1
|
Greenwood H, Barnes K, Clark J, Ball L, Albarqouni L. Long-Term Effect of Salt Substitution for Cardiovascular Outcomes : A Systematic Review and Meta-analysis. Ann Intern Med 2024; 177:643-655. [PMID: 38588546 DOI: 10.7326/m23-2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Salt substitution is a simple yet increasingly promising strategy to improve cardiovascular outcomes. PURPOSE To evaluate the long-term effects of salt substitution on cardiovascular outcomes. DATA SOURCES PubMed, EMBASE, Cochrane CENTRAL, and CINAHL searched from inception to 23 August 2023. Trial registries, citation analysis, and hand-search were also done. STUDY SELECTION Randomized controlled trials (RCTs) comparing provision of or advice to use a salt substitute with no intervention or use of regular salt among adults for 6 months or longer in total study duration. DATA EXTRACTION Two authors independently screened articles, extracted data, and assessed risk of bias. Primary outcomes include mortality, major cardiovascular events (MACE), and adverse events at 6 months or greater. Secondary and post hoc outcomes include blood pressure, cause-specific mortality, and urinary excretion at 6 months or greater. Random-effects meta-analyses were done and certainty of effect estimates were assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). DATA SYNTHESIS Of the 16 included RCTs, 8 reported on primary outcomes. Most (n = 7 of 8) were done in China or Taiwan, 3 were done in residential facilities, and 7 included populations of older age (average 62 years) and/or with higher-than-average cardiovascular risk. In this population, salt substitute may reduce risk for all-cause mortality (6 RCTs; 27 710 participants; rate ratio [RR], 0.88 [95% CI, 0.82 to 0.93]; low certainty) and cardiovascular mortality (4 RCTs; 25 050 participants; RR, 0.83 [CI, 0.73 to 0.95]; low certainty). Salt substitute may result in a slight reduction in MACE (3 RCTs; 23 215 participants; RR, 0.85 [CI, 0.71 to 1.00]; very low certainty), with very low-certainty evidence of serious adverse events (6 RCTs; 27 995 participants; risk ratio, 1.04 [CI, 0.87 to 1.25]). LIMITATIONS The evidence base is dominated by a single, large RCT. Most RCTs were from China or Taiwan and involved participants with higher-than-average cardiovascular risk; therefore, generalizability to other populations is very limited. CONCLUSION Salt substitution may reduce all-cause or cardiovascular mortality, but the evidence for reducing cardiovascular events and for not increasing serious adverse events is uncertain, particularly for a Western population. The certainty of evidence is higher among populations at higher cardiovascular risk and/or following a Chinese diet. PRIMARY FUNDING SOURCE National Health and Medical Research Council. (PROSPERO: CRD42022327566).
Collapse
Affiliation(s)
- Hannah Greenwood
- Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia (H.G., L.A.)
| | - Katelyn Barnes
- Menzies Health Institute Queensland, Griffith University, Brisbane, and Academic Unit of General Practice, ACT Health Directorate and Australian National University Medical School, Canberra, Australian Capital Territory, Australia (K.B.)
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia. (J.C.)
| | - Lauren Ball
- Centre for Community Health and Wellbeing, The University of Queensland, Brisbane, Australia (L.B.)
| | - Loai Albarqouni
- Institute for Evidence-Based Healthcare, Bond University, Queensland, Australia (H.G., L.A.)
| |
Collapse
|
2
|
Earle WB, Ormseth G, Morales-Alvarez MC, Kaushik M, Juraschek SP. Dietary Sodium Reduction Is Best for Reducing Blood Pressure: Controversies in Hypertension. Hypertension 2024; 81:510-515. [PMID: 37641925 PMCID: PMC11067439 DOI: 10.1161/hypertensionaha.123.20544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The global burden of cardiovascular disease (CVD) continues to grow, as does the incidence of hypertension, one of the most important modifiable risk factors of CVD. Non-pharmacologic, population level interventions are critically needed to halt the hypertension pandemic, but there is an ongoing debate as to whether public policy efforts should focus more on dietary sodium reduction or increasing potassium. In this commentary, we summarize arguments in favor of policy geared towards reduced sodium intake. Recognizing increasing dietary sodium as one of the drivers of the hypertension pandemic is critical to developing public policy to reduce population level sodium exposure and blood pressure. We draw from a robust field of evidence to show that reducing sodium intake improves blood pressure in a linear fashion, across the lifespan, at an individual level and a population level, and may even reduce CVD events. While potassium plays an important role in blood pressure regulation, potassium interventions are less effective at reducing blood pressure, carry risk of hyperkalemia in select populations, and are more logistically challenging. There is an urgent need for nation-wide policies to reduce sodium intake to help stem the hypertension pandemic and prevent CVD.
Collapse
Affiliation(s)
- William B Earle
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - George Ormseth
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | | | - Milan Kaushik
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Zhang X, Zhang T, Li S, Zhao R, Li S, Wang C. Mixed whey and pea protein based cold-set emulsion gels induced by calcium chloride: Fabrication and characterization. Int J Biol Macromol 2023; 253:126641. [PMID: 37657583 DOI: 10.1016/j.ijbiomac.2023.126641] [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: 06/12/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
The cold-set gels of oil-in-water emulsions stabilized by mixtures of whey protein isolate (WPI) and pea protein isolate (PPI) with mass ratios of 10:0, 7:3, 5:5, 3:7, and 0:10 were investigated to evaluate the possibility of pea protein to replace milk protein. Particle size and surface charge of emulsions increased and decreased with raised PPI content, respectively. The redness and yellowness of emulsion gels were strengthened with elevated pea protein percentage and independent of calcium concentration applied. Considerable differences in water holding capacity were observed between samples with different mixed proteins and high percentage of pea protein gave better water retaining ability. Gradual decreases in hardness and chewiness of emulsion gels were observed at three calcium levels with the increased PPI proportion. FT-IR spectra indicated no new covalent bonds were generated between samples with different whey and pea protein mass ratios. As PPI concentration elevated, the network structure of emulsion gels gradually became loose and disordered. The established cold-set calcium-induced whey/pea protein composite gels may have the potential to be utilized as a new material to encapsulate and deliver environment sensitive bio-active substances.
Collapse
Affiliation(s)
- Xiaoge Zhang
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China
| | - Tiehua Zhang
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China
| | - Siyao Li
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China
| | - Ru Zhao
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China
| | - Shuyi Li
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China
| | - Cuina Wang
- Department of Food Science, College of Food Science and Engineering, Jilin University, Changchun, Jilin 130062, China.
| |
Collapse
|
4
|
Yuan Y, Jin A, Neal B, Feng X, Qiao Q, Wang H, Zhang R, Li J, Duan P, Cao L, Zhang H, Hu S, Li H, Gao P, Xie G, Yuan J, Cheng L, Wang S, Zhang H, Niu W, Fang H, Zhao M, Gao R, Chen J, Elliott P, Labarthe D, Wu Y. Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial. Nat Med 2023; 29:973-981. [PMID: 37055566 DOI: 10.1038/s41591-023-02286-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 03/02/2023] [Indexed: 04/15/2023]
Abstract
There is a paucity of high-quality evidence on the effectiveness and safety of salt reduction strategies, particularly for older people, who have the most to benefit but are at higher risk of adverse effects. Here, we conducted a clinical trial in which 48 residential elderly care facilities in China (1,612 participants including 1,230 men and 382 women, 55 years or older) were cluster-randomized using a 2 × 2 factorial design to provision of salt substitute (62.5% NaCl and 25% KCl) versus usual salt and to a progressively restricted versus usual supply of salt or salt substitute for 2 years. Salt substitute compared with usual salt lowered systolic blood pressure (-7.1 mmHg, 95% confidence interval (CI) -10.5 to -3.8), meeting the primary outcome of the trial, whereas restricted supply compared with usual supply of salt or salt substitute had no effect on systolic blood pressure. Salt substitute also lowered diastolic blood pressure (-1.9 mmHg, 95% CI -3.6 to -0.2) and resulted in fewer cardiovascular events (hazard ratio (HR) 0.60, 95% CI 0.38-0.96), but had no effect on total mortality (HR 0.84, 95% CI 0.63-1.13). From a safety standpoint, salt substitute increased mean serum potassium and led to more frequent biochemical hyperkalemia, but was not associated with adverse clinical outcomes. In contrast, salt restriction had no effect on any study outcome. The results of this trial indicate that use of salt substitute, but not efforts to restrict salt supply, may achieve blood pressure lowering and deliver health benefits to residents of elderly care facilities in China. Clinicaltrials.gov registration: NCT03290716.
Collapse
Affiliation(s)
- Yifang Yuan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China
| | - Aoming Jin
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, UK
| | | | - Qianku Qiao
- Yangcheng Ophthalmic Hospital, Shanxi, China
| | - Hongxia Wang
- Department of Nutrition and Food Safety, Hohhot Center for Disease Control and Prevention, Inner Mongolia, China
| | - Ruijuan Zhang
- Department of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Jiayu Li
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China
| | | | - La'e Cao
- Yangcheng Ophthalmic Hospital, Shanxi, China
| | - Hui Zhang
- Department of Nutrition and Food Safety, Hohhot Center for Disease Control and Prevention, Inner Mongolia, China
| | - Senke Hu
- Department of Public Health, Xi'an Jiaotong University, Shaanxi, China
| | - Huijuan Li
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China
| | - Gaoqiang Xie
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China
| | | | - Lili Cheng
- Yangcheng Ophthalmic Hospital, Shanxi, China
| | - Sujuan Wang
- Department of Nutrition and Food Safety, Hohhot Center for Disease Control and Prevention, Inner Mongolia, China
| | - Haijun Zhang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Wenyi Niu
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Fuwai Hospital, Peking Union Medical College, Beijing, China
| | - Junshi Chen
- China National Food Safety Risk Assessment Center, Beijing, China
| | - Paul Elliott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- UK Dementia Research Institute at Imperial College London, London, UK
- British Heart Foundation Centre for Research Excellence, Imperial College London, London, UK
| | - Darwin Labarthe
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yangfeng Wu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China.
