The epidemiological burden of reducing salt intake in Paraguay: A modeling study / A carga epidemiológica da redução do sal no Paraguai: um estudo de modelagem

ABSTRACT Objective This study aims to estimate the epidemiological burden of excessive salt intake reduction and achieve the World Health Organization salt reduction target for 2025 in Paraguay, in 2019. Methods We used the Preventable Risk Integrated Model, a comparative risk assessment macro-simulation model, to estimate the averted deaths, disease incidence, and disability-adjusted life years from cardiovascular disease attributable to salt intake in the population of Paraguay for different salt reduction policy scenarios. Results As a result, in Paraguay, excessive salt intake (over 5 g/day) is responsible for approximately 2,656 cardiovascular disease deaths (95% Uncertainty Interval: 1,250-3,765), 4,816 cardiovascular disease cases (95% UI: 2,251-6,947), and 60,529 disability-adjusted life years (95% UI: 27,828-86,258) per year. By reducing salt consumption by 30%, as recommended by the World Health Organization until 2025, approximately 1,188 deaths (95% UI: 520 to 1,820), 2,100 incident cases (95% UI: 923-3,234), and 27,272 disability-adjusted life years (95% UI: 11,999-41,675) from cardiovascular disease could be averted every year. Conclusion In conclusion, the burden of cardiovascular disease attributable to excessive salt intake is significant and salt reduction policies must become a priority in Paraguay.

RESUMO Objetivo Este estudo visa estimar a carga epidemiológica do consumo excessivo de sal e o alcance da meta da Organização Mundial de Saúde para 2025 no Paraguai, em 2019. Métodos Foi usado um modelo de avaliação comparativa de risco (Preventable Risk Integrated Model) para análise comparativa de risco para estimar mortes, casos incidentes e anos de vida ajustados por incapacidade (DALYs) por doenças cardiovasculares atribuíveis ao consumo excessivo de sal na população paraguaia em diferentes cenários. Resultados No Paraguai, o consumo excessivo de sal é responsável por aproximadamente 2.656 mortes (Intervalo de Incerteza 95%: 1.250-3.765), 4.816 casos incidentes (95% II: 2.251-6.947) e 60.529 DALYs (95% II: 27.828-86.258) por doenças cardiovasculares por ano. Com uma redução de 30% no consumo de sal, como recomendado pela Organização Mundial de Saúde até 2025, aproximadamente 1.188 mortes (95% II: 520-1.820), 2.100 casos incidentes (95% II: 923-3.234) e 27.272 DALYs (95% II: 11.999-41.675) por doenças cardiovasculares poderiam ser prevenidos ou adiados por ano. Conclusão Concluiu-se que a carga de doenças cardiovasculares atribuível ao consumo excessivo de sal no Paraguai é significante e políticas de redução deveriam ser priorizadas no país.

Maternal Intake of Flaxseed During Lactation and Exercise Training Protect Against Salt Overload-Induced Aortic Remodeling in Adult Offspring

Abstract Background High dietary sodium intake can induce endothelial stiffness even without changes in blood pressure. Objectives To evaluate the effects of exercise training and chronic intake of sodium chloride solution on aortic morphology of male offspring of rat dams who consumed flaxseed during lactation. Methods Female rats were fed with a control diet or a flaxseed diet during lactation. At weaning, two male offspring of each rat dam were allocated into eight groups for 180 days: four groups received a control diet e four received a flaxseed diet, with /without exercise and with/without NaCl solution supply. Aorta was collected for histomorphometric analysis. The one-way analysis of variance was used and P value < 0.05 was considered statistically significant. Results The chronic use of 1% NaCl solution led to changes in aortic histoarchitecture in the control group: increase in aortic intima-media thickness (10,4%, p<0.0001) and reduced number of elastic lamellae (-8,1%, p<0.0001). Groups of offspring of mother that consumed flaxseed during lactation, the chronic use of 1% NaCl alone did not lead to an increase in the aortic intima-media thickness. Exercise training of adult offspring increased aortic intima-media thickness (13.3%, p<0.0001), with preservation of elastic components and aortic flexibility. Conclusion Chronic salt overload caused adverse effects on the aorta of rats, and maternal consumption of the flaxseed diet during lactation protected against aortic remodeling. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Conocimientos, actitudes y prácticas sobre el consumo de sal/sodio en niños del departamento de Antioquia, Colombia / Knowledge, attitudes and practices regarding salt/sodium consumption in children of Antioquia, Colombia

