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1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 148-153, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465181

RESUMO

Introduction: It is recommended to limit the consumption of sodium to 2 g / day and consume 25 g / 2000 kcal of fiber. Baked and cookies are the key food-vehicle to achieve these recommendations. x Objective: To evaluate the acceptability of the optimal healthy bread with nutritional information in a breakfast, teatime or snack (DMC) in real consumption situation. Methodology: In the offices of the Faculty of Medicine, a tray was delivered with: infusions, sweeteners, milk powder, jams, healthy bread, commercial orange juice and nutritional information to be consumed by participants as DMC. 100 students, teachers and non-teachers performed the acceptance test of different components of the tray using a scale of 1 (dislike very much) to 10 (like very much), they answered demographic data, what was your DM C, amount of bread consumed and the price they would pay for it. Results: 43.4% consumed the tray for teatime. Most consumed infusion: coffee. 100% consumed the bread and 91% accompanied it with jam. The average value of acceptability was 8.57 ± 1.44 without significant differences by age, sex or Body Mass Index. 76% consumed at least 3/4. The average price they were willing to pay was $ 54.65 / kilo ±12.32 (reference French bread $ 50 / kilo). The average scores of acceptability were: 8.82±1.27 for presentation of the tray, 8.53±1.43 of the DMC consumed and 8.17±2 of the commercial orange juice. Conclusions: The acceptability of the bread in real situation of consumption was very good, being an effective strategy to reduce the ingestion of NaCl and increase the fiber.


Assuntos
/métodos , Dieta Hipossódica/métodos , Comportamento Alimentar/fisiologia , Valor Nutritivo , Adolescente , Adulto , Argentina , Índice de Massa Corporal , Pão , Estudos de Coortes , Comportamento do Consumidor , Estudos Transversais , Inquéritos sobre Dietas , Fibras na Dieta , Ingestão de Energia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Cloreto de Sódio na Dieta , Inquéritos e Questionários , Adulto Jovem
2.
Hypertension ; 74(1): 194-200, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31079530

RESUMO

Dietary sodium restriction has multiple beneficial effects on cardiovascular health. The underlying mechanisms are not fully understood, and the roles of metabolomics have been rarely studied. We aimed to test the hypothesis that the reduction in dietary sodium intake would induce changes in metabolomic profiling among black hypertensives, and the changes would be associated with reduced blood pressure (BP) and improved skin capillary density. A total of 64 untreated black hypertensives were included from a randomized, double-blind, placebo-controlled cross-over trial of sodium reduction. The participants were given either 9 slow sodium tablets (10 mmol sodium per tablet) or placebo tablets daily for 6 weeks, they then crossed over to receive the other tablets for another 6 weeks, while on reduced sodium diet aiming at achieving daily sodium intake around 2.0 g. Untargeted metabolomic profiling was performed in paired serum samples, which were collected at the end of each period, so were BP and capillary density. Mixed-effects models were used. There were 34 metabolites identified with raw P's<0.05. Among those, 2 metabolites including ß-hydroxyisovalerate and methionine sulfone were significantly increased with sodium reduction (false discovery rate =0.006 and 0.099, respectively). Increased ß-hydroxyisovalerate was associated with reduced office systolic BP and ambulatory daytime systolic BP, whereas increased methionine sulfone was associated with reduced 24-hour diastolic BP, ambulatory nighttime diastolic BP, and increased skin capillary density. Our results suggest that dietary sodium reduction increases the circulating levels of ß-hydroxyisovalerate and methionine sulfone. Further studies are warranted. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT00152074.


Assuntos
Afro-Americanos/genética , Doenças Cardiovasculares/prevenção & controle , Dieta Hipossódica/métodos , Hipertensão/dietoterapia , Metabolômica/métodos , Cloreto de Sódio na Dieta/efeitos adversos , Adulto , Determinação da Pressão Arterial , Doenças Cardiovasculares/etnologia , Estudos Cross-Over , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Medição de Risco , Cloreto de Sódio , Cloreto de Sódio na Dieta/administração & dosagem
3.
Nurs Res ; 68(3): 246-252, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033867

