Blood pressure (BP) displays a higher seasonal variation in winter than in summer. However, evidence of seasonal variations in salt intake is limited. No study has evaluated the same individuals over time using daily urine collection. Further, there are no reports that demonstrates the relationship between BP and salt intake by sex on a seasonal basis. This study included 168 patients with chronic kidney disease (CKD) (mean 62.1years, 93 males) over a 1-year period. We analyzed the seasonal variation between summer and winter in 147 patients with CKD for whom both summer and winter data were available. In addition, we evaluated 90 patients separately who were not taking medications that impact urinary sodium excretion. In 147 patients, body weight, body mass index (BMI), BP, choline esterase (ChE), low-density lipoprotein (LDL) cholesterol, and salt intake were higher in winter in males, whereas only BP, albumin, ChE and LDL cholesterol were higher in winter in females. In the multiple regression analyses, systolic BP significantly and positively correlated with salt intake in males and this trend was more pronounced in summer. Contrarily, females did not show a correlation between systolic BP and salt intake in both summer and winter. Moreover, the 90 patients who were not taking medications that impact sodium excretion showed a similar relationship between systolic BP and salt intake. Salt intake in patients with CKD was higher in winter. Furthermore, the correlation between systolic BP and salt intake was particularly pronounced in males in summer.

Introduction. Cardiovascular diseases remain the leading cause of mortality, disability, and premature loss of working capacity worldwide. Nutrition is one of the major modifiable cardiovascular risk factors, as dietary habits directly influence lipid and carbohydrate metabolism, endothelial function, blood pressure regulation, systemic inflammation, and oxidative stress. Excessive intake of salt, saturated fats, trans fats, refined carbohydrates, and ultra-processed foods contributes to dyslipidemia, arterial hypertension, obesity, insulin resistance, and atherosclerosis. The aim of the study. To summarise current scientific evidence regarding the role of nutrients in the prevention and complex treatment of cardiovascular diseases, as well as to evaluate the potential of nutrient correction in reducing cardiovascular risk and improving patient prognosis. Materials and methods. An analytical review of current scientific publications, clinical guidelines, systematic reviews, meta-analyses, and randomised clinical trials was conducted. The effects of dietary patterns, macro- and micronutrients on cardiometabolic risk were analysed. Results. Adequate intake of omega-3 polyunsaturated fatty acids, potassium, magnesium, dietary fibre, antioxidants, and polyphenols was associated with improved lipid profile, endothelial function, blood pressure stabilisation, and reduced inflammatory activity. The Mediterranean and DASH diets demonstrated the strongest cardioprotective effects. Conclusions. Nutrient correction is an important component of cardiovascular prevention and complex treatment. Rational nutrition should be combined with lifestyle modification, individualised dietary recommendations, and evidence-based pharmacotherapy.

Hypertension, a leading cause of cardiovascular disease, is a significant public health challenge, with urban India reporting prevalence rates up to 40%. Excessive salt intake, averaging 8 to 11 g/day in India, far exceeds the World Health Organization-recommended limit of 5 g/day and is a key modifiable risk factor. While 24-hour urine collection is the gold standard for measuring 24-hour urinary excreted salt levels, its practicality in large-scale studies is limited, necessitating alternative methods such as spot urine sampling and dietary recall. This study aimed to address current knowledge gaps by evaluating 24-hour urinary excretory salt levels across age groups and comparing the gold standard of 24-hour urinary salt excretion with estimates from spot urine samples and 24-hour dietary recalls among adolescents and their parents in Chandigarh, India. A cross-sectional survey was conducted among 462 adolescents and 395 parents from public schools in Chandigarh, part of a cluster randomized controlled trial focused on reducing chronic disease risk factors. Twenty-four-hour urinary excreted salt levels were measured via 24-hour urine collection, spot urine samples were analyzed with the Kawasaki, Tanaka, and INTERSALT equations, and 2 nonconsecutive 24-hour dietary recalls using a correction factor of 0.9. Bland-Altman plots were used to assess agreement between methods. The mean 24-hour urinary excreted salt levels measured via 24-hour urine samples were 6.95 g/day (SD 0.24; 95% CI 6.48-7.42) for adolescents and 7.73 g/day (SD 0.3; 95% CI 7.18-8.28) for parents. Spot urine estimates showed variability, with the INTERSALT equation with potassium yielding the closest results to 24-hour measurements for parents (mean 8.12, SD 0.4 g/d; 95% CI 7.36-8.95) and adolescents (mean 7.97, SD 0.4 g/day; 95% CI 7.16-8.77). Dietary recall underestimated 24-hour urinary excreted salt levels for both groups (mean 4.15, SD 0.08 g/day for adolescents and mean 3.62, SD 0.08 g/day for parents). Spot urine sampling, particularly the INTERSALT with potassium equation, offers a feasible alternative to 24-hour urine collection for estimating population-level 24-hour urinary excreted salt levels among adolescents and adults in resource-limited settings. Dietary recall alone significantly underestimates intake and should be supplemented with objective measures. These findings support the use of tailored estimation methods based on age for improved hypertension management strategies in India.