- Peking University Clinical Research Center, Peking University First Hospital, Beijing, China.
| |
Collapse
|
5
|
Lee J, Sohn C, Kim OY, Lee YM, Yoon MO, Lee M. The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis. Nutr Res Pract 2023; 17:175-191. [PMID: 37009133 PMCID: PMC10042719 DOI: 10.4162/nrp.2023.17.2.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. SUBJECTS/METHODS A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. RESULTS This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m2; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I2 = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m2; 95% CI, 1.13-1.55; P < 0.001; I2 = 95%) and dietary methods (mean difference = 0.85 kg/m2; 95% CI, 0.1-1.51; P < 0.05; I2 = 95%). CONCLUSIONS Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.
Collapse
Affiliation(s)
- Jounghee Lee
- Department of Food and Nutrition, Kunsan National University, Gunsan 54150, Korea
| | - Cheongmin Sohn
- Department of Food and Nutrition, Wonkwang University, Iksan 54538, Korea
| | - Oh-Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea
| | - Young-Min Lee
- Department of Practical Science Education, Gyeongin National University of Education, Incheon 21044, Korea
| | - Mi Ock Yoon
- Nutrition Information Center, Korean Nutrition Society, Seoul 04376, Korea
| | - Myoungsook Lee
- Department of Food and Nutrition, School of Bio-Health Convergence, Health & Wellness College, Sungshin Women’s University, Seoul 01133, Korea
| |
Collapse
|
6
|
Yin X, Rodgers A, Perkovic A, Huang L, Li KC, Yu J, Wu Y, Wu JHY, Marklund M, Huffman MD, Miranda JJ, Di Tanna GL, Labarthe D, Elliott P, Tian M, Neal B. Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Heart 2022; 108:1608-1615. [PMID: 35945000 DOI: 10.1136/heartjnl-2022-321332] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/06/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results. METHODS We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups. RESULTS There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was -4.61 mm Hg (95% CI -6.07 to -3.14) and of diastolic blood pressure (DBP) was -1.61 mm Hg (95% CI -2.42 to -0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity >0.05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a -1.53 mm Hg (95% CI -3.02 to -0.03, p=0.045) greater reduction in SBP and a -0.95 mm Hg (95% CI -1.78 to -0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94). CONCLUSIONS The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide. TRIAL REGISTRATION NUMBER CRD42020161077.
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Adam Perkovic
- School of Health Science, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Ka-Chun Li
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - J H Y Wu
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA
| | - J Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Darwin Labarthe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Paul Elliott
- School of Public Health, Imperial College of Science Technology and Medicine, London, UK
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia .,School of Public Health, Harbin Medical University, Harbin, China
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia.,School of Public Health, Imperial College of Science Technology and Medicine, London, UK
| |
Collapse
|
7
|
Tsai Y, Tsao Y, Huang C, Tai Y, Su Y, Chiang C, Sung S, Chen C, Cheng H. Effectiveness of salt substitute on cardiovascular outcomes: A systematic review and meta‐analysis. J Clin Hypertens (Greenwich) 2022; 24:1147-1160. [DOI: 10.1111/jch.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/14/2022] [Accepted: 07/30/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Yi‐Ching Tsai
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Yen‐Po Tsao
- Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Chi‐Jung Huang
- Center for Evidence‐Based Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Yen‐Hsuan Tai
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Yang‐Chin Su
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
| | - Chern‐En Chiang
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- General Clinical Research Center Taipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Hsien Sung
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Division of Cardiology Department of Internal Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Chen‐Huan Chen
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| | - Hao‐Min Cheng
- Department of Medical Education Taipei Veterans General Hospital Taipei Taiwan
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Center for Evidence‐Based Medicine Taipei Veterans General Hospital Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center National Yang Ming Chiao Tung University School of Medicine Taipei Taiwan
| |
Collapse
|
8
|
Chanmuang S, Kim BM, Gu SY, Son YJ, Le HG, Nam YD, Song EJ, Ham KS, Kim HJ. Effects of sea salt intake on metabolites, steroid hormones, and gut microbiota in rats. PLoS One 2022; 17:e0269014. [PMID: 35960707 PMCID: PMC9374251 DOI: 10.1371/journal.pone.0269014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
High salt intake is positively linked to many health problems, but the effect of mineral-rich sea salt (SS) has rarely been studied. To better understand the physiological effects of SS intake, the changes in general characteristics, metabolites, steroid hormones, and gut microbiota of SS-fed rats were investigated. Male rats were fed either a normal diet (ND, control) or ND containing 1% SS or 4% SS for 5 weeks. SS intake decreased fat, spleen, liver, and body weight, and increased blood urea nitrogen (BUN), water intake, and gut salt content. Accumulated gut salt content led to a decrease in beneficial bacteria, such as Lachnospiraceae and Lactobacillus, but an increase in potentially harmful bacteria, resulting in a change in lipid metabolites associated with gut health. Interestingly, most renal lysophosphatidylcholines (LPCs) associated with many renal functions were dramatically decreased and female hormones, such as estrogens, were significantly more altered than the male hormones by high SS intake. Although further investigation is needed, these data suggest that high SS intake could be positively linked to kidney dysfunction and gut health problems, and salt-related physiological changes may be sex-specific. Additionally, these data will be useful to better under-stand the physiological effects of SS intake.
Collapse
Affiliation(s)
- Saoraya Chanmuang
- Department of Food Science and Technology, and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
| | - Bo-Min Kim
- Department of Food Science and Technology, and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
| | - Su-Yeon Gu
- Department of Food Science and Technology, and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
- Division of Applied Life Science (BK21 four), Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
| | - Ye-Jin Son
- Department of Food Science and Technology, and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
- Division of Applied Life Science (BK21 four), Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
| | - Huong-Giang Le
- Division of Applied Life Science (BK21 four), Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
| | - Young-Do Nam
- Research Group of Healthcare, Korea Food Research Institute, Jeollabuk, Republic of Korea
| | - Eun-Ji Song
- Research Group of Healthcare, Korea Food Research Institute, Jeollabuk, Republic of Korea
| | - Kyung-Sik Ham
- Department of Food Engineering, Mokpo National University, Muan, Jeonnam, Republic of Korea
| | - Hyun-Jin Kim
- Department of Food Science and Technology, and Institute of Agriculture and Life Science, Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
- Division of Applied Life Science (BK21 four), Gyeongsang National University, Jinju, Gyeongsang, Republic of Korea
- * E-mail:
| |
Collapse
|
9
|
Brand A, Visser ME, Schoonees A, Naude CE. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Cochrane Database Syst Rev 2022; 8:CD015207. [PMID: 35944931 PMCID: PMC9363242 DOI: 10.1002/14651858.cd015207] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium contribute to elevated blood pressure. The WHO recommends decreasing mean population sodium intake through effective and safe strategies to reduce hypertension and its associated disease burden. Incorporating low-sodium salt substitutes (LSSS) into population strategies has increasingly been recognised as a possible sodium reduction strategy, particularly in populations where a substantial proportion of overall sodium intake comes from discretionary salt. The LSSS contain lower concentrations of sodium through its displacement with potassium predominantly, or other minerals. Potassium-containing LSSS can potentially simultaneously decrease sodium intake and increase potassium intake. Benefits of LSSS include their potential blood pressure-lowering effect and relatively low cost. However, there are concerns about potential adverse effects of LSSS, such as hyperkalaemia, particularly in people at risk, for example, those with chronic kidney disease (CKD) or taking medications that impair potassium excretion. OBJECTIVES To assess the effects and safety of replacing salt with LSSS to reduce sodium intake on cardiovascular health in adults, pregnant women and children. SEARCH METHODS We searched MEDLINE (PubMed), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 18 August 2021, and screened reference lists of included trials and relevant systematic reviews. No language or publication restrictions were applied. SELECTION CRITERIA We included randomised controlled trials (RCTs) and prospective analytical cohort studies in participants of any age in the general population, from any setting in any country. This included participants with non-communicable diseases and those taking medications that impair potassium excretion. Studies had to compare any type and method of implementation of LSSS with the use of regular salt, or no active intervention, at an individual, household or community level, for any duration. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles to determine eligibility; and extracted data, assessed risk of bias (RoB) using the Cochrane RoB tool, and assessed the certainty of the evidence using GRADE. We stratified analyses by adults, children (≤ 18 years) and pregnant women. Primary effectiveness outcomes were change in diastolic and systolic blood pressure (DBP and SBP), hypertension and blood pressure control; cardiovascular events and cardiovascular mortality were additionally assessed as primary effectiveness outcomes in adults. Primary safety outcomes were change in blood potassium, hyperkalaemia and hypokalaemia. MAIN RESULTS We included 26 RCTs, 16 randomising individual participants and 10 randomising clusters (families, households or villages). A total of 34,961 adult participants and 92 children were randomised to either LSSS or regular salt, with the smallest trial including 10 and the largest including 20,995 participants. No studies in pregnant women were identified. Studies included only participants with hypertension (11/26), normal blood pressure (1/26), pre-hypertension (1/26), or participants with and without hypertension (11/26). This was unknown in the remaining studies. The largest study included only participants with an elevated risk of stroke at baseline. Seven studies included adult participants possibly at risk of hyperkalaemia. All 26 trials specifically excluded participants in whom an increased potassium intake is known to be potentially harmful. The majority of trials were conducted in rural or suburban settings, with more than half (14/26) conducted in low- and middle-income countries. The proportion of sodium chloride replacement in the LSSS interventions varied from approximately 3% to 77%. The majority of trials (23/26) investigated LSSS where potassium-containing salts were used to substitute sodium. In most trials, LSSS implementation was discretionary (22/26). Trial duration ranged from two months to nearly five years. We assessed the overall risk of bias as high in six trials and unclear in 12 trials. LSSS compared to regular salt in adults: LSSS compared to regular salt probably reduce DBP on average (mean difference (MD) -2.43 mmHg, 95% confidence interval (CI) -3.50 to -1.36; 20,830 participants, 19 RCTs, moderate-certainty evidence) and SBP (MD -4.76 mmHg, 95% CI -6.01 to -3.50; 21,414 participants, 20 RCTs, moderate-certainty evidence) slightly. On average, LSSS probably reduce non-fatal stroke (absolute effect (AE) 20 fewer/100,000 person-years, 95% CI -40 to 2; 21,250 participants, 3 RCTs, moderate-certainty evidence), non-fatal acute coronary syndrome (AE 150 fewer/100,000 person-years, 95% CI -250 to -30; 20,995 participants, 1 RCT, moderate-certainty evidence) and cardiovascular mortality (AE 180 fewer/100,000 person-years, 95% CI -310 to 0; 23,200 participants, 3 RCTs, moderate-certainty evidence) slightly, and probably increase blood potassium slightly (MD 0.12 mmol/L, 95% CI 0.07 to 0.18; 784 participants, 6 RCTs, moderate-certainty evidence), compared to regular salt. LSSS may result in little to no difference, on average, in hypertension (AE 17 fewer/1000, 95% CI -58 to 17; 2566 participants, 1 RCT, low-certainty evidence) and hyperkalaemia (AE 4 more/100,000, 95% CI -47 to 121; 22,849 participants, 5 RCTs, moderate-certainty evidence) compared to regular salt. The evidence is very uncertain about the effects of LSSS on blood pressure control, various cardiovascular events, stroke mortality, hypokalaemia, and other adverse events (very-low certainty evidence). LSSS compared to regular salt in children: The evidence is very uncertain about the effects of LSSS on DBP and SBP in children. We found no evidence about the effects of LSSS on hypertension, blood pressure control, blood potassium, hyperkalaemia and hypokalaemia in children. AUTHORS' CONCLUSIONS When compared to regular salt, LSSS probably reduce blood pressure, non-fatal cardiovascular events and cardiovascular mortality slightly in adults. However, LSSS also probably increase blood potassium slightly in adults. These small effects may be important when LSSS interventions are implemented at the population level. Evidence is limited for adults without elevated blood pressure, and there is a lack of evidence in pregnant women and people in whom an increased potassium intake is known to be potentially harmful, limiting conclusions on the safety of LSSS in the general population. We also cannot draw firm conclusions about effects of non-discretionary LSSS implementations. The evidence is very uncertain about the effects of LSSS on blood pressure in children.
