Effects of dietary salt intake restriction on blood glucose levels: a meta-analysis of crossover study.

BACKGROUND/OBJECTIVES: To identify modifiable risk factors for type 2 diabetes mellitus and explore the relationship between diet sodium intake and blood glucose levels. MATERIALS/METHODS: Based on inclusion and exclusion criteria, we extracted, analyzed, and assessed the available crossover studies of dietary salt intake restriction and insulin resistance in PubMed, Web of Science, MEDLINE, Embase, Wanfang, and CNKI databases. RESULTS: We included 6 studies with 8 sets of data, covering 485 subjects. I2 statistics results showed insignificant heterogeneity among all data (I2 = 39.2% < 50%). Thus, a fixed-effect model was adopted for the final pooled effect size. Weighted mean difference and its 95% confidence interval (CI) value was 0.193 (95% CI, 0.129-0.257), and the test of the overall effect showed P < 0.001. The results revealed that the blood glucose levels in the subjects in the low-salt intake group were significantly higher than those in the normal or high-salt intake groups. We also found no significant change occurred after the removal of any study through sensitivity analysis, which confirmed that the outcome we calculated was prudent and credible. The quantitative Egger's test (P = 0.109 > 0.05) indicated that insignificant publication bias existed. CONCLUSION: This meta-analysis highlights the relationship between dietary sodium intake and blood glucose levels. Our findings show that higher blood glucose levels might be expected in hypertensive or normal people with low-salt consumption compared to those with normal or high-salt consumption, although these differences were not clinically significant. Trial Registration: PROSPERO Identifier: CRD42021256998.

Comparison of participant and non-participant perceptions on healthy restaurant for sodium reduction: a qualitative study.

BACKGROUND/OBJECTIVES: In the Republic of Korea, "Healthy Restaurant for Sodium Reduction (HRSR)" project have been designated as one of the representative policies for sodium intake reduction. However, as of 2021, only 879 restaurants, less than 0.1% of all restaurants, had been designated. Therefore, to increase the participation of restaurants in this policy, it is necessary to examine the in-depth perception and experience of participants and non-participants in the HRSR. MATERIALS/METHODS: Two focus group discussions were conducted for HRSR project participants and non-participants. RESULTS: A total of 260 semantic units were derived from the 2 groups. The units were further classified into 5 upper categories and 11 subcategories. All the study participants knew the importance of low sodium intake, but they had little information on HRSR project. Various attempts have been made to encourage low sodium practice in restaurants, and the participants reported that the amount of salt used in their restaurants currently is reduced compared to that used in the past. However, they were worried about customers' complaints about the low sodium in their diet and the insignificant beneficent associated with the policy, which makes restaurant owners reluctant to participate in this policy. All the participants agreed on the urgent need for the improvement of public awareness of low-sodium diets and for substantive government support for HRSR. CONCLUSION: This study concluded that strategies such as more active publicity for the practice of sodium reduction in restaurants, identification of approaches to dispel the perception that low-salt diet is not tasty, and development of plans to increase the sale of food in of HRSR, are needed.

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Abstract Background Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition. Objective To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients. Methods A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet (cooked without salt; salt [2g per meal] added by the patient at the time of consumption) on one day and on the next day patients were given the intervention diet - a low sodium diet cooked with salt (2 grams of salt, divided between preparations). Dietary acceptance was evaluated by weighing leftover food and calculating intake. A questionnaire was used to verify reasons that influenced acceptance. For data analysis, parametric data are presented as mean and standard deviation, Student's t test was used to compare means, with significance defined as p<0.05. Results Sixty-four patients were evaluated, with a mean age of 66 ± 11.3 years; 64% were male. There were no differences in percentage acceptance between the standard low-sodium diet and the low-sodium diet cooked with salt at lunch (p= 0.876) or at dinner (p= 0.255). Around 80% of what was offered at each meal was consumed by the patients, with no significant difference between groups. Conclusions The low-sodium diet cooked with salt was well accepted, but there was no difference when compared with the standard low-sodium diet, which also had adequate acceptance.

Is there sufficient evidence to justify changes in dietary habits in heart failure patients? A systematic review.

The incidence and prevalence of heart failure (HF) is increasing worldwide, leading to high morbidity and mortality. The global management of HF involves lifestyle changes in addition to pharmacological treatments. Changes include exercise and dietary recommendations, mainly salt and fluid restriction, but without any clear evidence. We conducted a systematic review to analyse the degree of evidence for these dietary recommendations in HF. Only randomized controlled trials (RCT), and observational studies in humans were selected. Studies were considered eligible if they included participants with HF and sodium and/or fluid restriction. Publications in languages other than English or Spanish were excluded. We included 15 studies related to sodium or fluid restriction. Nine RCT and six observational studies showed some improvements in symptoms and quality of life and a degree of reduction in new hospitalizations, but the results are based on limited population groups, applying different methodologies, and with different restriction goals. We found a lack of clear evidence of the benefits of sodium/fluid restriction in chronic HF. The evidence is limited to few studies with conflicting results. Randomized clinical trials are needed to fill this gap in our knowledge.

