Low Sodium Intake Research Articles

Dietary counselling to reduce moderate sodium intake: effects on cardiovascular and renal biomarkers: primary findings of the COSIP and STICK phase II feasibility randomised controlled trials.

While low sodium intake (<2.3g/day) is recommended, there is uncertainty about long-term feasibility and effects on cardiorenal biomarkers in populations with moderate intake. In two phase IIb, feasibility, randomised, parallel, open-label, controlled, single-centre trials, individuals aged >40 years with stable blood pressure (BP), without heart failure or postural hypotension were randomised to intensive dietary counselling (target sodium intake <2.3g/day) or usual care between March 2016 and July 2018. One trial included participants with chronic kidney disease (CKD); the other excluded those with CKD or cardiovascular disease. All participants received healthy eating advice. Primary outcomes were NT-pro B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), C-reactive protein (CRP), renin, aldosterone and, creatinine clearance (CrCl) at 2-years. These trials are registered with ClinicalTrials.gov, STICK trial (NCT02458248) and COSIP trial (NCT02738736). 373 participants, with mean 24-h urine sodium 3.16±1.47g/day, were randomised to intervention (n=187) or usual care (n=186). At 3-months, the intervention reduced 24-h urine sodium (intervention-0.11g/day, usual care+0.28g/day, p=0.003), BP (systolic-2.52mmHg, p=0.05; diastolic-1.92, p=0.02) and increased renin (+33.35 mIU/L [95%CI 3.78-62.91]). At 2-years, the intervention significantly reduced self-reported salt use (p<0.001), but not 24-h urine sodium (intervention-0.23g/day, usual care+0.05g/day, p=0.47). At 2-years, there were no significant between-group differences in BP (systolic p=0.66; diastolic p=0.09), NT-proBNP (p=0.68), hsTnT (p=0.20), CRP (p=0.56), renin (p=0.52), aldosterone (p=0.61), or CrCl (p=0.68). Among individuals with moderate sodium intake, intensive dietary counselling resulted in small short-term reductions in sodium intake and BP, but no significant effect on sodium intake, BP, or cardiorenal biomarkers at two years. Our trial suggests that it may not feasible to reduce sodium sustainably in those with a sodium intake around 3.0g/day, through an intensive dietary counselling intervention. The STICK trial was funded by the Health Research Board of Ireland and the COSIP trial was funded by the European Research Council.

Abstract MP12: Dash Diet and Its Components is Associated With Visceral Fat Area and Hepatic Attenuation Among South Asian Adults in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study (2010-2013)

Introduction: South Asians (SA) are a growing population group in the US that remain understudied in research despite their high cardiometabolic risk. Compared to other ethnic groups, SA experience cardiometabolic disease onset at a younger age, and have higher abdominal, visceral and hepatic fat despite lower BMI. SA in the US have a unique dietary pattern characterized by a combination of traditional and western food items. Examining the dietary pattern of SA in relation to central adiposity may provide a tenable strategy for disease prevention and treatment. Hypothesis: We assessed the hypothesis that higher DASH diet score is associated with lower central adiposity, indicated by visceral fat area and hepatic attenuation measurements, among SA in the US. Methods: Using baseline data from 822 adults enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, we computed a Dietary Approaches to Stop Hypertension (DASH) concordance score from the FFQ validated to measure diet of South Asians in North America. Using an established method, score concordance was based on 8 components including high intake of fruit, vegetables, nuts/legumes, low-fat dairy products, whole grains; and low intake of sodium, sugar-sweetened beverages, and red/processed meats. We examined the association between the DASH score and its components with CT imaging of visceral fat area and hepatic attenuation (higher score indicates lower liver fat). Results: The overall DASH score among participants ranged from 13-35 (mean ± SD, 24.6 ± 4.4). Hepatic attenuation was 5 HU higher among participants in the highest category DASH score compared to the lowest (aβ (SE): 5 (1), 95% CI: 2, 7) in the age-adjusted model. The relationship was not significant in the fully adjusted model. Visceral fat area was 13.6 cm 2 lower among participants in the highest category of DASH score compared to the lowest (aβ (SE): -3.6 (5.1), 95% CI: -23.5, -3.7) in the model adjusted for age, sex, percent of life in US, education, BMI, physical activity, smoking, alcohol, and energy intake. When examining individual components of DASH, participants with the highest intake of low-fat dairy had hepatic attenuation 3 HU higher than those with the lowest intake, and those with the lowest intake of red/processed meat had hepatic attenuation 2 HU higher in the fully adjusted model. Participants with the lowest red/processed meat intake had visceral fat area that was 11 cm 2 lower in the fully adjusted model. Conclusions: In conclusion, our results indicate that greater adherence to DASH and some of its individual components is associated with favorable abdominal fat areas among a sample of SA adults in the US. These findings support the relationship between diet and abdominal fat accretion. Forthcoming analyses will use the DASH score to further elucidate the diet-disease relationship among SA in the US.