El presente estudio tiene como objetivo identificar los conocimientos, actitudes y prácticas (CAP) relacionados con la ingesta de sal/sodio en niños, desde la perspectiva de los cuidadores. Este, es un estudio de corte transversal en el que participaron 2997 cuidadores que asistieron a una sesión educativa sobre alimentación saludable realizada en el marco del proyecto "Acciones Complementarias del Programa de Alimentación Escolar y Maná Infantil" de la Gobernación de Antioquia, liderado por la Escuela de Nutrición y Dietética de la Universidad de Antioquia, entre agosto y septiembre de 2015. Al recolectar la información, se obtuvo que un alto porcentaje de encuestados refieren no conocer la diferencia entre sal y sodio (79,1%) y desconocen la cantidad de sodio contenida en los alimentos que consumen sus hijos; no obstante, consideran importante limitar la ingesta de sal en los niños. Finalmente, se identifica un alto número de personas dispuestas a disminuir la ingesta de sal en sus hijos, pero no sucede lo mismo cuando se hace referencia al sodio, debido a que se requiere un conocimiento más especializado y específico para tomar decisiones relacionadas con el contenido de este mineral en los alimentos, dado que está oculto.

The present study aims to identify the knowledge, attitudes and practices related to salt / sodium intake in children from the perspective of caregivers. We conducted a crosssectional study involving 2997 caregivers who attended an educational session on healthy eating carried out within the framework of the project "Complementary Actions of the School Feeding Program and Children's Mana" carried out by the Government of Antioquia and led by the School of Nutrition and Dietetics of the University of Antioquia between August and September 2015. When collecting the information, it was found that a high percentage of persons surveyed reported not knowing the difference between salt and sodium (79.1%) and not knowing the amount of sodium contained in their child's foods; however, they considered the limiting of salt intake important for their children. Finally, a high percentage of participants were willing to reduce the salt intake of their children, but this was not the case with regard to sodium, because more specialized and specific knowledge is required to make decisions related to the content of this mineral in food, since it is hidden.

Estimación del impacto del consumo de sal en los niveles de presión arterial en población no hipertensa entre 15 y 64 años / Impact of high salt consumption of blood pressure on a non-hypertensive population

Background There is conflicting evidence regarding the role of salt intake in blood pressure (BP). Aim To estimate the impact of salt consumption on the BP level of a non-hypertensive population aged between 15 and 64 years. Material and Methods Analytical-observational study using data from the National Health Survey 2009-2010. A BP cut-off point at 120/80 mmHg BP was considered to determine risk. Salt consumption was divided into four strata. The prevalence ratios (PR) were determined using the Poisson model with robust variance. The formulas of the studies of Dal Grande and Walter for the estimation of population attributable fraction (PAF) were used. Results The sample was constituted by 1,263 individuals and 24.3% had BP at risk. A statistically significant association was observed between high salt intake and risk BP with PR of 1.91 (95% confidence intervals (CI) 1.44-2.57) in the consumption stratum of 11 g / day and more. It was estimated that 4.7% (95% CI 4.2-5.2) of BP risk can be attributed to salt consumption, when controlling by age group, sex and educational level. Conclusions The 4.7% PAF is lower than the figure of 30% reported abroad. Interventions to reduce salt consumption in the entire population and the identification of risk groups are recommended.