[São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]. / Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial, 2020.

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

Cerca de una cuarta parte de los adultos tienen hipertensión, el principal factor de riesgo de muerte (inclusive la causada por cardiopatía y accidente cerebrovascular).Existen políticas eficaces que podrían ayudar a las personas a elegir opciones saludables para prevenir el aumento de la presión arterial; si se las aplicara plenamente, se podría evitar en gran medida el desarrollo de hipertensión.La hipertensión es fácil de detectar y tratar, PERO solo alrededor de 50% de los adultos que presentan dicha afección son conscientes de su situación y solamente 1 de cada 7 de ellos recibe el tratamiento adecuado.La prevención y el control de la hipertensión es el mecanismo principal para prevenir y controlar las enfermedades no transmisibles y un modelo para evitar otros riesgos de presentar dichas enfermedades.La adopción de un modo de vida saludable y el tratamiento farmacológico efectivo podrían prevenir y controlar la hipertensión en la mayoría de las personas si se implementaran de manera sistemática en la población; en todos los entornos es posible aplicar intervenciones sencillas, que pueden usarse para mejorar la atención primaria.Es urgente adoptar medidas sostenidas para introducir cambios eficaces en las políticas públicas y los sistemas de salud pública con miras a prevenir y controlar la hipertensión.

[São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]. / Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020.

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

Cerca de » dos adultos têm hipertensão arterial, que é o fator de risco isolado mais importante para morte (incluídas as mortes por cardiopatia e acidente vascular cerebral).Existem políticas eficazes que poderiam facilitar escolhas pessoais saudáveis para evitar a elevação da pressão arterial e, se plenamente implementadas, podem prevenir a ocorrência da hipertensão arterial.É fácil rastrear e tratar a hipertensão, MAS somente cerca de 50% dos adultos hipertensos estão cientes de sua condição, e apenas cerca de 1 em cada 7 é tratado adequadamente.A prevenção e controle da hipertensão é o principal mecanismo de prevenção e controle das doenças não transmissíveis e um modelo para outros riscos de doenças não transmissíveis.Tratamentos eficazes com mudanças de estilo de vida e medicamentos poderiam prevenir e controlar a hipertensão arterial na maioria das pessoas se aplicados sistematicamente à população; as intervenções simples são viáveis em todos os ambientes e podem melhorar a atenção primária.É necessária a ação continuada e urgente a fim de obter mudanças efetivas nas políticas públicas e no sistema de saúde para prevenir e controlar a hipertensão arterial.

Validação de comunicação persuasiva audiovisual para redução do consumo de sal por pessoas com insuficiência cardíaca / Validación de la comunicación persuasiva audiovisual para reducir el consumo de sal en personas con insuficiencia cardíaca / Validation of persuasive audiovisual communication to reduce salt consumption by people with heart failure

RESUMO Objetivo Construir e validar o conteúdo de comunicação persuasiva audiovisual, para reduzir o consumo de sal na dieta de pessoas com insuficiência cardíaca. Método Estudo metodológico, de natureza tecnológica, ancorado na Teoria do Comportamento Planejado, no qual foram seguidas as etapas de pré-produção, produção e pós-produção. Realizou-se validação de conteúdo com especialistas na área da saúde e comunicação. Resultados Com base no levantamento de crenças relacionadas à redução de sal, o vídeo dispõe de 42 telas, três minutos e onze segundos de duração e contém animações e argumentos motivacionais com o objetivo de influenciar positivamente a intenção comportamental e modelar crenças negativas em positivas. Na validação de conteúdo, os juízes concordaram, em unanimidade, com os critérios de avaliação para o público-alvo, linguagem, harmonia, ilustrações, narração e estratégia de persuasão. O Índice de Validade de Conteúdo mostrou-se satisfatório com concordância de 97%. Conclusão A comunicação persuasiva, no formato audiovisual, foi considerada válida quanto ao conteúdo, tornando-se uma ferramenta para potencializar a redução do consumo de sal no cuidado de pessoas com insuficiência cardíaca.

