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1.
Am J Physiol Renal Physiol ; 320(3): F485-F491, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33522411

RESUMO

Extracellular proteases can activate the epithelial Na channel (ENaC) by cleavage of the γ subunit. Here, we investigated the cleavage state of the channel in the kidneys of mice and rats on a low-salt diet. We identified the cleaved species of channels expressed in Fisher rat thyroid cells by coexpressing the apical membrane-bound protease channel-activating protease 1 (CAP1; prostasin). To compare the peptides produced in the heterologous system with those in the mouse kidney, we treated both lysates with PNGaseF to remove N-linked glycosylation. The apparent molecular mass of the smallest COOH-terminal fragment of γENaC (52 kDa) was indistinguishable from that of the CAP1-induced species in Fisher rat thyroid cells. Similar cleaved peptides were observed in total and cell surface fractions of the rat kidney. This outcome suggests that most of the subunits at the surface have been processed by extracellular proteases. This was confirmed using nonreducing gels, in which the NH2- and COOH-terminal fragments of γENaC are linked by a disulfide bond. Under these conditions, the major cleaved form in the rat kidney had an apparent molecular mass of 56 kDa, ∼4 kDa lower than that of the full-length form, consistent with excision of a short peptide by two proteolytic events. We conclude that the most abundant γENaC species in the apical membrane of rat and mouse kidneys on a low-Na diet is the twice-cleaved, presumably activated form.NEW & NOTEWORTHY We have identified the major aldosterone-dependent cleaved form of the epithelial Na channel (ENaC) γ subunit in the kidney as a twice-cleaved peptide. This form appears to be identical in size with a subunit cleaved in vitro by the extracellular protease channel-activating protease 1 (prostasin). In the absence of reducing agents, it has an overall molecular mass less than that of the intact subunit, consistent with the excision of an inhibitory domain.


Assuntos
Canais Epiteliais de Sódio/metabolismo , Rim/metabolismo , Serina Endopeptidases/metabolismo , Sódio/metabolismo , Aldosterona/metabolismo , Animais , Dieta Hipossódica/métodos , Camundongos , Subunidades Proteicas/metabolismo , Proteólise , Ratos
2.
Am Heart J ; 226: 198-205, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32615357

RESUMO

BACKGROUND: High sodium intake has been considered as the leading dietary risk factor for deaths and disability-adjusted life-years among older adults. High-quality randomized trials to evaluate the effects of practical sodium reduction strategies are needed. METHODS: The study is a cluster randomized trial with a 2 × 2 factorial design conducted in 48 senior residential facilities in northern China. These facilities are randomly assigned (1:1:1:1) to 1 of 4 groups: stepwise salt supply control (SSSC) in which 5%-10% of the study salt supply in the institutional kitchens will be reduced every 3 months, replacing normal salt with salt substitute (SS); SSSC only; SS only; or neither SSSC nor SS. The interventions last for 2 years with follow-up every 6 months. The primary outcome is the change in systolic blood pressure from baseline to 24 months. Secondary outcomes include the incidence of hyperkalemia, hyponatremia, cardiovascular events, and death. CURRENT STATUS: The study has recruited and randomized 48 senior residential facilities with 1,606 participants. Mean age at baseline was 71 years, and 76% are male. Both types of salt intervention were initiated in the study facilities between January and April 2018. CONCLUSION: The study is well placed to define the effects of 2 practical and scalable sodium reduction strategies for blood pressure reduction and will provide important new data about safety of these strategies among older adults in China.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Dieta Hipossódica/métodos , Aromatizantes/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Cloreto de Sódio na Dieta/farmacologia , Idoso , Feminino , Instituição de Longa Permanência para Idosos , Humanos , Masculino
3.
Medicine (Baltimore) ; 99(17): e19769, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332617

RESUMO

INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).