RESUMO

BACKGROUND: Cardiovascular disease accounts for more than half of all deaths in the hemodialysis (HD) population. Although much of this mortality is associated with fluid overload (FO), FO is difficult to measure, and many HD patients have significant pulmonary congestion despite the absence of clinical presentation. Cohort studies have observed that FO, as measured by bioimpedance spectroscopy (BIS), correlates with mortality. Other studies have observed that lower sodium intake is associated with less fluid-related weight gain, improved hypertension, and survival. Whether sodium intake influences FO in HD patients as measured by BIS is not known. OBJECTIVE: The aims of the study were to determine the feasibility of assessing the impact of sodium restriction on body fluid composition as measured by BIS among patients with three levels of sodium intake and to determine if there are statistical and/or clinical differences in BIS measures across sodium intake groups. METHODS: We used a double-blinded randomized controlled trial design with three levels of sodium restriction, 2,400 mg per day, 1,500 mg per day, and unrestricted (control group), to test our aims. Forty-two HD patients from a tertiary acute care academic institution associated with three urban DaVita dialysis centers were enrolled. Participants remained in the inpatient center for 5 days and 4 nights and were randomly assigned to sodium intake groups. Body fluid composition was measured with BIS. RESULTS: Recruitment, enrollment, and retention statistics supported the feasibility of the study design. Regression analyses showed that there were no statistically significant differences among sodium intake groups on any of the outcomes. DISCUSSION: Our data suggest the need for additional research into the effects of sodium restriction on body fluid composition.


Assuntos
Composição Corporal/fisiologia , Líquidos Corporais/fisiologia , Falência Renal Crônica/metabolismo , Sódio/metabolismo , Equilíbrio Hidroeletrolítico/fisiologia , Dieta Hipossódica/métodos , Estudos de Viabilidade , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal , Sódio na Dieta/administração & dosagem
4.
Eur Arch Otorhinolaryngol ; 276(7): 1943-1950, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30976990

RESUMO

PURPOSE: Ménière's disease (MD) is an inner ear disorder of unknown etiology, whose pathological substrate is the endolymphatic hydrops. Different treatments have been proposed; however, evidence of their effectiveness is lacking. The aim of this study was to evaluate by a questionnaire which medical and surgical treatments are used in Italy for the treatment of MD and to compare them with those proposed in other countries. METHODS: An electronic questionnaire of 40 questions was formulated and sent to Italian otolaryngologist (ENT) divided into two groups: Group 1 ("generalists" 60.8%) and Group 2 ("neurotologist- NO" 39.2%). RESULTS: One hundred and twenty five ENT replied. Treatment of the acute phase, apart from symptomatics, was based on diuretics that are prescribed by 83.5% of respondents, steroids, prescribed by 66.7%, and vasodilators, prescribed by 22%. In the intercritical phase, 87.2% of respondents recommended low-salt diet, 78.4% of respondents prescribed betahistine, and 52.8% diuretics. Statistical analysis did not show correlation neither with the declared specialization nor with the number of patients treated. In case of failure of medical treatment, IT gentamicin was suggested by 48.8% of the respondents and IT steroids by 40.8%. Statistical analysis showed that generalists prefer IT steroids and NO IT gentamicin (p 0.019). In case of failure of both medical treatment and IT treatment, vestibular neurectomy was indicated by 58.4% of the respondents, 6.4% indicated endolymphatic sac surgery, and 2.4% surgical labyrinthectomy. CONCLUSION: In Italy, the treatment of MD stand on a gradual approach that starts from the dietary-behavioral changes and a pharmacological therapy based on betahistine. In refractory cases, IT treatment initially with steroids and, therefore, with gentamicin allows the control in vertigo in the majority of cases. In case of failure of IT treatment, VNS is the surgery of choice.


Assuntos
beta-Histina/uso terapêutico , Dieta Hipossódica/métodos , Gentamicinas/uso terapêutico , Glucocorticoides/uso terapêutico , Doença de Meniere , Otolaringologia , Procedimentos Cirúrgicos Otológicos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Comparação Transcultural , Humanos , Itália/epidemiologia , Doença de Meniere/dietoterapia , Doença de Meniere/tratamento farmacológico , Doença de Meniere/epidemiologia , Doença de Meniere/cirurgia , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Inibidores da Síntese de Proteínas/uso terapêutico , Inquéritos e Questionários , Vasodilatadores/uso terapêutico
5.
Hypertension ; 73(3): 587-593, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30661474