RESUMEN Objetivo Construir y validar el contenido de la comunicación audiovisual persuasiva para reducir el consumo de sal en la dieta de personas con insuficiencia cardíaca. Método Se trata de un estudio metodológico, de carácter tecnológico, basado en la Teoría del Comportamiento Planificado, en el que se siguieron las etapas de preproducción, producción y postproducción. La validación del contenido se realizó con especialistas en el área de la salud y la comunicación. Resultados Basado en la encuesta sobre las creencias relacionadas con la reducción de la sal, el vídeo tiene 42 pantallas, tres minutos y once segundos de duración, con animaciones y argumentos motivacionales que pretenden influir positivamente en la intención del comportamiento y transformar las creencias negativas en positivas. En la validación del contenido, los jueces estuvieron unánimemente de acuerdo con los criterios de evaluación del público objetivo, el lenguaje, la armonía, las ilustraciones, la narración y la estrategia de persuasión. El índice de Validez del Contenido resultó satisfactorio con un 97% de concordancia. Conclusión La comunicación persuasiva, en formato audiovisual, se consideró válida respecto al contenido, convirtiéndose en una herramienta para potenciar la reducción de la ingesta de sal en el cuidado de personas con insuficiencia cardíaca.

ABSTRACT Objective To build and validate persuasive audiovisual communication content to reduce salt consumption in the diet of people with heart failure. Method Methodological study, of a technological method, based on the Theory of Planned Behavior, in which the stages of pre-production, production and post-production were followed. Content validation was carried out with specialists in the field of health and communication. Results Based on the survey of beliefs related to salt reduction, the video contains 42 screens with three minutes and eleven seconds in duration and has animations and motivational arguments with the aim of positively influencing behavioral intention and modeling negative beliefs in positive ones. In content validation, the judges unanimously agreed with the evaluation criteria for the target audience, language, harmony, figures, narration and persuasion strategy. The Content Validity Index was satisfactory with a 97% agreement. Conclusion Persuasive audiovisual communication was considered valid in terms of content, becoming a tool to enhance the reduction of salt consumption in the care of people with heart failure.

Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020 / São Paulo call to action for the prevention and control of high blood pressure: 2020 / Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial, 2020

RESUMEN Cerca de una cuarta parte de los adultos tienen hipertensión, el principal factor de riesgo de muerte (inclusive la causada por cardiopatía y accidente cerebrovascular). Existen políticas eficaces que podrían ayudar a las personas a elegir opciones saludables para prevenir el aumento de la presión arterial; si se las aplicara plenamente, se podría evitar en gran medida el desarrollo de hipertensión. La hipertensión es fácil de detectar y tratar, PERO solo alrededor de 50% de los adultos que presentan dicha afección son conscientes de su situación y solamente 1 de cada 7 de ellos recibe el tratamiento adecuado. La prevención y el control de la hipertensión es el mecanismo principal para prevenir y controlar las enfermedades no transmisibles y un modelo para evitar otros riesgos de presentar dichas enfermedades. La adopción de un modo de vida saludable y el tratamiento farmacológico efectivo podrían prevenir y controlar la hipertensión en la mayoría de las personas si se implementaran de manera sistemática en la población; en todos los entornos es posible aplicar intervenciones sencillas, que pueden usarse para mejorar la atención primaria. Es urgente adoptar medidas sostenidas para introducir cambios eficaces en las políticas públicas y los sistemas de salud pública con miras a prevenir y controlar la hipertensión.

ABSTRACT About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke). There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring. Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated. Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks. Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care. Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

RESUMO Cerca de » dos adultos têm hipertensão arterial, que é o fator de risco isolado mais importante para morte (incluídas as mortes por cardiopatia e acidente vascular cerebral). Existem políticas eficazes que poderiam facilitar escolhas pessoais saudáveis para evitar a elevação da pressão arterial e, se plenamente implementadas, podem prevenir a ocorrência da hipertensão arterial. É fácil rastrear e tratar a hipertensão, MAS somente cerca de 50% dos adultos hipertensos estão cientes de sua condição, e apenas cerca de 1 em cada 7 é tratado adequadamente. A prevenção e controle da hipertensão é o principal mecanismo de prevenção e controle das doenças não transmissíveis e um modelo para outros riscos de doenças não transmissíveis. Tratamentos eficazes com mudanças de estilo de vida e medicamentos poderiam prevenir e controlar a hipertensão arterial na maioria das pessoas se aplicados sistematicamente à população; as intervenções simples são viáveis em todos os ambientes e podem melhorar a atenção primária. É necessária a ação continuada e urgente a fim de obter mudanças efetivas nas políticas públicas e no sistema de saúde para prevenir e controlar a hipertensão arterial.

Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020 / São Paulo call to action for the prevention and control of high blood pressure: 2020 / Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial, 2020

RESUMEN Cerca de una cuarta parte de los adultos tienen hipertensión, el principal factor de riesgo de muerte (inclusive la causada por cardiopatía y accidente cerebrovascular). Existen políticas eficaces que podrían ayudar a las personas a elegir opciones saludables para prevenir el aumento de la presión arterial; si se las aplicara plenamente, se podría evitar en gran medida el desarrollo de hipertensión. La hipertensión es fácil de detectar y tratar, PERO solo alrededor de 50% de los adultos que presentan dicha afección son conscientes de su situación y solamente 1 de cada 7 de ellos recibe el tratamiento adecuado. La prevención y el control de la hipertensión es el mecanismo principal para prevenir y controlar las enfermedades no transmisibles y un modelo para evitar otros riesgos de presentar dichas enfermedades. La adopción de un modo de vida saludable y el tratamiento farmacológico efectivo podrían prevenir y controlar la hipertensión en la mayoría de las personas si se implementaran de manera sistemática en la población; en todos los entornos es posible aplicar intervenciones sencillas, que pueden usarse para mejorar la atención primaria. Es urgente adoptar medidas sostenidas para introducir cambios eficaces en las políticas públicas y los sistemas de salud pública con miras a prevenir y controlar la hipertensión.

ABSTRACT About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke). There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring. Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated. Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks. Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care. Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.

RESUMO Cerca de » dos adultos têm hipertensão arterial, que é o fator de risco isolado mais importante para morte (incluídas as mortes por cardiopatia e acidente vascular cerebral). Existem políticas eficazes que poderiam facilitar escolhas pessoais saudáveis para evitar a elevação da pressão arterial e, se plenamente implementadas, podem prevenir a ocorrência da hipertensão arterial. É fácil rastrear e tratar a hipertensão, MAS somente cerca de 50% dos adultos hipertensos estão cientes de sua condição, e apenas cerca de 1 em cada 7 é tratado adequadamente. A prevenção e controle da hipertensão é o principal mecanismo de prevenção e controle das doenças não transmissíveis e um modelo para outros riscos de doenças não transmissíveis. Tratamentos eficazes com mudanças de estilo de vida e medicamentos poderiam prevenir e controlar a hipertensão arterial na maioria das pessoas se aplicados sistematicamente à população; as intervenções simples são viáveis em todos os ambientes e podem melhorar a atenção primária. É necessária a ação continuada e urgente a fim de obter mudanças efetivas nas políticas públicas e no sistema de saúde para prevenir e controlar a hipertensão arterial.

Efeito da Redução do Sal de Adição sobre a Pressão Arterial Central e Periférica / Effects of added salt reduction on central and peripheral blood pressure

Resumo Fundamento Os efeitos da redução na ingestão do sal sobre a pressão arterial (PA) casual de hipertensos já foram amplamente estudados, entretanto essa análise ainda é escassa no contexto da redução exclusiva do sal de adição na rigidez arterial e em indivíduos normotensos e pré-hipertensos. Objetivo Avaliar os efeitos da redução progressiva na ingestão do sal de adição (de 6 para 4 g/dia) sobre os valores da pressão periférica e central, a rigidez arterial em normotensos, pré-hipertensos e hipertensos. Métodos Ensaio clínico, simples cego com 13 semanas de seguimento. Foram avaliados normotensos (≤130/85 mmHg), pré-hipertensos (≥130 e <139/≥85 e <90 mmHg) e hipertensos estágio 1 (≥140 e <160/≥90 e <100 mmHg). Utilizou-se medida casual e monitorização residencial da PA com aparelho automático OMRON 705CP, medida central da PA com Sphygmocor®, dosagem do sódio urinário de 24h (colhido no intervalo entre cada visita) e mensuração de sal de adição. Foi adotado nível de significância p<0,05 para todas as análises. Resultados Foram avaliados 55 participantes (18 normotensos; 15 pré-hipertensos; 22 hipertensos) com mediana 48 anos (IQ:39-54). Os grupos foram semelhantes em relação a idade e sexo. Não houve diferença entre medidas de PA e excreção de sódio antes e depois da intervenção. Os parâmetros de rigidez arterial também não sofreram alterações significativas. Conclusão A redução gradativa da ingestão de sal de adição num seguimento de 13 semanas não foi capaz de reduzir de maneira significativa os valores periféricos e centrais da PA. (Arq Bras Cardiol. 2020; 114(3):554-561)

Abstract Background Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. Objective To evaluate the effects of progressive reduction in added salt intake (from 6 grams to 4 grams per day) on peripheral and central blood pressure and arterial stiffness in normotensive, prehypertensive and hypertensive individuals. Methods This was a single-blinded clinical trial with 13 weeks of follow-up. Normotensive (≤ 130/85 mmHg), prehypertensive (≥ 130 e < 139/≥ 85 e < 90 mmHg) and stage 1 hypertensive individuals (< 139/≥ 85 and < 90 mmHg) were assessed. Casual blood pressure measurements and ambulatory blood pressure monitoring were performed using the automated OMRON 705CP device, and central blood pressure was measured using the Sphygmocor®. Twenty-four-hour urinary sodium excretion and the amounts of added salt consumed were measured. Statistically significance level was set at p < 0.05 for all analysis. Results A total of 55 participants (18 normotensive, 15 prehypertensive and 22 hypertensive), median age 48 years (IQR:39-54) were studied. The groups were not different in age or sex. No difference was observed in blood pressure or sodium excretion levels before and after the intervention. No significant changes in arterial stiffness parameters were observed. Conclusion The progressive reduction in added salt intake during a period of 13 weeks did not cause significant reductions in peripheral and central blood pressure. (Arq Bras Cardiol. 2020; 114(3):554-561)

