Serum potassium level and dietary potassium intake as risk factors for stroke.

PubMed

Green, D M; Ropper, A H; Kronmal, R A; Psaty, B M; Burke, G L

2002-08-13

Numerous studies have found that low potassium intake and low serum potassium are associated with increased stroke mortality, but data regarding stroke incidence have been limited. Serum potassium levels, dietary potassium intake, and diuretic use in relation to risk for stroke in a prospectively studied cohort were investigated. The study comprised 5,600 men and women older than 65 years who were free of stroke at enrollment. Baseline data included serum potassium level, dietary potassium intake, and diuretic use. Participants were followed for 4 to 8 years, and the incidence and types of strokes were recorded. Low serum potassium was defined as less than 4.1 mEq/L, and low potassium intake as less than 2.4 g/d. Among diuretic users, there was an increased risk for stroke associated with lower serum potassium (relative risk [RR]: 2.5, p < 0.0001). Among individuals not taking diuretics, there was an increased risk for stroke associated with low dietary potassium intake (RR: 1.5, p < 0.005). The small number of diuretic users with lower serum potassium and atrial fibrillation had a 10-fold greater risk for stroke compared with those with higher serum potassium and normal sinus rhythm. A lower serum potassium level in diuretic users, and low potassium intake in those not taking diuretics were associated with increased stroke incidence among older individuals. Lower serum potassium was associated with a particularly high risk for stroke in the small number of diuretic users with atrial fibrillation. Further study is required to determine if modification of these factors would prevent strokes.

Socioeconomic inequality in salt intake in Britain 10 years after a national salt reduction programme.

PubMed

Ji, Chen; Cappuccio, Francesco P

2014-08-14

The impact of the national salt reduction programme in the UK on social inequalities is unknown. We examined spatial and socioeconomic variations in salt intake in the 2008-2011 British National Diet and Nutrition Survey (NDNS) and compared them with those before the programme in 2000-2001. Cross-sectional survey in Great Britain. 1027 Caucasian males and females, aged 19-64 years. Participants' dietary sodium intake measured with a 4-day food diary. Bayesian geo-additive models used to assess spatial and socioeconomic patterns of sodium intake accounting for sociodemographic, anthropometric and behavioural confounders. Dietary sodium intake varied significantly across socioeconomic groups, even when adjusting for geographical variations. There was higher dietary sodium intake in people with the lowest educational attainment (coefficient: 0.252 (90% credible intervals 0.003, 0.486)) and in low levels of occupation (coefficient: 0.109 (-0.069, 0.288)). Those with no qualification had, on average, a 5.7% (0.1%, 11.1%) higher dietary sodium intake than the reference group. Compared to 2000-2001 the gradient of dietary sodium intake from south to north was attenuated after adjustments for confounders. Estimated dietary sodium consumption from food sources (not accounting for discretionary sources) was reduced by 366 mg of sodium (∼0.9 g of salt) per day during the 10-year period, likely the effect of national salt reduction initiatives. Social inequalities in salt intake have not seen a reduction following the national salt reduction programme and still explain more than 5% of salt intake between more and less affluent groups. Understanding the socioeconomic pattern of salt intake is crucial to reduce inequalities. Efforts are needed to minimise the gap between socioeconomic groups for an equitable delivery of cardiovascular prevention. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

Reducing salt in food; setting product-specific criteria aiming at a salt intake of 5 g per day.

PubMed

Dötsch-Klerk, M; Goossens, W P M M; Meijer, G W; van het Hof, K H

2015-07-01

There is an increasing public health concern regarding high salt intake, which is generally between 9 and 12 g per day, and much higher than the 5 g recommended by World Health Organization. Several relevant sectors of the food industry are engaged in salt reduction, but it is a challenge to reduce salt in products without compromising on taste, shelf-life or expense for consumers. The objective was to develop globally applicable salt reduction criteria as guidance for product reformulation. Two sets of product group-specific sodium criteria were developed to reduce salt levels in foods to help consumers reduce their intake towards an interim intake goal of 6 g/day, and—on the longer term—5 g/day. Data modelling using survey data from the United States, United Kingdom and Netherlands was performed to assess the potential impact on population salt intake of cross-industry food product reformulation towards these criteria. Modelling with 6 and 5 g/day criteria resulted in estimated reductions in population salt intake of 25 and 30% for the three countries, respectively, the latter representing an absolute decrease in the median salt intake of 1.8-2.2 g/day. The sodium criteria described in this paper can serve as guidance for salt reduction in foods. However, to enable achieving an intake of 5 g/day, salt reduction should not be limited to product reformulation. A multi-stakeholder approach is needed to make consumers aware of the need to reduce their salt intake. Nevertheless, dietary impact modelling shows that product reformulation by food industry has the potential to contribute substantially to salt-intake reduction.

Increased salt consumption induces body water conservation and decreases fluid intake.

PubMed

Rakova, Natalia; Kitada, Kento; Lerchl, Kathrin; Dahlmann, Anke; Birukov, Anna; Daub, Steffen; Kopp, Christoph; Pedchenko, Tetyana; Zhang, Yahua; Beck, Luis; Johannes, Bernd; Marton, Adriana; Müller, Dominik N; Rauh, Manfred; Luft, Friedrich C; Titze, Jens

2017-05-01

The idea that increasing salt intake increases drinking and urine volume is widely accepted. We tested the hypothesis that an increase in salt intake of 6 g/d would change fluid balance in men living under ultra-long-term controlled conditions. Over the course of 2 separate space flight simulation studies of 105 and 205 days' duration, we exposed 10 healthy men to 3 salt intake levels (12, 9, or 6 g/d). All other nutrients were maintained constant. We studied the effect of salt-driven changes in mineralocorticoid and glucocorticoid urinary excretion on day-to-day osmolyte and water balance. A 6-g/d increase in salt intake increased urine osmolyte excretion, but reduced free-water clearance, indicating endogenous free water accrual by urine concentration. The resulting endogenous water surplus reduced fluid intake at the 12-g/d salt intake level. Across all 3 levels of salt intake, half-weekly and weekly rhythmical mineralocorticoid release promoted free water reabsorption via the renal concentration mechanism. Mineralocorticoid-coupled increases in free water reabsorption were counterbalanced by rhythmical glucocorticoid release, with excretion of endogenous osmolyte and water surplus by relative urine dilution. A 6-g/d increase in salt intake decreased the level of rhythmical mineralocorticoid release and elevated rhythmical glucocorticoid release. The projected effect of salt-driven hormone rhythm modulation corresponded well with the measured decrease in water intake and an increase in urine volume with surplus osmolyte excretion. Humans regulate osmolyte and water balance by rhythmical mineralocorticoid and glucocorticoid release, endogenous accrual of surplus body water, and precise surplus excretion. Federal Ministry for Economics and Technology/DLR; the Interdisciplinary Centre for Clinical Research; the NIH; the American Heart Association (AHA); the Renal Research Institute; and the TOYOBO Biotechnology Foundation. Food products were donated by APETITO

Reducing salt in food; setting product-specific criteria aiming at a salt intake of 5 g per day

PubMed Central

Dötsch-Klerk, M; PMM Goossens, W; Meijer, G W; van het Hof, K H

2015-01-01

Background/Objectives: There is an increasing public health concern regarding high salt intake, which is generally between 9 and 12 g per day, and much higher than the 5 g recommended by World Health Organization. Several relevant sectors of the food industry are engaged in salt reduction, but it is a challenge to reduce salt in products without compromising on taste, shelf-life or expense for consumers. The objective was to develop globally applicable salt reduction criteria as guidance for product reformulation. Subjects/Methods: Two sets of product group-specific sodium criteria were developed to reduce salt levels in foods to help consumers reduce their intake towards an interim intake goal of 6 g/day, and—on the longer term—5 g/day. Data modelling using survey data from the United States, United Kingdom and Netherlands was performed to assess the potential impact on population salt intake of cross-industry food product reformulation towards these criteria. Results: Modelling with 6 and 5 g/day criteria resulted in estimated reductions in population salt intake of 25 and 30% for the three countries, respectively, the latter representing an absolute decrease in the median salt intake of 1.8–2.2 g/day. Conclusions: The sodium criteria described in this paper can serve as guidance for salt reduction in foods. However, to enable achieving an intake of 5 g/day, salt reduction should not be limited to product reformulation. A multi-stakeholder approach is needed to make consumers aware of the need to reduce their salt intake. Nevertheless, dietary impact modelling shows that product reformulation by food industry has the potential to contribute substantially to salt-intake reduction. PMID:25690867

Salt craving: the psychobiology of pathogenic sodium intake.

PubMed

Morris, Michael J; Na, Elisa S; Johnson, Alan Kim

2008-08-06

Ionic sodium, obtained from dietary sources usually in the form of sodium chloride (NaCl, common table salt) is essential to physiological function, and in humans salt is generally regarded as highly palatable. This marriage of pleasant taste and physiological utility might appear fortunate--an appealing taste helps to ensure that such a vital substance is ingested. However, the powerful mechanisms governing sodium retention and sodium balance are unfortunately best adapted for an environment in which few humans still exist. Our physiological and behavioral means for maintaining body sodium and fluid homeostasis evolved in hot climates where sources of dietary sodium were scarce. For many reasons, contemporary diets are high in salt and daily sodium intakes are excessive. High sodium consumption can have pathological consequences. Although there are a number of obstacles to limiting salt ingestion, high sodium intake, like smoking, is a modifiable behavioral risk factor for many cardiovascular diseases. This review discusses the psychobiological mechanisms that promote and maintain excessive dietary sodium intake. Of particular importance are experience-dependent processes including the sensitization of the neural systems underlying sodium appetite and the effects of sodium balance on hedonic state and mood. Accumulating evidence suggests that plasticity within the central nervous system as a result of experience with high salt intake, sodium depletion, or a chronic unresolved sodium appetite fosters enduring changes in sodium related appetitive and consummatory behaviors.

Salt intake and dietary sources of salt on weekdays and weekend days in Australian adults.

PubMed

Nowson, Caryl; Lim, Karen; Land, Mary-Ann; Webster, Jacqui; Shaw, Jonathan E; Chalmers, John; Flood, Victoria; Woodward, Mark; Grimes, Carley

2018-02-01

To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days. A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall. Community-dwelling adults living in the State of Victoria, Australia. Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years). Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na. Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8-14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.

Increased salt consumption induces body water conservation and decreases fluid intake

PubMed Central

Rakova, Natalia; Kitada, Kento; Lerchl, Kathrin; Dahlmann, Anke; Birukov, Anna; Daub, Steffen; Kopp, Christoph; Pedchenko, Tetyana; Zhang, Yahua; Beck, Luis; Marton, Adriana; Müller, Dominik N.; Rauh, Manfred; Luft, Friedrich C.

2017-01-01

BACKGROUND. The idea that increasing salt intake increases drinking and urine volume is widely accepted. We tested the hypothesis that an increase in salt intake of 6 g/d would change fluid balance in men living under ultra-long-term controlled conditions. METHODS. Over the course of 2 separate space flight simulation studies of 105 and 205 days’ duration, we exposed 10 healthy men to 3 salt intake levels (12, 9, or 6 g/d). All other nutrients were maintained constant. We studied the effect of salt-driven changes in mineralocorticoid and glucocorticoid urinary excretion on day-to-day osmolyte and water balance. RESULTS. A 6-g/d increase in salt intake increased urine osmolyte excretion, but reduced free-water clearance, indicating endogenous free water accrual by urine concentration. The resulting endogenous water surplus reduced fluid intake at the 12-g/d salt intake level. Across all 3 levels of salt intake, half-weekly and weekly rhythmical mineralocorticoid release promoted free water reabsorption via the renal concentration mechanism. Mineralocorticoid-coupled increases in free water reabsorption were counterbalanced by rhythmical glucocorticoid release, with excretion of endogenous osmolyte and water surplus by relative urine dilution. A 6-g/d increase in salt intake decreased the level of rhythmical mineralocorticoid release and elevated rhythmical glucocorticoid release. The projected effect of salt-driven hormone rhythm modulation corresponded well with the measured decrease in water intake and an increase in urine volume with surplus osmolyte excretion. CONCLUSION. Humans regulate osmolyte and water balance by rhythmical mineralocorticoid and glucocorticoid release, endogenous accrual of surplus body water, and precise surplus excretion. FUNDING. Federal Ministry for Economics and Technology/DLR; the Interdisciplinary Centre for Clinical Research; the NIH; the American Heart Association (AHA); the Renal Research Institute; and the TOYOBO Biotechnology

Role of salt intake in prevention of cardiovascular disease: controversies and challenges.

PubMed

He, Feng J; MacGregor, Graham A

2018-06-01

Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to <5 g daily. This recommendation has been challenged by several studies, including cohort studies, which have suggested a J-shaped relationship between salt intake and CVD risk. However, these studies had severe methodological problems, such as reverse causality and measurement error due to assessment of salt intake by spot urine. Consequently, findings from such studies should not be used to derail vital public health policy. Gradual, stepwise salt reduction as recommended by the WHO remains an achievable, affordable, effective, and important strategy to prevent CVD worldwide. The question now is how to reduce population salt intake. In most developed countries, salt reduction can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. The UK has pioneered a successful salt-reduction programme by setting incremental targets for >85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings.

Nutritional modelling: distributions of salt intake from processed foods in New Zealand.

PubMed

Thomson, Barbara M

2009-09-01

The salt content of processed foods is important because of the high intake of Na by most New Zealanders. A database of Na concentrations in fifty-eight processed foods was compiled from existing and new data and combined with 24 h diet recall data from two national nutrition surveys (5771 respondents) to derive salt intakes for seven population groups. Mean salt intakes from processed foods ranged from 6.9 g/d for young males aged 19-24 years to 3.5 g/d for children aged 5-6 years. A total of > or = 50 % of children aged 5-6 years, boys aged 11-14 years and young males aged 19-24 years had salt intakes that exceeded the upper limit for Na, calculated as salt (3.2-5.3 g/d), from processed foods only. Bread accounted for the greatest contribution to salt intake for each population group (35-43 % of total salt intake). Other foods that contributed 2 % or more and common across most age groups were sausage, meat pies, pizza, instant noodles and cheese. The Na concentrations of key foods have changed little over the 16-year period from 1987 to 2003 except for corned beef and whole milk that have decreased by 34 and 50 % respectively. Bread is an obvious target for salt reduction but the implication on iodine intake needs consideration as salt is used as a vehicle for iodine fortification of bread.

Salt craving: The psychobiology of pathogenic sodium intake

PubMed Central

Morris, Michael J.; Na, Elisa S.; Johnson, Alan Kim

2008-01-01

Ionic sodium, obtained from dietary sources usually in the form of sodium chloride (NaCl, common table salt) is essential to physiological function, and in humans salt is generally regarded as highly palatable. This marriage of pleasant taste and physiological utility might appear fortunate – an appealing taste helps to ensure that such a vital substance is ingested. However, the powerful mechanisms governing sodium retention and sodium balance are unfortunately best adapted for an environment in which few humans still exist. Our physiological and behavioral means for maintaining body sodium and fluid homeostasis evolved in hot climates where sources of dietary sodium were scarce. For many reasons, contemporary diets are high in salt and daily sodium intakes are excessive. High sodium consumption can have pathological consequences. Although there are a number of obstacles to limiting salt ingestion, high sodium intake, like smoking, is a modifiable behavioral risk factor for many cardiovascular diseases. This review discusses the psychobiological mechanisms that promote and maintain excessive dietary sodium intake. Of particular importance are experience-dependent processes including the sensitization of the neural systems underlying sodium appetite and the effects of sodium balance on hedonic state and mood. Accumulating evidence suggests that plasticity within the central nervous system as a result of experience with high salt intake, sodium depletion, or a chronic unresolved sodium appetite fosters enduring changes in sodium related appetitive and consummatory behaviors. PMID:18514747

Dietary potassium intake and risk of stroke: a dose-response meta-analysis of prospective studies.

PubMed

Larsson, Susanna C; Orsini, Nicola; Wolk, Alicja

2011-10-01

Potassium intake has been inconsistently associated with risk of stroke. Our aim was to conduct a meta-analysis of prospective studies to assess the relation between potassium intake and stroke risk. Pertinent studies were identified by a search of PubMed from January 1966 through March 2011 and by reviewing the reference lists of retrieved articles. We included prospective studies that reported relative risks with 95% CIs of stroke for ≥3 categories of potassium intake or for potassium intake analyzed as a continuous variable. Study-specific results were pooled using a random-effects model. Ten independent prospective studies, with a total of 8695 stroke cases and 268 276 participants, were included in the meta-analysis. We observed a statistically significant inverse association between potassium intake and risk of stroke. For every 1000-mg/day increase in potassium intake, the risk of stroke decreased by 11% (pooled relative risk, 0.89; 95% CI, 0.83 to 0.97). In the 5 studies that reported results for stroke subtypes, the pooled relative risks were 0.89 (95% CI, 0.81 to 0.97) for ischemic stroke, 0.95 (95% CI, 0.83 to 1.09) for intracerebral hemorrhage, and 1.08 (95% CI, 0.92 to 1.27) for subarachnoid hemorrhage. Dietary potassium intake is inversely associated with risk of stroke, in particular ischemic stroke.

Effect of salt intensity on ad libitum intake of tomato soup similar in palatability and on salt preference after consumption.

PubMed

Bolhuis, Dieuwerke P; Lakemond, Catriona M M; de Wijk, Rene A; Luning, Pieternel A; de Graaf, Cees

2010-11-01

Sensory properties of food play an important role in satiation. Studies on the effect of taste intensity on satiation show conflicting results. This may be due to the notion that in these studies taste intensity and palatability were confounded. The objective of this study was to investigate the effect of salt intensity of tomato soup on ad libitum intake (satiation), while controlling for palatability on an individual basis. Forty-eight subjects consumed both a low-salt (LS) and high-salt (HS) soup ad libitum from a self-refilling bowl. The results showed no difference between LS and HS soup in ad libitum intake, eating rate, changes in appetite ratings, and changes in hedonic ratings after intake. After intake of HS soup, LS soup was perceived as more bland than before intake of HS soup. After intake of LS soup, HS soup was perceived as more salt intense than before intake of LS soup. In conclusion, this study found no effect of salt intensity on satiation of tomato soups that were similar in palatability. During consumption, subjects adapted quickly to the exposed salt intensity as contrasting salt intensities were rated further from the ideal salt intensity and therefore perceived as less pleasant after consumption.

Ecological study for refrigerator use, salt, vegetable, and fruit intakes, and gastric cancer.

PubMed

Park, Boyoung; Shin, Aesun; Park, Sue K; Ko, Kwang-Pil; Ma, Seung Hyun; Lee, Eun-Ha; Gwack, Jin; Jung, En-Joo; Cho, Lisa Y; Yang, Jae Jeong; Yoo, Keun-Young

2011-11-01

We used an ecological approach to determine the correlation between vegetable, fruit and salt intakes, refrigerator use, and gastric cancer mortality in Korean population. Information on fruit and vegetable intakes per capita from the National Health and Nutrition Survey, death certificate data from the National Statistical office, refrigerator per household data from Korean Statistical Information Service, and salt/sodium intake data from a cross-sectional survey were utilized. Correlation coefficients were calculated between vegetable and fruit intakes, refrigerator per household, and gastric cancer mortality and between salt and sodium intakes, and gastric cancer mortality and incidence in the four areas. With 5, 10, and 15 years lag time, refrigerator usage and fruit intake were negatively associated with gastric cancer mortality (p < 0.01), but vegetable intake was not associated with gastric cancer mortality. When estimates of salt/sodium intake evaluated by 24-h urine collection in four areas of Korea were compared to the gastric cancer mortality and incidence in these regions, positive correlation was shown between salt/sodium intake, and gastric cancer incidence and mortality. Negative associations between refrigerator use, fruit intake, and gastric cancer mortality and positive associations between salt/sodium intake and gastric cancer mortality and incidence were suggested.

Dietary calcium intake and risk of cardiovascular disease, stroke, and fracture in a population with low calcium intake.

PubMed

Kong, Sung Hye; Kim, Jung Hee; Hong, A Ram; Cho, Nam H; Shin, Chan Soo

2017-07-01

Background: The role of dietary calcium intake in cardiovascular disease (CVD), stroke, and fracture is controversial. Most previous reports have evaluated populations with high calcium intake. Objective: We aimed to evaluate whether high dietary calcium intake was associated with the risk of CVD, stroke, and fracture in a population with low calcium intake. Design: In a prospective cohort study beginning in 2001 in Ansung-Ansan, Korea, 2158 men and 2153 women aged >50 y were evaluated for all-cause mortality, CVD, stroke, and fractures over a median 9-y follow-up. Results: During follow-up, 242 and 100 deaths, 149 and 150 CVD events, 58 and 82 stroke events, and 211 and 292 incident fractures occurred in men and women, respectively. The first quartiles of energy-adjusted dietary calcium intake were 249 mg/d (IQR: 169 mg/d) in men and 209 mg/d (IQR: 161 mg/d) in women. Both men and women with higher dietary calcium intake tended to have higher fat, protein, sodium, phosphorus, fruit, and vegetable intakes. In men, outcomes were not significantly associated with dietary calcium intake with or without adjustments, and CVD risk tended to increase with increasing energy-adjusted dietary calcium intake, but this was not statistically significant ( P = 0.078 and P = 0.093 with and without adjustment, respectively). In women, CVD risk and dietary calcium intake showed a U-shaped association; the HRs (95% CIs) without adjustment relative to the first quartile were 0.71 (0.47, 1.07), 0.57 (0.36, 0.88), and 0.52 (0.33, 0.83) for quartiles 2, 3, and 4, respectively, and the values after adjustment were 0.70 (0.45, 1.07), 0.51 (0.31, 0.81), and 0.49 (0.29, 0.83) for quartiles 2, 3, and 4, respectively. Conclusion: In Korean women, increased dietary calcium intake was associated with a decreased CVD risk, but it did not influence the risk of stroke or fracture. © 2017 American Society for Nutrition.

Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

PubMed

Goetz, Margarethe E; Judd, Suzanne E; Hartman, Terryl J; McClellan, William; Anderson, Aaron; Vaccarino, Viola

2016-11-01

Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed. We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence. We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA's Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders. Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure. Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake may contribute to regional disparities in ischemic

Salt intake belief, knowledge, and behavior: a cross-sectional study of older rural Chinese adults.

PubMed

Zhang, Jing; Wu, Tao; Chu, Hongling; Feng, Xiangxian; Shi, Jingpu; Zhang, Ruijuan; Zhang, Yuhong; Zhang, Jianxin; Li, Nicole; Yan, Lijing; Niu, Wenyi; Wu, Yangfeng

2016-08-01

Excess sodium consumption is a major cause of high blood pressure and subsequent vascular disease. However, the factors driving people's salt intake behavior remains largely unknown. This study aims to assess the relationship of salt intake behaviors with knowledge and belief on salt and health among older adults in rural China.A cross-sectional survey was conducted among 4693 older participants (men ≥50 and women ≥60 years old) randomly selected from 120 rural villages in 5 northern provinces in China. Healthy salt intake behavior was defined as either not eating pickled foods or not adding pickles/soy sauce/salt when food was not salty enough in prior 3 months.There were 81% participants having healthy salt intake behavior. Healthy salt intake behavior was more common among women (P < 0.01) and was positively associated with age (P < 0.01) and poorer health status (P < 0.01), but negatively associated with years in school (P < 0.05). After adjusting for age, sex, years in school, and health status, participants who believed in the harm of high salt intake were more likely to have healthy salt intake behavior, compared with those who did not believe (Odds Ratio = 1.6, P < 0.001). Knowledge of salt intake was not significantly related to healthy salt intake behavior.Our study demonstrated that belief in the harm of high salt intake rather than knowledge about salt and health was associated with healthy salt intake behavior, independent of age, sex, years in school, and health status. Future population salt reduction programs should place more emphasis on establishing health beliefs rather than only delivering salt-related knowledge.Clinical trial registration number of the study is NCT01259700.

Variable iodine intake persists in the context of universal salt iodization in China.

PubMed

Wu, Yongning; Li, Xiaowei; Chang, Suying; Liu, Liping; Zou, Shurong; Hipgrave, David Barry

2012-09-01

Iodine deficiency disorders were prevalent in China until the introduction of universal salt iodization in 1995. Concerns have recently arisen about possible excess iodine intake in this context. To document iodine intake and the contribution from iodized salt in China, we surveyed dietary iodine intake during China's nationally representative 2007 total diet study (TDS) and during an additional TDS in 4 coastal provinces and Beijing in 2009. Iodine intake was broken down by age and sex in 2009. Mean daily iodine and salt intake and the contribution from different food and beverage groups (and in 2009, individual items) was measured. The iodine in food cooked with iodized and noniodized salt was also assessed. The mean calculated iodine intake of a standard male in China was 425 μg/d in 2007 and 325 μg/d in coastal areas in 2009, well below the upper limit (UL) in all provinces. In 2009, iodine intake was above the UL in only 1-7% of age-sex groups, except among children (18-19%). A concerning number of individuals consumed less than the WHO-recommended daily allowance, including 31.5% of adult women. Salt contributed 63.5% of food iodine, and 24.6% of salt iodine was lost in cooking. Overall salt consumption declined between the surveys. Salt iodization assures iodine nutrition in China where environmental iodine is widely lacking. The risk of iodine excess is low, but planned decreases in salt iodization levels may increase the existing risk of inadequate intake. Regular monitoring of urinary iodine and more research on the impact of excess iodine intake is recommended.

Daily salt intake estimated by overnight urine collections indicates a high cardiovascular disease risk in Thailand.

PubMed

Yokokawa, Hirohide; Yuasa, Motoyuki; Nedsuwan, Supalert; Moolphate, Saiyud; Fukuda, Hiroshi; Kitajima, Tsutomu; Minematsu, Kazuo; Tanimura, Susumu; Marui, Eiji

2016-01-01

This cross-sectional study (February 2012 to March 2013) was conducted to estimate daily salt intake and basic characteristics among 793 community-dwelling participants at high risk of cardiovascular disease (Framingham risk score >15%), who had visited diabetes or hypertension clinics at health centres in the Muang district, Chiang Rai, Thailand. We performed descriptive analysis of baseline data and used an automated analyser to estimate the average of 24-hour salt intake estimated from 3 days overnight urine collection. Participants were divided into two groups based on median estimated daily salt intake. Mean age and proportion of males were 65.2 years and 37.6% in the higher salt intake group (>=10.0 g/day, n=362), and 67.5 years and 42.7% in the lower salt intake group (<10.0 g/day, n=431), respectively (p=0.01, p<0.01). The higher salt intake group comprised more patients with a family history of hypertension, antihypertensive drug use, less ideal body mass index (18.5-24.9), higher exercise frequency (>=2 times weekly) and lower awareness of high salt intake. Among higher salt intake participants, those with lower awareness of high salt intake were younger and more often had a family history of hypertension, relative to those with more awareness. Our data indicated that families often share lifestyles involving high salt intake, and discrepancies between actual salt intake and awareness of high salt intake may represent a need for salt reduction intervention aiming at family level. Awareness of actual salt intake should be improved for each family.

Self-monitoring urinary salt excretion in adults: A novel education program for restricting dietary salt intake

PubMed Central

YASUTAKE, KENICHIRO; SAWANO, KAYOKO; YAMAGUCHI, SHOKO; SAKAI, HIROKO; AMADERA, HATSUMI; TSUCHIHASHI, TAKUYA

2011-01-01

This study aimed to examine the usefulness of the self-monitoring of urinary salt excretion for educating individuals about the risk of excessive dietary salt intake. The subjects were 30 volunteers (15 men and 15 women) not consuming anti-hypertensive medication. The subjects measured urinary salt excretion at home for 4 weeks using a self-monitoring device. Blood pressure (BP), anthropometric variables and nutritional variables (by a dietary-habits questionnaire) were measured before and after the measurement of urinary salt excretion. Statistical analyses were performed, including paired t-tests, Chi-square test, Pearson’s product moment correlation coefficient and multiple linear regression analysis. In all subjects, the average urinary salt excretion over 4 weeks was 8.05±1.61 g/day and the range (maximum-minimum value) was 5.58±2.15 g/day. Salt excretion decreased significantly in weeks 3 and 4 (P<0.05 and P<0.01, respectively). Diastolic BP decreased from 77.7±14.3 (at baseline) to 74.3±13.3 after 4 weeks (P<0.05), while systolic BP and anthropometric variables remained unchanged. Nutrition surveys indicated that energy intake was correlated with salt intake both before and after the measurements; changes in both variables during the observation period were correlated (r=0.40, P<0.05). The percentage of subjects who were aware of the restriction in dietary salt intake increased from 47 to 90%. In conclusion, daily monitoring of the amount of urinary salt excretion using a self-monitoring device appears to be an effective educational tool for improving the quality of life of healthy adults. PMID:22977549

Self-monitoring urinary salt excretion in adults: A novel education program for restricting dietary salt intake.

PubMed

Yasutake, Kenichiro; Sawano, Kayoko; Yamaguchi, Shoko; Sakai, Hiroko; Amadera, Hatsumi; Tsuchihashi, Takuya

2011-07-01

This study aimed to examine the usefulness of the self-monitoring of urinary salt excretion for educating individuals about the risk of excessive dietary salt intake. The subjects were 30 volunteers (15 men and 15 women) not consuming anti-hypertensive medication. The subjects measured urinary salt excretion at home for 4 weeks using a self-monitoring device. Blood pressure (BP), anthropometric variables and nutritional variables (by a dietary-habits questionnaire) were measured before and after the measurement of urinary salt excretion. Statistical analyses were performed, including paired t-tests, Chi-square test, Pearson's product moment correlation coefficient and multiple linear regression analysis. In all subjects, the average urinary salt excretion over 4 weeks was 8.05±1.61 g/day and the range (maximum-minimum value) was 5.58±2.15 g/day. Salt excretion decreased significantly in weeks 3 and 4 (P<0.05 and P<0.01, respectively). Diastolic BP decreased from 77.7±14.3 (at baseline) to 74.3±13.3 after 4 weeks (P<0.05), while systolic BP and anthropometric variables remained unchanged. Nutrition surveys indicated that energy intake was correlated with salt intake both before and after the measurements; changes in both variables during the observation period were correlated (r=0.40, P<0.05). The percentage of subjects who were aware of the restriction in dietary salt intake increased from 47 to 90%. In conclusion, daily monitoring of the amount of urinary salt excretion using a self-monitoring device appears to be an effective educational tool for improving the quality of life of healthy adults.

Flavanone Intake Is Inversely Associated with Risk of Incident Ischemic Stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study1234

PubMed Central

Goetz, Margarethe E; Judd, Suzanne E; Hartman, Terryl J; McClellan, William; Anderson, Aaron; Vaccarino, Viola

2016-01-01

Background: Flavonoids may have beneficial cerebrovascular effects, but evidence from racially and geographically representative cohorts in comprehensive flavonoid databases is lacking. Given racial and geographic disparities in stroke incidence, representative cohort studies are needed. Objectives: We evaluated the association between flavonoid intake and incident ischemic stroke in a biracial, national cohort using updated flavonoid composition tables and assessed differences in flavonoid intake by sex, race, and region of residence. Methods: We evaluated 20,024 participants in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a biracial prospective study. Participants with stroke history or missing dietary data were excluded. Flavonoid intake was estimated by using a Block98 food frequency questionnaire and the USDA’s Provisional Flavonoid Addendum and Proanthocyanidin Database. Associations between quintiles of flavonoid intake and incident ischemic stroke were evaluated by using Cox proportional hazards models, adjusting for confounders. Results: Over 6.5 y, 524 acute ischemic strokes occurred. Flavanone intake was lower in the Southeastern United States but higher in blacks than in whites. After multivariable adjustment, flavanone intake was inversely associated with incident ischemic stroke (HR: 0.72; 95% CI: 0.55, 0.95; P-trend = 0.03). Consumption of citrus fruits and juices was inversely associated with incident ischemic stroke (HR: 0.69; 95% CI: 0.53, 0.91; P-trend = 0.02). Total flavonoids and other flavonoid subclasses were not associated with incident ischemic stroke. There was no statistical interaction with sex, race, or region for any flavonoid measure. Conclusions: Greater consumption of flavanones, but not total or other flavonoid subclasses, was inversely associated with incident ischemic stroke. Associations did not differ by sex, race, or region for the association; however, regional differences in flavanone intake

Implementation Intentions on the Effect of Salt Intake among Hypertensive Women: A Pilot Study

PubMed Central

Cornélio, Marilia Estevam; Rodrigues, Roberta Cunha Matheus; Gallani, Maria-Cecilia

2014-01-01

This experimental study was aimed at assessing the potential effect of a theory-driven intervention—implementation intentions—on reducing salt intake among hypertensive Brazilian women. Ninety-eight participants were randomly assigned to participate in an implementation intentions intervention aimed at promoting lower salt intake through decreased addition of salt and salty spices to meals (intervention group, n = 49; group, n = 49). Endpoints were assessed at baseline and at the 2-month follow-up. Primary endpoints were a self-reporting measure of salt intake given by salt addition to meals (discretionary salt + salty spices = total added salt) and the 24 h urinary-sodium excretion. Secondary endpoints included intention, self-efficacy, and habit related to adding salt to meals. Patients in the intervention group showed a significant reduction in salt intake as assessed by 24 h urinary-sodium excretion. A significant reduction in the measure of habit was observed for both groups. No differences were observed for intention and self-efficacy. The results of this pilot study suggest the efficacy of planning strategies to help hypertensive women reduce their salt intake. PMID:25243084

The effect of social class on the amount of salt intake in patients with hypertension.

PubMed

Mazloomy Mahmoodabad, Seyed Saeed; Tehrani, Hadi; Gholian-Aval, Mahdi; Gholami, Hasan; Nematy, Mohsen

2016-12-01

Reducing salt intake is a factor related to life style which can influence the prevention of blood pressure. This study was conducted to assess the impact of social class on the amount of salt intake in patients with hypertension in Iran. This was an observational on the intake of salt, as estimated by Kawasaki formula in a sample from Iranian population, stratified for social background characteristics. The finding in general was that the estimated salt intake was somewhat higher in subjects from a lower social background, while the opposite was true for lipid levels (LDL and HDL cholesterol). There was also a significant correlation between salt intake and the level of systolic blood pressure, but not the level of diastolic blood pressure. Considering high salt intake (almost double the standard amount in Iran), especially in patients with low-social class and the effects of salt on human health, it is suggested to design and perform suitable educational programs based on theories and models of health education in order to reduce salt intake.

Salt taste preference, sodium intake and gastric cancer in China.

PubMed

Zhang, Zhiyong; Zhang, Xiefu

2011-01-01

The risk factors mostly strongly associated with gastric cancer are gastric bacteria Helicobacter pylori and diet. By using a case-control study among residents in China, we examined the association between sodium intake, presence of H,pylori, and gastric cancer risk. A population-based case-control study including 235 cases and 410 controls were used. Potential risk factors of gastric cancer were interview for cases and controls by questionnaire, salt taste preference was measured for all subjects, and IgG antibodies to H,pylori was used for H.pylori infection. Risk measures were calculated using unconditional logistic regression. H.pylori infection and smoking increased the risk of gastric cancer, with the OR(95%CI) of 1.91(1.32-2.79) and 1.47(1.05- 2.05), respectively. Dietary sodium intake independently increased the risk of gastric cancer. Participants with the highest sodium intake(>5g/day) had a high gastric cancer risk [OR(95%CI)= 3.78(1.74-5.44)]. Participants with the salt taste preference at 7.3g/L and ≥ 14.6g/L showed higher risk of gastric cancer [OR(95%) for 7.3g/L and ≥ 14.6g/L were 5.36(2.72-10.97) and 4.75(2.43-8.85), respectively]. A significantly interaction was found between salt taste preference and H.pylori infection (p=0.037). Salt taste preference was significantly correlated with sodium intake (Correlation coefficient=0.46, p< 0.001). Salt taste preference test could be a simple way to evaluate an inherited characteristic of sodium intake, and our study confirms the gastric cancer is associated with sodium intake and H.pylori.

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis.

PubMed

Choe, Hansaem; Hwang, Ji-Yun; Yun, Jin A; Kim, Ji-Myung; Song, Tae-Jin; Chang, Namsoo; Kim, Yong-Jae; Kim, Yuri

2016-10-01

This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B 6 , β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B 6 , B 12 , and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B 12 intake per 1,000 kcal differed according to the TOAST classification ( P = 0.004), but no differences among groups existed based on the post-hoc test. When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke.

Reducing the population's sodium intake: the UK Food Standards Agency's salt reduction programme.

PubMed

Wyness, Laura A; Butriss, Judith L; Stanner, Sara A

2012-02-01

To describe the UK Food Standards Agency's (FSA) salt reduction programme undertaken between 2003 and 2010 and to discuss its effectiveness. Relevant scientific papers, campaign materials and evaluations and consultation responses to the FSA's salt reduction programme were used. Adult salt intakes, monitored using urinary Na data collected from UK-wide surveys, indicate a statistically significant reduction in the population's average salt intake from 9·5 g/d in 2000-2001 to 8·6 g/d in 2008, which is likely to have health benefits. Reducing salt intake will have an impact on blood pressure; an estimated 6 % of deaths from CHD in the UK can be avoided if the number of people with high blood pressure is reduced by 50 %. Salt levels in food, monitored using commercial label data and information collected through an industry self-reporting framework, indicated that substantial reductions of up to 70 % in some foods had been achieved. The FSA's consumer campaign evaluation showed increased awareness of the benefits of reducing salt intake on health, with 43 % of adults in 2009 claiming to have made a special effort to reduce salt in their diet compared with 34 % of adults in 2004, before the campaign commenced. The UK's salt reduction programme successfully reduced the average salt intake of the population and increased consumers' awareness. Significant challenges remain in achieving the population average salt intake of 6 g/d recommended by the UK's Scientific Advisory Committee on Nutrition. However, the UK has demonstrated the success of its programme and this approach is now being implemented elsewhere in the world.

Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward.

PubMed

Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Nahoko; Nishimura, Hitoshi; Katsuki, Yasuo

2017-05-01

Percutaneous endoscopic gastrostomy may be performed in dysphagic stroke patients. However, some patients regain complete oral intake without gastrostomy. This study aimed to investigate the predictive factors of intake, thereby determining gastrostomy indications. Stroke survivors admitted to our convalescent rehabilitation ward who underwent gastrostomy or nasogastric tube placement from 2009 to 2015 were divided into 2 groups based on intake status at discharge. Demographic data and Functional Independence Measure (FIM), Dysphagia Severity Scale (DSS), National Institutes of Health Stroke Scale, and Glasgow Coma Scale (GCS) scores on admission were compared between groups. We evaluated the factors predicting intake using a stepwise logistic regression analysis. Thirty-four patients recovered intake, whereas 38 achieved incomplete intake. Mean age was lower, mean body mass index (BMI) was higher, and mean time from stroke onset to admission was shorter in the complete intake group. The complete intake group had less impairment in terms of GCS, FIM, and DSS scores. In the stepwise logistic regression analysis, BMI, FIM-cognitive score, and DSS score were significant independent factors predicting intake. The formula of BMI × .26 + FIM cognitive score × .19 + DSS score × 1.60 predicted recovery of complete intake with a sensitivity of 88.2% and a specificity of 84.2%. Stroke survivors with dysphagia with a high BMI and FIM-cognitive and DSS scores tended to recover oral intake. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Elaboration of garlic and salt spice with reduced sodium intake.

PubMed

Rodrigues, Jéssica F; Junqueira, Gabriela; Gonçalves, Carla S; Carneiro, João D S; Pinheiro, Ana Carla M; Nunes, Cleiton A

2014-12-01

Garlic and salt spice is widely used in Brazilian cookery, but it has a high sodium content; as high sodium intake has been strongly correlated to the incidence of chronic diseases. This study aimed to develop a garlic and salt spice with reduced sodium intake. Sensory evaluation was conducted by applying the spices to cooked rice. First, the optimal concentration of spice added during rice preparation was determined. Subsequently, seasonings (3:1) were prepared containing 0%, 50% and 25% less NaCl using a mixture of salts consisting of KCl and monosodium glutamate; a seasoning with a 0% NaCl reduction was established as a control. Three formulations of rice with different spices were assessed according to sensory testing acceptance, time-intensity and temporal domain of sensations. The proportions of salts used in the garlic and salt spice did not generate a strange or bad taste in the products; instead, the mixtures were less salty. However, the seasonings with lower sodium levels (F2 and F3) were better accepted in comparison to the traditional seasoning (F1). Therefore, a mixture of NaCl, KCl and monosodium glutamate is a viable alternative to develop a garlic and salt spice with reduced sodium intake.

Intakes of magnesium, potassium, and calcium and the risk of stroke among men.

PubMed

Adebamowo, Sally N; Spiegelman, Donna; Flint, Alan J; Willett, Walter C; Rexrode, Kathryn M

2015-10-01

Intakes of magnesium, potassium, and calcium have been inversely associated with the incidence of hypertension, a known risk factor for stroke. However, only a few studies have examined intakes of these cations in relation to risk of stroke. The aim of this study was to investigate whether high intake of magnesium, potassium, and calcium is associated with reduced stroke risk among men. We prospectively examined the associations between intakes of magnesium, potassium, and calcium from diet and supplements, and the risk of incident stroke among 42 669 men in the Health Professionals Follow-up Study, aged 40 to 75 years and free of diagnosed cardiovascular disease and cancer at baseline in 1986. We calculated the hazard ratio of total, ischemic, and haemorrhagic strokes by quintiles of each cation intake, and of a combined dietary score of all three cations, using multivariate Cox proportional hazard models. During 24 years of follow-up, 1547 total stroke events were documented. In multivariate analyses, the relative risks and 95% confidence intervals of total stroke for men in the highest vs. lowest quintile were 0·87 (95% confidence interval, 0·74-1·02; P, trend = 0·04) for dietary magnesium, 0·89 (95% confidence interval, 0·76-1·05; P, trend = 0·10) for dietary potassium, and 0·89 (95% confidence interval, 0·75-1·04; P, trend = 0·25) for dietary calcium intake. The relative risk of total stroke for men in the highest vs. lowest quintile was 0·74 (95% confidence interval, 0·59-0·93; P, trend = 0·003) for supplemental magnesium, 0·66 (95% confidence interval, 0·50-0·86; P, trend = 0·002) for supplemental potassium, and 1·01 (95% confidence interval, 0·84-1·20; P, trend = 0·83) for supplemental calcium intake. For total intake (dietary and supplemental), the relative risk of total stroke for men in the highest vs. lowest quintile was 0·83 (95% confidence interval, 0·70-0·99; P, trend = 0·04) for magnesium, 0�

Intake of antioxidants and B vitamins is inversely associated with ischemic stroke and cerebral atherosclerosis

PubMed Central

Choe, Hansaem; Hwang, Ji-Yun; Yun, Jin A; Kim, Ji-Myung; Song, Tae-Jin; Chang, Namsoo; Kim, Yong-Jae

2016-01-01

BACKGROUND/OBJECTIVES This study was conducted to examine relationships between dietary habits and intakes of antioxidants and B vitamins and the risk of ischemic stroke, and to compare dietary factors according to the presence of cerebral artery atherosclerosis and stroke subtypes. SUBJECTS/METHODS A total of 147 patients and 144 control subjects were recruited consecutively in the metropolitan area of Seoul, Korea. Sixty participants each in the case and control groups were included in analyses after 1:1 frequency matching. In addition, 117 acute ischemic stroke patients were classified into subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) guidelines. Dietary intake was measured using a semi-quantitative food frequency questionnaire composed of 111 food items and plasma lipid and homocysteine levels were analyzed. RESULTS When compared with control subjects, stroke patients had unfavorable dietary behaviors and lower intakes of fruits (73.1 ± 83.2 g vs. 230.9 ± 202.1 g, P < 0.001), vegetables (221.1 ± 209.0 g vs. 561.7 ± 306.6 g, P < 0.001), and antioxidants, including vitamins C, E, B6, β-carotene, and folate. The intakes of fruits, vegetables, vitamin C, and folate were inversely associated with the risk of ischemic stroke after adjusting for confounding factors. Intakes of vegetables, vitamins C, B6, B12, and folate per 1,000 kcal were lower in ischemic stroke with cerebral atherosclerosis than in those without. Overall vitamin B12 intake per 1,000 kcal differed according to the TOAST classification (P = 0.004), but no differences among groups existed based on the post-hoc test. CONCLUSIONS When compared with control subjects, ischemic stroke patients, particularly those with cerebral atherosclerosis, had unfavorable dietary intake, which may have contributed to the development of ischemic stroke. These results indicate that proper dietary recommendations are important for the prevention of ischemic stroke. PMID:27698959

Explaining variability in sodium intake through oral sensory phenotype, salt sensation and liking

PubMed Central

Hayes, John E.; Sullivan, Bridget S.; Duffy, Valerie B.

2010-01-01

Our sodium-rich food supply compels investigation of how variation in salt sensation influences liking and intake of high-sodium foods. While supertasters (those with heightened propylthiouracil (PROP) bitterness or taste papillae number) report greater saltiness from concentrated salt solutions, the non-taster/supertaster effect on sodium intake is unclear. We assessed taster effects on salt sensation, liking and intake among 87 healthy adults (45 men). PROP bitterness showed stronger associations with perceived saltiness in foods than did papillae number. Supertasters reported: greater saltiness in chips/pretzels and broth at levels comparable to regular-sodium products; greater sensory and/or liking changes to growing sodium concentration in cheeses (where sodium ions mask bitterness) and broths; and less frequently salting foods. PROP effects were attenuated in women. Compared with men, women reported more saltiness from high-sodium foods and greater liking for broth at salt levels comparable to regular-sodium products. Across men and women, Structural Equation Models showed PROP and papillae number independently explained variability in consuming high-sodium foods by impacting salt sensation and/or liking. PROP supertasters reported greater changes in sensation when more salt was added to broth, which then associated with greater changes in broth liking, and finally with more frequent high-sodium food intake. Greater papillae number was associated with less frequent high-sodium food intake via reduced liking for high-fat/high-sodium foods. In summary, variation in sensations from salt was associated with differences in hedonic responses to high-sodium foods and thus sodium intake. Despite adding less salt, PROP supertasters consumed more sodium through food, as salt was more important to preference, both for its salty taste and masking of bitterness. PMID:20380843

Dietary intakes of glutamic acid and glycine are associated with stroke mortality in Japanese adults.

PubMed

Nagata, Chisato; Wada, Keiko; Tamura, Takashi; Kawachi, Toshiaki; Konishi, Kie; Tsuji, Michiko; Nakamura, Kozue

2015-04-01

Dietary intakes of glutamic acid and glycine have been reported to be associated with blood pressure. However, the link between intakes of these amino acids and stroke has not been studied. We aimed to examine the association between glutamic acid and glycine intakes and the risk of mortality from stroke in a population-based cohort study in Japan. The analyses included 29,079 residents (13,355 men and 15,724 women) of Takayama City, Japan, who were aged 35-101 y and enrolled in 1992. Their body mass index ranged from 9.9 to 57.4 kg/m(2). Their diets were assessed by a validated food frequency questionnaire. Deaths from stroke were ascertained over 16 y. During follow-up, 677 deaths from stroke (328 men and 349 women) were identified. A high intake of glutamic acid in terms of a percentage of total protein was significantly associated with a decreased risk of mortality from total stroke in women after controlling for covariates; the HR (95% CI) for the highest vs. lowest quartile was 0.72 (0.53, 0.98; P-trend: 0.03). Glycine intake was significantly associated with an increased risk of mortality from total and ischemic stroke in men without history of hypertension at baseline; the HRs (95% CIs) for the highest vs. lowest tertile were 1.60 (0.97, 2.51; P-trend: 0.03) and 1.88 (1.01, 3.52; P-trend: 0.02), respectively. There was no association between animal or vegetable protein intake and mortality from total and any subtype of stroke. The data suggest that glutamic acid and glycine intakes may be associated with risk of stroke mortality. Given that this is an initial observation, our results need to be confirmed. © 2015 American Society for Nutrition.

An overview of salt intake reduction efforts in the Gulf Cooperation Council countries.

PubMed

Alhamad, Nawal; Almalt, Elsayed; Alamir, Najeeba; Subhakaran, Monica

2015-06-01

Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts vary in the GCC region, from achieving 20% salt reduction in bread, to the very early stages of planning.

An overview of salt intake reduction efforts in the Gulf Cooperation Council countries

PubMed Central

Almalt, Elsayed; Alamir, Najeeba; Subhakaran, Monica

2015-01-01

Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts vary in the GCC region, from achieving 20% salt reduction in bread, to the very early stages of planning. PMID:26090327

Effect of salt intensity in soup on ad libitum intake and on subsequent food choice.

PubMed

Bolhuis, Dieuwerke P; Lakemond, Catriona M M; de Wijk, Rene A; Luning, Pieternel A; de Graaf, Cees

2012-02-01

The effect of salt intensity on ad libitum intake of tomato soup was investigated when soup was served as a first course and as a second course. Also the effect of salt intensity in soup on subsequent sweet vs. savory choice of sandwich fillings was investigated. Forty-three healthy subjects consumed ad libitum a low-salt (LS), ideal-salt (IS) and high-salt (HS) tomato soup in both meal settings. The salt concentrations were selected on an individual basis, in a way that IS was most pleasant and LS and HS were similar in pleasantness. The ad libitum intake of IS soup was higher than that of LS and HS soup, and the ad libitum intake of LS soup was higher than that of HS soup. The meal setting, soup as a first or as a second course, did not affect ad libitum intake. Salt intensity in soup did not predict sweet vs. savory choice of fillings in grams or energy, although most sodium from fillings was consumed after intake of HS soup. In conclusion, a higher salt intensity lead to lower ad libitum intake of soup similar in palatability (LS vs. HS). In addition, salt intensity in soup does not predict sweet vs. savory food choice. Copyright © 2011 Elsevier Ltd. All rights reserved.

Recent changes in salt use and stroke mortality in England and Wales. Any help for the salt-hypertension debate?

PubMed Central

Cummins, R O

1983-01-01

This analysis attempts to fill the gap in the epidemiological evidence about the relation between dietary salt and hypertension. Changes in the purchase of salt in England and Wales are compared with changes in mortality from cerebrovascular disease (1958-78). Stroke mortality, a major sequel of hypertension, has declined in this period. Consumer purchases of salt have decreased also, as suggested by the National Food Survey. While these trends are consistent with the salt-hypertension hypothesis, the picture is confused by an increase in meals eaten outside the home, by the consumption of more processed food, and by a higher prevalence of refrigerators. Other events, such as medical treatment of hypertension or changes in the case fatality rate, could have contributed to the decline in stroke mortality. This secular trend analysis, using available data, does not clarify the salt-hypertension debate. PMID:6875440

Salt intakes around the world: implications for public health.

PubMed

Brown, Ian J; Tzoulaki, Ioanna; Candeias, Vanessa; Elliott, Paul

2009-06-01

High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption. Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data. Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources. Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide

Determination of discretionary salt intake in rural Guatemala and Benin to determine the iodine fortification of salt required to control iodine deficiency disorders: studies using lithium-labeled salt.

PubMed

Melse-Boonstra, A; Rozendaal, M; Rexwinkel, H; Gerichhausen, M J; van den Briel, T; Bulux, J; Solomons, N W; West, C E

1998-09-01

The use of discretionary salt, which is salt added during cooking and at the table, as a suitable vehicle for iodine intake was assessed by measuring salt consumption using the lithium-marker technique in rural areas of Guatemala and Benin. In both countries, we studied boys aged 6-12 y and their mothers. Subjects used lithium-labeled salt after all unlabeled salt was removed from their households. In Guatemala, 24-h urine samples for 9 mother-son pairs were collected at baseline and on days 7, 8, and 9 during the use of lithium-labeled salt. Total maternal salt intake averaged 5.2 +/- 1.7 g/d (mean +/- SD), of which 77 +/- 24% came from discretionary sources, whereas Guatemalan boys consumed 1.8 +/- 0.6 g salt/d, of which 72 +/- 12% came from discretionary sources. In Benin, urine collection from 13 mother-son pairs took place at baseline and on days 5 and 7. Beninese mothers had a total salt intake of 9.0 +/- 2.9 g/d and their sons had an intake of 5.7 +/- 2.8 g/d; discretionary salt contributed 52 +/- 14% and 50 +/- 13%, respectively, of total salt consumed. Therefore, fortification of household salt appears to be an appropriate method of controlling iodine deficiency in both countries, although fortification of other salt sources could be considered in Benin.

Estimating population salt intake in India using spot urine samples.