RESUMO

The American Heart Association recommends no more than 1500 mg of sodium/day as ideal. Some cohort studies suggest low-sodium intake is associated with increased cardiovascular mortality. Extremely low-sodium diets (≤500 mg/d) elicit activation of the renin-angiotensin-aldosterone system and stimulate sympathetic outflow. The effects of an American Heart Association-recommended diet on sympathetic regulation of the vasculature are unclear. Therefore, we assessed whether a 1000 mg/d diet alters sympathetic outflow and sympathetic vascular transduction compared with the more commonly recommended 2300 mg/d. We hypothesized that sodium reduction from 2300 to 1000 mg/d would not affect resting sympathetic outflow but would reduce sympathetic transduction in healthy young adults. Seventeen participants (age: 26±2 years, 9F/8M) completed 10-day 2300 and 1000 mg/d sodium diets in this randomized controlled feeding study (crossover). We measured resting renin activity, angiotensin II, aldosterone, blood pressure, muscle sympathetic nerve activity, and norepinephrine. We quantified beat-by-beat changes in mean arterial pressure and leg vascular conductance (femoral artery ultrasound) following spontaneous sympathetic bursts to assess sympathetic vascular transduction. Reducing sodium to 1000 mg/d increased renin activity, angiotensin II, and aldosterone ( P<0.01 for all) but did not alter mean arterial pressure (78±2 versus 77±2 mm Hg, P=0.56), muscle sympathetic nerve activity (13.9±1.3 versus 13.9±0.8 bursts/min, P=0.98), or plasma/urine norepinephrine. Sympathetic vascular transduction decreased ( P<0.01). These data suggest that reducing sodium from 2300 to 1000 mg/d stimulates the renin-angiotensin-aldosterone system, does not increase resting basal sympathetic outflow, and reduces sympathetic vascular transduction in normotensive adults.


Assuntos
Pressão Sanguínea/fisiologia , Dieta Hipossódica/métodos , Hipertensão/tratamento farmacológico , Cloreto de Sódio na Dieta/administração & dosagem , Sistema Nervoso Simpático/fisiopatologia , Resistência Vascular/fisiologia , Adulto , Estudos Cross-Over , Relação Dose-Resposta a Droga , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Músculo Liso Vascular/inervação , Músculo Liso Vascular/fisiopatologia , Adulto Jovem
6.
J Clin Hypertens (Greenwich) ; 20(12): 1654-1665, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30402970

RESUMO

The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from August 2016 to March 2017. The search strategy was adapted from a previous systematic review on dietary salt and health. Studies that meet standards for methodological quality criteria and eligible health outcomes are reported in detailed critical appraisals. Overall, 47 studies were identified and are summarized in this review. Two studies assessed all-cause or disease-specific mortality outcomes, eight studies assessed morbidity reduction-related outcomes, three studies assessed outcomes related to symptoms/quality of life/functional status, 25 studies assessed blood pressure (BP) outcomes and other clinically relevant surrogate outcomes, and nine studies assessed physiologic surrogate outcomes. Eight of these studies met the criteria for outcomes and methodological quality and underwent detailed critical appraisals and commentary. Five of these studies found adverse effects of salt intake on health outcomes (BP; death due to kidney disease and initiation of dialysis; total kidney volume and composite of kidney function; composite of cardiovascular disease (CVD) events including, and risk of mortality); one study reported the benefits of salt restriction in chronic BP and two studies reported neutral results (BP and risk of CKD). Overall, these articles confirm the negative effects of excessive sodium intake on health outcomes.


Assuntos
Hipertensão/complicações , Nefropatias/epidemiologia , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio/administração & dosagem , Adulto , Idoso , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Estudos de Casos e Controles , Estudos Transversais , Dieta Hipossódica/métodos , Dieta Hipossódica/estatística & dados numéricos , Feminino , Indicadores Básicos de Saúde , Humanos , Hipertensão/epidemiologia , Nefropatias/etiologia , Nefropatias/mortalidade , Nefropatias/terapia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Cloreto de Sódio/efeitos adversos , Cloreto de Sódio/urina , Cloreto de Sódio na Dieta/efeitos adversos
7.
Am Heart J ; 205: 87-96, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30205241

RESUMO

BACKGROUND: Patients with heart failure (HF) remain at high risk for future events despite medical and device therapy. Dietary sodium reduction is often recommended based on limited evidence. However, it is not known whether dietary sodium reduction reduces the morbidity or mortality associated with HF. METHODS: The SODIUM study is a pragmatic, randomized, open-label trial assessing the efficacy of dietary sodium reduction to <1500 mg daily counseling compared to usual care for patients with chronic HF. The intervention is provided by trained personnel at the site and uses 3-day food records for directing counseling. The primary outcome is an intention-to-treat analysis on the time to first cardiovascular event or death measured at 12 months. Secondary end points include the change in quality of life (using the Kansas City Cardiomyopathy Questionnaire), change in New York Heart Association class, and change in 6-minute walk test. The first patient was enrolled in March 2014, and subsequently, 27 sites in 6 countries enrolled patients. CONCLUSIONS: The SODIUM-HF trial will provide a robust evaluation of the effects of dietary sodium reduction in patients with HF. Results are expected in 2020.


