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Huang Y, Ao Y, Wan X, Liu X, Yao J, Ye H, Wang A, Zhuang P, Jiao J, Zhang Y. Assessing the Hypertension Risk: A Deep Dive into Cereal Consumption and Cooking Methods-Insights from China. Nutrients 2024; 16:3027. [PMID: 39275342 PMCID: PMC11397540 DOI: 10.3390/nu16173027] [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: 07/17/2024] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 09/16/2024] Open
Abstract
BACKGROUND Cereal grains are rich in carbohydrates and could trigger a hyperglycemic response which is closely linked to blood pressure status. We aim to examine the associations between the consumption of cereals with different cooking methods and hypertension risk. METHODS We conducted a prospective analysis utilizing the nationwide data of 11,080 adult participants who were free of hypertension at baseline. Cereal intake was assessed using 3-day 24 h dietary recalls with a weighing technique. Hypertension incidence was identified in adherence with the Seventh Joint National Commission guidelines during the follow-up. Cox proportional hazards regression models were used to extrapolate hazard ratios associated with hypertension risk. RESULTS Over an average follow-up span of 7 years (77,560 person-years), we identified 3643 new hypertension cases. The intake of total, fried, and baked cereals was associated with 15%, 20%, and 20% higher risk of hypertension, respectively. Whole grain consumers had an 8% lower risk of hypertension compared with non-consumers, while total refined grain consumers showed no significant association. Replacing one daily serving of fried or baked cereals with an equivalent serving of boiled cereals was related to a 28% or 14% lower risk, respectively. CONCLUSIONS Total, fried, and baked cereal consumption was positively associated with hypertension risk, while consuming whole grains was related to a lower risk. Modifying cooking methods from frying or baking to boiling for cereals may be beneficial to lower risk. The current study underscores the significance of considering both the degree of processing and cooking methods applied to cereals in addressing hypertension prevention and management.
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Affiliation(s)
- Yingyu Huang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Yang Ao
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Xuzhi Wan
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Xiaohui Liu
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jianxin Yao
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Hao Ye
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Anli Wang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
| | - Pan Zhuang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jingjing Jiao
- Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Nutrition, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Food Science and Nutrition, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou 310058, China
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Ferrari GT, Proserpio C, Stragliotto LK, Boff JM, Pagliarini E, Oliveira VRD. Salt reduction in bakery products: A critical review on the worldwide scenario, its impacts and different strategies. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hadian Z, Feizollahi E, Khosravi K, Mofid V, Rasekhi H. Salt Intake from Traditional Breads: A Public Health Challenge for Decreasing Non-communicable Diseases in Iran. CURRENT NUTRITION & FOOD SCIENCE 2020. [DOI: 10.2174/1573401316666200309150947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
In recent decades, a decrease of sodium chloride (NaCl) salt in diets such as
breads has raised public attention for control of non-communicable diseases (NCDs) in developed
and developing countries. Bread is an important food in public diets in Iran as well as many other
countries.
Aim:
The aim of this study was to assess salt (NaCl) content of the Iranian traditional breads and to
estimate daily salt intake through consumption of these foodstuffs. The study was carried out in five
major cities of Iran in 2016.
Methods:
In total, 237 traditional bread samples (including Sangak, Taftoon, Lavash and Barbari)
were collected and the sample NaCl content was assessed using published methods by the International
Organization for Standardization (ISO) and Association of Official Analytical Chemists
(AOAC). Values were compared to Iranian standard limit values.
Results:
Salt content of the traditional breads ranged from 0.03 g to 2.99 g per 100 g of dry weight
(D.W.). Overall, 49.2% of the traditional bread samples in Tehran and 47.2% of the traditional bread
samples in other cities exceeded the standard limit. Since 93.8% of Sangak breads from Tehran met
the salt limit criteria of national standards, this traditional bread includes a more favorable nutritional
status compared to that other breads do.
Conclusion:
Awareness of salt level in breads and monitoring salt use in bakeries can help update
food policies and improve public lifestyle. A decrease in the ratio of salt is recommended as the major
nutritional intervention for the prevention and control of NCDs.