PubMed

Petersen, Kristina S; Johnson, Claire; Mohan, Sailesh; Rogers, Kris; Shivashankar, Roopa; Thout, Sudhir Raj; Gupta, Priti; He, Feng J; MacGregor, Graham A; Webster, Jacqui; Santos, Joseph Alvin; Krishnan, Anand; Maulik, Pallab K; Reddy, K Srinath; Gupta, Ruby; Prabhakaran, Dorairaj; Neal, Bruce

2017-11-01

To compare estimates of mean population salt intake in North and South India derived from spot urine samples versus 24-h urine collections. In a cross-sectional survey, participants were sampled from slum, urban and rural communities in North and in South India. Participants provided 24-h urine collections, and random morning spot urine samples. Salt intake was estimated from the spot urine samples using a series of established estimating equations. Salt intake data from the 24-h urine collections and spot urine equations were weighted to provide estimates of salt intake for Delhi and Haryana, and Andhra Pradesh. A total of 957 individuals provided a complete 24-h urine collection and a spot urine sample. Weighted mean salt intake based on the 24-h urine collection, was 8.59 (95% confidence interval 7.73-9.45) and 9.46 g/day (8.95-9.96) in Delhi and Haryana, and Andhra Pradesh, respectively. Corresponding estimates based on the Tanaka equation [9.04 (8.63-9.45) and 9.79 g/day (9.62-9.96) for Delhi and Haryana, and Andhra Pradesh, respectively], the Mage equation [8.80 (7.67-9.94) and 10.19 g/day (95% CI 9.59-10.79)], the INTERSALT equation [7.99 (7.61-8.37) and 8.64 g/day (8.04-9.23)] and the INTERSALT equation with potassium [8.13 (7.74-8.52) and 8.81 g/day (8.16-9.46)] were all within 1 g/day of the estimate based upon 24-h collections. For the Toft equation, estimates were 1-2 g/day higher [9.94 (9.24-10.64) and 10.69 g/day (9.44-11.93)] and for the Kawasaki equation they were 3-4 g/day higher [12.14 (11.30-12.97) and 13.64 g/day (13.15-14.12)]. In urban and rural areas in North and South India, most spot urine-based equations provided reasonable estimates of mean population salt intake. Equations that did not provide good estimates may have failed because specimen collection was not aligned with the original method.

Enjoyment of Spicy Flavor Enhances Central Salty-Taste Perception and Reduces Salt Intake and Blood Pressure.

PubMed

Li, Qiang; Cui, Yuanting; Jin, Rongbing; Lang, Hongmei; Yu, Hao; Sun, Fang; He, Chengkang; Ma, Tianyi; Li, Yingsha; Zhou, Xunmei; Liu, Daoyan; Jia, Hongbo; Chen, Xiaowei; Zhu, Zhiming

2017-12-01

High salt intake is a major risk factor for hypertension and is associated with cardiovascular events. Most countries exhibit a traditionally high salt intake; thus, identification of an optimal strategy for salt reduction at the population level may have a major impact on public health. In this multicenter, random-order, double-blind observational and interventional study, subjects with a high spice preference had a lower salt intake and blood pressure than subjects who disliked spicy food. The enjoyment of spicy flavor enhanced salt sensitivity and reduced salt preference. Salt intake and salt preference were related to the regional metabolic activity in the insula and orbitofrontal cortex (OFC) of participants. Administration of capsaicin-the major spicy component of chili pepper-enhanced the insula and OFC metabolic activity in response to high-salt stimuli, which reversed the salt intensity-dependent differences in the metabolism of the insula and OFC. In animal study, OFC activity was closely associated with salt preference, and salty-taste information processed in the OFC was affected in the presence of capsaicin. Thus, interventions related to this region may alter the salt preference in mice through fiber fluorometry and optogenetic techniques. In conclusion, enjoyment of spicy foods may significantly reduce individual salt preference, daily salt intake, and blood pressure by modifying the neural processing of salty taste in the brain. Application of spicy flavor may be a promising behavioral intervention for reducing high salt intake and blood pressure. © 2017 American Heart Association, Inc.

Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study.

PubMed

Millett, Christopher; Laverty, Anthony A; Stylianou, Neophytos; Bibbins-Domingo, Kirsten; Pape, Utz J

2012-01-01

The UK introduced an ambitious national strategy to reduce population levels of salt intake in 2003. The aim of this study was to evaluate the impact of this strategy on salt intake in England, including potential effects on health inequalities. Secondary analysis of data from the Health Survey for England. Our main outcome measure was trends in estimated daily salt intake from 2003-2007, as measured by spot urine. Secondary outcome measures were knowledge of government guidance and voluntary use of salt in food preparation over this time period. There were significant reductions in salt intake between 2003 and 2007 (-0.175 grams per day per year, p<0.001). Intake decreased uniformly across all other groups but remained significantly higher in younger persons, men, ethnic minorities and lower social class groups and those without hypertension in 2007. Awareness of government guidance on salt use was lowest in those groups with the highest intake (semi-skilled manual v professional; 64.9% v 71.0% AOR 0.76 95% CI 0.58-0.99). Self reported use of salt added at the table reduced significantly during the study period (56.5% to 40.2% p<0.001). Respondents from ethnic minority groups remained significantly more likely to add salt during cooking (white 42.8%, black 74.1%, south Asian 88.3%) and those from lower social class groups (unskilled manual 46.6%, professional 35.2%) were more likely to add salt at the table. The introduction a national salt reduction strategy was associated with uniform but modest reductions in salt intake in England, although it is not clear precisely which aspects of the strategy contributed to this. Knowledge of government guidance was lower and voluntary salt use and total salt intake was higher among occupational and ethnic groups at greatest risk of cardiovascular disease.

Secular trends in salt and soy sauce intake among Chinese adults, 1997-2011.

PubMed

Yu, Lianlong; Li, Suyun; Zhao, Jinshan; Zhang, Junli; Wang, Liansen; Wang, Kebo

2018-03-01

Salt and soy sauce are the main ways of sodium intake in Chinese dietary. In this study, we used the data of the China Health and Nutrition Surveys to describe the secular trends of salt and soy sauce intake among Chinese adults from 1997 to 2011. Trends were tested by multiple linear regression models. During the past 14 years, the consumption of sodium, salt and soy sauce intake values decreased significantly across the six study periods (p < .0001) among both men and women. Averaged salt values decreased by 4.9 g/d in men and 4.1 g/d in women. Mean soy sauce intake values decreased by 9.0 g/d among men and 7.3 g/d among women. Similar significant trends were observed in all age groups, activity levels and regions (p < .0001).

Dietary flavonoid intake and the risk of stroke: a dose-response meta-analysis of prospective cohort studies

PubMed Central

Tang, Zhenyu; Li, Min; Zhang, Xiaowei; Hou, Wenshang

2016-01-01

Objective To clarify and quantify the potential association between intake of flavonoids and risk of stroke. Design Meta-analysis of prospective cohort studies. Data source Studies published before January 2016 identified through electronic searches using PubMed, Embase and the Cochrane Library. Eligibility criteria for selecting studies Prospective cohort studies with relative risks and 95% CIs for stroke according to intake of flavonoids (assessed as dietary intake). Results The meta-analysis yielded 11 prospective cohort studies involving 356 627 participants and more than 5154 stroke cases. The pooled estimate of the multivariate relative risk of stroke for the highest compared with the lowest dietary flavonoid intake was 0.89 (95% CI 0.82 to 0.97; p=0.006). Dose-response analysis indicated that the summary relative risk of stroke for an increase of 100 mg flavonoids consumed per day was 0.91 (95% CI 0.77 to 1.08) without heterogeneity among studies (I2=0%). Stratifying by follow-up duration, the relative risk of stroke for flavonoid intake was 0.89 (95% CI 0.81 to 0.99) in studies with more than 10 years of follow-up. Conclusions Results from this meta-analysis suggest that higher dietary flavonoid intake may moderately lower the risk of stroke. PMID:27279473

[How does salt intake influence blood pressure? Associated aetiopathogenic mechanisms].

PubMed

Fernández-Llama, P; Calero, F

2017-12-15

Abundant evidence from epidemiological and experimental studies has established a link between salt and blood pressure. However, there is heterogeneity in the blood pressure responses of humans to changes in sodium intake. Those individuals in whom a severe, abrupt change in salt intake causes the least change in arterial pressure and are termed salt-resistant, whereas in those in whom this leads to large changes in blood pressure, are called salt sensitive. Classically, Guyton's theory of the pressure-natriuresis phenomenon has been accepted to explain the pressor effect of salt, as well as the fundamental role played by the different protein sodium transporters of the renal tubules. In recent years, new theories have emerged pointing to the possible role of the immune system and the existence of a third sodium store in the body as aetiopathogenic factors. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women's Cohort Study.

PubMed

Threapleton, D E; Burley, V J; Greenwood, D C; Cade, J E

2015-04-01

Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types. A total of 27,373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake. A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6 g/day total fibre intake was 0.89 (95% confidence intervals: 0.81-0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk. Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.

Increased salt intake during early ontogenesis lead to development of arterial hypertension in salt-resistant Wistar rats.

PubMed

Svitok, Pavel; Molcan, Lubos; Vesela, Anna; Kruzliak, Peter; Moravcik, Roman; Zeman, Michal

2015-01-01

A direct relationship exists between salt consumption and hypertension. Increased sodium intake does not automatically lead to a rise in blood pressure (BP) because of marked intra-individual variability in salt sensitivity. Wistar rats are a salt-resistant strain and increased salt intake in adults does not induce hypertension. Mechanisms regulating BP develop during early ontogenesis and increased sodium consumption by pregnant females leads to an increase in BP of their offspring, but early postnatal stages have not been sufficiently analyzed in salt-resistant strains of rats. The aim of this work was to study the effects of increased salt during early ontogeny on cardiovascular characteristics of Wistar rats. We used 16 control (C; 8 males + 8 females) rats fed with a standard diet (0.2% sodium) and 16 experimental (S; 8 males + 8 females) rats fed with a diet containing 0.8% sodium. BP was measured weekly and plasma renin activity, aldosterone and testosterone concentrations were assayed by radioimmunoassay after the experiment in 16-week-old animals. In the kidney, AT1 receptors were determined by the western blot. BP was higher in the S as compared with the C rats and did not differ between males and females. The relative left ventricle mass was increased in S as compared with C males and no differences were recorded in females. No significant differences between groups were found in hormonal parameters and AT1 receptors. Results indicate that moderately increased salt intake during postnatal ontogeny results in a BP rise even in salt-resistant rats.

Salt intake during pregnancy alters offspring's myocardial structure.

PubMed

Alves-Rodrigues, E N; Veras, M M; Rosa, K T; de Castro, I; Furukawa, L N S; Oliveira, I B; Souza, R M; Heimann, J C

2013-05-01

To evaluate the effects of low or high salt intake during pregnancy on left ventricle of adult male offspring. Low- (LS, 0.15%), normal- (NS, 1.3%) or high-salt (HS, 8% NaCl) diet was given to Wistar rats during pregnancy. During lactation all dams received NS as well as the offspring after weaning. To evaluate cardiac response to salt overload, 50% of each offspring group was fed a high-salt (hs, 4% NaCl) diet from the 21st to the 36th week of age (LShs, NShs, HShs). The remaining 50% was maintained on NS (LSns, NSns and HSns). Echocardiography was done at 20 and 30 weeks of age. Mean blood pressure (MBP), histology and left ventricular angiotensin II content (AII) were analyzed at 36 weeks of age. Interventricular septum, left ventricular posterior wall and relative wall thickness increased from the 20th to the 30th week of age only in HShs, cardiomyocyte mean volume was higher in HShs compared to NShs, LShs and HSns. AII and left ventricular fibrosis were not different among groups. HS during pregnancy programs adult male offspring to a blood pressure and angiotensin II independent concentric left ventricular hypertrophy, with no fibrosis, in response to a chronic high-salt intake. Copyright © 2011 Elsevier B.V. All rights reserved.

Direct renal effects of a fructose-enriched diet: interaction with high salt intake

PubMed Central

Ares, Gustavo R.

2015-01-01

Consumption of fructose has increased during the last 50 years. Excessive fructose consumption has a detrimental effect on mammalian health but the mechanisms remain unclear. In humans, a direct relationship exists between dietary intake of added sugars and increased risk for cardiovascular disease mortality (52). While the causes for this are unclear, we recently showed that fructose provided in the drinking water induces a salt-dependent increase in blood pressure in Sprague-Dawley rats in a matter of days (6). However, little is known about the effects of fructose in renal salt handling and whether combined intake of high fructose and salt can lead to salt-sensitive hypertension before the development of metabolic abnormalities. The long-term (more than 4 wk) adverse effects of fructose intake on renal function are not just due to fructose but are also secondary to alterations in metabolism which may have an impact on renal function. This minireview focuses on the acute effect of fructose intake and its effect on salt regulation, as they affect blood pressure. PMID:26447210

Regulation of Renin Secretion and Arterial Pressure During Prolonged Baroreflex Activation: Influence of Salt Intake

PubMed Central

Hildebrandt, Drew A.; Irwin, Eric D.; Cates, Adam W.; Lohmeier, Thomas E.

2014-01-01

Chronic electrical activation of the carotid baroreflex produces sustained reductions in sympathetic activity and arterial pressure and is currently being evaluated as antihypertensive therapy for patients with resistant hypertension. However, the influence of variations in salt intake on blood pressure lowering during baroreflex activation has not been determined. As sensitivity of arterial pressure to salt intake is linked to the responsiveness of renin secretion, we determined steady-state levels of arterial pressure and neurohormonal responses in 6 dogs on low, normal, and high salt intakes ( 5, 40, 450 mmol/day, respectively) under control conditions and during a 7-day constant level of baroreflex activation. Under control conditions, there was no difference in mean arterial pressure at low (92±1) and normal (92±2 mmHg) sodium intakes, but pressure increased 9 ±2 mmHg during high salt. Plasma renin activity (2.01±0.23, 0.93±0.20, 0.01±0.01 ng ANGI/mL/hr) and plasma aldosterone (10.3±1.9, 3.5±0.5, 1.7±0.1ng/dL) were inversely related to salt intake, whereas there were no changes in plasma norepinephrine. Although mean arterial pressure (19-22 mmHg) and norepinephrine (20-40%) were lower at all salt intakes during baroreflex activation, neither the changes in pressure nor the absolute values for plasma renin activity or aldosterone in response to salt were different from control conditions. These findings demonstrate that suppression of sympathetic activity by baroreflex activation lowers arterial pressure without increasing renin release and indicate that changes in sympathetic activity are not primary mediators of the effect of salt on renin secretion. Consequently, blood pressure lowering during baroreflex activation is independent of salt intake. PMID:24935941

Potassium intake and risk of stroke in women with hypertension and nonhypertension in the Women's Health Initiative.

PubMed

Seth, Arjun; Mossavar-Rahmani, Yasmin; Kamensky, Victor; Silver, Brian; Lakshminarayan, Kamakshi; Prentice, Ross; Van Horn, Linda; Wassertheil-Smoller, Sylvia

2014-10-01

Dietary potassium has been associated with lower risk of stroke, but there are little data on dietary potassium effects on different stroke subtypes or in older women with hypertension and nonhypertension. The study population consisted of 90 137 postmenopausal women aged 50 to 79 at enrollment, free of stroke history at baseline, followed up prospectively for an average of 11 years. Outcome variables were total, ischemic, and hemorrhagic stroke, and all-cause mortality. Incidence was compared across quartiles of dietary potassium intake, and hazard ratios were obtained from Cox proportional hazards models after adjusting for potential confounding variables, and in women with hypertension and nonhypertension separately. Mean dietary potassium intake was 2611 mg/d. Highest quartile of potassium intake was associated with lower incidence of ischemic and hemorrhagic stroke and total mortality. Multivariate analyses comparing highest to lowest quartile of potassium intake indicated a hazard ratio of 0.90 (95% confidence interval, 0.85-0.95) for all-cause mortality, 0.88 (95% confidence interval, 0.79-0.98) for all stroke, and 0.84 (95% confidence interval, 0.74-0.96) for ischemic stroke. The effect on ischemic stroke was more apparent in women with nonhypertension among whom there was a 27% lower risk with hazard ratio of 0.73 (95% confidence interval, 0.60-0.88), interaction P<0.10. There was no association with hemorrhagic stroke. High potassium intake is associated with a lower risk of all stroke and ischemic stroke, as well as all-cause mortality in older women, particularly those who are not hypertensive. © 2014 American Heart Association, Inc.

Risk factors of hemorrhagic and ischemic stroke among hospitalized patients in Bangladesh--A case control study.

PubMed

Riaz, B K; Chowdhury, S H; Karim, M N; Feroz, S; Selim, S; Rahman, M R

2015-04-01

The risk factor profiles, management and outcome have significant difference between stroke subsets. Aim of this study was to investigate the risk for the two most common subtypes of stroke in Bangladeshi population. Seventy cases of hemorrhagic stroke (HS) and 105 cases of confirmed ischemic stroke (IS) were recruited from the Shaheed Suhrawardy Medical College Hospital (ShSMCH) and Dhaka Medical College Hospital between January-June 2011. Total 171 age, sex matched controls were selected from the hospitalized patients with history of no stroke ever. Average hemorrhagic stroke patients (60.4 ± 12.3 years) were younger than both ischemic strokes (63.5 ± 13 years). Family history of premature cardiovascular death was found more in HS patients (p = 0.001). Multivariate logistic regression showed, in IS model 'less fruit consumption (OR 4.6), table salt intake (OR 8.15), psychosocial stress (OR 3.5), abnormal ECG (OR 3.6) and Increased WHR (OR 6.9) appeared as significant predictors adjusted for all potential candidate confounders. In HS model less fruit consumption (OR 5.0), table salt intake (OR 9.9), Stress (OR 4.1), family history of cardiovascular disease (CVD) death (OR 11.3), hypertension (OR 43), aspirin intake (OR 4.5) and increased WHR (OR 3.7) remained as significant predictors.

Self-reported Slower Eating Is Associated with a Lower Salt Intake: A Population-based Cross-sectional Study.

PubMed

Wakasugi, Minako; James Kazama, Junichiro; Narita, Ichiei

2018-06-01

Objective Evidence suggests that the eating rate is positively associated with the body weight and blood pressure. Furthermore, people who are overweight or obese tend to have higher salt intakes than those of normal weight. To investigate whether or not the eating rate is also associated with the salt intake, a cross-sectional study was conducted using health examination survey data collected in 2014 from 7,941 residents of Sado City, Niigata, Japan. Methods The eating rates were evaluated using a questionnaire; 11.7% of participants rated themselves as slow eaters, 65.6% as normal eaters, and 22.7% as fast eaters. The salt intake was estimated from sodium and creatinine spot urine measurements using Tanaka's formula. Associations with eating rate were evaluated using multivariate linear regression analyses, with normal eaters as the reference (set at 0). Results Self-reported eating rates were positively associated with the salt intake after adjustment for age and sex [β coefficient (95% confidence interval) for slow -0.51 (-0.67, -0.35); fast 0.18 (0.05, 0.30) ]. Further adjustment for the body mass index showed that slower eaters had lower salt intakes than normal eaters, but there was no marked difference in the salt intake between normal and fast eaters. The association between slower eating and a lower salt intake persisted after further adjustment for comorbidities [slow -0.33 (-0.49, -0.18) ]. Conclusion Our results suggest that reducing eating rates may be an effective strategy for reducing dietary salt intake as well as preventing obesity.

Comparison of three methods for estimating daily individual discretionary salt intake: 24 hour recall, duplicate-portion method, and urinary lithium-labelled household salt excretion.

PubMed

Melse-Boonstra, A; Rexwinkel, H; Bulux, J; Solomons, N W; West, C E

1999-04-01

To compare methods for estimating discretionary salt intake, that is, salt added during food preparation and consumption in the home. The study was carried out in a rural Guatemalan village. Subjects were selected non-randomly, based on their willingness to cooperate. Nine mother-son dyads participated; the sons were aged 6-9 y. Three approaches for estimating the discretionary salt consumption were used: 24 h recall; collection of duplicate portions of salt; and urinary excretion of lithium during consumption of lithium-labelled household salt. Total salt intake was assessed from the excretion of chloride over 24 h. The mean discretionary salt consumption based on lithium excretion for mothers was 3.9+/-2.0 g/d (mean +/- s.d.) and for children 1.3+/-0.6 g/d. Estimates from the 24 h recalls and from the duplicate portion method were approximately twice and three times those measured with the lithium-marker technique respectively. The salt intake estimated from the recall method was associated with the lithium-marker technique for both mothers and children (Spearman correlation coefficient, 0.76 and 0.70 respectively). The mean daily coefficient of variation in consumption of discretionary salt measured by the three methods, for mothers and boys respectively, were: lithium marker, 51.7 and 43.7%; 24 h recall, 65.8 and 50.7%; and duplicate portion, 51.0 and 62.6%. We conclude that an interview method for estimating discretionary salt intake may be a reasonable approach for determining the relative rank-order in a population, especially among female food preparers themselves, but may grossly overestimate the actual intake of salt added during food preparation and consumption.

Intake flow modeling in a four stroke diesel using KIVA3

NASA Technical Reports Server (NTRS)

Hessel, R. P.; Rutland, C. J.

1993-01-01

Intake flow for a dual intake valved diesel engine is modeled using moving valves and realistic geometries. The objectives are to obtain accurate initial conditions for combustion calculations and to provide a tool for studying intake processes. Global simulation parameters are compared with experimental results and show good agreement. The intake process shows a 30 percent difference in mass flows and average swirl in opposite directions across the two intake valves. The effect of the intake process on the flow field at the end of compression is examined. Modeling the intake flow results in swirl and turbulence characteristics that are quite different from those obtained by conventional methods in which compression stroke initial conditions are assumed.

Potassium intake and risk of stroke in hypertensive and non-hypertensive women in the Women’s Health Initiative

PubMed Central

Seth, Arjun; Mossavar-Rahmani, Yasmin; Kamensky, Victor; Silver, Brian; Lakshminarayan, Kamakshi; Prentice, Ross; Van Horn, Linda; Wassertheil-Smoller, Sylvia

2014-01-01

Background and Purpose Dietary potassium has been associated with lower risk of stroke but there is little data on dietary potassium effects on different stroke subtypes or in older hypertensive and non-hypertensive women. Methods The study population consisted of 90,137 postmenopausal women aged 50–79 at enrollment, free of stroke history at baseline, followed prospectively for an average of 11 years. Outcome variables were total, ischemic, and hemorrhagic stroke, and all-cause mortality. Incidence was compared across quartiles of dietary potassium intake and hazard ratios were obtained from Cox proportional hazards models after adjusting for potential confounding variables, and in hypertensive and non-hypertensive women separately. Results Mean dietary potassium intake was 2611 mg/day. Highest quartile of potassium intake was associated with lower incidence of ischemic and hemorrhagic stroke, and total mortality. Multivariate analyses comparing highest to lowest quartile of potassium intake, indicated a hazard ratio (HR) for all-cause mortality of 0.90 (95% CI: 0.85 – 0.95), for all stroke of HR=0.88 (95% CI: 0.79 – 0.98), and for ischemic stroke of 0.84 (95% CI: 0.74 – 0.96). The effect on ischemic stroke was more apparent in non-hypertensive women among whom there was a 27% lower risk with HR of 0.73 (95% CI: 0.60 – 0.88), interaction p-value <.10. There was no association with hemorrhagic stroke. Conclusions High potassium intake is associated with a lower risk of all stroke and ischemic stroke as well as all-cause mortality in older women, particularly those who are not hypertensive. PMID:25190445

Lack of RAAS inhibition by high-salt intake is associated with arterial stiffness in hypertensive patients.

PubMed

Kotliar, Carol; Kempny, Pablo; Gonzalez, Sergio; Castellaro, Carlos; Forcada, Pedro; Obregon, Sebastián; Cavanagh, Elena; Chiabaut Svane, Jorge; Casarini, Maria Jesus; Rojas, Mercedes; Inserra, Felipe

2014-12-01

The relationship between salt intake, blood pressure and RAAS activation is still controversial, being that both high- and low-salt intakes are associated with cardiovascular events in a J-shaped curve pattern. We hypothesized that different patterns of RAAS response to dietary salt intake among hypertensives could be identified, while vascular damage would be related to high-salt intake plus absence of expected RAAS inhibition. We aim to assess the relationship between sodium intake, RAAS and vascular stiffness in hypertension. We screened 681 hypertensive patients for urinary/plasma electrolytes, renin, aldosterone and pulse wave velocity (PWV) under their usual salt intake level. After applying exclusion criteria, an inverse relation between urinary sodium and RAAS was observed in the 300 remaining subjects. Additionally, four types of response were identified: 1) Low (L) sodium (S)-Low RAAS, 2) LS-High (H) SRAAS, 3) HS-Low RAAS, 4) HS-High RAAS. We found no differences in age/BP among groups, but type 4 response individuals included more females and a higher pulse wave velocity. We showed a) an inverse salt-RAAS relation, b) an association between HS plus high RAAS with increased PWV that could identify a higher-risk hypertensive condition. © The Author(s) 2014.

The two-stroke poppet valve engine. Part 1: Intake and exhaust ports flow experimental assessments

NASA Astrophysics Data System (ADS)

Kamili Zahidi, M.; Razali Hanipah, M.; Ramasamy, D.; Noor, M. M.; Kadirgama, K.; Rahman, M. M.

2017-10-01

A two-stroke poppet valve engine is developed to overcome the common problems in conventional two-stroke engine designs. However, replacing piston control port with poppet valve will resulted different flow behaviour. This paper is looking at experimental assessment on a two-stroke poppet valve engine configuration to investigate the port flow performance. The aims are to evaluate the intake and exhaust coefficient of discharge and assess the twostroke capability of the cylinder head. The results has shown comparable coefficient of discharge values as production engine for the intake while the exhaust has higher values which is favourable for the two-stroke cycle operation.

Shifting human salty taste preference: Potential opportunities and challenges in reducing dietary salt intake of Americans

PubMed Central

Bobowski, Nuala

2015-01-01

Dietary salt reduction of Americans has been a focus of public health initiatives for more than 40 years primarily due to the association between high salt intake and development of hypertension. Despite past efforts, salt intake of Americans has remained at levels well above dietary recommendations, likely due in part to the hedonic appeal of salty taste. As such, in 2010 the Institute of Medicine suggested a strategy of gradual salt reduction of processed foods, the primary source of Americans’ dietary salt intake, via an approach intended to minimize impact on consumer acceptability of lower-sodium foods. This brief review discusses the ontogeny and development of human salt taste preference, the role of experience in shifting salt preference, and sources of dietary salt. Our current understanding of shifting human salt taste preference is discussed within the context of potential opportunities for success in reducing dietary salt, and gaps in the research that both limit our ability to predict effectiveness of gradual salt reduction and that need be addressed before a strategy to shift salt preference can realistically be implemented. PMID:26451233

Caffeine intake antagonizes salt sensitive hypertension through improvement of renal sodium handling

PubMed Central

Yu, Hao; Yang, Tao; Gao, Peng; Wei, Xing; Zhang, Hexuan; Xiong, Shiqiang; Lu, Zongshi; Li, Li; Wei, Xiao; Chen, Jing; Zhao, Yu; Arendshorst, William J.; Shang, Qianhui; Liu, Daoyan; Zhu, Zhiming

2016-01-01

High salt intake is a major risk factor for hypertension. Although acute caffeine intake produces moderate diuresis and natriuresis, caffeine increases the blood pressure (BP) through activating sympathetic activity. However, the long-term effects of caffeine on urinary sodium excretion and blood pressure are rarely investigated. Here, we investigated whether chronic caffeine administration antagonizes salt sensitive hypertension by promoting urinary sodium excretion. Dahl salt-sensitive (Dahl-S) rats were fed with high salt diet with or without 0.1% caffeine in drinking water for 15 days. The BP, heart rate and locomotor activity of rats was analyzed and urinary sodium excretion was determined. The renal epithelial Na+ channel (ENaC) expression and function were measured by in vivo and in vitro experiments. Chronic consumption of caffeine attenuates hypertension induced by high salt without affecting sympathetic nerve activity in Dahl-S rats. The renal α-ENaC expression and ENaC activity of rats decreased after chronic caffeine administration. Caffeine increased phosphorylation of AMPK and decrease α-ENaC expression in cortical collecting duct cells. Inhibiting AMPK abolished the effect of caffeine on α-ENaC. Chronic caffeine intake prevented the development of salt-sensitive hypertension through promoting urinary sodium excretion, which was associated with activation of renal AMPK and inhibition of renal tubular ENaC. PMID:27173481

Salt intake and gastric cancer risk according to Helicobacter pylori infection, smoking, tumour site and histological type.

PubMed

Peleteiro, B; Lopes, C; Figueiredo, C; Lunet, N

2011-01-04

Although salt intake is considered a probable risk factor for gastric cancer, relevant studies have provided heterogeneous results, and the magnitude of the association has not been accurately quantified. To quantify gastric cancer risk in relation to dietary salt exposure according to Helicobacter pylori infection status and virulence, smoking, tumour site, and histological type, we evaluated 422 gastric cancer cases and 649 community controls. Salt exposure was estimated in the year before the onset of symptoms through: sodium intake (estimated by a food frequency questionnaire (FFQ)); main food items/groups contributing to dietary sodium intake; visual analogical scale for salt intake preference; use of table salt; and duration of refrigerator ownership. Comparing subjects with the highest with those with the lowest salt exposure (3rd vs 1st third), sodium intake (OR=2.01, 95% CI: 1.16-3.46), consumption of food items with high contribution to sodium intake (OR=2.54, 95% CI: 1.56-4.14) and salt intake evaluated by visual analogical scale (OR=1.83, 95% CI: 1.28-2.63) were associated with an increased gastric cancer risk. Subjects owning a refrigerator for >50 years had a lower risk for gastric cancer (OR=0.28, 95% CI: 0.14-0.57). These associations were observed regardless of H. pylori infection status and virulence, smoking, tumour site or histological type. Our results support the view that salt intake is an important dietary risk factor for gastric cancer, and confirms the evidence of no differences in risk according to H. pylori infection and virulence, smoking, tumour site and histological type.

High salt intake does not exacerbate murine autoimmune thyroiditis

PubMed Central

Kolypetri, P; Randell, E; Van Vliet, B N; Carayanniotis, G

2014-01-01

Recent studies have shown that high salt (HS) intake exacerbates experimental autoimmune encephalomyelitis and have raised the possibility that a HS diet may comprise a risk factor for autoimmune diseases in general. In this report, we have examined whether a HS diet regimen could exacerbate murine autoimmune thyroiditis, including spontaneous autoimmune thyroiditis (SAT) in non-obese diabetic (NOD.H2h4) mice, experimental autoimmune thyroiditis (EAT) in C57BL/6J mice challenged with thyroglobulin (Tg) and EAT in CBA/J mice challenged with the Tg peptide (2549–2560). The physiological impact of HS intake was confirmed by enhanced water consumption and suppressed aldosterone levels in all strains. However, the HS treatment failed to significantly affect the incidence and severity of SAT or EAT or Tg-specific immunoglobulin (Ig)G levels, relative to control mice maintained on a normal salt diet. In three experimental models, these data demonstrate that HS intake does not exacerbate autoimmune thyroiditis, indicating that a HS diet is not a risk factor for all autoimmune diseases. PMID:24528002

Estimating mean change in population salt intake using spot urine samples.

PubMed

Petersen, Kristina S; Wu, Jason H Y; Webster, Jacqui; Grimes, Carley; Woodward, Mark; Nowson, Caryl A; Neal, Bruce

2017-10-01

Spot urine samples are easier to collect than 24-h urine samples and have been used with estimating equations to derive the mean daily salt intake of a population. Whether equations using data from spot urine samples can also be used to estimate change in mean daily population salt intake over time is unknown. We compared estimates of change in mean daily population salt intake based upon 24-h urine collections with estimates derived using equations based on spot urine samples. Paired and unpaired 24-h urine samples and spot urine samples were collected from individuals in two Australian populations, in 2011 and 2014. Estimates of change in daily mean population salt intake between 2011 and 2014 were obtained directly from the 24-h urine samples and by applying established estimating equations (Kawasaki, Tanaka, Mage, Toft, INTERSALT) to the data from spot urine samples. Differences between 2011 and 2014 were calculated using mixed models. A total of 1000 participants provided a 24-h urine sample and a spot urine sample in 2011, and 1012 did so in 2014 (paired samples n = 870; unpaired samples n = 1142). The participants were community-dwelling individuals living in the State of Victoria or the town of Lithgow in the State of New South Wales, Australia, with a mean age of 55 years in 2011. The mean (95% confidence interval) difference in population salt intake between 2011 and 2014 determined from the 24-h urine samples was -0.48g/day (-0.74 to -0.21; P < 0.001). The corresponding result estimated from the spot urine samples was -0.24 g/day (-0.42 to -0.06; P = 0.01) using the Tanaka equation, -0.42 g/day (-0.70 to -0.13; p = 0.004) using the Kawasaki equation, -0.51 g/day (-1.00 to -0.01; P = 0.046) using the Mage equation, -0.26 g/day (-0.42 to -0.10; P = 0.001) using the Toft equation, -0.20 g/day (-0.32 to -0.09; P = 0.001) using the INTERSALT equation and -0.27 g/day (-0.39 to -0.15; P < 0.001) using the

Iodine Intake Estimation from the Consumption of Instant Noodles, Drinking Water and Household Salt in Indonesia

PubMed Central

Sutrisna, Aang; Knowles, Jacky; Basuni, Abas; Menon, Ravi; Sugihantono, Anung

2018-01-01

The objective of this study was to assess the contribution of iodine intake from iodised household salt, iodised salt in instant noodles, and iodine in ground water in five regions of Indonesia. Secondary data analysis was performed using the 2013 Primary Health Research Survey, the 2014 Total Diet Study, and data from food industry research. Iodine intake was estimated among 2719 children, 10–12 years of age (SAC), 13,233 women of reproductive age (WRA), and 578 pregnant women (PW). Combined estimated iodine intake from the three stated sources met 78%, 70%, and 41% of iodine requirements for SAC, WRA and PW, respectively. Household salt iodine contributed about half of the iodine requirements for SAC (49%) and WRA (48%) and a quarter for PW (28%). The following variations were found: for population group, the percentage of estimated dietary iodine requirements met by instant noodle consumption was significantly higher among SAC; for region, estimated iodine intake was significantly higher from ground water for WRA in Java, and from household salt for SAC and WRA in Kalimantan and Java; and for household socio-economic status (SES), iodine intake from household salt was significantly higher in the highest SES households. Enforcement of clear implementing regulations for iodisation of household and food industry salt will promote optimal iodine intake among all population groups with different diets. PMID:29517995

Iodine Intake Estimation from the Consumption of Instant Noodles, Drinking Water and Household Salt in Indonesia.

PubMed

Sutrisna, Aang; Knowles, Jacky; Basuni, Abas; Menon, Ravi; Sugihantono, Anung

2018-03-08

The objective of this study was to assess the contribution of iodine intake from iodised household salt, iodised salt in instant noodles, and iodine in ground water in five regions of Indonesia. Secondary data analysis was performed using the 2013 Primary Health Research Survey, the 2014 Total Diet Study, and data from food industry research. Iodine intake was estimated among 2719 children, 10-12 years of age (SAC), 13,233 women of reproductive age (WRA), and 578 pregnant women (PW). Combined estimated iodine intake from the three stated sources met 78%, 70%, and 41% of iodine requirements for SAC, WRA and PW, respectively. Household salt iodine contributed about half of the iodine requirements for SAC (49%) and WRA (48%) and a quarter for PW (28%). The following variations were found: for population group, the percentage of estimated dietary iodine requirements met by instant noodle consumption was significantly higher among SAC; for region, estimated iodine intake was significantly higher from ground water for WRA in Java, and from household salt for SAC and WRA in Kalimantan and Java; and for household socio-economic status (SES), iodine intake from household salt was significantly higher in the highest SES households. Enforcement of clear implementing regulations for iodisation of household and food industry salt will promote optimal iodine intake among all population groups with different diets.

Diets enriched in whey or casein improve energy balance and prevent morbidity and renal damage in salt-loaded and high-fat-fed spontaneously hypertensive stroke-prone rats.

PubMed

Singh, Arashdeep; Pezeshki, Adel; Zapata, Rizaldy C; Yee, Nicholas J; Knight, Cameron G; Tuor, Ursula I; Chelikani, Prasanth K

2016-11-01

High-fat diets induce obesity and increase risks of diabetes and cardiovascular and renal disorders. Whey- or casein-enriched diets decrease food intake and weight gain; however, their cardiovascular and renal benefits are unclear. We determined whether whey- and casein-enriched diets improve energy balance and are protective against renal damage and morbidity associated with stroke in an obesogenic and hypertensive experimental setting. We also assessed whether the hypophagic effects of these diets were due to reduced diet preference. In experiment 1, spontaneously hypertensive stroke-prone rats were randomized to (a) control (CON; 14% kcal protein, 33% fat), (b) whey (WHY; 40% protein, 33% fat), (c) casein (CAS; 40% protein, 33% fat) or (d) chow (CHW; 24% protein, 13% fat) for 12 weeks with 1% salt in drinking water for CON, WHY and CAS groups. Our results demonstrated that both WHY and CAS produced short-term hypophagia, moderately increased energy expenditure and decreased respiratory quotient, body weight and lean mass, with effects of WHY being more prolonged. Further, only WHY decreased fat mass and blood pressure. Importantly, both WHY and CAS prevented morbidity associated with stroke and decreased indices of renal inflammation (tumor necrosis factor-α, interleukin-6) and damage (osteopontin, renal lesions). In experiment 2, following four initial conditioning trials, the preference for CON, WHY or CAS diet was determined. Both WHY and CAS decreased food intake during conditioning and decreased preference. In conclusion, diets enriched in whey or casein improved energy balance, increased survival and prevented renal damage in salt-loaded and high-fat-fed spontaneously hypertensive stroke-prone rats. Copyright © 2016 Elsevier Inc. All rights reserved.

How Can Diet Influence the Risk of Stroke?

PubMed Central

Medeiros, Fernanda; Casanova, Marcela de Abreu; Fraulob, Julio Cesar; Trindade, Michelle

2012-01-01

Cerebrovascular diseases are the second cause of mortality in the world, and hypertension is considered a main risk factor for occurrence of stroke. The mechanisms responsible for the increased stroke risk remain unclear. However, dietary interventions have been applied in the management and treatment of their risk factors, which include increased blood pressure levels, obesity, diabetes, and dyslipidemia. Further studies should be conducted to assess the effects of carotenoids, flavonoids, n-3 polyunsaturated fats, and lower salt and high glycemic index intake in risk of stroke. PMID:22693656

The Development of a Web-Based Program to Reduce Dietary Salt Intake in Schoolchildren: Study Protocol

PubMed Central

Booth, Alison; Khokhar, Durreajam; West, Madeline; Margerison, Claire; Campbell, Karen; Nowson, Caryl

2017-01-01

Background Salt intake of schoolchildren in the Australian state of Victoria is high. To protect future cardiovascular health, interventions that seek to reduce the amount of salt in children’s diets are required. Objective We sought to develop and pilot test a Web-based program (Digital Education to Limit Salt Intake in the Home [DELISH]) that aims to reduce dietary salt intake among schoolchildren and to improve child and parent knowledge, attitudes, and behaviors related to salt intake. This paper presents the DELISH study protocol, along with pilot findings used to inform the development of the program. Methods The DELISH program is a 5-week Web-based intervention that targets schoolchildren aged 7-10 years and their parents. This is a single-arm study with a pretest and posttest design. We will assess change in salt intake through analysis of 24-hour urinary sodium excretion. Children and parents will complete online surveys assessing knowledge, attitudes, and behaviors related to salt intake. We will assess feasibility of the program via process measures, which include metrics to describe intervention uptake (eg, number of children who complete Web-based sessions and of parents who view online newsletters) and evaluation surveys and interviews conducted with children, parents, and schoolteachers. The first 2 Web sessions developed for children were pilot tested in 19 children aged 8-12 years. Results Findings from pilot testing indicated that most children (session 1: 18/19, 95%; and session 2: 19/19, 100%) enjoyed completing each session and liked the inclusion of comic strips and interactive games. Commonly reported areas of improvement related to sessions being text and content heavy. Based on these findings, we simplified sessions and developed 3 additional sessions for use in the DELISH program. The DELISH program was implemented during June-December 2016. We expect to have results from this study at the end of 2017. Conclusions To our knowledge, this

Urinary Sodium-to-Potassium Ratio Tracks the Changes in Salt Intake during an Experimental Feeding Study Using Standardized Low-Salt and High-Salt Meals among Healthy Japanese Volunteers

PubMed Central

Yatabe, Midori Sasaki; Watanabe, Ami; Takano, Kozue; Sanada, Hironobu; Ichihara, Atsuhiro; Felder, Robin A.; Miura, Katsuyuki; Ueshima, Hirotsugu; Kimura, Junko; Yatabe, Junichi

2017-01-01

The Na/K ratio is considered to be a useful index, the monitoring of which allows an effective Na reduction and K increase, because practical methods (self-monitoring devices and reliable individual estimates from spot urine) are available for assessing these levels in individuals. An intervention trial for lowering the Na/K ratio has demonstrated that a reduction of the Na/K ratio mainly involved Na reduction, with only a small change in K. The present study aimed to clarify the relationship between dietary Na intake and the urinary Na/K molar ratio, using standardized low- and high-salt diets, with an equal dietary K intake, to determine the corresponding Na/K ratio. Fourteen healthy young adult volunteers ingested low-salt (3 g salt per day) and high-salt (20 g salt per day) meals for seven days each. Using a portable urinary Na/K meter, participants measured their spot urine at each voiding, and 24-h urine was collected on the last day of each diet period. On the last day of the unrestricted, low-salt, and high-salt diet periods, the group averages of the 24-h urine Na/K ratio were 4.2, 1.0, and 6.9, while the group averages of the daily mean spot urine Na/K ratio were 4.2, 1.1, and 6.6, respectively. The urinary Na/K ratio tracked changes in dietary salt intake, and reached a plateau approximately three days after each change in diet. Frequent monitoring of the spot urine Na/K ratio may help individuals adhere to an appropriate dietary Na intake. PMID:28850062

Urinary Sodium-to-Potassium Ratio Tracks the Changes in Salt Intake during an Experimental Feeding Study Using Standardized Low-Salt and High-Salt Meals among Healthy Japanese Volunteers.

PubMed

Yatabe, Midori Sasaki; Iwahori, Toshiyuki; Watanabe, Ami; Takano, Kozue; Sanada, Hironobu; Watanabe, Tsuyoshi; Ichihara, Atsuhiro; Felder, Robin A; Miura, Katsuyuki; Ueshima, Hirotsugu; Kimura, Junko; Yatabe, Junichi

2017-08-29

The Na/K ratio is considered to be a useful index, the monitoring of which allows an effective Na reduction and K increase, because practical methods (self-monitoring devices and reliable individual estimates from spot urine) are available for assessing these levels in individuals. An intervention trial for lowering the Na/K ratio has demonstrated that a reduction of the Na/K ratio mainly involved Na reduction, with only a small change in K. The present study aimed to clarify the relationship between dietary Na intake and the urinary Na/K molar ratio, using standardized low- and high-salt diets, with an equal dietary K intake, to determine the corresponding Na/K ratio. Fourteen healthy young adult volunteers ingested low-salt (3 g salt per day) and high-salt (20 g salt per day) meals for seven days each. Using a portable urinary Na/K meter, participants measured their spot urine at each voiding, and 24-h urine was collected on the last day of each diet period. On the last day of the unrestricted, low-salt, and high-salt diet periods, the group averages of the 24-h urine Na/K ratio were 4.2, 1.0, and 6.9, while the group averages of the daily mean spot urine Na/K ratio were 4.2, 1.1, and 6.6, respectively. The urinary Na/K ratio tracked changes in dietary salt intake, and reached a plateau approximately three days after each change in diet. Frequent monitoring of the spot urine Na/K ratio may help individuals adhere to an appropriate dietary Na intake.

The effect of zinc deficiency on salt taste acuity, preference, and dietary sodium intake in hemodialysis patients.

PubMed

Kim, So Mi; Kim, Miyeon; Lee, Eun Kyoung; Kim, Soon Bae; Chang, Jai Won; Kim, Hyun Woo

2016-07-01

Introduction High sodium intake is the main cause of fluid overload in hemodialysis (HD) patients, leading to increased cardiovascular mortality. High sodium intake is known to be associated with low salt taste acuity and/or high preference. As the zinc status could influence taste acuity, we analyzed the effect of zinc deficiency on salt taste acuity, preference, and dietary sodium intake in HD patients. Methods A total of 77 HD patients was enrolled in this cross-sectional study. Zinc deficiency was defined as serum zinc level with below 70 µg/mL. The patients were divided into two groups based on serum zinc level. Salt taste acuity and preference were determined by a sensory test using varying concentrations of NaCl solution, and dietary sodium intake was estimated using 3-day dietary recall surveys. Findings The mean salt recognition threshold and salt taste preference were significantly higher in the zinc deficient group than in the non-zinc deficient group. And there was significant positive correlation between salt taste preference and dietary sodium intake in zinc deficient group (r = 0.43, P = 0.002). Although, the dietary sodium intake showed a high tendency with no significance (P = 0.052), interdialytic weight gain was significantly higher in the zinc deficient group than in the non-zinc deficient group (2.68 ± 1.02 kg vs. 3.18 ± 1.02 kg; P = 0.047). Discussion Zinc deficiency may be related to low salt taste acuity and high salt preference, leading to high dietary sodium intake in HD patients. © 2016 International Society for Hemodialysis.

High salt intake causes leptin resistance and obesity in mice by stimulating endogenous fructose production and metabolism.

PubMed

Lanaspa, Miguel A; Kuwabara, Masanari; Andres-Hernando, Ana; Li, Nancy; Cicerchi, Christina; Jensen, Thomas; Orlicky, David J; Roncal-Jimenez, Carlos A; Ishimoto, Takuji; Nakagawa, Takahiko; Rodriguez-Iturbe, Bernardo; MacLean, Paul S; Johnson, Richard J

2018-03-20

Dietary guidelines for obesity typically focus on three food groups (carbohydrates, fat, and protein) and caloric restriction. Intake of noncaloric nutrients, such as salt, are rarely discussed. However, recently high salt intake has been reported to predict the development of obesity and insulin resistance. The mechanism for this effect is unknown. Here we show that high intake of salt activates the aldose reductase-fructokinase pathway in the liver and hypothalamus, leading to endogenous fructose production with the development of leptin resistance and hyperphagia that cause obesity, insulin resistance, and fatty liver. A high-salt diet was also found to predict the development of diabetes and nonalcoholic fatty liver disease in a healthy population. These studies provide insights into the pathogenesis of obesity and diabetes and raise the potential for reduction in salt intake as an additional interventional approach for reducing the risk for developing obesity and metabolic syndrome.

Dietary Intake of α-Linolenic Acid Is Not Appreciably Associated with Risk of Ischemic Stroke among Middle-Aged Danish Men and Women.

PubMed

Bork, Christian S; Venø, Stine K; Lundbye-Christensen, Søren; Jakobsen, Marianne U; Tjønneland, Anne; Schmidt, Erik B; Overvad, Kim

2018-06-01

Intake of the plant-derived omega-3 (n-3) fatty acid α-linolenic acid (ALA) may reduce the risk of ischemic stroke. We have investigated the associations between dietary intake of ALA and the risk of ischemic stroke and ischemic stroke subtypes. This was a follow-up study. A total of 57,053 participants aged 50-64 y were enrolled into the Danish Diet, Cancer and Health cohort between 1993 and 1997. Intake of ALA was assessed by a validated semiquantitative food frequency questionnaire. Potential incident cases of ischemic stroke were identified in the Danish National Patient Register, validated, and classified into subtypes based on assumed etiology. Statistical analyses were performed via Cox proportional hazard regression with adjustment for established ischemic stroke risk factors. A total of 1859 ischemic stroke cases were identified during a median of 13.5 y of follow-up. In multivariable analyses using restricted cubic splines adjusting for traditional risk factors for ischemic stroke, we observed no clear associations between dietary intake of ALA and the risk of total ischemic stroke or any of its subtypes including ischemic stroke due to large artery atherosclerosis, ischemic stroke due to small-vessel occlusion, and ischemic stroke due to cardio-embolism. Dietary intake of ALA was neither consistently nor appreciably associated with the risk of ischemic stroke or ischemic stroke subtypes among middle-aged Danish men and women. This study was registered at clinicaltrials.gov as NCT03258983.

The Development of a Web-Based Program to Reduce Dietary Salt Intake in Schoolchildren: Study Protocol.

PubMed

Grimes, Carley Ann; Booth, Alison; Khokhar, Durreajam; West, Madeline; Margerison, Claire; Campbell, Karen; Nowson, Caryl

2017-05-31

Salt intake of schoolchildren in the Australian state of Victoria is high. To protect future cardiovascular health, interventions that seek to reduce the amount of salt in children's diets are required. We sought to develop and pilot test a Web-based program (Digital Education to Limit Salt Intake in the Home [DELISH]) that aims to reduce dietary salt intake among schoolchildren and to improve child and parent knowledge, attitudes, and behaviors related to salt intake. This paper presents the DELISH study protocol, along with pilot findings used to inform the development of the program. The DELISH program is a 5-week Web-based intervention that targets schoolchildren aged 7-10 years and their parents. This is a single-arm study with a pretest and posttest design. We will assess change in salt intake through analysis of 24-hour urinary sodium excretion. Children and parents will complete online surveys assessing knowledge, attitudes, and behaviors related to salt intake. We will assess feasibility of the program via process measures, which include metrics to describe intervention uptake (eg, number of children who complete Web-based sessions and of parents who view online newsletters) and evaluation surveys and interviews conducted with children, parents, and schoolteachers. The first 2 Web sessions developed for children were pilot tested in 19 children aged 8-12 years. Findings from pilot testing indicated that most children (session 1: 18/19, 95%; and session 2: 19/19, 100%) enjoyed completing each session and liked the inclusion of comic strips and interactive games. Commonly reported areas of improvement related to sessions being text and content heavy. Based on these findings, we simplified sessions and developed 3 additional sessions for use in the DELISH program. The DELISH program was implemented during June-December 2016. We expect to have results from this study at the end of 2017. To our knowledge, this is the first Australian study to examine the

Alcohol intake in relation to non-fatal and fatal coronary heart disease and stroke: EPIC-CVD case-cohort study.

PubMed

Ricci, Cristian; Wood, Angela; Muller, David; Gunter, Marc J; Agudo, Antonio; Boeing, Heiner; van der Schouw, Yvonne T; Warnakula, Samantha; Saieva, Calogero; Spijkerman, Annemieke; Sluijs, Ivonne; Tjønneland, Anne; Kyrø, Cecilie; Weiderpass, Elisabete; Kühn, Tilman; Kaaks, Rudolf; Sánchez, Maria-Jose; Panico, Salvatore; Agnoli, Claudia; Palli, Domenico; Tumino, Rosario; Engström, Gunnar; Melander, Olle; Bonnet, Fabrice; Boer, Jolanda M A; Key, Timothy J; Travis, Ruth C; Overvad, Kim; Verschuren, W M Monique; Quirós, J Ramón; Trichopoulou, Antonia; Papatesta, Eleni-Maria; Peppa, Eleni; Iribas, Conchi Moreno; Gavrila, Diana; Forslund, Ann-Sofie; Jansson, Jan-Håkan; Matullo, Giuseppe; Arriola, Larraitz; Freisling, Heinz; Lassale, Camille; Tzoulaki, Ioanna; Sharp, Stephen J; Forouhi, Nita G; Langenberg, Claudia; Saracci, Rodolfo; Sweeting, Michael; Brennan, Paul; Butterworth, Adam S; Riboli, Elio; Wareham, Nick J; Danesh, John; Ferrari, Pietro

2018-05-29

To investigate the association between alcohol consumption (at baseline and over lifetime) and non-fatal and fatal coronary heart disease (CHD) and stroke. Multicentre case-cohort study. A study of cardiovascular disease (CVD) determinants within the European Prospective Investigation into Cancer and nutrition cohort (EPIC-CVD) from eight European countries. 32 549 participants without baseline CVD, comprised of incident CVD cases and a subcohort for comparison. Non-fatal and fatal CHD and stroke (including ischaemic and haemorrhagic stroke). There were 9307 non-fatal CHD events, 1699 fatal CHD, 5855 non-fatal stroke, and 733 fatal stroke. Baseline alcohol intake was inversely associated with non-fatal CHD, with a hazard ratio of 0.94 (95% confidence interval 0.92 to 0.96) per 12 g/day higher intake. There was a J shaped association between baseline alcohol intake and risk of fatal CHD. The hazard ratios were 0.83 (0.70 to 0.98), 0.65 (0.53 to 0.81), and 0.82 (0.65 to 1.03) for categories 5.0-14.9 g/day, 15.0-29.9 g/day, and 30.0-59.9 g/day of total alcohol intake, respectively, compared with 0.1-4.9 g/day. In contrast, hazard ratios for non-fatal and fatal stroke risk were 1.04 (1.02 to 1.07), and 1.05 (0.98 to 1.13) per 12 g/day increase in baseline alcohol intake, respectively, including broadly similar findings for ischaemic and haemorrhagic stroke. Associations with cardiovascular outcomes were broadly similar with average lifetime alcohol consumption as for baseline alcohol intake, and across the eight countries studied. There was no strong evidence for interactions of alcohol consumption with smoking status on the risk of CVD events. Alcohol intake was inversely associated with non-fatal CHD risk but positively associated with the risk of different stroke subtypes. This highlights the opposing associations of alcohol intake with different CVD types and strengthens the evidence for policies to reduce alcohol consumption. Published by the BMJ Publishing

Socioeconomic status is significantly associated with dietary salt intakes and blood pressure in Japanese workers (J-HOPE Study).

