Lowering Salt Intake Research Articles

Effect of home cook interventions for salt reduction in China: cluster randomised controlled trial.

To determine the effects of salt reduction interventions designed for home cooks and family members. Cluster randomised controlled trial. Six provinces in northern, central, and southern China from 15 October 2018 to 30 December 2019. 60 communities from six provinces (10 communities from each province) were randomised; each community comprised 26 people (two people from each of 13 families). Participants in the intervention group received 12 month interventions, including supportive environment building for salt reduction, six education sessions on salt reduction, and salt intake monitoring by seven day weighed record of salt and salty condiments. The control group did not receive any of the interventions. Difference between the two groups in change in salt intake measured by 24 hour urinary sodium during the 12 month follow-up. 1576 participants (775 (49.2%) men; mean age 55.8 (standard deviation 10.8) years) from 788 families (one home cook and one other adult in each family) completed the baseline assessment. After baseline assessment, 30 communities with 786 participants were allocated to the intervention group and 30 communities with 790 participants to the control group. During the trial, 157 (10%) participants were lost to follow-up, and the remaining 706 participants in the intervention group and 713 participants in the control group completed the follow-up assessment. During the 12 month follow-up, the urinary sodium excretion decreased from 4368.7 (standard deviation 1880.3) mg per 24 hours to 3977.0 (1688.8) mg per 24 hours in the intervention group and from 4418.7 (1973.7) mg per 24 hours to 4330.9 (1859.8) mg per 24 hours in the control group. Compared with the control group, adjusted mixed linear model analysis showed that the 24 hour urinary sodium excretion in the intervention group was reduced by 336.8 (95% confidence interval 127.9 to 545.7) mg per 24 hours (P=0.002); the systolic and diastolic blood pressures were reduced by 2.0 (0.4 to 3.5) (P=0.01) and 1.1 (0.1 to 2.0) mm Hg (P=0.03), respectively; and the knowledge, attitude, and behaviours in the intervention group improved significantly. The community based salt reduction package targeting home cooks and family members was effective in lowering salt intake and blood pressure. This intervention has the potential to be widely applied in China and other countries where home cooking remains a major source of salt intake. Chinese Clinical Trial Registry ChiCTR1800016804.

App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial

ObjectiveTo determine whether a smartphone application based education programme can lower salt intake in schoolchildren and their families.DesignParallel, cluster randomised controlled trial, with schools randomly assigned to either intervention or...

EARLY EVIDENCE FOR THE EFFECTIVENESS OF SOUTH AFRICA'S LEGISLATION ON SALT RESTRICTION IN FOODS: THE AFRICAN-PREDICT STUDY

Objective: South Africa was one of the first countries to adopt mandatory regulation in 2016 to lower the salt content of a wide range of processed foods. To assess the effectiveness of this regulation, we determined the change in salt intake of young adults over a mean follow-up time of 4.56-years spanning the implementation of the regulation. Since young populations have a higher salt intake, salt reduction may have a greater long-term impact as a preventative strategy in this age group. Design and method: This study included baseline (N = 668; aged 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data for the first 311 participants (aged 29.9 ± 3.09 years; 51.1% black; 43.4% men) tracked over time as part of the African-PREDICT study. Participants had baseline data before 30th June 2016, and follow-up from 2018 - 2020. Estimated salt intake at baseline and follow-up was calculated from 24-hour urinary sodium excretion. Results: The median salt intake of the population (N = 668) at baseline was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [median (IQR): 7.26 g/day (5.30)] in the total group [median difference (IQR): -0.82 g/day (7.02); p = 0.007], with a greater reduction observed in black adults [N = 159, median difference (IQR): -1.35 g/day (7.91); p = 0.003]. Reduced salt intake was more pronounced in black adults from a low (p = 0.007) and middle socio-economic status (p = 0.009), compared to a high socio-economic status (p = 0.27). Conclusions: Our preliminary findings suggest that South Africa's mandatory salt reduction regulation for processed foods has been effective in lowering salt intake in young adults by a magnitude of ∼0.82 g salt/day. Our study supports the effectiveness of “upstream” sodium reduction interventions at population level that may impact on the health and economic burden of countries.

Cortical perfusion as assessed with contrast-enhanced ultrasound is lower in patients with chronic kidney disease than in healthy subjects but increases under low salt conditions.

