Excessive Dietary Sodium Intake Research Articles

The Association of Urinary Sodium Excretion with Glaucoma and Related Traits in a Large United Kingdom Population

Excessive dietary sodium intake has known adverse effects on intravascular fluid volume and systemic blood pressure, which may influence intraocular pressure (IOP) and glaucoma risk. This study aimed to assess the association of urinary sodium excretion, a biomarker of dietary intake, with glaucoma and related traits, and determine whether this relationship is modified by genetic susceptibility to disease. Cross-sectional observational and gene-environment interaction analyses in the population-based UK Biobank study. Up to 103 634 individuals (mean age: 57 years; 51% women) with complete urinary, ocular, and covariable data. Urine sodium:creatinine ratio (UNa:Cr; mmol:mmol) was calculated from a midstream urine sample. Ocular parameters were measured as part of a comprehensive eye examination, and glaucoma case ascertainment was through a combination of self-report and linked national hospital records. Genetic susceptibility to glaucoma was calculated based on a glaucoma polygenic risk score comprising 2673 common genetic variants. Multivariable linear and logistic regression, adjusted for key sociodemographic, medical, anthropometric, and lifestyle factors, were used to model associations and gene-environment interactions. Corneal-compensated IOP, OCT derived macular retinal nerve fiber layer and ganglion cell-inner plexiform layer (GCIPL) thickness, and prevalent glaucoma. In maximally adjusted regression models, a 1 standard deviation increase in UNa:Cr was associated with higher IOP (0.14 mmHg; 95% confidence interval [CI], 0.12-0.17; P<0.001) and greater prevalence of glaucoma (odds ratio, 1.11; 95% CI, 1.07-1.14; P<0.001) but not macular retinal nerve fiber layer or ganglion cell-inner plexiform layer thickness. Compared with those with UNa:Cr in the lowest quintile, those in the highest quintile had significantly higher IOP (0.45 mmHg; 95% CI, 0.36-0.53, P<0.001) and prevalence of glaucoma (odds ratio, 1.30; 95% CI, 1.17-1.45; P<0.001). Stronger associations with glaucoma (P interaction=0.001) were noted in participants with a higher glaucoma polygenic risk score. Urinary sodium excretion, a biomarker of dietary intake, may represent an important modifiable risk factor for glaucoma, especially in individuals at high underlying genetic risk. These findings warrant further investigation because they may have important clinical and public health implications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines.

Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension-potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.

Excessive dietary sodium intake augments long-term risk of atrial fibrillation in older adults with hyperglycemia: A community-based prospective cohort study

AimStudies investigating the association between sodium intake and new-onset atrial fibrillation (AF) have come to controversial results. This study aimed to assess the effect of excessive sodium intake on new-onset AF in individuals with hyperglycemia. MethodsBetween April 2007 and November 2011, 2841 community-dwelling individuals aged 60 years and older were recruited from the Shandong area, China. Dietary sodium intake was estimated using 24-hour urine collection within seven consecutive days. Fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) were assessed. New-onset AF was diagnosed using ICD-10 with codes I48 (I48.0 – I48.9) during follow-up. ResultsThe findings were that excessive sodium intake significantly and independently increased the risk of new-onset AF in older adults with hyperglycemia: hazard ratio (HR) 1.525 [95% confidence interval 1.147;2.029] adjusted P = 0.004. The risk of new-onset AF increased by 29.3% (HR 1.293 [1.108;1.509] adjusted P = 0.001) with a one-standard deviation increase in sodium intake. Excessive sodium intake synergistically interacted with hyperglycemia on the increased risk of new-onset AF (HR 1.599 [1.342;1.905] adjusted P < 0.001 for FPG and HR 1.516 [1.271;1.808] adjusted P < 0.001 for HbA1c). ConclusionOur findings indicate that excessive sodium intake independently enhances the risk of new-onset AF among patients with hyperglycemia. A sodium-restricted diet may perhaps result in a multiplier effect on reducing the risk of new-onset AF.

Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action.

