Sodium Chloride Intake Research Articles

Effects of sodium chloride intake on urea-N recycling and renal urea-N kinetics in lactating Holstein cows

The effects of high (2.5% of DM) versus normal dietary sodium chloride (NaCl) intake on renal urea-N kinetics and urea-N metabolism were investigated in 9 rumen-cannulated and multi-catheterized lactating dairy cows in a crossover design with 21-d periods. It was hypothesized that urinary urea-N excretion would be greater, and blood urea-N concentration lower in response to greater diuresis induced by high NaCl intake. Also, urea-N transport across ruminal and portal drained viscera (PDV) tissues was hypothesized to be affected by dietary sodium intake. A second experiment was conducted using 8 lactating cows in a crossover design with 14-d periods to test high NaCl (2.5% of DM) versus high KCl (3.2% of DM) intake on milk yield and milk urea-N concentrations. Experiment 1 showed that despite greater diuresis there was no effect of high NaCl intake on urinary urea-N excretion or blood urea-N concentration. The high NaCl intake did not affect rumen ammonia concentrations, total rumen VFA concentrations, ruminal venous - arterial concentration differences for ammonia, or ammonia absorption indicating that high NaCl did not adversely affect ruminal fermentation and microbial protein synthesis. High NaCl intake did not affect the total amount of urea-N transport from blood to gut, but ruminal venous - arterial concentration differences for urea-N were lower with high NaCl and ruminal extraction of arterial urea-N was numerically smaller, indicating that the ruminal epithelial urea-N transport was lower with high NaCl. Energy corrected milk yield was greater with high NaCl (3.2 ± 1.5 kg/d); however, milk urea-N concentrations were not affected by treatment. In experiment 2, ECM was greater with NaCl (1.4 ± 0.31 kg/d) compared with KCl (30.2 and 28.8 ± 0.91 kg ECM / d, respectively). Milk urea-N concentration was lower with KCl, suggesting a urea-N lowering effect in milk not evident with high NaCl intake. In conclusion, the present data show that dietary Na intake of 12-13 g/kg DM was followed by greater diuresis but did not impact urea-N excretion or blood urea-N concentration. High NaCl intake did not affect the total amount of urea-N transfer across PDV tissues. Energy corrected milk yield was greater with high NaCl compared with both control and feeding KCl, however, with KCl milk urea-N decreased.

Myopia, Sodium Chloride, and Vitreous Fluid Imbalance: A Nutritional Epidemiology Perspective.

Theories of myopia etiology based on near work and lack of outdoor exposure have had inconsistent support and have not prevented the rising prevalence of global myopia. New scientific theories in the cause and prevention of myopia are needed. Myopia prevalence is low in native people consuming traditional diets lacking in sodium chloride, and nutritional epidemiological evidence supports the association of rising myopia prevalence with dietary sodium intake. East Asian populations have among the highest rates of myopia associated with high dietary sodium. Similar associations of sodium and rising myopia prevalence were observed in the United States in the late 20th century. The present perspective synthesizes nutritional epidemiology evidence with pathophysiological concepts and proposes that axial myopia occurs from increased fluid retention in the vitreous of the eye, induced by dietary sodium chloride intake. Salt disturbs ionic permeability of retinal membranes, increases the osmotic gradient flow of fluid into the vitreous, and stretches ocular tissue during axial elongation. Based on the present nutritional epidemiology evidence, experimental research should investigate the effect of sodium chloride as the cause of myopia, and clinical research should test a very low-salt diet in myopia correction and prevention.

Intakes of energy, macronutrients, and micronutrients in adult Lithuanian population: a national study of 2019-2020.

Dietary surveys are critical in evaluating dietary trends prevailing across the entire population. The aim of this study is to present the results of the latest research into the intakes of energy, macronutrients, and micronutrients amongst the adult population in Lithuania from 2019 through 2020. A cross-sectional study was conducted and dietary data was collected using a 24-h dietary recall method from a total of 2555 Lithuanian adults. Medians, 25th and 75th percentiles were calculated. The diet of Lithuanian adults was found insufficient as the energy intake from fats exceeded the recommended norms, while the energy intake from carbohydrates was below the lower range. The intakes of dietary fibre and most vitamins and minerals were insufficient. Men, compared to women, had a statistically higher total energy intake and energy intake from fats, and a higher intake of dietary fibre. Younger adults, compared to older ones, had statistically lower intakes of energy from fats, including saturated fats, and lower intakes of sodium chloride. Respondents with primary education, compared to those who had attained a higher degree of education, had a statistically lower intake of total energy and dietary fibre. Study showed that intakes of majority of nutrients in the diet of the adult Lithuanian population are not in compliance with the recommended daily intakes. Continuous nationally representative studies into food consumption and nutrient intake of the adult Lithuanian population must be carried out to assess the changes in the population's diet and the effectiveness of policies aimed at promoting healthy diets.

