Central mechanism of curcumin on the paraventricular hypothalamic nucleus of high salt induced hypertension rats / 中国临床药理学与治疗学

AIM: To assess the effect of curcumin in hypothalamic paraventricular nucleus (PVN) and mean arterial pressure so as to explore the central mechanism of hypertension. METHODS: Sixty Sprague-Dawley rats which body weights between 170 and 190 grams fed with a normal salt (0.3% NaCl) or a high salt (8% NaCl) diet for 6 weeks. Meanwhile half of each team received curcumin administration or vehicle by intragastric administration. Mean Arterial pressure was measured noninvasively via tail-cuff instrument and their recording system. The PVN tissue samPles were collected and stored at −80 °C for later analyses. We performed the following experimental procedures: Western blot analysis, immunofluorescence, immunofluorescence and statistical analysis. RESULTS:The average arterial blood Pressure of rats in the high-salt diet group was significantly reduced after 6 weeks of curcumin intervention. The levels of NOX2, NOX4, TLR4, MyD88, IL-6, IL-1β, MCP-1 and ROS in the long-term high-salt diet grouP were significantly higher after curcumin intervention. CONCLUSION:Curcumin can improve blood pressure in hypertensive rats induced by long-term high salt, the mechanism may be related to the imProvement of oxidative stress and inflammatory cytokines in the paraventricular nucleus of the hypothalamus.

Causes de réhospitalisation pour insuffisance cardiaque dans le service de cardiologie du CHU de Brazzaville (République du Congo) / The causes of rehospitalization for heart failure in the department of cardiology at the university hospital of Brazzaville (Republic of the Congo)

But: Identifier les causes de réhospitalisation pour insuffisance cardiaque (IC) Patients et méthode: cette étude transversale a été menée entre avril 2014 et mars 2015 dans le service de cardiologie du centre hospitalier universitaire de Brazzaville (République du Congo). Ont été inclus, les patients ayant des antécédents d'hospitalisation pour IC. Résultats: Quatre-vingt-onze patients, 54 femmes (59,3%) ont été inclus. Le sexe-ratio était de 0,7. La fréquence de réhospitalisation pour IC était de 19%. L'âge moyen était de 62 ± 16 ans (extrêmes: 24-89 ans). Le nombre moyen de réadmissions était de 2 ± 0,8 (extrêmes: 1 à 5), les réhospitalisation fréquentes (supérieur à 3) étaient de 33 (36,2%). Les patients présentaient un statut socioéconomique faible dans 59 cas (64,8%), et une hypertension artérielle dans 40 cas (43,9%). L'examen physique a retrouvé : une insuffisance cardiaque globale 77 cas (84,6%), une insuffisance cardiaque droite exclusive 5 cas (5,5%). Les causes de l'insuffisance cardiaque étaient: la cardiopathie hypertensive 40 cas (43,9%), la cardiomyopathie dilatée 28 cas (30,8%) et les valvulopathies 9 cas (10%). Les principales causes de réhospitalisation étaient: les écarts du régime hyposodé 64 cas (70,3%), la mauvaise observance du traitement 56 cas (61,5%), la grippe 15 cas (16,5%), la fibrillation atriale 12 cas (13,2%), débit de filtration glomérulaire réduite 12 cas (13,2%). La durée moyenne d'hospitalisation était de 11 ± 6,4 jours (extrêmes: 2-29). Le décès a été enregistré dans 5 cas (5,5%). Conclusion: L'absence de respect pour un régime pauvre en sodium et une mauvaise adhésion au médicament ont été les principales causes de réhospitalisation pour IC à Brazzaville. À cet égard, il est nécessaire de promouvoir l'éducation thérapeutique et d'améliorer l'accès au traitement.

Background: to identify the causes of readmission for heart failure (HF) Methods: this cross-sectional study was conducted in April 2014 to march 2015 in the department of cardiology, University Hospital of Brazzaville (Republic of the Congo). We had included, the patients who had a history of hospitalization for HF. Results: Ninety-one patients, 54 women (59.3%) were included. Sex-ratio was 0.7. The frequency of readmission for HF was 19%. The mean age was 62±16 years (range: 24-89). The average number of readmission was 2±0.8 (range: 1-5), the history of readmission ≥ 3, were 33 (36.2%). The patients were low socio-economic status in 59 cases (64.8%). In examination, patients were in congestive HF (n=77, 84.6%), right-sided HF (n=5). The causes of HF were: hypertensive heart disease (n=40, 43.9%), dilated cardiomyopathy (n=28, 30.8%), and valvular heart disease (n=9). The main causes of readmission were: excessive salt intake (n=64, 70.3%), poor drug-adherence (n=56, 61.5%), influenza (n=15, 16.5%), atrial fibrillation (n=12, 13.2%), reduced estimate glomerular filtration rate (n=12, 13.2%). The average length of hospitalization was 11±6.4 days (range: 2-29). The death was recorded in 5 cases (5.5%). Conclusion: No respect of low sodium diet and poor drug adherence, were the most causes of readmission for HF at Brazzaville. In regard of this facts, promoting therapeutic education is needed, and increasing access to treatment

