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Rashidmayvan M, Mansoori A, Derakhshan-Nezhad E, Tanbakuchi D, Sangin F, Mohammadi-Bajgiran M, Abedsaeidi M, Ghazizadeh S, Sarabi MMT, Rezaee A, Ferns G, Esmaily H, Ghayour-Mobarhan M. Nutritional intake of micronutrient and macronutrient and type 2 diabetes: machine learning schemes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2025; 44:31. [PMID: 39920736 PMCID: PMC11806732 DOI: 10.1186/s41043-024-00712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/05/2024] [Indexed: 02/09/2025]
Abstract
BACKGROUND Diabetes mellitus, an endocrine system disease, is a common disease involving many patients worldwide. Many studies are performed to evaluate the correlation between micronutrients/macronutrients on diabetes but few of them have a high statistical population and a long follow-up period. We aimed to investigate the relationship between intake of macro/micronutrients and the incidence of type 2 diabetes (T2D) using logistic regression (LR) and a decision tree (DT) algorithm for machine learning. METHOD Our research explores supervised machine learning models to identify T2D patients using the Mashhad Cohort Study dataset. The study population comprised 9704 individuals aged 35-65 years were enrolled regarding their T2D status, and those with T2D history. 15% of individuals are diabetic and 85% of them are non-diabetic. For ten years (until 2020), the participants in the study were monitored to determine the incidence of T2D. LR is a statistical model applied in dichotomous response variable modeling. All data were analyzed by SPSS (Version 22) and SAS JMP software. RESULT Nutritional intake in the T2D group showed that potassium, calcium, magnesium, zinc, iodine, carotene, vitamin D, tryptophan, and vitamin B12 had an inverse correlation with the incidence of diabetes (p < 0.05). While phosphate, iron, and chloride had a positive relationship with the risk of T2D (p < 0.05). Also, the T2D group significantly had higher carbohydrate and protein intake (p-value < 0.05). CONCLUSION Machine learning models can identify T2D risk using questionnaires and blood samples. These have implications for electronic health records that can be explored further.
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Affiliation(s)
- Mohammad Rashidmayvan
- Department of Nutrition, Food Sciences and Clinical Biochemistry, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Amin Mansoori
- Department of Applied Mathematics, School of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Elahe Derakhshan-Nezhad
- Faculty of Medicine, Islamic Azad University of Mashhad, Mashhad, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davoud Tanbakuchi
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sangin
- Department of Computer Engineering, Center of Excellence on Soft Computing and Intelligent Information, Processing Ferdowsi University of Mashhad, Mashhad, Iran
| | - Maryam Mohammadi-Bajgiran
- International UNESCO center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Malihehsadat Abedsaeidi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sara Ghazizadeh
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | | | - Ali Rezaee
- Department of Biology, Mashhad Branch, Islamic Azad University, Mashhad, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Gordon Ferns
- Brighton and Sussex Medical School, Division of Medical Education, Brighton, UK
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- International UNESCO center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
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Park SK, Oh CM, Ryoo JH, Jung JY. Intake of sodium and potassium, sodium-potassium intake ratio, and their relation to the risk of diabetes mellitus. Sci Rep 2025; 15:4411. [PMID: 39910340 PMCID: PMC11799388 DOI: 10.1038/s41598-025-88787-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 01/30/2025] [Indexed: 02/07/2025] Open
Abstract
We aimed to examine the effects of sodium and potassium intake on the risk of diabetes mellitus (DM). In a cohort of 99,552 working-age Korean adults (60,591 men; mean age 39.7 ± 6.9 and 38,961 women; mean age 38.4 ± 6.5), we longitudinally evaluated the risk of DM in relation to quartile levels of sodium intake, potassium intake, and the sodium-potassium ratio. A Cox proportional hazards model was used to assess the risk of DM by calculating adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident DM (adjusted HR [95% CI]). In men, sodium intake was not associated with the risk of DM (first quartile: reference, second quartile: 0.96 [0.87-1.07], third quartile: 0.94 [0.84-1.05], and fourth quartile: 1.02 [0.89-1.18]). Women did not show a significant association between sodium intake and the risk of DM (first quartile: reference, second quartile: 0.87 [0.69-1.09], third quartile: 1.02 [0.81-1.29], and fourth quartile: 1.01 [0.76-1.33]). Additionally, potassium intake and the sodium-potassium ratio were not significantly associated with the risk of DM in either men or women. In conclusion, no significant association was observed between sodium or potassium intake and the risk of DM among working-age Korean adults.
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Affiliation(s)
- Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ju Young Jung
- Total healthcare center, Kangbuk Samsung Hospital, Sungkyunkwan University School of medicine, Seoul, Republic of Korea, 67, Sejong‑daero, Jung‑gu, Seoul, 04514.
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Pan X, He H, Bao Y, Bi Y, Chen L, Chen X, Fang H, Feng W, Gao L, Guo L, Guo Y, Han Y, Hua Q, Li N, Li Q, Li Y, Li Y, Li X, Liu J, Ma H, Mu J, Nong K, Shang H, Shen Y, Shi Z, Sun F, Sun N, Tao J, Wang J, Wang X, Wu J, Xiao X, Xie L, Xu J, Xu J, Ye H, Yu D, Yuan H, Zhang H, Zhang J, Zhang L, Zhang Y, Zhou J, Zhou X, Zhu D, Zhu T, Li S, Zhu Z. Chinese expert consensus on the management of hypertension in adults with type 2 diabetes. J Evid Based Med 2024; 17:851-864. [PMID: 39529557 DOI: 10.1111/jebm.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024]
Abstract
Both hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence-to-decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.
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Affiliation(s)
- Xiaohui Pan
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Hongbo He
- Department of Hypertension and Endocrinology, Army Medical University, Chongqing, China
- Chongqing Institute of Hypertension, Chongqing, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Bi
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Luyuan Chen
- Department of Cardiology, People's Hospital of Guangdong Province, Guangzhou, China
- Guangdong Institute of Cardiovascular Disease, Guangzhou, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Fang
- Department of Endocrinology, Tangshan Gongren Hospital Affiliated to Hebei Medical University, Tangshan, China
| | - Wenhuan Feng
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ling Gao
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital of the Ministry of Health, Beijing, China
- National Center of Geriatics and Gerotology, Beijing, China
- Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing, China
| | - Yifang Guo
- Department of Geriatric Cardiovascular Medicine, Hebei General Hospital, Shijiazhuang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Military Cardiovascular Disease Research Institute, Shenyang, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nanfang Li
- Hypertension Diagnosis and Treatment Research Center, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, China
| | - Quanmin Li
- Department of Endocrinology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yan Li
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Hypertension, Shanghai, China
| | - Yong Li
- Department of Cardiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xialian Li
- Department of Endocrinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Liu
- Department of Cardiovascular Medicine, Peking University People's Hospital, Beijing, China
| | - Huijuan Ma
- Department of Endocrinology, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kailei Nong
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Huiqian Shang
- Department of Cardiovascular Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Zhongwei Shi
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Sun
- Department of Hypertension and Endocrinology, Daping Hospital, Army Special Medical Center, Army Medical University, Chongqing, China
| | - Ningling Sun
- Department of Cardiovascular Medicine, Peking University People's Hospital, Beijing, China
| | - Jun Tao
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiguang Wang
- Shanghai Institute of Hypertension, Shanghai, China
- Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinling Wang
- Department of endocrinology, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi, China
| | - Jing Wu
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, China
| | - Xinhua Xiao
- Department of Endocrinology and Metabolism, First Affiliated Hospital of University of South China, Hengyang, China
| | - Liangdi Xie
- Department of Cardiovascular Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jing Xu
- Department of Endocrinology, Second Affiliated Hospital of Xi'an Jiaotong University, X''an, China
| | - Jing Xu
- Department of Endocrinology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongni Yu
- Department of Endocrinology, Beijing Hospital of the Ministry of Health, Beijing, China
| | - Hong Yuan
- Department of Cardiology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Huijie Zhang
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Zhang
- Department of Encephalopathy, Hubei Provincial Hospital of TCM, Wuhan, P.R. China
| | - Lili Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuqing Zhang
- Department of Cardiovascular Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaqiang Zhou
- Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, China
| | - Xinli Zhou
- Department of endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dalong Zhu
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Tiehong Zhu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Army Medical University, Chongqing, China
- Chongqing Institute of Hypertension, Chongqing, China
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Shen W, Cai L, Wang B, Li J, Sun Y, Chen Y, Xia F, Wang N, Lu Y. Associations of a proinflammatory diet, habitual salt intake, and the onset of type 2 diabetes: A prospective cohort study from the UK Biobank. Diabetes Obes Metab 2024; 26:2119-2127. [PMID: 38409502 DOI: 10.1111/dom.15517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
AIM To explore the relationship between proinflammatory diet, habitual salt intake and the onset of type 2 diabetes. METHODS This prospective study was conducted among 171 094 UK Biobank participants who completed at least one 24-h dietary questionnaire and were free of diabetes at baseline. Participants were followed up until 1 March 2023 for type 2 diabetes incidence, with diagnosis information obtained from linked medical records. An Energy-adjusted Diet Inflammatory Index (E-DII) was calculated based on 28 food parameters. Habitual salt intake was determined through the self-reported frequency of adding salt to foods. The associations between E-DII, habitual salt intake and type 2 diabetes incidence were tested by the Cox proportional hazard regression model. RESULTS Over a median follow-up period of 13.5 years, 6216 cases of type 2 diabetes were documented. Compared with participants with a low E-DII (indicative of an anti-inflammatory diet), participants with a high E-DII (indicative of a proinflammatory diet) had an 18% heightened risk of developing type 2 diabetes. The association between E-DII and type 2 diabetes tends to be linear after adjustment for major confounders. Participants with a proinflammatory diet and always adding salt to foods had the highest risk of type 2 diabetes incidence (hazard ratio 1.60, 95% confidence interval 1.32-1.94). CONCLUSIONS Our findings indicate that a proinflammatory diet and higher habitual salt intake were associated with an increased risk of type 2 diabetes. These results support the public health promotion of an anti-inflammatory diet and reducing salt intake to prevent the onset of type 2 diabetes.
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Affiliation(s)
- Wenqi Shen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingli Cai
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Li
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Sun
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Chen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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5
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Lee J, Lee JY, Yang YJ. Sex-Specific Association between Sodium Intake Estimated by 24-Hour Urinary Sodium Excretion and Nonalcoholic Fatty Liver Disease: The Community-Based Prospective Cohort Study. Nutrients 2024; 16:548. [PMID: 38398872 PMCID: PMC10892959 DOI: 10.3390/nu16040548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/03/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Evidence for the association between high sodium intake and the onset of nonalcoholic fatty liver disease (NAFLD) is insufficient. This study examined the sex-specific association between sodium intake and the risk of NAFLD. This study included 2582 adults (aged 40-69 years; 1011 males and 1571 females). The total sodium excreted over 24 h was estimated from spot urine specimens using Tanaka's equation. Based on these estimates, participants were categorized into three groups according to their 24-h urinary sodium excretion levels: lowest (T1), middle (T2), and highest (T3). In addition, the participants were divided into non-NAFLD (≤36) and NAFLD (>36) groups based on the hepatic steatosis index. During the follow-up period (14 years), NAFLD was observed in 551 participants. The estimated 24-h urinary sodium excretion levels were positively associated with the incidence of NAFLD in all subjects. Upon sex stratification, females in the T2 and T3 groups exhibited adjusted hazard ratios of 1.35 and 1.51, respectively, compared with the T1 group. However, a significant relationship was not observed in males. High intake of sodium, especially among females, may be an important factor contributing to the development of NAFLD. Individuals with high sodium intake should be appropriately counselled and monitored for the risk of NAFLD.
