Modelling the impact of sodium intake on cardiovascular disease mortality in Mexico.

BACKGROUND: Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model. METHODS: The Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an "optimistic" reduction of 30%; and (c) an "intermediate" reduction of 10%. RESULTS: The results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke. CONCLUSIONS: The results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed.

The epidemiological burden of reducing salt intake in Paraguay: A modeling study / A carga epidemiológica da redução do sal no Paraguai: um estudo de modelagem

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país.

Strategies to reduce the consumption of nutrients critical to health: the case of sodium. / Estratégias para redução do consumo de nutrientes críticos para a saúde: o caso do sódio.

Chronic non-communicable diseases correspond to the main cause of death in the world and have inadequate nutrition as one of its main modifiable risk factors, highlighting the excessive consumption of sodium and its association with cardiovascular diseases, mediated by blood pressure. This study evaluated the impact of different policy scenarios for reducing sodium consumption from processed and ultra-processed foods in the prevention of deaths due to cardiovascular outcomes in the adult population in Brazil. We used secondary data from public reports and databases of the Brazilian Unified National Health System (SUS) and population surveys. We analyzed the impacts, up to 2027, of three scenarios: maintenance of the current voluntary targets, and two mandatory scenarios, considering the lowest targets in the Americas and the lowest global targets. The Preventable Risk Integrated ModEl (PRIME) analyzed the deaths prevented or delayed from sodium consumption in such scenarios. In 2027, more than 72,000 deaths would be attributed to excess sodium; the voluntary goals would result in the prevention or postponement of up to 4,001 (95% uncertainty intervals - 95%UI: 1,611-6,563) deaths, while the mandatory scenarios would result in the prevention of 9,704 (95%UI: 3,955-15,665) and 15,561 (95%UI: 6,350-25,096) deaths from cardiovascular diseases, considering the lower regional and international targets, respectively. The findings suggest that the maintenance of voluntary targets has limited impact when compared to possible and more restrictive scenarios of reducing sodium content in processed and ultra-processed foods and reinforce the need to adopt measures with greater effectiveness in the country.

Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ModEl (PRIME). Em 2027, mais de 72 mil mortes seriam atribuíveis ao excesso de sódio e as metas voluntárias resultariam na prevenção ou adiamento de até 4.001 (intervalos de 95% de incerteza - II95%: 1.611-6.563) mortes, e os cenários mandatórios resultariam na prevenção de 9.704 (II95%: 3.955-15.665) e 15.561 (II95%: 6.350-25.096) mortes por doenças cardiovasculares, considerando as menores metas regionais e internacionais, respectivamente. Os achados sugerem que a manutenção de metas voluntárias tem impacto limitado quando comparada a cenários possíveis e mais restritivos de redução do teor de sódio em alimentos processados e ultraprocessados, e reforçam a necessidade de adoção de medidas com maior efetividade no país.

Las enfermedades crónicas no transmisibles son la principal causa de muerte en el mundo y cuentan con la alimentación inadecuada, como uno de sus principales factores de riesgo modificables, destacándose el consumo excesivo de sodio y su asociación con enfermedades cardiovasculares, causadas por la presión arterial. Este estudio evaluó el impacto de diferentes escenarios de políticas para la reducción del consumo de sodio, en base a alimentos procesados y ultraprocesados, en la prevención de muertes por desenlaces cardiovasculares en la población adulta brasileña. Se utilizaron datos secundarios, de informes y bases públicas del Sistema Único de Salud y de encuestas poblacionales. Se analizaron impactos, hasta 2027, en tres escenarios: mantenimiento de las actuales metas voluntarias, y dos escenarios obligatorios, considerando metas menores en las Américas y las menores metas mundiales. Para el análisis de las muertes prevenidas o pospuestas, basándose en el consumo de sodio en tales escenarios, se utilizó el Preventable Risk Integrated ModEl (PRIME). En 2027, más de 72 mil muertes serían atribuibles al exceso de sodio y las metas voluntarias resultarían en la prevención o aplazamiento de hasta 4.001 (intervalos de 95% de incertidumbre - II95%: 1.611-6.563) muertes, y los escenarios obligatorios resultarían en la prevención de 9.704 (II95%: 3.955-15.665) y 15.561 (II95%: 6.350-25.096) muertes por enfermedades cardiovasculares, considerando las menores metas regionales e internacionales, respectivamente. Los resultados sugieren que el mantenimiento de metas voluntarias tiene un impacto limitado, cuando se compara con escenarios posibles y más restrictivos de reducción del contenido de sodio en alimentos procesados y ultraprocesados, y refuerzan la necesidad de adopción de medidas con una mayor efectividad en el país.