Attitudes, beliefs and barriers for adherence to the hyposodic diet in patients with heart failure / Actitudes, creencias y barreras para la adhesión a la dieta hiposódica en pacientes con insuficiencia cardíaca / Atitudes, crenças e barreiras para a adesão à dieta hipossódica em pacientes com insuficiência cardíaca

ABSTRACT Objectives: To identify attitudes, beliefs and barriers to adherence to the hyposodic diet in patients with heart failure and associated factors. Methods: Cross-sectional study with 41 individuals. The Dietary Sodium Restriction Questionnaire was used. Fisher's test was applied for analysis. Results: Attitudes were based on family and professional relationships; in the beliefs, it was highlighted to believe in the diet to improve health. As barriers, insufficient efforts were found to change the diet and taste of low salt foods. It was associated with adherence among the components factors such as: income, perception of cardiac improvement with the diet, family history of renal and heart failure and family adherence to the diet. Conclusions: The identified attitudes and beliefs refer, respectively, to social relationships and trust in the diet to improve health status. The barriers were: insufficient effort to modify the diet and food palatability. Economic, family and clinical factors were associated with hyposodic adherence.

RESUMEN Objetivos: Identificar actitudes, creencias y barreras para la adhesión a la dieta de hiposodio en pacientes con insuficiencia cardíaca y factores asociados. Métodos: Estudio transversal con 41 individuos. Se utilizó el Cuestionario de restricción de sodio en la dieta. La prueba de Fisher se aplicó para el análisis. Resultados: Las actitudes se basaron en las relaciones familiares y profesionales; En las creencias, se destacó creer en la dieta para mejorar la salud. Como barreras, se encontraron esfuerzos insuficientes para cambiar la dieta y el sabor de los alimentos bajos en sal. Se asoció con la adherencia entre los factores componentes como: ingresos, percepción de mejoría cardíaca con la dieta, antecedentes familiares de insuficiencia renal y cardíaca y adherencia familiar a la dieta. Conclusiones: Las actitudes y creencias identificadas se refieren, respectivamente, a las relaciones sociales y la confianza en la dieta para mejorar el estado de salud. Las barreras fueron: esfuerzo insuficiente para modificar la dieta y la palatabilidad de los alimentos. Factores económicos, familiares y clínicos se asociaron con baja adherencia al sodio.

RESUMO Objetivos: Identificar atitudes, crenças e barreiras para a adesão à dieta hipossódica em pacientes com Insuficiência Cardíaca e fatores associados. Métodos: Estudo transversal com 41 indivíduos. Utilizou-se o Questionário de Restrição de Sódio na Dieta. Para análise aplicou-se o teste de Fisher. Resultados: As atitudes basearam-se nas relações familiares e com profissionais; nas crenças destacou-se acreditar na dieta para melhoria da saúde. Como barreiras, encontrou-se empenho insuficiente para mudança dietética e sabor dos alimentos com pouco sal. Associou-se à adesão entre os componentes fatores como: renda, percepção da melhora cardíaca com a dieta, histórico familiar de insuficiência renal e cardíaca e adesão familiar à dieta. Conclusões: As atitudes e crenças identificadas referem-se, respectivamente, às relações sociais e à confiança na dieta para melhorar a condição de saúde. As barreiras foram: empenho insuficiente em modificar a dieta e a palatabilidade alimentar. Fatores econômicos, familiares e clínicos estiveram associados à adesão hipossódica.

Evidence related to sodium restriction in patients with heart failure / Pruebas relacionadas con la restricción de sodio en pacientes con insuficiencia cardíaca / Evidências relacionadas à restrição de sódio em pacientes com insuficiência cardíaca

ABSTRACT Objectives: to analyze the scientific production about sodium restriction in patients with heart failure. Methods: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. Results: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. Conclusions: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

RESUMEN Objetivo: analizar la producción científica sobre la restricción de sodio en pacientes con insuficiencia cardíaca. Métodos: revisión integral de la literatura de artículos publicados de 2007 a 2017, ubicados en las bases de datos CINAHL y Scopus. Resultados: se analizaron trece estudios. La restricción en la ingesta de sodio se asoció con resultados clínicos desfavorables más bajos en pacientes con marcada sintomatología. La dosis de sodio en orina de 24 horas fue la herramienta principal para evaluar el cumplimiento de la dieta baja en sodio. Conclusión: según los estudios incluidos en esta revisión, en pacientes sintomáticos, se debe fomentar la restricción de sodio en la dieta en la práctica clínica como medida de protección para la salud. Sin embargo, en pacientes asintomáticos, debe estudiarse bien.