Dietary Potassium Supplementation Reduces Chronic Kidney Lesions Independent of Blood Pressure in Deoxycorticosterone-Acetate and High Sodium Chloride-Treated Mice

We have previously shown that an excess of deoxycorticosterone acetate and high sodium chloride intake (DOCA/salt) in one-renin gene mice induces a high urinary Na/K ratio, hypokalemia, and cardiac and renal hypertrophy in the absence of hypertension. Dietary potassium supplementation prevents DOCA/salt-induced pathological processes. In the present study, we further study whether DOCA/salt-treated mice progressively develop chronic inflammation and fibrosis in the kidney and whether dietary potassium supplementation can reduce the DOCA/salt-induced renal pathological process. Results showed that (1) long-term DOCA/salt-treated one-renin gene mice developed severe kidney injuries including tubular/vascular hypertrophy, mesangial/interstitial/perivascular fibrosis, inflammation (lymphocyte’s immigration), proteinuria, and high serum creatinine in the absence of hypertension; (2) there were over-expressed mRNAs of plasminogen activator inhibitor-1 (PAI-1), fibronectin, collagen type I and III, interferon-inducible protein-10 (IP-10), monocyte chemotactic protein-1 (MCP1), transforming growth factor-β (TGF-β), tumor necrosis factor-alpha (TNF-α), osteopontin, Nuclear factor kappa B (NF-κB)/P65, and intercellular adhesion molecule (ICAM)-1; and (3) dietary potassium supplementation normalized urinary Na/K ratio, hypokalemia, proteinuria, and serum creatinine, reduced renal hypertrophy, inflammations, and fibrosis, and down-regulated mRNA expression of fibronectin, Col-I and III, TGF-β, TNF-α, osteopontin, and ICAM without changes in the blood pressure. The results provide new evidence that potassium and sodium may modulate proinflammatory and fibrotic genes, leading to chronic renal lesions independent of blood pressure.

Application of Umami Tastants for Sodium Reduction in Food: An Evidence Analysis Center Scoping Review.

Sodium chloride intake far exceeds the guidelines from health and regulatory agencies. Acknowledging the positive relationship between sodium intake and blood pressure, interest in substances that assist in sodium reduction, while contributing a savory taste such as umami, are highly investigated. The objective of this scoping review was to identify and characterize studies investigating umami tastants on sodium reduction in food, with the goal of informing future research. A literature search was conducted in Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, EBSCO PsycInfo, PROSPERO, National Institutes of Health RePORTER, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform and completed in March 2022 to identify peer-reviewed publications among adults (18 years and older) with interventions focusing on umami tastants to reduce sodium content. The literature search identified 52 studies, among which monosodium glutamate was the most studied umami tastant or food. Furthermore, most of the research on umami was represented through cross-sectional sensory studies to determine acceptability of foods with part of the original sodium chloride replaced with umami tastants. Only 1 study investigated the use of an umami tastant on overall daily sodium intake. To assist individuals in adhering to sodium reduction intake goals set forth by regulatory agencies and their guiding policies, these findings indicated that additional research on umami tastants, including systematic reviews and prospective trials, is warranted. In these prospective studies, both intermediate outcomes (ie, dietary pattern changes, daily dietary intake of sodium, and blood pressure) and hard outcomes (ie, incidence of hypertension or stroke, as well as cardiovascular composite outcomes) should be considered.

