Tipos de leite e sua contribuição na ingestão diária de sódio e cálcio / Milk types and their contribution to daily sodium and calcium intake

Resumo O baixo consumo de cálcio e elevado de sódio por adolescentes configura um sério problema de saúde pública. A biodisponibilidade e o teor de cálcio contido no leite fazem dele a melhor opção no atendimento a Ingestão Dietética Recomendada (IDR) desse nutriente. Como o leite pode contribuir para a ingestão de sódio, a realização de programas que visem aumentar o seu consumo deve ser precedida de ações para diminuir o teor de sódio nele presente. O conhecimento dos teores de cálcio e sódio presentes nos leites industrializados é fundamental para que se estabeleça a quantidade adequada a ser consumida. O estudo realizado visou quantificar o cálcio e o sódio de leites em pó e ultrapasteurizados comercializados em supermercados da cidade do Rio de Janeiro e estimar a quantidade a ser consumida para atingir as necessidades diárias de cálcio e o impacto sobre a ingestão de sódio. O cálcio foi quantificado por volumetria e o sódio por fotometria de chama. Os teores médios de cálcio e sódio do leite em pó (mg/26g) foram, respectivamente, 262,5 ± 5,1mg e 116,8 ± 3,1mg, e do leite ultrapasteurizado (mg/200mL) foram, respectivamente, 246,0 ± 10,3mg e 162,5 ± 16,3mg. Para atingir a IDR do cálcio, pelo consumo de leite, os adolescentes consumiriam 584mg de sódio pelo leite em pó (39% da IDR) e 812,5mg pelo ultrapasteurizado (54% da IDR).

Abstract Low calcium consumption and high sodium intake among adolescents is a serious public health problem. Thehigh content and bioavailability of calcium in milk makes it the best choice for meeting the Dietary Reference Intakes (DRIs) for calcium. Since milk also contributes to sodium intake, programs promoting milk consumption should be preceded by initiatives to reduce its sodium content. Knowing the calcium and sodium content of processed milk is essential for establishing the adequate consumption of milk. The aim of this study was to estimate the calcium and sodium content of different brands of powdered and ultra heat treated (UHT) milk sold in supermarkets in Rio de Janeiro and calculate the amount of these milks that should be consumed by adolescents to meet daily calcium needs and the impact of this consumption on sodium intake. Volumetric analysis was used to measure calcium content and sodium content was determined using flame photometry. The mean calcium and sodium concentrations of powdered (mg/26g) and UHT milk (mg/200ml) were 262.5 ± 5.1 mg and 116.8 ± 3.1 mg and 246.0 ± 10.3 mg and 162.5 ± 16.3 mg, respectively. Milk intake sufficient to meet the DRI for calcium among adolescents would result in a sodium intake of 584 mg (39% of the AI) from the consumption of powdered milk and 812.5 mg (54% of the AI) from the consumption of UHT milk.

Contribution of Nova food groups to energy and nutrient supply in Mexican households / Contribución de los grupos de alimentos Nova a la disponibilidad de energía y nutrientes en los hogares mexicanos

Abstract: Objective: To analyze the contribution of natural, processed and ultra-processed foods to energy and nutrient supply in Mexican households. Materials and methods: The database of the National Household Expenditure Survey 2013 was analyzed (n=58 001), which is a cross-sectional survey. Food supply (g/adult equivalent/day) and energy, macro- and micro-nutrient supplies were estimated. Foods were classified following the Nova system. Households sociodemographic characteristics were analyzed as covariates. Results: Natural foods (NF) contributed with more energy (55.0%) followed by ultra-processed foods (UPF, 21.2%). NF were the main source of most nutrients. Processed culinary ingredients (PCI) and processed foods (PF) had high content of energy, total fats, and saturated fats, but low content of certain micronutrients. Sodium was mainly available in PF (34.6%) and UPF (31.4%). Sugar-sweetened beverages, fast foods, and biscuits and cookies were the main UPF in terms of energy supply. Conclusions; In Mexican households, the PCI, PF and UPF had low nutritional quality.

Resumen: Objetivo: Analizar la contribución de los alimentos naturales, procesados y ultraprocesados a la disponibilidad de energía y nutrientes en los hogares mexicanos. Material y métodos: Se analizó la base de datos de la Encuesta Nacional de Gasto de los Hogares 2013 (n= 58 001), la cual es una encuesta transversal. Se estimó la disponibilidad de alimentos (g/adulto equivalente/día), energía y nutrientes. Los alimentos fueron clasificados siguiendo el sistema Nova. Resultados: Los alimentos naturales (AN) y los ultraprocesados (AUP) contribuyeron con más energía. Los AN fueron la principal fuente de la mayoría de los nutrimentos. Los ingredientes culinarios procesados (ICP) y los alimentos procesados (AP) tenían alto contenido de energía, grasas totales y grasas saturadas pero bajo contenido de ciertos micronutrientes. El sodio estaba disponible principalmente en AP y AUP. Las bebidas azucaradas, comidas rápidas, galletas y panes fueron los principales AUP. Conclusión: En México, los ICP, AP y AUP tienen baja calidad nutricional.

