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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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Yang L, He ZW, He JW. The chemical profiling of aqueous soluble fraction from Lagopsis supina and its diuretic effects via suppression of AQP and RAAS pathways in saline-loaded rats. J Ethnopharmacol 2021; 272:113951. [PMID: 33610702 DOI: 10.1016/j.jep.2021.113951] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/11/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lagopsis supina (Steph.) Ik. -Gal. ex Knorr. has been widely used as a remedy treatment for diuresis and edema in China over 2500 years. Our previous results showed that the aqueous soluble fraction from L. supina (LSB) possessed acute diuretic effect. AIM OF THE STUDY The aim of this study was to appraise the acute (6 h) and prolonged (7 d) diuretic effects, underlying mechanisms, and chemical profiling of LSB. MATERIALS AND METHODS The chemical profiling of LSB was performed by ultra-high-performance liquid chromatography-quadrupole time-of-flight tandem mass spectrometry (UHPLC-qTOF-MS/MS). Then, oral administration of LSB (40, 80, 160 and 320 mg/kg) and furosemide (10 mg/kg) once daily for 7 consecutive days to evaluate the diuretic effects in saline-loaded rats. The body weight, food consumption, and water intake were recorded once daily. The urinary volume, pH and electrolyte concentrations (Na+, K+, Cl-, and Ca2+) were measured after administration drugs for acute and prolonged diuretic effects. In addition, the serum levels of Na+-K+-ATPase, angiotensin II (Ang II), anti-diuretic hormone (ADH), aldosterone (ALD), atriopeptin (ANP), aquaporins (AQPs)-1, 2 and 3 were determined by ELISA kits. The mRNA expressions and protein levels of AQPs-1, 2 and 3 were analyzed by real-time quantitative PCR and Western blot assays, respectively. RESULTS 30 compounds were identified in LSB based on accurate mass and MS/MS fragmentation compared to literature, among which phenylpropanoids and flavonoids could be partly responsible for the major diuretic effect. Daily administration of LSB (160 or 320 mg/kg) prominently increased urinary excretion volume after the 2 h at the first day of treatment, remaining until the 7th day. LSB did not cause Na+ and K+ electrolyte abnormalities, and has minor effect on Cl- and Ca2+ concentrations at 320 mg/kg. Furthermore, LSB observably suppressed renin-angiotensin-aldosterone system (RAAS) activation, including decreased serum levels of Ang II, ADH, and ALD, and prominently increased serum level of ANP in rats. LSB treatment significantly down-regulated the serum levels, mRNA expressions and protein levels of AQP1, AQP2, and AQP3. CONCLUSION LSB has a prominent acute and prolonged diuretic effects via suppression of AQP and RAAS pathways in saline-loaded rats, and support the traditional folk use of this plant. Taken together, LSB might be a potential diuretic agent.
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Affiliation(s)
- Li Yang
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, China.
| | - Zhong-Wei He
- School of Information Technology, Jiangxi University of Finance and Economics, Nanchang, 330013, China.
| | - Jun-Wei He
- Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, China.
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Hahn K, Hardimon JR, Caskey D, Jost DA, Roady PJ, Brenna JT, Dilger RN. Safety and Efficacy of Sodium and Potassium Arachidonic Acid Salts in the Young Pig. Nutrients 2021; 13:nu13051482. [PMID: 33925724 PMCID: PMC8145490 DOI: 10.3390/nu13051482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/06/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022] Open
Abstract
Arachidonic acid (ARA; 20:4n6) and docosahexaenoic acid (DHA; 22:6n3) are polyunsaturated fatty acids (FA) naturally present in breast milk and added to most North American infant formulas (IF). We investigated the safety and efficacy of novel sodium and potassium salts of arachidonic acid as bioequivalent to support tissue levels of ARA comparable to the parent oil; M. alpina oil (Na-ARA and K-ARA) and including a Na-DHA group. Pigs of both sexes were randomized to one of five dietary treatments (n = 16 per treatment; 8 male and 8 female) from postnatal day 2 to 23. ARA and DHA were included as either triglyceride (TG) or salt. Target dietary ARA/DHA concentrations as percent of total FA by weight were as follows: TT (0.47 TG/0.32 TG), NaT (0.47 Na-salt/0.32 TG), KT (0.47 K-salt/0.32 TG), and Na0 (0.47 Na-salt/0.00), NaNa (0.47 Na-salt/0.32 Na-salt). The primary outcome in this study was bioequivalence of ARA brain accretion. Growth performance; blood and tissue fatty acid levels; liver histology; complete blood cell counts; and serum chemistries were all evaluated. Overall, diets containing test sources of ARA and DHA did not affect growth performance; liver histology; or substantially influence hematological outcomes as compared with TT. The results confirm that the use of Na and K salt forms of ARA yield bioequivalent ARA accretion in the cerebral cortex and retinal tissue compared to TG-ARA. These findings confirm that use of Na-ARA and K-ARA salts in the young pig was safe and nutritionally bioequivalent to TG-ARA for critical neural tissues.
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Affiliation(s)
- Kaylee Hahn
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
| | | | - Doug Caskey
- Jost Chemical Co, St., Louis, MO 63114, USA; (J.R.H.); (D.C.); (D.A.J.)
| | - Douglas A. Jost
- Jost Chemical Co, St., Louis, MO 63114, USA; (J.R.H.); (D.C.); (D.A.J.)
| | - Patrick J. Roady
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA;
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL 61802, USA
| | - J. Thomas Brenna
- Dell Pediatric Research Institute, Department of Pediatrics, of Chemistry, and of Nutrition, University of Texas at Austin, Austin, TX 78723, USA;
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Ryan N. Dilger
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA;
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
- Correspondence:
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Ye W, Huang W, Chen L, Yao C, Sheng S, Liu Z, Xue C, Xing W. Pituitary tumor apoplexy associated with extrapontine myelinolysis during pregnancy: A case report. Medicine (Baltimore) 2021; 100:e25075. [PMID: 33725898 PMCID: PMC7969261 DOI: 10.1097/md.0000000000025075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy. PATIENT CONCERNS We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia. DIAGNOSES MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM). INTERVENTIONS The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25μg/day) was given. OUTCOMES The patient delivered a healthy baby via cesarean section at hospital at 38 + 1 week of gestation. We performed MRI examination regularly and the tumor regressed significantly 8 months postpartum. LESSONS We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.
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Affiliation(s)
| | | | | | | | | | - Zhengyu Liu
- Department of endocrinology, The Third Affiliated Hospital, Soochow University, Changzhou, Jiangsu, China
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Liu T, Rao H, Wang M, Xu H, Wang W, Li G, Wang H, Mu L. Comparative analysis of visit and home blood pressure in a pilot trial on the effect of 18% sodium substitute salt on blood pressure. Sci Rep 2021; 11:907. [PMID: 33441669 PMCID: PMC7806920 DOI: 10.1038/s41598-020-79282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 12/04/2020] [Indexed: 01/19/2023] Open
Abstract
Aim to compare the home blood pressure monitoring (HBPM) and visit blood pressure monitoring in a clinical phase I single-arm pilot trial. The 18% sodium substitute salt was used in 43 hypertensives for 8 weeks, and visited once a week, while weekly visit blood (VBP) pressure, daily home blood pressure (HBP) and urine test results before and after intervention were collected. 43 hypertensive patients were recruited, 4 were lost. And enrolled 39 patients for analysis. The VBP were lower than morning HBP and night HBP (P < 0.05). And VBP was good correlated with morning BP (SBP: r = 0.692, P < 0.001, DBP: r = 0.789, P < 0.001) and night BP (SBP: r = 0.571, P < 0.001, DBP: r = 0.738, P < 0.001). The results of mixed linear model analysis showed that patients' visit SBP (- 11.4 mmHg, 95% CI: - 17.0 to - 5.7, P < 0.001), morning home SBP (- 10.0 mmHg, 95% CI: - 16.4 to - 3.6, P = 0.003) and night home SBP (- 10.2 mmHg, 95% CI: - 15.8 to - 4.6, P = 0.001) decreased significantly, after intervention. Both HBP and VBP showed that 18% substitute salt intervention could decrease the blood pressure of hypertensives. Medication led to VBP lower than HBP, but the two still had a good correlation.Trial registration: NCT03226327. Registered 21 July 2017-Retrospectively registered, http://www.clinicaltrials.gov .
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Affiliation(s)
- Ting Liu
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Huakun Rao
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Meixian Wang
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Huini Xu
- Chongqing Nan'an District People's Hospital, Chongqing, China
| | - Wen Wang
- Chongqing Nan'an District People's Hospital, Chongqing, China
| | - Ge Li
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Hao Wang
- Chongqing Nan'an District People's Hospital, Chongqing, China
| | - Lihong Mu
- Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China.
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Jee D, Kang S, Huang S, Park S. Polygenetic-Risk Scores Related to Crystallin Metabolism Are Associated with Age-Related Cataract Formation and Interact with Hyperglycemia, Hypertension, Western-Style Diet, and Na Intake. Nutrients 2020; 12:nu12113534. [PMID: 33213085 PMCID: PMC7698476 DOI: 10.3390/nu12113534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/13/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 01/19/2023] Open
Abstract
Age-related cataract (ARC) development is associated with loss of crystalline lens transparency related to interactions between genetic and environmental factors. We hypothesized that polygenetic risk scores (PRS) of the selected genetic variants among the ARC-related genes might reveal significant genetic impacts on ARC risk, and the PRS might have gene–gene and gene–lifestyle interactions. We examined the hypothesis in 1972 and 39,095 subjects aged ≥50 years with and without ARC, respectively, in a large-scale hospital-based cohort study conducted from 2004 to 2013. Single nucleotide polymorphisms (SNPs) of the genes related to ARC risk were identified, and polygenetic risk scores (PRS) were generated based on the results of a generalized multifactor dimensionality reduction analysis. Lifestyle interactions with PRS were evaluated. The PRS derived from the best model included the following six SNPs related to crystallin metabolism: ULK4_rs1417380362, CRYAB_rs2070894, ACCN1_rs55785344, SSTR2_rs879419608, PTN_rs322348, and ICA1_rs200053781. The risk of ARC in the high-PRS group was 2.47-fold higher than in the low-PRS group after adjusting for confounders. Age, blood pressure, and glycemia interacted with PRS to influence the risk of ARC: the incidence of ARC was much higher in the elderly (≥65 years) and individuals with hypertension or hyperglycemia. The impact of PRS on ARC risk was greatest in middle-aged individuals with hypertension or hyperglycemia. Na, coffee, and a Western-style diet intake also interacted with PRS to influence ARC risk. ARC risk was higher in the high-PRS group than in the low-PRS group, and high Na intake, Western-style diet, and low coffee intake elevated its risk. In conclusion, ARC risk had a positive association with PRS related to crystallin metabolism. The genetic impact was greatest among those with high Na intake or hypertension. These results can be applied to precision nutrition interventions to prevent ARC.
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Affiliation(s)
- Donghyun Jee
- Division of Vitreous and Retina, Department of Ophthalmology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Korea;
| | - Suna Kang
- Food and Nutrition, Obesity/Diabetes Research Center, Institute of Basic Science, Hoseo University, Asan 31499, Korea; (S.K.); (S.H.)
| | - ShaoKai Huang
- Food and Nutrition, Obesity/Diabetes Research Center, Institute of Basic Science, Hoseo University, Asan 31499, Korea; (S.K.); (S.H.)
| | - Sunmin Park
- Food and Nutrition, Obesity/Diabetes Research Center, Institute of Basic Science, Hoseo University, Asan 31499, Korea; (S.K.); (S.H.)
