Sodium Intake Research Articles

Dietary potassium intake and its interaction with sodium intake on risk of developing cardiovascular disease in persons with type 2 diabetes: The Japan Diabetes Complication and its Prevention Prospective study (JDCP study 12).

Many guidelines recommend increases in potassium intake. However, the relationship of dietary potassium intake with incident cardiovascular disease (CVD) has not been examined in those with type 2 diabetes (T2DM), including sodium acting antagonistically with potassium. We investigated these relationships in Japanese patients with T2DM. The investigation was part of the JDCP study, a nationwide prospective study begun in 2007. Analysed were 1477 persons with T2DM, 40-75 years of age, who completed a brief-type, self-administered Diet History Questionnaire at baseline. Primary outcome was a CVD event during the follow-up median 7 years (3.9-8.1 years). Hazard ratios (HRs) for CVD were estimated by Cox regression adjusted for confounders of daily potassium intake categorized by tertiles. Tertiles of sodium intake were also analysed. Mean daily potassium intake in tertiles was 1877, 2627 and 3532 mg, respectively, and significant associations were not shown between potassium intake and incidence of CVD. When HRs for CVD were stratified for potassium intake in tertiles (reference group, bottom tertile) and sodium intake (reference group, bottom tertile), potassium intake in the bottom tertile and sodium intake in the second and top tertiles were associated with significantly elevated HR for CVD (2.79 [1.02-7.63] and 3.92 [1.30-11.79], respectively). Low potassium intake in conjunction with high sodium intake was significantly associated with increased incident CVD in persons with T2DM. However, CVD incidence was not related to high potassium intake, regardless of sodium intake.

The association between the dietary salt intake and glucose intolerance in the non-diabetic populations: from the Korean National Health and Nutritional Examination Survey (KNHANES)

Abstract Background Diabetes is known to be a strong risk factor for cardiovascular disease (CVD), and controlling salt intake in patients with type 2 diabetes may be a strategy to reduce the risk of CVD. However, the clear interaction between salt intake and glucose homeostasis has yet to be investigated. Our study evaluated the frequency and risk of glucose intolerance (pre-diabetes) according to dietary salt intake in the non-diabetic population in Korea. Methods The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). A total of 72,751 subjects were enrolled in the KNHANES database from 2010 to 2018. The subjects were categorized into the following: normal fasting glucose (i.e., no pre-diabetes; FPG < 100 mg/dL), stage 1 pre-diabetes (FPG 100–109 mg/dL), stage 2 pre-diabetes (FPG 110–125 mg/dL). All subjects were divided into 8-equal groups according to their sodium intake: Group 1: ≤ 3.5 g, Group 2: 3.5 to 5.0 g, Group 3: 5.0 to 6.3 g, Group 4: 6.3 to 7.8 g, Group 5: 7.8 to 9.5 g, Group 6: 9.5 to 11.8 g, Group 7: 11.8 to 15.5 g, Group 8: > 15.5 g. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status assessment at the same time. Results Of the total 57,165 subjects without diabetes, 29.5% (16,874 subjects) were pre-diabetic, of which 22.0% (12,577 patients) were stage I pre-diabetic, and 7.5% (4,297 subjects) were stage II pre-diabetic. From the lowest salt intake group (group 1, salt intake <3.5g) to the highest salt intake group (group 8, salt intake>.5g), the pre-diabetes prevalence continuously increased from 22.9% to 33.3%. The range of stage 1 pre-diabetes was 16.4% to 26.4%, and the range of stage 2 diabetes was 6.5% to 8.7%. The odds ratio (OR) of pre-diabetic risk according to salt intake in the non-diabetic population, compared with group 1, group 2 was 1.16 (95% confidence interval [CI]: 1.07-1.25), group 3 was 1.32 (95% CI: 1.23 -1.43), group 4 was 1.46 (95% CI: 1.35-1.57), group 5 was 1.51 (95% CI: 1.40-1.63), group 6 was 1.57 (95% CI: 1.46-1.69), group 7 was 1.65 (95% CI: 1.53-1.78), group 8 was 1.68 (95% CI: 1.56-1.81). Conclusions High salt intake is significantly associated with pre-diabetes prevalence in the non-diabetic Korean population.