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

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

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

Validation of single measurement of 12-hour urine excretion for estimation of sodium and potassium intake. A longitudinal study

ABSTRACT BACKGROUND: Evaluation of sodium and potassium intake can be carried out using different methods. Biological markers are able to capture intra and inter-individual variability and are used as separate measurements of consumption. The aim of this study was to test the validity of a single measurement of urinary sodium and potassium excretion as representative of habitual intake. DESIGN AND SETTING: Longitudinal study, federal university. METHODS: Food consumption data from a sample of adult university students and public servants (25 to 74 years old) were collected through 24-hour records and 12-hour urinary sodium and potassium excretion at five different times over a one-year period. The dietary data were entered into a nutritional research data software system and the sodium and potassium intakes were estimated. The variables were tested for normal distribution using the Kolmogorov-Smirnov test. One-way analysis of variance or the Kruskal-Wallis test was used to evaluate means. Correlations between measurements using Pearson or Spearman coefficients were calculated. The degree of agreement between the five measurements was given by the intraclass correlation coefficient. RESULTS: Satisfactory agreement was found between the five measurements of urinary sodium and potassium excretion over a year, with little variability in consumption. CONCLUSION: A single measurement of urinary sodium and potassium accurately estimated the usual average consumption of these electrolytes. This can be used in population-based studies.

Determinação do valor nutricional do cardápio para o almoço de uma UAN e verificação de sua adequação ao programa de alimentação do trabalhador / Determination of the nutritional value of the lunch menu of a UAN and verification of its adequacy to the worker's feeding program

Uma Unidade de Alimentação e Nutrição (UAN) tem o objetivo de fornecer refeições equilibradas nutricionalmente e com qualidade higienicossanitária adequada. O Programa de Alimentação ao Trabalhador tem como objetivo melhorar a alimentação dos trabalhadores. O presente trabalho teve como objetivo analisar se o valor energético, valor de gordura saturada, fibras e sódio do cardápio do almoço de uma Unidade de Alimentação e Nutrição, seguem os valores preconizados pelo Programa de Alimentação do Trabalhador (PAT). Foram analisados 5 cardápios, do turno do almoço, de uma UAN terceirizada que presta serviço a uma empresa na cidade de Estrela, Rio Grande do Sul. Após foram comparados os valores encontrados de calorias, gordura saturada, fibras e sódio com os valores recomendados pelo PAT. Pode-se verificar que os valores de calorias, gordura saturada, fibras e sódio analisados não estavam de acordo com os valores preconizados pelo PAT.

A Feeding and Nutrition Unit (FNU) has the purpose to provide nutritionally balanced meals and with hygienic-sanitary quality. The Worker Feeding Program (WFP) has the purpose to improve the workers nourishment. The aim of the present work was to analyze if the caloric energy content, saturated fat, fiber and sodium of the lunch menu in a Feeding and Nutrition Unit are in accordance with the values recommended by the Worker Feeding Program. Five meals were analyzed, of lunch shift, from an outsourced FNU that provides service to a company in the city of Estrela, Rio Grande do Sul. After the values of calories, saturated fat, fibers and sodium were found, they were compared with the ones recommended by WFP. It was observed that the analyzed value of calories, saturated fat, fibers and sodium were not in accordance with the values established by WFP.

Hypertensives' Knowledge About High-Sodium Foods and Their Behavior / Conhecimento e Atitudes Sobre Alimentos Ricos em Sódio por Pacientes Hipertensos

Abstract Background: In Brazil, the prevalence of systemic arterial hypertension (SAH) is approximately 30% of the total population. In 2010, SAH was the cause of death of about 9.4 million people worldwide. A healthy dietary pattern is important to maintain proper blood pressure levels and, consequently, disease control. Objectives: To describe the knowledge and practices of hypertensive patients cared for at a public hypertension outpatient clinic, and its relationship with high-sodium food. Methods: We applied a questionnaire to patients with questions related to sociodemographics, dietary pattern, frequency of ingestion of certain foods, and knowledge about their own disease. Results: We studied 221 patients, 56.1% of whom were women, and 53.8% had only elementary education. Their mean age was 57.7 ±13.5 years, and 75.6% of them reported having high blood pressure, and 11.3%, diabetes mellitus. Regarding dietary pattern, 62% used ready-to-use seasonings, but 94.1% reported not adding extra salt to their ready meals. Regarding patients' knowledge about high-sodium foods and SAH, only 8 patients had 100% of right answers, 37 patients had 73.8%, and 42 patients, 57% of right answers. Conclusion: Knowledge about SAH prevention and high-sodium foods was insufficient. Based on this study's findings, more effective educational strategies targeted at this population can be developed.

Resumo Fundamento: No Brasil, a prevalência de hipertensão arterial sistêmica (HAS) é aproximadamente 30% do total da população. No mundo, HAS é a causa de morte de cerca de 9,4 milhões de pessoas. Um padrão alimentar saudável é importante para a manutenção de níveis pressóricos adequados e, consequentemente, controle da doença. Objetivos: Descrever o conhecimento e as práticas alimentares de pacientes hipertensos sobre a HAS, relacionando-a com alimentos ricos em sódio. Métodos: Aplicou-se aos pacientes um questionário contendo perguntas relacionadas ao seu padrão alimentar, hábitos e frequência de consumo de determinados alimentos e conhecimento sobre a doença e condições sociodemográficas. Resultados: Avaliaram-se 221 pacientes, sendo 56,1% mulheres, 53,8% com ensino fundamental incompleto, e média de idade de 57,7±13,5 anos. Desses, 75,6% referiram ser portadores de HAS e 11,3% eram diabéticos. Em relação ao padrão alimentar, verificou-se que 62% utilizam temperos prontos para o preparo das refeições, porém 94,1% referiram não adicionar sal à refeição pronta. Em relação ao conhecimento dos pacientes quanto aos alimentos com alto teor de sódio e à HAS, apenas 8 acertaram 100% das questões do questionário (14 acertos = 100%), 37 pacientes tiveram 73,8% de acertos e 42 pacientes, 57% de acertos. Conclusão: O conhecimento sobre prevenção da HAS e alimentos ricos em sódio foi considerado insuficiente. Com base nesses achados, será possível elaborar estratégias educativas mais efetivas e direcionadas para essa população.