- Correspondence: ; Tel.: +82-41-540-5633; Fax: +82-41-540-5638
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Wang YJ, Yeh TL, Shih MC, Tu YK, Chien KL. Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients 2020; 12:nu12102934. [PMID: 32992705 PMCID: PMC7601012 DOI: 10.3390/nu12102934] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 08/18/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
Dietary sodium intake has received considerable attention as a potential risk factor of cardiovascular disease. However, evidence on the dose-response association between dietary sodium intake and cardiovascular disease risk is unclear. Embase and PubMed were searched from their inception to 17 August 2020 and studies that examined the association between sodium intake and cardiovascular disease in adolescents were not included in this review. We conducted a meta-analysis to estimate the effect of high sodium intake using a random effects model. The Newcastle-Ottawa Scale assessment was performed. A random-effects dose-response model was used to estimate the linear and nonlinear dose-response relationships. Subgroup analyses and meta-regression were conducted to explain the observed heterogeneity. We identified 36 reports, which included a total of 616,905 participants, and 20 of these reports were also used for a dose-response meta-analysis. Compared with individuals with low sodium intake, individuals with high sodium intake had a higher adjusted risk of cardiovascular disease (Rate ratio: 1.19, 95% confidence intervals = 1.08–1.30). Our findings suggest that there is a significant linear relationship between dietary sodium intake and cardiovascular disease risk. The risk of cardiovascular disease increased up to 6% for every 1 g increase in dietary sodium intake. A low-sodium diet should be encouraged and education regarding reduced sodium intake should be provided.
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Affiliation(s)
- Yi-Jie Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Tzu-Lin Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City 30071, Taiwan
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 10002, Taiwan
- Correspondence: ; Tel.: +886-2-3366-8017
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Marshall MR, Vandal AC, de Zoysa JR, Gabriel RS, Haloob IA, Hood CJ, Irvine JH, Matheson PJ, McGregor DOR, Rabindranath KS, Schollum JBW, Semple DJ, Xie Z, Ma TM, Sisk R, Dunlop JL. Effect of Low-Sodium versus Conventional Sodium Dialysate on Left Ventricular Mass in Home and Self-Care Satellite Facility Hemodialysis Patients: A Randomized Clinical Trial. J Am Soc Nephrol 2020; 31:1078-1091. [PMID: 32188697 PMCID: PMC7217404 DOI: 10.1681/asn.2019090877] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Fluid overload in patients undergoing hemodialysis contributes to cardiovascular morbidity and mortality. There is a global trend to lower dialysate sodium with the goal of reducing fluid overload. METHODS To investigate whether lower dialysate sodium during hemodialysis reduces left ventricular mass, we conducted a randomized trial in which patients received either low-sodium dialysate (135 mM) or conventional dialysate (140 mM) for 12 months. We included participants who were aged >18 years old, had a predialysis serum sodium ≥135 mM, and were receiving hemodialysis at home or a self-care satellite facility. Exclusion criteria included hemodialysis frequency >3.5 times per week and use of sodium profiling or hemodiafiltration. The main outcome was left ventricular mass index by cardiac magnetic resonance imaging. RESULTS The 99 participants had a median age of 51 years old; 67 were men, 31 had diabetes mellitus, and 59 had left ventricular hypertrophy. Over 12 months of follow-up, relative to control, a dialysate sodium concentration of 135 mmol/L did not change the left ventricular mass index, despite significant reductions at 6 and 12 months in interdialytic weight gain, in extracellular fluid volume, and in plasma B-type natriuretic peptide concentration (ratio of intervention to control). The intervention increased intradialytic hypotension (odds ratio [OR], 7.5; 95% confidence interval [95% CI], 1.1 to 49.8 at 6 months and OR, 3.6; 95% CI, 0.5 to 28.8 at 12 months). Five participants in the intervention arm could not complete the trial because of hypotension. We found no effect on health-related quality of life measures, perceived thirst or xerostomia, or dietary sodium intake. CONCLUSIONS Dialysate sodium of 135 mmol/L did not reduce left ventricular mass relative to control, despite improving fluid status. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER The Australian New Zealand Clinical Trials Registry, ACTRN12611000975998.
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Affiliation(s)
- Mark R Marshall
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Medical Affairs, Baxter Healthcare (Asia) Pte Ltd., Singapore
| | - Alain C Vandal
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Janak R de Zoysa
- Department of Renal Medicine, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
- Waitemata Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ruvin S Gabriel
- Department of Cardiology, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Imad A Haloob
- Department of Renal Medicine, Bathurst Base Hospital, New South Wales, Bathurst, Australia
| | - Christopher J Hood
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - John H Irvine
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Philip J Matheson
- Department of Nephrology, Wellington Hospital, Capital & Coast District Health Board, Wellington, New Zealand
| | - David O R McGregor
- Department of Nephrology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Kannaiyan S Rabindranath
- Department of Nephrology, Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand
| | - John B W Schollum
- Nephrology Service, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - David J Semple
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Zhengxiu Xie
- Middlemore Clinical Trials, Auckland, New Zealand; and
| | - Tian Min Ma
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand;
| | - Rose Sisk
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Joanna L Dunlop
- Department of Renal Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
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9
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Urwin S, Willows J, Sayer JA. The challenges of diagnosis and management of Gitelman syndrome. Clin Endocrinol (Oxf) 2020; 92:3-10. [PMID: 31578736 DOI: 10.1111/cen.14104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/27/2019] [Revised: 08/13/2019] [Accepted: 09/18/2019] [Indexed: 12/21/2022]
Abstract
Gitelman syndrome is an inherited tubulopathy characterized by renal salt wasting from the distal convoluted tubule. Defects in the sodium chloride cotransporter (encoded by SLC12A3) underlie this autosomal recessive condition. This article focuses on the specific challenges of diagnosing and treating Gitelman syndrome, with use of an illustrative case report. Symptoms relate to decreased serum potassium and magnesium levels, which include muscle weakness, tetany, fatigue and palpitations. Sudden cardiac deaths have been reported. Making a diagnosis may be difficult given its rarity but is important. A knowledge of the serum and urine biochemical picture is vital to distinguish it from a broad differential diagnosis, and application of genetic testing can resolve difficult cases. There is a group of Gitelman syndrome heterozygous carriers that experience symptoms and electrolyte disturbance and these patients should be managed in a similar way, though here genetic investigations become key in securing a difficult diagnosis. Potassium and magnesium replacement is the cornerstone of treatment, though practically this can be hard for patients to manage and often does not fully relieve symptoms even when serum levels are normalized. Challenges arise due to the lack of randomized controlled trials focussing on treatment of this rare disease; hence, clinicians endorse strategies in line with correction of the underlying pathophysiology such as sodium loading or pharmacological treatments, which seem to help some patients. Focussed dietary advice and knowing the best tolerated preparations of potassium and magnesium medications are useful tools for the physician, as well as an awareness of the specific burdens that this patient group face in order to signpost appropriate support.
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Affiliation(s)
- Stephanie Urwin
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jamie Willows
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John A Sayer
- Renal Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
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10
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Wang X, Kim D, Tucker KL, Weisskopf MG, Sparrow D, Hu H, Park SK. Effect of Dietary Sodium and Potassium Intake on the Mobilization of Bone Lead among Middle-Aged and Older Men: The Veterans Affairs Normative Aging Study. Nutrients 2019; 11:nu11112750. [PMID: 31766133 PMCID: PMC6893449 DOI: 10.3390/nu11112750] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 01/25/2023] Open
Abstract
Bone is a major storage site as well as an endogenous source of lead in the human body. Dietary sodium and potassium intake may play a role in the mobilization of lead from bone to the circulation. We examined whether association between bone lead and urinary lead, a marker of mobilized lead in plasma, was modified by dietary intake of sodium and potassium among 318 men, aged 48–93 years, in the Veterans Affairs (VA) Normative Aging Study. Dietary sodium and potassium were assessed by flame photometry using 24-h urine samples, and a sodium-to-potassium ratio was calculated from the resulting measures. Patella and tibia bone lead concentrations were measured by K-shell-x-ray fluorescence. Urinary lead was measured by inductively coupled plasma mass spectroscopy in 24-h urine samples. Linear regression models were used to regress creatinine clearance-corrected urinary lead on bone lead, testing multiplicative interactions with tertiles of sodium, potassium, and sodium-to-potassium ratio, separately. After adjustment for age, body mass index, smoking, vitamin C intake, calcium, and total energy intake, participants in the highest tertile of sodium-to-potassium ratio showed 28.1% (95% CI: 12.5%, 45.9%) greater urinary lead per doubling increase in patella lead, whereas those in the second and lowest tertiles had 13.8% (95% CI: −1.7%, 31.7%) and 5.5% (95% CI: −8.0%, 21.0%) greater urinary lead, respectively (p-for-interaction = 0.04). No statistically significant effect modification by either sodium or potassium intake alone was observed. These findings suggest that relatively high intake of sodium relative to potassium may play an important role in the mobilization of lead from bone into the circulation.
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Affiliation(s)
- Xin Wang
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
| | - Douglas Kim
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
| | - Katherine L. Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, Lowell, MA 01854, USA;
| | - Marc G. Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - David Sparrow
- Normative Aging Study, Veterans Affairs Boston Healthcare System, and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Howard Hu
- School of Public Health, University of Washington, Seattle, WA 98195, USA;
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (X.W.); (D.K.)
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Correspondence: ; Tel.: +1-(734)-936-1719; Fax: +1-(734)-936-2084
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11
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Jiang SQ, Azzam MM, Yu H, Fan QL, Li L, Gou ZY, Lin XJ, Liu M, Jiang ZY. Sodium and chloride requirements of yellow-feathered chickens between 22 and 42 days of age. Animal 2019; 13:2183-2189. [PMID: 30940270 DOI: 10.1017/s1751731119000594] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Sodium and chloride are the key factors maintaining normal osmotic pressure (OSM) and volume of the extracellular fluid, and influencing the acid-base balance of body fluids. The experiment was conducted to investigate the effects of dietary Na+ and Cl- level on growth performance, excreta moisture, blood biochemical parameters, intestinal Na+-glucose transporter 1 (SGLT1) messenger RNA (mRNA), and Na+-H+ exchanger 2 (NHE2) mRNA, and to estimate the optimal dietary sodium and chlorine level for yellow-feathered chickens from 22 to 42days. A total of 900 22-day-old Lingnan yellow-feathered male chickens were randomly allotted to five treatments, each of which included six replicates of 30 chickens per floor pen. The basal control diet was based on corn and soybean meal (without added NaCl and NaHCO3). Treatments 2 to 5 consisted of the basal diet supplemented with equal weights of Na+ and Cl-, constituting 0.1%, 0.2%, 0.3% and 0.4% of the diets. Supplemental dietary Na+ and Cl- improved the growth performance (P<0.05). Average daily gain (ADG) showed a quadratic broken-line regression to increasing dietary Na+ and Cl- (R2=0.979, P<0.001), and reached a plateau at 0.1%. Supplemental Na+ and Cl- increased (P<0.05) serum Na+ and OSM in serum and showed a quadratic broken-line regression (R2=0.997, P=0.004) at 0.11%. However, supplemental Na+ and Cl- decreased (P<0.05) serum levels of K+, glucose (GLU) and triglyceride. Higher levels of Na+and Cl- decreased duodenal NHE2 transcripts (P<0.05), but had no effect on ileal SGLT1 transcripts. The activity of Na+ /K+-ATPase in the duodenum decreased (P<0.05) with higher levels of dietary Na+ and Cl-. In conclusion, the optimal dietary Na+ and Cl- requirements for yellow-feathered chickens in the grower phase, from 22 to 42 days of age, to optimize ADG, serum Na+, OSM, K+ and GLU were 0.10%, 0.11%, 0.11%,0.17% and 0.16%, respectively, by regression analysis.