The positive association between excessive dietary sodium intake, hypertension, and cardiovascular disease (CVD) has been widely investigated in observational studies and clinical trials. Reducing sodium intake is a proven strategy to prevent hypertension and the onset of CVD, a major cause of morbidity and mortality globally. Africa has the youngest population globally, which is key to the continent's sustainable development. However, in Africa, the epidemics of hypertension and CVD negatively impact life expectancy and economic growth. Ghana, like other African countries, is no exception. The factors contributing to the increasing burden of CVD and excessive sodium consumption are multi-faceted and multi-level, including individual lifestyle, neighborhood and built environments, and socio-economic and health policies. Thus, the implementation of evidence-based interventions such as the World Health Organization Best Buys that target the multi-level determinants of sodium consumption is urgently needed in Ghana and other African countries. The aim of this commentary is to highlight factors that contribute to excessive sodium consumption. Second, the commentary will showcase lessons of successful implementation of sodium reduction interventions in other countries. Such lessons may help avert CVD in young adults in Ghana and Africa.

A2AR-mediated lymphangiogenesis via VEGFR2 signaling prevents salt-sensitive hypertension.

Excess dietary sodium intake and retention lead to hypertension. Impaired dermal lymphangiogenesis and lymphatic dysfunction-mediated sodium and fluid imbalance are pathological mechanisms. The adenosine A2A receptor (A2AR) is expressed in lymphatic endothelial cells (LECs), while the roles and mechanisms of LEC-A2AR in skin lymphangiogenesis during salt-induced hypertension are not clear. The expression of LEC-A2AR correlated with lymphatic vessel density in both high-salt diet (HSD)-induced hypertensive mice and hypertensive patients. Lymphatic endothelial cell-specific A2AR knockout mice fed HSD exhibited 17 ± 2% increase in blood pressure and 17 ± 3% increase in Na+ content associated with decreased lymphatic density (-19 ± 2%) compared with HSD-WT mice. A2AR activation by agonist CGS21680 increased lymphatic capillary density and decreased blood pressure in HSD-WT mice. Furthermore, this A2AR agonist activated MSK1 directly to promote VEGFR2 activation and endocytosis independently of VEGF as assessed by phosphoprotein profiling and immunoprecipitation assays in LECs. VEGFR2 kinase activity inhibitor fruquintinib or VEGFR2 knockout in LECs but not VEGF-neutralizing antibody bevacizumab suppressed A2AR activation-mediated decrease in blood pressure. Immunostaining revealed phosphorylated VEGFR2 and MSK1 expression in the LECs were positively correlated with skin lymphatic vessel density and A2AR level in hypertensive patients. The study highlights a novel A2AR-mediated VEGF-independent activation of VEGFR2 signaling in dermal lymphangiogenesis and sodium balance, which might be a potential therapeutic target in salt-sensitive hypertension.

Association between Eating Habits and Sodium Intake among Chinese University Students.

(1) Background: Insufficient evidence exists regarding the dietary habits that may contribute to high sodium intake among college students in China. This cross-sectional study aimed to investigate the dietary sodium intake of college students in Hunan and its association with their dietary habits. (2) Methods: In total, 585 university students from Hunan were recruited for this study. The sodium Food Frequency Questionnaire (sodium-FFQ) and dietary habits were assessed. (3) Results: Excluding cooking salt and high-sodium seasonings, the daily dietary sodium intake among college students in Changsha, Hunan Province, was 1183.74 (563.38, 2054.86) mg/day. A vast majority (89%) of college students reported eating outside of school at least once a week, and approximately one-third (34%) ordered takeaways at least once a week. After adjusting for confounding factors, the associations between the frequency of eating out and ordering takeaways with college students' sodium intake remained significant. (4) Conclusions: The findings indicate that excessive dietary sodium intake among college students in Hunan is a growing concern. College students who frequently eat out and order takeaways tend to have a higher sodium intake. Future research should focus on identifying the main sources of dietary sodium and developing interventions that promote healthy dietary habits among college students.