Reliability and validity of Chinese version of measuring change in restriction of salt (sodium ) in diet in hypertensives / 中华行为医学与脑科学杂志

Objective:To develop the Chinese version of measuring change in restriction of salt (sodium ) in diet in hypertensives(MCRSDH), and to test its reliability and validity.Methods:Authorization was obtained from the original authors of MCRSDH.Cross-cultural revision of the MCRSDH was conducted according to the guidelines from November 2020 to January 2021.Totally 700 patients with hypertension were recruited through convenience sampling from 4 community health service centers in 2 main urban districts of Changsha and investigated by the Chinese version of MCRSDH.Reliability and validity of the scale were assessed.Results:The correlation coefficient between each item and the total score ranged from 0.327-0.799 and 0.468-0.893 in MCRSDH initiation (MCRSDH-INIT)and MCRSDH sustenance(MCRSDH-SUST) respectively.The item of content validity index(I-CVI) of each item ranged from 0.802 to 1.000, and the scale of content validity index(S-CVI) was 0.914.Four factors were extracted by exploratory factor analysis(EFA)and could explain 68.511% of the total variance for MCRSDH-INIT.Three factors were extracted by EFA and could explain 76.558% of the total variance for MCRSDH-SUST.Values of factor loading ranged from 0.541 to 0.926 for MCRSDH-INIT, and from 0.586 to 0.888 for MCRSDH-SUST.The Confirmatory factor analysis indicated that χ 2/ df=1.732, GFI=0.902, CFI=0.945, RMSEA=0.046, NFI=0.931, TLI=0.936 for initiation model and χ 2/ df=1.248, GFI=0.937, CFI=0.971, RMSEA=0.018, NFI=0.943, TLI=0.937 for sustenance model.The cronbach's α coefficient of the scale was 0.901 and the test-retest reliability was 0.917. Conclusion:The Chinese version of the MCRSDH is reliable and valid, and can be used as a tool to MCRSDH in China.

Relationship between the intake of salt and salted food and the infection of Helicobacter pylori in 40-69 years old local residents in a county with high gastric cancer risk in Anhui Province / 中华疾病控制杂志

Objective The aim of the present study was to investigate the relationship between the intake of salt and salted food and the infection of Helicobacter pylori (Hp) among 40-69 years old local residents in a county with high gastric cancer risk in Anhui province. Methods From July 2015 to August 2018, we conducted a questionnaire and a serological test for Hp among 40-69 years old local residents in Lujiang county, Anhui province. The questionnaire focused on the consumptions of salt and salted food. The relationship between Hp infection and risk factors was analyzed by gender. Univariate and multivariate logistic regression analysis were used to analyze the relevant influencing factors. Results The Hp infection rate of total local residents was 50.07%. Among male subjects, age, body mass index(BMI), marital status, educational level, job, labor intensity and income had no link to Hp infection (all P>0.05). But among female subjects, BMI was associated with Hp infection ( 2=13.454,P=0.001). Besides, alcohol consumption was a risk factor for Hp infection in male subjects(OR=1.789，95% CI:1.188-2.694，P=0.003). But, high intake of salt and salted food had no effect on Hp infection after adjustment for alcohol consumption variable in men using multivariate analysis (all P>0.05). After adjusted for BMI variable among female individuals, high salt intake (≥9 g/day) (OR=1.462，95% CI:1.060-2.015，P=0.021) and the high salted food intake (≥1 times /day) were risk factors for Hp infection in women(OR=1.560，95% CI:1.021-2.383，P=0.040). Conclusions In one county with high gastric cancer risk in Anhui province, high salt intake (≥9 g/day) and high salted food intake (≥1 times/day) are risk factors for Hp infection among 40-69 years old female local residents.

The Effect of Lifestyle Changes on Blood Pressure Control among Hypertensive Patients / 가정의학회지

BACKGROUND: Hypertension is highly prevalent among patients who visit primary care clinics. Various factors and lifestyle behaviors are associated with effective blood pressure control. We aimed to identify factors and lifestyle modifications associated with blood pressure control among patients prescribed antihypertensive agents. METHODS: This survey was conducted at 15 hospital-based family practices in Korea from July 2008 to June 2010. We prospectively recruited and retrospectively assessed 1,453 patients prescribed candesartan. An initial evaluation of patients' lifestyles was performed using individual questions. Follow-up questionnaires were administered at 4, 8, and 12 weeks. We defined successful blood pressure control as blood pressure <140 mm Hg systolic and <90 mm Hg diastolic. RESULTS: Of the 1,453 patients, 1,139 patients with available data for initial and final blood pressures were included. In the univariate analysis of the change in performance index, weight gain (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.52 to 3.11; P<0.001), physical inactivity (OR, 1.195; 95% CI, 1.175 to 3.387; P=0.011), and increased salt intake (OR, 1.461; 95% CI, 1.029 to 2.075; P=0.034) were related to inadequate blood pressure control. Salt intake also showed a significant association. Multivariate ORs were calculated for age, sex, body mass index, education, income, alcohol consumption, smoking status, salt intake, comorbidity, and family history of hypertension. In the multivariate analysis, sex (OR, 3.55; 95% CI, 2.02 to 6.26; P<0.001), salt intake (OR, 0.64; 95% CI 0.43 to 0.97; P=0.034), and comorbidity (OR, 1.82; 95% CI, 1.23 to 2.69; P=0.003) were associated with successful blood pressure control. CONCLUSION: Weight gain, physical inactivity, and high salt intake were associated with inadequate blood pressure control.

