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Maximova K, Loyola Elizondo E, Rippin H, Breda J, Cappuccio FP, Hajihosseini M, Wickramasinghe K, Novik I, Pisaryk V, Sturua L, Akmatova A, Obreja G, Mustafo SA, Ekinci B, Erguder T, Shukurov S, Hagverdiyev G, Andreasyan D, Ferreira-Borges C, Berdzuli N, Whiting S, Fedkina N, Rakovac I. Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries. Public Health Nutr 2023; 26:s20-s31. [PMID: 36779266 PMCID: PMC10801379 DOI: 10.1017/s1368980023000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/28/2022] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.
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Affiliation(s)
- Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ONM5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Enrique Loyola Elizondo
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - João Breda
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Francesco P Cappuccio
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Irina Novik
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RSPC MT), Minsk, Belarus
| | - Vital Pisaryk
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RSPC MT), Minsk, Belarus
| | - Lela Sturua
- National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Ainura Akmatova
- Department of Public Health, Ministry of Health, Bishkek, Kyrgyzstan
| | - Galina Obreja
- Department of Social Medicine and Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Saodat Azimzoda Mustafo
- State Research Institute of Gastroenterology, Ministry of Health and Social Protection of Population, Dushanbe, Republic of Tajikistan
| | - Banu Ekinci
- Department of Chronic Disease and Elderly Health, General Directorate of Public Health of Ministry of Health of Turkey, Ankara, Turkey
| | | | - Shukhrat Shukurov
- Central Project Implementation Bureau of the Health-3 Project, Tashkent, Uzbekistan
| | | | - Diana Andreasyan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Carina Ferreira-Borges
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Nino Berdzuli
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Stephen Whiting
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Natalia Fedkina
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Ivo Rakovac
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
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Marakis G, Marques Domingues A, Crispo A, Magriplis E, Vasara E, Kontopoulou L, Triantafyllou C, Skepastianos P, Papadopoulou SK, Rodopaios NE, Hassapidou M, Zampelas A, Cappuccio FP, Breda J. Pertinence of Salt-Related Knowledge and Reported Behaviour on Salt Intake in Adults: A Cross-Sectional Study. Nutrients 2023; 15:4114. [PMID: 37836397 PMCID: PMC10574173 DOI: 10.3390/nu15194114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.
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Affiliation(s)
- Georgios Marakis
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
| | - Ana Marques Domingues
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Anna Crispo
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
- Istituto Nazionale dei “Tumori Fondazione G. Pascale”, Via Mariano Semmola 52, 80131 Napoli, Italy
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Eleni Vasara
- School of Biology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece;
| | - Lamprini Kontopoulou
- Department of Nursing, University of Thessaly, Gaiopolis Campus, Larissa-Trikala Ring-Road, 41500 Larissa, Greece;
| | - Christos Triantafyllou
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | | | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | - Antonis Zampelas
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Francesco P. Cappuccio
- Medical School, University of Warwick, Coventry CV4 7AL, UK;
- WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry CV4 7AL, UK
| | - João Breda
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
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Campbell NRC, He FJ, McLean RM, Cappuccio FP, MacGregor GM. Comment on: Less sodium and more potassium to reduce cardiovascular risk and the PURE study. Eur Heart J Open 2023; 3:oead096. [PMID: 37860077 PMCID: PMC10584077 DOI: 10.1093/ehjopen/oead096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta T3L1S7, Canada
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Rachael M McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Francesco P Cappuccio
- University of Warwick, Warwick Medical School, WHO Collaborating Centre for Nutrition, Coventry CV47AL, UK
| | - Graham M MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
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Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
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Ali D, Tran P, Ennis S, Powell R, McGuire S, McGregor G, Kimani PK, Weickert MO, Miller MA, Cappuccio FP, Banerjee P. Rising arterial stiffness with accumulating comorbidities associates with heart failure with preserved ejection fraction. ESC Heart Fail 2023. [PMID: 37280726 PMCID: PMC10375151 DOI: 10.1002/ehf2.14422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/05/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Comorbidities play a significant role towards the pathophysiology of heart failure with preserved ejection fraction (HFpEF), characterized by abnormal macrovascular function and altered ventricular-vascular coupling. However, our understanding of the role of comorbidities and arterial stiffness in HFpEF remains incomplete. We hypothesized that HFpEF is preceded by a cumulative rise in arterial stiffness as cardiovascular comorbidities accumulate, beyond that associated with ageing. METHODS AND RESULTS Arterial stiffness was assessed using pulse wave velocity (PWV) in five groups: Group A, healthy volunteers (n = 21); Group B, patients with hypertension (n = 21); Group C, hypertension and diabetes mellitus (n = 20); Group D, HFpEF (n = 21); and Group E, HF with reduced ejection fraction (HFrEF) (n = 11). All patients were aged 70 and above. Mean PWV increased from Groups A to D (PWV 10.2, 12.2, 13.0, and 13.7 m/s, respectively) as vascular comorbidities accumulated independent of age, renal function, haemoglobin, obesity (body mass index), smoking status, and hypercholesterolaemia. HFpEF exhibited the highest PWV and HFrEF displayed near-normal levels (13.7 vs. 10 m/s, P = 0.003). PWV was inversely related to peak oxygen consumption (r = -0.304, P = 0.03) and positively correlated with left ventricular filling pressures (E/e') on echocardiography (r = -0.307, P = 0.014). CONCLUSIONS This study adds further support to the concept of HFpEF as a disease of the vasculature, underlined by an increasing arterial stiffness that is driven by vascular ageing and accumulating vascular comorbidities, for example, hypertension and diabetes. Reflecting a pulsatile arterial afterload associated with diastolic dysfunction and exercise capacity, PWV may provide a clinically relevant tool to identify at-risk intermediate phenotypes (e.g. pre-HFpEF) before overt HFpEF occurs.
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Affiliation(s)
- Danish Ali
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick Tran
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Stuart Ennis
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Scott McGuire
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gordon McGregor
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise and Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter K Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin O Weickert
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Francesco P Cappuccio
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Prithwish Banerjee
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
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6
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Cappuccio FP, D'Elia L, Rakovac I. Spot urine samples and estimation of population salt intake: the return of the phoenix? J Hypertens 2023; 41:869-871. [PMID: 37017034 DOI: 10.1097/hjh.0000000000003405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
- Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, UK
| | | | - Ivo Rakovac
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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7
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D’Elia L, Masulli M, Cappuccio FP, Zarrella AF, Strazzullo P, Galletti F. Dietary Potassium Intake and Risk of Diabetes: A Systematic Review and Meta-Analysis of Prospective Studies. Nutrients 2022; 14:nu14224785. [PMID: 36432472 PMCID: PMC9697076 DOI: 10.3390/nu14224785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Dietary potassium intake is positively associated with reduction of cardiovascular risk. Several data are available on the relationship between dietary potassium intake, diabetes risk and glucose metabolism, but with inconsistent results. Therefore, we performed a meta-analysis of the prospective studies that explored the effect of dietary potassium intake on the risk of diabetes to overcome these limitations. (2) Methods: A random-effects dose-response meta-analysis was carried out for prospective studies. A potential non-linear relation was investigated using restricted cubic splines. (3) Results: A total of seven prospective studies met the inclusion criteria. Dose-response analysis detected a non-linear relationship between dietary potassium intake and diabetes risk, with significant inverse association starting from 2900 mg/day by questionnaire and between 2000 and 5000 mg/day by urinary excretion. There was high heterogeneity among studies, but no evidence of publication bias was found. (4) Conclusions: The results of this meta-analysis indicate that habitual dietary potassium consumption is associated with risk of diabetes by a non-linear dose-response relationship. The beneficial threshold found supports the campaigns in favour of an increase in dietary potassium intake to reduce the risk of morbidity and mortality. Further studies should be carried out to explore this topic.
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Affiliation(s)
- Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
- Correspondence:
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Francesco P. Cappuccio
- World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Aquilino F. Zarrella
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy
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Zakauskiene U, Macioniene E, Zabuliene L, Sukackiene D, Linkeviciute-Dumce A, Banys V, Bratcikoviene N, Karosiene D, Slekiene V, Kontrimas V, Simanauskas K, Utkus A, Brazdziunaite D, Migline V, Makarskiene I, Zurlyte I, Rakovac I, Breda J, Cappuccio FP, Miglinas M. Sodium, Potassium and Iodine Intake in an Adult Population of Lithuania. Nutrients 2022; 14:nu14183817. [PMID: 36145201 PMCID: PMC9504939 DOI: 10.3390/nu14183817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Hypertension is a leading risk factor for cardiovascular events and death. A reduction in salt intake is among the most cost-effective strategies to reduce blood pressure and the risk of cardiovascular diseases. Increasing potassium lowers blood pressure and is associated with lower cardiovascular risk. Adequate iodine intake is important to prevent iodine deficiency disorders. Salt iodization is a key strategy to prevent such deficiency. In Lithuania, no surveys have been performed to directly assess sodium, potassium and iodine consumption. The aim of the present study was to measure sodium, potassium and iodine intake in a randomly selected adult Lithuanian adult population using 24 h urine collections, and to assess knowledge, attitudes and behavior towards salt consumption. Salt and potassium intakes were estimated in 888 randomly selected participants by 24 h urine sodium and potassium excretion and 679 individuals provided suitable 24 h urine samples for the analysis of iodine excretion. Average salt intake was 10.0 (SD 5.3) g/24 h and average potassium intake was 3.3 (SD 1.3) g/24 h. Only 12.5% of participants consumed less than 5 g/24 h of salt. The median value of urinary iodine concentration (UIC) was 95.5 μg/L. Our study showed that average salt intake is twice as high as the maximum level recommended by the World Health Organization while potassium and iodine intakes in Lithuania are below the recommended levels.