Factores de riesgo asociados al desarrollo de hipertensión arterial en Chile / Risk factors associated with hypertension: analysis of the 2009-2010 Chilean health survey

Background: High blood pressure is one of the major risk factors for the development of cardiovascular disease, affecting 27% of the Chilean population in 2010. Aim: To determine the risk factors associated with the development of hypertension. Material and Methods: Analysis of the database of the 2009-2010 National Health Survey in which 4,901 participants were included. Socio-demographic factors, physical activity, eating habits, well-being and comorbidities were analyzed. Results: Women had a lower risk of developing hypertension than men (Odds ratio (OR): 0.69, 95% confidence intervals (CI): 0.59-0.81, p < 0.01). In both men and women, the risk is greater over the age of 25 years (OR: 2.90, 95% CI: 1.55-5.43, p < 0.01). The risk is greater in subjects who were overweight (OR: 1.61, 95% CI: 1.31-1.98, p < 0.01), obese (OR: 3.18, 95% CI: 2.56-3.95, p < 0.01), or had central obesity (OR: 2.25, 95% CI: 1.85-2.72, p < 0.01). Subjects with a family history of hypertension and diabetes also have a higher risk. Conclusions: Identifying the risk factors associated with hypertension allows public health policies to be tailored to its prevention.

Resistance training attenuates salt overload-induced cardiac remodeling and diastolic dysfunction in normotensive rats

Elevated salt intake induces changes in the extracellular matrix collagen, leading to myocardial stiffness and impaired relaxation. Resistance training (RT) has been used as a remarkably successful strategy in the treatment of heart disease. Therefore, the aim of this study was to investigate the effects of RT on preventing pathological adaptation of the left ventricle (LV) induced by salt overload. Male Wistar rats (10 weeks old) were distributed into four groups (n=8/group): control (CO), control+1% salt (CO+SALT), RT and RT+1% salt (RT+SALT). The RT protocol consisted of 4×12 bouts of squat training, 5/week for 8 weeks, with 80% of one repetition maximum (1RM). Echocardiographs were analyzed and interstitial collagen volume fraction (CVF) was determined in the LV. The 1RM tests in the RT and RT+SALT groups increased 145 and 137%, respectively, compared with the test performed before the training program. LV weight-to-body weight ratio and LV weight-to-tibia length ratio were greater in the RT and RT+SALT groups, respectively, compared with the CO group. Although there was no difference in the systolic function between groups, diastolic function decreased 25% in the CO+SALT group compared with the CO group measured by E/A wave ratio. RT partially prevented this decrease in diastolic function compared with the CO+SALT group. A 1% salt overload increased CVF more than 2.4-fold in the CO+SALT group compared with the CO group and RT prevented this increase. In conclusion, RT prevented interstitial collagen deposition in LV rats subjected to 1% NaCl and attenuated diastolic dysfunction induced by salt overload independent of alterations in blood pressure.

Consumo de alimentos ricos em sódio e alteração dos níveis pressóricos em adolescentes de Itaqui/RS / Intake of high-sodium foods and change of pressure levels in adolescents living in Itaqui/RS, Brazil

Introdução: O elevado consumo de alimentos do tipo fast food por adolescentes está diretamente associado à maior prevalência de doenças crônicas não transmissíveis nesta população. O objetivo deste trabalho foi avaliar o consumo de alimentos ricos em sódio, o estado nutricional e os níveis pressóricos em escolares adolescentes de Itaqui. Métodos: Tratou-se de um estudo transversal, de base escolar, com adolescentes residentes no município, os quais forneceram, por meio de um questionário autoaplicado, informações sociodemográficas, sobre o consumo habitual de alimentos ricos em sódio e sal e sobre hipertensão. Foram aferidos ainda peso e altura (para a obtenção do estado nutricional), circunferência abdominal e as pressões sistólica e diastólica, com posterior classificação de acordo com os valores de referência para a idade. Resultados: Participaram do estudo 645 adolescentes, entre 13 e 19 anos de idade, matriculados no ensino médio, período diurno, da rede pública no município. Foi observado consumo adequado de cinco dos sete alimentos ricos em sódio, assim como a não utilização de sal adicional pela maioria dos adolescentes. A prevalência de sobrepeso e obesidade foi de 18,3% e 2,8%, respectivamente, e de pressão arterial limítrofe ou aumentada foi de 20,2%. Houve associação positiva da pressão arterial aumentada com sobrepeso (p< 0,001) circunferência abdominal aumentada (p< 0,001) e consumo de biscoitos doces (p= 0,014). Conclusão: Tais informações poderão nortear o desenvolvimento de estratégias educativas quanto ao consumo de alimentos ricos em sódio, o controle da pressão arterial, bem como alertar esses jovens quanto às consequências da hipertensão(AU)