Impact of salt intake reduction on CVD mortality in Costa Rica: A scenario modelling study.

Cardiovascular diseases (CVD) represent the leading cause of death in Costa Rica and high blood pressure was associated with a mortality rate of 29% in 2018. The average household sodium intake in the country is also two times higher than the World Health Organization recommendation. The objective of this study was to estimate the impact of reducing salt intake on CVD mortality in Costa Rica using a scenario simulation model. The Preventable Risk Integrated ModEl (PRIME) was used to estimate the number of deaths that would be averted or delayed in the Costa Rican population by following the national and the international guidelines to reduce salt consumption, according to two scenarios: A) 46% reduction and B) 15% reduction, both at an energy intake of 2171 kcal. The scenarios estimated that between 4% and 13%, respectively, of deaths due to CVD would be prevented or postponed. The highest percentages of deaths prevented or postponed by type of CVD would be related to Coronary heart disease (39% and 38%, respectively), Hypertensive disease (32% and 33%, respectively), and Stroke (22% in both). The results demonstrate that reducing salt consumption could prevent or postpone an important number of deaths in Costa Rica. More support for existing policies and programs urges.

Evidence related to sodium restriction in patients with heart failure.

OBJECTIVES: to analyze the scientific production about sodium restriction in patients with heart failure. METHODS: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. RESULTS: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. CONCLUSIONS: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

The Influence of Dietary Salt on the Osseointegration of Implants in Aging Rats

Introduction: The bone-implant interface has been studied extensively, but only few papers focused on the nutritional aspects that may affect bone quality, especially salt intake. Objective: To study the osseointegration of implants in salt-loaded rats with low mineral bone content. Methods: A total of 60 4-month-old male rats were divided in 2 groups ( n = 30), being these groups divided in 2 periods, (2 and 4 months). The control group received a normal diet, while the test group received a diet supplemented with 1% sodium chloride (NaCl). Implants were placed in the tibia of both groups. A total of 15 animals of each group were sacrificed at the 2 nd month of the experiment, while the remaining animals were sacrificed at the 4 th month. Results: No statistically significant difference was found in food intake between the groups on any experimental period, but a statistically significant difference was found in the liquid intake in the saline group in both periods. For all groups, osseointegration was observed in both groups. The mean percentage of osseointegration in the cortical bone, in the trabecular bone, and in the total osseointegrated surface between the control (46.38 ± 16.17%) and saline (49.13 ± 11.52%) groups at 2 months was not statistically different ( p = 0.61). The total osseointegration areas of the control (53.98 ± 12.06%) and saline (51.40 ± 13.01%) groups at the 4 th month of the study were not statistically ( p = 0.61). Conclusion: Ingestion of salt did not affect directly the osseointegration process during the period of the experiment. The results suggest that mineral losses may not affect the achievement of good osseointegration in aging rats. (AU)

Monitoring Sodium Content in Processed Foods in Argentina 2017-2018: Compliance with National Legislation and Regional Targets.

Sodium intake in Argentina has been estimated to be at least double the dose of 2000 mg/day recommended by WHO, mostly coming from processed foods. Argentina is one of the few countries in the world that have regulated sodium content in certain food products. This study presents an assessment of sodium content in a selection of food groups and categories as reported in the nutrient information panels. We surveyed 3674 food products, and the sodium content of 864 and 1375 of them was compared to the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of sodium content. Over 90% of the products included in the national sodium reduction law were found to be compliant. Food groups with high median sodium, such as condiments, sauces and spreads, and fish and fish products, are not included in the national law. In turn, comparisons with the lower regional targets indicated that almost 50% of the products analyzed had sodium contents above the recommended values. This evidence suggests that enhancing sodium reduction in processed foods may be a necessity for public health objectives and it is also technically feasible in Argentina.