PubMed

Miyaki, Koichi; Song, Yixuan; Taneichi, Setsuko; Tsutsumi, Akizumi; Hashimoto, Hideki; Kawakami, Norito; Takahashi, Masaya; Shimazu, Akihito; Inoue, Akiomi; Kurioka, Sumiko; Shimbo, Takuro

2013-03-11

The association of socioeconomic status (SES) with nutrients intakes attracts public attention worldwide. In the current study, we examined the associations of SES with dietary salt intake and health outcomes in general Japanese workers (2,266) who participated in this Japanese occupational cohort. SES was assessed by a self-administered questionnaire. Dietary intakes were assessed with a validated, brief, self-administered diet history questionnaire (BDHQ). Multiple linear regression and stratified analysis were used to evaluate the associations of salt intake with the confounding factors. Education levels and household incomes were significantly associated with salt intake, as well as blood pressures (P < 0.05). After adjusting for age, sex and total energy intake, both years of education and household income significantly affect the salt intake (for education, β = -0.031, P = 0.040; for household income, β = -0.046, P = 0.003). SES factors also affect the risk of hypertension, those subjects with higher levels of education or income had lower risk to become hypertensive (ORs for education was 0.904, P < 0.001; ORs for income was 0.956, P = 0.032). Our results show that SES is an independent determinant of salt intake and blood pressure, in order to lower the risk of hypertension, the efforts to narrow the social status gaps should be considered by the health policy-makers.

Ultra-long–term human salt balance studies reveal interrelations between sodium, potassium, and chloride intake and excretion12

PubMed Central

Birukov, Anna; Rakova, Natalia; Lerchl, Kathrin; Engberink, Rik HG Olde; Johannes, Bernd; Wabel, Peter; Moissl, Ulrich; Rauh, Manfred; Luft, Friedrich C; Titze, Jens

2016-01-01

Background: The intake of sodium, chloride, and potassium is considered important to healthy nutrition and cardiovascular disease risk. Estimating the intake of these electrolytes is difficult and usually predicated on urine collections, commonly for 24 h, which are considered the gold standard. We reported on data earlier for sodium but not for potassium or chloride. Objective: We were able to test the value of 24-h urine collections in a unique, ultra-long–term balance study conducted during a simulated trip to Mars. Design: Four healthy men were observed while ingesting 12 g salt/d, 9 g salt/d, and 6 g salt/d, while their potassium intake was maintained at 4 g/d for 105 d. Six healthy men were studied while ingesting 12 g salt/d, 9 g salt/d, and 6 g salt/d, with a re-exposure of 12 g/d, while their potassium intake was maintained at 4 g/d for 205 d. Food intake and other constituents were recorded every day for each subject. All urine output was collected daily. Results: Long-term urine recovery rates for all 3 electrolytes were very high. Rather than the expected constant daily excretion related to daily intake, we observed remarkable daily variation in excretion, with a 7-d infradian rhythm at a relatively constant intake. We monitored 24-h aldosterone excretion in these studies and found that aldosterone appeared to be the regulator for all 3 electrolytes. We report Bland–Altman analyses on the value of urine collections to estimate intake. Conclusions: A single 24-h urine collection cannot predict sodium, potassium, or chloride intake; thus, multiple collections are necessary. This information is important when assessing electrolyte intake in individuals. PMID:27225435

Effects of excess salt and fat intake on myocardial function and infarct size in rat.

PubMed

Mozaffari, Mahmood S; Patel, Champa; Ballas, Claudia; Schaffer, Stephen W

2006-03-13

Important risk factors for cardiovascular disease include excess dietary intake of saturated fat and (or) salt. This study tested the hypothesis that excess intakes of saturated fat (e.g., beef tallow) and salt cause greater myocardial cell death following ischemia-reperfusion injury than each risk factor alone. Male rats were divided into four groups: basal fat diet (4.5% as calories; control), high fat diet (40% as calories; FAT), basal fat diet and high salt (1% NaCl solution; SALT) and high fat diet and high salt (FATSALT). The gain in body weight was significantly higher for FAT and FATSALT groups than those of either the control or the SALT group. Five weeks of exposure to the dietary regimens did not significantly affect the coronary flow rate and except for the salt-fed group, had no effect on the rate-pressure-product of the isolated heart perfused in Langendorff mode. Although infarct size was not affected by the high fat diet, it was reduced by the high salt regimen relative to the high fat diet or the control groups. When rats were fed the FAT and SALT combination, the effect of salt feeding on infarct size was not observed. In addition, the FATSALT group displayed a more marked deterioration in contractile function following ischemia-reperfusion injury than the other groups. In conclusion, short-term intake of a high fat diet, which significantly increases body weight, does not worsen ischemia-reperfusion injury although the treatment prevents the reduction of infarct size associated with high salt feeding.

Reporting accuracy of population dietary sodium intake using duplicate 24 h dietary recalls and a salt questionnaire.

PubMed

De Keyzer, Willem; Dofková, Marcela; Lillegaard, Inger Therese L; De Maeyer, Mieke; Andersen, Lene Frost; Ruprich, Jirí; Řehůřková, Irena; Geelen, Anouk; van 't Veer, Pieter; De Henauw, Stefaan; Crispim, Sandra Patricia; de Boer, Evelien; Ocké, Marga; Slimani, Nadia; Huybrechts, Inge

2015-02-14

High dietary Na intake is associated with multiple health risks, making accurate assessment of population dietary Na intake critical. In the present study, reporting accuracy of dietary Na intake was evaluated by 24 h urinary Na excretion using the EPIC-Soft 24 h dietary recall (24-HDR). Participants from a subsample of the European Food Consumption Validation study (n 365; countries: Belgium, Norway and Czech Republic), aged 45-65 years, completed two 24 h urine collections and two 24-HDR. Reporting accuracy was calculated as the ratio of reported Na intake to that estimated from the urinary biomarker. A questionnaire on salt use was completed in order to assess the discretionary use of table and cooking salt. The reporting accuracy of dietary Na intake was assessed using two scenarios: (1) a salt adjustment procedure using data from the salt questionnaire; (2) without salt adjustment. Overall, reporting accuracy improved when data from the salt questionnaire were included. The mean reporting accuracy was 0·67 (95 % CI 0·62, 0·72), 0·73 (95 % CI 0·68, 0·79) and 0·79 (95 % CI 0·74, 0·85) for Belgium, Norway and Czech Republic, respectively. Reporting accuracy decreased with increasing BMI among male subjects in all the three countries. For women from Belgium and Norway, reporting accuracy was highest among those classified as obese (BMI ≥ 30 kg/m2: 0·73, 95 % CI 0·67, 0·81 and 0·81, 95 % CI 0·77, 0·86, respectively). The findings from the present study showed considerable underestimation of dietary Na intake assessed using two 24-HDR. The questionnaire-based salt adjustment procedure improved reporting accuracy by 7-13 %. Further development of both the questionnaire and EPIC-Soft databases (e.g. inclusion of a facet to describe salt content) is necessary to estimate population dietary Na intakes accurately.

Mean population salt intake estimated from 24-h urine samples and spot urine samples: a systematic review and meta-analysis.

PubMed

Huang, Liping; Crino, Michelle; Wu, Jason H Y; Woodward, Mark; Barzi, Federica; Land, Mary-Anne; McLean, Rachael; Webster, Jacqui; Enkhtungalag, Batsaikhan; Neal, Bruce

2016-02-01

Estimating equations based on spot urine samples have been identified as a possible alternative approach to 24-h urine collections for determining mean population salt intake. This review compares estimates of mean population salt intake based upon spot and 24-h urine samples. We systematically searched for all studies that reported estimates of daily salt intake based upon both spot and 24-h urine samples for the same population. The associations between the two were quantified and compared overall and in subsets of studies. A total of 538 records were identified, 108 were assessed as full text and 29 were included. The included studies involved 10,414 participants from 34 countries and made 71 comparisons available for the primary analysis. Overall average population salt intake estimated from 24-h urine samples was 9.3 g/day compared with 9.0 g/day estimated from the spot urine samples. Estimates based upon spot urine samples had excellent sensitivity (97%) and specificity (100%) at classifying mean population salt intake as above or below the World Health Organization maximum target of 5 g/day. Compared with the 24-h samples, estimates based upon spot urine overestimated intake at lower levels of consumption and underestimated intake at higher levels of consumption. Estimates of mean population salt intake based upon spot urine samples can provide countries with a good indication of mean population salt intake and whether action on salt consumption is required. Published by Oxford University Press on behalf of the International Epidemiological Association 2015. This work is written by US Government employees and is in the public domain in the US.

Effect of salt intake on blood pressure in patients receiving antihypertensive therapy: Shimane CoHRE Study.

PubMed

Ito, Tomoko; Takeda, Miwako; Hamano, Tsuyoshi; Kijima, Tsunetaka; Yamasaki, Masayuki; Isomura, Minoru; Yano, Shozo; Shiwaku, Kuninori; Nabika, Toru

2016-03-01

Salt intake is recognized as an important risk factor for hypertension in the general population. On the other hand, the availability of various classes of antihypertensive drugs means that it is generally not considered crucial to control the salt intake of hypertensive patients. In this study, we evaluated whether blood pressure (BP) was correlated with 24-hour salt intake in patients receiving antihypertensive therapy. A total of 1496 consecutive participants undergoing health screening examinations were recruited. Subjects were divided into two groups according to their antihypertensive medications checked on prescriptions: 1005 subjects without antihypertensive therapy (untreated subjects) and 491 subjects with antihypertensive therapy (treated subjects). The 24-hour urinary sodium excretion (24h-uNa), a surrogate marker for daily salt intake, was estimated with the formula proposed by Tanaka et al. in 2002. Univariate analysis indicated that 24h-uNa was positively correlated with the systolic BP of both untreated and treated subjects. This was confirmed by multiple linear regression analysis after adjustment for confounding factors (untreated subjects: partial regression coefficient β=1.45 ± 0.26, p<0.001; treated subjects: β=0.75 ± 0.27, p=0.01). Salt intake was also correlated with the pulse pressure in both treated subjects (β=0.55 ± 0.24, p=0.02) and untreated subjects (β=0.93 ± 0.19, p<0.001). These results suggest the importance of reducing salt intake in hypertensive patients on pharmacotherapy, as well as in the general population. Further studies of hypertensive patients employing 24-h urine collection are warranted to confirm the present findings. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Recurrence risk after noncardioembolic mild ischemic stroke in a Japanese population.

PubMed

Kono, Yuji; Yamada, Sumio; Kamisaka, Kenta; Araki, Amane; Fujioka, Yusuke; Yasui, Keizo; Hasegawa, Yasuhiro; Koike, Yasuo

2011-01-01

This study aimed to identify the recurrence rate and risk factors or clinical variables predictive of vascular events after mild ischemic stroke (IS). From December 2006 to September 2007, patients with acute IS with a modified Rankin Scale of 0∼1 were consecutively enrolled in this study. Variables including sex, family history of vascular disease, age, height, weight, stroke subtype, blood pressure, lipid profile, fasting glucose, HbA1c, smoking, alcohol consumption, exercise habits, waist circumference, ankle-brachial pressure index, salt intake and physical activity were assessed. The primary outcome was stroke recurrence or other vascular events such as myocardial infarction, angina pectoris, and peripheral artery disease. Survival curves were calculated by Kaplan-Meier survival analysis, and hazard ratios for recurrence were determined by univariate and multivariate Cox proportional hazards regression models. A total of 102 mild IS patients (78 men and 24 women, mean age 64 years) were successfully followed for 3 years. Of those 102 patients, 25 (24.5%) had stroke recurrence, and 4 (3.9%) had a coronary event. Among the variables studied, abnormal ankle-brachial pressure index, metabolic syndrome, stroke subtypes, salt intake and poor lifestyle management were significant independent predictors of stroke recurrence or cardiovascular events. In mild IS patients within 3 years after onset, not only pathophysiological factors but also lifestyle factors can aid in the identification of patients at high risk for recurrence. Copyright © 2011 S. Karger AG, Basel.

Dietary intake, nutritional status and rehabilitation outcomes of stroke patients in hospital.

PubMed

Nip, W F R; Perry, L; McLaren, S; Mackenzie, A

2011-10-01

Nutrition affects rehabilitation through its influence on physical and mental functioning, although little attention has been paid to effects on rehabilitation outcomes. The present study aimed to describe nutritional status and food consumption in stroke patients within 2 weeks of hospital admission and before discharge, as well as to investigate the effects of nutritional and dietary factors on rehabilitation outcomes. One hundred patients from a consecutive cohort admitted to a metropolitan hospital with acute stroke were recruited and assessed by a single researcher, with 38 reassessed at discharge. Nutritional status was assessed using Mini-Nutritional Assessment and anthropometric indices and dietary intake was assessed by 1-day weighed dietary records. Rehabilitation outcomes were changes in Barthel index scores and the rehabilitation efficiency index. Few (n = 9; 10%) consumed ≥100% of the estimated average requirement (EAR) for energy within 2 weeks of admission and 13 (33%) had energy intakes <50% of EAR before discharge. A small but increasing proportion (7% at admission, 13% at discharge) were identified as being malnourished across the inpatient stay. Younger age, lower Barthel index and a higher energy intake in the early stages of admission predicted the extent and rate of restoration of functional abilities by discharge (F = 7.503, P = 0.001; F = 14.558, P < 0.001). Given a general finding of nutritional deterioration identified for these patients, as well as the identification of energy intake as a modifiable influence on the extent and rate of recovery, there is clearly scope for the multidisciplinary development of nutritional support for stroke patients to improve rehabilitation outcomes. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

Urinary Sodium Excretion and Dietary Sources of Sodium Intake in Chinese Postmenopausal Women with Prehypertension

PubMed Central

Liu, Zhao-min; Ho, Suzanne C.; Tang, Nelson; Chan, Ruth; Chen, Yu-ming; Woo, Jean

2014-01-01

Background Reducing salt intake in communities is one of the most effective and affordable public health strategies to prevent hypertension, stroke and renal disease. The present study aimed to determine the sodium intake in Hong Kong Chinese postmenopausal women and identify the major food sources contributing to sodium intake and urine excretion. Methods This was a cross-sectional study among 655 Chinese postmenopausal women with prehypertension who were screened for a randomized controlled trial. Data collection included 24 h urine collection for the measurement of sodium, potassium and creatinine, 3-day dietary records, anthropometric measures and questionnaire survey on demographic data and dietary habits. Results The average salt intake estimated from urinary excretion was 7.8±3.2 g/d with 82.1% women above WHO recommendation of 5 g/day. Food groups as soup (21.6%), rice and noodles (13.5%), baked cereals (12.3%), salted/preserved foods (10.8%), Chinese dim sum (10.2%) and sea foods (10.1%) were the major contributors of non-discretionary salt. Discretionary salt use in cooking made a modest contribution to overall intake. Vegetable and fruit intake, age, sodium intake from salted foods, sea foods and soup were the independent determinants of urinary sodium excretion. Conclusions Our data revealed a significant room for reduction of the sodium intake. Efforts to reduce sodium from diets in Hong Kong Chinese postmenopausal women should focus on both processed foods and discretionary salt during cooking. Sodium reduction in soup and increase in fruit intake would be potentially effective strategy for reducing sodium. PMID:25083775

High Iodine and Salt Intakes and Obesity do not Modify the Thyroid Function in Mexican Schoolchildren.

PubMed

Méndez-Villa, Lorena; García-Solís, Pablo; Solís-S, Juan Carlos; García-Gutiérrez, David Gustavo; Pérez-Mora, Valeria Alejandra; Robles-Osorio, Ludivina; Sampson-Zaldívar, Eduardo

2016-08-01

Mexico is considered as a nutritional transition country with a high prevalence of overweight and obesity, and recent studies have reported a high iodine intake in children. Both high iodine intake and obesity have been associated with thyroid dysfunction. Our aim was to assess iodine and salt intake and thyroid function in Mexican schoolchildren with normal weight and obesity. A cross-sectional study was performed during 2012-2013 in schoolchildren from Queretaro, Mexico. Six hundred seventy-eight schoolchildren were evaluated to obtain nutrition status, urinary iodine concentration (UIC) and thyroid volume (TVol). The prevalence of overweight and obesity was 47.3 %, the median UIC was 428 μg/L and TVol was normal in all schoolchildren; however, obese girls had a higher TVol than normal weight at the age of 8, 10 and 12 years. A subsample of schoolchildren was divided in 6-8 and 9-12-year-old groups, in order to compare thyroid function (thyrotropin, free T4, and anti-thyroid antibodies); iodine and salt intake were estimated with 24-h urinary samples. No differences in thyroid function were observed in both age groups. In the 6-8-year-old group, obese schoolchildren had higher iodine intake than normal-weight children (415.5 vs. 269.1 μg/day, p < 0.05), but no differences in salt intake. In contrast, in the 9-12-year-old group, obese schoolchildren had higher salt intake than normal-weight children (6.2 vs. 3.8 g/day, p < 0.05), but no differences in iodine intake. Dietary patterns could explain the differences between both age groups. Further studies are needed to identify the main sources of iodine intake in Mexican populations.

Interaction of ACE genotype and salt intake on hypertension among Chinese Kazakhs: results from a population-based cross-sectional study.

PubMed

Wang, Yuyan; Zhang, Biao; Hou, Lei; Han, Wei; Xue, Fang; Wang, Yanhong; Tang, Yong; Liang, Shaohua; Wang, Weizhi; Asaiti, Kuliqian; Wang, Zixing; Hu, Yaoda; Wang, Lei; Qiu, Changchun; Zhang, Mingtao; Jiang, Jingmei

2017-05-17

To explore the effect of interaction between ACE genotype and salt intake on hypertension among Chinese Kazakhs, and to compare applications of interactions between logistic model and generalised partially linear tree-based regression (GPLTR) model. Population-based cross-sectional study. Hong Dun, North Xinjiang, China. Non-consanguineous Chinese Kazakh participants (n=916, 342 men and 574 women) aged ≥30 years. Association between ACE genotype and hypertension, association between salt intake and hypertension, and interaction of ACE genotype and salt intake on hypertension in two models. Associations between salt intake and hypertension were different in ACE genotype of II and ID+DD. Under the logistic models, main and interaction effects were not observed for men, but effects were present in opposite directions for women (main effect of ACE: OR=0.20, p=0.003; interaction effect: OR=1.07, p=0.027). Under the GPLTR model, Bayesian information criterion trees included both salt intake and ACE genotype as split variables. Individuals with a salt intake ≥19.5 g/day and ID+DD genotypes had a 3.99-fold (p=0.004) higher risk of hypertension compared with the II genotype for men, whereas salt intake <20.1 g/day and ID+DD genotypes had an OR=0.55 (p=0.014) compared with the II genotype for women. An interaction of ACE genotype and salt intake on hypertension was observed among Chinese Kazakhs but in different ways according to sex. The GPLTR model appears to be more suitable for an exploration of interactions in complex diseases. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effect of salt intake and potassium supplementation on urinary renalase and serum dopamine levels in Chinese adults.

PubMed

Wang, Yang; Wang, Dan; Chu, Chao; Mu, Jian-Jun; Wang, Man; Liu, Fu-Qiang; Xie, Bing-Qing; Yang, Fan; Dong, Zhen-Zhen; Yuan, Zu-Yi

2015-01-01

The aim of our study was to assess the effects of altered salt and potassium intake on urinary renalase and serum dopamine levels in humans. Forty-two subjects (28–65 years of age) were selected from a rural community of northern China. All subjects were sequentially maintained on a low-salt diet for 7 days (3.0 g/day of NaCl), a high-salt diet for an additional 7 days (18.0 g/day of NaCl), and a high-salt diet with potassium supplementation for a final 7 days (18.0 g/day of NaCl + 4.5 g/day of KCl). Urinary renalase excretions were significantly higher during the high-salt diet intervention than during the low-salt diet. During high-potassium intake, urinary renalase excretions were not significantly different from the high-salt diet, whereas they were significantly higher than the low-salt levels. Serum dopamine levels exhibited similar trends across the interventions. Additionally, a significant positive relationship was observed between the urine renalase and serum dopamine among the different dietary interventions. Also, 24-hour urinary sodium excretion positively correlated with urine renalase and serum dopamine in the whole population. The present study indicates that dietary salt intake and potassium supplementation increase urinary renalase and serum dopamine levels in Chinese subjects. © 2015 S. Karger AG, Basel

Mean Dietary Salt Intake in Urban and Rural Areas in India: A Population Survey of 1395 Persons.

PubMed

Johnson, Claire; Mohan, Sailesh; Rogers, Kris; Shivashankar, Roopa; Thout, Sudhir Raj; Gupta, Priti; He, Feng J; MacGregor, Graham A; Webster, Jacqui; Krishnan, Anand; Maulik, Pallab K; Reddy, K Srinath; Prabhakaran, Dorairaj; Neal, Bruce

2017-01-06

The scientific evidence base in support of population-wide salt reduction is strong, but current high-quality data about salt intake levels in India are mostly absent. This project sought to estimate daily salt consumption levels in selected communities of Delhi and Haryana in north India and Andhra Pradesh in south India. In this study, 24-hour urine samples were collected using an age- and sex-stratified sampling strategy in rural, urban, and slum areas. Salt intake estimates were made for the overall population of each region and for major subgroups by weighting the survey data for the populations of Delhi and Haryana, and Andhra Pradesh. Complete 24-hour urine samples were available for 637 participants from Delhi and Haryana and 758 from Andhra Pradesh (65% and 68% response rates, respectively). Weighted mean population 24-hour urine excretion of salt was 8.59 g/day (95% CI 7.68-9.51) in Delhi and Haryana and 9.46 g/day (95% CI 9.06-9.85) in Andhra Pradesh (P=0.097). Estimates inflated to account for the minimum likely nonurinary losses of sodium provided corresponding estimates of daily salt intake of 9.45 g/day (95% CI 8.45-10.46) and 10.41 g/day (95% CI 9.97-10.84), respectively. Salt consumption in India is high, with mean population intake well above the World Health Organization recommended maximum of 5 g/day. A national salt reduction program would likely avert much premature death and disability. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Effect of Salt Intake and Potassium Supplementation on Serum Renalase Levels in Chinese Adults

PubMed Central

Wang, Yang; Liu, Fu-Qiang; Wang, Dan; Mu, Jian-Jun; Ren, Ke-Yu; Guo, Tong-Shuai; Chu, Chao; Wang, Lan; Geng, Li-Ke; Yuan, Zu-Yi

2014-01-01

Abstract Renalase, a recently discovered enzyme released by the kidneys, breaks down blood-borne catecholamines and may thus regulate blood pressure (BP). Animal studies have suggested that high levels of dietary salt might reduce blood and kidney renalase levels. We conducted a randomized trial to assess the effects of altered salt and potassium intake on serum renalase levels and the relationship between serum renalase levels and BP in humans. Forty-two subjects (28–65 years of age) were selected from a rural community of northern China. All subjects were sequentially maintained on a low-salt diet for 7 days (3.0 g/day of NaCl), a high-salt diet for additional 7 days (18.0 g/day of NaCl), and a high-salt diet with potassium supplementation for final 7 days (18.0 g/day of NaCl + 4.5 g/day of KCl). Serum renalase levels were significantly higher than baseline levels during the low-salt diet intervention period. Renalase levels decreased with the change from the low-salt to high-salt diet, whereas dietary potassium prevented the decrease in serum renalase induced by the high-salt diet. There was a significant inverse correlation between the serum renalase level and 24-h urinary sodium excretion. No significant correlation was found between the renalase level and BP among the different dietary interventions. The present study indicates that variations in dietary salt intake and potassium supplementation affect the serum renalase concentration in Chinese subjects. PMID:25058146

Intake of dietary salt and drinking water: Implications for the development of age-related macular degeneration

PubMed Central

Hollborn, Margrit; Kohen, Leon; Wiedemann, Peter

2016-01-01

Purpose Systemic hypertension is a risk factor of age-related retinal diseases such as diabetic retinopathy and age-related macular degeneration. High intake of dietary salt and low intake of water increase extracellular osmolality resulting in hypertension, in particular in salt-sensitive individuals. This review summarizes the present knowledge regarding the impact of salt and water intake on the regulation of blood pressure, retinal function, and the development of age-related retinal diseases. Methods A literature search of the Medline database and a summary of recent studies that used human RPE cells. Results The salt sensitivity of the blood pressure and plasma osmolality increase with age, and body water deficits are common in older individuals. High plasma osmolality has adverse effects in the retina. In RPE cells, high osmolality induces expression and secretion of angiogenic factors, such as vascular endothelial growth factor (VEGF), placental growth factor, and basic fibroblast growth factor, and expression of aquaporin-5, a water channel implicated in transepithelial water transport. The transcriptional activities of hypoxia-inducible factor-1 (HIF-1) and nuclear factor of activated T cell 5 (NFAT5) are critical for the production of VEGF in response to salt-induced osmotic stress. Salt-induced osmotic stress also induces priming of the NLRP3 inflammasome and activates inflammatory enzymes in RPE cells. Conclusions Raised plasma osmolality may aggravate age-related retinal diseases by stimulation of local inflammation and angiogenic factor production in the RPE. Alterations in salt and water consumption, and of minerals that stimulate renal salt excretion, may offer nutritional approaches to prevent age-related retinal disorders, in particular in salt-sensitive individuals and individuals who show signs of body dehydration. PMID:28031693

Intake of dietary salt and drinking water: Implications for the development of age-related macular degeneration.

PubMed

Bringmann, Andreas; Hollborn, Margrit; Kohen, Leon; Wiedemann, Peter

2016-01-01

Systemic hypertension is a risk factor of age-related retinal diseases such as diabetic retinopathy and age-related macular degeneration. High intake of dietary salt and low intake of water increase extracellular osmolality resulting in hypertension, in particular in salt-sensitive individuals. This review summarizes the present knowledge regarding the impact of salt and water intake on the regulation of blood pressure, retinal function, and the development of age-related retinal diseases. A literature search of the Medline database and a summary of recent studies that used human RPE cells. The salt sensitivity of the blood pressure and plasma osmolality increase with age, and body water deficits are common in older individuals. High plasma osmolality has adverse effects in the retina. In RPE cells, high osmolality induces expression and secretion of angiogenic factors, such as vascular endothelial growth factor (VEGF), placental growth factor, and basic fibroblast growth factor, and expression of aquaporin-5, a water channel implicated in transepithelial water transport. The transcriptional activities of hypoxia-inducible factor-1 (HIF-1) and nuclear factor of activated T cell 5 (NFAT5) are critical for the production of VEGF in response to salt-induced osmotic stress. Salt-induced osmotic stress also induces priming of the NLRP3 inflammasome and activates inflammatory enzymes in RPE cells. Raised plasma osmolality may aggravate age-related retinal diseases by stimulation of local inflammation and angiogenic factor production in the RPE. Alterations in salt and water consumption, and of minerals that stimulate renal salt excretion, may offer nutritional approaches to prevent age-related retinal disorders, in particular in salt-sensitive individuals and individuals who show signs of body dehydration.

Dietary salt intake assessed by 24 h urinary sodium excretion in Australian schoolchildren aged 5-13 years.

PubMed

Grimes, Carley A; Riddell, Lynn J; Campbell, Karen J; Nowson, Caryl A

2013-10-01

To measure total daily salt intake using 24 h urinary Na excretion within a sample of Victorian schoolchildren aged 5-13 years and to assess discretionary salt use habits of children and parents. Cross-sectional study. Completed within a convenience sample of independent primary schools (n 9) located in Victoria, Australia. Two hundred and sixty children completed a 24 h urine collection over a school (34%) or non-school day (66%). Samples deemed incomplete (n 18), an over-collection (n 1) or that were incorrectly processed at the laboratory (n 3) were excluded. The sample comprised 120 boys and 118 girls with a mean age of 9.8 (SD 1.7) years. The average 24 h urinary Na excretion (n 238) was 103 (SD 43) mmol/24 h (salt equivalent 6.0 (SD 2.5) g/d). Daily Na excretion did not differ by sex; boys 105 (SD 46) mmol/24 h (salt equivalent 6.1 (SD 2.7) g/d) and girls 100 (SD 41) mmol/24 h (salt equivalent 5.9 (SD 2.4) g/d; P=0.38). Sixty-nine per cent of children (n 164) exceeded the recommended daily Upper Limit for Na. Reported discretionary salt use was common: two-thirds of parents reported adding salt during cooking and almost half of children reported adding salt at the table. The majority of children had salt intakes exceeding the recommended daily Upper Limit. Strategies to lower salt intake in children are urgently required, and should include product reformulation of lower-sodium food products combined with interventions targeting discretionary salt use within the home.

Prenatal programming of renal salt wasting resets postnatal salt appetite, which drives food intake in the rat.

PubMed

Alwasel, Saleh H; Barker, David J P; Ashton, Nick

2012-03-01

Sodium retention has been proposed as the cause of hypertension in the LP rat (offspring exposed to a maternal low-protein diet in utero) model of developmental programming because of increased renal NKCC2 (Na+/K+/2Cl- co-transporter 2) expression. However, we have shown that LP rats excrete more rather than less sodium than controls, leading us to hypothesize that LP rats ingest more salt in order to maintain sodium balance. Rats were fed on either a 9% (low) or 18% (control) protein diet during pregnancy; male and female offspring were studied at 4 weeks of age. LP rats of both sexes held in metabolism cages excreted more sodium and urine than controls. When given water to drink, LP rats drank more and ate more food than controls, hence sodium intake matched excretion. However, when given a choice between saline and water to drink, the total volume of fluid ingested by LP rats fell to control levels, but the volume of saline taken was significantly larger [3.8±0.1 compared with 8.8±1.3 ml/24 h per 100 g of body weight in control and LP rats respectively; P<0.001]. Interestingly food intake also fell to control levels. Total body sodium content and ECF (extracellular fluid) volumes were greater in LP rats. These results show that prenatal programming of renal sodium wasting leads to a compensatory increase in salt appetite in LP rats. We speculate that the need to maintain salt homoeostasis following malnutrition in utero stimulates greater food intake, leading to accelerated growth and raised BP (blood pressure).

The iodized salt programme in Bangalore, India provides adequate iodine intakes in pregnant women and more-than-adequate iodine intakes in their children.

PubMed

Jaiswal, Nidhi; Melse-Boonstra, Alida; Sharma, Surjeet Kaur; Srinivasan, Krishnamachari; Zimmermann, Michael B

2015-02-01

To compare the iodine status of pregnant women and their children who were sharing all meals in Bangalore, India. A cross-sectional study evaluating demographic characteristics, household salt iodine concentration and salt usage patterns, urinary iodine concentrations (UIC) in women and children, and maternal thyroid volume (ultrasound). Antenatal clinic of an urban tertiary-care hospital, which serves a low-income population. Healthy pregnant women in all trimesters, aged 18-35 years, who had healthy children aged 3-15 years. Median (range) iodine concentrations of household powdered and crystal salt were 55·9 (17·2-65·9) ppm and 18·9 (2·2-68·2) ppm, respectively. The contribution of iodine-containing supplements and multi-micronutrient powders to iodine intake in the families was negligible. Adequately iodized salt, together with small amounts of iodine in local foods, were providing adequate iodine during pregnancy: (i) the overall median (range) UIC in women was 172 (5-1024) µg/l; (ii) the median UIC was >150 µg/l in all trimesters; and (iii) thyroid size was not significantly different across trimesters. At the same time, the median (range) UIC in children was 220 (10-782) µg/l, indicating more-than-adequate iodine intake at this age. Median UIC was significantly higher in children than in their mothers (P=0·008). In this selected urban population of southern India, the iodized salt programme provides adequate iodine to women throughout pregnancy, at the expense of higher iodine intake in their children. Thus we suggest that the current cut-off for median UIC in children indicating more-than-adequate intake, recommended by the WHO/UNICEF/International Council for the Control of Iodine Deficiency Disorders may, need to be reconsidered.

Within-country variation of salt intake assessed via urinary excretion in Japan: a multilevel analysis in all 47 prefectures.

PubMed

Uechi, Ken; Asakura, Keiko; Masayasu, Shizuko; Sasaki, Satoshi

2017-06-01

Salt intake in Japan remains high; therefore, exploring within-country variation in salt intake and its cause is an important step in the establishment of salt reduction strategies. However, no nationwide evaluation of this variation has been conducted by urinalysis. We aimed to clarify whether within-country variation in salt intake exists in Japan after adjusting for individual characteristics. Healthy men (n=1027) and women (n=1046) aged 20-69 years were recruited from all 47 prefectures of Japan. Twenty-four-hour sodium excretion was estimated using three spot urine samples collected on three nonconsecutive days. The study area was categorized into 12 regions defined by the National Health and Nutrition Survey Japan. Within-country variation in sodium excretion was estimated as a population (region)-level variance using a multilevel model with random intercepts, with adjustment for individual biological, socioeconomic and dietary characteristics. Estimated 24 h sodium excretion was 204.8 mmol per day in men and 155.7 mmol per day in women. Sodium excretion was high in the Northeastern region. However, population-level variance was extremely small after adjusting for individual characteristics (0.8 and 2% of overall variance in men and women, respectively) compared with individual-level variance (99.2 and 98% of overall variance in men and women, respectively). Among individual characteristics, greater body mass index, living with a spouse and high miso-soup intake were associated with high sodium excretion in both sexes. Within-country variation in salt intake in Japan was extremely small compared with individual-level variation. Salt reduction strategies for Japan should be comprehensive and should not address the small within-country differences in intake.

Changes in the renin-angiotensin-aldosterone system in response to dietary salt intake in normal and hypertensive pregnancy. A randomized trial.

PubMed

Nielsen, Lise H; Ovesen, Per; Hansen, Mie R; Brantlov, Steven; Jespersen, Bente; Bie, Peter; Jensen, Boye L

2016-11-01

It was hypothesized that primary renal sodium retention blunted the reactivity of the renin-angiotensin-aldosterone system to changes in salt intake in preeclampsia (PE). A randomized, cross-over, double-blinded, dietary intervention design was used to measure the effects of salt tablets or placebo during low-salt diet in PE patients (n = 7), healthy pregnant women (n = 15), and nonpregnant women (n = 13). High-salt intake decreased renin and angiotensin II concentrations significantly in healthy pregnant women (P < .03) and in nonpregnant women (P < .001), but not in PE (P = .58), while decreases in aldosterone and increases in brain natriuretic peptid (BNP) were similar in the groups. In PE patients, uterine and umbilical artery indices were not adversely changed during low-salt diet. Creatinine clearance was significantly lower in PE with no change by salt intake. PE patients displayed alterations of plasma renin and angiotensin II in response to changes in dietary salt intake compatible with a primary increase in renal sodium reabsorption in hypertensive pregnancies. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Preventive and therapeutic effect of brozopine on stroke in Dahl Salt-sensitive hypertensive rats.

PubMed

Gao, Yuan; Wang, Yan; Li, Miao; Liu, Yali; Chang, Junbiao; Qiao, Hailing

2017-10-01

Our aim was to explore the preventive and therapeutic effects of sodium (±)-5-bromo-2-(α-hydroxypentyl) benzoate (brand name: brozopine, BZP) on stroke in Dahl Salt-sensitive (Dahl-SS) hypertensive rats. Dahl-SS rats were fed a high-salt diet to observe the effect of BZP on blood pressure, and brain, heart, and kidney tissues. Additionally, the incidence of stroke was recorded according to the neurological score. The relative mechanisms investigated included anti-oxidative effects and anti-platelet aggregation. BZP reduced the incidence of stroke, neuronal necrosis in the brain, and cell swelling and inflammatory infiltration in the kidney. Its mechanisms were related to the increased activities of gluthatione peroxidase and catalase and the decreased level of plasma nitric oxide. BZP inhibited arachidonic acid (AA) - induced platelet aggregation (IC 50 : 12µM) rather than that of adenosine diphosphate (ADP) - and/or thrombin-induced platelet aggregation in vitro. Interestingly, BZP inhibited ADP-, thrombin-, or AA-induced platelet aggregation and elevated the level of AMP-activated protein kinase, cyclic guanosine monophosphate, and vasodilator-stimulated-phosphoprotein, and attenuated ATP contents and mitogen-activated protein kinase levels in platelet and inhibited thrombus formation in a carotid artery thrombosis model, dose-dependently, in Dahl-SS hypertensive-induced stroke rats. In conclusion, BZP can have therapeutic and preventive effects on stroke in Dahl-SS hypertensive rats, the mechanisms of which may be related to anti-oxidant, anti-platelet aggregation and anti-thrombus formation. Copyright © 2017 Elsevier B.V. All rights reserved.

High salt intake increases plasma trimethylamine N-oxide (TMAO) concentration and produces gut dysbiosis in rats.

PubMed

Bielinska, Klaudia; Radkowski, Marek; Grochowska, Marta; Perlejewski, Karol; Huc, Tomasz; Jaworska, Kinga; Motooka, Daisuke; Nakamura, Shota; Ufnal, Marcin

2018-03-22

A high-salt diet is considered a cardiovascular risk factor; however, the mechanisms are not clear. Research suggests that gut bacteria-derived metabolites such as trimethylamine N-oxide (TMAO) are markers of cardiovascular diseases. We evaluated the effect of high salt intake on gut bacteria and their metabolites plasma level. Sprague Dawley rats ages 12-14 wk were maintained on either water (controls) or 0.9% or 2% sodium chloride (NaCl) water solution (isotonic and hypertonic groups, respectively) for 2 wk. Blood plasma, urine, and stool samples were analyzed for concentrations of trimethylamine (TMA; a TMAO precursor), TMAO, and indoxyl sulfate (indole metabolite). The gut-blood barrier permeability to TMA and TMA liver clearance were assessed at baseline and after TMA intracolonic challenge test. Gut bacterial flora was analyzed with a 16S ribosomal ribonucleic acid (rRNA) gene sequence analysis. The isotonic and hypertonic groups showed a significantly higher plasma TMAO and significantly lower 24-hr TMAO urine excretion than the controls. However, the TMA stool level was similar between the groups. There was no significant difference between the groups in gut-blood barrier permeability and TMA liver clearance. Plasma indoxyl concentration and 24-hr urine indoxyl excretion were similar between the groups. There was a significant difference between the groups in gut bacteria composition. High salt intake increases plasma TMAO concentration, which is associated with decreased TMAO urine excretion. Furthermore, high salt intake alters gut bacteria composition. These findings suggest that salt intake affects an interplay between gut bacteria and their host homeostasis. Copyright © 2018 Elsevier Inc. All rights reserved.

The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients.

PubMed

Ozkayar, Nihal; Dede, Fatih; Ates, Ihsan; Akyel, Fatma; Yildirim, Tolga; Altun, Bulent

High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV). This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female) with a mean age of 50.7±11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium)] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r=0.371 and p=0.001, r=0.329 and p=0.028, respectively). Similarly, log(24-h urinary sodium) was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r=0.381 and p=0.001, r=0.320 and p=0.020 respectively). Log(24-h urinary sodium) was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Artificial neural network modeling using clinical and knowledge independent variables predicts salt intake reduction behavior

PubMed Central

Isma’eel, Hussain A.; Sakr, George E.; Almedawar, Mohamad M.; Fathallah, Jihan; Garabedian, Torkom; Eddine, Savo Bou Zein

2015-01-01

Background High dietary salt intake is directly linked to hypertension and cardiovascular diseases (CVDs). Predicting behaviors regarding salt intake habits is vital to guide interventions and increase their effectiveness. We aim to compare the accuracy of an artificial neural network (ANN) based tool that predicts behavior from key knowledge questions along with clinical data in a high cardiovascular risk cohort relative to the least square models (LSM) method. Methods We collected knowledge, attitude and behavior data on 115 patients. A behavior score was calculated to classify patients’ behavior towards reducing salt intake. Accuracy comparison between ANN and regression analysis was calculated using the bootstrap technique with 200 iterations. Results Starting from a 69-item questionnaire, a reduced model was developed and included eight knowledge items found to result in the highest accuracy of 62% CI (58-67%). The best prediction accuracy in the full and reduced models was attained by ANN at 66% and 62%, respectively, compared to full and reduced LSM at 40% and 34%, respectively. The average relative increase in accuracy over all in the full and reduced models is 82% and 102%, respectively. Conclusions Using ANN modeling, we can predict salt reduction behaviors with 66% accuracy. The statistical model has been implemented in an online calculator and can be used in clinics to estimate the patient’s behavior. This will help implementation in future research to further prove clinical utility of this tool to guide therapeutic salt reduction interventions in high cardiovascular risk individuals. PMID:26090333

Effect of salt intake on beat-to-beat blood pressure nonlinear dynamics and entropy in salt-sensitive versus salt-protected rats.

PubMed

Fares, Souha A; Habib, Joseph R; Engoren, Milo C; Badr, Kamal F; Habib, Robert H

2016-06-01

Blood pressure exhibits substantial short- and long-term variability (BPV). We assessed the hypothesis that the complexity of beat-to-beat BPV will be differentially altered in salt-sensitive hypertensive Dahl rats (SS) versus rats protected from salt-induced hypertension (SSBN13) maintained on high-salt versus low-salt diet. Beat-to-beat systolic and diastolic BP series from nine SS and six SSBN13 rats (http://www.physionet.org) were analyzed following 9 weeks on low salt and repeated after 2 weeks on high salt. BP complexity was quantified by detrended fluctuation analysis (DFA), short- and long-range scaling exponents (αS and αL), sample entropy (SampEn), and traditional standard deviation (SD) and coefficient of variation (CV(%)). Mean systolic and diastolic BP increased on high-salt diet (P < 0.01) particularly for SS rats. SD and CV(%) were similar across groups irrespective of diet. Salt-sensitive and -protected rats exhibited similar complexity indices on low-salt diet. On high salt, (1) SS rats showed increased scaling exponents or smoother, systolic (P = 0.007 [αL]) and diastolic (P = 0.008 [αL]) BP series; (2) salt-protected rats showed lower SampEn (less complex) systolic and diastolic BP (P = 0.046); and (3) compared to protected SSBN13 rats, SS showed higher αL for systolic (P = 0.01) and diastolic (P = 0.005) BP Hypertensive SS rats are more susceptible to high salt with a greater rise in mean BP and reduced complexity. Comparable mean pressures in sensitive and protective rats when on low-salt diet coupled with similar BPV dynamics suggest a protective role of low-salt intake in hypertensive rats. This effect likely reflects better coupling of biologic oscillators. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

High salt intake increases blood pressure via BDNF-mediated downregulation of KCC2 and impaired baroreflex inhibition of vasopressin neurons.

PubMed

Choe, Katrina Y; Han, Su Y; Gaub, Perrine; Shell, Brent; Voisin, Daniel L; Knapp, Blayne A; Barker, Philip A; Brown, Colin H; Cunningham, J Thomas; Bourque, Charles W

2015-02-04

The mechanisms by which dietary salt promotes hypertension are unknown. Previous work established that plasma [Na(+)] and osmolality rise in proportion with salt intake and thus promote release of vasopressin (VP) from the neurohypophysis. Although high levels of circulating VP can increase blood pressure, this effect is normally prevented by a potent GABAergic inhibition of VP neurons by aortic baroreceptors. Here we show that chronic high salt intake impairs baroreceptor inhibition of rat VP neurons through a brain-derived neurotrophic factor (BDNF)-dependent activation of TrkB receptors and downregulation of KCC2 expression, which prevents inhibitory GABAergic signaling. We show that high salt intake increases the spontaneous firing rate of VP neurons in vivo and that circulating VP contributes significantly to the elevation of arterial pressure under these conditions. These results provide the first demonstration that dietary salt can affect blood pressure through neurotrophin-induced plasticity in a central homeostatic circuit. Copyright © 2015 Elsevier Inc. All rights reserved.

High salt intake enhances swim stress-induced PVN vasopressin cell activation and active stress coping.

PubMed

Mitchell, N C; Gilman, T L; Daws, L C; Toney, G M

2018-07-01

Stress contributes to many psychiatric disorders; however, responsivity to stressors can vary depending on previous or current stress exposure. Relatively innocuous heterotypic (differing in type) stressors can summate to result in exaggerated neuronal and behavioral responses. Here we investigated the ability of prior high dietary sodium chloride (salt) intake, a dehydrating osmotic stressor, to enhance neuronal and behavioral responses of mice to an acute psychogenic swim stress (SS). Further, we evaluated the contribution of the osmo-regulatory stress-related neuropeptide arginine vasopressin (VP) in the hypothalamic paraventricular nucleus (PVN), one of only a few brain regions that synthesize VP. The purpose of this study was to determine the impact of high dietary salt intake on responsivity to heterotypic stress and the potential contribution of VPergic-mediated neuronal activity on high salt-induced stress modulation, thereby providing insight into how dietary (homeostatic) and environmental (psychogenic) stressors might interact to facilitate psychiatric disorder vulnerability. Salt loading (SL) with 4% saline for 7 days was used to dehydrate and osmotically stress mice prior to exposure to an acute SS. Fluid intake and hematological measurements were taken to quantify osmotic dehydration, and serum corticosterone levels were measured to index stress axis activation. Immunohistochemistry (IHC) was used to stain for the immediate early gene product c-Fos to quantify effects of SL on SS-induced activation of neurons in the PVN and extended amygdala - brain regions that are synaptically connected and implicated in responding to osmotic stress and in modulation of SS behavior, respectively. Lastly, the role of VPergic PVN neurons and VP type 1 receptor (V1R) activity in the amygdala in mediating effects of SL on SS behavior was evaluated by quantifying c-Fos activation of VPergic PVN neurons and, in functional experiments, by nano-injecting the V1R selective

High salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation.

PubMed

Kitada, Kento; Daub, Steffen; Zhang, Yahua; Klein, Janet D; Nakano, Daisuke; Pedchenko, Tetyana; Lantier, Louise; LaRocque, Lauren M; Marton, Adriana; Neubert, Patrick; Schröder, Agnes; Rakova, Natalia; Jantsch, Jonathan; Dikalova, Anna E; Dikalov, Sergey I; Harrison, David G; Müller, Dominik N; Nishiyama, Akira; Rauh, Manfred; Harris, Raymond C; Luft, Friedrich C; Wassermann, David H; Sands, Jeff M; Titze, Jens

2017-05-01

Natriuretic regulation of extracellular fluid volume homeostasis includes suppression of the renin-angiotensin-aldosterone system, pressure natriuresis, and reduced renal nerve activity, actions that concomitantly increase urinary Na+ excretion and lead to increased urine volume. The resulting natriuresis-driven diuretic water loss is assumed to control the extracellular volume. Here, we have demonstrated that urine concentration, and therefore regulation of water conservation, is an important control system for urine formation and extracellular volume homeostasis in mice and humans across various levels of salt intake. We observed that the renal concentration mechanism couples natriuresis with correspondent renal water reabsorption, limits natriuretic osmotic diuresis, and results in concurrent extracellular volume conservation and concentration of salt excreted into urine. This water-conserving mechanism of dietary salt excretion relies on urea transporter-driven urea recycling by the kidneys and on urea production by liver and skeletal muscle. The energy-intense nature of hepatic and extrahepatic urea osmolyte production for renal water conservation requires reprioritization of energy and substrate metabolism in liver and skeletal muscle, resulting in hepatic ketogenesis and glucocorticoid-driven muscle catabolism, which are prevented by increasing food intake. This natriuretic-ureotelic, water-conserving principle relies on metabolism-driven extracellular volume control and is regulated by concerted liver, muscle, and renal actions.

High salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation

PubMed Central

Kitada, Kento; Daub, Steffen; Zhang, Yahua; Klein, Janet D.; Nakano, Daisuke; Pedchenko, Tetyana; Lantier, Louise; LaRocque, Lauren M.; Marton, Adriana; Neubert, Patrick; Schröder, Agnes; Rakova, Natalia; Jantsch, Jonathan; Dikalova, Anna E.; Dikalov, Sergey I.; Harrison, David G.; Müller, Dominik N.; Nishiyama, Akira; Rauh, Manfred; Harris, Raymond C.; Luft, Friedrich C.; Wasserman, David H.; Sands, Jeff M.

2017-01-01

Natriuretic regulation of extracellular fluid volume homeostasis includes suppression of the renin-angiotensin-aldosterone system, pressure natriuresis, and reduced renal nerve activity, actions that concomitantly increase urinary Na+ excretion and lead to increased urine volume. The resulting natriuresis-driven diuretic water loss is assumed to control the extracellular volume. Here, we have demonstrated that urine concentration, and therefore regulation of water conservation, is an important control system for urine formation and extracellular volume homeostasis in mice and humans across various levels of salt intake. We observed that the renal concentration mechanism couples natriuresis with correspondent renal water reabsorption, limits natriuretic osmotic diuresis, and results in concurrent extracellular volume conservation and concentration of salt excreted into urine. This water-conserving mechanism of dietary salt excretion relies on urea transporter–driven urea recycling by the kidneys and on urea production by liver and skeletal muscle. The energy-intense nature of hepatic and extrahepatic urea osmolyte production for renal water conservation requires reprioritization of energy and substrate metabolism in liver and skeletal muscle, resulting in hepatic ketogenesis and glucocorticoid-driven muscle catabolism, which are prevented by increasing food intake. This natriuretic-ureotelic, water-conserving principle relies on metabolism-driven extracellular volume control and is regulated by concerted liver, muscle, and renal actions. PMID:28414295

High Salt Intake Promotes Urinary Loss of Vitamin D Metabolites by Dahl Salt-Sensitive Rats in a Space Flight Model

NASA Technical Reports Server (NTRS)

Thierry-Palmer, M.; Cephas, S.; Sayavongsa, P.; Clark, T.; Arnaud, S. B.

2004-01-01

Vitamin D metabolism in the Dahl salt-sensitive (S) rat, a model of salt-induced hypertension, differs from that in the Dahl salt-resistant (R) rat. We have demonstrated that female S rats are more vulnerable than female R rats to decreases in plasma 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) concentrations during hind limb unloading (a space flight model). We report here on the response of the vitamin D endocrine system of S and R rats to hind limb unloading during high salt intake. Dahl female rats (9.7-week-old) were tail-suspended (hind limb unloaded) for 28 days, while fed a diet containing twice the salt in standard rat chow (2 % sodium chloride). Control rats were fed the same diet, but were not hind limb unloaded. Vitamin D metabolites were analyzed by HPLC and radioimmunoassay kits from Diasorin.

Individual efforts to reduce salt intake in China, Japan, UK, USA: what did people achieve? The INTERMAP Population Study.

PubMed

Okuda, Nagako; Stamler, Jeremiah; Brown, Ian J; Ueshima, Hirotsugu; Miura, Katsuyuki; Okayama, Akira; Saitoh, Shigeyuki; Nakagawa, Hideaki; Sakata, Kiyomi; Yoshita, Katsushi; Zhao, Liancheng; Elliott, Paul

2014-12-01

Habitual high-salt intake raises blood pressure and risk of cardiovascular diseases. To prevent/control these risks, reduced salt diet (RSD) is recommended in many countries and some people report practicing it; however, little is known about actual achievement. This population-based study assessed level of 24-h dietary sodium intake of participants reporting RSD and others. Participants were 4680 men and women ages 40-59 years randomly selected from 17 populations in People's Republic of China (PRC), Japan, UK and USA, for an observational study on diet and blood pressure (INTERMAP). Daily sodium intake was determined by two timed 24-h urine collections. Antihypertensive treatment status and RSD were ascertained by questionnaire. Participants reporting RSD were few; 3.1% (Japan), 1.3% (PRC), 2.5% (UK), 7.2% (USA); 15.1, 7.9, 16.7 and 16.8% of people with treated hypertension. For those reporting RSD, 24-h urinary sodium excretion was significantly, but only modestly lower than for others, by 17.9 mmol/day (Japan), 56.7 (PRC) and 14.7 (USA), but higher by 10.5 in UK. Sodium intakes for participants reporting RSD remained higher than recommended; 181.0 mmol/day (Japan), 171.5 (PRC), 155.2 (UK) and 148.9 (USA). For these people, as for others, main sources of salt were processed foods in Japan, UK and USA; in PRC, salt added in preparation at home. Enhanced sustained efforts are needed to raise general awareness of the harmful effects of salt on health and the benefits of salt reduction. Population approaches are needed to reduce salt content of processed foods and restaurant meals.