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Affiliation(s)
- Urte Zakauskiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
- Correspondence:
| | - Ernesta Macioniene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Lina Zabuliene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Diana Sukackiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Ausra Linkeviciute-Dumce
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Valdas Banys
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nomeda Bratcikoviene
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Faculty of Fundamental Sciences, Vilnius Gediminas Technical University, LT-10223 Vilnius, Lithuania
| | - Dovile Karosiene
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | | | | | - Kazys Simanauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
| | - Algirdas Utkus
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Deimante Brazdziunaite
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Vilma Migline
- Community Well-Being Center, Mykolas Romeris University, LT-08303 Vilnius, Lithuania
| | | | | | - Ivo Rakovac
- WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Joao Breda
- WHO Athens Quality of Care Office, 10675 Athens, Greece
| | - Francesco P. Cappuccio
- World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Department of Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
- Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT-08661 Vilnius, Lithuania
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9
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Campbell NRC, He FJ, McLean RM, Cappuccio FP, Woodward M, MacGregor GA, Guichon J, Mitchell I. Dietary sodium and cardiovascular disease in China: addressing the authors' response, statements and claims. J Hypertens 2022; 40:1831-1836. [PMID: 35943106 DOI: 10.1097/hjh.0000000000003122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Norman R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Rachael M McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Mark Woodward
- The George Institute for Global Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Juliet Guichon
- Departments of Community Health Sciences and Pediatrics, Cumming School of Medicine
| | - Ian Mitchell
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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10
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Abstract
OBJECTIVE To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA). DESIGN Systematic review. DATA SOURCES Medline, Embase, Scopus and Web of Science. ELIGIBILITY CRITERIA Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA. METHODS Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool. RESULTS 1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified. CONCLUSIONS There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies. PROSPERO REGISTRATION NUMBER CRD42020223043.
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Affiliation(s)
- Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | - Busola Oronti
- School of Engineering, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
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11
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Miller MA, Cappuccio FP. Reply to Hu et al. Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19. Sleep Med Rev 2022; 63:101625. [PMID: 35367720 PMCID: PMC8920960 DOI: 10.1016/j.smrv.2022.101625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle A Miller
- University of Warwick, Warwick Medical School, Division of Health Sciences (Mental Health and Wellbeing), Coventry UK.
| | - Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Division of Health Sciences (Mental Health and Wellbeing), Coventry UK
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12
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Maj C, Salvi E, Citterio L, Borisov O, Simonini M, Glorioso V, Barlassina C, Glorioso N, Thijs L, Kuznetsova T, Cappuccio FP, Zhang ZY, Staessen JA, Cusi D, Lanzani C, Manunta P. Dissecting the Polygenic Basis of Primary Hypertension: Identification of Key Pathway-Specific Components. Front Cardiovasc Med 2022; 9:814502. [PMID: 35252394 PMCID: PMC8888857 DOI: 10.3389/fcvm.2022.814502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/19/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction and Objectives Genome-wide association studies have identified a high number of genetic loci associated with hypertension suggesting the presence of an underlying polygenic architecture. In this study, we aimed to dissect the polygenic component of primary hypertension searching also for pathway-specific components. Methods The polygenic risk score (PRS) models, based on the UK biobank genetic signals for hypertension status, were obtained on a target Italian case/control cohort including 561 cases and 731 hyper-normal controls from HYPERGENES, and were then applied to an independent validation cohort composed by multi-countries European-based samples including 1,284 cases and 960 hyper-normal controls. Results The resulting genome-wide PRS was capable of stratifying the individuals for hypertension risk by comparing between individuals in the last PRS decile and the median decile: we observed an odds ratio (OR) of 3.62, CI = [2.01, 6.32] (P = 9.01E-07) and 3.22, 95% CI = [2.06, 5.10] (P = 6.47E-08) in the target and validation cohorts, respectively. The relatively high case/control ORs across PRS quantiles corroborates the presence of strong polygenic components which could be driven by an enrichment of risk alleles within the cases but also by potential enrichment of protective alleles in the old normotensive controls. Moreover, novel pathway-specific PRS revealed an enrichment of the polygenic signal attributable to specific biological pathways. Among those the most significantly associated with hypertension status was the calcium signaling pathway together with other mainly related such as the phosphatidylinositol/inositol phosphate pathways. Conclusions The development of pathway-specific PRS could prioritize biological mechanisms, according to their contribution to the genetic susceptibility, whose regulations might be a potential pharmacological preventive target.
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Affiliation(s)
- Carlo Maj
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
- *Correspondence: Carlo Maj
| | - Erika Salvi
- Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Lorena Citterio
- Genomics of Renal Diseases and Hypertension Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Oleg Borisov
- Institute for Genomic Statistics and Bioinformatics, Medical Faculty, University of Bonn, Bonn, Germany
| | - Marco Simonini
- Genomics of Renal Diseases and Hypertension Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Glorioso
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | | | - Nicola Glorioso
- Department of Clinical and Experimental Medicine, Hypertension and Related Diseases Centre, University of Sassari, Sassari, Italy
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Francesco P. Cappuccio
- Warwick Medical School, and UHCW NHS Trust, University of Warwick, Coventry, United Kingdom
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium
- Biomedical Science Group, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Daniele Cusi
- Institute of Biomedical Technologies Milano National Research Council of Italy (CNR), Milano, Italy
- Bio4Dreams Scientific Unit, Bio4Dreams-Business Nursery for Life Sciences, Milano, Italy
| | - Chiara Lanzani
- Genomics of Renal Diseases and Hypertension Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Manunta
- Genomics of Renal Diseases and Hypertension Unit, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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13
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Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, Banerjee A, Gill P. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol 2021; 9:419-426. [PMID: 33989535 PMCID: PMC8208895 DOI: 10.1016/s2213-8587(21)00088-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND National and global recommendations for BMI cutoffs to trigger action to prevent obesity-related complications like type 2 diabetes among non-White populations are questionable. We aimed to prospectively identify ethnicity-specific BMI cutoffs for obesity based on the risk of type 2 diabetes that are risk-equivalent to the BMI cutoff for obesity among White populations (≥30 kg/m2). METHODS In this population-based cohort study, we used electronic health records across primary care (Clinical Practice Research Datalink) linked to secondary care records (Hospital Episodes Statistics) from a network of general practitioner practices in England. Eligible participants were aged 18 years or older, without any past or current diagnosis of type 2 diabetes, had a BMI of 15·0-50·0 kg/m2 and complete ethnicity data, were registered with a general practitioner practice in England at any point between Sept 1, 1990, and Dec 1, 2018, and had at least 1 year of follow-up data. Patients with type 2 diabetes were identified by use of a CALIBER phenotyping algorithm. Self-reported ethnicity was collapsed into five main categories. Age-adjusted and sex-adjusted negative binomial regression models, with fractional polynomials for BMI, were fitted with incident type 2 diabetes and ethnicity data. FINDINGS 1 472 819 people were included in our study, of whom 1 333 816 (90·6%) were White, 75 956 (5·2%) were south Asian, 49 349 (3·4%) were Black, 10 934 (0·7%) were Chinese, and 2764 (0·2%) were Arab. After a median follow-up of 6·5 years (IQR 3·2-11·2), 97 823 (6·6%) of 1 472 819 individuals were diagnosed with type 2 diabetes. For the equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m2 in White populations, the BMI cutoffs were 23·9 kg/m2 (95% CI 23·6-24·0) in south Asian populations, 28·1 kg/m2 (28·0-28·4) in Black populations, 26·9 kg/m2 (26·7-27·2) in Chinese populations, and 26·6 kg/m2 (26·5-27·0) in Arab populations. INTERPRETATION Revisions of ethnicity-specific BMI cutoffs are needed to ensure that minority ethnic populations are provided with appropriate clinical surveillance to optimise the prevention, early diagnosis, and timely management of type 2 diabetes. FUNDING National Institute for Health Research.