Assuntos
Anti-Hipertensivos/normas , Determinação da Pressão Arterial/normas , Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial/métodos , Restrição Calórica/métodos , Análise por Conglomerados , Dieta Hipossódica/métodos , Exercício Físico/fisiologia , Feminino , Humanos , Hipertensão/psicologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autogestão/métodos , Autogestão/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Resultado do Tratamento
4.
Am J Kidney Dis ; 75(6): 847-856, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31955921

RESUMO

RATIONALE & OBJECTIVE: Patients with chronic kidney disease (CKD) are particularly sensitive to dietary sodium. We evaluated a self-management approach for dietary sodium restriction in patients with CKD. STUDY DESIGN: Randomized controlled trial. SETTING & PARTICIPANTS: Nephrology outpatient clinics in 4 Dutch hospitals. 99 adults with CKD stages 1 to 4 or a functioning (estimated glomerular filtration rate≥25mL/min/1.73m2) kidney transplant, hypertension, and sodium intake>130mmol/d. INTERVENTION: Routine care was compared with routine care plus a web-based self-management intervention including individual e-coaching and group meetings implemented over a 3-month intervention period, followed by e-coaching over a 6-month maintenance period. OUTCOMES: Primary outcomes were sodium excretion after the 3-month intervention and after the 6-month maintenance period. Secondary outcomes were blood pressure, proteinuria, costs, quality of life, self-management skills, and barriers and facilitators for implementation. RESULTS: Baseline estimated glomerular filtration rate was 55.0±22.0mL/min/1.73m2. During the intervention period, sodium excretion decreased in the intervention group from 188±8 (SE) to 148±8mmol/d (P<0.001), but did not change significantly in the control group. At 3 months, mean sodium excretion was 24.8 (95% CI, 0.1-49.6) mmol/d lower in the intervention group (P=0.049). At 3 months, systolic blood pressure (SBP) decreased in the intervention group from 140±3 to 132±3mm Hg (P<0.001), but was unchanged in the control group. Mean difference in SBP across groups was-4.7 (95% CI, -10.7 to 1.3) mm Hg (P=0.1). During the maintenance phase, sodium excretion increased in the intervention group, but remained lower than at baseline at 160±8mmol/d (P=0.01), while it decreased in the control group from 174±9 at the end of the intervention period to 154±9mmol/d (P=0.001). Consequently, no difference in sodium excretion between groups was observed after the maintenance phase. There was no difference in SBP between groups after the maintenance phase. LIMITATIONS: Limited power, postrandomization loss to follow-up, Hawthorne effect, lack of dietary data, short-term follow-up. CONCLUSIONS: A coaching intervention reduced sodium intake at 3 months. Efficacy during the maintenance phase was diminished, possibly due to inadvertent adoption of the intervention by the control group. FUNDING: Grant funding from the Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation. TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT02132013.


Assuntos
Dieta Hipossódica/métodos , Educação a Distância/métodos , Eliminação Renal , Autogestão , Cloreto de Sódio na Dieta/metabolismo , Adulto , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Processos Grupais , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Gravidade do Paciente , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/dietoterapia , Insuficiência Renal Crônica/urina , Autogestão/educação , Autogestão/métodos
5.
J Am Soc Nephrol ; 31(3): 650-662, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31996411

RESUMO

BACKGROUND: Distal diuretics are considered less effective than loop diuretics in CKD. However, data to support this perception are limited. METHODS: To investigate whether distal diuretics are noninferior to dietary sodium restriction in reducing BP in patients with CKD stage G3 or G4 and hypertension, we conducted a 6-week, randomized, open-label crossover trial comparing amiloride/hydrochlorothiazide (5 mg/50 mg daily) with dietary sodium restriction (60 mmol per day). Antihypertension medication was discontinued for a 2-week period before randomization. We analyzed effects on BP, kidney function, and fluid balance and related this to renal clearance of diuretics. RESULTS: A total of 26 patients (with a mean eGFR of 39 ml/min per 1.73 m2) completed both treatments. Dietary sodium restriction reduced sodium excretion from 160 to 64 mmol per day. Diuretics produced a greater reduction in 24-hour systolic BP (SBP; from 138 to 124 mm Hg) compared with sodium restriction (from 134 to 129 mm Hg), as well as a significantly greater effect on extracellular water, eGFR, plasma renin, and aldosterone. Both interventions resulted in a similar decrease in body weight and NT-proBNP. Neither approaches decreased albuminuria significantly, whereas diuretics did significantly reduce urinary angiotensinogen and ß2-microglobulin excretion. Although lower eGFR and higher plasma indoxyl sulfate correlated with lower diuretic clearance, the diuretic effects on body weight and BP at lower eGFR were maintained. During diuretic treatment, higher PGE2 excretion correlated with lower free water clearance, and four patients developed mild hyponatremia. CONCLUSIONS: Distal diuretics are noninferior to dietary sodium restriction in reducing BP and extracellular volume in CKD. Diuretic sensitivity in CKD is maintained despite lower diuretic clearance. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: DD-study: Diet or Diuretics for Salt-sensitivity in Chronic Kidney Disease (DD), NCT02875886.