Bread Consumption Is Associated with Elevated Blood Pressure among Adults Living in Mexico City⁻A Sub-Analysis of the Tlalpan 2020 Study.

Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01⁻1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53⁻0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level.

Urinary sodium excretion in a young to middle-aged adult urban population: a pilot study in Ecuador / Excreción de sodio urinario en una población urbana de adultos jóvenes y de mediana edad: un estudio piloto en Ecuador

ABSTRACT Objective High sodium consumption is associated with cardiovascular disease (CVD). CVD is the leading cause of mortality in Ecuador, which may be caused in part by unhealthy eating habits. Currently, there are no data on the consumption of sodium using 24-hr urine samples. The aims of the study were to provide preliminary data of sodium intake in an urban population sample consisting of adults between 25 and 64 years old, and to explore the feasibility to conduct a population-level sodium intake determination by using 24-hr urine samples. Methods A cross-sectional study was conducted in a sample of 129 adults living in an urban setting. 24-hr urinary samples were collected and the WHO STEPS instrument was used to collect the socio-demographic and clinical characteristics of participants. A reference value of 2.0 g/day was used to differentiate between normal and high sodium intake groups. Results Participants' median age was 39 years, 91% of them identified themselves as belonging to the mestizo race, and 60% were female. The average sodium intake was 2 655(±1 185) mg/d (range: 1 725 to 3 404), which is equivalent to a salt intake of 6.8 g/d (range: 4.4 to 8.7). Sodium intake was significantly higher in males than in females: 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectively, (p<.01). Conclusions Sodium consumption in two-thirds of the participants was higher than the WHO recommended level. These results should help to support the execution of a national sodium intake survey that, in turn, would provide information to guide and plan public health strategies seeking to decrease cardiovascular diseases occurrence rates in Ecuador.(AU)

RESUMEN Objetivo Un exceso de sodio dietético se asocia con enfermedades cardiovasculares (ECV). Las ECV son la principal causa de mortalidad en el Ecuador, tal vez por patrones dietéticos no saludables en su población. Al momento no existe información del consumo de sodio usando orina de 24-hr. Los objetivos del estudio fueron proveer información preliminar de la ingesta de sodio en una muestra urbana de adultos de 25-64 años, y explorar la factibilidad de realizar un estudio a nivel nacional. Métodos Estudio de corte-transversal de 129 adultos residentes en un entorno urbano. Se recolectó muestras urinarias de 24-hr y se recolectaron características socio-demográficas y clínicas usando los cuestionarios STEPS de la OMS. Un valor de referencia de 2.0 g/día fue utilizado para discriminar entre consumidores normales y altos de sodio. Resultados La mediana de edad de la población estudiada fue de 39 años, 91% se autodefinió de raza mestiza, y 60% fueron femeninas. La ingesta promedio de sodio fue de 2 655(±1 185) mg/d (rango: 1 725 to 3 404), que es equivalente a una ingesta de sal de 6.8 g/d (rango: 4.4 to 8.7). La ingesta masculina fue significativamente mayor que el de las mujeres 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectivamente, (p<.01). Conclusiones Dos tercios de la población estudiada consume sodio mayor al recomendado por la OMS. Estos resultados apoyan la ejecución de un estudio nacional que guíe la planificación en salud pública e informe estrategias para mejorar la salud cardiovascular en el Ecuador.(AU)

Sodium Intake Is associated With Endothelial Damage Biomarkers and Metabolic Dysregulation.