High Salt Diet Exacerbates Intestinal Radiotoxicity by Promoting Intestinal Epithelial Barrier Dysfunction after RT

Intestinal side effects have a substantial impact on patients' quality of life and constrain radiation therapy (RT) of abdominal and pelvic tumors. We aim at gaining a better understanding of the pathogenesis of intestinal radiotoxicity and identifying contributing factors. A high salt diet is common among countries of the Global North. The effects of an increased sodium-chloride (NaCl) intake on the development of intestinal side effects have not been investigated. C57BL/6 wild-type (WT) mice were fed a high salt diet (HSD) or normal salt diet (NSD) and irradiated with 12 Gy total body irradiation (TBI) or 13 Gy abdominal irradiation (ABI). Following TBI the mice received a syngeneic bone marrow transplant to reconstitute hematopoiesis. Readouts after RT included weight monitoring, histopathological analysis and assessment of intestinal epithelial barrier function. To corroborate our findings in vitro, murine organoids of the small intestine were cultivated, treated with varying NaCl concentrations (110-200 mM) and irradiated with 2 or 4 Gy. Organoid survival and growth were determined using multiple methods. Additionally, colony formation assays (CFA) of murine MC38 colon carcinoma cells were performed after stimulation with NaCl. Mechanistically, we analyzed the apoptosis rates of MC38 cells and intestinal epithelial organoids. Irradiated HSD animals showed increased acute weight loss, reduced weight regeneration, a more severe dysfunction of the intestinal barrier (enhanced FITC-dextran permeability) and increased histopathological damage when compared with NSD animals. Murine intestinal organoids and MC38 cells showed decreased survival after RT in hypernatremic conditions. Interestingly, our preliminary data show that there are no increased rates of apoptotic cells in vitro, suggesting a different mechanism affecting the increased radiosensitivity in hypernatremic conditions. Our data show a NaCl induced intensification of intestinal tissue injury following RT. These findings can potentially pave the way for investigating the effect of high salt diet on intestinal radiotoxicity in clinical trials.

Study on the mechanism of soy protein isolate to improve quality of reduced-salt Hypophthalmichthys molitrix surimi gel: Focus on gel quality, protein structure, and in vitro digestibility

Excessive intake of sodium chloride may bring a series of diseases; as a result, reduced-salt surimi gels have gained growing popularity for sodium reduction. This paper studied soy protein isolate (SPI, 2.0%, 4.0%, and 6.0%, w/w) as a gel enhancer for reduced-salt silver carp surimi. Compared with the control (2.0% NaCl), the addition of SPI significantly increased (P < 0.05) the total SH content, hydrophobic interaction force, disulfide bond, hardness, gel strength, and water-holding capacity of the gels. During the thermal denaturation process, SPI and myofibrillar protein jointly participated in the formation of the gel network, resulting in a G′ value increase at 90 °C, forming a denser/more stable gel network structure. In vitro pepsin digestion results showed the digestibility of the reduced-salt gel with SPI was higher than that of the control. Therefore, appropriate SPI addition can improve the gel performance of reduced-salt surimi gel without affecting digestion and absorption.

META-ANALYSIS OF DEPENDENCE OF THE DEVELOPMENT OF EXPERIMENTAL RENOVASCULAR HYPERTENSION “2 KIDNEYS, 1 CLAMP” ON LIFESTYLE FACTORS

Background. According to WHO controllable hypertension risk factors include an unhealthy diet, physical inactivity, and wrong daily routine. To date, a large number of experimental studies in rats have studied the effect on the development of unilateral renovascular hypertension (URH) of dietary supplements (minerals, vitamins, flavonoids, caffeine, fats, carbohydrates), physical activity and melatonin therapy.Objective. To conduct a meta- analysis of studies on risk factors for the development of URH.Design and methods. The search for publications was carried out in the PubMed, Scopus, Google Scholar databases. A total of 52 publications were selected.Results. The severity of hypertension decreases when the diet is enriched with potassium, as well as with various antioxidants (vitamin C, flavonoids, melatonin), which reduce oxidative stress in the ischemic kidney. In addition, physical activity can help reduce blood pressure in URH, but at the same time, it increases myocardial hypertrophy. There was no hypertensive effect of increased sodium chloride intake in renal artery stenosis, and no effect of calcium or magnesium supplementation on the URH development. At the same time, caffeine intake significantly increases plasma renin activity and blood pressure in URH.Conclusion. The majority of experimental studies included in our meta-analysis investigated the influence of factors on the development of URH, but not their effect on blood pressure in the chronic stage of URH.

Excessive sodium chloride ingestion promotes inflammation and kidney fibrosis in aging mice.

