[Impact of the ExSel(®) test administration on the excessive salt consumption in hypertensive patients followed in general practice]

OBJECTIVE

To evaluate the impact of the Exsel(®) test administration on salt intake in hypertensive subjects followed in general practice.

METHOD

In a group practice of general practitioners in the Île-de-France, the ExSel(®) test http://www.comitehta.org/testez-vous/consommez-vous-du-sel-en-exces-test-exsel/ was administered to 329 outpatients. The questionnaire was filled in the waiting room and then commented by the doctor. In patients treated for hypertension, 24hours urinary Na was prescribed after the consultation. Excessive salt consumption (ESC) was defined as a urinary Na≥200mmol/day.

RESULTS

The population included subjects aged on average 57 years with 43 % of hypertensive patients. According Exsel(®), an ESC was suspected in 36 % of patients and was more common in treated hypertensive patients (44 %; [36-52]) in hypertensive men (57 %; [46-68]) than among non-hypertensive (31 %; [24-38]) and non hypertensive women (18 % [11-25]). Urinary Na has been finally performed by 63 % of subjects and 24hours excretion was 157±56mmol in men and 123±39mmol in women. After this 24hours urinary sodium evaluation, subsequent to ExSel(®) test, ESC frequency was lower among men (19 %) and very low among women (5 %).

CONCLUSION

To estimate the ESC, the ExSel(®) test is easily performed in general practice while 24hours urinary sodium is more difficult to obtain. Achieving an ExSel(®) test was accompanied by a decrease in the frequency of excessive salt consumers with a greater effect in women.

[New insights into sodium in kidney and cardiovascular diseases]

Recent guidelines recommend a restriction of sodium intake below 2,4 g/day (6 g/day of NaCl) in general population to prevent arterial hypertension and cardiovascular disease. Three papers published in 2014 by The New England Journal of Medecine confirm the association between high sodium intake and arterial hypertension. However, marked sodium restriction is also associated with increased mortality. On the other hand, a diet rich in potassium, over 1.5 g/day, is associated with less cardiovascular mortality, and less chronic kidney disease progression.

[Development and evaluation of ExSel Test to screen for excess salt intake in hypertensive subjects]

OBJECTIVE

Development of a test to screen excess salt intake (ESI) in hypertensive patients.

METHODS

Hypertensive subjects living in Paris area have been included. A 24-hour urinary sodium collection has been performed the day before the visit for a day hospital. A food diary was completed on the day of the urine collection and validated after an interview with a dietetician. An ESI was defined by a urinary sodium ≥ 200mmol/d. Clinical or food characteristics associated to an ESI were retained for the ExSel Test variables. A ROC curve was performed to determine the optimal score for the ExSel Test in detection of ESI in hypertensive patients.

RESULTS

One hundred and forty-eight hypertensive patients have been included living in the Île-de-France area. ESI was observed in 19% with a higher frequency in men. Seven major determinants of ESI have been identified and are the questions that constitute the ExSel Test. A positive response assigns points: man (1); BMI > 30 (2); bread 4 or 5 pieces per day (1) or more than 6 pieces; cheese at least 1 time per day (2); charcuterie at least 2 times per week (2); use of processed broth or pilaf (1); food rich in hidden salt (pizza, cheeseburger, quiche, shrimp, potato chips, smoked fish, olive) at least 2 times per week (1). The ROC curve analysis shows that a score of 5 or more has the best Youden index with a sensitivity of 0.63, specificity of 0.95, PPV of 0.75, NPV of 0.92.

CONCLUSIONS

In hypertensive subjects, an excessive salt intake can be detected by the realization of the ExSel Test based only on a simple food-questionnaire and some clinical parameters. For a clinical use of the ExSel Test, an electronic version is available on http://www.comitehta.org.

Selenium and diabetes--evidence from animal studies

Whereas selenium was found to act as an insulin mimic and to be antidiabetic in earlier studies, recent animal experiments and human trials have shown an unexpected risk of prolonged high Se intake in potentiating insulin resistance and type 2 diabetes. Elevating dietary Se intake (0.4 to 3.0mg/kg of diet) above the nutrient requirements, similar to overproduction of selenoproteins, led to insulin resistance and/or diabetes-like phenotypes in mice, rats, and pigs. Although its diabetogenic mechanism remains unclear, high Se intake elevated activity or production of selenoproteins including GPx1, MsrB1, SelS, and SelP. This upregulation diminished intracellular reactive oxygen species and then dysregulated key regulators of β cells and insulin synthesis and secretion, leading to chronic hyperinsulinemia. Overscavenging intracellular H2O2 also attenuated oxidative inhibition of protein tyrosine phosphatases and suppressed insulin signaling. High Se intake might affect expression and/or function of key regulators of glycolysis, gluconeogenesis, and lipogenesis. Future research is needed to find out if certain forms of Se metabolites in addition to selenoproteins and if mechanisms other than intracellular redox control mediate the diabetogenic effects of high Se intake. Furthermore, a potential interactive role of high Se intake in the interphase of carcinogenesis and diabetogenesis should be explored to make optimal use of Se in human nutrition and health.