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Affiliation(s)
- S Q Jiang
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
| | - M M Azzam
- Department of Animal Production College of Food & Agriculture Sciences, King Saud University, Riyadh, 11451, Saudi Arabia
- Poultry Production Department, Faculty of Agriculture, Mansoura University, Mansoura, 35516, Egypt
| | - H Yu
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
- College of Animal Science and Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, P.R.China
| | - Q L Fan
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
| | - L Li
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
| | - Z Y Gou
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
| | - X J Lin
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
| | - M Liu
- College of Animal Science and Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, P.R.China
| | - Z Y Jiang
- Institute of Animal Science, Guangdong Academy of Agricultural Sciences, State Key Laboratory of Livestock and Poultry Breeding, The Key Laboratory of Animal Nutrition and Feed Science in South China of Ministry of Agriculture, Guangdong Key Laboratory of Animal Breeding and Nutrition, Guangdong Public Laboratory of Animal Breeding and Nutrition, Guangzhou 510640, P.R. China
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12
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Van Regenmortel N, Hendrickx S, Roelant E, Baar I, Dams K, Van Vlimmeren K, Embrecht B, Wittock A, Hendriks JM, Lauwers P, Van Schil PE, Van Craenenbroeck AH, Verbrugghe W, Malbrain MLNG, Van den Wyngaert T, Jorens PG. 154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial. Intensive Care Med 2019; 45:1422-1432. [PMID: 31576437 PMCID: PMC6773673 DOI: 10.1007/s00134-019-05772-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 07/12/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the effects of the sodium content of maintenance fluid therapy on cumulative fluid balance and electrolyte disorders. METHODS We performed a randomized controlled trial of adults undergoing major thoracic surgery, randomly assigned (1:1) to receive maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of sodium from the start of surgery until their discharge from the ICU, the occurrence of a serious adverse event or the third postoperative day at the latest. Investigators, caregivers and patients were blinded to the treatment. Primary outcome was cumulative fluid balance. Electrolyte disturbances were assessed as secondary endpoints, different adverse events and physiological markers as safety and exploratory endpoints. FINDINGS We randomly assigned 70 patients; primary outcome data were available for 33 and 34 patients in the Na54 and Na154 treatment arms, respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95% CI 601-2137) more positive in the Na154 arm (p < 0.001), despite comparable non-study fluid sources. Hyponatremia < 135 mmol/L was encountered in four patients (11.8%) under Na54 compared to none under Na154 (p = 0.04), but there was no significantly more hyponatremia < 130 mmol/L (1 versus 0; p = 0.31). There was more hyperchloremia > 109 mmol/L under Na154 (24/35 patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p < 0.001). The treating clinicians discontinued the study due to clinical or radiographic fluid overload in six patients receiving Na154 compared to one patient under Na54 (excess risk 14.2%; 95% CI - 0.2-30.4%, p = 0.05). CONCLUSIONS In adult surgical patients, sodium-rich maintenance solutions were associated with a more positive cumulative fluid balance and hyperchloremia; hypotonic fluids were associated with mild and asymptomatic hyponatremia.
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Affiliation(s)
- Niels Van Regenmortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium.
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
| | - Steven Hendrickx
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- StatUa, Center for Statistics, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Ingrid Baar
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Karolien Dams
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Karen Van Vlimmeren
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Bart Embrecht
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Anouk Wittock
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Amaryllis H Van Craenenbroeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Department of Nephrology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Walter Verbrugghe
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, Jette, 1090, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
| | - Tim Van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Peng AW, Appel LJ, Mueller NT, Tang O, Miller ER, Juraschek SP. Effects of sodium intake on postural lightheadedness: Results from the DASH-sodium trial. J Clin Hypertens (Greenwich) 2019; 21:355-362. [PMID: 30690866 PMCID: PMC6420359 DOI: 10.1111/jch.13487] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 12/22/2022]
Abstract
Lightheadedness after standing contributes to adverse clinical events, including falls. Recommendations for higher sodium intake to treat postural lightheadedness have not been evaluated in a trial setting. The Dietary Approaches to Stop Hypertension (DASH)-Sodium trial (1998-1999) tested the effects of the DASH diet and sodium reduction on blood pressure (BP). Participants were randomly assigned to DASH or a typical Western diet (control). During either diet, participants ate three sodium levels (50, 100, 150 meq/d at 2100 kcal) in random order for 30-days, separated by 5-day breaks. Participants reported the presence and severity of postural lightheadedness at baseline and after each feeding period. There were 412 participants (mean age 48 years; 57% women; 57% black). Mean baseline SBP/DBP was 135/86 mm Hg; 9.5% reported baseline lightheadedness. Among those consuming the DASH diet, high vs low sodium increased lightheadedness (OR 1.71; 95% CI: 1.01, 2.90; P = 0.047) and severity of lightheadedness (P = 0.02), but did not affect lightheadedness in those consuming the control diet (OR 0.77; 95% CI: 0.46, 1.29; P = 0.32). Among those consuming high vs low sodium in the context of the DASH diet, adults <60 vs ≥60 years old experienced more lightheadedness (P-interaction = 0.04), along with obese vs non-obese adults (P-interaction = 0.01). In the context of the DASH diet, higher sodium intake was associated with more frequent and severe lightheadedness. These findings challenge traditional recommendations to increase sodium intake to prevent lightheadedness.
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Affiliation(s)
- Allison W. Peng
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Lawrence J. Appel
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Noel T. Mueller
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Olive Tang
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Edgar R. Miller
- The Johns Hopkins University School of MedicineThe Johns Hopkins Bloomberg School of Public Health, and The Welch Center for Prevention, Epidemiology and Clinical ResearchBaltimoreMaryland
| | - Stephen P. Juraschek
- Division of General Medicine and Primary CareBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonMassachusetts
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14
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Cui YN, Xia ZR, Ma Q, Wang WY, Chai WW, Wang SM. The synergistic effects of sodium and potassium on the xerophyte Apocynum venetum in response to drought stress. Plant Physiol Biochem 2019; 135:489-498. [PMID: 30447942 DOI: 10.1016/j.plaphy.2018.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/27/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Apocynum venetum is an eco-economic plant species with high adaptability to saline and arid environments. Our previous work has found that A. venetum could absorb large amount of Na+ and maintain high K+ level under saline conditions. To investigate whether K+ and Na+ could simultaneously enhance drought resistance in A. venetum, seedlings were exposed to osmotic stress (-0.2 MPa) in the presence or absence of additional 25 mM NaCl under low (0.01 mM) and normal (2.5 mM) K+ supplying conditions, respectively. The results showed that A. venetum should be considered as a typical K+-efficient species since its growth was unimpaired and possessed a strong K+ uptake and prominent K+ utilization efficiency under K+ deficiency condition. Leaf K+ concentration remained stable or was even significantly increased under osmotic stress in the presence or absence of NaCl, compared with that under control condition, regardless of whether the K+ supply was sufficient or not, and the contribution of K+ to leaf osmotic potential consistently exceeded 37%, indicating K+ is the uppermost contributor to osmotic adjustment of A. venetum. Under osmotic stress, the addition of 25 mM NaCl significantly increase Na+ accumulation in leaves and the contribution of Na+ to osmotic adjustment, thus improving the relative water content, concomitantly, promoting the photosynthetic activity resulting in an enhancement of overall plant growth. These findings suggested that, K+ and Na+ simultaneously play crucial roles in the osmotic adjustment and the maintenance of water status and photosynthetic activity, which is beneficial for A. venetum to cope with drought stress.
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Affiliation(s)
- Yan-Nong Cui
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China
| | - Zeng-Run Xia
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China; Ankang R&D Center of Se-enriched Products, Key Laboratory of Se-enriched Products Development and Quality Control, Ministry of Agriculture, Ankang, Shaanxi, 725000, PR China
| | - Qing Ma
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China
| | - Wen-Ying Wang
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China
| | - Wei-Wei Chai
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China
| | - Suo-Min Wang
- State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, PR China.
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Shawk DJ, Tokach MD, Goodband RD, Dritz SS, Woodworth JC, DeRouchey JM, Lerner AB, Wu F, Vier CM, Moniz MM, Nemechek KN. Effects of sodium and chloride source and concentration on nursery pig growth performance. J Anim Sci 2019; 97:745-755. [PMID: 30452648 PMCID: PMC6358269 DOI: 10.1093/jas/sky429] [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: 08/31/2018] [Accepted: 11/02/2018] [Indexed: 11/13/2022] Open
Abstract
Three studies were conducted to determine the effects of source and concentration of Na and Cl on pig growth performance from 7 to 12 kg. In all three experiments, pigs were fed a common diet (0.33% Na and 0.77% Cl) for 7 or 8 d after weaning then randomly assigned to dietary treatments. In Exp. 1, 360 mixed-sex pigs were used in a 14-d study with 15 replications per treatment and six pigs per pen. Treatments included a 10% dried whey diet with 0.60% added salt (0.37% Na and 0.75% Cl); or three diets with 7.2% crystalline lactose with either: 0.35% added salt (0.18% Na and 0.47% Cl); 0.78% added salt (0.35% Na and 0.72% Cl); or 1.15% NaHCO3 and 0.40% KCl (0.35% Na and 0.45% Cl). Pigs fed the 0.78% added salt-lactose diet had greater (P < 0.05) ADG than pigs fed the 0.35% added salt-lactose diet, with others intermediate. In Exp. 2, 360 barrows were used in a 14-d study with 12 replications per treatment and five pigs per pen. Treatments included two added salt diets (providing 0.13% Na and 0.35% Cl or 0.35% Na and 0.68% Cl), three diets with Na and Cl provided by KCl and NaHCO3 (0.13%, 0.35%, or 0.57% Na and 0.50% Cl), or a diet with NaHCO3 and CaCl2 (0.35% Na and 0.50% Cl). Regardless of Na source, ADG and ADFI increased (quadratic, P < 0.05) as dietary Na increased from 0.13% to 0.35%, with no further benefits observed thereafter. There was no evidence for differences among pigs fed NaCl or NaHCO3 nor evidence for differences among pigs fed the different Na and Cl sources at similar concentrations. In Exp. 3, 300 pigs were used in a 21-d trial with 10 replications per treatment and five pigs per pen. Treatments included a control diet with added salt to provide 0.33% Na and 0.55% Cl or five diets with 0.33 % Na and added KCl to provide 0.09, 0.21, 0.32, 0.45, or 0.55% Cl. ADG and G:F increased (quadratic, P < 0.035) as Cl increased from 0.09% to 0.32%. Pigs fed the control diet (added salt) and the 0.55% Cl diet had similar ADG. For ADG and ADFI, the broken line linear model indicated a breakpoint of 0.23% Cl. For G:F, the quadratic polynomial model suggested the maximum at 0.38% Cl. In conclusion, 7 to 12 kg pigs fed diets that contained at least 0.35% Na and 0.38% Cl had greater ADG and G:F compared to pigs fed diets with lower concentrations and minimal effects were observed among the sources of Na or Cl used in these studies.