Salt intake of patients undergoing maintenance hemodialysis and their knowledge and behaviour / 现代临床护理

Objective To study the salt intake of patients undergoing maintenance hemodialysis and explore their knowledge and behaviour. Methods The patients undergoing maintenance hemodialysis were offered salt spoon and soy sauce cup. Their diaries on home meals for 3 consecutive days were collected to calculate their salt intake. Meanwhile, a one to one interview was done to evaluate the accuracy of patient′s diet diary and the knowledge and behavior of low salt diet and find out related factors of salt intake. Results The average salt intake was (6.49 ± 1.64)g/d. The average composition rate in the low salt diet knowledge in low salt diet behavior was 51.00% and 47.00% respectively. Age and education level were the influencing factors of salt intake. Conclusions The average salt intake is much higher than the standard for the patients undergoing maintenance hemodialysis. Their low salt diet knowledge is in the middle level and their low salt diet behavior is in the middle or lower level. The related factors include age and education among patients undergoing maintenance hemodialysis.

Relationship between salt consumption measured by 24-h urine collection and blood pressure in the adult population of Vitória (Brazil)

High salt intake is related to an increase in blood pressure and development of hypertension. However, currently, there are no national representative data in Brazil using the gold standard method of 24-h urine collection to measure sodium consumption. This study aimed to determine salt intake based on 24-h urine collection in a sample of 272 adults of both genders and to correlate it with blood pressure levels. We used a rigorous protocol to assure an empty bladder prior to initiating urine collection. We excluded subjects with a urine volume <500 mL, collection period outside of an interval of 23-25 h, and subjects with creatinine excretion that was not within the range of 14.4-33.6 mg/kg (men) and 10.8-25.2 mg/kg (women). The mean salt intake was 10.4±4.1 g/day (d), and 94% of the participants (98% of men and 90% of women) ingested more than the recommended level of 5 g/d. We found a positive association between salt and body mass index (BMI) categories, as well as with salt and blood pressure, independent of age and BMI. The difference in systolic blood pressure reached 13 mmHg between subjects consuming less than 6 g/d of salt and those ingesting more than 18 g/d. Subjects with hypertension had a higher estimated salt intake than normotensive subjects (11.4±5.0 vs 9.8±3.6 g/d, P<0.01), regardless of whether they were under treatment. Our data indicate the need for interventions to reduce sodium intake, as well the need for ongoing, appropriate monitoring of salt consumption in the general population.

Hypertension and associated risk factors in some selected rural areas of Bangladesh.

Background: Although, Bangladesh has the ninth highest rate of age-standardized rates of deaths due to chronic diseases, mostly due to cardiovascular diseases and diabetes. There is scanty literature on the estimated burden, and the determinants of hypertension in the rural areas of Bangladesh. Methods: This facility based cross-sectional survey was conducted at sub-urban field research clinic from four unions of Araihazar upazilla of Narayangong district, Bangladesh. The analyses were based on 212 male and female respondents of more than 30 years of age. The prevalence of hypertension was the main outcome of interest. Results: The study found that the prevalence of systolic hypertension among the respondents is 15.6% and that of diastolic pressure is 12.3%. Systolic pressure was found in an increasing manner with the increase of age and BMI. Tendency of increase systolic pressure was observed among those who took extra salt. Significant association was also found between increasing systolic pressure with the heart disease. No significant association was found between increasing systolic pressure with smoking habit, physical activity and vegetable intake and with the development of systemic diseases namely cardiovascular disease (CVD), diabetes mellitus and coronary obstetrics pulmonary disease. Conclusion: Suggestion on regular periodical health check-up especially including blood pressure monitoring and restriction of taking extra salt to all the people of age more than 30 years is recommended.