Assuntos
Dieta Hipossódica/métodos , Insuficiência Cardíaca/dietoterapia , Hospitalização/estatística & dados numéricos , Qualidade de Vida , Volume Sistólico/fisiologia , Idoso , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Teste de Caminhada
8.
Hipertens. riesgo vasc ; 35(3): 130-135, jul.-sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180568

RESUMO

Existen numerosas evidencias tanto epidemiológicas como experimentales que demuestran la existencia de una relación entre el consumo de sal y las cifras de presión arterial. Los individuos tienen distintos grados de susceptibilidad al efecto presor de la sal, fenómeno que se conoce como sensibilidad a la sal. El fenómeno del incremento o no modificación de las cifras de presión arterial al pasar de una dieta pobre en sal a otra rica ha llevado a acuñar los conceptos de sensibilidad o resistencia a la sal. Clásicamente se ha aceptado la teoría de Guyton del fenómeno de natriuresis por presión para explicar este efecto, así como, el papel fundamental que desempeñan las distintas proteínas transportadoras de sodio de los túbulos renales. En los últimos años, hay trabajos que cuestionan esta teoría y apuntan al posible papel del sistema inmune y de un tercer almacén de sodio en el organismo como factores etiopatogénicos


Abundant evidence from epidemiological and experimental studies has established a link between salt and blood pressure. However, there is heterogeneity in the blood pressure responses of humans to changes in sodium intake. Those individuals in whom a severe, abrupt change in salt intake causes the least change in arterial pressure and are termed salt-resistant, whereas in those in whom this leads to large changes in blood pressure, are called salt sensitive. Classically, Guyton's theory of the pressure-natriuresis phenomenon has been accepted to explain the pressor effect of salt, as well as the fundamental role played by the different protein sodium transporters of the renal tubules. In recent years, new theories have emerged pointing to the possible role of the immune system and the existence of a third sodium store in the body as aetiopathogenic factors


Assuntos
Humanos , Pressão Arterial , Dieta Hipossódica/métodos , Cloreto de Sódio/efeitos adversos , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/complicações , Taxa de Filtração Glomerular , Fatores de Risco
9.
Semin Dial ; 31(6): 557-562, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30084190

RESUMO

Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves clinical outcomes in hemodialysis patients. BP-lowering in these individuals should initially utilize nonpharmacological strategies aiming to control sodium and volume overload. Accordingly, restricting dietary sodium intake, eliminating intradialytic sodium gain via individualized dialysate sodium prescription, optimally assessing and managing dry-weight and providing a sufficient duration of dialysis are first-line treatment considerations to control BP. If BP remains uncontrolled despite the adequate management of volume, antihypertensive therapy is the next consideration. Contrary to nonhemodialysis populations, emerging clinical-trial evidence suggests that among those on hemodialysis, ß-blockers are more effective than agents blocking the renin-angiotensin-system (RAS) in reducing BP levels and protecting from serious adverse cardiovascular complications. Accordingly, ß-blockade is our first-line approach in pharmacotherapy of hypertension. Long-acting calcium-channel-blockers and RAS-blockers are our next considerations, taking into account the comorbidities and the overall risk profile of each individual patient. Additional research efforts, mainly randomized trials, are clearly warranted in order to elucidate aspects of management that remain elusive in hypertensive dialysis patients.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/terapia , Diálise Renal/efeitos adversos , Dieta Hipossódica/métodos , Humanos , Hipertensão/etiologia , Falência Renal Crônica/terapia , Resultado do Tratamento
10.
J Food Sci ; 83(8): 2204-2211, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30133837

