Open Access
Open access
The Lancet, volume 392, issue 10146, pages 496-506

Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study

Andrew Mente 1, 2
, 
Maureen O’Donnell 3, 4
, 
Sumathy Rangarajan 2
, 
Matthew McQueen 2, 5
, 
G. R. Dagenais 6
, 
A.T. Wielgosz 7
, 
Scott A. Lear 8
, 
Shelly Tse Lap Ah 9
, 
Wei Li 10
, 
Rafael Diaz 11
, 
Alvaro Avezum 12
, 
P. Lopez-Jaramillo 13
, 
F. Lanas 14
, 
Prem Mony 15
, 
Andrzej Szuba 16
, 
Romaina Iqbal 17
, 
Rita Yusuf 18
, 
Noushin Mohammadifard 19
, 
Rasha Khatib 20
, 
Khalid Yusoff 21, 22
, 
Noor Hassim Ismail 23
, 
Sadi Güleç 24
, 
Annika Rosengren 25
, 
Iolanthè M. Kruger 26
, 
Lanthe Kruger 27
, 
Lungiswa P. Tsolekile 28
, 
Jephat Chifamba 29
, 
Antonio Dans 30
, 
Khalid F. Alhabib 31
, 
Karen Yeates 32
, 
Koon K. Teo 2, 3
, 
Salim Yusuf 2, 3
Show full list: 32 authors
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Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina | 
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Dante Pazzanese Institute of cardiology, Sao Paulo, Brazil | 
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Fundacion Oftalmologica de Santander (FOSCAL), Floridablanca-Santander, Colombia | 
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University of the Philippines, Ermita, Manila, Philippines | 
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Publication type: Journal Article
Publication date: 2018-08-09
Journal: The Lancet
scimago Q1
wos Q1
SJR: 12.113
CiteScore: 148.1
Impact factor: 98.4
ISSN: 01406736, 1474547X
General Medicine
Abstract
WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality.The Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35-70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all >50 participants) and cardiovascular disease and mortality in 255 communities (all >100 participants), and used individual-level data to adjust for known confounders.95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3-5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p<0·0001 for heterogeneity). The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity (p=0·043) due to a significant inverse association in the lowest tertile of sodium intake (lowest tertile <4·43 g/day, mean intake 4·04 g/day, range 3·42-4·43; change -1·00 events per 1000 years, 95% CI -2·00 to -0·01, p=0·0497), no association in the middle tertile (middle tertile 4·43-5·08 g/day, mean intake 4·70 g/day, 4·44-5.05; change 0·24 events per 1000 years, -2·12 to 2·61, p=0·8391), and a positive but non-significant association in the highest tertile (highest tertile >5·08 g/day, mean intake 5·75 g/day, >5·08-7·49; change 0·37 events per 1000 years, -0·03 to 0·78, p=0·0712). A strong association was seen with stroke in China (mean sodium intake 5·58 g/day, 0·42 events per 1000 years, 95% CI 0·16 to 0·67, p=0·0020) compared with in other countries (4·49 g/day, -0·26 events, -0·46 to -0·06, p=0·0124; p<0·0001 for heterogeneity). All major cardiovascular outcomes decreased with increasing potassium intake in all countries.Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.Population Health Research Institute, Canadian Institutes of Health Research, Canadian Institutes of Health Canada Strategy for Patient-Oriented Research, Ontario Ministry of Health and Long-Term Care, Heart and Stroke Foundation of Ontario, and European Research Council.
Found 46
By date By citations
Ovid Technologies (Wolters Kluwer Health)
Relation of Dietary Sodium (Salt) to Blood Pressure and Its Possible Modulation by Other Dietary Factors
Stamler J., Chan Q., Daviglus M.L., Dyer A.R., Van Horn L., Garside D.B., Miura K., Wu Y., Ueshima H., Zhao L., Elliott P.
Hypertension scimago Q1 wos Q1 , 
2018-03-05,  citations by CoLab: 83 ,  Abstract  
Available data indicate that dietary sodium (as salt) relates directly to blood pressure (BP). Most of these findings are from studies lacking dietary data; hence, it is unclear whether this sodium–BP relationship is modulated by other dietary factors. With control for multiple nondietary factors, but not body mass index, there were direct relations to BP of 24-hour urinary sodium excretion and the urinary sodium/potassium ratio among 4680 men and women 40 to 59 years of age (17 population samples in China, Japan, United Kingdom, and United States) in the INTERMAP (International Study on Macro/Micronutrients and Blood Pressure), and among its 2195 American participants, for example, 2 SD higher 24-hour urinary sodium excretion (118.7 mmol) associated with systolic BP 3.7 mm Hg higher. These sodium–BP relations persisted with control for 13 macronutrients, 12 vitamins, 7 minerals, and 18 amino acids, for both sex, older and younger, blacks, Hispanics, whites, and socioeconomic strata. With control for body mass index, sodium–BP—but not sodium/potassium–BP—relations were attenuated. Normal weight and obese participants manifested significant positive relations to BP of urinary sodium; relations were weaker for overweight people. At lower but not higher levels of 24-hour sodium excretion, potassium intake blunted the sodium–BP relation. The adverse association of dietary sodium with BP is minimally attenuated by other dietary constituents; these findings underscore the importance of reducing salt intake for the prevention and control of prehypertension and hypertension. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT00005271.
