A systematic review on the effects of dietary management in chronic kidney disease / 中华临床营养杂志

Objective:To systematically evaluate the effects of protein restriction, low-sodium diet and alkaline diet on renal outcomes, the rate of change in estimated glomerular filtration rate (eGFR) and all-cause mortality in chronic kidney disease (CKD) patients.Methods:Three main databases, Ovid, EMBASE and the Cochrane Library database, were searched for randomized controlled trials about the effects of protein restriction, alkaline diet, low-sodium diet in chronic kidney disease. The primary outcome was renal composite endpoint events, the annual rate of change in eGFR and all-cause mortality. Renal composite endpoint events was defined as >25% or 50% decrease from baseline in eGFR, doubling of serum creatinine, or the development of end-stage renal diseaseas during follow-up.The studies were selected according to inclusion and exclusion criteria and assessed for quality using Jadad Scale. Two investigators were chosen to search, extract and evaluate the data independently. Software Stata 16.0 and RevMan 5.4 were used for meta-analysis.Results:A total of 34 studies with 5 589 participants were included. Protein restriction ( RR = 0.78, 95% CI: 0.64 to 0.96, P < 0.001), alkaline diet ( RR = 0.64, 95% CI: 0.43 to 0.98, P < 0.001) and low-sodium diet ( RR = 0.45, 95% CI: 0.28 to 0.73, P < 0.01) reduced the risk of renal composite outcomes. Protein restriction ( MD = 1.85, 95% CI: 0.77 to 2.93, P = 0.001), alkaline diet ( MD = 1.45, 95% CI: 0.53 to 2.37, P < 0.001) and low-sodium diet ( MD = 1.84, 95% CI: 1.06 to 2.63, P < 0.001) also decreased the rate of delince in eGFR. But these dietary patterns did not show a clear beneficial effect for all-cause mortality ( RR = 1.15, 95% CI: 0.76 to 1.73, P = 0.167 for protein restriction, RR = 0.96, 95% CI: 0.31 to 3.02, P = 0.546 for alkaline diet and RR = 0.82, 95% CI: 0.48 to 1.40, P = 0.057 for low-sodium diet). Conclusion:The three dietary interventions may decline the rate of renal function exacerbation and decrease the risk of unfavourable renal outcomes in CKD patients, while have no clear beneficial effect on all-cause mortality.

Customers' Perceptions of Operational Status of and Needs for Sodium Reduction in the Industry Foodservice in Seoul / 대한지역사회영양학회지

OBJECTIVES: This study aimed to compare customers' perceptions of the need for a low-sodium diet and sodium-reduced operations in the industry foodservice by age. The relationships between health concerns and perceptions of the need for sodium-reduced operations and low-sodium diets in the industry foodservice were analyzed.METHODS: A survey was conducted among 340 industry foodservice customers aged 20–50 years and residing in Seoul, Korea. This study investigated the respondents' health concerns, their perception of the need for sodium-reduced foodservice operations, their perception of a sodium-reduced diet, and the general details of the foodservices they used. A cross-tabulation analysis and ANOVA were performed to identify differences in measurement items by age, and a simple regression analysis was performed to examine relationships between measurement items.RESULTS: For the customers' perception of the need for a sodium-reduced foodservice operation, the item “it is necessary to provide separate spices and sauces to reduce sodium intake” achieved the highest score (3.88 points out of a possible 5 points). For the perception of a sodium-reduced diet, the item “I think it is helpful for one's health” obtained the highest score (4.13 points). Respondents' health concerns had a positive effect on increasing the level of perception of the need for sodium-reduced foodservice operations and that of a sodium-reduced diet.CONCLUSIONS: Foodservice nutritionists could help enhance their customers' perceptions of the needs for sodium-reduced foodservice operations and sodium-reduced diets by frequently providing them with sodium-related health information.