Assuntos
Dieta Hipossódica/métodos , Diuréticos/administração & dosagem , Taxa de Filtração Glomerular/efeitos dos fármacos , Hipertensão/dietoterapia , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/terapia , Adulto , Idoso , Amilorida/administração & dosagem , Determinação da Pressão Arterial , Estudos Cross-Over , Diuréticos/farmacologia , Feminino , Seguimentos , Humanos , Hidroclorotiazida/administração & dosagem , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Medição de Risco , Sódio na Dieta/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
6.
Am Heart J ; 221: 136-145, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31986290

RESUMO

The Salt Substitute and Stroke Study is an ongoing 5-year large-scale cluster randomized trial investigating the effects of potassium-enriched salt substitute compared to usual salt on the risk of stroke. The study involves 600 villages and 20,996 individuals in rural China. Intermediate risk markers were measured in a random subsample of villages every 12 months over 3 years to track progress against key assumptions underlying study design. Measures of 24-hour urinary sodium, 24-hour urinary potassium, blood pressure and participants' use of salt substitute were recorded, with differences between intervention and control groups estimated using generalized linear mixed models. The primary outcome of annual event rate in the two groups combined was determined by dividing confirmed fatal and non-fatal strokes by total follow-up time in the first 2 years. The mean differences (95% CI) were -0.32 g (-0.68 to 0.05) for 24-hour urinary sodium, +0.77 g (+0.60 to +0.93) for 24-hour urinary potassium, -2.65 mmHg (-4.32 to -0.97) for systolic blood pressure and +0.30 mmHg (-0.72 to +1.32) for diastolic blood pressure. Use of salt substitute was reported by 97.5% in the intervention group versus 4.2% in the control group (P<.0001). The overall estimated annual event rate for fatal and non-fatal stroke was 3.2%. The systolic blood pressure difference and the annual stroke rate were both in line with the statistical assumptions underlying study design. The trial should be well placed to address the primary hypothesis at completion of follow-up.


Assuntos
Pressão Sanguínea , Dieta Hipossódica/métodos , Hipertensão/dietoterapia , Cloreto de Potássio , Potássio/urina , Cloreto de Sódio na Dieta , Sódio/urina , Acidente Vascular Cerebral/epidemiologia , Idoso , China , Culinária , Feminino , Conservação de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade
7.
Hypertension ; 75(2): 266-274, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31838902

RESUMO

Use of salt substitutes containing potassium chloride is a potential strategy to reduce sodium intake, increase potassium intake, and thereby lower blood pressure and prevent the adverse consequences of high blood pressure. In this review, we describe the rationale for using potassium-enriched salt substitutes, summarize current evidence on the benefits and risks of potassium-enriched salt substitutes and discuss the implications of using potassium-enriched salt substitutes as a strategy to lower blood pressure. A benefit of salt substitutes that contain potassium chloride is the expected reduction in dietary sodium intake at the population level because of reformulation of manufactured foods or replacement of sodium chloride added to food during home cooking or at the dining table. There is empirical evidence that replacement of sodium chloride with potassium-enriched salt substitutes lowers systolic and diastolic blood pressure (average net Δ [95% CI] in mm Hg: -5.58 [-7.08 to -4.09] and -2.88 [-3.93 to -1.83], respectively). The risks of potassium-enriched salt substitutes include a possible increased risk of hyperkalemia and its principal adverse consequences: arrhythmias and sudden cardiac death, especially in people with conditions that impair potassium excretion such as chronic kidney disease. There is insufficient evidence regarding the effects of potassium-enriched salt substitutes on the occurrence of hyperkalemia. There is a need for additional empirical research on the effect of increasing dietary potassium and potassium-enriched salt substitutes on serum potassium levels and the risk of hyperkalemia, as well as for robust estimation of the population-wide impact of replacing sodium chloride with potassium-enriched salt substitutes.


