A Low-Sodium DASH Dietary Pattern Affects Serum Markers of Inflammation and Mineral Metabolism in Adults with Elevated Blood Pressure

Association of dietary inflammatory index on all-cause and cardiovascular mortality in U.S. adults with metabolic dysfunction associated steatotic liver disease

Backgrounds

An inflammatory diet is pivotal in metabolic dysfunction-associated steatotic liver disease (MASLD) development. However, it remains unclear whether Dietary Inflammatory Index (DII), which serves as a reliable indicator to assess pro-inflammatory diet, have associative effects on mortality outcomes of MASLD.

Methods

Participants in the National Health and Nutrition Examination Survey (NHANES) database from 1999 to 2018 years were included. Kaplan-Meier (KM) curves were used to estimate survival probabilities, while Cox regression analysis and restricted cubic splines (RCS) were employed to assess the association between DII and mortality outcomes. The concordance index (C-index) evaluated the accuracy of multivariate-adjusted DII for mortality among MASLD participants.

Results

The cohort consisted of 4,510 men and 4,323 women with a median age of 52 years. Multivariate-adjusted Cox regression analysis revealed that high levels of DII were significantly associated with the all-cause mortality of participants with MASLD (multivariable-adjusted hazard ratio (aHR) = 1.28, 95% confidence interval (CI) 1.10-1.49, p = 0.002, DII aHR for cardiovascular mortality = 1.28, 95% CI 1.07-1.53, p = 0.006). The C-index for the multivariate model, integrating DII and other clinical variables, was 0.837 for all-cause mortality and 0.860 for cardiovascular mortality. RCS analysis showed a positive linear relationship between DII and all-cause mortality rate (p for nonlinearity = 0.057), with no significant nonlinearity for cardiovascular mortality (p = 0.953). Subgroup analyses indicated stronger associations in participants <65 years, married, with a college education, non-smokers, non-drinkers, and those without hypertension.

Conclusion

Elevated DII levels are linked to higher mortality in adults with MASLD, underscoring the index's utility in predicting mortality risks. These findings shows that dietary interventions targeted inflammation may be helpful in this population.

The association between urinary sodium and the risk of dementia: Evidence from a population-based cohort study

BACKGROUND

Sodium intake reduction is crucial for cardiovascular health, however, its lasting impact on dementia remains unclear.

METHODS

We included 458,577 UK Biobank participants without dementia at baseline. We estimated 24-h urinary sodium (E24hUNa) using spot urinary parameters and obtained the incidence of all-cause dementia, Alzheimer's disease, and vascular dementia from multiple sources.

RESULTS

The mean E24hUNa was 3.0 g (1st-99th percentile: 1.5 g-5.1 g). Over a mean follow-up of 13.6 years, 7886 (1.7 %) participants developed all-cause dementia, including 3763 (0.8 %) Alzheimer's disease and 1851 (0.4 %) vascular dementia. In the restricted cubic spline model, we identify a potential cutoff of 3.13 g for E24hUNa, below which each 1 g decrease in E24hUNa was associated with 21 % (95 % confidence interval [CI] 1.11-1.34) higher all-cause dementia risk and 35 % (95 % CI 1.11-1.63) higher vascular dementia risk (P-value <0.001 for non-linearity). The hazard ratios were 1.15 (95 % CI, 1.07-1.24) for all-cause dementia and 1.21 (95 % CI 1.04-1.40) for vascular dementia among individuals with E24hUNa below 3.13 g compared to those with E24hUNa higher than 3.13 g.

LIMITATIONS

One of the major limitations is the estimation of 24-h urinary sodium with spot urine samples.

CONCLUSIONS

An E24hUNa level below 3.13 g, equivalent to 3.37 g daily sodium intake, is associated with increased risks of all-cause and vascular dementia. This exploratory study suggests a potential lower limit below which the risk of dementia increases with a lower sodium level. Future studies are necessary to validate our findings.

C-reactive protein, pharmacological treatments and diet: how to target your inflammatory burden

PURPOSE OF REVIEW

This article focuses on pharmacological agents as well as dietary changes aimed at the reduction of the inflammatory burden measured by circulating C-reactive protein concentrations.

RECENT FINDINGS

Over the last years, repurposed as well as new anti-inflammatory agents have been investigated in outcome trials in the cardiovascular field. Currently, a specific inhibition of the inflammatory cascade via the interleukin-6 ligand antibody ziltivekimab is being explored in large-scale outcome trials, after the efficacy of this agent with regard to the reduction of inflammatory biomarkers was proven recently. Next to the investigated pharmacological agents, specific dietary patterns possess the ability to improve the inflammatory burden. This enables patients themselves to unlock a potential health benefit ahead of the initiation of a specific medication targeting the inflammatory pathway.

SUMMARY

Both pharmacological agents as well as diet provide the opportunity to improve the inflammatory profile and thereby lower C-reactive protein concentrations. Whilst advances in the field of specific anti-inflammatory treatments have been made over the last years, their broad implementation is currently limited. Therefore, optimization of diet (and other lifestyle factors) could provide a cost effective and side-effect free intervention to target low-grade vascular inflammation.

Sex and race differences in urinary Tumor Necrosis Factor-α (TNF-α) levels: Secondary analysis of the DASH-sodium trial

Previous work in mouse models shows that urinary TNF-α levels become elevated when dietary salt (NaCl) intake increases. To examine if this relationship exists in humans, we conducted a secondary analysis of the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial to determine levels of urinary TNF-α in 367 subjects categorized by race, sex, and blood pressure. The DASH-Sodium trial is a multicenter feeding trial in which subjects were randomly assigned to either the DASH or control diet, and high, medium, and low sodium in random order. Multivariable linear regression was used to model baseline TNF-α and a mixed model was used to model TNF-α as a function of dietary intervention. At baseline, with all subjects on a "typical American diet", urinary TNF-α levels were lowest in Black, p = 0.002 and male subjects, p < 0.001. After randomization to either the DASH or control diet, with increasing levels of sodium, urinary TNF-α levels increased only in subjects on the control diet, p < 0.05. As in the baseline analysis, TNF-α levels were highest in White females, then White males, Black females and lowest in Black males. The results indicate that urinary TNF-α levels in DASH-Sodium subjects are regulated by NaCl intake, modulated by the DASH diet, and influenced by both race and sex. The inherent differences between subgroups support studies in mice showing that increases in renal TNF-α minimize the extent salt-dependent activation of NKCC2.