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Affiliation(s)
- Jihye Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan 44429, Republic of Korea;
| | - Ju-Yeon Lee
- College of Medicine, Catholic Kwandong University, Gangneung-si 25601, Republic of Korea;
| | - Yun-Jung Yang
- Department of Convergence Science, College of Medicine, Catholic Kwandong University International St. Mary’s Hospital, Incheon 22711, Republic of Korea
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Wang X, Ma H, Kou M, Tang R, Xue Q, Li X, Harlan TS, Heianza Y, Qi L. Dietary Sodium Intake and Risk of Incident Type 2 Diabetes. Mayo Clin Proc 2023; 98:S0025-6196(23)00118-0. [PMID: 37921793 DOI: 10.1016/j.mayocp.2023.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To fill the knowledge gap of the relation between long-term dietary sodium intake and type 2 diabetes (T2D), we evaluate the association between the frequency of adding salt to foods, a surrogate marker for evaluating the long-term sodium intake, and incident T2D risk. METHODS A total of 402,982 participants from UK Biobank (March 13, 2006 - October 10, 2010) who were free of diabetes, chronic kidney disease, cancer, or cardiovascular disease at baseline, and had completed information on adding salt were analyzed in this study. RESULTS During a median of 11.9 years of follow-up, 13,120 incident cases of T2D were documented. Compared with participants who "never/rarely" added salt to foods, the adjusted HRs were 1.11 (95% CI, 1.06 to 1.15), 1.18 (95% CI, 1.12 to 1.24), and 1.28 (95% CI, 1.20 to 1.37) across the groups of "sometimes," "usually," and "always," respectively (P-trend<.001). We did not find significant interactions between the frequency of adding salt to foods and baseline hypertension status and other covariates on the risk of incident T2D. The observed positive association was partly mediated by body mass index, waist to hip ratio, and C-reactive protein, with a significant mediation effect of 33.8%, 39.9%, and 8.6%, respectively. The significant mediation effect of body mass index was largely driven by the body fat mass rather than the body fat-free mass. CONCLUSION Our findings for the first time indicate that higher frequency of adding salt to foods, a surrogate marker for a person's long-term salt taste preference and intake, is associated with a higher T2D risk.
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Affiliation(s)
- Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Minghao Kou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Rui Tang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Timothy S Harlan
- George Washington University Culinary Medicine Program, Washington, DC, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Fan Y, Wu M, Ding L, Ji H, Zhao J, Li X, Li Z, Liu S, Jiang H, Shi J, Lei H, Wang M, Wang D, Ma L. Potassium status and the risk of type 2 diabetes, cardiovascular diseases, and mortality: a meta-analysis of prospective observational studies. Crit Rev Food Sci Nutr 2023; 64:13212-13224. [PMID: 37788131 DOI: 10.1080/10408398.2023.2262584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Epidemiological evidence on the association between potassium and cardiometabolic outcomes remains controversial. This study aimed to examine associations of dietary intake and blood and urinary levels of potassium with risk of type 2 diabetes, cardiovascular disease (CVD), and mortality. Relevant prospective studies were retrieved through a comprehensive search of four electronic databases up to July 1, 2023. Random-effects models were used to pool the study-specific relative risks (RRs) and 95% confidence intervals (CIs). Fifty-six studies were included in this meta-analysis. A higher intake of potassium was significantly associated with a 16% lower risk of CVD (RR: 0.84, 95% CI: 0.78-0.90). Similar inverse associations were also observed between potassium intake and mortality. Each 1.0 g/d increment in potassium intake was associated with a decreased risk of CVD (RR: 0.85, 95% CI: 0.80-0.91) and all-cause mortality (RR: 0.93, 95% CI: 0.88-0.99). For blood and urinary potassium levels, higher level of blood potassium increased the risk of all-cause mortality by 23% (RR: 1.23, 95% CI: 1.11-1.36). The association of blood potassium levels with mortality was nonlinear (Pnon-linearit<0.001). However, urinary potassium levels were inversely associated with the risk of all-cause mortality (RR: 0.84, 95% CI: 0.76-0.93). Our findings support the benefits of moderate potassium consumption for primary prevention of chronic diseases and premature death.
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Affiliation(s)
- Yahui Fan
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Min Wu
- The First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Lu Ding
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Huixin Ji
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jinping Zhao
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Xiaohui Li
- Department of Maternal and Child Health Management, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Zhaofang Li
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Sijiao Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hong Jiang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jia Shi
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Haoyuan Lei
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Mingxu Wang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education of China, Xi'an, China
| | - Duolao Wang
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education of China, Xi'an, China
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Takase H, Takeuchi Y, Fujita T, Ohishi T. Excessive salt intake reduces bone density in the general female population. Eur J Clin Invest 2023; 53:e14034. [PMID: 37272759 DOI: 10.1111/eci.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/06/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Osteoporosis is a multifactorial disorder in which nutrition is associated with its onset and progression. Excessive salt intake is closely associated with the onset and progression of various diseases, such as osteoporosis and hypertension. We investigated the effects of dietary salt intake on bone density in the general female population. METHODS In 884 female participants (60.1 ± 10.1 years old) who visited our hospital for an annual physical checkup, salt intake (g/day) was assessed using a spot urine sample, and bone density was evaluated as a speed of sound (m/s) of ultrasonic pulses in a calcaneus by quantitative ultrasound. We investigated the relationship between bone density and salt intake and the differences in bone density or salt intake between the presence and absence of lifestyle-related diseases such as hypertension, diabetes mellitus and dyslipidaemia. RESULTS The average bone density and salt intake were 1497 ± 26 m/s and 8.5 ± 1.8 g/day, respectively. Univariate and multivariate regression analyses revealed that bone density was significantly negatively associated with salt intake. Bone density was lower, and salt intake was higher in participants with hypertension, diabetes mellitus and dyslipidaemia than in those without. After adjusting for age, hypertension, diabetes mellitus and dyslipidaemia, bone density was negatively correlated with salt intake. CONCLUSIONS We confirmed that excessive salt intake reduces bone density independently of age and lifestyle-related diseases in the general female population. Since dietary salt intake is a modifiable factor, osteoporosis can be prevented by dietary intervention, including salt reduction.
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Affiliation(s)
- Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Hamamatsu, Japan
| | - Yuki Takeuchi
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
| | - Tomotada Fujita
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
| | - Tsuyoshi Ohishi
- Department of Orthopedic Surgery, Enshu Hospital, Hamamatsu, Japan
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9
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Ribeiro NG, Lelis DF, Molina MDCB, Schmidt MI, Duncan BB, Griep RH, Barreto SM, Bensenor I, Lotufo PA, Mill JG, Baldo MP. The high salt intake in adults with metabolic syndrome is related to increased waist circumference and blood pressure: the Brazilian Longitudinal Study of Adult Health study (ELSA-Brasil). Nutrition 2023; 114:112108. [PMID: 37406608 DOI: 10.1016/j.nut.2023.112108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES The association between metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, and salt consumption has fed intense debate in recent years, although it is yet to be fully elucidated. We aimed to evaluate whether individuals with MetS have a high salt consumption and to identify which components of the MetS diagnosis could be independently related to high salt consumption. METHODS We analyzed data from 11 982 adults, ages 35 to 74 y, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study, from which clinical and anthropometric data were assessed, and a validated 12-h overnight urine collection was used to estimate salt intake. MetS was defined according to the Adult Treatment Panel III criteria. RESULTS Salt intake was increased in individuals with MetS compared with individuals without MetS, regardless of sex (men: 14.3 ± 6.4 g/d versus 12.2 ± 5.5 g/d, P < 0.001; women: 10.6 ± 4.9 g/d versus 8.9 ± 4.0 g/d, P < 0.001) and increased progressively as the MetS criteria accumulated. The high salt intake in MetS participants, however, was observed only in the presence of elevated waist circumference and/or blood pressure and not with the other MetS criteria (reduced high-density lipoprotein, increased triglycerides, and impaired fasting blood glucose), regardless of the presence of MetS. When diabetes was incorporated as a MetS criterion, increased salt intake was observed in men but not in women. CONCLUSIONS Salt intake should be reduced worldwide, but strategies must be more intense in people with elevated blood pressure and waist circumference, regardless of MetS diagnosis, to avoid the associated morbidity and mortality.
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Affiliation(s)
| | - Deborah F Lelis
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil
| | | | - Maria I Schmidt
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rosane H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Sandhi M Barreto
- Faculty of Medicine and Clinical Hospital, Empresa Brasileira de Serviços Hospitalares - EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabela Bensenor
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil
| | - José G Mill
- Department of Physiological Sciences, Federal University of Espírito Santo, Vitória, Brazil
| | - Marcelo P Baldo
- Department of Pathophysiology, Montes Claros State University (UNIMONTES), Montes Claros, Brazil.
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10
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Jung JY, Oh CM, Kim E, Park SK. Dietary sodium intake and its relation to sleep duration, sleep quality and nocturnal urination in working-aged Korean adults. NUTR BULL 2023; 48:365-375. [PMID: 37458133 DOI: 10.1111/nbu.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Both sodium intake and sleep have an important effect on cardiovascular health. However, few studies have looked at the association between sodium intake and sleep. Therefore, we analysed the association of sodium intake with sleep quality, sleep duration and nocturnal urination. The data for the present study were obtained from the Kangbuk Samsung Health Study. Study participants were 156 696 working-aged Korean adults (average age 38.0 years ±8.0 in men and 36.0 years ±8.1 in women). They were categorised into five groups by quintile of sodium intake, measured by food frequency questionnaire. Poor sleep quality and short sleep duration were determined by Pittsburgh Sleep Quality Index >5, and sleep duration <7 h, respectively. Nocturnal urination was defined as awakening to urinate more than three times a week. Multivariable adjusted logistic regression analysis was used in calculating the odds ratio (OR) and 95% confidence interval (CI) for poor sleep quality, short sleep duration and nocturnal urination (adjusted OR [95% CI]) across five study groups. In all study participants, increased sodium intake was significantly associated with poor sleep quality (quintile 1: reference, quintile 2: 1.07 [1.04-1.11], quintile 3: 1.12 [1.08-1.16], quintile 4: 1.15 [1.11-1.19] and quintile 5: 1.13 [1.09-1.18]). This pattern of relationship was similarly observed in association of sodium intake with short sleep duration (p for trend <0.001) and nocturnal urination (p for trend <0.001). In gender subgroup analysis, increased sodium intake had a significant association with poor sleep quality and short sleep duration in men and with poor sleep quality and nocturnal urination in women. In conclusion, high sodium intake is associated with an increased likelihood of poor sleep quality, short sleep duration and nocturnal urination.
