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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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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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3.
Sodium status and the metabolic syndrome: A systematic review and meta-analysis of observational studies.
Soltani, S, Kolahdouz Mohammadi, R, Shab-Bidar, S, Vafa, M, Salehi-Abargouei, A
Critical reviews in food science and nutrition. 2019;(2):196-206
Abstract
The prevalence of metabolic syndrome (MetS) has been greatly increased, worldwide. In recent years, investigators have proposed that sodium might contribute to the development of metabolic syndrome; however, the published data were conflicting. The present systematic review aimed to summarize the evidence from observational studies in this regard. We conducted a systematic search for relevant observational studies investigating the association between sodium status and MetS, published until June 2017 in electronic databases including PubMed, EMBASE, Scopus and Google Scholar. Summary effects were derived using random effects model. After screening the records, seventeen publications with 66,274 participants were eligible to be included in the systematic review and meta-analysis. The analysis revealed that subjects with MetS have significantly higher levels of sodium compared to healthy controls (Hedges' g = 0.21, 95% CI: 0.12, 0.29, I2 = 68.6). Subgroup analyses revealed that the difference was significant when the sodium status was assessed using urinary sodium levels. The random effects meta-regression analysis also revealed that body sodium level increases with the number of MetS components. Furthermore, participants with highest dietary/urinary or serum sodium levels had 37% higher chance of developing MetS when compared with participants with the lowest sodium levels (OR = 1.37 95%CI: 1.31, 1.42, I2 = 86.9). The current meta-analysis revealed that higher sodium input into the body is directly associated with the likelihood of MetS. Prospective cohort studies and well-designed randomized clinical trials considering the effect of sodium restricted diets on the risk of MetS as an outcome are necessary to represent the causal association.
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[Scientific statement] Report of the Salt Reduction Committee of the Japanese Society of Hypertension(1) Role of salt in hypertension and cardiovascular diseases.
Ando, K, Kawarazaki, H, Miura, K, Matsuura, H, Watanabe, Y, Yoshita, K, Kawamura, M, Kusaka, M, Kai, H, Tsuchihashi, T, et al
Hypertension research : official journal of the Japanese Society of Hypertension. 2013;(12):1009-19
Abstract
Dietary salt consumption is closely associated with the level of blood pressure (BP); stricter salt reduction more markedly decreased BP. Obesity/metabolic syndrome, Dietary Approach to Stop Hypertension (DASH) diet, exercise and mental stress influence the BP-elevating effect of high-salt diet. Observational and intervention studies suggested that salt restriction improved the risk of cardiovascular diseases. However, the effects may differ among the types of the hypertensive complications; salt reduction may decrease the risk of stroke more than that of ischemic heart disease. Small-scale studies demonstrated that excess salt increased the risk of the left ventricular hypertrophy, heart failure, the urinary protein/albumin levels and end-stage renal failure. These diverse beneficial effects of salt reduction are probably because low-salt diet is an effective strategy to decrease BP and body fluid volume but is less effective to ameliorate the other cardiovascular risk factors. A mean salt intake in Japan is markedly high. Considering the present condition, salt reduction is essential for the prevention and treatment of hypertension and for the prevention of cardiovascular diseases.