Disturbances in renal microcirculation play an important role in the pathophysiology of chronic kidney disease (CKD), but the lack of easy accessible techniques hampers our understanding of the regulation of the renal microcirculation in humans. We assessed whether contrast-enhanced ultrasound (CEUS) can identify differences in cortical perfusion and alterations induced by different dietary salt intakes in CKD patients and controls. Participants underwent CEUS twice: once after 5 days of high-salt (HS) intake, and again after 5 days of low salt (LS) diet. Sonovue® (0.015 mL/kg/min) was perfused as contrast agent and four consecutive destruction-reperfusion sequences were analysed per visit. The primary outcome measure was the (change in) mean perfusion index (PI) of the renal cortex. Forty healthy volunteers (mean age ± standard deviation 50 ± 8 years) and 18 CKD Stages 2-4 patients [aged 55 ± 11 years, estimated glomerular filtration rate (eGFR) 54 ± 28 mL/min/1.73 m2] were included and underwent CEUS without side effects. Under HS conditions, cortical PI was significantly lower in CKD patients [1618 ± 1352 versus 3176 ± 2278 arbitrary units (a.u) in controls, P = 0.034]. Under LS, renal PI increased in CKD patients (with +1098 to 2716 ± 1540 a.u., P = 0.048), whereas PI remained stable in controls. In the continuous analysis, PI correlated with eGFR (Spearman's r = 0.54, P = 0.005) but not with age, sex, blood pressure or aldosterone levels. CEUS identified important reductions in cortical micro-perfusion in patients with moderate CKD. Lowering salt intake increased perfusion in CKD patients, but not in controls, underlining the benefits of an LS diet in CKD patients. Whether a low PI is an early sign of kidney damage and predicts renal function decline needs further study.

Midterm Evaluation of Malaysia’s National Salt Reduction Strategy – Lessons Learned on Adapting Salt Reduction ‘Best Buys’ to the Local Context

Abstract Objectives To evaluate the implementation progress and contextual influences of Malaysia's five-year national salt reduction program at midpoint, with a view to generating lessons on adapting the World Health Organization's salt reduction ‘best buys’ to suit the local context. Methods The Malaysian Government's multi-faceted strategy includes three of four salt-related ‘best buys’; reduce salt intake through 1) behavior change communication, 2) reformulation of food products to contain less salt and 3) implementation of front-of-pack labeling, as well as a strategy to monitor population salt intake and sodium levels in foods. Based on the UK Medical Research Council's guidance on process evaluation, routinely-collected administrative data, 12 semi-structured interviews and public information were used and synthesized in NVivo to evaluate the reach, dose, adoption, fidelity and contextual influences of implementation. This was supplemented with data from three focus groups (43 participants) conducted using the nominal group technique to understand the priority barriers and facilitators of lowering salt intake in Malaysia. Results In the first 3 years, there was high progress in accurately monitoring population salt intake and developing culturally-specific education resources. However, a major barrier to implementing the other interventions was the absence of mandatory sodium content declaration on packaged foods. A lack of packaged foods with sodium content labeling hindered the program implementers' ability to identify and engage high-salt food producers in reformulation, identify low-salt foods eligible for the Healthy Choice Logo front-of-pack label, educate consumers to identify high or lower-salt foods and monitor the sodium content of packaged foods. This aligns with the perceived challenges of reducing salt consumption in Malaysia being poor consumer knowledge and attitudes around salt reduction, and the absence of low-salt alternatives. Conclusions Countries without mandatory sodium or salt labeling on packaged foods should prioritize this regulation to enable effective implementation of the salt reduction ‘best buys’. Interim process evaluations are useful for identifying necessary intervention adaptations. Funding Sources The World Health Organization.

The influences of salt replacers on the antioxidative activity of pork

Lowering salt intake is of great importance for reducing blood pressure and cardiovascular diseases. The aim of this research was to study the effects of salt replacers on the antioxidative activity of meat. The treatments were formulated with minced pork muscles that were salted with 2.0% salt (control) or different salt mixtures with reduced sodium content (composition 1 – 1.0 % NaCl + 1.2% KCl (experiment 1), composition 2 – 1.0% NaCl + 0.6% KCl + 0.8% CaCl2 (experiment 2)). After 24 hours of curing, the total antioxidative activity of the antioxidant enzymes was measured. The use of potassium chloride instead of half the sodium chloride did not lead to a significant change in the total antioxidative activity, nor in the activities of glutathione peroxidase and catalase; however, it induced a decrease in the activity of superoxide dismutase (p<0.05). Addition of composition 2 led to a reduction in the total antioxidative activity by 17.7%, and inhibited the activity of superoxide dismutase by 23.8% (p<0.05). The obtained results of the negative effect of the compositions of sodium, potassium and calcium salts suggest the need to develop approaches that allow inhibition of the oxidative changes in meat products with reduced sodium content.