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Affiliation(s)
- Zahra Hadian
- Department of Food Science and Technology, National Nutrition Science and Food Science Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Feizollahi
- Department of Food Science and Technology, National Nutrition Science and Food Science Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kianoosh Khosravi
- Department of Food Science and Technology, National Nutrition Science and Food Science Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Mofid
- Department of Food Science and Technology, National Nutrition Science and Food Science Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rasekhi
- Department of Food Science and Technology, National Nutrition Science and Food Science Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Erdem Y, Akpolat T, Derici Ü, Şengül Ş, Ertürk Ş, Ulusoy Ş, Altun B, Arıcı M. Dietary Sources of High Sodium Intake in Turkey: SALTURK II. Nutrients 2017; 9:nu9090933. [PMID: 28837102 PMCID: PMC5622693 DOI: 10.3390/nu9090933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 01/28/2023] Open
Abstract
Previous research has shown daily salt intakes in Turkey to be far above the recommended limits. Knowing the sources of dietary salt could form a basis for preventive strategies aimed towards salt reduction. This study aimed to investigate dietary sources of salt in Turkey. A sub-group (n = 657) was selected from the PatenT2 study population, which represented the urban and rural areas of 4 major cities (Ankara, Istanbul, Izmir, and Konya). A questionnaire inquiring about sociodemographic characteristics, medical histories, detailed histories of diet, and salt consumption was completed. Participants were asked to collect a 24-h urine sample and to record their food intake (dietary recall) on the same day. Of 925 participants selected, 657 (71%) provided accurate 24-h urine collections, based on creatinine excretion data. The mean daily 24-h urinary sodium excretion was 252.0 ± 92.2 mmol/day, equal to daily salt intake of 14.8 ± 5.4 g. Of the 657 participants with accurate 24-h urine collections, 464 (70%) provided fully completed dietary recalls. Among these 464 participants, there was a significant difference between the 24-h urinary sodium excretion-based salt intake estimation (14.5 ± 5.1 g/day) and the dietary recall-based salt intake estimation (12.0 ± 7.0 g/day) (p < 0.001). On the other hand, a positive correlation was obtained between the dietary recall-based daily salt intake and 24-h urinary sodium excretion-based daily salt intake (r = 0.277, p < 0.001). Bread was the main source of salt (34%) followed by salt added during cooking and preparing food before serving (30%), salt from various processed foods (21%), and salt added at the table during food consumption (11%). Conclusively, this study confirmed a very high salt intake of the adult population in four major cities in Turkey. The present findings support the emerging salt reduction strategy in Turkey by promoting lower salt content in baked bread, and less salt use in habitual food preparation and during food consumption in the home.
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Affiliation(s)
- Yunus Erdem
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
| | - Tekin Akpolat
- Department of Internal Medicine, Division of Nephrology, Istinye University Liv Hospital, Istanbul 34510, Turkey.
| | - Ülver Derici
- Department of Internal Medicine, Division of Nephrology, Gazi University Faculty of Medicine, Ankara 06560, Turkey.
| | - Şule Şengül
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine, Ankara 06100, Turkey.
| | - Şehsuvar Ertürk
- Department of Internal Medicine, Division of Nephrology, Ankara University Faculty of Medicine, Ankara 06100, Turkey.
| | - Şükrü Ulusoy
- Department of Internal Medicine, Karadeniz Teknik University Faculty of Medicine, Trabzon 61080, Turkey.
| | - Bülent Altun
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
| | - Mustafa Arıcı
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
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Abstract
Objectives: The study aimed to assess the current epidemiology of hypertension, including its prevalence, the awareness of the condition and its treatment and control, in Turkey to evaluate changes in these factors over the last 10 years by comparing the results with the prevalence, awareness, treatment, and control of hypertension in Turkey (PatenT) study data (2003), as well as to assess parameters affecting awareness and the control of hypertension. Methods: The PatenT 2 study was conducted on a representative sample of the Turkish adult population (n = 5437) in 2012. Specifically trained staff performed the data collection. Hypertension was defined as mean SBP or DBP at least 140/90 mmHg, previously diagnosed disease or the use of antihypertensive medication. Awareness and treatment were assessed by self-reporting, and control was defined as SBP/DBP less than 140/90 mmHg. Results: Although the prevalence of hypertension in the PatenT and PatenT 2 surveys was stable at approximately 30%, hypertension awareness, treatment, and control rates have improved in Turkey. Overall, 54.7% of hypertensive patients were aware of their diagnosis in 2012 compared with 40.7% in 2003. The hypertension treatment rate increased from 31.1% in 2003 to 47.4% in 2012, and the control rate in hypertensives increased from 8.1% in 2003 to 28.7% in 2012. The rate of hypertension control in treated patients improved between 2003 (20.7%) and 2012 (53.9%). Awareness of hypertension was positively associated with older age, being a woman, residing in an urban area, a history of parental hypertension, being a nonsmoker, admittance by a physician, presence of diabetes mellitus, and being obese or overweight; it was inversely associated with a higher amount of daily bread consumption. Factors associated with better control of hypertension were younger age, female sex, residing in an urban area, and higher education level in Turkey. Conclusion: Although some progress has been made in recognizing hypertension from 2003 to 2012, there is still a large population of untreated or inadequately treated hypertensives in Turkey. Strengthening of population-based efforts to improve the prevention, early detection, and treatment of hypertension is needed.