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Affiliation(s)
- Rishi Caleyachetty
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Warwick Medical School, University of Warwick, Coventry, UK.
| | - Thomas M Barber
- Warwick Medical School, University of Warwick, Coventry, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Rebecca Hardy
- Social Research Institute, University College London, London, UK
| | - Rohini Mathur
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
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14
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Campbell NR, He FJ, Cappuccio FP, MacGregor GA, McLean RM. Levels of dietary sodium intake: diverging associations with arterial stiffness and Atheromatosis. Concerns about the evidence review and methods. Hellenic J Cardiol 2021; 63:92-93. [PMID: 34157420 DOI: 10.1016/j.hjc.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Francesco P Cappuccio
- University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, UK
| | - Rachael M McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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15
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Abstract
PURPOSE OF REVIEW High dietary sodium is estimated to be the leading dietary risk for death attributed to 1.8 million deaths in 2019. There are uniform recommendations to reduce sodium consumption based on evidence that increased dietary sodium is responsible for approximately a third of the prevalence of hypertension, and meta-analyses of randomized controlled trials show that sodium reduction lowers blood pressure, cardiovascular disease, and total mortality. Nevertheless, there is a perception that the beneficial effect of reducing dietary sodium is controversial. We provide experiential evidence relating to some sources of the controversy and propose potential solutions. RECENT FINDINGS Inappropriate research methodology, lack of rigor in research, conflicts of interest and commercial bias, questions of professional conduct, and lack of policies to protect public interests are likely to contribute to the controversy about reducing dietary sodium. There is a failure to protect policies to reduce dietary sodium from nonscientific threats. Significant efforts need to be made to ensure the integrity of nutritional research and maintain public trust.
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Affiliation(s)
- N R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - F J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - F P Cappuccio
- University of Warwick, WHO Collaborating Centre for Nutrition, Coventry, UK
| | - G A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
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16
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McDonnell BJ, Rees E, Cockcroft JR, Beaney T, Clayton B, Le Kieu P, Brady AJB, Padmanabhan S, McCallum L, Dolan E, O'Brien E, Tomaszewski M, Schutte AE, Poulter NR, Cappuccio FP. May Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland. Eur Heart J Suppl 2021; 23:B147-B150. [PMID: 34054372 PMCID: PMC8141951 DOI: 10.1093/eurheartj/suab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor for around half of all deaths from coronary heart disease or stroke. We participated in May Measurement Month 2019 to increase awareness of blood pressure (BP) measurement, and to identify the proportion of undiagnosed hypertension and degree of uncontrolled hypertension in the community. The 2019 campaign set up screening sites within the community at places of worship, supermarkets, GP surgeries, workplaces, charity events, community pharmacies, gyms, and various other public places. We screened 10194 participants (mean age 51 ± 18 years, 60% women) and found that 1013 (9.9%) were on antihypertensive treatment, while 3408 (33.4%) had hypertension. Of the 3408 participants with hypertension, only 33.5% were aware of their condition despite 98.8% having previous BP measurements. In those on antihypertensive medication, only 38.2% had controlled BP (<140 and <90 mmHg). Our UK and Republic of Ireland data demonstrate concerning levels of undiagnosed hypertension and sub-optimal BP control in many individuals with a diagnosis. This evidence supports a critical need for better systematic community and primary care screening initiatives.
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Affiliation(s)
- Barry J McDonnell
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK
| | - Emma Rees
- Faculty of Health and Life Science, Swansea University, Singleton Campus, Swansea SA2 8PP, UK
| | - John R Cockcroft
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | | | | | - Adrian J B Brady
- University of Glasgow, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow G12 8TD, UK
| | - Linsay McCallum
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, Glasgow G12 8TD, UK
| | | | - Eoin O'Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Aletta E Schutte
- Faculty of Medicine, University of New South Wales, George Institute for Global Health, Sydney, Australia
| | - Neil R Poulter
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
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17
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Guo Y, Miller MA, Cappuccio FP. Short duration of sleep and incidence of overweight or obesity in Chinese children and adolescents: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2021; 31:363-371. [PMID: 33487495 DOI: 10.1016/j.numecd.2020.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Overweight and obesity in children have become a global public health problem. Epidemiological studies suggest that sleep duration may contribute to the incidence of overweight and obesity in all stages of life. China has an increasing prevalence of overweight and obesity, and sleep deprivation is common among Chinese children. The aim of this study was to assess the prospective relationship between short sleep duration and overweight or obesity in Chinese children and to gain an estimate of the risk. METHODS AND RESULTS A systematic search was performed on 28/04/2020 by using Medline, PubMed and Web of Science. The exposure was the duration of sleep, and the outcome measure the incidence of overweight or obesity. The odds ratios (OR) and hazard ratios (HR) and 95% confidence intervals (C.I.) were extracted to calculate the pooled relative risk (RR) by a random effect model. Heterogeneity and publication bias of the studies were checked by sensitivity analysis. Seven studies fulfilled the criteria for a systematic review, and 5 studies for a meta-analysis. The total of 33,206 participants included boys and girls, aged 6-17 years old. In Chinese children the pooled RR for short sleep duration and overweight or obesity combined was 1.47 (95% C.I. 1.26, 1.71, p < 0.00001, n = 32,607), and for obesity alone 1.40 (95% C.I. 1.01, 1.95, p = 0.04, n = 17,038). There was no significant heterogeneity or publication bias between studies. CONCLUSION Short sleep duration is associated with the development of overweight and obesity in Chinese children.
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Affiliation(s)
- Yuan Guo
- University of Warwick, Warwick Medical School, Division of Health Sciences (Mental Health & Wellbeing), Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Michelle A Miller
- University of Warwick, Warwick Medical School, Division of Health Sciences (Mental Health & Wellbeing), Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Division of Health Sciences (Mental Health & Wellbeing), Gibbet Hill Road, Coventry, CV4 7AL, UK; University Hospital Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
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18
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Miller MA, Bates S, Ji C, Cappuccio FP. Systematic review and meta-analyses of the relationship between short sleep and incidence of obesity and effectiveness of sleep interventions on weight gain in preschool children. Obes Rev 2021; 22:e13113. [PMID: 33237635 DOI: 10.1111/obr.13113] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study is to determine (a) whether short sleep is associated with the incidence of obesity and (b) whether interventions beneficial for sleep reduce weight gain in preschool children. We systematically searched PubMed, Embase, Web of Science and Cochrane up to 12/09/2019. (a) Studies that were included were prospective, had follow-up ≥1 year, with sleep duration at baseline and required outcome measures. (b) Intervention trials with sleep intervention and measures of overweight or obesity were included. Data were extracted according to PRISMA guidelines. (a) The risk of developing overweight/obesity was greater in short sleeping children (13 studies, 42 878 participants, RR: 1.54; 95% CI, 1.33 to 1.77; p < 0.001). Sleep duration was associated with a significant change in BMI z-score (10 studies, 11 cohorts and 29 553 participants) (mean difference: -0.02 unit per hour sleep; -0.03 to -0.01; p < 0.001). (b) Four of the five intervention studies reported improved outcomes: for BMI (-0.27 kg/m2 ; -0.50 to -0.03; p = 0.03); for BMI z-score (-0.07 unit; -0.12 to -0.02; p = 0.006). Short sleep duration is a risk factor or marker of the development of obesity in preschool children. Intervention studies suggest that improved sleep may be beneficially associated with a reduced weight gain in these children.
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Affiliation(s)
- Michelle A Miller
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Sarah Bates
- Birmingham Community Healthcare NHS Foundation Trust (Birmingham Community Nutrition), Birmingham, UK
| | - Chen Ji
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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19
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Abstract
The aims of the study were to review the rapidly emerging COVID-19 literature to determine 1) the relationship between obstructive sleep apnoea (OSA) and adverse COVID-19 outcomes and, 2) potential causal mechanisms 3) what effect COVID-19 has had on OSA diagnosis and 4) what effect COVID-19 has had on treatment and management of OSA during this period. PubMed was systematically searched up to 020620. Studies were included if they had examined the relationship between COVID-19 and OSA. Studies were included that were in English and had the full text available. The findings from this study suggest that many of the risk factors and co-morbidities associated for OSA which include obesity, hypertension and diabetes mellitus are associated with poor COVID-19 outcomes. There are plausible mechanisms by which OSA may independently increase one's risk of morbidity and mortality associated with COVID-19 and data from the newly published CORONADO study suggests that OSA treated patients may be at increased risk of death from COVID-19. It is clear that the pandemic has had a major effect on the treatment management and diagnosis of OSA and moving forward it may be necessary to explore new diagnosis and treatment pathways for these individuals.
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Affiliation(s)
- Michelle A Miller
- Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK.
