodium intake, sources of dietary sodium and discretionary salt use at a population level. METHODS Data (24-h urinary sodium excretion, self-report survey, a 24-h dietary recall) were collected cross-sectionally at baseline (2016/2017) and follow-up (2020) from adults in Victoria, Australia. Intervention activities included consumer awareness advertising campaign, public debate generation via mass media, strengthening existing policy initiatives and supporting food innovation with industry. RESULTS There were 339 participants at baseline and 211 at follow-up, with 144 and 90 of participants completing a 24-h dietary recall, respectively. There was no difference in adjusted 24-h urinary sodium excretion between baseline and follow-up (134 vs 131 mmol/24 h; p = 0.260). There were no differences in the percentage of participants adding salt during cooking (63% vs 68%; p = 0.244), adding salt at the table (34% vs 37%; p = 0.400) or regularly taking action to control salt/sodium intake (22% vs 21%; p = 0.793). There were large differences in the quantity of dietary sodium sourced from retail stores (57% vs 77%, p < 0.001), and less sodium was sourced from foods at fresh food markets (13% vs 2%; p ≤ 0.001) at follow-up. No large differences were apparent for foods with different levels of processing or for food groups. CONCLUSION There was no clear population-level effect of the 4-year multi-component Victorian Salt Reduction Intervention on sodium intake with Victorian adults continuing to consume sodium above recommended levels. The findings indicate that more intensive and sustained efforts aiming at the retail and food industry with national level support are likely to be required to achieve a measurable improvement in sodium intake at a state level.
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Affiliation(s)
- Kristy A Bolton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation (VicHealth), Melbourne, VIC, Australia
| | - Caryl Nowson
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Imperial College London, London, UK
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | - Bruce Bolam
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Carley Grimes
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Marakis G, Marques Domingues A, Crispo A, Magriplis E, Vasara E, Kontopoulou L, Triantafyllou C, Skepastianos P, Papadopoulou SK, Rodopaios NE, Hassapidou M, Zampelas A, Cappuccio FP, Breda J. Pertinence of Salt-Related Knowledge and Reported Behaviour on Salt Intake in Adults: A Cross-Sectional Study. Nutrients 2023; 15:4114. [PMID: 37836397 PMCID: PMC10574173 DOI: 10.3390/nu15194114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.
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Affiliation(s)
- Georgios Marakis
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
| | - Ana Marques Domingues
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Anna Crispo
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
- Istituto Nazionale dei “Tumori Fondazione G. Pascale”, Via Mariano Semmola 52, 80131 Napoli, Italy
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Eleni Vasara
- School of Biology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece;
| | - Lamprini Kontopoulou
- Department of Nursing, University of Thessaly, Gaiopolis Campus, Larissa-Trikala Ring-Road, 41500 Larissa, Greece;
| | - Christos Triantafyllou
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | | | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | - Antonis Zampelas
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Francesco P. Cappuccio
- Medical School, University of Warwick, Coventry CV4 7AL, UK;
- WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry CV4 7AL, UK
| | - João Breda
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
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Ghimire K, McLachlan CS, Mishra SR, Kallestrup P, Neupane D. Estimating mean population salt intake using spot urine samples in Nepal: a cross-sectional study. J Hypertens 2023; 41:711-722. [PMID: 36723497 DOI: 10.1097/hjh.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the usefulness of spot urine testing compared with 24-h urine samples to estimate salt intake in low-income settings. This is given 24-h urinary collection can be costly, burdensome, and impractical in population surveys. The primary objective of the study was to compare urinary sodium levels (as an estimate of salt intake) of Nepalese population between 24-h urine and spot urine using previously established spot urine-based equations. Additionally, this study explored the 24-h prediction of creatinine and potassium excretion from spot urine samples using available prediction equations. METHODS The sample population was derived from the community-based survey conducted in Nepal in 2018. Mean salt intake was estimated from spot urine samples comparing previously published equations, and this was then contrasted with mean salt intake estimations from 24-h urine samples, using paired t test, Pearson correlation coefficient, intraclass correlation coefficient, and Bland-Altman plots. RESULTS A total of 451 participants provided both complete 24-h and morning spot urine samples. Unweighted mean (±SD) salt intake based on 24-h urine collection was 13.28 ± 4.72 g/day. The corresponding estimates were 15.44 ± 5.92 g/day for the Kawasaki, 11.06 ± 3.17 g/day for the Tanaka, 15.22 ± 16.72 g/day for the Mage, 10.66 ± 3.35 g/day for the Toft, 8.57 ± 1.72 g/day for the INTERSALT with potassium, 8.51 ± 1.73 g/day for the INTERSALT without potassium, 7.88 ± 1.94 g/day for the Whitton, 18.13 ± 19.92 g/day for the Uechi simple-mean and 12.07 ± 1.77 g/day using the Uechi regression. As compared with 24-h urine estimates, all equations showed significant mean differences (biases); the Uechi regression had the least difference with 9% underestimation (-1.21 g/day, P < 0.001).Proportional biases were evident for all equations depending on the level of salt intake in the Bland-Altman plots. CONCLUSION None of the included spot urine-based equations accurately corresponded to 24-h salt intake in the present study. These equations may be useful for longitudinal monitoring of population salt intake in Nepal, our study highlights that there are limitations on using existing equations for estimating mean salt intake in Nepali population. Further studies are warranted for accuracy and validation.
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Affiliation(s)
- Kamal Ghimire
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Craig S McLachlan
- School of Health, Torrens University, Sydney, New South Wales, Australia
| | - Shiva R Mishra
- World Heart Federation, Salim Yusuf Emerging Leaders Programme, Geneva, Switzerland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Per Kallestrup
- Department of Public Health, Centre for Global Health, Aarhus University, Aarhus, Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Nepal Development Society, Bharatpur, Chitwan, Nepal
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Cappuccio FP, D'Elia L, Rakovac I. Spot urine samples and estimation of population salt intake: the return of the phoenix? J Hypertens 2023; 41:869-871. [PMID: 37017034 DOI: 10.1097/hjh.0000000000003405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, UK
| | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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10
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Campbell NR, Whelton PK, Orias M, Cobb LL, Jones ES, Garg R, Willliams B, Khan N, Chia YC, Jafar TH, Ide N. It is strongly recommended to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes: a policy statement of the World Hypertension League, International Society of Hypertension and Resolve to Save Lives. J Hypertens 2023; 41:683-686. [PMID: 36723484 PMCID: PMC10090307 DOI: 10.1097/hjh.0000000000003385] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 02/02/2023]
Abstract
Spot urine samples with estimating equations have been used to assess individuals' sodium (salt) intake in association with health outcomes. There is large random and systematic error in estimating sodium intake using this method and spurious health outcome associations. Substantial controversy has resulted from false claims the method is valid. Hence, the World Hypertension League, International Society of Hypertension and Resolve to Save Lives, supported by 21 other health organizations, have issued this policy statement that strongly recommends that research using spot urine samples with estimating equations to assess individuals' sodium (salt) intake in association with health outcomes should not be conducted, funded or published. Literature reviews on the health impacts of reducing dietary sodium that include studies that have used spot and short duration timed urine samples with estimating equations need to explicitly acknowledge that the method is not recommended to be used and is associated with spurious health outcome associations.
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Affiliation(s)
| | - Paul K. Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | - Erika S.W. Jones
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Renu Garg
- Resolve to Save Lives, New York, New York, USA
| | - Bryan Willliams
- University College London, NIHR University College London, Hospitals Biomedical Research Centre, London, UK
| | - Nadia Khan
- Center for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Medical and Live Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Tazeen H. Jafar
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nicole Ide
- Resolve to Save Lives, New York, New York, USA
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Imai N, Sakurada T, Osako K, Shibagaki Y. Twenty-four-hour Urinary Salt Excretion on Admission Predicts Significant Weight Loss with Seven-day Dietary Salt Restriction in Hospitalized Patients with Chronic Kidney Disease: A Single-center Study. Saudi J Kidney Dis Transpl 2023; 34:111-116. [PMID: 38146719 DOI: 10.4103/1319-2442.391888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
In patients with chronic kidney disease (CKD), restricting dietary salt is recommended to prevent fluid retention. Rapid weight loss is often observed when CKD patients with a high salt intake are hospitalized and started on a low-salt diet. We investigated the effects of 7-day dietary salt restriction on weight loss in hospitalized patients with CKD. During the 7-day hospitalization, a low-salt (6 g/day) and low-protein (0.6-0.8 g/kg/day ideal body weight) diet was served to all patients. Urine samples were collected for the first 24 h after admission, and patients were divided into quartiles (Q1-Q4) by urinary salt excretion. Body weight was measured on days 1 and 7. Weight loss after admission was compared among the groups. Factors associated with weight loss were evaluated by multivariate logistic regression. The mean age of the patients was 70.3 ± 11.7 years, and 73% were male. Mean weight loss was 1.6 ± 1.7 kg on day 7. Weight loss was significantly greater in Q3 and Q4 than in Q1 (P = 0.009 and P <0.001, respectively). In the univariate analysis, weight loss correlated positively with 24-h urinary salt excretion on admission (γ2 = 0.146) and body mass index (γ2 = 0.223). The 24-h urinary salt excretion on admission and BMI were independently associated with weight loss of >2 kg. The adjusted odds ratios (95% confidence interval) were 1.24 (1.13-1.36) and 1.15 (1.07-1.22), respectively. Twenty-four-hour urinary salt excretion on admission is useful for predicting significant weight loss with short-term dietary salt restriction.
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Affiliation(s)
- Naohiko Imai
- Department of Internal Medicine, Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Kanagawa, Japan
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12
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Toit JDD, Kapaon D, Crowther NJ, Abrahams-Gessel S, Fabian J, Kabudula CW, Wade AN, Tollman S, Gaziano TA. Estimating population level 24-h sodium excretion using spot urine samples in older adults in rural South Africa. J Hypertens 2023; 41:280-287. [PMID: 36583353 PMCID: PMC10198169 DOI: 10.1097/hjh.0000000000003327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND South Africa has introduced regulations to reduce sodium in processed foods. Assessing salt consumption with 24-h urine collection is logistically challenging and expensive. We assess the accuracy of using spot urine samples to estimate 24-h urine sodium (24hrUNa) excretion at the population level in a cohort of older adults in rural South Africa. METHODS 24hrUNa excretion was measured and compared to that estimated from matched spot urine samples in 399 individuals, aged 40-75 years, from rural Mpumalanga, South Africa. We used the Tanaka, Kawasaki, International Study of Sodium, Potassium, and Blood Pressure (INTERSALT), and Population Mean Volume (PMV) method to predict 24hrUNa at the individual and population level. RESULTS The population median 24hrUNa excretion from our samples collected in 2017 was 2.6 g (interquartile range: 1.53-4.21) equal to an average daily salt intake of 6.6 g, whereas 65.4% of participants had a salt excretion above the WHO recommended 5 g/day. Estimated population median 24hrUNa derived from the INTERSALT, both with and without potassium, showed a nonsignificant difference of 0.25 g (P = 0.59) and 0.21 g (P = 0.67), respectively. In contrast, the Tanaka, Kawasaki, and PMV formulas were markedly higher than the measured 24hrUNa, with a median difference of 0.51 g (P = 0.004), 0.99 g (P = 0.00), and 1.05 g (P = 0.00) respectively. All formulas however performed poorly when predicting an individual's 24hrUNa. CONCLUSION In this population, the INTERSALT formulas are a well suited and cost-effective alternative to 24-h urine collection for the evaluation of population median 24hrUNa excretion. This could play an important role for governments and public health agencies in evaluating local salt regulations and identifying at-risk populations.