BACKGROUND: Mounting evidence has associated high sodium (HS) intake with hypertension, cardiovascular disease, and stroke. We investigated whether HS intake modulates the parameters of endothelial damage, inflammation, and oxidative stress. METHODS: We used a cross-sectional study design including 223 Chilean subjects (6.9-65.0 years old). We measured aldosterone, renin activity, cortisol, cortisone, adiponectin, leptin, hsCRP, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), plasminogen activator inhibitor type 1 (PAI-1), metalloproteinase (MMP)-9 and MMP-2 activity, and malondialdehyde. Sodium and creatinine were measured in 24-hour urine samples. The subjects were divided by sodium intake, high sodium (HS): ≥150 mEq/day, n = 118, and adequate sodium (AS): <150 mEq/day, n = 105. RESULTS: We observed a positive correlation between urinary sodium excretion and blood pressure (r = 0.1669, P = 0.0124 for systolic and r = 0.2416, P = 0.0003 for diastolic), glycemia (r = 0.2660, P < 0.0001), and triglycerides (r = 0.1604, P = 0.0175) and a highly significant correlation between sodium excretion and PAI-1 (r = 0.2701, P < 0.0001). An inverse correlation was observed between urinary sodium and HDL-cholesterol (r = -0.2093, P = 0.0018) and adiponectin (r = -0.2679, P < 0.0001). In a linear regression model, urinary sodium excretion remained significantly associated with PAI-1 values even after adjusting for age, gender, and BMI. The HS group had higher blood pressure, glycemia, HOMA-IR, atherogenic index of plasma, and PAI-1 values than the group with AS intake. CONCLUSIONS: HS intake is associated with endothelial damage (high PAI-1) and metabolic dysregulation. On the other hand, inflammation and oxidative stress parameters are not modified by sodium intake.

Contemporary Dietary Intake: Too Much Sodium, Not Enough Potassium, yet Sufficient Iodine: The SALMEX Cohort Results.

Initiatives to reduce sodium intake are encouraged globally, yet there is concern about compromised iodine intake supplied through salt. The aim of the present study was to determine baseline sodium, potassium, and iodine intake in a sample of workers from our Institution in Mexico City (SALMEX Cohort). Methods. From a cohort of 1009 workers, appropriate 24-h urine and three-day dietary recall was collected in a sample of 727 adult subjects for assessment of urinary sodium, potassium, and iodine concentrations. Median urinary iodine excretion (UIE) was compared across categories of sodium intake of <2, 2⁻3.6, and ≥3.6 g/day. Results. Average sodium intake was 3.49 ± 1.38 g/day; higher in men than women (4.14 vs. 3.11 g/day, p ≤0.001). Only 10.6% of the population had sodium intake within the recommended range (<2 g/day); 45.4% had high (2⁻3.6 g/day) and 44% had excessive intake (>3.6 g/day). Average urinary Na/K ratio was 3.15 ± 1.22 (ideal < 1), higher in men (3.42 vs. 3.0, p ≤ 0.001). The multivariate analysis showed that sodium intake was associated with age (p = 0.03), male sex (p < 0.001), caloric intake (p = 0.002), UKE (p < 0.001) and BMI (p < 0.001). Median iodine intake was 286.7 µg/day (IQR 215⁻370 µg/day). Less than 2% of subjects had iodine intake lower than recommended for adults (95 µg/day); 1.3% of subjects in the recommended range of salt intake had low iodine intake. There is a direct relationship between iodine and sodium urinary excretion (r = 0.57, p < 0.0001). Conclusions. In the studied population, there was an excessive sodium intake and an imbalance between sodium and potassium intake. Only 10.6% of the population had sodium intake within the recommended values, but iodine intake in this group appears to be adequate.

Inappropriate activity of local renin-angiotensin-aldosterone system during high salt intake: impact on the cardio-renal axis.

Although there is a general agreement on the recommendation for reduced salt intake as a public health issue, the mechanism by which high salt intake triggers pathological effects on the cardio-renal axis is not completely understood. Emerging evidence indicates that the renin-angiotensin-aldosterone system (RAAS) is the main target of high Na+ intake. An inappropriate activation of tissue RAAS may lead to hypertension and organ damage. We reviewed the impact of high salt intake on the RAAS on the cardio-renal axis highlighting the molecular pathways that leads to injury effects. We also provide an assessment of recent observational studies related to the consequences of non-osmotically active Na+ accumulation, breaking the paradigm that high salt intake necessarily increases plasma Na+ concentration promoting water retention.

