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Sodium Intake Beliefs, Information Sources, and Intended Practices of Endurance Athletes Before and During Exercise.
McCubbin, AJ, Cox, GR, Costa, RJS
International journal of sport nutrition and exercise metabolism. 2019;(4):371–381
Abstract
There is little information describing how endurance athletes perceive sodium intake in relation to training and competition. Using an online questionnaire, this study assessed the beliefs, information sources, and intended practices regarding sodium ingestion for training and competition. Endurance athletes (n = 344) from six English-speaking countries completed the questionnaire and were included for analysis. The most cited information sources were social supports (63%), self-experimentation (56%), and media (48%). Respondents generally believed (>50% on electronic visual analog scale) endurance athletes require additional sodium on a daily basis (median 67% [interquartile range: 40-81%]), benefit from increased sodium in the days preceding competition (60% [30-77%]), should replace sodium losses during training (69% [48-83%]) and competition (74% [54-87%]), and would benefit from sweat composition testing (82% [65-95%]). Respondents generally believed sodium ingestion during endurance exercise prevents exercise-associated muscle cramps (75% [60-88%]) and exercise-associated hyponatremia (74% [62-89%]). The majority (58%) planned to consciously increase sodium or total food intake (i.e., indirectly increasing sodium intake) in the days preceding competition. Most (79%) were conscious of sodium intake during competition, but only 29% could articulate a specific intake plan. A small minority (5%) reported using commercial sweat testing services, of which 75% believed it was beneficial. We conclude that endurance athletes commonly perceive sodium intake as important for their sporting activities. Many intend to consciously increase sodium intake in the days preceding and during competition, although these views appear informed mostly by nonscientific and/or non-evidence-based sources.
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[Effect of lifestyle intervention among pre-hypertensive population in Futian District of Shenzhen City from 2013 to 2015].
Liu, M, Ni, W, Xu, J, Xu, J, Ji, N, Bai, Y
Wei sheng yan jiu = Journal of hygiene research. 2019;(2):208-213
Abstract
OBJECTIVE To evaluate the effect of lifestyle intervention program among pre-hypertensive adults in Futian District, Shenzhen City. METHODS A total of 12 communities were selected randomly from Futian District, Shenzhen City between October and November of 2013. A total of 1183 pre-hypertension population was screened and divided into intervention group(834) and control group(349) according to community sources. Comprehensive intervention including reducing sodium intake, weight control and exercise, quitting smoking and limiting alcohol consumption were implemented in intervention group. The form of intervention was a combination of group activities and individual follow-up, and at least one kind of activity and follow-up was carried out every quarter. The control group did not actively provide any intervention except routine work. The evaluation survey was taken both in intervention group and control group in 2015. RESULTS In the intervention group, the proportion of oil control measures was increased from 36. 6% to 55. 7%(χ~2=44. 71, P<0. 01), the proportion of salt reduction measures was increased from 44. 8% to 61. 1%(χ~2=32. 72, P<0. 01), the regular exercise rate was increased from 24. 1% to 37. 1%(χ~2=24. 23, P<0. 01), adequate intake of fruits and vegetables rate rose from 44. 6% to 53. 5%(χ~2=9. 61, P<0. 01) after intervention. There was no statistical difference in these indicators in the control group before and after intervention(P>0. 05). After intervention, the blood pressure of 329(54. 2%) persons in the intervention group returned to healthy state, 244(40. 2%) persons remained in the pre-hypertensive state and 34(5. 6%) persons were converted to hypertensive patients. In the control group, the blood pressure of 55(16. 4%) persons returned to health, 236(70. 0%) persons maintain prehypertension, and 46(13. 6%) persons became hypertensive patients. Compared with the two groups, the difference was statistically significant(χ~2=130. 93, P<0. 01). The result showed that the systolic blood pressure of the pre-hypertensive group decreased by 7. 605 mmHg and the diastolic blood pressure decreased by 3. 727 mmHg. CONCLUSION After 2 years of follow-up and intervention, the lifestyle of the pre-hypertension population in the intervention group has been improved. The comprehensive intervention has achieved good result.
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Impact of fractional excretion of sodium on a single morning void urine collection as an estimate of 24-hour urine sodium.
Nowson, CA, Lim, K, Campbell, NRC, O'Connell, SL, He, FJ, Daly, RM
Journal of clinical hypertension (Greenwich, Conn.). 2019;(12):1763-1770
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Abstract
The standard for assessing dietary sodium intake is to measure 24-hour urine sodium. On average, 93% of daily sodium intake is excreted over 24-hours. Expense and difficulties in obtaining complete 24-hour collections have led to the measurement of sodium concentration in spot and single-void urine samples, using predictive equations to estimate 24-hour urine sodium. Although multiple predictive equations have been developed, in addition to having an average bias, all the equations overestimate 24-hour sodium at lower levels of 24-hour sodium and underestimate 24-hour urine sodium at higher levels of 24-hour sodium. One of the least biased estimating equations is the INTERSALT equation, which incorporates a spot urine creatinine concentration. The authors hypothesized that differential fractional excretion of sodium (FeNa)(derived from a morning void collection) relative to creatinine would impact on the accuracy of the INTERSALT equation in estimating 24-hour urine sodium. In a prospective study of 139 adults aged 65 years and over, three sequential morning void and 24-hour urine samples were examined. There was a significant correlation between increasing FENa and the difference between estimated and measured 24-hours urine sodium (r = 0.358, P < .01). In the lowest quartile of FENa, the INTERSALT equation overestimated 24-hour urine sodium, but underestimated 24-hour urine sodium with greater magnitude in each of the subsequent quartiles of FENa. Differential excretion of sodium relative to creatinine, potentially impacted by renal blood flow and hydration, among other factors, affected the accuracy of the INTERSALT equation. Additional research may refine the INTERSALT and other predictive equations to increase their accuracy.