In aging kidneys, a decline of function resulting from extracellular matrix (ECM) deposition and organ fibrosis is regarded as "physiological." Whether a direct link between high salt intake and fibrosis in aging kidney exists autonomously from arterial hypertension is unclear. This study explores kidney intrinsic changes (inflammation, ECM derangement) induced by a high-salt diet (HSD) in a murine model lacking arterial hypertension. The contribution of cold shock Y-box binding protein (YB-1) as a key orchestrator of organ fibrosis to the observed differences is determined by comparison with a knockout strain (Ybx1ΔRosaERT+TX). Comparisons of tissue from mice fed with normal-salt diet (NSD, standard chow) or high-salt diet (HSD, 4% NaCl in chow; 1% NaCl in water) for up to 16 mo revealed that with HSD tubular cell numbers decrease and tubulointerstitial scarring [periodic acid-Schiff (PAS), Masson's trichrome, Sirius red staining] prevails. In Ybx1ΔRosaERT+TX animals tubular cell damage, a loss of cell contacts with profound tubulointerstitial alterations, and tubular cell senescence was seen. A distinct tubulointerstitial distribution of fibrinogen, collagen type VI, and tenascin-C was detected under HSD, transcriptome analyses determined patterns of matrisome regulation. Temporal increase of immune cell infiltration was seen under HSD of wild type, but not Ybx1ΔRosaERT+TX animals. In vitro Ybx1ΔRosaERT+TX bone marrow-derived macrophages exhibited a defect in polarization (IL-4/IL-13) and abrogated response to sodium chloride. Taken together, HSD promotes progressive kidney fibrosis with premature cell aging, ECM deposition, and immune cell recruitment that is exacerbated in Ybx1ΔRosaERT+TX animals.NEW & NOTEWORTHY Short-term experimental studies link excessive sodium ingestion with extracellular matrix accumulation and inflammatory cell recruitment, yet long-term data are scarce. Our findings with a high-salt diet over 16 mo in aging mice pinpoints to a decisive tipping point after 12 mo with tubular stress response, skewed matrisome transcriptome, and immune cell infiltration. Cell senescence was aggravated in knockout animals for cold shock Y-box binding protein (YB-1), suggesting a novel protective protein function.

#3406 CARDIOPROTECTIVE EFFECT OF SOY PROTEIN ON LONG-TERM HIGH-SALT DIET IN CYNOMOLGUS MONKEYS

Abstract Background and Aims A high salt content in the diet is one of the reasons for the increase in blood pressure (BP) and the development of cardiovascular disorders. However, high intake of sodium chloride does not always lead to an increase in blood pressure, but causes endothelial dysfunction and cardiac remodeling. It has been established that the introduction of soy products into the diet can have a nephro- and cardioprotective effect in chronic kidney disease. At the same time, it is not clear whether the damaging effect of a high-salt diet on the cardiovascular system can be offset by other dietary interventions, in particular, soy proteins. In this regard, the aim of the study was to study the effect of long-term use of diets with different content of sodium chloride and soy protein on myocardial remodeling in cynomolgus monkeys. Method A total of 18 cynomolgus male monkeys with age 6–8 years were studied. The animals were divided into three groups (six in each group). The first (control) group received the standard diet. The second group received the diet rich in common salt (8 g of NaCl/kg), and the third, the high salt diet in combination with soy protein SUPRO 760 (200 g/kg; Protеin Tеchnology Intеrnational, USA). Systolic (BP) and diastolic (BPd) blood pressure (BP) in monkeys was recorded by oscillometric method on a veterinary tonometer ML-410 VET (Microlux, Russia) under anesthesia. After registration of blood pressure, an echocardiographic study (EchoCG) was performed with a sector sensor with a frequency of 3-5 MHz on an ultrasound system Chison SonoTouch 60 (China). Echocardiography was performed in B-mode (two-dimensional scanning), M-mode (one-dimensional scanning), as well as in pulsed and tissue Doppler modes. Echocardiography and blood pressure measurements were performed at baseline, after 4 and 12 months of follow-up. Results BP values (group 1 - BPs: 109±10.09, BPd: 60±7.42; group 2 - BPs: 109±25.14, BPd: 57±11.86; group 3 - BPs: 101±8, 59, BPd: 57±6.92 mm Hg, all p&amp;gt;0.05) and heart rate (group 1 - 77±12.61, group 2 - 81±18.07, group 3-80±19.9 beats/min, all p&amp;gt;0.05) in macaques did not undergo significant changes over 12 months of the experiment in any of the groups. In group 1, there were also no significant changes in echocardiographic parameters. Group 2 monkeys showed no early changes in LV shortening fraction (FU) and ejection fraction (EF). However, after 12 months, FU decreased by an average of 26.6%, and EF by 12.8% compared with the indicator for a period of 4 months. In addition, the speed of the transmitral flow in early diastole (E) decreased by 19.1% compared with the baseline. Long-term intake of soy proteins prevented a decrease in LV FU in macaques on a high-salt diet. Its value was 25.1% greater than in group 2. In group 3 monkeys, after 12 months, the magnitude of systolic excursion of the mitral annulus plane and the maximum rate of excursion of the fibrous annulus of the mitral valve in early diastole (e') increased, the thickness of the interventricular septum in diastole decreased, and E/e' ratio. In group 3, the thickness of the posterior wall of the left ventricle decreased in systole (0.57±0.056 mm), the mass of the LV myocardium (14.9±2.94 g/m2), the average diameter of the base of the right ventricle (1.20±0.115 mm) compared with group 2 (0.69±0.040 mm, 19.6±2.83 g/m2, 1.40±0.111 mm, respectively; all p&amp;lt;0.01). Conclusion The obtained results can be considered as confirmation of the hypothesis that high consumption of sodium chloride leads to adverse structural and functional changes in the heart and blood vessels, not associated with an increase in blood pressure. The inclusion of isolated soy proteins in the diet is likely to reduce the effects of this negative impact. The specific mechanisms of this cardioprotective effect remain to be explored. Statistical analysis used One-way analysis of variance for unrelated samples when comparing the data of 3 studied groups and one-way analysis of variance for related samples when studying the dynamics of the indicator in each of the groups during 12 months of observation. Results are presented as mean ± standard deviation (M ± SD). Differences were considered significant at p&amp;lt;0.05.