Sulfonated peptide alleviates hypertensive renal injury via antioxidant, anti-inflammatory, and renal metabolomics.

Excess salt intake is one of the relevant dietary determinants of elevated blood pressure and hypertension, with a direct impact on cardiovascular risk. In today's food environment, a substantial proportion of sodium comes from "hidden salt" added to processed and ultra-processed foods, which limits the effectiveness of interventions focused exclusively on the salt shaker and reinforces the need for combined strategies. The most robust scientific evidence shows that reducing sodium/salt lowers blood pressure, with a greater effect in people with hypertension and in salt-sensitive profiles. Although associations have been reported with other outcomes, such as gastric cancer, kidney stones and bone mineral balance, or cognitive decline, study findings are more heterogeneous and require cautious interpretation. Part of the current controversy arises from observational results suggesting non-linear associations and a potential modifying role of potassium, together with limitations in estimating sodium intake. Overall, the most effective approach integrates individual and population-level measures: promoting overall healthy dietary patterns, prioritizing reductions in hidden salt, using culinary strategies to preserve palatability, improving label reading, and supporting product reformulation and monitoring.

High dietary salt intake elevates blood pressure and drives multiorgan damage. However, the molecular programs underlying progressive organ injury remain poorly defined. Here, we present a longitudinal multiorgan transcriptomic atlas of salt-induced hypertensive injury. We profiled kidney cortex, kidney medulla, heart, and liver across 4 stages, spanning early hypertension to advanced pathology in Dahl salt-sensitive rats. We identified dynamic and tissue-specific molecular trajectories, including a shared early proliferative response that converges on proinflammatory and fibrotic remodeling. Notably, we uncovered compartment-specific renal responses, showing that the cortex and medulla, despite their proximity, follow distinct molecular trajectories during disease progression. We further identified 79 stage- and tissue-specific transcription factors that drive gene expression dynamics in salt-induced hypertensive injury. Integration with human genome-wide association studies revealed conserved pathways in endocrine signaling, ion transport, lipid metabolism, and detoxification, establishing cross-species relevance and highlighting mechanistic targets of clinical importance. Compound-transcriptome analysis revealed stage- and organ-specific therapeutic opportunities, prioritizing kinase and epigenetic modulators as candidates to rebalance maladaptive gene programs. Overall, this study provides a resource for understanding molecular mechanisms from early salt-induced hypertension to tissue-specific injury and underscores the need for precision interventions.