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Affiliation(s)
- Jacques D. Du Toit
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - David Kapaon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nigel J. Crowther
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa
| | - Shafika Abrahams-Gessel
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston Massachusetts, USA
| | - June Fabian
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Chodziwadziwa W. Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha N. Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas A. Gaziano
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, Massachusetts, USA
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Strauss-Kruger M, van Zyl T, Pieters M, Kruger R, Mokwatsi G, Gafane-Matemane L, Mbongwa H, Jacobs A, Schutte AE, Louw R, Mels C. Urinary metabolomics, dietary salt intake and blood pressure: the African-PREDICT study. Hypertens Res 2023; 46:175-186. [PMID: 36229536 DOI: 10.1038/s41440-022-01071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023]
Abstract
In Black populations excessive salt intake may exacerbate the genetic predisposition to hypertension and promote the early onset of cardiovascular disease. Ethnic differences in the interaction between sodium intake and the metabolome may play a part in hypertension and cardiovascular disease development. We determined (1) urinary amino acid and acylcarnitine profiles of young Black and White adults according to low, moderate, and high dietary salt intake, and (2) investigated the triad of salt intake, systolic blood pressure (SBP), and the associated metabolomics profile. This study included 447 White and 380 Black adults aged 20-30 years from the African-PREDICT study. Estimated salt intake was determined from 24-hour urinary sodium levels. Urinary amino acids and acylcarnitines were measured using liquid chromatography-tandem mass spectrometry. Black adults exhibited no significant differences in SBP, amino acids, or acylcarnitines across low (<5g/day), moderate (5-10g/day), and high (>10g/day) salt intake. White adults with a high salt intake had elevated SBP compared to those with low or moderate intakes (p < 0.001). Furthermore, gamma-aminobutyric acid (GABA) (q = 0.020), citrulline (q = 0.020), glutamic acid (q = 0.046), serine (q = 0.054) and proline (q = 0.054) were lowest in those with higher salt intake. Only in White and not Black adults did we observe inverse associations of clinic SBP with GABA (Adj. R2 = 0.34; Std. β = -0.133; p = 0.003), serine (Adj. R2 = 0.33; Std. β = -0.109; p = 0.014) and proline (Adj. R2 = 0.33; Std. β = -0.109; p = 0.014). High salt intake in White, but not in black adults, were related to metabolomic changes and may contribute to pathophysiological mechanisms associated with increased BP.
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Affiliation(s)
- Michél Strauss-Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Tertia van Zyl
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520, South Africa
| | - Marlien Pieters
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Gontse Mokwatsi
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Lebo Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Hlengiwe Mbongwa
- Hypertension in Africa Research Team (HART), North-West University, Mahikeng, 2745, North-West Province, South Africa
| | - Adriaan Jacobs
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia
- The George Institute for Global Health, Sydney, NSW, 2042, Australia
| | - Roan Louw
- Human Metabolomics, North-West University, Potchefstroom, 2520, North-West Province, South Africa
| | - Carina Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, North-West Province, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, North-West Province, South Africa.
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Bhattarai S, Bista B, Yadav BK, Gynawali P, Poudyal A, Jha AK, Dhimal M. Estimation of mean population salt intakes using spot urine samples and associations with body mass index, hypertension, raised blood sugar and hypercholesterolemia: Findings from STEPS Survey 2019, Nepal. PLoS One 2022; 17:e0266662. [PMID: 35413065 PMCID: PMC9004746 DOI: 10.1371/journal.pone.0266662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
High dietary salt intake is recognized as a risk factor for several non-communicable diseases (NCDs), in particular cardiovascular diseases (CVDs), including heart attack and stroke. Accurate measurement of population level salt intake is essential for setting targeted goals and plans for salt reduction strategies. We used a spot urine sample to estimate the mean population salt intake in Nepal and evaluated the association of salt intake with excess weight, hypertension, raised blood sugar and hypercholesterolemia, and a number of socio-demographic characteristics.
Methods
A population-based cross-sectional study was carried out from February to May 2019 using a WHO STEPwise approach to surveillance. Spot urine was collected from 4361 participants aged 15–69 years for the analysis of salt intake. We then used the INTERSALT equation to calculate population salt intake. Student’s ‘t’ test, one-way ANOVA and multivariable linear regression were used to assess the association between salt intake and a number of factors. Statistical significance was accepted at P < .05.
Results
The average (±SD) age of participants was 40 (14.1) years. Mean salt intake, derived from spot urine samples, was estimated to be 9.1g/d. A total of 70.8% of the population consumed more than the WHO’s recommended amount of 5g salt per day, with almost one third of the population (29%) consuming more than 10g of salt per day. Higher salt intake was significantly associated with male gender (β for male = 0.98g; 95%CI:0.87,1.1) and younger age groups (β25–39 years = 0.08; 95%CI:-0.08,0.23) and higher BMI (β = 0.19; 95%CI:0.18,0.21). Participants who were hypertensive and had raised blood cholesterol consumed less salt than people who had normal blood pressure and cholesterol levels (P<0.001).
Conclusions
Salt consumption in Nepal is high, with a total of 70.8% of the population having a mean salt intake >5g/d, well above the World Health Organization recommendation. High salt intake was found to be associated with sex, age group, education, province, BMI, and raised cholesterol level of participants These findings build a strong case for action to reduce salt consumption in Nepal in order to achieve the global target of 30% reduction in population salt intake by 2025.
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Affiliation(s)
- Saroj Bhattarai
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Bihungum Bista
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Binod Kumar Yadav
- Department of Biochemistry, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Pradip Gynawali
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Anil Poudyal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | | | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
- * E-mail: ,
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Remer T, Hua Y, Esche J, Thamm M. The DONALD study as a longitudinal sensor of nutritional developments: iodine and salt intake over more than 30 years in German children. Eur J Nutr 2022; 61:2143-2151. [PMID: 35043251 PMCID: PMC9106614 DOI: 10.1007/s00394-022-02801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022]
Abstract
Purpose Mild-to-moderate iodine deficiency was present in large parts of Germany up to the beginning 1990s and improved from then on. Current epidemiological data on spot urine iodine measurements in German children strongly suggest the re-occurrence of an impaired iodine status. We thus examined whether this re-occurrence is identifiable in more detail, through iodine analyses of 24-h urine samples of a well-characterized cohort of German children in whom samples have been systematically collected from 1985 onward. As iodized salt is a major source for iodine supply, urinary sodium excretion was additionally studied. Methods Daily iodine and sodium excretions were measured in 2600 24-h urine samples collected between 1985 and 2018 by 677 healthy children aged 6–12 years (participants of the DONALD study). These data were compared with 24-h iodine and sodium excretion estimates obtained from spot urine samples collected in the representative German Health Interview and Examination Surveys for Children and Adolescents KiGGS-baseline (2003–2006) and KiGGS-wave-2 (2014–2017). Results Between 1985 and1992, DONALD participants started with a median daily iodine excretion level of 40.1 µg/d. Then, during 1993–2003, iodine excretions mounted up to an approximate plateau (~ 84.8 µg/d). This plateau lasted until 2012. Thereafter, iodine concentrations started to decrease again resulting in a median iodine excretion of only 58.9 µg/d in 2018. Sodium excretion, however, had increased. The marked decrease in iodine status along with an abundant sodium excretion corresponded closely with nationwide KiGGS data. Conclusions As exemplified for the clearly worsening iodine status in German children, longitudinal cohort studies collecting detailed biomarker-based prospective data have the potential to reliably capture health-relevant nutritional changes and trends, applicable on a more comprehensive and even representative population level. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02801-6.
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Affiliation(s)
- Thomas Remer
- DONALD Study Center Dortmund, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, 44225, Dortmund, Germany.
| | - Yifan Hua
- DONALD Study Center Dortmund, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, 44225, Dortmund, Germany
| | - Jonas Esche
- DONALD Study Center Dortmund, Department of Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, 44225, Dortmund, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany
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Liu Y, Chu H, Peng K, Yin X, Huang L, Wu Y, Pearson SA, Li N, Elliott P, Yan LL, Labarthe DR, Hao Z, Feng X, Zhang J, Zhang Y, Zhang R, Zhou B, Li Z, Sun J, Zhao Y, Yu Y, Tian M, Neal B, Liu H. Factors Associated With the Use of a Salt Substitute in Rural China. JAMA Netw Open 2021; 4:e2137745. [PMID: 34878549 PMCID: PMC8655604 DOI: 10.1001/jamanetworkopen.2021.37745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Lowering sodium intake reduces blood pressure and may reduce the risk of cardiovascular diseases. The use of reduced-sodium salt (a salt substitute) may achieve sodium reduction, but its effectiveness may be associated with the context of its use. OBJECTIVE To identify factors associated with the use of salt substitutes in rural populations in China within the Salt Substitute and Stroke Study, a large-scale cluster randomized trial. DESIGN, SETTING, AND PARTICIPANTS This sequential mixed-methods qualitative evaluation, conducted from July 2 to August 28, 2018, in rural communities across 3 provinces in China, included a quantitative survey, collection of 24-hour urine samples, and face-to-face interviews. A random subsample of trial participants, selected from the 3 provinces, completed the quantitative survey (n = 1170) and provided urine samples (n = 1025). Interview respondents were purposively selected from the intervention group based on their different ranges of urinary sodium excretion levels. Statistical analysis was performed from September 18, 2018, to February 22, 2019. EXPOSURES The intervention group of the Salt Substitute and Stroke Study was provided with the free salt substitute while the control group continued to use regular salt. MAIN OUTCOMES AND MEASURES Knowledge, attitudes, and behaviors regarding the use of the salt substitute were measured using quantitative surveys, and urinary sodium levels were measured using 24-hour urine samples. Contextual factors were explored through semistructured interviews and integrated findings from surveys and interviews. RESULTS A total of 1170 individuals participated in the quantitative survey. Among the 1025 participants with successful urine samples, the mean (SD) age was 67.4 (7.5) years, and 502 (49.0%) were female. The estimated salt intake of participants who believed that high salt intake was good for health was higher; however, it was not significantly different (0.84 g/d [95% CI, -0.04 to 1.72 g/d]) from those who believed that high salt intake was bad for health. Thirty individuals participated in the qualitative interviews (18 women [60.0%]; mean [SD] age, 70.3 [6.0] years). Quantitative and qualitative data indicated high acceptability of and adherence to the salt substitute. Contextual factors negatively associated with the use of the salt substitute included a lack of knowledge about the benefits associated with salt reduction and consumption of high-sodium pickled foods. In addition, reduced antihypertensive medication was reported by a few participants using the salt substitute. CONCLUSIONS AND RELEVANCE This study suggests that lack of comprehensive understanding of sodium reduction and salt substitutes and habitual consumption of high-sodium foods (such as pickled foods) were the main barriers to the use of salt substitutes to reduce sodium intake. These factors should be considered in future population-based, sodium-reduction interventions.