Abstract P416: Higher Quality Diet is Associated With Lower Serum Levels of NT-proBNP

Introduction: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is widely used as a diagnostic biomarker for heart failure. Higher diet quality is associated with lower risk of cardiovascular disease. However, the association between diet and subclinical cardiovascular disease, as assessed by biomarker concentrations, is less well-studied. Hypothesis: We hypothesized that higher diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), would be associated with lower serum levels of NT-proBNP. Methods: We included 9,782 adults from the National Health and Nutrition Examination Survey (NHANES), 1999-2004. The HEI-2015 ranges from 0 to 100, with higher scores indicating better diet quality, and was categorized into sex-specific quintiles. Weighted multivariable linear regression models were used to estimate associations between the overall HEI-2015 score as well as its 13 components and log-transformed NT-proBNP. Results: Among 9,782 participants, mean age was 45 years, 48% were men, and 72% were non-Hispanic White adults. After adjusting for sociodemographic characteristics, lifestyle factors, and medical history, persons in the highest HEI-2015 quintile had a 10.0% lower NT-proBNP level compared to those in the lowest HEI-2015 quintile (95% CI: -17.7% to -2.6%). There was a dose-response relationship between HEI-2015 and NT-proBNP ( Figure ). For each 1-unit higher sodium and added sugars score, NT-proBNP was lower by 7.7% and 6.8% respectively (95% CI: -13.8 % to -2.2%, and 95% CI: -13.1% to -0.9% respectively). Conclusion: Higher diet quality, especially lower intakes of sodium and added sugars, was associated with lower serum levels of NT-proBNP.

Abstract P635: Poverty, Sodium Intake and Abnormal Blood Pressure Among Youth 13 to 18 Years of Age

Hypertension (HTN) is a primary cause of cardiovascular disease (CVD) and begins in youth. Among adults, low socioeconomic status (SES) is a demonstrated risk factor for HTN. Low SES has been associated with increased sodium intake and obesity. In this study, we assess the impact of family income, obesity and sodium intake during adolescence on average systolic blood pressure (SBP) to determine if these factors are associated with HTN and elevated BP during adolescence. Methods: Using 2007-2018 National Health and Nutrition Examination Survey data, representative of the non-institutionalized civilian population 13 to 18 years of age, we employed multivariable logistic regression (proc survey logistic) to assess the relationship between abnormal BP diagnosis (HTN or elevated BP), family income, obesity, and sodium intake. Poverty was defined as a family income less than 5-times the poverty level. Sodium intake was estimated based upon a combined 1-day total dietary and 1-day diet supplement recall and was adjusted for total caloric intake per day. The upper quartile of adjusted sodium intake was used to distinguish high from low sodium intake. Abnormal BP was defined as an average systolic blood pressure (SBP) at or above 120mmHg. Multivariable logistic regression was carried out. Results: 2.4% and 13% of the adolescent population had average SBP at or above 130mmHg (HTN) or at or above 120mmHg (elevated BP), respectively. According to multivariable logistic regression, predictors of the HTN/Elevated BP were overweight status (OR: 2.4, 95%CI: 1.8, 3.2), obesity (OR: 3.6 95%CI: 2.8, 4.7), male sex (OR:3.6, 95%CI: 2.7, 4.9), non-Hispanic black race (OR: 1.8, 95%CI: 1.2, 1.4) and age (OR: 1.3, 95%CI: 1.2, 1.4). Poverty status (OR: 1.2, 95%CI: 0.74, 1.9), Hispanic ethnicity (OR 1.2, 95%CI: 0.87, 1.5), and sodium intake (OR: 1.1, 95%CI: 0.86, 1.4) were not associated with HTN/elevated BP. Conclusion: While SES factors contribute to abnormal BP, sodium intake and family income were not associated with HTN/elevated BP in adolescents using a single day dietary intake recall. According to our results, additional SES factors contribute to HTN/elevated BP in adolescents and should be further explored.