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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20
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Clarke L, Chisholm K, Cappuccio FP, Tang NKY, Miller MA, Elahi F, Thompson AD. Sleep disturbances and the At Risk Mental State: A systematic review and meta-analysis. Schizophr Res 2021; 227:81-91. [PMID: 32646803 DOI: 10.1016/j.schres.2020.06.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and investigate how sleep disturbances relate to psychotic symptoms, functioning and Quality of Life (QoL) in At Risk Mental State (ARMS) youth. METHOD A comprehensive search of six databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and CENTRAL) was conducted. Eligible studies provided data on sleep disturbances or disorders in ARMS patients. RESULTS Sixteen studies met the inclusion criteria (n = 1962 ARMS patients) including 7 cross-sectional studies, 2 RCT's and 7 cohort studies. Narrative synthesis revealed that self-reported sleep (e.g., general disturbances, fragmented night time sleep and nightmares) was poorer among ARMS patients compared to healthy controls. In the limited studies (n = 4) including objective measurements of sleep disturbances, ARMS patients experienced higher levels of movement during sleep, more daytime naps and increased sleep latency compared to controls. Furthermore, sleep disturbances were associated with attenuated psychotic symptoms and functional outcomes cross-sectionally and longitudinally. Only one study investigated the relationship between sleep and QoL. The exploratory meta-analysis revealed a significant difference in self-reported sleep disturbances measured by the PSQI (mean difference in score: 3.30 (95% CI 1.87, 4.74), p < 0.00001) and SIPS (mean difference in score: 1.58 (95% CI 0.80, 2.35), p < 0.00001) of ARMS patients compared to control groups. CONCLUSIONS ARMS individuals report impaired sleep quality and reduced sleep quantity compared to healthy controls. However, further research is needed to explore the longitudinal relationship between sleep disruptions and QoL in early psychosis. Significant variations in how sleep is measured across studies highlight a need to assess disturbances to sleep using robust and consistent approaches in this patient group.
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Affiliation(s)
- Latoya Clarke
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK.
| | | | - Francesco P Cappuccio
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nicole K Y Tang
- Department of Psychology, University of Warwick, Coventry, UK
| | - Michelle A Miller
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Farah Elahi
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew D Thompson
- Mental Health and Wellbeing Division, Warwick Medical School, University of Warwick, Coventry, UK
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21
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Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials. J Hypertens 2021; 39:23-37. [PMID: 33275398 DOI: 10.1097/hjh.0000000000002604] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The consumption of strict vegetarian diets with no animal products is associated with low blood pressure (BP). It is not clear whether less strict plant-based diets (PBDs) containing some animal products exert a similar effect. The main objective of this meta-analysis was to assess whether PBDs reduce BP in controlled clinical trials. METHODS We searched Cumulative Index to Nursing and Allied Health Literature, Medline, Embase, and Web of Science to identify controlled clinical trials investigating the effect of PBDs on BP. Standardized mean differences in BP and 95% confidence intervals were pooled using a random effects model. Risk of bias, sensitivity, heterogeneity, and publication bias were assessed. RESULTS Of the 790 studies identified, 41 clinical trials met the inclusion criteria (8416 participants of mean age 49.2 years). In the pooled analysis, PBDs were associated with lower SBP [Dietary Approach to Stop Hypertension -5.53 mmHg (95% confidence intervals -7.95,-3.12), Mediterranean -0.95 mmHg (-1.70,-0.20), Vegan -1.30 mmHg (-3.90,1.29), Lacto-ovo vegetarian -5.47 mmHg (-7.60,-3.34), Nordic -4.47 mmHg (-7.14,-1.81), high-fiber -0.65 mmHg (-1.83,0.53), high-fruit and vegetable -0.57 mmHg (-7.45,6.32)]. Similar effects were seen on DBP. There was no evidence of publication bias and some heterogeneity was detected. The certainty of the results is high for the lacto-ovo vegetarian and Dietary Approach to Stop Hypertension diets, moderate for the Nordic and Mediterranean diets, low for the vegan diet, and very low for the high-fruit and vegetable and high-fiber diets. CONCLUSION PBDs with limited animal products lower both SBP and DBP, across sex and BMI.
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Affiliation(s)
- Joshua Gibbs
- University of Warwick, World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences
| | - Eleanor Gaskin
- University of Warwick, World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences
| | - Chen Ji
- University of Warwick, World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences
| | - Michelle A Miller
- University of Warwick, World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences
| | - Francesco P Cappuccio
- University of Warwick, World Health Organization Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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22
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Al-Mawali A, D'Elia L, Jayapal SK, Morsi M, Al-Shekaili WN, Pinto AD, Al-Kharusi H, Al-Balushi Z, Idikula J, Al-Harrasi A, Cappuccio FP. National survey to estimate sodium and potassium intake and knowledge attitudes and behaviours towards salt consumption of adults in the Sultanate of Oman. BMJ Open 2020; 10:e037012. [PMID: 33099493 PMCID: PMC7590363 DOI: 10.1136/bmjopen-2020-037012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate population sodium and potassium intakes and explore knowledge, attitudes and behaviour (KAB) towards the use of salt in adults in the Sultanate of Oman. DESIGN National cross-sectional population-based survey. SETTING Proportional random samples, representative of Omani adults (18 years or older), were obtained from all governorates of the Sultanate of Oman. PARTICIPANTS Five hundred and sixty-nine (193 men, 376 women; 18 years or older) were included in the analysis (response rate 57%). Mean age was 39.4 years (SD 13.1). Participants attended a screening including demographic, anthropometric and physical measurements. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed dietary sodium, potassium and creatinine by 24-hour urinary sodium (UNa), potassium (UK) and creatinine (UCr) excretions. We collected KAB by a questionnaire on an electronic tablet. RESULTS Mean UNa was 144.3 (78.8) mmol/day, equivalent to 9.0 g of salt/day and potassium excretion 52.6 (32.6) mmol/day, equivalent to 2.36 g/day, after adjusting for non-urinary losses. Men ate significantly more sodium and potassium than women. Only 22% of the sample had a salt intake below the WHO recommended target of 5 g/day and less than 10% met WHO targets for potassium excretion (>90 mmol/day). While 89.1% of those interviewed knew that consuming too much salt could cause serious health problems and only 6.9% felt they were using too much added salt, one in two participants used always or often salt, salty seasonings or salty sauces in cooking or when preparing food at home. CONCLUSIONS In the Sultanate of Oman, salt consumption is higher and potassium consumption lower than recommended by WHO, both in men and in women. The present data provide, for the first time, evidence to support a national programme of population salt reduction to prevent the increasing burden of cardiovascular disease in the area.
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Affiliation(s)
- Adhra Al-Mawali
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
- The Research Council, Seeb, Oman
| | - Lanfranco D'Elia
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | | | - Magdi Morsi
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | - Avinash D Pinto
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | | | - John Idikula
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | - Francesco P Cappuccio
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Division of Medicine, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Abstract
The accurate measurement, prediction and treatment of high blood pressure (BP) are essential to the management of hypertension and the prevention of its associated cardiovascular (CV) risks. However, even if BP is optimally controlled during the day, nocturnal high blood pressure may still increase the risk of CV events. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). Night-time ABPM is more closely associated with fatal and nonfatal CV events than daytime ambulatory BP. However, the use of ABPM is limited by low availability and the fact that it can cause sleep disturbance, therefore may not provide realistic nocturnal measurements. Home blood pressure monitoring (HBPM) offers an inexpensive alternative to ABPM, is preferred by patients and provides a more realistic assessment of BP during an individual’s daily life. However, until recently, HBPM did not offer the possibility to measure nocturnal (sleep time) BP. The development and validation of new BP devices, such as the NightView (OMRON Healthcare, HEM9601T-E3) HBPM device, could overcome these limitations, offering the possibility of daytime and night-time BP measurements with minimal sleep disturbance.
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Affiliation(s)
- Francesco P Cappuccio
- ESH Centre of Excellence in Hypertension and Cardio-metabolic Research, University of Warwick Medical School Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK
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Cappuccio FP, Siani A. Covid-19 and cardiovascular risk: Susceptibility to infection to SARS-CoV-2, severity and prognosis of Covid-19 and blockade of the renin-angiotensin-aldosterone system. An evidence-based viewpoint. Nutr Metab Cardiovasc Dis 2020; 30:1227-1235. [PMID: 32595085 PMCID: PMC7256508 DOI: 10.1016/j.numecd.2020.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023]
Abstract
The presence of cardiovascular co-morbidities and the known effects of coronaviruses on the cardiovascular system have called attention to the potential implications for patients with cardiovascular risk factors. This evidence-based viewpoint will address two questions: (a) are individuals with underlying cardiovascular risk factors (e.g. high blood pressure or diabetes) or overt disease (e.g. coronary heart disease, heart failure, kidney disease) more likely to develop severe Covid-19 and to die than those without underlying conditions? (b) does the regular use of angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin-receptor blockers (ARB) make patients more likely to get infected and to die of Covid-19? With a necessary cautionary note that the evidence around the links between Covid-19 and cardiovascular disease is accruing at a fast pace, to date we can conclude that: (a) the greater susceptibility of individuals with underlying cardiovascular conditions to develop more severe Covid-19 with higher mortality rate is likely to be confounded, in part, by age and the type of co-morbidities. Patients with heart failure or chronic kidney disease might show an excess risk; (b) neither ACE-i nor ARB are associated with greater risk of SARS-Cov2 infection, or severity or risk of death in patients with Covid-19. Patients on these drugs should not stop them, unless under strict medical supervision and with the addition of a suitable replacement medicine.
