Forecasting disability-adjusted life years for chronic diseases: reference and alternative scenarios of salt intake for 2017-2040 in Japan.

BACKGROUND: In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS: We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS: In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS: The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.

Consumption of Moringa oleifera Lam Leaves Lowers Postprandial Blood Pressure.

Objective: This clinical study monitored the effect of eating cooked Moringa oleifera leaves on the blood pressure (BP) of healthy participants in view of the perception that consumption of Moringa is associated with an increase in blood pressure, which is contradictory to the findings from the literature.Methods: A random sample of 41 healthy participants were enrolled in this prospective, placebo-controlled clinical study. Participants in the case study consumed 120 g of cooked M. oleifera leaves while the control group did not eat Moringa leaves. BP was measured at baseline before the meal and followed up at regular intervals over 24 hours for both groups. Baseline (T0) mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and postprandial follow-up (T2-T24) were measured for both groups. Participants recorded their diet for a week and this led to an estimation of the total salt consumption per day.Results: A significant difference was observed between DBP at baseline and two hours postprandial (T2) for the case group (p = 0.013). Moreover, in the case group, despite high consumption of salt (7 g/d) during the week preceding the clinical study, there was a significant decrease in both the SBP and DBP. In the control group, participants with prior high consumption of salt (7 g/d) during the week had elevated SBP and DBP.Conclusions: These findings in human subjects indicated the lowering effect of Moringa oleifera leaves consumption on the 2 hours postprandial BP and showed a potential lowering effect on both SBP and DBP despite prior high consumption of salt (7 g/d).

Estimating sodium intake from spot urine samples at population level: a validation and application study in French adults.

The aim of this study was to assess the validity of the predictive INTERSALT equation using spot urine samples to estimate 24-h urinary Na (24-hUNa) excretion and daily Na intake among the French adult population. Among 193 French adults ('validation sample'), we assessed the validity by comparing predicted 24-hUNa excretion from spot urine and measured 24-hUNa excretion from 24-h urine collections. Spearman correlation coefficients and Bland-Altman plots were used and we calculated calibration coefficients. In a nationally representative sample of 1720 French adults ('application sample'), the calibrated predictive equation was then applied to the spot urine Na values to estimate 24-hUNa excretion and daily Na intake. In that sample, predicted Na intake was compared with that estimated from 24-h dietary recalls. Results were adjusted and corrected using calibration coefficients. In the validation sample, the measured 24-hUNa excretion was on average 14 % higher than the predicted 24-hUNa (+13 % for men and +16 % for women). Correlation between measured and predicted 24-hUNa excretion was moderate (Spearman r 0·42), and the Bland-Altman plots showed underestimation at lower excretion level and overestimation at higher level. In the application study, estimated daily salt intake was 8·0 g/d using dietary recalls, 8·1 g/d using predicted INTERSALT equation and 9·3 g/d after applying calibration coefficients calculated in the validation study. Despite overall underestimation of 24-hUNa excretion by spot urinary Na, the use of predictive INTERSALT equation remains an acceptable alternative in monitoring global Na intake/excreted in the French population but its use is not advised at the individual level.

The responses of the inflammatory marker, pentraxin 3, to dietary sodium and potassium interventions.

Pentraxin-3 is a sensitive marker of inflammation that plays dual roles, pathogenic and cardioprotective, in the progression of cardiovascular diseases. Inflammation is intimately involved in salt-induced hypertension. We investigated the responses of pentraxin-3 to sodium and potassium supplementation to elucidate the potential role of pentraxin-3 in salt-induced hypertension. A total of 48 participants from northwest China were enrolled. All participants were maintained on a 3-day normal diet, which was sequentially followed by a 7-day low-sodium diet, a 7-day high-sodium diet, and a 7-day high-sodium plus potassium diet. Plasma concentrations of pentraxin-3 were assessed using ELISA. Plasma pentraxin-3 decreased significantly during the low-salt period compared to baseline (0.57 ± 0.19 ng/mL vs 0.72 ± 0.33 ng/mL, P = .012) and increased during the high-salt period (0.68 ± 0.26 ng/mL vs 0.57 ± 0.19 ng/mL, P = .037). Potassium supplementation inhibited salt-induced increase in pentraxin-3 (0.56 ± 0.21 ng/mL vs 0.68 ± 0.26 ng/mL, P = .015). Ln-transformed pentraxin-3 at baseline was inversely correlated with BMI (r = -.349, P = .02), DBP (r = -.414, P = .005), MAP (r = -.360, P = .017). We found a positive correlation between the ln-transformed concentrations of pentraxin-3 and 24-hour urinary sodium during low and high Na+ periods (r = .269, P = .012) and a negative relationship with 24 hours urinary potassium excretion during high-salt and high-salt plus potassium periods (r = -.246, P = .02). These correlations remained significant after adjusting for confounders. Pentraxin-3 responses were more prominent in salt-sensitive individuals than salt-resistant individuals. Dietary salt and potassium interventions significantly altered circulating pentraxin-3.