Salt-induced epithelial-to-mesenchymal transition in Dahl salt-sensitive rats is dependent on elevated blood pressure

Dietary salt intake has been linked to hypertension and cardiovascular disease. Accumulating evidence has indicated that salt-sensitive individuals on high salt intake are more likely to develop renal fibrosis. Epithelial-to-mesenchymal transition (EMT) participates in the development and progression of renal fibrosis in humans and animals. The objective of this study was to investigate the impact of a high-salt diet on EMT in Dahl salt-sensitive (SS) rats. Twenty-four male SS and consomic SS-13BN rats were randomized to a normal diet or a high-salt diet. After 4 weeks, systolic blood pressure (SBP) and albuminuria were analyzed, and renal fibrosis was histopathologically evaluated. Tubular EMT was evaluated using immunohistochemistry and real-time PCR with E-cadherin and alpha smooth muscle actin (α-SMA). After 4 weeks, SBP and albuminuria were significantly increased in the SS high-salt group compared with the normal diet group. Dietary salt intake induced renal fibrosis and tubular EMT as identified by reduced expression of E-cadherin and enhanced expression of α-SMA in SS rats. Both blood pressure and renal interstitial fibrosis were negatively correlated with E-cadherin but positively correlated with α-SMA. Salt intake induced tubular EMT and renal injury in SS rats, and this relationship might depend on the increase in blood pressure.

Not Salt Taste Perception but Self-Reported Salt Eating Habit Predicts Actual Salt Intake

Excessive dietary salt intake is related to cardiovascular morbidity and mortality. Although dietary salt restriction is essential, it is difficult to achieve because of salt palatability. However, the association between salt perception or salt eating habit and actual salt intake remains uncertain. In this study, we recruited 74 healthy young individuals. We investigated their salt-eating habits by questionnaire and salt taste threshold through a rating scale that used serial dilution of a sodium chloride solution. Predicted 24-hr urinary salt excretions using Kawasaki's and Tanaka's equations estimated dietary salt intake. Participants' mean age was 35 yr, and 59.5% were male. Salt sense threshold did not show any relationship with actual salt intake and a salt-eating habit. However, those eating "salty" foods showed higher blood pressure (P for trend=0.048) and higher body mass index (BMI; P for trend=0.043). Moreover, a salty eating habit was a significant predictor for actual salt intake (regression coefficient [beta] for Kawasaki's equation 1.35, 95% confidence interval [CI] 10-2.69, P=0.048; beta for Tanaka's equation 0.66, 95% CI 0.01-1.31, P=0.047). In conclusion, a self-reported salt-eating habit, not salt taste threshold predicts actual salt intake.

Estimation of Daily Salt Intake through a 24-Hour Urine Collection in Pohang, Korea

There is an established relationship between a high salt diet and public health problems, especially hypertension and cardiovascular disease. We estimated daily salt intake in a group of adults and assessed its association with related variables in Pohang, Korea. We conducted a cross-sectional survey in 2013 with 242 adults. Urine was collected for 24 hr to estimate daily salt intake, and questionnaires about salt preference were administered. The mean daily salt intake was 9.9+/-4.6 g. There was no difference in salt intake between high systolic blood pressure (SBP) participants and normal SBP participants (10.5+/-4.7 g/d vs. 9.6+/-4.3 g/d, P=0.339), but high diastolic blood pressure (DBP) participants reported more salt intake than normal DBP participants (10.4+/-4.9 g/d vs. 9.7+/-4.1 g/d, P=0.049). Salt intake and body mass index demonstrated a positive correlation (P=0.001). A preference for Korean soup or stew was associated with high salt intake (P=0.038). Dietary salt intake in Korean adults is still higher than the recommendation from the World Health Organization. More efforts should be made to reduce the salt consumption of Korean adults.

Sal y salud: avances en conocimientos, acciones y propuestas / Salt and health: progess in knowledge, actions and proposals / Sal e saúde: avanços em conhecimentos, ações e propostas

En la Argentina y el mundo existen acciones tendientes a reducir la ingesta de sal; entre ellas, intervenciones de educación al consumidor y reducción del contenido de sal en alimentos procesados. Las Guías Alimentarias parala Población Argentina editadas en 2000 incluyen un mensaje específico destinado a orientar una ingesta que no supere los 6g diarios. El Foro de la Organización Mundial de la Salud s obre la Reducción del Consumo de Sal enla Población recomienda educar al consumidor y promover entornos que faciliten la elección de alimentos mássanos. Pocas investigaciones reflejan la ingesta de sal por parte de los consumidores; diversos estudios muestran que las personas tienen un deficiente reconocimiento de su ingesta de sal y no son plenamente conscientes de la relación “ingesta de s al-salud”. Las intervenciones preventivas más efectivas son las que involucran al consumidor desde su planificación, teniendo en cuenta los intereses, representaciones, preconceptos y posibilidades concretas de ejercer el autocuidado de las personas. Acciones sinérgicas entre el sector salud, la industriay las organizaciones de la sociedad civil para educar al consumidor y ofrecer entornos alimentarios más saludables redundarán en mayores y mejores resultados en la reducción de la ingesta de sal/sodio y su efecto perjudi-cial sobre la salud.

In Argentina and the world there is an effort to lower sal tintake, including consumer education and reduction of the salt content of processed foods. The Dietary Guidelines for Argentine Population published in 2000 specifically advise a maximum daily salt intake of 6 g.The World Health Organization Forum on Reducing Salt Intake in Populations recommends educating consumers and promoting environments that facilitate healthy food choices. There are not many investigations on the amount of salt consumers use, while several studies show that people have a poor recognition of their sal tintake and they are not fully aware of the relationship between salt intake and health. The most effective preventive interventions are those that involve consumer sat the very beginning of the planning process, taking into account their interests, representations, beliefs and their real possibilities of participating in their own care...