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Affiliation(s)
- Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Coventry, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
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25
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Affiliation(s)
- Francesco P Cappuccio
- University of Warwick and University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV4 7AL, UK
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26
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D'Elia L, Giaquinto A, Cappuccio FP, Iacone R, Russo O, Strazzullo P, Galletti F. Circulating leptin is associated with serum uric acid level and its tubular reabsorption in a sample of adult middle-aged men. J Endocrinol Invest 2020; 43:587-593. [PMID: 31691260 DOI: 10.1007/s40618-019-01140-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Leptin is associated with cardiovascular risk factors (e.g. hypertension, insulin resistance, kidney disease and excess body weight). Experimental studies showed that leptin might affect serum uric acid, by modulation of the uric acid excretion. However, there are few observational data on the relationship between leptin and uric acid in the general population. Therefore, the aim of the present study was to evaluate the relationship between leptin and uric acid and its excretion in a large middle-aged male general population. METHODS A sample of 930 adult male individuals (mean age: 52 years) without therapy for high uric acid was included in the analysis (the Olivetti Heart Study). RESULTS Uric acid was significantly and positively associated with blood pressure, BMI, waist circumference, insulin resistance, C-reactive protein and leptin (p < 0.01), while inversely with renal function (p = 0.01). The multivariate analysis confirmed the association between leptin and uric acid after adjustment for potential confounders (p < 0.01). After division for adiposity, this trend was confirmed separately for normal weight and excess body weight participants. Moreover, leptin was inversely associated with excretion of uric acid (p < 0.01), also in multivariate analysis (p = 0.03). CONCLUSION The results of this study indicate a positive association between circulating leptin levels and uric acid, independently of potential confounders, both in normal and excess body weight men. Furthermore, an inverse association between leptin and uric acid excretion was detected.
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Affiliation(s)
- L D'Elia
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy.
| | - A Giaquinto
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - F P Cappuccio
- World Health Organization Collaborating Centre for Nutrition, University of Warwick, Coventry, CV4 7AL, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - R Iacone
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - O Russo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - P Strazzullo
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy
| | - F Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Via S. Pansini, 5, 80131, Naples, Italy.
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27
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Cappuccio FP, Sever PS. Correction: The importance of a valid assessment of salt intake in individuals and populations. A scientific statement of the British and Irish Hypertension Society. J Hum Hypertens 2020; 34:338. [PMID: 32103155 PMCID: PMC7165124 DOI: 10.1038/s41371-020-0317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Maluf CB, Barreto SM, Giatti L, Ribeiro AL, Vidigal PG, Azevedo DRM, Griep RH, Matos SMA, Ji C, Cappuccio FP, Miller MA. Association between C reactive protein and all-cause mortality in the ELSA-Brasil cohort. J Epidemiol Community Health 2020; 74:421-427. [PMID: 32102838 PMCID: PMC7307658 DOI: 10.1136/jech-2019-213289] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 01/15/2023]
Abstract
Background High-sensitivity C reactive protein (hsCRP) has been proposed as a marker of incident cardiovascular disease and vascular mortality, and may also be a marker of non-vascular mortality. However, most evidence comes from either North American or European cohorts. The present proposal aims to investigate the association of hsCRP with the risk of all-cause mortality in a multiethnic Brazilian population. Methods Baseline data (2008–2010) of a cohort of 14 238 subjects participating in the Brazilian Longitudinal Study of Adult Health were used. hsCRP was assayed with immunochemistry. The association of baseline covariates with all-cause mortality was calculated by Cox regression for univariate model and adjusted for different confounders after a mean follow-up of 8.0±1.1 years. The final model was adjusted for age, sex, self-rated race/ethnicity, schooling, health behaviours and prevalent chronic disease. Results The risk of death increased steadily by quartiles of hsCRP, from 1.45 (95% CI 1.05 to 2.01) in quartile 2 to 1.95 (95% CI 1.42 to 2.69) in quartile 4, compared with quartile 1. Furthermore, the persistence of a significant graded association after the exclusion of deaths in the first year of follow-up suggests that these results are unlikely to be due to reverse causality. Finally, the HR was unaffected by the exclusion of participants who had self-reported medical history of diabetes, cancer and chronic obstructive pulmonary disease. Conclusions Our study shows that hsCRP level is associated with mortality in a highly admixed population, independent of a large set of lifestyle and clinical variables.
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Affiliation(s)
- Chams B Maluf
- Clinical Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Preventive Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luana Giatti
- Preventive Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antonio Luiz Ribeiro
- Clinical Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Pedro G Vidigal
- Clinical Pathology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Douglas R M Azevedo
- Department of Statistics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosane H Griep
- Epidemiology, Oswaldo Cruz Foundation-National School of Public Health, Rio de Janeiro, Brazil
| | | | - Chen Ji
- Warwick Medical School, University of Warwick, Coventry, UK
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29
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Affiliation(s)
- Tracey L Sletten
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | | | - Alec J Davidson
- Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA
| | - Eve Van Cauter
- Department of Medicine, University of Chicago, Chicago, IL
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA
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30
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Ali D, Callan N, Ennis S, Powell R, McGuire S, McGregor G, Weickert MO, Miller MA, Cappuccio FP, Banerjee P. Heart failure with preserved ejection fraction (HFpEF) pathophysiology study (IDENTIFY-HF): does increased arterial stiffness associate with HFpEF, in addition to ageing and vascular effects of comorbidities? Rationale and design. BMJ Open 2019; 9:e027984. [PMID: 31748285 PMCID: PMC6886989 DOI: 10.1136/bmjopen-2018-027984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS There has been a paradigm shift proposing that comorbidities are a major contributor towards the heart failure with preserved ejection fraction (HFpEF) syndrome. Furthermore, HFpEF patients have abnormal macrovascular and microvascular function, which may significantly contribute towards altered ventricular-vascular coupling in these patients. The IDENTIFY-HF study will investigate whether gradually increased arterial stiffness (in addition to ageing) as a result of increasing common comorbidities, such as hypertension and diabetes, is associated with HFpEF. METHODS AND ANALYSIS In our observational study, arterial compliance and microvascular function will be assessed in five groups (Groups A to E) of age, sex and body mass index matched subjects (age ≥70 years in all groups):Group A; normal healthy volunteers without major comorbidities such as hypertension and diabetes mellitus (control). Group B; patients with hypertension without diabetes mellitus or heart failure (HF). Group C; patients with hypertension and diabetes mellitus without HF. Group D; patients with HFpEF. Group E; patients with heart failure and reduced ejection fraction (parallel group). Vascular function and arterial compliance will be assessed using pulse wave velocity, as the primary outcome measure. Further outcome measures include cutaneous laser Doppler flowmetry as a measure of endothelial function, transthoracic echocardiography and exercise tolerance measures. Biomarkers include NT-proBNP, high-sensitivity troponin T, as well as serum galectin-3 as a marker of fibrosis. ETHICS AND DISSEMINATION The study was approved by the regional research ethics committee (REC), West Midland and Black Country 17/WM/0039, UK, and permission to conduct the study in the hospital was also obtained from the RDI, UHCW NHS Trust. The results will be published in peer-reviewed journals and presented in local, national and international medical society meetings. TRIAL REGISTRATION NUMBER NCT03186833.
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Affiliation(s)
- Danish Ali
- Department of Academic Cardiology, University Hospitals Coventry & Warwickshire NHS trust, Coventry, UK
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Nualla Callan
- Department of Academic Cardiology, University Hospitals Coventry & Warwickshire NHS trust, Coventry, UK
| | - Stuart Ennis
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK
| | - Richard Powell
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Scott McGuire
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Gordon McGregor
- Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- University of Warwick, Warwick Medical School, Coventry, UK
- Department of Endocrinology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Dept of Health & Life Sciences, Coventry University, Coventry, UK
| | - Michelle A Miller
- Division of Translational and Systems Medicine, University of Warwick, Warwick Medical School, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, University of Warwick, Warwick Medical School, Coventry, UK
| | - Prithwish Banerjee
- University of Warwick, Warwick Medical School, Coventry, UK
- Dept of Health & Life Sciences, Coventry University, Coventry, UK
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31
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Cappuccio FP, Sever PS. Reply to Chiolero: Salt intake monitoring at a population level. J Hum Hypertens 2019; 34:666-667. [PMID: 31641195 DOI: 10.1038/s41371-019-0271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Francesco P Cappuccio
- WHO Collaborating Centre for Nutrition, Warwick Medical School, and UHCW NHS Trust, University of Warwick, Coventry, UK
| | - Peter S Sever
- Imperial College London, National Heart & Lung Institute, London, UK
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32
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Campbell NRC, Webster J, Blanco-Metzler A, He FJ, Tan M, MacGregor GA, Cappuccio FP, Arcand J, Trieu K, Farrand C, Jones A, Whelton PK, Zhang XH. Packages of sodium (Salt) sold for consumption and salt dispensers should be required to have a front of package health warning label: A position statement of the World Hypertension League, national and international health and scientific organizations. J Clin Hypertens (Greenwich) 2019; 21:1623-1625. [PMID: 31553515 DOI: 10.1111/jch.13698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Norm 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, AB, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Adriana Blanco-Metzler
- Unit of Health and Nutrition, Costa Rican Institute of Research and Teaching in Nutrition and Health, Tres Rios, Costa Rica
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - JoAnne Arcand
- Ontario Tech University (University of Ontario Institute of Technology), Oshawa, ON, Canada
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Clare Farrand
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Tulane University of Medicine, New Orleans, LA, USA
| | - Xin-Hua Zhang
- Beijing Hypertension League Institute, Beijing, China
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Lobo MD, Sharp ASP, Kapil V, Davies J, de Belder MA, Cleveland T, Bent C, Chapman N, Dasgupta I, Levy T, Mathur A, Matson M, Saxena M, Cappuccio FP. Joint UK societies' 2019 consensus statement on renal denervation. Heart 2019; 105:1456-1463. [PMID: 31292190 PMCID: PMC6817707 DOI: 10.1136/heartjnl-2019-315098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/11/2019] [Accepted: 04/16/2019] [Indexed: 02/06/2023] Open
Abstract
Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.