An Application-based programme to reinforce and maintain lower salt intake (AppSalt) in schoolchildren and their families in China

IntroductionSalt intake is very high in China, with ≈80% being added by the consumers. It is difficult to reduce salt in such settings. Our previous study (School-based Education programme to...

How much salt is too much salt?

The overall prevalence of hypertension in Turkey’s adult population is 21.4% and reaches a maximum of 43.3% in patients aged >65 years (1). The SALTURK study reported that Turkey’s salt consumption averages between 14.8 and 18.1 g per day (2, 3). This leads to a simple question, how much salt is too much salt? Guideline recommendations The American Heart Association (AHA) recommends a daily salt intake of <3.75 g for the general population (4). This indicates that the average Turkish citizen’s salt consumption is more than five times higher than the amount AHA recommends. Therefore, salt consumption is high in Turkey by any standards. However, before we embark on a massive anti-salt campaign, we need to verify the evidence regarding the AHA recommendations, i.e., what is the scientific evidence that healthy people, young and old, men, women, and children should consume less than 3.75 g salt or 1.5 g sodium per day? The AHA’s recommendations regarding salt restriction are based on multiple well-established observations such as salt increases blood pressure (BP), and high BP is known to cause cardiovascular disease. However, the AHA’s recommendation of 3.75 g per day is arbitrary, as are most dietary recommendations. Other institutions, such as WHO and European Society of Cardiology, recommend sodium intake of 2.0-2.5 g per day (5, 6). However, it does not necessarily mean that lowering BP by eating less salt will consistently decrease the risk of heart disease, regardless of whether you are hypertensive or have normal BP, whether your salt consumption is excessive, moderate, or even low. In the US, we have observed a drastic reduction in cardiovascular disease over the past decades (7). However, the average American continues to consume about 9 g of salt daily, (approximately half of that an average Turk’s salt intake) an amount that has not changed in years despite the reduction in heart disease. Conceivably, a reduction in dietary sodium may prove beneficial in high salt eaters who also have high BP. However, in people with normal BP, lowering salt intake has little, if any, effect and may even be harmful when becoming too severe (8).

Long-Term Effects of Intensive Low-Salt Diet Education on Deterioration of Glomerular Filtration Rate among Non-Diabetic Hypertensive Patients with Chronic Kidney Disease

Background: Diet modification, especially a decrease in salt intake, might be an important non-pharmacological strategy to improve chronic kidney disease (CKD) prognosis. Objectives: We conducted a prospective cohort study to investigate whether an intensive low-salt diet education program effectively attenuated the rate of renal function decline in hypertensive patients with CKD. Methods: This cohort study recruited 171 participants from a previous open-labelled, case-controlled, randomized clinical trial that originally consisted of 245 hypertensive CKD patients who were assigned to two groups, intensive low-salt diet or conventional education. We evaluated the renal outcomes, which included the rate of change in estimated glomerular filtration rate (eGFR) per year, the increase in serum creatinine ≥50%, the decrease in eGFR ≥30%, and the percent change in albuminuria throughout the entire study period. Results: The baseline characteristics of the cohort participants between the two groups were similar at the time of trial phase randomization. During the whole study period, the rate of renal function decline was significantly faster in the conventional group (0.11 ± 4.63 vs. –1.53 ± 3.04 mL/min/1.73 m2/year, p = 0.01). The percent of incremental change in serum creatinine ≥50% was 1.1% in the intensive group and 8.2% in the conventional group (p = 0.025), and the percent of decremental change in eGFR ≥30% was 3.3% in the intensive group and 11.1% in the conventional group (p= 0.048). With logistic regression analysis adjusted for related factors, we found that the conventional group showed a higher risk for deterioration in serum creatinine and eGFR during the entire study period. Especially, we found that the intensive education program preserved eGFR in participants with one, several, or all of the following characteristics at the time of randomization: older age, female, obese, had higher protein intake, higher amounts of albuminuria, higher salt intake. Conclusion: This cohort study demonstrated that an intensive low-salt diet education program attenuated the rate of renal function decline in hypertensive CKD patients independent of its effect on lowering salt intake or albuminuria during the 36 months of follow-up.