Inappropriate activity of local renin-angiotensin-aldosterone system during high salt intake: impact on the cardio-renal axis / Atividade inadequada do sistema renina-angiotensina-aldosterona local durante período de alta ingestão de sal: impacto sobre o eixo cardiorrenal

ABSTRACT Although there is a general agreement on the recommendation for reduced salt intake as a public health issue, the mechanism by which high salt intake triggers pathological effects on the cardio-renal axis is not completely understood. Emerging evidence indicates that the renin-angiotensin-aldosterone system (RAAS) is the main target of high Na+ intake. An inappropriate activation of tissue RAAS may lead to hypertension and organ damage. We reviewed the impact of high salt intake on the RAAS on the cardio-renal axis highlighting the molecular pathways that leads to injury effects. We also provide an assessment of recent observational studies related to the consequences of non-osmotically active Na+ accumulation, breaking the paradigm that high salt intake necessarily increases plasma Na+ concentration promoting water retention

RESUMO Apesar de haver uma concordância geral sobre a necessidade de redução na ingestão de sal como questão de saúde publica, o mecanismo pelo qual a alta ingesta de sal deflagra efeitos patológicos sobre o eixo cardiorrenal não está ainda completamente elucidado. Cada vez mais evidencias indicam que o sistema renina-angiotensina-aldosterona (SRAA) seja o principal alvo da alta ingesta de Na+. Uma ativação inadequada do SRAA tecidual pode causar hipertensão e dano ao órgão. Nós revisamos o impacto da dieta com alto teor de sódio sobre o eixo cardiorrenal, destacando as vias moleculares que causam a lesão. Também fizemos uma avaliação de recentes estudos observacionais relacionados às consequências do acúmulo de Na+ não osmoticamente ativo, quebrando assim o paradigma de que a alta ingestão de sódio necessariamente aumenta a concentração sérica de Na+, assim promovendo a retenção de água.

The effectiveness of an educational intervention for sodium restriction in patients with hypertension: study protocol for a randomized controlled trial.

BACKGROUND: The effectiveness of nonpharmacological interventions in blood pressure reduction has been evidenced by several studies. Nevertheless, as adherence to a low-sodium diet is poor, interventions regarding habit changing should be of a motivational nature in order to develop the ability of overcoming obstacles regarding sodium-restriction behavior. The present study aims to describe the protocol and randomization of a clinical trial design in order to evaluate the effectiveness of an educational intervention based on Dietary Sodium Restriction Questionnaire (DSRQ) scores. The effectiveness measures are the DSRQ score variation and reduction in urinary sodium values from baseline to after 2 and 6 months. METHODS/DESIGN: This parallel, randomized clinical trial will include 120 participants, recruited and randomized as follows: 60 of them to be allocated to a sodium-restriction educational intervention group whose results are based on the DSRQ application; and the other 60 allocated to a control group with usual care. Educational orientation and usual care sessions will be conducted once a month for a period of 6 months. Both spot urine collection - estimating sodium intake - and the DSRQ will be applied at the baseline, in the eighth week and at the end of the follow-up. There will also be blood collection and 24-h ambulatory blood pressure monitoring (ABPM) at the beginning and end of the follow-up. Anthropometric measurements, blood pressure measurement and 24-h food recall will be collected during follow-up. DISCUSSION: The study "The effectiveness of an educational intervention to sodium restriction in patients with hypertension" is based on the results of the DSRQ application, whose objective is to evaluate aspects related to nonadherence to the recommendation of a low-sodium diet, identifying adherence barriers and facilitators, contributing to the planning of interventions for improving the adoption of a low-sodium diet and, consequently, hypertension control. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, Identifier: NCT02848690 . Registered retrospectively on 27 July 2016.

Food Sources of Sodium Intake in an Adult Mexican Population: A Sub-Analysis of the SALMEX Study.

