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1.
Core Strategies to Increase the Uptake and Use of Potassium-Enriched Low-Sodium Salt.
Ajenikoko, A, Ide, N, Shivashankar, R, Ge, Z, Marklund, M, Anderson, C, Atun, A, Thomson, A, Henry, ME, Cobb, LK
Nutrients. 2021;(9)
Abstract
Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.
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2.
Sodium Intake as a Cardiovascular Risk Factor: A Narrative Review.
Jaques, DA, Wuerzner, G, Ponte, B
Nutrients. 2021;(9)
Abstract
While sodium is essential for human homeostasis, current salt consumption far exceeds physiological needs. Strong evidence suggests a direct causal relationship between sodium intake and blood pressure (BP) and a modest reduction in salt consumption is associated with a meaningful reduction in BP in hypertensive as well as normotensive individuals. Moreover, while long-term randomized controlled trials are still lacking, it is reasonable to assume a direct relationship between sodium intake and cardiovascular outcomes. However, a consensus has yet to be reached on the effectiveness, safety and feasibility of sodium intake reduction on an individual level. Beyond indirect BP-mediated effects, detrimental consequences of high sodium intake are manifold and pathways involving vascular damage, oxidative stress, hormonal alterations, the immune system and the gut microbiome have been described. Globally, while individual response to salt intake is variable, sodium should be perceived as a cardiovascular risk factor when consumed in excess. Reduction of sodium intake on a population level thus presents a potential strategy to reduce the burden of cardiovascular disease worldwide. In this review, we provide an update on the consequences of salt intake on human health, focusing on BP and cardiovascular outcomes as well as underlying pathophysiological hypotheses.
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3.
The Dietary Approach to the Treatment of the Rare Genetic Tubulopathies Gitelman's and Bartter's Syndromes.
Francini, F, Gobbi, L, Ravarotto, V, Toniazzo, S, Nalesso, F, Spinella, P, Calò, LA
Nutrients. 2021;(9)
Abstract
Gitelman's (GS) and Bartter's (BS) syndromes are rare, inherited autosomal recessive tubulopathies characterized by hypokalemia, metabolic alkalosis, renal sodium, chloride, and potassium and magnesium-wasting. While the treatment based on potassium, sodium, chloride, and magnesium supplementation in addition to other pharmacologic options are widely established, recommendations about the dietary approach to GS and BS still remain generic. In this review we focus on the dietary strategies to increase sodium, potassium, and magnesium intake in GS and BS patients. Potassium and magnesium-rich foods and supplements are considered together with those that may reduce through different mechanisms the potassium and magnesium plasma level. Magnesium supplementation is often poorly tolerated, causing abdominal pain and diarrhea in most patients. New formulations using liposome and, in particular, sucrosomial technology have been recently proposed for magnesium supplementation in order to increase magnesium supplement tolerability and intestinal absorption. The dietary approach to GS and BS may be very important in the therapeutic approach to these syndromes. Due to the relevance of the dietary approach to these syndromes, a nutritional counseling should always be recommended and the nutritionist should join nephrologists in the follow-up of GS and BS patient care.
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Advances in Genomics Research of Blood Pressure Responses to Dietary Sodium and Potassium Intakes.
Razavi, MA, Bazzano, LA, Nierenberg, J, Huang, Z, Fernandez, C, Razavi, AC, Whelton, SP, He, J, Kelly, TN
Hypertension (Dallas, Tex. : 1979). 2021;(1):4-15
Abstract
More than half of US adults have hypertension by 40 years of age and a subsequent increase in atherosclerotic cardiovascular disease risk. Dietary sodium and potassium are intricately linked to the pathophysiology of hypertension. However, blood pressure responses to dietary sodium and potassium, phenomena known as salt and potassium sensitivity of blood pressure, respectively, are heterogenous and normally distributed in the general population. Like blood pressure, salt and potassium sensitivity are complex phenotypes, and previous research has shown that up to 75% of individuals experience a blood pressure change in response to such dietary minerals. Previous research has also implicated both high salt sensitivity and low salt sensitivity (or salt resistance) of blood pressure to an increased risk of hypertension and potentially atherosclerotic cardiovascular disease risk. Given the clinical challenges required to accurately measure the sodium and potassium response phenotypes, genomic characterization of these traits has become of interest for hypertension prevention initiatives on both the individual and population levels. Here, we review advances in human genomics research of blood pressure responses to dietary sodium and potassium by focusing on 3 main areas, including the phenotypic characterization of salt sensitivity and resistance, clinical challenges in diagnosing such phenotypes, and the genomic mechanisms that may help to explain salt and potassium sensitivity and resistance. Through this process, we hope to further underline the value of leveraging genomics and broader multiomics for characterizing the blood pressure response to sodium and potassium to improve precision in lifestyle approaches for primordial and primary atherosclerotic cardiovascular disease prevention.
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5.
Nutrition and the Covid-19 pandemic: Three factors with high impact on community health.