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Affiliation(s)
- Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Keun Park
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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11
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Yu HJ, Ho M, Liu X, Yang J, Chau PH, Fong DYT. Incidence and temporal trends in type 2 diabetes by weight status: A systematic review and meta-analysis of prospective cohort studies. J Glob Health 2023; 13:04088. [PMID: 37651631 PMCID: PMC10471153 DOI: 10.7189/jogh.13.04088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Diabetes is more prevalent among overweight/obese individuals, but has become a significant public health challenge among normal weight populations. In this meta-analysis, we aimed to estimate diabetes/prediabetes incidence and its temporal trends by weight status. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched until 8 December 2021. Prospective cohort studies reporting diabetes incidence by baseline body mass index (BMI) categories in adults were included. The median year of data collection was used to assess the temporal trends. Subgroup analyses and meta-regression were also performed. Results We included 94 studies involving 3.4 million adults from 22 countries. The pooled diabetes incidence in underweight, normal-weight, and overweight/obese adults was 4.5 (95% confidence interval (CI) = 2.8-7.3), 2.7 (95% CI = 2.2-3.3), and 10.5 (95% CI = 9.3-11.8) per 1000 person-years, respectively. The diabetes incidence in low- and middle-income countries (LMICs) was higher than in high-income countries among normal-weight (5.8 vs 2.0 per 1000 person-years) or overweight/obese (15.9 vs 8.9 per 1000 person-years) adults. European and American regions had a higher diabetes incidence than the non-Western areas, regardless of weight status. Underweight diabetes incidence decreased significantly from 1995-2000 to 2005-2010. Diabetes incidence in normal-weight populations has increased continuously since 1985 by an estimated 36% every five years. In overweight/obese adults, diabetes incidence increased between 1985-1990 and 1995-2000, stabilised between 2000 and 2010, and spiked suddenly after 2010. Conclusions Diabetes incidence and its temporal trends differed by weight status. The continuous upward trend of diabetes incidence among overweight/obese individuals requires urgent attention, particularly in LMICs. Furthermore, diabetes among normal-weight individuals is becoming a significant public health problem. Registration PROSPERO (CRD42020215957).
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Affiliation(s)
- Hong-jie Yu
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Mandy Ho
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Xiangxiang Liu
- National Clinical Research Center for Infectious Diseases, The Third People’s Hospital of Shenzhen, Shenzhen, China
| | - Jundi Yang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Pui Hing Chau
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
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12
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Ming L, Wang D, Zhu Y. Association of sodium intake with diabetes in adults without hypertension: evidence from the National Health and Nutrition Examination Survey 2009-2018. Front Public Health 2023; 11:1118364. [PMID: 37727604 PMCID: PMC10506081 DOI: 10.3389/fpubh.2023.1118364] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Background Sodium is essential for human health, however the prevalence of various diseases is associated with excessive sodium intake, particularly cardiovascular disorders. However, in most countries, salt intake is much higher than the World Health Organization recommends. Several studies in recent years have revealed that high salt intake is associated with diabetes in the general population, but the association is uncertain in people who do not have hypertension. In this study, we aimed to find out whether high sodium intake increases the risk of diabetes in this particular population. Method Data were extracted from the National Health and Nutrition Examination Survey (NHANES; 2009-2018). Participants included adults aged over 20 years old who have undergone the diabetes questionnaire, and the hypertension population was excluded. In order to adjust the confounders, multivariate analysis models were built. Finally, subgroup analysis were conducted to investigate the association between sodium intake and diabetes separately. Result In the present study, 7,907 participants are included (3,920 female and 3,987 male), and 512 (6.48%) individuals reported diabetes. The median sodium intake of the participants was 3,341 mg/d (IQR: 2498, 4,364 mg/d). A linear association between sodium intake and the prevalence of diabetes was found (p = 0.003). According to the multivariate analysis models, the odds ratio of diabetes for every 1,000 mg sodium intake increment is 1.20 (OR: 1.20, 95% CI 1.07-1.35). The highest sodium intake quartile was 1.80-fold more likely to have diabetes than the lowest quartile (OR: 1.80, 95% CI 1.17-2.76). Conclusion Our results suggest that higher sodium intake is associated with an increased risk of diabetes in the population without hypertension, and for every 1,000 mg sodium intake increment, the risk of diabetes increased by 1.20-fold. To sum up, we have provided the clue to the etiology of diabetes and further prospective research is needed to contribute recommendations for the primary prevention of diabetes in the US.
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Affiliation(s)
- Li Ming
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Duan Wang
- Department of Rehabilitation, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Pediatric Intensive Care Medicine, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
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13
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Glucoregulatory Properties of Fermented Soybean Products. FERMENTATION-BASEL 2023. [DOI: 10.3390/fermentation9030254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Type 2 diabetes mellitus is a chronic metabolic disease, characterized by persistent hyperglycemia, the prevalence of which is on the rise worldwide. Fermented soybean products (FSP) are rich in diverse functional ingredients which have been shown to exhibit therapeutic properties in alleviating hyperglycemia. This review summarizes the hypoglycemic actions of FSP from the perspective of different target-related molecular signaling mechanisms in vitro, in vivo and clinical trials. FSP can ameliorate glucose metabolism disorder by functioning as carbohydrate digestive enzyme inhibitors, facilitating glucose transporter 4 translocation, accelerating muscular glucose utilization, inhibiting hepatic gluconeogenesis, ameliorating pancreatic dysfunction, relieving adipose tissue inflammation, and improving gut microbiota disorder. Sufficiently recognizing and exploiting the hypoglycemic activity of traditional fermented soybean foods could provide a new strategy in the development of the food fermentation industry.
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Hua Y, Zhang Z, Liu A. Long-Term Diet Quality and Risk of Diabetes in a National Survey of Chinese Adults. Nutrients 2022; 14:nu14224841. [PMID: 36432527 PMCID: PMC9695385 DOI: 10.3390/nu14224841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
There is little evidence involving the association between diet quality and the risk of diabetes among the Asian populations, especially from the long-term prospective cohort studies in China. This study evaluated the long-term diet quality of Chinese adults by the Chinese diet balance index 2016 (DBI-16) and firstly explored its role in diabetes prevention. A total of 9394 participants from the China health and nutrition survey (2004-2015) prospective cohort were included. Dietary information was selected by three consecutive 24-h dietary recalls, combined with a household food inventory and further calculated as the scores of the DBI-16 components and indicators. Three major indicators, the low bound score (LBS), the high bound score (HBS) and the diet quality distance (DQD), were divided into four level groups, according to the total scores, respectively, including Level 1 (scores below 20%), Level 2 (20-40% of scores), Level 3 (40-60% of scores) and Level 4 (scores above 60%). Diabetes cases were identified through a questionnaire or by testing the overnight fasting blood samples. Cox's proportional hazards models were used to estimate the hazard ratios (HRs) and 95% CIs, while restricted cubic splines (RCS) were applied to explore the potentially non-linear relationships. During a median follow-up of 6.0 years (61,979 persons-years), 657 participants developed diabetes. The LBS and DQD scores were positively associated with diabetes risks, whereas no significant association of the HBS scores with diabetes risks was observed. Compared with those on the lowest level, the adjusted HRs (95%) across the increased levels of diet quality were 2.43 (1.36, 4.37), 3.05 (1.69, 5.53) and 4.90 (2.46, 9.78) for the LBS; 1.06 (0.74, 1.51), 1.30 (0.99, 1.88) and 0.99 (0.39, 2.55) for the HBS; 1.28 (1.01, 1.61) and 2.10 (1.57, 2.82) for the DQD after pooling the participants on Level 1 and 2 as the reference group, due to the few who developed diabetics on Level 1 of the DQD. No significantly non-linear shape was observed for all three indicators. Our findings indicated a significant inverse association between the long-term diet quality assessed by the DBI-16 and diabetes risks, providing evidence for the positive role of healthy diets in diabetes prevention in Asia.
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15
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D’Elia L, Masulli M, Cappuccio FP, Zarrella AF, Strazzullo P, Galletti F. Dietary Potassium Intake and Risk of Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients 2022; 14:nu14224785. [PMID: 36432472 PMCID: PMC9697076 DOI: 10.3390/nu14224785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that explored the effect of dietary potassium intake on the risk of diabetes to overcome these limitations. (2) Methods: A random-effects dose-response meta-analysis was carried out for prospective studies. A potential non-linear relation was investigated using restricted cubic splines. (3) Results: A total of seven prospective studies met the inclusion criteria. Dose-response analysis detected a non-linear relationship between dietary potassium intake and diabetes risk, with significant inverse association starting from 2900 mg/day by questionnaire and between 2000 and 5000 mg/day by urinary excretion. There was high heterogeneity among studies, but no evidence of publication bias was found. (4) Conclusions: The results of this meta-analysis indicate that habitual dietary potassium consumption is associated with risk of diabetes by a non-linear dose-response relationship. The beneficial threshold found supports the campaigns in favour of an increase in dietary potassium intake to reduce the risk of morbidity and mortality. Further studies should be carried out to explore this topic.
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Affiliation(s)
- Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
- Correspondence:
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Francesco P. Cappuccio
- World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Aquilino F. Zarrella
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
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Clerjon S, El Sabbagh N, Pages G, Traore A, Bonny JM. Quantitative sodium magnetic resonance imaging in food: Addressing sensitivity issues using single quantum chemical shift imaging at high field. MAGNETIC RESONANCE IN CHEMISTRY : MRC 2022; 60:628-636. [PMID: 34907589 DOI: 10.1002/mrc.5239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
According to various health organizations, the global consumption of salt is higher than recommended and needs to be reduced. Ideally, this would be achieved without losing the taste of the salt itself. In order to accomplish this goal, both at the industrial and domestic levels, we need to understand the mechanisms that govern the final distribution of salt in food. The in-silico solutions in use today greatly over-simplify the real food structure. Measuring the quantity of sodium at the local level is key to understanding sodium distribution. Sodium magnetic resonance imaging (MRI), a non-destructive approach, is the ideal choice for salt mapping along transformational process. However, the low sensitivity of the sodium nucleus and its short relaxation times make this imaging difficult. In this paper, we show how sodium MRI can be used to highlight salt heterogeneities in food products, provided that the temporal decay is modeled, thus correcting for differences in relaxation speeds. We then propose an abacus which shows the relationship between the signal-to-noise ratio of the sodium MRI, the salt concentration, the B0 field, and the spatial and temporal resolutions. This abacus simplifies making the right choices when implementing sodium MRI.