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Affiliation(s)
- Yishu Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Ke Peng
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Peking University Clinical Research Institute, Peking University, Beijing, China
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Nicole Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Paul Elliott
- School of Public Health, Imperial College London, London, United Kingdom
| | - Lijing L. Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Duke Global Health Institute, and Global Health Research Centre, Duke Kunshan, University, Kunshan, China
| | | | - Zhixin Hao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Xiangxian Feng
- School of Public Health, Changzhi Medical College, Changzhi, China
| | - Jianxin Zhang
- Department of Noncommunicable Disease Prevention and Control, Center for Disease Control of Hebei Province, Shijizhuang, China
| | - Yuhong Zhang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Ruijuan Zhang
- School of Public Health, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Bo Zhou
- Department of Evidence-based Medicine, First Hospital of China Medical University, Shenyang, China
| | - Zhifang Li
- School of Public Health, Changzhi Medical College, Changzhi, China
| | - Jixin Sun
- Department of Noncommunicable Disease Prevention and Control, Center for Disease Control of Hebei Province, Shijizhuang, China
| | - Yi Zhao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Yan Yu
- School of Public Health, Xi’an Jiaotong University School of Medicine, Xi’an, China
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health, Harbin Medical University, Harbin, China
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, Australia
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17
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Delshad H, Raeisi A, Abdollahi Z, Tohidi M, Hedayati M, Mirmiran P, Nobakht F, Azizi F. Iodine supplementation for pregnant women: a cross-sectional national interventional study. J Endocrinol Invest 2021; 44:2307-2314. [PMID: 33704696 DOI: 10.1007/s40618-021-01538-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although Iran has been considered iodine replete since 2000, the first national survey of iodine intake among Iranian pregnant women in 2014 indicated that despite the adequate intake of iodine by the general population, this vulnerable group has moderate iodine deficiency. Therefore, in this national cross-sectional interventional study, we aimed to assess the iodine intake and thyroid function of Iranian pregnant women 2 years after implementing national iodine supplementation for this vulnerable group. MATERIALS AND METHODS In this cross-sectional study, we conducted a national interventional survey of pregnant women. A total of 1200 pregnant women (400 women from each trimester) from 12 provinces of Iran were recruited from the antenatal care clinics from October 2018 to March 2019. The median urinary iodine concentration (MUIC), as an indicator of iodine status in three spot urine samples, was measured, along with the serum total T4 (TT4), thyrotropin (TSH), thyroglobulin (Tg), thyroid peroxidase antibody (TPO-Ab), and iodine content of household salt. RESULTS The mean age of the cohort was 28 ± 6.2 years, with the mean gestational age of 22.7 ± 13.0 weeks. The overall MUIC (IQR) of pregnant women was 188 µg/L (124.2-263 µg/L). Also, the MUICs in the three trimesters of pregnancy were 174 µg/L (110-254), 175 µg/L (116-251), and 165 µg/L (114-235), respectively. The MUICs ≥ 150, 100-149, and < 100 µg/L were found in 63, 19.8, and 16.2% of the subjects, respectively. The mean TT4 level was 12 ± 4.5 µg/dL, and the median (IQR) level of TSH was 2.37 mIU/L (1.66-3.18 mIU/L). According to our local reference range, 118 (10.5%) pregnant women had subclinical hypothyroidism, 6 (0.53%) women had isolated hypothyroxinemia, and 65 (5.7%) women were TPO-Ab positive. Also, the median (IQR) level of Tg was 10.08 µg/dL (5.7-20.4 µg/dL), and the median iodine content of household salt was 29.6 µg/g; the iodine content was ≥ 30 µg/g in 85% of household salt. The results showed that more than 95% of households were under iodized salt coverage. CONCLUSION The results of this study indicated that iodine supplementation with at least 150 µg of iodine per day improved the iodine intake of pregnant women. Except for subclinical hypothyroidism, the prevalence of clinical hypothyroidism, clinical/subclinical thyrotoxicosis, TPO-Ab positivity, and isolated hypothyroxinemia decreased significantly, which emphasizes the importance of iodine supplementation during pregnancy.
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Affiliation(s)
- H Delshad
- Micronutrient Research Office, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Raeisi
- Iran's Ministry of Health and Medical Education, Tehran, Iran
| | - Z Abdollahi
- General of Nutrition Department, Iran's Ministry of Health and Medical Education, Tehran, Iran
| | - M Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P Mirmiran
- Nutrition Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Nobakht
- National IDD Program, Iran's Ministry of Health and Medical Education, Tehran, Iran
| | - F Azizi
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P. O. Box 19395-4763, Tehran, Iran.
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18
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Takahashi F, Hashimoto Y, Kaji A, Sakai R, Miki A, Kawate Y, Okamura T, Kitagawa N, Okada H, Nakanishi N, Majima S, Senmaru T, Ushigome E, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Association of Estimated Salt and Miso Intake with the Prevalence of Obesity in People with Type 2 Diabetes: A Cross-Sectional Study. Nutrients 2021; 13:3014. [PMID: 34578892 PMCID: PMC8472052 DOI: 10.3390/nu13093014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Salt intake is often estimated by the amount of sodium excreted in urine, and miso has been reported to increase it. This cross-sectional study investigated the relationship between obesity and high estimated salt intake with and without habitual miso consumption. Estimates of salt intake (g/day) were calculated using urinary sodium excretion, and a high estimated intake was defined as greater than the median amount of 9.5 g/day. Participants were divided into four groups based on estimated salt intake and miso consumption. Among 300 people, the proportions of obesity were 77.8% (n = 14/18), 40.2% (n = 53/132), 26.0% (n = 33/127), and 34.8% (n = 8/23) in the (+/-), (+/+), (-/+), and (-/-) groups of high estimated salt intake/habitual miso consumption, respectively. Compared with the (+/-) group, the adjusted odds ratios for obesity were 0.07 (95% confidence interval (CI): 0.02-0.26, p < 0.001), 0.16 (95% CI: 0.03-0.76, p = 0.022), and 0.14 (95% CI: 0.04-0.51, p = 0.003) in the (-/+), (-/-), and (+/+) groups, respectively. The presence of obesity was not much higher in people with high estimated salt intake with habitual miso consumption than that in people without. Clinicians should be aware that miso consumption promotes salt excretion, which may lead to an apparently higher estimated salt intake than actual.
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Affiliation(s)
- Fuyuko Takahashi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Ayumi Kaji
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Ryosuke Sakai
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Akane Miki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Yuka Kawate
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Noriyuki Kitagawa
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
- Department of Diabetology, Kameoka Municipal Hospital, Kyoto 621-8585, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi 570-8540, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (F.T.); (A.K.); (R.S.); (A.M.); (Y.K.); (T.O.); (N.K.); (H.O.); (N.N.); (S.M.); (T.S.); (E.U.); (M.H.); (M.A.); (M.Y.); (M.F.)
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19
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Donfrancesco C, Lo Noce C, Russo O, Minutoli D, Di Lonardo A, Profumo E, Buttari B, Iacone R, Vespasiano F, Vannucchi S, Onder G, Galletti F, Galeone D, Bellisario P, Gulizia MM, Giampaoli S, Palmieri L, Strazzullo P. Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE project surveys. Nutr Metab Cardiovasc Dis 2021; 31:802-813. [PMID: 33546949 DOI: 10.1016/j.numecd.2020.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys. METHODS AND RESULTS Data were from cross-sectional surveys of randomly selected age and sex-stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008-2012, and 967 men and 1010 women examined in 2018-2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5-11.1) in men and 8.3 g (8.1-8.5) in women in 2008-2012 and respectively 9.5 g (9.3-9.8) and 7.2 g (7.0-7.4) in 2018-2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes. CONCLUSIONS The average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level.
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Affiliation(s)
| | | | - Ornella Russo
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | - Roberto Iacone
- Federico II University of Naples Medical School, Naples, Italy
| | | | | | | | | | | | | | - Michele M Gulizia
- National Hospital of High Relevance and Specialization "Garibaldi", Catania, Italy; Heart Care Foundation, Florence, Italy
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20
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Sedaka R, Hyndman KA, Mironova E, Stockand JD, Pollock JS. High salt intake induces collecting duct HDAC1-dependent NO signaling. Am J Physiol Renal Physiol 2021; 320:F297-F307. [PMID: 33356953 PMCID: PMC7988806 DOI: 10.1152/ajprenal.00323.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 01/13/2023] Open
Abstract
We reported that high salt (HS) intake stimulates renal collecting duct (CD) endothelin (ET) type B receptor (ETBR)/nitric oxide (NO) synthase 1β (NOS1β)-dependent NO production inhibiting the epithelial sodium channel (ENaC) promoting natriuresis. However, the mechanism underlying the HS-induced increase of NO production is unclear. Histone deacetylase 1 (HDAC1) responds to increased fluid flow, as can occur in the CD during HS intake. The renal inner medulla (IM), in particular the IMCD, has the highest NOS1 activity within the kidney. Hence, we hypothesized that HS intake provokes HDAC1 activation of NO production in the IM. HS intake for 1 wk significantly increased HDAC1 abundance in the IM. Ex vivo treatment of dissociated IM from HS-fed mice with a selective HDAC1 inhibitor (MS-275) decreased NO production with no change in ET-1 peptide or mRNA levels. We further investigated the role of the ET-1/ETBR/NOS1β signaling pathway with chronic ETBR blockade (A-192621). Although NO was decreased and ET-1 levels were elevated in the dissociated IM from HS-fed mice treated with A-192621, ex vivo MS-275 did not further change NO or ET-1 levels suggesting that HDAC1-mediated NO production is regulated at the level or downstream of ETBR activation. In split-open CDs from HS-fed mice, patch clamp analysis revealed significantly higher ENaC activity after MS-275 pretreatment, which was abrogated by an exogenous NO donor. Moreover, flow-induced increases in mIMCD-3 cell NO production were blunted by HDAC1 or calcium inhibition. Taken together, these findings indicate that HS intake induces HDAC1-dependent activation of the ETBR/NO pathway contributing to the natriuretic response.
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Affiliation(s)
- Randee Sedaka
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly A Hyndman
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elena Mironova
- Department of Cellular and Integrative Physiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James D Stockand
- Department of Cellular and Integrative Physiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jennifer S Pollock
- Section of Cardio-Renal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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21
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Sakaguchi K, Takemi Y, Hayashi F, Koiwai K, Nakamura M. Effect of workplace dietary intervention on salt intake and sodium-to-potassium ratio of Japanese employees: A quasi-experimental study. J Occup Health 2021; 63:e12288. [PMID: 34731526 PMCID: PMC8565653 DOI: 10.1002/1348-9585.12288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Excess salt intake is a major risk factor for hypertension and cardiovascular disease. Modifying workplace environments has been recognized to be important for reducing salt intake. However, studies examining the effects of improving the workplace environment regarding salt reduction are limited. This study aimed to evaluate the effects of workplace dietary intervention on employees' salt intake and sodium-to-potassium (Na/K) ratio. METHODS A quasi-experimental study was conducted. Two small business establishments in Saitama Prefecture, Japan, were allocated as the intervention (n = 69) and comparison (n = 68) workplaces, respectively. The 1-year intervention involving healthy lunch and nutrition education was implemented in the intervention workplace. Spot urine samples, physical assessments, and self-administered questionnaire data were collected at baseline, 6 months, and 1 year after the start of the intervention. Analysis of covariance was conducted to investigate differences in the salt intake or Na/K ratio between the study workplaces at year 1. Educational status and rotating work schedules were included as covariates. RESULTS Salt intake in the intervention workplace decreased significantly from 10.7 to 9.3 g (-1.4 g change; 95% confidence interval [CI]: "-2.4, -0.5"). The adjusted difference in changes in salt intake between workplaces was statistically significant (-3.7 g change; 95% CI: "-5.2, -2.3"). Although no significant change was observed in the Na/K ratio in the intervention workplace (3.37-3.08; -0.29 change; 95% CI: "-0.59, 0.01"), the adjusted difference in changes between the workplaces was statistically significant (-0.60 change; 95% CI: "-1.03, -0.17"). CONCLUSIONS Providing healthy lunch and nutrition education may be effective approaches to reduce employees' salt intake and Na/K ratio.