The association between the dietary salt intake and glucose intolerance in healthy populations: from the Korean National Health and Nutritional Examination Survey (KNHANES)

Abstract Background Diabetes is known to be a strong risk factor for cardiovascular disease (CVD), and controlling salt intake in patients with type 2 diabetes may be a strategy to reduce the risk of CVD. However, the clear interaction between salt intake and glucose homeostasis has yet to be investigated. Our study evaluated the frequency and risk of glucose intolerance (pre-diabetes) according to dietary salt intake in a healthy population in Korea. Methods The Korean National Health and Nutritional Examination Survey (KNHANES) database was utilized for this study (https://knhanes.cdc.go.kr). A total of 72,751 subjects were enrolled in the KNHANES database from 2010 to 2018. The subjects were categorized into the following: normal fasting glucose (i.e., no pre-diabetes; FPG < 100 mg/dL), stage 1 pre-diabetes (FPG 100–109 mg/dL), stage 2 pre-diabetes (FPG 110–125 mg/dL). All subjects were divided into 8-equal groups according to their sodium intake: Group 1: ≤ 3.5 g, Group 2: 3.5 to 5.0 g, Group 3: 5.0 to 6.3 g, Group 4: 6.3 to 7.8 g, Group 5: 7.8 to 9.5 g, Group 6: 9.5 to 11.8 g, Group 7: 11.8 to 15.5 g, Group 8: > 15.5 g. This study is a retrospective cross-sectional study, so future risks cannot be assessed, but only the disease status assessment at the same time. Results Of the total 36,782 healthy adults, 17.6% (6,481 subjects) were pre-diabetic, of which 14.7% (5,397 subjects) were stage I pre-diabetic, and 2.9% (1,084 patients) were stage II pre-diabetic. From the lowest salt intake group (group 1, salt intake <3.5g) to the highest salt intake group (group 8, salt intake>.5g), the pre-diabetes prevalence continuously increased from 9.2% to 22.8%. The range of stage 1 pre-diabetes was 7.3% to 18.3%, and stage 2 diabetes was 1.9% to 4.5%. The odds ratio (OR) of pre-diabetic risk according to salt intake in the non-diabetic population, compared with group 1, group 2 was 1.46 (95% confidence interval [CI]: 1.30-1.68), group 3 was 1.84 (95% CI: 1.62 -2.08), group 4 was 2.24 (95% CI: 1.99-2.54), group 5 was 2.43 (95% CI: 2.15-2.75), group 6 was 2.49 (95% CI: 2.20-2.81), group 7 was 2.83 (95% CI: 2.51-3.19), group 8 was 2.90 (95% CI: 2.57-3.27). Conclusions High salt intake is significantly associated with pre-diabetes prevalence in healthy Korean population.

The Effects of Subsidies for Healthy Foods on Food Purchasing Behaviors, Consumption Patterns, and Obesity/Overweight: A Systematic Review.

Taxing unhealthy foods and drinks is an essential measure against the double burden of malnutrition that affects every nation worldwide. In turn, subsidizing the consumption of healthy foods can also be a critical measure for changing the population's behavior and improving health indicators. A systematic review was conducted of food subsidies and their potential impact on food purchases, consumption, overweight/obesity, and changes in body mass index (BMI). The PubMed, Embase, LILAC, Scientific Electronic Library Online, and Google Scholar databases were searched to identify studies investigating the effects of subsidies on the amount of food purchased, food consumption, caloric intake, nutrient intake, and their impact on overweight, obesity, and BMI changes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Two investigators independently performed data screening, extraction, and quality assessment. Of the 6135 studies screened, 149 were read in full and 18 were included in this systematic review. Most studies investigated the effects of subsidy scenarios on food purchases and observed increases in fruit and vegetable (F&V) purchases when these were subsidized. In randomized controlled studies, subsidized healthy foods were purchased more often. However, when the subsidy was suspended, F&V consumption decreased. Although quasi-experimental studies have demonstrated increased F&V consumption due to subsidies, some studies showed increased saturated fat and sodium intake. Only 2 studies evaluated the relationship between subsidies and obesity, yielding conflicting results. Although the subsidies appear to encourage purchase and consumption of healthier foods, enhancing the quality and diversity of dietary choices, the removal of subsidies can lead to a decline in the consumption of healthier foods. Additionally, their impact on obesity and BMI remains uncertain and requires further research. PROSPERO registration by the number CRD42023442122.