Dietary patterns are closely associated with the prevention and management of chronic diseases. Although large-scale national nutrition and health surveys have been conducted in China, evidence on dietary patterns and their associations with chronic diseases remains scarce in high-altitude regions, where unique dietary habits and lifestyles are prevalent. A cross-sectional study was conducted among high-altitude residents using food frequency questionnaires (FFQs) to assess dietary intake. Principal Component Analysis(PCA) was used to extract dietary patterns, and the scores were categorized into tertiles (from low to high: T1, T2, T3). Logistic regression models were used to examine their associations with chronic diseases, smoking, alcohol use, local tea drinking, and physical exercise. Five dietary patterns were identified: dry nuts and beverages, traditional Tibetan, three-high (characterized by high salt, high carbohydrate, and high fat intake), animal-predominant high protein, and high dietary fiber. Among the 606 participants, 39.9% reported having at least one chronic disease. Fully adjusted model showed that the three-high pattern (T2 vs. T1: OR = 1.81, 95% CI: 1.10-2.99; T3 vs. T1: OR = 1.90, 95% CI: 1.09-3.33), animal-predominant high protein pattern (T2 vs. T1: OR = 2.37, 95% CI: 1.42-3.94), smoking (OR = 1.88, 95% CI: 1.06-3.35), and local tea drinking (OR = 1.85, 95% CI: 1.13-3.02) were positively associated with chronic diseases. Conversely, the traditional Tibetan pattern (T2 vs. T1: OR = 0.47, 95% CI: 0.28-0.80) and physical exercise (OR = 0.62, 95% CI: 0.39-0.99) were negatively associated with chronic diseases. Among high-altitude populations, traditional Tibetan pattern and physical exercise appear to be protective factors against chronic diseases, while the three-high pattern, animal-predominant high protein pattern, smoking, and local tea drinking constitute potential risk factors. Modifying dietary pattern and lifestyle thus play a significant role in the prevention and management of chronic diseases in these unique environments.

Primary aldosteronism (PA) is the most common endocrine cause of hypertension, yet emerging longitudinal data indicate that its injurious effects extend to the brain. A nationwide Korean cohort study demonstrated that patients with PA exhibit a significantly higher incidence of all-cause dementia than matched individuals with essential hypertension, independent of blood pressure. However, this association was attenuated for Alzheimer's disease after multivariable adjustment, whereas vascular dementia remained significantly associated with PA. Aldosterone activates mineralocorticoid receptors (MRs) in the brain, triggering oxidative stress, blood-brain-barrier leakage and neuro-inflammation that damage hippocampal and prefrontal networks, leading to deficits in executive function, language and attention. Notably, these effects are amplified by dietary salt intake, and experimental evidence suggests that aldosterone-induced end-organ damage requires a high-salt milieu. In animal models, chronic aldosterone exposure reproduces these cognitive impairments, whereas MR blockade or adrenalectomy reverses learning and memory deficits. However, current PA guidelines omit recommendations for cognitive screening or intervention, rendering this potentially reversible aetiology largely overlooked. Here we systematically synthesize the pleiotropic mechanisms of aldosterone signalling in neurons, glia and cerebral vessels; integrate cross-sectional, prospective and interventional clinical evidence to quantify the strength of the PA-dementia association; and compare the differential cognitive outcomes of surgery versus pharmacotherapy. We also discuss emerging aldosterone synthase inhibitors as a novel therapeutic strategy that eliminates ligand production rather than merely blocking receptor signalling. Finally, we propose a risk-prediction framework that incorporates neuroimaging and fluid biomarkers, and call for a transdisciplinary clinical pathway to enable early recognition and precision intervention.

Uncontrolled systolic blood pressure (SBP) is a major modifiable determinant of cardiovascular morbidity and mortality in older adults. This study aimed to evaluate the prevalence, associated factors, and cardiovascular implications of uncontrolled SBP among treated older adults in Sri Lanka. A nationwide multicenter cross-sectional study was conducted in medical outpatient clinics of ten tertiary care hospitals representing all nine provinces of Sri Lanka. A total of 1,339 adults aged ≥ 65 years receiving antihypertensive therapy for at least six months were recruited using systematic sampling. Blood pressure (BP) was measured using a standardized three-reading protocol. Uncontrolled SBP was defined as SBP ≥ 130 mmHg irrespective of diastolic BP, in accordance with contemporary guideline recommendations. Data was collected using interviewer-administered questionnaires and medical record review. Associations between patient characteristics and uncontrolled SBP were assessed using chi-square tests, independent samples t-tests, and multivariable logistic regression analysis. The mean age of participants was 69.4 ± 6.6 years, and 56.8% were female. The mean duration of hypertension was 9.8 ± 8.3 years. Uncontrolled SBP was present in 71.2% of treated older adults. Only 34.4% were receiving dual antihypertensive therapy, while 42.2% remained on monotherapy. Major adverse cardiovascular events (MACE) were reported in 38.2% of participants, and other vascular comorbidities were present in 81.6%. In multivariable analysis, satisfactory income (OR 1.96, 95% CI 1.20-3.20, p = 0.007), low physical activity (OR 1.41, 95% CI 1.07-1.86, p = 0.015), and higher neck circumference (OR 1.01, 95% CI 1.01-1.02, p = 0.014) were independently associated with uncontrolled SBP. Importantly, uncontrolled SBP was significantly associated with MACE (OR 1.31, 95% CI 1.01-1.69, p = 0.044). Medication adherence, dietary salt intake, BMI, and vascular comorbidities were not independently associated with uncontrolled SBP. Over two-thirds of treated older adults in Sri Lanka had uncontrolled SBP, which was more common among participants with MACE. Higher income, low physical activity, and increased neck circumference were associated with uncontrolled SBP among treated older adults. These findings highlight the importance of targeted strategies, including lifestyle modification and improved risk-based management, to optimize BP control in this population.