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Affiliation(s)
- Sylvie Clerjon
- INRAE, UR QuaPA, St Genes Champanelle, France
- INRAE, PROBE Research Infrastructure, AgroResonance Facility, St Genes Champanelle, France
| | - Nour El Sabbagh
- INRAE, UR QuaPA, St Genes Champanelle, France
- INRAE, PROBE Research Infrastructure, AgroResonance Facility, St Genes Champanelle, France
- Institute Pascal, Clermont Auvergne University, CHU, CNRS, Clermont Auvergne INP, Clermont-Ferrand, France
| | - Guilhem Pages
- INRAE, UR QuaPA, St Genes Champanelle, France
- INRAE, PROBE Research Infrastructure, AgroResonance Facility, St Genes Champanelle, France
| | - Amidou Traore
- INRAE, UR QuaPA, St Genes Champanelle, France
- INRAE, PROBE Research Infrastructure, AgroResonance Facility, St Genes Champanelle, France
| | - Jean-Marie Bonny
- INRAE, UR QuaPA, St Genes Champanelle, France
- INRAE, PROBE Research Infrastructure, AgroResonance Facility, St Genes Champanelle, France
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Sang M, Liu Y, Wu T, Zhou X, Wang D, Sun Z, Qiu S. Association of a novel electrolyte index, SUSPPUP, based on the measurement of fasting serum and spot urinary sodium and potassium, with prediabetes and diabetes in Chinese population. Clin Chim Acta 2022; 531:426-433. [PMID: 35525267 DOI: 10.1016/j.cca.2022.04.1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND SUSPPUP, calculated as serum sodium [Na+] to urinary Na+ divided by (serum potassium [K+]) 2 to urinary K+, is a composite electrolyte index that reflects renal Na+ retention and K+ excretion. It remains unclear whether SUSPPUP and its components including serum or urinary Na+ or K+, are associated with glucose metabolism. This study aimed to address their associations. METHODS We conducted a cross-sectional study enrolling 5,581 Chinese adults (1,269 with prediabetes, 1,044 with diabetes, and 3,268 with normoglycemia). Fasting serum and morning spot urine were used to measure electrolytes that included Na+ and K+. RESULTS SUSPPUP was higher in prediabetes and diabetes than normoglycemia. The odds of prediabetes and diabetes were increased by 21% and 39% for every 1-standard deviation increment of SUSPPUP after multivariable-adjustment. Multiple linear regression analysis showed that SUSPPUP correlated positively with fasting plasma glucose, 2 h plasma glucose after OGTT, and glycated hemoglobin A1c. Higher spot urinary Na+ was associated with lower odds of prediabetes and diabetes, while spot urinary K+ showed the opposite. CONCLUSION Increases in Na+ retention and K+ excretion in the kidney, as reflected by an elevated SUSPPUP, are associated with increased prevalence of prediabetes and diabetes in Chinese community-dwellers.
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Affiliation(s)
- Miaomiao Sang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Yu Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Tongzhi Wu
- Adelaide Medical School and Centre of Research Excellence (CRE) in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
| | - Xiaoying Zhou
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China.
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Zou M, Chen Y, Zheng Z, Sheng S, Jia Y, Wang X, Ren S, Yang Y, Li X, Dong W, Guan M, Zhang Q, Xue Y. High-Salt Attenuates the Efficacy of Dapagliflozin in Tubular Protection by Impairing Fatty Acid Metabolism in Diabetic Kidney Disease. Front Pharmacol 2022; 12:741087. [PMID: 34987387 PMCID: PMC8720966 DOI: 10.3389/fphar.2021.741087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
High-salt intake leads to kidney damage and even limits the effectiveness of drugs. However, it is unclear whether excessive intake of salt affects renal tubular energy metabolism and the efficacy of dapagliflozin on renal function in diabetic kidney disease (DKD). In this study, we enrolled 350 DKD patients and examined the correlation between sodium level and renal function, and analyzed influencing factors. The results demonstrated that patients with macroalbuminuria have higher 24 h urinary sodium levels. After establishment of type 2 diabetes mellitus model, the animals received a high-salt diet or normal-salt diet. In the presence of high-salt diet, the renal fibrosis was aggravated with fatty acid metabolism dysregulation. Furthermore, Na+/K+-ATPase expression was up-regulated in the renal tubules of diabetic mice, while the fatty acid metabolism was improved by inhibiting Na+/K+-ATPase of renal tubular epithelial cells. Of note, the administration with dapagliflozin improved renal fibrosis and enhanced fatty acid metabolism. But high salt weakened the above-mentioned renal protective effects of dapagliflozin in DKD. Similar results were recapitulated in vitro after incubating proximal tubular epithelial cells in high-glucose and high-salt medium. In conclusion, our results indicate that high salt can lead to fatty acid metabolism disorders by increasing Na+/K+-ATPase expression in the renal tubules of DKD. High salt intake diminishes the reno-protective effect of dapagliflozin in DKD.
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Affiliation(s)
- Meina Zou
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanrong Chen
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zongji Zheng
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuyue Sheng
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yijie Jia
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiangyu Wang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shijing Ren
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanling Yang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomin Li
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenhui Dong
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Meiping Guan
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Zhang
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Itoh N, Tsuya A, Togashi H, Kimura H, Konta T, Nemoto K, Yamashita H, Kayama T. Increased salt intake is associated with diabetes and characteristic dietary habits: a community-based cross-sectional study in Japan. J Clin Biochem Nutr 2022; 71:143-150. [PMID: 36213786 PMCID: PMC9519413 DOI: 10.3164/jcbn.21-153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/29/2022] [Indexed: 11/22/2022] Open
Abstract
We investigated the association of salt intake with lifestyle-related diseases and also the association of habitually consumed foods with salt intake. A cross-sectional study was conducted using data from a baseline survey of 2,129 residents of Yonezawa city (980 males and 1,149 females), Yamagata prefecture. The residents were divided into three groups based on their estimated daily salt intake: low, medium, and high. In both genders, the prevalence of hypertension and diabetes increased in the order of high > medium > low salt intake (trend p<0.001). Similar trends were observed in the prevalence of hyperlipidemia in females and metabolic syndrome in males. The prevalence of diabetes in the high salt intake group was significantly higher than that in the control group (matched from the low and medium salt intake groups), even when confounding factors were excluded by propensity score matching (p<0.01). Network analysis showed that the low salt intake group had a greater tendency to habitually consume various vegetables than the high salt intake group. Our findings reveal that the prevalence of lifestyle-related diseases increased with higher salt intake. We speculate that a dietary shift to multiple vegetable consumption could have salt-lowering effects.
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Affiliation(s)
- Nanami Itoh
- Yamagata University Health Administration Center
| | - Atsushi Tsuya
- Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | | | - Hirohito Kimura
- Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University Faculty of Medicine
| | - Kenji Nemoto
- Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | - Hidetoshi Yamashita
- Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | - Takamasa Kayama
- Institute for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
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20
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Tuomilehto J. How to prevent non-communicable diseases? - A continuous need for a better understanding of the role of nutritional factors through scientific research. Eur J Clin Nutr 2021; 76:1357-1363. [PMID: 34711929 PMCID: PMC9550625 DOI: 10.1038/s41430-021-00997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland. .,Department of Public Health, University of Helsinki, Helsinki, Finland. .,Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia. .,Department of International Health, National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
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21
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Association between Dietary Habits and Type 2 Diabetes Mellitus in Yangon, Myanmar: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111056. [PMID: 34769575 PMCID: PMC8582904 DOI: 10.3390/ijerph182111056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
In Myanmar, the escalating prevalence of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance among adults was recently reported, with the highest prevalence in the Yangon Region. The aim of the present study was to identify the risk factors in dietary habits and their relationship with T2DM in urban Myanmar residents. We conducted a case–control study recruiting 300 individuals aged 25–74 years living in the Yangon Region, consisting of 150 newly diagnosed cases attending a diabetes clinic, and 150 controls, who were community residents and free of diabetes. The case group had a significantly higher consumption of noodles, fish, beans, fermented food and pickles, dried food, topping seasonings, and non-dairy milk products than the control group, whereas they had a lower vegetable intake (more than three servings/day) and fruit intake (more than three servings/day) than the control group. Furthermore, the case group exhibited a higher frequency of some dietary behaviors than the control group, such as (1) having meals with family, (2) skipping breakfast, and (3) eating out. The final model showed that topping seasonings (adjusted odds ratio (aOR) 11.23, 95% confidence interval (CI) 3.08–40.90), more than three servings/day of vegetable intake (aOR 0.18, 95% CI 0.05–0.67), and having meals with family (aOR 2.23, 95% CI 1.05–4.71) were associated with diabetes. The study suggests that Myanmar’s characteristic dietary culture of topping their meals with salty seasonings and sauces and eating multiple dishes together as a family are risk factors associated with T2DM. Our findings may contribute recommendations and opportunities for the primary prevention of T2DM in urban Myanmar.
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22
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Kolahdouz-Mohammadi R, Soltani S, Clayton ZS, Salehi-Abargouei A. Sodium status is associated with type 2 diabetes mellitus: a systematic review and meta-analysis of observational studies. Eur J Nutr 2021; 60:3543-3565. [PMID: 34052916 DOI: 10.1007/s00394-021-02595-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The relationship between sodium intake and the risk of developing type 2 diabetes mellitus (T2DM) is inconsistent. We, therefore, aimed to summarize the current evidence by conducting a systematic review and meta-analysis of observational studies. METHODS We retrieved studies which compared any marker of sodium status between individuals with T2DM and those without diabetes published in any language by searching online databases from inception up to June 2019. Summary effects were derived using random-effects model. RESULTS A total of 44 studies with 503,830 participants from 25 countries were included in this study. Sodium status was significantly different between individuals with and without T2DM (Hedges' g = 0.21; 95% CI 0.02, 0.40; P = 0.029). Individuals with T2DM had higher sodium intake compared to non-diabetic controls (WMD = 621.79 mg/day; 95% CI 321.53, 922.06; P < 0.001) and 24-h urinary excretion was associated with likelihood of developing T2DM (OR = 1.27, 95% CI 1.15, 1.41; P < 0.001). Furthermore, salivary, hair, and platelet sodium were higher in patients with T2DM compared to controls (P < 0.05). CONCLUSION The findings of the current meta-analysis suggest that sodium levels are higher in patients with T2DM compared to non-diabetic controls; however, given that these studies are observational, it is not possible to infer causality.
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Affiliation(s)
- Roya Kolahdouz-Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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23
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Horikawa C, Aida R, Tanaka S, Kamada C, Tanaka S, Yoshimura Y, Kodera R, Fujihara K, Kawasaki R, Moriya T, Yamashita H, Ito H, Sone H, Araki A. Sodium Intake and Incidence of Diabetes Complications in Elderly Patients with Type 2 Diabetes-Analysis of Data from the Japanese Elderly Diabetes Intervention Study (J-EDIT). Nutrients 2021; 13:nu13020689. [PMID: 33670045 PMCID: PMC7926689 DOI: 10.3390/nu13020689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
This study investigates the associations between sodium intake and diabetes complications in a nationwide cohort of elderly Japanese patients with type 2 diabetes aged 65–85. Data from 912 individuals regarding their dietary intake at baseline is analyzed and assessed by the Food Frequency Questionnaire based on food groups. Primary outcomes are times to diabetic retinopathy, overt nephropathy, cardiovascular disease (CVD), and all-cause mortality during six years. We find that mean sodium intake in quartiles ranges from 2.5 g to 5.9 g/day. After adjustment for confounders, no significant associations are observed between sodium intake quartiles and incidence of diabetes complications and mortality, except for a significant trend for an increased risk of diabetic retinopathy (p = 0.039). Among patients whose vegetable intake was less than the average of 268.7 g, hazard ratios (HRs) for diabetic retinopathy in patients in the second, third, and fourth quartiles of sodium intake compared with the first quartile were 0.87 (95% CI, 0.31–2.41), 2.61 (1.00–6.83), and 3.70 (1.37–10.02), respectively. Findings indicate that high sodium intake under conditions of low vegetable intake is associated with an elevated incidence of diabetic retinopathy in elderly patients with type 2 diabetes.