Independent and joint associations of urinary potassium excretion with cardiovascular death: a national population-based cohort study

Abstract Background Elevated potassium excretion is associated with lower blood pressure, as well as reduced risks of cardiovascular disease (CVD) death. However, the impact of varied sodium levels on this association remains a topic of debate, and the mediators of this association besides blood pressure remain uncertain. Purpose To examine the joint association of potassium and sodium with CVD mortality risk, and to identify potential mediating factors of this association. Methods Based on the ChinaHEART (China Health Evaluation And risk Reduction through nationwide Teamwork) project, participants aged 35-75 from 239 sites across all 31 provinces in the mainland of China were recruited from November 2014 to December 2022. We collected spot urine samples from participants and estimated 24-hour sodium and potassium excretion using the Kawasaki formula. Death records were captured through data linkage with the National Mortality Surveillance System and Vital Registration. Multiple regressions were used to analyze the association between potassium excretion and CVD death, as well as to examine the addictive interaction of potassium and sodium. Results This study included 270,991 participants with a mean age of 55.8±9.8 years, and 60.5% of them were female. The mean potassium excretion was 54.36±12.58 mmol/d , which was higher in males and people living in the north. Findings revealed a positive correlation between low urinary potassium levels and CVD death , and the lowest adjusted hazard rate for CVD mortality was 0.65 (95% CI: 0.58-0.73) in the group with the highest potassium excretion (i.e. ≥64.27 mmol/d) compared with the reference group (<43.79 mmol/d), after adjusting for sociodemographic characteristics, medical histories, and lifestyles. Age modified the association between potassium excretion and risk of CVD death (P for interaction=0.031). In addition to systolic blood pressure (16.6%), heart rate (2.2%) also served as the significant mediator between urinary potassium excretion and CVD death. The relative excess risk of interaction (RERI) of lower potassium excretion and lower sodium was significantly positive (RERI=0.22, 95% CI: 0.02-0.42), which implied the synergy effect. Conclusion Potassium intake in the Chinese population is evidently lower than the guideline recommendations, and increasing potassium intake, especially in the population aged <65 years, may reduce the risk and burden of cardiovascular and other diseases. Moreover, when sodium intake is insufficient, supplementation with both sodium and potassium salt can achieve greater health benefits.Graphic abstract

Sodium and potassium intake in adults: the Italian Health Examination Survey 2023 – CUORE Project

Abstract Background The WHO recommends a 30% relative reduction in mean population intake of salt/sodium within 2025 (baseline 2010) and an adequate potassium intake. To these ends, the Italian Ministry of Health (MoH) has strengthened prevention/health promotion. To update the assessment of the habitual salt and potassium intake in the Italian general adult population, national health examination surveys (HESs), funded by the MoH-CCM, are conducted within the CUORE Project. Methods In 2023 a new HES started including salt and potassium intake assessment by the use of 24h urine collection. Up to now, data from random samples of residents in 7 Regions (of 20 regions) distributed in North, Centre and South of Italy and aged 35-74 years are available (686 men, 702 women). Urinary excretion is assayed by a central lab. Persons with urinary volume < 500 ml and/or a urinary creatinine content referred to body weight outside the range of population mean ± 2 standard deviations are excluded. Results Out of 657 men and 671 women, mean level of salt per day was 9,2 g (95% CI: 9,0-9.5 g) and 7,1 g (6,9-7,3 g) respectively, and mean level of potassium per day was 2,9 g (2,8-3,0 g) and 2,4 g (2,3-2,5 g) respectively. A salt intake level lower than the WHO recommended target of 5g/day was detected in 9,5 % (5,2 -13,9 %) of men and 23,7 % (17,5 -29,9 %) of women and a potassium intake level higher than the WHO recommended target of 3510 mg/day was detected in 22,4 % (16,3 -28,6 %) of men and 9,7 % (5,4 -14,0 %) of women. Conclusions These preliminary data showed that in Italian adults the average salt intake is still higher and the average potassium intake is still lower than recommended. Compared to 2008, the habitual salt intake decreased of about 12% in 2018 and remained stable in 2023; the habitual potassium intake remained stable in 2008, 2018 and 2023.These results justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of WHO targets. Key messages • In Italian adults the average salt intake is still higher than recommended and the habitual salt intake decreased compared to 15 years ago. • In Italian adults the average potassium intake is still lower than recommended and remained stable compared to 15 years ago.

Effect of DASH vs. Mediterranean diet on metabolic syndrome and cardiometabolic profile in adults with high normal blood pressure or grade 1 hypertension: the DASH-MedDiet randomized controlled trial