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Affiliation(s)
- Dwight J Shawk
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Mike D Tokach
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Robert D Goodband
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Steve S Dritz
- Department of Diagnostic Medicine/Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan
| | - Jason C Woodworth
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Joel M DeRouchey
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Annie B Lerner
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Fangzhou Wu
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Carine M Vier
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Madison M Moniz
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
| | - Kayla N Nemechek
- Department of Animal Sciences and Industry, College of Agriculture, Kansas State University, Manhattan
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Abstract
BACKGROUND Cardiovascular (CV) disease is the leading cause of death in dialysis patients, and strongly associated with fluid overload and hypertension. It is plausible that low dialysate [Na+] may decrease total body sodium content, thereby reducing fluid overload and hypertension, and ultimately reducing CV morbidity and mortality. OBJECTIVES This review evaluated harms and benefits of using a low (< 138 mM) dialysate [Na+] for maintenance haemodialysis (HD) patients. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 7 August 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs), both parallel and cross-over, of low (< 138 mM) versus neutral (138 to 140 mM) or high (> 140 mM) dialysate [Na+] for maintenance HD patients were included. DATA COLLECTION AND ANALYSIS Two investigators independently screened studies for inclusion and extracted data. Statistical analyses were performed using random effects models, and results expressed as risk ratios (RR) for dichotomous outcomes, and mean differences (MD) or standardised MD (SMD) for continuous outcomes, with 95% confidence intervals (CI). Confidence in the evidence was assessed using GRADE. MAIN RESULTS We included 12 studies randomising 310 patients, with data available for 266 patients after dropout. All but one study evaluated a fixed concentration of low dialysate [Na+], and one profiled dialysate [Na+]. Three studies were parallel group, and the remaining nine cross-over. Of the latter, only two used a washout between intervention and control periods. Most studies were short-term with a median (interquartile range) follow-up of 3 (3, 8.5) weeks. Two were of a single HD session, and two of a single week's HD. Half of the studies were conducted prior to 2000, and five reported use of obsolete HD practices. Risks of bias in the included studies were often high or unclear, lowering confidence in the results.Compared to neutral or high dialysate [Na+], low dialysate [Na+] had the following effects on "efficacy" endpoints: reduced interdialytic weight gain (10 studies: MD -0.35 kg, 95% CI -0.18 to -0.51; high certainty evidence); probably reduced predialysis mean arterial blood pressure (BP) (4 studies: MD -3.58 mmHg, 95% CI -5.46 to -1.69; moderate certainty evidence); probably reduced postdialysis mean arterial BP (MAP) (4 studies: MD -3.26 mmHg, 95% CI -1.70 to -4.82; moderate certainty evidence); probably reduced predialysis serum [Na+] (7 studies: MD -1.69 mM, 95% CI -2.36 to -1.02; moderate certainty evidence); may have reduced antihypertensive medication (2 studies: SMD -0.67 SD, 95% CI -1.07 to -0.28; low certainty evidence). Compared to neutral or high dialysate [Na+], low dialysate [Na+] had the following effects on "safety" endpoints: probably increased intradialytic hypotension events (9 studies: RR 1.56, 95% 1.17 to 2.07; moderate certainty evidence); probably increased intradialytic cramps (6 studies: RR 1.77, 95% 1.15 to 2.73; moderate certainty evidence).Compared to neutral or high dialysate [Na+], low dialysate [Na+] may make little or no difference to: intradialytic BP (2 studies: MD for systolic BP -3.99 mmHg, 95% CI -17.96 to 9.99; diastolic BP 1.33 mmHg, 95% CI -6.29 to 8.95; low certainty evidence); interdialytic BP (2 studies:, MD for systolic BP 0.17 mmHg, 95% CI -5.42 to 5.08; diastolic BP -2.00 mmHg, 95% CI -4.84 to 0.84; low certainty evidence); dietary salt intake (2 studies: MD -0.21g/d, 95% CI -0.48 to 0.06; low certainty evidence).Due to very low quality of evidence, it is uncertain whether low dialysate [Na+] changed extracellular fluid status, venous tone, arterial vascular resistance, left ventricular mass or volumes, thirst or fatigue. Studies did not examine cardiovascular or all-cause mortality, cardiovascular events, or hospitalisation. AUTHORS' CONCLUSIONS It is likely that low dialysate [Na+] reduces intradialytic weight gain and BP, which are effects directionally associated with improved outcomes. However, the intervention probably also increases intradialytic hypotension and reduces serum [Na+], effects that are associated with increased mortality risk. The effect of the intervention on overall patient health and well-being is unknown. Further evidence is needed in the form of longer-term studies in contemporary settings, evaluating end-organ effects in small-scale mechanistic studies using optimal methods, and clinical outcomes in large-scale multicentre RCTs.
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Affiliation(s)
- Joanna L Dunlop
- Counties Manukau HealthDepartment of MedicineOrakau RdAucklandNew Zealand
| | - Alain C Vandal
- Auckland University of TechnologyDepartment of BiostatisticsPrivate Bag 92006AucklandAucklandNew Zealand1142
- Counties Manukau HealthKo AwateaAucklandNew Zealand
| | - Mark R Marshall
- Counties Manukau HealthDepartment of MedicineOrakau RdAucklandNew Zealand
- University of AucklandSchool of Medicine, Faculty of Medical and Health SciencesAucklandNew Zealand
- Baxter Healthcare (Asia) Pty LtdMedical AffairsSingaporeSingapore
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17
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Audureau E, Guellich A, Guéry E, Canouï-Poitrine F, Benedyga V, Duchossoir H, Taieb C, Damy T. Development and Validation of a New Tool to Assess Burden of Dietary Sodium Restriction in Patients with Chronic Heart Failure: The BIRD Questionnaire. Nutrients 2018; 10:nu10101453. [PMID: 30301251 PMCID: PMC6213449 DOI: 10.3390/nu10101453] [Citation(s) in RCA: 2] [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: 08/31/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Burden scales are useful in estimating the impact of interventions from patients' perspectives. This is overlooked in sodium diet/heart failure (HF). The aim of this study is to develop and validate a specific tool to assess the burden associated with low-sodium diets in HF: the Burden scale In Restricted Diets (BIRD). (2) Methods: Based on the literature and reports from patients, 14 candidate items were identified for the following dietary-related domains: organization, pleasure, leisure, social life, vitality, and self-rated health. The validation study was conducted prospectively. The questionnaire was refined via item reduction according to inter-item correlations and exploratory factor analysis. Internal consistency was determined using Cronbach's alpha (Cα) and convergent validity by assessing correlations between BIRD and the health-related quality of life (HRQoL) Minnesota Living with HF questionnaire (MLHF). (3) Results: Of the 152 invited patients, 96 (63%) returned the questionnaire. The median score was 6.5 (IQR 2.0⁻14.0). The results showed good acceptability (non-response rates/item from 2.0% to 12.1%), an excellent internal consistency (Cα = 0.903) and a good convergent validity (rhos = 0.37 (physical), 0.4 (mental), and 0.45 (global); all p < 0.05). (4) Conclusions: BIRD demonstrates good psychometric properties and is useful to quantify the burden associated with sodium restriction. It may help optimize dietary interventions and improve the overall management of patients with HF.
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Affiliation(s)
- Etienne Audureau
- Public Health Department, CEpiA (EA4393), 94000 Créteil, France.
| | - Aziz Guellich
- Heart Failure Unit, Department of Cardiology, INSERM U955, ARI, DHU ATVB, AP-HP Henri Mondor Hospital, University Paris Est Créteil (UPEC), 94000 Créteil, France.
| | - Esther Guéry
- Public Health Department, CEpiA (EA4393), 94000 Créteil, France.
| | | | - Véronique Benedyga
- Dietetic Unit, AP-HP Henri Mondor Hospital, University Paris Est Créteil (UPEC), 94000 Créteil, France.
| | - Hélène Duchossoir
- Dietetic Unit, AP-HP Henri Mondor Hospital, University Paris Est Créteil (UPEC), 94000 Créteil, France.
| | - Charles Taieb
- EMMA, European Market Maintenance Assessment, 94080 Vincennes, France.
| | - Thibaud Damy
- Heart Failure Unit, Department of Cardiology, INSERM U955, ARI, DHU ATVB, AP-HP Henri Mondor Hospital, University Paris Est Créteil (UPEC), 94000 Créteil, France.
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Abstract
BACKGROUND AND OBJECTIVES To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 - 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey. METHODS AND STUDY DESIGN Individual level, consecutive 3 - day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces representing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size. RESULTS From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p<0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p<0.05). Sodium-potassium ratios decreased overall and across both sexes (p<0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p<0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p<0.01). CONCLUSIONS This suggests Chinese adolescents are transitioning to a low carbohydrate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodiumpotassium ratios are primarily due to decreased sodium intake and require further reduction efforts.
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Affiliation(s)
- Alice Yunzi L Yu
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Nancy López-Olmedo
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, USA.
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19
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Lassen AD, Trolle E, Bysted A, Knuthsen P, Andersen EW. The Salt Content of Lunch Meals Eaten at Danish Worksites. Nutrients 2018; 10:nu10101367. [PMID: 30249979 PMCID: PMC6213428 DOI: 10.3390/nu10101367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Monitoring levels of sodium (salt) in meals consumed out-of-home is needed to support effective implementation of salt-reduction strategies. The objective of the study was to examine lunch salt intake at 15 worksite canteens and to compare with results from a comparable study conducted 10 years before. A duplicate-portion-technique with subsequent chemical analysis was used to quantify 240 customers’ lunch salt intake. Estimated mean salt intake was 2.6 g/meal (95% Cl: 2.2 to 3.0 g/meal) and 0.78 g/100 g (95% Cl: 0.69 to 0.88 g/100 g). Salt intake measured both as g per meal and per 100 g was found to be significantly higher for male compared with female participants (+0.10 g/100 g, 95% Cl: +0.02 to +0.17 g/100 g, p = 0.011). Compared with the study conducted 10 years before, there was a significantly lower estimated salt intake of 0.5 g/meal (95% CI: −0.8 to −0.2 g/meal, p = 0.001), suggesting a possible reduction in canteen lunch salt intake during a 10-year period. Still, 40% of the meals exceeded the Nordic Keyhole label requirements of maximum 0.8 g salt per 100 g for ready meals. A further reduction of salt intake is warranted to comply with salt reduction targets.
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Affiliation(s)
- Anne D Lassen
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Ellen Trolle
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Anette Bysted
- Research Group for Bioactives ⁻ Analysis and Application, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Pia Knuthsen
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Elisabeth W Andersen
- Danish Cancer Society Research Center, Statistics and Pharmacoepidemiology, DK-2100 Copenhagen, Denmark.
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20
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Abstract
Two groups of patients suffering from advanced neoplastic disease were fed parenterally for a period ranging from 1 to 16 weeks. The parameters considered were: weight change, serum albumin level, lymphocyte transformation test and serum immunoglobulin level. There were 23 patients in one group and 21 patients in the other. Regimens included for group I: saline solution (1000–1500 ml), glucose (100–150 g) and amino acids (15–30 g) per day; for group 2: 40–50 Cal/kg per day (dextrose about 15 g/kg per day), about 2 g of amino acids/kg/day and about 40–50 ml water/kg/day. In addition, 13 patients underwent both treatments sequentially. All the Group I patients lost weight (1.3 kg/week); while out of 23 patients in Group 2, 15 gained weight, 2 remained unchanged and 6 continued to lose weight, but to a lesser rate than before hyperalimentation (the average weight gain was 1.1 kg/week). Serum albumin levels decreased in 19 out of 25 patients in Group I and increased in 14 out of 26 patients of Group 2. Initial values of the lymphocyte blast transformation test were very low in both groups of patients, and an increase was observed only in patients treated by hyperalimentation. The increase was more evident in patients who were not under antiblastic treatment. Changes in serum immunoglobulin levels were not significant. The authors conclude that malnutrition plays a very important role in neoplastic cachexia and can be improved by parenteral hyperalimentation. Although it is possible that in the near future hyperalimentation and conventional neoplastic therapies will play complementary roles in treatment of advanced neoplastic disease, malnutrition is still the specific indication for intravenous hyperalimentation.