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Affiliation(s)
| | - Yukari Takemi
- Nutrition EcologyKagawa Nutrition UniversitySakado‐shiJapan
| | - Fumi Hayashi
- Nutrition EcologyKagawa Nutrition UniversitySakado‐shiJapan
| | - Kaori Koiwai
- Public Health NutritionKagawa Nutrition UniversitySakado‐shiJapan
| | - Masakazu Nakamura
- Health Promotion Research CenterInstitute of Community MedicineJapan Association for Development of Community MedicineChiyoda kuJapan
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Charlton KE, Schutte AE, Wepener L, Corso B, Kowal P, Ware LJ. Correcting for Intra-Individual Variability in Sodium Excretion in Spot Urine Samples Does Not Improve the Ability to Predict 24 h Urinary Sodium Excretion. Nutrients 2020; 12:nu12072026. [PMID: 32650384 PMCID: PMC7400094 DOI: 10.3390/nu12072026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 01/11/2023] Open
Abstract
Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.
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Affiliation(s)
- Karen Elizabeth Charlton
- School of Medicine, University of Wollongong, Wollongong 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia
- Correspondence: ; Tel.: +61-2-42214754
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney 2052, Australia;
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Leanda Wepener
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Barbara Corso
- Neuroscience Institute, National Research Council, 35121 Padova, Italy;
| | - Paul Kowal
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
- World Health Organization (WHO), CH-1211 Geneva 27, Switzerland
| | - Lisa Jayne Ware
- SA MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg 2013, South Africa;
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Cai W, Lang M, Jiang X, Yu Q, Zhou C, Zou W, Zhang X, Lei J. Correlation among high salt intake, blood pressure variability, and target organ damage in patients with essential hypertension: Study protocol clinical trial (SPIRIT compliant). Medicine (Baltimore) 2020; 99:e19548. [PMID: 32243371 PMCID: PMC7220693 DOI: 10.1097/md.0000000000019548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Essential hypertension is a multifactorial disease, which is affected by genetic and environmental factors, and can cause diseases such as cerebrovascular disease, heart failure, coronary heart disease, and chronic renal failure. High salt intake is a risk factor for hypertension, stroke, and cardiovascular disease. Blood pressure variability (BPV) is a reliable independent predictor of cardiovascular events and death. At present, there are few studies about the correlation among high salt intake, BPV, and target organ damage (TOD) in patients with hypertension. OBJECTIVE The purpose of this study is to compare 24-hour urine sodium excretion, BPV, carotid intima-media thickness, left ventricular mass index, and serum creatinine or endogenous creatinine clearance rate. To clarify the relationship between high salt load and BPV and TOD in patients with hypertension.This study is a cross-sectional study. It will recruit 600 patients with essential hypertension in the outpatient and inpatient department of cardiovascular medicine of Chengdu Fifth People's Hospital. Researchers will obtain blood and urine samples with the patient's informed consent. In addition, we will measure patient's blood pressure and target organ-related information. TRIAL REGISTRY The study protocol was approved by the Chengdu Fifth People's Hospital. Written informed consent will be obtained from all the participants. The trial was registered in the Chinese Clinical trial registry, ChiCTR2000029243. This trial will provide for the correlation among high salt intake, BPV, and TOD in patients with essential hypertension.
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Affiliation(s)
- Wei Cai
- Department of Cardiology, The Affiliated Chengdu Fifth People's Hospital, North Sichuan Medical College
| | - MingJian Lang
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - XiaoBo Jiang
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Qian Yu
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Congliang Zhou
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Wenshu Zou
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - Xiaohua Zhang
- Department of Cardiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan Province, China
| | - JianGuo Lei
- Department of Cardiology, The Affiliated Chengdu Fifth People's Hospital, North Sichuan Medical College
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Wang Y, Cui Y, Chen C, Duan Y, Wu Y, Li W, Zhang D, Li F, Hou C. Stopping the supply of iodized salt alone is not enough to make iodine nutrition suitable for children in higher water iodine areas: A cross-sectional study in northern China. Ecotoxicol Environ Saf 2020; 188:109930. [PMID: 31727496 DOI: 10.1016/j.ecoenv.2019.109930] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND For the sake of children's health, iodized salt supply has been stopped in many areas with excessive iodine in the drinking water, but children's iodine nutrition status and thyroid function after terminating the iodized salt supply is unknown. Objective We assessed the iodine nutrition, thyroid function and influencing factors for thyroid abnormalities in children from areas with different concentrations of water iodine; the supply of iodized salt has been stopped in high water iodine areas. This study aimed to evaluate whether the strategy of stopping the supplies of iodized salt alone is enough to avoid thyroid dysfunction in all areas with excess water iodine while still meeting the iodine nutrition needs of children. METHODS A cross-sectional study was conducted in children from four areas with different drinking water iodine concentrations in Tianjin, China. The drinking water samplings and spot urine samples were collected to estimate the external and internal iodine exposure levels. The thyroid volume was measured, and blood samples were collected to assess thyroid function. Logistic regression analysis was used to analyze risk factors for thyroid abnormalities. A dietary survey was conducted to determine the sources of iodine nutrition among the areas with different iodine concentrations in the drinking water. RESULTS In the area with a drinking water iodine concentration ≥300 μg/L, the median urinary iodine concentration (UIC) in children was 476.30 (332.20-639.30) μg/L, which was higher than that in other groups (all P < 0.05), and the prevalence of thyroid nodules and the thyroid goiter rate were higher than those in the <100 μg/L, 100-150 μg/L and 150-300 μg/L areas (all P < 0.01). Binary logistic regression analysis indicated that the risk of thyroid abnormalities was significantly increased in the UIC 200-299 μg/L group (OR: 4.534; 95% CI: 1.565, 13.135; bootstrapped 95% CI: 1.689, 21.206, P = 0.004) and in the UIC ≥ 300 μg/L group (OR: 6.962; 95% CI: 2.490, 19.460; bootstrapped 95% CI: 2.838, 32.570, P = 0.001) compared to the 100-199 μg/L group. The iodine contribution rates from water in areas with water iodine concentrations ≥300 μg/L are up to 63.04%. CONCLUSIONS After termination of the iodized salt supply, the level of iodine nutrition of children in the area with drinking water iodine concentrations ≥300 μg/L is still excessive. The water source needs to be replaced in this area. In the area with a water iodine concentration of 150-300 μg/L, it is proposed that stopping the supply of iodized salt is sufficient to achieve the proper iodine nutrition status in children.
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Affiliation(s)
- Yang Wang
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Yushan Cui
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Chen Chen
- Tianjin Health Education Center, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Yani Duan
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Yinghong Wu
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Wenfeng Li
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - DanDan Zhang
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Fang Li
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China
| | - Changchun Hou
- Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, 300011, PR China.
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Cuadrado-Soto E, Peral-Suarez Á, Rodríguez-Rodríguez E, Aparicio A, Andrés P, Ortega RM, López-Sobaler AM. The association of parents' behaviors related to salt with 24 h urinary sodium excretion of their children: A Spanish cross-sectional study. PLoS One 2019; 14:e0227035. [PMID: 31881048 PMCID: PMC6934279 DOI: 10.1371/journal.pone.0227035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 12/11/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sodium intake is excessive among Spanish children, but the salt use behaviors of parents and children are unknown. This study aims to determine behaviors related to salt intake in both schoolchildren and parents and the relationship between parental behaviors and 24 h urinary sodium excretion (UNa-24h) in children. SUBJECTS AND METHODS A convenience sample was taken from a cross-sectional analysis. Parents completed a self-reported questionnaire about their behaviors related to salt, and their responses were compared with the UNa-24h of their own children. The median test was used to identify differences in UNa-24h according to behaviors. Logistic regression was used to assess the relationship between the behaviors of parents and high sodium excretion in the children and the risk of children's use of table salt, adjusting for age, sex, and BMI. Multinomial logistic regression models, adjusted by the covariates, were used to study the children's salt preferences. RESULTS A total of 329 schoolchildren from different Spanish provinces were included in the study (mean age: 9.0 ± 1.2 years, 157 girls). The majority of families (parents mean age: 42.0 ± 5.2 years) reported adding salt to food during cooking (92%), and 59% of them never looked at the sodium content on food labels. However, none of these behaviors were related to UNa-24h (p > 0.05). The use of iodized salt (53%), the presence of a salt shaker on the table (6%), and the use of table salt by fathers (57%), mothers (52%) or children (17%) increased the odds (p < 0.05) of children having a higher UNa-24h. Checking sodium content on food labels and the use of table salt by the children or father was associated with a lower preference for salty foods (p < 0.05). CONCLUSIONS It is important to make parents aware of the relationship between their behaviors regarding the use of discretionary salt and their children's sodium intake. Our data suggest that salt-specific education programs on how to reduce salt both in-home and outside the home should be implemented to improve behavior skills related to salt consumption in parents and children.
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Affiliation(s)
- Esther Cuadrado-Soto
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - África Peral-Suarez
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Elena Rodríguez-Rodríguez
- Department of Chemistry in Pharmaceutical Sciences, Analytical Chemistry, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Aránzazu Aparicio
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Pedro Andrés
- Department of Chemistry in Pharmaceutical Sciences, Analytical Chemistry, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Rosa M. Ortega
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
| | - Ana M. López-Sobaler
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal S/N, Madrid, Spain
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Du X, Fang L, Xu J, Chen X, Zhang J, Bai Y, Wu J, Ma J, Yu M, Zhong J. Prevalence, awareness, treatment and control of hypertension and sodium intake in Zhejiang Province, China: A cross-sectional survey in 2017. PLoS One 2019; 14:e0226756. [PMID: 31869377 PMCID: PMC6927602 DOI: 10.1371/journal.pone.0226756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In recent decades, hypertension has become a popular public health problem in China. In 2017, a cross-sectional survey about hypertension and sodium intake measured by 24-hour (24-h) urine was launched in Zhejiang Province, to provide the basis of the Chinese population to develop a salt reduction intervention and prevention of hypertension strategy. METHODS Cross-sectional data were obtained from 7512 participants aged 18 to 69 years in Zhejiang Province of China by complex, multistage sampling methods. The survey included face-to-face questionnaires and physical examination among all participants. Blood pressures and the use of anti-hypertension medications were used to determine hypertension. One thousand five hundred participants of them were asked to collect 24-h urine to measure sodium and potassium levels to assess intake. All rates and means were weighted by sampling weight and population structure of the province. RESULTS The weighted means of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 127.78 mm Hg (95% confidence interval [CI], 127.21-128.36) and 79.40 mm Hg (95%CI, 79.04-79.76). The weighted hypertension prevalence was 30.41% (95%CI, 28.91-31.91). Among those classified as having hypertension, 43.55% (95%CI, 40.77-46.34) were aware of the fact that they were suffering from hypertension, 32.05% (95%CI, 29.49-34.61) of them reported taking anti-hypertension medications, only 14.48% (95%CI, 12.54-16.42) had their blood pressure controlled. The weighted means of 24-h urinary sodium was 165.52 mmol (standard deviation [SD], 2.92), representing that the mean intake of sodium chloride was 9.68g (SD, 0.17) through conversion. CONCLUSION These cross-sectional survey results show that hypertension and excessive sodium intake in adults are prevalent in Zhejiang Province, China. Salt reduction and prevention of hypertension is still an urgent public health work.