Relationship Between High Sodium Chloride Intake and Obesity in Hypertensive Population A Cross-Sectional Study

Background: High Sodium chloride intake and obesity are significant, regarding hypertension in the population which may develop several medical complications. Objective: The aims and objectives of the current study were to introduce lifestyle medicine awareness in people for managing high blood pressure caused by high sodium chloride intake and obesity. Study Design: It was a cross-sectional clinical Study of the management of high blood pressure in a population with the help of nutrition &amp; physical exercise. Place and Duration: The present study was conducted from January to May 2023 and Patients were selected from the community health center and Ghurky Hospital Lahore. Methodology: ToA total of 10 of 0 hypertensive individuals were selected and divided into different groups regarding hypertension, obesity, sodium chloride intake in daily life, and other demographics. People were separated into different groups based on their sodium intake levels and BMI people were separated into different groups. In group- A there was 50 male and female while in group B other 50 male and female were included respectively. Results: Significant (P≤0.05) changes in systolic and diastolic blood pressure were seen in the individuals of both groups regarding NaCl intake. The mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of men in Group-A and Group-B in the beginning (27.03±0.02, 130.01±0.01, 90.01±0.02), (30.01±0.02, 135.01±0.01, 90.01±0.02) after 15 days (27.03±0.02, 125.01±0.01, 83.01±0.01), (30.01±0.02, 140.01±0.01, 90.01±0.02) and after30 days (27.03±0.02, 124.01±0.01, 80.01±0.01), (30.01±0.02, 145.01±0.01, 100.01±0.01) were measured respectively. Similarly the mean standard deviation levels, BMI, Systolic and Diastolic blood pressure of women in Group-A and Group B in the beginning (28.03±0.02, 131.01±0.01, 88.01±0.02), (31.02±0.02, 131.01±0.01, 88.01±0.02) after 15 days (28.03±0.02, 125.01±0.01, 83.01±0.01), (31.02±0.02, 140.01±0.01, 90.01±0.02) and after30 days (28.03±0.02, 120.01±0.01, 84.01±0.01), (31.02±0.02, 150.01±0.01, 92.01±0.01) were calculated. Conclusion: All recommendations suggest limiting dietary salt as one of the tried-and-true ways to lower high blood pressure because there is a well-established link between excessive salt consumption and hypertension. A current study proved that high sodium chloride intake may increase blood pressure in humans. Keywords: Hypertensive, Sodium Chloride, BMI, Systolic and Diastolic blood pressure.

Tff3-/- Knock-Out Mice with Altered Lipid Metabolism Exhibit a Lower Level of Inflammation following the Dietary Intake of Sodium Chloride for One Week.