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21
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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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Imaizumi T, Nakatochi M, Fujita Y, Nomura R, Watanabe K, Maekawa M, Yamakawa T, Katsuno T, Maruyama S. The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan. BMJ Open 2017; 7:e016248. [PMID: 28821524 PMCID: PMC5629676 DOI: 10.1136/bmjopen-2017-016248] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Hypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases. DESIGN A retrospective cohort study. SETTING The incidence of ICU-acquired hypernatraemia was assessed retrospectively in a single tertiary care facility in Japan. PARTICIPANTS Adult patients (≥18 years old) whose length of stay in ICU was >2 days and those whose serum sodium concentrations were 130-149 mEq/L on admission to ICU were included. OUTCOME MEASURES 28-day in-hospital mortality risk was assessed by Cox regression analysis. Hypernatraemia was defined as serum sodium concentration ≥150 mEq/L. Using multivariate analysis, we examined whether ICU-acquired hypernatraemia and the main symptom present at ICU admission were associated with time to death among ICU patients. We also evaluated how the maximum and minimum sodium concentrations during ICU stay were associated with mortality, using restricted cubic splines. RESULTS Of 1756 patients, 121 developed ICU-acquired hypernatraemia. Multivariate Cox proportional hazard analysis revealed an association between ICU-acquired hypernatraemia and 28-day mortality (adjusted HR, 3.07 (95% CI 2.12 to 4.44)). The interaction between ICU-acquired hypernatraemia and cerebrovascular disease was significantly associated with 28-day mortality (HR, 3.03 (95% CI 1.29 to 7.15)). The restricted cubic splines analysis of maximum serum sodium concentration in ICU patients determined a threshold maximum of 147 mEq/L. There was no significant association between minimum sodium concentration and mortality. CONCLUSIONS ICU-acquired hypernatraemia was associated with an increased mortality rate among critically ill patients with cerebrovascular diseases; the threshold maximum serum sodium concentration associated with mortality was 147 mEq/L.
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Affiliation(s)
- Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Nakatochi
- Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yoshiro Fujita
- Department of Nephrology and Rheumatology, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Rie Nomura
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Kenshi Watanabe
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Michitaka Maekawa
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Taishi Yamakawa
- Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Takayuki Katsuno
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Polhuis KCMM, Wijnen AHC, Sierksma A, Calame W, Tieland M. The Diuretic Action of Weak and Strong Alcoholic Beverages in Elderly Men: A Randomized Diet-Controlled Crossover Trial. Nutrients 2017; 9:nu9070660. [PMID: 28657601 PMCID: PMC5537780 DOI: 10.3390/nu9070660] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 05/10/2017] [Revised: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 11/16/2022] Open
Abstract
With ageing, there is a greater risk of dehydration. This study investigated the diuretic effect of alcoholic beverages varying in alcohol concentration in elderly men. Three alcoholic beverages (beer (AB), wine (AW), and spirits (S)) and their non-alcoholic counterparts (non-alcoholic beer (NAB), non-alcoholic wine (NAW), and water (W)) were tested in a diet-controlled randomized crossover trial. For the alcoholic beverages, alcohol intake equaled a moderate amount of 30 g. An equal volume of beverage was given for the non-alcoholic counterpart. After consumption, the urine output was collected every hour for 4 h and the total 24 h urine output was measured. AW and S resulted in a higher cumulative urine output compared to NAW and W during the first 4 h (effect size: 0.25 mL p < 0.003, effect size: 0.18 mL, p < 0.001, respectively), but not after the 24h urine collection (p > 0.40, p > 0.10). AB and NAB did not differ at any time point (effect size: -0.02 mL p > 0.70). For urine osmolality, and the sodium and potassium concentration, the findings were in line. In conclusion, only moderate amounts of stronger alcoholic beverages, such as wine and spirits, resulted in a short and small diuretic effect in elderly men.
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Affiliation(s)
- Kristel C M M Polhuis
- The Dutch Beer Institute, Wageningen 6701, The Netherlands.
- Division of Health and Society, Wageningen University, Wageningen 6706, The Netherlands.
| | | | - Aafje Sierksma
- The Dutch Beer Institute, Wageningen 6701, The Netherlands.
| | - Wim Calame
- StatistiCal B.V., 2241 MN Wassenaar, The Netherlands.
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of applied sciences, Amsterdam 1097, The Netherlands.
- Division of Human Nutrition, Wageningen University, Wageningen 6700, The Netherlands.
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Abstract
Dialysate composition is a critical aspect of the hemodialysis prescription. Despite this, trial data are almost entirely lacking to help guide the optimal dialysate composition. Often, the concentrations of key components are chosen intuitively, and dialysate composition may be determined by default based on dialysate manufacturer specifications or hemodialysis facility practices. In this review, we examine the current epidemiological evidence guiding selection of dialysate bicarbonate, calcium, magnesium, and potassium, and identify unresolved issues for which pragmatic clinical trials are needed.
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Affiliation(s)
- Rita L McGill
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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25
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Al-Saber F, Aldosari W, Alselaiti M, Khalfan H, Kaladari A, Khan G, Harb G, Rehani R, Kudo S, Koda A, Tanaka T, Nakajima M, Darwish A. The Safety and Tolerability of 5-Aminolevulinic Acid Phosphate with Sodium Ferrous Citrate in Patients with Type 2 Diabetes Mellitus in Bahrain. J Diabetes Res 2016; 2016:8294805. [PMID: 27738640 PMCID: PMC5055962 DOI: 10.1155/2016/8294805] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/23/2016] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes mellitus is prevalent especially in Gulf countries and poses serious long-term risks to patients. A multifaceted treatment approach can include nutritional supplements with antioxidant properties such as 5-aminolevulinic acid (5-ALA) with sodium ferrous citrate (SFC). This prospective, randomized, single-blind, placebo-controlled, dose escalating pilot clinical trial assessed the safety of 5-ALA with SFC at doses up to 200 mg 5-ALA/229.42 mg SFC per day in patients living in Bahrain with type 2 diabetes mellitus that was uncontrolled despite the use of one or more antidiabetic drugs. Fifty-three patients (n = 53) from 3 sites at one center were enrolled by Dr. Feryal (Site #01), Dr. Hesham (Site #02), and Dr. Waleed (Site #03) (n = 35, 5-ALA-SFC; n = 18, placebo). There was no significant difference in incidence of adverse events reported, and the most frequent events reported were gastrointestinal in nature, consistent with the known safety profile of 5-ALA in patients with diabetes. No significant changes in laboratory values and no difference in hypoglycemia between patients receiving 5-ALA and placebo were noted. Overall, the current results support that use of 5-ALA-SFC up to 200 mg per day taken as 2 divided doses is safe in patients taking concomitant oral antidiabetic medications and may offer benefits in the diabetic population. This trial is registered with ClinicalTrials.gov NCT02481141.
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Affiliation(s)
- Feryal Al-Saber
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
| | - Waleed Aldosari
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
| | - Mariam Alselaiti
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
| | - Hesham Khalfan
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
| | - Ahmed Kaladari
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
| | - Ghulam Khan
- SBI Pharmaceuticals Middle East and North Africa, Seef, Bahrain
| | | | - Riyadh Rehani
- SBI Pharmaceuticals Middle East and North Africa, Seef, Bahrain
| | | | - Aya Koda
- SBI Pharmaceuticals, Tokyo, Japan
| | | | | | - Abdulla Darwish
- Bahrain Defense Force Hospital/Royal Medical Services, Riffa, Bahrain
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Zisimopoulou S, Pechère-Bertschi A, Burnier M. [Potassium and blood pressure, an old story, revisited]. Rev Med Suisse 2016; 12:1502-1506. [PMID: 28677923] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Food in industrialized countries is rich in processed products with a high sodium and low potassium content. There is abundant evidence in the literature depicting the relationship between a high daily sodium/potassium intake ratio and the high prevalence of arterial hypertension in modern societies. There is also increasing evidence suggesting a blood pressure lowering effect of potassium, especially in cases of high sodium intake or in patients with increased salt sensibility. Our dietary advice for the prevention and treatment of hypertension should follow a thorough evaluation of our patients' daily nutritional habits and should not only focus on sodium intake but also aim for a balanced sodium/potassium uptake.
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Affiliation(s)
- Sofia Zisimopoulou
- Service de médecine de premier recours, Département de médecine communautaire, de premier recours et des urgences, HUG, 1211 Genève 14
| | - Antoinette Pechère-Bertschi
- Unité d'hypertension, Département des Spécialités de médecine, HUG, 1211 Genève 14
- Département de médecine communautaire, de premier recours et des urgences, HUG, 1211 Genève 14
| | - Michel Burnier
- Service de néphrologie, Département de médecine, CHUV, 1011 Lausanne
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Głąbska D, Włodarek D, Kołota A, Czekajło A, Drozdzowska B, Pluskiewicz W. Assessment of mineral intake in the diets of Polish postmenopausal women in relation to their BMI-the RAC-OST-POL study : Mineral intake in relation to BMI. J Health Popul Nutr 2016; 35:23. [PMID: 27484324 PMCID: PMC5025999 DOI: 10.1186/s41043-016-0061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/25/2016] [Indexed: 05/08/2023]
Abstract
BACKGROUND The diets of postmenopausal women in Western countries tend to be deficient in minerals, even if the energy value is at the recommended level. The objective of the presented population-based cohort study was to assess the intake of minerals (sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper) in the diets of women aged above 55 years and to analyse the relations between BMI and mineral intake in this group. METHODS The study was conducted in a group of 406 women who were randomly recruited from the general population of those aged above 55 years. The main outcome measures included BMI, reported sodium, potassium, calcium, phosphorus, magnesium, iron, zinc and copper intake assessed by dietary record (conducted during two typical, non-consecutive days). The distribution was verified with the use of the Shapiro-Wilk test. The comparison between groups was conducted using ANOVA with the LSD post hoc test or Kruskal-Wallis ANOVA with multiple comparisons. A comparison of satisfying nutritional needs was conducted using the chi-square test. RESULTS Normal body weight individuals were characterised by lower sodium intake per 1000 kcal of diet than obese class II and III individuals (BMI ≥ 35.0 kg/m(2)). Overweight individuals were characterised by lower potassium and magnesium intake per 1000 kcal of diet than obese class I individuals (BMIϵ < 30.0; 35.0 kg/m(2)). The majority of individuals was characterised by insufficient potassium, calcium and magnesium intake. No differences in satisfying nutritional needs between BMI groups were observed for all minerals. CONCLUSIONS Following an improperly balanced diet was observed in the group of postmenopausal female individuals analysed. It was stated that the daily intake of all the assessed minerals was not BMI-dependent for the postmenopausal female individuals, but the nutrient density of diet (for sodium, potassium and magnesium) was associated with BMI.
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Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | - Dariusz Włodarek
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | - Aleksandra Kołota
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences-SGGW, 159c Nowoursynowska Street, 02-776 Warsaw, Poland
| | | | - Bogna Drozdzowska
- Department of Pathomorphology, Medical University of Silesia, Katowice, Poland
| | - Wojciech Pluskiewicz
- Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
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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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Affiliation(s)
| | | | - Xiaowei Li
- Key Laboratory for Food Safety Risk Assessment, China National Centre for Food Safety Risk Assessment, Beijing, China
| | - Yongning Wu
- Key Laboratory for Food Safety Risk Assessment, China National Centre for Food Safety Risk Assessment, Beijing, China
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Ben-Shalom E, Toker O, Schwartz S. Hypernatremic Dehydration in Young Children: Is There a Solution? Isr Med Assoc J 2016; 18:95-99. [PMID: 26979001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Hypernatremic dehydration is a common and potentially life-threatening condition in children. There is currently no consensus as to the optimal strategy for fluid management. OBJECTIVES To describe the relationship between the type, route and rate of fluids administered and the rate of decline in serum sodium (Na+) concentration. METHODS We reviewed the medical records of all children under the age of 2 years who were hospitalized with hypernatremic dehydration (serum Na+ ≥ 155 mEq/L) in Shaare Zedek Medical Center during the period 2001-2010. Collected data of 62 subjects included initial and subsequent serum Na+ levels, and rate and Na+ concentration of all intravenous and oral fluids administered until the serum Na+ reached ≤ 150 mEq/L. RESULTS Median initial serum Na+ was 159.5 mEq/L (IQR 157-163, maximal value 170). The median rate of decline in serum Na+ until serum Na+ reached 150 mEq/L was 0.65 mEq/L/hr (IQR 0.45-0.95). Forty-two children received hypotonic oral fluids which accounted for approximately one-quarter of all fluids they received. There was no significant difference in the rate of decline in serum Na+ between those who consumed oral fluids and those who did not. Neither was there a correlation between the rate of IV fluids, receipt of oral fluids or the degree of dehydration, with the rate of decline in serum Na+. No child experienced an apparent short-term adverse outcome. CONCLUSIONS A cumulative rate of 5.9 mI/kg/hr of IV fluid administration may reduce the serum Na+ by an acceptable rate (0.65 mEq/L/hr). Fluid therapy comprising up to 25% hypotonic oral fluids and 75% IV fluids high in Na+ concentration was not associated with any short-term adverse outcome in our patient population.