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Affiliation(s)
- Melvin D Lobo
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Andrew S P Sharp
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Department of Cardiology, Exeter Hospital, University of Exeter, Exeter, UK
| | - Vikas Kapil
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Justin Davies
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Mark A de Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK.,The National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
| | - Trevor Cleveland
- Sheffield Vascular Institute, Sheffield Teaching Hospitals NHSFT, Northern General Hospital, Sheffield, UK
| | - Clare Bent
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Neil Chapman
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - Terry Levy
- Department of Interventional Radiology, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Anthony Mathur
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Manish Saxena
- William Harvey Research Institute, Centre for Clinical Pharmacology, NIHR Biomedical Research Centre at Barts, Queen Mary University London, London, UK.,Department of Cardiovascular Medicine, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Francesco P Cappuccio
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Campbell NRC, He FJ, Tan M, Cappuccio FP, Neal B, Woodward M, Cogswell ME, McLean R, Arcand J, MacGregor G, Whelton P, Jula A, L'Abbe MR, Cobb LK, Lackland DT. The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24-hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake. J Clin Hypertens (Greenwich) 2019; 21:700-709. [PMID: 31087778 DOI: 10.1111/jch.13551] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/26/2022]
Abstract
The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology, Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Francesco P Cappuccio
- Division of Health Sciences, WHO Collaborating Centre for Nutrition, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bruce Neal
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Rachael McLean
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa Ontario, Canada
| | - Graham MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Paul Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.,Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Antti Jula
- Department of Public Health Solutions, National Institute for Health and Welfare, Turku, Finland
| | - Mary R L'Abbe
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura K Cobb
- Resolve to Save Lives, Vital Strategies, New York, NY
| | - Daniel T Lackland
- Department of Neurology, Division of Translational Neuroscience and Population Studies, Medical University of South Carolina, Charleston, South Carolina
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McDonnell BJ, Keitley J, Beaney T, Tay T, Brady AJB, Padmanabhan S, Cockcroft JR, Dolan E, Heagerty A, Greenstein A, Tomaszewski M, Schutte AE, Poulter NR, Cappuccio FP. May Measurement Month 2017: an analysis of blood pressure screening results from the United Kingdom and the Republic of Ireland-Europe. Eur Heart J Suppl 2019; 21:D121-D123. [PMID: 31043898 PMCID: PMC6479415 DOI: 10.1093/eurheartj/suz072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
Elevated blood pressure (BP), or hypertension, is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and acting as a stimulus to improving screening programmes worldwide. In the United Kingdom (UK) nearly 1 in 5 people, and in the Republic of Ireland (RoI) 3 out of 10, have hypertension, of which a large proportion remains undiagnosed. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed a standardized protocol. Screenings sites in hospitals, universities, shopping centres, workplaces, sports clubs, community centres, GP practices, and pharmacies were set up across the UK and RoI as part of this initiative. Seven thousand seven hundred and fourteen individuals were screened during MMM17. After multiple imputation, 3099 (40.3%) had hypertension. Of individuals not receiving antihypertensive medication, 1406 (23.4%) were hypertensive. Of individuals receiving antihypertensive medication, 682 (40.5%) had uncontrolled BP. MMM17 was the largest BP screening campaign ever undertaken in the UK and RoI. These data prove for the first time that a relatively inexpensive, volunteer based, convenience sampling of screening BP in the community identified two out of five individuals as hypertensive, with one in four not receiving treatment. Of major concern is that these data demonstrate that of those individuals receiving treatment, two out of five still did not have controlled BP.
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Affiliation(s)
| | - James Keitley
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Tricia Tay
- University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | | - Alta E Schutte
- North-West University/Medical Research Council, Potchefstroom, South Africa
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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Leng Y, Musiek ES, Hu K, Cappuccio FP, Yaffe K. Association between circadian rhythms and neurodegenerative diseases. Lancet Neurol 2019; 18:307-318. [PMID: 30784558 PMCID: PMC6426656 DOI: 10.1016/s1474-4422(18)30461-7] [Citation(s) in RCA: 314] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/07/2018] [Accepted: 11/21/2018] [Indexed: 02/07/2023]
Abstract
Dysfunction in 24-h circadian rhythms is a common occurrence in ageing adults; however, circadian rhythm disruptions are more severe in people with age-related neurodegenerative diseases, including Alzheimer's disease and related dementias, and Parkinson's disease. Manifestations of circadian rhythm disruptions differ according to the type and severity of neurodegenerative disease and, for some patients, occur before the onset of typical clinical symptoms of neurodegeneration. Evidence from preliminary studies suggest that circadian rhythm disruptions, in addition to being a symptom of neurodegeneration, might also be a potential risk factor for developing Alzheimer's disease and related dementias, and Parkinson's disease, although large, longitudinal studies are needed to confirm this relationship. The mechanistic link between circadian rhythms and neurodegeneration is still not fully understood, although proposed underlying pathways include alterations of protein homoeostasis and immune and inflammatory function. While preliminary clinical studies are promising, more studies of circadian rhythm disruptions and its mechanisms are required. Furthermore, clinical trials are needed to determine whether circadian interventions could prevent or delay the onset of neurodegenerative diseases.
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Affiliation(s)
- Yue Leng
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA.
| | - Erik S Musiek
- Hope Center for Neurological Disorders and Knight Alzheimer Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Kun Hu
- Medical Biodynamics Program, Division of Sleep and Circadian Disorders, Department of Medicine and Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; San Francisco VA Medical Center, San Francisco, CA, USA
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D'Elia L, Brajović M, Klisic A, Breda J, Jewell J, Cadjenović V, Cappuccio FP. Sodium and Potassium Intake, Knowledge Attitudes and Behaviour Towards Salt Consumption Amongst Adults in Podgorica, Montenegro. Nutrients 2019; 11:nu11010160. [PMID: 30642124 PMCID: PMC6356471 DOI: 10.3390/nu11010160] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/14/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Excess salt and inadequate potassium intakes are associated with high cardiovascular disease (CVD). In Montenegro, CVD is the leading cause of death and disability. There is no survey that has directly measured salt and potassium consumption in Montenegro. The aim is to estimate population salt and potassium intakes and explore knowledge, attitudes and behaviour (KAB), amongst the adult population of Podgorica. Random samples of adults were obtained from primary care centres. Participants attended a screening including demographic, anthropometric and physical measurements. Dietary salt and potassium intakes were assessed by 24 h urinary sodium (UNa) and potassium (UK) excretions. Creatinine was measured. KAB was collected by questionnaire. Six hundred and thirty-nine (285 men, 25–65 years) were included in the analysis (response rate 63%). Mean UNa was 186.5 (SD 90.3) mmoL/day, equivalent to 11.6 g of salt/day and potassium excretion 62.5 (26.2) mmoL/day, equivalent to 3.2 g/day. Only 7% of them had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and 13% ate enough potassium (>90 mmoL/day). The majority (86%) knew that high salt causes ill-health. However, only 44% thought it would be useful to reduce consumption. Salt consumption is high and potassium consumption is low, in men and women living in Podgorica.
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Affiliation(s)
- Lanfranco D'Elia
- World Health Organization Collaborating Centre for Nutrition, University of Warwick, Coventry CV4 7AL, UK.
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, 80131 Naples, Italy.
| | - Mina Brajović
- World Health Organization Regional Office, 81000 Podgorica, Montenegro.
| | - Aleksandra Klisic
- Center for Laboratory Diagnostics, Primary Health Care Centre, 81000 Podgorica, Montenegro.
| | - Joao Breda
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, Moscow 229994, Russia.
| | - Jo Jewell
- World Health Organization European Office for Prevention and Control of Noncommunicable Diseases, DK-2100 Copenhagen, Denmark.
| | - Vuk Cadjenović
- Statistical Office of Montenegro, MONSTAT, 81000 Podgorica, Montenegro.
| | - Francesco P Cappuccio
- World Health Organization Collaborating Centre for Nutrition, University of Warwick, Coventry CV4 7AL, UK.