Development of pharmacological screening method for evaluation of effect of drug on elevated pulse pressure and arterial stiffness.

INTRODUCTION: Elevated pulse pressure (PP) and amplification of arterial stiffness (AS) are responsible for various cardiovascular disease and deaths. Numerous investigations have identified that different antihypertensive agents influence PP and AS differently. None of the previous studies described any reliable animal model particularly to screen drugs having effects on PP and AS. In present study, we developed an animal model to screen such drugs particularly affecting PP and AS. METHODS: Elevation of PP and amplification of AS were induced in rats by uninephrectomy along with high salt intake (NaCl 4% w/v) for a period of six weeks, and weekly changes in body weight, PP, systolic, diastolic, mean pressure and pulse wave velocity (PWV) were estimated. After six weeks, collagen elastin ratio of aortic segment was estimated. Histomorphometry of abdominal aortic section of rats was done using trinocular microscope. RESULTS: After six weeks, uninephrectomized rats that were kept on high salt drinking water shown significant increase (P < 0.001) in MAP, PP and PWV indicates that hypertension along with elevated PP developed in rats, and increase in collagen/elastin ratio (P < 0.001) as well as PWV as compared to normal rats indicates the increase in AS. CONCLUSION: The development of condition of hypertension in conjunction with increase in PP and AS in rats can be used as in-vivo screening model to determine the potency of drugs for the treatment of hypertension or other cardiovascular diseases associated with high PP and AS.

The XRCC 1 DNA repair gene modifies the environmental risk of stomach cancer: a hospital-based matched case-control study.

BACKGROUND: Previous studies have found that polymorphisms of the DNA repair gene X-ray repair cross-complementing group 1(XRCC1) and environmental factors are both associated with an increased risk of stomach cancer, but no study has reported on the potential additive effect of these factors among Thai people. The aim of this study was to investigate whether the risk of stomach cancer from XRCC1 gene polymorphisms was modified by environmental factors in the Thai population. METHODS: Hospital-based matched case-control study data were collected from 101 new stomach cancer cases and 202 controls, which were recruited from2002 to 2006 and were matched for gender and age. Genotype analysis was performed using real-time PCR-HRM. The data were analysed by the chi-square test and conditional logistic regression. RESULTS: The Arg/Arg homozygote polymorphism of the XRCC1 gene was associated with an increased risk of stomach cancer in the Thai population (OR adj, 3.7; 95%CI, 1.30-10.72) compared with Gln/Gln homozygosity. The effect of the XRCC1gene on the risk of stomach cancer was modified by both a high intake of vegetable oils and salt (p = 0.036 and p = 0.014), particularly for the Arg/Arg homozygous genotype. There were, however, no additive effects on the risk of stomach cancer between variants of the XRCC1gene and smoking,alcohol or pork oil consumption. CONCLUSIONS: The effect of the XRCC1 gene homozygosity, particularly Arg/Arg, on the risk for stomach cancer was elevated by a high intake of vegetable oils and salt.

Iodine Prophylaxis in the Lights of the Last Recommendation of WHO on Reduction of Daily Salt Intake.

BACKGROUND: In 1994, International Organizations: WHO, UNICEF and ICCIDD indicat ed salt Natrium Chloride as the main carrier of iodine in the prophilaxis systems in the iodine deficient areas over the world. Following this recommendation, 24 European countries introduced the model of iodine p rop hylaxis based on the salt iodization. However in 7 European countries only - among tchem in Poland - salt iodization is mandatory as the most effective mode lon the population level. OBJECTIVE: Presenting the method for the reduction of the consumption of iodized salt and supplement ation of iodine by other iodine carriers. METHODS: Concentration of iodine in the salt has been calculated according to the daily salt consumption and WHO recommendation on the daily dose of iodine that should be supplied in different groups of age and in pregnant and breast feeding women. No relevant recent patents were available for this WHO report. RESULTS: Consumption of salt in European countries is from 8 to 11g/day/person. In Poland, it is very high 11.5g/day/person. WHO in 1996 introduced recommendation on reducing daily salt intake to 5g/day/person as Natrium is a risk factor of hypertension and some neoplastic processes. CONCLUSION: When iodized salt is the main carrier of iodine in the prophylaxis systems, additional carriers of iodine should be introduced in the food market for instant -iodized mineral water. A very important factor is the proper information and education on the population level. This action is under control of the Polish Council for Control of Iodine Deficiency Disorders [PCCIDD] established in 1991 following the example of the International Council for Control of Iodine Deficiency Disorders [ICCIDD].

Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology.

This position paper of the study group "Conservative treatment of Chronic Kidney Disease-CKD" of the Italian Society of Nephrology addresses major practical, unresolved, issues related to the conservative treatment of chronic renal disease. Specifically, controversial topics from everyday clinical nephrology practice which cannot find a clear, definitive answer in the current literature or in nephrology guidelines are discussed. The paper reports the point of view of the study group. Concise and practical advice is given on several common issues: renal biopsy in diabetes; dual blockade of the renin-angiotensin-aldosterone system (RAAS); management of iron deficiency; low protein diet; dietary salt intake; bicarbonate supplementation; treatment of obesity; the choice of conservative therapy vs. dialysis. For each topic synthetic statements, guideline-style, are reported.

Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension.

Excessive dietary salt (sodium chloride) intake is associated with an increased risk for hypertension, which in turn is especially a major risk factor for stroke and other cardiovascular pathologies, but also kidney diseases. Besides, high salt intake or preference for salty food is discussed to be positive associated with stomach cancer, and according to recent studies probably also obesity risk. On the other hand a reduction of dietary salt intake leads to a considerable reduction in blood pressure, especially in hypertensive patients but to a lesser extent also in normotensives as several meta-analyses of interventional studies have shown. Various mechanisms for salt-dependent hypertension have been put forward including volume expansion, modified renal functions and disorders in sodium balance, impaired reaction of the renin-angiotensin-aldosterone-system and the associated receptors, central stimulation of the activity of the sympathetic nervous system, and possibly also inflammatory processes.Not every person reacts to changes in dietary salt intake with alterations in blood pressure, dividing people in salt sensitive and insensitive groups. It is estimated that about 50-60 % of hypertensives are salt sensitive. In addition to genetic polymorphisms, salt sensitivity is increased in aging, in black people, and in persons with metabolic syndrome or obesity. However, although mechanisms of salt-dependent hypertensive effects are increasingly known, more research on measurement, storage and kinetics of sodium, on physiological properties, and genetic determinants of salt sensitivity are necessary to harden the basis for salt reduction recommendations.Currently estimated dietary intake of salt is about 9-12 g per day in most countries of the world. These amounts are significantly above the WHO recommended level of less than 5 g salt per day. According to recent research results a moderate reduction of daily salt intake from current intakes to 5-6 g can reduce morbidity rates. Potential risks of salt reduction, like suboptimal iodine supply, are limited and manageable. Concomitant to salt reduction, potassium intake by higher intake of fruits and vegetables should be optimised, since several studies have provided evidence that potassium rich diets or interventions with potassium can lower blood pressure, especially in hypertensives.In addition to dietary assessment the gold standard for measuring salt intake is the analysis of sodium excretion in the 24 h urine. Spot urine samples are appropriate alternatives for monitoring sodium intake. A weakness of dietary evaluations is that the salt content of many foods is not precisely known and information in nutrient databases are limited. A certain limitation of the urine assessment is that dietary sources contributing to salt intake cannot be identified.Salt reduction strategies include nutritional education, improving environmental conditions (by product reformulation and optimization of communal catering) up to mandatory nutrition labeling and regulated nutrition/health claims, as well as legislated changes in the form of taxation.Regarding dietary interventions for the reduction of blood pressure the Dietary Approaches to Stop Hypertension (DASH) diet can be recommended. In addition, body weight should be normalized in overweight and obese people (BMI less than 25 kg/m2), salt intake should not exceed 5 g/day according to WHO recommendations (<2 g sodium/day), no more than 1.5 g sodium/d in blacks, middle- and older-aged persons, and individuals with hypertension, diabetes, or chronic kidney disease, intake of potassium (~4.7 g/day) should be increased and alcohol consumption limited. In addition, regular physical activity (endurance, dynamic resistance, and isometric resistance training) is very important.

Watering cattle (young bulls) with brackish water--a hazard due to its salt content?