S-36-2: SOCIAL FRAMEWORK TO PROMOTE SALT REDUCTION AND HEALTHY DIETS WITHIN HYPERTENSION AND STROKE PREVENTION

Beyond the physiological effects of sodium and potassium strong evidence from animal, clinical and epidemiological studies, has implicated excess dietary sodium and low potassium intake as major factors associated with the development of hypertension and increase in stroke risk. Daily salt intake of 5–6 g 85–100 mmol was recommended for the general population i.e. 2.0–2.4 g Na along with K intake to at least 90 mmol d 3.51 g perd. Randomized trials demonstrate that salt reduction and potassium increase in diet lowers blood pressure and reduces the risk of brain damage and cardiovascular disease. Population studies showed that 15 percent reduction of salt intake from 9.5 g/day was associated with a 40 percent reduction of stroke and CHD mortality. Potassium lowers BP via multiple mechanisms, by acting directly on the vasculature and by triggering a signalling cascade mediated by endothelium and also reduces salt-sensitivity. A meta-analysis of 21 RCTs reported that increasing potassium intake lowers BP 3.5/2.0 mm Hg and the risk of stroke. Eating more than 11 g of salt /day was associated with 2.5 times more likely to have a stroke than those who got less than 4.5 g /day. Switching from regular salt to a salt substitute reduced the risk for stroke, major CV events and death in a large trial of adults in rural China with a history of stroke or high risk for stroke. High salt intake reduces resting cerebral blood flow and induces endothelial dysfunction in mice and impairs vasodilatory responses of cerebral vessels. Gut-brain relation links dietary salt to cognitive impairment though a gut-initiated adaptative immune response damaging brain function via increase in circulating IL-17. A high potassium diet reduces cerebral infact size and improves vascular function independently of BP changes. Thus high salt and low potassium intake interfere in multtiple brain vascular strutural complex processes including fluid homeostasis and inflammatory mechanisms, immune responses and gut-microbiome-brain axis.

S-54-1: SUBSTITUTING THE WORLDS SALT SUPPLY

The adverse effects of excess dietary sodium intake on blood pressure levels are well-established. On average the world eats dietary sodium, mostly in the form of salt, at twice the level recommended by the World Health Organization and five times the level consumed during a million years of hominid evolution. At the same time, average dietary potassium intake is below recommended intake levels in many populations, and inadequate potassium intake is also associated with high blood pressure. Potassium-enriched salt substitute, in which some of the sodium chloride is replaced with potassium chloride, was first showed to lower blood pressure more than a decade ago. Most recently, in 2021, the Salt Substitute and Stroke Study showed that potassium-enriched salt can also reduce the risks of stroke (rate ratio 14%; p = 0.006), major cardiovascular events (13%; p &lt; 0.001) and premature death (12%; p &lt; 0.001). This large-scale randomised trial done amongst 21,000 individuals followed for 5 years also showed that these benefits were achieved without harm, and in particular, with no evidence of hyperkalemia (rate ratio 1.04; p = 0.76). Potassium-enriched salts are a pragmatic means of reducing dietary sodium intake and supplementing dietary potassium intake in parallel. Unlike many other sodium reduction strategies, they are easy to implement because potassium-enriched salt can be used in just the same way as regular salt. This provided for excellent adherence in the Salt Substitute and Stroke Study, with 93% of participants still using the salt substitute at the end of the study. The potential health gains from a switch to potassium-enriched salt are very large. Modelling done for China indicates that about 1 million strokes and heart attacks could be prevented each year if the switch was made nationwide. Several million more events might be averted if implementation was global. Another key feature of potassium-enriched salt is that it can be provided at low cost. While on average about twice as expensive as regular salt, potassium-enriched salt has a median price of less than $3 per kilogram in low- and middle-income countries. Over the last 50 years, the fight against iodine deficiency disorders has seen the global salt supply switched from salt to iodized salt. It is now time to make a second switch from iodized salt to iodized and potassium-enriched salt to also prevent blood pressure related diseases.