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Contribution of fat, sugar and salt to diets in the Pacific Islands: a systematic review.
Santos, JA, McKenzie, B, Trieu, K, Farnbach, S, Johnson, C, Schultz, J, Thow, AM, Snowdon, W, Bell, C, Webster, J
Public health nutrition. 2019;(10):1858-1871
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OBJECTIVE Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands. DESIGN Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies. RESULTS Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake. CONCLUSIONS Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
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Association between Sodium Intake and Urinary Fractional Albumin and Immunoglobulin G Excretion in Chronic Nondialytic Renal Disease: A Prospective Longitudinal Study.
Martinez, MG, Dos Santos Silva, V, do Valle, AP, de Oliveira, RC, Banin, VB, Hokama, NK, Martin, LC
Nephron. 2019;(1):62-67
Abstract
BACKGROUND/AIMS: Previous studies reported that fractional clearance of urinary proteins is better than total proteinuria in predicting chronic kidney disease (CKD) progression. However, the role of sodium in the fractional excretion of proteins has not been established. We aimed to evaluate the association between sodium intake and fractional albumin and immunoglobulin G (IgG) excretion in nondialytic CKD. METHODS We did a longitudinal, observational, and prospective study that included CKD patients aged 18-80. Included patients performed basal routine laboratory evaluations, urinary sodium excretion, and fractional albumin and IgG excretion that were repeated after 6-month of follow-up. RESULTS We evaluated 84 patients, mean age 55 ± 15.6 years, 40 women, and 74 whites. The change of estimated sodium intake had an association with the change of fractional albumin (R = 0.54; p < 0.001) and IgG (R = 0.56; p < 0.001) excretion in univariate analysis (increases in sodium intake were paralleled by increases in albumin and IgG excretion fractions). This association was maintained in a multiple generalized linear model even after adjusting for age and for changes in blood pressure, urinary potassium, protein intake, and blood glucose. CONCLUSION In CKD patients, changes in estimated sodium intake were associated with changes in the fractional albumin and IgG excretion regardless of confounding factors. Findings of this study support the idea that reducing salt intake, and consequently, albumin and IgG fractional excretions could help to slow CKD progression. This hypothesis must be tested in long-term interventional studies.
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Online Randomized Controlled Trials of Restaurant Sodium Warning Labels.
Musicus, AA, Moran, AJ, Lawman, HG, Roberto, CA
American journal of preventive medicine. 2019;(6):e181-e193
Abstract
INTRODUCTION Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers' hypothetical choices, meal perceptions, and knowledge. STUDY DESIGN Four sequential, randomized, controlled online experiments were conducted. SETTING/PARTICIPANTS Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk. INTERVENTION Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., "sodium warning" versus "high sodium"), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016-2019. MAIN OUTCOME MEASURES The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge. RESULTS In Experiments 1-3, all warning labels reduced average sodium ordered across both restaurants (by 19-81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (-68 mg, p=0.002 and -46 mg, p=0.049, respectively). Warnings also significantly increased participants' knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label. CONCLUSIONS Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
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Determinants and the Role of Self-Efficacy in a Sodium-Reduction Trial in Hemodialysis Patients.
Hu, L, St-Jules, DE, Popp, CJ, Sevick, MA
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2019;(4):328-332
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OBJECTIVE This study was to assess the impact of baseline dietary self-efficacy on the effect of a dietary intervention to reduce sodium intake in patients undergoing hemodialysis (HD) and to identify determinants of low dietary self-efficacy. METHODS This is a post hoc analysis of the BalanceWise study, a randomized controlled trial that aimed to reduce dietary sodium intake in HD patients recruited from 17 dialysis centers in Pennsylvania. The main outcome measures include dietary self-efficacy and reported dietary sodium density. Analysis of variance with post hoc group-wise comparison was used to examine the effect of baseline dietary self-efficacy on changes in reported sodium density in the intervention and control groups at 8 and 16 weeks. Chi-square test, independent t tests, or Wilcoxon rank-sum tests were used to identify determinants of low dietary self-efficacy. RESULTS The interaction between dietary self-efficacy and the impact of the intervention on changes in reported dietary sodium density approached significance at 8 and 16 weeks (P interaction = 0.051 and 0.06, respectively). Younger age and perceived income inadequacy were significantly associated with low self-efficacy in patients undergoing HD. CONCLUSION The benefits of dietary interventions designed to improve self-efficacy may differ by the baseline self-efficacy status. This may be particularly important for HD patients who are younger and report inadequate income as they had lower dietary self-efficacy.