Abstract P387: Effects of Reduced Dietary Sodium and the Dash Diet on Glomerular Filtration Rate: Results From the Dash-Sodium Trial

Background: While prior studies demonstrated that a low-sodium, DASH diet reduced blood pressure, the effects of sodium reduction, alone or in combination with the DASH diet, on kidney function are still unknown. Objective: We measured cystatin C in stored specimens of the DASH-Na trial, to determine the effects of sodium reduction and the DASH diet, alone or combined, on kidney function assessed by eGFR. Methods: DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4-weeks following a 2-week run-in period where all consumed a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes included eGFR by cystatin C (CKD-EPI 2021 equation) at baseline and at the end of each feeding period. Results: Cystatin C was measured in 409 of the original 412 participants, 207 were assigned the DASH diet, and 202 were assigned the control diet. The mean age was 48 years; 56% were women, and 56% were Black. The mean baseline BP was 135/86 mm Hg and BMI was 29.2 kg/m 2 . Compared with control, the DASH diet did not affect eGFR (β=-0.96 mL/min per 1.73 m 2 ; 95% CI: -2.74, 0.83) ( Figure ). In contrast, low versus high sodium intake decreased eGFR (β=-2.36 mL/min per 1.73 m 2 ; 95% CI: -3.64, -1.07). Together, compared to the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 mL/min per 1.73 m 2 (95% CI: -5.46, -0.73). Conclusions: A combined low sodium-DASH diet reduced eGFR over a 4-week feeding period. Whether these effects are reno-protective long-term represent an important clinical inquiry for subsequent research.

Low sodium intake ameliorates hypertension and left ventricular hypertrophy in mice with primary aldosteronism.

The goal of this paper is to elucidate the effects of sodium restriction on hypertension and left ventricular (LV) hypertrophy in a mouse model with primary aldosteronism (PA). Mice with genetic deletion of TWIK-related acid-sensitive K (TASK)-1 and TASK-3 channels (TASK-/-) were used as the animal model of PA. Parameters of the LV were assessed using echocardiography and histomorphology analysis. Untargeted metabolomics analysis was conducted to reveal the mechanisms underlying the hypertrophic changes in the TASK-/- mice. The TASK-/- adult male mice exhibited the hallmarks of PA, including hypertension, hyperaldosteronism, hypernatremia, hypokalemia, and mild acid-base balance disorders. Two weeks of low sodium intake significantly reduced the 24-h average systolic and diastolic BP in TASK-/- but not TASK+/+ mice. In addition, TASK-/- mice showed increasing LV hypertrophy with age, and 2weeks of the low-sodium diet significantly reversed the increased BP and LV wall thickness in adult TASK-/- mice. Furthermore, a low-sodium diet beginning at 4weeks of age protected TASK-/- mice from LV hypertrophy at 8-12weeks of age. Untargeted metabolomics demonstrated that the disturbances in heart metabolism in the TASK-/- mice (e.g., Glutathione metabolism; biosynthesis of unsaturated fatty acids; amino sugar and nucleotide sugar metabolism; pantothenate and CoA biosynthesis; D-glutamine and D-glutamate metabolism), some of which were reversed after sodium restriction, might be involved in the development of LV hypertrophy. In conclusion, adult male TASK-/- mice exhibit spontaneous hypertension and LV hypertrophy, which are ameliorated by a low-sodium intake.