Fish consumption and risk of stroke, coronary heart disease, and cardiovascular mortality in a Dutch population with low fish intake.

PubMed

Hengeveld, L M; Praagman, J; Beulens, J W J; Brouwer, I A; van der Schouw, Y T; Sluijs, I

2018-05-22

Fish consumption of at least 1 portion/week is related to lower cardiovascular disease (CVD) risk. It is uncertain whether a less frequent intake is also beneficial and whether the type of fish matters. We investigated associations of very low intakes of total, fatty, and lean fish, compared with no fish intake, with 18-year incidences of stroke, coronary heart disease (CHD), and CVD mortality. Data were used from 34,033 participants, aged 20-70 years, of the EPIC-Netherlands cohort. Baseline (1993-1997) fish consumption was estimated using a food frequency questionnaire. We compared any fish consumption, <1 portion/week (<100 g) and ≥1 portion/week to non-fish consumption. During 18 follow-up years, 753 stroke events, 2134 CHD events, and 540 CVD deaths occurred. Among the fish consumers (~92%) median intakes of total, lean, and fatty fish were 57.9, 32.9, and 10.7 g/week, respectively. Any fish consumption compared with non-consumption was not associated with incidences of stroke, CHD, MI, and CVD mortality. Furthermore, consumption of <1 portion/week of total, fatty, or lean fish was not associated with any CVD outcome, as compared with non-consumption. Consumption of ≥1 portion/week of lean fish (HR: 0.70, 95% CI: 0.57-0.86) and of fatty fish (HR: 0.63, 95% CI: 0.39-1.02) were associated with lower incidence of ischaemic stroke. Baseline fish consumption of <1 portion/week, regardless of the type of fish, was unrelated to incidences of stroke, CHD, and CVD mortality in this Dutch cohort. Consumption of ≥1 portion/week of fatty or of lean fish reduced the incidence of ischaemic stroke.

Malnutrition risk predicts recovery of full oral intake among older adult stroke patients undergoing enteral nutrition: Secondary analysis of a multicentre survey (the APPLE study).

PubMed

Nishioka, Shinta; Okamoto, Takatsugu; Takayama, Masako; Urushihara, Maki; Watanabe, Misuzu; Kiriya, Yumiko; Shintani, Keiko; Nakagomi, Hiromi; Kageyama, Noriko

2017-08-01

Whether malnutrition risk correlates with recovery of swallowing function of convalescent stroke patients is unknown. This study was conducted to clarify whether malnutrition risks predict achievement of full oral intake in convalescent stroke patients undergoing enteral nutrition. We conducted a secondary analysis of 466 convalescent stroke patients, aged 65 years or over, who were undergoing enteral nutrition. Patients were extracted from the "Algorithm for Post-stroke Patients to improve oral intake Level; APPLE" study database compiled at the Kaifukuki (convalescent) rehabilitation wards. Malnutrition risk was determined by the Geriatric Nutritional Risk Index as follows: severe (<82), moderate (82 to <92), mild (92 to <98), and no malnutrition risks (≥98). Swallowing function was assessed by Fujishima's swallowing grade (FSG) on admission and discharge. The primary outcome was achievement of full oral intake, indicated by FSG ≥ 7. Binary logistic regression analysis was performed to identify predictive factors, including malnutrition risk, for achieving full oral intake. Estimated hazard risk was computed by Cox's hazard model. Of the 466 individuals, 264 were ultimately included in this study. Participants with severe malnutrition risk showed a significantly lower proportion of achievement of full oral intake than lower severity groups (P = 0.001). After adjusting for potential confounders, binary logistic regression analysis showed that patients with severe malnutrition risk were less likely to achieve full oral intake (adjusted odds ratio: 0.232, 95% confidence interval [95% CI]: 0.047-1.141). Cox's proportional hazard model revealed that severe malnutrition risk was an independent predictor of full oral intake (adjusted hazard ratio: 0.374, 95% CI: 0.166-0.842). Compared to patients who did not achieve full oral intake, patients who achieved full oral intake had significantly higher energy intake, but there was no difference in protein intake and

Salt Content in Ready-to-Eat Food and Bottled Spring and Mineral Water Retailed in Novi Sad.

PubMed

Paplović, Ljiljana B Trajković; Popović, Milka B; Bijelović, Sanja V; Velicki, Radmila S; Torović, Ljilja D

2015-01-01

Salt intake above 5 g/person/day is a strong independent risk factor for hypertension, stroke and cardiovascular diseases. Published studies indicate that the main source of salt in human diet is processed ready-to-eat food, contributing with 65-85% to daily salt intake. The aim of this paper was to present data on salt content of ready-to-eat food retailed in Novi Sad, Serbia, and contribution of the salt contained in 100 g of food to the recommended daily intake of salt for healthy and persons with cardiovascular disease (CVD) risk. In 1,069 samples of ready-to-eat food, salt (sodium chloride) content was calculated based on chloride ion determined by titrimetric method, while in 54 samples of bottled water sodium content was determined using flame-photometry. Food items in each food group were categorized as low, medium or high salt. Average salt content of each food group was expressed as a percentage of recommended daily intake for healthy and for persons with CVD risk. Average salt content (g/100 g) ranged from 0.36 ± 0.48 (breakfast cereals) to 2.32 ± 1.02 (grilled meat). The vast majority of the samples of sandwiches (91.7%), pizza (80.7%), salami (73.9%), sausages (72.9%), grilled meat (70.0%) and hard cheese (69.6%) had a high salt profile. Average amount of salt contained in 100 g of food participated with levels ranging from 7.2% (breakfast cereals) to 46.4% (grilled meat) and from 9.6% to 61.8% in the recommended daily intake for healthy adult and person with CVD risk, respectively. Average sodium content in 100 ml of bottled spring and mineral water was 0.33 ± 0.30 mg and 33 ± 44 mg, respectively. Ready-to-eat food retailed in Novi Sad has high hidden salt content, which could be considered as an important contributor to relatively high salt consumption of its inhabitants.

Collecting Evidence to Inform Salt Reduction Policies in Argentina: Identifying Sources of Sodium Intake in Adults from a Population-Based Sample

PubMed Central

Gutierrez, Laura; Romero, Iris B.; Moyano, Daniela L.; Poggio, Rosana; Calandrelli, Matías; Mores, Nora; Rubinstein, Adolfo; Irazola, Vilma

2017-01-01

The maximum content of sodium in selected processed foods (PF) in Argentina was limited by a law enacted in 2013. Data about intake of these and other foods are necessary for policy planning, implementation, evaluation, and monitoring. We examined data from the CESCAS I population-based cohort study to assess the main dietary sources among PF and frequency of discretionary salt use by sex, age, and education attainment, before full implementation of the regulations in 2015. We used a validated 34-item FFQ (Food Frequency Questionnaire) to assess PF intake and discretional salt use. Among 2127 adults in two Argentinean cities, aged 35–76 years, mean salt intake from selected PFs was 4.7 g/day, higher among male and low education subgroups. Categories of foods with regulated maximum limits provided near half of the sodium intake from PFs. Use of salt (always/often) at the table and during cooking was reported by 9% and 73% of the population, respectively, with higher proportions among young people. Reducing salt consumption to the target of 5 g/day may require adjustments to the current regulation (reducing targets, including other food categories), as well as reinforcing strategies such as education campaigns, labeling, and voluntary agreement with bakeries. PMID:28858263

Effect of salt intake and potassium supplementation on serum renalase levels in Chinese adults: a randomized trial.

PubMed

Wang, Yang; Liu, Fu-Qiang; Wang, Dan; Mu, Jian-Jun; Ren, Ke-Yu; Guo, Tong-Shuai; Chu, Chao; Wang, Lan; Geng, Li-Ke; Yuan, Zu-Yi

2014-07-01

Renalase, a recently discovered enzyme released by the kidneys, breaks down blood-borne catecholamines and may thus regulate blood pressure (BP). Animal studies have suggested that high levels of dietary salt might reduce blood and kidney renalase levels. We conducted a randomized trial to assess the effects of altered salt and potassium intake on serum renalase levels and the relationship between serum renalase levels and BP in humans.Forty-two subjects (28-65 years of age) were selected from a rural community of northern China. All subjects were sequentially maintained on a low-salt diet for 7 days (3.0 g/day of NaCl), a high-salt diet for additional 7 days (18.0 g/day of NaCl), and a high-salt diet with potassium supplementation for final 7 days (18.0 g/day of NaCl + 4.5 g/day of KCl).Serum renalase levels were significantly higher than baseline levels during the low-salt diet intervention period. Renalase levels decreased with the change from the low-salt to high-salt diet, whereas dietary potassium prevented the decrease in serum renalase induced by the high-salt diet. There was a significant inverse correlation between the serum renalase level and 24-h urinary sodium excretion. No significant correlation was found between the renalase level and BP among the different dietary interventions.The present study indicates that variations in dietary salt intake and potassium supplementation affect the serum renalase concentration in Chinese subjects.

Potential roles of high salt intake and maternal malnutrition in the development of hypertension in disadvantaged populations.

PubMed

Thrift, Amanda G; Srikanth, Velandai; Fitzgerald, Sharyn M; Kalyanram, Kartik; Kartik, Kamakshi; Hoppe, Chantal C; Walker, Karen Z; Evans, Roger G

2010-02-01

1. It has been argued that all major risk factors for cardiovascular disease have been identified. Yet, epidemiological studies undertaken to identify risk factors have largely focused on populations in developed nations or on the urban or relatively affluent rural populations of developing countries. Poor rural populations are seldom studied. 2. Somewhat different risk factors may operate in poor rural populations. Evidence for this is provided by the finding that, in disadvantaged rural India, the prevalence of hypertension is greater than would be expected based on established risk factors in these populations. One risk factor to be considered is a poor intrauterine environment. 3. In animals, maternal macro- and micronutrient malnutrition can lead to reduced nephron endowment. Nephron deficiency, in turn, can render blood pressure salt sensitive. The combination of nephron deficiency and excessive salt intake will predispose to hypertension. 4. Human malnutrition may have similar effects, particularly in regions of the world where malnutrition is endemic and where women are disadvantaged by existing social practices. 5. Moreover, high salt intake is endemic in many parts of Asia, including India. Therefore, we propose that maternal malnutrition (leading to reduced nephron endowment), when combined with excessive salt intake postnatally, will account, at least in part, for the unexpectedly high prevalence of hypertension in disadvantaged rural communities in India and elsewhere.

Substitutions of dairy product intake and risk of stroke: a Danish cohort study.

PubMed

Laursen, Anne Sofie Dam; Dahm, Christina Catherine; Johnsen, Søren Paaske; Tjønneland, Anne; Overvad, Kim; Jakobsen, Marianne Uhre

2018-02-01

Low fat dairy products are part of dietary guidelines to prevent stroke. However, epidemiological evidence is inconclusive with regard to the association between dairy products and stroke. We therefore investigated associations for substitutions between dairy product subgroups and risk of total stroke and stroke subtypes. We included 55,211 Danish men and women aged 50-64 years without previous stroke. Baseline diet was assessed by a food frequency questionnaire. Cases were identified through a national register and subsequently verified. The associations were analyzed using Cox proportional hazard regression. During a median follow-up of 13.4 years, we identified 2272 strokes, of which 1870 were ischemic (318 large artery atherosclerotic, 839 lacunar, 102 cardioembolic, 98 other determined types, 513 of unknown type), 389 were hemorrhages (273 intracerebral, 116 subarachnoid) and 13 of unknown etiology. Substitution of semi-skimmed fermented milk or cheese for whole-fat fermented milk was associated with a higher rate of ischemic stroke [semi-skimmed fermented milk: hazard ratio (HR) = 1.20 (95% confidence interval (CI) 0.99-1.45), cheese: HR = 1.14 (95% CI 0.98-1.31) per serving/day substituted] and substitutions of whole-fat fermented milk for low-fat milk, whole-fat milk or buttermilk were associated with a lower rate [low-fat milk: HR = 0.85 (95% CI 0.74-0.99), whole-fat milk: HR = 0.84 (95% CI 0.71-0.98) and buttermilk: HR = 0.83 (95% CI 0.70-0.99)]. We observed no associations for substitutions between dairy products and hemorrhagic stroke. Our results suggest that intake of whole-fat fermented milk as a substitution for semi-skimmed fermented milk, cheese, buttermilk or milk, regardless of fat content, is associated with a lower rate of ischemic stroke.

Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

PubMed

Nahab, Fadi; Pearson, Keith; Frankel, Michael R; Ard, Jamy; Safford, Monika M; Kleindorfer, Dawn; Howard, Virginia J; Judd, Suzanne

2016-12-01

The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality. Prospective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA. The primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infarction and all-cause mortality, based on cumulative average fish consumption ascertained at baseline. Participants (n 16 479) were enrolled between 2003 and 2007, completed the self-administered Block98 FFQ and were free of CVD at baseline. There were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week (v. <1 serving/month) were at a significantly increased risk of cardiovascular events (HR=1·63; 95 % CI 1·11, 2·40). Intake of non-fried fish was not associated with risk of incident CVD. There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality. Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events. Given the increased intake of fried fish in the stroke belt and among African Americans, these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD.

Stimulation of Intestinal Cl- Secretion Through CFTR by Caffeine Intake in Salt-Sensitive Hypertensive Rats.

PubMed

Wei, Xiao; Lu, Zongshi; Yang, Tao; Gao, Peng; Chen, Sijiao; Liu, Daoyan; Zhu, Zhiming

2018-03-16

High salt consumption is a major risk factor for hypertension, and sodium homeostasis is regulated by both intestinal sodium absorption and urinary sodium excretion. Chronic caffeine intake has been reported to attenuate salt-sensitive hypertension by promoting urinary sodium excretion; however, its exact role in intestinal sodium absorption remains unknown. Here, we investigated whether and how chronic caffeine consumption antagonizes salt-sensitive hypertension by inhibiting intestinal sodium absorption. Dahl salt-sensitive rats were fed 8% NaCl chow and 0.1% caffeine in their drinking water for 15 days. The blood pressure and fecal sodium content were measured. The effect of caffeine on the movement of Cl- in enterocyte cells was determined with the Ussing chamber assay. Rats that were treated with caffeine displayed significantly lower mean blood pressure and higher fecal sodium content than the controls. Consistent with these findings, caffeine intake decreased fluid absorption by the intestine in the fluid perfusion experiment. Further, the results from the Ussing chamber assay indicated that caffeine promoted Cl- secretion through enterocyte apical cystic fibrosis transmembrane conductance regulator (CFTR), and thus inhibited sodium absorption. Moreover, depletion of cAMP or inhibition of CFTR completely abolished the effect of caffeine on Cl- secretion. The results indicate that chronic caffeine consumption reduces sodium absorption by promoting CFTR-mediated Cl- secretion in the intestine, which contributes to the anti-hypertensive effect of caffeine in salt-sensitive rats. © 2018 The Author(s). Published by S. Karger AG, Basel.

Incorporating hypertensive patient education on salt intake into an introductory pharmacy practice experience.

PubMed

Garza, Kimberly B; Westrick, Salisa C; Teeter, Benjamin S; Stevenson, T Lynn

2013-11-12

To evaluate the impact of the Salt Education Program for hypertensive adults on student pharmacists' knowledge, behaviors, and attitudes regarding sodium consumption. As part of the introductory pharmacy practice experience program in community pharmacies, student pharmacists assessed patients' sodium intake knowledge and behaviors, taught them how to read nutrition labels, and obtained information about their hypertensive conditions. Students completed pre-and post-intervention questionnaires in April and August 2012, respectively. One hundred thirty student pharmacists (70% female, 78% white) completed pre- and post-intervention questionnaires. Students demonstrated significant improvements in knowledge scores (p<0.001) and perceived benefit of a low-salt diet (p=0.004). Further, there were significant improvements in the self-reported frequency of looking at sodium content of foods when shopping (p<0.001) and purchasing low-salt foods (p=0.004). Changes in students' knowledge, behaviors, and attitudes after participating in the Salt Education program suggested that the program was effective in improving student knowledge, behaviors, and attitudes.

Reliable Quantification of the Potential for Equations Based on Spot Urine Samples to Estimate Population Salt Intake: Protocol for a Systematic Review and Meta-Analysis.

PubMed

Huang, Liping; Crino, Michelle; Wu, Jason Hy; Woodward, Mark; Land, Mary-Anne; McLean, Rachael; Webster, Jacqui; Enkhtungalag, Batsaikhan; Nowson, Caryl A; Elliott, Paul; Cogswell, Mary; Toft, Ulla; Mill, Jose G; Furlanetto, Tania W; Ilich, Jasminka Z; Hong, Yet Hoi; Cohall, Damian; Luzardo, Leonella; Noboa, Oscar; Holm, Ellen; Gerbes, Alexander L; Senousy, Bahaa; Pinar Kara, Sonat; Brewster, Lizzy M; Ueshima, Hirotsugu; Subramanian, Srinivas; Teo, Boon Wee; Allen, Norrina; Choudhury, Sohel Reza; Polonia, Jorge; Yasuda, Yoshinari; Campbell, Norm Rc; Neal, Bruce; Petersen, Kristina S

2016-09-21

Methods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake. The aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake. A systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations

[Salt and cancer].

PubMed

Strnad, Marija

2010-05-01

Besides cardiovascular disease, a high salt intake causes other adverse health effects, i.e., gastric and some other cancers, obesity (risk factor for many cancer sites), Meniere's disease, worsening of renal disease, triggering an asthma attack, osteoporosis, exacerbation of fluid retention, renal calculi, etc. Diets containing high amounts of food preserved by salting and pickling are associated with an increased risk of cancers of the stomach, nose and throat. Because gastric cancer is still the most common cancer in some countries (especially in Japan), its prevention is one of the most important aspects of cancer control strategy. Observations among Japanese immigrants in the U.S.A. and Brazil based on the geographic differences, the trend in cancer incidence with time, and change in the incidence patterns indicate that gastric cancer is closely associated with dietary factors such as the intake of salt and salted food. The findings of many epidemiological studies suggest that high dietary salt intake is a significant risk factor for gastric cancer and this association was found to be strong in the presence of Helicobacter (H.) pylori infection with atrophic gastritis. A high-salt intake strips the lining of the stomach and may make infection with H. pylori more likely or may exacerbate the infection. Salting, pickling and smoking are traditionally popular ways of preparing food in Japan and some parts of Asia. In addition to salt intake, cigarette smoking and low consumption of fruit and vegetables increase the risk of stomach cancer. However, it is not known whether it is specifically the salt in these foods or a combination of salt and other chemicals that can cause cancer. One study identified a mutagen in nitrite-treated Japanese salted fish, and chemical structure of this mutagen suggests that it is derived from methionine and that salt and nitrite are precursors for its formation. Working under conditions of heat stress greatly increased the workers

[Assessment of individual iodine intake by the adult population in the Potsdam region on the basis of sea fish and iodized salt consumption].

PubMed

Pfaff, G; Georg, T

1995-06-01

Iodized salt has a high acceptance in the Potsdam region: 82% of the interviewed people use iodized salt, 13% do not use it, and only 5% of the probands were not able to make any statements. The current average iodine intake for adults is 76 micrograms/day. Only 5% of the adult population has an iodine intake of more than 100 micrograms/day. An efficient elimination of iodine deficiency in Germany requires a broad usage of iodized salt in the food industry.

Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke.

PubMed

Mituuti, Cláudia T; Bianco, Vinicius C; Bentim, Cláudia G; de Andrade, Eduardo C; Rubo, José H; Berretin-Felix, Giédre

2015-01-01

According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses. To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase. Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS) and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30) and two groups designated by the affected body part, right (RHG, n=8) and left (LHG, n=11), excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke. There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02) and RHG (P=0.01). Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01) and lower dental arch in the RHG (P=0.04). A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05). There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04) for the HG. The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with the level of oral intake and the degree of oropharyngeal dysphagia.

Sodium intake, salt taste and gastric cancer risk according to Helicobacter pylori infection, smoking, histological type and tumor site in China.

PubMed

Zhong, Chen; Li, Kai-Nan; Bi, Jing-Wang; Wang, Bao-Cheng

2012-01-01

The risk factors mostly strongly associated with gastric cancer are gastric bacteria Helicobacter pylori and diet. Using a case-control study among residents in Jinan, we examined the association between the salt taste and gastric cancer according to H. pylori infection, smoking and histological type as well as tumor site. This population-based case-control study included 207 cases and 410 controls. Data on potential risk factors of gastric cancer were obtained by interview of cases and controls with a questionnaire, salt taste preference was measured for all subjects, and IgG antibodies to H. pylori were applied to assess infection. Risk measures were determined using unconditional logistic regression. The proportions of salt taste at intervals of 1.8-7.2 g/L and ≥ 7.2 g/L were significantly higher in cases than controls, with ORs of 1.56 (1.23-3.64) and 2.03 (2.12- 4.11), respectively, subjects with high salt intake having an elevated risk for gastric cancer when infected with H. pylori. Significant modification by smoking and tumor site was observed across the different measures of salt intake, the highest salt taste showed higher cancer risk in ever smokers or with non-cardia cancers. Our study supports the view that high intake of sodium is an important dietary risk factor for gastric cancer, with a synergistic effect found between salt and H.pylori and smoking, dependent on the tumor site.

Salt-Sensitive Hypertension: Perspectives on Intrarenal Mechanisms

PubMed Central

Majid, Dewan S.A.; Prieto, Minolfa C.; Navar, L Gabriel

2015-01-01

Salt sensitive hypertension is characterized by increases in blood pressure in response to increases in dietary salt intake and is associated with an enhanced risk of cardiovascular and renal morbidity. Although researchers have sought for decades to understand how salt sensitivity develops in humans, the mechanisms responsible for the increases in blood pressure in response to high salt intake are complex and only partially understood. Until now, scientists have been unable to explain why some individuals are salt sensitive and others are salt resistant. Although a central role for the kidneys in the development of salt sensitivity and hypertension has been generally accepted, it is also recognized that hypertension is of multifactorial origin and a variety of factors can induce, or prevent, blood pressure responsiveness to the manipulation of salt intake. Excess salt intake in susceptible persons may also induce inappropriate central and sympathetic nervous system responses and increase the production of intrarenal angiotensin II, catecholamines and other factors such as oxidative stress and inflammatory cytokines. One key factor is the concomitant inappropriate or paradoxical activation of the intrarenal renin-angiotensin system, by high salt intake. This is reflected by the increases in urinary angiotensinogen during high salt intake in salt sensitive models. A complex interaction between neuroendocrine factors and the kidney may underlie the propensity for some individuals to retain salt and develop salt-dependent hypertension. In this review, we focus mainly on the renal contributions that provide the mechanistic link between chronic salt intake and the development of hypertension. PMID:26028244

Replacement of salt by a novel potassium- and magnesium-enriched salt alternative improves the cardiovascular effects of ramipril.

PubMed Central

Mervaala, E. M.; Paakkari, I.; Laakso, J.; Nevala, R.; Teräväinen, T. M.; Fyhrquist, F.; Vapaatalo, H.; Karppanen, H.

1994-01-01

1. The influence of salt (sodium chloride; NaCl) (an additional 6% in the diet) and that of a novel sodium-reduced, potassium-, magnesium-, and L-lysine-enriched salt alternative on the cardiovascular effects of ramipril was studied in stroke-prone spontaneously hypertensive rats in a 6-week study. The intake of sodium chloride was adjusted to the same level by adding the salt alternative at a 1.75 times higher amount than regular salt. 2. Salt produced a marked rise in blood pressure and induced cardiac hypertrophy and significant mortality, while the salt alternative neither increased blood pressure nor caused any mortality and produced less cardiac hypertrophy than salt. 3. Ramipril treatment at a daily dose of 3 mg kg-1 normalized blood pressure and prevented the development of cardiac hypertrophy of rats on control diet. These effects of ramipril were blocked by the addition of salt but were only slightly attenuated by the addition of the salt alternative. The mortality in the salt group was prevented by ramipril. 4. Responses of mesenteric arterial rings in vitro were examined at the end of the study. Salt, but not the salt alternative, increased vascular contractile responses to noradrenaline. Ramipril treatment improved the arterial relaxation responses to acetylcholine and to sodium nitroprusside. The vascular relaxation enhancing effect of ramipril was blocked by salt but only slightly attenuated by the salt alternative. 5. Ramipril treatment did not significantly increase plasma renin activity in the presence or in the absence of salt supplementation. The salt alternative did not cause hyperkalaemia, either alone or in combination with ramipril treatment.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8032605

Healthy Eating Exploratory Program for the Elderly: Low Salt Intake in Congregate Meal Service.

PubMed

Seo, S; Kim, O Y; Ahn, J

2016-03-01

This study reported on an exploratory program to help the low income elderly improve healthy eating behavior, specifically by reducing salt intake. We conducted an exploratory program for 4 weeks for this study. The exploratory program involved offering menus with reduced salt and providing education on healthy eating. After the exploratory program, a survey of the elderly and in-depth interviews allowed us to evaluate the program for foodservice providers (dietitian, social workers, and volunteer workers). This study included both foodservice workers and elderly who actually used the foodservice in a congregate meal service system. This is a unique approach. A congregate meal service center in Seoul, Korea. Seventy four elderly in a congregate meal service center. Demographics were collected, and the healthy eating program and healthy eating education for elderly respondents were evaluated. The elderly showed high satisfaction with the exploratory program for healthy eating. We found no significant differences in satisfaction with the program between the elderly who attended education sessions and those who did not, but more of the elderly from the education sessions showed positive behavioral change intentions. The exploratory program influenced to reduce the salt intake of the elderly in congregate meal service. This study suggests cooperation of foodservice providers and the support of administrators is critical to the success of such programs.

Effects of salt supplementation on the albuminuric response to telmisartan with or without hydrochlorothiazide therapy in hypertensive patients with type 2 diabetes are modulated by habitual dietary salt intake.

PubMed

Ekinci, Elif I; Thomas, Georgina; Thomas, David; Johnson, Cameron; Macisaac, Richard J; Houlihan, Christine A; Finch, Sue; Panagiotopoulos, Sianna; O'Callaghan, Chris; Jerums, George

2009-08-01

OBJECTIVE This prospective randomized double-blind placebo-controlled crossover study examined the effects of sodium chloride (NaCl) supplementation on the antialbuminuric action of telmisartan with or without hydrochlorothiazide (HCT) in hypertensive patients with type 2 diabetes, increased albumin excretion rate (AER), and habitual low dietary salt intake (LDS; <100 mmol sodium/24 h on two of three consecutive occasions) or high dietary salt intake (HDS; >200 mmol sodium/24 h on two of three consecutive occasions). RESEARCH DESIGN AND METHODS Following a washout period, subjects (n = 32) received 40 mg/day telmisartan for 4 weeks followed by 40 mg telmisartan plus 12.5 mg/day HCT for 4 weeks. For the last 2 weeks of each treatment period, patients received either 100 mmol/day NaCl or placebo capsules. After a second washout, the regimen was repeated with supplements in reverse order. AER and ambulatory blood pressure were measured at weeks 0, 4, 8, 14, 18, and 22. RESULTS In LDS, NaCl supplementation reduced the anti-albuminuric effect of telmisartan with or without HCT from 42.3% (placebo) to 9.5% (P = 0.004). By contrast, in HDS, NaCl supplementation did not reduce the AER response to telmisartan with or without HCT (placebo 30.9%, NaCl 28.1%, P = 0.7). Changes in AER were independent of changes in blood pressure. CONCLUSIONS The AER response to telmisartan with or without HCT under habitual low salt intake can be blunted by NaCl supplementation. By contrast, when there is already a suppressed renin angiotensin aldosterone system under habitual high dietary salt intake, the additional NaCl does not alter the AER response.

Effects of Salt Supplementation on the Albuminuric Response to Telmisartan With or Without Hydrochlorothiazide Therapy in Hypertensive Patients With Type 2 Diabetes Are Modulated by Habitual Dietary Salt Intake

PubMed Central

Ekinci, Elif I.; Thomas, Georgina; Thomas, David; Johnson, Cameron; MacIsaac, Richard J.; Houlihan, Christine A.; Finch, Sue; Panagiotopoulos, Sianna; O'Callaghan, Chris; Jerums, George

2009-01-01

OBJECTIVE This prospective randomized double-blind placebo-controlled crossover study examined the effects of sodium chloride (NaCl) supplementation on the antialbuminuric action of telmisartan with or without hydrochlorothiazide (HCT) in hypertensive patients with type 2 diabetes, increased albumin excretion rate (AER), and habitual low dietary salt intake (LDS; <100 mmol sodium/24 h on two of three consecutive occasions) or high dietary salt intake (HDS; >200 mmol sodium/24 h on two of three consecutive occasions). RESEARCH DESIGN AND METHODS Following a washout period, subjects (n = 32) received 40 mg/day telmisartan for 4 weeks followed by 40 mg telmisartan plus 12.5 mg/day HCT for 4 weeks. For the last 2 weeks of each treatment period, patients received either 100 mmol/day NaCl or placebo capsules. After a second washout, the regimen was repeated with supplements in reverse order. AER and ambulatory blood pressure were measured at weeks 0, 4, 8, 14, 18, and 22. RESULTS In LDS, NaCl supplementation reduced the anti-albuminuric effect of telmisartan with or without HCT from 42.3% (placebo) to 9.5% (P = 0.004). By contrast, in HDS, NaCl supplementation did not reduce the AER response to telmisartan with or without HCT (placebo 30.9%, NaCl 28.1%, P = 0.7). Changes in AER were independent of changes in blood pressure. CONCLUSIONS The AER response to telmisartan with or without HCT under habitual low salt intake can be blunted by NaCl supplementation. By contrast, when there is already a suppressed renin angiotensin aldosterone system under habitual high dietary salt intake, the additional NaCl does not alter the AER response. PMID:19549737

Influence of salt intake, ANG II synthesis and SFO lesion on thirst and blood pressure during sodium depletion. Subfornical organ.

PubMed

Starbuck, E M; Fitts, D A

1998-12-01

Water intake was elevated in sodium-depleted rats during a daytime salt appetite test, but other rats drank a similar amount of water when saline was not available for drinking during the test. This water intake stimulated by sodium depletion was blocked by an inhibition of angiotensin (ANG) II synthesis with a high dose of captopril (100 mg/kg, sc). Captopril did not reduce water intake by causing hypotensive shock or uremia, because water and saline intakes were increased rather than decreased after a low dose of captopril (5 mg/kg) that also reduced blood pressure and elevated blood urea nitrogen. The water intake, but not salt appetite, induced by sodium depletion was greatly reduced by a lesion of the subfornical organ (SFO) in one-bottle tests, and this was not clearly related to any effects of the lesion on blood pressure. A physiological role for ANG II in water intake induced by sodium depletion has recently been disputed, but the simplest explanation for the data remains that elevated levels of circulating ANG II bind to receptors in the SFO to generate daytime water drinking during sodium depletion.

High Dietary Sodium Intake Impairs Endothelium-Dependent Dilation in Healthy Salt-Resistant Humans

PubMed Central

DuPont, Jennifer J.; Greaney, Jody L.; Wenner, Megan M.; Lennon-Edwards, Shannon L.; Sanders, Paul W.; Farquhar, William B.; Edwards, David G.

2014-01-01

Excess dietary sodium has been linked to the development of hypertension and other cardiovascular diseases. In humans, the effects of sodium consumption on endothelial function have not been separated from the effects on blood pressure. The present study was designed to determine if dietary sodium intake affected endothelium-dependent dilation (EDD) independently of changes in blood pressure. Fourteen healthy salt resistant adults were studied (9M, 5F; age 33 ± 2.4 years) in a controlled feeding study. After a baseline run-in diet, participants were randomized to a 7 day high sodium (HS) (300-350 mmol/day) and 7 day low sodium (LS) (20 mmol/day) diet. Salt resistance, defined as a ≤ 5 mm Hg change in a 24-hour mean arterial pressure, was individually assessed while on the low sodium and high sodium diets and confirmed in the subjects undergoing study (LS: 85±1 mm Hg; HS: 85±2 mmHg). EDD was determined in each subject via brachial artery flow-mediated dilation on the last day of each diet. Sodium excretion increased during the high sodium diet (p < 0.01). EDD was reduced on the high sodium diet (Low: 10.3±0.9%, High: 7.3±0.7%, p < 0.05). The HS diet significantly suppressed plasma renin activity (PRA), plasma angiotensin II, and aldosterone (p < 0.05). These data demonstrate that excess salt intake in humans impairs endothelium-dependent dilation independently of changes in blood pressure. PMID:23263240

The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast.

PubMed

Gillespie, Duncan O S; Allen, Kirk; Guzman-Castillo, Maria; Bandosz, Piotr; Moreira, Patricia; McGill, Rory; Anwar, Elspeth; Lloyd-Williams, Ffion; Bromley, Helen; Diggle, Peter J; Capewell, Simon; O'Flaherty, Martin

2015-01-01

Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality. We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts' predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect. Mandatory reformulation might prevent or postpone 4,500 (2,900-6,100) CHD deaths in total, with the effect greater by 500 (300-700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200-5,000) CHD deaths in total, with the effect greater by 100 (-100-600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400-500 CHD deaths, but minimally affect inequality. Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity.

The Health Equity and Effectiveness of Policy Options to Reduce Dietary Salt Intake in England: Policy Forecast

PubMed Central

Gillespie, Duncan O. S.; Allen, Kirk; Guzman-Castillo, Maria; Bandosz, Piotr; Moreira, Patricia; McGill, Rory; Anwar, Elspeth; Lloyd-Williams, Ffion; Bromley, Helen; Diggle, Peter J.; Capewell, Simon; O’Flaherty, Martin

2015-01-01

Background Public health action to reduce dietary salt intake has driven substantial reductions in coronary heart disease (CHD) over the past decade, but avoidable socio-economic differentials remain. We therefore forecast how further intervention to reduce dietary salt intake might affect the overall level and inequality of CHD mortality. Methods We considered English adults, with socio-economic circumstances (SEC) stratified by quintiles of the Index of Multiple Deprivation. We used IMPACTSEC, a validated CHD policy model, to link policy implementation to salt intake, systolic blood pressure and CHD mortality. We forecast the effects of mandatory and voluntary product reformulation, nutrition labelling and social marketing (e.g., health promotion, education). To inform our forecasts, we elicited experts’ predictions on further policy implementation up to 2020. We then modelled the effects on CHD mortality up to 2025 and simultaneously assessed the socio-economic differentials of effect. Results Mandatory reformulation might prevent or postpone 4,500 (2,900–6,100) CHD deaths in total, with the effect greater by 500 (300–700) deaths or 85% in the most deprived than in the most affluent. Further voluntary reformulation was predicted to be less effective and inequality-reducing, preventing or postponing 1,500 (200–5,000) CHD deaths in total, with the effect greater by 100 (−100–600) deaths or 49% in the most deprived than in the most affluent. Further social marketing and improvements to labelling might each prevent or postpone 400–500 CHD deaths, but minimally affect inequality. Conclusions Mandatory engagement with industry to limit salt in processed-foods appears a promising and inequality-reducing option. For other policy options, our expert-driven forecast warns that future policy implementation might reach more deprived individuals less well, limiting inequality reduction. We therefore encourage planners to prioritise equity. PMID:26131981

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial

PubMed Central

2012-01-01

Background Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people’s awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases. Methods/Design This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed. Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention

Reducing salt intake for prevention of cardiovascular diseases in high-risk patients by advanced health education intervention (RESIP-CVD study), Northern Thailand: study protocol for a cluster randomized trial.

PubMed

Aung, Myo Nyein; Yuasa, Motoyuki; Moolphate, Saiyud; Nedsuwan, Supalert; Yokokawa, Hidehiro; Kitajima, Tsutomu; Minematsu, Kazuo; Tanimura, Susumu; Fukuda, Hiroshi; Hiratsuka, Yoshimune; Ono, Koichi; Kawai, Sachio; Marui, Eiji

2012-09-04

Decreasing salt consumption can prevent cardiovascular diseases (CVD). Practically, it is difficult to promote people's awareness of daily salt intake and to change their eating habits in terms of reducing salt intake for better cardiovascular health. Health education programs visualizing daily dietary salt content and intake may promote lifestyle changes in patients at high risk of cardiovascular diseases. This is a cluster randomized trial. A total of 800 high-CVD-risk patients attending diabetes and hypertension clinics at health centers in Muang District, Chiang Rai province, Thailand, will be studied with informed consent. A health center recruiting 100 participants is a cluster, the unit of randomization. Eight clusters will be randomized into intervention and control arms and followed up for 1 year. Within the intervention clusters the following will be undertaken: (1) salt content in the daily diet will be measured and shown to study participants; (2) 24-hour salt intake will be estimated in overnight-collected urine and the results shown to the participants; (3) a dietician will assist small group health education classes in cooking meals with less salt. The primary outcome is blood pressure change at the 1-year follow-up. Secondary outcomes at the 1-year follow-up are estimated 24-hoursalt intake, incidence of CVD events and CVD death. The intention-to-treat analysis will be followed.Blood pressure and estimated 24-hour salt intake will be compared between intervention and control groups at the cluster and individual level at the 1-year follow-up. Clinical CVD events and deaths will be analyzed by time-event analysis. Retinal blood vessel calibers of CVD-risk patients will be assessed cross-sectionally. Behavioral change to reduce salt intake and the influencing factors will be determined by structured equation model (SEM). Multilevel regression analyses will be applied. Finally, the cost effectiveness of the intervention will be analyzed. This study is

Development of the SALdável programme to reduce salt intake among hypertensive Brazilian women: an intervention mapping approach.

PubMed

Cornélio, Marilia Estevam; Godin, Gaston; Rodrigues, Roberta; Agondi, Rúbia; Spana, Thaís; Gallani, Maria-Cecilia

2013-08-01

Despite strong evidence for a relationship between high salt intake and hypertension, plus the widespread recommendations for dietary salt restriction among hypertensive subjects, there are no nursing studies describing effective theory-based interventions. To describe a systematic process for development of a theory-based nursing intervention that is aimed at reducing salt intake among hypertensive women, by applying the 'intervention mapping' protocol. We developed our intervention following the six steps of the 'intervention mapping' protocol: assessing needs, creating a matrix of change objectives, selecting theoretical methods and practical applications, defining the intervention programme, organizing the adoption and implementation plan, and defining the evaluation plan. Addition of salt during cooking is identified as the main source for salt consumption, plus women are identified as the people responsible for cooking meals at home. In our study, the motivational predictors of this behaviour were self-efficacy and habit. Guided practice, verbal persuasion, coping barriers, consciousness-raising and counter-conditioning were the theoretical methods we selected for enhancing self-efficacy and promoting habit change, respectively. Brainstorming, role-playing, cookbook use, measuring spoon use, label reading, hands-on skill-building activities and reinforcement phone calls were the chosen practical applications. We designed our intervention programme, and then organized the adoption and implementation plans. Finally, we generated a plan to evaluate our intervention. 'Intervention mapping' was a feasible methodological framework to guide the development of a theory-based nursing intervention for dietary salt reduction among hypertensive women.

Differential Stiffening between the Abdominal and Thoracic Aorta: Effect of Salt Loading in Stroke-Prone Hypertensive Rats.

PubMed

Lindesay, George; Bézie, Yvonnick; Ragonnet, Christophe; Duchatelle, Véronique; Dharmasena, Chandima; Villeneuve, Nicole; Vayssettes-Courchay, Christine

2018-06-08

Central artery stiffening is recognized as a cardiovascular risk. The effects of hypertension and aging have been shown in human and animal models but the effect of salt is still controversial. We studied the effect of a high-salt diet on aortic stiffness in salt-sensitive spontaneously hypersensitive stroke-prone rats (SHRSP). Distensibility, distension, and β-stiffness were measured at thoracic and abdominal aortic sites in the same rats, using echotracking recording of the aortic diameter coupled with blood pressure (BP), in SHRSP-salt (5% salted diet, 5 weeks), SHRSP, and normotensive Wistar-Kyoto (WKY) rats. Hemodynamic parameters were measured at BP matched to that of WKY. Histological staining and immunohistochemistry were used for structural analysis. Hemodynamic isobaric parameters in SHRSP did not differ from WKY and only those from the abdominal aorta of SHRSP-salt presented decreased distensibility and increased stiffness compared with WKY and SHRSP. The abdominal and thoracic aortas presented similar thickening, increased fibrosis, and remodeling with no change in collagen content. SHRSP-salt presented a specific increased elastin disarray at the abdominal aorta level but a decrease in elastin content in the thoracic aorta. This study demonstrates the pro-stiffening effect of salt in addition to hypertension; it shows that only the abdominal aorta presents a specific pressure-independent stiffening, in which elastin disarray is likely a key mechanism. © 2018 S. Karger AG, Basel.

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

PubMed

Meier, Toni; Senftleben, Karolin; Deumelandt, Peter; Christen, Olaf; Riedel, Katja; Langer, Martin

2015-01-01

Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

Contribution of inappropriate complementary foods to the salt intake of 8-month-old infants.

PubMed

Cribb, V L; Warren, J M; Emmett, P M

2012-01-01

Complementary feeding is a critical developmental time for establishing variety, and appropriate feeding practices are important. These include recommendations for a maximum intake of sodium (salt), because of the potential harmful effect of excessive intake on the developing kidneys and blood pressure in later life. Sodium intakes were examined to establish, if inappropriate complementary feeding practices were contributing to high intakes. Data were collected from a cohort of 1178 8-month-old infants born in 1991/92, participating in the Avon Longitudinal Study of Parents and Children, using a 3-day dietary records completed by their mothers. Sodium and energy intakes were calculated and infants were categorised into quartiles of sodium intake. Majority of infants were first introduced to solids around 3-4 months, with plain baby rice, rusks and other cereals being the first foods consumed during complementary feeding. In the whole sample, 70% consumed in excess, of 400 mg sodium per day, the maximum UK recommendation for children up to age 12 months. The mean sodium intake for the highest quartile was 1060 mg per day. Infants in this quartile were often consuming cows' milk as a main drink; eating three times the amount of bread compared with the lowest quartile and used salty flavourings such as yeast extract and gravy. Sodium intakes in this cohort of infants were higher than recommendations. Clear and practical education is needed on complementary feeding practice for mothers highlighting what foods to introduce and when. Manufacturers have a responsibility to reduce the sodium content of food products.

Salt Intake and the Association with Blood Pressure in Young Iranian Children: First Report From the Middle East and North Africa

PubMed Central

Kelishadi, Roya; Gheisari, Alaleh; Zare, Narges; Farajian, Sanam; Shariatinejad, Keyvan

2013-01-01

Background: This study aimed to assess the salt intake of Iranian children, and to assess the correlation of urinary electrolytes excretion with blood pressure. Methods: This cross-sectional study was conducted in 2011-2012 among 3-10-year-old children, selected by multi-stage cluster sampling from urban and rural areas of Isfahan, Iran. The sodium (Na), potassium (K), and creatinine (Cr) were measured in a random sample of the children's first morning fasting urine. Three-day averages of dietary intakes were analyzed by the Nutritionist-4 software. Results: The mean (SD) of urinary Na was 177.17 (28.68) mEq/day without significant difference according to gender and living area. The mean (SD) dietary intakes of Na and K were 2017.76 (117.94) and 1119.06 (76.03) mg/day, respectively. Children of urban and rural areas consumed similar sources of salty foods (bread, cheese, and snacks) and had low intake of vegetables. No significant association was documented between urinary electrolytes excretions and blood pressure. Conclusions: This study, which to the best of our knowledge is the first of its kind in the Middle East and North Africa region, revealed that Iranian young children consume a large amount of sodium and small amount of potassium. The non-significant associations of electrolyte excretions with blood pressure may be because of the very young age group of participants. Given the development of preference to salt taste from early childhood, and the tracking of risk factors of chronic diseases from this age, reducing salt intake of young children should be emphasized. PMID:23671781

High fat and/or high salt intake during pregnancy alters maternal meta‐inflammation and offspring growth and metabolic profiles

PubMed Central

Reynolds, Clare M.; Vickers, Mark H.; Harrison, Claudia J.; Segovia, Stephanie A.; Gray, Clint

2014-01-01

Abstract A high intake of fat or salt during pregnancy perturbs placental function, alters fetal development, and predisposes offspring to metabolic disease in adult life. Despite its relevance to modern dietary habits, the developmental programming effects of excessive maternal fat and salt, fed in combination, have not been examined. We investigated the effects of moderately high maternal fat and/or salt intake on maternal metainflammation and its consequences on fetal and weanling growth and metabolic profile. Female Sprague–Dawley rats were fed a standard control diet (CD), 4% salt diet (SD), 45% fat diet (HF) or 4% salt/45% fat combined diet (HFSD) 3 weeks prior to and throughout pregnancy and lactation. Plasma and tissue samples were collected at day 18 of pregnancy from mother and fetus, and at postnatal day 24 in weanlings. Markers of adipose tissue inflammation, macrophage infiltration, lipogenesis, nutrient transport, and storage were altered in pregnant dams receiving high‐fat and/or ‐salt diets. This was accompanied by increased fat mass in high‐fat groups and differential hepatic lipid and glucose homeostasis. Offspring of high fat‐fed mothers had reduced fetal weight, displayed catch‐up growth, increased fat mass, and altered metabolic profiles at weaning. Maternal diets high in fat and/or salt affect maternal metabolic parameters, fetal growth and development, metabolic status, and adipoinsular axis in the weanling. Results presented here highlight the importance of diet in expectant mothers or women considering pregnancy. Furthermore, the potential for maternal nutritional intervention strategies may be employed to modify the metabolic disease risk in adult offspring during later life. PMID:25096554

Consumption of sodium and salted foods in relation to cancer and cardiovascular disease: the Japan Public Health Center-based Prospective Study.

PubMed

Takachi, Ribeka; Inoue, Manami; Shimazu, Taichi; Sasazuki, Shizuka; Ishihara, Junko; Sawada, Norie; Yamaji, Taiki; Iwasaki, Motoki; Iso, Hiroyasu; Tsubono, Yoshitaka; Tsugane, Shoichiro

2010-02-01

Although the influence of salt, per se, on the risk of cancer or cardiovascular disease (CVD) might differ from that of salt-preserved foods, few studies have simultaneously examined the effects of sodium and salted foods on the risk of either cancer or CVD. We simultaneously examined associations between sodium and salted food consumption and the risk of cancer and CVD. During 1995-1998, a validated food-frequency questionnaire was administered to 77,500 men and women aged 45-74 y. During up to 598,763 person-years of follow-up until the end of 2004, 4476 cases of cancer and 2066 cases of CVD were identified. Higher consumption of sodium was associated with a higher risk of CVD but not with the risk of total cancer: multivariate hazard ratios for the highest compared with lowest quintiles of intake were 1.19 (95% CI: 1.01, 1.40; P for trend: 0.06) for CVD and 1.04 (95% CI: 0.93, 1.16; P for trend: 0.63) for total cancer. Higher consumption of salted fish roe was associated with higher risk of total cancer, and higher consumption of cooking and table salt was associated with higher risk of CVD. Similar results were seen for the risk of gastric or colorectal cancer and stroke. Sodium intake as a whole salt equivalent may not increase the risk of cancer but may increase that of CVD. In contrast, salted food intake may increase the risk of cancer. Our findings support the notion that sodium and salted foods have differential influences on the development of cancer and CVD.

American Indian and Alaska Native Heart Disease and Stroke

MedlinePlus

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The impact of a workplace catering initiative on dietary intakes of salt and other nutrients: a pilot study.

PubMed

Geaney, F; Harrington, J; Fitzgerald, Ap; Perry, Ij

2011-08-01

Owing to modern lifestyles, individuals are dependent on out-of-home eating. The catering sector can have a pivotal role in influencing our food choices. The objective of the present study was to examine the impact of a structured catering initiative on food choices in a public sector workplace setting. A cross-sectional comparison study in two hospitals, one of which had implemented a catering initiative designed to provide nutritious food while reducing sugar, fat and salt intakes. Two public sector hospitals in Cork, Ireland. A total of 100 random participants aged 18-64 years (fifty intervention, fifty non-intervention) who consumed at least one main meal in the hospital staff canteen daily. Each respondent was asked to complete one anonymous 24 h dietary recall and questionnaire. Food and nutrient analysis was conducted using WISP (Weighed Intake Software Program). Reported mean intakes of total sugars (P < 0·001), total fat (P < 0·000), saturated fat (P < 0·000) and salt (P < 0·046) were significantly lower in the intervention hospital when adjusted for age and gender. In the intervention hospital, 72 % of respondents, compared with 42 % in the non-intervention hospital, complied with the recommended under-3 daily servings of food high in fat and sugar (P < 0·005). In the intervention hospital, 43 % of respondents exceeded the recommended salt intake of 4-6 g/d, compared with 57 % in the non-intervention hospital. Structured catering initiatives in the workplace are a potentially important option in the promotion of healthy food choices. Targeted public health programmes and health policy changes are needed to motivate caterers in the public sector and other industries to develop interventions that promote a healthy diet.

Excess maternal salt intake produces sex-specific hypertension in offspring: putative roles for kidney and gastrointestinal sodium handling.

PubMed

Gray, Clint; Al-Dujaili, Emad A; Sparrow, Alexander J; Gardiner, Sheila M; Craigon, Jim; Welham, Simon J M; Gardner, David S

2013-01-01

Hypertension is common and contributes, via cardiovascular disease, towards a large proportion of adult deaths in the Western World. High salt intake leads to high blood pressure, even when occurring prior to birth - a mechanism purported to reside in altered kidney development and later function. Using a combination of in vitro and in vivo approaches we tested whether increased maternal salt intake influences fetal kidney development to render the adult individual more susceptible to salt retention and hypertension. We found that salt-loaded pregnant rat dams were hypernatraemic at day 20 gestation (147±5 vs. 128±5 mmoles/L). Increased extracellular salt impeded murine kidney development in vitro, but had little effect in vivo. Kidneys of the adult offspring had few structural or functional abnormalities, but male and female offspring were hypernatraemic (166±4 vs. 149±2 mmoles/L), with a marked increase in plasma corticosterone (e.g. male offspring; 11.9 [9.3-14.8] vs. 2.8 [2.0-8.3] nmol/L median [IQR]). Furthermore, adult male, but not female, offspring had higher mean arterial blood pressure (effect size, +16 [9-21] mm Hg; mean [95% C.I.]. With no clear indication that the kidneys of salt-exposed offspring retained more sodium per se, we conducted a preliminary investigation of their gastrointestinal electrolyte handling and found increased expression of proximal colon solute carrier family 9 (sodium/hydrogen exchanger), member 3 (SLC9A3) together with altered faecal characteristics and electrolyte handling, relative to control offspring. On the basis of these data we suggest that excess salt exposure, via maternal diet, at a vulnerable period of brain and gut development in the rat neonate lays the foundation for sustained increases in blood pressure later in life. Hence, our evidence further supports the argument that excess dietary salt should be avoided per se, particularly in the range of foods consumed by physiologically immature young.

Excess Maternal Salt Intake Produces Sex-Specific Hypertension in Offspring: Putative Roles for Kidney and Gastrointestinal Sodium Handling

PubMed Central

Gray, Clint; Al-Dujaili, Emad A.; Sparrow, Alexander J.; Gardiner, Sheila M.; Craigon, Jim; Welham, Simon J.M.; Gardner, David S.

2013-01-01

Hypertension is common and contributes, via cardiovascular disease, towards a large proportion of adult deaths in the Western World. High salt intake leads to high blood pressure, even when occurring prior to birth – a mechanism purported to reside in altered kidney development and later function. Using a combination of in vitro and in vivo approaches we tested whether increased maternal salt intake influences fetal kidney development to render the adult individual more susceptible to salt retention and hypertension. We found that salt-loaded pregnant rat dams were hypernatraemic at day 20 gestation (147±5 vs. 128±5 mmoles/L). Increased extracellular salt impeded murine kidney development in vitro, but had little effect in vivo. Kidneys of the adult offspring had few structural or functional abnormalities, but male and female offspring were hypernatraemic (166±4 vs. 149±2 mmoles/L), with a marked increase in plasma corticosterone (e.g. male offspring; 11.9 [9.3–14.8] vs. 2.8 [2.0–8.3] nmol/L median [IQR]). Furthermore, adult male, but not female, offspring had higher mean arterial blood pressure (effect size, +16 [9–21] mm Hg; mean [95% C.I.]. With no clear indication that the kidneys of salt-exposed offspring retained more sodium per se, we conducted a preliminary investigation of their gastrointestinal electrolyte handling and found increased expression of proximal colon solute carrier family 9 (sodium/hydrogen exchanger), member 3 (SLC9A3) together with altered faecal characteristics and electrolyte handling, relative to control offspring. On the basis of these data we suggest that excess salt exposure, via maternal diet, at a vulnerable period of brain and gut development in the rat neonate lays the foundation for sustained increases in blood pressure later in life. Hence, our evidence further supports the argument that excess dietary salt should be avoided per se, particularly in the range of foods consumed by physiologically immature young. PMID

Heart rate and blood pressure variabilities in salt-sensitive hypertension.