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Affiliation(s)
- Xiaofu Du
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
| | - Le Fang
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiangyu Chen
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
| | - Jie Zhang
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Jixiang Ma
- Division of Non-communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
| | - Min Yu
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
| | - Jieming Zhong
- Department of Non-Communicable Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, P. R. China
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Santos JA, Rosewarne E, Hogendorf M, Trieu K, Pillay A, Ieremia M, Naseri LTT, Tukana I, Snowdon W, Petersen K, Webster J. Estimating mean population salt intake in Fiji and Samoa using spot urine samples. Nutr J 2019; 18:55. [PMID: 31506072 PMCID: PMC6737719 DOI: 10.1186/s12937-019-0484-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa. METHODS The study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses. RESULTS A total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of - 0.92 g/day, 95% CI - 1.67 to - 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation. CONCLUSION These data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.
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Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Martyna Hogendorf
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases, Fiji National University, Nasinu, Fiji
| | | | | | - Isimeli Tukana
- National Wellness Centre, Ministry of Health and Medical Services, Suva, Fiji
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, 3216 Australia
| | - Kristina Petersen
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802 USA
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, 2052 Australia
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McLean RM, Petersen KS, Arcand J, Malta D, Rae S, Thout SR, Trieu K, Johnson C, Campbell NRC. Science of Salt: A regularly updated systematic review of salt and health outcomes studies (April to October 2018). J Clin Hypertens (Greenwich) 2019; 21:1030-1042. [PMID: 31245918 PMCID: PMC8030306 DOI: 10.1111/jch.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022]
Abstract
The Science of Salt reviews identify, summarize, and critically appraise published studies on dietary salt and health outcomes according to pre-specified methods. This review covers the period April 3 to October 30, 2018. Here, nineteen studies that fit pre-specified criteria for review and summary are included. Three of these, one prospective cohort study, one randomized controlled trial, and a post hoc analysis of the Dietary Approaches to Stop Hypertension (DASH) sodium trial fulfilled the quality criteria for detailed critical appraisal, including risk of bias assessment, and commentary. Two trials demonstrated a positive association between salt intake and blood pressure. In a cohort of older Italians, increased risk of total mortality was observed with salt intake less than ~16 g/d (6300 mg sodium/d) at baseline; no association existed for incident cardiovascular disease (CVD) or CVD mortality. The paucity of published studies which met our criteria for methodological quality is of concern.
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Affiliation(s)
- Rachael M. McLean
- Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Kristina S. Petersen
- Department of Nutritional SciencesPennsylvania State UniversityUniversity ParkPA
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - JoAnne Arcand
- Faculty of Health SciencesThe University of Ontario Institute of TechnologyOshawaOntarioCanada
| | | | - Sarah Rae
- University of Ontario Institute of TechnologyOshawaOntarioCanada
| | | | - Kathy Trieu
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Claire Johnson
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Norman R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
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Ma Y, Feng X, Ma J, He FJ, Wang H, Zhang J, Xie W, Wu T, Yin Y, Yuan J, MacGregor GA, Wu Y. Social support, social network and salt-reduction behaviours in children: a substudy of the School-EduSalt trial. BMJ Open 2019; 9:e028126. [PMID: 31203245 PMCID: PMC6589018 DOI: 10.1136/bmjopen-2018-028126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Healthy behaviour changes, such as reducing salt intake, are important to prevent lifestyle-related diseases. Social environment is a major challenge to achieve such behaviours, but the explicit mechanisms remain largely unknown. We investigated whether social networks of children were associated with their behaviours to reduce salt intake. DESIGN An ancillary study of a school-based cluster randomised controlled trial to reduce salt intake in children and their families (School-EduSalt), in which salt intake of children was significantly reduced by 25%. SETTING 14 primary schools in urban Changzhi, northern China. PARTICIPANTS 603 children aged 10-12 years in the intervention arm. PRIMARY AND SECONDARY OUTCOME MEASURES We developed a score assessing salt-reduction behaviours (SRB score) of children based on self-administered questionnaires. The SRB score was validated by the changes in salt intake measured by 24-hour urine collection in a random sample of 135 children. A 1-unit increase in SRB score was associated with a 0.31 g/day greater reduction in salt intake during the trial (95% CI 0.06 to 0.57, p=0.016). RESULTS Children from families with more family members not supporting salt reduction had significantly lower SRB scores (p<0.0001). Children from a class with a smaller size and from a class with more friendship connections, as well as children having more friends within the class all showed higher SRB scores (all p<0.05). Children whose school teachers attended the intervention programme more frequently also had higher SRB scores (p=0.043). CONCLUSION Social networks were associated with the behaviours to reduce salt intake in children. Future salt-reduction programmes may benefit from strategies that actively engage families and teachers, and strategies that enhance interconnectivity among peers. TRIAL REGISTRATION NUMBER NCT01821144; post-results.
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Affiliation(s)
- Yuan Ma
- Peking University Health Science Centre, Department of Epidemiology and Biostatistics, Beijing, China
- Department of Epidemiology, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xiangxian Feng
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Jun Ma
- Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Haijun Wang
- Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Beijing, China
| | - Tao Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yunjian Yin
- Department of Probability and Statistics, Peking University School of Mathematical Sciences, Beijing, China
| | - Jianhui Yuan
- Department of Preventive Medicine, Changzhi Medical College, Changzhi, China
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Yangfeng Wu
- Peking University Health Science Centre, Department of Epidemiology and Biostatistics, Beijing, China
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
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30
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Thout SR, Santos JA, McKenzie B, Trieu K, Johnson C, McLean R, Arcand J, Campbell NRC, Webster J. The Science of Salt: Updating the evidence on global estimates of salt intake. J Clin Hypertens (Greenwich) 2019; 21:710-721. [PMID: 31033166 PMCID: PMC8030574 DOI: 10.1111/jch.13546] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 09/11/2023]
Abstract
The Global Burden of Disease (GBD) 2010 study estimated national salt intake for 187 countries based on data available up to 2010. The purpose of this review was to identify studies that have measured salt intake in a nationally representative population using the 24-hour urine collection method since 2010, with a view to updating evidence on population salt intake globally. Studies published from January 2011 to September 2018 were searched for from MEDLINE, Scopus, and Embase databases using relevant terms. Studies that provided nationally representative estimates of salt intake among the healthy adult population based on the 24-hour urine collection were included. Measured salt intake was extracted and compared with the GBD estimates. Of the 115 identified studies assessed for eligibility, 13 studies were included: Four studies were from Europe, and one each from the United States, Canada, Benin, India, Samoa, Fiji, Barbados, Australia, and New Zealand. Mean daily salt intake ranged from 6.75 g/d in Barbados to 10.66 g/d in Portugal. Measured mean population salt intake in Italy, England, Canada, and Barbados was lower, and in Fiji, Samoa, and Benin was higher, in recent surveys compared to the GBD 2010 estimates. Despite global targets to reduce population salt intake, only 13 countries have published nationally representative salt intake data since the GBD 2010 study. In all countries, salt intake levels remain higher than the World Health Organization's recommendation, highlighting the need for additional global efforts to lower salt intake and monitor salt reduction strategies.
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Affiliation(s)
- Sudhir Raj Thout
- The George Institute for Global Health IndiaANR CenterHyderabadIndia
| | - Joseph Alvin Santos
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
| | - Briar McKenzie
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
| | - Kathy Trieu
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
| | - Claire Johnson
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
| | - Rachael McLean
- Department of Preventive & Social MedicineUniversity of OtagoDunedinNew Zealand
| | - JoAnne Arcand
- Faculty of Health SciencesOntario Tech UniversityOshawaOntarioCanada
| | - Norman R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryAlbertaCanada
| | - Jacqui Webster
- The George Institute for Global HealthUniversity of New South WalesSydneyNSWAustralia
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Wen X, Zhou L, Stamler J, Chan Q, Horn LV, Daviglus ML, Dyer AR, Elliott P, Ueshima H, Miura K, Okuda N, Wu Y, Zhao L. Agreement between 24-h dietary recalls and 24-h urine collections for estimating sodium intake in China, Japan, UK, USA: the International Study of Macro- and Micro-nutrients and Blood Pressure. J Hypertens 2019; 37:814-819. [PMID: 30817463 PMCID: PMC6690055 DOI: 10.1097/hjh.0000000000001941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The present study aims to compare 24-h dietary recalls with 24-h urine collections for the estimation of sodium intake at both population and individual levels in China, Japan, the United Kingdom (UK), and the United States of America (USA), using data from the International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP). METHODS Mean differences between 24-h dietary recalls and 24-h urine collections were calculated for their agreement in estimating sodium intake at the population level; relative and absolute differences as well as misclassification of salt intake groups (salt intake <6, 6-8.9, 9-11.9, 12-14.9, and ≥15 g/day) were used to determine the agreement at the individual level. RESULTS The mean differences (95% CI) between dietary recalls and urine collections for China, Japan, UK, and USA were -54.0 (-59.8, -48.3), 3.9 (0.6, 7.2), 2.9 (-1.8, 7.6), and -3.5 (-5.8, -1.1) mmol/day, respectively. The proportions of individual relative differences beyond ±40% were 34.3% for China, 16.9% for Japan, 24.2% for UK, and 21.3% for USA; the proportions of individual absolute differences greater than 51.3 mmol/day (3 g salt) were 58.6% for China, 32.8% for Japan, 25.4% for UK, and 31.9% for USA. The rate for misclassification of salt intake groups at individual level for China, Japan, UK, and USA were 71.4, 60.9, 58.7, and 60.0%, respectively. CONCLUSION The 24-h dietary recalls demonstrate greater agreement with the 24-h urine collections in estimating population sodium intake for Japan, UK, and USA, compared with China. The 24-h dietary recall has poor performance in assessing individual sodium intake in these four countries.
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Affiliation(s)
- Xiaoxiao Wen
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Long Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeremiah Stamler
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, Illinois, USA
| | - Alan R. Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan and
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Isiklar Ozberk D, Kutlu R, Kilinc I, Kilicaslan AO. Effects of mandatory salt iodization on breast milk, urinary iodine concentrations, and thyroid hormones: is iodine deficiency still a continuing problem? J Endocrinol Invest 2019; 42:411-418. [PMID: 30099723 DOI: 10.1007/s40618-018-0930-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate whether mandatory use of iodized salt in Turkey, since 1999 has sufficient effects on pregnant women and their newborns' urinary iodine concentrations (UIC), maternal and newborns' thyroid function tests and breast milk iodine concentrations (BMIC). METHODS This cross-sectional analytical-type study was conducted in an obstetrics and gynecology hospital in Konya, Turkey. One hundred and seven pregnant women and their 107 full-term newborns were included into the study. Levels of pregnant women and their newborns' UIC, thyroid-stimulated hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), and BMIC were studied. RESULTS Of 107 women with term pregnancy, mean TSH value and hypothyroidism frequency were found as 2.34 ± 1.33 mIU/L and 18.7%, respectively. Cord blood TSH level was found higher (≥ 10 mIU/L) in five newborns. Accordingly, the incidence of transient congenital hypothyroidism was 4.7% (5/107). Tg levels were observed to be higher in 50.5% of newborns and 22.4% of pregnant women. Frequency of iodized salt use in pregnancies was detected as 96.3% in general population, 97.5% in urban, and 92.9% in rural areas. Of pregnancies and newborns, 57.9 and 53.3% were found to have deficient urinary iodine, respectively, and BMIC deficiency was detected as 52.0%. There was a significant positive correlation between pregnant women's UIC, and newborns' UIC and BMIC. CONCLUSIONS Despite the effective struggle with iodine deficiency and salt iodination control program in Konya, we concluded that iodine deficiency still persists as a significant problem in pregnancies.