Insight into mechanism of quality changes in tilapia fillets during salting from physicochemical and microstructural perspectives

The effects and mechanisms of salting on quality properties of tilapia fillets were investigated in the present study. Salting under high NaCl concentrations (12 % and 15 %) resulted in low water content and decreased yields, due to the salting-out effects and low pH. Water in fillets increased in the later stage of salting in 3 % and 6 % NaCl solutions (p < 0.05). The released proteins accumulated with increasing time (p < 0.05). The TBARS value increased from 0.01 to 0.20 mg/kg after 10 h in 15 % NaCl solution (p < 0.05). The quality changes were mainly correlated to the shrinking or swelling of myofibers, extracellular spaces, and existential state of muscle proteins. In consideration of fish quality and increasing call for low sodium intake, it was recommended to prepare fillets below 9 % NaCl with short times. The finding provided instructions to obtain target quality properties from tilapia by controlling salting conditions.

Low Sodium Intake, Low Protein Intake, and Excess Mortality in an Older Dutch General Population Cohort: Findings in the Prospective Lifelines-MINUTHE Study.

Several studies have found a U-shaped association between sodium intake and mortality. The increased mortality risk of low sodium intake has raised debates and hampers widespread acceptance of public health campaigns and dietary guidelines on reducing sodium intake. Whether the excess risk can be attributed to low sodium intake alone or concomitant inadequate intake of other relevant nutrients is unknown. We investigated whether concomitant low protein intake could explain the lower part of the U-shaped association of sodium intake with all-cause mortality. We included 1603 individuals aged between 60 and 75 years old from the gender- and socioeconomic status-balanced prospective Lifelines-MINUTHE cohort study. Using multivariable Cox regression analyses, we investigated the association of sodium intake (24 h urinary sodium excretion) with all-cause mortality, including the interaction with protein intake calculated from the Maroni formula. Mean intakes of sodium and protein were 3.9 ± 1.6 g/day and 1.1 ± 0.3 g/kg/day, respectively. After a median follow-up of 8.9 years, 125 individuals (7.8%) had died. The proportion of participants with insufficient protein intake (&lt;0.8 g/kg/day) was inversely related to sodium intake (i.e., 23.3% in Q1 versus 2.8% in Q4, p &lt; 0.001). We found an increased risk for mortality in both the highest quartile (Q4, &gt;4.7 g/day; hazard ratio (HR) 1.74 (95% confidence interval (CI) 1.03-2.95)) and the lowest two quartiles of sodium intake (Q1, 0.7-2.8 g/day; 2.05 (1.16-3.62); p = 0.01 and Q2, 2.8-3.6 g/day; 1.85 (1.08-3.20); p = 0.03), compared with the third quartile of sodium intake (Q3, 3.6-4.7 g/day). This U-shaped association was significantly modified by protein intake (Pinteraction = 0.006), with the increased mortality risk of low sodium intake being reversed to the lowest mortality risk with concomitant high protein intake. In contrast, the increased mortality risk of low sodium intake was magnified by concomitant low protein intake. We found that a higher protein intake counteracts the increased mortality risk observed in subjects with a low sodium intake. In contrast, a joint low intake of sodium and protein is associated with an increased mortality risk, allegedly due to poor nutritional status. These findings support the guidelines that advocate a lower sodium intake, while highlighting the importance of recognizing overall nutritional status among older adults.

Estimated Dietary and Health Impact of the World Health Organization's Global Sodium Benchmarks on Packaged Foods in Australia: a Modeling Study.

In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO's sodium benchmarks in Australia and compared it to the potential impact of Australia's 2020 sodium reformulation targets. We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia's sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. Compliance with the WHO's sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168-2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603-9513) new cases, and 25 700 (17 655-35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO's more stringent and comprehensive sodium benchmarks.