RESUMO

Salt reduction is becoming a major concern for public authorities, especially in cereal products. As childhood is important for the development of healthy eating habits, this study aimed to formulate salt-reduced breads with satisfying sensory properties for children. Sourdough and an artisanal bread-making process were used to compensate the flavor loss due to salt reduction. French breads (FBs) made with sourdough and artisanal processing were compared with white breads (WBs). Two salt levels were applied (1.2 and 1.8 g /100 g flour). To determine their acceptability and characterization, the four breads were assessed (i) by an adult panel (n = 39) according to cohesiveness, overall odor intensity, overall aroma in the mouth and saltiness intensity and (ii) a panel of children (n = 100, aged 6 to 11 years) according to overall liking and saltiness intensity. Finally, consumption by children (n = 89, aged 6 to 11 years) was measured during school lunch to evaluate the acceptability of salt reduction in a real consumption context. Both formulation and salt level induced physical and sensory changes in breads perceived by adults. They described WB as less dense, cohesive, and aromatic but more odorant than FB. Saltiness differences were perceived by adults but not by children. Children showed a preference for the saltiest breads and the FB but these drivers of preference were not confirmed during consumption measurements. These results shed new light on how natural solutions to enhance the flavor of bread can reduce its salt level while maintaining acceptability. PRACTICAL APPLICATION: Salt reduction in bread could be compensated by the use of sourdough and an artisanal bread-making process. These methods allow an improvement of the nutritional quality of breads while maintaining their acceptance by young consumers by favoring the development of appealing organoleptic characteristics (aroma, texture). These methods are natural, easy to implement, and could be adapted to other fermented products in order to improve their nutritional quality.


Assuntos
Pão/análise , Dieta Hipossódica/métodos , Preferências Alimentares , Cloreto de Sódio na Dieta/análise , Adulto , Criança , Feminino , Fermentação , Farinha/análise , Manipulação de Alimentos/métodos , Humanos , Masculino , Valor Nutritivo , Sensação , Paladar , Triticum
11.
Am J Physiol Regul Integr Comp Physiol ; 315(5): R915-R924, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30024774

RESUMO

Inbred salt-sensitive (SS) rats developed by John Rapp and distributed by Harlan (SS/JrHsd) were shown to model ovariectomy-induced hypertension because on a low-sodium (LS) diet, ovariectomized SS (SS-OVX) animals became hypertensive in contrast to their sham-operated (SS-SHAM) normotensive littermates. After Harlan merged with Envigo in 2015, inconsistencies in the LS normotensive phenotype were reported. To further investigate these inconsistencies, we studied the effects of ovariectomy on SS and salt-resistant (SR) rats purchased from Envigo (SS/JrHsd/Env) between 2015 and 2017. The mean arterial pressure (MAP) in SS rats on a LS diet exceeded 160 mmHg at 7 mo old. Ovariectomy at 3 mo had no detectable effect on MAP from 4 to 7 mo, nor did ovariectomy at 1.5 mo significantly affect MAP at 10 mo in either strain; only strain differences in MAP were observed [MAP: SR-SHAM ( n = 7 rats), 102 ± 3 mmHg; SR-OVX ( n = 6 rats), 114 ± 1 mmHg; SS-SHAM ( n = 7 rats), 177 ± 6 mmHg; SS-OVX ( n = 5 rats), 190 ± 12 mmHg; where P < 0.0001 vs. SR, same ovarian-status for SS-SHAM and SS-OVX, respectively]. Whole genome sequencing revealed more genomic variants of SS/JrHsd/Env, including single nucleotide and insertion deletion polymorphisms and higher heterozygous/homozygous ratios compared with the reference genome, than for SS/JrHsd/Mcwi and SS/Jr rats maintained in Milwaukee, WI and Toledo, OH, respectively, and which still exhibit normal blood pressure on a LS diet. These findings demonstrate that the female SS/JrHsd/Env rat has genetically diverged from the original phenotype, which was normotensive on a LS diet when the ovaries were intact but rapidly developed hypertension when the ovaries were removed. Nonetheless, the SS/JrHsd/Env rat could be a valuable model that complements other animal models of spontaneous hypertension used to investigate mechanisms of essential hypertension.


Assuntos
Hipertensão/etiologia , Ovariectomia/efeitos adversos , Cloreto de Sódio na Dieta/farmacologia , Cloreto de Sódio/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Dieta Hipossódica/métodos , Feminino , Hipertensão/fisiopatologia , Ratos , Sódio na Dieta/farmacologia
12.
BMC Nephrol ; 19(1): 151, 2018 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-29954331