Introduction: The high consumption of fast-food type food by teens is directly associated with a higher prevalence of chronic diseases in this population. The aim of this study was to evaluate the consumption of high-sodium foods, nutritional status, and blood pressure among adolescent students from Itaqui. Methods: This was a school-based cross-sectional study with adolescents living in the city, who provided, through a self-administered questionnaire, social demographic information on their usual consumption of high-sodium foods and salt and on hypertension. Student height and weight (to obtain their nutritional status), waist circumference, and systolic and diastolic pressures were also measured, with subsequent classification according to reference values for age. Results: The study included 645 adolescents between 13 and 19 years of age, enrolled in the public daytime high school network. We found adequate intake of five of the seven sodium-rich foods and no use of additional salt by most adolescents. The prevalence of overweight and obesity was 18.3% and 2.8%, respectively, and of increased blood pressure 20.2%. There was a positive association between increased blood pressure and overweight (p<0.001) , increased waist circumference (p<0.001), and consumption of sweet cookies (p = .014). Conclusion: Such information can guide the development of educational strategies regarding the consumption of high-sodium foods and blood pressure control, as well as to warn these young people about the consequences of high blood pressure(AU)

Alternatives to reduce sodium in processed foods and the potential of high pressure technology

In most industrialized countries, the sodium intake exceeds the nutritional recommendations. In this sense the search for healthier foods has led the food industry to review their formulations in relation to food components such as salt, which is associated with increased risk of chronic diseases. As a result, different strategies for reducing salt levels in processed foods have been investigated. Among the technological options available, the high-pressure processing has stood out by presenting intrinsic technological advantages that can contribute to optimization of food formulations with low / reduced sodium contents. This review provides a brief overview of the key strategies and use of high pressure in the development of reduced-salt products.(AU)

Evaluation of salt content in school meals / Avaliação do conteúdo de sal em refeições escolares

OBJECTIVE: High blood pressure is a major rick factor for cardiovascular disease, and it is closely associated with salt intake. Schools are considered ideal environments to promote health and proper eating habits. Therefore the objective of this study was to evaluate the amount of salt in meals served in school canteens and consumers' perceptions about salt. METHODS: Meals, including all the components (bread, soup, and main dish) were retrieved from school canteens. Salt was quantified by a portable salt meter. For food perception we constructed a questionnaire that was administered to high school students. RESULTS: A total of 798 food samples were analysed. Bread had the highest salt content with a mean of 1.35 g/100 g (SD=0.12). Salt in soups ranged from 0.72 g/100 g to 0.80 g/100 g (p=0.05) and, in main courses, from 0.71 g/100 to 0.97 g/100g (p=0.05). The salt content of school meals is high with a mean value of 2.83 to 3.82 g of salt per meal. Moreover, a high percentage of students consider meals neither salty nor bland, which shows they are used to the intensity/amount of salt consumed. CONCLUSION: The salt content of school meals is high, ranging from 2 to 5 times more than the Recommended Dietary Allowances for children, clearly exceeding the needs for this population, which may pose a health risk. Healthy choices are only possible in environments where such choices are possible. Therefore, salt reduction strategies aimed at the food industry and catering services should be implemented, with children and young people targeted as a major priority. .