The association of sodium intake with the development of hypertensive disorders of pregnancy

To assess the association between daily sodium intake and risk of hypertensive disorders of pregnancy. This was a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. In this analysis, we included those with non-anomalous, singleton pregnancies who completed food frequency questionnaires in which they recorded their sodium intake in the 3 months prior to pregnancy. Individuals who did not progress beyond 20 weeks’ gestation were excluded. Sodium intake was categorized as low (< 2g per day), medium (2g to < 3g per day), or high (≥ 3g per day). The primary outcome was development of a new-onset hypertensive disorder of pregnancy (HDP), including antenatal gestational hypertension, preeclampsia, HELLP, and superimposed preeclampsia. Other maternal and neonatal outcomes also were assessed. Kruskal-Wallis and Chi square tests were used to compare baseline characteristics. Adjusted incidence risk ratios (aIRR) with 95% confidence intervals (CIs) were estimated using Poisson regression to control for confounders. Among 7927 individuals eligible for this analysis, 2,482 (31%) reported low sodium intake, 2,978 (38%) medium sodium intake, and 2,467 (31%) high sodium intake. Baseline characteristics, including age, BMI, self-reported race and ethnicity, and tobacco use differed significantly between groups (all p< 0.01, Table 1). The risk of developing HDP was similar among groups (medium vs. low aIRR 1.03, 95% CI 0.88-1.22; high vs. low aIRR 1.13, CI 0.96-1.34). There were no differences in other adverse maternal or neonatal outcomes by sodium intake (Table 2). There was no association between sodium intake and risk of HDP. This may reflect a difference in the pathophysiology underlying pregnancy and non-pregnancy related hypertensive disorders.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Comparison of participant and non-participant perceptions on healthy restaurant for sodium reduction: a qualitative study.

In the Republic of Korea, "Healthy Restaurant for Sodium Reduction (HRSR)" project have been designated as one of the representative policies for sodium intake reduction. However, as of 2021, only 879 restaurants, less than 0.1% of all restaurants, had been designated. Therefore, to increase the participation of restaurants in this policy, it is necessary to examine the in-depth perception and experience of participants and non-participants in the HRSR. Two focus group discussions were conducted for HRSR project participants and non-participants. A total of 260 semantic units were derived from the 2 groups. The units were further classified into 5 upper categories and 11 subcategories. All the study participants knew the importance of low sodium intake, but they had little information on HRSR project. Various attempts have been made to encourage low sodium practice in restaurants, and the participants reported that the amount of salt used in their restaurants currently is reduced compared to that used in the past. However, they were worried about customers' complaints about the low sodium in their diet and the insignificant beneficent associated with the policy, which makes restaurant owners reluctant to participate in this policy. All the participants agreed on the urgent need for the improvement of public awareness of low-sodium diets and for substantive government support for HRSR. This study concluded that strategies such as more active publicity for the practice of sodium reduction in restaurants, identification of approaches to dispel the perception that low-salt diet is not tasty, and development of plans to increase the sale of food in of HRSR, are needed.

Mizoribine combined with steroids and dietary sodium restriction on the treatment of primary membranous nephropathy: a prospective study.

We aimed to initially explore the efficiency and safety of mizoribine (MZR) combined with steroids and dietary sodium restriction on the treatment of primary membranous nephropathy (MN) compared with cyclophosphamide (CPM)-based steroids. Patients with primary MN were enrolled. According to the therapy, they were divided into theMZR combined with steroids and dietary sodium restriction group (N = 30) and CPM-based steroids group (N = 30). Both groups were followed up for 1year to monitor safety and efficacy. Compared with the CPM-based steroids group, theMZR combined with steroids and dietary sodium restriction group had significantly lower daily sodium intake, serum sodium, blood pressure (BP), and 24h urine protein (all P < 0.05). Conversely, plasma albumin and complete remission rate in the MZR group were higher at the 12th follow-up (40.39 ± 5.14g/L vs. 37.63 ± 5.40g/L; 86.67% vs. 66.67%; all P < 0.05). These two groups showed similar adverse events rates (20.00% vs. 26.67%, P = 0.54). This study demonstrates that MZR combined with steroids and dietary sodium restriction is superior to CPM-based steroids in terms of completeremission and 24h urine protein in patients with primary MN.