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

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

YIA 02-03 ESTIMATION OF SALT INTAKE WITH A SINGLE BASELINE MEASUREMENT IS INACCURATE AND AFFECTS THE RELATION BETWEEN SALT INTAKE AND LONG-TERM CARDIOVASCULAR AND RENAL OUTCOME

Objective: Lowering salt intake has been shown to decrease blood pressure (BP). However, data from large cohort studies on salt intake and cardiovascular and renal outcomes are inconsistent. These studies have estimated long-term salt intake using 1 baseline measurement, which may be inaccurate. In this retrospective cohort study, the effect of using successive and multiple 24h samples on the relation between salt intake and long-term outcome was investigated. Design and Method: We selected adult subjects with an eGFR > 60 mL/min and at least 1 outpatient 24h urine sample >300 mL between 1998–1999. Salt intake was estimated using 1 baseline 24h sodium excretion into urine and the average of 1, 5 and 15-year samples (Fig-A). We divided subjects in tertiles of 24h sodium excretion for Cox-regression analysis, after adjustment for cardiovascular and renal risk factors. Primary outcomes were a composite of cardiovascular events and mortality, and development of end-stage renal disease (ESRD: renal replacement therapy or >60% eGFR decline). Results: We included 574 subjects with 9,776 24h urine samples during follow-up. Average (±SD) age was 47 ± 14 years and 46% were male. Median follow-up was 16.2 years. Average 24h salt excretion, 10 ± 4 grams, was equal among all methods (p = 0.98) (Fig-B). However, relative to 1 baseline measurement, 49% (1-year), 50% (5-year) and 48% (15-year) of the subjects had a difference of >2 grams in salt intake with new estimations (Fig-C). As a result, 45–50% of all subjects switched between tertiles of salt intake. Point estimates of risk for primary outcomes changed considerably when using single baseline vs. subsequent 24h samples, particularly for ESRD (Fig-D,E). Conclusions: Relative to 1 baseline 24h sodium measurement, the use of multiple 24h urine samples resulted in different estimations of an individual's salt intake, while population averages remained similar. This had significant consequences for the relation between salt intake and long-term renal outcomes.

ISH NIA PS 02-04 Urinary Na and K excretion values in outpatients with hypertension compared to patients with other diseases

Objective: Restricting salt intake is considered important in the treatment of hypertension, and knowledge of the profile of salt and potassium (K) intakes is required in outpatients with hypertension. We collected spot urine from outpatients to determine urinary sodium (Na) and K excretion values and urinary creatinine to calculate daily salt and K intakes. Design and Method: Spot urine from outpatients with hypertension (n = 377) or other diseases (n = 282) was collected when they presented to our hospital to receive medical examination from morning to noon. Urinary Na and K levels were determined, and daily excretion values were calculated based on the urinary Na (mEq/L) or K (mEq/L) values, body weight (BW, kg), height (cm), urinary creatinine value (mg/dl), age (years) and sex, according to previously reported method. Results: Urinary Na and K excretion values were significantly lower in patients with hypertension (Na, 188.9 ± 3.9 mEq/day; K, 46.7 ± 0.7 mEq/day) than in patients with other diseases (Na, 204.5 ± 4.7 mEq/day; K, 50.1 ± 0.9 mEq/day). Body mass index was significantly higher in patients with hypertension (23.8 ± 0.2 kg/m2) than in patients with other disease (22.8 ± 0.2 kg/m2). Age did not differ significantly between groups (patients with hypertension, 72.0 ± 0.6 years; patients with others, 71.9 ± 0.8 years). Urinary Na and K excretion values correlated negatively with age and positively with body weight and BMI in both groups. Conclusions: Lower Na excretion values in patients with hypertension might be attributable to effective education about the importance of lowering salt intake. On the other hand, lower K excretion suggests lower K intake, which might act to increase blood pressure. Education on this issue may help to increase K ingestion and body weight might be decreased. A simple method to determine 24-h urinary Na and K excretion in outpatients is useful for clinical application.

Predicting the health impact of lowering salt consumption in Turkey using the DYNAMO health impact assessment tool

ObjectiveTo estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool. Study designStatistical disease modelling study. MethodsDYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. TurkSTAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012–2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025. ResultsThe gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively. ConclusionThis model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit.

School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial

Objective To determine whether an education programme targeted at schoolchildren could lower salt intake in children and their families.Design Cluster randomised controlled trial, with schools randomly assigned to either the...

KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

In response to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for blood pressure management in patients with chronic kidney disease not on dialysis, the National Kidney Foundation organized a group of US experts in hypertension and transplant nephrology to review the recommendations and comment on their relevancy in the context of current US clinical practice and concerns. The overriding message was the dearth of clinical trial evidence to provide strong evidence-based recommendations. For patients with CKD with normal to mildly increased albuminuria, goal blood pressure has been relaxed to ≤140/90 mm Hg for both diabetic and nondiabetic patients. In contrast, KDIGO continues to recommend goal blood pressure ≤130/80 mm Hg for patients with chronic kidney disease with moderately or severely increased albuminuria and for all renal transplant recipients regardless of the presence of proteinuria, without supporting data. The expert panel thought the KDIGO recommendations were generally reasonable but lacking in sufficient evidence support and that additional studies are greatly needed.

Determinants of Blood Pressure Response to Low‐Salt Intake in a Healthy Adult Population

Although the beneficial effects of lowering salt intake in hypertensive patients are widely appreciated, the impact of promoting dietary salt restriction for blood pressure (BP) reduction at the population level remains controversial. The authors used 24-hour ambulatory BP monitoring to characterize the determinants of systolic BP (SBP) response to low-salt intake in a large, relatively healthy Amish population. Patients received a high- and low-sodium diet for 6 days each, separated by a 6- to 14-day washout period. Variance component analysis was used to assess the association of several variables with SBP response to low-salt diet. Mean SBP was 0.7 ± 5.8 mm Hg and 1.3 ± 6.1 mm Hg lower on the low-salt compared with the high-salt diet during daytime (P=.008) and nighttime (P<.0001), respectively. SBP response to a low-salt diet was significantly associated with increasing age and pre-intervention SBP, in both daytime and nighttime, while the association with female sex and SBP response to cold pressor test (CPT) was significant only during nighttime. Our results suggest that salt reduction may have greater BP-lowering effects on women, older individuals, individuals with higher SBP, and individuals with higher SBP response to CPT.

The effect of lowering salt intake on blood pressure and biochemical indices of cardiovascular and bone health in adult subjects with slightly elevated blood pressure

The effect of lowering salt intake on blood pressure and biochemical indices of cardiovascular and bone health in adult subjects with slightly elevated blood pressure

Altered dietary salt intake for preventing and treating diabetic kidney disease.

There is strong evidence that our current consumption of salt is a major factor for increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no consensus in restricting salt intake in diabetic patients. To evaluate the effect of altered salt intake on BP and markers of cardiovascular disease and DKD. In January 2010, we searched the Cochrane Renal Group's Specialised Register, CENTRAL (in The Cochrane Library), MEDLINE (from 1966) and EMBASE (from 1980) to identify appropriate articles. We included all randomised controlled trials of salt reduction in individuals with type 1 and type 2 diabetes. Two authors independently assessed studies and resolved differences by discussion with a third independent author. We calculated mean effect sizes using both the fixed-effect and random-effects models. Thirteen studies (254 individuals) met our inclusion criteria. These included 75 individuals with type 1 diabetes and 158 individuals with type 2 diabetes. The median reduction in urinary sodium was 203 mmol/24 h (11.9 g/day) in type 1 diabetes and 125 mmol/24 h (7.3 g/day) in type 2 diabetes. The median duration of salt restriction was one week in both type 1 and type 2 diabetes. BP was reduced in both type 1 and type 2 diabetes. In type 1 diabetes (56 individuals), salt restriction reduced BP by -7.11/-3.13 mm Hg (systolic/diastolic); 95% CI: systolic BP (SBP) -9.13 to -5.10; diastolic BP (DBP) -4.28 to -1.98). In type 2 diabetes (56 individuals), salt restriction reduced BP by -6.90/-2.87 mm Hg (95% CI: SBP -9.84 to -3.95; DBP -4.39 to -1.35). There was a greater reduction in BP in normotensive patients, possibly due to a larger decrease in salt intake in this group. Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt restriction, similar to that of single drug therapy.All diabetics should consider reducing salt intake at least to less than 5-6 g/day in keeping with current recommendations for the general population and may consider lowering salt intake to lower levels, although further studies are needed.

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

BackgroundCardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.MethodsAn epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.ResultsAn estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I$ 14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I$ 59,433 per DALY saved)ConclusionsMost of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.

Population-Based Benefits of Salt Reduction

Excessive salt intake is associated with a higher population-based risk for hypertension and coronary heart disease. Current daily mean salt intakes in the U.S. — three quarters of which come from processed foods — are 10.4 g for men and 7.3 g for women (roughly twice the recommended levels). Researchers used validated models for predicting CHD and stroke to estimate benefits that would accrue from lowering salt intake in adults. The investigators assumed that a linear benefit would …