Assuntos
Dieta Hipossódica/métodos , Hipertensão , Cloreto de Potássio/farmacologia , Cloreto de Sódio na Dieta/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Humanos , Hipertensão/metabolismo , Hipertensão/prevenção & controle , Medição de Risco , Equilíbrio Hidroeletrolítico/fisiologia
8.
Nutr Clin Pract ; 35(1): 98-107, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31407834

RESUMO

BACKGROUND: Nutrition can play a significant role in the management of liver cirrhosis and its complications. However, adherence to the clinical practice guidelines (CPGs) is essential for the practice of evidence-based medicine and is considered as a health-quality indicator. METHODS: A systematic search was conducted in scientific databases, and retrieved CPGs fulfilling the inclusion criteria were independently reviewed and appraised from 3 experienced researchers, based on the Appraisal of Guidelines for Research and Evaluation II instrument. RESULTS: A total of 13 relevant CPGs were retrieved, published by 7 associations/societies, focusing on the nutrition management (enteral nutrition and/or parenteral nutrition) on cirrhosis, decompensated cirrhosis, liver transplantation, and cirrhosis-related complications. Most CPGs scored low in the stakeholder, rigor of development, and applicability domains. Half of the CPGs recognized the need for counseling patients with cirrhosis on nutrition-related issues. Small meals spread throughout the day, including a late-night snack, were suggested, with protein intake ranging between 1.2 and 1.5 g/kg of body weight. In ascites, Na restriction recommendation appeared unanimous. CONCLUSIONS: Several shortcomings and bias were recognized in cirrhosis-related medical nutrition therapy CPGs, indicating the need of improving CPG methodology.


Assuntos
Cirrose Hepática/terapia , Terapia Nutricional/métodos , Guias de Prática Clínica como Assunto , Dieta , Dieta Hipossódica/métodos , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Humanos , Refeições , Política Nutricional
9.
Trials ; 20(1): 761, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870424

RESUMO

BACKGROUND: Hypertension is present in more than 50% of patients with type 2 diabetes mellitus. Dietary salt restriction is recommended for the management of high blood pressure. Instructions on dietary salt restriction, provided by a dietitian, have been shown to help patients reduce their salt intake. However, appointments for the dietitians in hospitals are often already fully booked, making it difficult for patients to receive instructions on the same day as the outpatient clinic visit. AIM: The aim of this trial is to test a new intervention to assess whether guidance on dietary salt restriction provided by physicians during outpatient visits is effective in reducing salt intake in patients with type 2 diabetes mellitus who have an excessive salt intake. METHODS: In this unblinded randomized controlled trial (RCT), a total of 200 patients, male or female, aged between 20 and 90 years, who have type 2 diabetes mellitus and consume excessive salt will be randomly assigned to two groups: an intervention group and a control group. In addition to being given routine treatment, participants in the intervention group will be given individual guidance on restricting their dietary salt intake by a physician upon enrollment. The control group will only be given routine treatment. Participants will be followed up for 24 weeks. The primary outcome will be dietary salt intake, which will be assessed at baseline and at 8, 16, and 24 weeks. The secondary outcomes, including body weight, body mass index, hemoglobin A1c level, blood pressure, blood glucose level, serum lipid profile, and urinary albumin excretion level, will be assessed at baseline and at 8, 16, and 24 weeks. DISCUSSION: The results of this RCT have the potential to provide a simple and novel clinical approach to reduce salt intake among patients with type 2 diabetes, making regular visits to their physician, in outpatient facilities. This protocol will contribute to the literature because it describes a practical intervention that has not been tested previously, and it may serve as guidance to other researchers interested in testing similar interventions. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN), UMIN000028809. Registered retrospectively on 24 August 2017. http://www.umin.ac.jp.


Assuntos
Aconselhamento , Diabetes Mellitus Tipo 2/terapia , Dieta Hipossódica/métodos , Hipertensão/dietoterapia , Médicos , Cloreto de Sódio na Dieta , Assistência Ambulatorial , Pressão Sanguínea , Creatinina/urina , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Angiopatias Diabéticas/etiologia , Humanos , Hipertensão/complicações , Sódio/urina
10.
Am J Physiol Heart Circ Physiol ; 317(6): H1194-H1202, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584837