Aceptabilidad del sabor de preparaciones hiposódicas con sustitutos de sal en pacientes diabéticos e hipertensos / Acceptability of the taste of low sodium preparations with salt substitutes in diabetic and hypertensive patients

The purpose of this experimental study was to compare the acceptability of the taste between different preparations with low sodium in diabetic and hypertensive patients. It was conducted between April and May 2015 at the Centro de Atención Integral de Diabetes e Hipertensión (CEDHI) in Lima, Peru. Sixty-seven outpatient subjects from CEDHI were assessed; they were over 18 years of age, of both genders, diagnosed with hypertension or type 2 diabetes. In total 134 sensory tests were applied and 402 prepared food samples. The evaluated samples were rice, broth, chicken and cooked vegetables that were added with common salt, potassium chloride [25%] with salt [75%] and monosodium glutamate. In order to measure the results two hedonic tests were applied, ordered by preference and acceptability test (score of 1 to 5) were used. No significant global differences were found regarding the acceptability and preference in low sodium preparations. Therefore, the replacement of common salt by any of the substitutes is viable for patient's prescribed low-sodium diet (1500 mg Na/day).

El objetivo de este estudio experimental fue comparar la aceptabilidad del sabor entre diferentes preparaciones con bajo contenido de sodio en pacientes diabéticos e hipertensos. Se realizó entre abril y mayo del 2015 en el Centro de Atención Integral de Diabetes e Hipertensión (CEDHI) en Lima, Perú. Las personas evaluadas fueron 67 pacientes ambulatorios del CEDHI, mayores de 18 años de ambos géneros, diagnosticados de hipertensión arterial o diabetes tipo 2. En total fueron aplicadas 134 pruebas sensoriales y 402 muestras preparadas. Las preparaciones que fueron sometidas a evaluación fueron arroz, caldo, pollo y verduras cocidas, adicionándoles sal común, cloruro de potasio [25%] con sal común [75%] y glutamato monosódico. Para medir los resultados se utilizaron dos pruebas hedónicas, de preferencia por ordenamiento y prueba de aceptabilidad (puntuación del 1 al 5). En los resultados no se encontraron diferencias significativas a nivel global en cuanto a la aceptabilidad y preferencia de las preparaciones con bajo contenido de sodio. Por lo cual, el reemplazo de la sal común por cualquiera de los sustitutos es viable para pacientes con prescripción de dieta hiposódica (1500 mg Na/día).

Adaptación para la Argentina y evaluación de las propiedades psicométricas del Cuestionario sobre la Dieta Restrictiva de Sodio en pacientes con insuficiencia cardíaca / Evaluation of Psychometric Properties in the Argentine-Adapted Dietary Sodium Restriction Questionnaire in Heart Failure Patients

Introducción: El Cuestionario sobre la Dieta Restrictiva de Sodio [Dietary Sodium Restriction Questionnaire (DSRQ)] está basado en la teoría del comportamiento planificado. Originalmente desarrollado en inglés, este instrumento, compuesto por tres subescalas (en 16 ítems que evalúan los parámetros vinculados con la actitud en relación con el comportamiento, la norma subjetiva y el control comportamental percibido), identifica los factores que afectan la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca congestiva (ICC). Objetivos: Realizar la adaptación transcultural del DSRQ en idioma español para su utilización en la Argentina y evaluar las propiedades psicométricas (validez y confiabilidad). Material y métodos: La adaptación transcultural se realizó con la metodología recomendada (traducción, síntesis, revisión y retrotraducción). La validez se determinó mediante análisis de forma y factorial de componentes principales con la extracción de factores y rotación Varimax. El análisis de la confiabilidad se efectuó mediante el cálculo de la consistencia interna (alfa de Cronbach) y la correlación ítem-total de la escala. Resultados: En la adaptación transcultural se adaptaron los encabezados y solamente una pregunta tuvo alteraciones semánticas relevantes. Para el análisis de las propiedades psicométricas se incluyeron 230 pacientes con ICC. La proporción de datos faltantes fue muy baja (0,20%). En el análisis de componentes principales se extrajeron tres factores. Luego de la rotación Varimax, los ítems se agruparon con los factores seleccionados, coincidiendo con las tres subescalas originales. En el análisis ítem-total, ninguna correlación mostró un valor < 0,30. El alfa de Cronbach global fue de 0,86 (0,89, 0,71 y 0,89 para las tres subescalas, de actitud en relación con el comportamiento, norma subjetiva y control comportamental percibido, respectivamente). Conclusiones: En nuestro trabajo se realizó por primera vez la adaptación transcultural del DSRQ al español para su utilización en la Argentina; la confiabilidad y la validez de esta versión del instrumento fueron adecuadas.