PubMed

Piccirillo, G; Bucca, C; Durante, M; Santagada, E; Munizzi, M R; Cacciafesta, M; Marigliano, V

1996-12-01

In salt-sensitive hypertension, a high sodium intake causes plasma catecholamines to rise and pulmonary baroreceptor plasticity to fall. In salt-sensitive and salt-resistant hypertensive subjects during low and high sodium intakes, we studied autonomic nervous system activity by power spectral analysis of heart rate and arterial pressure variabilities and baroreceptor sensitivity. In all subjects, high sodium intake significantly enhanced the low-frequency power of heart rate and arterial pressures at rest and after sympathetic stress. It also increased heart rate and arterial pressure variabilities. During high sodium intake, salt-sensitive hypertensive subjects had significantly higher low-frequency powers of systolic arterial pressure (7.5 mm Hg2, P < .05) and of heart rate at rest (59.2 +/- 2.4 normalized units [NU], P < .001) than salt-resistant subjects (6.6 +/- 0.3 mm Hg2, 55.0 +/- 3.2 NU) and normotensive control subjects (5.1 +/- 0.5 mm Hg2, 41.6 +/- 2.9 NU). In salt-sensitive subjects, low sodium intake significantly reduced low-frequency normalized units (P < .001) and the ratio of low- to high-power frequency (P < .001). High-sodium intake significantly increased baroreflex sensitivity in control subjects (from 10.0 +/- 0.7 to 17.5 +/- 0.7 ms/mm Hg, P < .001) and salt-resistant subjects (from 6.9 +/- 0.7 to 13.9 +/- 0.9, P < .05) but not in salt-sensitive subjects (7.4 +/- 0.3 to 7.9 +/- 0.4). In conclusion, a high sodium intake markedly enhances cardiac sympathetic activity in salt-sensitive and salt-resistant hypertension. In contrast, although reduced sodium intake lowers arterial pressure and sympathetic activity, it does so only in salt-sensitive subjects. Hence, in salt-resistant subjects, neither arterial pressure nor sympathetic activity depends on salt intake. During a high sodium intake in normotensive subjects and salt-resistant hypertensive subjects, increased sympathetic activity is probably compensated by enhanced baroreflex sensitivity.

Effect of dietary salt intake on epithelial Na+ channels (ENaC) in vasopressin magnocellular neurosecretory neurons in the rat supraoptic nucleus.

PubMed

Sharma, Kaustubh; Haque, Masudul; Guidry, Richard; Ueta, Yoichi; Teruyama, Ryoichi

2017-09-01

A growing body of evidence suggests that epithelial Na + channels (ENaCs) in the brain play a significant role in the regulation of blood pressure; however, the brain structures that mediate the effect are not well understood. Because vasopressin (VP) neurons play a pivotal role in coordinating neuroendocrine and autonomic responses to maintain cardiovascular homeostasis, a basic understanding of the regulation and activity of ENaC in VP neurons is of great interest. We show that high dietary salt intake caused an increase in the expression and activity of ENaC which resulted in the steady state depolarization of VP neurons. The results help us understand one of the mechanisms underlying how dietary salt intake affects the activity of VP neurons via ENaC activity. All three epithelial Na + channel (ENaC) subunits (α, β and γ) are located in vasopressin (VP) magnocellular neurons in the hypothalamic supraoptic (SON) and paraventricular nuclei. Our previous study demonstrated that ENaC mediates a Na + leak current that affects the steady state membrane potential in VP neurons. In the present study, we evaluated the effect of dietary salt intake on ENaC regulation and activity in VP neurons. High dietary salt intake for 7 days caused an increase in expression of β- and γENaC subunits in the SON and the translocation of αENaC immunoreactivity towards the plasma membrane. Patch clamp experiments on hypothalamic slices showed that the mean amplitude of the putative ENaC currents was significantly greater in VP neurons from animals that were fed a high salt diet compared with controls. The enhanced ENaC current contributed to the more depolarized basal membrane potential observed in VP neurons in the high salt diet group. These findings indicate that high dietary NaCl intake enhances the expression and activity of ENaCs, which augments synaptic drive by depolarizing the basal membrane potential close to the action potential threshold during hormonal demand. However

Dietary Sources of High Sodium Intake in Turkey: SALTURK II.

PubMed

Erdem, Yunus; Akpolat, Tekin; Derici, Ülver; Şengül, Şule; Ertürk, Şehsuvar; Ulusoy, Şükrü; Altun, Bülent; Arıcı, Mustafa

2017-08-24

Previous research has shown daily salt intakes in Turkey to be far above the recommended limits. Knowing the sources of dietary salt could form a basis for preventive strategies aimed towards salt reduction. This study aimed to investigate dietary sources of salt in Turkey. A sub-group ( n = 657) was selected from the PatenT2 study population, which represented the urban and rural areas of 4 major cities (Ankara, Istanbul, Izmir, and Konya). A questionnaire inquiring about sociodemographic characteristics, medical histories, detailed histories of diet, and salt consumption was completed. Participants were asked to collect a 24-h urine sample and to record their food intake (dietary recall) on the same day. Of 925 participants selected, 657 (71%) provided accurate 24-h urine collections, based on creatinine excretion data. The mean daily 24-h urinary sodium excretion was 252.0 ± 92.2 mmol/day, equal to daily salt intake of 14.8 ± 5.4 g. Of the 657 participants with accurate 24-h urine collections, 464 (70%) provided fully completed dietary recalls. Among these 464 participants, there was a significant difference between the 24-h urinary sodium excretion-based salt intake estimation (14.5 ± 5.1 g/day) and the dietary recall-based salt intake estimation (12.0 ± 7.0 g/day) ( p < 0.001). On the other hand, a positive correlation was obtained between the dietary recall-based daily salt intake and 24-h urinary sodium excretion-based daily salt intake ( r = 0.277, p < 0.001). Bread was the main source of salt (34%) followed by salt added during cooking and preparing food before serving (30%), salt from various processed foods (21%), and salt added at the table during food consumption (11%). Conclusively, this study confirmed a very high salt intake of the adult population in four major cities in Turkey. The present findings support the emerging salt reduction strategy in Turkey by promoting lower salt content in baked bread, and less salt use in habitual food

Comparison of salt taste thresholds and salt usage behaviours between adults in Myanmar and Korea.

PubMed

Cho, Hyungjin; Kim, So Mi; Jeong, Seong Su; Kim, Soon Bae

2016-12-01

Excessive oral salt intake can induce hypertension. According to previous studies, the prevalence of hypertension is higher in Myanmar than in Korea. We postulated that Myanmar adults had higher salt taste thresholds and eat much saltier food. This study aimed to compare salt taste thresholds and salt usage behaviour scores between adults in Myanmar and Korea. This cross-sectional study enrolled patients who visited volunteer medical service clinics at Ansung in Korea and Hlegu and Bago in Myanmar in August 2014. We measured the vital signs, heights, and weights of each patient and evaluated detection thresholds, recognition thresholds, and salt preferences. All patients underwent urinalysis and spot urine Na tests. Additionally, they each completed a salt usage behaviour questionnaire. A total of 131 patients were enrolled, including 64 Myanmarese patients and 67 Korean patients. Blood pressure was significantly higher in the Myanmarese than in the Koreans. Detection and recognition thresholds, salt preferences, and spot urine sodium and salt usage behaviour scores were also higher in the Myanmarese than in the Korean subjects. We calculated correlation coefficients between systolic blood pressure and parameters that were related to salt intake. The detection and recognition thresholds were significantly correlated with systolic blood pressure. All parameters related to salt intake, including detection and recognition thresholds, salt preference, salt usage behaviour scores and spot urine sodium concentrations, are significantly higher in Myanmarese than in Korean individuals.

Salt-induced epithelial-to-mesenchymal transition in Dahl salt-sensitive rats is dependent on elevated blood pressure.

PubMed

Wang, Y; Mu, J J; Liu, F Q; Ren, K Y; Xiao, H Y; Yang, Z; Yuan, Z Y

2014-02-01

Dietary salt intake has been linked to hypertension and cardiovascular disease. Accumulating evidence has indicated that salt-sensitive individuals on high salt intake are more likely to develop renal fibrosis. Epithelial-to-mesenchymal transition (EMT) participates in the development and progression of renal fibrosis in humans and animals. The objective of this study was to investigate the impact of a high-salt diet on EMT in Dahl salt-sensitive (SS) rats. Twenty-four male SS and consomic SS-13(BN) rats were randomized to a normal diet or a high-salt diet. After 4 weeks, systolic blood pressure (SBP) and albuminuria were analyzed, and renal fibrosis was histopathologically evaluated. Tubular EMT was evaluated using immunohistochemistry and real-time PCR with E-cadherin and alpha smooth muscle actin (α-SMA). After 4 weeks, SBP and albuminuria were significantly increased in the SS high-salt group compared with the normal diet group. Dietary salt intake induced renal fibrosis and tubular EMT as identified by reduced expression of E-cadherin and enhanced expression of α-SMA in SS rats. Both blood pressure and renal interstitial fibrosis were negatively correlated with E-cadherin but positively correlated with α-SMA. Salt intake induced tubular EMT and renal injury in SS rats, and this relationship might depend on the increase in blood pressure.

High and Low Salt Intake during Pregnancy: Impact on Cardiac and Renal Structure in Newborns.

PubMed

Seravalli, Priscila; de Oliveira, Ivone Braga; Zago, Breno Calazans; de Castro, Isac; Veras, Mariana Matera; Alves-Rodrigues, Edson Nogueira; Heimann, Joel C

2016-01-01

Previous studies from our laboratory demonstrated that dietary salt overload and salt restriction during pregnancy were associated with cardiac and renal structural and/or functional alterations in adult offspring. The present study evaluated renal and cardiac structure and the local renin-angiotensin system in newborns from dams fed high-, normal- or low-salt diets during pregnancy. Female Wistar rats were fed low- (LS, 0.15% NaCl), normal- (NS, 1.3% NaCl) or high- (HS, 8% NaCl) salt diets during pregnancy. Kidneys and hearts were collected from newborns (n = 6-8/group) during the first 24 hours after birth to evaluate possible changes in structure using stereology. Protein expression of renin-angiotensin system components was evaluated using an indirect enzyme-linked immunosorbent assay (ELISA). No differences between groups were observed in total renal volume, volume of renal compartments or number of glomeruli. The transverse diameter of the nuclei of cardiomyocytes was greater in HS than NS males in the left and right ventricles. Protein expression of the AT1 receptor was lower in the kidneys of the LS than in those of the NS and HS males but not females. Protein expression of the AT2 receptor was lower in the kidneys of the LS males and females than in those of the NS males and females. High salt intake during pregnancy induced left and right ventricular hypertrophy in male newborns. Salt restriction during pregnancy reduced the expression of renal angiotensin II receptors in newborns.

Barriers for progress in salt reduction in the general population. An international study.

PubMed

Newson, R S; Elmadfa, I; Biro, Gy; Cheng, Y; Prakash, V; Rust, P; Barna, M; Lion, R; Meijer, G W; Neufingerl, N; Szabolcs, I; van Zweden, R; Yang, Y; Feunekes, G I J

2013-12-01

Salt reduction is important for reducing hypertension and the risk of cardiovascular events, nevertheless worldwide salt intakes are above recommendations. Consequently strategies to reduce intake are required, however these require an understanding of salt intake behaviours to be effective. As limited information is available on this, an international study was conducted to derive knowledge on salt intake and associated behaviours in the general population. An online cohort was recruited consisting of a representative sample from Germany, Austria, United States of America, Hungary, India, China, South Africa, and Brazil (n=6987; aged 18-65 years; age and gender stratified). Participants completed a comprehensive web-based questionnaire on salt intake and associated behaviours. While salt reduction was seen to be healthy and important, over one third of participants were not interested in salt reduction and the majority were unaware of recommendations. Salt intake was largely underestimated and people were unaware of the main dietary sources of salt. Participants saw themselves as mainly responsible for their salt intake, but also acknowledged the roles of others. Additionally, they wanted to learn more about why salt was bad for health and what the main sources in the diet were. As such, strategies to reduce salt intake must raise interest in engaging in salt reduction through improving understanding of intake levels and dietary sources of salt. Moreover, while some aspects of salt reduction can be globally implemented, local tailoring is required to match level of interest in salt reduction. These findings provide unique insights into issues surrounding salt reduction and should be used to develop effective salt reduction strategies and/or policies. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Both high and low maternal salt intake in pregnancy alter kidney development in the offspring.

PubMed

Koleganova, Nadezda; Piecha, Grzegorz; Ritz, Eberhard; Becker, Luis Eduardo; Müller, Annett; Weckbach, Monika; Nyengaard, Jens Randel; Schirmacher, Peter; Gross-Weissmann, Marie-Luise

2011-08-01

In humans, low glomerular numbers are related to hypertension, cardiovascular, and renal disease in adult life. The present study was designed 1) to explore whether above- or below-normal dietary salt intake during pregnancy influences nephron number and blood pressure in the offspring and 2) to identify potential mechanisms in kidney development modified by maternal sodium intake. Sprague-Dawley rats were fed low (0.07%)-, intermediate (0.51%)-, or high (3.0%)-sodium diets during pregnancy and lactation. The offspring were weaned at 4 wk and subsequently kept on a 0.51% sodium diet. The kidney structure was assessed at postnatal weeks 1 and 12 and the expression of proteins of interest at term and at week 1. Blood pressure was measured in male offspring by telemetry from postnatal month 2 to postnatal month 9. The numbers of glomeruli at weeks 1 and 12 were significantly lower and, in males, telemetrically measured mean arterial blood pressure after month 5 was higher in offspring of dams on a high- or low- compared with intermediate-sodium diet. A high-salt diet was paralleled by higher concentrations of marinobufagenin in the amniotic fluid and an increase in the expression of both sprouty-1 and glial cell-derived neutrophic factor in the offspring's kidney. The expression of FGF-10 was lower in offspring of dams on a low-sodium diet, and the expression of Pax-2 and FGF-2 was lower in offspring of dams on a high-sodium diet. Both excessively high and excessively low sodium intakes during pregnancy modify protein expression in offspring kidneys and reduce the final number of glomeruli, predisposing the risk of hypertension later in life.

Salt Toxicity (Sodium Intake): A Serious Threat to Infants and Children of Pakistan

PubMed Central

WASEEM, Amir; NAFEES, Muhammad; MURTAZA, Ghulam; SAJJAD, Ashif; MEHMOOD, Zahid; SIDDIQI, Abdul Rauf

2014-01-01

Abstract Background Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease. The aim of this study was to investigate the sodium and potassium contents of foodstuff used by infants and children of Pakistan. Methods We analyzed the sodium and potassium contents of infant milk formula (<6 months), follow up milk formula (>6 months), baby food (cereals), biscuits, fruit juices, potato chips (crisps), cheese puffs, roasted cereals (salty), ice cream cones (kulfi) all of which are the processed food extensively used by the children. The amount of sodium and potassium contents in drinking water of few cities of Pakistan were also considered to assess the additional sodium/potassium in the preparation of milk using infant milk formula. Results Na to K ratio (Na:K) was determined 0.3-1.23, 0.3-1.16, 0.33-0.82, 0.54-2.68, 0.51-0.85, 2.86 and 1.02 for infant milk formula (<6 months), follow up milk formula (>6 months), baby food (cereals), biscuits, fruit juices, potato chips (crisps, cheese puffs, roasted cereals), ice cream cones (kulfi), respectively. Conclusion The higher sodium content is present than most of the quoted values; whereas lower potassium is present than the recommended values. The higher Na:K ratio indicates the severity of the situation where it is commonly stated that “higher an individual’s salt intake, the higher an individual’s blood pressure". Present study indicates that nearly all Pakistani children consume substantially more salt than they need which will affect health status in later life. PMID:26175974

Voluntary sodium intake during effort in hot environments

NASA Technical Reports Server (NTRS)

Sohar, E.; Adar, R.; Hershco, A.

1982-01-01

The factors that influence the amount of salt that a person adds to his food at mealtime, and the part played by the general requirement for salt in the daily diet stemming from the coluntary input of salt are studied. Careful measurements of salt intake and outflow were performed on ten marchers in a high temperature environment who were given individual salt shakers that were weighed before and after each meal. Some marchers were told to add salt to their meals on specific days. No parallelity was found between the voluntary sodium intake and the general sodium intake, the excretion of sodium in the urine or the environmental heat stress. Individual food habit was found to be the most important factor.

Cost and cost-effectiveness of a school-based education program to reduce salt intake in children and their families in China

PubMed Central

Li, Xian; Jan, Stephen; Yan, Lijing L.; Hayes, Alison; Chu, Yunbo; Wang, Haijun; Feng, Xiangxian; Niu, Wenyi; He, Feng J.; Ma, Jun; Han, Yanbo; MacGregor, Graham A.; Wu, Yangfeng

2017-01-01

Objective The School-based Education Program to Reduce Salt Intake in Children and Their Families study was a cluster randomized control trial among grade five students in 28 primary schools and their families in Changzhi, China. It achieved a significant effect in lowering systolic blood pressure (SBP) in all family adults by 2.3 mmHg and in elderlies (aged > = 60 years) by 9.5 mmHg. The aim of this study was to assess the cost-effectiveness of this salt reduction program. Methods Costs of the intervention were assessed using an ingredients approach to identify resource use. A trial-based incremental cost-effectiveness ratio (ICER) was estimated based on the observed effectiveness in lowering SBP. A Markov model was used to estimate the long-term cost-effectiveness of the intervention, and then based on population data, extrapolated to a scenario where the program is scaled up nationwide. Findings were presented in terms of an incremental cost per quality-adjusted life year (QALY). The perspective was that of the health sector. Results The intervention cost Int$19.04 per family and yielded an ICER of Int$2.74 (90% CI: 1.17–12.30) per mmHg reduction of SBP in all participants (combining children and adult participants together) compared with control group. If scaled up nationwide for 10 years and assumed deterioration in treatment effect of 50% over this period, it would reach 165 million families and estimated to avert 42,720 acute myocardial infarction deaths and 107,512 stroke deaths in China. This would represent a gain of 635,816 QALYs over 10-year time frame, translating into Int$1,358 per QALY gained. Conclusion Based on WHO-CHOICE criteria, our analysis demonstrated that the proposed salt reduction strategy is highly cost-effective, and if scaled up nationwide, the benefits could be substantial. Trial registration ClinicalTrials.gov NCT01821144 PMID:28902880

Association Between Macrominerals Intake and Changes in Internal Carotid Artery-Intima Media Thickness in POST Ischemic Stroke Patients

NASA Astrophysics Data System (ADS)

Pudjonarko, Dwi; Tugasworo, Dodik; Silaen, Rumintang

2017-02-01

Carotid Intima Media Thickness (C-IMT) has been widely used as marker for atherosclerosis. Previous studies on minerals intake and its association with C-IMT revealed various. Most of the studies showed inconsistent results. The aim of this study is to determine wether macro minerals intake is related to internal carotid-intima media thickness (IC-IMT). This is a longitudinal study, pre test post test design conducted in Neurology clinic, Kariadi hospital, Semarang from June to December 2014. Subjects were 22 post ischemic stroke patients. Minerals intake and IC-IMT was measured using Food Frequency Questionnaire and Duplex Carotid Ultrasonography. Statistical analysis was performed using Chi-Square, Fisher Exact and Logistic Regression test. Subjects included in this study were 17 male subjects (77.3%) and 5 female subjects (22.7%). Mean of IC-IMT in female subjects was found to be higher than in male. Mean of total IC-IMT was increased after a period of six months (0.96±0.80 to 0.97±0.21 mm). There were significant association between calcium as well as sodium intakes and IC-IMT. In contrast, there were no association between magnesium as well as potassium intake and IC-IMT. Multivariate analysis suggest that sodium intake (OR=26.828) was the most influencing factor for IC-IMT, followed by calcium intake (OR=0.042). Calcium as well as potassium intake were independently associated with IC-IMT. Magnecium as well as sodium intake were not independently associated with IC-IMT changes. Sodium intake was the most influencing variable to IC-IMT changes, followed by calcium intake.

Salt Intake and Health Risk in Climate Change Vulnerable Coastal Bangladesh: What Role Do Beliefs and Practices Play?

PubMed Central

Rasheed, Sabrina; Siddique, A. K.; Sharmin, Tamanna; Hasan, A. M. R.; Hanifi, S. M. A.; Iqbal, M.; Bhuiya, Abbas

2016-01-01

Background High salt consumption is an important risk factor of elevated blood pressure. In Bangladesh about 20 million people are at high risk of hypertension due to climate change induced saline intrusion in water. The objective of this study is to assess beliefs, perceptions, and practices associated with salt consumption in coastal Bangladesh. Methods The study was conducted in Chakaria, Bangladesh between April-June 2011. It was a cross sectional mixed method study. For the qualitative study 6 focus group discussions, 8 key informant interviews, 60 free listing exercises, 20 ranking exercises and 10 observations were conducted. 400 adults were randomly selected for quantitative survey. For analysis we used SPSS for quantitative data, and Anthropac and Nvivo for qualitative data. Results Salt was described as an essential component of food with strong cultural and religious roots. People described both health benefits and risks related to salt intake. The overall risk perception regarding excessive salt consumption was low and respondents believed that the cooking process can render the salt harmless. Respondents were aware that salt is added in many foods even if they do not taste salty but did not recognize that salt can occur naturally in both foods and water. Conclusions In the study community people had low awareness of the risks associated with excess salt consumption and salt reduction strategies were not high in their agenda. The easy access to and low cost of salt as well as unrecognised presence of salt in drinking water has created an environment conducive to excess salt consumption. It is important to design general messages related to salt reduction and test tailored strategies especially for those at high risk of hypertension. PMID:27044049

Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment.

PubMed

Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C; Titze, Jens

2015-10-01

Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects' daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials. © 2015 American Heart Association, Inc.

Prevalence, Awareness, Treatment, and Control of Hypertension among Kazakhs with high Salt Intake in Xinjiang, China: A Community-based Cross-sectional Study

PubMed Central

Hu, Yaoda; Wang, Zixing; Wang, Yuyan; Wang, Lei; Han, Wei; Tang, Yong; Xue, Fang; Hou, Lei; Liang, Shaohua; Zhang, Biao; Wang, Weizhi; Asaiti, Kuliqian; Pang, Haiyu; Zhang, Mingtao; Jiang, Jingmei

2017-01-01

Hypertension is a leading cause of death worldwide; data on hypertension among ethnic minorities in China are sparse. This study aimed to estimate hypertension prevalence, awareness, treatment, and control in a Kazakh population, and to assess the association between salt intake and the above measures. A cross-sectional survey was conducted among Kazakh adults (≥30 years old) in the town of Hongdun, Altay, Xinjiang. Survey procedures included a questionnaire, physical measurement, and laboratory tests. Of 1805 eligible individuals, 1668 (92.4%) were included in the analysis. After adjustment for gender, age, and occupation, prevalence of hypertension was 45.5%. The proportions with awareness, treatment, control, or medication-control were 61.0%, 28.8%, 2.9% and 10.1%, respectively. Higher prevalence was seen among nomads and farmers (50.7% and 44.6%, respectively). However, the proportions with treatment or control were lower than seen among urban citizens. Hypertension prevalence was higher in those with higher salt intake (p = 0.0008). In contrast, the proportions with awareness (p = 0.0389), treatment (p = 0.0010), control (p = 0.0503), and medication-control (p = 0.2012) reduced as salt intake increased. In conclusion, hypertension prevalence is high in this population, but the proportions with awareness, treatment, or control are sub-optimal. Public health interventions that improve hypertension prevention and control, particularly among nomads, is needed. PMID:28358015

An evaluation of the UK Food Standards Agency's salt campaign.

PubMed

Shankar, Bhavani; Brambila-Macias, Jose; Traill, Bruce; Mazzocchi, Mario; Capacci, Sara

2013-02-01

Excessive salt intake is linked to cardiovascular disease and several other health problems around the world. The UK Food Standards Agency initiated a campaign at the end of 2004 to reduce salt intake in the population. There is disagreement over whether the campaign was effective in curbing salt intake or not. We provide fresh evidence on the impact of the campaign, by using data on spot urinary sodium readings and socio-demographic variables from the Health Survey for England over 2003-2007 and combining it with food price information from the Expenditure and Food Survey. Aggregating the data into a pseudo-panel, we estimate fixed effects models to examine the trend in salt intake over the period and to deduce the heterogeneous effects of the policy on the intake of socio-demographic groups. Our results are consistent with a previous hypothesis that the campaign reduced salt intakes by approximately 10%. The impact is shown to be stronger among women than among men. Older cohorts of men show a larger response to the salt campaign compared to younger cohorts, while among women, younger cohorts respond more strongly than older cohorts. Copyright © 2012 John Wiley & Sons, Ltd.

Consumption and sources of dietary salt in family members in Beijing.

PubMed

Zhao, Fang; Zhang, Puhong; Zhang, Lu; Niu, Wenyi; Gao, Jianmei; Lu, Lixin; Liu, Caixia; Gao, Xian

2015-04-10

In China, few people are aware of the amount and source of their salt intake. We conducted a survey to investigate the consumption and sources of dietary salt using the "one-week salt estimation method" by weighing cooking salt and major salt-containing food, and estimating salt intake during dining out based on established evidence. Nine hundred and three families (1981 adults and 971 children) with students in eight primary or junior high schools in urban and suburban Beijing were recruited. On average, the daily dietary salt intake of family members in Beijing was 11.0 (standard deviation: 6.2) g for children and adolescents (under 18 years old), 15.2 (9.1) g for adults (18 to 59 years old), and 10.2 (4.8) g for senior citizens (60 years old and over), respectively. Overall, 60.5% of dietary salt was consumed at home, and 39.5% consumed outside the home. Approximately 90% of the salt intake came from cooking (household cooking and cafeteria or restaurant cooking), while less than 10% came from processed food. In conclusion, the dietary salt intake in Beijing families far surpassed the recommended amounts by World Health Organization, with both household cooking and dining-out as main sources of salt consumption. More targeted interventions, especially education about major sources of salt and corresponding methods for salt reduction should be taken to reduce the risks associated with a high salt diet.

Increasing the volumetric efficiency of Diesel engines by intake pipes

NASA Technical Reports Server (NTRS)

List, Hans

1933-01-01

Development of a method for calculating the volumetric efficiency of piston engines with intake pipes. Application of this method to the scavenging pumps of two-stroke-cycle engines with crankcase scavenging and to four-stroke-cycle engines. The utility of the method is demonstrated by volumetric-efficiency tests of the two-stroke-cycle engines with crankcase scavenging. Its practical application to the calculation of intake pipes is illustrated by example.

Effect of Genetic Information Regarding Salt-Sensitive Hypertension on the Intent to Maintain a Reduced Salt Diet: Implications for Health Communication in Japan.

PubMed

Miyamoto, Keiko; Iwakuma, Miho; Nakayama, Takeo

2017-03-01

The authors investigated the relationship between the awareness of dietary salt and genetics and the intent to maintain a low-salt diet. In particular, they assessed whether hypothetical genetic information regarding salt-sensitive hypertension motivates the intent to reduce dietary salt for communicating the health benefits of lower salt consumption to citizens. A self-administered questionnaire survey was conducted with 2500 randomly sampled residents aged 30 to 69 years living in Nagahama, Japan. Genetic information regarding higher salt sensitivity increased motivation to reduce salt intake for both those who agreed that genes cause hypertension and those who did not. Less than 50% of those who agreed that genes cause hypertension lost their intention to lower their salt consumption when they found they did not possess the susceptibility gene. Communicating genetic information positively affected motivation to reduce salt intake. The present study clarifies the difficulty in changing the behavioral intent of those who have significantly less incentive to reduce salt intake. Therefore, a multidimensional approach is crucial to reduce salt consumption. ©2016 Wiley Periodicals, Inc.

Agreement between twenty-four hour salt ingestion and sodium excretion in a controlled environment

PubMed Central

Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F.; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C.; Titze, Jens

2015-01-01

Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed two independent ultra-long-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 grams per day and collected all urine. The subjects’ daily menus consisted of 27,279 individual servings, out of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady state sodium balance in both studies. Even at fixed salt intake, 24-hour sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-gram difference in salt intake. Due to the biological variability in UNaV, only every-other daily urine sample correctly classified a 3-gram difference in salt intake (49%). By increasing the observations to three consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6–12 grams salt per day were not suitable to detect a 3-gram difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials. PMID:26259596

Simultaneous Study of Intake and In-Cylinder IC Engine Flow Fields to Provide an Insight into Intake Induced Cyclic Variations

NASA Astrophysics Data System (ADS)

Justham, T.; Jarvis, S.; Clarke, A.; Garner, C. P.; Hargrave, G. K.; Halliwell, N. A.

2006-07-01

Simultaneous intake and in-cylinder digital particle image velocimetry (DPIV) experimental data is presented for a motored spark ignition (SI) optical internal combustion (IC) engine. Two individual DPIV systems were employed to study the inter-relationship between the intake and in-cylinder flow fields at an engine speed of 1500 rpm. Results for the intake runner velocity field at the time of maximum intake valve lift are compared to incylinder velocity fields later in the same engine cycle. Relationships between flow structures within the runner and cylinder were seen to be strong during the intake stroke but less significant during compression. Cyclic variations within the intake runner were seen to affect the large scale bulk flow motion. The subsequent decay of the large scale motions into smaller scale turbulent structures during the compression stroke appear to reduce the relationship with the intake flow variations.

Stroke and Nutrition: A Review of Studies

PubMed Central

Foroughi, Mehdi; Akhavanzanjani, Mohsen; Maghsoudi, Zahra; Ghiasvand, Reza; Khorvash, Fariborz; Askari, Gholamreza

2013-01-01

Background: Stroke is one of the leading causes of death and certainly the major cause of disability in the world. Diet and nutrient has an effective role in prevention and control of the risk of stroke. The aim of this study was to review the studies on the relationship between dietary intake and stroke incidence. Methods: In this study, the terms of “Fat”, “cholesterol”, “antioxidant”, “vitamins”, “salt”, “potassium”, “calcium”, “carbohydrate”, “vegetables”, “fruits”, “meat”, “tea”, “whole grains”, “sugar-sweetened beverages”, “Mediterranean diet”, “dietary approaches to stop hypertension diet (DASH diet)”, “Western diet”, and “stroke” were searched in Pubmed search engine. The observational studies, cohort studies, clinical trial studies, systemic review, and meta-analysis reviews are also included in this study. Results: The study revealed that adherence to theimprovements in nutrition and diet canreducethe incidence ofstroke. Higher antioxidant, vitamins, potassium, calcium, vegetables, fruits, whole grain intake, and adherence to the Mediterranean dietor DASH diet can lower stroke incidence. Conclusions: Adherence to Mediterranean diet or DASH diet and increasing the consumption of antioxidant, vitamins, potassium, calcium food sources, vegetables, fruits, and whole grains intake can lower the risk of stroke. Healthy diet is effective in reducing risk of stroke, however, more studies need to be carried out in this area. PMID:23776719

Numerical studies of the formation and destruction of vortices in a motored four-stroke piston-cylinder configuration

NASA Technical Reports Server (NTRS)

Schock, H. J.; Sosoka, D. J.; Ramos, J. I.

1983-01-01

A finite-difference procedure which solves the conservation equations of mass, momentum, and energy is used to investigate the effects of the compression ratio, engine speed, bore-to-stroke ratio, and air intake flow angle on the turbulent flow field within an axisymmetric piston-cylinder configuration. It is shown that in a four-stroke piston-cylinder configuration, the intake stroke is characterized by the formation of a piston vortex. The piston vortex is stretched during the intake stroke, and the head vortex has an almost constant diameter. For a 0-deg air intake flow angle, both vortices disappear by the end of the compression stroke; for an air intake flow angle of 45 deg, the flow field within the cylinder shows three elongated vortices which persist into the compression stroke and then break up and merge. It is also shown that larger bore-to-stroke ratios give rise to lower turbulent levels than smaller bore-to-stroke ratios and that the turbulent intensity is almost independent of the rpm.

High salt diet induces metabolic alterations in multiple biological processes of Dahl salt-sensitive rats.

PubMed

Wang, Yanjun; Liu, Xiangyang; Zhang, Chen; Wang, Zhengjun

2018-06-01

High salt induced renal disease is a condition resulting from the interactions of genetic and dietary factors causing multiple complications. To understand the metabolic alterations associated with renal disease, we comprehensively analyzed the metabonomic changes induced by high salt intake in Dahl salt-sensitive (SS) rats using GC-MS technology and biochemical analyses. Physiological features, serum chemistry, and histopathological data were obtained as complementary information. Our results showed that high salt (HS) intake for 16 weeks caused significant metabolic alterations in both the renal medulla and cortex involving a variety pathways involved in the metabolism of organic acids, amino acids, fatty acids, and purines. In addition, HS enhanced glycolysis (hexokinase, phosphofructokinase and pyruvate kinase) and amino acid metabolism and suppressed the TCA (citrate synthase and aconitase) cycle. Finally, HS intake caused up-regulation of the pentose phosphate pathway (glucose 6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase), the ratio of NADPH/NADP + , NADPH oxidase activity and ROS production, suggesting that increased oxidative stress was associated with an altered PPP pathway. The metabolic pathways identified may serve as potential targets for the treatment of renal damage. Our findings provide comprehensive biochemical details about the metabolic responses to a high salt diet, which may contribute to the understanding of renal disease and salt-induced hypertension in SS rats. Copyright © 2018. Published by Elsevier Inc.

Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study.

PubMed

Grimes, Carley A; Riddell, Lynn J; Campbell, Karen J; Beckford, Kelsey; Baxter, Janet R; He, Feng J; Nowson, Caryl A

2017-10-30

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. Cross-sectional study. Primary schools located in Victoria, Australia. 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. 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. 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. 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

Dietary intake and sources of sodium and potassium among Australian schoolchildren: results from the cross-sectional Salt and Other Nutrients in Children (SONIC) study

PubMed Central

Grimes, Carley A; Riddell, Lynn J; Campbell, Karen J; Beckford, Kelsey; Baxter, Janet R; He, Feng J; Nowson, Caryl A

2017-01-01

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

Two-stroke engine diagnostics and design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-01-01

This paper focuses on research and development efforts on two-stroke cycle engines for automotive applications. Partial contents include: Velocity Field Characteristics in Motored Two-Stroke Ported Engines; Flow Vector Measurements at the Scavenging Ports in a Fired Two-Stroke Engine; A Study on Exhaust Dynamic Effect of Two-Stroke Motorcycle Petrol Engine; Characterization of Ignition and Parametric Study of a Two-Stroke-Cycle Direct-Injected Gasoline Engine; LDV Measurements of Intake Port Flow in a Two-Stroke Engine with and without Combustion; Appraisal of Regenerative Blowers for Scavenging of Small 2T S.I. Powerplants; and Development Experience of a Poppet-Valved Two-Stroke Flagship Engine.

[Hungarian Diet and Nutritional Status Survey - the OTAP2009 study. IV. Macroelement intake of the Hungarian population].

PubMed

Martos, Eva; Bakacs, Márta; Sarkadi-Nagy, Eszter; Ráczkevy, Tímea; Zentai, Andrea; Baldauf, Zsolt; Illés, Eva; Lugasi, Andrea

2012-07-22

The adequate intake of minerals is basically important for healthy nutrition. The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present publication describes the macroelement intake. The salt intake is unusually high (17.2 g in men and 12.0 g in women), the potassium intake remains well below the recommendation. These factors substantially increase the risk of cardiovascular diseases including high blood-pressure. The calcium intake stays below the recommendation except in the youngest males, the oldest men and women are at risk from this point of view. While magnesium intake suited the recommendation, the intake of phosphorus exceeded it twice. Focusing on marcroelements, high sodium/salt intake represents the highest public health risk. The implementation of STOP SALT! National Salt Reducing Programme, i.e. decrease the salt content of processed food and provide proper information to the population about excessive salt consumption, should result in a beneficial change of salt intake and ameliorate the public health conditions.

The Effect of Salt Intake and Potassium Supplementation on Serum Gastrin Levels in Chinese Adults: A Randomized Trial

PubMed Central

Wang, Yuan-Yuan; He, Wen-Wen; Liu, Yan-Chun; Lin, Yi-Feng; Hong, Lu-Fei

2017-01-01

Excess dietary salt is strongly correlated with cardiovascular disease, morbidity, and mortality. Conversely, potassium likely elicits favorable effects against cardiovascular disorders. Gastrin, which is produced by the G-cells of the stomach and duodenum, can increase renal sodium excretion and regulate blood pressure by acting on the cholecystokinin B receptor. The aim of our study was to assess the effects of altered salt and potassium supplementation on serum gastrin levels in humans. A total of 44 subjects (38–65 years old) were selected from a rural community in northern China. All subjects were sequentially maintained on a relatively low-salt diet for 7 days (3.0 g/day of NaCl), a high-salt diet for 7 days (18.0 g/day of NaCl), and then a high-salt diet supplemented with potassium for another 7 days (18.0 g/day of NaCl + 4.5 g/day of KCl). The high-salt intake significantly increased serum gastrin levels (15.3 ± 0.3 vs. 17.6 ± 0.3 pmol/L). This phenomenon was alleviated through potassium supplementation (17.6 ± 0.3 vs. 16.5 ± 0.4 pmol/L). Further analyses revealed that serum gastrin was positively correlated with 24 h urinary sodium excretion (r = 0.476, p < 0.001). By contrast, gastrin level was negatively correlated with blood pressure in all dietary interventions (r = −0.188, p = 0.031). The present study indicated that variations in dietary salt and potassium supplementation affected the serum gastrin concentrations in the Chinese subjects. PMID:28420122

The biopsychology of salt hunger and sodium deficiency

PubMed Central

Hurley, Seth W.; Johnson, Alan Kim

2015-01-01

Sodium is a necessary dietary macromineral that tended to be sparsely distributed in mankind’s environment in the past. Evolutionary selection pressure shaped physiological mechanisms including hormonal systems and neural circuits that serve to promote sodium ingestion. Sodium deficiency triggers the activation of these hormonal systems and neural circuits to engage motivational processes that elicit a craving for salty substances and a state of reward when salty foods are consumed. Sodium deficiency also appears to be associated with aversive psychological states including anhedonia, impaired cognition, and fatigue. Under certain circumstances the psychological processes that promote salt intake can become powerful enough to cause “salt gluttony,” or salt intake far in excess of physiological need. The present review discusses three aspects of the biopsychology of salt hunger and sodium deficiency: 1) the psychological processes that promote salt intake during sodium deficiency, 2) the effects of sodium deficiency on mood and cognition, and 3) the sensitization of sodium appetite as a possible cause of salt gluttony. PMID:25572931

Prevalence, risk factors and secondary prevention of stroke recurrence in eight countries from south, east and southeast asia: a scoping review.

PubMed

Chin, Y Y; Sakinah, H; Aryati, A; Hassan, B M

2018-04-01

In most Asian countries, stroke is one of the major causes of mortality. A stroke event is life-changing for stroke survivors, which results in either mortality or disability. Therefore, this study comprehensively focuses on prevalence, risk factors, and secondary prevention for stroke recurrence identified in South, East, and Southeast Asian countries. This scoping review uses the methodological framework of Arksey and O'Malley. A comprehensive search of academic journals (English) on this topic published from 2007 to 2017 was conducted. A total of 22 studies were selected from 585 studies screened from the electronic databases. First-year stroke recurrence rates are in the range of 2.2% to 25.4%. Besides that, modifiable risk factors are significantly associated with pathophysiological factors (hypertension, ankle-brachial pressure index, atherogenic dyslipidaemia, diabetes mellitus, metabolic syndrome, and atrial fibrillation) and lifestyle factors (obesity, smoking, physical inactivity, and high salt intake). Furthermore, age, previous history of cerebrovascular events, and stroke subtype are also significant influence risk factors for recurrence. A strategic secondary prevention method for recurrent stroke is health education along with managing risk factors through a combination of appropriate lifestyle intervention and pharmacological therapy. To prevent recurrent stroke, health intervention should be geared towards changing lifestyle to embody a healthier approach to life. This is of great importance to public health and stroke survivors' quality of life.

Phasic Stimulation of Midbrain Dopamine Neuron Activity Reduces Salt Consumption

PubMed Central

Sandhu, Eleanor C.; Fernando, Anushka B. P.; Tossell, Kyoko; Kokkinou, Michelle; Glegola, Justyna; Howes, Oliver D.

2018-01-01

Abstract Salt intake is an essential dietary requirement, but excessive consumption is implicated in hypertension and associated conditions. Little is known about the neural circuit mechanisms that control motivation to consume salt, although the midbrain dopamine system, which plays a key role in other reward-related behaviors, has been implicated. We, therefore, examined the effects on salt consumption of either optogenetic excitation or chemogenetic inhibition of ventral tegmental area (VTA) dopamine neurons in male mice. Strikingly, optogenetic excitation of dopamine neurons decreased salt intake in a rapid and reversible manner, despite a strong salt appetite. Importantly, optogenetic excitation was not aversive, did not induce hyperactivity, and did not alter salt concentration preferences in a need-free state. In addition, we found that chemogenetic inhibition of dopamine neurons had no effect on salt intake. Lastly, optogenetic excitation of dopamine neurons reduced consumption of sucrose following an overnight fast, suggesting a more general role of VTA dopamine neuron excitation in organizing motivated behaviors. PMID:29766048

[Salt, renal function and high blood pressure--reflections on a current issue].

PubMed

Aurell, Mattias

2002-11-21

The role of salt intake for blood pressure control has been discussed for a long time. A brief review is given of some pertinent physiological facts to explain this relationship and evolutionary aspects of renal function are emphasized. Salt intake is very high in the modern society, often as high as 15 g sodium chloride per 24 hours while 3-6 g may be more than enough to maintain an adequate salt balance. If the kidneys cannot cope with this severe sodium overload, blood pressure will rise. Therefore, the kidneys' ability to excrete sodium is a key factor and the salt excretion capacity is the kidneys' major barostatic function. As barostats, the kidneys control the blood pressure by ultimately determining the sodium excretion. Reducing sodium intake is, however, difficult as more than 50% of the intake is contained in the food we buy such as bread, sausages, canned food, chips and fast-food. Food products should therefore be "salt declared", but information on this aspect is generally lacking. If the population's salt intake could be reduced by 50%, the prevalence of hypertension will be much reduced, perhaps also by as much as 50%. The cost to society for treating hypertension would be reduced accordingly. Salt intake is also an important aspect of the overweight problem among today's youth. Salt and overweight impose great health risks later in life. Preventive measures in this area must be given high priority in future health care work.

Race and Region Are Associated with Nutrient Intakes among Black and White Men in the United States12

PubMed Central

Newby, P. K.; Noel, Sabrina E.; Grant, Rachael; Judd, Suzanne; Shikany, James M.; Ard, Jamy

2011-01-01

Stroke mortality rates and prevalence of several chronic diseases are higher in Southern populations and blacks in the US. This study examined the relationships of race (black, white) and region (Stroke Belt, Stroke Buckle, other) with selected nutrient intakes among black and white American men (n = 9229). The Block 98 FFQ assessed dietary intakes and multivariable linear regression analysis was used to examine whether race and region were associated with intakes of fiber, saturated fat, trans fat, sodium, potassium, magnesium, calcium, and cholesterol. Race and region were significant predictors of most nutrient intakes. Black men consumed 1.00% lower energy from saturated fat compared with white men [multivariable-adjusted β: 1.00% (95% CI = −0.88, −1.13)]. A significant interaction between race and region was detected for trans fat (P < 0.0001), where intake was significantly lower among black men compared with white men only in the Stroke Belt [multivariable-adjusted β: −0.21 (95% CI = −0.11, −0.31)]. Among black men, intakes of sodium, potassium, magnesium, and calcium were lower, whereas cholesterol was higher, compared with white men (P < 0.05 for all). Comparing regions, men in the Stroke Buckle had the lowest intakes of fiber, potassium, magnesium, and calcium compared with those in the Stroke Belt and other regions; men in both the Stroke Buckle and Stroke Belt had higher intakes of cholesterol compared with those in other regions (P < 0.005 for all). Given these observed differences in dietary intakes, more research is needed to understand if and how they play a role in the health disparities and chronic disease risks observed among racial groups and regions in the US. PMID:21178088

Hypertension prevalence, awareness, treatment, and control and sodium intake in Shandong Province, China: baseline results from Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011.

PubMed

Bi, Zhenqiang; Liang, Xiaofeng; Xu, Aiqiang; Wang, Linghong; Shi, Xiaoming; Zhao, Wenhua; Ma, Jixiang; Guo, Xiaolei; Zhang, Xiaofei; Zhang, Jiyu; Ren, Jie; Yan, Liuxia; Lu, Zilong; Wang, Huicheng; Tang, Junli; Cai, Xiaoning; Dong, Jing; Zhang, Juan; Chu, Jie; Engelgau, Michael; Yang, Quanhe; Hong, Yuling; Wang, Yu

2014-05-22

In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. Overall, 23.4% (95% confidence interval [CI], 20.9%-26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg-6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg-4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg-5,683 mg). Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China.

The excess salt appetite of humans is not due to sodium loss in adulthood.

PubMed

Leshem, Micah

2009-09-07

In seeking the determinants of high salt intake, studies in rat have shown that sodium depletion in utero, neonatally, or in maturity, permanently enhances salt appetite. In humans too, salt appetite is permanently enhanced after perinatal sodium loss, but it is not known if sodium loss in adults also enhances salt intake. If it does, it might contribute to high sodium intake and its associated pathologies. Therefore, using methods that revealed the perinatal determinants of sodium appetite, here we evaluated whether salt appetite is enhanced in adults with a varied history of sodium loss. We find that putative sodium loss due to hyperhidrosis, hemorrhage, dehydration, or breastfeeding, does not increase salt appetite significantly. The findings contrast with the many studies showing enduring enhancement of salt appetite by perinatal sodium loss in humans, and suggest that lifelong salt appetite is established very early in development. In turn this counsels very early intervention to prevent lifelong excess sodium intake.

Spot Urine-guided Salt Reduction in Chronic Kidney Disease Patients.

PubMed

Uchiyama, Kiyotaka; Yanai, Akane; Ishibashi, Yoshitaka

2017-09-01

Dietary salt restriction is important in patients with chronic kidney disease (CKD) to reduce hypertension, cardiovascular events, progression of CKD, and mortality. However, recommending salt reduction for patients is difficult without knowing their actual sodium intake. This study evaluated the effectiveness of spot urine-guided salt reduction in CKD outpatients. A prospective cohort study was used. This study included a total of 127 adult outpatients (aged 60 ± 18 years, 80 males) with CKD. Their baseline estimated glomerular filtration rate was 51.4 ± 25.1 (mL/minute/1.73 m 2 ), and 64 (50%) of them were with CKD stage 3a or 3b (both 32 [25%]). We informed the patients of their individual spot urine-estimated salt intake every time they visited the outpatient clinic. Based on the data, the nephrologist encouraged the patients to achieve their salt restriction goal. The primary outcome was the estimated salt excretion, and the secondary outcome was the urinary protein-to-Cr ratio (UPCR). Multiple regression analyses were performed to clarify the contributing factors of changes in both outcomes. Over a follow-up of 12 months, the median number of patients' visits was 7 (5-8). The estimated salt intake was significantly reduced from 7.98 ± 2.49 g/day to 6.77 ± 1.77 g/day (P < .0001). The median UPCR was also reduced from 0.20 (0.10-0.80) to 0.10 (0.10-0.48) (P < .0001). On multiple regression analysis, a reduction in UPCR was positively associated with the baseline UPCR and a reduction in systolic blood pressure significantly (P < .0001 and P < .01, respectively) as well as positively correlated with a reduction in the estimated salt intake, with borderline significance (P = .08). Providing spot urine-estimated salt intake feedback effectively motivated CKD patients to reduce their salt intake. Spot urine-guided salt reduction may slow CKD progression through decreased urinary protein excretion. Copyright © 2017 National Kidney

Reducing the Salt Added to Takeaway Food: Within-Subjects Comparison of Salt Delivered by Five and 17 Holed Salt Shakers in Controlled Conditions

PubMed Central

Goffe, Louis; Wrieden, Wendy; Penn, Linda; Hillier-Brown, Frances; Lake, Amelia A.; Araujo-Soares, Vera; Summerbell, Carolyn; White, Martin; Adamson, Ashley J.

2016-01-01

Objectives To determine if the amount of salt delivered by standard salt shakers commonly used in English independent takeaways varies between those with five and 17 holes; and to determine if any differences are robust to variations in: the amount of salt in the shaker, the length of time spent shaking, and the person serving. Design Four laboratory experiments comparing the amount of salt delivered by shakers. Independent variables considered were: type of shaker used (five or 17 holes), amount of salt in the shaker before shaking commences (shaker full, half full or nearly empty), time spent shaking (3s, 5s or 10s), and individual serving. Setting Controlled, laboratory, conditions. Participants A quota-based convenience sample of 10 participants (five women) aged 18–59 years. Main Outcome Measures Amount of salt delivered by salt shakers. Results Across all trials, the 17 holed shaker delivered a mean (SD) of 7.86g (4.54) per trial, whilst the five holed shaker delivered 2.65g (1.22). The five holed shaker delivered a mean of 33.7% of the salt of the 17 holed shaker. There was a significant difference in salt delivered between the five and 17 holed salt shakers when time spent shaking, amount of salt in the shaker and participant were all kept constant (p<0.001). This difference was robust to variations in the starting weight of shakers, time spent shaking and participant shaking (pssalt shakers have the potential to reduce the salt content of takeaway food, and particularly food from Fish & Chip shops, where these shakers are particularly used. Further research will be required to determine the effects of this intervention on customers’ salt intake with takeaway food and on total dietary salt intake. PMID:27668747

Prospective observational study of isoflavone and the risk of stroke recurrence: potential clinical implications beyond vascular function.

PubMed

Chan, Y-H; Lau, K-K; Yiu, K-H; Siu, C-W; Chan, H-T; Li, S-W; Tam, S; Lam, T-H; Lau, C-P; Tse, H-F

2012-04-01

Whether isoflavone has any effect on recurrent cardiovascular events is unknown. To investigate the relations between isoflavone intake and the risk of stroke recurrence. We recruited 127 consecutive patients with prior history of atherothrombotic/ hemorrhagic stroke (mean age: 67 ± 11 years, 69% male) and prospectively followed up for a mean duration of 30 months. Stroke recurrence and major adverse cardiovascular events (MACE) were documented. Brachial flow-mediated dilatation (FMD) was measured using high-resolution ultrasound. Isoflavone intake was estimated using a validated food frequency questionnaire. Median isoflavone intake was 6.9 (range: 2.1 - 14.5) mg/day. Isoflavone intake was independently associated with increased FMD (Pearson R=0.23, p=0.012). At 30 months, there were 10 stroke recurrence and 12 MACE. Kaplan-Meier analysis showed that patients with isoflavone intake higher than median value had significantly longer median stroke recurrence-free survival time (19.0 [range: 10.4 - 27.6] mth versus 5.0 [range: 4.1 - 5.9] mth, p=0.021) and MACE-free survival time (19.0 [range: 10.4 - 27.6] mth versus 4.0 [range: 2.4 - 5.6] mth, p=0.013). Using multivariate cox regression, higher isoflavone intake was an independent predictor for lower risk of stroke recurrence (hazards ratio 0.18 [95%CI: 0.03 - 0.95], risk reduction 82%, p=0.043) and MACE (hazards ratio 0.16 [95%CI: 0.03 - 0.84], risk reduction 84%, p=0.030). Higher isoflavone intake in stroke patients was associated with prolonged recurrence-free survival, and reduced risk of stroke recurrence and MACE independent of baseline vascular function. Whether isoflavone may confer clinically significant secondary protection in stroke patients should be further investigated in a randomized controlled trial.

Associations between dietary salt, potassium and blood pressure in South African adults: WHO SAGE Wave 2 Salt & Tobacco.