In patients undergoing dialysis, increased salt intake is associated with an increased risk of cardiovascular disease (CVD) events, including a higher incidence of congestive heart failure. We calculated the estimated salt intake (eSALT) using a salt intake estimation formula based on the amount of sodium removed by dialysis and investigated its relationship with patients' prognosis. We included 6,180 patients undergoing dialysis who attended the Zenjinkai Outpatient Clinic. We used Watson's body water and Ramdeen's salt estimation equations, utilizing pre- and post-dialysis blood samples collected once a month at the beginning of the week, with a 2-day interval. The eSALT was measured repeatedly in all patients, 36 times in 3 years, starting on April 1, 2016. The observational outcomes included all-cause mortality and CVD events. Statistical analyses were performed using Cox proportional hazard analysis, cubic spline curves, and Generalized Estimating Equations (GEE). Baseline and previous time-dependent repeated-measured eSALT were used in the GEE for exposure factor. The outcomes included normalized protein catabolic rate (nPCR), Geriatric Nutritional Risk Index (GNRI), and body mass index (BMI), as well as percentage change in creatinine clearance rate, blood pressure, creatinine, albumin, and uric acid. Salt intake was 8.15 g/day over 3 years. The eSALT did not predict CVD events in adjusted Cox proportional hazard analysis. Spline curves showed an increased hazard ratio for heart failure with eSALT ≥ 6 g, but not for all-cause mortality. The GEE model indicated that eSALT was associated with nutritional indices, including the GNRI, %CGR, nPCR, and BMI, from longitudinal data. eSALT can be used to estimate patients' prognosis and nutritional status. Although eSALT > 6 g/day increases the risk of congestive heart failure, it improves nutritional status. This requires an increase in the uptake of other nutrients with low salt intake.

Background/Objectives: To promote salt reduction before health problems arise, it is important to understand factors associated with reduced-salt product purchasing among consumers with low interest in such products. This study examined psychological determinants of intention to purchase reduced-salt products among Japanese adults who were not actively purchasing them. Methods: An exploratory sequential mixed-methods design was used, including qualitative interviews followed by a cross-sectional web-based survey of 800 men and women aged 18–59 years in Japan. Participants were categorized into precontemplation and contemplation stages based on the transtheoretical model. Associations between purchase intention and three Integrated Behavioral Model categories—attitude, perceived norm, and personal agency—were examined. Percentage-to-gain values were calculated for each belief item. Results: All three category scores were significantly associated with purchase intention, with attitude showing the strongest association (OR = 12.56, 95% CI: 6.93–22.79). In stratified analysis, attitude showed a stronger association in the precontemplation stage (OR = 18.40, 95% CI: 8.51–39.78), whereas no category score was significantly associated with purchase intention in the contemplation stage. In the precontemplation stage, relatively high percentage-to-gain values were observed for holistic wellness-oriented beliefs and product availability in usual supermarkets. Conclusions: Attitude was most strongly associated with intention to purchase reduced-salt products, particularly in the precontemplation stage. Holistic wellness-oriented beliefs and product availability may represent promising targets for future communication or food environment interventions. These findings may provide a basis for future studies testing strategies to increase actual purchases of reduced-salt products and reduce salt intake.