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Affiliation(s)
- Chika Horikawa
- Department of Health and Nutrition, University of Niigata Prefecture Faculty of Human Life Studies, 471 Ebigase, Higashi-ku, Niigata 950-8680, Japan;
| | - Rei Aida
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; (R.A.); (S.T.)
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; (R.A.); (S.T.)
| | - Chiemi Kamada
- Training Department of Administrative Dietitians, Shikoku University, 123-1 Ebisuno, Furukawa, Ojin-cho, Tokushima 771-1151, Japan; (C.K.); (Y.Y.)
| | - Sachiko Tanaka
- Department of Public Health, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Sihga 520-2192, Japan;
| | - Yukio Yoshimura
- Training Department of Administrative Dietitians, Shikoku University, 123-1 Ebisuno, Furukawa, Ojin-cho, Tokushima 771-1151, Japan; (C.K.); (Y.Y.)
| | - Remi Kodera
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan; (R.K.); (H.I.)
- Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuoh-ku, Niigata 951-8510, Japan; (K.F.); (H.S.)
| | - Kazuya Fujihara
- Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuoh-ku, Niigata 951-8510, Japan; (K.F.); (H.S.)
| | - Ryo Kawasaki
- Department of Vision Informatics, Graduate School of Medicine Faculty of Medicine, Osaka University, Osaka, 2-2 Yamadaoka, Suita 565-0871, Japan;
| | - Tatsumi Moriya
- Health Care Center, Kitasato University, 1-15-1, Kitazato, Minami-ku, Sagamihara-shi 252-0373, Japan;
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine, 2-2-2 Iidanishi, Yamagata-shi 990-8560, Japan;
| | - Hideki Ito
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan; (R.K.); (H.I.)
| | - Hirohito Sone
- Department of Hematology, Endocrinology, and Metabolism, Niigata University Faculty of Medicine, 1-757 Asahimachi-dori, Chuoh-ku, Niigata 951-8510, Japan; (K.F.); (H.S.)
| | - Atsushi Araki
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan; (R.K.); (H.I.)
- Correspondence: ; Tel.: +81-03-3964-1141; Fax: +81-03-3964-1982
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24
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Vuori MA, Harald K, Jula A, Valsta L, Laatikainen T, Salomaa V, Tuomilehto J, Jousilahti P, Niiranen TJ. 24-h urinary sodium excretion and the risk of adverse outcomes. Ann Med 2020; 52:488-496. [PMID: 32602794 PMCID: PMC7877963 DOI: 10.1080/07853890.2020.1780469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The objective was to evaluate whether sodium intake, assessed with the gold standard 24-h urinary collections, was related to long-term incidence of death, cardiovascular disease (CVD) and diabetes mellitus (DM). METHODS A cohort of 4630 individuals aged 25-64 years collected 24-h urine samples in 1979-2002 and were followed up to 14 years for the incidence of any CVD, coronary heart disease (CHD), stroke, heart failure (HF) and DM event, and death. Cox proportional hazards models were used to estimate the association between the baseline salt intake and incident events and adjusted for baseline age, body mass index, serum cholesterol, prevalent DM, and stratified by sex and cohort baseline year. RESULTS During the follow-up, we observed 423 deaths, 424 CVD events (288 CHD events, 142 strokes, 139 HF events) and 161 DM events. Compared with the highest quartile of salt intake, persons in the lowest quartile had a lower incidence of CVD (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.51-0.95, p = .02), CHD (HR 0.63 [95% CI 0.42-0.94], p = .02) and DM (HR 0.52 [95% CI 0.31-0.87], p = .01). The results were non-significant for mortality, HF, and stroke. CONCLUSION High sodium intake is associated with an increased incidence of CVD and DM.
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Affiliation(s)
- Matti A Vuori
- Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Kennet Harald
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Antti Jula
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Liisa Valsta
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Veikko Salomaa
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Teemu J Niiranen
- Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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25
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Yuan S, Larsson SC. An atlas on risk factors for type 2 diabetes: a wide-angled Mendelian randomisation study. Diabetologia 2020; 63:2359-2371. [PMID: 32895727 PMCID: PMC7527357 DOI: 10.1007/s00125-020-05253-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 02/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to use Mendelian randomisation (MR) to identify the causal risk factors for type 2 diabetes. METHODS We first conducted a review of meta-analyses and review articles to pinpoint possible risk factors for type 2 diabetes. Around 170 possible risk factors were identified of which 97 risk factors with available genetic instrumental variables were included in MR analyses. To reveal more risk factors that were not included in our MR analyses, we conducted a review of published MR studies of type 2 diabetes. For our MR analyses, we used summary-level data from the DIAbetes Genetics Replication And Meta-analysis consortium (74,124 type 2 diabetes cases and 824,006 controls of European ancestry). Potential causal associations were replicated using the FinnGen consortium (11,006 type 2 diabetes cases and 82,655 controls of European ancestry). The inverse-variance weighted method was used as the main analysis. Multivariable MR analysis was used to assess whether the observed associations with type 2 diabetes were mediated by BMI. We used the Benjamini-Hochberg method that controls false discovery rate for multiple testing. RESULTS We found evidence of causal associations between 34 exposures (19 risk factors and 15 protective factors) and type 2 diabetes. Insomnia was identified as a novel risk factor (OR 1.17 [95% CI 1.11, 1.23]). The other 18 risk factors were depression, systolic BP, smoking initiation, lifetime smoking, coffee (caffeine) consumption, plasma isoleucine, valine and leucine, liver alanine aminotransferase, childhood and adulthood BMI, body fat percentage, visceral fat mass, resting heart rate, and four plasma fatty acids. The 15 exposures associated with a decreased risk of type 2 diabetes were plasma alanine, HDL- and total cholesterol, age at menarche, testosterone levels, sex hormone binding globulin levels (adjusted for BMI), birthweight, adulthood height, lean body mass (for women), four plasma fatty acids, circulating 25-hydroxyvitamin D and education years. Eight associations remained after adjustment for adulthood BMI. We additionally identified 21 suggestive risk factors (p < 0.05), such as alcohol consumption, breakfast skipping, daytime napping, short sleep, urinary sodium, and certain amino acids and inflammatory factors. CONCLUSIONS/INTERPRETATION The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.
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Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden.
- Department of Surgical Sciences, Uppsala University, Dag Hammarskjölds Väg 14B, 75185, Uppsala, Sweden.
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26
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Ongosi AN, Wilunda C, Musumari PM, Techasrivichien T, Wang CW, Ono-Kihara M, Serrem C, Kihara M, Nakayama T. Prevalence and Risk Factors of Elevated Blood Pressure and Elevated Blood Glucose among Residents of Kajiado County, Kenya: A Population-Based Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196957. [PMID: 32977566 PMCID: PMC7579460 DOI: 10.3390/ijerph17196957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/19/2020] [Indexed: 12/15/2022]
Abstract
Kenya is experiencing a rising burden of non-communicable diseases (NCDs), yet data to inform effective interventions are limited. We investigated the prevalence of elevated blood pressure, elevated blood glucose and their determinants in a rapidly urbanizing area in Kenya. Data on socio-demographics, dietary and behavioural risk factors, anthropometric measurements, blood pressure, blood glucose, plasma lipids and urinary biomarkers were collected from 221 men and 372 women (25-64 years). Multivariable logistic regression models assessed correlates of elevated blood pressure (EBP) and elevated blood glucose (EBG). Participants' mean age was 38.0. ± 11.1 years. The prevalence rates of pre-hypertension and hypertension were 49.0% and 31.6% in men and 43.7% and 20.1% in women, respectively, while those of pre-diabetes and diabetes were 8.4% and 8.0% in men and 11.6% and 7.4% in women, respectively. The prevalence of Body Mass Index (BMI) ≥ 25 kg/m2 was higher in women (60.2%) than in men (39.7%). However, both the risk of EBP and EBG were stronger among men than among women. The high prevalence rates of EBP, EBG and overweight/obesity coupled with low physical activity and low fruit and vegetable intake predispose this population to a higher NCD risk. Interventions to mitigate this risk considering the sex differences are urgently required.
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Affiliation(s)
- Anita Nyaboke Ongosi
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-Ku, Kyoto 606-8501, Japan;
- Correspondence: ; Tel.: +81-090-6660-5961
| | - Calistus Wilunda
- African Population and Health Research Centre, Manga Close, Nairobi P.O. Box 10787-00100, Kenya;
| | - Patou Masika Musumari
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida hon-machi, Sakyo-ku, Kyoto 606-8501, Japan; (P.M.M.); (T.T.); (M.O.-K.); (M.K.)
- International Institute of Socio-Epidemiology, Kitagosho-cho, Sakyo-ku, Kyoto 606-8336, Japan
| | - Teeranee Techasrivichien
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida hon-machi, Sakyo-ku, Kyoto 606-8501, Japan; (P.M.M.); (T.T.); (M.O.-K.); (M.K.)
- International Institute of Socio-Epidemiology, Kitagosho-cho, Sakyo-ku, Kyoto 606-8336, Japan
| | - Chia-Wen Wang
- Population Health Research Centre, College of Public Health, National Taiwan University, Taipei 100, Taiwan;
| | - Masako Ono-Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida hon-machi, Sakyo-ku, Kyoto 606-8501, Japan; (P.M.M.); (T.T.); (M.O.-K.); (M.K.)
| | - Charlotte Serrem
- Department of Consumer Science, School of Agriculture and Biotechnology, University of Eldoret, Eldoret P.O. Box 1125-30100, Kenya;
| | - Masahiro Kihara
- Interdisciplinary Unit for Global Health, Centre for the Promotion of Interdisciplinary Education and Research, Kyoto University, Yoshida hon-machi, Sakyo-ku, Kyoto 606-8501, Japan; (P.M.M.); (T.T.); (M.O.-K.); (M.K.)
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-Ku, Kyoto 606-8501, Japan;
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27
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Abdulai T, Runqi T, Mao Z, Oppong TB, Amponsem-Boateng C, Wang Y, Liu X, Zhang H, Wang C. Preference for High Dietary Salt Intake Is Associated With Undiagnosed Type 2 Diabetes: The Henan Rural Cohort. Front Nutr 2020; 7:537049. [PMID: 33117839 PMCID: PMC7557361 DOI: 10.3389/fnut.2020.537049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Diabetes continues to be a serious disease burden globally. Nutrition plays a vital role in human life and health, and both inadequate and over nutrition have been implicated in cause the of disease. Objective: We explored the role of preference for high dietary salt intake and diabetes in a rural population. We also looked at possible mediating factors in the relationship between diabetes and preference for high dietary salt intake. Methods/Participants: Data from the Henan rural cohort in China were analyzed. Using multinomial regression models, the association between diabetes diagnosis type and reported preference for dietary salt was assessed. Adjusted odds ratios (aORs) with confidence interval (CI) at a 95% level are reported. Mediation analyses using structural equation models in Stata were performed. Results: Of the 39,183 participants included in the analyses, 4.07% were previously diagnosed with diabetes, and 5.80% with undiagnosed diabetes. Eighteen percent had a preference for salty meals, the mean age was 55.45 years, and 60% were women. Preference for salty meals was associated with undiagnosed diabetes (aOR = 1.17, 95% CI 1.03, 1.32), but not with previously diagnosed diabetes. Stratified analysis revealed that the association with undiagnosed diabetes was only significant in men (aOR = 1.36, 95% CI 1.13, 1.70) but not in women (aOR = 1.06, 95% CI 0.81, 1.38). BMI and central obesity fully mediated the association. Dietary salt intake was self-reported and therefore presents a limitation. Conclusion: Our study demonstrated that preference for high dietary salt intake is associated with undiagnosed diabetes but not prevalent diabetes.
