Excessive Sodium Intake Research Articles

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021.

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6– 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

Experiences of Disease Adaptation in Patients With Heart Failure: A Qualitative Study.

This study aimed to explore the experiences of adaptation in heart failure (HF) patients according to the Roy adaptation model. A qualitative study was conducted between December 2020 and March 2021 in China. A total of 21 patients with HF were recruited at of two general hospitals. Semi structured face-to-face interviews were conducted with each participant. NVivo 11 was used to encode the transcription and thematic analysis was preformed to analyze the transcripts. Eleven minor themes emerged from the data, namely unbalanced nutrition, inappropriate activities, unrestricted liquid intake, excessive sodium intake, worrying about the future, negative emotions, poor spiritual aspect, unable to fulfill social roles, forced to stop work, interpersonal alienation, and less communication with friends or family. Most participants with HF experienced poor disease adaptation. The themes that emerged offer a new perspective on the experiences of disease adaptation in patients with HF.

Sodium and Potassium Dysregulation in the Patient With Cancer.

Sodium and potassium disorders are pervasive in patients with cancer. The causes of these abnormalities are wide-ranging, are often primary or second-order consequences of the underlying cancer, and have prognostic implications. The approach to hyponatremia should focus on cancer-related etiologies, such as syndrome of inappropriate antidiuretic hormone, to the exclusion of other causes. Hypernatremia in non-iatrogenic forms is generally due to water loss rather than excessive sodium intake. Debilitated or dependent patients with cancer are particularly vulnerable to hypernatremia. Hypokalemia can occur in patients with cancer due to gastrointestinal disturbances, resulting from decreased intake or increased losses. Renal losses can occur as a result of excessive mineralocorticoid secretion or therapy-related nephrotoxicity. The approach to hyperkalemia should be informed by historical and laboratory clues, and pseudohyperkalemia is particularly common in patients with hematological cancers. Hyperkalemia can be seen in primary or metastatic disease that interrupts the adrenal axis. It can also develop as a consequence of immunotherapy, which can cause adrenalitis or hypophysitis. Tumor lysis syndrome (TLS) is defined by the development of hyperkalemia and is a medical emergency. Awareness of the electrolyte abnormalities that can befall patients with cancer is vital for its prompt recognition and management.

Predicting the effectiveness of interventions on population-level sodium reduction: A simulation modeling study.

Background and AimsInterventions that significantly reduce dietary sodium intake are anticipated to decrease gastric cancer (GCa) burden. However, the optimal restriction strategies remain unknown at present. This study aims to understand where and to what extent policies modifying sodium consumption change the distribution of GCa burden, and the effects of potential salt reduction strategies in China.MethodsThe synthetic population in this microscopic simulation study is close to reality. We incorporated estimates of dietary patterns and GCa risk into the model of excess salt consumption. These estimates and simulated population were obtained from the China Health and Nutrition Survey, Global Burden of Disease Project, and the sixth census of China's National Bureau of Statistics, respectively.ResultsIn the no intervention scenario, we estimated that disease burdens due to excess sodium intake would be at 472.9 million disability‐adjusted life years (DALYs) nationally between 2010 and 2030 (95% credible interval [CrI]: 371.1–567.7). The GCa burden caused by high sodium is projected to have a disproportionate impact on the central and southern provinces of China (9.2 and 4.5 million DALYs, respectively). Implementing a cooking salt substitute strategy would be expected to avoid a larger portion of GCa burden (about 67.2%, 95% CrI: 66.8%–67.6%) than the salt‐restriction spoon program (about 16.7%, 95% CrI: 16.1%–17.4%).ConclusionDietary salt reduction policy is very powerfully effective in reducing the GCa burden overall. It is expected that proposed salt substitutes are more effective than traditional salt‐restriction spoons to avoid increased inequality.