RESUMO

BACKGROUND: For patients with end-stage renal failure (ESFR), thrice-weekly hemodialysis is a standard care. Once-weekly hemodialysis combined with low-protein and low-salt dietary treatment (OWHD-DT) have been rarely studied. Therefore, here, we describe our experience on OWHD-DT, and assess its long-term effectiveness. METHODS: We instituted OWHD-DT therapy in 112 highly motivated patients with creatinine clearance below 5.0 mL/min. They received once-weekly hemodialysis on a diet of 0.6 g/kg/day of protein adjusted for sufficient energy intake, and less than 6 g/day of salt intake. Serial changes in their clinical, biochemical and nutritional parameters were prospectively observed, and the weekly time spent for hospital visits as well as their monthly medical expenses were compared with 30 age, sex- and disease-matched thrice-weekly hemodialysis patients. RESULTS: The duration of successfully continued OWHD-DT therapy was more than 4 years in 11.6% of patients, 3 years in 16.1%, 2 years in 24.1% and 1 year in 51.8%. Time required per week for hospital attendance was 66.7% shorter and monthly medical expenses were 50.5% lower in the OWHD-DT group than in the thrice-weekly hemodialysis group (both p < 0.001). Patient survival rates in the OWHD-DT group were better than those in the Japan Registry (p < 0.001). Serum urea nitrogen significantly decreased; hemoglobin significantly increased; and albumin and body mass index were not significantly different from baseline values. In the OWHD-DT patients, serum albumin at 1 and 2 years after initiation of therapy was significantly higher compared with prevalent thrice-weekly hemodialysis patients. Furthermore, residual urine output was significantly higher in the OWHD-DT patients than in those receiving thrice-weekly hemodialysis (p < 0.05). Interdialytic weight gain over the course of the entire week between treatments in patients on OWHD-DT were 0.9 ± 1.0, 2.0 ± 1.3, 1.9 ± 1.2, 1.9 ± 1.5 and 1.8 ± 1.0 kg at 1, 6, 12, 18 and 24 months, respectively, though the weekly weight gain for thrice-weekly hemodialysis group (summed over all 3 treatments) was 8.6 ± 0.63 kg, p < 0.001. CONCLUSIONS: OWHD-DT may be a favorable therapeutic modality for selected highly motivated patients with ESRF. However, this treatment cannot be seen as a general maintenance strategy. TRIAL REGISTRATION: UMIN000027555 , May 30, 2017 (retrospectively registered).


Assuntos
Dieta com Restrição de Proteínas/métodos , Dieta Hipossódica/métodos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/métodos , Idoso , Terapia Combinada/métodos , Feminino , Humanos , Japão/epidemiologia , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
13.
Nutrition ; 54: 111-117, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29793053

RESUMO

OBJECTIVES: Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF. METHODS: Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d. RESULTS: Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found. CONCLUSIONS: Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.


Assuntos
Dieta Hipossódica/métodos , Insuficiência Cardíaca/dietoterapia , Volume Sistólico , Privação de Água , Idoso , Idoso de 80 Anos ou mais , Ingestão de Energia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sede , Resultado do Tratamento , Perda de Peso
15.
Medicine (Baltimore) ; 97(15): e0371, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29642188

RESUMO

Restricted sodium intake has been recommended for more than 1 century for the treatment of hypertension. However, restriction seems to increase blood cholesterol. In women with excess weight, blood cholesterol may increase even more because of insulin resistance and the high lipolytic activity of adipose tissue.The aim of this study was to assess the association between blood cholesterol and sodium intake in hypertensive women with and without excess weight.This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited at the primary healthcare units of Maceio, Alagoas, Brazilian Northeast. Excess weight was defined as body mass index (BMI) ≥25.0 kg/m. Sodium intake was estimated by the 24-hour urinary excretion of sodium. Blood cholesterol was the primary outcome investigated by this study, and its relationship with sodium intake and other variables was assessed by Pearson correlation and multivariate linear regression using a significance level of 5%.This study included 165 hypertensive women. Of these, 135 (81.8%) were with excess weight. The mean sodium intake was 3.7 g (±1.9) and 3.4 g (±2.4) in hypertensive women with and without excess weight, respectively. The multiple normal linear regression models fitted to the "blood cholesterol" in the 2 groups reveal that for the group of hypertensive women without excess weight only 1 independent variable "age" is statistically significant to explain the variability of the blood cholesterol levels. However, for the group of hypertensive women with excess weight, 2 independent variables, age and sodium intake, can statistically explain variations of the blood cholesterol levels.Blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight.