Collapse
Affiliation(s)
- Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste E Naude
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
10
|
Hu J, Feng C, Yu Z, Zhu Y. Effect of partial substitution of NaCl by KCl, CaCl
2
, and MgCl
2
on properties of mixed gelation from myofibrillar protein and
Flammulina velutipes
protein. J FOOD PROCESS PRES 2022. [DOI: 10.1111/jfpp.16525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jingrong Hu
- College of Food Science and Engineering Shanxi Agricultural University Taigu 030801 China
| | - Cuiping Feng
- College of Food Science and Engineering Shanxi Agricultural University Taigu 030801 China
| | - Zhihui Yu
- College of Food Science and Engineering Shanxi Agricultural University Taigu 030801 China
| | - Yingchun Zhu
- College of Food Science and Engineering Shanxi Agricultural University Taigu 030801 China
| |
Collapse
|
11
|
Che L, Song W, Zhang Y, Lu Y, Cheng Y, Jiang Y. A randomized, double-blind clinical trial to evaluate the blood pressure lowing effect of low-sodium salt substitution on middle-aged and elderly hypertensive patients with different plasma renin concentrations. J Clin Hypertens (Greenwich) 2021; 24:140-147. [PMID: 34967126 PMCID: PMC8845456 DOI: 10.1111/jch.14396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/12/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
This study aimed to evaluate the blood pressure (BP) lowing effect of low‐sodium (LS) salt substitution and how the effect influenced by plasma renin concentration (PRC) on middle‐aged and elderly hypertensive patients. Three hundred fifty‐two hypertensives were randomized at a 1:1 ratio into a LS group and a normal salt (NS) group. We compared intergroup changes observed in office blood pressure measurement (OBPM) and home blood pressure measurement (HBPM). Then, all patients in LS group were divided into tertiles according to baseline PRC, aldosterone concentration, and aldosterone/renin ratio (ARR), and changes in OBPM and HBPM were compared across the three tertile subgroups. Follow‐up surveys were completed by 322 patients. The intergroup net reduction in systolic OBPM, systolic HBPM, and diastolic HBPM was −6.6, −4.6, and −2.3 mmHg, respectively (all P < .05), and −1.8 mmHg in diastolic OBPM (P = .068). There was a more significant reduction in OBPM and HBPM among the low baseline PRC subgroup than among the high PRC subgroup. There were no significant differences in the changes in OBPM and HBPM between the three subgroups when grouped according to baseline aldosterone concentration. The reduction in OBPM and HBPM in the high tertile of ARR was larger than that in the low tertile subgroup. LS salt substitution is effective in reducing systolic OBPM, systolic HBPM, and diastolic HBPM in middle‐aged and elderly hypertensive patients. LS salt substitution may offer a non‐pharmaceutical therapy for hypertensive patients. Baseline PRC may be a marker to predict BP response after salt restriction.
Collapse
Affiliation(s)
- Li Che
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wei Song
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan Lu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yunpeng Cheng
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| |
Collapse
|
12
|
Astutik E, Farapti F, Tama TD, Puspikawati SI. Differences Risk Factors for Hypertension Among Elderly Woman in Rural and Urban Indonesia. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:407-415. [PMID: 34602880 PMCID: PMC8461578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction: Hypertension is a major risk factor for cardiovascular disease. A high prevalence of hypertension is found in elderly women. Rural areas have different characteristics from urban areas. Therefore, it is necessary to identify risk factors for hypertension in rural and urban elderly women for optimal therapy management. Methods: This cross-sectional study was conducted in rural (Banyuwangi district) and urban (Surabaya city) areas, East Java, Indonesia. The study was carried out in 2015-2016 in women aged ≥45 years, residing in an area for ≥10 years, and willing to collect urine for 24 hours. Respondents consisted of 54 older adults from rural areas and 51 older adults from urban areas who actively participate in the integrated healthcare center for the elderly. The independent t-test and multivariate logistic regression were used to analyze the data. Results: The prevalence of hypertension in the rural area was 27.8% and in the urban area was 37.25%. The risk factors for hypertension in the urban area were urine sodium level (AOR=1.02, 95% CI=1.001-1.04, p-value=0.043), urine potassium level (AOR=0.88, 95% CI=0.78-0.999, p-value=0.022), and Body Mass Index (AOR=1.26, 95% CI=1.06-1.49, p-value=0.008). Meanwhile, the factor associated with hypertension in the rural area was age (AOR=1.08, 95% CI=1.003-1.16, p-value=0.042). Conclusion: The prevalence of hypertension in the urban area was higher than in the rural area. There were differences in risk factors for hypertension that occurred both in rural and urban areas. However, risk factors in both areas are equally important to overcome. Collaboration from multiple stakeholders and sectors is urgently needed, such as the Public Health Center, Integrated Assistance Post for Non-Communicable Diseases, and the local health office.
Collapse
Affiliation(s)
- Erni Astutik
- Department of Epidemiology, Biostatistics, Population
Studies, and Health Promotion, Faculty of Public Health, Universitas Airlangga,
Mulyorejo, Surabaya, East Java, Indonesia,To whom all correspondence should be addressed:
Erni Astutik, Department of Epidemiology, Biostatistics, Population Studies, and
Health Promotion, Faculty of Public Health, Universitas Airlangga, Mulyorejo
Kampus C, Surabaya, East Java, Indonesia, 60115; Tel: +6231-5920948, Fax:
+6231-5924618; ; ORCID iD:
https://orcid.org/0000-0003-2934-1290
| | - Farapti Farapti
- Department of Nutrition, Faculty of Public Health,
Universitas Airlangga, Mulyorejo, Surabaya, East Java, Indonesia
| | - Tika D. Tama
- Department of Public Health, Faculty of Sport Science,
Universitas Negeri Malang, Malang, East Java, Indonesia
| | - Septa I. Puspikawati
- Department of Nutrition, Faculty of Public Health,
Universitas Airlangga, Banyuwangi Campus, Banyuwangi, East Java Indonesia
| |
Collapse
|
13
|
The association between dietary sodium intake, adiposity and sugar-sweetened beverages in children and adults: a systematic review and meta-analysis. Br J Nutr 2020; 126:409-427. [PMID: 33054868 DOI: 10.1017/s0007114520004122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Higher intakes of Na may contribute to weight gain. The primary aim of this systematic review and meta-analysis was to examine the relationship between dietary Na intake and measures of adiposity in children and adults. Given the previous link between Na intake and the consumption of sugar-sweetened beverages (SSB), which are a known risk factor for obesity, a secondary aim examining the relationship between Na intake and SSB consumption was assessed. A systematic literature search identified cross-sectional and longitudinal studies and randomised controlled trials (RCT) which reduced dietary Na (≥3 months). Meta-analysis was performed for outcomes with ≥3 studies. Cross-sectionally higher Na intakes were associated with overweight/obesity in adults (five studies; n 11 067; OR 1·74; 95 % CI 1·43, 2·13) and in children (three studies; n 3625, OR 3·29; 95 % CI 2·25, 4·80), and abdominal obesity (five studies; n 19 744; OR 2·04; 95 % CI 1·72, 2·42) in adults. Overall, associations remained in sensitivity analyses which adjusted for energy. Findings from longitudinal studies were inconsistent. RCT in adults indicated a trend for lower body weight on reduced-Na compared with control diets (fifteen studies; n 5274; -0·29 kg; 95 % CI -0·59, 0·01; P = 0·06); however, it is unclear if energy intakes were also altered on reduced-Na diets. Among children higher Na intakes were associated with higher intake of SSB (four studies, n 10 329, b = 22, 16 and 26 g/d); no studies were retrieved for adults. Overall, there was a lack of high-quality studies retrieved. While cross-sectional evidence indicates Na intake was positively associated with adiposity, these findings have not been clearly confirmed by longitudinal studies or RCT.