Exploring the norms of eating-out practice among adults in Malaysia

Introduction: Eating-out is common in almost all countries, including Malaysia, but this frequent practice may affect human health. In Malaysia, data on eating-out is limited. This study aimed to assess the proportion of eating-out, to assess the association between socio-demographic factors and eating patterns, and to compare energy and nutrient intakes between people eating-out and eating-in. Methods: This cross-sectional study was conducted among 100 adults aged 30 to 70 years old. Three-day food diaries were used to collect data on dietary intake. Eating-out was defined as eating foods prepared outside the home. Respondents who ate outside for at least one meal per day, for two or three days per week were considered as those who frequently practised eating-out. Results: A total of 84% of respondents who ate out had significantly higher sodium intake than those who ate at home (2934 mg/day vs. 2165 mg/day, p=0.025). Foods and drinks that were most commonly consumed outside were nasi lemak, roti canai, rice, ayam masak kicap, vegetable soup, tomyam, rice vermicelli soup (mee-hoon soup), hot teh-o, iced tea, and orange juice. Occupation (p=0.004) and location type (p=0.001) were associated with eatingout. Government and semi-government workers (61%) and urban population (57%) had higher percentage of eating-out compared to eating at home (19% and 12%, respectively). Conclusion: More than two-thirds of our respondents ate out and this habit was related to poor diet quality with excessive intake of sodium. Interventions are needed to improve the diet quality of the overall eating-out behaviour among targeted population.

Sodium-containing acetaminophen and cardiovascular outcomes in individuals with and without hypertension.

AimsPrevious studies have found high sodium intake to be associated with increased risks of cardiovascular disease (CVD) and all-cause mortality among individuals with hypertension; findings on the effect of intake among individuals without hypertension have been equivocal. We aimed to compare the risks of incident CVD and all-cause mortality among initiators of sodium-containing acetaminophen with the risk of initiators of non-sodium-containing formulations of the same drug according to the history of hypertension.Methods and resultsUsing The Health Improvement Network, we conducted two cohort studies among individuals with and without hypertension. We examined the relation of sodium-containing acetaminophen to the risk of each outcome during 1-year follow-up using marginal structural models with an inverse probability weighting to adjust for time-varying confounders. The outcomes were incident CVD (myocardial infarction, stroke, and heart failure) and all-cause mortality. Among individuals with hypertension (mean age: 73.4 years), 122 CVDs occurred among 4532 initiators of sodium-containing acetaminophen (1-year risk: 5.6%) and 3051 among 146 866 non-sodium-containing acetaminophen initiators (1-year risk: 4.6%). The average weighted hazard ratio (HR) was 1.59 [95% confidence interval (CI) 1.32–1.92]. Among individuals without hypertension (mean age: 71.0 years), 105 CVDs occurred among 5351 initiators of sodium-containing acetaminophen (1-year risk: 4.4%) and 2079 among 141 948 non-sodium-containing acetaminophen initiators (1-year risk: 3.7%), with an average weighted HR of 1.45 (95% CI 1.18–1.79). Results of specific CVD outcomes and all-cause mortality were similar.ConclusionThe initiation of sodium-containing acetaminophen was associated with increased risks of CVD and all-cause mortality among individuals with or without hypertension. Our findings suggest that individuals should avoid unnecessary excessive sodium intake through sodium-containing acetaminophen use.

Dietary patterns of Chinese pregnant women in Hong Kong.

Maternal nutrition is important for healthy pregnancy, but it has not been well studied among pregnant women in Hong Kong. This study aims to examine the dietary pattern and nutritional intake of women in early pregnancy, and the associations between dietary patterns, dietary quality, and other health parameters. This is a prospective cohort study of healthy Chinese pregnant women, recruited at their first antenatal appointment. Dietary intakes were assessed by a locally validated food frequency questionnaire (FFQ) and dietary patterns were derived by principal component analysis. Of 160 women recruited, the mean age was 32.7±3.9 years and body mass index (BMI) before pregnancy was 22.6±3.8 kg/m2. The dietary analyses were restricted to 156 women who had completed the FFQ. 99% of women had excessive sodium intake and only 2.6% of women met the recommended fibre intake. Three dietary patterns identified were 'sweet and fast-food pattern', 'prudent pattern' and 'meat pattern', which altogether accounted for 23.5% of the total variation. The 'prudent pattern' was positively associated with dietary quality indices [Dietary Approaches to Stop Hypertension score, ρ=0.323, p<0.01; Dietary Quality Index-International, ρ=0.400, p<0.01; Mediterranean Diet Score, ρ=0.243, p=0.02]; and was inversely associated systolic (B=-3.71, 95% CI -7.06, -0.36) and diastolic blood pressure (B=-2.69, 95% CI -5.12, -0.26), suggesting this pattern represented a relatively healthier dietary option. Suboptimal dietary intake is a common issue among pregnant women in Hong Kong. Early dietary assessment and attention are warranted in this population.

Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults.

Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03–3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.

Effect of Mineral-Balanced Deep-Sea Water on Kidney Function and Renal Oxidative Stress Markers in Rats Fed a High-Salt Diet.

This study investigated the effect of mineral-balanced deep-sea water (DSW) on kidney health using an animal model of kidney injury due to a high-sodium diet. High magnesium/low sodium (HMLS) and high magnesium/high calcium (HMHC) DSW samples with different mineral contents were prepared. Sprague–Dawley rats were fed an 8% sodium chloride (NaCl) diet for four weeks to induce kidney injury, and each group was supplied with purified water or mineral water. Kidney injury was observed in the NaCl group according to increased kidney injury markers and malondialdehydes, providing evidence of oxidative stress. However, the kidney injury was repaired by the intake of mineral-balanced DSW. It was confirmed that the HMLS and HMHC groups showed improved Na+ excretion through the urine. Kidney injury markers in urine decreased and upregulation of low-density lipoprotein receptor-related protein2 mRNA expression was observed in the HMLS and HMHC groups. In addition, superoxide dismutase activity was increased in the HMHC groups. The gene expression patterns of the RNA sequencing were similar between the CON and HMLS groups. These results suggest that DSW has beneficial effects on kidney health due to the balanced magnesium and calcium levels in models of kidney injury caused by excessive sodium intake.

High Adherence to the Food Pyramid’s Recommendations Avoids the Risk of Insufficient Nutrient Intake among Farmers in Peri-Urban Kenya

This study aimed to investigate whether the Kenyan Food Pyramid (FP) can evaluate excess or insufficient nutrient intake. Participants were farmers (56 men and 64 women, aged 18–60 years) in Wangige Village, Kiambu County—a peri-urban area of Kenya. Cross-sectional data were collected for demographic characteristics, physical measurements, and 2-day and 24-h dietary recalls. The average adherence level to the FP (hereafter, “FP score”) was 25.0 out of 50.0, with a minimum and maximum of 14.1 and 41.5, respectively. Energy and protein % energy ratio were significantly higher (p for trend < 0.05) in the higher FP score group. A higher FP score was also associated with a higher energy-adjusted micronutrient intake, and it was more likely to meet nutrient requirements. However, the higher FP score group had a higher risk of excess sodium intake (p for trend < 0.001). The Kenyan FP could be a useful tool for avoiding the risk of insufficient nutrient intake, but not for avoiding high energy and sodium intake. It is necessary to include appropriate evaluations to limit energy, sugar, and salt. Food groups and recommendations of the FP should be optimised according to the dietary environment of the target population so as to promote their health.

Evolution of energy and nutrient intake in Brazil between 2008-2009 and 2017-2018.

ABSTRACTOBJECTIVE:To assess the evolution of energy and nutrient intake and the prevalence of inadequate micronutrients intakes according to sociodemographic characteristics and Brazilian regions.METHODS:The food consumption of 32,749 individuals from the National Dietary Survey of the Household Budget Survey 2008–2009 was analyzed by two food registries, as well as 44,744 subjects from two 24-hour recalls in 2017–2018. Usual intake and percentage of individuals with consumption below the average recommendation for calcium, magnesium, phosphorus, copper and zinc, vitamins A, C, D, E, thiamine, riboflavin, pyridoxine and cobalamin were estimated. Sodium intake was compared to the reference value to reduce the risk of chronic diseases. Analyses were stratified by sex, age group, region and income.RESULTS:Mean daily energy intake was 1,753 kcal in 2008–2009 and 1,748 kcal in 2017–2018. The highest prevalence of inadequacy (> 50%) in the two periods were calcium; magnesium; vitamins A, D and E; pyridoxine and, only among adolescents, phosphorus. There was an increase in the prevalence of inadequate vitamin A, riboflavin, cobalamin, magnesium, and zinc among women, and riboflavin among men. The prevalence of inadequacy decreased for thiamine. Sodium intake was excessive in approximately 50% of the population in both periods. The highest variations (about 50%) in the prevalence of inadequacy between the lowest and highest income (< 0.5 minimum wage and > 2 minimum wages per capita) were observed for vitamin B12 and C in both periods. The North and Northeast regions had the highest prevalence of inadequacy.CONCLUSION:Both surveys found high prevalence of inadequate nutrient intake and excessive sodium intake. The inadequacy varies according to income strata, increasing in the poorest regions of the country.