Excessive dietary sodium intake increases blood pressure and cardiovascular risk. In Western diets, the majority of dietary sodium comes from packaged and prepared foods (≈75%); however, in Mexico there is no available data on the main food sources of dietary sodium. The main objective of this study was to identify and characterize the major food sources of dietary sodium in a sample of the Mexican Salt and Mexico (SALMEX) cohort. Adult male and female participants of the SALMEX study who provided a complete and valid three-day food record during the baseline visit were included. Overall, 950 participants (mean age 38.6 ± 10.7 years) were analyzed to determine the total sodium contributed by the main food sources of sodium identified. Mean daily sodium intake estimated by three-day food records and 24-h urinary sodium excretion was 2647.2 ± 976.9 mg/day and 3497.2 ± 1393.0, in the overall population, respectively. Processed meat was the main contributor to daily sodium intake, representing 8% of total sodium intake per capita as measured by three-day food records. When savory bread (8%) and sweet bakery goods (8%) were considered together as bread products, these were the major contributor to daily sodium intake, accounting for the 16% of total sodium intake, followed by processed meat (8%), natural cheeses (5%), and tacos (5%). These results highlight the need for public health policies focused on reducing the sodium content of processed food in Mexico.

Warnings as a directive front-of-pack nutrition labelling scheme: comparison with the Guideline Daily Amount and traffic-light systems.

OBJECTIVE: Warnings have recently been proposed as a new type of directive front-of-pack (FOP) nutrition labelling scheme to flag products with high content of key nutrients. In the present work, this system was compared with the two most common FOP nutrition labelling schemes (Guideline Daily Amounts (GDA) and traffic-light system) in terms of goal-directed attention, influence on perceived healthfulness and ability to differentiate between products. Design/Setting/Subjects Goal-directed attention to FOP labels was evaluated using a visual search task in which participants were presented with labels on a computer screen and were asked to indicate whether labels with high sodium content were present or absent. A survey with 387 participants was also carried out, in which the influence of FOP labels on perceived healthfulness and ability to identify the healthful alternative were evaluated. RESULTS: Warnings improved consumers' ability to correctly identify a product with high content of a key nutrient within a set of labels compared with GDA and received the highest goal-directed attention. In addition, products with high energy, saturated fat, sugar and/or sodium content that featured warnings on the label were perceived as less healthful than those featuring the GDA or traffic-light system. Warnings and the traffic-light system performed equally well in the identification of the most healthful product. CONCLUSIONS: Results from the present work suggest that warnings have potential as directive FOP nutrition labels to improve consumer ability to identify unhealthful products and highlight advantages compared with the traffic-light system.

Patrones de excreción urinaria de Sodio en población adulta en muestras de orina espontánea / Urinary sodium excretion patterns in adult population in spot urine samples

Introducción: El presente estudio describe los patrones de natriuresis según las características clínicas y sociodemográficas en una población adulta de Asunción. Métodos: Estudio transversal tipo encuesta y toma de muestra de orina a personas que acudieron al Mercado de Abasto y al Policlínico Municipal durante los meses de junio-setiembre del 2014. Se estimó natriuria en muestras de orina espontánea a primera hora de la mañana y en ayunas. Se incluyeron sujetos de 18 a 65 años. Se compararon las medianas de los valores de natriuria en mmol/L, utilizándose el test U de Mann-Whitney para comparar las variables de dos categorías y Kruskal-Wallis para las que tienen más de dos categorías. Resultados: Se aplicó la encuesta y se tomó muestra de orina a 463 personas. El 69,5% (322) eran mujeres. La media de edad fue 50,5 años (DE: 14,2). El 26,6% (123) negó antecedentes patológicos. La mediana de natriuria global fue 97,5 mmol/L (RIC: 59,3­139,3). Los niveles de natriuria no presentaron diferencias por sexo. Las personas menores de 30 años, con bajo consumo de verduras y mayor consumo de frituras presentaron valores de natriuria altos y estadísticamente significativos. El grupo de sujetos sanos mostró mayor excreción de sodio que los que refirieron diabetes o hipertensión arterial. Conclusiones: La mayor excreción de sodio en orina observada se presenta en personas jóvenes, sin antecedentes patológicos y, al mismo tiempo son los que también presentan los peores hábitos alimenticios. Estos resultados muestran la necesidad de intervención en el ámbito de la salud pública a fin de prevenir la patología cardiovascular y renal del futuro.