Using a field experiment conducted in a real table-service restaurant, this study investigated how nudging strategies can be used to guide diners to choose healthier food with lower sodium in an urban area of China. By randomly employing a changing default nudging strategy and a verbal prompting nudging strategy in the same setting and with 313 tables of diners, this study compared both changes in salt-reducing ordering behavior and salt intake reduction in two nudging groups and a control group. The results showed that both nudging strategies have significantly promoted diners to make salt-reducing ordering behavioral changes. The verbal prompting nudging strategy was significantly more effective than the changing default nudging strategy in altering diners' ordering behavior; however, its efficacy was significantly moderated by table size and diners' taste primacy. The changing default nudging strategy proved robust against diner heterogeneity and achieved a significant reduction in per-person sodium intake, thus representing a more promising strategy for broader application. The findings of the present study provide empirical evidence for implementing precision nudging policies to reduce salt intake in restaurant settings. We suggest that health authorities prioritize the changing default nudging strategy for initial implementation in restaurants as a practical approach for improving public health.

Gitelman syndrome (GS) is a rare inherited renal salt‐wasting tubulopathy characterized by hypokalemia, hypomagnesemia, and hypocalciuria. Its nonspecific presentation often overlaps with that of more common pediatric conditions, leading to delayed diagnosis, particularly in resource‐limited settings. We report an 11‐year‐old boy who presented with progressive weight loss, polyuria, polydipsia, and salt craving. His course was complicated by recurrent episodes of severe hypokalemia and hypomagnesemia, and he was initially evaluated for diabetes mellitus, other endocrine disorders, chronic infections such as tuberculosis, and malnutrition without a definitive diagnosis. During the index admission, he developed acute worsening of muscle weakness associated with severe hypokalemia and hypomagnesemia and biochemical findings consistent with renal salt wasting, supporting a diagnosis of GS in the absence of genetic testing. Management with correction of hypovolemia, electrolyte supplementation, liberal salt intake, and nutritional support led to marked clinical improvement and stabilization of biochemical abnormalities on follow‐up. This case highlights the importance of maintaining a high index of suspicion for GS in children presenting with polyuria, polydipsia, salt craving, and unexplained electrolyte disturbances, particularly in resource‐limited settings.

Aim . To assess the frequency, structure, and combination of cardiovascular risk factors in university students. Material and methods. This cross-sectional online survey was conducted among 446 first-year students of a technical university. The questionnaire assessed the following cardiovascular risk factors: smoking, family history of hypertension, low fruit and vegetable consumption, physical activity level, salt intake, and alcohol consumption. Results. Following unfavorable behavioral risk factors are highly prevalent among first-year university students: low fruit and vegetable consumption (43%), excessive salt intake (40%), and insufficient physical activity (33%). A quarter of these cases are associated with a family history of hypertension. Conclusion . The online survey is an effective tool for reaching young people and demonstrates a high prevalence of cardiovascular risk factors among students, consistent with previous studies in these cohorts, including large epidemiological data. Young people with a history of high blood pressure require close attention to primary cardiovascular disease prevention, as they are more likely to experience individual risk factors and their combinations.

With the increase in dining out, high consumption of salt, oil, and sugar has led to deteriorating diet quality in China. We developed and validated the Nutritional Quality Index of Chinese Dishes (NQICD), a new nutrient profiling model for Chinese composite dishes, addressing a gap not covered by existing models. NQICD was based on seven domains. Its content validity was confirmed against the Dietary Guidelines for Chinese Residents (DGCR), and convergent validity against existing NP models. Criterion validity was assessed using a population-based cohort (n = 3629) with 12-year follow-up, linking i.NQICD to dietary quality, biomarkers, and health outcomes. In content validity, i.NQICD scores (range: 1-10) showed weak-to-moderate correlations with the DGCR (r: -0.39 to -0.21). In criterion validation, each 1-SD increase (≈1.8 points) was associated with lower body mass index (BMI) (-0.13 kg/m²), SBP (-1.69 mmHg), DBP (-1.05 mmHg), and HbA1c (-0.12%). Prospectively, after adjusting for key variables, a higher baseline i.NQICD score was associated with reduced risks of diabetes (HR 0.93, p = 0.024) and all‑cause mortality (HR 0.88, p = 0.011) over 12 years. The NQICD aligns with DGCR goals, demonstrates adequate validity for evaluating Chinese dishes, and can serve as a public health tool to assess their healthiness.