Collapse
|
14
|
Fu J, Liu Y, Zhang L, Zhou L, Li D, Quan H, Zhu L, Hu F, Li X, Meng S, Yan R, Zhao S, Onwuka JU, Yang B, Sun D, Zhao Y. Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension. J Am Heart Assoc 2020; 9:e016804. [PMID: 32975166 PMCID: PMC7792371 DOI: 10.1161/jaha.120.016804] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Nonpharmacologic interventions that modify lifestyle can lower blood pressure (BP) and have been assessed in numerous randomized controlled trials and pairwise meta‐analyses. It is still unclear which intervention would be most efficacious. Methods and Results Bayesian network meta‐analyses were performed to estimate the comparative effectiveness of different interventions for lowering BP. From 60 166 potentially relevant articles, 120 eligible articles (14 923 participants) with a median follow‐up of 12 weeks, assessing 22 nonpharmacologic interventions, were included. According to the surface under the cumulative ranking probabilities and Grading of Recommendations Assessment, Development and Evaluation (GRADE) quality of evidence, for adults with prehypertension to established hypertension, high‐quality evidence indicated that the Dietary Approach to Stop Hypertension (DASH) was superior to usual care and all other nonpharmacologic interventions in lowering systolic BP (weighted mean difference, 6.97 mm Hg; 95% credible interval, 4.50–9.47) and diastolic BP (weighted mean difference, 3.54 mm Hg; 95% credible interval, 1.80–5.28). Compared with usual care, moderate‐ to high‐quality evidence indicated that aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, breathing‐control, and meditation could lower systolic BP and diastolic BP. For patients with hypertension, moderate‐ to high‐quality evidence suggested that the interventions listed (except comprehensive lifestyle modification) were associated with greater systolic BP and diastolic BP reduction than usual care; salt restriction was also effective in lowering both systolic BP and diastolic BP. Among overweight and obese participants, low‐calorie diet and low‐calorie diet plus exercise could lower more BP than exercise. Conclusions DASH might be the most effective intervention in lowering BP for adults with prehypertension to established hypertension. Aerobic exercise, isometric training, low‐sodium and high‐potassium salt, comprehensive lifestyle modification, salt restriction, breathing‐control, meditation and low‐calorie diet also have obvious effects on BP reduction.
Collapse
Affiliation(s)
- Jinming Fu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Yupeng Liu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Lei Zhang
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Lu Zhou
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Dapeng Li
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Hude Quan
- Department of Community Health Sciences University of Calgary Alberta Canada
| | - Lin Zhu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Fulan Hu
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Xia Li
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Shuhan Meng
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Ran Yan
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Suhua Zhao
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Justina Ucheojor Onwuka
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Baofeng Yang
- Department of Pharmacology and the State-Province Key Laboratory of Biomedicine and Pharmaceutics Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Dianjun Sun
- Center for Endemic Disease Control Chinese Center for Disease Control and Prevention Harbin Medical University Harbin Heilongjiang Province P.R. China
| | - Yashuang Zhao
- Department of Epidemiology College of Public Health Harbin Medical University Harbin Heilongjiang Province P.R. China
| |
Collapse
|
15
|
Jafarnejad S, Mirzaei H, Clark CCT, Taghizadeh M, Ebrahimzadeh A. The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis. BMC Cardiovasc Disord 2020; 20:98. [PMID: 32106813 PMCID: PMC7047420 DOI: 10.1186/s12872-020-01347-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Hypertension (HTN) is a ubiquitous risk factor for numerous non-communicable diseases, including cardiovascular disease and stroke. There are currently no wholly effective pharmacological therapies for subjects with HTN. However, salt substitutes have emerged as a potential therapy for the treatment of HTN. The aim of the present study was to assess the effect of salt substitutes on reducing systolic blood pressure (SBP) and diastolic BP (DBP), following a meta-analysis of randomized controlled trials. Methods Studies were found via systematic searches of the Pubmed/Medline, Scopus, Ovid, Google Scholar and Cochrane library. Ten studies, comprised of 11 trials and 1119 participants, were included in the meta-analysis. Results Pooled weighted mean differences showed significant reductions of SBP (WMD − 8.87 mmHg; 95% CI − 11.19, − 6.55, p < 0.001) and DBP (WMD − 4.04 mmHg; 95% CI − 5.70, − 2.39) with no statistically significant heterogeneity between the 11 included comparisons of SBPs and DBPs. The stratified analysis of trials based on the mean age of participants showed a significant reduction in the mean difference of SBP in both adults (< 65 years old) and elderly (≥65 years old). However, the DBP-lowering effect of salt substitutes was only observed in adult patients (WMD − 4.22 mmHg; 95% CI − 7.85, − 0.58), but not in the elderly subjects. Conclusions These findings suggest that salt-substitution strategies could be used for lowering SBP and DBP in patients with stage 2 HTN; providing a nutritional platform for the treatment, amelioration, and prevention of HTN.
Collapse
Affiliation(s)
- Sadegh Jafarnejad
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan, University of Medical Sciences, Kashan, IR, Iran.
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan, University of Medical Sciences, Kashan, IR, Iran
| | - Cain C T Clark
- Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, UK
| | - Mohsen Taghizadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan, University of Medical Sciences, Kashan, IR, Iran
| | - Armin Ebrahimzadeh
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan, University of Medical Sciences, Kashan, IR, Iran
| |
Collapse
|
16
|
Effect of salt substitution on community-wide blood pressure and hypertension incidence. Nat Med 2020; 26:374-378. [DOI: 10.1038/s41591-020-0754-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
|
17
|
Greer RC, Marklund M, Anderson CAM, Cobb LK, Dalcin AT, Henry M, Appel LJ. Potassium-Enriched Salt Substitutes as a Means to Lower Blood Pressure: Benefits and Risks. Hypertension 2019; 75:266-274. [PMID: 31838902 DOI: 10.1161/hypertensionaha.119.13241] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Use of salt substitutes containing potassium chloride is a potential strategy to reduce sodium intake, increase potassium intake, and thereby lower blood pressure and prevent the adverse consequences of high blood pressure. In this review, we describe the rationale for using potassium-enriched salt substitutes, summarize current evidence on the benefits and risks of potassium-enriched salt substitutes and discuss the implications of using potassium-enriched salt substitutes as a strategy to lower blood pressure. A benefit of salt substitutes that contain potassium chloride is the expected reduction in dietary sodium intake at the population level because of reformulation of manufactured foods or replacement of sodium chloride added to food during home cooking or at the dining table. There is empirical evidence that replacement of sodium chloride with potassium-enriched salt substitutes lowers systolic and diastolic blood pressure (average net Δ [95% CI] in mm Hg: -5.58 [-7.08 to -4.09] and -2.88 [-3.93 to -1.83], respectively). The risks of potassium-enriched salt substitutes include a possible increased risk of hyperkalemia and its principal adverse consequences: arrhythmias and sudden cardiac death, especially in people with conditions that impair potassium excretion such as chronic kidney disease. There is insufficient evidence regarding the effects of potassium-enriched salt substitutes on the occurrence of hyperkalemia. There is a need for additional empirical research on the effect of increasing dietary potassium and potassium-enriched salt substitutes on serum potassium levels and the risk of hyperkalemia, as well as for robust estimation of the population-wide impact of replacing sodium chloride with potassium-enriched salt substitutes.
Collapse
Affiliation(s)
- Raquel C Greer
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.C.G., C.A.M.A., M.H., L.J.A.).,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (R.C.G., A.T.D., L.J.A.)
| | | | - Cheryl A M Anderson
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.C.G., C.A.M.A., M.H., L.J.A.).,Department of Family Medicine and Public Health, University of California San Diego School of Medicine (C.A.M.A.)
| | | | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (R.C.G., A.T.D., L.J.A.)
| | - Megan Henry
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.C.G., C.A.M.A., M.H., L.J.A.)
| | - Lawrence J Appel
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.C.G., C.A.M.A., M.H., L.J.A.).,Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (R.C.G., A.T.D., L.J.A.)
| |
Collapse
|
18
|
Gritter M, Rotmans JI, Hoorn EJ. Role of Dietary K + in Natriuresis, Blood Pressure Reduction, Cardiovascular Protection, and Renoprotection. Hypertension 2019; 73:15-23. [PMID: 30571564 DOI: 10.1161/hypertensionaha.118.11209] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Gritter
- From the Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (M.G., E.J.H.)
| | - Joris I Rotmans
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, the Netherlands (J.I.R.)
| | - Ewout J Hoorn
- From the Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (M.G., E.J.H.)
| |
Collapse
|
19
|
Farrand C, MacGregor G, Campbell NRC, Webster J. Potential use of salt substitutes to reduce blood pressure. J Clin Hypertens (Greenwich) 2019; 21:350-354. [PMID: 30690859 DOI: 10.1111/jch.13482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Clare Farrand
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Graham MacGregor
- Wolfson Institute of Preventive Health, Queen Mary University of London, London, UK
| | - Norman R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Li N, Yan LL, Niu W, Yao C, Feng X, Zhang J, Shi J, Zhang Y, Zhang R, Hao Z, Chu H, Zhang J, Li X, Pan J, Li Z, Sun J, Zhou B, Zhao Y, Yu Y, Engelgau M, Labarthe D, Ma J, MacMahon S, Elliott P, Wu Y, Neal B. The Effects of a Community-Based Sodium Reduction Program in Rural China - A Cluster-Randomized Trial. PLoS One 2016; 11:e0166620. [PMID: 27935977 PMCID: PMC5147834 DOI: 10.1371/journal.pone.0166620] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/29/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. OBJECTIVE We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. DESIGN This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. RESULTS Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56). CONCLUSION There were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01259700.