Introduction: The present study describes natriuresis patterns according to clinical and sociodemographic characteristics in adult population of Asuncion. Methods: Cross-sectional study of convenience sampling to people who attended the Mercado de Abasto and the Municipal Polyclinic during June to September 2014. People from 18 to 65 years old were included. Sodium was estimated from urine samples of spot urine taken in the morning and fasting. Median values of natriuresis in mmol/L were compared using the test Mann-Whitney and Kruskal-Wallis. Results: 463 people participated. 69.5% (322) were women. The mean age was 50.5 years (SD 14.2). 26.6% (123) denied pathological medical history. The median overall natriuresis was 97.5 mmol/L (IQR: 59.3-139.3). Natriuresis levels did not differ by sex. High values with statistically significant were presented in people under 30 years old, with low consumption of vegetables and increased consumption of fried food. The group of healthy subjects showed increased sodium excretion than those who reported diabetes or high blood pressure. Conclusions: The increased natriuresis occurs in young people without having pathological medical history and also having the worst eating habits. Public health policies must focus at this level to prevent future cardiovascular and renal disease it is at this level where public health must intervene to prevent future cardiovascular and renal disease.

Cafeteria diet increases liquid intake and serum creatinine levels in rats

Introduction: Important changes in human dietary pattern occurred in recent decades. Increased intake of processed foods leads to obesity, which is related with the development of chronic diseases such as type 2 diabetes mellitus, hypertension, as well as cardiovascular and chronic kidney diseases. The prevalence of hypertension has also dramatically increased in recent years, and high sodium intake contributes to this scenario. In healthy individuals, kidneys are the primary end-organs that regulate sodium homeostasis. This study aims to evaluate renal function parameters and systolic blood pressure measurements in an animal model of obesity. Methods: Sixty-day-old male Wistar rats (n=30) were divided into two groups: standard (SD) and cafeteria diet (CD). Cafeteria diet was altered daily and was composed by crackers, wafers, sausages, chips, condensed milk, and soda. All animals had free access to water and chow and the experiment was carried out for 6 weeks. Weight gain, sodium and liquid intake control, systolic blood pressure measurements, and renal function parameters were evaluated. Results: Animals exposed to cafeteria diet had an increase of 18% in weight compared to the control group. Sodium intake was increased by cafeteria diet and time (F(1,28)=773.666, P=0.001 and F(5,28)=2.859, P=0.02, respectively) and by the interaction of both factors (F(6,28)=2.859, P=0.02). On liquid intake occurred only effect of cafeteria diet and time (F(1,28)=147.04, P=0.001 and F(5,28)=3.996, P=0.003, respectively). Cafeteria diet exposure also induced an increase on creatinine serum levels (P=0.002), however this effect was not observed on creatinine urine levels (P>0.05) nor on systolic pressure measurements (Students' t test, P>0.05). Conclusions: Obesity induced by cafeteria diet exposure increases liquid intake and alters creatinine serum levels, an important renal function marker. Considering the high consumption of hypercaloric food currently in the world, further studies are required to elucidate the modifications on renal function triggered by this diet over time (AU)

[Measurement of dietary sodium intake in a group of children from one to 18 months of age in a pediatric service in Cali, Colombia].

INTRODUCTION: The fatty streaks in an arterial wall can appear from the third year of age, and they show an association with atherogenic risk factors such as hypertension and sodium in the diet. Given the difficulty of data gathering, few studies report the intake of sodium in the diet. OBJECTIVE: To determine average sodium intake in the diet of children between one and 18 months of age through a three-day dietary survey. MATERIALS AND METHODS: This was a cross-sectional study with 48 children without renal disease or diet restrictions seen in pediatric practice between January and June, 2011. It included a dietary survey for the parents, nutritional status classification by anthropometry, and blood pressure measurements. Sodium content and other nutrients in the diet program were analyzed with the International Food Consumption Program (CERES), anthropometry with the World Health Organization Anthro program, and Epi-info for socio-demographic characteristics. RESULTS: In total, 69% of children had high sodium consumption, 6.2% had high blood pressure, and 20.7% were overweight and obese. CONCLUSIONS: The prevalence of hypertension exceeds that reported for Colombia (1-3%). Two of the three children with high blood pressure had high sodium intake and they were overweight and obese, with values above those reported for Colombian children (16%). We suggest to measure blood pressure early, and to restrict salt and sugar in food for infants and children under two years of age. Also, larger studies should be conducted to collect population data on sodium intake and develop appropriate and timely intervention strategies to reduce risks in adulthood.