Abstract Background Lifestyle interventions are recommended as the first-line treatment to control metabolic syndrome components and improve cardiometabolic profile. However, studies directly comparing the effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) on metabolic syndrome prevalence and cardiometabolic risk factors are currently lacking. Purpose We aimed to assess the effects of a 3-month intensive dietary intervention implementing salt restriction either alone or on top of the DASH and MedDiet compared to no/ minimal intervention on metabolic syndrome prevalence and cardiometabolic profile in never drug-treated adults with high normal blood pressure (BP) or grade 1 hypertension. Methods We randomly assigned individuals to the control group (CG, n = 60), salt restriction group (SRG, n = 60), DASH diet with salt restriction group (DDG, n = 60), or MedDiet with salt restriction group (MDG, n = 60). All patients were followed monthly for 3 months in individual sessions coordinated by the clinical dietician. For the patients of all four study groups, the goal was to maintain the initial body weight unchanged. Patients in the CG received general advice on dietary principles for BP control. For the patients in all three intervention groups, the goal was to limit sodium intake to 2,000 mg/ day (equivalent to 5,0g salt/ day). In addition, patients in the DDG and the MDG received an individualized dietary plan with six daily sample menus to facilitate the adoption of the assigned dietary pattern. Anthropometric indices, dietary intake, office BP, and fasting blood samples were evaluated pre- and post-intervention. Results According to the intention-to-treat analysis, at 3 months post-intervention, the DDG and the MDG had lower odds ratio (OR) (95% CI) of metabolic syndrome [0.29 (0.12, 0.72), and 0.15 (0.06, 0.41), respectively] compared to the CG. Moreover, the MDG had lower odds of elevated BP levels compared to both the DDG and the SRG [0.08 (0.03, 0.19), and 0.13 (0.05, 0.34), respectively], and lower odds of metabolic syndrome compared to the SRG [0.25 (0.09, 0.67)]. In addition, the DDG and the MDG had lower odds of elevated fasting glucose compared to both the CG and the SRG, whereas the study groups did not differ regarding the odds of elevated waist circumference, elevated triglycerides, and reduced HDL- cholesterol. Regarding cardiometabolic indices, total and LDL-cholesterol, fasting glucose, HbA1c, and systolic/ diastolic BP were reduced in all three intervention groups compared to the CG. Conclusions On a background of salt restriction, the MedDiet was superior in BP reduction, but the DASH and MedDiet reduced the prevalence of metabolic syndrome to the same extent.

Sex differences in association between dietary sodium intake and white matter hyperintensity volume

Abstract Background There is limited evidence on the relationship between dietary sodium intake (dNa) and brain health, and very little on sex differences in associations. Purpose To study the relationship between dNa and imaging measures of brain health in men and women from the INSIGHT 46 substudy of the MRC National Survey of Health and Development (British 1946 birth cohort). Methods Participants had measurements (dNa using 5-day food diary, anthropometrics, blood pressure (BP) body mass index (BMI)) at 60-64years. Whole-brain and hippocampal volumes, white matter hyperintensity volume (WMHV) and florbetapir amyloid-β positivity were measured using MRI-PET imaging at 69-71years. Associations (β (95% confidence intervals)) were estimated separately in men and women using generalized linear models with robust standard errors adjusted for potential confounders (age, diet quality, energy intake, socioeconomic status) or potential mediators (BMI, BP). Results Participants’ characteristics are shown in Table 1. In women but not men dNa was positively associated with higher WMHV (β[women]=32(1, 72) %/g; p=0.043; β[men]=-10(-27, 11)%/g; p=0.342); this relationship in women was independent of BMI (β = 32(1, 72)%/g; p = 0.043) or systolic BP (β = 31(1, 70)%/g; p=0.041). dNa was not associated with total brain volume, hippocampal volume or amyloid-β positivity in either sex. Conclusions Elevated sodium consumption in the diet is associated with cerebral small vessel disease in older age women but not men. This association was independent of BMI or BP.Table 1

Associations of the Healthy Beverage Index (HBI) and the risk of Breast Cancer (BrCa): a case–control study

BackgroundBreast cancer (BrCa) is one of the leading causes of cancer-related deaths. There are several factors for getting BrCa, including some changeable factors related to lifestyle like unhealthy dietary patterns, so modifying them can prevent one third of the complications and deaths caused by BrCa. Therefore, we decided to investigate the relationship between Healthy Beverage Index (HBI) and the risk of BrCa.MethodsIn this hospital-based case–control study, 253 patients with BrCa and 267 non-BrCa controls were enrolled. Food consumption was recorded to calculate the HBI score using a semi-quantitative Food Frequency Questionnaire (FFQ). Additionally, by using binary logistic regression analysis with adjustment for confounders, the relationship between HBI and the risk of BrCa were assessed. HBI was established by Duffey et al. and is used to evaluate the overall quality of beverage intake and identify changes in consumption.ResultsMean ± SD of age and BMI of the study participants were 47.92 ± 10.33 years and 29.43 ± 5.51 kg/m2, respectively. Patients with BrCa considerably outperformed controls in terms of waist circumference (WC), age at first pregnancy, history of abortion, and number of children(Pvalue < 0.05). Compared with those in the lowest quartile of HBI, subjects in the highest quartile had higher intake of energy, carbohydrate, protein, fat, fiber, sodium, potassium, calcium, magnesium, zinc, vitamin C, E, B9, fruits, vegetables, fish and nut as well as lower BMI and WC (Pvalue < 0.05). After adjustment for potential confounders, individuals in highest compared to lowest quartile of HBI had significantly lower risk of BrCa for total population (odds ratio (OR): 0.40; 95% confidence interval (95%CI): 0.21–0.76, Pvalue < 0.05), premenopausal (OR: 0.38; 95% CI: 0.16–0.92, Pvalue = 0.013), and postmenopausal (OR: 0.27; 95% CI: 0.10–0.78, Pvalue = 0.023).ConclusionFindings of this study suggested that higher HBI score decreased the risk of BrCa. However, further investigation is needed.