Development of a lower-sodium oxybate formulation for the treatment of patients with narcolepsy and idiopathic hypersomnia

ABSTRACT Introduction Sodium oxybate (SXB) is a standard of care for cataplexy, excessive daytime sleepiness, and disrupted nighttime sleep in narcolepsy. At recommended dosages in adults (6–9 g/night), SXB increases daily dietary intake of sodium by 1100–1640 mg. Because excess sodium intake is associated with increased blood pressure and cardiovascular risk, an oxybate formulation containing 92% less sodium than SXB (lower-sodium oxybate; LXB) was developed to provide an alternative oxybate treatment option. In 2020, LXB was approved for treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy, and in 2021, for treatment of idiopathic hypersomnia in adults. Areas Covered Development of LXB from initial concept to regulatory approval is described, including formulation development and preclinical and clinical studies. Pharmacokinetic parameters and bioequivalence evaluations from phase 1 clinical trials are detailed. Efficacy and safety results from phase 3 clinical trials of LXB in patients with narcolepsy or idiopathic hypersomnia are presented and discussed. Expert Opinion Reducing sodium from high sodium‒containing medications is an important step to offset cardiovascular risks associated with high sodium consumption. The development of LXB exemplifies the importance of a collaborative approach to drug development, with patient needs paramount. Plain Language Summary Sodium oxybate (Xyrem®) is a medication for people with narcolepsy aged 7 years and older. Xyrem treats symptoms of excessive daytime sleepiness (EDS) or cataplexy (attacks of muscle weakness caused by emotion) in narcolepsy. At the recommended dosages in adults, Xyrem adds a large amount of sodium to daily dietary intake. Too much sodium in the diet is associated with increased blood pressure and risks of damage to the heart and blood vessels. Researchers used calcium, magnesium, and potassium ions in addition to a small amount of sodium to make a new oxybate medication, called Xywav®, that has 92% less sodium than Xyrem. Xywav and Xyrem were similar in laboratory and animal studies. In people, the body absorbs and processes Xywav slightly differently than Xyrem, but Xywav treatment has been shown to work the same to reduce symptoms of cataplexy and EDS in people with narcolepsy and is approved by the US Food and Drug Administration. Another neurological disorder with EDS is called idiopathic hypersomnia. Based on a clinical study, Xywav also reduced EDS and other symptoms in people with idiopathic hypersomnia. Side effects with Xywav are similar to those seen in previous studies with Xyrem.

Development and application of the sodium index to estimate and assess sodium intake for Korean adults.

BACKGROUND/OBJECTIVESThe purpose of this study was to develop a sodium index, which is a tool for estimating and assessing sodium intake easily and quickly, to assist in the prevention of various diseases induced by excess sodium intake in Korean adults.SUBJECTS/METHODSThe 24-h urine collection and dietary behavior surveys were performed on 640 healthy people in 4 regions of South Korea, and an equation for the estimation of 24-h sodium intake was developed. The validity and reliability of the equation were verified with 200 adults. The sodium index was developed by converting the estimated sodium intake using the equation. Finally, the sodium intake status of 1,600 adults was assessed using the sodium index.RESULTSThe equation included sex, age, body mass index, eating habit and dietary behaviors related to sodium intake. In validity test of the equation, the mean bias between sodium intake using 24-h urine analysis and using the equation from the Bland-Altman plots was −1.5 mg/day. The sensitivity and specificity of the equation for estimation of sodium intake were 80.5% and 64.4%, respectively. In the reliability test of the equation, there was no significant difference between the first and second sodium intakes calculated using the equations, and Spearman's correlation coefficient between the 2 sodium intakes was 0.98. Sodium intake can be assessed as ‘very moderate’ for 75–100 on the sodium index, ‘moderate’ for 100–150, ‘careful’ for less than 75 or 150–200, and ‘severe’ for 250 or more. When sodium intake was assessed using the sodium index in 1,600 subjects, 54.3% and 24.3% of the subjects were assessed to be in the ‘careful’ and ‘severe’ categories, respectively.CONCLUSIONSUsing a simple questionnaire, the sodium index can be used to monitor and assess sodium intake status, assisting in nutrition education and counseling in a large population.