Assuntos
Colesterol/sangue , Hipertensão , Sobrepeso , Sódio na Dieta/metabolismo , Sódio/urina , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Dieta Hipossódica/métodos , Feminino , Humanos , Hipertensão/dietoterapia , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Pessoa de Meia-Idade , Sobrepeso/diagnóstico , Sobrepeso/metabolismo , Sobrepeso/fisiopatologia , Estatística como Assunto
16.
Medicine (Baltimore) ; 97(14): e0342, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29620663

RESUMO

Evidence has shown that long-term sodium reduction can not only reduce blood pressure, but also provide cardiovascular benefits. To date, there is little evidence related to the effects of salt reduction on isolated systolic hypertension (ISH).A total of 126 hypertensive patients were divided into an ISH group (n = 51) and a non-ISH (NISH) group (n = 75). The members of each group were then randomly assigned to low sodium salt (LSSalt) or normal salt (NSalt) diets for 6 months. Their blood pressure was measured every 2 months. Serum plasma renin-angiotensin activity, blood biochemical assays and urinary measurements were determined at the baseline and at the end of the 6 months.At the end of the study, the mean systolic blood pressure (SBP) of the ISH LSSalt group had significantly decreased by 10.18 mm Hg (95% confidence interval (CI): 3.13 to 17.2, P = .006) compared with that of the ISH NSalt group, while the mean SBP only decreased by 5.10 mm Hg (95% CI: -2.02 to 12.2, P = .158) in the NISH LSSalt group compared with that of the NISH NSalt group. The mean diastolic blood pressure (DBP) had no significant differences in the ISH and NISH groups. No obvious renin angiotensin system activation was found after LSSalt intervention. Regarding the urinary excretion of electrolytes and blood biochemical assays, the LSSalt treatment had the same effects on the ISH group as on the NISH group.The present study showed that the SBP of ISH patients was significantly decreased with the LSSalt intervention, while neither the SBP of the NISH patients nor the DBP of either group were similarly decreased, which indicated that ISH patients were more sensitive to salt restriction.


Assuntos
Dieta Hipossódica/métodos , Hipertensão/dietoterapia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Cloreto de Sódio na Dieta/efeitos adversos , Sístole/fisiologia , Resultado do Tratamento
17.
Hypertension ; 71(5): 858-865, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29555665

RESUMO

Dietary Na recommendations are expressed as absolute amounts (mg/d) rather than as Na density (mg/kcal). Our objective was to determine whether the strength of the relationship of Na intake with blood pressure (BP) varied with energy intake. The DASH (Dietary Approaches to Stop Hypertension)-Sodium trial was a randomized feeding trial comparing 2 diets (DASH and control) and 3 levels of Na density. Participants with pre- or stage 1 hypertension consumed diets for 30 days in random order; energy intake was controlled to maintain body weight. This secondary analysis of 379 non-Hispanic black and white participants used mixed-effects models to assess the association of Na and energy intakes with BP. The relationships between absolute Na and both systolic and diastolic BP varied with energy intake. BP rose more steeply with increasing Na at lower energy intake than at higher energy intake (P interaction<0.001). On the control diet with 2300 mg Na, both systolic and diastolic BP were higher (3.0 mm Hg; 95% confidence interval, 0.2-5.8; and 2.7 mm Hg; 95% confidence interval, 1.0-4.5, respectively) among those with lower energy intake (higher Na density) than among those with higher energy intake (lower Na density). The association of Na with systolic BP was stronger at lower levels of energy intake in both blacks and whites (P<0.001). The association of Na and diastolic BP varied with energy intake only among blacks (P=0.001). Sodium density should be considered as a metric for expressing dietary Na recommendations.


Assuntos
Dieta Hipossódica/métodos , Abordagens Dietéticas para Conter a Hipertensão/métodos , Ingestão de Energia , Hipertensão/dietoterapia , Hipertensão/prevenção & controle , Sódio na Dieta/efeitos adversos , Adulto , Análise de Variância , Determinação da Pressão Arterial/métodos , Estudos Cross-Over , Seguimentos , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Valores de Referência , Medição de Risco , Resultado do Tratamento , Estados Unidos
18.
Semin Dial ; 31(2): 115-121, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29455475

RESUMO

Diet counseling and nutrition education are recommended in the prevention and management of chronic kidney disease (CKD) and end-stage renal disease (ESRD). The importance of effectively addressing nutrition with patients has grown given the increasing prevalence of obesity, hypertension, and diabetes; conditions which influence CKD/ESRD. Dietary advice for individuals with CKD/ESRD can be seen as complex; and successful dietary management requires careful planning, periodic assessment of nutritional status, as well as monitoring of dietary compliance. In spite of recommendations and pressing need, formal training in nutrition and adequate preparation for providers is limited; and for physicians the lack of nutrition education has been acknowledged, repeatedly, as an area for improvement in medical training curricula. It has also been suggested that dietitians have an essential role in management of CKD in the primary care setting; however, dietitians who do not practice renal education daily may need training on the specific challenges in CKD/ESRD. The objectives of this chapter were to: characterize select nutrition education resources for providers who care for patients with CKD/ESRD; summarize key dietary components emphasized in the care of patients with CKD/ESRD; and address practical considerations in educational efforts focused on nutrition and CKD/ESRD.