Salt-related knowledge, attitudes, and practices and their relationship with 24-hour urinary sodium and potassium excretions among a group of healthy residents in the UAE: A cross-sectional study.

This study aimed to measure urinary sodium and potassium as a measure of sodium and potassium intake concerning the knowledge, attitude, and practice (KAP) toward sodium intake among a group of healthy residents in the UAE. A cross-sectional study on a sample of healthy adults in the UAE. In addition to the KAP questionnaire, sodium and potassium excretions, and food records were taken. The United Arab Emirates. A sample of 190 healthy individuals aged between 20-60 years. The mean (± SD) age of the sample was 38.6 (± 12.5) years and 50.5% were females. The mean urinary sodium and potassium intake were 2816.2± 675.7 mg /day and 2533.3± 615 mg/day, respectively. The means were significantly different compared to the World Health Organization (WHO) recommendation of sodium and potassium, (p < 0.001). About 65% of the participants exceeded the WHO recommendations for salt intake, and participants' knowledge classification for health-related issues was fair while food-related knowledge was poor (P=0.001). A two-stage stepwise multiple regression analysis revealed that KAP scores were negatively associated with urinary sodium excretion (r = -0.174; p = 0.017) and those older participants and females had lower urinary sodium excretion (p<0.001). These findings may suggest an increase in the risk of hypertension in the UAE population. Moreover, these findings emphasize the need to establish education and public awareness programs focusing on identifying the sodium contents of foods and establishing national regulations regarding food reformulation, particularly for staple foods such as bread.

Sleep, dietary intake and physical activity changes with onset of shift work in intern paramedics

Paramedic work is associated with high staff turn-over, insufficient sleep and adverse health outcomes. Our understanding of the relationship between paramedic work and the health behaviours that may precede adverse health outcomes is limited, as few longitudinal studies have examined health behaviours in workers before they commence on the road work. Such research is needed to inform evidence-based recommendations specifically for new paramedics. The current observational cohort study examined self-reported sleep, dietary intake and physical activity in 21 intern paramedics: 15 female and 6 male (median age: 23.0 years [interquartile range (IQR): 4.0]) from an Australian ambulance service. A subset of participants ( n = 16) provided fasting blood samples for cardiometabolic markers (cholesterol, triglycerides and fasting glucose). Data were collected quarterly (pre-shift work, 3 months, 6 months, 9 months and 12 months post commencement). Linear mixed models showed that the first 12 months of shift work were associated with poorer sleep quality ( p = .036), consumption of fewer kilojoules ( p = .026), reduced saturated fat consumption ( p = .005) and lower sodium ( p = .043) and sugar ( p = .038) intake. There were significant increases in leisure time physical activity ( p = .008). This study shows negative changes in sleep quality and improvements in diet and leisure time physical activity during the first 12 months of paramedic work. Individual differences observed in this study, and ongoing suboptimal dietary intake, highlight a need for larger studies with more participants and a focus on personalised strategies for new recruit paramedics.

Determinants of sodium intake knowledge and attitude: a cross-national analysis of socio-economic and health factors.