24 hours urinary sodium and potassium excretion and association with blood pressure among people aged 18-75 years old in six Chinese provinces

Objective: To analyze the level of sodium and potassium intake and their association with blood pressure among people aged 18 to 75 years old in six provinces. Methods: From October to December 2018, participants aged 18 to 75 years were selected from Hebei, Hunan, Sichuan, Jiangxi, Qinghai and Heilongjiang provinces by using cluster random sampling method. Demographic characteristics and lifestyle information were collected by using questionnaire survey. Physical measurement and 24-hour urine collection were also conducted. Results: A total of 2 636 subjects were finally included in the analysis. The average urine sodium, potassium and sodium-to-potassium molar ratio were(4 438.4±1 822.8)mg/d, (1 566.2±646.3)mg/d, and 5.2±2.2, respectively. According to World Health Organization standards, 94.5% and 98.7% of the respondents had excessive sodium intake and insufficient potassium intake. After adjusting for related factors, each 1 000 mg increase in sodium excretion was associated with increased systolic blood pressure (1.65 mmHg, 95%CI: 1.07, 2.22) and diastolic blood pressure (0.53 mmHg, 95%CI: 0.21, 0.84), and each 1 000 mg increase in potassium excretion was associated with decreased systolic blood pressure (3.02 mmHg, 95%CI:-4.25, -1.80) and diastolic blood pressure (1.27 mmHg, 95%CI:-2.05, -0.48). Conclusion: The sodium intake in Chinese population remains excessive and potassium intake is insufficient. Sodium and potassium could be associated with blood pressure and the intervention of reducing sodium and supplementing potassium should be conducted in the corresponding population.

Added sugars, saturated fat, and sodium intake from snacks among U.S. adolescents by eating location

Snacking away from home is thought to contribute to excess intake of energy, added sugars, saturated fat, and sodium compared to snacking at home. Using data from the National Health and Nutrition Examination Survey 2009–2016, we examined associations between location of snack consumption (at home or away from home) and added sugars, saturated fat, and sodium intake from food and beverage snacks in U.S. adolescents aged 12–19. We also compared top snack contributors to intakes of these nutrients by location of consumption. Nutrient intake (added sugars, saturated fat, and sodium) from food and beverage snacks was estimated by the average intake from two 24-hour dietary recalls, and location of consumption for each snack was reported by participants as at home or away from home. Adjusted mixed effects models were performed to examine associations between nutrient intakes and the location of consumption. Adolescents (n = 3,869) had lower intakes of added sugars (−5.20 g/day), saturated fat (−2.06 g/day) and sodium (−170.15 mg/day) from food snacks consumed away from home compared to at home (p < 0.0001). Similarly, adolescents had lower intake of added sugars (−2.74 g/day), saturated fat (−0.32 g/day) and sodium (−16.04 mg/day) from beverage snacks consumed away from home compared to at home (p < 0.0001). The top contributors to the target nutrients were similar irrespective of location. Taken together, our results demonstrate that adolescents consumed more target nutrients from snacks at home than away from home. Larger snack portion sizes and higher frequency of snacking at home may explain these findings and requires further study.

Temporal Trends in Dietary Sodium Intake Among Adults Aged ≥19 Years - United States, 2003-2016.