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Affiliation(s)
- D Isiklar Ozberk
- Department of Family Medicine, Güzelyurt District Government Hospital, Aksaray, Turkey.
| | - R Kutlu
- Department of Family Medicine, Meram Medical Faculty, University of Necmettin Erbakan, Konya, Turkey
| | - I Kilinc
- Department of Clinical Biochemistry, Meram Medical Faculty, University of Necmettin Erbakan, Konya, Turkey
| | - A O Kilicaslan
- Department of Family Medicine, Karatay Fetih Family Health Center, Konya, Turkey
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Abstract
Both Shanghai and Switzerland are developed regions with long-standing salt iodization programs and periodic monitoring. However, the two regions have their own approach to the implementation of the iodized salt policy. In Shanghai, monitoring was carried out every few years, using probability-proportional-to-size sampling technique to select 30 sampling units. Each unit consisted of more than 12 pregnant women and one randomly selected primary school. Urine samples were then taken from the chosen pregnant women and randomly recruited students of that school for iodine test. Data of Switzerland used in this comparative study was extracted from published researches. In Shanghai, the median urinary iodine concentration (UIC) in 2014 was 20% lower than in 1999 (P < 0.05). The median UIC of pregnant women in 2014 was 9.5% lower than that in 2011 (P < 0.05). In terms of iodized salt concentration, opposite to the increasing in Switzerland, it has exhibited a downward trend in Shanghai (P < 0.05). For the years monitored, the iodized salt concentration in Shanghai was significantly (P < 0.05) higher than in Switzerland. Though the UIC of children exhibited a downward trend in Shanghai (P < 0.05), it was still significantly (P < 0.05) higher than in Switzerland over the same monitoring period. However, the UIC in pregnant women was a totally different story, which was significantly (P < 0.05) lower in Shanghai than in Switzerland. Iodized salt is very important for maintaining sufficient iodine level in the population. Appropriate concentration of iodine in fortified salt needs to be decided according to local conditions. Special attention should be paid to the iodine level of pregnant women in Shanghai, and more education about iodine is necessary for the public health.
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Affiliation(s)
- Zhengyuan Wang
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Peng Liu
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaohui Su
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China
| | - Shurong Zou
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jun Song
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shoujun Liu
- Institute of Iodine Deficiency Disorders Prevention and Control, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang, China.
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Delshad H, Mirmiran P, Abdollahi Z, Salehi F, Azizi F. Continuously sustained elimination of iodine deficiency: a quarter of a century success in the Islamic Republic of Iran. J Endocrinol Invest 2018; 41:1089-1095. [PMID: 29446011 PMCID: PMC6132563 DOI: 10.1007/s40618-018-0838-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/22/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND Iodine deficiency and related disorders were very common in Iran prior to 1996, when universal salt iodization (USI) was implemented and in 2000 Iran was declared iodine deficiency disorders (IDD) free. The aim of this study was to evaluate the adequacy of iodine intake by Iranian households in all 30 provinces of Iran, a quarter of a century after the intervention. METHODS A total of 18,000 school-aged children (8-10 years with mean 8.7 ± 1 year) were included in this study. Urine samples were collected from all children for measurement of urinary iodine excretion and 1800, 210 and 3000 salt samples were randomly collected from the family kitchen, production site of 73 salt factories and distribution circles of 30 provinces, respectively. RESULTS The median urinary iodine concentration (UIC) of participants was 161 μg/L. The proportion of children with UIC of, 20-49, 50-99 and ≥ 100 μg/L were 10.3, 15.9 and 73.7%, respectively. The mean (± SD) and median salt iodine values were 28.2 (± 12.6) and 31.7 ppm, at the production site, and 31.5 (± 13.6) and 29.6 ppm at the distribution circles, respectively. About 80% of factory salts had more than 20 ppm iodine. 98% of households consumed iodized salt, 80% had appropriate salt storage, and 83% of the household salts contained ≥ 20 ppm. CONCLUSIONS Based on the results of this study, Iranian populations are consuming adequate iodine. The well-maintained and monitored USI program has improved the dietary iodine intakes of the population, and the country has achieved all criteria of a well-controlled IDD program.
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Affiliation(s)
- H. Delshad
- Micronutrient Research Office, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, 19395-4763 Tehran, Islamic Republic of Iran
| | - P. Mirmiran
- Nutrition Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Z. Abdollahi
- Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - F. Salehi
- Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran
| | - F. Azizi
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Herrick KA, Perrine CG, Aoki Y, Caldwell KL. Iodine Status and Consumption of Key Iodine Sources in the U.S. Population with Special Attention to Reproductive Age Women. Nutrients 2018; 10:E874. [PMID: 29986412 PMCID: PMC6073695 DOI: 10.3390/nu10070874] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
We estimated iodine status (median urinary iodine concentration (mUIC (µg/L))) for the US population (6 years and over; n = 4613) and women of reproductive age (WRA) (15⁻44 years; n = 901). We estimated mean intake of key iodine sources by race and Hispanic origin. We present the first national estimates of mUIC for non-Hispanic Asian persons and examine the intake of soy products, a potential source of goitrogens. One-third of National Health and Nutrition Examination Survey (NHANES) participants in 2011⁻2014 provided casual urine samples; UIC was measured in these samples. We assessed dietary intake with one 24-h recall and created food groups using the USDA’s food/beverage coding scheme. For WRA, mUIC was 110 µg/L. For both non-Hispanic white (106 µg/L) and non-Hispanic Asian (81 µg/L) WRA mUIC was significantly lower than mUIC among Hispanic WRA (133 µg/L). Non-Hispanic black WRA had a mUIC of 124 µg/L. Dairy consumption was significantly higher among non-Hispanic white (162 g) compared to non-Hispanic black WRA (113 g). Soy consumption was also higher among non-Hispanic Asian WRA (18 g compared to non-Hispanic black WRA (1 g). Differences in the consumption pattern of key sources of iodine and goitrogens may put subgroups of individuals at risk of mild iodine deficiency. Continued monitoring of iodine status and variations in consumption patterns is needed.
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Affiliation(s)
- Kirsten A Herrick
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), Hyattsville, MD 20782, USA.
| | - Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, CDC, Atlanta, GA 30341, USA.
| | - Yutaka Aoki
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), Hyattsville, MD 20782, USA.
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Maseko M, Mashao M, Bawa-Allah A, Phukubje E, Mlambo B, Nyundu T. Obesity masks the relationship between dietary salt intake and blood pressure in people of African ancestry: the impact of obesity on the relationship between sodium and blood pressure. Cardiovasc J Afr 2018; 29:172-176. [PMID: 29443353 PMCID: PMC6107806 DOI: 10.5830/cvja-2018-011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 01/29/2018] [Indexed: 11/21/2022] Open
Abstract
Previous studies conducted to investigate the relationship between sodium intake and blood pressure in our African population have yielded contradictory results. With the high prevalence of obesity in this population, it is possible that these contradictory findings are due to the masking effects of obesity on this relationship. We measured 24–hour ambulatory blood pressure and 24–hour urine excretion on 547 South Africans of African ancestry. A multivariate regression analysis revealed no independent relationship between 24–hour sodium excretion and blood pressure in the total population sample, but when participants were stratified according to body mass index (BMI) status, there was a significant association between 24–hour sodium excretion and blood pressure in the normal–BMI participants but not in the overweight/obese participants. We concluded that dietary salt intake, indexed by 24–hour urinary sodium excretion, was associated with increased ambulatory blood pressure but this relationship was masked because of a high proportion of overweight/obese individuals in this population.
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Affiliation(s)
- Muzi Maseko
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Mercy Mashao
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdulraheem Bawa-Allah
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edgar Phukubje
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bongubuhle Mlambo
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thamsanqa Nyundu
- School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Grimes CA, Booth A, Khokhar D, West M, Margerison C, Campbell KJ, Nowson CA. Digital Education to Limit Salt in the Home (DELISH) Program Improves Knowledge, Self-Efficacy, and Behaviors Among Children. J Nutr Educ Behav 2018; 50:547-554. [PMID: 29886898 DOI: 10.1016/j.jneb.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the efficacy of a Web-based salt reduction program on children's salt-related knowledge, attitudes, and behaviors (KABs), self-efficacy, and intake of dietary salt. DESIGN Pretest and posttest. An online survey determined KABs and self-efficacy and a 24-hour urine collection revealed salt intake. SETTING Victoria, Australia. PARTICIPANTS Child-parent dyads (n = 102) recruited from 5 government schools. INTERVENTION A 5-week behavior-based education program delivered via weekly online interactive education sessions. MAIN OUTCOME MEASURES Change in KABs, self-efficacy, and daily salt intake. ANALYSIS Changes in outcomes were assessed using McNemar test, paired t test, and Cohen's δ (CD). RESULTS A total of 83 children participated (mean age, 9.2 years [SD, 0.8 years]; 59% girls); 35% to 76% of children viewed weekly education session. Children with complete survey data (n = 75) had improved scores for salt-related knowledge (+3.6 ± 0.4 points; P < .001; CD: 1.16), behaviors (+1.3 ± 0.1 points; P < .001; CD: 1.08), and self-efficacy (+0.9 ± 0.2 points; P < .001; CD: 0.64), but not attitude. Children with valid urine collections (n = 51) showed no change in salt intake. CONCLUSIONS AND IMPLICATIONS Participation resulted in improvement of salt related knowledge, self-efficacy and behavior. Further research is required to confirm these results using a more robust study design which includes a control group. In addition, the long term impact on children's salt intakes of comparable education programs needs to be assessed.
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Affiliation(s)
- Carley Ann Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
| | - Alison Booth
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Durreajam Khokhar
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Madeline West
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Claire Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen Jane Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Caryl Anne Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Grimes CA, Riddell LJ, Campbell KJ, Beckford K, Baxter JR, He FJ, Nowson CA. Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study. BMJ Open 2017; 7:e016639. [PMID: 29084791 PMCID: PMC5665305 DOI: 10.1136/bmjopen-2017-016639] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To examine sodium and potassium urinary excretion by socioeconomic status (SES), discretionary salt use habits and dietary sources of sodium and potassium in a sample of Australian schoolchildren. DESIGN Cross-sectional study. SETTING Primary schools located in Victoria, Australia. PARTICIPANTS 666 of 780 children aged 4-12 years who participated in the Salt and Other Nutrients in Children study returned a complete 24-hour urine collection. PRIMARY AND SECONDARY OUTCOME MEASURES 24-hour urine collection for the measurement of sodium and potassium excretion and 24-hour dietary recall for the assessment of food sources. Parent and child reported use of discretionary salt. SES defined by parental highest level of education. RESULTS Participants were 9.3 years (95% CI 9.0 to 9.6) of age and 55% were boys. Mean urinary sodium and potassium excretion was 103 (95% CI 99 to 108) mmol/day (salt equivalent 6.1 g/day) and 47 (95% CI 45 to 49) mmol/day, respectively. Mean molar Na:K ratio was 2.4 (95% CI 2.3 to 2.5). 72% of children exceeded the age-specific upper level for sodium intake. After adjustment for age, sex and day of urine collection, children from a low socioeconomic background excreted 10.0 (95% CI 17.8 to 2.1) mmol/day more sodium than those of high socioeconomic background (p=0.04). The major sources of sodium were bread (14.8%), mixed cereal-based dishes (9.9%) and processed meat (8.5%). The major sources of potassium were dairy milk (11.5%), potatoes (7.1%) and fruit/vegetable juice (5.4%). Core foods provided 55.3% of dietary sodium and 75.5% of potassium while discretionary foods provided 44.7% and 24.5%, respectively. CONCLUSIONS For most children, sodium intake exceeds dietary recommendations and there is some indication that children of lower socioeconomic background have the highest intakes. Children are consuming about two times more sodium than potassium. To improve sodium and potassium intakes in schoolchildren, product reformulation of lower salt core foods combined with strategies that seek to reduce the consumption of discretionary foods are required.