Na Argentina e no mundo existem ações tendentes areduzir a ingestão de sal; entre elas, intervenções deeducação ao consumidor e redução do conteúdo de salem a limentos processados. Os Guias Alimentícios para aPopulação Argentina editados em 2000 incluem umamensagem específica destinada a orientar uma ingestãoque não supere 6g diárias. O Foro da OrganizaçãoMundial da Saúde sobre a Redução do Consumo de Salna População recomenda educar o consumidor e promoverambientes que facilitem a escolha de alimentos maissaudáveis. Poucas pesquisas refletem a ingestão d e salpor parte dos consumidores; diversos estudos mostramque as pessoas têm um deficiente reconhecimento dasua iconscientes da relação “ingestão de sal – saúde”. Asintervenções preventivas mais efetivas são as queenvolvem o consumidor desde o seu planejamento,tendo em conta os intereses, representaconcebidos...

Correlation between salt consumption and certain behavioral factors in the population of the eastern and Khangai regions of Mongolia / Монголын Анагаах Ухаан

IntroductionIn Mongolia, cardiovascular diseases (CVDs) and stroke have consistently been the number one cause of population mortality since 1990s. Hypertension is an independent risk factor for CVDs and stroke. There is a conclusive evidence that high salt intake is the strongest dietary factor for hypertension. However, in Mongolia, evidence on actual salt intake of the population, its potential sources and relations to high blood pressure has been in lack so far.GoalThe survey was aimed to determine actual daily salt intake and related behavior patterns in the population residing in Eastern and Khangai regions and in the city and to identify the directions of further activities to decrease the amount of salt consumed per day by the target population.Materials and MethodsThe survey recruited a total of 475 adults from Khentii, Bulgan aimags and Bayanzurkh district of Ulaanbaatar. Questionnaires, physical measurements and laboratory analyses were applied to collect and process the data on population demographics, behavior patterns and salt related KAP, blood pressure and sodium and potassium values in 24 hour urine samples to estimate daily salt intake. A survey database was developed using EPI INFO and the data was entered in twice. SPSS 18 software was used for the data analysis, mean and standard deviations were estimated using t and F statistics on continuous variables with normal distribution, and chi square test was applied to differences in proportions.ResultsMean age of the survey population was 44.5 years; the survey population was not differing in their age, gender and region. Average daily consumption of salt was 9.5 grams in the survey population; it was not differing in terms of region. Men consumed on average 10.1 grams of salt which is twice much higher than the WHO recommended amount. Salt consumption was higher among those aged 45-54 years and rural persons, particularly men. For men and people aged 45-54 years old, the salt consumption was directly related to their salt tea drinking habit (r= 0.14; p=0.04). Those who drink alcoholic drinks frequently have higher body mass index and/or less educational attainment were more likely to drink tea with salt. In the Eastern Region, regardless of a habit of drinking tea without salt, the high salt consumption seems to be caused by insufficient knowledge of salt containing meals and food products (r=.27; p=0.001), lack of awareness of health impacts of salt, as well as lack of attitude towards their control of daily salt intake (r= ; p= ). In the Khangai Region and the urban city, salt added to meals and food preparation (Partial r =.22; p=0.05), salt containing food products and salt tea are the main factors of high salt consumption. The survey population in these areas lacks attitude and practice to decrease and control their daily salt intake.ConclusionSalt consumption is generally high among the adults of the Eastern and Khangai Regions and in UB city; males and rural people are lacking in knowledge and attitude related with salt content of food, food choice and with the potential health impacts of excessive sodium intake.

Correlation between sodium and potassium excretion in 24- and 12-h urine samples

Low-sodium and high-potassium diets have been recommended as an adjunct to prevention and treatment of hypertension. Analysis of these nutrients in 24-h urine has been considered the reference method to estimate daily intake of these minerals. However, 24-h urine collection is difficult in epidemiological studies, since urine must be collected and stored in job environments. Therefore, strategies for shorter durations of urine collection at home have been proposed. We have previously reported that collecting urine during a 12-h period (overnight) is more feasible and that creatinine clearance correlated strongly with that detected in 24-h samples. In the present study, we collected urine for 24 h divided into two 12-h periods (from 7:00 am to 7:00 pm and from 7:00 pm to 7:00 am next day). A sample of 109 apparently healthy volunteers aged 30 to 74 years of both genders working in a University institution was investigated. Subjects with previous myocardial infarction, stroke, renal insufficiency, and pregnant women were not included. Significant (P < 0.001) Spearman correlation coefficients (r s) were found between the total amount of sodium and potassium excreted in the urine collected at night and in the 24-h period (r s = 0.76 and 0.74, respectively). Additionally, the 12-h sodium and potassium excretions (means ± SD, 95% confidence interval) corresponded to 47.3 ± 11.2%, 95%CI = 45.3-49.3, and 39.3 ± 4.6%, 95%CI = 37.3-41.3, respectively, of the 24-h excretion of these ions. Therefore, these findings support the assumption that 12-h urine collected at night can be used as a reliable tool to estimate 24-h intake/excretion of sodium and potassium.