Background: The Dietary Sodium Restriction Questionnaire (DSRQ) is based on the theory of planned behavior. Originally developed in English, this instrument, consisting of three subscales (divided in 16 items evaluating the parameters associated with attitude relative to behavior, the subjective norm and the perceived behavioral control), identifies the factors affecting adherence to low-sodium diet in patients with congestive heart failure (CHF). Objectives: The purpose of this study was to perform the DSRQ transcultural adaptation into Spanish to be used in Argentina and assess its psychometric properties (validity and reliability). Methods: The transcultural adaptation was done with the recommended methodology (translation, synthesis, revision and back translation). Its validity was explored by principal component structure and factor analysis with factor extraction and Varimax rotation. Reliability was analyzed by internal consistency calculation (Cronbach's alpha) and the item-total scale correlation. Results: Headlines were adjusted and one question only had relevant semantic changes in the transcultural adaptation. A total of 230 CHF patients were included for the psychometric analysis. The proportion of missing data was very low (0.20%). Three factors were extracted from the main component analysis. After Varimax rotation, the items were grouped with the selected factors, matching the three original subscales. In the item-total analysis, no correlation showed a value < 0.30. Global Cronbach's alpha was 0.86 (0.89, 0.71 and 0.89 for the three subscales, of attitude relative to behavior, subjective norm and perceived behavioral control, respectively). Conclusions: We performed for the first time the DSRQ transcultural adaptation into Spanish for its use in Argentina. This version of the instrument showed adequate validity and reliability.

Restrição no consumo de sódio durante a gestação é responsável pelo baixo peso ao nascimento e pela resistência à insulina da prole na idade adulta: estudo do mecanismo epigenético por metilação do DNA / Sodium intake restriction during pregnancy is responsible for low birth weight and the insulin resistance of offspring in adulthood: a study of epigenetic mechanism by DNA methylation

Sabe-se que algumas alterações nutricionais maternas durante o período perinatal estão associadas com doenças metabólicas na vida adulta das proles, tais como diabetes melito tipo 2, resistência à insulina, obesidade e hipertensão arterial. O período da gestação em que estas alterações nutricionais influenciam a prole na idade adulta ainda não está elucidado. Modificações epigenéticas têm sido propostas como mecanismos responsáveis por estas desordens metabólicas. Ratas Wistar de doze semanas de idade foram alimentadas com dieta com conteúdo baixo (HO - 0,15% NaCl) ou normal (NR - 1,3% NaCl) de sódio desde o primeiro dia de gestação até o nascimento da prole ou HO durante a primeira (HO10) ou segunda (HO20) metade da gestação. O peso corpóreo e a ingestão de água e ração foram avaliados semanalmente durante a gestação. Teste de tolerância à insulina (ITT) e à glicose (GTT) e HOMA-IR foram realizados nas proles adultas. Expressão gênica por qRT-PCR e metilação do DNA na região promotora dos genes foram mapeadas utilizando tratamento com bissulfito de sódio e avaliadas por pirosequenciamento. O ganho de peso materno foi menor no HO e HO20 na terceira semana de gestação em comparação com NR e HO10. O peso ao nascimento da prole foi menor em machos e fêmeas dos grupos HO e HO20 em relação ao NR e HO10. O HOMA-IR foi maior nos machos com 12 semanas de idade do grupo HO em comparação com NR e com 20 semanas de idade do grupo HO10 em comparação com NR e HO20. Nas fêmeas com 12 semanas de idade o HOMA-IR foi maior no HO10 comparado com HO. Os níveis de insulina no soro foram maiores tanto nos machos com 20 semanas de idade do grupo HO10 comparado com NR quanto nas fêmeas com 12 semanas de idade do grupo HO10 comparado com HO. A área sob a curva do GTT indicou intolerância à glicose nos machos do grupo HO. A porcentagem de metilação das ilhas CpG no promotor dos genes de Igf1, Igf1r, Ins1, Ins2 e Insr no fígado de machos e fêmeas neonatais e no...