Sodium and potassium intake estimated using two methods in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) / Consumo de sódio e potássio estimado por dois métodos no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

ABSTRACT CONTEXT AND OBJECTIVE: Sodium and potassium intake from different food sources is an important issue regarding cardiovascular physiology. Epidemiological assessment of the intake of these electrolytes intake is done through food frequency questionnaires or urinary excretion measurements. Our aim was to compare these methods using a sample of Brazilian civil servants. DESIGN AND SETTING: Cross-sectional baseline evaluation from the Brazilian Longitudinal Study of Adult Health. METHODS: Sodium and potassium intake was obtained using two methods: a semi-quantitative questionnaire including 114 food items; and overnight 12-hour urinary excretion measurement. Sodium and potassium estimates obtained through the questionnaire were adjusted for energy intake using the residual method. Urinary excretion measurements were considered valid if they met three adequacy criteria: collection time, volume and total creatinine excretion. Mean nutrients were estimated, and Spearman correlations were calculated. Sodium and potassium intake was categorized into quintiles, and weighted kappa coefficients and percentage agreement were calculated. The significance level for all tests was 0.05. RESULTS: Data from 15,105 participants were analyzed, and significant differences between mean intakes of sodium (questionnaire: 4.5 ± 1.7 g; urine: 4.2 ± 2.1 g) and potassium (questionnaire: 4.7 ± 1.8 g; urine: 2.4 ± 1 g) were found. Weak agreement was found for sodium (K = 0.18) and potassium (K = 0.16). The percentage disagreement between methods ranged from 41.8 to 44.5%, while exact concordance ranged from 22.1% to 23.9%. CONCLUSIONS: The agreement between the food frequency questionnaire and urinary excretion measurements for assessment of sodium and potassium intakes was modest.

RESUMO CONTEXTO E OBJETIVO: O consumo de sódio e potássio de diferentes fontes alimentares é uma questão importante para a fisiologia cardiovascular. A avaliação epidemiológica do consumo desses eletrólitos é feita pelo questionário de frequência alimentar ou pela excreção urinária. O objetivo deste estudo é comparar esses métodos em uma amostra de servidores públicos brasileiros. TIPO DE ESTUDO E LOCAL: Avaliação transversal da linha de base do Estudo Longitudinal de Saúde do Adulto. MÉTODOS: O consumo de sódio e potássio foi obtido por dois métodos: questionário semi-quantitativo com 114 itens alimentares e excreção urinária de 12 horas noturnas. Estimativas de sódio e potássio obtidas pelo questionário foram ajustadas pela energia utilizando o método residual. A excreção urinária foi considerada válida se atendesse a três critérios: tempo de coleta, volume e excreção total de creatinina adequados. Foram estimadas médias dos nutrientes e calculada a correlação de Spearman. O consumo de sódio e potássio foi categorizado em quintis e foram calculados o kappa ponderado e o percentual de concordância. O nível de significância para todos os testes foi de 0,05. RESULTADOS: Foram analisados dados de 15,105 participantes e encontradas diferenças significativas entre médias de sódio (questionário: 4,5 ± 1,7 g; urina: 4,2 ± 2,1 g) e potássio (questionário: 4,7 ± 1,8 g; urina: 2,4 ± 1 g). Foi encontrada fraca concordância para sódio (K = 0,18) e potássio (K = 0,16). Percentuais de discordância entre métodos variaram de 41,8-44,5%; concordâncias exatas de 22,1-23,9%. CONCLUSÃO: A concordância entre o questionário de frequência alimentar e excreção urinária para avaliação do consumo de sódio e potássio foi modesta.

Ingesta de sodio y potasio en niños de 0 a 15 años: lo observado versus lo esperado / Sodium and potassium intake in children aged 0-15 years: measured versus expected

INTRODUCCIÓN: El diagnóstico de hipertensión arterial en pediatría tiene una prevalencia de alrededor de un 2 a 3%. Existen factores de riesgo modificables como los estilos de vida saludable, que han demostrado ser eficaces en reducir los niveles de presión arterial. Para objeto de este estudio se estudiaron las concentraciones de NaCl y K en la nutrición en pediatría. OBJETIVO: El objetivo del estudio fue determinar el consumo de cloruro de sodio y potasio en la nutrición que recibían un grupo de pacientes hospitalizados de 0 a 15 años de edad, recibiendo alimentación normal y compararla con el valor esperado normal. Para posteriormente realizar las modificaciones necesarias, dependiendo de los resultados del estudio, en conjunto con una elaboración de un programa de educación a los padres. MÉTODO: Es un estudio observacional analítico transversal, que fue realizado entre los meses de marzo y noviembre de 2013, donde se midió la concentración de cloruro de sodio y potasio en la alimentación que reciben los lactantes y niños hospitalizados en el servicio de pediatría de Clínica Las Condes y se comparó con los niveles recomendados para cada grupo de edad. Se analizaron 20 muestras recolectadas por cinco días consecutivos. Medición realizada por absorción atómica. Las nutriciones estudiadas fueron divididas en cuatro grupos de edad y aquellos que realizaron las mediciones estuvieron ciegos a éstos. RESULTADOS: Existieron diferencias estadísticamente significativas entre los valores esperados y los observados en la ingesta de cloruro de sodio y potasio en todos los grupos. CONCLUSIÓN: El aumento del cloruro de sodio se debía al uso de alimentos procesados. Al cambiarlos por alimentos naturales se logró llegar a los valores esperados. La baja ingesta de potasio se corrigió aumentando la oferta de frutas y verduras.