OBJETIVO: Considerando que a pressão arterial elevada constitui um dos maiores fatores de risco para as doenças cardiovasculares e sua associação ao consumo elevado de sal, bem como o fato de as escolas serem considerados ambientes de excelência para fomentar a aquisição de bons hábitos alimentares e promover a saúde, o objetivo deste estudo foi avaliar o conteúdo de sal presente nas refeições escolares e a percepção dos consumidores sobre o sabor salgado. MÉTODOS: Foram recolhidas refeições nas cantinas das escolas, analisando-se todos os seus componentes (pão, sopa e prato principal). A quantificação de sal foi realizada com um medidor de sal portátil. Para a avaliar a percepção dos consumidores foi desenvolvido e aplicado um questionário aos alunos das escolas preparatórias e secundárias. RESULTADOS: Foram analisados 798 componentes de refeições. O pão apresentou o valor mais elevado de sal, com média de 1,35 g/100 g (SD=0.12). O conteúdo de sal nas sopas apresentou média de 0,72 g/100 g a 0,80 g/100 g (p=0,05) e, nos pratos principais, de 0,71 g/100 a 0,97 g/100 g (p=0,05). Em média, as refeições escolares disponibilizaram entre 2,83 e 3,82 g de sal por porção servida, o que representa de duas a cinco vezes mais em relação à dose diária recomendada para crianças e jovens. Para a maioria dos estudantes, o sabor das refeições foi percebido como sendo nem salgado nem insosso, o que parece demonstrar adaptação à intensidade/ quantidade de sal consumida. CONCLUSÃO: Escolhas alimentares saudáveis e adequadas só são possíveis se sustentadas por um ambiente que as facilite. Considerando o impacto que o consumo de sal tem na saúde, em particular nas doenças crônicas, a implementação de estratégias de redução de sal - nas indústrias, serviços de catering e restaurantes -, é imperativa, em particular direcionada para o público mais jovem. .

Percepciones y conocimientos acerca de la sal, el sodio y la salud en adultos de clase media de la provincia de San José, Costa Rica / Perceptions and knowledge about salt, sodium and health in middle-class adults living in San José, Costa Rica

En el ámbito mundial se realizan acciones para desarrollar e implementar estrategias que permitan la reducción del consumo de sal/sodio y de esta manera disminuir la prevalencia de hipertensión arterial (HTA) y de enfermedades cardiovasculares (ECV). El objetivo de la investigación fue explorar las percepciones y los conocimientos acerca de la sal, el sodio y la salud de los adultos de clase media de la zona urbana de la provincia de San José; con el fin de proporcionar información para el desarrollo de estrategias educativas. Se realizaron entrevistas (formulario precodificado en el Anexo 1) a 400 personas entre 40 y 55 años de edad de clase media, subdividida en tres subestratos (alto, medio y bajo). Se analizaron frecuencias y se aplicó la prueba de Chi cuadrada. Se encontró que las personas no se sienten en riesgo de desarrollar HTA independientemente del subestrato socioeconómico (p>0,05) y 68% de éstas no consideró un exceso en el consumo de sal/sodio. Además, 70% no tenían conocimiento sobre la relación entre sal y sodio y hubo asociación (p<0,05) entre la subdivisión del estrato socioeconómico y el conocimiento de esta relación. Además, poseían un conocimiento calificado como medio acerca del riesgo del consumo excesivo de sal/sodio y de los beneficios de la disminución de su ingesta. Se concluyó que existen vacíos de conocimientos en la población de Costa-Rica y que es necesario desarrollar estrategias educativas basadas en la situación actual, acompañadas por intervenciones que impacten a las personas en riesgo y cambien sus hábitos de alimentación.