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Current Data on Dietary Sodium, Arterial Structure and Function in Humans: A Systematic Review.
Tsirimiagkou, C, Basdeki, ED, Argyris, A, Manios, Y, Yannakoulia, M, Protogerou, AD, Karatzi, K
Nutrients. 2019;(1)
Abstract
BACKGROUND Subclinical arterial damage (SAD) (arteriosclerosis, arterial remodeling and atheromatosis) pre-exists decades before cardiovascular disease (CVD) onset. Worldwide, sodium (Na) intake is almost double international recommendations and has been linked with CVD and death, although in a J-shape manner. Studies regarding dietary Na and major types of SAD may provide pathophysiological insight into the association between Na and CVD. OBJECTIVES Systematic review of data derived from observational and interventional studies in humans, investigating the association between dietary Na with (i) atheromatosis (arterial plaques); (ii) arteriosclerosis (various biomarkers of arterial stiffness); (iii) arterial remodeling (intima-media thickening and arterial lumen diameters). DATA SOURCES Applying the PRISMA criteria, the PubMed and Scopus databases were used. RESULTS 36 studies were included: 27 examining arteriosclerosis, four arteriosclerosis and arterial remodeling, three arterial remodeling, and two arterial remodeling and atheromatosis. CONCLUSIONS (i) Although several studies exist, the evidence does not clearly support a clinically meaningful and direct (independent from blood pressure) effect of Na on arterial wall stiffening; (ii) data regarding the association of dietary Na with arterial remodeling are limited, mostly suggesting a positive trend between dietary Na and arterial hypertrophy but still inconclusive; (iii) as regards to atheromatosis, data are scarce and the available studies present high heterogeneity. Further state-of-the-art interventional studies must address the remaining controversies.
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Perceived Barriers to Adherence to Hemodialysis Dietary Recommendations.
Clark-Cutaia, MN, Sevick, MA, Thurheimer-Cacciotti, J, Hoffman, LA, Snetselaar, L, Burke, LE, Zickmund, SL
Clinical nursing research. 2019;(8):1009-1029
Abstract
Barriers to following dietary recommendations have been described; however, they remain poorly understood. The purpose of this qualitative study was to explore perceived barriers to adherence to dietary recommendations in a diverse hemodialysis patient population. Participants were eligible to participate in a semi-structured qualitative telephone interview prior to randomization for an ongoing clinical trial to evaluate the efficacy of an intervention designed to reduce dietary sodium intake. Interviews were digitally recorded, transcribed verbatim and coded using an iterative qualitative process. In total, 30 (37% females, 53% Caucasians) participants, 63.2 ± 13.3 years, were interviewed. Time, convenience, and financial constraints hindered dietary adherence. Dietary counseling efforts were rated positively but require individualization. Ability to follow recommended guidelines was challenging. Suggestions for addressing barriers include technology-based interventions that allow patients to improve food choices and real-time decision-making, and permit tailoring to individual barriers and preferences.
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Dose-response association of dietary sodium intake with all-cause and cardiovascular mortality: a systematic review and meta-analysis of prospective studies.
Milajerdi, A, Djafarian, K, Shab-Bidar, S
Public health nutrition. 2019;(2):295-306
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OBJECTIVE High Na intake has been associated with different health problems. However, serious controversies exist over studies investigating associations of Na intake with mortality from all-causes and CVD. The present systematic review and meta-analysis was done to investigate, for the first time, the dose-response association of dietary Na intake with all-cause and CVD mortality among prospective studies. DESIGN Relevant papers published up to August 2017 were searched in MEDLINE, EMBASE and Google Scholar databases. Prospective cohort studies on the association of dietary Na intake with all-cause or/and CVD mortality were included. Linear and non-linear dose-response associations between Na intake and CVD and all-cause mortality were examined. RESULTS Overall, twenty publications met inclusion criteria. A significant non-linear association (P<0·001) was found between Na intake and CVD mortality risk among studies assessing urinary Na excretion, with a relatively steep slope at Na intakes above 2400mg/d. However, the association was not significant in studies using dietary Na intake (P=0·61). Additionally, the non-linear association of Na intake with all-cause mortality was also non-significant. No linear association (effect size; 95 % CI; I 2) was seen between 100mg/d increment in Na intake and CVD mortality (1·01; 0·97, 1·05; 98·4 %) or all-cause mortality (1·01; 1·00, 1·02; 89·2 %). Following subgroup analyses, the association between Na intake and CVD mortality was observed only among studies conducted in the USA (0·99; 0·99, 1·00; 20·0 %). CONCLUSIONS The study showed a direct association between urinary Na excretion and CVD mortality which was more considerable at intakes above 2400mg/d. In contrast, no significant association was found between Na intake and all-cause mortality. Further long-term prospective studies on different populations are required to confirm these findings.