A high salt intake causes hemodynamic changes and promotes immune response through cell activation and cytokine production, leading to pro-inflammatory conditions. Transgenic Tff3-/- knock-out mice (TFF3ko) (n = 20) and wild-type mice (WT) (n = 20) were each divided into the (1) low-salt (LS) group and (2) high-salt (HS) group. Ten-week-old animals were fed with standard rodent chow (0.4% NaCl) (LS) or food containing 4% NaCl (HS) for one week (7 days). Inflammatory parameters from the sera were measured by Luminex assay. The integrin expression and rates of T cell subsets of interest from the peripheral blood leukocytes (PBLs) and mesenteric lymph nodes (MLNs) were measured using flow cytometry. There was a significant increase in high-sensitivity C reactive protein (hsCRP) only in the WT mice following the HS diet, while there were no significant changes in the serum levels of IFN-γ, TNF-α, IL-2, IL-4, or IL-6 as a response to treatment in either study groups. The rates of CD4+CD25+ T cells from MLNs decreased, while CD3+γδTCR+ from peripheral blood increased following the HS diet only in TFF3ko. γδTCR expressing T cell rates decreased in WT following the HS diet. The CD49d/VLA-4 expression decreased in the peripheral blood leukocytes in both groups following the HS diet. CD11a/LFA-1 expression significantly increased only in the peripheral blood Ly6C-CD11ahigh monocytes in WT mice following salt loading. In conclusion, salt-loading in knock-out mice caused a lower level of inflammatory response compared with their control WT mice due to gene depletion.

Oral Sodium to Preserve Renal Efficiency in Acute Heart Failure: A Randomized, Placebo-Controlled, Double-Blind Study

Evidence for modulating the sodium chloride (NaCl) intake of patients hospitalized with acute heart failure (AHF) is inconclusive. Salt restriction may not benefit; hypertonic saline may aid diuresis. To compare the safety and efficacy of oral NaCl during intravenous (IV) diuretic therapy in renal function and weight. Seventy hospitalized patients with AHF who were being treated with IV furosemide infusion consented to receive, randomly, 2 grams of oral NaCl or placebo 3 times a day in a double-blind manner during diuresis. Treatment efficacy (bivariate primary endpoints of change in serum creatinine levels and change in weight) was measured at 96 hours, and adverse safety events were tracked for 90 days. Sixty-five patients (34 NaCl, 31 placebo) were included for analysis after 5 withdrew. A median of 13 grams of NaCl was given compared to placebo. At 96 hours, there was no significant difference between treatment groups with respect to the primary endpoint (P = 0.33); however, the trial was underpowered, and there was greater than expected standard deviation in weight change. The mean change in creatinine levels and weight was 0.15 ± 0.44 mg/dL and 4.6 ± 4.2 kg in the placebo group compared with 0.04 ± 0.40 mg/dL and 4.0 ± 4.3 kg in the NaCl group (P = 0.30 and 0.57, respectively). Across efficacy and safety endpoints, we observed no significant difference between the 2 groups other than changes in serum sodium levels (-2.6 ± 2.7 in the placebo group and -0.3 ± 3.3 mEq/L in the NaCl group; P < 0.001) and in serum blood urea nitrogen levels (11 ± 15 in the placebo group; 3.1 ± 13 mEq/L in the NaCl group; P = 0.025). In this single-center study, liberal vs restrictive oral sodium chloride intake strategies did not impact the safety and efficacy of intravenous diuretic therapy in patients with AHF. (ClinicalTrials.gov registration NCT04334668.).

Effect of Regulated Add-on Sodium Chloride Intake on Stabilization of Serum Lithium Concentration in Bipolar Disorder: A Randomized Controlled Trial