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Abstract
CONTEXT The plasma aldosterone concentration (PAC) is less than 5 ng/dL after saline infusion test (SIT) in essential hypertension (EH) and healthy people. It is unclear if the same standard is applicable for Chinese subjects. OBJECTIVE AND DESIGN We assessed the serum aldosterone response after SIT in subjects with primary aldosteronism (PA), EH, and healthy volunteers (normal control, NC), and to investigate the optimal aldosterone level of post-SIT for the diagnosis of PA. SUBJECTS AND SETTING The study included 120 hypertensive patients who conform to the PA screening criteria and 21 healthy volunteers. INTERVENTION All subjects underwent SIT. MAIN OUTCOME MEASURES PAC was measured in all subjects before and after SIT. The total sodium intake was estimated from 2 timed 24-hour urinary excretion. RESULTS The area under the receiver-operator characteristic curves was higher than under the diagonal (0.967, 95% confidence interval [CI]: 0.94-0.993). The best cutoff value for PAC after SIT for diagnosis of PA was 11.45 ng/dL, with sensitivity and specificity of 88.2% and 95.4%, respectively. The PAC of post-SIT was more than 10 ng/dL in most PA patients, whereas it was greater than 5 ng/dL in both EH and NC except for 1 at 4.93 ng/dL. Serum aldosterone level was unrelated to dietary salt intake. CONCLUSIONS The optimal post-SIT aldosterone cutoff value for identifying PA was 11.45 ng/dL in Chinese patients. However, the PAC higher than 5 ng/dL after SIT was found in a majority of EH and healthy subjects. The cutoff value of aldosterone post-SIT is higher than the current clinical recommendations and practice guidelines of The Endocrine Society. We found no relationship between high salt intake and lower responses of renin aldosterone system to high loading with saline infusion.
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Affiliation(s)
- Yanyan Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yuping Liu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jianwei Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaohao Wang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yerong Yu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Saraví FD, González Otárula KA, Carra GE, Ibáñez JE. Aldosterone increases oxygen consumption of rectal epithelia of normal, sodium-deprived and sodiumloaded rats. Acta Gastroenterol Latinoam 2015; 45:203-211. [PMID: 28590603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The colonic epithelium is a classical aldosterone target, but the effect of the hormone on the oxygen consumption rate (QO2 ) of this tissue is unknown. Objectives. We aimed at assessing, in the rectal epithelium of rats fed with diets of different sodium content, the effect of epithelial sodium channel (ENaC) blockade on short-circuit current (ISC ) and QO2 , and the acute effect of aldosterone incubation on ISC and QO2 . METHODS Adult male rats were fed with normal, low or high-sodium diets for 8 days. Plasma sodium and serum aldosterone were measured. Isolated mucosa preparations from the rectal portion of the colon were mounted in Ussing chambers modified to measure ISC and QO2. RESULTS Baseline ISC and QO2 were highest in sodium-deprived rats. Both were proportionally reduced by amiloride (0.1 mM) in this group and in the normal sodium group, but not in sodium-loaded rats. In separate experiments, incubation with aldosterone (10 nM) for 7 h increased ISC and QO2 in all groups; increases were larger in the normal and sodium-loaded groups. Amiloride decreased both ISC and QO2 , abolishing the differences between groups. Linear regression of the decrease in QO2 and ISC after amiloride showed the steepest slope for the sodium-deprived group and the flattest one for the sodium-loaded group. CONCLUSIONS Baseline epithelial QO2 of sodium-deprived and control rats is reduced by ENaC blockade. Aldosterone increased QO2 proportionally to ISC augmentation in all groups, but the coupling between aerobic metabolism and electrogenic transport seems more efficient in sodium-deprived animals.
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Maisel K, Chattopadhyay S, Moench T, Hendrix C, Cone R, Ensign LM, Hanes J. Enema ion compositions for enhancing colorectal drug delivery. J Control Release 2015; 209:280-7. [PMID: 25937321 PMCID: PMC4458383 DOI: 10.1016/j.jconrel.2015.04.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 03/04/2015] [Revised: 04/12/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
Delivering drugs to the colorectum by enema has advantages for treating or preventing both local and systemic diseases. However, the properties of the enema itself are not typically exploited for improving drug delivery. Sodium ions are actively pumped out of the lumen of the colon, which is followed by osmotically-driven water absorption, so we hypothesized that this natural mechanism could be exploited to drive nanoparticles and drugs to the colorectal tissue surface. Here, we report that sodium-based, absorption-inducing (hypotonic) enemas rapidly transport hydrophilic drugs and non-mucoadhesive, mucus penetrating nanoparticles (MPP), deep into the colorectal folds to reach virtually the entire colorectal epithelial surface. In contrast, isotonic and secretion-inducing (hypertonic) vehicles led to non-uniform, poor surface coverage. Sodium-based enemas induced rapid fluid absorption even when moderately hyper-osmolal (~350 mOsm) compared to blood (~300 mOsm), which suggests that active sodium absorption plays a key role in osmosis-driven fluid uptake. We then used tenofovir, an antiretroviral drug in clinical trials for preventing HIV, to test the effects of enema composition on local and systemic drug delivery. We found that strongly hypotonic and hypertonic enemas caused rapid systemic drug uptake, whereas moderately hypotonic enemas with ion compositions similar to feces resulted in high local tissue levels with minimal systemic drug exposure. Similarly, moderately hypotonic enemas provided improved local drug retention in colorectal tissue, whereas hypertonic and isotonic enemas provided markedly reduced drug retention in colorectal tissue. Lastly, we found that moderately hypotonic enema formulations caused little to no detectable epithelial damage, while hypertonic solutions caused significant damage, including epithelial sloughing; the epithelial damage caused increased systemic drug absorption and penetration of MPP into colorectal tissue, a potential advantage in certain drug delivery applications. In summary, we illustrate that enema composition can be adjusted to maximize local versus systemic drug delivery, and that mildly hypotonic, sodium-based vehicles can provide uniform drug and MPP delivery in the colon that maximizes local drug concentrations.
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Affiliation(s)
- Katharina Maisel
- Center for Nanomedicine, Johns Hopkins University School of Medicine, 400N. Broadway, Baltimore, MD 21231 USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205 USA
| | - Sumon Chattopadhyay
- Center for Nanomedicine, Johns Hopkins University School of Medicine, 400N. Broadway, Baltimore, MD 21231 USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - Thomas Moench
- Department of Biophysics, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA; ReProtect, Inc, 703 Stags Head Road, Baltimore, MD 21286 USA
| | - Craig Hendrix
- Department of Clinical Pharmacology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Richard Cone
- Center for Nanomedicine, Johns Hopkins University School of Medicine, 400N. Broadway, Baltimore, MD 21231 USA; Department of Biophysics, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA
| | - Laura M Ensign
- Center for Nanomedicine, Johns Hopkins University School of Medicine, 400N. Broadway, Baltimore, MD 21231 USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA; Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 N. Broadway, Baltimore, MD 21231, USA; Center for Cancer Nanotechnology Excellence, the Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA.
| | - Justin Hanes
- Center for Nanomedicine, Johns Hopkins University School of Medicine, 400N. Broadway, Baltimore, MD 21231 USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205 USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 USA; Department of Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 N. Broadway, Baltimore, MD 21231, USA; Center for Cancer Nanotechnology Excellence, the Institute for NanoBioTechnology, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218, USA; Departments of Neurosurgery, Oncology, and Pharmacology & Molecular Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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Chen G, de las Fuentes L, Gu CC, He J, Gu D, Kelly T, Hixson J, Jacquish C, Rao DC, Rice TK. Aggregate blood pressure responses to serial dietary sodium and potassium intervention: defining responses using independent component analysis. BMC Genet 2015; 16:64. [PMID: 26088064 PMCID: PMC4474450 DOI: 10.1186/s12863-015-0226-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 06/10/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hypertension is a complex trait that often co-occurs with other conditions such as obesity and is affected by genetic and environmental factors. Aggregate indices such as principal components among these variables and their responses to environmental interventions may represent novel information that is potentially useful for genetic studies. RESULTS In this study of families participating in the Genetic Epidemiology Network of Salt Sensitivity (GenSalt) Study, blood pressure (BP) responses to dietary sodium interventions are explored. Independent component analysis (ICA) was applied to 20 variables indexing obesity and BP measured at baseline and during low sodium, high sodium and high sodium plus potassium dietary intervention periods. A "heat map" protocol that classifies subjects based on risk for hypertension is used to interpret the extracted components. ICA and heat map suggest four components best describe the data: (1) systolic hypertension, (2) general hypertension, (3) response to sodium intervention and (4) obesity. The largest heritabilities are for the systolic (64%) and general hypertension (56%) components. There is a pattern of higher heritability for the component response to intervention (40-42%) as compared to those for the traditional intervention responses computed as delta scores (24%-40%). CONCLUSIONS In summary, the present study provides intermediate phenotypes that are heritable. Using these derived components may prove useful in gene discovery applications.
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Affiliation(s)
- Gengsheng Chen
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | | | - Chi C Gu
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Jiang He
- Tulane University Health Sciences Center, New Orleans, LA, USA.
| | - Dongfeng Gu
- Chinese Academy of Medical Sciences, Beijing, China.
| | - Tanika Kelly
- Tulane University Health Sciences Center, New Orleans, LA, USA.
| | - James Hixson
- University of Texas Health Sciences Center at Houston, Houston, TX, USA.
| | | | - D C Rao
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Treva K Rice
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Liebau H, Eisenbach GM, Mariss P, Hilfenhaus M. Role of sodium and water in hypertensive patients on maintenance hemodialysis. Contrib Nephrol 2015; 8:126-34. [PMID: 891207 DOI: 10.1159/000400622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In 46 patients of the chronic hemodialysis program blood pressure regulation was studied according to variations of sodium and fluid balance. A strong relationship was observed between blood pressure and the amount of exchangeable sodium. In the hypertensive patients exchangeable sodium was increased depite fulfilled clinical signs of sufficient dehydration. The blood volume was found to be small and the plasma renin activity increased in those hypertensive patients, in which sufficient fluid depletion was inhibited by extreme fluctuations of the blood pressure during dialysis. A diminution of the sodium concentration keeping the fluid balance constant induced an increase of blood pressure and deteriorated the subjective feeling of the patients. By an increase of the sodium concentration up to 155 mEq/l severe blood pressure fluctuations during during dialysis could be prevented, although further fluid was taken off by ultrafiltration. This effect seemed to be mediated--at least partly--by an increase of the low blood volume and a suppression of plasma renin activity. After the patients became normotensive, dialysis procedure could be continued with normal sodium concentration. By a temporary high sodium regimen of the dialysis procedure some patients with renal failure and 'uncontrollable hypertension' can be preserved from bilateral nephrectomy.