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Modesti PA, Marzotti I, Rapi S, Rogolino A, Cappuccio FP, Zhao D, Costanzo G, Galanti G, Boddi M. Daily urinary sodium and potassium excretion in Chinese first-generation migrants in Italy. Int J Cardiol 2018; 286:175-180. [PMID: 30583922 DOI: 10.1016/j.ijcard.2018.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/04/2018] [Accepted: 12/10/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND China has one of the highest salt intake levels in the world, and Chinese people form one of the largest foreign-born communities now living in Europe. The present study was performed to assess 24-hour urinary sodium and potassium excretion in Chinese migrants in Italy and to explore possible associations with hypertension, hypertension awareness, and length of residence in Italy. METHODS A cross-sectional evaluation was conducted on 319 first-generation Chinese migrants (154 women and 165 men) aged 18-70 years. Subjects were asked to do a 24-hour urine collection and the relationships of urinary sodium and potassium and arterial blood pressure, hypertension (BP ≥ 140/90 mmHg or anti-hypertensive drug use), hypertension awareness, and years of residence in Italy were investigated with linear or logistic regression analysis. RESULTS Sodium excretion was 145.2 mmol/day (95%CI 138.0-152.3) in men, and 134.7 (95%CI 127.6-141.8) in women corresponding to a dietary salt intake of 9.4 g/day (95%CI 9.0-9.9) and 8.8 (95%CI 8.3-9.2) respectively. Potassium excretion was 35.1 mmol/day (95%CI 33.6-36.5), with no significant difference by gender. At multivariable adjusted linear regression analysis body mass index, low education level, and hypertension were positive predictors of sodium urinary excretion; gender (women), and body mass index were positive predictors of potassium excretion. Sodium and potassium excretion were unaffected by hypertension awareness or years of residence in Italy. CONCLUSIONS Sodium excretion in Chinese workers is higher than recommended and in line with high salt intake in Italy. Potassium consumption remains low.
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Affiliation(s)
| | - Ilaria Marzotti
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Stefano Rapi
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Angela Rogolino
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Coventry, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital, and National Institute of Heart, Lung & Blood Disease, Beijing, China
| | | | - Giorgio Galanti
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Maria Boddi
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
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Cappuccio FP, Beer M, Strazzullo P. Population dietary salt reduction and the risk of cardiovascular disease. A scientific statement from the European Salt Action Network. Nutr Metab Cardiovasc Dis 2018; 29:107-114. [PMID: 30583888 DOI: 10.1016/j.numecd.2018.11.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022]
Abstract
The publication in the last few years of a number of prospective observational studies suggesting a J-shaped association between levels of salt (sodium) consumption and cardiovascular outcomes has opened a debate on the pertinence of population-wide salt reduction policies to reduce cardiovascular disease burden, and some have even questioned the global World Health Organization guidelines, that recommend a 30% reduction in salt consumption by 2025, aiming at an ideal target of no more than 5 g of salt consumption per day. In September 2018 the European Salt Action Network (E.S.A.N.), after appraising the quality of publications questioning the appropriateness of population salt reduction, discussed the scientific evidence and identified the pitfalls of recent data. The new evidence was deemed inadequate and, in places, biased by flawed methodology. These were identified in the biased assessment of sodium intake from spot urine and the use of the Kawasaki formula, the biased assessment of the sodium-outcome relationships in prospective observational studies using spot urine samples, the impact of reverse causality in such studies, the inadequate analytical approaches to data analysis, the lack of biological plausibility and the lack of precision in assessing long-term salt consumption, as recently demonstrated in studies using more stringent quality features in their study designs. On the basis of such appraisal, the E.S.A.N. agreed a statement confirming the support to the implementation of national and regional programmes of moderate reduction in salt intake, as recommended by the World Health Organization.
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Affiliation(s)
- F P Cappuccio
- University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences (MHWB), Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, United Kingdom.
| | - M Beer
- Federal Food Safety and Veterinary Office FSVO, Division Food and Nutrition, Sector Nutrition, Schwarzenburgstrasse 155, CH-3003, Bern, Switzerland
| | - P Strazzullo
- Department of Internal Medicine, University of Naples Federico II, Via S Pansini 5, 80131, Naples, Italy
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Montesinos L, Castaldo R, Cappuccio FP, Pecchia L. Day-to-day variations in sleep quality affect standing balance in healthy adults. Sci Rep 2018; 8:17504. [PMID: 30504839 PMCID: PMC6269497 DOI: 10.1038/s41598-018-36053-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/10/2018] [Indexed: 11/23/2022] Open
Abstract
Acute sleep deprivation is known to affect human balance and posture control. However, the effects of variations in sleep quality and pattern over consecutive days have received less attention. This study investigated the associations between day-to-day variations in sleep quality and standing balance in healthy subjects. Twenty volunteers (12 females and 8 males; age: 28.8 ± 5.7 years, body mass index: 23.4 ± 3.4 kg/m2, resting heart rate: 63.1 ± 8.7 bpm) with no history of sleep disorders or balance impairments participated in the study. Sleep and balance were assessed over two consecutive days. Sleep quality variations were assessed using sleep diary, actigraphy and heart rate variability (HRV) measures. Sleep was monitored at home, using an unobtrusive wearable device. Balance was assessed in a gait lab using foot centre of pressure (COP) displacement during quiet standing. Subjects with a day-to-day deterioration in sleep quantity and quality (i.e., decreased duration and increased fragmentation, increased nocturnal activity and decreased HRV) exhibited significant changes in balance (i.e., larger COP area, amplitude and standard deviation). Conversely, subjects with no significant alterations in sleep quantity and quality showed no significant changes in COP displacements. These results confirmed our hypothesis that changes in sleep quality and pattern over consecutive days may affect balance.
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Affiliation(s)
- Luis Montesinos
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Escuela de Ingenieria y Ciencias, Tecnologico de Monterrey, Mexico City, Mexico
| | - Rossana Castaldo
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Institute of Advanced Study, University of Warwick, Coventry, United Kingdom
| | - Francesco P Cappuccio
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom.
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Cappuccio FP. The 'scent' and 'flavour' of hypertension. Nutr Metab Cardiovasc Dis 2018; 28:884-886. [PMID: 30093303 DOI: 10.1016/j.numecd.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- F P Cappuccio
- University of Warwick, WHO Collaborating Centre for Nutrition, Warwick Medical School, Division of Health Sciences (MHWB), Gibbet Hill Road, Coventry, CV4 7AL, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
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Affiliation(s)
- Francesco P Cappuccio
- WHO Collaborating Centre for NutritionWarwick Medical SchoolThe University of WarwickGibbet Hill Road, Coventry CV4 7AL, UK
| | - Lanfranco D'Elia
- Federico II University of Naples, Naples, Italy and WHO Collaborating Centre for Nutrition, Coventry, UK
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Affiliation(s)
- Francesco P Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Miller MA, Kruisbrink M, Wallace J, Ji C, Cappuccio FP. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep 2018. [DOI: 10.1093/sleep/zsy018 pmid: 29401314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Michelle A Miller
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Marlot Kruisbrink
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
- Epidemiology and Public Health, Wageningen University, The Netherlands
| | - Joanne Wallace
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Miller MA, Kruisbrink M, Wallace J, Ji C, Cappuccio FP. Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep 2018; 41:4833233. [DOI: 10.1093/sleep/zsy018] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Michelle A Miller
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Marlot Kruisbrink
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
- Epidemiology and Public Health, Wageningen University, The Netherlands
| | - Joanne Wallace
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kruisbrink M, Robertson W, Ji C, Miller MA, Geleijnse JM, Cappuccio FP. Association of sleep duration and quality with blood lipids: a systematic review and meta-analysis of prospective studies. BMJ Open 2017; 7:e018585. [PMID: 29247105 PMCID: PMC5735405 DOI: 10.1136/bmjopen-2017-018585] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To assess the longitudinal evidence of the relationships between sleep disturbances (of quantity and quality) and dyslipidaemia in the general population and to quantify such relationships. SETTING Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS We performed a systematic search of PubMed and Embase (up to 9 September 2017), complemented with manual searches, of prospective population studies describing the association between sleep duration and quality and the incidence of dyslipidaemias. Relative risks (95% CIs) were extracted and pooled using a random effects model. Subgroup analyses by lipid type were performed. Heterogeneity and publication bias were also assessed. Quality was assessed with Downs and Black score. PARTICIPANTS Studies were included if they were prospective, had measured sleep quantity and/or quality at baseline and either incident cases of dyslipidaemia or changes in blood lipid fractions assessed prospectively. PRIMARY OUTCOME MEASURES Incidence of dyslipidaemia and changes in lipid fractions. Dyslipidaemia was defined as a high total cholesterol, triglycerides, low-density lipoprotein cholesterol or low high-density lipoprotein cholesterol compared with the reference group. RESULTS Thirteen studies were identified (eight using sleep duration, four sleep quality and one both). There was heterogeneity in the sleep quality aspects and types of lipids assessed. Classification of sleep duration (per hour/groups) also varied widely. In the pooled analysis of sleep duration (6 studies, 16 cohort samples; 30 033 participants; follow-up 2.6-10 years), short sleep was associated with a risk of 1.01 (95% CI 0.93 to 1.10) of developing dyslipidaemia, with moderate heterogeneity (I2=56%, P=0.003) and publication bias (P=0.035). Long sleep was associated with a risk of 0.98 (95% CI 0.87 to 1.10) for dyslipidaemia, with heterogeneity (I2=63%, P<0.001) and no significant publication bias (P=0.248). CONCLUSION The present analysis was unable to find supportive evidence of a significant relationship between sleep duration and the development of dyslipidaemia. However, heterogeneity and small number of studies limit the interpretation. PROSPERO REGISTRATION NUMBER CRD42016045242.