IntroductionThe therapeutic use of lithium in bipolar disorder is often restricted due to its narrow therapeutic window and adverse drug reactions. Lithium-induced early renal dysfunction is clinically important as it may lead to sodium depletion due to natriuresis leading to lithium retention and lithium toxicity. This is most often seen in the initial phases of therapy, and psychiatrists struggle titrating the dose of lithium and stabilizing the serum lithium level.ObjectivesThe present study was conducted to evaluate the effect of add-on sodium chloride on serum lithium levels in bipolar disorder.MethodsThe present randomized controlled trial (NCT04222816) was conducted in 60 patients with type I bipolar disorder who were randomized into the control group who received lithium carbonate with the advice not to take additional salt (at the table) and the test group who received sachets of sodium chloride (1 g/d) as an add-on to lithium carbonate and were advised to restrict their additional salt intake (at the table) to 1 g/d. After baseline assessments, all patients were followed up at 4 weeks, 8 weeks, and 12 weeks when serum lithium, sodium and potassium were estimated. Serum creatinine and aldosterone were repeated at 12 weeks.ResultsIn the test group, the fluctuation rate in serum lithium (26.7%) was significantly (p=0.01) lower than in the control group (63.3%). There was a significant difference in serum lithium in the control group at different time points; however, the changes were not significant in the test group. There was a significant difference in serum lithium between the groups at 8 and 12 weeks of follow-up. There were no significant differences in the change in serum sodium, potassium, creatinine, aldosterone, creatinine clearance, and blood pressure within the group and between the groups. A significant positive correlation was found between serum lithium and aldosterone at baseline.ConclusionsIntake of add-on sodium chloride (1 gm/day) may reduce the fluctuations in serum lithium during the maintenance phase of lithium therapy in type I bipolar disorder.Disclosure of InterestNone Declared

Continuous ingestion of sodium chloride solution promotes allergen absorption and may exacerbate allergy symptoms on ovalbumin-induced food allergy in mice.

Various studies have reported relationships between salt intake and diseases, such as hypertension, cardiovascular disease, stroke, gastric cancer, and bronchial asthma. However, no reports exist on the relationship between salt intake and food allergies. In this study, we investigated the effect of continuous ingestion of sodium chloride (NaCl) on allergy symptoms using a mouse model of food allergy. BALB/c mice were divided into four groups of 6-8 animals each. The control-water group (CW) and sensitization-water group (SW) groups were provided free access to water, and the control-1% NaCl group (CS) and sensitization-1% NaCl group (SS) groups were provided a 1% NaCl solution. The SW and SS groups were sensitized with 50 µg ovalbumin (OVA) at 2 timepoints by intraperitoneal injection. After oral administration of OVA, anaphylactic response was measured and blood was collected. The mice were sacrificed, and serum levels of OVA and anti-OVA immunoglobulin (Ig)E and IgG1 were measured by enzyme-linked immunosorbent assays. The sodium ion (Na+) concentrations in duodenal and jejunal extracts were measured using a Na+ ion meter. The results suggested that continuous ingestion of a 1% NaCl solution for 36 days promoted allergen absorption and may have aggravated allergy symptoms in the mice. However, NaCl ingestion did not affect Na+ concentrations in the small intestine or OVA-specific antibody production.

Selective pressure on a saccharin intake phenotype and its correlates: a replication study.

The Occidental High- and Low-Saccharin rats (respectively, HiS and LoS lines) were selectively bred for decades to examine mechanisms and correlates of a saccharin intake phenotype. Observed line differences ranged from taste and eating to drug self-administration and defensive behavior, paralleling human research on relationships between gustation, personality, and psychopathology. The original lines were terminated in 2019, and replicate lines (HiS-R and LoS-R) were selectively bred for 5 generations to test for reproducible, rapid selection for the phenotype and its correlates. The line differences chosen for replication included intake of tastants (saccharin, sugars, quinine-adulterated sucrose, sodium chloride, and ethanol) and foods (cheese, peas, Spam, and chocolate) and several noningestive behaviors (deprivation-induced hyperactivity, acoustic startle, and open field behavior). The HiS-R and LoS-R lines diverged on intake of saccharin, disaccharides, quinine-adulterated sucrose, sodium chloride, and complex foods, and open field behavior. Differences from the original lines also were observed. Reasons for and implications of the pattern of replication and lack thereof in 5 generations are discussed.

High Intake of Sodium Chloride for 28 Days Causes No Effect on Serum FGF23 Concentrations in Cats.

FGF23 is an acknowledged parameter to assess kidney health. As chronic kidney failure is one of the most common diseases in aging cats, dietary influences on renal health warrant investigation. The purpose of this study was therefore to investigate potential correlations between dietary sodium chloride and FGF23. In a total of two trials, 11 cats were included. In the first trial, the cats were fed a complete and balanced control diet; in the second trial, sodium chloride was added (8 g/kg/DM)). Blood, urinary, feed, and faecal samples were analysed for major minerals. FGF23 and creatinine were measured in blood and urine samples. Serum phosphate and FGF23 were unaffected by high sodium chloride intake, thus showing no correlation between serum FGF23 and sodium concentrations. Apparent phosphorus digestibility was significantly increased, however, by high sodium chloride intake, whereas apparent digestibility of calcium was unaffected. The present study confirms differences in FGF23 and sodium chloride interaction in cats compared with other species. Further research regarding the correlation between sodium chloride and phosphate homeostasis is warranted.