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Affiliation(s)
- Carley A Grimes
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Lynn J Riddell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kelsey Beckford
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Janet R Baxter
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Feng J He
- Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Caryl A Nowson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Wang Y, Zhang B, Hou L, Han W, Xue F, Wang Y, Tang Y, Liang S, Wang W, Asaiti K, Wang Z, Hu Y, Wang L, Qiu C, Zhang M, Jiang J. Interaction of ACE genotype and salt intake on hypertension among Chinese Kazakhs: results from a population-based cross-sectional study. BMJ Open 2017; 7:e014246. [PMID: 28515190 PMCID: PMC5541444 DOI: 10.1136/bmjopen-2016-014246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To explore the effect of interaction between ACE genotype and salt intake on hypertension among Chinese Kazakhs, and to compare applications of interactions between logistic model and generalised partially linear tree-based regression (GPLTR) model. DESIGN Population-based cross-sectional study. SETTING Hong Dun, North Xinjiang, China. PARTICIPANTS Non-consanguineous Chinese Kazakh participants (n=916, 342 men and 574 women) aged ≥30 years. MAIN OUTCOME MEASURES Association between ACE genotype and hypertension, association between salt intake and hypertension, and interaction of ACE genotype and salt intake on hypertension in two models. RESULTS Associations between salt intake and hypertension were different in ACE genotype of II and ID+DD. Under the logistic models, main and interaction effects were not observed for men, but effects were present in opposite directions for women (main effect of ACE: OR=0.20, p=0.003; interaction effect: OR=1.07, p=0.027). Under the GPLTR model, Bayesian information criterion trees included both salt intake and ACE genotype as split variables. Individuals with a salt intake ≥19.5 g/day and ID+DD genotypes had a 3.99-fold (p=0.004) higher risk of hypertension compared with the II genotype for men, whereas salt intake <20.1 g/day and ID+DD genotypes had an OR=0.55 (p=0.014) compared with the II genotype for women. CONCLUSIONS An interaction of ACE genotype and salt intake on hypertension was observed among Chinese Kazakhs but in different ways according to sex. The GPLTR model appears to be more suitable for an exploration of interactions in complex diseases.
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Affiliation(s)
- Yuyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Biao Zhang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Hou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Tang
- The People’s Hospital in Altay Region, Xinjiang, China
| | - Shaohua Liang
- The People’s Hospital in Altay Region, Xinjiang, China
| | - Weizhi Wang
- The People’s Hospital in Altay Region, Xinjiang, China
| | | | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Changchun Qiu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingtao Zhang
- The People’s Hospital in Altay Region, Xinjiang, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
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Aparicio A, Rodríguez-Rodríguez E, Cuadrado-Soto E, Navia B, López-Sobaler AM, Ortega RM. Estimation of salt intake assessed by urinary excretion of sodium over 24 h in Spanish subjects aged 7-11 years. Eur J Nutr 2017; 56:171-178. [PMID: 26482149 PMCID: PMC5290043 DOI: 10.1007/s00394-015-1067-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/30/2015] [Indexed: 11/01/2022]
Abstract
PURPOSE High intake of salt is associated with early development of cardiovascular risk factors (e.g., hypertension, obesity). In "developed" countries, individuals frequently exceed dietary recommendations for salt intake. Taking into account the limited data on sodium intake by 24-h excretion in urine in schoolchildren, we wished to determine baseline salt intake in Spanish subjects aged 7-11 years. METHODS The present study was an observational study involving 205 schoolchildren (109 boys and 96 girls) selected from various Spanish provinces. Sodium intake was ascertained by measuring sodium excretion in urine over 24 h. Creatinine was used to validate completeness of urine collections. The correlation between fat-free mass determined by anthropometry and that determined via urinary excretion of creatinine was calculated (r = 0.651; p < 0.001). RESULTS Mean 24-h urinary excretion of sodium was 132.7 ± 51.4 mmol/24 h (salt equivalent: 7.8 ± 3.1 g/day). Hence, 84.5 % of subjects aged ≤10 years had intakes of >4 g salt/day, and 66.7 % of those aged >10 years had intakes of >5 g salt/day. Urinary excretion of sodium was correlated with systolic blood pressure and diastolic blood pressure (r = 0.1574 and r = 0.1400, respectively). Logistic regression analyses, adjusted by sex, showed that a high body mass index (odds ratio = 1.159; 95 % CI 1.041-1.290; p < 0.05) was associated with an increased likelihood of high urinary excretion of sodium. CONCLUSIONS Sodium intake, as estimated by 24-h urinary excretion, was (on average) higher than recommended. Reducing the sodium content children's diet is a sound policy to reduce cardiovascular risk.
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Affiliation(s)
- A Aparicio
- Departamento de Nutrición Y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
- UCM Research Group: VALORNUT-920030, Madrid, Spain.
| | - E Rodríguez-Rodríguez
- Sección Departamental de Química Analítica, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Madrid, Spain
| | - E Cuadrado-Soto
- Departamento de Nutrición Y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Madrid, Spain
| | - B Navia
- Departamento de Nutrición Y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Madrid, Spain
| | - A M López-Sobaler
- Departamento de Nutrición Y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Madrid, Spain
| | - R M Ortega
- Departamento de Nutrición Y Bromatología I (Nutrición), Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
- UCM Research Group: VALORNUT-920030, Madrid, Spain
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Ahmedbeyli RM. [Caries prevention with fluoridated and iodinated salt in school-aged children living in areas with fluoride and iodine deficiency]. Stomatologiia (Mosk) 2017; 96:66-68. [PMID: 29072650 DOI: 10.17116/stomat201796566-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of the study was to evaluate the efficacy of dental caries prevention program with 3 years follow-up in children living in areas with fluoride and iodine deficiency. The study involved 625 school-aged children aged 6, 12 and 15 years receiving endogenous prevention with fluoridated and iodinated salt (300±50 mgF/kg and 40±10 mgI/kg). Enamel and dentine concentrations of CA, P, F and I were measured in 98 intact deciduous teeth by X-ray microanalysis before and after prevention program. Enamel and dentin microhardness was assessed in the same 98 teeth by Vickers Hardness Test. Obtained reduction of DMFT growth, positive changes of mineral composition and dental hard tissues microhardness prove high clinical efficacy of applied prevention program.
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Torres VE, Abebe KZ, Schrier RW, Perrone RD, Chapman AB, Yu AS, Braun WE, Steinman TI, Brosnahan G, Hogan MC, Rahbari FF, Grantham JJ, Bae KT, Moore CG, Flessner MF. Dietary salt restriction is beneficial to the management of autosomal dominant polycystic kidney disease. Kidney Int 2016; 91:493-500. [PMID: 27993381 DOI: 10.1016/j.kint.2016.10.018] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 02/07/2023]
Abstract
The CRISP study of polycystic kidney disease (PKD) found that urinary sodium excretion associated with the rate of total kidney volume increase. Whether sodium restriction slows the progression of Autosomal Dominant PKD (ADPKD) is not known. To evaluate this we conducted a post hoc analysis of the HALT-PKD clinical trials of renin-angiotensin blockade in patients with ADPKD. Linear mixed models examined whether dietary sodium affected rates of total kidney volume or change in estimated glomerular filtration rate (eGFR) in patients with an eGFR over 60 ml/min/1.73 m2 (Study A) or the risk for a composite endpoint of 50% reduction in eGFR, end-stage renal disease or death, or the rate of eGFR decline in patients with an eGFR 25-60 ml/min/1.73 m2 (Study B) all in patients initiated on an under100 mEq sodium diet. During the trial urinary sodium excretion significantly declined by an average of 0.25 and 0.41 mEq/24 hour per month in studies A and B, respectively. In Study A, averaged and time varying urinary sodium excretions were significantly associated with kidney growth (0.43%/year and 0.09%/year, respectively, for each 18 mEq urinary sodium excretion). Averaged urinary sodium excretion was not significantly associated with faster eGFR decline (-0.07 ml/min/1.73m2/year for each 18 mEq urinary sodium excretion). In Study B, the averaged but not time-varying urinary sodium excretion significantly associated with increased risk for the composite endpoint (hazard ratio 1.08 for each 18 mEq urinary sodium excretion) and a significantly faster eGFR decline (-0.09 ml/min/1.73m2/year for each mEq 18 mEq urinary sodium excretion). Thus, sodium restriction is beneficial in the management of ADPKD.
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Affiliation(s)
| | - Kaleab Z Abebe
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert W Schrier
- University of Colorado Health Sciences Center, Denver, Colorado, USA
| | | | | | - Alan S Yu
- Kansas University Medical Center, Kansas City, Kansas, USA
| | | | | | - Godela Brosnahan
- University of Colorado Health Sciences Center, Denver, Colorado, USA
| | - Marie C Hogan
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | | | - Kyongtae T Bae
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wang X, Li X, Vaartjes I, Neal B, Bots ML, Hoes AW, Wu Y. Does education level affect the efficacy of a community based salt reduction program? - A post-hoc analysis of the China Rural Health Initiative Sodium Reduction Study (CRHI-SRS). BMC Public Health 2016; 16:759. [PMID: 27515930 PMCID: PMC4982434 DOI: 10.1186/s12889-016-3454-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary salt reduction program was affected by the level of education of participants. METHODS The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province. RESULTS Daily salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to salt (all p > 0.05). CONCLUSIONS The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations. TRIAL REGISTRATION The trial was registered with clinicaltrial.gov ( NCT01259700 ).
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Affiliation(s)
- Xin Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing, 100088 People’s Republic of China
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bruce Neal
- The George Institute for Global Health, Australia, Sydney, Australia
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing, 100088 People’s Republic of China
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Terry AL, Cogswell ME, Wang CY, Chen TC, Loria CM, Wright JD, Zhang X, Lacher DA, Merritt RK, Bowman BA. Feasibility of collecting 24-h urine to monitor sodium intake in the National Health and Nutrition Examination Survey. Am J Clin Nutr 2016; 104:480-8. [PMID: 27413136 PMCID: PMC4962154 DOI: 10.3945/ajcn.115.121954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 06/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Twenty-four-hour urine sodium excretion is recommended for monitoring population sodium intake. Because of concerns about participation and completion, sodium excretion has not been collected previously in US nationally representative surveys. OBJECTIVE We assessed the feasibility of implementing 24-h urine collections as part of a nationally representative survey. DESIGN We selected a random half sample of nonpregnant US adults aged 20-69 y in 3 geographic locations of the 2013 NHANES. Participants received explicit instructions, started and ended the urine collection in a urine study mobile examination center, and answered questions about their collection. Among those with a complete 24-h urine collection, a random one-half were asked to collect a second 24-h urine sample. Sodium, potassium, chloride, and creatinine excretion were analyzed. RESULTS The final NHANES examination response rate for adults aged 20-69 y in these 3 study locations was 71%. Of those examined (n = 476), 282 (59%) were randomly selected to participate in the 24-h urine collection. Of these, 212 persons [75% of those selected for 24-h urine collection; 53% (equal to 71% × 75% of those selected for the NHANES)] collected a complete initial 24-h specimen and 92 persons (85% of 108 selected) collected a second complete 24-h urine sample. More men than women completed an initial collection (P = 0.04); otherwise, completion did not vary by sociodemographic characteristics, body mass index, education, or employment status for either collection. Mean 24-h urine volume and sodium excretion were 1964 ± 1228 mL and 3657 ± 2003 mg, respectively, for the first 24-h urine sample, and 2048 ± 1288 mL and 3773 ± 1891 mg, respectively, for the second collection. CONCLUSION Given the 53% final component response rate and 75% completion rate, 24-h urine collections were deemed feasible and implemented in the NHANES 2014 on a subsample of adults aged 20-69 y to assess population sodium intake. This study was registered at clinicaltrials.gov as NCT02723682.