RESUMO Objetivos: analisar a produção científica acerca da restrição de sódio em pacientes com insuficiência cardíaca. Métodos: revisão integrativa da literatura, a partir de artigos publicados no período de 2007 a 2017, localizados nas bases de dados CINAHL e Scopus. Resultados: foram analisados 13 estudos. A restrição no consumo de sódio se mostrou associada a menores desfechos clínicos desfavoráveis em pacientes com sintomatologia acentuada. A dosagem de sódio na urina coletada em 24 horas foi a ferramenta principal para avaliar adesão à dieta com baixo teor de sódio. Conclusões: com base nos estudos incluídos nesta revisão, em pacientes sintomáticos, a restrição de sódio na dieta deve ser encorajada na prática clínica como medida protetora à saúde. No entanto, em pacientes assintomáticos, deve ser bem estudada.

Effect of case management based on 5E mode on water-salt control in patients with peritoneal dialysis / 重庆医学

Objective To assess the influence of case management based on 5E mode on water-salt control in the patients with peritoneal dialysis.Methods One hundred eligible cases of peritoneal dialysis were randomly divided into two groups,50 cases in each group.The control group received regular nursing care,while on this basis the experimental group applied the case management based on 5E mode for conducting the nursing intervention.The various indicators were evaluated at 3 time points (the first stage of the baseline data ceollection),second stage (4-month intervention) and third stage (3-month follow up).Results There was no statistically significant difference in the first stage between the two groups;in the second and third stage the body weight,systolic blood pressure,diastolic blood pressure,water and salt intake amount in the experimental group were lower than those in the control group,compliance was superior to thas of the control group(P＜0.05);the descent speed of urine volume and PD ultrafiltration amount in the experimental group was slowed down compared with the control group(P＜0.05);the patient's daily sleeping time was improved(P＜0.05).Conclusion The case management based on 5E mode used in the water-sak control of the patients with peritoneal dialysis is effective and feasible.

Protective effect of low salt diet on vascular remodeling induced by high-fructose / 重庆医学

Objective To investigate the effect of low salt diet on vascular remodeling of rat induced by high fructose(HF).Methods Wistar male rats weighed 180-200 g were fed for 8 weeks and randomly divided into 6 groups:(1) control group was given the normal fodder and distilled water;(2) high fructose group(HF) was given normal fodder (0.5 ％ NaCl,w/w) and fructose water(10 ％,w/v);(3) high-salt group (HNa) was given high salt fodder (7 ％ NaCl,w/w) and distilled water;(4) high fructose combined with high salt diet group(HFNa) was simultaneously given high salt fodder and 10 ％ fructose water;(5)high fructose combined low salt group(HFLNa) was simultaneously given low salt fodder and 10％ fructose water;(6) high fructose combined with spirotaclone group(HFE) was given 10％ fructose water for 4 weeks and then added with spirotaelone(50 mg · kg-1 · d-1 by tube feeding) for continuous 4 weeks.The changes of arterial blood pressure,vascular wall histological evaluation and expression of α-SMA and fibronectin in vascular wall were detected in each group.Results (1) Compared with the blood pressure[(111.03 ±9.17) mm Hg] in the control group,the blood pressure in the HF and HNa groups were (133.94± 5.86) mm Hg and (128.09±7.56) mm Hg respectively,which were significantly increased(P＜0.05);(2) HF mainly caused the hyperplasia of vascular wall middle layer smooth muscle.The a-SMA expression results in the HF group was (0.006 3 ±0.000 21),which in the control group was (0.004 6 ± 0.000 31),the difference was statistically significant(P＜0.05),moreover which promoted the elastic fibers increase;while HNa mainly stimulated the elastic fibers to thicken and extracellular matrix deposition,the fibronectin expression was 0.002 6 ± 0.000 2 in the HNa group and (0.004 7±0.000 2)in the HF group,compared with(0.001 3±0.000 1)in the normal group,which were significantly increased(P＜0.001);(3) the blood pressure was (106.04±9.59) mm Hg in the HFLNa group,(103.99±7.12) mm Hg in the HFE group,compared with(133.94±5.86) mm Hg in the HF group,showing that the blood pressure in the HFLNa group and HFE group was significantly decreased compared with the HF group (P＜0.05);moreover the vascular remodeling in the HFLNa group(0.006 8±0.000 2) and HFE group (0.004 2±0.000 4) was improved,and compared with the HF group(0.006 3±0.000 2),α-SMA expression was significantly decreased (P＜0.05).Conclusion Low salt diet can effectively improve vascular remodeling induced by HEF.