Collapse
Affiliation(s)
- Nicole Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Lijing L. Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Wenyi Niu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Chen Yao
- Peking University Clinical Research Institute, Beijing, China
| | | | - Jianxin Zhang
- Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Jingpu Shi
- First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuhong Zhang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | | | - Zhixin Hao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Hongling Chu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jianhong Pan
- Peking University Clinical Research Institute, Beijing, China
| | - Zhifang Li
- Changzhi Medical College, Changzhi, Shanxi, China
| | - Jixin Sun
- Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Bo Zhou
- First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Zhao
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yan Yu
- Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Michael Engelgau
- United States Centers for Disease Control and Prevention, Beijing, China
| | - Darwin Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephen MacMahon
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
| | | | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
- Imperial College London, United Kingdom
- Royal Prince Alfred Hospital, Sydney
| |
Collapse
|
21
|
Nghiem N, Blakely T, Cobiac LJ, Cleghorn CL, Wilson N. The health gains and cost savings of dietary salt reduction interventions, with equity and age distributional aspects. BMC Public Health 2016; 16:423. [PMID: 27216490 PMCID: PMC4877955 DOI: 10.1186/s12889-016-3102-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/13/2016] [Indexed: 01/09/2023] Open
Abstract
Background A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. We therefore aimed to model health gains and costs (savings) of salt reduction interventions related to salt substitution and maximum levels in bread, including by ethnicity and age. We also ranked these four interventions compared to eight other modelled interventions. Methods A Markov macro-simulation model was used to estimate QALYs gained and net health system costs for four dietary sodium reduction interventions, discounted at 3 % per annum. The setting was New Zealand (NZ) (2.3 million adults, aged 35+ years) which has detailed individual-level administrative cost data. Results The health gain was greatest for an intervention where most (59 %) of the sodium in processed foods was replaced by potassium and magnesium salts. This intervention gained 294,000 QALYs over the remaining lifetime of the cohort (95 % UI: 238,000 to 359,000; 0.13 QALY per 35+ year old). Such salt substitution also produced the highest net cost-savings of NZ$ 1.5 billion (US$ 1.0 billion) (95 % UI: NZ$ 1.1 to 2.0 billion). All interventions generated relatively larger per capita QALYs for men vs women and for the indigenous Māori population vs non-Māori (e.g., 0.16 vs 0.12 QALYs per adult for the 59 % salt substitution intervention). Of relevance to workforce productivity, in the first 10 years post-intervention, 22 % of the QALY gain was among those aged <65 years (and 37 % for those aged <70). Conclusions The benefits are consistent with the international literature, with large health gains and cost savings possible from some, but not all, sodium reduction interventions. Health gain appears likely to occur among working-age adults and all interventions contributed to reducing health inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3102-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nhung Nghiem
- University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand
| | - Tony Blakely
- University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand
| | - Linda J Cobiac
- British Heart Foundation Centre on Population Approaches to NCD Prevention, Oxford University, Oxford, UK
| | | | - Nick Wilson
- University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
| |
Collapse
|
22
|
Israr T, Rakha A, Sohail M, Rashid S, Shehzad A. Salt reduction in baked products: Strategies and constraints. Trends Food Sci Technol 2016. [DOI: 10.1016/j.tifs.2016.03.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Zhang Z, Yang Y, Tang X, Chen Y, You Y. Chemical forces study of heat-induced myofibrillar protein gel as affected by partial substitution of NaCl with KCl, MgCl2and CaCl2. CYTA - JOURNAL OF FOOD 2015. [DOI: 10.1080/19476337.2015.1091038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
24
|
Tahergorabi R, Matak KE, Jaczynski J. Fish protein isolate: Development of functional foods with nutraceutical ingredients. J Funct Foods 2015. [DOI: 10.1016/j.jff.2014.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Peng YG, Li W, Wen XX, Li Y, Hu JH, Zhao LC. Effects of salt substitutes on blood pressure: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2014; 100:1448-54. [PMID: 25411279 DOI: 10.3945/ajcn.114.089235] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Clinical trials assessing the effects of salt substitutes on blood pressure (BP) have reported mixed results. OBJECTIVES A meta-analysis of randomized controlled trials was conducted to evaluate the effect of salt substitutes on BP, including systolic BP (SBP) and diastolic BP (DBP). DESIGN Studies were identified via systematic searches of the PubMed, Embase, Cochrane Library, Wanfang Data, and the China National Knowledge Infrastructure databases through December 2013. Random-effects models were used to estimate pooled mean differences in SBP and DBP. RESULTS Six cohorts from 5 articles (1 trial enrolled 2 cohorts for independent intervention) consisting of 1974 participants were included. Pooled results showed that salt substitutes had a significant effect on SBP (mean difference: -4.9 mm Hg; 95% CI: -7.3, -2.5 mm Hg; P < 0.001) and DBP (mean difference: -1.5 mm Hg; 95% CI: -2.7, -0.3 mm Hg; P = 0.013). Significant heterogeneity was found for both SBP (I(2) = 76.7%) and DBP (I(2) = 65.8%). The sensitivity analysis indicated that the pooled effects of salt substitutes on SBP and DBP were robust to systematically dropping each trial. Furthermore, no evidence of significant publication bias from funnel plots or Egger's tests (P = 0.17 and 0.22 for SBP and DBP, respectively) was found. CONCLUSION This meta-analysis showed that salt-substitution strategies are effective at lowering SBP and DBP, which supports a nutritional approach to preventing hypertension.
Collapse
Affiliation(s)
- Ya-Guang Peng
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| | - Wei Li
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| | - Xiao-Xiao Wen
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| | - Ying Li
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| | - Ji-Hong Hu
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| | - Lian-Cheng Zhao
- From the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y-GP, WL, X-XW, YL, and L-CZ) and the Public Health School, Gansu University of Traditional Chinese Medicine, Gansu, China (J-HH)
| |
Collapse
|
26
|
Zareisedehizadeh S, Tan CH, Koh HL. A Review of Botanical Characteristics, Traditional Usage, Chemical Components, Pharmacological Activities, and Safety of Pereskia bleo (Kunth) DC. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:326107. [PMID: 24987426 PMCID: PMC4060302 DOI: 10.1155/2014/326107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/02/2014] [Indexed: 12/03/2022]
Abstract
Pereskia bleo, a leafy cactus, is a medicinal plant native to West and South America and distributed in tropical and subtropical areas. It is traditionally used as a dietary vegetable, barrier hedge, water purifier, and insect repellant and for maintaining health, detoxification, prevention of cancer, and/or treatment of cancer, hypertension, diabetes, stomach ache, muscle pain, and inflammatory diseases such as dermatitis and rheumatism. The aim of this paper was to provide an up-to-date and comprehensive review of the botanical characteristics, traditional usage, phytochemistry, pharmacological activities, and safety of P. bleo. A literature search using MEDLINE (via PubMed), Science direct, Scopus and Google scholar and China Academic Journals Full-Text Database (CNKI) and available eBooks and books in the National University of Singapore libraries in English and Chinese was conducted. The following keywords were used: Pereskia bleo, Pereskia panamensis, Pereskia corrugata, Rhodocacus corrugatus, Rhodocacus bleo, Cactus panamensis, Cactus bleo, Spinach cactus, wax rose, Perescia, and Chinese rose. This review revealed the association between the traditional usage of P. bleo and reported pharmacological properties in the literature. Further investigation on the pharmacological properties and phytoconstituents of P. bleo is warranted to further exploit its potentials as a source of novel therapeutic agents or lead compounds.
Collapse
Affiliation(s)
- Sogand Zareisedehizadeh
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore 117543
| | - Chay-Hoon Tan
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
| | - Hwee-Ling Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore 117543
| |
Collapse
|
27
|
Bernabe-Ortiz A, Diez-Canseco F, Gilman RH, Cárdenas MK, Sacksteder KA, Miranda JJ. Launching a salt substitute to reduce blood pressure at the population level: a cluster randomized stepped wedge trial in Peru. Trials 2014; 15:93. [PMID: 24667035 PMCID: PMC3976551 DOI: 10.1186/1745-6215-15-93] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/05/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Controlling hypertension rates and maintaining normal blood pressure, particularly in resource-constrained settings, represent ongoing challenges of effective and affordable implementation in health care. One of the strategies being largely advocated to improve high blood pressure calls for salt reduction strategies. This study aims to estimate the impact of a population-level intervention based on sodium reduction and potassium increase - in practice, introducing a low-sodium, high-potassium salt substitute - on adult blood pressure levels. METHODS/DESIGN The proposed implementation research study includes two components: Phase 1, an exploratory component, and Phase 2, an intervention component. The exploratory component involves a triangle taste test and a formative research study designed to gain an understanding of the best implementation methods. Phase 2 involves a pragmatic stepped wedge trial design where the intervention will be progressively implemented in several clusters starting the intervention randomly at different times. In addition, we will evaluate the implementation strategy using a cost-effectiveness analysis. DISCUSSION This is the first project in a Latin-American setting to implement a salt substitution intervention at the population level to tackle high blood pressure. Data generated and lessons learnt from this study will provide a strong platform to address potential interventions applicable to other similar low- and middle-income settings. TRIAL REGISTRATION This study is registered in ClinicalTrials.gov NCT01960972.