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Sengul S, Erdem Y, Batuman V, Erturk S. Hypertension and chronic kidney disease in Turkey. Kidney Int Suppl (2011) 2013; 3:308-311. [PMID: 25019009 PMCID: PMC4089601 DOI: 10.1038/kisup.2013.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Worldwide, both hypertension and chronic kidney disease are major public health problems, due to their epidemic proportions and their association with high cardiovascular mortality. In 2003, the first Prevalence, awareness, treatment, and control of hypertension in Turkey (the PatenT) study was conducted in a nationally representative population (n=4910) by the Turkish Society of Hypertension and Renal Diseases, and showed that overall age- and sex-adjusted prevalence of hypertension in Turkey was 31.8%. The PatenT study also reported that overall awareness (40.7%), treatment (31.1%), and control rates (8.1%) of hypertension were strikingly low. Only 20.7% of the patients who were aware of their hypertension and receiving treatment had their blood pressure controlled to <140/90 mm Hg. In the Chronic Renal Disease in Turkey (CREDIT) study (n=10,748), the overall prevalence of chronic kidney (including all stages) disease was 15.7% and increased with advancing age. In the same population, the prevalence of hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome were reported as 32.7%, 12.7%, 76.3%, 20.1%, and 31.3%, respectively. The prevalence and awareness of hypertension in CREDIT population was 32.7% and 48.6%, respectively. According to the data obtained from national surveys, the prevalence of hypertension and chronic kidney disease in Turkey is alarmingly high. To improve prevention, early diagnosis, and treatment of these major public health problems, appropriate health strategies should be implemented by the government, together with medical societies, non-governmental organizations, industry, health-care providers, and academia.
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Affiliation(s)
- Sule Sengul
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Yunus Erdem
- Department of Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vecihi Batuman
- Division of Nephrology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Sehsuvar Erturk
- Department of Nephrology, Ankara University School of Medicine, Ankara, Turkey
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Affiliation(s)
- Joan Quilez
- Human Nutrition Unit, School of Medicine, IISSPV, Universitat Rovira i Virgili, Reus, Spain, and CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
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Abstract
Data from different national and regional surveys show that hypertension is common in developing countries, particularly in urban areas, and that rates of awareness, treatment, and control are low. Several hypertension risk factors seem to be more common in developing countries than in developed regions. Findings from serial surveys show an increasing prevalence of hypertension in developing countries, possibly caused by urbanisation, ageing of population, changes to dietary habits, and social stress. High illiteracy rates, poor access to health facilities, bad dietary habits, poverty, and high costs of drugs contribute to poor blood pressure control. The health system in many developing countries is inadequate because of low funds, poor infrastructure, and inexperience. Priority is given to acute disorders, child and maternal health care, and control of communicable diseases. Governments, together with medical societies and non-governmental organisations, should support and promote preventive programmes aiming to increase public awareness, educate physicians, and reduce salt intake. Regulations for the food industry and the production and availability of generic drugs should be reinforced.
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Erdem Y, Arici M, Altun B, Turgan C, Sindel S, Erbay B, Derici U, Karatan O, Hasanoglu E, Caglar S. The relationship between hypertension and salt intake in Turkish population: SALTURK study. Blood Press 2011; 19:313-8. [PMID: 20698734 DOI: 10.3109/08037051003802541] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This population-based epidemiological study was aimed to evaluate the daily salt intake and its relation to blood pressure in a representative group of Turkish population. The enrolled normotensive and hypertensive individuals (n = 1970) completed a questionnaire including demographics, dietary habits, hypertension awareness and drug usage. Blood pressure was measured and to estimate salt consumption, 24-h urine samples were collected. The daily urinary sodium excretion was 308.3 ± 143.1 mmol/day, equal to a salt intake of 18.01 g/day. Salt intake was higher in obese participants, rural residents, participants with lower education levels and elderly. A positive linear correlation between salt intake and systolic and diastolic blood pressures was demonstrated (r = 0.450, p = 0.020; r = 0.406, p = 0.041; respectively), and each 100 mmol/day of salt intake resulted in 5.8 and 3.8 mmHg increase in systolic and diastolic blood pressures, respectively. Salt intake and systolic blood pressure was significantly correlated in normal weight individuals (r = 0.257, p < 0.01). The Turkish population consumes a great amount of salt; salt intake and blood pressure was positively correlated. Efforts in sodium restriction are therefore crucial in the management of hypertension as part of national and global health policies.
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Mittal BV, Singh AK. Hypertension in the developing world: challenges and opportunities. Am J Kidney Dis 2009; 55:590-8. [PMID: 19962803 DOI: 10.1053/j.ajkd.2009.06.044] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/29/2009] [Indexed: 11/11/2022]
Abstract
Hypertension is a major public health problem and a leading cause of death and disability in developing countries. One-quarter of the world's adult population has hypertension, and this is likely to increase to 29% by 2025. Modeled projections indicate an increase to 1.15 billion hypertensive patients by 2025 in developing countries. There is variability in the global prevalence of hypertension: hypertension is present in approximately 35% of the Latin American population, 20%-30% of the Chinese and Indian population, and approximately 14% in Sub-Saharan African countries. This heterogeneity has been attributed to several factors, including urbanization with its associated changes in lifestyle, racial ethnic differences, nutritional status, and birth weight. Compounding this high burden of hypertension is a lack of awareness and insufficient treatment in those with hypertension. The public health response to this challenge should drive greater promotion of awareness efforts, studies of risk factors for hypertension, and understanding of the impact of lifestyle changes. Also important are efforts to develop multipronged strategies for hypertension management in developing nations.
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Affiliation(s)
- Bharati V Mittal
- Renal Division, Brigham & Women's Hospital and Harvard Medical School Dubai Center Institute of Postgraduate Education and Research, Dubai, UAE
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