PubMed

Ware, L J; Charlton, K; Schutte, A E; Cockeran, M; Naidoo, N; Kowal, P

2017-09-01

In June 2016, South Africa implemented legislation mandating maximum sodium levels in a range of processed foods with a goal of reducing population salt intake and disease burden from hypertension. Our aim was to explore the relationship between salt and blood pressure (BP) in a subsample of the World Health Organization Study on global AGEing and adult health (SAGE) Wave 2 before implementation of legislation in South Africa. Blood pressure (BP) was measured in triplicate (n = 2722; median age 56 years; 33% male) and 24-h urine collected in a nested subsample (n = 526) for sodium, potassium and creatinine analysis. Hypertension prevalence was 55% in older adults (50-plus years) and 28% in younger adults (18-49 years). Median salt intake (6.8 g/day) was higher in younger than older adults (8.6 g vs 6.1 g/day; p < 0.001), and in urban compared to rural populations (7.0 g vs 6.0 g/day; p = 0.033). Overall, 69% of participants had salt intakes above 5 g/day. Potassium intakes were generally low (median 35 mmol/day) with significantly lower intakes in rural areas and older adults. Overall, 91% of adults failed to meet the daily potassium recommendation of 90 mmol/d. Salt intakes above 5 g/day, and to a greater extent, a dietary sodium-to-potassium (Na:K) ratio above 2 mmol/mmol, were associated with significantly steeper regression slopes of BP with age. These preliminary results indicate that high dietary Na:K ratio may lead to a greater increase in BP and hypertension risk with age. Interventions to increase potassium intakes alongside sodium reduction initiatives may be warranted. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

[Study on the amount of daily iodine intake of inhabitants living in drinking water with excessive iodine content areas after termination of iodized salt supply].

PubMed

Zhang, Gen-hong; Li, Su-mei; Zheng, He-ming; Wang, Chuan-gang; Liu, Lie-jun; Li, Xiu-wei; Zhang, Hao-feng; Ke, Geng-yin; Ma, Jian-guo; Yang, Jin; Ma, Ying; Liu, Jin-wen

2007-03-01

To investigate the amount of daily iodine intake in the diet of the target population in drinking water with areas of excessive iodine after stopping supply of iodized salt, to provide evidence for developing strategies on control and prevention of excessive iodine. 335 objectives were selected by a two-stage sampling method in 4 administrative villages with different iodine contents in drinking water. The amount of drinking water intake and dietary survey for 335 people were done by a door-to-door survey,while the iodine contents in the drinking water of each selected family, local staple food and vegetable were measured. The median level of iodine in drinking water was 431.5 microg/L while the daily amount of iodine intake among the three groups of waters with different iodine contents were all greater than RNI. The daily iodine intake of local people was all greater than UL in the areas where the water iodine contents were more than 300 microg/L. It was of statistical sense that the iodine mean intake per capita per day of the three groups differed at different water iodine levels (P < 0.01). The iodine mean intake per capita per day of the three groups of different water iodine levels increased along with water iodine and showed a uptrend (P < 0.01). 83.2%-98.7% of the daily iodine intake of the three groups was from drinking water and 1.3%-16.8% came from food. The iodine intake had high-positive correlation relation with the content of water iodine (P < 0.01). It was concluded that drinking water was the main source of iodine intake in areas with iodine excessive water by the percentage of over 80%. It was necessary to adopt measures to improve the quality of water to decrease the iodine content other than just stopping supplies of iodized salt in the areas where the water iodine contents were greater than 300 microg/L, in order to prevent and control excessive intake of iodine.

Validation of the Chinese Version of the Functional Oral Intake Scale (FOIS) Score in the Assessment of Acute Stroke Patients with Dysphagia.

PubMed

Zhou, Hongzhen; Zhu, Yafang; Zhang, Xiaomei

2017-01-01

This study aimed to validate the Chinese version of the Functional Oral Intake Scale (FOIS) score in acute stroke patients with dysphagia. A sample of 128 consecutive patients with acute stroke, admitted to Department of Neurology from April to October in 2016, completed the FOIS. The interrater reliability, criterion validity, discriminant validity, cross validation, and the sensitivity of FOIS scale were evaluated. Results showed that rater agreements were excellent for FOIS (Kw = 0.881, p < 0.001). A highly negative correlation between FOIS and WST (water swallow test) was detected (r = -0.937, p < 0.001). There was significant difference for FOIS level of patients with different evaluation outcomes (χ² = 126.551, p < 0.001). The FOIS evaluation results were significantly correlated with two physiological measures of swallowing. The Chinese version of the FOIS score is a reliable scale for evaluating the level of oral feeding function in patients with acute stroke.

Risk factors of young ischemic stroke in Qatar.

PubMed

Khan, Fahmi Yousef

2007-11-01

There is limited information about risk factors of young ischemic stroke in Qatar. The aim of this study was to describe the risk factors and subtypes of young ischemic stroke among Qatari and non-Qatari residents. Hospital based prospective observational study involving all young adults (15-45 years of age) admitted to Hamad General Hospital with first-ever ischemic stroke from September 2004 to September 2005. A stroke was defined according to WHO criteria. Stroke was confirmed in 40 (32 males and 8 females). Their ages ranged from 17 to 44 years (mean 37.1+/-13.27). Thirty (75%) of the patients were non-Qatari. The most common risk factors were hypertension 16 (40%), diabetes mellitus 13 (32.5%), hypercholesterolemia 11 (27.5%), smoking 11 (27.5%), and alcohol intake 9 (22.5%). Regarding stroke subtypes, lacunar stroke syndrome (LACS) was diagnosed in 17 (42.5%), total anterior circulation stroke syndrome (TACS) in 16 (40%), partial anterior circulation stroke syndrome (PACS) in 5 (12.5%) and posterior circulation stroke syndrome (POCS) in 2 (5%). Partial anterior circulation stroke syndrome (PACS) was observed with a higher frequency in Qatari patients compared with non-Qataris (p=0.009), whereas total anterior circulation stroke syndrome (TACS) was observed more in non-Qatari than in Qatari patients (p=0.03). Average hospital stay was 18 days. In-hospital mortality was 2.5%. The risk factors of ischemic stroke in young adults are numerous. The most common were hypertension, diabetes mellitus, hypercholesterolemia, smoking and alcohol intake. Only one Indonesian male patient with POCS died in the hospital.

Salt reduction in China: a state-of-the-art review

PubMed Central

Shao, Shuai; Hua, Yechu; Yang, Ying; Liu, Xiaojuan; Fan, Jingruo; Zhang, An; Xiang, Jingling; Li, Mingjing; Yan, Lijing L

2017-01-01

Objective This study aimed to reveal the latest evidence on salt reduction initiatives in China in order to identify the contextual cost-effective interventions, as well as the barriers encountered during China’s long march to reach its population salt reduction goal. Background Population-based salt reduction has been considered as one of the most cost-effective strategies in the world for the prevention and control of noncommunicable diseases. China, along with its sustained economic growth, faces increasing burdens from chronic diseases such as cardiovascular and kidney diseases. With policy support and cross-sector collaboration, various salt reduction initiatives have been adopted in China in order to reduce such dietary risk, especially since the beginning of this millennium. Methods This study conducted structured literature reviews in both English and Chinese databases and synthesized the latest evidence on the association of salt intake and health, as well as salt intake among Chinese and population-based salt reduction strategies in China and around the world. Findings Dietary salt restriction has been found to contribute to the reduction of blood pressure among both the normotensives and hypertensives bringing associated reduced disease burdens and great public health benefits. With gender, ethnic, and regional variations, salt intake levels in the population in China are well above the recommended threshold and physiological need. Admittedly, excessive salt intake precipitates the high prevalence of hypertension and cardiovascular disease among the Chinese. Considering that the majority of the dietary salt is added during cooking in China, salt substitutes, salt restriction tools, and health education are the most common salt reduction initiatives with varying levels of effectiveness and acceptability among the Chinese population. Implication Overwhelming evidence is in support of a well-coordinated nationwide salt restriction initiative as a key

Dietary Sodium to Potassium Ratio and Risk of Stroke in a Multiethnic Urban Population: The Northern Manhattan Study.

PubMed

Willey, Joshua; Gardener, Hannah; Cespedes, Sandino; Cheung, Ying K; Sacco, Ralph L; Elkind, Mitchell S V

2017-11-01

There is growing evidence that increased dietary sodium (Na) intake increases the risk of vascular diseases, including stroke, at least in part via an increase in blood pressure. Higher dietary potassium (K), seen with increased intake of fruits and vegetables, is associated with lower blood pressure. The goal of this study was to determine the association of a dietary Na:K with risk of stroke in a multiethnic urban population. Stroke-free participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were followed-up for incident stroke. Baseline food frequency questionnaires were analyzed for Na and K intake. We estimated the hazard ratios and 95% confidence intervals for the association of Na:K with incident total stroke using multivariable Cox proportional hazards models. Among 2570 participants with dietary data (mean age, 69±10 years; 64% women; 21% white; 55% Hispanic; 24% black), the mean Na:K ratio was 1.22±0.43. Over a mean follow-up of 12 years, there were 274 strokes. In adjusted models, a higher Na:K ratio was associated with increased risk for stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1) and specifically ischemic stroke (hazard ratio, 1.6; 95% confidence interval, 1.2-2.1). Na:K intake is an independent predictor of stroke risk. Further studies are required to understand the joint effect of Na and K intake on risk of cardiovascular disease. © 2017 American Heart Association, Inc.

Self-report of stroke, transient ischemic attack, or stroke symptoms and risk of future stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

PubMed Central

Judd, Suzanne E; Kleindorfer, Dawn O; McClure, Leslie A; Rhodes, J. David; Howard, George; Cushman, Mary; Howard, Virginia J.

2013-01-01

Background and Purpose History of stroke and Transient Ischemic Attack (TIA) are documented risk factors for subsequent stroke and all-cause mortality. Recent reports suggest increased risk among those reporting stroke symptoms absent stroke or TIA. However, the relative magnitude of increased stroke risk has not been described across the symptomatic spectrum: 1) asymptomatic (Asx), 2) stroke symptoms only (SS), 3) TIA, 4) stroke in the distant past (DS), and 5) recent stroke (RS). Methods Between 2003–2007 the REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30,239 black and white Americans aged 45+. DS and RS were defined as self-report of physician diagnosis of stroke >5 or <5 years before baseline, respectively. SS was defined as a history of any of six sudden onset stroke symptoms absent TIA/stroke diagnosis. Kaplan-Meier and proportional hazards analysis were used to contrast stroke risk differences. Results Over 5.0 ± 1.72 years of follow up, 737 strokes were validated. Compared to Asx persons, those with SS, TIA, DS and RS all had increased risk of future stroke. After adjustment for age, race, sex, income, education, alcohol intake, current smoking, and a history of diabetes, hypertension, myocardial infarction, atrial fibrillation, and dyslipidemia, there was 1.20-fold (not statistically significant) increased stroke risk for SS (95% CI 0.96, 1.51), 1.73-fold for TIA (95% CI 1.27, 2.36), 2.23-fold for DS (95% CI 1.61, 3.09) and 2.85-fold for RS (95% CI 2.16, 3.76). Discussion Results suggest a spectrum of risk from stroke symptoms to TIA, distant stroke, and recent stroke, and imply a need for establishing these categories in health screenings to manage risk for future stroke, reinforcing the clinical importance of stroke history including the presence of stroke symptoms. PMID:23233382

Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies.

PubMed

Juan, Juan; Liu, Gang; Willett, Walter C; Hu, Frank B; Rexrode, Kathryn M; Sun, Qi

2017-12-01

Higher intake of whole grains may exert cardiometabolic benefits, although findings on stroke risk are inconclusive. The potentially differential effects of individual whole grain foods on ischemic stroke have not been examined. We analyzed whole grain consumption in relation to ischemic stroke among 71 750 women from the Nurses' Health Study and 42 823 men from the Health Professionals Follow-up Study who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline (1984 and 1986, respectively) through 2010 using a Cox proportional hazards model. Validated semiquantitative food frequency questionnaires were used to assess consumption of whole grain intake, including whole grain cold breakfast cereal, dark bread, oatmeal, brown rice, popcorn, bran, and germ. Self-reported incident cases of ischemic stroke were confirmed through medical record review. During 2 820 128 person-years of follow-up in the 2 cohorts, 2458 cases of ischemic stroke were identified and confirmed. Intake of total whole grains was not associated with risk of ischemic stroke after adjustment for covariates: the pooled hazard ratio (95% confidence interval) comparing extreme intake levels was 1.04 (0.91-1.19). However, intake of whole grain cold breakfast cereal and total bran was inversely associated with ischemic stroke after multivariate adjustment: the pooled hazard ratios (95% confidence intervals) were 0.88 (0.80-0.96; P trend =0.008) and 0.89 (0.79-1.00; P trend =0.004), respectively. Other whole grain foods were not associated with a lower risk of ischemic stroke. Although overall consumption of whole grains was not associated with lower risk of ischemic stroke, greater consumption of whole grain cold breakfast cereal and bran was significantly associated with a lower risk of ischemic stroke. More studies are needed to replicate these associations between individual whole grain foods and risk of ischemic stroke among other populations. © 2017 American Heart

Hypertension Prevalence, Awareness, Treatment, and Control and Sodium Intake in Shandong Province, China: Baseline Results From Shandong–Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011

PubMed Central

Bi, Zhenqiang; Liang, Xiaofeng; Xu, Aiqiang; Wang, Linghong; Shi, Xiaoming; Zhao, Wenhua; Ma, Jixiang; Guo, Xiaolei; Zhang, Xiaofei; Zhang, Jiyu; Ren, Jie; Yan, Liuxia; Lu, Zilong; Wang, Huicheng; Tang, Junli; Cai, Xiaoning; Dong, Jing; Zhang, Juan; Chu, Jie; Engelgau, Michael; Yang, Quanhe; Hong, Yuling

2014-01-01

Introduction In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. Methods Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. Results Overall, 23.4% (95% confidence interval [CI], 20.9%–26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg–6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg–4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg–5,683 mg). Conclusion Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China. PMID:24854239

Target Salt 2025: A Global Overview of National Programs to Encourage the Food Industry to Reduce Salt in Foods

PubMed Central

Webster, Jacqui; Trieu, Kathy; Dunford, Elizabeth; Hawkes, Corinna

2014-01-01

Reducing population salt intake has been identified as a priority intervention to reduce non-communicable diseases. Member States of the World Health Organization have agreed to a global target of a 30% reduction in salt intake by 2025. In countries where most salt consumed is from processed foods, programs to engage the food industry to reduce salt in products are being developed. This paper provides a comprehensive overview of national initiatives to encourage the food industry to reduce salt. A systematic review of the literature was supplemented by key informant questionnaires to inform categorization of the initiatives. Fifty nine food industry salt reduction programs were identified. Thirty eight countries had targets for salt levels in foods and nine countries had introduced legislation for some products. South Africa and Argentina have both introduced legislation limiting salt levels across a broad range of foods. Seventeen countries reported reductions in salt levels in foods—the majority in bread. While these trends represent progress, many countries have yet to initiate work in this area, others are at early stages of implementation and further monitoring is required to assess progress towards achieving the global target. PMID:25195640

Target salt 2025: a global overview of national programs to encourage the food industry to reduce salt in foods.

PubMed

Webster, Jacqui; Trieu, Kathy; Dunford, Elizabeth; Hawkes, Corinna

2014-08-21

Reducing population salt intake has been identified as a priority intervention to reduce non-communicable diseases. Member States of the World Health Organization have agreed to a global target of a 30% reduction in salt intake by 2025. In countries where most salt consumed is from processed foods, programs to engage the food industry to reduce salt in products are being developed. This paper provides a comprehensive overview of national initiatives to encourage the food industry to reduce salt. A systematic review of the literature was supplemented by key informant questionnaires to inform categorization of the initiatives. Fifty nine food industry salt reduction programs were identified. Thirty eight countries had targets for salt levels in foods and nine countries had introduced legislation for some products. South Africa and Argentina have both introduced legislation limiting salt levels across a broad range of foods. Seventeen countries reported reductions in salt levels in foods-the majority in bread. While these trends represent progress, many countries have yet to initiate work in this area, others are at early stages of implementation and further monitoring is required to assess progress towards achieving the global target.

Knowledge, attitudes and behaviours related to dietary salt among adults in the state of Victoria, Australia 2015.

PubMed

Grimes, Carley A; Kelley, Sarah-Jane; Stanley, Sonya; Bolam, Bruce; Webster, Jacqui; Khokhar, Durreajam; Nowson, Caryl A

2017-05-30

Information on consumer's knowledge, attitudes and behaviours (KABs) related to salt can be used to inform awareness and education campaigns and serve as a baseline measure to monitor changes in KABs over time. The aim of this study was to determine KABs related to salt intake among Victorian adults. Cross-sectional survey conducted in Victorian adults aged 18-65 years. Participants were recruited from shopping centres located in Melbourne and Geelong and via online methods (Facebook and Consumer Research Panel) to complete an online survey assessing KABs related to dietary salt. Descriptive statistics (mean (SD) or n (%)) were used to report survey findings. A total of 2398 participants provided a valid survey (mean age 43 years (SD 13), 57% female). The majority (80%) were born in Australia and 63% were the main household grocery shopper. The majority (89%) were aware of the health risks associated with a high salt intake. Eighty three percent believed that Australians eat too much salt. Three quarters (75%) correctly identified salt from processed foods as being the main source of salt in the diet. Less than a third (29%) of participants believed their own individual salt intake exceeded dietary recommendations and only 28% could correctly identify the maximum recommended daily intake for salt. Just under half (46%) of participants were concerned about the amount of salt in food. Almost two thirds (61%) of participants believed that there should be laws which limit the amount of salt added to manufactured foods and 58% agreed that it was difficult to find lower salt options when eating out. The findings of this study serve as a baseline assessment of KABs related to salt intake in Victorian adults and can be used to assess changes in salt related KABs over time. Public concern about salt is low as many people remain unaware of their own salt intake. An increased awareness of the excessive amount of salt consumed and increased availability of lower salt foods

Potassium Inhibits Dietary Salt-Induced Transforming Growth Factor-β Production

PubMed Central

Ying, Wei-Zhong; Aaron, Kristal; Wang, Pei-Xuan; Sanders, Paul W.

2009-01-01

Human and animal studies demonstrate an untoward effect of excess dietary NaCl (salt) intake on cardiovascular function and life span. The endothelium in particular augments the production of transforming growth factor (TGF)-β, a fibrogenic growth factor, in response to excess dietary salt intake. This study explored the initiating mechanism that regulates salt-induced endothelial cell production of TGF-β. Male Sprague-Dawley rats were given diets containing different amounts of NaCl and potassium for 4 days. A bioassay for TGF-β demonstrated increased (35.2%) amounts of active TGF-β in the medium of aortic ring segments from rats on the high-salt diet compared with rats maintained on a 0.3% NaCl diet. Inhibition of the large-conductance, calcium-activated potassium channel inhibited dietary salt-induced vascular production of TGF-β but did not affect production of TGF-β by ring segments from rats on the low-salt diet. Immunohistochemical and Western analyses demonstrated the α subunit of the calcium-activated potassium channel in endothelial cells. Increasing medium [K+] inhibited production of dietary salt-induced vascular production levels of total and active TGF-β but did not alter TGF-β production by aortic rings from rats on the 0.3% NaCl diet. Increasing dietary potassium content decreased urinary active TGF-β in animals receiving the high-salt diet but did not change urinary active TGF-β in animals receiving the low-salt diet. The findings demonstrated an interesting interaction between the dietary intake of potassium and excess NaCl and further showed the fundamental role of the endothelial calcium-activated potassium channel in the vascular response to excess salt intake. PMID:19738156

Salt as a public health challenge in continental European convenience and ready meals.

PubMed

Kanzler, Sonja; Hartmann, Christina; Gruber, Anita; Lammer, Guido; Wagner, Karl-Heinz

2014-11-01

To assess the salt content of continental European convenience and ready meals. A multistage study in which, after laboratory analysis of the products' salt contents (n 32), new salt-reduced meals were developed through food reformulation. Additionally, a comprehensive survey of convenience meals from the Austrian market (n 572) was conducted to evaluate the salt contents of a wider product range. Six continental European countries participated. No subjects enrolled. The salt contents of continental European convenience and ready meals mostly exceeded 1·8 g/100 g, which is 30 % of the targeted daily intake level; some contained even more than the recommended daily intake of 6 g. The highest salt contents were found in pizzas and pasta dishes, the lowest ones in sweet meals. Large variations in salt levels were found not only between and within meal type categories, but also between similar meals from different producers. In addition, our approach to develop new salt-reduced meals showed that a stepwise reduction of the ready meals' salt contents is possible without compromising the sensory quality. To address the problem of hypertension and increased risk for CVD through high salt intake, a reduction of the salt levels in continental European convenience and ready meals is urgently needed, since they are providing a major part of the daily salt intake. Successful national-wide salt reduction strategies in the UK or Finland have already demonstrated the public health impact of this setting.

Self-report of stroke, transient ischemic attack, or stroke symptoms and risk of future stroke in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.

PubMed

Judd, Suzanne E; Kleindorfer, Dawn O; McClure, Leslie A; Rhodes, J David; Howard, George; Cushman, Mary; Howard, Virginia J

2013-01-01

History of stroke and transient ischemic attack (TIA) are documented risk factors for subsequent stroke and all-cause mortality. Recent reports suggest increased risk among those reporting stroke symptoms absent stroke or TIA. However, the relative magnitude of increased stroke risk has not been described across the symptomatic spectrum: (1) asymptomatic, (2) stroke symptoms (SS) only, (3) TIA, (4) distant stroke (DS), and (5) recent stroke (RS). Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30 239 black and white Americans ≥45 years of age. DS and RS were defined as self-report of physician diagnosis of stroke >5 or <5 years before baseline, respectively. SS was defined as a history of any of 6 sudden onset stroke symptoms absent TIA/stroke diagnosis. Kaplan-Meier and proportional hazards analysis were used to contrast stroke risk differences. Over 5.0±1.72 years of follow-up, 737 strokes were validated. Compared with asymptomatic persons, those with SS, TIA, DS, and RS all had increased risk of future stroke. After adjustment for age, race, sex, income, education, alcohol intake, current smoking, and a history of diabetes mellitus, hypertension, myocardial infarction, atrial fibrillation, and dyslipidemia, there was 1.20-fold (not statistically significant) increased stroke risk for SS (95% CI, 0.96-1.51), 1.73-fold for TIA (95% CI, 1.27-2.36), 2.23-fold for DS (95% CI, 1.61- 3.09), and 2.85-fold for RS (95% CI, 2.16-3.76). Results suggest a spectrum of risk from stroke symptoms to TIA, DS, and RS, and imply a need for establishing these categories in health screenings to manage risk for future stroke, reinforcing the clinical importance of stroke history including the presence of stroke symptoms.

Substitution of Linoleic Acid for Other Macronutrients and the Risk of Ischemic Stroke.

PubMed

Venø, Stine K; Schmidt, Erik B; Jakobsen, Marianne U; Lundbye-Christensen, Søren; Bach, Flemming W; Overvad, Kim

2017-12-01

Ischemic stroke is a major health problem worldwide, but the influence of dietary factors on stroke risk is not well known. This study aimed to investigate the risk of ischemic stroke and its subtypes with a higher intake from linoleic acid and a concomitant lower intake from saturated fatty acids, monounsaturated fatty acids, or glycemic carbohydrates. In the Danish prospective Diet, Cancer, and Health Study of 57 053 participants aged 50 to 64 years at baseline, information on diet was collected using a validated semiquantitative food frequency questionnaire. Information on ischemic stroke was obtained from the Danish National Patient Register, and cases were all validated and subclassified according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Substitution of linoleic acid for saturated fatty acid, monounsaturated fatty acid, or glycemic carbohydrates was investigated in relation to the risk of ischemic stroke and subtypes. Cox proportional hazards regression was used to estimate the associations with ischemic stroke adjusting for appropriate confounders. During 13.5 years of follow-up 1879 participants developed ischemic stroke. A slightly lower risk of ischemic stroke was found with a 5% higher intake of linoleic acid and a concomitant lower intake of saturated fatty acid (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16), monounsaturated fatty acid (hazard ratio, 0.80; 95% confidence interval, 0.63-1.02), and glycemic carbohydrates (hazard ratio, 0.92; 95% confidence interval, 0.78-1.09), although not statistically significant. Similar patterns of association were found for large-artery atherosclerosis and small-vessel occlusions. This study suggests that replacing saturated fatty acid, glycemic carbohydrate, or monounsaturated fatty acid with linoleic acid may be associated with a lower risk of ischemic stroke. © 2017 American Heart Association, Inc.

Association between executive and food functions in the acute phase after stroke.

PubMed

Mourão, Aline Mansueto; Vicente, Laélia Cristina Caseiro; Abreu, Mery Natali Silva; Chaves, Tatiana Simões; Sant'Anna, Romeu Vale; Braga, Marcela Aline Fernandes; Meira, Fidel Castro Alves de; de Souza, Leonardo Cruz; Miranda, Aline Silva de; Rachid, Milene Alvarenga; Teixeira, Antônio Lucio

2018-03-01

Purpose To investigate potential associations among executive, physical and food functions in the acute phase after stroke. Methods This is a cross-sectional study that evaluated 63 patients admitted to the stroke unit of a public hospital. The exclusion criteria were other neurological and/or psychiatric diagnoses. The tools for evaluation were: Mini-Mental State Examination and Frontal Assessment Battery for cognitive functions; Alberta Stroke Program Early CT Score for quantification of brain injury; National Institutes of Health Stroke Scale for neurological impairment; Modified Rankin Scale for functionality, and the Functional Oral Intake Scale for food function. Results The sample comprised 34 men (54%) and 29 women with a mean age of 63.6 years. The Frontal Assessment Battery was significantly associated with the other scales. In multivariate analysis, executive function was independently associated with the Functional Oral Intake Scale. Conclusion Most patients exhibited executive dysfunction that significantly compromised oral intake.

Normotensive blood pressure in pregnancy: the role of salt and aldosterone.

PubMed

Gennari-Moser, Carine; Escher, Geneviève; Kramer, Simea; Dick, Bernhard; Eisele, Nicole; Baumann, Marc; Raio, Luigi; Frey, Felix J; Surbek, Daniel; Mohaupt, Markus G

2014-02-01

A successful pregnancy requires an accommodating environment. Salt and water availability are critical for plasma volume expansion. Any changes in sodium intake would alter aldosterone, a hormone previously described beneficial in pregnancy. To date, it remains ambiguous whether high aldosterone or high salt intake is preferable. We hypothesized that increased aldosterone is a rescue mechanism and appropriate salt availability is equally effective in maintaining a normotensive blood pressure (BP) phenotype in pregnancy. We compared normotensive pregnant women (n=31) throughout pregnancy with young healthy female individuals (n=31-62) and performed salt sensitivity testing within the first trimester. Suppression of urinary tetrahydro-aldosterone levels by salt intake as measured by gas chromatography-mass spectrometry and urinary sodium excretion corrected for creatinine, respectively, was shifted toward a higher salt intake in pregnancy (P<0.0001). In pregnancy, neither high urinary tetrahydro-aldosterone nor sodium excretion was correlated with higher BP. In contrast, in nonpregnant women, systolic BP rose with aldosterone (P<0.05). Testing the impact of salt on BP, we performed salt sensitivity testing in a final cohort of 19 pregnant and 24 nonpregnant women. On salt loading, 24-hour mean arterial pressure rose by 3.6±1.5 and dropped by -2.8±1.5 mm Hg favoring pregnant women (P<0.01; χ(2)=6.04; P<0.02). Our data suggest first that salt responsiveness of aldosterone is alleviated in conditions of pregnancy without causing aldosterone-induced hypertension. Second, salt seems to aid in BP lowering in pregnancy for reasons incompletely elucidated, yet involving renin suppression and potentially placental sensing mechanisms. Further research should identify susceptible individuals and clarify effector mechanisms.

A Multicomponent Behavioral Intervention to Reduce Stroke Risk Factor Behaviors: The Stroke Health and Risk Education Cluster-Randomized Controlled Trial.

PubMed

Brown, Devin L; Conley, Kathleen M; Sánchez, Brisa N; Resnicow, Kenneth; Cowdery, Joan E; Sais, Emma; Murphy, Jillian; Skolarus, Lesli E; Lisabeth, Lynda D; Morgenstern, Lewis B

2015-10-01

The Stroke Health and Risk Education Project was a cluster-randomized, faith-based, culturally sensitive, theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans. Ten Catholic churches were randomized to intervention or control group. The intervention group received a 1-year multicomponent intervention (with poor adherence) that included self-help materials, tailored newsletters, and motivational interviewing counseling calls. Multilevel modeling, accounting for clustering within subject pairs and parishes, was used to test treatment differences in the average change since baseline (ascertained at 6 and 12 months) in dietary sodium, fruit and vegetable intake, and physical activity, measured using standardized questionnaires. A priori, the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level. Of 801 subjects who consented, 760 completed baseline data assessments, and of these, 86% completed at least one outcome assessment. The median age was 53 years; 84% subjects were Hispanic/Latino; and 64% subjects were women. The intervention group had a greater increase in fruit and vegetable intake than the control group (0.25 cups per day [95% confidence interval: 0.08, 0.42], P=0.002), a greater decrease in sodium intake (-123.17 mg/d [-194.76, -51.59], P=0.04), but no difference in change in moderate- or greater-intensity physical activity (-27 metabolic equivalent-minutes per week [-526, 471], P=0.56). This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake, reaching its primary end point. The intervention also seemed to lower sodium intake. Church-based health promotions can be successful in primary stroke prevention efforts. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01378780. © 2015 American Heart Association, Inc.

The long-term nutritional status in stroke patients and its predictive factors.

PubMed

Paquereau, Julie; Allart, Etienne; Romon, Monique; Rousseaux, Marc

2014-07-01

Malnutrition is common in the first few months after stroke and contributes to a poor overall outcome. We analyzed long-term weight changes and their predictive factors. A total of 71 first-ever stroke patients were included in the study and examined (1) their weight on admission to the acute stroke unit (usual weight [UW]), on admission to the rehabilitation unit, on discharge from the rehabilitation unit, and then 1 year or more after the stroke (median time: 2.5 years), (2) the presence of malnutrition after stroke, and (3) possible predictive factors, namely, sociodemographic factors, clinical characteristics (concerning the stroke, the patient's current neurologic status and the presence of diabetes mellitus and depression), and the present nutritional state (including eating difficulties, anorexia, and changes in food intake and food preferences). Body weight fell (4.0 kg) during the patients' stay in the stroke unit, increased moderately in the rehabilitation unit (2.0 kg), and returned to the UW by the long-term measurement. However, at the last observation, 40.1% of the patients weighed markedly less than their UW, 38.0% weighed markedly more, and 21.1% were relatively stable. Predictors of weight change were a change in preferences for sweet food products and a change in food intake. Malnutrition was frequent (47.9%) and associated with reduced food intake, residence in an institution, and diabetes mellitus. Malnutrition was highly prevalent, with an important role of change in food intake and food preferences, which could result from brain lesions and specific regimens. Living in an institution needs consideration, as its negative effects can be prevented. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Effects of Aging and Alterations in Dietary Sodium Intake on Total Nitric Oxide Production

PubMed Central

Schmidt, Rebecca J.; Beierwaltes, William H.; Baylis, Chris

2009-01-01

Animal studies suggest that nitric oxide (NO) deficiency is linked to salt-sensitive hypertension and that NO activity decreases during normal aging. This study investigates the impact of increasing age and manipulations in dietary salt intake on biochemical indices of the NO system in healthy humans. We measured NO2 + NO3 (NOX; stable oxidation products of NO) and cyclic guanosine monophosphate (cGMP; major second messenger) in plasma and urine of 30 healthy subjects aged 22 to 77 years. Subjects were maintained on controlled low NOX and low-, normal-, or high-salt diets for 3 days. Salt sensitivity of blood pressure was seen only in the oldest subjects. Plasma renin activity was suppressed by a high salt intake in all age groups, and baseline values declined with advancing age. Neither age nor salt intake correlated with indices of NO activity over the third 24-hour period of controlled salt intake. In a subgroup of subjects aged 33 ± 4 years challenged with ultrahigh sodium intake (400 mEq/24 h), again there was no increase in NO2 + NO3 or cGMP measures. In contrast to animal studies, there is no correlation in humans between either salt intake or age and total NO production and activity, indicated by NO2 + NO3 and cGMP measures. This does not preclude undetected alterations occurring in NO production and/or activity in strategic locations in the kidney and cardiovascular system. Limitations of blood and urine measurements of NO2 + NO3 and cGMP as indices of NO activity are discussed. PMID:11325670

Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure

PubMed Central

2011-01-01

Background High salt intake is linked to hypertension whereas a restriction of dietary salt lowers blood pressure (BP). Substituting potassium and/or magnesium salts for sodium chloride (NaCl) may enhance the feasibility of salt restriction and lower blood pressure beyond the sodium reduction alone. The aim of this study was to determine the feasibility and effect on blood pressure of replacing NaCl (Regular salt) with a novel mineral salt [50% sodium chloride and rich in potassium chloride (25%), magnesium ammonium potassium chloride, hydrate (25%)] (Smart Salt). Methods A randomized, double-blind, placebo-controlled study was conducted with an intervention period of 8-weeks in subjects (n = 45) with systolic (S)BP 130-159 mmHg and/or diastolic (D)BP 85-99 mmHg. During the intervention period, subjects consumed processed foods salted with either NaCl or Smart Salt. The primary endpoint was the change in SBP. Secondary endpoints were changes in DBP, daily urine excretion of sodium (24-h dU-Na), potassium (dU-K) and magnesium (dU-Mg). Results 24-h dU-Na decreased significantly in the Smart Salt group (-29.8 mmol; p = 0.012) and remained unchanged in the control group: resulting in a 3.3 g difference in NaCl intake between the groups. Replacement of NaCl with Smart Salt resulted in a significant reduction in SBP over 8 weeks (-7.5 mmHg; p = 0.016). SBP increased (+3.8 mmHg, p = 0.072) slightly in the Regular salt group. The difference in the change of SBP between study groups was significant (p < 0.002). Conclusions The substitution of Smart Salt for Regular salt in subjects with high normal or mildly elevated BP resulted in a significant reduction in their daily sodium intake as well as a reduction in SBP. Trial Registration ISRCTN: ISRCTN01739816 PMID:21888642

Should we eat less salt?

PubMed

Delahaye, François

2013-05-01

High blood pressure is a major cardiovascular risk factor. There is overwhelming evidence that high salt consumption is a major cause of increased blood pressure. There is also a link between high salt consumption and risk of stroke, left ventricular hypertrophy, renal disease, obesity, renal stones and stomach cancer. Reducing salt consumption leads to a decrease in blood pressure and the incidence of cardiovascular disease. There are no deleterious effects associated with reducing salt consumption and it is also very cost-effective. Many organizations and state governments have issued recommendations regarding the suitable amount of salt consumption. In France, the objective is a salt consumption<8g/day in men and<6.5g/day in women and children. As 80% of consumed salt comes from manufactured products in developed countries, reduction of salt consumption requires the participation of the food industry. The other tool is consumer information and education. Salt consumption has already decreased in France in recent years, but efforts must continue. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Salt-responsive gut commensal modulates TH17 axis and disease.

PubMed

Wilck, Nicola; Matus, Mariana G; Kearney, Sean M; Olesen, Scott W; Forslund, Kristoffer; Bartolomaeus, Hendrik; Haase, Stefanie; Mähler, Anja; Balogh, András; Markó, Lajos; Vvedenskaya, Olga; Kleiner, Friedrich H; Tsvetkov, Dmitry; Klug, Lars; Costea, Paul I; Sunagawa, Shinichi; Maier, Lisa; Rakova, Natalia; Schatz, Valentin; Neubert, Patrick; Frätzer, Christian; Krannich, Alexander; Gollasch, Maik; Grohme, Diana A; Côrte-Real, Beatriz F; Gerlach, Roman G; Basic, Marijana; Typas, Athanasios; Wu, Chuan; Titze, Jens M; Jantsch, Jonathan; Boschmann, Michael; Dechend, Ralf; Kleinewietfeld, Markus; Kempa, Stefan; Bork, Peer; Linker, Ralf A; Alm, Eric J; Müller, Dominik N

2017-11-30

A Western lifestyle with high salt consumption can lead to hypertension and cardiovascular disease. High salt may additionally drive autoimmunity by inducing T helper 17 (T H 17) cells, which can also contribute to hypertension. Induction of T H 17 cells depends on gut microbiota; however, the effect of salt on the gut microbiome is unknown. Here we show that high salt intake affects the gut microbiome in mice, particularly by depleting Lactobacillus murinus. Consequently, treatment of mice with L. murinus prevented salt-induced aggravation of actively induced experimental autoimmune encephalomyelitis and salt-sensitive hypertension by modulating T H 17 cells. In line with these findings, a moderate high-salt challenge in a pilot study in humans reduced intestinal survival of Lactobacillus spp., increased T H 17 cells and increased blood pressure. Our results connect high salt intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions.

Consumer attitudes, knowledge, and behavior related to salt consumption in sentinel countries of the Americas.

PubMed

Claro, Rafael Moreira; Linders, Hubert; Ricardo, Camila Zancheta; Legetic, Branka; Campbell, Norm R C

2012-10-01

To describe individual attitudes, knowledge, and behavior regarding salt intake, its dietary sources, and current food-labeling practices related to salt and sodium in five sentinel countries of the Americas. A convenience sample of 1 992 adults (≥ 18 years old) from Argentina, Canada, Chile, Costa Rica, and Ecuador (approximately 400 from each country) was obtained between September 2010 and February 2011. Data collection was conducted in shopping malls or major commercial areas using a questionnaire containing 33 questions. Descriptive estimates are presented for the total sample and stratified by country and sociodemographic characteristics of the studied population. Almost 90% of participants associated excess intake of salt with the occurrence of adverse health conditions, more than 60% indicated they were trying to reduce their current intake of salt, and more than 30% believed reducing dietary salt to be of high importance. Only 26% of participants claimed to know the existence of a recommended maximum value of salt or sodium intake and 47% of them stated they knew the content of salt in food items. More than 80% of participants said that they would like food labeling to indicate high, medium, and low levels of salt or sodium and would like to see a clear warning label on packages of foods high in salt. Additional effort is required to increase consumers' knowledge about the existence of a maximum limit for intake and to improve their capacity to accurately monitor and reduce their personal salt consumption.

Dietary flavonoid intake and incident coronary heart disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

PubMed

Goetz, Margarethe E; Judd, Suzanne E; Safford, Monika M; Hartman, Terryl J; McClellan, William M; Vaccarino, Viola

2016-11-01

Flavonoids are dietary polyphenolic compounds with a variety of proposed beneficial cardiovascular effects, but rigorous prospective studies that examine the association between flavonoid intake and incident coronary heart disease (CHD) in geographically and racially diverse US samples are limited. With the use of the new, expanded USDA flavonoid database, we assessed the association between total flavonoid and flavonoid subclass intakes with incident CHD in a biracial and geographically diverse cohort, as well as effect modification by age, sex, race, and region of residence. Participants were 16,678 black and white men and women enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a national prospective cohort study. All participants were without CHD at baseline, and all completed a Block98 food-frequency questionnaire. Flavonoid intakes were estimated from USDA flavonoid databases, which were recently improved to address missing values for cooked foods and to adjust for flavonoid losses due to processing. Incident CHD events were participant reported and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident CHD by using Cox proportional hazards regression to obtain HRs. Tests for trend used the quintile medians. Over a mean ± SD follow-up of 6.0 ± 1.9 y, 589 CHD events occurred. High flavonoid intake was associated with self-identified white race, exercise, not smoking, more education, and higher income. In models that adjusted for sociodemographic, health behavior, and dietary factors, there was an inverse association between anthocyanidin and proanthocyanidin intakes and incident CHD (HRs for quintile 5 compared with quintile 1-anthocyanidins: 0.71; 95% CI: 0.52, 0.98; P-trend = 0.04; proanthocyanidins: 0.63; 95% CI: 0.47, 0.84; P-trend = 0.02). There was no association between total flavonoid or other flavonoid subclass intakes and incident CHD. Reported anthocyanidin and

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India.

PubMed

Johnson, Claire; Mohan, Sailesh; Rogers, Kris; Shivashankar, Roopa; Thout, Sudhir Raj; Gupta, Priti; He, Feng J; MacGregor, Graham A; Webster, Jacqui; Krishnan, Anand; Maulik, Pallab K; Reddy, K Srinath; Prabhakaran, Dorairaj; Neal, Bruce

2017-02-16

Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals ( p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.

'Just a pinch of salt'. An experimental comparison of the effect of repeated exposure and flavor-flavor learning with salt or spice on vegetable acceptance in toddlers.

PubMed

Bouhlal, Sofia; Issanchou, Sylvie; Chabanet, Claire; Nicklaus, Sophie

2014-12-01

Children's vegetable intake is below the recommended amounts. No studies to date have tested the relevance of using salt or spices to increase children's vegetable acceptance. Our objective was to compare the effect of repeated exposure (RE) and of flavor-flavor learning (FFL) on toddlers' acceptance of a non-familiar vegetable. Two unconditioned stimuli were used: salt and a salt-associated spice. Toddlers attending six nurseries were assigned to 3 groups in a between subject design. Groups were exposed 8 times to a basic salsify puree (0.2% salt w/w; RE group; n = 47), a salty salsify puree (0.5% salt w/w; FFL-Salt group; n = 54) or a spiced salsify puree (0.2% salt and 0.02% nutmeg w/w; FFL-Nutmeg group; n = 50). Acceptance (intake and liking) of the target vegetable (basic salsify puree) and of a control vegetable (carrot puree) was evaluated at pre-exposure, at each exposure of the learning period, at post-exposure, and at 1, 3 and 6 months after exposure. In all groups, intake of the target vegetable increased from pre- to post-exposure. This increase was significantly higher in the RE group (64 ± 11 g) than in the FFL-Salt group (23 ± 11 g) and marginally higher than in the FFL-Nutmeg group (36 ± 11 g). No difference between groups was observed on the increase in liking of the target vegetable from pre- to post-exposure. The increase of the target vegetable intake was still observed after 6 months for all groups. Thus, repeated exposure appears to be the simplest choice to increase vegetable intake on the short and long term in toddlers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Relationship between Sodium Intake and Water Intake: The False and the True.

PubMed

Bankir, Lise; Perucca, Julie; Norsk, Peter; Bouby, Nadine; Damgaard, Morten

2017-01-01

Generally, eating salty food items increases thirst. Thirst is also stimulated by the experimental infusion of hypertonic saline. But, in steady state, does the kidney need a higher amount of water to excrete sodium on a high than on a low sodium intake? This issue is still controversial. The purpose of this review is to provide examples of how the kidney handles water in relation to salt intake/output. It is based on re-analysis of previously published studies in which salt intake was adjusted to several different levels in the same subjects, and in databases of epidemiologic studies in populations on an ad libitum diet. Summary and Key Messages: These re-analyses allow us to draw the following conclusions: (1) In a steady state situation, the urine volume (and thus the fluid intake) remains unchanged over a large range of sodium intakes. The adaptation to a higher sodium excretion rests only on changes in urinary sodium concentration. However, above a certain limit, this concentration cannot increase further and the urine volume may then increase. (2) In population studies, it is not legitimate to assume that sodium is responsible for changes in urine volume, since people who eat more sodium also eat more of other nutrients leading to an increase in the excretion of potassium, urea and other solutes, besides sodium. (3) After an abrupt increase in sodium intake, fluid intake is increased in the first few days, but urine volume does not change. The extra fluid drunk is responsible for an increase in body weight. © 2017 The Author(s) Published by S. Karger AG, Basel.

Stroke: roles of B vitamins, homocysteine and antioxidants.

PubMed

Sánchez-Moreno, Concepción; Jiménez-Escrig, Antonio; Martín, Antonio

2009-06-01

In the present review concerning stroke, we evaluate the roles of B vitamins, homocysteine and antioxidant vitamins. Stroke is a leading cause of death in developed countries. However, current therapeutic strategies for stroke have been largely unsuccessful. Several studies have reported important benefits on reducing the risk of stroke and improving the post-stroke-associated functional declines in patients who ate foods rich in micronutrients, including B vitamins and antioxidant vitamins E and C. Folic acid, vitamin B6 and vitamin B12 are all cofactors in homocysteine metabolism. Growing interest has been paid to hyperhomocysteinaemia as a risk factor for CVD. Hyperhomocysteinaemia has been linked to inadequate intake of vitamins, particularly to B-group vitamins and therefore may be amenable to nutritional intervention. Hence, poor dietary intake of folate, vitamin B6 and vitamin B12 are associated with increased risk of stroke. Elevated consumption of fruits and vegetables appears to protect against stroke. Antioxidant nutrients have important roles in cell function and have been implicated in processes associated with ageing, including vascular, inflammatory and neurological damage. Plasma vitamin E and C concentrations may serve as a biological marker of lifestyle or other factors associated with reduced stroke risk and may be useful in identifying those at high risk of stroke. After reviewing the observational and intervention studies, there is an incomplete understanding of mechanisms and some conflicting findings; therefore the available evidence is insufficient to recommend the routine use of B vitamins, vitamin E and vitamin C for the prevention of stroke. A better understanding of mechanisms, along with well-designed controlled clinical trials will allow further progress in this area.

Study of the propensity for hemorrhage in Hispanic Americans with stroke.

PubMed

Frey, James L; Jahnke, Heidi K; Goslar, Pamela W

2008-01-01

Multiple sources document a higher proportion of intraparenchymal hemorrhage (HEM) in Hispanic (HIS) than white (WHI) patients with stroke. We sought an explanation for this phenomenon through analysis of multiple variables in our hospital-based stroke population. We performed univariate and multivariate analysis of risk factors in our HIS and WHI patients with stroke to identify differences that might account for a greater propensity for HEM in HIS patients. Multivariate analysis disclosed that the risk of HEM correlated significantly with untreated hypertension (HTN), HIS ethnicity, and heavy alcohol intake. A negative correlation was found for hyperlipidemia and diabetes. Our HIS patients with stroke had a greater prevalence of untreated HTN and heavy alcohol intake, with HIS men being at greatest risk. HIS patients with stroke in our hospital-based population appear relatively more prone to HEM than do WHI patients. This risk correlates with a greater likelihood of having untreated HTN and heavy alcohol intake, more so for HIS men. The explanation appears to be a relative lack of health awareness and involvement in our health care system. The possibility that HIS ethnicity itself constitutes a biological risk factor for HEM remains a matter of speculation. Validation of this work with community data should lead to remediation through a community-based effort.

Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK

PubMed Central

Hashem, Kawther M; He, Feng J; Jenner, Katharine H; MacGregor, Graham A

2014-01-01

Objective To investigate the salt (sodium chloride) content in cheese sold in UK supermarkets. Study design We carried out a cross-sectional survey in 2012, including 612 cheeses available in UK supermarkets. Methods The salt content (g/100 g) was collected from product packaging and nutrient information panels of cheeses available in the top seven retailers. Results Salt content in cheese was high with a mean (±SD) of 1.7±0.58 g/100 g. There was a large variation in salt content between different types of cheeses and within the same type of cheese. On average, halloumi (2.71±0.34 g/100 g) and imported blue cheese (2.71±0.83 g/100 g) contained the highest amounts of salt and cottage cheese (0.55±0.14 g/100 g) contained the lowest amount of salt. Overall, among the 394 cheeses that had salt reduction targets, 84.5% have already met their respective Department of Health 2012 salt targets. Cheddar and cheddar-style cheese is the most popular/biggest selling cheese in the UK and has the highest number of products in the analysis (N=250). On average, salt level was higher in branded compared with supermarket own brand cheddar and cheddar-style products (1.78±0.13 vs 1.72±0.14 g/100 g, p<0.01). Ninety per cent of supermarket own brand products met the 2012 target for cheddar and cheddar-style cheese compared with 73% of branded products (p=0.001). Conclusions Salt content in cheese in the UK is high. There is a wide variation in the salt content of different types of cheeses and even within the same type of cheese. Despite this, 84.5% of cheeses have already met their respective 2012 targets. These findings demonstrate that much larger reductions in the amount of salt added to cheese could be made and more challenging targets need to be set, so that the UK can continue to lead the world in salt reduction. PMID:25099933

Cross-sectional survey of salt content in cheese: a major contributor to salt intake in the UK.

PubMed

Hashem, Kawther M; He, Feng J; Jenner, Katharine H; MacGregor, Graham A

2014-07-18

To investigate the salt (sodium chloride) content in cheese sold in UK supermarkets. We carried out a cross-sectional survey in 2012, including 612 cheeses available in UK supermarkets. The salt content (g/100 g) was collected from product packaging and nutrient information panels of cheeses available in the top seven retailers. Salt content in cheese was high with a mean (±SD) of 1.7±0.58 g/100 g. There was a large variation in salt content between different types of cheeses and within the same type of cheese. On average, halloumi (2.71±0.34 g/100 g) and imported blue cheese (2.71±0.83 g/100 g) contained the highest amounts of salt and cottage cheese (0.55±0.14 g/100 g) contained the lowest amount of salt. Overall, among the 394 cheeses that had salt reduction targets, 84.5% have already met their respective Department of Health 2012 salt targets. Cheddar and cheddar-style cheese is the most popular/biggest selling cheese in the UK and has the highest number of products in the analysis (N=250). On average, salt level was higher in branded compared with supermarket own brand cheddar and cheddar-style products (1.78±0.13 vs 1.72±0.14 g/100 g, p<0.01). Ninety per cent of supermarket own brand products met the 2012 target for cheddar and cheddar-style cheese compared with 73% of branded products (p=0.001). Salt content in cheese in the UK is high. There is a wide variation in the salt content of different types of cheeses and even within the same type of cheese. Despite this, 84.5% of cheeses have already met their respective 2012 targets. These findings demonstrate that much larger reductions in the amount of salt added to cheese could be made and more challenging targets need to be set, so that the UK can continue to lead the world in salt reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Active kallikrein response to changes in sodium-chloride intake in essential hypertensive patients.

PubMed

Ferri, C; Bellini, C; Carlomagno, A; Desideri, G; Santucci, A

1996-03-01

To evaluate the behavior of active kallikrein excretion in salt-sensitive and salt-resistant hypertensive patients during changes in sodium-chloride (NaCl) intake, 61 male, nonobese, nondiabetic outpatients affected by uncomplicated essential hypertension were given a diet that contained 140 mmol NaCl per day for 2 wk. Patients then received either a low- (20 mmol NaCl/day) or a high- (320 mmol NaCl/day) sodium diet for 2 wk, according to a randomized, double-blind, cross-over protocol. Hypertensive patients were classified as salt sensitive when their diastolic blood pressure rose by at least 10 mm Hg after the high-sodium diet, and decreased by at least 10 mm Hg after the low-sodium diet, considering as baseline blood pressure values those that were taken at the end of the 140 mmol NaCl/day intake period. The remaining patients were classified as salt resistant or, when diastolic blood pressure increased by 10 mm Hg or more after low-sodium intake, as counter-regulating. Twenty-three patients were therefore classified as salt sensitive, 28 as salt resistant, and 10 as counter-regulating. The baseline active kallikrein excretion was significantly lower (P < 0.0001) in salt-sensitive (0.62 +/- 0.31 U/24 h) patients than in salt-resistant (1.39 +/- 0.44 U/24 h) and counter-regulating patients (1.27 +/- 0.38 U/24 h). Surprisingly, the kallikrein response to changes in sodium intake was similar in all subgroups, although enzyme excretion was always at the lowest level in salt-sensitive hypertensive patients. This latter group also showed the highest plasma atrial natriuretic peptide levels (28.2 +/- 8.5 fmol/mL, P < 0.0001 versus salt-resistant and counter-regulating patients), and the greatest peptide increment with sodium load (P < 0.0001 versus salt-resistant and counter-regulating patients). Counter-regulating patients showed the steepest increase in plasma renin activity (from 0.24 +/- 0.18 to 0.83 +/- 0.21 ng/L per s, P < 0.001) and decrease of plasma atrial

A High Salt Diet Inhibits Obesity and Delays Puberty in the Female Rat

PubMed Central

Pitynski-Miller, Dori; Ross, Micah; Schmill, Margaret; Schambow, Rachel; Fuller, Teresa; Flynn, Francis W.; Skinner, Donal C.