Low Intake of Fruits and Vegetables and High Intake of Processed Meats and Juices Are Associated with Risk of MGUS in the National Health and Nutrition Examination Survey (NHANES) Database

Introduction Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell disorder with a prevalence of about 3% in adults over age 50. The annual average risk of progression to multiple myeloma (MM) is approximately 1%. MGUS has also been reported to be associated with excess risk of cardiac, renal, neurologic, and immune-related conditions. Although inflammatory or insulinemic diets or diets low in plant-based foods have been associated with risk of MM, there is limited information on dietary factors and risk of MGUS from one Icelandic cohort study which focused on Caucasians (Thordardottir et al. 2018). Given that food intake can vary greatly across ethnic/racial groups, we were motivated to conduct a large population-based study including Caucasians, African-Americans, Hispanics, Asians, Pacific Islanders, and other ethnic/racial groups. Methods Using the National Health and Nutrition Examination Survey (NHANES), we conducted a case-control study including 373 individuals with MGUS (cases) and 1,406 frequency-matched controls. Diet was characterized by 24-hour dietary recall (DR) and food frequency questionnaire (FFQ). MGUS status was determined by screening. Unconditional multivariable logistic regression analyses were used to model the association between MGUS and daily intake of macronutrients, 18 micronutrients, and nine USDA food groups from the DR, and analogous food groups from the FFQ, with odds ratios (OR) and 95% confidence intervals (CI) for MGUS as the measures of association. Results Descriptive characteristics of the study sample are shown in Table 1. Over 40% of the participants were members of racial or ethnic minorities. Among the micronutrients, only sodium intake achieved significance (Figure 1); individuals with insufficient daily sodium intake were 54% more likely to have MGUS than those with sufficient intake (OR=1.54; 95% CI=1.07-2.21), which could be indicative of individuals with kidney disease or hypertension (both associated with MGUS) or heart failure following low-sodium diets. Excessive sodium intake was not significantly associated with MGUS in this study. Daily gram intake of "Fruits, excluding juices, and vegetables" was higher in non-MGUS, with the highest quartile associated with 33% lower odds of MGUS (Q4 OR=0.67; 95% CI=0.48-0.94; p for trend=0.02). Daily gram intake of "Sugars, sweets, and beverages" was significantly associated with an increased odds of MGUS (Q4 OR=1.45; 95% CI= 1.01-2.08; p for trend=0.02). Monthly frequency of intake of "Meat, poultry, seafood, stews" (Q4 OR=1.61; 95% CI=1.03-2.50, p for trend<0.05) was associated with MGUS, with most of the effect coming from processed meat (data not shown). Frequency of intake of "Fruit juice" (Q3 OR=1.91; 95% CI=1.24-2.96; Q4 OR=1.81; 95% CI= 1.17-2.81; p for trend<0.01) was also associated with MGUS. There was a suggestion of an inverse association between monthly intake of "Bread, cereal, rice, starchy entrees, cakes" and MGUS. Compared to Q1, Q2 was significantly associated with reduced risk of MGUS (Q2 OR=0.62; 95% CI=0.41-0.96); Q3 and Q4 supported this trend but were not significant. Most of the category effect was due to dry cereals and yeast breads (data not shown). No other micronutrient or food group, measured by DR or FFQ, was found to be associated with MGUS. Conclusions Our study shows that certain dietary characteristics, including low intake of sodium, fruits and vegetables, and cereals and yeast breads, and high intake of sugars, sweets, and beverages, juices, and processed meat, are associated with MGUS. The identification of novel dietary risk factors for MGUS in a diverse population are of direct public health relevance. The findings of this study also provide rationale for exploration of mechanistic links between diet and the microbiome, immune system, metabolism, and epigenetics, such as the ongoing plant-based diet pilot study at Memorial Sloan Kettering Cancer Center (NCT04920084) and intermittent fasting study at Roswell Park Comprehensive Cancer Center (NCT05312255). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 11691: Self-Reported Sodium Intake Identifies a Sodium Vulnerable State With Increased Response to Spironolactone in HFpEF