INTRODUCTION: The diagnosis of hypertension in children has a prevalence of about 2-3%. There are modifiable risk factors such as healthy lifestyles, which have proven to be effective in reducing blood pressure levels. For the purpose of this study the concentrations of NaCl and K in pediatric nutrition were studied. OBJECTIVE: The aim of the study was to determine the use of sodium chloride and potassium in the nutrition received by a group of hospitalized patients from 0-15 years old, receiving normal diet and compare it with the normal expected value. Depending on the study results, the concentration will be modified to reach the recommended concetrations for age. Also we will elaborate an education program for parents. METHOD: A cross-sectional observational study, was conducted between March and November 2013, where the sodium chloride and potassium concentrations in the diet received by infants and children hospitalized in the pediatric unit of Clinic Las Condes were measured and compared with those recommended for each age group. Twenty samples collected for five consecutive days were analyzed. Measures were performed by atomic absorption. Foods studied were divided in four age groups. Those measurements were performed blind to the age grupo. RESULTS: The concentration of NaCl in all age groups was higher than the recommended and the K concentration was less than the recomendad. There were statistically significant differences between expected and observed values in intake of sodium chloride and potasium in all groups. CONCLUSION: Increased sodium chloride due to the use of processed foods. It was replaced by natural foods so will be able to reach the expected values. Low potassium intake was corrected by increasing the supply of fruits and vegetables.

Oferta de sódio na alimentação em crechesmunicipais: um risco à saúde / Sodium offer in public child daycare centers: a health risk

O objetivo da pesquisa foi determinar a quantidade de sódio oferecida nas refeições de crianças de 12 a 36 meses emcreches municipais, por meio de análises laboratoriais. O estudo transversal foi realizado em quatro creches de um municípioda Região Metropolitana de Curitiba/PR, sorteadas aleatoriamente por amostragem estratificada por conglomerados.De junho a novembro/2013 foram coletadas amostras das seis refeições diárias servidas às crianças, durante cinco diasnão consecutivos nas quatro creches, totalizando 20 dias e 120 amostras analisadas. O teor de sódio foi determinado pelométodo de cloretos por volumetria e os resultados foram comparados a quatro parâmetros: 1) quantidade máxima diáriapreconizada para o sódio na alimentação escolar, 2) limite superior tolerável de ingestão do nutriente para a idade, 3)atendimento máximo de 70% da recomendação nutricional e 4) teor máximo de sódio recomendado para uma refeição,na alimentação escolar. O teor médio de sódio oferecido foi 1251mg/dia (n=20), atendendo ao preconizado para a alimentaçãoescolar e correspondendo a 83,4% do limite superior de ingestão para a idade. Cem por cento dos almoços e60% dos jantares apresentaram valores de sódio acima do recomendado para uma refeição, indicando um fator de riscopara a hipertensão arterial infantil e necessidade de intervenção nessa população.

This paper aimed to determine sodium amount in meals offered to children from 12 to 36 months old, in municipal childdaycare centers, using laboratorial analysis. The study was conducted in 4 child daycare centers from a city in the metropolitanregion of Curitiba/PR, Brazil, randomly selected after complex sampling techniques. From June to November/2013,samples of the 6 daily meals served to children were collected in 4 child daycare centers, for 5 non-consecutive days, totaling20 days and 120 samples analyzed. Sodium content was determined by the method of chlorides by volumetry and theresults were compared to 4 parameters, as follows: 1) maximum sodium value recommended by PNAE to full-time schoolfeeding, 2) tolerable upper intake level (UL) for the age group, 3) compliance to maximum 70% of tolerable upper intakelevel (UL) for the age group, and 4) maximum sodium value recommended by PNAE to a single meal. The average amountof sodium offered to children was 1251mg/day, which met PNAE’s guidelines and corresponded to 83.4% of UL for age. Asto sodium content in a single meal, 100% of lunches and 60% of dinners exceeded the maximum recommended by PNAE,indicating risk factor to hypertension in childhood and highlighting intervention required in this population.

Evaluación de la ingesta dietética y excreción urinaria de sodio y potasio en adultos / Assessment of dietary intake and urinary excretion of sodium and potassium in adults

Background: Hypertension is associated with elevated sodium and low potassium intakes. The determination of sodium and potassium intake by dietary records is inaccurate, being its measurement from 24-h urine collection the reference method. Aim: To determine urinary sodium and potassium excretion in adults. To compare dietary sodium and potassium intake and their excretion from an isolated urine sample against the reference method. Material and Methods: Seventy healthy adults aged 35 ± 8 years with a body mass index 25 ± 2 kg/m² (36 women) were studied. Urine was collected over 24 h, including an isolated urine sample taken in fasting conditions. Additionally, three 24-h dietary records were performed. Results: Reported sodium and potassium intake was 2,720 ± 567 and 1,068 ± 433 mg/day, respectively. In turn, urinary excretion of sodium and potassium was 4,770 ± 1,532 and 1,852 ± 559 mg/day, respectively. These latter values were significantly higher than those obtained by dietary records. Furthermore, the urinary sodium and potassium excretion estimated from an isolated urine sample was 4,839 ± 1,355 and 1,845 ± 494 mg/day, respectively. These values were similar to those obtained with a 24 h urine collection. Conclusions: Dietary records underestimated electrolyte intake when compared with the reference method. Using an isolated urine sample to estimate electrolyte intake may be a reliable alternative.