The aim of this study is to conduct a comparative analysis across nations to: (1) identify the determinants influencing knowledge and attitudes related to sodium (Na) intake and (2) to analyse the association between knowledge and attitudes related to Na intake. We utilised a secondary data from a cross-sectional study that was conducted across seven nations. Structural equation modelling (SEM) was utilised to assess the impact of socio-economic and health-related predictors on knowledge and attitudes pertaining to Na intake and further to investigate the relationship between knowledge and attitude. Indonesia, Brazil, Thailand, Japan, France, the UK and the USA. 7090 participants aged 15 years and above were included in the study. SEM analysis showed a strong association between knowledge about Na intake and related attitude across all countries, particularly in the UK (2·65, 95 % CI 1·48-3·82), France (2·62, 1·45-3·79) and the USA (1·97, 1·21-2·73). In Brazil, Japan and France, individuals or family members having certain health conditions such as raised blood pressure, heart diseases, strokes or other diseases exhibited a positive attitude towards reducing Na intake. Conversely, socio-economic factors like education and income demonstrated the complexity of influences on knowledge and attitudes about Na intake. The study underscores the need for tailored public health interventions to reduce excessive Na consumption, considering the diverse cultural, social and economic factors. It highlights the complex determinants of knowledge and attitudes towards Na intake, calling for further research in varied populations.

Effect of NaCl partial replacement by KCl, Ca-ascorbate, and spent hen meat hydrolysate on the physicochemical properties and quality of Cantonese sausage.

A large amount of NaCl is usually used to provide a unique flavor and extend the shelf life of meat products. However, excessive sodium intake may cause diseases such as cardiovascular diseases. Spent hen meat hydrolysate (SHH) as an efficient NaCl substitute was developed with inefficient research related to SHH application in food systems. Therefore, the effects of NaCl replacement with SHH, KCl, and Ca-ascorbate on the quality of low-sodium Cantonese sausage were investigated. Four groups of salt formulation, I (100% NaCl), II (NaCl/KCl/Ca-ascorbate=60%/30%/10%), III (NaCl/KCl/Ca-ascorbate/SHH=50%/30%/10%/10%), and IV (NaCl/KCl/Ca-ascorbate/SHH=30%/30%/10%/30%), were used to produce Cantonese sausages. The moisture and nitrite content decreased, the microbiological growth was inhibited, and the protein content increased after adding SHH for Cantonese sausages with NaCl substitution degrees of 50% and 70%. The saltiness, overall flavor, color, and texture of low-sodium Cantonese sausages with SHH were maintained or improved compared to the Cantonese sausage without sodium replacement. The proportion of peptides with molecular weight<1kDa in Cantonese sausages increased after adding SHH, which may improve the overall flavor by interacting with peptides or other compounds. SHH combined with KCl and Ca-ascorbate is an efficient NaCl substitute, which can maintain and even improve Cantonese sausage quality and reduce sodium content up to 70%. These findings offer a promising reference for SHH application in the food industry and promote the development of salt taste-enhancing hydrolysate in food science.

Qualidade da água envasada consumida no estado de São Paulo: análise de substâncias inorgânicas

Introduction: The availability of different brands of bottled water on the national market, combined with the growing consumption by the population, makes it important to assess the quality of its chemical composition. Objective: To quantify inorganic chemical substances (nutrients and toxic metals) in samples of bottled water from national and imported sources consumed in the State of São Paulo, in compliance with legislation and compendiums; verify the parameters of inorganic elements indicated on labeling, as well as the recommended daily intake. Method: Determinations were carried out by inductively coupled plasma mass spectrometry. Results: The evaluation indicated that 93.5% of the total of the 107 samples analyzed presented concentrations of inorganic chemical elements in accordance with the maximum values allowed in national legislation for all analytes (96.5% for national and 81.0% for imported), thus being considered suitable for human consumption. Discordant results were obtained for 6.5% for the elements chromium (2.3%) and selenium (1.2%) in national water and chromium (19.0%) in imported water. Levels above the recommended limits by the international compendia for sodium intake were quantified in an imported water sample that could cause illness in the body. Furthermore, the variability observed between the experimental results and values declared in the chemical composition tables (labeling) can lead consumers to purchase a product containing inadequate information, thereby harming their daily intake needs. Conclusions: The results highlight the importance of establishing and maintaining continuous monitoring programs in the country to monitor the sanitary quality of food consumed by the population and thus protect population’s health.

Dietary sodium intake restriction in patients with heart failure: an overview of systematic reviews.

This study aimed to identify, assess, and summarize systematic reviews on dietary sodium intake restrictions for patients with heart failure. Literature searches were conducted on Pubmed, CINAHL, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, and the Wanfang Database up to January 2024. The methodological quality of the included reviews was assessed using the quality assessment tool from the Australian JBI Center for Evidence-Based Healthcare (2016). The results of systematic reviews and meta-analyses were synthesized and presented according to different outcome indicators. Nine systematic reviews were included in this study. The current evidence does not support the fact that dietary sodium intake restrictions for patients with heart failure have a positive impact on mortality rates, rehospitalization rates, and quality of life. Conversely, strict dietary sodium intake restrictions (≤ 2000mg/day) may increase the risk of death, rehospitalization, and symptom exacerbation. Dietary sodium intake restriction may not have a positive impact on clinical outcomes in patients with heart failure. Nevertheless, more evidence is required to explore the differences in the impact of various levels of dietary sodium restriction on the outcomes and symptom management indicators of patients with heart failure.