Organizations and governments globally are making great efforts to develop strategies to reduce population salt intake, and thus reduce the prevalence of hypertension and CVD. The objective of this study was to explore the perceptions and knowledge about salt, sodium and their effects on health of adults of middle income in the urban area of San José; in order to provide information for the development of educational strategies. Four hundred interviews to subjects between 40 to 55 years old, belonging to middle income socioeconomics strata, sub-divided into three levels (high, medium and low) were performed. Frequencies analyses were performed, and the Chi-square test was applied. We found that people felt that they are not at risk of developing hypertension regardless of the sub-middle socioeconomic strata (p> 0.05) and 68% of individuals did not consider that their consumption of salt and/or sodium was excessive. In addition, 70% of subjects had no knowledge about the relationship between salt and sodium, and an association (p <0.05) between the sub-division of the socioeconomic status and knowledge about this relationship was found. Individuals had an average knowledge about the risk of excessive salt/sodium consumption and the benefits of reduced intake. It was concluded that there is a knowledge gap in subjects and there is a need for developing initiatives to reduce salt/sodium intake, shocking enough to make people be more aware of their risk and change their eating habits.

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.

¿Es la hipertensión sensible a sal una enfermedad inflamatoria?: Papel de los linfocitos y macrófagos / Is salt sensitive hypertension an inflammatory disease?: Role of lymphocytes and macrophages

La hipertensión arterial sistémica es un problema de salud pública. Esta entidad afecta al 43% de la población mexicana y es considerada una de los principales factores de riesgo para el desarrollo de eventos vasculares cerebrales, insuficiencia cardiaca e insuficiencia renal. La prevalencia de hipertensión arterial sistémica se ha incrementado durante las últimas décadas debido a la adopción de una dieta alta en sal. Existe evidencia de que la hipertensión sensible a sal se acompaña de alteraciones estructurales renales como dilatación tubular, fibrosis intersticial en parches, expresión de osteopontina e infiltrado túbulo intersticial de linfocitos y macrófagos, que impiden una excreción urinaria de sodio adecuada y en consecuencia, favorecen el desarrollo de HAS. De forma experimental se ha demostrado que estas alteraciones estructurales tienen una naturaleza inflamatoria y que la administración de medicamentos inmunosupresores disminuye la lesión tisular y mejoran el control de la presión arterial. En conjunto, los conocimientos derivados de los estudios de hipertensión sensible a sal pueden derivar en el desarrollo de nuevos fármacos destinados a mejorar el pronóstico asociado a la hipertensión arterial sistémica.

High blood pressure is a public health problem. This entity affects 43% of the mexican population and is considered a major risk factor for development of stroke, cardiac failure and chronic kidney disease. Hypertension prevalence has increased over the last decades, mainly because of high salt diet. There is evidence showing that salt-sensitive hypertension develops structural changes as tubular dilation, patchy interstitial fibrosis, osteopontin expression and lymphocytic/macrophage tubulointerstitial infiltrate that blunts urinary sodium excretion and therefore promotes HBP. It has been shown that this structural damage has an inflammatory origin and that immunosuppresant drugs down-regulates tissular injury and improves blood pressure control. In summary, this salt-sentitive hypertension data can be used in development of new and potent blood pressure drugs.

Análisis de la evidencia experimental que muestra efectos nocivos de la sal y su relación con la hipertensión arterial / Analysis of experimental evidence that shows adverse effects of salt and its relation to hypertension

El artículo publicado por Taylor y cols., en junio de 2010 en el American Journal of Hypertension, puso en duda la eficacia que tendría la reducción de la ingesta de sal en la dieta como medida para la prevención y tratamiento de la hipertensión arterial y de otras patologías de causa cardiovascular. La publicación de este artículo ha generado una gran controversia, y las respuestas no se hicieron esperar tanto desde sociedades médicas como científicas. Éstas han criticado fuertemente los resultados de este metaanálisis, señalando serias falencias metodológicas. En el presente artículo presentamos críticamente la evidencia experimental que muestra la importancia del aporte dietario de sal y su papel como determinante de la presión arterial. Describimos muy brevemente el paradigma que explica el papel de la ingesta de sal en la presión arterial (hipótesis y modelo de Guyton) y mencionamos evidencia experimental que lo sustenta. Comentamos brevemente los estudios clásicos que indican que la ingesta de sal (NaCl) contribuye directamente al desarrollo de hipertensión arterial y daño de tejidos diana. Finalmente, exponemos brevemente los datos experimentales que motivan la controversia en cuanto al papel de la sal (NaCl) o el sodio como agentes prohipertensivos.