Lack of Association between Self-reported Saltiness of Eating and Actual Salt Intake / 가정의학회지

BACKGROUND: Reducing salt intake is known to be an important factor for lowering blood pressure and preventing cardiovascular disease. Estimating amount of salt intake is a necessary step towards salt intake reduction. Self-reported saltiness of diet is a method most easily used to measure a patient's salt intake. The purpose of this study was to examine the value of self-reported saltiness of diet in measuring salt intake. METHODS: We used data from 681 participants who visited a health center at a university hospital between August 2003 and November 2005. A self-administered questionnaire was used to collect information on self-reported saltiness of diet, other dietary habits and lifestyle factors. Salt intake was estimated on the basis of 24-hour dietary recall with a computer-aided nutritional analysis program (CAN-Pro 2.0, Korean Nutrition Society). RESULTS: There was no statistically significant difference between the mean salt intake of the self-reported salty diet group (13.7 +/- 4.8 g/d) and the self-reported unsalty diet group (13.3 +/- 4.4 g/d). If we assume calculated salt intake as the gold standard, the sensitivity and specificity of self-reported saltiness were 39.5% and 63.6%, respectively. Salt intake was increased with higher calorie intake, frequency of eating breakfast (> or =5 times/wk) and being satiated with usual diet in men, but it was increased only with higher calorie intake in women. Regardless of actual salt intake, the group satiated with a usual diet tended to be in the group of self-reported salty diet. CONCLUSION: Self-reported saltiness of diet was not associated with actual salt intake. Further studies will be needed on the simpler and more objective tools to estimate salt intake.

Sodio urinario como marcador bioquímico de la ingesta estimada de sal en niños y adolescentes / Urinary sodium as biochemical marker of estimated salt intake in children and adolescents / Sódio urinário como marcador bioquímico da ingestão de sal estimada em crianças e adolescentes

El objetivo de este trabajo fue estimar la ingesta de sal en niños y adolescentes "clínicamente sanos" utilizando como marcador o indicador bioquímico la excreción urinaria de sodio en 24 h. Se estudiaron 112 niños de ambos sexos, entre 5 y 15 años, sin restricción dietética, que concurrieron al Hospital de Pediatría - Posadas, Misiones. Se determinó la concentración de sodio en orina de 24 h utilizando un electrodo ión selectivo. La ingesta estimada de sal (g/día) se calculó a partir de: sodio urinario (mmol/día) x 58,5. No se encontraron diferencias significativas para la ingesta de sal por género. Los niños entre 9 y 15 años poseen una ingesta estimada (2,5 a 17 g sal/día) significativamente mayor (p < 0,05) que el grupo de 5 a 8 años (1,3 a 11,7 g sal/día). Un 24% de los niños de 5 a 8 años y sólo el 15% del grupo etáreo de 9 a 15 años, consumen de acuerdo a las recomendaciones establecidas por organismos internacionales. La ingesta de sal diaria estimada indica que un gran porcentaje de la población estudiada presenta una ingesta habitual elevada de sal, mayor a sus necesidades fisiológicas y a las metas recomendadas para prevenir la hipertensión arterial.

The aim of this study was to evaluate the estimated salt intake in "clinically healthy" children and adolescents, using the 24 h sodium urinary excretion as biochemical marker or indicator. A hundred and twelve male and female children aged 5 to 15, without a dietary restriction who visited the Province Pediatric Hospital - Posadas were evaluated. Urinary sodium in 24 hours was measured using the electrode selective ion method. The salt intake (g/day) was calculated as: urinary sodium (mmol/day) x 58.5. There were no significant differences in estimated salt intake by gender. Children aged from 9 to 15 have a significantly higher (p< 0.05) consumption (2.5 to 17 g salt /day) than those between the ages of 5 to 8 (1.3 a 11.7 g salt/day). A 24% of the children aged 5 to 8 and only a 15% at the age range 9 to 15 consume according international recommendations. The daily estimated salt intake indicates that a great percentage of the population studied presents a usual high consumption of salt, greater than their physiological needs and the recommended aims for prevention hypertension.

O objetivo deste trabalho foi estimar a ingestão de sal em crianças e adolescentes "clinicamente saudáveis" utilizando como marcador ou indicador bioquímico a excreção urinária de sódio em 24 h. Foram estudadas 112 crianças de ambos os sexos, entre 5 e 15 anos, sem restrição dietética, que assistiram ao Hospital de Pediatria - Posadas, Misiones. Determinou-se a concentração de sódio em urina de 24 h utilizando um eletrodo íon seletivo. A ingestão estimada de sal (g/dia) se calculou a partir do sódio urinário (mmoles/dia) x 58,5. Não se encontraram diferenças signiOcativas para a ingestão de sal por gênero. Crianças entre 9 e 15 anos têm uma ingestão estimada (2,5 a 17 g sal/dia) signiOcativamente maior (p < 0,05) que o grupo de 5 a 8 anos (1,3 a 11,7 g sal/dia). 24% das crianças de 5 a 8 anos e apenas 15% do grupo entre 9 e 15 anos, consomem conforme as recomendações estabelecidas por organismos internacionais. A ingestão de sal diária estimada indica que um grande percentual da população estudada apresenta ingestão habitual elevada de sal, maior a suas necessidades Osiológicas e às metas recomendadas para prevenir hipertensão arterial.