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Affiliation(s)
- Marlot Kruisbrink
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Wendy Robertson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chen Ji
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michelle A Miller
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Johanna M Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Francesco P Cappuccio
- ESH Centre of Excellence in Hypertension & Cardiometabolic Research, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Abstract
PURPOSE OF REVIEW This review summarises and discusses the epidemiological evidence suggesting a causal relationship between sleep duration and cardio-metabolic risk and outcomes in population. RECENT FINDINGS Sleep duration is affected by a variety of cultural, social, psychological, behavioural, pathophysiological and environmental influences. Changes in modern society-like longer working hours, more shift-work, 24/7 availability of commodities and 24-h global connectivity-have been associated with a gradual reduction in sleep duration and sleeping patterns across westernised populations. We review the evidence of an association between sleep disturbances and the development of cardio-metabolic risk and disease and discuss the implications for causality of these associations. Prolonged curtailment of sleep duration is a risk factor for the development of obesity, diabetes, hypertension, heart disease and stroke and may contribute, in the long-term, to premature death.
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Affiliation(s)
- Francesco P Cappuccio
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK. .,University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Michelle A Miller
- Warwick Medical School, Division of Health Sciences, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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Hyseni L, Elliot-Green A, Lloyd-Williams F, Kypridemos C, O’Flaherty M, McGill R, Orton L, Bromley H, Cappuccio FP, Capewell S. Systematic review of dietary salt reduction policies: Evidence for an effectiveness hierarchy? PLoS One 2017; 12:e0177535. [PMID: 28542317 PMCID: PMC5436672 DOI: 10.1371/journal.pone.0177535] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 04/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable disease (NCD) prevention strategies now prioritise four major risk factors: food, tobacco, alcohol and physical activity. Dietary salt intake remains much higher than recommended, increasing blood pressure, cardiovascular disease and stomach cancer. Substantial reductions in salt intake are therefore urgently needed. However, the debate continues about the most effective approaches. To inform future prevention programmes, we systematically reviewed the evidence on the effectiveness of possible salt reduction interventions. We further compared "downstream, agentic" approaches targeting individuals with "upstream, structural" policy-based population strategies. METHODS We searched six electronic databases (CDSR, CRD, MEDLINE, SCI, SCOPUS and the Campbell Library) using a pre-piloted search strategy focussing on the effectiveness of population interventions to reduce salt intake. Retrieved papers were independently screened, appraised and graded for quality by two researchers. To facilitate comparisons between the interventions, the extracted data were categorised using nine stages along the agentic/structural continuum, from "downstream": dietary counselling (for individuals, worksites or communities), through media campaigns, nutrition labelling, voluntary and mandatory reformulation, to the most "upstream" regulatory and fiscal interventions, and comprehensive strategies involving multiple components. RESULTS After screening 2,526 candidate papers, 70 were included in this systematic review (49 empirical studies and 21 modelling studies). Some papers described several interventions. Quality was variable. Multi-component strategies involving both upstream and downstream interventions, generally achieved the biggest reductions in salt consumption across an entire population, most notably 4g/day in Finland and Japan, 3g/day in Turkey and 1.3g/day recently in the UK. Mandatory reformulation alone could achieve a reduction of approximately 1.45g/day (three separate studies), followed by voluntary reformulation (-0.8g/day), school interventions (-0.7g/day), short term dietary advice (-0.6g/day) and nutrition labelling (-0.4g/day), but each with a wide range. Tax and community based counselling could, each typically reduce salt intake by 0.3g/day, whilst even smaller population benefits were derived from health education media campaigns (-0.1g/day). Worksite interventions achieved an increase in intake (+0.5g/day), however, with a very wide range. Long term dietary advice could achieve a -2g/day reduction under optimal research trial conditions; however, smaller reductions might be anticipated in unselected individuals. CONCLUSIONS Comprehensive strategies involving multiple components (reformulation, food labelling and media campaigns) and "upstream" population-wide policies such as mandatory reformulation generally appear to achieve larger reductions in population-wide salt consumption than "downstream", individually focussed interventions. This 'effectiveness hierarchy' might deserve greater emphasis in future NCD prevention strategies.
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Affiliation(s)
- Lirije Hyseni
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Alex Elliot-Green
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Chris Kypridemos
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Rory McGill
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Lois Orton
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Helen Bromley
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Francesco P. Cappuccio
- University of Warwick, WHO Collaborating Centre, Warwick Medical School, Coventry, United Kingdom
| | - Simon Capewell
- Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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Vasara E, Marakis G, Breda J, Skepastianos P, Hassapidou M, Kafatos A, Rodopaios N, Koulouri AA, Cappuccio FP. Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area-The Salt Intake in Northern Greece (SING) Study. Nutrients 2017; 9:E417. [PMID: 28441726 PMCID: PMC5409756 DOI: 10.3390/nu9040417] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/06/2017] [Accepted: 04/20/2017] [Indexed: 12/14/2022] Open
Abstract
A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies for setting targets and monitoring effectiveness within each country, the current level of consumption should be known. Greece lacks data on actual sodium and potassium intake. The aim of the present study was therefore to assess dietary salt (using sodium as biomarker) and potassium intakes in a sample of healthy adults in northern Greece, and to determine whether adherence to a Mediterranean diet is related to different sodium intakes or sodium-to-potassium ratio. A cross-sectional survey was carried out in the Thessaloniki greater metropolitan area (northern Greece) (n = 252, aged 18-75 years, 45.2% males). Participants' dietary sodium and potassium intakes were determined by 24-hour urinary sodium and potassium excretions. In addition, we estimated their adherence to Mediterranean diet by the use of an 11-item MedDietScore (range 0-55). The mean sodium excretion was 175 (SD 72) mmol/day, equivalent to 4220 (1745) mg of sodium or 10.7 (4.4) g of salt per day, and the potassium excretion was 65 (25) mmol/day, equivalent to 3303 (1247) mg per day. Men had higher sodium and potassium excretions compared to women. Only 5.6% of the sample had salt intake <5 g/day, which is the target intake recommended by the World Health Organization. Mean sodium-to-potassium excretion ratio was 2.82 (1.07). There was no significant difference in salt or potassium intake or their ratio across MedDietScore quartiles. No significant relationships were found between salt intake and adherence to a Mediterranean diet, suggesting that the perception of the health benefits of the Mediterranean diet does not hold when referring to salt consumption. These results suggest the need for a larger, nation-wide survey on salt intake in Greece and underline the importance of continuation of salt reduction initiatives in Greece.
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Affiliation(s)
- Eleni Vasara
- Laboratory of Animal Physiology, Department of Zoology, School of Biology, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
| | - Georgios Marakis
- Nutrition Policy and Research Directorate, Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., Athens 11526, Greece.
| | - Joao Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen DK-2100, Denmark.
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, Alexander Technological and Educational Institute of Thessaloniki, Sindos, Thessaloniki 57400, Greece.
| | - Maria Hassapidou
- Department of Nutrition and Dietetics, Alexander Technological and Educational Institute of Thessaloniki, Sindos, Thessaloniki 57400, Greece.
| | - Anthony Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Nikolaos Rodopaios
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Alexandra A Koulouri
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, Medical School, University of Crete, Heraklion 71003, Crete, Greece.
| | - Francesco P Cappuccio
- Division of Health Sciences (Mental Health & Wellbeing), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK.
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Webster J, Waqanivalu T, Arcand J, Trieu K, Cappuccio FP, Appel LJ, Woodward M, Campbell NRC, McLean R. Understanding the science that supports population-wide salt reduction programs. J Clin Hypertens (Greenwich) 2017; 19:569-576. [DOI: 10.1111/jch.12994] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
| | | | - JoAnne Arcand
- Faculty of Health Sciences; University of Ontario Institute of Technology; Oshawa Ontario Canada
| | - Kathy Trieu
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
| | | | - Lawrence J. Appel
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins University; Baltimore MD USA
| | - Mark Woodward
- The George Institute for Global Health; University of Sydney; Sydney New South Wales Australia
- University of Oxford; Oxford UK
- Department of Epidemiology; Johns Hopkins University; Baltimore Maryland USA
| | - Norm 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
| | - Rachael McLean
- Departments of Preventive & Social Medicine; University of Otago; Dunedin New Zealand
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