Fatores associados à ingestão de sal em pacientes em tratamento crônico de hemodiálise / Factors associated to salt intake in chronic hemodialysis patients

INTRODUÇÃO: A ingestão de sal tem sido diretamente relacionada ao aumento da ingestão hídrica e, consequentemente, ao incremento dos níveis da pressão arterial (PA) e do ganho de peso interdialítico (GPID), fatores de risco de morbimortalidade em pacientes em hemodiálise (HD). OBJETIVO: Avaliar a ingestão de sal e suas fontes alimentares, bem como sua associação com parâmetros demográficos, clínicos e nutricionais. MÉTODOS: Estudo transversal no qual participaram 109 pacientes (66% mulheres; idade = 49,0 ± 12,6 anos) de cinco centros de diálise. Para obtenção da ingestão de sal total, foi utilizado um questionário de frequência alimentar (QFA) validado somado à estimativa da ingestão de sal de adição. Os dados obtidos foram relacionados a diversos parâmetros. RESULTADOS: A ingestão de sal média foi elevada (8,6 ± 5,4 g/dia), sendo 72% proveniente do sal de adição. Apenas a escolaridade se correlacionou tanto com a ingestão de sal total (r = -0,29; p < 0,01) como com o sal de adição (r = -0,30; p < 0,01). Com o sal dos itens alimentares do QFA, houve correlação direta com o percentual de GPID (%GPID) (r = 0,26; p < 0,01) e inversa com a idade (r = -0,35; p < 0,001). Relação direta da ingestão de sal total com o %GPID foi encontrada no subgrupo de pacientes anúricos (r = 0,26; p < 0,05). Associação positiva da ingestão de sal total com a PA média (PAM) foi evidenciada apenas nos que não faziam uso de hipotensores (r = 0,35; p < 0,05). CONCLUSÃO: A ingestão de sal total foi elevada devido, principalmente, ao sal de adição. A mesma associou-se com a escolaridade e afetou adversamente o %GPID nos pacientes anúricos e a PAM nos que não utilizavam drogas hipotensoras.

INTRODUCTION: Salt intake increases fluid intake and, consequently, blood pressure (BP) and interdialytic weight gain (IDWG), known as morbi-mortality risk factors for hemodialysis (HD) patients. OBJECTIVE: Evaluate salt intake and food sources, as well as its relationship with demographics, clinical and nutritional parameters. METHODS: Cross-sectional study with 109 patients (66% women, age = 49.0 ± 12.6 years) from five dialysis centers. For total salt intake, a validated food frequency questionnaire (FFQ) and the use of discretionary salt were estimated. The relationship of salt intake with many factors was studied. RESULTS: Salt intake was high (8.6 ± 5.4 g/day) and 72% came from discretionary salt. Only literacy was significantly correlated total salt intake (r = -0.29, p < 0.01) and discretionary salt (r = -0.30, p < 0.01). With FFQ food items, there was a positive correlation with the %IDWG (r = 0.26, p < 0.01) and negative with age (r = -0.35, p < 0.001). Direct relationship between salt intake with %IDWG was found in the anuric subgroup (r = 0.26, p < 0.05) and with medium BP in those with no prescription of hypotensive drugs (r = 0.35, p < 0.05). CONCLUSION: Salt intake was high mainly due to discretionary salt. It was associated with education and adversely affected %IDWG in anuric patients and medium BP in those not taking hypotensive drugs.

La dieta en el tratamiento de la litiasis renal. Bases fisiopatológicas / [Diet in the treatment of renal lithiasis. Pathophysiological basis].

The composition of urine is influenced by diet and changes in dietary factors have been proposed to modify the risk of recurrent nephrolithiasis. Nutrients that have been implicated include calcium, oxalate, sodium, animal protein, magnesium and potassium. There is significant evidence showing that a high calcium diet is associated with a reduction of lithogenic risk. One of the possible mechanisms to explain this apparent paradox is that the higher intake of calcium in the intestine binds with dietary oxalate, reducing its absorption and urinary excretion. Oxalate from the diet seems to provide only a small contribution to excretion and dietary restriction is appropriate only in those with hyperoxaluria and hyperabsorption. Observational studies have shown a positive and independent association between sodium intake and the formation of new kidney stones. Consumption of animal protein creates an acid load that increases urinary excretion of calcium and uric acid and reduced citrate, all factors that could participate in the genesis of stones. Potassium-rich foods increase urinary citrate because of its alkali content. In prospective observational studies, diets rich in magnesium were associated with a lower risk of kidney stone formation in men. In conclusion, diet is a key element in the management of the patient with kidney stones but always subordinated to present metabolic risk factors.

Inadequação do consumo de nutrientes entre adolescentes brasileiros / Inadequate nutrient intake in Brazilian adolescents / Consumo inadecuado de nutrientes entre adolescentes brasileños

OBJETIVO: Estimar o consumo de energia e nutrientes e a prevalência de inadequação da ingestão de micronutrientes entre adolescentes brasileiros. MÉTODOS: Amostra probabilística composta por 6.797 adolescentes (49,7% do sexo feminino) entre dez e 18 anos de idade foi avaliada no Inquérito Nacional de Alimentação, 2008-2009. Os fatores de expansão, a complexidade do desenho da amostra e a correção da variabilidade intrapessoal do consumo foram considerados. A prevalência de inadequação de consumo de micronutrientes foi estimada pela proporção de adolescentes com ingestão abaixo da necessidade média estimada. Para o sódio, estimou-se a prevalência de consumo acima do valor de ingestão máxima tolerável. RESULTADOS: A média de consumo de energia variou de 1.869 kcal, observada nas adolescentes de 10 a 13 anos, a 2.198 kcal, estimada para os adolescentes de 14 a 18 anos. Os carboidratos forneceram 57% da energia total, os lipídios, 27% e as proteínas, 16%. As maiores prevalências de inadequação foram observadas para cálcio (> 95%), fósforo (entre 54% e 69%) e vitaminas A (entre 66% e 85%), E (100%) e C (entre 27% e 49%). Mais de 70% dos adolescentes apresentaram consumo de sódio superior à ingestão máxima tolerável. CONCLUSÕES: As médias de consumo energético e a distribuição de macronutrientes eram adequadas, mas foram observadas elevadas prevalências de inadequação no consumo de vitaminas e minerais, destacando-se consumo de sódio muito acima do recomendado, consumo de cálcio reduzido e nas adolescentes de 14 a 18 anos foi observada importante inadequação na ingestão de ferro.