2017-01-01

Background/Objectives Processed foods are considered major contributors to the worldwide obesity epidemic. In addition to high sugar and fat contents, processed foods contain large amounts of salt. Due to correlations with rising adiposity, salt has recently been proposed to be obesogenic. This study investigated three hypotheses: i) high salt contributes to weight gain and adiposity in juvenile female rats, ii) puberty onset would be altered because salt is known to affect neuronal systems involved in activating the reproductive system, and iii) enhanced adiposity will act synergistically with salt to drive early puberty onset. Design Female weanling rats (post-natal day 21, n=105) were fed a low fat/low salt diet, low fat/high salt diet, high fat/low salt diet, or a high salt/high fat diet for 24 days. Metabolic measures, including weight gain, food intake, fecal output, activity, and temperature were recorded in subsets of animals. Results Body weight, retroperitoneal and perirenal fat pad weight, and adipocyte size were all lower in animals fed high fat/high salt compared to animals fed high fat alone. Leptin levels were reduced in high fat/high salt fed animals compared to high fat/low salt fed animals. Daily calorie intake was higher initially but declined with adjusted food intake and was not different among groups after 5 days. Osmolality and corticosterone were not different among groups. Fecal analysis showed excess fat excretion and a decreased digestive efficiency in animals fed high fat/low salt but not in animals fed high fat/high salt. Although respiratory exchange ratio was reduced by high dietary fat or salt, aerobic resting metabolic rate was not affected by diet. High salt delayed puberty onset, regardless of dietary fat content. Conclusions Salt delays puberty and prevents the obesogenic effect of a high fat diet. The reduced weight gain evident in high salt fed animals is not due to differences in food intake or digestive efficiency. PMID

Salt reduction in Australia: from advocacy to action

PubMed Central

Trieu, Kathy; Dunford, Elizabeth; Nowson, Caryl; Jolly, Kellie-Ann; Greenland, Rohan; Reimers, Jenny; Bolam, Bruce

2015-01-01

Background As part of its endorsement of the World Health Organization’s Global Action Plan to prevent non-communicable diseases, the Federal Government of Australia has committed to a 30% reduction in average population salt intake by 2025. Currently, mean daily salt intake levels are 8-9 g, varying by sex, region and population group. A number of salt reduction initiatives have been established over the last decade, but key elements for a co-ordinated population-level strategy are still missing. The objective of this review is to provide a comprehensive overview of existing population-level salt reduction activities in Australia and identify opportunities for further action. Methods A review of the published literature and stakeholder activities was undertaken to identify and document current activities. The activities were then assessed against a pre-defined framework for salt reduction strategies. Results A range of initiatives were identified from the review. The Australian Division of World Action on Salt and Health (AWASH) was established in 2005 and in 2007 launched its Drop the Salt! Campaign. This united non-governmental organisations (NGOs), health and medical and food industry organisations in a co-ordinated advocacy effort to encourage government to develop a national strategy to reduce salt. Subsequently, in 2010 the Federal Government launched its Food and Health Dialogue (FHD) with a remit to improve the health of the food supply in Australia through voluntary partnerships with food industry, government and non-government public health organisations. The focus of the FHD to date has been on voluntary reformulation of foods, primarily through salt reduction targets. More recently, in December 2014, the government’s Health Star Rating system was launched. This front of pack labelling scheme uses stars to highlight the nutritional profile of packaged foods. Both government initiatives have clear targets or criteria for industry to meet, however

Role of Vasopressin in Rat Models of Salt-Dependent Hypertension.

PubMed

Prager-Khoutorsky, Masha; Choe, Katrina Y; Levi, David I; Bourque, Charles W

2017-05-01

Dietary salt intake increases both plasma sodium and osmolality and therefore increases vasopressin (VP) release from the neurohypophysis. Although this effect could increase blood pressure by inducing fluid reabsorption and vasoconstriction, acute activation of arterial baroreceptors inhibits VP neurons via GABA A receptors to oppose high blood pressure. Here we review recent findings demonstrating that this protective mechanism fails during chronic high salt intake in rats. Two recent studies showed that chronic high sodium intake causes an increase in intracellular chloride concentration in VP neurons. This effect causes GABA A receptors to become excitatory and leads to the emergence of VP-dependent hypertension. One study showed that the increase in intracellular chloride was provoked by a decrease in the expression of the chloride exporter KCC2 mediated by local secretion of brain-derived neurotrophic factor and activation of TrkB receptors. Prolonged high dietary salt intake can cause pathological plasticity in a central homeostatic circuit that controls VP secretion and thereby contribute to peripheral vasoconstriction and hypertension.

Salt Sensitivity and Hypertension: A Paradigm Shift from Kidney Malfunction to Vascular Endothelial Dysfunction

PubMed Central

Choi, Hoon Young; Park, Hyeong Cheon

2015-01-01

Hypertension is a complex trait determined by both genetic and environmental factors and is a major public health problem due to its high prevalence and concomitant increase in the risk for cardiovascular disease. With the recent large increase of dietary salt intake in most developed countries, the prevalence of hypertension increases tremendously which is about 30% of the world population. There is substantial evidence that suggests some people can effectively excrete high dietary salt intake without an increase in arterial BP, and another people cannot excrete effectively without an increase in arterial BP. Salt sensitivity of BP refers to the BP responses for changes in dietary salt intake to produce meaningful BP increases or decreases. The underlying mechanisms that promote salt sensitivity are complex and range from genetic to environmental influences. The phenotype of salt sensitivity is therefore heterogeneous with multiple mechanisms that potentially link high salt intake to increases in blood pressure. Moreover, excess salt intake has functional and pathological effects on the vasculature that are independent of blood pressure. Epidemiologic data demonstrate the role of high dietary salt intake in mediating cardiovascular and renal morbidity and mortality. Almost five decades ago, Guyton and Coleman proposed that whenever arterial pressure is elevated, pressure natriuresis enhances the excretion of sodium and water until blood volume is reduced sufficiently to return arterial pressure to control values. According to this hypothesis, hypertension can develop only when something impairs the excretory ability of sodium in the kidney. However, recent studies suggest that nonosmotic salt accumulation in the skin interstitium and the endothelial dysfunction which might be caused by the deterioration of vascular endothelial glycocalyx layer (EGL) and the epithelial sodium channel on the endothelial luminal surface (EnNaC) also play an important role in

Dietary flavonoid intake and incident coronary heart disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study12

PubMed Central

Goetz, Margarethe E; Judd, Suzanne E; Safford, Monika M; Hartman, Terryl J; McClellan, William M; Vaccarino, Viola

2016-01-01

Background: Flavonoids are dietary polyphenolic compounds with a variety of proposed beneficial cardiovascular effects, but rigorous prospective studies that examine the association between flavonoid intake and incident coronary heart disease (CHD) in geographically and racially diverse US samples are limited. Objective: With the use of the new, expanded USDA flavonoid database, we assessed the association between total flavonoid and flavonoid subclass intakes with incident CHD in a biracial and geographically diverse cohort, as well as effect modification by age, sex, race, and region of residence. Design: Participants were 16,678 black and white men and women enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a national prospective cohort study. All participants were without CHD at baseline, and all completed a Block98 food-frequency questionnaire. Flavonoid intakes were estimated from USDA flavonoid databases, which were recently improved to address missing values for cooked foods and to adjust for flavonoid losses due to processing. Incident CHD events were participant reported and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident CHD by using Cox proportional hazards regression to obtain HRs. Tests for trend used the quintile medians. Results: Over a mean ± SD follow-up of 6.0 ± 1.9 y, 589 CHD events occurred. High flavonoid intake was associated with self-identified white race, exercise, not smoking, more education, and higher income. In models that adjusted for sociodemographic, health behavior, and dietary factors, there was an inverse association between anthocyanidin and proanthocyanidin intakes and incident CHD (HRs for quintile 5 compared with quintile 1—anthocyanidins: 0.71; 95% CI: 0.52, 0.98; P-trend = 0.04; proanthocyanidins: 0.63; 95% CI: 0.47, 0.84; P-trend = 0.02). There was no association between total flavonoid or other flavonoid subclass intakes and incident

The Importance of Assessing Nutritional Status to Ensure Optimal Recovery during the Chronic Phase of Stroke.

PubMed

Serra, Monica C

2018-01-01

Despite evidence that many of the consequences of stroke that hinder recovery (i.e., obesity, muscle atrophy, and functional declines) have nutritionally modifiable behavior components, little attention has been focused on the significance of nutrition beyond the acute phase of stroke. This literature review summarizes the evidence for and against the influence of nutrition on optimal recovery and rehabilitation in chronic (>6 months) stroke. The literature, which is mainly limited to cross-sectional studies, suggests that a suboptimal nutritional status, including an excess caloric intake, reduced protein intake, and micronutrient deficiencies, particularly the B-vitamins, vitamin D, and omega 3 fatty acids, may have deleterious effects on metabolic, physical, and psychological functioning in chronic stroke survivors. Careful evaluation of dietary intake, especially among those with eating disabilities and preexisting malnutrition, may aid in the identification of individuals at increased nutritional risk through which early intervention may benefit recovery and rehabilitation and prevent further complications after stroke.

Risks for Heart Disease & Stroke

MedlinePlus

... Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your Risk Factors YouTube embed video: YouTube ... https://www.youtube-nocookie.com/embed/GQ0f7-ksmGI Video: José’s Story YouTube embed video: YouTube embed video: ...

Relationship Between Dietary Vitamin D and Deaths From Stroke and Coronary Heart Disease: The Japan Collaborative Cohort Study.

PubMed

Sheerah, Haytham A; Eshak, Ehab S; Cui, Renzhe; Imano, Hironori; Iso, Hiroyasu; Tamakoshi, Akiko

2018-02-01

There is growing evidence about the importance of vitamin D for cardiovascular health. Therefore, we examined the relationship between dietary vitamin D intake and risk of mortality from stroke and coronary heart disease in Japanese population. A prospective study encompassing 58 646 healthy Japanese adults (23 099 men and 35  547 women) aged of 40 to 79 years in whom dietary vitamin D intake was determined via a self-administered food frequency questionnaire. The median follow-up period was 19.3 years (1989-2009). The hazard ratios and 95% confidence intervals of mortality were calculated using categories of vitamin D intake. During 965 970 person-years of follow-up, 1514 stroke and 702 coronary heart disease deaths were documented. Vitamin D intake was inversely associated with risk of mortality from total stroke especially intraparenchymal hemorrhage but not from coronary heart disease; the multivariable hazard ratios (95% confidence intervals) for the highest (≥440 IU/d) versus lowest (<110 IU/D) categories of vitamin D intake were 0.70 (0.54-0.91; P for trend=0.04) for total stroke and 0.66 (0.46-0.96; P for trend=0.04) for intraparenchymal hemorrhage. Dietary vitamin D intake seems to be inversely associated with mortality from stroke. © 2018 American Heart Association, Inc.

Assessment of salt concentration in bread commonly consumed in the Eastern Mediterranean Region.

PubMed

Al Jawaldeh, Ayoub; Al-Khamaiseh, Manal

2018-04-05

Hypertension is the most important cardiovascular risk factor in the World Health Organization (WHO) Eastern Mediterranean Region. Excessive salt and sodium intake is directly related to hypertension, and its reduction is a priority of WHO. Bread is the leading staple food in the Region; therefore, reducing the amount of salt added to bread could be an effective measure for reducing salt intake. The study sought to determine the levels of sodium and salt in locally produced staple bread from 8 countries in the Region. Bread samples were collected randomly from bakeries located in the capital cities of the selected countries. The samples were analysed for sodium content using atomic absorption spectroscopy. The mean salt content of breads varied from 4.28 g/kg in Jordan to 12.41 g/kg in Tunisia. The mean salt and sodium content in bread for all countries was 7.63 (SD 3.12) and 3.0 (SD 1.23) g/kg, respectively. The contribution of bread to daily salt intake varied considerably between countries, ranging from 1.3 g (12.5%) in Jordan to 3.7 g (33.5%) in Tunisia. Interventions to reduce population salt intake should target reduction of salt in bread in all countries. The amount of salt added to bread should be standardized and relevant legislation developed to guide bakers. Setting an upper limit for salt content in flat bread (pita or Arabic bread) at 0.5% is strongly recommended. However, salt levels at ≤ 1% would be appropriate for other kind of breads. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Dietary sodium, sodium-to-potassium ratio, and risk of stroke: A systematic review and nonlinear dose-response meta-analysis.

PubMed

Jayedi, Ahmad; Ghomashi, Farnoosh; Zargar, Mahdieh Sadat; Shab-Bidar, Sakineh

2018-06-01

The association of high sodium intake with risk of stroke has been accepted. But considering the proposed J/U-shaped association between sodium intake and risk of all-cause mortality, the shape of the dose-response relationship has not been determined yet. This study aimed to test the dose-response association of dietary sodium and sodium-to-potassium ratio with risk of stroke in adults aged 18 years or older. We performed a systematic search using PubMed and Scopus, from database inception up to October 2017. Prospective and retrospective observational studies reporting risk estimates of stroke for three or more quantitative categories of dietary sodium or sodium-to-potassium ratio were included. Studies that reported results as continuous were also included. Two independent authors extracted the information and assessed the quality of included studies. Pooled relative risk (RR) was calculated using a random-effects model. Publication bias was tested. Sensitivity and subgroup analyses were done. Of initial 20,412 studies identified, 14 prospective cohort studies, one case-cohort study, and one case-control study (total n = 261,732) with 10,150 cases of stroke were included. The Pooled RRs of stroke were 1.06 (95%CI: 1.02, 1.10; I 2  = 60%, n = 14 studies) for a 1 gr/d increment in dietary sodium intake, and 1.22 (95%CI: 1.04, 1.41; I 2  = 60%, n = 5 studies) for a one-unit increment in dietary sodium-to-potassium ratio (mmol/mmol). The risk of stroke increased linearly with increasing dietary sodium intake, and also along with the increase in dietary sodium-to-potassium ratio. No evidence of a J/U-shaped association was found in the analyses of total stroke, stroke incidence, and stroke mortality. High sodium intake was associated with a somewhat worse prognosis among Asian countries as compared to westerns. Higher sodium intake and higher dietary sodium-to-potassium ratio were associated with a higher risk of stroke. Reducing dietary sodium

Determinants of handicap after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS).

PubMed

Sturm, Jonathan W; Donnan, Geoffrey A; Dewey, Helen M; Macdonell, Richard A L; Gilligan, Amanda K; Thrift, Amanda G

2004-03-01

Handicap, although more relevant to the patient than impairment or disability, has received little attention in people with stroke. The aim of this study was to identify, in an unselected population, factors determining handicap at 2 years after stroke. All first-ever cases of stroke in a population of 306 631 over a 1-year period were assessed. Stroke severity, comorbidity, and demographic information was recorded. Among survivors, 2-year poststroke handicap was assessed with the London Handicap Scale. Disability, physical impairment, depression, anxiety, living arrangements, and recurrent stroke at 2 years were documented. If necessary, proxy assessments were obtained, except for mood. Linear regression analyses were performed to identify factors independently associated with handicap. First, all assessments (proxy and nonproxy) were examined; then, the nonproxy assessments were used to examine the effects of mood. Of 266 patients with incident stroke who were alive at 2 years, 226 (85%) were assessed. Significant determinants of handicap on univariable analysis were age, female sex, socioeconomic status, alcohol intake, stroke subtype, initial stroke severity; 2-year physical impairment, disability, depression and anxiety scores; institutionalization; and recurrent stroke. On multivariable analysis, the independent determinants of handicap were age and 2-year physical impairment and disability. In analysis restricted to nonproxy data, depression and anxiety were also independently associated with handicap. Age, concurrent disability, and physical impairment were more important determinants of handicap than other demographic factors or initial stroke severity. Because depression and anxiety were independently associated with handicap, their treatment may potentially reduce handicap in stroke patients.

Liking, salt taste perception and use of table salt when consuming reduced-salt chicken stews in light of South Africa's new salt regulations.

PubMed

De Kock, H L; Zandstra, E H; Sayed, N; Wentzel-Viljoen, E

2016-01-01

This study investigated the impact of salt reduction on liking, salt taste perception, and use of table salt when consuming chicken stew in light of South Africa's new salt recommendations. In total, 432 South-African consumers (aged 35.2 ± 12.3 years) consumed a full portion of a chicken stew meal once at a central location. Four stock cube powders varying in salt content were used to prepare chicken stews: 1) no reduction - 2013 Na level; regular salt level as currently available on the South African market (24473 mg Na/100 g), 2) salt reduction smaller than 2016 level, i.e. 10%-reduced (22025 mg Na/100 g), 3) 2016 salt level, as per regulatory prescriptions (18000 mg Na/100 g), 4) 2019 salt level, as per regulatory prescriptions (13000 mg Na/100 g). Consumers were randomly allocated to consume one of the four meals. Liking, salt taste perception, and use of table salt and pepper were measured. Chicken stews prepared with reduced-salt stock powders were equally well-liked as chicken stews with the current salt level. Moreover, a gradual reduction of the salt in the chicken stews resulted in a reduced salt intake, up to an average of 19% for the total group compared to the benchmark 2013 Na level stew. However, 19% of consumers compensated by adding salt back to full compensation in some cases. More salt was added with increased reductions of salt in the meals, even to the point of full compensation. Further investigation into the impacts of nutrition communication and education about salt reduction on salt taste perception and use is needed. This research provides new consumer insights on salt use and emphasises the need for consumer-focused behaviour change approaches, in addition to reformulation of products. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sodium intake among U.S. school-aged children - United States, 2009-2010

USDA-ARS?s Scientific Manuscript database

A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts. Average sodium intake, sodium consumed p...

Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort Study for Evaluation of Cancer Risks.

PubMed

Umesawa, Mitsumasa; Iso, Hiroyasu; Date, Chigusa; Yamamoto, Akio; Toyoshima, Hideaki; Watanabe, Yoshiyuki; Kikuchi, Shogo; Koizumi, Akio; Kondo, Takaaki; Inaba, Yutaka; Tanabe, Naohito; Tamakoshi, Akiko

2008-07-01

Limited evidence is available about the relations between sodium and potassium intakes and cardiovascular disease in the general population. The objective was to investigate relations between sodium and potassium intakes and cardiovascular disease in Asian populations whose mean sodium intake is generally high. Between 1988 and 1990, a total of 58,730 Japanese subjects (n = 23,119 men and 35,611 women) aged 40-79 y with no history of stroke, coronary heart disease, or cancer completed a lifestyle questionnaire including food intake frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk sponsored by the Ministry of Education, Sports and Science. After 745,161 person-years of follow-up, we documented 986 deaths from stroke (153 subarachnoid hemorrhages, 227 intraparenchymal hemorrhages, and 510 ischemic strokes) and 424 deaths from coronary heart disease. Sodium intake was positively associated with mortality from total stroke, ischemic stroke, and total cardiovascular disease. The multivariable hazard ratio for the highest versus the lowest quintiles of sodium intake after adjustment for age, sex, and cardiovascular disease risk factors was 1.55 (95% CI: 1.21, 2.00; P for trend < 0.001) for total stroke, 2.04 (95% CI: 1.41, 2.94; P for trend < 0.001) for ischemic stroke, and 1.42 (95% CI: 1.20, 1.69; P for trend < 0.001) for total cardiovascular disease. Potassium intake was inversely associated with mortality from coronary heart disease and total cardiovascular disease. The multivariable hazard ratio for the highest versus the lowest quintiles of potassium intake was 0.65 (95% CI: 0.39, 1.06; P for trend = 0.083) for coronary heart disease and 0.73 (95% CI: 0.59, 0.92; P for trend = 0.018) for total cardiovascular disease, and these associations were more evident for women than for men. A high sodium intake and a low potassium intake may increase the risk of mortality from cardiovascular disease.

Sugar- and artificially-sweetened beverages and the risks of incident stroke and dementia: A prospective cohort study

PubMed Central

Pase, Matthew P.; Himali, Jayandra J.; Beiser, Alexa S.; Aparicio, Hugo J.; Satizabal, Claudia L.; Vasan, Ramachandran S.; Seshadri, Sudha; Jacques, Paul F.

2017-01-01

Background and purpose Sugar- and artificially-sweetened beverage intake have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia. We examined whether sugar- or artificially-sweetened beverage consumption were associated with the prospective risks of incident stroke or dementia in the community-based Framingham Heart Study Offspring cohort. Methods We studied 2888 participants aged over 45 for incident stroke (mean age 62 [SD, 9] years; 45% men) and 1484 participants aged over 60 for incident dementia (mean age 69 [SD, 6] years; 46% men). Beverage intake was quantified using a food frequency questionnaire at cohort examinations 5 (1991–1995), 6 (1995–1998) and 7 (1998–2001). We quantified recent consumption at examination 7 and cumulative consumption by averaging across examinations. Surveillance for incident events commenced at examination 7 and continued for 10-years. We observed 97 cases of incident stroke (82 ischemic) and 81 cases of incident dementia (63 consistent with Alzheimer’s disease [AD]). Results After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity and smoking, higher recent and higher cumulative intake of artificially-sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and AD dementia. When comparing daily cumulative intake to <1 per week (reference), the hazard ratios were 2.96 (95% CI, 1.26–6.97) for ischemic stroke and 2.89 (95% CI, 1.18–7.07) for AD. Sugar-sweetened beverages were not associated with stroke or dementia. Conclusions Artificially-sweetened soft drink consumption was associated with a higher risk of stroke and dementia. PMID:28428346

The coffee paradox in stroke: Increased consumption linked with fewer strokes.

PubMed

Liebeskind, David S; Sanossian, Nerses; Fu, Katherine A; Wang, He-Jing; Arab, Lenore

2016-11-01

To determine the association in amount of daily coffee consumption with incidence of stroke in a broad cohort, considering other vascular risk factors. We utilized the Third National Health and Nutrition Examination Survey (1988-1994; NHANES III) data on participants aged ≥17 years old to examine coffee consumption and stroke. Multivariate logistic regression models related the amount of coffee use reported in a food frequency questionnaire with stroke, controlling for other vascular risk factors. Of 33 994 NHANES III subjects, coffee consumption and stroke data in adults ≥17 years old were available in 19 994. Daily coffee consumption ranged from 0 to 20 (median 1) cups and 644 (3.2%) participants had a stroke diagnosed by a physician. Coffee intake varied with age, gender, and ethnicity (P < 0.001). Interestingly, heart failure, diabetes, and hypertension were less frequent, and high cholesterol more frequent in those consuming ≥3 cups per day (P < 0.001). Smoking was more frequent in all coffee drinkers (P < 0.0001). Multivariate analyses revealed an independent effect of heavier coffee consumption (≥3 cups/day) on reduced stroke (OR 0.44, 95% CI 0.22-0.87, P < 0.02) in healthy subjects that was attenuated by vascular risk factors (OR 0.78, 95% CI 0.58-1.07, P ≈ 0.12). Heavier daily coffee consumption is associated with decreased stroke prevalence, despite smoking tendency in heavy coffee drinkers.

Combined Electrical Stimulation and Exercise for Swallow Rehabilitation Post-Stroke: A Pilot Randomized Control Trial

ERIC Educational Resources Information Center

Sproson, Lise; Pownall, Sue; Enderby, Pam; Freeman, Jenny

2018-01-01

Background: Dysphagia is common after stroke, affecting up to 50% of patients initially. It can lead to post-stroke pneumonia, which causes 30% of stroke-related deaths, a longer hospital stay and poorer health outcomes. Dysphagia care post-stroke generally focuses on the management of symptoms, via modified oral intake textures and adapted…

Novel Mechanism for Buffering Dietary Salt in Humans

PubMed Central

Mäki-Petäjä, Kaisa M.; Pedro, Liliana; Bruggraber, Sylvaine F.A.; Burling, Keith; Goodhart, Anna K.; Brown, Morris J.; McEniery, Carmel M.; Wilkinson, Ian B.

2017-01-01

High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na+ accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na+ and K+ concentrations were measured in mg/g of wet tissue and expressed as the ratio Na+:K+ to correct for variability in sample hydration. Skin Na+:K+ increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P=0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na+:K+ in men (2.59±0.09 versus 2.88±0.12; P=0.008) but not women (3.23±0.10 versus 3.36±0.12; P=0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P<0.001) while men did not (96±2 versus 96±2 mm Hg; P=0.91). Skin Na+:K+ correlated with BP, stroke volume, and peripheral vascular resistance in men but not in women. No change was noted in plasma VEGF-C. These findings suggest that the skin may buffer dietary Na+, reducing the hemodynamic consequences of increased salt, and this may be influenced by sex. PMID:28974570

Determination of salt content in hot takeaway meals in the United Kingdom.

PubMed

Jaworowska, Agnieszka; Blackham, Toni; Stevenson, Leonard; Davies, Ian G

2012-10-01

High sodium intake is associated with negative health outcomes, including an independent correlation with high blood pressure which increases the risk of cardiovascular disease. A high proportion of sodium intake in the UK is from processed and out of the home food; this includes takeaway food which is increasing in popularity. The aim of the present study was to evaluate salt levels in popular hot takeaway meals. A total of 411 samples of 23 different types of takeaway meals were analysed. Obtained results show the salt content in these kinds of foods is alarmingly high. Comparing medians (interquartile range) for different meal categories, Pizzas contained the highest salt content per portion (9.45 g (6.97-12.83)), followed by Chinese meals (8.07 g (5.47-10.99 g)), Kebabs (6.21 g (4.01-8.35)) and Indian meals (4.73 g (3.61-6.10)). In addition, significant differences in the salt content between meals within the same category were reported. To enable the consumer to meet the UK's target salt intake, a significant reduction in the salt content of hot takeaway meals should be considered. Copyright © 2012 Elsevier Ltd. All rights reserved.

Contemporary thinking in stroke prevention and management.

PubMed

Bryan, Jenny

Stroke is the third largest cause of death in the UK, after heart disease and cancer, and the largest single cause of severe adult disability (Stroke Association, 2003). Specialist and consultant stroke nurses are playing a growing role in rapid assessment clinics and acute care, as well as in coordinating rehabilitation and other follow-up services, including secondary prevention clinics. Health promotion to reduce the risk of stroke is also an important consideration and an area where nurses can play a leading role. Risk prevention measures and behaviours include physical activity, and cutting down on smoking and alcohol intake. A healthy diet is also a major factor in reducing stroke risk. This year Stoke Awareness Week, which starts on 29 September, is focusing on the importance of eating a colourful variety of fruit and vegetables, with the message: 'Eat a rainbow. Beat a stroke'.

Knowledge and Attitudes Are Related to Selected Salt-Specific Behaviours among Australian Parents.

PubMed

Khokhar, Durreajam; Nowson, Caryl Anne; Margerison, Claire; Bolam, Bruce; Grimes, Carley Ann

2018-06-04

Salt intake in adults and children exceeds recommended levels. Salt-related knowledge, attitudes, and behaviours (KABs) may influence the amount of salt consumed. The aims of this study were to assess salt-related KABs among parents, and investigate whether salt-related knowledge and attitudes are associated with salt-specific behaviours. Parents with children.

Intake of low sodium salt substitute for 3years attenuates the increase in blood pressure in a rural population of North China - A randomized controlled trial.

PubMed

Zhou, Bo; Webster, Jacqui; Fu, Ling-Yu; Wang, Hai-Long; Wu, Xiao-Mei; Wang, Wen-Li; Shi, Jing-Pu

2016-07-15

Lowering salt intake is one of the successful and cost-effective methods to reduce blood pressure (BP). In this randomized controlled study, we investigated the effects of a 3-year substitution of table salt with a low-sodium salt substitute in a rural population of North China. Subjects from 200 families residing in five villages in Liaoning, North China were registered in this study and randomly divided into two groups: normal salt (100% sodium chloride) and low salt substitute (65% NaCl, 25% KCl, 10% MgSO4). We compared the effects of the low-sodium salt substitute and normal salt on differences in BP from baseline to various follow-up time points during this 3-year study period. We also examined several factors that may affect the long-term changes in BP. Hypertension was defined per World Health Organization guidelines as BP≥140/90mmHg. The low sodium substitute significantly reduced the increase in both systolic and diastolic BP compared with the regular salt (P=0.000). Also, the population aged 40-70years showed most beneficial response to the salt substitute compared with those aged <40 or >70years. The low salt substitute had similar beneficial effects in both males and females. In addition, the salt type consumed and body mass index significantly affected the change in BP. Use of the salt substitute significantly reduces the increase in BP over a long term, and thus, the salt substitute can be used as a replacement for regular salt in the daily diet to prevent/diminish the incidence of hypertension. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Oxytocin-receptor-expressing neurons in the parabrachial nucleus regulate fluid intake.

PubMed

Ryan, Philip J; Ross, Silvano I; Campos, Carlos A; Derkach, Victor A; Palmiter, Richard D

2017-12-01

Brain regions that regulate fluid satiation are not well characterized, yet are essential for understanding fluid homeostasis. We found that oxytocin-receptor-expressing neurons in the parabrachial nucleus of mice (Oxtr PBN neurons) are key regulators of fluid satiation. Chemogenetic activation of Oxtr PBN neurons robustly suppressed noncaloric fluid intake, but did not decrease food intake after fasting or salt intake following salt depletion; inactivation increased saline intake after dehydration and hypertonic saline injection. Under physiological conditions, Oxtr PBN neurons were activated by fluid satiation and hypertonic saline injection. Oxtr PBN neurons were directly innervated by oxytocin neurons in the paraventricular hypothalamus (Oxt PVH  neurons), which mildly attenuated fluid intake. Activation of neurons in the nucleus of the solitary tract substantially suppressed fluid intake and activated Oxtr PBN neurons. Our results suggest that Oxtr PBN neurons act as a key node in the fluid satiation neurocircuitry, which acts to decrease water and/or saline intake to prevent or attenuate hypervolemia and hypernatremia.

Preference and intake frequency of high sodium foods and dishes and their correlations with anthropometric measurements among Malaysian subjects

PubMed Central

Choong, Stella Sinn-Yee; Balan, Sumitha Nair; Chua, Leong-Siong

2012-01-01

This study investigated the preference and intake frequency of a list of 15 commonly available high sodium Malaysian foods/dishes, discretionary salt use, and their possible association with demographics, blood pressures and anthropometric measurements among 300 Malaysian university students (114 males, 186 females; 259 ethnic Chinese, 41 Indians; 220 lean, 80 overweight). French fries and instant soup noodle were found to be the most preferred and most frequently consumed salty food, respectively, while salted fish was least preferred and least frequently consumed. Males had a significantly higher intake frequency of at least 6 of the salty foods, but the preference of most salty foods was not significantly different between genders. Ethnic Chinese significantly preferred more and took more frequently traditional and conventional Malaysian foods like asam laksa (a Malaysian salty-sour-spicy noodle in fish stock), salted biscuits and salted vegetable, while Indians have more affinity and frequency towards eating salty Western foods. Body Mass Index was significantly negatively correlated with the intake frequency of canned/packet soup and salted fish while waist circumference was significantly positively correlated with the preference of instant noodle. Also, an increased preference of potato chips and intake frequency of salted biscuits seemed to lead to a decreased WHR. Other than these, all the other overweight/obesity indicators did not seem to fully correlate with the salty food preference and intake frequency. Nevertheless, the preference and intake frequency of asam laksa seemed to be significant negative predictors for blood pressures. Finally, increased preference and intake frequency of high sodium shrimp paste (belacan)-based foods like asam laksa and belacan fried rice seemed to discourage discretionary salt use. In conclusion, the preference and intake frequency of the high sodium belacan-based dish asam laksa seems to be a good predictor for ethnic

Preference and intake frequency of high sodium foods and dishes and their correlations with anthropometric measurements among Malaysian subjects.

PubMed

Choong, Stella Sinn-Yee; Balan, Sumitha Nair; Chua, Leong-Siong; Say, Yee-How

2012-06-01

This study investigated the preference and intake frequency of a list of 15 commonly available high sodium Malaysian foods/dishes, discretionary salt use, and their possible association with demographics, blood pressures and anthropometric measurements among 300 Malaysian university students (114 males, 186 females; 259 ethnic Chinese, 41 Indians; 220 lean, 80 overweight). French fries and instant soup noodle were found to be the most preferred and most frequently consumed salty food, respectively, while salted fish was least preferred and least frequently consumed. Males had a significantly higher intake frequency of at least 6 of the salty foods, but the preference of most salty foods was not significantly different between genders. Ethnic Chinese significantly preferred more and took more frequently traditional and conventional Malaysian foods like asam laksa (a Malaysian salty-sour-spicy noodle in fish stock), salted biscuits and salted vegetable, while Indians have more affinity and frequency towards eating salty Western foods. Body Mass Index was significantly negatively correlated with the intake frequency of canned/packet soup and salted fish while waist circumference was significantly positively correlated with the preference of instant noodle. Also, an increased preference of potato chips and intake frequency of salted biscuits seemed to lead to a decreased WHR. Other than these, all the other overweight/obesity indicators did not seem to fully correlate with the salty food preference and intake frequency. Nevertheless, the preference and intake frequency of asam laksa seemed to be significant negative predictors for blood pressures. Finally, increased preference and intake frequency of high sodium shrimp paste (belacan)-based foods like asam laksa and belacan fried rice seemed to discourage discretionary salt use. In conclusion, the preference and intake frequency of the high sodium belacan-based dish asam laksa seems to be a good predictor for ethnic

The Use and Interpretation of Sodium Concentrations in Casual (Spot) Urine Collections for Population Surveillance and Partitioning of Dietary Iodine Intake Sources

PubMed Central

Conkle, Joel; van der Haar, Frits

2016-01-01

In 2013, the World Health Organization (WHO) called for joint surveillance of population salt and iodine intakes using urinary analysis. 24-h urine collection is considered the gold standard for salt intake assessment, but there is an emerging consensus that casual urine sampling can provide comparable information for population-level surveillance. Our review covers the use of the urinary sodium concentration (UNaC) and the urinary iodine concentration (UIC) from casual urine samples to estimate salt intakes and to partition the sources of iodine intakes. We reviewed literature on 24-h urinary sodium excretion (UNaE) and UNaC and documented the use of UNaC for national salt intake monitoring. We combined information from our review of urinary sodium with evidence on urinary iodine to assess the appropriateness of partitioning methods currently being adapted for cross-sectional survey analyses. At least nine countries are using casual urine collection for surveillance of population salt intakes; all these countries used single samples. Time trend analyses indicate that single UNaC can be used for monitoring changes in mean salt intakes. However; single UNaC suffers the same limitation as single UNaE; i.e., an estimate of the proportion excess salt intake can be biased due to high individual variability. There is evidence, albeit limited, that repeat UNaC sampling has good agreement at the population level with repeat UNaE collections; thus permitting an unbiased estimate of the proportion of excess salt intake. High variability of UIC and UNaC in single urine samples may also bias the estimates of dietary iodine intake sources. Our review concludes that repeated collection, in a sub-sample of individuals, of casual UNaC data would provide an immediate practical approach for routine monitoring of salt intake, because it overcomes the bias in estimates of excess salt intake. Thus we recommend more survey research to expand the evidence-base on predicted-UNaE from

A case-control study on red meat consumption and risk of stroke among a group of Iranian adults.

PubMed

Saneei, Parvane; Saadatnia, Mohammad; Shakeri, Forough; Beykverdi, Masumeh; Keshteli, Ammar Hassanzadeh; Esmaillzadeh, Ahmad

2015-04-01

We aimed to examine the association between red meat consumption and stroke in a group of Iranian adults. A hospital-based case-control study. The study included stroke patients and hospital-based controls. Usual dietary intakes of participants were assessed by means of a validated 168-item semi-quantitative FFQ. Total red meat consumption was calculated by summing up the consumption of red, processed and visceral meats. One hundred and ninety-five cases were stroke patients hospitalized in the neurology ward and 195 controls were recruited from patients hospitalized in other wards with no history of cerebrovascular diseases or neurological disorders. Participants with stroke were older, more likely to be male and less likely to be obese. Individuals in the highest tertile of red meat intake were 119 % more likely to have stroke (OR=2·19; 95% CI 1·33, 3·60) compared with those in the lowest tertile. After controlling for age, sex and total energy intake, the association between red meat consumption and stroke was strengthened (OR=2·72; 95% CI 1·53, 4·83). This association remained significant even after further controlling for physical activity and smoking as well as dietary intakes. Additional adjustments for BMI, diabetes, hypertension and hyperlipidaemia did not influence the association significantly (OR=2·51; 95 % CI 1·19, 5·09). Consumption of red meat was associated with greater odds of having stroke in a group of Iranian adults.

Choline and Betaine Intakes Are Not Associated with Cardiovascular Disease Mortality Risk in Japanese Men and Women.

PubMed

Nagata, Chisato; Wada, Keiko; Tamura, Takashi; Konishi, Kie; Kawachi, Toshiaki; Tsuji, Michiko; Nakamura, Kozue

2015-08-01

Dietary intakes of betaine and choline may reduce the risk of cardiovascular disease; however, epidemiologic evidence is limited. Seafood is a rich source of betaine and is a popular traditional food in Japan. We examined the associations of betaine and choline intakes with cardiovascular disease mortality in a population-based cohort study in Japan. Study subjects were 13,355 male and 15,724 female residents of Takayama City, Japan, who were aged ≥35 y and enrolled in 1992. Their diets were assessed by a validated food frequency questionnaire. Deaths from coronary heart disease and stroke were identified from death certificates over 16 y. Multivariable-adjusted HRs were computed by using Cox regression models. During follow-up, we documented 308 deaths from coronary heart disease and 676 deaths from stroke (393 from ischemic and 153 from hemorrhagic strokes). Compared with the lowest quartile, the second, third, and highest quartiles of betaine intake were significantly associated with a decreased risk of mortality from coronary heart disease in men after controlling for covariates. The HRs were 0.58 (95% CI: 0.36, 0.93), 0.62 (95% CI: 0.39, 0.998), and 0.60 (95% CI: 0.37, 0.97), respectively. The trend was not statistically significant (P = 0.08). There was no significant association between betaine intake and the risk of mortality from ischemic stroke. In women, betaine intake was unrelated risk of mortality from coronary heart disease and stroke (P = 0.32 and 0.73, respectively, for interaction by sex). There was no significant association between choline intake and cardiovascular disease mortality risk in men or women. Overall, we found no clear evidence of significant associations between choline and betaine intakes and cardiovascular disease mortality risk in Japanese men and women. © 2015 American Society for Nutrition.

Multivitamin use and risk of stroke mortality: the Japan collaborative cohort study.

PubMed

Dong, Jia-Yi; Iso, Hiroyasu; Kitamura, Akihiko; Tamakoshi, Akiko

2015-05-01

An effect of multivitamin supplement on stroke risk is uncertain. We aimed to examine the association between multivitamin use and risk of death from stroke and its subtypes. A total of 72 180 Japanese men and women free from cardiovascular diseases and cancers at baseline in 1988 to 1990 were followed up until December 31, 2009. Lifestyles including multivitamin use were collected using self-administered questionnaires. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) of total stroke and its subtypes in relation to multivitamin use. During a median follow-up of 19.1 years, we identified 2087 deaths from stroke, including 1148 ischemic strokes and 877 hemorrhagic strokes. After adjustment for potential confounders, multivitamin use was associated with lower but borderline significant risk of death from total stroke (HR, 0.87; 95% confidence interval, 0.76-1.01), primarily ischemic stroke (HR, 0.80; 95% confidence interval, 0.63-1.01), but not hemorrhagic stroke (HR, 0.96; 95% confidence interval, 0.78-1.18). In a subgroup analysis, there was a significant association between multivitamin use and lower risk of mortality from total stroke among people with fruit and vegetable intake <3 times/d (HR, 0.80; 95% confidence interval, 0.65-0.98). That association seemed to be more evident among regular users than casual users. Similar results were found for ischemic stroke. Multivitamin use, particularly frequent use, was associated with reduced risk of total and ischemic stroke mortality among Japanese people with lower intake of fruits and vegetables. © 2015 American Heart Association, Inc.

[Secondary prevention of ischemic non cardioembolic stroke].

PubMed

Armario, Pedro; Pinto, Xavier; Soler, Cristina; Cardona, Pere

2015-01-01

Stroke patients are at high risk for recurrence or new occurrence of other cardiovascular events or cardiovascular mortality. It is estimated that a high percentage of non-cardioembolic ischemic stroke can be prevented by a suitable modification of lifestyle (diet and exercise), reducing blood pressure (BP) with antihypertensive medication, platelet aggregation inhibitors, statins and high intake reducing consumption of. Unfortunately the degree of control of the different risk factors in secondary prevention of stroke is low. The clinical practice guidelines show clear recommendations with corresponding levels of evidence, but only if implemented in a general way they will get a better primary and secondary stroke prevention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Assessing U.S. sodium intake through dietary data and urine biomarkers

USDA-ARS?s Scientific Manuscript database

Sodium intake is directly related to blood pressure, a primary risk factor for heart disease and stroke. Reducing intake is estimated to save billions in U.S. health care dollars annually. Current public health recommendations and efforts targeting sodium reductions make accurate monitoring of pop...

Shift in sodium chloride sources in past 10 years of salt reduction campaign in Japan.

PubMed

Shimbo, S; Hatai, I; Saito, T; Yokota, M; Imai, Y; Watanabe, T; Moon, C S; Zhang, Z W; Ikeda, M

1996-11-01

Twenty four-hr total food duplicate samples were collected from nonsmoking house-wives (aged mostly 30 to 60 years) twice at a 10-year interval in winter seasons, once in around 1980 and then in around 1990 in 11 prefectures in Japan. In practice, 342 and 472 samples were obtained in the 1980 and 1990 studies, respectively. Sodium chloride (NaCl) intake via each food item was estimated from the weight of the item in the duplicate. The comparison of 1990 results with 1980 results showed that the total NaCl intake (i.e., NaCl intake via all food items) decreased after a 10-year campaign to lower salt intake. The NaCl/energy ratio however stayed essentially unchanged. Whereas NaCl intake via pickles decreased remarkably and that via miso paste [a fermentation product of soy bean, rice (or wheat) and salt] slightly, the decreases were counteracted by a substantial increase in NaCl intake via soy bean sauce. Meaning of this unexpected counteraction was discussed in relation to the difficulties in the campaign to lower salt intake.

Consumer Knowledge, Attitudes and Salt-Related Behavior in the Middle-East: The Case of Lebanon

PubMed Central

Nasreddine, Lara; Akl, Christelle; Al-Shaar, Laila; Almedawar, Mohamad M.; Isma’eel, Hussain

2014-01-01

Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association of socio-demographic factors, knowledge and attitudes with salt-related behaviors. Using a multicomponent questionnaire, a cross-sectional study was conducted in nine supermarkets in Beirut, based on systematic random sampling (n = 442). Factors associated with salt-related behaviors were examined by multivariate regression analysis. Specific knowledge and attitude gaps were documented with only 22.6% of participants identifying processed foods as the main source of salt, 55.6% discerning the relationship between salt and sodium, 32.4% recognizing the daily limit of salt intake and 44.7% reporting being concerned about the amount of salt in their diet. The majority of participants reported behavioral practices that increase salt intake with only 38.3% checking for salt label content, 43.7% reporting that their food purchases are influenced by salt content and 38.6% trying to buy low-salt foods. Knowledge, attitudes and older age were found to significantly predict salt-related behaviors. Findings offer valuable insight on salt-related knowledge, attitude and behaviors in a sample of Lebanese consumers and provide key information that could spur the development of evidence-based salt-reduction interventions specific to the Middle East. PMID:25401502

Carotenoids as Potential Antioxidant Agents in Stroke Prevention: A Systematic Review

PubMed Central

Bahonar, Ahmad; Saadatnia, Mohammad; Khorvash, Fariborz; Maracy, Mohammadreza; Khosravi, Alireza

2017-01-01

Stroke and other cerebrovascular diseases are among the most common causes of death worldwide. Prevention of modifiable risk factors is a cost-effective approach to decrease the risk of stroke. Oxidative stress is regarded as the major flexible operative agent in ischemic brain damage. This review presents recent scientific advances in understanding the role of carotenoids as antioxidants in lowering stroke risk based on observational studies. We searched Medline using the following terms: (Carotenoids [MeSH] OR Carotenes [tiab] OR Carotene [tiab] OR “lycopene [Supplementary Concept]” [MeSH] OR lycopene [tiab] OR beta-Carotene [tiab]) AND (stroke [MeSH] OR stroke [tiab] OR “Cerebrovascular Accident” [tiab] OR “Cerebrovascular Apoplexy” [tiab] OR “Brain Vascular Accident” [tiab] OR “Cerebrovascular Stroke” [tiab]) AND (“oxidative stress” [MeSH] OR “oxidative stress”[tiab]). This search considered papers that had been published between 2000 and 2017. Recent studies indicated that high dietary intake of six main carotenoids (i.e., lycopene, <- and®-carotene, lutein, zeaxanthin, and astaxanthin) was associated with reduced risk of stroke and other cardiovascular outcomes. However, the main mechanism of the action of these nutrients was not identified, and multiple mechanisms except antioxidant activity were suggested to be involved in the observed beneficial effects. The dietary intake of six major carotenoids should be promoted as this may have a substantial positive effect on stroke prevention and stroke mortality reduction. PMID:28983399

The salt-taste threshold in untreated hypertensive patients.

PubMed

Kim, Chang-Yeon; Ye, Mi-Kyung; Lee, Young Soo

2017-01-01

The salt-taste threshold can influence the salt appetite, and is thought to be another marker of sodium intake. Many studies have mentioned the relationship between the sodium intake and blood pressure (BP). The aim of this study was to evaluate the relationship between the salt-taste threshold and urinary sodium excretion in normotensive and hypertensive groups. We analyzed 199 patients (mean age 52 years, male 47.3%) who underwent 24-h ambulatory BP monitoring (ABPM). Hypertension was diagnosed as an average daytime systolic BP of ≥135 mmHg or diastolic BP of ≥85 mmHg by the ABPM. We assessed the salt-taste threshold using graded saline solutions. The salt-taste threshold, 24-h urinary sodium and potassium excretion, and echocardiographic data were compared between the control and hypertensive groups. The detection and recognition threshold of the salt taste did not significantly differ between the control and hypertensive groups. The 24-h urinary sodium excretion of hypertensive patients was significantly higher than that of the control group (140.9 ± 59.8 vs. 117.9 ± 57.2 mEq/day, respectively, p  = 0.011). Also, the urinary sodium-potassium ratio was significantly higher in the hypertensive patients. There was no correlation between the salt-taste threshold and 24-h urinary sodium excretion. The salt-taste threshold might not be related to the BP status as well as the 24-h urinary sodium excretion.

Iodine and Selenium Intakes of Postmenopausal Women in New Zealand.

PubMed

Brough, Louise; Gunn, Caroline A; Weber, Janet L; Coad, Jane; Jin, Ying; Thomson, Jasmine S; Mauze, Mathilde; Kruger, Marlena C

2017-03-09

Iodine and selenium are required for thyroid function. This study investigated iodine and selenium intakes in healthy, women aged 50-70 years ( n = 97) from three cities in the North Island of New Zealand, after mandatory fortification of bread with iodised salt. Iodine and selenium concentrations were determined in 24-h urine samples; daily intakes were extrapolated from amounts in urine (90% and 55% of daily intake, respectively). Three day diet diaries (3DDD) also estimated selenium and iodine (excluding iodised salt) intake. Median urinary iodine concentration (UIC) was 57 (41, 78) µg/L, indicating mild iodine deficiency. Estimated median iodine intake based on urine was 138 (100, 172) µg/day, below Recommended Dietary Intake (RDI) (150 µg/day) with 25% below Estimated Average Requirement (EAR) (100 µg/day). Estimated median selenium intake was 50 (36, 71) µg/day based on urine and 45 (36, 68) µg/day using 3DDD, below RDI (60 µg/day) with 49%-55% below EAR (50 µg/day). Median bread intakes were low at 1.8 (1.1, 2.7) serves/day; 25% consumed ≤1 serve/day. Although population iodine intakes improved following mandatory fortification, some had low intakes. Selenium intakes remain low. Further research should investigate thyroid function of low consumers of iodine fortified bread and/or selenium in New Zealand.

Novel Mechanism for Buffering Dietary Salt in Humans: Effects of Salt Loading on Skin Sodium, Vascular Endothelial Growth Factor C, and Blood Pressure.

PubMed

Selvarajah, Viknesh; Mäki-Petäjä, Kaisa M; Pedro, Liliana; Bruggraber, Sylvaine F A; Burling, Keith; Goodhart, Anna K; Brown, Morris J; McEniery, Carmel M; Wilkinson, Ian B

2017-11-01

High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na + accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na + and K + concentrations were measured in mg/g of wet tissue and expressed as the ratio Na + :K + to correct for variability in sample hydration. Skin Na + :K + increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P =0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na + :K + in men (2.59±0.09 versus 2.88±0.12; P =0.008) but not women (3.23±0.10 versus 3.36±0.12; P =0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P <0.001) while men did not (96±2 versus 96±2 mm Hg; P =0.91). Skin Na + :K + correlated with BP, stroke volume, and peripheral vascular resistance in men but not in women. No change was noted in plasma VEGF-C. These findings suggest that the skin may buffer dietary Na + , reducing the hemodynamic consequences of increased salt, and this may be influenced by sex. © 2017 The Authors.

Calcium supplement intake and risk of cardiovascular disease in women.

PubMed

Paik, J M; Curhan, G C; Sun, Q; Rexrode, K M; Manson, J E; Rimm, E B; Taylor, E N

2014-08-01

Some recent reports suggest that calcium supplement use may increase risk of cardiovascular disease. In a prospective cohort study of 74,245 women in the Nurses' Health Study with 24 years of follow-up, we found no independent associations between supplemental calcium intake and risk of incident coronary heart disease (CHD) and stroke. Some recent reports suggest that calcium supplements may increase cardiovascular disease (CVD) risk. The objective was to examine the independent associations between calcium supplement use and risk of CVD. We conducted a prospective cohort study of supplemental calcium use and incident CVD in 74,245 women in the Nurses' Health Study (1984-2008) free of CVD and cancer at baseline. Calcium supplement intake was assessed every 4 years. Outcomes were incident CHD (nonfatal or fatal MI) and stroke (ischemic or hemorrhagic), confirmed by medical record review. During 24 years of follow-up, 4,565 cardiovascular events occurred (2,709 CHD and 1,856 strokes). At baseline, women who took calcium supplements had higher levels of physical activity, smoked less, and had lower trans fat intake compared with those who did not take calcium supplements. After multivariable adjustment for age, body mass index, dietary calcium, vitamin D intake, and other CVD risk factors, the relative risk of CVD for women taking >1,000 mg/day of calcium supplements compared with none was 0.82 (95% confidence interval [CI] 0.74 to 0.92; p for trend <0.001). For women taking >1,000 mg/day of calcium supplements compared with none, the multivariable-adjusted relative risk for CHD was 0.71 (0.61 to 0.83; p for trend < 0.001) and for stroke was 1.03 (0.87 to 1.21; p for trend = 0.61). The relative risks were similar in analyses limited to non-smokers, women without hypertension, and women who had regular physical exams. Our findings do not support the hypothesis that calcium supplement intake increases CVD risk in women.

Adherence to the Nordic Nutrition Recommendations in a Nordic population with metabolic syndrome: high salt consumption and low dietary fibre intake (The SYSDIET study).

PubMed

Jonsdottir, Svandis Erna; Brader, Lea; Gunnarsdottir, Ingibjorg; Kally Magnusdottir, Ola; Schwab, Ursula; Kolehmainen, Marjukka; Risérus, Ulf; Herzig, Karl-Heinz; Cloetens, Lieselotte; Helgegren, Hannah; Johansson-Persson, Anna; Hukkanen, Janne; Poutanen, Kaisa; Uusitupa, Matti; Hermansen, Kjeld; Thorsdottir, Inga

2013-12-16

The Nordic countries collaborate in setting recommendations for intake of nutrients by publishing the Nordic Nutrition Recommendations (NNR). Studies exploring how well the Nordic population adheres to the NNR are limited and none are available for the metabolic syndrome (MetS) subgroup. Individuals with MetS are a large part of the adult Nordic population and their diet's nutritional quality is of great importance as it can affect the progression of MetS. To evaluate nutritional intake in a cohort of Nordic adults with MetS or MetS risk factors and their adherence to the NNR. A multi-centre study was carried out in six centres in four Nordic countries (SYSDIET CoE). Participants (n=175) were 30-65 years of age, with BMI 27-38 kg/m(2) and had at least two criteria for MetS. The NNR was used to evaluate the baseline nutrient intake calculated from the participants' 4-day food diaries using national nutrient databases. Less than 20% of participants consumed ≤10 E% from saturated fat as recommended in the NNR. Recommended intake (RI) of polyunsaturated fat was met by approximately one-third of participants. Only 20% of men and 26% of women met the RI of dietary fibre. Intake below the defined lower intake level of 2.5 µg/day for vitamin D was observed in nearly 20% of participants. The daily median intake of salt was 8.8 g for men and 6.7 g for women. Dietary quality of this Nordic population with Mets or MetS risk factors is unsatisfactory and characterised by high intakes of SFA and sodium and low intakes of PUFA and dietary fibre. Vitamin D intake was below RI level in a large part of the population. Authorities in the Nordic countries are encouraged to develop intervention programmes for high-risk groups.