Hypertension, which can be brought on by excess sodium intake, affects nearly one half of U.S. adults and is a major risk factor for heart disease, the leading cause of death in the United States (1). In 2019, the National Academies of Sciences, Engineering, and Medicine (NASEM) established the Chronic Disease Risk Reduction (CDRR) intake, a chronic-disease-specific recommendation for dietary sodium of 2,300 mg/day. Reducing daily sodium to CDRR intake is expected to reduce chronic disease risk among healthy persons, primarily by lowering blood pressure (2). Although the 2019 sodium CDRR intake is equivalent in number to the 2005 Tolerable Upper Limit (UL) released by NASEM (then known as the Institute of Medicine), the UL was intended to provide guidance on safe intake levels, not to serve as an intake goal (2). To describe excess sodium intake in the context of the CDRR intake goal, this report analyzed National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2016 to yield temporal trends in usual sodium intake >2,300 mg/day and in mean sodium intake, unadjusted and adjusted for total energy intake, among U.S. adults aged ≥19 years. The percentage of U.S. adults with sodium intake above CDRR intake was 87.0% during 2003-2004 and 86.7% during 2015-2016. Among U.S. adults overall, no significant linear trend was noted from 2003 to 2016 in unadjusted or energy intake-adjusted mean sodium intake. Small, significant declines were observed in mean usual sodium intake among some groups (adults aged 19-50 years, non-Hispanic White adults, adults experiencing obesity, and adults without hypertension). However, after energy adjustment, only adults aged ≥71 years and Mexican American adults demonstrated significant change in usual sodium intake. Many U.S. adults might be at risk for chronic disease associated with sodium intake above CDRR intake, and efforts to lower sodium intake could improve population cardiovascular health. The results of this report support enhanced efforts to reduce population sodium intake and cardiovascular disease risk, including the Food and Drug Administration's (FDA's) recently released guidance for the reduction of sodium in the commercially processed, packaged, and prepared food supply.

Change trend in disease burden of stroke and its risk factors in China, 1990 – 2017

Objective To analyze change trend in disease burden of stroke and its risk factors in China from 1990 through 2017 and to provide evidences for rational allocation of health resources and the development of targeted stroke prevention and treatment strategies. Methods Data on disease burden of stroke during the period from 1990 through 2017 in China were extracted from the Global Burden of Disease (GBD) Study of 1990, 2000, 2010 and 2017. Years lived with disability (YLDs), years of life lost (YLLs), disability adjusted life years (DALYs) were used to evaluate the disease burden of stroke and population attributable fraction (PAF) was adopted to analyze risk factors of stroke-related disease burden. Disparities in disease burden of stroke between China and the world were compared. Results During the period of 1990 – 2017 in China, the YLLs rate and DALYs rate of stroke increased gradually; the YLLs rate also increased generally but with a temporary decline in 2010. In 2017 in China, the age-specific YLDs, YLLs, and DALYs rate of stroke increased with the increment of age and the highest rates were observed among the population aged ≥ 70 years (2 617.2/100 000 for YLDs, 16 789.4/100 000 for YLLs, and 16 773.4/100 000 for DALYs); the YLDs rate was lower for the males than that for the females (475.5/100 000 vs. 530.9/100 000) but the YLLs and DALYs rate were higher for the males than those for the females (3 181.7/100 000 vs. 2 060.9/100 000 and 3 657.1/100 000 vs. 2 591.8/100 000); the age-standardized YLDs, YLLs, and DALYs rate of stroke were higher than those in the world (374.5/100 000 vs. 235.0/100 000, 1 967.8/100 000 vs. 1 422.2/100 000, and 2 342.3/100 000 vs. 1 657.2/100 000). Compared to those in 1990 in China, the age-standardized YLDs rate of stroke increased by 30.9%; while, the age-standardized YLLs rate and DALYs rate decreased by 38.8% and 33.1%; the change trend of the three rates were consistent with the changes in global stroke burden (5.9% for YLDs, = – 34.5% for YLLs, and – 30.7% for DALYs). Among the 16 risk factors associated with DALYs (million person-years), PAF, and DALYs rate of stroke, the top five were hypertension (24.974, 56.4%, and 1 768.1/100 000), excessive sodium intake (17. 060, 38.5%, and 1 207.8/100 000), insufficient fruit intake (10.717, 24.2%, and 758.7/100000), insufficient cereal intake (10.690, 24.1%, and 756.8/100 000), and smoking (10.037, 22.7%, and 710.6/100 000) for the population in China in 2017; from 1990 to 2017, PAF for the 10 of the 16 stroke risk factors increased and the other 6 decreased, with the highest increase (90.0%) for high body mass index and the greatest decrease ( – 71.3%) for indoor air pollution. Conclusion In China, the disability caused by stroke is increasing gradually and although being effectively controlled, stroke-related premature death is still the main contribution of disease burden. Primary prevention strategies should be promoted to alleviate the disease burden of stroke.