Sudden Infant Death Syndrome, Pulmonary Edema, and Sodium Toxicity: A Grounded Theory.

Sudden Infant Death Syndrome (SIDS) occurs unexpectedly in an otherwise healthy infant with no identifiable cause of death following a thorough investigation. A general hypervolemic state has been identified in SIDS, and fluid in the lungs suggests the involvement of pulmonary edema and hypoxia as the cause of death. The present perspective paper reviews pathophysiological, epidemiological, and dietary evidence in SIDS. A grounded theory is presented that proposes an association of SIDS with sodium toxicity from excessive sodium chloride intake, mediated by noncardiogenic pulmonary edema, hypoxia, and alveolar damage. The peak of SIDS cases occurs in infants 2–4 months of age, who are less efficient in excreting excessive dietary sodium load. Evidence implicating sodium toxicity in SIDS includes increased levels of sodium associated with fever and with inflammatory/immune responses in the lungs. Conditions in near-miss SIDS cases are linked to dysregulated sodium, and increased sodium dietary intake suggests that sodium toxicity from a high-salt diet potentially mediates the association of seasonality and socioeconomic status with SIDS incidence. In addition, exposure to sodium toxicity meets three main criteria of the triple risk model of SIDS. The proposed pathophysiological effects of pulmonary edema related to sodium toxicity in SIDS merit further investigations.

Microbiological Safety and Shelf-Life of Low-Salt Meat Products-A Review.

Salt is widely employed in different foods, especially in meat products, due to its very diverse and extended functionality. However, the high intake of sodium chloride in human diet has been under consideration for the last years, because it is related to serious health problems. The meat-processing industry and research institutions are evaluating different strategies to overcome the elevated salt concentrations in products without a quality reduction. Several properties could be directly or indirectly affected by a sodium chloride decrease. Among them, microbial stability could be shifted towards pathogen growth, posing a serious public health threat. Nonetheless, the majority of the literature available focuses attention on the sensorial and technological challenges that salt reduction implies. Thereafter, the need to discuss the consequences for shelf-life and microbial safety should be considered. Hence, this review aims to merge all the available knowledge regarding salt reduction in meat products, providing an assessment on how to obtain low salt products that are sensorily accepted by the consumer, technologically feasible from the perspective of the industry, and, in particular, safe with respect to microbial stability.

Orthostatic intolerance as a potential contributor to prolonged fatigue and inconsistent performance in elite swimmers

BackgroundAthletic underperformance is characterized by fatigue and an inability to sustain a consistent exercise workload. We describe five elite swimmers with prolonged fatigue and athletic underperformance. Based on our work in myalgic encephalomyelitis /chronic fatigue syndrome, we focused on orthostatic intolerance as a possible contributor to symptoms.MethodsParticipants were referred for evaluation of fatigue and underperformance to the Chronic Fatigue Clinic at the Johns Hopkins Children’s Center. All patients were evaluated for overtraining syndrome, as well as for features commonly seen in myalgic encephalomyelitis/chronic fatigue syndrome. The latter included joint hypermobility, orthostatic intolerance, and non-IgE mediated milk protein intolerance. Orthostatic intolerance was tested by performing a ten-minute passive standing test or a head-up tilt table test.ResultsOrthostatic testing provoked fatigue and other symptoms in all five swimmers, two of whom met heart rate criteria for postural tachycardia syndrome. Treatment was individualized, primarily consisting of an increased intake of sodium chloride and fluids to address orthostasis. All patients experienced a relatively prompt improvement in fatigue and other orthostatic symptoms and were able to either return to their expected level of performance or improve their practice consistency.ConclusionsOrthostatic intolerance was an easily measured and treatable contributor to athletic underperformance in the five elite swimmers we describe. We suggest that passive standing tests or formal tilt table tests be incorporated into the clinical evaluation of athletes with fatigue and underperformance as well as into scientific studies of this topic. Recognition and treatment of orthostatic intolerance provides a new avenue for improving outcomes in underperforming athletes.