Prevalence of Hypertension in Policemen in Greyhounds Visakhapatnam, Andhra Pradesh, India

BACKGROUND&#x0D; Hypertension, an elevated blood pressure of systolic /diastolic, is a serious medical condition and is a "silent killer" which increases the risks of heart disease, brain stroke, renal diseases etc. The WHO estimate is that 45% of deaths from heart disease and 51% of deaths from stroke worldwide are caused by hypertension. Policemen working in Greyhounds are having one of the most stressful occupations; hypertension is highly prevalent in this population, because their job is task-oriented, stressful duties and combing operations in naxalite areas. Some of the policemen habituated to unhealthy habits like smoking, consumption of alcohol and irregular dietary pattern. The contributory factors like obesity, excessive dietary sodium intake, and low physical activity, family history of hypertension increase BMI. The prevalence of hypertension observed among Greyhounds policemen is 39.6%, which is significantly higher than previous studies of hypertension in policemen. Hypertension can be prevented by adopting healthy lifestyle modifications, periodical check-ups, timely diagnosis and treatment. In this study, we wanted to find out the prevalence of hypertension in the policemen randomly selected in greyhounds Visakhapatnam.&#x0D; METHODS&#x0D; A cross-sectional study of total of 124 police men randomly selected greyhounds Visakhapatnam, the age ranged from 18 to 60 years. Data were collected using sphygmomanometer, body mass analyser (In Body 570), semi-structured interview schedule, and analysed in EXCEL using SPSS version 21.0.&#x0D; RESULTS&#x0D; Among 124 participants, 49 (39.6%) participants were found to be hypertensive. Increasing age, family history, smoking, higher BMI, presence of diabetes were the significant factors associated with hypertension among study subjects.&#x0D; CONCLUSIONS&#x0D; Hypertension in policemen emerged as an important health problem. Therefore, it is the need of the hour to devise a sound screening strategy to diagnose and treat hypertension among policemen. Devise a comprehensive strategy for the management of HTN.

241 The association between sodium intake and atopic dermatitis in a US population-based cohort

Diet may be an important environmental factor driving the onset and persistence of atopic dermatitis. Recent evidence showing that most of the body’s exchangeable sodium is stored in the skin and that high sodium environments trigger and perpetuate local immune dysregulation support the hypothesis that excessive dietary sodium intake could be associated with atopic dermatitis. We aimed to investigate this hypothesis using data from 13,183 children and adults in the 1999-2000, 2001-2002, and 2003-2004 cycles of the National Health and Nutrition Examination Survey, which included validated dietary intake questionnaires and questions about participants’ history of dermatitis, eczema, or rash.

Microbial Safety and Sensory Analyses of Cold-Smoked Salmon Produced with Sodium-Reduced Mineral Salts and Organic Acid Salts.

Cold-smoked (CS) salmon contains high levels of sodium salts, and excess dietary sodium intake is associated with an array of health complications. CS salmon may also represent a food safety risk due to possible presence and growth of the foodborne pathogen Listeria monocytogenes which may cause fatal human infections. Here we determine how reformulated CS salmon using commercial sodium-reduced salt replacers containing KCl (e.g., Nutek, Smart Salt, SOLO-LITE) and acetate-based preservative salts (Provian K, proviant NDV) affect sensory properties, quality, and microbial safety. Initial sensory screening of sodium-reduced CS salmon was followed by L. monocytogenes growth analyses in selected variants of reformulated CS salmon, and finally by analyses of CS salmon variants produced in an industrial smokehouse. Projective mapping indicated overall minor sensory changes in sodium-replaced samples compared with a conventional product with NaCl. Growth of L. monocytogenes was temperature-dependent (4 °C vs. 8 °C storage) with similar growth in sodium-reduced and conventional CS salmon. The addition of 0.9% of the preservative salts Provian K or Provian NDV gave up to 4 log lower L. monocytogenes counts in both sodium-reduced and conventional cold-smoked salmon after 29 days of chilled storage. No changes in pH (range 6.20–6.33), aw levels (range 0.960–0.973), or weight yield (96.8 ± 0.2%) were evident in CS salmon with salt replacers or Provian preservative salts. Analyses of CS salmon produced with selected mineral salt and preservative salt combinations in an industrial salmon smokery indicated marginal differences in sensory properties. Samples with the preservative salt Provian NDV provided L. monocytogenes growth inhibition and low-level total viable counts (<2.8 log/g) dominated by Photobacterium and Carnobacterium during storage. Production of sodium-reduced CS salmon with inhibiting salts provides a simple method to achieve a healthier food product with increased food safety.

Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study.

Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.

Locked on salt? Excessive consumption of high-sodium foods during COVID-19 presents an underappreciated public health risk: a review.

Abrupt changes in food preferences and eating habits have induced an overlooked health risk during the coronavirus disease pandemic (COVID-19). Indeed, emerging evidence points to a major shift to consumption of high-sodium foods during the pandemic lockdowns in the population from different countries and cultures. High-sodium foods have sodium contents exceeding 500 mg per 100 g, and many processed and preserved foods fall into this category. Excessive dietary sodium intake is associated with chronic diseases including hypertension, cardiovascular diseases, and kidney diseases, and thus poses confounding risks during the pandemic. Here, we review food categories in consumers’ shopping lists and food parcels delivered to people who needed assistance during the pandemic, when frozen meals, canned foods, instant foods, snacks, and other high-sodium foods gained substantial popularity. Such change in consumers’ behavior is driven by several factors: the perceived risk of viral infection in grocery shopping trips, limited supplies and inflated prices of fresh produce, preference on foods with long shelf lives, and emotional eating. Moreover, the general low awareness of sodium contents in food has contributed to the increased consumption of high-sodium foods during the pandemic. We also discuss the possible effects on COVID-19 infection and severity caused by excessive sodium intake. We conclude that the public should be educated to maintain a healthy sodium intake during the pandemic, and measures should be adopted by governments and private donors in procuring food parcels with more balanced sodium contents to lower the risks of prolonged and excessive sodium intakes in the vulnerable population.

Knowledge, perception, and practice related to sodium intake among Malaysian adults: findings from the Malaysian Community Salt Study (MyCoSS)

BackgroundExcessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake.MethodsData were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis.ResultsMajority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05).ConclusionThe absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

Locked on Salt? Increased Consumption of High Sodium Foods During COVID-19 Presents an Underappreciated Public Health Risk

Abrupt changes in food preferences and eating habits pose an overlooked public health risk during the coronavirus disease (COVID-19) pandemic. Emerging evidence suggests an ongoing, population-level shift to consumption of high-sodium foods, during COVID-19 and lockdowns, in the general population surveyed in different countries and cultures. High-sodium foods are defined as those with sodium contents exceeding 500 mg per 100 g, and many processed and preserved foods fall into this particular category. Excessive dietary sodium intake is associated with chronic diseases including hypertension, cardiovascular diseases, and kidney diseases, and poses confounding risks during COVID-19. Here, we review food categories in consumers’ shopping lists and food parcels delivered to those who need assistance during the current pandemic, when frozen meals, canned foods, instant foods, snacks, and other high-sodium foods gained substantial popularity. Such emerging trends in consumers’ behavior are driven by a multitude of factors. Specifically, the perceived risk of COVID-19 infection in grocery shopping trips, limited supplies and inflated prices of fresh produce, preference on foods with long shelf lives, emotional eating, and the general low awareness of sodium contents in food have all contributed to the increased consumption of high-sodium foods during COVID-19. We also discuss the possible effects on COVID-19 infection and severity caused by excessive sodium intake, by reviewing current reports and hypotheses examining their relations. In light of the evidence, it is advisable to educate the public to maintain a healthy sodium intake during the current pandemic, and measures could be adopted by governments and private donors in procuring food parcels with more balanced sodium contents to lower the risks of prolonged and excessive sodium intakes in vulnerable population groups.

