"Doctor as a Drug" in a Stroke Follow-Up

Each year about 400 000 people in Russia get strokes. Whereas an acute treatment takes place in specialized intensive care units in hospitals, follow-up is handed over to general (rarely - private) practitioner. The majority of stroke survivors show low adherence to follow-up resulting in repeated hospitalizations and growth of multi-morbidity burden. With COVID-19 pandemic negatively affecting availability of medical services and increasing health risks for stroke survivors, a physician-patient relation becomes the means of persuading patients to health-promoting behaviour.Copyright © 2022 University of Latvia. All Rights Reserved.

The need for sensory nutrition research in individuals with smell loss

Millions of people will now suffer from long-term smell loss as a result of infection with the SARS-CoV-2 virus. Smell is an integral component of the flavor of foods, which is one of the primary drivers of ingestive behavior. When individuals lose their sense of smell, they find food to be less flavorful and less enjoyable, which negatively impacts their quality of life. To compensate, many individuals alter their diet by focusing on tastes, chemesthesis (e.g., chili pepper heat, menthol cooling), and the texture of foods to make it more palatable. Some diet alterations, such as increasing salt use, can result in a lower diet quality, and an increased risk for chronic disease. Sensory nutrition is an area of research that focuses on how the chemical senses (e.g. taste, smell, chemesthesis) and oral somatosensation) affect dietary choices and health. Sensory nutrition strategies designed for individuals with smell loss may help improve the flavor and liking of foods while improving diet quality, and are a necessary area of future research to help improve health and quality of life in the growing population with smell loss.Copyright © 2022 The Author(s)

OCCUPATIONAL AND ENVIRONMENTAL INFLUENCES ON HYPERTENSION

In this brief review I shall try to discuss several topics related to hypertension which maybe associated with occupational and environmental effects. Effects of dietary sodium will not be discussed as these are extensively discussed elsewhere. Occupational stress is difficult to define but there seems to be a relationship between high demands and relatively low control, and blood pressure in both men and women despite different professional distribution. Noise, a relatively less recognized stressor that may be associated with hypertension Both industrial noise and urban noise. Recently due to the Covid19 lockdown and reduction of aircraft noise in relevant areas a reduction of bloodpressure was noted. Seasonal variation with rise of blood pressure during cold and perhaps shorter daytime light seasons, and subsequent reduction in the summer with its higher temperatures and longer light hours is one environmental factor. Air pollution, especially that associated with high level small particulate matter equal to, or smaller than 0.25 μm, was associated with hypertension in several studies, with quite and ethnic and geographic variability. High altitude exposure (higher than 2500 m), involves hypoxemia (in addition to radiation, cold temperatures, and dehydration because of dryness of inhaled air), resulting in renin angiotensin system activation and sympathetically induced vascular contraction, and elevation of pulse rate and blood-pressure at rest and an exaggerated increase during exercise. Immigration seems to be associated with hypertension through different mechanisms in different populations. Mechanisms of these effects are not well understood though some must be mediated through sympathetic activation, others through the renin angiotensin system though, hypoxemia, altered redox state and inflammation all might participate along with other mechanisms.

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Introduction: Dietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis. Purpose: To evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era. Methods: The study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA's Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively. Results: A total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043). Conclusion: Our findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

Locked on salt? Excessive consumption of high-sodium foods during COVID-19 presents an underappreciated public health risk: a review.

Abrupt changes in food preferences and eating habits have induced an overlooked health risk during the coronavirus disease pandemic (COVID-19). Indeed, emerging evidence points to a major shift to consumption of high-sodium foods during the pandemic lockdowns in the population from different countries and cultures. High-sodium foods have sodium contents exceeding 500 mg per 100 g, and many processed and preserved foods fall into this category. Excessive dietary sodium intake is associated with chronic diseases including hypertension, cardiovascular diseases, and kidney diseases, and thus poses confounding risks during the pandemic. Here, we review food categories in consumers' shopping lists and food parcels delivered to people who needed assistance during the pandemic, when frozen meals, canned foods, instant foods, snacks, and other high-sodium foods gained substantial popularity. Such change in consumers' behavior is driven by several factors: the perceived risk of viral infection in grocery shopping trips, limited supplies and inflated prices of fresh produce, preference on foods with long shelf lives, and emotional eating. Moreover, the general low awareness of sodium contents in food has contributed to the increased consumption of high-sodium foods during the pandemic. We also discuss the possible effects on COVID-19 infection and severity caused by excessive sodium intake. We conclude that the public should be educated to maintain a healthy sodium intake during the pandemic, and measures should be adopted by governments and private donors in procuring food parcels with more balanced sodium contents to lower the risks of prolonged and excessive sodium intakes in the vulnerable population.