Collapse
Affiliation(s)
- Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Ingenieria, Lima 31, Peru
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, USA
- Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Carlos Gonzales 251, Maranga, Lima 32, Peru
| | - María K Cárdenas
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru
| | - Katherine A Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima 18, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Ingenieria, Lima 31, Peru
| |
Collapse
|
28
|
[Scientific statement] Report of the Salt Reduction Committee of the Japanese Society of Hypertension(2) Goal and strategies of dietary salt reduction in the management of hypertension. Hypertens Res 2013; 36:1020-5. [PMID: 24152612 DOI: 10.1038/hr.2013.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/08/2022]
Abstract
In this section of the Report of the Salt Reduction Committee of the Japanese Society of Hypertension, the target level of dietary salt reduction and its scientific evidence, present status of salt consumption in Japan, salt-reducing measures/guidance methods in individuals and population strategies to reduce salt intake are introduced. In the Dietary Reference Intake for the general population in Japan (2010 version), the target levels of salt restriction in men and women were established as less than 9.0 per day and 7.5 g per day, respectively. The Japanese Society of Hypertension Guidelines for the Management of Hypertension 2009 recommended the target level of dietary salt restriction in patients with hypertension as less than 6 g per day. However, the National Health and Nutrition Survey of Japan in 2010 reported that the mean salt intake in adults was 10.6 g per day (men: 11.4 g per day and women: 9.8 g per day). To effectively decrease salt intake in Japan, it is necessary to reduce the consumption of high-salt foods (especially traditional foods) and replace high-salt seasonings (soy sauce and so on) with low-salt alternatives. Health-care professionals must effectively perform salt-reduction guidance for hypertensive patients in hospitals/administrative organizations. To promote population strategies for salt reduction in the whole society of Japan, social strategies, such as administrative policies, companies' cooperation and educational staff's cooperation, are necessary.
Collapse
|
29
|
Aaron KJ, Sanders PW. Role of dietary salt and potassium intake in cardiovascular health and disease: a review of the evidence. Mayo Clin Proc 2013; 88:987-95. [PMID: 24001491 PMCID: PMC3833247 DOI: 10.1016/j.mayocp.2013.06.005] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/22/2013] [Accepted: 06/04/2013] [Indexed: 02/07/2023]
Abstract
The objective of this review was to provide a synthesis of the evidence on the effect of dietary salt and potassium intake on population blood pressure, cardiovascular disease, and mortality. Dietary guidelines and recommendations are outlined, current controversies regarding the evidence are discussed, and recommendations are made on the basis of the evidence. Designed search strategies were used to search various databases for available studies. Randomized trials of the effect of dietary salt intake reduction or increased potassium intake on blood pressure, target organ damage, cardiovascular disease, and mortality were included. Fifty-two publications from January 1, 1990, to January 31, 2013, were identified for inclusion. Consideration was given to variations in the search terms used and the spelling of terms so that studies were not overlooked, and search terms took the following general form: (dietary salt or dietary sodium or [synonyms]) and (dietary potassium or [synonyms]) and (blood pressure or hypertension or vascular disease or heart disease or chronic kidney disease or stroke or mortality or [synonyms]). Evidence from these studies demonstrates that high salt intake not only increases blood pressure but also plays a role in endothelial dysfunction, cardiovascular structure and function, albuminuria and kidney disease progression, and cardiovascular morbidity and mortality in the general population. Conversely, dietary potassium intake attenuates these effects, showing a linkage to reduction in stroke rates and cardiovascular disease risk. Various subpopulations, such as overweight and obese individuals and aging adults, exhibit greater sensitivity to the effects of reduced salt intake and may gain the most benefits. A diet that includes modest salt restriction while increasing potassium intake serves as a strategy to prevent or control hypertension and decrease cardiovascular morbidity and mortality. Thus, the body of evidence supports population-wide sodium intake reduction and recommended increases in dietary potassium intake as outlined by current guidelines as an essential public health effort to prevent kidney disease, stroke, and cardiovascular disease.
Collapse
Affiliation(s)
- Kristal J. Aaron
- Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA 35294-0007
| | - Paul W. Sanders
- Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA 35294-0007
- Department of Veterans Affairs Medical Center, Birmingham, AL, USA 35233
| |
Collapse
|
30
|
Zhou B, Wang HL, Wang WL, Wu XM, Fu LY, Shi JP. Long-term effects of salt substitution on blood pressure in a rural north Chinese population. J Hum Hypertens 2012; 27:427-33. [PMID: 23254595 DOI: 10.1038/jhh.2012.63] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dietary sodium and potassium intake can influence blood pressure. The effects of salt substitution on patients with hypertension and normotensive family member controls, however, have not been evaluated in a rural Chinese population. The objective of this study, accordingly, was to assess the long-term effects of salt substitution on blood pressure. We conducted a double-blind, randomized controlled trial among 200 families in rural China to establish the 2-year effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with normal salt (100% sodium chloride) on blood pressure. Of the 462 individuals in the trial, 372 completed the study (81%). For normotensive subjects, the mean overall difference in systolic and diastolic blood pressure between the two groups at the 24-month follow-up was 2 mm Hg (95% confidence interval (CI) 0-4 mm Hg, P<0.05) and 2 mm Hg (95% CI 1-3 mm Hg, P<0.05), respectively. For subjects with hypertension, the mean overall decrease in systolic blood pressure showed a 4-mm Hg (95% CI 2-6 mm Hg, P<0.05) decrease between the two groups. Diastolic blood pressure was not affected by salt use in the hypertensive group. Salt substitution lowers systolic blood pressure in hypertensive patients and lowers both systolic and diastolic blood pressure in normotensive controls. Salt substitution, therefore, may be an effective adjuvant therapy for hypertensive patients and the potential efficacy in preventing hypertension in normotensive individuals.
Collapse
Affiliation(s)
- B Zhou
- Department of Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, China
| | | | | | | | | | | |
Collapse
|
31
|
Tahergorabi R, Beamer SK, Matak KE, Jaczynski J. Salt substitution in surimi seafood and its effects on instrumental quality attributes. Lebensm Wiss Technol 2012. [DOI: 10.1016/j.lwt.2012.03.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
32
|
Tahergorabi R, Jaczynski J. Physicochemical changes in surimi with salt substitute. Food Chem 2011; 132:1281-1286. [PMID: 29243612 DOI: 10.1016/j.foodchem.2011.11.104] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 11/29/2022]
Abstract
Protein endothermic transitions (thermal denaturation), rheological properties (protein gelation), and fundamental texture properties (shear stress and strain at mechanical fracture) of Alaska pollock surimi gels made with 0 (control), 1, 2, and 3g/100g of salt (NaCl) were determined and compared with equal molar concentration of salt substitute. Salt and salt substitute shifted the onset of myosin transition to higher temperature and resulted in larger myosin peaks (i.e., transition enthalpy). Endothermic transitions showed similar trends to rheological properties. The elastic modulus (G') increased when salt or salt substitute was added to surimi, except at the highest concentration of salt and salt substitute. Salt and salt substitute also induced the onset of protein gelation (i.e., as measured by significant increase of G') at lower temperature. Surimi gels with salt substitute and salt at equal molar concentrations had similar texture properties (shear stress and strain). Based on the present study, salt substitute can be used in the development of low-sodium surimi seafood products without significant change in gelation and texture.
Collapse
Affiliation(s)
- Reza Tahergorabi
- Animal and Nutritional Sciences, West Virginia University, P.O. Box 6108, Morgantown, WV, USA
| | - Jacek Jaczynski
- Animal and Nutritional Sciences, West Virginia University, P.O. Box 6108, Morgantown, WV, USA.