Methods of dietary sodium estimation

Excessive dietary sodium intake is found to be associated with high blood pressure and its consequences such as cardiovascular disease and stroke. Daily sodium intake is found to vary from place to place as it is dependent on geography, ethnicity, socioeconomic factors, etc. In this review, we summarize the various methods of assessment of daily sodium intake such as dietary estimation methods using 24-h dietary recall, food frequency questionnaire and diet record, and biochemical methods using 24-h urine sodium or spot urine sodium estimation. Daily sodium intake estimated with spot urine sodium is dependent on the equation used to convert spot urine sodium to 24-h urine sodium. To identify the appropriate equation, validation studies need to be conducted. Population level sodium intake and it's monitoring is important for reduction of noncommunicable diseases.

Impaired NCC Activity and Regulation on Dietary High Dietary Salt Intake in Aged Sprague Dawley Rats Is Associated with Increased Salt Sensitivity of Blood Pressure

BackgroundHypertension (HTN) is one of the leading causes of death worldwide and its prevalence increases with age. Studies revealed that enhanced global sympathetic tone is related to increases in blood pressure (BP) in aged human subjects. Dietary sodium intake is associated with the regulation of blood pressure, as increased sodium retention is a well‐established precursor of hypertension risk. An excessive dietary sodium intake leads to increases in BP in individuals that demonstrate the salt sensitivity of BP and evoke the development of salt sensitive HTN (SSH). Recent studies have demonstrated that excessive release of norepinephrine by increased sympathetic nerve activity upregulates renal sodium chloride cotransporter (NCC) activity to promote sodium reabsorption. However, the underlying mechanisms of the regulation of sodium homeostasis and blood pressure in response to increase in sympathetic tone with age remain unclear.HypothesisNCC‐mediated sodium retention driven by increased sympathetic tone with age contributes to age‐related HTN. Furthermore, the activity and regulation of NCC are impaired on a high salt (HS) diet and this impaired NCC activity and regulation drives the development of age‐dependent SSH.MethodsThree different age groups (3, 8, 16 month old (MO)) of male Sprague‐Dawley (SD) rats were fed a normal salt (NS; 0.6% NaCl) or HS (4% NaCl) diet for 21 days respectively. On day 21, basal MAP, NCC activity (peak natriuresis to IV hydrochlorothiazide (2mg/kg) infusion), and vascular sympathetic tone (peak MAP change in response to ganglionic blockade (IV hexamethonium; 30mg/kg)) were measured in vivo. Plasma and renal NE concentrations were also assessed via ELISA. The expression of total NCC, phosphorylated NCC, with‐no‐lysine [K] kinases (WNK) 1, WNK4, STE20/SPS1‐related proline‐alanine‐rich protein kinase (SPAK), oxidative stress responsive kinase 1 (OxSR1), and phosphorylated SPAK/OxSR1 were assessed via immunoblotting (N=6/gp).ResultsFirst, 3MO SD rats are normotensive in both diet groups and show dietary sodium‐evoked suppression of NCC activity, expression, and phosphorylation and upstream regulatory kinases including WNK1, SPAK, and OxSR1 on a HS diet relative to a NS diet. Second, SD rats show age‐dependent HTN, increases in renal sympathetic tone, NCC activity and expression, and WNK1 expression. Last, SD rats show aged‐dependent SSH, increased sympathetic tone, and impaired suppression of NCC activity, phosphorylation, and the expression of kinases SPAK and OxSR1.ConclusionSD rats show age‐dependent HTN that is coupled with increases in sympathetic tone, NCC activity and expression, which strongly suggests that the NCC contributes to the development of age‐dependent HTN. Moreover, the NCC may play a pivotal role in the development of age‐dependent SSH as aged SD rats show impaired dietary‐sodium evoked suppression of NCC activity and regulation. Collectively, these findings suggest that increased sympathetic tone may drive NCC activity that evokes age‐dependent HTN and SSH. MO, month old; NS, 0.6% NaCl; HS, 4% NaCl. Variables 3 MO 8 MO 16 MO NS HS NS HS NS HS MAP (mmHg) 124 ± 2 126 ± 3 135 ± 4 # 143 ± 5 # 149 ± 3 # † 169 ± 1 * # † ΔUNaV to HCTZ (μeq/min) 9 ± 1 7 ± 1 * 18 ± 2 # 16 ± 1 # 15 ± 5 # 16 ± 6 # Plasma NE (nmol/L) 44 ± 4 28 ± 4 * 55 ± 3 # 42 ± 4 * # 54 ± 4 # 41 ± 4 * # Renal NE (pg/mg) 612 ± 36 368 ± 32 * 835 ± 48 # 722 ± 44 * # 974 ± 13 # † 1019 ± 134 # † ΔMAP to hexamethonium (mmHg) −33 ± 4 −24 ± 3 * −64 ± 5 # −65 ± 6 # −60 ± 3 # −67 ± 7 # Total NCC expression (fold change) 1.00 ± 0.22 0.32 ± 0.09 * 1.91 ± 0.25 # 1.13 ± 0.15 * # 1.82 ± 0.23 # 0.75 ± 0.11 * Total pNCCT53 expression (fold change) 1.00 ± 0.20 0.19 ± 0.05 * 1.24 ± 0.46 0.87 ± 0.22 0.49 ± 0.18 1.73 ± 0.22 * # WNK1 expression (fold change) 1.00 ± 0.20 0.49 ± 0.06 * 1.07 ± 0.34 1.36 ± 0.15 2.15 ± 0.38 # † 1.60 ± 0.29 # WNK4 expression (fold change) 1.00 ± 0.11 0.86 ± 0.07 1.95 ± 0.14 # 1.28 ± 0.10 # 1.05 ± 0.07 † 1.17 ± 0.09 SPAK expression (fold change) 1.00 ± 0.12 0.48 ± 0.09 * 1.25 ± 0.09 1.30 ± 0.23 # 0.42 ± 0.04 # † 0.41 ± 0.13 † OxSR1 expression (fold change) 1.00 ± 0.12 0.62 ± 0.05 * 1.09 ± 0.12 1.10 ± 0.06 # 1.19 ± 0.20 1.17 ± 0.08 # pSPAK/OxSR1 expression (fold change) 1.00 ± 0.24 0.84 ± 0.30 0.55 ± 0.23 1.42 ±0.24 * 1.12 ± 0.17 2.86 ± 0.43 * # † *p&lt;0.05 vs. respective NS group; #p&lt;0.05 vs. respective 3 MO group; † p&lt;0.05 vs. respective 8 MO group.