It is known that some maternal nutritional alterations during pregnancy are associated with metabolic disorders in adult offspring, such as insulin resistance, type 2 diabetes mellitus, obesity and arterial hypertension. The period of pregnancy in which these nutritional alterations influence adult offspring remains uncertain. Epigenetic changes are proposed to underlie these metabolic disorders. Twelve-week-old female Wistar rats were fed a low-salt (LS - 0.15% NaCl) or normal-salt (NS - 1.3% NaCl) diet since the first day of gestation until delivery or LS during the first (LS10) or second (LS20) half of gestation. Body weight, food and water intake were weekly evaluated during gestation. Blood glucose, insulin (ITT) and glucose (GTT) tolerance tests, HOMA-IR were performed in adult offspring. Gene expression and DNA methylation were mapped using bisulfite treatment evaluated by pyrosequencing in the male and female neonates and adult offspring. Weight gain was lower in LS and LS20 dams than in NS and LS10 dams in the third week of pregnancy. Birth weights were lower in male and female LS20 and LS rats compared with NS and LS10 neonates. HOMA-IR was higher in 12-week-old LS males compared with NS and in 20-week-old male LS10 rats compared with NS and LS20 rats. In 12-week-old LS10 females, HOMA-IR was higher than in LS. Serum insulin levels were higher in 20 week-old LS10 male compared with NS rats and in 12-week-old LS10 female compared to LS rats. The area under the curve of GTT indicated glucose intolerance in 12- and 20-week-old LS male. Methylation of CpG islands of the Insr, Igf1, Igf1r, Ins1 and Ins2 genes in liver in neonates male and female offspring and liver, white adipose tissue and muscle in 20-week-old male offspring were influenced by low-salt intake during pregnancy. None of these alterations was identified in 20-week-old females. In conclusion, low-salt diet consumption in the second half of pregnancy can result in low birth weights in the...

Factors Associated with a Low-sodium Diet: The Fourth Korean National Health and Nutrition Examination Survey / 한국역학회지

OBJECTIVES: The low-sodium diet is a known preventive factor for hypertension and cardiovascular disease. Factors associated with low-sodium diets should be identified to reduce sodium intake effectively. This study was conducted to identify factors correlated with a low-sodium diet. METHODS: This cross-sectional study analyzed data from a total of 14,539 Koreans aged 20 years or older, who participated in the Fourth (2007-2009) Korean National Health and Nutrition Examination Survey. A low-sodium diet was defined as having or =1 time/day, respectively. CONCLUSIONS: Our study suggests that sex, age, number of family members, occupation, total energy intake, and lower frequency of eating out were associated with a low-sodium diet in Korean adults.