OBJECTIVE: To assess energy and nutrient consumption and the prevalence of inadequate micronutrient intake among Brazilian adolescents. METHODS: A random sample composed of 6,797 adolescents (49.7% girls), between 10 and 18 years old, was evaluated in the first National Dietary Survey, part of the Household Budget Survey carried out in 2008-2009. Expansion factors, sample complexity design and correction of intraindividual variability were considered. The prevalence of inadequate micronutrient intake was based on the proportion of adolescents with intake below the Estimated Average Requirement (EAR). The prevalence of intake above the Tolerable Upper Intake Level (UL) was estimated for sodium. RESULTS: The mean energy intake ranged between 1,869 kcal (10 to 13 year old females) and 2,198 kcal (14 to 18 year old males). Of the total energy intake, 57% came from carbohydrates, 27% from lipids and about 16% from proteins. Inadequacies were higher for calcium (> 95%), phosphorous (54% to 69%) and vitamins A (66% to 85%), E (100%) and C (27% to 49%). More than 70% of adolescents reported sodium intake above the UL. CONCLUSIONS: Mean energy consumption and distribution of macro-nutrients were adequate, but prevalence of inadequate vitamin and mineral intake were high and notable consumption of sodium above the recommended levels, low levels of calcium consumption and, in 14 to 18 year old females, important inadequacies in iron intake were found.

OBJETIVO: Estimar el consumo de energía y nutrientes y la prevalencia de ingestión inadecuada de micronutrientes entre adolescentes brasileños. MÉTODOS: La muestra probabilística compuesta por 6.797 adolescentes (49,7% del sexo femenino) entre diez y 18 años de edad fue evaluada en la Pesquisa Nacional de Alimentación, 2008-2009. Se consideraron los factores de expansión, la complejidad de diseño de la muestra y la corrección de la variabilidad intra-personal de consumo. La prevalencia de consumo inadecuado de micronutrientes fue estimada por la proporción de adolescentes con ingestión por debajo de la necesidad promedio estimada. Para el sodio, se estimó la prevalencia de consumo por encima del valor de ingestión máxima tolerable. CONCLUSIÓN: Los promedios de consumo energético y la distribución de macronutrientes eran adecuados, sin embargo, se observaron elevadas prevalencias de consumo inadecuado de vitaminas y minerales, destacándose el consumo de sodio muy por encima de lo recomendado, consumo de calcio reducido y en las adolescentes de 14 a 18 años fue observada importante ingestión inadecuada de hierro.

Ingestão inadequada de nutrientes na população de idosos do Brasil: Inquérito Nacional de Alimentação 2008-2009 / Inadequate nutrient intake among the Brazilian elderly: National Dietary Survey 2008-2009 / Ingestión inadecuada de nutrientes en la población de ancianos de Brasil: pesquisa nacional de alimentación 2008-2009

OBJETIVO: Estimar a prevalência de ingestão inadequada de nutrientes na população idosa brasileira. MÉTODOS: Foram analisados dados do Inquérito Nacional de Alimentação como parte da Pesquisa de Orçamentos Familiares, em 2008-2009. Dados de consumo alimentar individual de 4.322 indivíduos com 60 anos ou mais foram obtidos por meio do registro alimentar de dois dias não consecutivos. A ingestão habitual para cada nutriente foi estimada pelo método do National Cancer Institute, cujos modelos tiveram como covariáveis sexo e região. As prevalências de inadequação de ingestão de micronutrientes foram estimadas segundo sexo e região utilizando o método da EAR como ponte de corte. RESULTADOS: Elevadas prevalências de inadequação (> 50%) foram observadas para as vitaminas E, D, A, cálcio, magnésio e piridoxina em ambos os sexos. Em todas as regiões, observou-se 100% de inadequação de vitamina E. Vitamina D obteve percentuais de inadequação próximos de 100% em todas as regiões, exceto para a região Norte. As prevalências de inadequação de vitamina A foram superiores a 70% nas regiões Norte, Nordeste e Centro-Oeste. Cálcio e magnésio foram os minerais com maior prevalência de ingestão inadequada (> 80%) em todas as regiões. CONCLUSÕES: Idosos brasileiros apresentam elevada inadequação da ingestão de nutrientes, reconhecidos como protetores contra doenças crônicas.

OBJECTIVE: To estimate the prevalence of inadequate nutrient intake in the Brazilian elderly. METHODS: This study was based on data from the National Dietary Survey, part of the Household Budget Survey 2008-2009. All individuals aged 60 and over, totaling 4,322 individuals, were included. Individual food intake was obtained from food records from two non-consecutive days. The habitual intake for each nutrient was estimated by the National Cancer Institute method, in which sex and region were included as covariates. The prevalence of inadequate nutrient intake was estimated stratified by sex and region using the EAR method to define cut-off points. RESULTS: A high prevalence of inadequate intake (> 50%) of vitamins E, D and A, calcium, magnesium and pyridoxine was observed for both sexes. In all regions, 100% inadequate vitamin E intake was observed. Vitamin D showed almost 100% inadequate intake except in the North region. The prevalence of inadequate vitamin A intake was higher than 70% in the North, Northeast, and Midwest regions. Among the minerals evaluated, calcium and magnesium showed the highest prevalence of inadequate intake (> 80%) in all regions. CONCLUSIONS: The present study found a high prevalence of inadequate intake of nutrients recognized as being protective against chronic diseases among the Brazilian elderly.