Medición de la ingestión de sodio en la dieta de un grupo de niños entre uno y 18 meses de edad en una consulta pediátrica en Cali, Colombia / Measurement of dietary sodium intake in a group of children from one to 18 months of age in a pediatric service in Cali, Colombia

Resumen Introducción. Las estrías de grasa en la pared arterial pueden aparecer desde el tercer año Resumende vida y se relacionan con factores de riesgo aterogénico, como la hipertensión arterial sistémica y el contenido de sodio en la dieta. En pocos estudios se reporta el consumo de sodio en la dieta debido a la dificultad para la recolección de los datos. Objetivo. Determinar el consumo promedio de sodio en la dieta de niños de uno a 18 meses de edad, mediante una encuesta sobre la dieta a lo largo de tres días. Materiales y métodos. Se hizo un estudio de corte transversal con 48 niños sin enfermedad renal ni restricciones en la dieta, atendidos en consulta pediátrica entre enero y junio del 2011, el cual incluyó una encuesta sobre la dieta a los padres y la clasificación del estado nutricional por antropometría y medición de la presión arterial. Se analizaron el contenido de sodio y demás nutrientes de la dieta con el Programa Internacional de Consumo de Alimentos (CERES), las medidas antropométricas con el programa Anthro de la Organización Mundial de la Salud y las características sociodemográficas con el programa de Epi-info. Resultados. El 69 % de los niños tenía un consumo alto de sodio, el 6,2 % presentaba presión arterial elevada, y el 20,7 %, sobrepeso y obesidad. Conclusiones. La prevalencia de hipertensión arterial sistémica superó la informada para Colombia (1 a 3 %). Dos de los tres niños con presión arterial elevada tenían una dieta rica en sodio, así como sobrepeso y obesidad con valores superiores a lo informado para Colombia (16 %). Se sugiere medir la presión arterial tempranamente, recomendar la restricción de sal y azúcar en la alimentación de los menores de dos años, desarrollar estudios más grandes para obtener datos poblacionales sobre la ingestión de sodio, y diseñar estrategias de intervención, adecuadas y oportunas, para disminuir los riesgos en la edad adulta.

Abstract Introduction: The fatty streaks in an arterial wall can appear from the third year of age, and they show an association with atherogenic risk factors such as hypertension and sodium in the diet. Given the difficulty of data gathering, few studies report the intake of sodium in the diet. Objective: To determine average sodium intake in the diet of children between one and 18 months of age through a three-day dietary survey. Materials and methods: This was a cross-sectional study with 48 children without renal disease or diet restrictions seen in pediatric practice between January and June, 2011. It included a dietary survey for the parents, nutritional status classification by anthropometry, and blood pressure measurements. Sodium content and other nutrients in the diet program were analyzed with the International Food Consumption Program (CERES), anthropometry with the World Health Organization Anthro program, and Epi-info for socio-demographic characteristics. Results: In total, 69% of children had high sodium consumption, 6.2% had high blood pressure, and 20.7% were overweight and obese. Conclusions: The prevalence of hypertension exceeds that reported for Colombia (1-3%). Two of the three children with high blood pressure had high sodium intake and they were overweight and obese, with values above those reported for Colombian children (16%). We suggest to measure blood pressure early, and to restrict salt and sugar in food for infants and children under two years of age. Also, larger studies should be conducted to collect population data on sodium intake and develop appropriate and timely intervention strategies to reduce risks in adulthood.