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Boeckner LS, Young TD, Pullen CH, Dizona P, Hageman PA. Dietary mineral intakes of rural midlife to older adult women with prehypertension in Midwestern United States. J Nutr Health Aging 2015; 19:13-9. [PMID: 25560811 DOI: 10.1007/s12603-014-0482-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Midlife to older rural women with prehypertension are at increased risk for hypertension and its impact on cardiovascular health with advancing age. Because modification of dietary factors could help alleviate risk, the objective of this study was to explore calcium, magnesium, potassium and sodium intakes of midlife to older rural women, with identification of their top food sources. DESIGN Survey of baseline dietary intake data of women and comparison to standard recommendations. SETTING Rural Midwestern United States. PARTICIPANTS 289 rural women, age 40-69, with prehypertension who volunteered for lifestyle modification to reduce blood pressure. MEASUREMENTS Baseline nutrition data using the Block Health Habit and History Questionnaire were collected over a twelve-month rolling enrollment period from rural women with prehypertension. Mineral intakes were calculated and compared to recommended standards. Top ten foods contributing to each mineral were identified. RESULTS The percent of women who met the Recommended Dietary Allowance (RDA)/Adequate Intake (AI) recommendations for their age groups ranged from a high 42.9% for magnesium to a low of 4.2% for potassium. Mean intakes of calcium, magnesium and potassium were all below recommended levels and sodium intakes were above recommendation. CONCLUSION Midlife to older rural US women with prehypertension were eating some of the foods that would help them meet mineral recommendations. As a preventive approach to reducing hypertension risk, clinical practice could include advising on ways to increase both commonly and less commonly consumed nutrient-rich foods with awareness of what is typically available in the rural area.
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Affiliation(s)
- L S Boeckner
- Linda S. Boeckner, 119 Ruth Leverton, University of Nebraska-Lincoln, Lincoln, NE 68583-0808, Phone: 402-472-7634,
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Abstract
OBJECTIVES Headaches are a common medical problem, yet few studies, particularly trials, have evaluated therapies that might prevent or control headaches. We, thus, investigated the effects on the occurrence of headaches of three levels of dietary sodium intake and two diet patterns (the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat) and a control diet (typical of Western consumption patterns)). DESIGN Randomised multicentre clinical trial. SETTING Post hoc analyses of the DASH-Sodium trial in the USA. PARTICIPANTS In a multicentre feeding study with three 30 day periods, 390 participants were randomised to the DASH or control diet. On their assigned diet, participants ate food with high sodium during one period, intermediate sodium during another period and low sodium during another period, in random order. OUTCOME MEASURES Occurrence and severity of headache were ascertained from self-administered questionnaires, completed at the end of each feeding period. RESULTS The occurrence of headaches was similar in DASH versus control, at high (OR (95% CI)=0.65 (0.37 to 1.12); p=0.12), intermediate (0.57 (0.29 to 1.12); p=0.10) and low (0.64 (0.36 to 1.13); p=0.12) sodium levels. By contrast, there was a lower risk of headache on the low, compared with high, sodium level, both on the control (0.69 (0.49 to 0.99); p=0.05) and DASH (0.69 (0.49 to 0.98); p=0.04) diets. CONCLUSIONS A reduced sodium intake was associated with a significantly lower risk of headache, while dietary patterns had no effect on the risk of headaches in adults. Reduced dietary sodium intake offers a novel approach to prevent headaches. TRIAL REGISTRATION NUMBER NCT00000608.
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Affiliation(s)
- Muhammad Amer
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Howard University Hospital, Washington DC, USA
| | - Mark Woodward
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Cañamares-Orbis I, Silva JT, López-Medrano F, Aguado JM. Is high-dose intravenous fosfomycin safe for the treatment of patients prone to heart failure? Enferm Infecc Microbiol Clin 2014; 33:294. [PMID: 25444038 DOI: 10.1016/j.eimc.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/06/2014] [Accepted: 07/10/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Irene Cañamares-Orbis
- Pharmacy Department, University Hospital 12 Octubre, Avda. Cordoba s/n., 28041 Madrid, Spain.
| | - José Tiago Silva
- Infectious Diseases Unit, University Hospital 12 Octubre, Madrid, Spain
| | | | - Jose Maria Aguado
- Infectious Diseases Unit, University Hospital 12 Octubre, Madrid, Spain
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Charlton K, Webster J, Kowal P. To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs. Nutrients 2014; 6:3672-95. [PMID: 25230210 PMCID: PMC4179182 DOI: 10.3390/nu6093672] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 07/19/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries.
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Affiliation(s)
- Karen Charlton
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Jacqui Webster
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| | - Paul Kowal
- WHO Study on global AGEing and adult health, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
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Anzid K, Baali A, Vimard P, Levy-Desroches S, Cherkaoui M, López PM. Inadequacy of vitamins and minerals among high-school pupils in Ouarzazate, Morocco. Public Health Nutr 2014; 17:1786-95. [PMID: 23953955 PMCID: PMC10282389 DOI: 10.1017/s1368980013002140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 06/14/2013] [Accepted: 07/08/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess micronutrient intakes and the prevalence of inadequacy in a sample of high-school pupils in Ouarzazate, Morocco. DESIGN Food records were compiled over three non-consecutive days by pre-trained pupils. Micronutrient intakes were estimated using the DIAL software, adapted to include foods commonly eaten in Morocco. The prevalence of inadequacy was estimated by the proportion of individuals with intakes below the Estimated Average Requirement (EAR) for vitamins B12, A and K, thiamin, riboflavin, niacin, pyridoxine, folate, ascorbic acid, iodine, Ca, Mg and P; below the Adequate Intake (AI) level for pantothenic acid, biotin, Na and K; and using the probability approach for Fe. Data were adjusted for intra-individual variation with exclusion of under-reporters. SETTING Ouarzazate, a semi-urban region situated on the southern slopes of the High Atlas with little industrial development but an important tourism sector. SUBJECTS A self-selected sample of 312 pupils aged 15-19 years from the five public high schools. After exclusion of under-reporters, 293 remained for analysis. RESULTS The highest proportions of below-EAR/AI intakes were seen for pantothenic acid (girls 85·1 %, boys 78·0 %), biotin (boys 83·1 %, girls 79·4 %), thiamin (boys 66·9 %), folate (girls 93·1 %, boys 74·6 %), iodine (boys 94·9 %, girls 88·0 %) and Ca (girls 83·4 %, boys 74·6 %). Na intake was generally in excess whereas K intake was below the AI level. In general, girls had better-quality diets than boys, who appeared to consume more 'empty calories'. CONCLUSIONS Our findings suggest that in this population of Moroccan adolescents, nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies. To provide reliable and precise estimates of nutrient intakes, an update of Moroccan food composition databases is urgently needed. We recommend that national authorities address these issues.
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Affiliation(s)
- Karim Anzid
- 1Department of Biology,Laboratory of Human Ecology,Cadi Ayyad University,Faculty of Sciences Semlalia,Bvd Prince My Abdellah,BP 2390,40000 Marrakesh,Morocco
| | - Abdellatif Baali
- 1Department of Biology,Laboratory of Human Ecology,Cadi Ayyad University,Faculty of Sciences Semlalia,Bvd Prince My Abdellah,BP 2390,40000 Marrakesh,Morocco
| | - Patrice Vimard
- 2Population-Environment-Development Laboratory,University of Provence,Marseille,France
| | | | - Mohamed Cherkaoui
- 1Department of Biology,Laboratory of Human Ecology,Cadi Ayyad University,Faculty of Sciences Semlalia,Bvd Prince My Abdellah,BP 2390,40000 Marrakesh,Morocco
| | - Pilar Montero López
- 4Unidad de Antropología,Departamento de Biología, Facultad de Ciencias,Universidad Autónoma de Madrid,Madrid,Spain
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Hendriksen MAH, van Raaij JMA, Geleijnse JM, den Hooven CWV, Ocké MC, van der A DL. Monitoring salt and iodine intakes in Dutch adults between 2006 and 2010 using 24 h urinary sodium and iodine excretions. Public Health Nutr 2014; 17:1431-8. [PMID: 23739290 PMCID: PMC10282408 DOI: 10.1017/s1368980013001481] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 11/22/2012] [Revised: 04/10/2013] [Accepted: 04/24/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To monitor the effectiveness of salt-reduction initiatives in processed foods and changes in Dutch iodine policy on Na and iodine intakes in Dutch adults between 2006 and 2010. DESIGN Two cross-sectional studies among adults, conducted in 2006 and 2010, using identical protocols. Participants collected single 24 h urine samples and completed two short questionnaires on food consumption and urine collection procedures. Daily intakes of salt, iodine, K and Na:K were estimated, based on the analysis of Na, K and iodine excreted in urine. SETTING Doetinchem, the Netherlands. SUBJECTS Men and women aged 19 to 70 years were recruited through random sampling of the Doetinchem population and among participants of the Doetinchem Cohort Study (2006: n 317, mean age 48·9 years, 43 % men; 2010: n 342, mean age 46·2 years, 45 % men). RESULTS While median iodine intake was lower in 2010 (179 μg/d) compared with 2006 (257 μg/d; P < 0·0001), no difference in median salt intake was observed (8·7 g/d in 2006 v. 8·5 g/d in 2010, P = 0·70). In 2006, median K intake was 2·6 g/d v. 2·8 g/d in 2010 (P < 0·01). In this 4-year period, median Na:K improved from 2·4 in 2006 to 2·2 in 2010 (P < 0·001). CONCLUSIONS Despite initiatives to lower salt in processed foods, dietary salt intake in this population remains well above the recommended intake of 6 g/d. Iodine intake is still adequate, although a decline was observed between 2006 and 2010. This reduction is probably due to changes in iodine policy.
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Affiliation(s)
- Marieke AH Hendriksen
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Joop MA van Raaij
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Marga C Ocké
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
| | - Daphne L van der A
- National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands
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McLaren L, Heidinger S, Dutton DJ, Tarasuk V, Campbell NR. A repeated cross-sectional study of socio-economic inequities in dietary sodium consumption among Canadian adults: implications for national sodium reduction strategies. Int J Equity Health 2014; 13:44. [PMID: 24903535 PMCID: PMC4058444 DOI: 10.1186/1475-9276-13-44] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/09/2014] [Accepted: 05/25/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In many countries including Canada, excess consumption of dietary sodium is common, and this has adverse implications for population health. Socio-economic inequities in sodium consumption seem likely, but research is limited. Knowledge of socio-economic inequities in sodium consumption is important for informing population-level sodium reduction strategies, to ensure that they are both impactful and equitable. METHODS We examined the association between socio-economic indicators (income and education) and sodium, using two outcome variables: 1) sodium consumption in mg/day, and 2) reported use of table salt, in two national surveys: the 1970/72 Nutrition Canada Survey and the 2004 Canadian Community Health Survey, Cycle 2.2. This permitted us to explore whether there were any changes in socio-economic patterning in dietary sodium during a time period characterized by modest, information-based national sodium reduction efforts, as well as to provide baseline information against which to examine the impact (equitable or not) of future sodium reduction strategies in Canada. RESULTS There was no evidence of a socio-economic inequity in sodium consumption (mg/day) in 2004. In fact findings pointed to a positive association in women, whereby women of higher education consumed more sodium than women of lower education in 2004. For men, income was positively associated with reported use of table salt in 1970/72, but negatively associated in 2004. CONCLUSIONS An emerging inequity in reported use of table salt among men could reflect the modest, information-based sodium reduction efforts that were implemented during the time frame considered. However, for sodium consumption in mg/day, we found no evidence of a contemporary inequity, and in fact observed the opposite effect among women. Our findings could reflect data limitations, or they could signal that sodium differs from some other nutrients in terms of its socio-economic patterning, perhaps reflecting very high prevalence of excess consumption. It is possible that socio-economic inequities in sodium consumption will emerge as excess consumption declines, consistent with fundamental cause theory. It is important that national sodium reduction strategies are both impactful and equitable.