The study by Taylor et al published in June 2010 in the American Journal of Hypertension questions the effectiveness of reducing salt intake in the diet in the prevention and treatment of high blood pressure and other cardiovascular conditions. The publication of this article has lead to great controversy and medical associations and learned societies responded promptly. The response criticized the results of the meta-analysis and pointed out its methodological shortcomings. In this review we critically appraise the experimental evidence that shows the importance of diet salt intake and its role as a determinant of blood pressure. We briefly describe the paradigm that explains the role of salt intake in contributing in the regulation of blood pressure (Guyton hypothesis and model) and we mention the experimental evidence that supports this. We briefly comment on the classical studies that indicate that salt intake (NaCl) contributes directly to the development of high blood pressure and target tissues. Finally, we briefly mention the experimental data that is related with the controversy on the role of salt (NaCl) or sodium as prohypertensive agents.

Papel de la sensibilidad a la sal y los polimorfismos genéticos como determinantes de la modificación de los factores de riesgo cardiovascular durante la pérdida de peso en sujetos con sobrepeso u obesidad / Role of salt sensitivity and genetic polymorphisms as determinants of the modification of cardiovascular risk factors during weight loss in overweight or obese subjects

El incremento de la ingesta de sal no siempre se acompaña de un aumento en la presión arterial; aquellos sujetos que así lo hacen, son denominados Sal Sensibles (SS), mientras que los que no, se denominan Sal Resistentes (SR). La sensibilidad a la sal se ha asociado con mayor riesgo cardiometabólico y es más frecuente en los sujetos obesos hipertensos, sin embargo, no todos los obesos son SS y se desconoce como se origina este fenotipo. Debido a que la obesidad es un estado proinflamatorio, se propone que es necesario cierto grado y/o tiempo de obesidad para ser SS. Es por ello, que en esta investigación se evaluó el cambio en el tiempo de las interleuquinas 6, 10 y 18 (IL-6, IL-10 e IL-18), adiponectina, leptina, glicemia, lípidos, insulina, depuración de creatinina, microalbuminuria, ADMA, metabolitos urinarios del óxido nrico (NO), y además se estudió la prevalencia de los polimorfismos genéticos más frecuentemente asociados a riesgo cardiometabólico de la IL-6, 10,18, y de la sintasa de NO endotelial (eNOS), en sujetos SR (n=11) y SS (n=17), con sobrepeso u obesidad grado I, que fueron sometidos por 18 semanas a dieta y ejercicio. Se encontró que la pérdida de peso revertió el estado SS, el cual fue mas evidente en los sujetos que tenían más tiempo de obesidad, mayor concentración de insulina y ADMA sanguíneo, menor excreción urinaria de los metabolito del NO, mayor índice IL-6/ circunferencia abdominal y presentaban al alelo ä"del polimorfismo 4ab de la eNOS, por lo que se concluye que la sensibilidad a la sal pudiera ser producto de la interacción entre los componentes inflamatorios, vasculares y metabólicos y probablemente sea modulada por el polimorfismo 4ab de la eNOS