| |
Collapse
|
33
|
Feasibility and antihypertensive effect of replacing regular salt with mineral salt -rich in magnesium and potassium- in subjects with mildly elevated blood pressure. Nutr J 2011; 10:88. [PMID: 21888642 PMCID: PMC3175151 DOI: 10.1186/1475-2891-10-88] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/02/2011] [Indexed: 12/04/2022] Open
Abstract
Background High salt intake is linked to hypertension whereas a restriction of dietary salt lowers blood pressure (BP). Substituting potassium and/or magnesium salts for sodium chloride (NaCl) may enhance the feasibility of salt restriction and lower blood pressure beyond the sodium reduction alone. The aim of this study was to determine the feasibility and effect on blood pressure of replacing NaCl (Regular salt) with a novel mineral salt [50% sodium chloride and rich in potassium chloride (25%), magnesium ammonium potassium chloride, hydrate (25%)] (Smart Salt). Methods A randomized, double-blind, placebo-controlled study was conducted with an intervention period of 8-weeks in subjects (n = 45) with systolic (S)BP 130-159 mmHg and/or diastolic (D)BP 85-99 mmHg. During the intervention period, subjects consumed processed foods salted with either NaCl or Smart Salt. The primary endpoint was the change in SBP. Secondary endpoints were changes in DBP, daily urine excretion of sodium (24-h dU-Na), potassium (dU-K) and magnesium (dU-Mg). Results 24-h dU-Na decreased significantly in the Smart Salt group (-29.8 mmol; p = 0.012) and remained unchanged in the control group: resulting in a 3.3 g difference in NaCl intake between the groups. Replacement of NaCl with Smart Salt resulted in a significant reduction in SBP over 8 weeks (-7.5 mmHg; p = 0.016). SBP increased (+3.8 mmHg, p = 0.072) slightly in the Regular salt group. The difference in the change of SBP between study groups was significant (p < 0.002). Conclusions The substitution of Smart Salt for Regular salt in subjects with high normal or mildly elevated BP resulted in a significant reduction in their daily sodium intake as well as a reduction in SBP. Trial Registration ISRCTN: ISRCTN01739816
Collapse
|
34
|
Physicochemical changes in dry-cured hams salted with potassium, calcium and magnesium chloride as a partial replacement for sodium chloride. Meat Sci 2010; 86:331-6. [DOI: 10.1016/j.meatsci.2010.05.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 11/23/2022]
|
35
|
Physicochemical properties and microbiology of dry-cured loins obtained by partial sodium replacement with potassium, calcium and magnesium. Meat Sci 2010; 85:580-8. [DOI: 10.1016/j.meatsci.2010.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 12/16/2009] [Accepted: 03/08/2010] [Indexed: 11/23/2022]
|
36
|
Characterisation of pile salting with sodium replaced mixtures of salts in dry-cured loin manufacture. J FOOD ENG 2010. [DOI: 10.1016/j.jfoodeng.2009.10.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
37
|
|
38
|
Park JN, Hwang KT, Kim SB, Kim SZ. Partial replacement of NaCl by KCl in salted mackerel (Scomber japonicus) fillet products: effect on sensory acceptance and lipid oxidation. Int J Food Sci Technol 2009. [DOI: 10.1111/j.1365-2621.2008.01841.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
39
|
Hu J, Jiang X, Li N, Yu X, Perkovic V, Chen B, Zhao L, Neal B, Wu Y. Effects of salt substitute on pulse wave analysis among individuals at high cardiovascular risk in rural China: a randomized controlled trial. Hypertens Res 2009; 32:282-8. [PMID: 19262499 DOI: 10.1038/hr.2009.7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reduced-sodium, increased-potassium salt substitutes lower blood pressure but may also have direct effects on vascular structure and arterial function. This study aimed to test the effects of long-term salt substitution on indices of these outcomes. The China Salt Substitute Study was a randomized, controlled trial designed to establish the effects of salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulfate) compared with regular salt (100% sodium chloride) on blood pressure among 600 high-risk individuals living in six rural areas in northern China over a 12-month intervention period. Data on central aortic blood pressure, aortic pressure augmentation (AUG), augmentation index (AIx), the differences of the peak of first and baseline waves (P(1)-P(0)) and pulse wave reflection time (RT) were collected at randomization and at the completion of follow-up in 187 participants using the Sphygmocor pulse wave analysis system. Mean baseline blood pressure was 150.1/91.4 mm Hg, mean age was 58.4 years, 41% were male and three quarters had a history of vascular disease. After 12 months of intervention, there were significant net reductions in peripheral (7.4 mm Hg, P=0.009) and central (6.9 mm Hg, P=0.011) systolic blood pressure levels and central pulse pressure (4.5 mm Hg, P=0.012) and correspondingly there was a significant net reduction in P(1)-P(0) (3.0 mm Hg, P=0.007), borderline significant net reduction in AUG (1.5 mm Hg, P=0.074) and significant net increase in RT (2.59 ms, P=0.001). There were no detectable reductions in peripheral (2.8 mm Hg, P=0.14) or central (2.4 mm Hg, P=0.13) diastolic blood pressure levels or AIx (0.06%, P=0.96). In conclusion, over the 12-month study period the salt substitute significantly reduced not only peripheral and central systolic blood pressure but also reduced arterial stiffness.
Collapse
Affiliation(s)
- Jihong Hu
- Cardiovascular Institute, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
A food-based dietary strategy lowers blood pressure in a low socio-economic setting: a randomised study in South Africa. Public Health Nutr 2008; 11:1397-406. [DOI: 10.1017/s136898000800342x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo assess the impact of a food-based intervention on blood pressure (BP) in free-living South African men and women aged 50–75 years, with drug-treated mild-to-moderate hypertension.MethodsA double-blind controlled trial was undertaken in eighty drug-treated mild-to-moderate hypertensive subjects randomised to an intervention (n40) or control (n40) arm. The intervention was 8-week provision of six food items with a modified cation content (salt replacement (SOLO™), bread, margarine, stock cubes, soup mix and a flavour enhancer) and 500 ml of maas (fermented milk)/d. The control diet provided the same quantities of the targeted foods but of standard commercial composition and 500 ml/d of artificially sweetened cooldrink.FindingsThe intervention effect estimated as the contrast of the within-diet group changes in BP from baseline to post-intervention was a significant reduction of 6·2 mmHg (95 % CI 0·9, 11·4) for systolic BP. The largest intervention effect in 24 h BP was for wake systolic BP with a reduction of 5·1 mmHg (95 % CI 0·4, 9·9). For wake diastolic BP the reduction was 2·7 mmHg (95 % CI −0·2, 5·6).ConclusionsModification of the cation content of a limited number of commonly consumed foods lowers BP by a clinically significant magnitude in treated South African hypertensive patients of low socio-economic status. The magnitude of BP reduction provides motivation for a public health strategy that could be adopted through lobbying of the food industry by consumer and health agencies.
Collapse
|
41
|
Abstract
Dietary salt has long been recognized as a major factor affecting blood pressure such that sodium intake is a component of lifestyle modification guidelines for control of high blood pressure. These recommendations are based on results from epidemiologic observational studies and clinical trials of various sodium diets among normotensives and hypertensives. Nonetheless, results from the different studies vary such that specific recommendations regarding sodium intake are difficult to interpret. The results from several recent major trials indicated greater associations of blood pressure and sodium intake than earlier studies as well as meta-analyses of numerous clinical trials. The studies of sodium intake and blood pressures are complicated by measurements of intake, salt sensitivity, hypertension treatment, effects of sodium independent of blood pressure, and length of interventions. Limitations in the methodology of different studies have reduced the value of the results to provide specific and reliable sodium intake levels essential for clinical and lifestyle guidelines.
Collapse
Affiliation(s)
- Daniel T Lackland
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Charleston, SC 29425, USA.
| | | |
Collapse
|
42
|
Can a low-sodium, high-potassium salt substitute reduce blood pressure in rural Chinese people? ACTA ACUST UNITED AC 2008; 5:186-7. [PMID: 18227813 DOI: 10.1038/ncpcardio1122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 11/14/2007] [Indexed: 11/08/2022]
|
43
|
The effect of a dietary supplement of potassium chloride or potassium citrate on blood pressure in predominantly normotensive volunteers. Br J Nutr 2007; 99:1284-92. [PMID: 18053306 DOI: 10.1017/s0007114507864853] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Blood pressure (BP) shows a continuous relationship with the risk of CVD. There is substantial evidence that dietary potassium exerts an anti-pressor effect. Most clinical trials have used KCl. However, the chloride ion may have a pressor effect and in foods potassium is associated with organic anions. In a double-blind randomized placebo-controlled trial we explored the effect on BP of two salts of potassium, KCl and potassium citrate (K-cit), in predominantly young healthy normotensive volunteers. The primary outcome was the change in mean arterial pressure as measured in a clinic setting. After 6 weeks of supplementation, compared with the placebo group (n 31), 30 mmol K-cit/d (n 28) changed mean arterial pressure by -5.22 mmHg (95% CI -8.85, -4.53) which did not differ significantly from that induced by KCl (n 26), -4.70 mmHg (-6.56, -2.84). The changes in systolic and diastolic BP were -6.69 (95% CI -8.85, -4.43) and -4.26 (95% CI -6.31, -2.21) mmHg with K-cit and -5.24 (95% CI -7.43, -3.06) and -4.30 (95% CI -6.39, -2.20) mmHg with KCl, and did not differ significantly between the two treatments. Changes in BP were not related to baseline urinary electrolytes. A greater treatment-related effect was observed in those with higher systolic BP. Increasing dietary potassium could therefore have a significant impact on the progressive rise in BP in the entire population.
Collapse
|
44
|
Abstract
The kidneys play a major role in the regulation of the salt balance and thereby regulate blood pressure. Salt sensitivity is acquired or genetically-induced and is noted in about 50% of patients with essential hypertension. This property leads to a high cardiovascular risk. In this situation, the benefit of salt restriction is significant, and this dietary change should be associated with a high potassium intake. In patients treated by antihypertensive drugs, salt restriction improves the blood pressure control, which can permit a reduction of the number of drugs required to achieve a normal blood pressure. The recommended maximal salt intake should not exceed 6 grams/day (NaCl). Because most dietary salt comes from processed foods, the help of the food industry is crucial for a long-term compliance with a reduced salt intake, which could yield an additional important benefit in the reduction of cardiovascular risk.
Collapse
Affiliation(s)
- J-M Krzesinski
- Division of Nephrology/Transplantation, University of Liège, Sart Tilman B35 Belgium.
| | | |
Collapse
|
45
|
Lipowicz A. Hypertension among Polish males during the economic transition. ECONOMICS AND HUMAN BIOLOGY 2007; 5:61-73. [PMID: 17276743 DOI: 10.1016/j.ehb.2006.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 10/23/2006] [Indexed: 05/13/2023]
Abstract
In the late 1980s and early 1990s Polish society experienced deep political, economic and social changes. The aim of the study is to investigate whether changes that occurred in Poland during the transformation significantly influenced the risk of hypertension among adult men. We find that irrespective of age, marital status, education, degree of urbanization, lifestyle variables (smoking, drinking alcohol, and physical activity), and BMI the risk of hypertension after 1989 was higher than before transformation (odds ratio=1.45, p<0.001). Psychosocial factors are proposed as factors which might at least partly explain the higher risk of hypertension during the first years of economic transition in Poland.