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Affiliation(s)
- Lindsay McLaren
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6, Canada
| | - Shayla Heidinger
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6, Canada
| | - Daniel J Dutton
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3rd Floor, TRW Building, 3280 Hospital Dr. NW, Calgary, Alberta T2N 4Z6, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 150 College Street, Toronto, Ontario M5S 3E2, Canada
| | - Norman R Campbell
- Departments of Medicine; Community Health Sciences; Physiology and Pharmacology, Faculty of Medicine, University of Calgary, Foothills Medical Centre, North Tower, 9th Floor, 1403 29th St. NW, Calgary, Alberta T2N 2 T9, Canada
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Afsar B, Elsurer R. The relationship between central hemodynamics, morning blood pressure surge, glycemic control and sodium intake in patients with type 2 diabetes and essential hypertension. Diabetes Res Clin Pract 2014; 104:420-6. [PMID: 24780746 DOI: 10.1016/j.diabres.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/24/2014] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/11/2022]
Abstract
AIMS The current study aimed to investigate the relationship between morning blood pressure surge (MBPS), hemodynamic parameters, glycemic control and 24-h urinary sodium excretion (USE) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS MBPS and central hemodynamic parameters were assessed from ambulatory blood pressure measurements. In addition to routine biochemistry, 24h urine collection was performed to measure protein, albumin and sodium excretion. RESULTS There were 146 (38%) patients with T2DM and 238 (72%) patients without T2DM (control group). Patients with T2DM had statistically higher MBPS compared with patients without T2DM (P<0.0001). In patients with T2DM, MBPS was correlated with HbA1c (rho=0.311, P<0.0001), 24h urinary sodium excretion (USE) (rho=0.292, P=0.004) and various hemodynamic parameters. Additionally, regression analysis showed that being male (P=0.006), the presence of coronary artery disease (P=0.023), HbA1c (P=0.012), and 24h USE (P=0.001) were independently related with log MBPS in T2DM patients. CONCLUSION This study demonstrated that T2DM was an independent risk factor for increased MBPS and MBPS was associated with central hemodynamic parameters. Additionally poor glycemic control and sodium intake were associated with worse MBPS in T2DM.
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Affiliation(s)
- Baris Afsar
- Konya Numune State Hospital, Department of Nephrology, Turkey.
| | - Rengin Elsurer
- Selcuklu Faculty of Medicine, Selcuk University, Department of Nephrology, Turkey
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Bokeriya LA, Boldyrev AA, Movsesyan RR, Kulaga OI, Bledzhyants GA, Egorov DN, Popov AE, Plyushch MG, Kozar EF, Kalaeva NV. Experimental study of the effects of sodium ion concentrations on the function of the myocardium exposed to cardioplegic ischemia. Bull Exp Biol Med 2014; 156:880-4. [PMID: 24824721 DOI: 10.1007/s10517-014-2474-4] [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] [Received: 09/27/2012] [Indexed: 11/25/2022]
Abstract
A new cardioplegic solution based on three natural dipeptides was developed and introduced at the Laboratory of Cardioplegia, A. N. Bakulev Research Center of Cardiovascular Surgery. The electrolyte composition of the solution corresponded to the category of intracellular cardioplegic solutions. The results of 60 experiments on isolated rat hearts were analyzed for choosing the optimal concentration of sodium ions (35, 60, or 80 mmol/liter). The composition of the studied cardioplegic solutions was selected by ion concentrations in the intra- and extracellular fluid. Earlier and most effective recovery of cardiac function with minimum rhythm and conductivity disorders was observed in the group treated with cardioplegic solution with sodium ion concentration of 60 mmol/liter.
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Affiliation(s)
- L A Bokeriya
- A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow, Russia
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McLean R, Hoek J. Sodium and nutrition labelling: a qualitative study exploring New Zealand consumers' food purchasing behaviours. Public Health Nutr 2014; 17:1138-46. [PMID: 23651916 PMCID: PMC10282311 DOI: 10.1017/s1368980013001079] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 10/29/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Dietary sodium reduction is an important public health intervention that would reduce blood pressure and chronic disease. An understanding of how New Zealand consumers' food purchasing behaviour is influenced by perceptions of dietary sodium will inform future sodium-reduction strategies. DESIGN The present qualitative study used in-depth interviews of adult consumers to explore consumer knowledge, understanding of food labels and food purchasing behaviour with respect to dietary sodium. SETTING New Zealand. SUBJECTS A convenience sample of sixteen adult grocery shoppers. RESULTS A thematic analysis of the transcripts showed New Zealand consumers lacked the background knowledge necessary to understand and regulate their own salt intake and were unable to interpret existing food labels with respect to dietary salt. CONCLUSIONS The findings add further weight to calls for food labels that do not require background knowledge or numerical skills and highlight the need for population-based public health interventions. Education of New Zealand consumers on the health benefits of sodium reduction and how this may be achieved would complement this approach.
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Affiliation(s)
- Rachael McLean
- Edgar National Centre for Diabetes & Obesity Research, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand
| | - Janet Hoek
- Department of Marketing, University of Otago. Dunedin, New Zealand
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Abstract
OBJECTIVES Postnatal brain development is affected by the in utero environment. Modern people usually have a high sodium intake. The aim of this study was to investigate the effect of sodium hyperingestion during pregnancy on the postnatal brain development of rat offspring. METHODS The sodium-overloaded rats received 1.8% NaCl in their drinking water for 7 days during the last week of gestation. Their body weight, urine, and blood levels of sodium and other parameters were measured. Some rats were sacrificed at pregnancy day 22 and the weight and length of the placenta and foetus were measured. The cerebral cortex and hippocampus were obtained from their offspring at postnatal day 1 and at postnatal weeks 1, 2, 4, and 8. Western blot analyses were conducted with brain tissue lysates. RESULTS The sodium-overloaded animals had decreased weight gain in the last week of gestation as well as decreased food intake, increased water intake, urine volume, urine sodium, and serum sodium. There were no differences in placental weight and length. The foetuses of sodium-overloaded rats showed decreased body weight and size, and this difference was maintained postnatally for 2 weeks. In the cerebral cortex and hippocampus of the offspring, the protein levels of myelin basic protein, calmodulin/calcium-dependent protein kinase II, and brain-derived neurotrophic factor were decreased or aberrantly expressed. DISCUSSION The present data suggest that increased sodium intake during pregnancy affects the brain development of the offspring.
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Bihari S, Peake SL, Seppelt I, Williams P, Bersten A. Sodium administration in critically ill patients in Australia and New Zealand: a multicentre point prevalence study. CRIT CARE RESUSC 2013; 15:294-300. [PMID: 24289511] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Inadvertent sodium administration in excess of recommended daily requirements has been reported during routine care of critically ill patients. AIM To determine the amount and sources of sodium administered in Australian and New Zealand intensive care units. DESIGN, SETTING AND PARTICIPANTS Prospective, observational, single-day, point prevalence survey conducted in 46 Australian and New Zealand ICUs on 21 September 2011. All patients present in ICU at 10 am and not receiving an oral diet on the study day were evaluated. Demographic data, ICU admission diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score and sources of sodium administration over the study day were recorded. RESULTS 356 patients (64% male) were enrolled. Mean (SD) age and weight were 58.5 years (18.0 years) and 81.6 kg (24.0 kg), respectively. Mean ICU admission APACHE II score was 20 (SD, 8). Overall median (interquartile range [IQR]) sodium administration was 224.5 mmol (IQR, 144.9-367.6 mmol), or 2.8 mmol/kg (IQR, 1.6-4.7 mmol/kg). Among patients who were on Day 2-10 of their ICU admission on the study day, sodium sources and amounts administered were: i) maintenance or replacement intravenous (IV) infusions, 69.3mmol; 30.9% of all sodium sources; ii) IV fluid boluses, 36.5 mmol; 16.3%; iii) IV drug boluses, 27.6 mmol; 12.3%; iv) enteral nutrition, 26.5 mmol; 11.8%; v) IV drug infusions, 19.3 mmol; 8.6%; vi) IV flushes, 16.6mmol; 7.4%; vii) blood products, 13.5 mmol; 6%; viii) IV antimicrobials, 11.2mmol; 5%; and ix) parenteral nutrition, 4.3 mmol; 1.9%. Factors associated with sodium administration were site (P = 0.04), age (P < 0.001), administered fluid (P = 0.03) and day of ICU stay (P = 0.01) (multiple linear regression). CONCLUSION This point prevalence study suggests that sodium administration in excess of recommended daily requirements may be common in Australia and New Zealand ICUs. The main sodium source was IV maintenance fluids, followed by fluid boluses and drug boluses.
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Affiliation(s)
- Shailesh Bihari
- Department of Critical Care Medicine, Flinders University, Adelaide, SA, Australia.
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Port F, Hecking M, Karaboyas A, Pisoni R, Robinson B. Current evidence argues against lowering the dialysate sodium. Nephrol News Issues 2013; 27:18-21. [PMID: 24597066] [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: 06/03/2023]
Affiliation(s)
- Fritz Port
- Arbor Research Collaborative, University of Michigan, USA
| | - Manfred Hecking
- Clinical Division of Nephrology and Dialysis, Department of Internal Medicine Ill, Medical University of Vienna
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Gattas DJ, Saxena MK. Is maintenance fluid therapy in need of maintenance? CRIT CARE RESUSC 2013; 15:255-256. [PMID: 24289504] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- David J Gattas
- Intensive Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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George J, Majeed W, Mackenzie IS, Macdonald TM, Wei L. Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study. BMJ 2013; 347:f6954. [PMID: 24284017 PMCID: PMC3898660 DOI: 10.1136/bmj.f6954] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine whether patients taking formulations of drugs that contain sodium have a higher incidence of cardiovascular events compared with patients on non-sodium formulations of the same drugs. DESIGN Nested case-control study. SETTING UK Primary Care Patients registered on the Clinical Practice Research Datalink (CPRD). PARTICIPANTS All patients aged 18 or over who were prescribed at least two prescriptions of sodium-containing formulations or matched standard formulations of the same drug between January 1987 and December 2010. MAIN OUTCOME MEASURES Composite primary outcome of incident non-fatal myocardial infarction, incident non-fatal stroke, or vascular death. We performed 1:1 incidence density sampling matched controls using the UK Clinical Practice Research Datalink (CPRD). For the secondary analyses, cases were patients with the individual components of the primary study composite endpoint of hypertension, incident heart failure, and all cause mortality. RESULTS 1,292,337 patients were included in the study cohort. Mean follow-up time was 7.23 years. A total of 61,072 patients with an incident cardiovascular event were matched with controls. For the primary endpoint of incident non-fatal myocardial infarction, incident non-fatal stroke, or vascular death the adjusted odds ratio for exposure to sodium-containing drugs was 1.16 (95% confidence interval 1.12 to 1.21). The adjusted odds ratios for the secondary endpoints were 1.22 (1.16 to 1.29) for incident non-fatal stroke, 1.28 (1.23 to 1.33) for all cause mortality, 7.18 (6.74 to 7.65) for hypertension, 0.98 (0.93 to 1.04) for heart failure, 0.94 (0.88 to 1.00) for incident non-fatal myocardial infarction, and 0.70 (0.31 to 1.59) for vascular death. The median time from date of first prescription (that is, date of entry into cohort) to first event was 3.92 years. CONCLUSIONS Exposure to sodium-containing formulations of effervescent, dispersible, and soluble medicines was associated with significantly increased odds of adverse cardiovascular events compared with standard formulations of those same drugs. Sodium-containing formulations should be prescribed with caution only if the perceived benefits outweigh these risks.
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Affiliation(s)
- Jacob George
- Division of Medical Science, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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