RESUMO

Dietary salt restriction is a well-established approach to lower blood pressure and reduce cardiovascular disease risk in hypertensive individuals. However, little is currently known regarding the effects of salt restriction on central and peripheral hemodynamic responses to exercise in those with hypertension. Therefore, this study sought to determine the impact of salt restriction on the central and peripheral hemodynamic responses to static-intermittent handgrip (HG) and dynamic single-leg knee extension (KE) exercise in individuals with hypertension. Twenty-two subjects (14 men and 8 women, 51 ± 10 yr, 173 ± 11 cm, 99 ± 23 kg) forewent their antihypertensive medication use for at least 2 wk before embarking on a 5-day liberal salt (LS: 200 mmol/day) diet followed by a 5-day restricted salt (RS: 10 mmol/day) diet. Subjects were studied at rest and during static intermittent HG exercise at 15, 30, and 45% of maximal voluntary contraction and KE exercise at 40, 60, and 80% of maximum KE work rate. Salt restriction lowered resting systolic blood pressure (supine: -12 ± 12 mmHg, seated: -17 ± 12 mmHg) and diastolic blood pressure (supine: -3 ± 9 mmHg, seated: -5 ± 7 mmHg, P < 0.05). Despite an ~8 mmHg lower mean arterial blood pressure during both HG and KE exercise following salt restriction, neither central nor peripheral hemodynamics were altered. Therefore, salt restriction can lower blood pressure during exercise in subjects with hypertension, reducing the risk of cardiovascular events, without impacting central and peripheral hemodynamics during either arm or leg exercise.NEW & NOTEWORTHY This is the first study to examine the potential blood pressure-lowering benefit of a salt-restrictive diet in individuals with hypertension without any deleterious effects of exercising blood flow. While mean arterial pressure decreased by ~8 mmHg following salt restriction, these findings provide evidence for salt restriction to provide protective effects of reducing blood pressure without inhibiting central or peripheral hemodynamics required to sustain arm or leg exercise in subjects with hypertension.


Assuntos
Pressão Sanguínea , Dieta Hipossódica/métodos , Exercício Físico , Força da Mão , Hipertensão/dietoterapia , Adulto , Feminino , Hemodinâmica , Humanos , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional
11.
Kidney Blood Press Res ; 44(5): 1101-1114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533093

RESUMO

BACKGROUND: Diet modification, especially a decrease in salt intake, might be an important non-pharmacological strategy to improve chronic kidney disease (CKD) prognosis. OBJECTIVES: We conducted a prospective cohort study to investigate whether an intensive low-salt diet education program effectively attenuated the rate of renal function decline in hypertensive patients with CKD. METHODS: This cohort study recruited 171 participants from a previous open-labelled, case-controlled, randomized clinical trial that originally consisted of 245 hypertensive CKD patients who were assigned to two groups, intensive low-salt diet or conventional education. We evaluated the renal outcomes, which included the rate of change in estimated glomerular filtration rate (eGFR) per year, the increase in serum creatinine ≥50%, the decrease in eGFR ≥30%, and the percent change in albuminuria throughout the entire study period. RESULTS: The baseline characteristics of the cohort participants between the two groups were similar at the time of trial phase randomization. During the whole study period, the rate of renal function decline was significantly faster in the conventional group (0.11 ± 4.63 vs. -1.53 ± 3.04 mL/min/1.73 m2/year, p = 0.01). The percent of incremental change in serum creatinine ≥50% was 1.1% in the intensive group and 8.2% in the conventional group (p = 0.025), and the percent of decremental change in eGFR ≥30% was 3.3% in the intensive group and 11.1% in the conventional group (p= 0.048). With logistic regression analysis adjusted for related factors, we found that the conventional group showed a higher risk for deterioration in serum creatinine and eGFR during the entire study period. Especially, we found that the intensive education program preserved eGFR in participants with one, several, or all of the following characteristics at the time of randomization: older age, female, obese, had higher protein intake, higher amounts of albuminuria, higher salt intake. CONCLUSION: This cohort study demonstrated that an intensive low-salt diet education program attenuated the rate of renal function decline in hypertensive CKD patients independent of its effect on lowering salt intake or albuminuria during the 36 months of follow-up.