Effects of spironolactone in spontaneously hypertensive adult rats subjected to high salt intake

OBJECTIVE: To evaluate the effect of spironolactone on ventricular stiffness in spontaneously hypertensive adult rats subjected to high salt intake. INTRODUCTION: High salt intake leads to cardiac hypertrophy, collagen accumulation and diastolic dysfunction. These effects are partially mediated by cardiac activation of the renin-angiotensin-aldosterone system. METHODS: Male spontaneously hypertensive rats (SHRs, 32 weeks) received drinking water (SHR), a 1 percent NaCl solution (SHR-Salt), or a 1 percent NaCl solution with a daily subcutaneous injection of spironolactone (80 mg.kg-1) (SHRSalt- S). Age-matched normotensive Wistar rats were used as a control. Eight weeks later, the animals were anesthetized and catheterized to evaluate left ventricular and arterial blood pressure. After cardiac arrest, a doublelumen catheter was inserted into the left ventricle through the aorta to obtain in situ left ventricular pressurevolume curves. RESULTS: The blood pressures of all the SHR groups were similar to each other but were different from the normotensive controls (Wistar = 109±2; SHR = 118±2; SHR-Salt = 117±2; SHR-Salt-S = 116±2 mmHg; P<0.05). The cardiac hypertrophy observed in the SHR was enhanced by salt overload and abated by spironolactone (Wistar = 2.90±0.06; SHR = 3.44±0.07; SHR-Salt = 3.68±0.07; SHR-Salt-S = 3.46±0.05 mg/g; P<0.05). Myocardial relaxation, as evaluated by left ventricular dP/dt, was impaired by salt overload and improved by spironolactone (Wistar = -3698±92; SHR = -3729±125; SHR-Salt = -3342±80; SHR-Salt-S = -3647±104 mmHg/s; P<0.05). Ventricular stiffness was not altered by salt overload, but spironolactone treatment reduced the ventricular stiffness to levels observed in the normotensive controls (Wistar = 1.40±0.04; SHR = 1.60±0.05; SHR-Salt = 1.67±0.12; SHR-Salt- S = 1.45±0.03 mmHg/ml; P<0.05). CONCLUSION: Spironolactone reduces left ventricular hypertrophy secondary to high salt intake and ventricular stiffness in adult SHRs.

Excreción urinaria de sodio en niños y adultos de una comuna de la Región Metropolitana de Santiago de Chile / Urinary sodium excretion in children and adults from a bourough of the Metropolitan Region of Chile

Arterial hypertension has increased sharply in Chile, during the last 3 decades. The National Health Survey (2003) registered a 33.7 percent prevalence in Chilean population over 17 years of age. It is known that an excessive sodium intake is a risk factor for arterial hypertension (AH). Objective: To measure urinary sodium excretion in an exploratory study in school age children and adults of a borough of the Metropolitan Region, and later on increase to a representative population sample. Subjects and method: 158 school age children of both sexes aged 10.6 +/- 2.5 years and 48 adults older than 20 years were evaluated. Weight was measured in 0.1 kg precision scale (SECA model 286). Body Mass Index (BMI) was calculated according to the formula weight (kg)/stature (m)2. Arterial pressure was measured with a mercury manual sphygmomanometer. Urinary sodium in 24 hours was calculated with the formula of Tanaka et al. This information was used to predict theoretical NaCI intake using the equation Na mg/day = Na mEq/d x 23; NaCI = Na g/d x 100139.3. Results: BMI in children was 19.2 +/- 4,9 In 28.6 percent and 40.5 percent of adults diastolic and systolic pressure were higher than 90 mm Hg and over 130 mm Hg, respectively. In 1.7 percent and 0.9 percent of children systolic and diastolic pressure were high, according to age and sex. Salt intake per day was calculated assuming that all sodium ingested was consumed as NaCI. Children NaCI intake was 3 +/- 2.2 g per day and in adults was 10.4 +/- 2.5 g per day. Conclusions: BMI was elevated in children and adults in accordance with the high obesity prevalence in the country. The high percentages of elevated blood pressure present in adults were in accordance with high prevalence of hypertension in Chilean adults. Salt intake was high in children and adults constituting a risk factor of hypertension in our population.