Current evidence does not clearly support an association between hypertension awareness and improved cardiovascular outcomes. This study aimed to investigate the relationship between awareness of high blood pressure and adoption of healthy lifestyle behaviors among healthcare workers (HCWs) in Iran. We analyzed cross-sectional data from 1,178 HCWs enrolled in the SHAHWAR cohort study. Anthropometric measurements, blood pressure assessments, structured health interviews, and physical examinations were conducted by trained investigators. Multivariable logistic regression models were applied to evaluate the association between hypertension awareness and preventive behaviors, including salt intake, smoking status, physical activity, and body mass index (BMI). Among the 1,178 participants (58.7% women; mean age 39.4 ± 7.8 years), the prevalence of hypertension was 27% (age-standardized: 29.2%). Hypertension was significantly more prevalent in men than in women (38.8% vs. 19.0%, p < 0.001) and increased with age. Awareness (38.2% vs. 26.5%, p = 0.028) and control (85.1% vs. 58.1%, p = 0.004) of hypertension were significantly higher among women and younger individuals. Smoking and BMI ≥ 25 were more common among hypertensive individuals compared with non-hypertensive individuals (9.7% vs. 4.5%, p = 0.001; and 72.3% vs. 27.7%, p < 0.001, respectively). Smoking was not associated with hypertension awareness, treatment, or control. However, blood pressure control was significantly poorer among participants with BMI ≥ 25. Among women, hypertension awareness was associated with a higher proportion of individuals with BMI < 25 (36.0% vs. 18.8%; p = 0.028). Similarly, among participants younger than 38 years, awareness was linked to a higher prevalence of BMI < 25 (51.2% vs. 25.9%; p = 0.011) and lower salt intake (75.6% vs. 53.7%; p = 0.028). Despite their medical knowledge and professional status, hypertension awareness among HCWs does not appear to exceed that of the general population. The findings highlight suboptimal adherence to healthy lifestyle behaviors among HCWs with hypertension and emphasize the need for more effective lifestyle counseling and targeted educational interventions.

Salt is essential for the maintenance of cellular homeostasis and transmission of nerve impulses. However, excessive salt intake (especially NaCl) causes hypertension and neoplasms and is associated with neoplasms, including esophageal and gastric cancer. High concentrations of NaCl enhances intracellular reactive oxygen species (ROS) production, especially that of superoxide anions (O2−), and induces injury to rat gastric mucosal cells (RGM1). In contrast, cells overexpressing manganese superoxide dismutase exhibit attenuated NaCl-induced cytotoxicity. Therefore, antioxidants can reduce the risk of salt-induced gastric mucosal injury. NaCl also affects the remodeling of the cytoskeleton and lamellipodia, and potentially modulates the cellular elastic modulus. In this study, we aimed to determine the possibility of cellular physiological changes by NaCl treatment and the effect of antioxidant laminaran in attenuating NaCl-derived cytotoxicity. Our in vitro assay revealed that laminaran attenuated NaCl-induced cytotoxicity and reduced intracellular ROS production caused by NaCl exposure. Laminaran upregulated antioxidant enzyme expression, suggesting that the observed reduction in ROS was mediated, at least in part, by the activation of these enzymes. Moreover, apoptosis derived from NaCl was inhibited by laminaran. NaCl also induced changes in lamellipodia formation; however, laminaran suppressed this formation.