OBJECTIVE: The aim of this experimental study was primarily to test the effects and reactions of cattle offered salty water as the only source of drinking water. MATERIAL AND METHODS: Mineral balance studies were carried out on three bull, continuously fed a ration based on hay, hay cobs, barley, soybean meal and a vitamin/mineral supplement. The salt content of the drinking water varied between the trials (trials I/II/III: 0.10/5.00/10.0 g/l; town water supplemented by different amounts of an additive containing 95.4% sodium chloride and 4.6% potassium chloride). RESULTS: Rising salt concentration of the drinking water led to significantly higher sodium, potassium and chloride intake (sodium: trial I/II/III = 5.42/59.5/ 157 g/day; potassium: trials I/II/III = 108/117/121 g/day; chloride: trials I/II/III = 22.8/112/266 g/day) mainly caused by a significantly higher water intake (trials I/II/III: 21.8 ± 2.03/30.4 ± 3.08/41.5 ± 5.89 kg/day). Amounts of urine increased significantly (trials I/II/III: 3.99 ± 0.46/ 9.66 ± 1.34/20.2 ± 3.14 kg/day). The concentrations of minerals in the urine (sodium: trials I/II/III = 123/3729/6705 mg/kg; potassium: trials I/II/III = 17345/9996/ 5496 mg/kg; chloride: trials I/II/III = 2020/ 9672/11870 mg/kg) and faeces (sodium: trials I/II/III = 1299/6544/ 7653 mg/kg; potassium: trials I/II/III = 6343/3719/3490 mg/kg; chloride: trials I/II/III = 3851/4580/4693 mg/kg) also changed significantly over time. Serum values of sodium tended to decrease (trials I/II/III: 142/137/137 mmol/l) within the physiological range, whereas those of chloride increased (trials I/II/III: 91.5/95.6/97.5 mmol/l) at higher salt concentrations in drinking water. The haematocrit, pH-value as well as urea content in blood were not affected by the higher salt intake. In balance trial III (highest salt load: 10.0 g/l), sodium intake of the bulls reached 0.57 ± 0.03 g/kg BW (~22.1 ± 0.9 g sodium/kg dry matter feed). CONCLUSION AND CLINICAL RELEVANCE: An increase of salinity in drinking water up to 10 g/l--with otherwise harmless water quality--had no measurable negative effects on animal health in the investigation period and subsequent periods (total of 58 days with more than 5.00 g of salt per litre drinking water).

Prevalence of modifiable cardiovascular risk factors among tea garden and general population in Dibrugarh, Assam, India.

INTRODUCTION: Risk factors for cardiovascular disease (CVD) are multifactorial. Previous research has reported a high prevalence of CVD risk factors in tea-garden workers. This study was conducted to assess prevalence and level of modifiable cardiovascular risk factors among tea-garden and general population in Dibrugarh, Assam. METHODS: A community-based cross-sectional study using the World Health Organization's (WHO) Stepwise methodology was conducted in Dibrugarh District of Assam. A multistep random sampling was done to include adults aged 35 years and above, with an intended equal sampling from tea-garden and general population. INTERHEART modifiable non-laboratory based risk score was estimated. Salt consumption was estimated using questionnaire-based methods in both subgroups. RESULTS: A total of 2826 individuals participated in the study (1231 [43.6%] tea-garden workers; 1595 [56.4%] general population). Tobacco consumption was higher in tea-garden workers as compared with general population (85.2% vs. 41.7% (p < 0.0001). Mean daily per-capita salt consumption was also significantly higher among tea-garden workers (29.60 vs. 22.89 g, p = 0.0001). Overall prevalence of hypertension was similar (44.4% vs. 45.2%), but among those who had hypertension, prevalence of undiagnosed hypertension was higher in tea-garden workers (82.8% vs. 74.4%, p < 0.0001). Tea-garden workers had lower BMI, were more physically active, and had a lower prevalence of diabetes mellitus and metabolic syndrome. Their INTERHEART modifiable risk score was also lower (1.44 [2.5] vs. 1.79 [2.8], p = 0.001). CONCLUSION: High prevalence of modifiable risk factors like tobacco consumption, high salt intake and high prevalence of hypertension indicates the need for early implementation of preventive actions in this population.

A Case of Hypernatremia by Folk Remedies in a CRF Patient / 대한신장학회잡지

We report a case of chronic hypernatremia caused by excessive salt intake as folk remedies for three months. The patient had chronic tubulointerstitial nephritis (CTIN), but without documented cognitive or psychiatric disorders. She presented with severe hypernatremia 189 mmol/L and general weakness. Fluid therapy was done initially with isotonic and then with 0.45% hypotonic saline until serum sodium level reached to 157 mmol/L. Finally hemodialysis was supplemented to achieve normal serum sodium level, and she recovered without any sequelae. This report might be the first case of chronic hypernatremia due to voluntary ingestion of excessive salt in an adult patient with CTIN but without cognitive or psychiatric disorders.