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Affiliation(s)
- Ana L Terry
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD;
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA; and
| | - Chia-Yih Wang
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Te-Ching Chen
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Catherine M Loria
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
| | - Jacqueline D Wright
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
| | - Xinli Zhang
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD
| | - David A Lacher
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, Hyattsville, MD
| | - Robert K Merritt
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA; and
| | - Barbara A Bowman
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA; and
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Méndez-Villa L, García-Solís P, Solís-S JC, García-Gutiérrez DG, Pérez-Mora VA, Robles-Osorio L, Sampson-Zaldívar E. High Iodine and Salt Intakes and Obesity do not Modify the Thyroid Function in Mexican Schoolchildren. Biol Trace Elem Res 2016; 172:290-298. [PMID: 26689929 DOI: 10.1007/s12011-015-0591-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Mexico is considered as a nutritional transition country with a high prevalence of overweight and obesity, and recent studies have reported a high iodine intake in children. Both high iodine intake and obesity have been associated with thyroid dysfunction. Our aim was to assess iodine and salt intake and thyroid function in Mexican schoolchildren with normal weight and obesity. A cross-sectional study was performed during 2012-2013 in schoolchildren from Queretaro, Mexico. Six hundred seventy-eight schoolchildren were evaluated to obtain nutrition status, urinary iodine concentration (UIC) and thyroid volume (TVol). The prevalence of overweight and obesity was 47.3 %, the median UIC was 428 μg/L and TVol was normal in all schoolchildren; however, obese girls had a higher TVol than normal weight at the age of 8, 10 and 12 years. A subsample of schoolchildren was divided in 6-8 and 9-12-year-old groups, in order to compare thyroid function (thyrotropin, free T4, and anti-thyroid antibodies); iodine and salt intake were estimated with 24-h urinary samples. No differences in thyroid function were observed in both age groups. In the 6-8-year-old group, obese schoolchildren had higher iodine intake than normal-weight children (415.5 vs. 269.1 μg/day, p < 0.05), but no differences in salt intake. In contrast, in the 9-12-year-old group, obese schoolchildren had higher salt intake than normal-weight children (6.2 vs. 3.8 g/day, p < 0.05), but no differences in iodine intake. Dietary patterns could explain the differences between both age groups. Further studies are needed to identify the main sources of iodine intake in Mexican populations.
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Affiliation(s)
- Lorena Méndez-Villa
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - Pablo García-Solís
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico.
| | - Juan Carlos Solís-S
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - David Gustavo García-Gutiérrez
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
| | - Valeria Alejandra Pérez-Mora
- Laboratorio de Endocrinología y Nutrición, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Clavel 200. Fracc. Prados de la Capilla, Querétaro, Querétaro, CP. 76176, Mexico
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Gu F, Ding G, Lou X, Wang X, Mo Z, Zhu W, Zhou J, Mao G. Incidence of thyroid diseases in Zhejiang Province, China, after 15 years of salt iodization. J Trace Elem Med Biol 2016; 36:57-64. [PMID: 27259353 DOI: 10.1016/j.jtemb.2016.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/01/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
Thyroid diseases(TD) can be induced by either deficient or excessive iodine intake. Universal Salt Iodization(USI) program has been implemented in China since 1995, to prevent iodine deficiency disorders (IDD). To evaluate the current conditions of TD and the role of USI, a multi-stage stratified random sampling scheme was used to perform a cross-sectional survey on the incidence of TD among participants in 6600 households in Zhejiang Province, a coastal area in China. Iodine nutrition status of the population was assessed by dietary iodine intake recall and urinary iodine concentration (UIC) of the participants, and TD were diagnosed by thyroid ultrasonography for 15122 participants and for 5873 participants by serum criteria for thyroid function(fT3, fT4, TSH, TRAb, TgAb, TPOAb; see Introduction for abbreviations). The median UIC of the surveyed population was 163μg iodine/L. From the participants 23.2% had UIC<100μg/L which is moderately iodine-deficient according to WHO classification. Diffuse goiter was present in 2.3% of the population and thyroid nodule in 20.9%. The incidence of hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, subclinical hypothyroidism, Graves' disease and chronic lymphocytic thyroiditis was 0.5%, 0.6%, 0.6%, 7.8%, 0.2% and 0.3%, respectively. The proportion of several TD for participants with non-iodized salt intake was higher than that for participants with iodized salt intake.
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Affiliation(s)
- Fang Gu
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China
| | - Gangqiang Ding
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Xiaoming Lou
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Xiaofeng Wang
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Zhe Mo
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Wenming Zhu
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Jinshui Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
| | - Guangming Mao
- Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binshen Road, Hangzhou 310051, China.
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Rohner F, Wirth JP, Woodruff BA, Chiwile F, Yankson H, Sesay F, Koroma AS, Petry N, Pyne-Bailey S, Dominguez E, Kupka R, Hodges MH, de Onis M. Iodine Status of Women of Reproductive Age in Sierra Leone and Its Association with Household Coverage with Adequately Iodized Salt. Nutrients 2016; 8:74. [PMID: 26848685 PMCID: PMC4772038 DOI: 10.3390/nu8020074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 11/16/2022] Open
Abstract
Salt iodization programs are a public health success in tackling iodine deficiency. Yet, a large proportion of the world's population remains at risk for iodine deficiency. In a nationally representative cross-sectional survey in Sierra Leone, household salt samples and women's urine samples were quantitatively analyzed for iodine content. Salt was collected from 1123 households, and urine samples from 817 non-pregnant and 154 pregnant women. Household coverage with adequately iodized salt (≥15 mg/kg iodine) was 80.7%. The median urinary iodine concentration (UIC) of pregnant women was 175.8 µg/L and of non-pregnant women 190.8 µg/L. Women living in households with adequately iodized salt had higher median UIC (for pregnant women: 180.6 µg/L vs. 100.8 µg/L, respectively, p < 0.05; and for non-pregnant women: 211.3 µg/L vs. 97.8 µg/L, p < 0.001). Differences in UIC by residence, region, household wealth, and women's education were much smaller in women living in households with adequately iodized salt than in households without. Despite the high household coverage of iodized salt in Sierra Leone, it is important to reach the 20% of households not consuming adequately iodized salt. Salt iodization has the potential for increasing equity in iodine status even with the persistence of other risk factors for deficiency.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elisa Dominguez
- World Health Organization West Africa, Ouagadougou, Burkina Faso.
| | | | | | - Mercedes de Onis
- World Health Organization Headquarters, 1211 Geneva, Switzerland.
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Taylor JM, Hamilton-Reeves JM, Sullivan DK, Gibson CA, Creed C, Carlson SE, Wesson DE, Grantham JJ. Diet and polycystic kidney disease: A pilot intervention study. Clin Nutr 2016; 36:458-466. [PMID: 26811129 DOI: 10.1016/j.clnu.2016.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 12/14/2015] [Accepted: 01/04/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Dietary sodium, protein, acid precursors, and water have been linked to cyst growth in polycystic kidney disease; yet, no studies in patients have examined the feasibility of using a dietary intervention that controls all of these factors. The aim of this study was to determine if a diet, appropriate for persons of most ages, reduces the excretion of sodium, urea, acid, and decreases mean urine osmolality while gaining acceptance by patients with autosomal dominant polycystic kidney disease (ADPKD). METHODS Twelve adults with ADPKD enrolled in a pre-post pilot feasibility study and served as their own controls. Individuals consumed their usual diet for one week then for four weeks followed an isocaloric diet lower in sodium and protein and higher in fruits, vegetables, and water. Three-day diet records and two 24-h urine samples were collected at baseline, week 2, and week 4 visits; blood pressure, weight, and serum were obtained at all three visits. A modified nutrition hassles questionnaire was completed on the last visit. RESULTS During the dietary intervention, subjects (n = 11) consumed less sodium, protein, and dietary acid precursors 36%, 28%, and 99%, respectively, and increased fluid intake by 42%. Urinary sodium, urea, net acid excretion, osmoles, and osmolality decreased 20%, 28%, 20%, 37%, and 15%, respectively; volume increased 35%. Urine changes were in accord with the diet record. Ninety-one percent of participants reported that none of the hassles were worse than "somewhat severe", and most participants felt "somewhat confident" or "very confident" that they could manage the new diet. CONCLUSIONS A majority of adult patients with ADPKD successfully prepared and followed a composite diet prescription with decreased sodium, protein, acid precursors, and increased fluid intake. This trail was registered at ClinicalTrials.gov (NCT01810614).
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Affiliation(s)
- Jacob M Taylor
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Department of Nutrition Services, Children's Mercy Hospital & Clinics, Kansas City, MO, USA.
| | - Jill M Hamilton-Reeves
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Debra K Sullivan
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Cheryl A Gibson
- Department of Internal Medicine, Division of General Medicine, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Catherine Creed
- Department of Medicine-Nephrology, Kidney Institute, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Susan E Carlson
- Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Donald E Wesson
- Department of Internal Medicine, Baylor Scott and White Health, Texas A&M Health Science Center College of Medicine-Temple Campus, USA.
| | - Jared J Grantham
- Department of Medicine-Nephrology, Kidney Institute, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
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Abstract
Sodium intake was reported to be related to metabolic syndrome (MS). Although a strong association between sodium intake and blood pressure (BP) has been reported, the relationship between sodium intake and other components of MS is unknown. An observational study of 18,146 adults in the Korea National Health and Nutrition Examination Survey IV-V databases (2008-2011) was performed. Estimates of 24-h sodium excretion were made from a single fasting urine sample. A significant positive association was found between sodium excretion and systolic BP and between sodium excretion and diastolic BP in participants with and without hypertension after adjusting for multiple covariates (P < 0.001 for trend). The relationship between triglyceride or glucose levels and sodium excretion was linear (P < 0.005). In both men and women, a positive relationship between sodium excretion and waist circumference and an inverse relationship between sodium excretion and high-density lipoprotein were found (P ≤ 0.001). Body fat percentage, body fat mass, and insulin level were positively related to sodium excretion (P ≤ 0.001), and HOMA-IR was significantly associated with sodium excretion (P < 0.05). The risk of MS was elevated 1.279-fold in the second quartile of sodium excretion (95% CI, 1.088-1.504, P = 0.003), 1.479-fold in the third quartile (95% CI, 1.262-1.734; P < 0.001), and 1.929-fold in the highest quartile (95% CI 1.654-2.249, P < .001) compared with the lowest quartile. Sodium intake is significantly associated with all components of MS, body fat, and insulin resistance. Therefore, a high-salt diet is a significant risk factor for MS.
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Affiliation(s)
- Se Won Oh
- From the Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (SWO, KHH, SYH); Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine (HSK); The Research Institute of Salt and Health, Seoul (HSK, SK, HJC); Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam (HJC); and Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (HJC)
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Yadav V, Pathania A, Yadav K. Spot urine sample for estimating sodium intake of a population. Natl Med J India 2015; 28:239-240. [PMID: 27132955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Vikas Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi,
| | - Abhishek Pathania
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi
| | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi
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