Rationale and validation of predicting high sodium intake by spot urinary chloride in patients with chronic kidney disease.

To analyze the rationale and evaluate the validity of spot urinary chloride or derived formulas to predict high sodium intake in patients with chronic kidney disease (CKD). We collected consecutive CKD patients at stages 1-4 who were admitted to our Nephrology department in a single center from January 01, 2014, to December 31, 2017, and tested spot and 24-hour urinary analysis on the same day. The feasibility of urinary chloride to predict urinary sodium was firstly analyzed by calculating their correlations. The validity of predicting excessive sodium intake by spot urinary sodium and chloride, two derived formulas based on spot urinary sodium or chloride, and our previous "CKDSALT" equation were accessed. We finally conducted Receiver operating characteristic (ROC) curves to compare their performance in detecting high sodium intake. All 5204 patients were eventually analyzed. In the derivation cohort (n=2447), a strong positive linear correlation existed between urinary sodium and chloride in both spot urine (R2=0.804) and 24-hour urine samples (R2=0.905), and two predictive equations based on spot urinary sodium or chloride were derived. In the validation cohort (n=2757), spot urinary sodium and chloride only showed "fair" performance. However, both urinary sodium and chloride equations had a "good" performance in ICC, Pearson's correlation, Bland-Altman plots, and ROC curves, while and CKDSALT equation showed the best performance. Spot urinary chloride is a feasible method to predict and monitor high sodium intake in CKD patients, while a novel derived formula could elevate its diagnostic accuracy.

Sodium Content of Foods Sold in the Spanish Market. Results from the BADALI Project.

High sodium/salt intake is a risk factor for Non-Communicable Diseases (NCDs). Excess sodium intake has been associated with high coronary heart disease, stroke and high blood pressure. The sodium daily intake is above the recommendations in the world as well as in Spain. Reducing salt content in processed foods and ready meals is one of the main strategies for reducing sodium intake. The aim of the present work is to characterise the presence of sodium in foods sold in the Spanish market. We also study a possible shift in sodium content in products over the last few years. For this purpose, 3897 products included in the BADALI food database were analysed, classified into 16 groups (G). We found that 93.3% of all foods displayed the sodium/salt content in the nutrition declaration. Meat—processed and derivatives (G8) had the highest mean and median values for sodium content, followed by snacks (G15) and sauces (G14). Only 12.7% of foods were sodium-free (≤5 mg/100 g or 100 mL), 32.4% had very low sodium (≤40 mg/100 g or 100 mL) and 48.2% were low in sodium (≤120 mg/100 g or 100 mL). On the contrary, 47.2% were high in sodium according to the Pan American Health Organisation Nutrient Profile Model (PAHO-NPM), while there were 31.9% according to the Chile-NPM. The agreement between the two NPMs was considered ‘substantial’ (κ = 0.67). When sodium content was compared over the years, no decrease was observed. This analysis was performed in the entire food population, by food group and in matched products. Therefore, more effort should be made by all parties involved in order to decrease the sodium/salt intake in the population.

Total Body Sodium Balance in Chronic Kidney Disease

Excess sodium intake is a leading but modifiable risk factor for mortality, with implications on hypertension, inflammation, cardiovascular disease, and chronic kidney disease (CKD). This review will focus mainly on the limitations of current measurement methods of sodium balance particularly in patients with CKD who have complex sodium physiology. The suboptimal accuracy of sodium intake and excretion measurement is seemingly more marked with the evolving understanding of tissue (skin and muscle) sodium. Tissue sodium represents an extrarenal influence on sodium homeostasis with demonstrated clinical associations of hypertension and inflammation. Measurement of tissue sodium has been largely unexplored in patients with CKD. Development and adoption of more comprehensive and dynamic assessment of body sodium balance is needed to better understand sodium physiology in the human body and explore therapeutic strategies to improve the clinical outcomes in the CKD population.