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Affiliation(s)
- Tanko Abdulai
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
- Department of Community Health and Family Medicine, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana
| | - Tu Runqi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Timothy Bonney Oppong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
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28
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Naser AM, Rahman M, Unicomb L, Doza S, Selim S, Chaity M, Luby SP, Anand S, Staimez L, Clasen TF, Gujral UP, Gribble MO, Narayan KMV. Past Sodium Intake, Contemporary Sodium Intake, and Cardiometabolic Health in Southwest Coastal Bangladesh. J Am Heart Assoc 2020; 9:e014978. [PMID: 32875927 PMCID: PMC7727005 DOI: 10.1161/jaha.119.014978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
Background We compared the relationship of past and contemporary sodium (Na) intake with cardiometabolic biomarkers. Methods and Results A total of 1191 participants' data from a randomized controlled trial in coastal Bangladesh were analyzed. Participants provided 24-hour urine Na (24UNa) data for 5 monthly visits. Their fasting blood glucose, total cholesterol, triglycerides, high-density lipoprotein, blood pressure, and 24-hour urine protein were measured at the fifth visit. Participants' mean 24UNa over the first 4 visits was the past Na, and 24UNa of the fifth visit was the contemporary Na intake. We estimated the prevalence ratios of elevated cardiometabolic biomarkers and metabolic syndrome across 24UNa tertiles by multilevel logistic regression using participant-, household-, and community-level random intercepts. Models were adjusted for age, sex, body mass index, smoking, physical activity, alcohol consumption, sleep hours, religion, and household wealth. Compared with participants in tertile 1 of past urine Na, those in tertile 3 had 1.46 (95% CI, 1.08-1.99) times higher prevalence of prediabetes or diabetes mellitus, 5.49 (95% CI, 2.73-11.01) times higher prevalence of large waist circumference, and 1.60 (95% CI, 1.04-2.46) times higher prevalence of metabolic syndrome. Compared with participants in tertile 1 of contemporary urine Na, those in tertile 3 had 1.93 (95% CI, 1.24-3.00) times higher prevalence of prediabetes or diabetes mellitus, 3.14 (95% CI, 1.45-6.83) times higher prevalence of proteinuria, and 2.23 (95% CI, 1.34-3.71) times higher prevalence of large waist circumference. Conclusions Both past and contemporary Na intakes were associated with higher cardiometabolic disease risk.
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Affiliation(s)
- Abu Mohd Naser
- Emory Global Diabetes Research CenterHubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease ResearchBangladesh (icddr,b)DhakaBangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease ResearchBangladesh (icddr,b)DhakaBangladesh
| | - Solaiman Doza
- International Centre for Diarrhoeal Disease ResearchBangladesh (icddr,b)DhakaBangladesh
| | - Shahjada Selim
- Department of EndocrinologyBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | | | - Stephen P. Luby
- Division of Infectious Diseases and Geographic MedicineStanford UniversityStanfordCA
| | - Shuchi Anand
- Division of NephrologySchool of MedicineStanford UniversityStanfordCA
| | - Lisa Staimez
- Emory Global Diabetes Research CenterHubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
| | - Thomas F. Clasen
- Gangarosa Department of Environmental Health SciencesRollins School of Public HealthEmory UniversityAtlantaGA
| | - Unjali P. Gujral
- Emory Global Diabetes Research CenterHubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
| | - Matthew O. Gribble
- Gangarosa Department of Environmental Health SciencesRollins School of Public HealthEmory UniversityAtlantaGA
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - K. M. Venkat Narayan
- Emory Global Diabetes Research CenterHubert Department of Global HealthRollins School of Public HealthEmory UniversityAtlantaGA
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Xhakaza L, Abrahams-October Z, Mohammednur MM, Pearce B, Adeniyi OV, Johnson R, Benjeddou M. Socio-demographic and modifiable risk factors of diabetes and hypertension among resource constrained patients from rural areas in Mdantsane Township in South Africa. Afr Health Sci 2020; 20:1344-1354. [PMID: 33402984 PMCID: PMC7751544 DOI: 10.4314/ahs.v20i3.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Recently, developing countries have shown a dramatic increase in non-communicable diseases (NCDs). The burden of NCDs in South Africa has increased over the past years resulting in an estimated 37% of all- cause mortality and 16% of disability-adjusted life years. Currently, diabetes mellitus (DM) and hypertension (HTN) are the two most prevalent NCDs associated with the rapid increase in mortality. OBJECTIVE To demonstrate the socio-demographic and modifiable risk factors of diabetes mellitus (DM) and hypertension (HTN) among South African adults. METHODS A cross-sectional analytical study was conducted in the Cecilia Makiwane Hospital serving the residents of Mdantsane. Relevant socio-demographic data, anthropometric measurements, triplicate blood pressure, fasting blood glucose and lipogram analysis were obtained from 265 outpatients. RESULTS Multivariate anlysis shows that; salt intake, smoking, elevated triglycerides and decreased high-density lipoprotein levels were significantly associated with DM with adjusted odds ratio of 0.18 (p=0.002), 0.26 (p=0.048), 2.19 (p=0.006) and 0.38 (p=0.001), respectively. Overweight and obesity were significantly associated with hypertension with odds ratio of 0.03 (p=0.01) and 0.06 (p=0.006), respectively. CONCLUSION The burden of DM and HTN on society can be drastically reduced with simple lifestyle changes, development of preventative strategies, large-scale screening and better disease management in South Africa.
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Affiliation(s)
- Lettilia Xhakaza
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Zainonesa Abrahams-October
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Mohammedmekin Mohammedseid Mohammednur
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Brendon Pearce
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | | | - Rabia Johnson
- South African Medical Research Council, Parow, Cape Town, South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa.
| | - Mongi Benjeddou
- Precision Medicine Unit, Department of Biotechnology, Faculty of Natural Sciences, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
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Van Laecke S, Veys N, Verbeke F, Vanholder R, Van Biesen W. The Fate of Older Diabetic Patients on Peritoneal Dialysis: Myths and Mysteries and Suggestions for Further Research. Perit Dial Int 2020. [DOI: 10.1177/089686080702700602] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The outcome of older and especially of female diabetic patients appears to be worse on peritoneal dialysis (PD) than on hemodialysis (HD). This opinion is based mostly on data coming from the USA, whereas data from other regions seem to give a more balanced picture. The questions arise whether indeed outcome is worse in this patient group, and what might be the underlying reasons for this; further research to unravel this phenomenon is warranted. This review proposes several suggestions for further exploration. The observed differences in outcome might be attributable to differences in treatment practices and experience with PD versus HD. As cardiovascular mortality is a major killer in end-stage renal disease patients, differences in fluid homeostasis and how it is achieved are potential explanations. Fluid balance is potentially more difficult to obtain in PD patients, especially as in the past it was spuriously suggested that fluid restriction was less important in PD patients. PD and HD might also have different impacts on factors related to inflammation, insulin resistance, and hormone balance. The adipocytokine network is of special interest in this respect. It is also possible that bias introduced by the way we measure body composition might have a more negative impact on PD than on HD patients. Finally, it still is not fully established that if diabetic patients are treated appropriately, their outcome on PD is worse than that on HD; further observational trials in this respect are needed. All these topics require further clarification and investigation.
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Affiliation(s)
- Steven Van Laecke
- Renal Division, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Nic Veys
- Renal Division, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Francis Verbeke
- Renal Division, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Internal Medicine, University Hospital Ghent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, University Hospital Ghent, Belgium
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Bansal V, Mishra SK. Reduced-sodium cheeses: Implications of reducing sodium chloride on cheese quality and safety. Compr Rev Food Sci Food Saf 2020; 19:733-758. [PMID: 33325171 DOI: 10.1111/1541-4337.12524] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/21/2019] [Accepted: 11/21/2019] [Indexed: 02/06/2023]
Abstract
Sodium chloride (NaCl) universally well-known as table salt is an ancient food additive, which is broadly used to increase the storage stability and the palatability of foods. Though, in recent decades, use of table salt in foods is a major concern among the health agencies of the world owing to ill effects of sodium (Na) that are mostly linked to hypertension and cardiovascular diseases. As a result, food scientists are working to decrease the sodium content in food either by decreasing the rate of NaCl addition or by partial or full replacement of NaCl with other suitable salts like potassium chloride (KCl), calcium chloride (CaCl2 ), or magnesium chloride (MgCl2 ). However, in cheese, salt reduction is difficult to accomplish owing to its multifaceted role in cheese making. Considering the significant contribution in dietary salt intake (DSI) from cheese, researchers across the globe are exploring various technical interventions to develop reduced-sodium cheeses (RSCs) without jeopardizing the quality and safety of cheeses. Thus, the purpose of this study is to provide an insight of NaCl reduction on sensory, physicochemical, and technofunctional attributes of RSCs with an aim to explore various strategies for salt reduction without affecting the cheese quality and safety. The relationship between salt reduction and survival of pathogenic and spoilage-causing microorganisms and growth of RSCs microflora is also discussed. Based on the understanding of conceptual and applied information on the complex changes that occur in the development of RSCs, the quality and safety of RSCs can be accomplished effectively in order to reduce the DSI from cheese.
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Affiliation(s)
- Venus Bansal
- Department of Dairy Technology, College of Dairy Science & Technology, Guru Angad Dev Veterinary & Animal Sciences University, Ludhiana, India
| | - Santosh Kumar Mishra
- Department of Dairy Microbiology, College of Dairy Science & Technology, Guru Angad Dev Veterinary & Animal Sciences University, Ludhiana, India
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Hao G, Liu K, Halbert JD, Chen H, Wu J, Jing C. Dietary sodium and potassium and risk of diabetes: A prospective study using data from the China Health and Nutrition Survey. DIABETES & METABOLISM 2019; 46:377-383. [PMID: 31838058 DOI: 10.1016/j.diabet.2019.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/24/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Abstract
AIMS Dietary sodium and potassium intakes are well-known risk factors for cardiovascular outcomes. However, the associations between dietary sodium and potassium and diabetes are still controversial. Our study aimed to examine whether dietary sodium, potassium and the sodium-potassium ratio are associated with the risk of diabetes, based on a large sample of Chinese adults. METHODS The study data were from the 2004-2009 China Health and Nutrition Survey (CHNS), and 5867 participants were eligible for analysis. Sodium and potassium intakes were estimated based on three consecutive 24-h recalls at an individual level combined with a food inventory at a household level performed over the same 3-day period. Diabetes was defined as fasting glucose ≥7.0mmol/L (≥126mg/dL), HbA1c ≥6.5% or use of antidiabetic drugs. RESULTS Over a mean follow-up of 4.7 years, there were 611 (10.4%) incident cases of diabetes. Participants in the higher quartiles (Q3 and Q4) of sodium intake had significantly higher risks of diabetes than those with the lowest sodium intake [Q3, RR: 1.41, 95% CI: 1.06-1.86 and Q4, RR: 1.35, 95% CI: 1.02-1.80; P<0.001 for trend]. In addition, high sodium intakes were significantly associated with levels of fasting glucose and HbA1c (P<0.05 for trend), with similar associations also found with sodium-potassium ratios (P<0.05 for trend), but not for potassium intakes. CONCLUSION This study found that higher sodium intakes and sodium-potassium ratios were significantly associated with a higher risk of diabetes. Further clinical research is now necessary to confirm these results.