Collapse
Affiliation(s)
- Anna Lipowicz
- Institute of Anthropology, Polish Academy of Sciences, Kuźnicza 35, 50-951 Wrocław, Poland.
| |
Collapse
|
46
|
Abstract
In current diets, the level of sodium is very high, whereas that of potassium, calcium, and magnesium is low compared with the level in diets composed of unprocessed, natural foods. We present the biologic rationale and scientific evidence that show that the current salt intake levels largely explain the high prevalence of hypertension. Comprehensive reduction of salt intake, both alone and particularly in combination with increases in intakes of potassium, calcium, and magnesium, is able to lower average blood pressure levels substantially. During the past 30 years, the one-third decrease in the average salt intake has been accompanied by a more than 10-mm Hg fall in the population average of both systolic and diastolic blood pressure, and a 75% to 80% decrease in both stroke and coronary heart disease mortality in Finland. There is no evidence of any harmful effects of salt reduction. Salt-reduction recommendations alone have a very small, if any, population impact. In the United States, for example, the per capita use of salt increased by approximately 55% from the mid-1980s to the late 1990s. We deal with factors that contribute toward increasing salt intakes and present examples of the methods that have contributed to the successful salt reduction in Finland.
Collapse
Affiliation(s)
- Heikki Karppanen
- Institute of Biomedicine, Pharmacology, University of Helsinki, Helsinki, Finland.
| | | |
Collapse
|
47
|
Beyer FR, Dickinson HO, Nicolson DJ, Ford GA, Mason J. Combined calcium, magnesium and potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev 2006:CD004805. [PMID: 16856060 DOI: 10.1002/14651858.cd004805.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Previous research suggests that increasing dietary intakes of calcium, potassium or magnesium separately may reduce BP to a small degree over the short term. It is unclear whether increasing intakes of a combination of these minerals produces a larger reduction in BP. OBJECTIVES To evaluate the effects of combined mineral supplementation as a treatment for primary hypertension in adults. SEARCH STRATEGY We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review. The search was unrestricted by language or publication status. SELECTION CRITERIA Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral supplements comprising a combination of potassium, and/or calcium, and/or magnesium with placebo, no treatment, or usual care; 2) treatment and follow-up >=8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >=140 mmHg or diastolic blood pressure (DBP) >=85 mmHg with no known primary cause; 4) SBP and DBP reported at end of follow-up. We excluded trials where participants were pregnant, or received antihypertensive medication which changed during the study. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted. MAIN RESULTS We included three RCTs (n=277) with between 24 and 28 weeks follow-up. Three combinations of minerals were investigated: potassium & magnesium, calcium & magnesium, and calcium & potassium. One trial investigated combinations of calcium & magnesium and of calcium & potassium, and for each found a statistically non-significant increase in both SBP and DBP. All three trials investigated the combination of potassium & magnesium. None of the trials provided data on mortality or morbidity. The combination of potassium & magnesium compared to control resulted in statistically non-significant reductions in both SBP (mean difference = -4.6 mmHg, 95% CI: -9.9 to 0.7) and DBP (mean difference = -3.8 mmHg, 95% CI: -9.5 to 1.8), although the results were heterogeneous (I(2)=68% and 85% for SBP and DBP respectively).A sensitivity analysis using alternative reported values which accounted for missing data had very little effect on DBP but resulted in a larger, statistically significant reduction in SBP (mean difference = -5.8 mmHg, 95% CI: -10.5 to -1.0). The quality of the trials was not well reported. AUTHORS' CONCLUSIONS We found no robust evidence that supplements of any combination of potassium, magnesium or calcium reduce mortality, morbidity or BP in adults. More trials are needed to investigate whether the combination of potassium & magnesium is effective.
Collapse
Affiliation(s)
- F R Beyer
- University of Newcastle, Centre for Health Services Research, 21 Claremont Place, Newcastle upon Tyne,Tyne & Wear, UK NE2 4AA.
| | | | | | | | | |
Collapse
|
48
|
Dickinson HO, Nicolson DJ, Campbell F, Beyer FR, Mason J. Potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev 2006:CD004641. [PMID: 16856053 DOI: 10.1002/14651858.cd004641.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Epidemiological evidence on the effects of potassium on blood pressure is inconsistent. OBJECTIVES To evaluate the effects of potassium supplementation on health outcomes and blood pressure in people with elevated blood pressure. SEARCH STRATEGY We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review. SELECTION CRITERIA Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral potassium supplements with placebo, no treatment, or usual care; 2) treatment and follow-up >=8 weeks; 3) participants over 18 years, with raised systolic blood pressure (SBP) >=140 mmHg or diastolic blood pressure (DBP) >=85 mmHg); 4) SBP and DBP reported at end of follow-up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or potassium supplementation was combined with other interventions. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted. MAIN RESULTS Six RCT's (n=483), with eight to 16 weeks follow-up, met our inclusion criteria. Meta-analysis of five trials (n=425) with adequate data indicated that potassium supplementation compared to control resulted in a large but statistically non-significant reductions in SBP (mean difference: -11.2, 95% CI: -25.2 to 2.7) and DBP (mean difference: -5.0, 95% CI: -12.5 to 2.4). The substantial heterogeneity between trials was not explained by potassium dose, quality of trials or baseline blood pressure. Excluding one trial in an African population with very high baseline blood pressure resulted in smaller overall reductions in blood pressure (SBP mean difference: -3.9, 95% CI: -8.6 to 0.8; DBP mean difference: -1.5, 95% CI: -6.2 to 3.1). Further sensitivity analysis restricted to two high quality trials (n=138) also found non-significant reductions in blood pressure (SBP mean difference: -7.1, 95% CI: -19.9 to 5.7; DBP mean difference: -5.5, 95% CI: -14.5 to 3.5). AUTHORS' CONCLUSIONS This systematic review found no statistically significant effect of potassium supplementation on blood pressure. Because of the small number of participants in the two high quality trials, the short duration of follow-up, and the unexplained heterogeneity between trials, the evidence about the effect of potassium supplementation on blood pressure is not conclusive. Further high quality RCTs of longer duration are required to clarify whether potassium supplementation can reduce blood pressure and improve health outcomes.
Collapse
|
49
|
Dickinson HO, Nicolson DJ, Campbell F, Cook JV, Beyer FR, Ford GA, Mason J. Magnesium supplementation for the management of essential hypertension in adults. Cochrane Database Syst Rev 2006:CD004640. [PMID: 16856052 DOI: 10.1002/14651858.cd004640.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Epidemiological evidence on the effects of magnesium on blood pressure is inconsistent. Metabolic and experimental studies suggest that magnesium may have a role in the regulation of blood pressure. OBJECTIVES To evaluate the effects of magnesium supplementation as treatment for primary hypertension in adults. SEARCH STRATEGY We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review. SELECTION CRITERIA Inclusion criteria were: 1) RCTs of a parallel or crossover design comparing oral magnesium supplementation with placebo, no treatment, or usual care; 2) treatment and follow-up >/=8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >/=140 mmHg or diastolic blood pressure (DBP) >/=85 mmHg; 4) SBP and DBP reported at end of follow-up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or magnesium supplementation was combined with other interventions. DATA COLLECTION AND ANALYSIS Two reviewers independently abstracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted. MAIN RESULTS Twelve RCTs (n=545) with eight to 26 weeks follow-up met our inclusion criteria. The results of the individual trials were heterogeneous. Combining all trials, participants receiving magnesium supplements as compared to control did not significantly reduce SBP (mean difference: -1.3 mmHg, 95% CI: -4.0 to 1.5, I(2)=67%), but did statistically significantly reduce DBP (mean difference: -2.2 mmHg, 95% CI: -3.4 to -0.9, I(2)=47%). Sensitivity analyses excluding poor quality trials yielded similar results. Sub-group analyses and meta-regression indicated that heterogeneity between trials could not be explained by dose of magnesium, baseline blood pressure or the proportion of males among the participants. AUTHORS' CONCLUSIONS In view of the poor quality of included trials and the heterogeneity between trials, the evidence in favour of a causal association between magnesium supplementation and blood pressure reduction is weak and is probably due to bias. This is because poor quality studies generally tend to over-estimate the effects of treatment. Larger, longer duration and better quality double-blind placebo controlled trials are needed to assess the effect of magnesium supplementation on blood pressure and cardiovascular outcomes.
Collapse
Affiliation(s)
- H O Dickinson
- University of Newcastle, National Guideline Research & Development Unit, 21 Claremont Place, Newcastle upon Tyne, Tyne & Wear, UK NE2 4AA.
| | | | | | | | | | | | | |
Collapse
|
50
|
Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens 2006; 24:215-33. [PMID: 16508562 DOI: 10.1097/01.hjh.0000199800.72563.26] [Citation(s) in RCA: 467] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To quantify effectiveness of lifestyle interventions for hypertension. DATA SOURCES Electronic bibliographic databases from 1998 onwards, existing guidelines, systematic reviews. STUDY SELECTION AND DATA ABSTRACTION We included randomized, controlled trials with at least 8 weeks' follow-up, comparing lifestyle with control interventions, enrolling adults with blood pressure at least 140/85 mmHg. Primary outcome measures were systolic and diastolic blood pressure. Two independent reviewers selected trials and abstracted data; differences were resolved by discussion. RESULTS We categorized trials by type of intervention and used random effects meta-analysis to combine mean differences between endpoint blood pressure in treatment and control groups in 105 trials randomizing 6805 participants. Robust statistically significant effects were found for improved diet, aerobic exercise, alcohol and sodium restriction, and fish oil supplements: mean reductions in systolic blood pressure of 5.0 mmHg [95% confidence interval (CI): 3.1-7.0], 4.6 mmHg (95% CI: 2.0-7.1), 3.8 mmHg (95% CI: 1.4-6.1), 3.6 mmHg (95% CI: 2.5-4.6) and 2.3 mmHg (95% CI: 0.2-4.3), respectively, with corresponding reductions in diastolic blood pressure. Relaxation significantly reduced blood pressure only when compared with non-intervention controls. We found no robust evidence of any important effect on blood pressure of potassium, magnesium or calcium supplements. CONCLUSIONS Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.
Collapse
Affiliation(s)
- Heather O Dickinson
- University of Newcastle upon Tyne, Centre for Health Services Research, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | |
Collapse
|