Assuntos
Estado Nutricional , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Insuficiência Renal Crônica/dietoterapia , Aconselhamento , Dieta com Restrição de Proteínas/métodos , Dieta Hipossódica/métodos , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/dietoterapia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Masculino , Nutricionistas/educação , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Medição de Risco , Análise de Sobrevida , Estados Unidos
19.
J Clin Hypertens (Greenwich) ; 20(3): 518-527, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29450958

RESUMO

This study aims to evaluate the 4 non-pharmacological strategies adopted by patients for hypertension control and patient characteristics that affect the choice of strategies. Four thousand hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey. Odds ratios of the choice of strategies were analyzed using weighted logistic models. Clinical recommendations of non-pharmacological strategies for hypertension control were relatively low. More exercise was the least frequent strategy used for hypertension control. More patients reported using ≥3 strategies than using ≤2 strategies (79.1% vs 20.9%, P < .0001). Non-Hispanic blacks were more likely to use each individual strategy and to use ≥3 strategies simultaneously. Patients with obesity and diabetes were less likely to attempt weight control or more exercise, but more likely to use ≥3 strategies than peers. Educational programs should be developed to enhance physician's advice for lifestyle modifications and to increase patient's acceptance of physical activity.


Assuntos
Dieta Hipossódica/métodos , Exercício , Hipertensão/terapia , Perda de Peso , Adulto , Diabetes Mellitus/epidemiologia , Gerenciamento Clínico , Feminino , Humanos , Hipertensão/etnologia , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/epidemiologia , Cooperação do Paciente , Guias de Prática Clínica como Assunto , Estados Unidos/etnologia , Adulto Jovem
20.
Nephrol Dial Transplant ; 33(7): 1159-1168, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29361057

RESUMO

Background: Considering the fact that subjects with dysglycemia, dyslipidemia or high blood pressure are at high risk for chronic kidney disease (CKD), long-term adherence to the Dietary Approaches to Stop Hypertension (DASH)-style diet may contribute to the prevention of CKD. This study, examined the association between adherence to the low-sodium DASH-style diet and incident CKD among high-risk adults over 3 years of follow-up. Methods: In this prospective cohort study (followed up for 3 years, 2012-15), we selected 1100 subjects with dysglycemia, 2715 with dyslipidemia and 2089 with high blood pressure, all of whom were free of CKD at baseline (2009-11) in a subgroup of the Tehran Lipid and Glucose Study. The low-sodium DASH-style diet was designed based on eight foods and nutrients using a food frequency questionnaire. Estimated glomerular filtration rate (eGFR) was calculated and CKD was defined as eGFR <60 mL/min/1.73 m2. Results: After 3 years of follow-up, among subjects with dysglycemia, dyslipidemia or high blood pressure, the rate of incident CKD was ∼16%. In multivariable-adjusted analyses for participants in the highest compared with the lowest quartile of the low-sodium DASH-style diet score, the odds ratio was 0.58 [95% confidence interval (CI) 0.36-0.92] for subjects with dysglycemia, 0.64 (95% CI 0.48-0.87) for subjects with dyslipidemia and 0.62 (95% CI 0.44-0.87) for subjects with high blood pressure. Conclusions: Higher adherence to the low-sodium DASH-style diet might be associated with a lower risk of incident CKD among high-risk adults, highlighting the importance of adherence to the low-sodium DASH-style diet in substantially reducing both the occurrence of CKD and the burden imposed by it in the future.


Assuntos
Dieta Hipossódica/métodos , Abordagens Dietéticas para Conter a Hipertensão/métodos , Hipertensão/prevenção & controle , Cooperação do Paciente , Insuficiência Renal Crônica/complicações , Medição de Risco/métodos , Prevenção Secundária/métodos , Adulto , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Incidência , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Insuficiência Renal Crônica/tratamento farmacológico , Fatores de Risco
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