OBJETIVO: Estimar la prevalencia de ingestión inadecuada de nutrientes en la población anciana brasileña. MÉTODOS: Se analizaron datos de la Pesquisa Nacional de Alimentación como parte de la Investigación de Presupuestos Familiares, en 2008-2009. Datos de consumo alimentario individual de 4.322 individuos con 60 años o más se obtuvieron por medio de registro alimentario de dos días no consecutivos. La ingestión habitual para cada nutriente fue estimada por el método del National Cancer Institute, cuyos modelos tuvieron como co-variables sexo y región. Las prevalencias de inadecuación de ingestión de micronutrientes se estimaron según sexo y región utilizando el método de la EAR como punto de corte. RESULTADOS: Elevadas prevalencias de inadecuación (>50%) se observaron para las vitaminas E, D, A, calcio, magnesio y piridoxina en ambos sexos. En todas las regiones, se observó 100% de inadecuación de vitamina E. Vitamina D obtuvo porcentajes de inadecuación próximos a 100% en todas las regiones, excepto para la región Norte. Las prevalencias de inadecuación de vitamina A fueron superiores a 70% en las regiones Norte, Noreste y Centro-oeste. Calcio y magnesio fueron los minerales con mayor prevalencia de ingestión inadecuada (>80%) en todas las regiones. CONCLUSIONES: Ancianos brasileños presentaban elevada inadecuación de ingestión de nutrientes, reconocidos como protectores contra enfermedades crónicas.

Inadequate food intake among adults living with HIV / Inadequacao do consumo alimentar em adultos vivendo com HIV

CONTEXT AND OBJECTIVE The number of people living with HIV (PLHIV) in Brazil is between 600,000 and 890,000. Assessing the diet is important in planning healthcare actions and improving PLHIV's quality of life. This study aimed to estimate the prevalence of inappropriate protein, total fat, saturated fat, carbohydrate, fiber, sodium, calcium and cholesterol intake among PVHIV on highly-active antiretroviral therapy (HAART). DESIGN AND SETTING Cross-sectional study in nine Specialized STD/AIDS Healthcare Centers in São Paulo. METHODS Men and women aged 20 to 59 years, on HAART for at least three months, were included. Nutrient intake was assessed using 24-hour food recall applied in person and repeated among 30% of the population by telephone. The between and within-person variances were corrected. RESULTS 507 individuals were evaluated: 58% male, mean age 41.7 years (standard deviation, SD = 7.8). The mean time since HIV diagnosis was 6.6 years (SD = 4.1), and since HAART onset, 5.1 years (SD = 3.3). More than 20% of the population presented intake above the recommendations for saturated fat, cholesterol and/or sodium, and below the recommendations for fiber. The recommended maximum tolerable sodium level was exceeded by 99% of the sample, and 86% of men and 94% of women did not reach the daily recommendations for calcium. Protein, carbohydrate and total fat intakes were adequate for the majority of the population. CONCLUSIONS A significant portion of the population presented inappropriate intake of saturated fat, sodium, fiber and calcium. Interventions aimed at improving PLHIV's dietary quality are needed. .

CONTEXTO E OBJETIVO O número de pessoas vivendo com HIV (PVH) no Brasil oscila entre 600.000 e 890.000. A avaliação de dietas é relevante para o planejamento de ações de saúde e melhoria da qualidade de vida desses indivíduos. Este estudo visa estimar a prevalência de inadequação do consumo de proteínas, lipídios totais, lipídios saturados, carboidratos, fibras, sódio, cálcio e colesterol em PVH em terapia antirretroviral de alta atividade (TARV). TIPO DE ESTUDO E LOCAL Estudo transversal em nove Centros de Assistência Especializados em DST/Aids localizados em São Paulo. MÉTODOS Homens e mulheres com idade entre 20 e 59 anos, em TARV por no mínimo 3 meses, foram incluídos. O consumo de nutrientes foi avaliado com um recordatório alimentar de 24 horas aplicado pes-soalmente e repetido em 30% da população por telefone. A variabilidade intra e interpessoal foi corrigida. RESULTADOS Foram avaliados 507 indivíduos, 58% homens e idade média de 41,7 anos (desvio padrão, DP = 7,8). O tempo médio de infecção por HIV foi de 6,6 anos (DP = 4,1), e de TARV, de 5,1 anos (DP = 3,3). Mais que 20% da população apresentou consumo acima das recomendações para lipídios saturados, colesterol e/ou sódio, e abaixo para fibras. Excederam a recomendação máxima tolerada para sódio 99% da amostra, enquanto 86% dos homens e 94% das mulheres não atingiram as recomendações diárias para o cálcio. O consumo de proteínas, carboidratos e lipídios totais mostrou-se adequado para a maioria da população. CONCLUSÕES Uma importante parcela da população apresentou consumo inadequado para lipídios saturados, sódio, fibras ...

Avances en la reducción del consumo de sal y sodio en Costa Rica / Advances in reducing salt and sodium intake in Costa Rica

En el presente artículo se describen los avances logrados en Costa Rica —así como los desafíos y limitaciones— en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011–2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricional; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.