A Self-Administered Eating Behavior Scale for Patients With Heart Failure Living at Home: Protocol for a Mixed Methods Scale Development Study.

The prevalence of heart failure (HF) is increasing worldwide, with the associated mortality rates rising consistently. Preventing HF progression requires adherence to restricted sodium intake alongside sufficient and balanced nutritional consumption. For patients at home, preparing nutritionally balanced meals is essential, either self-assisted or with the aid of close individuals. Patients with HF frequently experience decreased exercise tolerance, depression, anxiety, and social isolation, which interfere with eating behaviors, leading to inadequate dietary habits. However, measures focusing on the determinants of eating behavior among patients with HF are currently lacking. This study aims to develop a self-administered scale to assess the eating behaviors of patients with HF living at home (Self-Administered Eating Behaviors Scale for Heart Failure [SEBS-HF]). This study encompasses 3 phases. Phase 1 involves identifying factors influencing eating behaviors in patients with HF. First, a literature review will be conducted using PubMed and CINAHL databases. The specified literature will be analyzed qualitatively and inductively. Additionally, verbatim transcripts obtained from semistructured interviews of patients with HF and medical experts will be qualitatively analyzed. Based on the Phase 1 results, a preliminary scale will be constructed. In Phase 2, cognitive interviews will be conducted with patients with HF and experts; the preliminary scale will be used to qualitatively evaluate its content validity. After validation, the scale will be used in Phase 3 to conduct a cross-sectional study involving patients with HF. In Phase 3, data will be collected from clinical records and self-administered questionnaires or scales. After conducting a preliminary survey, the main survey will be conducted. The reliability and validity of the scale will be assessed using statistical methods. The first phase of this study commenced in September 2023, and by May 2, 2024, a total of 7 patients with HF and 6 expert professionals were enrolled as study participants. The draft creation of the scale will be completed in 2024, and the content validity evaluation of the draft scale is expected to be finished by early 2025. The third phase will begin its investigation in mid-2025 and is expected to be completed by late 2025, after which the SEBS-HF will be published. The development and use of this scale will enable a more comprehensive evaluation of the factors influencing eating behaviors in patients with HF. Thus, medical and welfare professionals should provide appropriate support tailored to the specific needs of patients with HF. DERR1-10.2196/60719.

Nutritional Status, Diet, and Intestinal Permeability of Mexican Children with Autism Spectrum Disorders

Introduction: Autism spectrum disorder (ASD) comprises a group of developmental disorders characterized by deficits in social interaction and behavioral patterns. Children with ASD may face nutritional challenges, primarily due to their restrictive behaviors and frequent gastrointestinal issues. Objective: The objective of the present study was to assess nutritional status, dietary habits, and intestinal permeability in a sample of individuals with ASD. Methods: A cross-sectional study was conducted with 24 children and adolescents (both sexes), aged 4 to 18 years, living in two cities of Mexico (Aguascalientes and Querétaro). Weight and height were measured, and body mass index for age was calculated and compared using WHO Z-scores. Diet was assessed through three 24 h dietary recalls and a food frequency questionnaire. Intestinal permeability was evaluated using a lactulose/mannitol test by HPLC. Results: A high prevalence of malnutrition was observed; 12.5% of the participants were underweight, and 45.8% were overweight or obese. Children had a low intake of fiber, vitamin E, folate, potassium, zinc, and phosphorus and a high intake of sodium. On average, the intestinal permeability ratio was 0.09 ± 0.05, with 54.2% of the children exhibiting high intestinal permeability. Conclusions: It is advisable to develop food counseling strategies for children with ASD to prevent micronutrient deficiencies, promote healthy weight, and improve gastrointestinal integrity.

Associations between nine dietary minerals intake and all-cause mortality in individuals with atherosclerotic cardiovascular disease.