Introduction: Asking patients about sodium intake is standard practice in heart failure (HF). Hypothesis: Self-reported sodium intake in HF with preserved ejection fraction (HFpEF) reflects a vulnerability to sodium intake driven by aldosterone. Methods: The TOPCAT trial registered self-reported sodium intake at baseline. Cox-regression and linear-mixed models were used to assess the relationship between self-reported sodium intake and outcome. Interaction analysis between self-reported sodium intake and the treatment effect of spironolactone on HF-outcome, blood pressure (BP), dyspnea and edema at follow-up were used to assess sodium vulnerability mediated by an aldosterone effect. Results: Self-reported sodium intake of 1748 HFpEF patients included in TOPCAT were divided according to tertiles of sodium intake (47% low, 35% moderate and 18% reported high sodium intake). After covariate adjustment lower self-reported sodium intake associated with higher risk for HF-admission (p=0.009). Patients with a lower sodium intake demonstrated higher E-wave and LV-end diastolic volume and higher estimated plasma volume (p&lt;0.001). Lower sodium intake was associated with a larger treatment effect of spironolactone on HF-admission (HR=0.69, 95%CI 0.53-0.91 vs highest tertile HR=1.37 95%CI 0.79-2.38, p-interaction=0.030). Additionally, linear-mixed models indicated larger BP-reduction (Figure) and larger reduction in dyspnea and edema (p-interaction all&lt;0.001) in patients with lower sodium intake receiving spironolactone. Conclusions: Low self-reported sodium in HFpEF is associated with volume status and higher risk of HFH. The more pronounced treatment effect with spironolactone on HF-outcome, BP and volume status in patients with the lowest self-reported sodium intake potentially suggests that low self-reported sodium intake is an indicator of a sodium vulnerable, potentially aldosterone driven, state.

Low sodium intake and cardiovascular disease mortality among adults with hypertension

BackgroundThough high sodium intake is linked to an increased risk of hypertension and cardiovascular diseases, the relationship between sodium intake and mortality remains controversial. Given that medications used to treat hypertension can potentially lower blood sodium levels and alter electrolyte balance, it begs the question whether a further reduction in dietary sodium below the recommended daily intake of 2300 mg is beneficial among adults with hypertension. ObjectiveTo evaluate the effect of low sodium intake on cardiovascular disease (CVD) mortality and all-cause mortality among adults with hypertension. DesignA retrospective cohort study was conducted using data from the Continuous NHANES (1999–2010) linked to mortality files from the National Death Index. Using sodium intake categorized as low <2300 mg/day and high ≥2300 mg/day, the baseline demographic and health characteristics of participants were determined. Hazard ratios (HR) for CVD and all-cause mortality were determined through cox proportional hazard regression analysis adjusted for age, sex, race, total dietary calories, body mass index, physical activity, smoking, diabetes, alcohol consumption, and total serum cholesterol while considering the complex survey design. ResultsOf the 8542 adults with hypertension, 71.01% consumed sodium higher than the recommended daily intake of 2300 mg. The mean age was 54 years, 52.3% were female and 73.1% were white. Over 12.7 years of follow-up, there were 971 deaths, with 232 deaths from CVD. The low sodium intake group had a nonsignificant 5% higher risk of CVD mortality, [Adjusted HR 1.05,95% CI (0.7–1.6), p-value 0.82]. Similarly, there was a nonsignificant 17% higher risk for all-cause mortality for the low sodium intake group, [Adjusted HR 1.17,95% CI (1.0–1.4), p-value 0.10]. There was no effect modification by age, race, or sex. ConclusionThe findings of an inverse association between sodium intake and mortality among adults with hypertension seen here, though not statistically significant warrant further investigation.