Pooled Analysis of Multiple Crossover Trials To Optimize Individual Therapy Response to Renin-Angiotensin-Aldosterone System Intervention.

BACKGROUND AND OBJECTIVES: In the treatment of CKD, individual patients show a wide variation in their response to many drugs, including renin-angiotensin-aldosterone system inhibitors (RAASi). To investigate whether therapy resistance to RAASi can be overcome by uptitrating the dose of drug, changing the mode of intervention (with drugs from similar or different classes), or lowering dietary sodium intake, we meta-analyzed individual responses to different modes of interventions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Randomized crossover trials were analyzed to assess correlation of individual responses to RAASi and nonsteroidal anti-inflammatory drugs (NSAIDs; n=395 patients). Included studies compared the antialbuminuric effect of uptitrating the dose of RAASi (n=10 studies) and NSAIDs (n=1), changing within the same class of RAASi (e.g., angiotensin-converting enzyme inhibition to angiotensin receptor blockers; n=5) or NSAIDs (n=1), changing from RAASi to NSAIDs (n=2), and changing from high to low sodium intake (n=5). A two-stage meta-analysis was conducted: Deming regression was conducted in each study to assess correlations in response, and individual study results were then meta-analyzed. RESULTS: The albuminuria response to one dose of RAASi or NSAIDs positively correlated with the response to a higher dose of the same drug (r=0.72; 95% confidence interval [95% CI], 0.66 to 0.78), changes within the same class of RAASi or NSAIDs (r=0.54; 95% CI, 0.35 to 0.68), changes between RAASi and NSAIDs (r=0.44; 95% CI, 0.16 to 0.66), and changes from high to moderately low salt intake (r=0.36; 95% CI, 0.22 to 0.48). Results were similar when the individual systolic BP and potassium responses were analyzed, and were consistent in patients with and without diabetes. CONCLUSIONS: Individuals who show a poor response to one dose or type of RAASi also show a poor response to higher doses, other types of RAASi or NSAIDs, or a reduction in dietary salt intake. Whether other drugs or drug combinations targeting pathways beyond the renin-angiotensin-aldosterone system and prostaglandins would improve the individual poor response requires further study.

Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial.

OBJECTIVE: The purpose of this study was to test the efficacy of a tailored motivational interviewing (MI) intervention versus usual care for improving HF self-care behaviors, physical HF symptoms and quality of life. METHODS: This is a single-center, randomized controlled trial. Participants were enrolled in the hospital. Immediately after discharge, those in the intervention group received a single home visit and 3-4 follow-up phone calls by a nurse over 90 days. RESULTS: A total of 67 participants completed the study (mean age 62±12.8 years), of which 54% were African American, 30% were female, 84% had class III/IV symptoms, and 63% were educated at a high school level or less. There were no differences between the groups in self-care maintenance, self-care confidence, physical HF symptoms, or quality of life at 90 days. CONCLUSION: Patients who received the MI intervention had significant and clinically meaningful improvements in HF self-care maintenance over 90 days that exceeded that of usual care. PRACTICE IMPLICATIONS: These data support the use of a nurse-led MI intervention for improving HF self-care. Identifying methods to improve HF self-care may lead to improved clinical outcomes.

Effect of low salt diet on insulin resistance in salt-sensitive versus salt-resistant hypertension.

Accumulating evidence shows an increase in insulin resistance on salt restriction. We compared the effect of low salt diet on insulin resistance in salt-sensitive versus salt-resistant hypertensive subjects. We also evaluated the relationship between salt sensitivity of blood pressure and salt sensitivity of insulin resistance in a multivariate regression model. Studies were conducted after 1 week of high salt (200 mmol per day sodium) and 1 week of low salt (10 mmol per day sodium) diet. Salt sensitivity was defined as the fall in systolic blood pressure>15 mm Hg on low salt diet. The study includes 389 subjects (44% women; 16% blacks; body mass index, 28.5±4.2 kg/m2). As expected, blood pressure was lower on low salt (129±16/78±9 mm Hg) as compared with high salt diet (145±18/86±10 mm Hg). Fasting plasma glucose, insulin, and homeostasis model assessment were higher on low salt diet (95.4±19.4 mg/dL; 10.8±7.3 mIU/L; 2.6±1.9) as compared with high salt diet (90.6±10.8 mg/dL; 9.4±5.8 mIU/L; 2.1±1.4; P<0.0001 for all). There was no difference in homeostasis model assessment between salt-sensitive (n=193) versus salt-resistant (n=196) subjects on either diet. Increase in homeostasis model assessment on low salt diet was 0.5±1.4 in salt-sensitive and 0.4±1.5 in salt-resistant subjects (P=NS). On multivariate regression analysis, change in systolic blood pressure was not associated with change in homeostasis model assessment after including age, body mass index, sex, change in serum and urine aldosterone, and cortisol into the model. We conclude that the increase in insulin resistance on low salt diet is not affected by salt sensitivity of blood pressure.