Estrategias globales para reducir el consumo de sal

En la actualidad, las enfermedades cardiovasculares son la primera causa de muerte en el mundo. La presión arterial elevada es uno de los factores más importantes para su desarrollo, la cual está fuertemente relacionada con el consumo de sal. A nivel mundial el consumo de sal actual sobrepasa en más del doble la ingesta recomendada, lo que se ha asociado con el desarrollo de enfermedades cardiovasculares y de algunos cánceres. Los efectos beneficiosos demostrados al reducir su consumo (menor morbi-mortalidad y menores gastos en salud) han servido de aliciente para desarrollar diversas estrategias nacionales para lograr este efecto. Dentro de las estrategias más utilizadas se encuentran campañas educativas y la disminución paulatina de la sal agregada en los alimentos industrializados. Chile, se ha sumado a estas iniciativas con un acuerdo entre los productores de pan y el Ministerio de Salud con el fin de disminuir progresivamente la concentración de sal en el pan a nivel nacional. El objetivo de esta revisión es aportar información actualizada sobre las recomendaciones de ingesta de sal, ingesta real, efectos nocivos del exceso de consumo, beneficios atribuidos a su disminución y analizar las estrategias globales para reducir el consumo de sal en la población.

Global strategies to reduce salt intake.

Currently, cardiovascular diseases (CVD) are the leading cause of death worldwide. High blood pressure is one of the main risk factors for the development of CVD and blood pressure levels are strongly associated with salt intake. Worldwide, salt consumptions accounts more than two fold the recommended daily intake, which has been described to be associated with CVD and some cancers. Benefits of decrease salt intake (reduction of morbidity, mortality and health related costs) have promoted several public health strategies to reduce salt consumption globally. Among the most commonly used strategies include educational campaigns and the gradual decrease of added salt in processed foods. Chile has joined these initiatives with an agreement between the producers of bread and the Ministry of Health to gradually decrease the concentration of salt in bread nationwide. The purpose of this review is to provide updated information regarding recommended intakes of salt, real intake, adverse effects of excess consumption, profits attributable to a decline and analyze the global strategies to reduce salt intake in the population.

Feasibility of salt reduction in processed foods in Argentina / Factibilidad de reducir el contenido de sal de los alimentos procesados en la Argentina

OBJECTIVE: To assess an intervention to reduce salt intake based on an agreement with the food industry. METHODS: Salt content was measured in bakery products through a national survey and biochemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine whether a reduced salt bread could remain undetected. French bread accounts for 25 percent of the total salt intake in Argentina; hence, reducing its salt concentration from 2 percent to 1.4 percent was proposed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium and blood pressure in participants during consumption of the low-salt bread compared with ordinary bread. RESULTS: Average salt content in bread was 2 percent. This study evaluated low-salt bread containing 1.4 percent salt. This reduction remained mostly undetected by the panels of taste testers. In the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a reduction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake. CONCLUSIONS: The study showed that dietary salt reduction was feasible and well accepted in the population studied through a reduction of salt content in bread. Although the effects on urinary sodium and blood pressure were moderate, a countrywide intervention could have a greater public health impact.

OBJETIVO: Evaluar una intervención destinada a reducir el consumo de sal a partir de un convenio con la industria alimentaria. MÉTODOS: Se midió el contenido de sal de los productos de panadería por medio de una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado que el pan francés representa 25 por ciento del consumo total de sal en la Argentina, se propuso someter a prueba este tipo de pan con una disminución de la concentración de sal de 2 por ciento a 1,4 por ciento. Se realizó un estudio cruzado con el fin de evaluar si los participantes presentaban una concentración urinaria de sodio más baja y una presión arterial menor durante el período en que consumieron pan con bajo contenido de sal respecto del período en que consumieron pan común. RESULTADOS: El pan común contiene un porcentaje promedio de sal de 2 por ciento. En este estudio, el pan con bajo contenido de sal contenía 1,4 por ciento, disminución que, en general, pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 sujetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76 mmHg durante el período en que los participantes consumieron pan con bajo contenido de sal. CONCLUSIONES: El estudio demuestra que es factible reducir la ingesta de sal alimentaria y que la población estudiada considera aceptable que el pan contenga esta menor concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la presión arterial fueron moderados, es probable que una intervención nacional tenga repercusiones más importantes para la salud pública.