This article describes the progress—as well as the challenges and limitations—in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011–2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people’s diets; and 4) monitor and evaluate action geared to reducing salt/ sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

¿Está comprobado que la reducción de la ingesta de sal reduce la morbimortalidad por riesgo cardiovascular? / Is there evidence showing that salt intake reduction reduces cardiovascular morbidity and mortality risk?

Una revisión sistemática reciente de la colaboración Cochrane sobre el efecto de la reducción de sal en la dieta, concluyó que “aún no hay poder estadístico suficiente para excluir efectos clínicamente importantes de la dieta baja en sal en mortalidad o morbilidad cardiovascular en población normotensa o hipertensa”. Esta conclusión ha generado un debate importante porque la estimación que existe de que la reducción del consumo de sal prevendría los accidentes vasculares cerebrales en 24 por ciento y la enfermedad coronaria en 18 por ciento, ha llevado a las autoridades de salud de varios países a instaurar políticas públicas de reducción del consumo de sal. La revisión de estudios ecológicos y ensayos clínicos permite concluir que la reducción del consumo de sodio disminuye la presión arterial, y estudios metodológicamente sólidos de cohortes demuestran que el riesgo de eventos cardiovasculares disminuye progresivamente mientras más baja es la presión arterial. La combinación de estos dos resultados permite suponer que existiría un beneficio para las poblaciones al reducir la ingesta de sal aunque efectivamente no existan estudios que demuestren que en poblaciones con alto consumo de sal hay una reducción de eventos cardiovasculares al reducir la ingesta de sal.

A recent systematic review of Cochrane collaboration about the effect of reducing dietary salt concluded that “there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations”. This conclusion has generated an important debate, because the estimation that salt reduction can prevent 24 percent of strokes and 18 percent of myocardial infarctions has decided the health authorities of several nations to implement salt consumption reduction programs. The review of ecological studies and clinical trials allow to conclude that a reduction in salt consumption reduces blood pressure and methodological well conducted cohort studies has shown that cardiovascular events risk decreases progressively with lower levels of blood pressure. Combining this two finding we can assume that population should benefice from a decrease on salt consumption although there are no studies that shown a reduction in cardiovascular events in population with high sodium intake when dietary salt is reduced.

A comparative study of the clinico-aetiological profile of hyponatremia at presentation with that developing in the hospital

Background & objectives: Hyponatremia is a common problem encountered in patients presenting with nonspecific symptoms. We undertook this study to investigate the clinical profile of patients with hyponatremia, the precipitating factors, the response to therapy and to compare, using these parameters, hyponatremia at presentation to that developing in the hospital. Methods: Seventy consecutive patients with serum sodium less than or equal to 125 mmol/l at presentation or at any time during hospital admission were identified and studied using a proforma. The severity of hyponatremia, therapy given and time taken for recovery were analysed. Results: The mean age of patients was 48.1 ± 16.1 yr. The mean serum sodium was 117.8 ± 6.4 mmol/l. Confusion, headache and malaise were the most common symptoms, two patients had seizures, and 20.0 per cent patients showed no clinical manifestations. Nausea was significantly (P<0.05) more common in patients presenting with hyponatremia. 22 patients (31.4%) developed hyponatremia during their stay in the hospital. 3 patients (4.3%) presented with hyponatremia which got worse during the admission period. Most had multiple precipitating factors, decreased intake being the most common (82.9%), followed by increased losses (65.7%) and miscellaneous factors (70.0%). Drugs, fluid overload and inappropriate Ryle's tube feeds more commonly precipitated hyponatremia in in-hospital patients. Time taken for recovery showed negative correlation with the serum sodium. Patients with in-hospital hyponatremia took significantly longer time to recover (P<0.05). Interpretation & conclusions: Decreased intake was found to be the commonest cause of hyponatremia, thus, ensuring adequate oral intake, especially in patients on liquid diet and in manual labourers, and correction of hyponatremia as soon as an abnormality is detected is important.

A comparison between sphygmomanometer-based and ambulatory blood pressure monitoring in acute salt loading and depletion protocol

INTRODUCTION: Ambulatory blood pressure monitors have been used in salt loading and depletion protocols. However, the agreement between measurements made using ambulatory blood pressure monitors and those made with the sphygmomanometer has not been evaluated. OBJECTIVE: The objective of this study was to compare the concordance of the two methods of blood pressure measurements in protocols of acute salt loading and depletion. METHOD: Systolic blood pressure was measured using a sphygmomanometer at the completion of salt infusion (2 L NaCl 0.9 percent, 4 h) and salt depletion (furosemide, 120mg/day, p.o.) in 18 volunteers. Using the Pearson correlation coefficient (ρ), these readings were compared with the mean systolic blood pressure measured using the ambulatory blood pressure monitoring device during the following periods: 4 h of saline infusion and 12 h of salt depletion; 4 h of saline infusion and the last 6 h of salt depletion; 12 h of salt loading and the last 6 h of depletion; 12 h of salt loading and 12 h of depletion. Salt sensitivity was defined by a difference in the systolic blood pressure between salt loading and salt depletion greater than 10 mmHg when measured with the sphygmomanometer, and the Kappa analysis of concordance (K) was used with a significance level of P<0.05. RESULTS: Only the blood pressure readings obtained using the ambulatory blood pressure device during 4 h of intravenous NaCl and during 12 h of salt depletion showed a high correlation with the variation in the systolic blood pressure measured by the sphygmomanometer, with a full agreement with the salt sensitivity classification (p = 0.71; P = 0.001 and K=1). CONCLUSION: In acute salt loading and depletion protocols, an ambulatory blood pressure monitoring device should be used to record the blood pressure during the 4-h interval of salt infusion and 12-h interval of salt depletion.