Assuntos
Dieta Hipossódica/métodos , Taxa de Filtração Glomerular/efeitos dos fármacos , Hipertensão/terapia , Insuficiência Renal Crônica/terapia , Estudos de Casos e Controles , Feminino , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/patologia
13.
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
Dieta Saudável/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
15.
Am J Gastroenterol ; 114(7): 1109-1115, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31206400

RESUMO

INTRODUCTION: Bloating is one of the most common gastrointestinal complaints. Evidence has linked fiber and sodium to bloating; however, randomized trials examining these diet components are lacking. Here, we used a randomized trial to examine the effects of the high-fiber DASH diet and dietary sodium intake on abdominal bloating. We hypothesized that both the high-fiber DASH diet and higher sodium intake would increase bloating. METHODS: The DASH-Sodium trial (1998-1999) randomized healthy adults to a high-fiber (32 g/d) DASH or low-fiber (11 g/d) Western diet (control). On their assigned diet, participants ate 3 sodium levels (50, 100, and 150 mmol/d at 2100 kcal) in 30-day periods in random order, with 5-day breaks between each period. The participants reported the presence of bloating at baseline and after each feeding period. Statistical analyses included log-binomial models to evaluate the risk of bloating. RESULTS: Of 412 participants (mean age 48 years; 57% women; 57% black), 36.7% reported bloating at baseline. Regardless of the diet, high sodium intake increased the risk of bloating (risk ratio = 1.27; 95% confidence interval: 1.06-1.52; P = 0.01). The high-fiber DASH diet also increased the risk of bloating over all sodium levels (risk ratio = 1.41; 95% confidence interval: 1.22-1.64; P < 0.001). The effect of high-fiber DASH on bloating was greater in men than in women (P for interaction = 0.001). DISCUSSION: Higher dietary sodium increased bloating, as did the high-fiber DASH diet. Although healthful high-fiber diets may increase bloating, these effects may be partially mitigated by decreasing dietary sodium intake. Future research is needed to explore mechanisms by which sodium intake and diet can influence bloating.


Assuntos
Dieta Hipossódica/métodos , Abordagens Dietéticas para Conter a Hipertensão/efeitos adversos , Dispepsia/dietoterapia , Flatulência/dietoterapia , Qualidade de Vida , Adulto , Fatores Etários , Idoso , Abordagens Dietéticas para Conter a Hipertensão/métodos , Sistema Digestório/fisiopatologia , Dispepsia/diagnóstico , Dispepsia/psicologia , Feminino , Flatulência/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Sódio na Dieta/efeitos adversos , Resultado do Tratamento
16.
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
17.
J Clin Hypertens (Greenwich) ; 21(6): 730-738, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31058457

RESUMO

To prevent and treat hypertension, it is important to restrict salt in one's diet since adolescence. However, an effective salt-reduction education system has yet to be established. Besides accurate evaluation, we believe that the frequent usage of a measurement device may motivate individuals to avoid high salt intake. The present study evaluated the use of a urinary salt excretion measurement device for salt-reduction education in a parallel randomized trial of two groups. The sample comprised 100 university students who provided consent to participate. A survey with 24-hour home urine collection and blood pressure measurement was conducted. Participants in the self-monitoring group measured their own urinary salt excretion level for 4 weeks, using the self-measurement device. Analyses were conducted on 51 participants in the control group and 49 in the self-monitoring group. At baseline, there was no significant difference between the two groups in terms of their characteristics and 24-hour urinary salt excretion levels. After intervention, 24-hour urinary sodium/potassium ratio showed no change in the control group [baseline score: 4.1 ± 1.5; endline score: 4.2 ± 2.0; P = 0.723], but it decreased significantly in the self-monitoring group [baseline score: 4.0 ± 1.7; endline score: 3.5 ± 1.4; P = 0.044]. This change was significant even after adjusting for baseline and endline differences between groups using analysis of covariance (P = 0.045). The self-monitoring urinary salt excretion measurement device improved the 24-hour urinary sodium/potassium ratio. The device is a useful and practical tool for educating young individuals about dietary salt reduction.


Assuntos
Dieta Hipossódica/métodos , Hipertensão/prevenção & controle , Autocuidado/métodos , Cloreto de Sódio na Dieta/urina , Urinálise/instrumentação , Adolescente , Determinação da Pressão Arterial/métodos , Estudos de Casos e Controles , Comportamento Alimentar/psicologia , Feminino , Humanos , Hipertensão/dietoterapia , Japão/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Potássio/urina , Sódio/urina , Cloreto de Sódio na Dieta/administração & dosagem , Cloreto de Sódio na Dieta/efeitos adversos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
18.
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
19.
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
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