A importância do sal na origem da hipertensão / The role of salt on the origin of hypertension

A alta ingestão de sódio na dieta está associada ao desenvolvimento da hipertensão arterial. Alguns indivíduos são particularmente sensíveis ao sódio na dieta, sendo chamados de "sal sensíveis". Estes obtêm maior grau de redução na pressão arterial (PA) com a restrição de sódio na dieta. Entretanto, a redução do sódio na dieta pode reduzir a PA tanto em hipertensos quanto em normotensos e melhorar a resposta à maioria das terapias anti-hipertensivas. Além da redução das cifras pressóricas, a redução do sódio na dieta pode reduzir o risco de doença cardiovascular. Portanto, recomenda-se reduzir a ingestão de sódio na dieta para todos os hipertensos. Metas razoáveis de redução diária na ingestão de sódio nas diretrizes atuais são < 100 meq/dia (2,3 g de sódio ou 6 g de sal ­ cloreto de sódio [1 g de sódio=44meq; 1 g de cloreto de sódio contém 17 meq de sódio]). Napopulação geral, recomenda-se a redução do sódio na dieta com objetivo de prevenir a hipertensão e reduzir o risco de eventos cardiovasculares adversos.

High sodium intake is associated with hypertension development. Some individuals are particularly sensitive to sodium in their diet, and are called "salt sensitive". These individuals obtain greater reduction levels in blood pressure when lowering the intake of salt in their diet. Nevertheless, the reduction in sodium intake can reduce blood pressure in hypertensive and normotensive subjects. Besides, there is an improvement in the response to most antihypertensive therapies and a decrease in the risk of cardiovascular disease. Therefore, it is recommended to reduce the intake of sodium for all hypertensive patients. The reasonable targets for reduction of daily sodium intake in the current guidelines are < 100 meq/day (2.3 g of sodium or 6 g of salt ­ sodium chloride [1 g of sodium = 44 meq, 1g of sodium chloride contains 17 meq of sodium]). In general population, the reduction in sodium intake is recommended to prevent hypertension and reduce the risk of adverse cardiovascular events.

Disminución del consumo de sal en la población: ¿recomendar o no recomendar?

Resumen La ingesta habitual de sal excede largamente a la necesaria para reponer las pérdidas obligatorias de sodio y cloro por la orina, heces y sudor. A causa de los efectos del sodio sobre la presión arterial se ha señalado al excesivo consumo de sal como uno de los factores que contribuyen a las altas tasas de morbimortalidad cardiovascular que caracterizan a las sociedades actuales, en las que la hipertensión arterial tiene tan elevada prevalencia. En concordancia con esa opinión, distintas prestigiosas instituciones sanitarias y científicas recomiendan a toda la población disminuir el consumo de sal. La Organización Mundial de la Salud recomienda un consumo máximo de 5 g de sal/día, la American Heart Association, un máximo de 3.75 g de sal/día. Las estrategias de disminución de la ingesta de sal, si bien han sido capaces de disminuir la presión arterial, especialmente en los hipertensos, no han logrado en el mundo real resultados consistentes en cuanto a la disminución de la morbimortalidad cardiovascular, y en ciertos casos, los resultados son desfavorables. Esto ha determinado que el tema de recomendar o no en forma universal una disminución del consumo de sal se haya constituido en uno de los puntos más debatidos de la prevención cardiovascular. Análisis recientes de los resultados inconsistentes logrados con la disminución del consumo poblacional de sal permiten vislumbrar una interpretación satisfactoria para esas inconsistencias: las poblaciones con consumos excesivos de sal se beneficiarían con la disminución del consumo, en tanto que las que habitualmente consumen poca sal no se beneficiarían y, hasta en ciertos casos, se podrían perjudicar. En base a estas interpretaciones y aún reconociendo lo difícil que es no ya medir, sino estimar, el consumo individual de sal en la población general, podría recomendarse como medida global un consumo moderado de sal, que quienes consumen sal en exceso disminuyan su consumo y que quienes consumen poca sal, sigan haciéndolo. En los pacientes hipertensos la reducción del consumo de sal disminuye sistemáticamente la incidencia de accidentes cerebrovasculares, pero en relación con otras complicaciones los resultados no son tan consistentes, y debe limitarse la reducción del consumo de sal al suficiente para alcanzar, junto con las otras medidas terapéuticas que correspondan, las metas de presión arterial establecidas para cada situación clínica en particular