High salt intake is a recognized risk factor for calcium oxalate (CaOx) kidney stones, but the underlying biological mechanisms beyond urinary calcium excretion remain unclear. We investigated whether a high-salt diet promotes CaOx stone formation through gut microbiota-dependent inflammatory pathways involving trimethylamine (TMA), trimethylamine N-oxide (TMAO), and NF-κB signaling. In a clinical cohort of 153 subjects, high salt intake was independently associated with CaOx stones after multivariable adjustment (adjusted OR 2.52, 95% CI 1.10-5.94, p = 0.031). The gut microbiota of high-salt diet stone formers was enriched for inflammation-associated bacteria and NF-κB, tight junction, and sodium-calcium reabsorption pathways. In C57BL/6J mice, a one-month high-salt diet disrupted intestinal barrier integrity, induced renal inflammation with elevated TNF-α, IL-6, and IL-1β, and increased CaOx crystal deposition. 16S rRNA sequencing showed depletion of beneficial genera (Akkermansia, Bifidobacterium) and enrichment of TMA-producing bacteria. Cecal TMA and plasma TMAO were elevated in high-salt mice, while urinary TMA and TMAO were reduced, indicating impaired renal metabolite clearance. Fecal microbiota transplantation from high-salt diet donors reproduced the elevated TMAO, renal inflammation, and crystal deposition in recipient mice, confirming a causal role for the gut microbiota. Invitro, TMA disrupted tight junction proteins in Caco-2 intestinal epithelial cells, and TMAO activated NF-κB and increased CaOx crystal adhesion in HK-2 renal tubular cells; both effects were reversed by the NF-κB inhibitor QNZ. These findings identify the gut microbiota-TMA/TMAO-NF-κB axis as a mechanism linking high salt intake to CaOx kidney stone formation.

Reducing sodium intake in populations is essential, but insufficient for preventing and managing high blood pressure, while the importance of increasing potassium intake is overlooked. We investigated the effects of 1-year population-approach programs (2021-2022) promoting salt reduction and potassium intake using urinalysis feedback and food environment improvement. This retrospective observational study included 7649 participants (mean age, 54.0 years; 45.3% women) from 11 municipalities and 4 workplaces. Outcomes in intensive support programs-including urinary sodium, potassium, and sodium-to-potassium (Na/K) ratio measurements with feedback, dietary promotion, and food environment improvement-were compared with standard support programs providing usual health guidance. In linear regression adjusted for demographics, lifestyle factors, and medical history, the reduction in urinary Na/K ratio was greater in the intensive support group (n = 4064) than in the standard support group (n = 3585) (mean difference -0.14 [95% confidence interval, -0.27 to -0.01]). Although estimated potassium intake decreased in both groups, the decline was smaller in the intensive support group (mean difference 31 [12 to 51] mg/day). Estimated salt intake did not differ between the groups. The intensive support group showed greater increases in diastolic blood pressure and high-density lipoprotein cholesterol and smaller increases in blood glucose, as well as greater reductions in hemoglobin A1c and Salt Check Sheet scores. Mean differences between the groups for endpoints were not heterogeneous across intensive support program types. Our findings support the development of hypertension prevention and management strategies that promote healthier dietary behaviors and can be implemented in community and workplace settings, with broad public health applicability.

Purpose: Orthostatic intolerance is a common condition encountered in primary care and encompasses a range of symptoms triggered by standing. This review aims to provide general physicians with a practical framework for understanding terminology, diagnostic criteria, differential diagnosis, and management of orthostatic intolerance.Current concepts: Hemodynamic orthostatic dizziness/vertigo is defined by the International Classification of Vestibular Disorders as 5 or more episodes of dizziness, unsteadiness, or vertigo triggered by arising or present during the upright position, which improve with sitting or lying down, in the presence of documented orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS), or syncope. Measurement of orthostatic blood pressure and heart rate is essential for screening. The differential diagnosis includes benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, anxiety disorders, bilateral vestibulopathy, primary orthostatic tremor, sensory neuropathy, gait disorders, and cardiac conditions. Evaluation of OH requires a stepwise approach to distinguish neurogenic from non-neurogenic causes. Evaluation of POTS focuses on identifying pathophysiological subtypes, including neuropathic, hyperadrenergic, deconditioning-related, and hypovolemic forms.Discussion and conclusion: Management begins with nonpharmacological strategies, including adequate hydration, increased salt intake, use of compression garments, postural education, and adjustment of contributing medications. When these measures are insufficient, pharmacological treatments for OH include midodrine, droxidopa, fludrocortisone, and pyridostigmine, whereas POTS may be managed with low-dose beta-blockers, ivabradine, or midodrine. A systematic approach incorporating appropriate terminology, standardized diagnostic criteria, and stepwise management is essential for optimizing care in patients with orthostatic intolerance.