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Affiliation(s)
- G Hao
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China.
| | - K Liu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - J D Halbert
- Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - H Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - J Wu
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - C Jing
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China.
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Lee HA, Son N, Lee WK, Park H. A Diabetes-Related Dietary Pattern Is Associated with Incident Diabetes in Obese Men in the Korean Genome Epidemiology Study. J Nutr 2019; 149:323-329. [PMID: 30590687 DOI: 10.1093/jn/nxy274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/25/2018] [Accepted: 10/06/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diet plays an important role in both the development and management of diabetes. OBJECTIVE Using data from the Korean Genome Epidemiology Study, we assessed dietary patterns associated with the clinical indicators of diabetes. METHODS This study included 7255 subjects aged 40-69 y. Individuals with chronic diseases were excluded. The daily intakes of specific food items were assessed using a dish-based semiquantitative food-frequency questionnaire comprising 103 items; the food items were then grouped into 26 food groups. Dietary patterns were analyzed by the reduced rank regression method using glycated hemoglobin, the homeostasis model of insulin resistance, and fasting glucose concentrations as dependent variables. We investigated the associations between dietary patterns and incident diabetes using the Cox proportional hazards model. RESULTS During an 11.5-y follow-up, the incidence of diabetes was 11.8/1000 person-years. The dietary pattern related to selected biomarkers of diabetes was characterized by a relatively high intake of kimchi, beef, other meat, fish, and coffee in men and a high intake of rice, kimchi, and fruit in women. In men, the association of dietary patterns with incident diabetes was significant only in the obese group, and those in the top quartile of the dietary pattern score had a 1.72 times (95% CI: 1.15, 2.56 times) greater risk of incident diabetes than those in the bottom quartile. Conversely, dietary patterns in women were not associated with incident diabetes. CONCLUSION Using reduced rank regression, we identified dietary patterns related to selected biomarkers of diabetes in a long-term study with follow-up data in Korea.
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Affiliation(s)
| | - NaYeong Son
- Departments of Statistics and.,Office of Pharmacoepidemiology, Korea Institute of Drug Safety and Risk Management, Anyang-si, Korea
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hyesook Park
- Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Seah JYH, Koh WP, Yuan JM, van Dam RM. Rice intake and risk of type 2 diabetes: the Singapore Chinese Health Study. Eur J Nutr 2018; 58:3349-3360. [DOI: 10.1007/s00394-018-1879-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/06/2018] [Indexed: 12/31/2022]
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A positive association between dietary sodium intake and obesity and central obesity: results from the National Health and Nutrition Examination Survey 1999-2006. Nutr Res 2018; 55:33-44. [DOI: 10.1016/j.nutres.2018.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/24/2022]
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Kang SH, Cho KH, Do JY. Association Between the Modified Dietary Approaches to Stop Hypertension and Metabolic Syndrome in Postmenopausal Women Without Diabetes. Metab Syndr Relat Disord 2018; 16:282-289. [PMID: 29902116 DOI: 10.1089/met.2018.0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the association between the dietary approaches to stop hypertension (DASH) and metabolic syndrome in postmenopausal Korean women without diabetes. METHODS Our study enrolled postmenopaual women without diabetes (n = 6826). We used the DASH-Korean quartile (KQ) model using six nutrients. For protein, fiber, calcium, and potassium, we scored 1 for the first quartile (1Q), 2 for the second quartile (2Q), 3 for the third quartile (3Q), and 4 for the fourth quartile (4Q). For fat and sodium, we scored 4 for the 1Q, 3 for the 2Q, 2 for the 3Q, and 1 for the 4Q. We defined the sum of the six scores as the DASH-KQ score. Participants were divided into four quartiles (DASH-1Q, DASH-2Q, DASH-3Q, and DASH-4Q), according to the sum of the six DASH-KQ scores. RESULTS The number of participants with metabolic syndrome in DASH-1Q, DASH-2Q, DASH-3Q, or DASH-4Q was 601 (37.4%), 671 (31.1%), 440 (30.5%), and 492 (30.3%), respectively. The proportion of participants with metabolic syndrome was greatest in DASH-1Q (P < 0.001). Multivariate logistic regression analyses showed that every increase in the DASH-KQ score by 1 exhibited a 0.977-fold odds for metabolic syndrome. DASH-1Q, by DASH-KQ score, had higher odds for metabolic syndrome than the other groups. CONCLUSIONS The lowest quartile of the DASH-KQ score was associated with a higher prevalence of metabolic syndrome in postmenopausal Korean women without diabetes.
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Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital , Daegu, Republic of Korea
| | - Kyu Hyang Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital , Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital , Daegu, Republic of Korea
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Jensen T, Abdelmalek MF, Sullivan S, Nadeau KJ, Green M, Roncal C, Nakagawa T, Kuwabara M, Sato Y, Kang DH, Tolan DR, Sanchez-Lozada LG, Rosen HR, Lanaspa MA, Diehl AM, Johnson RJ. Fructose and sugar: A major mediator of non-alcoholic fatty liver disease. J Hepatol 2018; 68:1063-1075. [PMID: 29408694 PMCID: PMC5893377 DOI: 10.1016/j.jhep.2018.01.019] [Citation(s) in RCA: 614] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome; its rising prevalence parallels the rise in obesity and diabetes. Historically thought to result from overnutrition and a sedentary lifestyle, recent evidence suggests that diets high in sugar (from sucrose and/or high-fructose corn syrup [HFCS]) not only increase the risk of NAFLD, but also non-alcoholic steatohepatitis (NASH). Herein, we review the experimental and clinical evidence that fructose precipitates fat accumulation in the liver, due to both increased lipogenesis and impaired fat oxidation. Recent evidence suggests that the predisposition to fatty liver is linked to the metabolism of fructose by fructokinase C, which results in ATP consumption, nucleotide turnover and uric acid generation that mediate fat accumulation. Alterations to gut permeability, the microbiome, and associated endotoxemia contribute to the risk of NAFLD and NASH. Early clinical studies suggest that reducing sugary beverages and total fructose intake, especially from added sugars, may have a significant benefit on reducing hepatic fat accumulation. We suggest larger, more definitive trials to determine if lowering sugar/HFCS intake, and/or blocking uric acid generation, may help reduce NAFLD and its downstream complications of cirrhosis and chronic liver disease.
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Affiliation(s)
- Thomas Jensen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | | | - Shelby Sullivan
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kristen J Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Melanie Green
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carlos Roncal
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Takahiko Nakagawa
- Division of Future Basic Medicine, Nara Medical University, Nara, Japan
| | - Masanari Kuwabara
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Yuka Sato
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Duk-Hee Kang
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Dean R Tolan
- Dept of Biology, Boston University, Boston, MA, United States
| | | | - Hugo R Rosen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Miguel A Lanaspa
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Richard J Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Moreira P, Sousa AS, Guerra RS, Santos A, Borges N, Afonso C, Amaral TF, Padrão P. Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study. Food Nutr Res 2018; 62:1288. [PMID: 29545733 PMCID: PMC5846206 DOI: 10.29219/fnr.v62.1288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/18/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status. METHODS A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day, inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio was defined as >1, according to the World Health Organization cutoffs. RESULTS The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the younger elderly, married, and with higher income. CONCLUSION The majority of the Portuguese elderly population was classified as having inadequate sodium, potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing sodium and increasing potassium intake are priorities in the Portuguese elderly population.
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Affiliation(s)
- Pedro Moreira
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Centro de Atividade Física, Saúde e Lazer, Universidade do Porto, Porto, Portugal
| | - Ana S. Sousa
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- Escola Superior de Saúde, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Rita S. Guerra
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Alejandro Santos
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- I3S-Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Nuno Borges
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- CINTESIS–Centre for Health Technology and Services Research, Porto, Portugal
| | - Cláudia Afonso
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Teresa F. Amaral
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- UISPA-IDMEC, Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Soltani S, Kolahdouz Mohammadi R, Shab-Bidar S, Vafa M, Salehi-Abargouei A. Sodium status and the metabolic syndrome: A systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr 2017; 59:196-206. [DOI: 10.1080/10408398.2017.1363710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sepideh Soltani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemaat Highway, Tehran, Iran
| | - Roya Kolahdouz Mohammadi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemaat Highway, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Vafa
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemaat Highway, Tehran, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Peng Y, Zhong GC, Mi Q, Li K, Wang A, Li L, Liu H, Yang G. Potassium measurements and risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies. Oncotarget 2017; 8:100603-100613. [PMID: 29246005 PMCID: PMC5725047 DOI: 10.18632/oncotarget.21823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/23/2017] [Indexed: 01/15/2023] Open
Abstract
Objective To clarify the relationship between serum, dietary, and urinary potassium and the risk of type 2 diabetes mellitus (T2DM). Materials and Methods We searched PubMed and EMBASE through January 6, 2017 for studies reporting risk estimates on the association of potassium measurements and the risk of T2DM. The summary risk estimates were obtained through a random-effects model. Dose-response analysis was conducted. Results Eight studies involving 5,053 cases and 119,993 individuals were included. A trend toward significance was found in the highest versus lowest meta-analysis on serum potassium and T2DM risk (RR = 0.79; 95% CI 0.60-1.04); moreover, the RR per 1 mmol/L increase in serum potassium was 0.83 (95% CI 0.73-0.95). A non-significant association of dietary potassium and T2DM risk was detected (RR for the highest versus lowest category: 0.93; 95% CI 0.81-1.06; RR for every 1000mg increase per day: 1.00, 95% CI 0.96-1.05). A similar non-significant association was found for urinary potassium and T2DM risk (RR for the highest versus lowest category: 0.83; 95% CI 0.39-1.75; RR per 10 mmol increase: 1.00; 95% CI 0.95-1.05). Evidence of a linear association between serum, dietary, and urinary potassium and the risk of T2DM was found (all Pnon-linearity > 0.05). Conclusions Low serum potassium increases the risk of T2DM in a linear dose-response manner; nevertheless, neither dietary potassium nor urinary potassium shows any association with the risk of T2DM. However, these findings should be interpreted with caution due to limited studies.