En las últimas 3 décadas en Chile, la hipertensión arterial se incrementó notoriamente. La Encuesta Nacional de Salud (año 2003) registró que esta enfermedad afectaba al 33.7 por ciento de la población chilena mayor de 17 años. Se conoce que la ingesta excesiva de Na constituye un factor de riesgo para el desarrollo de hipertensión arterial (HTA). Objetivo: Medir la excreción urinaria de Na en escolares y adultos de una comuna de la Región Metropolitana en estudio exploratorio, para posteriormente ampliarlo a una muestra representativa poblacional. Sujetos y método: Se evaluaron 158 escolares de ambos sexos con edad promedio de 10.6 +/- 2.5 años y 48 adultos mayores de 20 años. El peso se determinó con una báscula con precisión de 0.10 kg (SECA, modelo 286). El índice de Masa Corporal (IMC) se calculó con la ecuación: peso (kg)/talla². La presión arterial se midió con un esfigmomanómetro manual de mercurio. La excreción urinaria de Na en 24 horas fue calculada utilizando la ecuación de Tanka T y col. Este dato se utilizó para predecir la ingesta teórica de NaCI, utilizando las siguientes ecuaciones: Na mg/día = Na mEq/d x 23, NaCl = Na g/d x 100/ 39.3. Resultados: El IMC en niños fue de 19.2 +/- 4.9 y en adultos de 29.0 +/- 5.9. En el 28.6 por ciento y en el 40.5 por ciento de los sujetos adultos evaluados se registró una cifra alta de de presión diastólica (> 90 mm Hg) y sistólica (130 > mm Hg), respectivamente. En 1.7 por ciento de los niños se detectó presión sistólica elevada y en 0.9 por ciento de la diastólica, de acuerdo a la edad y sexo. Se calculó la ingesta de sal por día, suponiendo que todo el sodio ingerido se consumió como NaCI. Los niños evaluados ingirieron 7.3 +/- 2.2 gramos de NaCl por día y los adultos 10.4 +/- 2.5 gramos de NaCI por día. Conclusiones: El IMC era elevado en adultos y niños, de acuerdo con las altas tasas de obesidad de nuestra población. Las porcentajes de presión elevada fueron mucho mayores en los adultos y ...

Hipertensión arterial y consumo de sal en pediatría / Arterial hypertension and salt intake in pediatrics

Pediatric arterial hypertension (AH) is an underdiagnosed disease, with a known prevalence of 2-3 percent. Its preventive management should begin early and includes life-style changes and diet salt reduction to a maximum of 5.8 g (2.3 g of sodium), since there is a direct relationship between total salt intake and arterial blood pressure. It has been previously shown that in populations with low salt diet (less than 3g), AH is rare and it does not increase with age. It has been estimated that 77 percent of salt found in regular diets comes from processed food. Mechanisms involved in salt intake and high blood pressure are analyzed in this paper. Arterial hypertension secondary to renal diseases and other pathologies are excluded. Considering renal physiology, the role of the kidney is crucial in arterial blood pressure regulation, through the capacity to affect the salt and water excretion; therefore, controlling total blood volume. The relationship between salt and AH in the newborn and older children, as well as genetic aspects of this disease, are discussed. In conclusion, there are biological and behavioural risk factors that can be modified in young population. It is necessary to promote these changes through active, as well as passive, prevention strategies. A government public health policy including educational publicity campaigns, permanent media information and accessible health food labelling is essential. Habits, old customs and trends need to be changed through a multifactorial approach to groups, families and community. The pediatrician should lead this effort.

La hipertensión arterial (HA) en pediatría es una patología sub diagnosticada, con una prevalencia de alrededor de un 2 a 3 por ciento. Su prevención debe comenzar precozmente con indicaciones de estilos de vida saludables, en especial reducción de sodio a 2,3 g equivalentes a 5,8 g de cloruro de sodio diarios, dada la relación directa entre cantidad de sal de la dieta y la presión arterial. En poblaciones humanas con dietas conteniendo menos de 3 g de sal por día la HA es infrecuente y no aumenta con la edad. La mayor parte del sodio ingerido se aporta por los alimentos elaborados industrialmente: el 77 por ciento se obtiene de los alimentos procesados. En esta comunicación se revisan los mecanismos que relacionan las alzas tensiónales con la ingesta de sal. Se excluyen los mecanismos que producen HA en las enfermedades renales y otras formas de HA secundarias. Desde el punto de vista fisiológico el riñón tiene un papel primordial en la regulación de la presión arterial, entre otros por su capacidad de modificar la excreción de agua y sal y con ello regular el volumen de sangre circulante. Se analiza la relación sodio/HA en el recién nacido y en el niño mayor y algunos aspectos genéticos de esta enfermedad. Se concluye que hay factores de riesgos biológicos y conductuales en los jóvenes que son modificables. Es necesario promover cambios en estos grupos a través de estrategias de prevención poblacional tanto activas como pasivas. Esto requiere un compromiso de políticas públicas que incluyan campañas educativas, manejo de la publicidad y fácil identificación de los alimentos saludables. Deben intervenirse los hábitos, costumbres y tendencias a través de acciones con un enfoque multifactorial, familiar, grupal y comunitario, siendo el pediatra quien debe liderar este desafío.