Potassium Intake in Austrian Adults

AbstractIntroductionBeing the predominant osmotically active element inside cells, potassium is a central regulator of the osmotic balance and the electrochemical membrane potential. As such, it has an effect on blood pressure and therefore counteracts the effects of excess dietary sodium intake. Furthermore, potassium affects glucose homeostasis by influencing insulin secretion from the pancreatic β-cells. Due to the health-promoting effects of potassium, the German-speaking countries have recently updated the reference values for potassium. The revised estimates of adequate potassium intake are 4000 mg/d instead of previously recommended 2000 mg/d. However, a typical Western diet on average contains less potassium and more sodium.Materials and methodsThe presented data were collected within the Austrian Study on Nutrition 2014/2016, a regularly conducted representative cross-sectional survey to monitor food consumption in Austria. Altogether, data from 2129 adults aged between 18 and 64 years were included in the analysis. In the course of two years, and thus with the consideration of seasonal variations, the survey was conducted on the basis of two non-consecutive 24 hour recalls in accordance with the guidelines of the European Food Safety Authority (EFSA). The survey was approved by the Ethical Committee of the University of Vienna (reference number: 00284).ResultsAfter exclusion of misreporters the final sample consisted of 2018 individuals, of which 1282 (63.5%) were women. The mean age was 38.8 ± 11.9 years.Median dietary potassium intake was 2783 mg/d (IQR: 1245). Men had a higher median intake than women (3018 mg/d (IQR: 1303) vs. 2546 mg/d (IQR: 1112), p &lt; 0.001). Significant differences between sexes existed in all age groups (p &lt; 0.001). However, there was no significant correlation between age and dietary potassium intake.The estimates of adequate potassium intake of 4000 mg/d (DGE et al., 2017) were met by only 13.3% of the participants, 7.4% of women and 19.2% of men. Moreover, only 479 participants (23.8%, 16.7% of women and 30.9% of men) had intakes equal to or above 3500 mg/d, the adequate intake established by EFSA (2016).DiscussionOur data show that potassium intake has to be improved in all gender and age groups by increasing the consumption of potassium-rich foods. However, since the estimates of adequate potassium intake have doubled recently, it seems even more difficult to achieve these recommendations in daily food routine.