Varied intake of dietary minerals critically affects cardiovascular health. This study examines the associations of nine dietary minerals intake with all-cause mortality in atherosclerotic cardiovascular diseases (ASCVDs). This study analyzed 4,125 individuals with ASCVD from the National Health and Nutrition Examination Survey, employing Kaplan-Meier survival analyses, weighted Cox models, and restricted cubic splines to assess linear and nonlinear relationships between dietary minerals intake and all-cause mortality. Associations across different body mass index (BMI) categories were also evaluated separately. Over 6.25 years of median follow-up, 1,582 deaths were documented. Adjusted for potential covariates, results show a negative linear correlation between dietary magnesium intake and all-cause mortality (p for trend <0.001). Compared to the lowest quartile, all-cause mortality risk in the highest quartile was found to be 0.63 (95% CI 0.49-0.81). The associations between intake of the other eight dietary minerals and all-cause mortality were not robust. BMI significantly influenced the links between dietary minerals intake and all-cause mortality (p for interaction <0.05). Across BMI categories, significant negative associations were found between intake of magnesium, phosphorus, potassium, sodium, and copper and all-cause mortality in underweight or normal weight groups. In overweight individuals, intake of calcium, iron, magnesium, and potassium was negatively linked to all-cause mortality. For obese groups, sodium intake negatively affected all-cause mortality (p for trend <0.001). Unlike other dietary minerals, increased magnesium intake significantly reduced all-cause mortality risk in ASCVD. BMI influenced the associations between dietary minerals intake and all-cause mortality.

Myeloid-Specific JAK2 Contributes to Inflammation and Salt Sensitivity of Blood Pressure.

Salt sensitivity of blood pressure (SSBP), characterized by acute changes in blood pressure with changes in dietary sodium intake, is an independent risk factor for cardiovascular disease and mortality in people with and without hypertension. We previously found that elevated sodium concentration activates antigen-presenting cells (APCs), resulting in high blood pressure, but the mechanisms are unknown. Here, we hypothesized that APC-specific JAK2 (Janus kinase 2) through STAT3 (signal transducer and activator of transcription 3) and SMAD3 (small mothers against decapentaplegic homolog 3) contributes to SSBP. We performed bulk or single-cell transcriptomic analyses following in vitro monocytes exposed to high salt and in vivo high sodium treatment in humans using a rigorous salt-loading/depletion protocol to phenotype SSBP. We also used a myeloid cell-specific CD11c+ JAK2 knockout mouse model and measured blood pressure with radiotelemetry after N-omega-nitro-L-arginine-methyl ester and a high salt diet treatment. We used flow cytometry for immunophenotyping and measuring cytokine levels. Fluorescence in situ hybridization and immunohistochemistry were performed to spatially visualize the kidney's immune cells and cytokine levels. Echocardiography was performed to assess cardiac function. We found that high salt treatment upregulates gene expression of the JAK/STAT/SMAD pathway while downregulating inhibitors of this pathway, such as suppression of cytokine signaling and cytokine-inducible SH2, in human monocytes. Expression of the JAK2 pathway genes mirrored changes in blood pressure after salt loading and depletion in salt-sensitive but not salt-resistant humans. Ablation of JAK2, specifically in CD11c+ APCs, attenuated salt-induced hypertension in mice with SSBP. Mechanistically, we found that SMAD3 acted downstream of JAK2 and STAT3, leading to increased production of highly reactive isolevuglandins and proinflammatory cytokine IL (interleukin)-6 in renal APCs, which activate T cells and increase production of IL-17A, IL-6, and TNF-α (tumor necrosis factor-alpha). Our findings reveal the APC JAK2 signaling pathway as a potential target for the diagnosis and treatment of SSBP in humans.

Relationship Between Sodium Intake, Physical Activity and Stress with the Incidence of Hypertension in Pregnant Women at the Gununghalu Health Center 2023

Hypertension or high blood pressure refers to a condition where blood pressure in the blood vessel system continues to increase (World Health Organization, 2018). Gestational hypertension can have detrimental effects on the mother and fetus, and increase the risk of cardiovascular disease in the future. Women who have experienced preeclampsia or hypertension have higher health risks, including a 7- to 8-fold increased risk of death from coronary artery disease (Subki &amp; et al, 2018). This study aims to investigate the correlation between factors that influence the incidence of hypertension in pregnant women in the area served by the Gununghalu Community Health Center. The research design used was case control, with a population of 1,473 people, where the sample consisted of pregnant women, including 63 of whom had hypertension. Data analysis was carried out using the Chi-Square method and multiple logistic regression analysis to identify factors that influence the incidence of hypertension. The research results show that there is a relationship between sodium consumption and hypertension in pregnant women showing a significance value of 0.007, indicating that there is a significant correlation between stress and the incidence of hypertension in pregnant women with a p value of 0.028. However, no significant relationship was found between physical activity and the incidence of hypertension in pregnant women, with a p value of 0.084. Multivariate analysis shows that sodium consumption is a risk factor for hypertension in pregnant women (p=0.004). It is hoped that all pregnant women will always have a pregnancy check-up with a health worker to avoid risks during pregnancy.