Salt Appetite: Interaction of Forebrain Angiotensinergic and Hindbrain Serotonergic Mechanisms

NASA Technical Reports Server (NTRS)

Menani, Jose Vanderlei; Colombari, Debora S. A.; Beltz, Terry G.; Thunhorst, Robert L.; Johnson, Alan Kim

1998-01-01

Methysergide injected into the lateral parabrachial nucleus (LPBN) increases the salt appetite of rats depleted of sodium by furosemide (FURO). The present study investigated the effects of angiotensin 2 (ANG 2) receptor blockade in the subfornical organ (SFO) on this increased salt appetite. The intake of 0.3 M NaCl and water was induced by combined administration of the diuretic, FURO, and the angiotensin-convertina, enzyme inhibitor, captopril (CAP). Pretreatment of the SFO with the anciotensin Type 1 (AT,) receptor antagonist, losartan (1 microgram/200 nl), reduced water intake but not 0.3 M NaCl intake induced by subcutaneous FURO+ CAP. Methysergide (4 microgram/200 nl) injected bilaterally into the LPBN increased 0.3 M NaCl intake after FURO + CAP. Losartan injected into the SFO prevented additional 0.3 M NaCl intake caused by methysergide injections into the LPBN. These results indicate that AT, receptors located in the SFO may have a role in mediatina the intake of sodium and water induced by sodium depletion. They also suggest that after treatment with FURO + CAP an LPBN-associated scrotonergic mechanism inhibits increased sodium intake.

Predictive Ability of an Emergency Medical Dispatch Stroke Diagnostic Tool in Identifying Hospital-Confirmed Strokes.

PubMed

Clawson, Jeff J; Scott, Greg; Gardett, Isabel; Youngquist, Scott; Taillac, Peter; Fivaz, Conrad; Olola, Christopher

2016-08-01

Early hospital notification of a possible stroke arriving via emergency medical services (EMS) can prepare stroke center personnel for timely treatment, especially timely administration of tissue plasminogen activator. Stroke center notification from the emergency dispatch center-before responders reach the scene-may promote even earlier and faster system activation, meaning that stroke center teams may be ready to receive patients as soon as the ambulance arrives. This study evaluates the use of a Medical Priority Dispatch System (MPDS; Priority Dispatch Corp., Salt Lake City, UT) Stroke Diagnostic Tool (SDxT) to identify possible strokes early by comparing the tools' results to on-scene and hospital findings. The retrospective descriptive study utilized stroke data from 3 sources: emergency medical dispatch, EMS, and emergency department/hospital. A total of 830 cases were collected between June 2012 and December 2013, of which 603 (72.7%) had matching dispatch records. Of the 603 cases, 304 (50.4%) were handled using MPDS Stroke Protocol 28. The SDxT had an 86.4% ability (OR [95% CI]: 2.3 [1.5, 3.5]) to effectively identify strokes among all the hospital-confirmed stroke cases (sensitivity), and a 26.6% ability to effectively identify nonstrokes among all the hospital-confirmed nonstroke cases (specificity). The SDxT demonstrated a very high sensitivity, compared to similar tools used in the field and at dispatch. The specificity was somewhat low, but this was expected-and is intended in the creation of protocols to be used over the phone in emergency situations. The tool is a valuable method for identifying strokes early and may allow early hospital notification. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Malnutrition in Patients with Acute Stroke

PubMed Central

Bouziana, Stella D.; Tziomalos, Konstantinos

2011-01-01

Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding. PMID:22254136

Digital Education to Limit Salt in the Home (DELISH) Program Improves Knowledge, Self-Efficacy, and Behaviors Among Children.

PubMed

Grimes, Carley Ann; Booth, Alison; Khokhar, Durreajam; West, Madeline; Margerison, Claire; Campbell, Karen Jane; Nowson, Caryl Anne

2018-06-01

To determine the efficacy of a Web-based salt reduction program on children's salt-related knowledge, attitudes, and behaviors (KABs), self-efficacy, and intake of dietary salt. Pretest and posttest. An online survey determined KABs and self-efficacy and a 24-hour urine collection revealed salt intake. Victoria, Australia. Child-parent dyads (n = 102) recruited from 5 government schools. A 5-week behavior-based education program delivered via weekly online interactive education sessions. Change in KABs, self-efficacy, and daily salt intake. Changes in outcomes were assessed using McNemar test, paired t test, and Cohen's δ (CD). A total of 83 children participated (mean age, 9.2 years [SD, 0.8 years]; 59% girls); 35% to 76% of children viewed weekly education session. Children with complete survey data (n = 75) had improved scores for salt-related knowledge (+3.6 ± 0.4 points; P < .001; CD: 1.16), behaviors (+1.3 ± 0.1 points; P < .001; CD: 1.08), and self-efficacy (+0.9 ± 0.2 points; P < .001; CD: 0.64), but not attitude. Children with valid urine collections (n = 51) showed no change in salt intake. Participation resulted in improvement of salt related knowledge, self-efficacy and behavior. Further research is required to confirm these results using a more robust study design which includes a control group. In addition, the long term impact on children's salt intakes of comparable education programs needs to be assessed. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

A population-based dietary intervention trial in a high-risk area for stomach cancer and stroke: changes in intakes and related biomarkers.

PubMed

Takashashi, Yoshiko; Sasaki, Satoshi; Takahashi, Masako; Okubo, Shunji; Hayashi, Masato; Tsugane, Shoichiro

2003-11-01

Dietary intervention is one of the important fields in cancer and cardiovascular disease prevention. The Hiraka Dietary Intervention Study is a community-based randomized cross-over trial designed to develop an effective dietary modification tool and system in an area with high mortality of stomach cancer and stroke. The subjects were 550 healthy volunteers and were randomized into two groups with tailored dietary education to decrease sodium intake and to increase vitamin C and carotene intakes either in the first year (intervention group) or in the second year (control group). Dietary changes were assessed using a validated self-administered diet history questionnaire, fasting blood samples, and 48-hour urine samples, which were obtained before and after the one year period. During the first year, changes differed significantly between the intervention and control group for both dietary sodium intake (-384 and +255 mg/day, intervention and control respectively, p < 0.001) and urinary sodium excretion (-1003 and -84 mg/day, p < 0.001). Although favorable net changes were also observed in dietary carotene (+418 and +220 mug/day, p < 0.05) and vitamin C (+13 and +2 mg/day, p < 0.05), the serum level differences were modest (+13 and -25 mg/L, p = 0.09 for carotene, +0.1 and -0.5 mg/L, p = 0.07 for ascorbic acid). The present dietary intervention strategy effectively decreased sodium and increased carotene and vitamin C intakes, although the former was more distinct.

Effect of cooking classes for housewives on salt reduction in family members: a cluster randomized controlled trial.

PubMed

Takada, T; Imamoto, M; Fukuma, S; Yamamoto, Y; Sasaki, S; Uchida, M; Miura, Y; Shimizu, S; Nihata, K; Fukuhara, S

2016-11-01

Sodium reduction is very important in preventing cardiovascular diseases, especially in regions with high salt intake such as Japan. One strategy for salt reduction is to raise consumer awareness of the need to reduce daily salt intake. We investigated whether cooking classes given to housewives focussing on salt reduction would influence not only their own consumption behaviour but also that of their family members. Single-blinded, cluster randomized trial. We randomly assigned housewives to participate in cooking classes focussing on salt reduction (intervention group) or lectures about a healthy lifestyle (control group). The main outcome measure was the difference in estimated daily salt intake by spot urine sampling of housewives and their family members 2 months after intervention between the groups. A total of 35 housewives and 33 family members were randomized. The mean daily salt intake was 10.00 (standard deviation [SD] 1.75) g/day in the control group (17 housewives and 15 family members) and 9.57 (SD 2.45) g/day in the intervention group (18 housewives and 18 family members) at baseline. Two months after the intervention, the mean salt intake was 10.30 (SD 1.78) g/day in the control group and 8.95 (SD 2.45) g/day in the intervention group. The mean difference was -1.19 g/day (95% confidence interval -2.29, -0.09; P = 0.034). A similar tendency was observed in the subgroups of housewives and family members. Our trial suggested that the effects of cooking classes focussing on salt reduction for housewives could be transferred to family members (UMIN-CTR: 000018870). Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in Black Americans

PubMed Central

Judd, Suzanne E; Gutiérrez, Orlando M.; Newby, PK; Howard, George; Howard, Virginia J; Locher, Julie L; Kissela, Brett M; Shikany, James M

2014-01-01

Background and Purpose Black Americans and residents of the Southeastern United States, are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. Methods Between 2003–2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30,239 black and white Americans aged 45 years or older. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox proportional hazards models were used to examine risk of stroke. Results Over 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the Plant-based pattern was associated with lower stroke risk (HR=0.71; 95% CI=0.56–0.91; ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (HR=1.39; 95% CI=1.05, 1.84), with a significant (p = 0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. Conclusions These data suggest that adherence to a Southern style diet may increase the risk of stroke while adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary impact on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke. PMID:24159061

Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans.

PubMed

Judd, Suzanne E; Gutiérrez, Orlando M; Newby, P K; Howard, George; Howard, Virginia J; Locher, Julie L; Kissela, Brett M; Shikany, James M

2013-12-01

Black Americans and residents of the Southeastern United States are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30 239 black and white Americans aged≥45 years. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox-proportional hazards models were used to examine risk of stroke. During 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the plant-based pattern was associated with lower stroke risk (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; Ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84), with a significant (P=0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. These data suggest that adherence to a Southern style diet may increase the risk of stroke, whereas adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary effect on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke.

Why Your Mother Was Right: How Potassium Intake Reduces Blood Pressure.

PubMed

Ellison, David H; Terker, Andrew S

2015-01-01

Low potassium intake, common in western diets, increases blood pressure and enhances salt-sensitivity. Most humans in "Westernized" countries also consume excess salt. In studies using mice, we found that a high-salt, low-potassium diet activates the thiazide-sensitive Na-Cl cotransporter in the kidney. This effect led to sodium retention and increased blood pressure, and was dependent on plasma potassium. We postulated that this effect was mediated by changes in intracellular chloride caused by changes in membrane voltage. We developed a model in cultured cells permitting us to confirm this hypothesis. We then confirmed, using urinary exosomes, that dietary changes in normal humans, affect the thiazide-sensitive Na-Cl cotransporter in the same way. These data show that dietary potassium deficiency increases blood pressure largely by stimulating salt reabsorption along the distal nephron. They suggest that global efforts should focus on increasing potassium intake, which will attenuate the effects of high-salt diets.

Vegetable and fruit intake and mortality from chronic disease in New Zealand.

PubMed

Tobias, Martin; Turley, Maria; Stefanogiannis, Niki; Vander Hoorn, Stephen; Lawes, Carlene; Mhurchu, Cliona Ni; Rodgers, Anthony

2006-02-01

To estimate mortality attributable to inadequate vegetable and fruit intake in New Zealand in 1997, and the burden of disease that could be avoided in 2011 if modest increases in vegetable and fruit intake were to occur. Comparative risk assessment methodology was used to estimate both attributable and avoidable mortality due to inadequate vegetable and fruit consumption (< 600 g/day). Vegetables and fruit were defined as all fresh, frozen, canned, dried or juiced vegetables and fruit, except potatoes, nuts, seeds and pulses. Disease outcomes assessed were mortality from ischaemic heart disease, ischaemic stroke, and lung, oesophageal, stomach and colorectal cancers. In 1997, mean vegetable and fruit intake was 420 g/day in males and 404 g/day in females. Inadequate vegetable and fruit intake is estimated to have contributed to 1,559 deaths (6% of all deaths) in that year, including 1,171 from ischaemic heart disease, 179 from ischaemic stroke and 209 from cancer. Modest increases in vegetable and fruit intake (40 g/day above the historic trend) could prevent 334 deaths each year from 2011, mostly from ischaemic heart disease. Inadequate vegetable and fruit intake is an important cause of mortality in New Zealand. Small increases in vegetable and fruit intake could have a major impact on population health within a decade.

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

PubMed Central

Johnson, Claire; Mohan, Sailesh; Rogers, Kris; Shivashankar, Roopa; Thout, Sudhir Raj; Gupta, Priti; He, Feng J.; MacGregor, Graham A.; Webster, Jacqui; Krishnan, Anand; Maulik, Pallab K.; Reddy, K. Srinath; Prabhakaran, Dorairaj; Neal, Bruce

2017-01-01

Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants’ physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87–9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake—less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55–9.87 g/day) versus less-educated (9.34, 8.57–10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt. PMID:28212309

Changing Face of Stroke: Implications for Occupational Therapy Practice

PubMed Central

Wolf, Timothy J.; Baum, Carolyn; Connor, Lisa Tabor

2010-01-01

Stroke is one of the most life-altering syndromes affecting the world population. Rehabilitation for people experiencing stroke is focused almost exclusively on self-care activities and being able to return home and has little to no focus on work rehabilitation or community reintegration. The Cognitive Rehabilitation Research Group (CRRG) at the Washington University School of Medicine in St. Louis was formed with the vision of improving everyday life for people after stroke by translating knowledge from neuroscience into treatment programs for productive living. Descriptive analysis of the intake assessment from the CRRG Clinical Core (N = 7,740) revealed three important findings: The age at stroke is decreasing, most strokes are neurologically mild to moderate in nature, and discharge placement decisions are being made largely on the basis of measures of impairment. The changes in the stroke population require occupational therapy to expand rehabilitation beyond the acute management of stroke to address full participation in work, family, and community life. PMID:19785261

Impact and risk factors of post-stroke bone fracture

PubMed Central

Huo, Kang; Hashim, Syed I; Yong, Kimberley L Y; Su, Hua; Qu, Qiu-Min

2016-01-01

Bone fracture occurs in stroke patients at different times during the recovery phase, prolonging recovery time and increasing medical costs. In this review, we discuss the potential risk factors for post-stroke bone fracture and preventive methods. Most post-stroke bone fractures occur in the lower extremities, indicating fragile bones are a risk factor. Motor changes, including posture, mobility, and balance post-stroke contribute to bone loss and thus increase risk of bone fracture. Bone mineral density is a useful indicator for bone resorption, useful to identify patients at risk of post-stroke bone fracture. Calcium supplementation was previously regarded as a useful treatment during physical rehabilitation. However, recent data suggests calcium supplementation has a negative impact on atherosclerotic conditions. Vitamin D intake may prevent osteoporosis and fractures in patients with stroke. Although drugs such as teriparatide show some benefits in preventing osteoporosis, additional clinical trials are needed to determine the most effective conditions for post-stroke applications. PMID:26929915

Iodine Intake through Processed Food: Case Studies from Egypt, Indonesia, the Philippines, the Russian Federation and Ukraine, 2010–2015

PubMed Central

Knowles, Jacky; Shehata, Magdy; Gerasimov, Gregory; Bimo, Bimo; Cavenagh, Bettina; Maramag, Cherry C.; Otico, Edward; Izwardy, Doddy; Spohrer, Rebecca; Garrett, Greg S.

2017-01-01

The current performance indicator for universal salt iodisation (USI) is the percentage of households using adequately iodised salt. However, the proportion of dietary salt from household salt is decreasing with the increase in consumption of processed foods and condiments globally. This paper reports on case studies supported by the Global Alliance for Improved Nutrition (GAIN)-UNICEF USI Partnership Project to investigate processed food industry use of adequately iodised salt in contrasting national contexts. Studies were conducted in Egypt, Indonesia, the Philippines, the Russian Federation, and Ukraine. In all cases, the potential iodine intake from iodised salt in selected food products was modelled according to the formula: quantity of salt per unit of food product × minimum regulated iodine level of salt at production × average daily per capita consumption of the product. The percent of adult recommended nutrient intake for iodine potentially provided by the average daily intake of bread and frequently consumed foods and condiments was from 10% to 80% at the individual product level. The potential contribution to iodine intake from the use of iodised salt in the processed food industry is of growing significance. National USI strategies should encourage co-operative industry engagement and include regulatory monitoring of iodised salt use in the food industry in order to achieve optimal population iodine status. PMID:28933750

Effects of mineral salt supplement on enteric methane emissions, ruminal fermentation and methanogen community of lactating cows.

PubMed

Li, Xiaohua; Liu, Chong; Chen, Yongxing; Shi, Rongguang; Cheng, Zhenhua; Dong, Hongmin

2017-08-01

We evaluated the effects of mineral salt supplement on enteric methane emissions, ruminal fermentation and methanogen community of dairy cows over a whole lactation period. Ten Holstein cows fed a total mixed ration (TMR) diet were randomly allocated into two groups, one supplied with mineral salts as the treatment group and the other as the control group. The methane measurement showed that the ingestion of mineral salts lowered enteric methane emissions significantly (P < 0.05), with an average of 10.5% reduction over the whole lactation period. Ruminal fermentation analysis showed the mineral salt intake could significantly decrease the acetate : propionate ratio (P < 0.05). Real-time PCR assay showed that rumen methanogen abundance significantly reduced in the treatment group (P < 0.05) but was not significantly influenced by mineral salt intake over the whole lactation period. Intergroup methanogen community composition was influenced slightly by mineral salt intake; however, significantly different intragroup profiles were apparent throughout the whole lactation period, according to denaturing gradient gel electrophoresis analysis. In conclusion, these results suggested that the effective mitigation of enteric methane emissions by mineral salt intake could be attributed to decreased density of methanogenic archaea and that fluctuations in methane emission over the lactation period might be related to Methanobrevibacter diversity. © 2016 Japanese Society of Animal Science.

Is socioeconomic status associated with dietary sodium intake in Australian children? A cross-sectional study

PubMed Central

Grimes, Carley A; Campbell, Karen J; Riddell, Lynn J; Nowson, Caryl A

2013-01-01

Objective To assess the association between socioeconomic status (SES) and dietary sodium intake, and to identify if the major dietary sources of sodium differ by socioeconomic group in a nationally representative sample of Australian children. Design Cross-sectional survey. Setting 2007 Australian National Children's Nutrition and Physical Activity Survey. Participants A total of 4487 children aged 2–16 years completed all components of the survey. Primary and secondary outcome measures Sodium intake was determined via one 24 h dietary recall. The population proportion formula was used to identify the major sources of dietary salt. SES was defined by the level of education attained by the primary carer. In addition, parental income was used as a secondary indicator of SES. Results Dietary sodium intake of children of low SES background was 2576 (SEM 42) mg/day (salt equivalent 6.6 (0.1) g/day), which was greater than that of children of high SES background 2370 (35) mg/day (salt 6.1 (0.1) g/day; p<0.001). After adjustment for age, gender, energy intake and body mass index, low SES children consumed 195 mg/day (salt 0.5 g/day) more sodium than high SES children (p<0.001). Low SES children had a greater intake of sodium from processed meat, gravies/sauces, pastries, breakfast cereals, potatoes and potato snacks (all p<0.05). Conclusions Australian children from a low SES background have on average a 9% greater intake of sodium from food sources compared with those from a high SES background. Understanding the socioeconomic patterning of salt intake during childhood should be considered in interventions to reduce cardiovascular disease. PMID:23396559

Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women.

PubMed

Mink, Pamela J; Scrafford, Carolyn G; Barraj, Leila M; Harnack, Lisa; Hong, Ching-Ping; Nettleton, Jennifer A; Jacobs, David R

2007-03-01

Dietary flavonoids may have beneficial cardiovascular effects in human populations, but epidemiologic study results have not been conclusive. We used flavonoid food composition data from 3 recently available US Department of Agriculture databases to improve estimates of dietary flavonoid intake and to evaluate the association between flavonoid intake and cardiovascular disease (CVD) mortality. Study participants were 34 489 postmenopausal women in the Iowa Women's Health Study who were free of CVD and had complete food-frequency questionnaire information at baseline. Intakes of total flavonoids and 7 subclasses were categorized into quintiles, and food sources were grouped into frequency categories. Proportional hazards rate ratios (RR) were computed for CVD, coronary heart disease (CHD), stroke, and total mortality after 16 y of follow-up. After multivariate adjustment, significant inverse associations were observed between anthocyanidins and CHD, CVD, and total mortality [RR (95% CI) for any versus no intake: 0.88 (0.78, 0.99), 0.91 (0.83, 0.99), and 0.90 (0.86, 0.95)]; between flavanones and CHD [RR for highest quintile versus lowest: 0.78 (0.65, 0.94)]; and between flavones and total mortality [RR for highest quintile versus lowest: 0.88 (0.82, 0.96)]. No association was found between flavonoid intake and stroke mortality. Individual flavonoid-rich foods associated with significant mortality reduction included bran (added to foods; associated with stroke and CVD); apples or pears or both and red wine (associated with CHD and CVD); grapefruit (associated with CHD); strawberries (associated with CVD); and chocolate (associated with CVD). Dietary intakes of flavanones, anthocyanidins, and certain foods rich in flavonoids were associated with reduced risk of death due to CHD, CVD, and all causes.

Pathophysiology of salt sensitivity hypertension.

PubMed

Ando, Katsuyuki; Fujita, Toshiro

2012-06-01

Dietary salt intake is the most important factor contributing to hypertension, but the salt susceptibility of blood pressure (BP) is different in individual subjects. Although the pathogenesis of salt-sensitive hypertension is heterogeneous, it is mainly attributable to an impaired renal capacity to excrete sodium (Na(+) ). We recently identified two novel mechanisms that impair renal Na(+) -excreting function and result in an increase in BP. First, mineralocorticoid receptor (MR) activation in the kidney, which facilitates distal Na(+) reabsorption through epithelial Na(+) channel activation, causes salt-sensitive hypertension. This mechanism exists not only in models of high-aldosterone hypertension as seen in conditions of obesity or metabolic syndrome, but also in normal- or low-aldosterone type of salt-sensitive hypertension. In the latter, Rac1 activation by salt excess causes MR stimulation. Second, renospecific sympathoactivation may cause an increase in BP under conditions of salt excess. Renal beta2 adrenoceptor stimulation in the kidney leads to decreased transcription of the gene encoding WNK4, a negative regulator of Na(+) reabsorption through Na(+) -Cl (-) cotransporter in the distal convoluted tubules, resulting in salt-dependent hypertension. Abnormalities identified in these two pathways of Na(+) reabsorption in the distal nephron may present therapeutic targets for the treatment of salt-sensitive hypertension.

Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples.

PubMed

Do, Ha Thi Phuong; Santos, Joseph Alvin; Trieu, Kathy; Petersen, Kristina; Le, Mai Bach; Lai, Duc Truong; Bauman, Adrian; Webster, Jacqui

2016-11-01

This study evaluated the effectiveness of the Communication for Behavioral Impact (COMBI)-Eat Less Salt intervention conducted in Viet Tri, Vietnam. The behavior change intervention was implemented in four wards and four communes for one year, which included mass media communication, school interventions, community programs, and focus on high-risk groups. Mean sodium excretion was estimated from spot urine samples using different equations. A subsample provided 24-hour urine to validate estimates from spot urine. Information about salt-related knowledge and behaviors was also collected. There were 513 participants at both baseline and follow-up. Mean sodium excretion estimated from spot urines fell significantly from 8.48 g/d at baseline to 8.05 g/d at follow-up (P=.001). All spot equations demonstrated a significant reduction in sodium levels; however, the change was smaller than the measured 24-hour urine. Participants showed improved knowledge and behaviors following the intervention. The COMBI intervention was effective in lowering average population salt intake and improving knowledge and behaviors. ©2016 Wiley Periodicals, Inc.

New Statistical Approach to Apportion Dietary Sources of Iodine Intake: Findings from Kenya, Senegal and India

PubMed Central

Knowles, Jacky; Bukania, Zipporah; Camara, Boubacar; Pandav, Chandrakant S.; Mwai, John Maina; Toure, Ndeye Khady; Yadav, Kapil

2018-01-01

Progress of national Universal Salt Iodization (USI) strategies is typically assessed by household coverage of adequately iodized salt and median urinary iodine concentration (UIC) in spot urine collections. However, household coverage does not inform on the iodized salt used in preparation of processed foods outside homes, nor does the total UIC reflect the portion of population iodine intake attributable to the USI strategy. This study used data from three population-representative surveys of women of reproductive age (WRA) in Kenya, Senegal and India to develop and illustrate a new approach to apportion the population UIC levels by the principal dietary sources of iodine intake, namely native iodine, iodine in processed food salt and iodine in household salt. The technique requires measurement of urinary sodium concentrations (UNaC) in the same spot urine samples collected for iodine status assessment. Taking into account the different complex survey designs of each survey, generalized linear regression (GLR) analyses were performed in which the UIC data of WRA was set as the outcome variable that depends on their UNaC and household salt iodine (SI) data as explanatory variables. Estimates of the UIC portions that correspond to iodine intake sources were calculated with use of the intercept and regression coefficients for the UNaC and SI variables in each country’s regression equation. GLR coefficients for UNaC and SI were significant in all country-specific models. Rural location did not show a significant association in any country when controlled for other explanatory variables. The estimated UIC portion from native dietary iodine intake in each country fell below the minimum threshold for iodine sufficiency. The UIC portion arising from processed food salt in Kenya was substantially higher than in Senegal and India, while the UIC portions from household salt use varied in accordance with the mean level of household SI content in the country surveys. The

Salt Reduction Initiatives around the World - A Systematic Review of Progress towards the Global Target.

PubMed

Trieu, Kathy; Neal, Bruce; Hawkes, Corinna; Dunford, Elizabeth; Campbell, Norm; Rodriguez-Fernandez, Rodrigo; Legetic, Branka; McLaren, Lindsay; Barberio, Amanda; Webster, Jacqui

2015-01-01

To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake.

Salt inactivates endothelial nitric oxide synthase in endothelial cells.

PubMed

Li, Juan; White, James; Guo, Ling; Zhao, Xiaomin; Wang, Jiafu; Smart, Eric J; Li, Xiang-An

2009-03-01

There is a 1-4 mmol/L rise in plasma sodium concentrations in individuals with high salt intake and in patients with essential hypertension. In this study, we used 3 independent assays to determine whether such a small increase in sodium concentrations per se alters endothelial nitric oxide synthase (eNOS) function and contributes to hypertension. By directly measuring NOS activity in living bovine aortic endothelial cells, we demonstrated that a 5-mmol/L increase in salt concentration (from 137 to 142 mmol/L) caused a 25% decrease in NOS activity. Importantly, the decrease in NOS activity was in a salt concentration-dependent manner. The NOS activity was decreased by 25, 45, and 70%, with the increase of 5, 10, and 20 mmol/L of NaCl, respectively. Using Chinese hamster ovary cells stably expressing eNOS, we confirmed the inhibitory effects of salt on eNOS activity. The eNOS activity was unaffected in the presence of equal milliosmol of mannitol, which excludes an osmotic effect. Using an ex vivo aortic angiogenesis assay, we demonstrated that salt attenuated the nitric oxide (NO)-dependent proliferation of endothelial cells. By directly monitoring blood pressure changes in response to salt infusion, we found that in vivo infusion of salt induced an acute increase in blood pressure in a salt concentration-dependent manner. In conclusion, our findings demonstrated that eNOS is sensitive to changes in salt concentration. A 5-mmol/L rise in salt concentration, within the range observed in essential hypertension patients or in individuals with high salt intake, could significantly suppress eNOS activity. This salt-induced reduction in NO generation in endothelial cells may contribute to the development of hypertension.

High Salt Intake Increases Blood Pressure in Normal Rats: Putative Role of 20-HETE and No Evidence on Changes in Renal Vascular Reactivity

PubMed Central

Walkowska, A.; Kuczeriszka, M.; Sadowski, J.; Olszyński, K.H.; Dobrowolski, L.; Červenka, L.; Hammock, B.D.; Kompanowska-Jezierska, E.

2015-01-01

Background/Aims High salt (HS) intake may elevate blood pressure (BP), also in animals without genetic salt sensitivity. The development of salt-dependent hypertension could be mediated by endogenous vasoactive agents; here we examined the role of vasodilator epoxyeicosatrienoic acids (EETs) and vasoconstrictor 20-hydroxyeicosatetraenoic acid (20-HETE). Methods In conscious Wistar rats on HS diet systolic BP (SBP) was examined after chronic elevation of EETs using 4-[4-(3-adamantan-1-yl-ureido)-cyclohexyloxy]-benzoic acid (c-AUCB), a blocker of soluble epoxide hydrolase, or after inhibition of 20-HETE with 1-aminobenzotriazole (ABT). Thereafter, in acute experiments the responses of renal artery blood flow (Transonic probe) and renal regional perfusion (laser-Doppler) to intrarenal acetylcholine (ACh) or norepinephrine were determined. Results HS diet increased urinary 20-HETE excretion. The SBP increase was not reduced by c-AUCB but prevented by ABT until day 5 of HS exposure. Renal vasomotor responses to ACh or norepinephrine were similar on standard and HS diet. ABT but not c-AUCB abolished the responses to ACh. Conclusions 20-HETE seems to mediate the early-phase HS diet-induced BP increase while EETs are not engaged in the process. Since HS exposure did not alter renal vasodilator responses to Ach, endothelial dysfunction is not a critical factor in the mechanism of salt-induced blood pressure elevation. PMID:26067851

Associations between the intake of miso soup and Japanese pickles and the estimated 24-hour urinary sodium excretion: a population-based cross-sectional study.

PubMed

Wakasugi, Minako; James Kazama, Junichiro; Narita, Ichiei

2015-01-01

In Japan, reducing the consumption of miso soup and Japanese pickles, both traditional Japanese dishes, is recommended in order to decrease dietary salt intake. With the Westernization of dietary habits, however, these dishes are now consumed less frequently, and thus a reduction in their effect on sodium intake is suspected. This study examined cross-sectional associations between the frequency of intake of miso soup and Japanese pickles and the estimated 24-hour urine sodium excretion using data obtained from health examination surveys conducted in 2013 in Sado City, Japan. The level of daily salt intake was estimated based on spot urine sodium and creatinine measurements. The frequency of intake of miso soup and Japanese pickles was determined using a self-reported questionnaire. Multiple linear regression models were used to assess associations. Among a total of 8,821 participants (3,956 men; age range, 19-97 years), the mean daily salt intake was 9.4 g/day. The frequency of intake of miso soup and Japanese pickles increased with age and was associated with the level of daily salt intake (p for trend <0.0001). A linear regression model analysis adjusted for age, sex, body mass index, hypertension, diabetes, hypercholesterolemia and chronic kidney disease revealed that daily salt intake was associated with the frequency of intake of miso soup (p<0.0001) and Japanese pickles (p<0.0001) in all age groups, except those ≥ 80 years of age. These findings suggest that reducing the consumption of miso soup and Japanese pickles may be an effective approach for decreasing the level of dietary salt intake in the general Japanese population, although not in octogenarians or nonagenarians.

A trip to inner space: insights into salt balance from cosmonauts.

PubMed

Ortiz-Melo, David; Coffman, Thomas M

2013-01-08

The epidemiological association between high salt intake and hypertension is well established. However, in most patients, the specific defect causing salt-dependent hypertension cannot be discerned. In this issue of Cell Metabolism, Rakova and associates use an unprecedented study design to characterize long-term salt balance in humans (Rakova et al., 2012). Copyright © 2013 Elsevier Inc. All rights reserved.

Salt appetite of adrenalectomized rats after a lesion of the SFO.

PubMed

Wilson, Wendy L; Starbuck, Elizabeth M; Fitts, Douglas A

2002-11-15

Circumventricular organs such as the subfornical organ (SFO) may mediate the effects of circulating angiotensin (ANG) II on salt appetite under conditions of sodium depletion in the rat. We studied the effects of an electrolytic lesion of SFO on salt appetite after adrenalectomy (ADX) in Long-Evans rats. The SFO lesion had no effect on saline intake, but it did abolish water intake after acute peripheral treatments with 2 mg/kg of captopril or a 10 mg/kg of furosemide. These findings contrast with other recent data from this laboratory demonstrating large reductions in salt appetite in adrenal-intact rats with lesions of either SFO or the organum vasculosum laminae terminalis during acute iv infusions of ANG II. Thus, the SFO may contribute to the salt appetite response to circulating ANG II, but it is not essential for the response to adrenalectomy. Copyright 2002 Elsevier Science B.V.

An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study.

PubMed

Collins, Marissa; Mason, Helen; O'Flaherty, Martin; Guzman-Castillo, Maria; Critchley, Julia; Capewell, Simon

2014-07-01

Dietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD). The validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a "do nothing" baseline. All policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million. All policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Experimental Evaluation of a Method for Turbocharging Four-Stroke, Single Cylinder, Internal Combustion Engines

NASA Astrophysics Data System (ADS)

Buchman, Michael; Winter, Amos

2015-11-01

Turbocharging an engine increases specific power, improves fuel economy, reduces emissions, and lowers cost compared to a naturally aspirated engine of the same power output. These advantages make turbocharging commonplace for multi-cylinder engines. Single cylinder engineers are not commonly turbocharged due to the phase lag between the exhaust stroke, which powers the turbocharger, and the intake stroke, when air is pumped into the engine. Our proposed method of turbocharging single cylinder engines is to add an ``air capacitor'' to the intake manifold, an additional volume that acts as a buffer to store compressed air between the exhaust and intake strokes, and smooth out the pressure pulses from the turbocharger. This talk presents experimental results from a single cylinder, turbocharged diesel engine fit with various sized air capacitors. Power output from the engine was measured using a dynamometer made from a generator, with the electrical power dissipated with resistive heating elements. We found that intake air density increases with capacitor size as theoretically predicted, ranging from 40 to 60 percent depending on heat transfer. Our experiment was able to produce 29 percent more power compared to using natural aspiration. These results validated that an air capacitor and turbocharger may be a simple, cost effective means of increasing the power density of single cylinder engines.

Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target

PubMed Central

Trieu, Kathy; Neal, Bruce; Hawkes, Corinna; Dunford, Elizabeth; Campbell, Norm; Rodriguez-Fernandez, Rodrigo; Legetic, Branka; McLaren, Lindsay; Barberio, Amanda; Webster, Jacqui

2015-01-01

Objective To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. Methods A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. Results A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. Conclusion The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake. PMID:26201031

Protein supplementation may enhance the spontaneous recovery of neurological alterations in patients with ischaemic stroke.

PubMed

Aquilani, Roberto; Scocchi, Marco; Iadarola, Paolo; Franciscone, Piero; Verri, Manuela; Boschi, Federica; Pasini, Evasio; Viglio, Simona

2008-12-01

To determine whether protein supplementation could enhance neurological recovery in subacute patients with ischaemic stroke. Alimentation-independent patients with ischaemic stroke were randomly allocated to either 21 days of protein supplementation (protein-supplemented group; n=20) or to a spontaneous diet only (control group; n=21) in order to investigate the recovery of neurological changes (measured using the National Institute of Health (NIH) Stroke Scale). Tertiary care rehabilitation in Italy. Forty-two patients (27 male and 15 female; 66.4 +/- 11 years) 16 +/-2 days after the acute event. Supplementation with a hyperproteic nutritional formula (10% protein). NIH Stroke Scale and protein intake. At admission to rehabilitation, both groups of patients were homogeneous for demographic, clinical and functional characteristics. After 21 days from the start of the protocol, the NIH Stroke Scale was found to be enhanced in the group with supplemental proteins (-4.4 +/- 1.5 score versus -3 +/- 1.4 of control group; P<0.01). When expressed as difference (triangle up) between baseline and 21 days, the NIH Stroke Scale correlated negatively with change in protein intake (g/day) (r=-0.50, P= 0.001) and positively with change in carbohydrate/protein ratio (r = +0.40, P=0.01) Protein supplementation may enhance neurological recovery in subacute patients with ischaemic stroke.

Evaluation of a Mass-Media Campaign to Increase the Awareness of the Need to Reduce Discretionary Salt Use in the South African Population.

PubMed

Wentzel-Viljoen, Edelweiss; Steyn, Krisela; Lombard, Carl; De Villiers, Anniza; Charlton, Karen; Frielinghaus, Sabine; Crickmore, Christelle; Mungal-Singh, Vash

2017-11-12

The South African strategic plan to reduce cardiovascular disease (CVD) includes reducing population salt intake to less than 5 g/day. A mass media campaign was undertaken to increase public awareness of the association between high salt intake, blood pressure and CVD, and focused on the reduction of discretionary salt intake. Community based surveys, before and after the campaign, were conducted in a cohort of black women aged 18-55 years. Questions on knowledge, attitudes and beliefs regarding salt use were asked. Current interest in engaging with salt reduction behaviors was assessed using the "stage of change" model. Five hundred fifty women participated in the baseline study and 477 in the follow-up survey. Most of the indicators of knowledge, attitudes and behavior change show a significant move towards considering and initiating reduced salt consumption. Post intervention, significantly more participants reported that they were taking steps to control salt intake (38% increased to 59.5%, p < 0.0001). In particular, adding salt while cooking and at the table occurred significantly less frequently. The findings suggest that mass media campaigns may be an effective tool to use as part of a strategy to reduce discretionary consumption of salt among the population along with other methods.

Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China123

PubMed Central

Du, Shufa; Neiman, Andrea; Batis, Carolina; Wang, Huijun; Zhang, Bing; Zhang, Jiguo; Popkin, Barry M

2014-01-01

Background: Recent studies have shown inconsistent effects of sodium reduction, potassium intake, and the ratio of sodium to potassium (Na/K ratio) on hypertension and other cardiovascular diseases. Major gaps exist in knowledge regarding these issues in China. Objective: We analyzed the patterns and trends of dietary sodium intake, potassium intake, and the Na/K ratio and their relations with incident hypertension in China. Design: The China Health and Nutrition Survey cohort includes 16,869 adults aged 20–60 y from 1991 to 2009. Three consecutive 24-h dietary recalls and condiment and food weights provided detailed dietary data. Multinomial logistic regression models determined trends and patterns of sodium and potassium intake and the Na/K ratio. Models for survival-time data estimated the hazard of incident hypertension. Results: Sodium intake is decreasing but remains double the Institute of Medicine recommendations. Most sodium comes from added condiments. Adults in the central provinces have the highest sodium intake and the most rapid increase in hypertension. Potassium intake has increased slightly but is below half of the recommended amount. The Na/K ratio is significantly higher than the recommended amounts. Recent measurements of high sodium intake, low potassium intake, and high Na/K ratio have strong independent dose-response associations with incident hypertension. Conclusions: Reducing sodium in processed foods, the major public health strategy in Western countries, may be less effective in China, where salt intake remains high. Replacing sodium with potassium in salt to control and prevent hypertension in China should be considered along with other public health and clinical prevention options. PMID:24257724

[Reason for dietary salt reduction and potential effect on population health--WHO recommendation].

PubMed

Kaić-Rak, Antoinette; Pucarin-Cvetković, Jasna; Heim, Inge; Skupnjak, Berislav

2010-05-01

It is well known that reduction of salt results in lowering blood pressure and cardiovascular incidents. Daily salt is double the recommended daily quantity and mainly comes from processed food. The assessment of daily salt intake for Croatia is 12 g/day (WHO recommendation is <5 g/day). The main source of sodium is processed food and food prepared in restaurants (77%), natural content of sodium in food (12%), added salt at table (6%) and prepared meals at home (5%). Reduction of salt by 50% would save nearly 180,000 lives per year in Europe. It is necessary to establish better collaboration with food manufacturers in order to reduce the content of salt in processed food and to achieve appropriate salt intake per day in accordance with the WHO recommendation. Further, it is necessary to encourage food manufacturers to produce food and meals with low or reduced salt content (shops, catering, changes in recipes, offer salt substitutions). This kind of collaboration is based on bilateral interests that can result in positive health effects. One of the most important public health tasks is to educate consumers and to give them choice when buying food. This can be achieved by effective campaigns and social marketing, by ensuring a declaration of salt content on the product, or specially designed signs for food products with low or reduced salt content.

Higher adherence to the Mediterranean diet is inversely associated with having hypertension: is low salt intake a mediating factor?

PubMed

La Verde, Melania; Mulè, Serena; Zappalà, Gaetano; Privitera, Gaetano; Maugeri, Giuseppe; Pecora, Francesco; Marranzano, Marina

2018-03-01

Blood pressure (BP) is a major risk factor for population health worldwide and a preventable disease through lifestyle modification. The aim of this study was to assess the association between adherence to the Mediterranean diet (MD) and occurrence of hypertension in a Mediterranean cohort. Demographic and dietary data of 1937 adults were collected in 2014-2015 from the general population of Catania, Sicily (Italy). Food frequency questionnaires and a MD adherence score were used to assess exposure variables. Higher adherence to the MD was inversely associated with hypertension. However, this association was no more significant after adjustment for sodium and potassium intake. These results suggest that salt may exert a mediating effect of high adherence to the MD towards hypertension.

Blood Pressure Regulation: Reviewing Evidence for Interplay Between Common Dietary Sugars and Table Salt.

PubMed

Preuss, Harry G; Clouatre, Dallas; Swaroop, Anand; Bagchi, Manashi; Bagchi, Debasis; Kaats, Gilbert R

2017-01-01

A popular concept is that the significant global progression in prevalence and intensification of elevated blood pressure (BP) levels is due in part to dietary indiscretions. Excess intake of several food sources causing overweight/obesity plays an important role in BP perturbations. However, certain nutrients are involved in ways other than via body fat accumulation, particularly table salt (sodium chloride) and popular refined carbohydrates like dietary sugars (sucrose, fructose, high fructose corn syrup). In nondiabetics and diabetics, several functions of salt and sugar influence BP and metabolism. For example, salt intake is linked to volume expansion, insulin resistance, and hypertension, while sugar intake is associated with enhanced salt sensitivity via urinary sodium retention, insulin resistance, and hypertension. The key postulate evaluated here is that when two popular nutrients-salt and dietary sugars-are consumed together in adequate amounts, their respective individual BP effects are significantly amplified. In previous laboratory studies, a sugar challenge did not increase BP in the face of marked sodium depletion, and combining sugar and salt challenges caused a synergistic BP elevation. Among examples of amplification on the clinical side, the greatest increases in BP following sugar challenges were seen in diabetic subjects having the highest sodium excretion. Interplay between table salt and common dietary sugars in BP regulation is a reasonable postulate and should be carefully considered when developing optimal prevention and treatment regimens to ameliorate the worldwide crisis arising from harmful elevated BP levels.

Salt Inactivates Endothelial Nitric Oxide Synthase in Endothelial Cells12

PubMed Central

Li, Juan; White, James; Guo, Ling; Zhao, Xiaomin; Wang, Jiafu; Smart, Eric J.; Li, Xiang-An

2009-01-01

There is a 1–4 mmol/L rise in plasma sodium concentrations in individuals with high salt intake and in patients with essential hypertension. In this study, we used 3 independent assays to determine whether such a small increase in sodium concentrations per se alters endothelial nitric oxide synthase (eNOS) function and contributes to hypertension. By directly measuring NOS activity in living bovine aortic endothelial cells, we demonstrated that a 5-mmol/L increase in salt concentration (from 137 to 142 mmol/L) caused a 25% decrease in NOS activity. Importantly, the decrease in NOS activity was in a salt concentration-dependent manner. The NOS activity was decreased by 25, 45, and 70%, with the increase of 5, 10, and 20 mmol/L of NaCl, respectively. Using Chinese hamster ovary cells stably expressing eNOS, we confirmed the inhibitory effects of salt on eNOS activity. The eNOS activity was unaffected in the presence of equal milliosmol of mannitol, which excludes an osmotic effect. Using an ex vivo aortic angiogenesis assay, we demonstrated that salt attenuated the nitric oxide (NO)-dependent proliferation of endothelial cells. By directly monitoring blood pressure changes in response to salt infusion, we found that in vivo infusion of salt induced an acute increase in blood pressure in a salt concentration-dependent manner. In conclusion, our findings demonstrated that eNOS is sensitive to changes in salt concentration. A 5-mmol/L rise in salt concentration, within the range observed in essential hypertension patients or in individuals with high salt intake, could significantly suppress eNOS activity. This salt-induced reduction in NO generation in endothelial cells may contribute to the development of hypertension. PMID:19176751

Effects of aging on mineralocorticoid-induced salt appetite in rats

PubMed Central

Beltz, Terry G.; Johnson, Alan Kim

2013-01-01

This work examined the effects of age on salt appetite measured in the form of daily saline (i.e., 0.3 M NaCl) drinking in response to administration of deoxycorticosterone acetate (DOCA; 5 mg/kg body wt) using young (4 mo), “middle-aged” adult (12 mo), and old (30 mo) male Brown Norway rats. Water and sodium intakes, excretions, and balances were determined daily. The salt appetite response was age dependent with “middle-aged” rats ingesting the most saline solution followed in order by young and then old rats. While old rats drank the least saline solution, the amounts of saline ingested still were copious and comprise an unambiguous demonstration of salt appetite in old rats. Middle-aged rats had the highest saline preference ratios of the groups under baseline conditions and throughout testing consistent with an increased avidity for sodium taste. There were age differences in renal handling of water and sodium that were consistent with a renal contribution to the greater saline intakes by middle-aged rats. There was evidence of impaired renal function in old rats, but this did not account for the reduced saline intakes of the oldest rats. PMID:24133100

Dietary soy and natto intake and cardiovascular disease mortality in Japanese adults: the Takayama study.

PubMed

Nagata, Chisato; Wada, Keiko; Tamura, Takashi; Konishi, Kie; Goto, Yuko; Koda, Sachi; Kawachi, Toshiyuki; Tsuji, Michiko; Nakamura, Kozue

2017-02-01

Whether soy intake is associated with a decreased risk of cardiovascular disease (CVD) remains unclear. A traditional Japanese soy food, natto, contains a potent fibrinolytic enzyme. However, its relation to CVD has not been studied. We aimed to examine the association of CVD mortality with the intake of natto, soy protein, and soy isoflavones in a population-based cohort study in Japan. The study included 13,355 male and 15,724 female Takayama Study participants aged ≥35 y. At recruitment in 1992, each subject was administered a validated semiquantitative food-frequency questionnaire. Deaths from CVD were ascertained over 16 y. A total of 1678 deaths from CVD including 677 stroke and 308 ischemic heart disease occurred during follow-up. The highest quartile of natto intake compared with the lowest intake was significantly associated with a decreased risk of mortality from total CVD after control for covariates: the HR was 0.75 (95% CI: 0.64, 0.88, P-trend = 0.0004). There were no significant associations between the risk of mortality from total CVD and intakes of total soy protein, total soy isoflavone, and soy protein or soy isoflavone from soy foods other than natto. The highest quartiles of total soy protein and natto intakes were significantly associated with a decreased risk of mortality from total stroke (HR = 0.75, 95% CI: 0.57, 0.99, P-trend = 0.03 and HR = 0.68, 95% CI: 0.52, 0.88, P-trend = 0.0004, respectively). The highest quartile of natto intake was also significantly associated with a decreased risk of mortality from ischemic stroke (HR = 0.67, 95% CI:0.47, 0.95, P-trend = 0.03). Data suggest that natto intake may contribute to the reduction of CVD mortality. © 2017 American Society for Nutrition.

Effect of Salt Reduction on Consumer Acceptance and Sensory Quality of Food

PubMed Central

Hoppu, Ulla; Hopia, Anu; Pohjanheimo, Terhi; Rotola-Pukkila, Minna; Mäkinen, Sari; Pihlanto, Anne

2017-01-01

Reducing salt (NaCl) intake is an important public health target. The food industry and catering services are searching for means to reduce the salt content in their products. This review focuses on options for salt reduction in foods and the sensory evaluation of salt-reduced foods. Simple salt reduction, mineral salts and flavor enhancers/modifiers (e.g., umami compounds) are common options for salt reduction. In addition, the modification of food texture and odor-taste interactions may contribute to enhanced salty taste perception. Maintaining consumer acceptance of the products is a challenge, and recent examples of the consumer perception of salt-reduced foods are presented. PMID:29186893

Stages of Behavioral Change for Reducing Sodium Intake in Korean Consumers: Comparison of Characteristics Based on Social Cognitive Theory

PubMed Central

Ahn, So-hyun; Kwon, Jong Sook; Kim, Kyungmin; Kim, Hye-Kyeong

2017-01-01

High sodium intake increases the risk of cardiovascular disease. Given the importance of behavioral changes to reducing sodium intake, this study aims to investigate the stages of change and the differences in cognitive and behavioral characteristics by stage in Korean consumers. Adult participants (N = 3892) completed a questionnaire on the stages of behavioral change, recognition of social efforts, outcome expectancy, barriers to practice, nutrition knowledge and dietary behaviors, and self-efficiency related to reduced sodium intake. The numbers of participants in each stage of behavioral change for reducing sodium intake was 29.5% in the maintenance stage, 19.5% in the action stage, and 51.0% in the preaction stage that included the precontemplation, contemplation, and preparation stages. Multiple logistic regression showed that the factors differentiating the three stages were recognizing a supportive social environment, perceived barriers to the practice of reducing sodium intake, and self-efficacy to be conscious of sodium content and to request less salt when eating out. Purchasing experience of sodium-reduced products for salty foods, knowledge of the recommended intake of salt and the difference between sodium and salt, and improving dietary habits of eating salted fish, processed food, and salty snacks were factors for being in the action stage versus the preaction stage. These findings suggest that tailored intervention according to the characteristics of each stage is helpful in reducing sodium intake. PMID:28749441

Stages of Behavioral Change for Reducing Sodium Intake in Korean Consumers: Comparison of Characteristics Based on Social Cognitive Theory.

PubMed

Ahn, So-Hyun; Kwon, Jong Sook; Kim, Kyungmin; Kim, Hye-Kyeong

2017-07-27

High sodium intake increases the risk of cardiovascular disease. Given the importance of behavioral changes to reducing sodium intake, this study aims to investigate the stages of change and the differences in cognitive and behavioral characteristics by stage in Korean consumers. Adult participants ( N = 3892) completed a questionnaire on the stages of behavioral change, recognition of social efforts, outcome expectancy, barriers to practice, nutrition knowledge and dietary behaviors, and self-efficiency related to reduced sodium intake. The numbers of participants in each stage of behavioral change for reducing sodium intake was 29.5% in the maintenance stage, 19.5% in the action stage, and 51.0% in the preaction stage that included the precontemplation, contemplation, and preparation stages. Multiple logistic regression showed that the factors differentiating the three stages were recognizing a supportive social environment, perceived barriers to the practice of reducing sodium intake, and self-efficacy to be conscious of sodium content and to request less salt when eating out. Purchasing experience of sodium-reduced products for salty foods, knowledge of the recommended intake of salt and the difference between sodium and salt, and improving dietary habits of eating salted fish, processed food, and salty snacks were factors for being in the action stage versus the preaction stage. These findings suggest that tailored intervention according to the characteristics of each stage is helpful in reducing sodium intake.

High salt intake shifts the mechanisms of flow-induced dilation in the middle cerebral arteries of Sprague-Dawley rats.

PubMed

Matic, Anita; Jukic, Ivana; Stupin, Ana; Baric, Lidija; Mihaljevic, Zrinka; Unfirer, Sanela; Tartaro Bujak, Ivana; Mihaljevic, Branka; Lombard, Julian H; Drenjancevic, Ines

2018-06-15

The goal of this study was to examine the effect of 1-week of high salt (HS) intake and the role of oxidative stress in changing the mechanisms of flow-induced dilation (FID) in isolated pressurized middle cerebral arteries (MCA) of male Sprague-Dawley rats (N=15-16/per group). Reduced FID in the HS group was restored by intake of the superoxide scavenger TEMPOL (HS+TEMPOL in vivo group). Nitric oxide synthases (NOS) inhibitor N ω -nitro-L-arginine methyl ester (L-NAME), COX inhibitor indomethacin (INDO) and selective inhibitor of microsomal CYP450 epoxidase activity N-(methylsulfonyl)-2-(2-propynyloxy)-benzenehexanamide (MS-PPOH) significantly reduced FID in the LS group, while FID in the HS group was mediated by NO only. COX-2 mRNA (but not protein) expression was decreased in the HS and HS+TEMPOL in vivo groups. HIF-1α and VEGF protein levels were increased in the HS group but decreased in the HS+TEMPOL in vivo group. Assessment by direct fluorescence of MCA under flow revealed significantly reduced vascular NO levels and increased superoxide/reactive oxygen species levels in the HS group. These results suggest that HS intake impairs FID and changes FID mechanisms to entirely NO-dependent, in contrast to the LS group where FID is NO, prostanoid and epoxyeicosatrienoic acids (EET's) dependent. Those changes were accompanied by increased lipid peroxidation products in the plasma of HS-fed rats, increased vascular superoxide/reactive oxygen species levels and decreased NO levels; together with increased expression of HIF-1α and VEGF.

Supplementation with Ca salts of soybean oil interacts with concentrate level in grazing dairy cows: intake, ingestive behavior, and ruminal parameters.