P4540Obesity in patients with heart failure and without diabetes mellitus is associated with longer event-free survival only among those with high dietary sodium intake

Abstract Background Obesity is paradoxically associated with better short- and long-term outcomes in patients with heart failure (HF) and without diabetes mellitus (DM). While excessive dietary sodium intake is common among obese persons, its impact on the association between obesity and outcomes has not been considered. Aim To determine whether dietary sodium intake levels would affect the association between obesity and better outcomes in patients with HF and without DM. Method A sample of 129 patients (age 60±12.4 years; 30% female) provided a single 24-hour urine collection sample to estimate dietary sodium intake. Patients were divided into 4 groups based on body mass index (BMI) and the sodium intake recommendation for HF of 3g/day (obese with high sodium intake [n=41; 32%], obese with low sodium intake [n=16; 12%], non-obese with high sodium intake [n=35; 27%], and non-obese with low sodium intake [n=37; 29%]). Patients were followed-up during an average period of 395 days to determine time to first event of all-cause hospitalization or death. Cox regression was used to determine the association between obesity and outcomes in the context of sodium intake after controlling for age, gender, NYHA class (I II vs. III IV) and LVEF. Results There were 41 patients (31.8%) who had an event of all-cause hospitalization or death. Obese patients with high sodium intake had 61% lower risk for events than those non-obese with low dietary sodium intake (figure). There were no differences in the event-free survival among other groups. Conclusion These data suggest that dietary sodium intake may be particularly important for obese patients with HF and without DM.

Renin-angiotensin System (RAS)-mediated Antiobesity and Antihypertensive Effects of Korean Traditional Soybean Paste (Doenjang) in Rat Model of Diet-induced Obesity (P08-097-19)

ObjectivesHypertension is becoming more prevalent and one of the main cause is found in the increase of excessive dietary sodium intake. It is also risk factors for cardiovascular and kidney disease. Korean Traditional Fermented Food, doenjang, is made with high salt, so many of them are thinking that there is a lot of relation to hypertension despite reporting many health benefits. Our previous studies reported that doenjang have been associated effect of anti-obesity in human and animal study. Therefore, we expected that doenjang may have different effects on blood pressure and lipid metabolism compared to same concentrations of salt. MethodsIn this study, Sprague-Dawley rats divided into four groups, normal diet (ND), high fat diet (HD), high fat diet with 8% table salt (HDS), high fat diet with Doenjang contains 8% table salt (HDJ) for 13 weeks. The systolic blood pressure (SBP), serum chemistry, Na+ and K+ concentrations, liver and renal gene expressions were measured. ResultsDoenjang decreased systolic blood pressure (SBP), body weight and hepatic lipids. Serum chemistry, leptin and aldosterone levels were increased in HD and HDS groups while decreased in HDJ group. Results from analysing feces and urine, Na+, Ca+ and K+concentrations were changed by Doenjang. Furthermore, fatty acid synthesis-related genes expression was decreased in liver and downregulated the renin, AT1 receptor and ACE in renal cortex of doenjang treatment group. ConclusionsThese results suggest that doenjang may have anti-obesity and anti-hypertension through regulation of the renin angiotensin system. We believed that it is an important result of demonstrating that doenjang has health benefits regardless of salt content. Funding SourcesThis work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government (MEST) (No. 2018R1A2B6006477).