Low Sodium Intake, Low Protein Intake, and Excess Mortality: Findings in the Lifelines-MINUTHE Study

Low Sodium Intake, Low Protein Intake, and Excess Mortality: Findings in the Lifelines-MINUTHE Study

Higher Potassium Intake and Lower Sodium Intake May Help in Reducing CVD Risk by Lowering Salt Sensitivity of Blood Pressure in the Han Chinese Population.

Sodium (Na) reduction with a parallel supplemental potassium (K) intake can prevent cardiovascular diseases (CVDs). The relationship of the urinary Na/K ratio and salt sensitivity of blood pressure (SSBP) with CVDs is not clearly explained. We assumed that the SSBP mediates the relationship between the Na/K ratio and CVDs. In total, 2055 subjects who had 24 h urine collected and SSBP determined were included in this study. CVD risk was estimated using the China-PAR equation. MediationMultivariate logistic regression was used to explore the associations between the Na/K ratio or SSBP with CVD risk. Mediation analysis using a logistic regression model was performed. Both the urinary Na/K ratio and SSBP were related to the estimated CVD risk (p < 0.05). The mediation analysis found that SSBP mediated approximately 12% of the association between Na/K ratio and CVD risk. Our findings indicate that higher K intake and lower Na intake may help in preventing CVD risk by reducing SSBP risk in individuals with normotension or stage-one hypertension.

Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt.

This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a “fight or flight” response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.

A Systematic Review of Salt Taste Function and Perception Impairments in Adults with Chronic Kidney Disease.

Individuals with chronic kidney disease (CKD) experience physiological changes that likely impair salt taste function and perception. Sodium restriction is a cornerstone of CKD management but dietary sodium plays an important role in food enjoyment and may interfere with compliance to this intervention. Therefore, confirming that taste deficits are present in CKD will improve our understanding of how taste deficits can affect intake, and inform dietary counselling in the future. A systematic review was conducted. Studies that included adults with CKD and healthy controls, and assessed salt taste sensitivity, perceived intensity, and/or hedonic ratings were included. Study quality was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Library Quality Criteria Checklist: Primary Research. Of the 16 studies, the majority reported decreased salt taste sensitivity, but no consistent differences in intensity or hedonic ratings were observed. Higher recognition thresholds in CKD patients were associated with higher sodium intake, but results should be interpreted with caution as the measures used were subject to error in this population. In conclusion, salt taste sensitivity is decreased in CKD, but intensity and hedonic evaluations appear to be more robust. Given that hedonic assessments are better predictors of intake, and that salt taste preferences can be changed over time, dietary counselling for low-sodium intake is likely to be effective for this population.

Quality assessment of consumer-facing websites on sodium reduction.

The purpose of this paper is to evaluate the quality of information and guidance on dietary sodium reduction available on consumer‐facing websites. Google Trends was used to identify the five most‐used search terms related to dietary sodium reduction. For each term, websites on the first two pages were collected (n = 18–20). Of 93 websites collected, 24 were excluded due to defective links, duplicate websites, or not being consumer‐focused. The remaining 69 websites were evaluated using a novel instrument, JHU‐SALT, that includes 14 questions on topics related to salt reduction. The questions are grouped into three domains (“information,” “guidance,” and “accuracy”). For each question, websites were scored using a 3‐step ordinal scale (“topic not addressed,” “topic somewhat addressed,” or “topic addressed adequately”). Only three of 14 JHU‐SALT questions were addressed adequately by a majority of websites. Many websites provided information on the adverse health effects of a high sodium diet (74%, n = 51) or mentioned intake recommendations (64%, n = 44). Information on fundamental concepts was largely missing. The majority of websites (80%, n = 55) provided information on lifestyle strategies to reduce blood pressure, but most did not provide guidance to help implement those strategies. While missing information was common, misinformation was uncommon. The DISCERN questionnaire was utilized as well. Consumers seeking information and guidance on dietary sodium reduction will find that most available websites provide accurate but limited information, and insufficient guidance on how to lower sodium intake. Websites that provide both relevant information and guidance are needed to help consumers effectively reduce dietary sodium.