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Affiliation(s)
- Yang Peng
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing, China
| | - Guo-Chao Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qiao Mi
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing, China
| | - Kejia Li
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing, China
| | - Ao Wang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing, China
| | - Ling Li
- Key Laboratory of Diagnostic Medicine (Ministry of Education) and Department of Clinical Biochemistry, College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Hua Liu
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University and Chongqing Clinical Research Center for Geriatrics, Chongqing, China
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Strohm D, Ellinger S, Leschik-Bonnet E, Maretzke F, Heseker H. Revised Reference Values for Potassium Intake. ANNALS OF NUTRITION & METABOLISM 2017; 71:118-124. [PMID: 28803230 PMCID: PMC5639605 DOI: 10.1159/000479705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The nutrition societies of Germany, Austria and Switzerland have revised the reference values for potassium intake in January 2017. METHODS For adults, the estimated value was based on the 24-h urinary potassium excretion and on preventive considerations regarding hypertension and stroke. The estimated values for children and adolescents were extrapolated from the adult estimated value considering differences in body mass. For infants aged 0 to under 4 months, the estimated value was set based on the potassium intake via breast milk. From this reference value, the estimated value for infants aged 4 to under 12 months was also derived by extrapolation. The estimated value for lactating women takes into account the potassium loss via breast milk. RESULTS The estimated values for potassium intake are set at 400 mg/day for breastfed infants aged 0 to under 4 months, 600 mg/day for infants aged 4 to under 12 months, 1,100-4,000 mg/day for children and adolescents, 4,000 mg/day for adults and pregnant women and 4,400 mg/day for lactating women. CONCLUSIONS The consumption of potassium-rich foods should be generally increased. Supplemental intake beyond the estimated values has no health benefit and is therefore not recommended.
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Affiliation(s)
| | - Sabine Ellinger
- Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Moenchengladbach, Germany
| | | | | | - Helmut Heseker
- Department of Sports and Health, University of Paderborn, Paderborn, Germany
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Lopes M, Cavaleiro C, Ramos F. Sodium Reduction in Bread: A Role for Glasswort (Salicornia ramosissimaJ. Woods). Compr Rev Food Sci Food Saf 2017; 16:1056-1071. [DOI: 10.1111/1541-4337.12277] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/25/2017] [Accepted: 05/27/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Maria Lopes
- Pharmacy Faculty; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
| | - Carlos Cavaleiro
- Pharmacy Faculty, CNC - Center for Neuroscience and Cell Biology; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
| | - Fernando Ramos
- Pharmacy Faculty, CNC - Center for Neuroscience and Cell Biology; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
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Association between 24-h urinary sodium excretion and obesity in Korean adults: A multicenter study. Nutrition 2017; 41:113-119. [PMID: 28760420 DOI: 10.1016/j.nut.2017.04.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/04/2017] [Accepted: 04/11/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to explore the association between sodium intake, as assessed by 24-h urinary sodium excretion, and various obesity parameters among South Korean adults. The associations of 24-h urinary sodium excretion and sodium intake calculated from the dietary questionnaire with obesity parameters also were compared. METHODS This multicenter, cross-sectional study analyzed data of 640 healthy adults from eight provinces in South Korea. Obesity was assessed by body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Mean 24-h urinary sodium excretion was calculated from repeatedly collected 24-h urine samples. Participants' dietary intake was assessed by 24-h dietary recall interview on the days before 24-h urine collection. RESULTS In both sexes, the means of all anthropometric measurements tended to increase proportionally with 24-h urinary sodium excretion quartiles, regardless of adjustment. Men in the highest quartile (Q4) of 24-h urinary sodium excretion had increased odds of obesity (as assessed by BMI, WC, WHR, and WHtR) compared with men in the three lower quartiles (Q1-Q3) of 24-h urinary sodium excretion. Women in Q4 of 24-h urinary sodium excretion exhibited a higher chance of general obesity and abdominal obesity. Sodium intake calculated from the dietary questionnaire was not significantly associated with obesity in either sex. CONCLUSIONS In Korean adults, there was a positive association between higher sodium intake as assessed by 24-h urinary sodium excretion and obesity independent of energy intake.
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de Mestral C, Mayén AL, Petrovic D, Marques-Vidal P, Bochud M, Stringhini S. Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis. Am J Public Health 2017; 107:e1-e12. [PMID: 28207328 DOI: 10.2105/ajph.2016.303629] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. OBJECTIVES To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. SEARCH METHODS We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. SELECTION CRITERIA We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. DATA COLLECTION AND ANALYSIS As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group - value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. MAIN RESULTS Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = -18, -9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. CONCLUSIONS People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization's target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.
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Affiliation(s)
- Carlos de Mestral
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Ana-Lucia Mayén
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Dusan Petrovic
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Pedro Marques-Vidal
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Murielle Bochud
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
| | - Silvia Stringhini
- Carlos de Mestral, Ana-Lucia Mayén, Dusan Petrovic, Murielle Bochud, and Silvia Stringhini are with the Division of Chronic Diseases, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. Pedro Marques-Vidal is with the Department of Internal Medicine, Lausanne University Hospital
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Radzeviciene L, Ostrauskas R. Adding Salt to Meals as a Risk Factor of Type 2 Diabetes Mellitus: A Case-Control Study. Nutrients 2017; 9:E67. [PMID: 28098780 PMCID: PMC5295111 DOI: 10.3390/nu9010067] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/23/2016] [Accepted: 01/10/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) is thought to arise from the complex interplay between genetic and environmental factors. It is important to identify modifiable risk factors that may help to reduce the risk of diabetes. Data on salt intake and the risk of type 2 diabetes are limited. The aim of this study was to assess the relationship between adding salt to prepared meals and the risk of type 2 diabetes. METHODS In a case-control study, we included 234 cases, all of whom were patients aged 35-86 years with a newly confirmed diagnosis of T2DM, and 468 controls that were free of the disease. Cases and controls (ratio 1:2) were matched by gender and age (±5 years). A questionnaire was used to collect information on possible risk factors for diabetes. Adding salt to prepared meals was assessed according to: Never, when there was not enough, or almost every time without tasting. The odds ratios (OR), and 95% confidence intervals (CI) for type 2 diabetes was calculated using a conditional logistic regression. RESULTS The cases had a higher body mass index and a significantly lower education level compared to the controls. Variables such as waist circumference, body mass index, eating speed, smoking, family history of diabetes, arterial hypertension, plasma triglycerides, educational level, occupational status, morning exercise, marital status, daily urine sodium excretion, and daily energy intake were retained in the models as confounders. After adjusting for possible confounders, an approximately two-fold increased risk of type 2 diabetes was determined in subjects who add salt to prepared meals when "it is not enough" or "almost every time without tasting" (1.82; 95% CI 1.19-2.78; p = 0.006) compared with never adding salt. CONCLUSION Presented data suggest the possible relationship between additional adding of salt to prepared meals and an increased risk of type 2 diabetes.
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Affiliation(s)
- Lina Radzeviciene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50009 Kaunas, Lithuania.
| | - Rytas Ostrauskas
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, 50009 Kaunas, Lithuania.
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Kim S, Lee B, Park M, Oh S, Chin HJ, Koo H. Prevalence of chronic disease and its controlled status according to income level. Medicine (Baltimore) 2016; 95:e5286. [PMID: 27858900 PMCID: PMC5591148 DOI: 10.1097/md.0000000000005286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The relationship between the prevalence of chronic diseases and income level has now become a main theme in poor national economic situations. We examined the prevalence of well-controlled chronic diseases according to income level. Data from the 2008 to 2014 Korea National Health and Nutrition Examination Survey, conducted by using a stratified, multistage, probability-cluster sampling method, were used. Systolic blood pressure (SBP) inversely correlated with income level (P < 0.001). Diastolic blood pressure (DBP) showed no relationship. In the low-income group, the prevalence rates of hypertension and diabetes mellitus (DM) were highest but the proportion of patients with well-controlled chronic disease and the SBPs of the patients with hypertension showed a decreasing trend. In the high-income group, the proportions of patients with well-controlled DM and chronic kidney disease were higher than those in other groups. After adjusting for age, body mass index, SBP, DBP, HbA1c level, and serum creatinine level, income level significantly affected the prevalence of chronic diseases (for income, β=0.184; 95% confidence interval, 1.105-1.042). The daily sodium intake estimated by using spot urine samples was higher in the low- and low-to-mid-income groups. The prevalence of not using essential medical service for chronic disease was highest in the low- and low-to-mid-income groups for economic reasons. In the low- and low-to-mid-income groups, the prevalence of chronic disease was higher and the proportion of patients with well-controlled chronic disease was lower than in the other groups.
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Affiliation(s)
| | | | - Mingu Park
- Department of Urology, Inje University Seoul Paik Hospital
| | - Sewon Oh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Jung-gu, Seoul
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Kyeonggi-do, Republic of Korea
| | - Hoseok Koo
- Department of Internal Medicine
- Correspondence: Hoseok Koo, Division of Nephrology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, 85 Jeo-dong 2-ga, Jung-gu, Seoul, Republic of Korea (e-mail: )
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Turck D, Bresson JL, Burlingame B, Dean T, Fairweather-Tait S, Heinonen M, Hirsch-Ernst KI, Mangelsdorf I, McArdle H, Neuhäuser-Berthold M, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Aggett P, Martin A, Przyrembel H, Brönstrup A, Ciok J, Gómez Ruiz JÁ, de Sesmaisons-Lecarré A, Naska A. Dietary reference values for potassium. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4592] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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48
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Dietary sodium and potassium intake in relation to non-alcoholic fatty liver disease. Br J Nutr 2016; 116:1447-1456. [PMID: 27725000 DOI: 10.1017/s0007114516003391] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A few epidemiological data are available assessing the associations of intakes of sodium (Na) and potassium (K) with non-alcoholic fatty liver disease (NAFLD). We aimed to examine the associations of dietary intake of Na and K with the prevalence of ultrasound-diagnosed NAFLD. We performed a cross-sectional study of 100 177 participants (46 596 men and 53 581 women) who underwent a health screening examination and completed a FFQ at the Kangbuk Samsung Hospital Total Healthcare Centers, South Korea, between 2011 and 2013. NAFLD was defined by ultrasonographic detection of fatty liver in the absence of excessive alcohol intake or other known causes of liver disease. The proportion of NAFLD was 35·6 % for men and 9·8 % for women. Increasing prevalence of NAFLD was observed with increasing Na intake. The multivariable-adjusted prevalence ratios (PR) of NAFLD comparing the highest with the lowest quintile of energy-adjusted Na intake were 1·25 (95 % CI 1·18, 1·32; P trend<0·001) in men and 1·32 (95 % CI 1·18, 1·47; P trend <0·001) in women. However, when we additionally adjusted for body fat percentage, the association became attenuated; the corresponding PR of NAFLD were 1·15 (95 % CI 1·09, 1·21) in men and 1·06 (95 % CI 0·95, 1·17) in women. No inverse association was observed for energy-adjusted K intake. Our findings suggest that higher Na intake is associated with a greater prevalence of NAFLD in young and middle-aged asymptomatic adults, which might be partly mediated by adiposity.
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Moosavian SP, Haghighatdoost F, Surkan PJ, Azadbakht L. Salt and obesity: a systematic review and meta-analysis of observational studies. Int J Food Sci Nutr 2016; 68:265-277. [DOI: 10.1080/09637486.2016.1239700] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Seyedeh Parisa Moosavian
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pamela J. Surkan
- Department of International Health, John Hopkins School of Public Health, Baltimore, MD USA
| | - Leila Azadbakht
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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50
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Affiliation(s)
- Mi Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
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