The effect of salt usage behavior on sodium intake and excretion among Korean women

This study was done to explore the effect of Korean women's salt usage behavior on their sodium intake and excretion according to aging. Dietary sodium intake and salt usage behavior were analyzed to compare the difference between young and middle-aged women. One hundred fifty six young women and 77 middle-aged women without hypertension or any current medication were recruited. Body mass index, waist hip ratio, blood pressure were measured from each subject. Salt usage behaviors were surveyed with questionnaire, sodium intake with 24-hr recall method, and sodium excretion with spot urine. Middle-aged women were more obese than young women according to body mass index and waist hip ratio. Blood pressure was significantly higher for the middle-aged. Young women consumed more fats and middle-aged women more carbohydrates. Middle-aged women consumed more sodium and potassium, and excreted more sodium. Among questionnaire items, kimchi, soup or pot stew, or salted vegetables were found to be related with high sodium diet. Salted vegetables and salted nuts and potato chips were significantly correlated with young women's high sodium diet, while soy sauce on fried food, kimchi, salted vegetables accounted for middle-aged women's high sodium diet. With these results, we concluded that middle-aged women consumed more carbohydrates, less fat, and more sodium and potassium than young women. Middle-aged women frequently choose kimchi, soup or pot stew, or salted vegetables, and they contribute to high sodium intake. We recommend to choose low-salt kimchi, less soup or pot stew, and more fresh vegetables for lower sodium diet.

Effect of a 6-month Low Sodium Diet on the Salt Taste Perception and Pleasantness, Blood Pressure and the Urinary Sodium Excretion in Female College Students

The study aim was to examine the effect of sensory responses of subjects after 6-month dietary sodium reduction with the aid of nutritional education. Fourteen female college students voluntarily restricted their sodium intake for 6 months, during which time they received nutritional education on the low sodium diet. As a control group, 10 students, whose anthropometric measurement, sodium intake behavior, and blood pressure were not different from those of the experimental group, were maintained on a normal diet. For the sensory responses of subjects, the salt taste perception and pleasantness for graded (0.15-1.3%) NaCl solutions were measured by a 9-point hedonic scale. The optimum sodium concentration, urinary sodium excretion, and blood pressure were measured. All the measurements were done at the beginning and end of the experiment. The sensory evaluation revealed an absence of any difference between the two groups in salt taste perception and pleasantness responses at the beginning. After 6-month adaptation, the experimental group subjects showed higher responses to low NaCl solution (0.15, 0.3, 0.5%) in salt taste perception and pleasantness evaluation while the control group subjects exhibited the opposite response. The optimum sodium concentration was reduced from 105.6 mmol to 80.7 mmol (p = 0.015) and the urinary sodium excretion was also reduced from 1,398 mg to 906 mg (p = 0.041) only in the experimental group. Systolic blood pressure was significantly reduced in the experimental group, although there was no correlation between the urinary sodium excretion and blood pressure. The optimum sodium concentration was negatively correlated with the urinary sodium excretion (r = 0.418, p = 0.053), indicating that adaptation to low sodium diet can reduce sodium intake. Further study on the individual responses of subjects on a low sodium diet by periodical evaluation may provide useful data for setting the duration needed to stabilize a lowered appetite for sodium.

The sodium and potassium content of Philippine foods I. foods of plant origin

The sodium and potassium content of 282 samples representing 218 different foods items and six samples of water are presented in two tables. Our results on 38 food items are compared with two studies by American workers in a third tableIn agreement with findings in the United States, our results show that our foods of plant origin generally have low sodium content. Most of them have less than 10 mg of this mineral per 100 gm. edible portion. This is especially true with fruits, shoots, vegetables flowers, vegetable fruits and legumes and unprocessed cereals. Wider variations (from 1 to more than 1000 mg. per 100 gm edible portion in a few items) were observed among the leafy vegetables, vegetables roots, bulbs and tubers, the pulses, nuts and seeds and the starches, sugars and syrupsOn the other hand, the potassium content generally was more than a hundred mg. sometimes above one thousand mg. per 100 gm. edible portionComparison with two studies of american authors using the same experimental methods also brings out the fact that despite the relatively big differences in individual values for severals items, the foods studied which are of plant origin have low sodium and high potassium content Our public water supply to the city of Manila and its suburbs has low sodium and potassium content. In contrast to this, one sample obtained from a deep well 300 feet from the shore line of Manila Bay gave high sodium and potassium values. (Summary)