Iaccarino Idelson, P, Rendina, D, Strazzullo, P
Nutrition, metabolism, and cardiovascular diseases : NMCD. 2021;(3):756-761
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Abstract
AIMS: In the course of the COVID-19 pandemic, multiple suggestions have been delivered through websites and social media referring to natural substances and various kinds of supplements with thaumaturgical properties in preventing and/or fighting the coronavirus infection. Indeed, there is no clinical trial evidence that a dietary or pharmacological supplementation of any particular substance will increase the effectiveness of the immune defences. There are however three nutritional issues that deserve special attention under the present circumstances, namely vitamin D deficiency, excess salt intake and inappropriate alcohol consumption. Here is a short review of the current knowledge about the possible role of these factors in the immunity defence system and their potential impact on the modulation of the immune response to SARS-COV2 infection. DATA SYNTHESIS For all of these factors there is convincing evidence of an impact on the immune defence structure and function. In the absence of RCT demonstration that increased ingestion of any given substance may confer protection against the new enemy, special attention to correction of these three nutritional criticisms is certainly warranted at the time of COVID pandemic. CONCLUSIONS We propose that the inappropriate intake of salt and alcohol and the risk of inadequate vitamin D status should be object of screening, in particular in subjects at high mortality risk from SARS-COV 2 infection, such as institutionalised elderly subjects and all those affected by predisposing conditions.
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Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education.
Razavi, AC, Dyer, A, Jones, M, Sapin, A, Caraballo, G, Nace, H, Dotson, K, Razavi, MA, Harlan, TS
Nutrients. 2020;(12)
Abstract
Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.
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Estimation of Sodium and Potassium Intake: Current Limitations and Future Perspectives.
Ginos, BNR, Engberink, RHGO
Nutrients. 2020;(11)
Abstract
Globally, average dietary sodium intake is double the recommended amount, whereas potassium is often consumed in suboptimal amounts. High sodium diets are associated with increased cardiovascular and renal disease risk, while potassium may have protective properties. Consequently, patients at risk of cardiovascular and renal disease are urged to follow these recommendations, but dietary adherence is often low due to high sodium and low potassium content in processed foods. Adequate monitoring of intake is essential to guide dietary advice in clinical practice and can be used to investigate the relationship between intake and health outcomes. Daily sodium and potassium intake is often estimated with 24-h sodium and potassium excretion, but long-term balance studies demonstrate that this method lacks accuracy on an individual level. Dietary assessment tools and spot urine collections also exhibit poor performance when estimating individual sodium and potassium intake. Collection of multiple consecutive 24-h urines increases accuracy, but also patient burden. In this narrative review, we discuss current approaches to estimating dietary sodium and potassium intake. Additionally, we explore alternative methods that may improve test accuracy without increasing burden.
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High-Salt Diet Gets Involved in Gastrointestinal Diseases through the Reshaping of Gastroenterological Milieu.
Li, J, Sun, F, Guo, Y, Fan, H
Digestion. 2019;(4):267-274
Abstract
BACKGROUND Gastrointestinal (GI) diseases are known to be largely influenced by one's lifestyle and dietary uptake. A high-salt diet (HSD) is well recognized as a risk factor for cardiovascular complications, hypertension, and metabolic syndromes. However, the relationship between an HSD and the GI system, which is the compartment that comes in direct contact with exogenous stimulants, has not been fully explored. AIMS We seek to better understand the complexity of the pathogenic effects of an HSD in the context of GI disorders. METHODS By searching the PubMed and Web of science, the review of literature was performed using keywords: high-salt and GI, high-salt and immunity, salt and microbiota, salt and hormone. RESULTS In this review, we concluded that high-salt intake potentially perturbs the local immune homeostasis, alters the gut microbiota composition and function, and affects the endocrine hormone profiling in the GI system. CONCLUSION HSD might get involved in GI diseases through the reshaping of gastroenterological milieu, which could help to better understand the complexity of the pathogenic effects of an HSD in the context of GI disorders.
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[Sodium restriction in heart failure: where are the data?].
Navis, GJ
Nederlands tijdschrift voor geneeskunde. 2019
Abstract
Mahtani et al. review the evidence for sodium restriction in heart failure. The paucity of solid studies is striking, but deplorably in line with the paucity of high-quality studies on lifestyle management in general. One hard endpoint study (Sodium-HF) is underway. Promising results were obtained in the GOURMET study, which integrated sodium restriction into a broader nutritional approach that simultaneously targeted malnutrition, a major problem in heart failure. Targeting overall nutritional status - rather than single nutrients - matches current trends in nutrition guidelines, and deserves further exploration. Using fresh products and avoiding processed foods is the main step towards an overall healthier diet with less sodium. Dietary improvement, with its clinical benefit, is feasible in most patients by means of adequate support and feedback. Hopefully, the emergence of 'lifestyle medicine' will, with clinical and scientific effort, allow for the health potential of nutrition to be translated into clinical benefit for patients.
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Impact of quality of research on patient outcomes in the Institute of Medicine 2013 report on dietary sodium.
Lucko, A, Doktorchik, CT, Campbell, NR
Journal of clinical hypertension (Greenwich, Conn.). 2018;(2):345-350
Abstract
The 2013 Institute of Medicine report entitled "Sodium Intake in Populations: Assessment of Evidence" found inconsistent evidence of health benefit with dietary sodium intake <2300 mg/d. Different studies reported benefit and harm of population dietary intake <2300 mg/d. The Institute of Medicine committee, however, did not assess whether the methodology used in each of the studies was appropriate to examine dietary sodium and health outcomes. This review investigates the association of methodological rigor and outcomes of studies in the Institute of Medicine report. For the 13 studies that met all methodological criteria, nine found a detrimental impact of high sodium consumption on health, one found a health benefit, and in three the effect was unclear (P = .068). For the 22 studies that failed to meet all criteria, 11 showed a detrimental impact, four a health benefit, and seven had unclear effects from increasing dietary sodium (P = .42).