Elsevier
Rationale, design, and baseline characteristics of the Salt Substitute and Stroke Study (SSaSS)—A large-scale cluster randomized controlled trial
Neal B., Tian M., Li N., Elliott P., Yan L.L., Labarthe D.R., Huang L., Yin X., Hao Z., Stepien S., Shi J., Feng X., Zhang J., Zhang Y., Zhang R., et. al.
American Heart Journal scimago Q1 wos Q1 , 
2017-06-01,  citations by CoLab: 67 ,  Abstract  
Lowering sodium intake with a reduced-sodium, added potassium salt substitute has been proved to lower blood pressure levels. Whether the same strategy will also reduce the risks of vascular outcomes is uncertain and controversial. The SSaSS has been designed to test whether sodium reduction achieved with a salt substitute can reduce the risk of vascular disease. The study is a large-scale, open, cluster-randomized controlled trial done in 600 villages across 5 provinces in China. Participants have either a history of stroke or an elevated risk of stroke based on age and blood pressure level at entry. Villages were randomized in a 1:1 ratio to intervention or continued usual care. Salt substitute is provided free of charge to participants in villages assigned to the intervention group. Follow-up is scheduled every 6months for 5years, and all potential endpoints are reviewed by a masked adjudication committee. The primary end point is fatal and nonfatal stroke, and the 2 secondary endpoints are total major cardiovascular events and total mortality. The study has been designed to provide 90% statistical power (with 2-sided α = .05) to detect a 13% or greater relative risk reduction for stroke. The power estimate assumes a primary outcome event rate of 3.5% per year and a systolic blood pressure difference of 3.0mm Hg between randomized groups. Recruitment is complete and there are 20,996 participants (about 35 per village) that have been enrolled. Mean age is 65years and 49% are female. There were 73% enrolled on the basis of a history of stroke. The trial is well placed to describe the effects of salt substitution on the risks of vascular disease and death and will provide important policy-relevant data.
Public Library of Science (PLoS)
The Effects of a Community-Based Sodium Reduction Program in Rural China – A Cluster-Randomized Trial
Li N., Yan L.L., Niu W., Yao C., Feng X., Zhang J., Shi J., Zhang Y., Zhang R., Hao Z., Chu H., Zhang J., Li X., Pan J., Li Z., et. al.
PLoS ONE scimago Q1 wos Q1 Open Access , 
2016-12-09,  citations by CoLab: 61 ,  PDF,  Abstract  
Background Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. Objective We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. Design This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. Results Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p
Elsevier
Sodium Intake and All-Cause Mortality Over 20 Years in the Trials of Hypertension Prevention
Cook N.R., Appel L.J., Whelton P.K.
Journal of the American College of Cardiology scimago Q1 wos Q1 , 
2016-10-03,  citations by CoLab: 175 ,  Abstract  
The relationship between lower sodium intake and total mortality remains controversial. This study examined the relationship between well-characterized measures of sodium intake estimated from urinary sodium excretion and long-term mortality. Two trials, phase I (1987 to 1990), over 18 months, and phase II (1990 to 1995), over 36 months, were undertaken in TOHP (Trials of Hypertension Prevention), which implemented sodium reduction interventions. The studies included multiple 24-h urine samples collected from pre-hypertensive adults 30 to 54 years of age during the trials. Post-trial deaths were ascertained over a median 24 years, using the National Death Index. The associations between mortality and the randomized interventions as well as with average sodium intake were examined. Among 744 phase I and 2,382 phase II participants randomized to sodium reduction or control, 251 deaths occurred, representing a nonsignificant 15% lower risk in the active intervention (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.66 to 1.09; p = 0.19). Among 2,974 participants not assigned to an active sodium intervention, 272 deaths occurred. There was a direct linear association between average sodium intake and mortality, with an HR of 0.75, 0.95, and 1.00 (references) and 1.07 (p trend = 0.30) for
Elsevier
Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies
Mente A., O'Donnell M., Rangarajan S., Dagenais G., Lear S., McQueen M., Diaz R., Avezum A., Lopez-Jaramillo P., Lanas F., Li W., Lu Y., Yi S., Rensheng L., Iqbal R., et. al.
The Lancet scimago Q1 wos Q1 Open Access , 
2016-07-01,  citations by CoLab: 378 ,  Abstract  
Summary Background Several studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status. Methods In this pooled analysis, we studied 133 118 individuals (63 559 with hypertension and 69 559 without hypertension), median age of 55 years (IQR 45–63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4·2 years (IQR 3·0–5·0) and blood pressure. Findings Increased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2·08 mm Hg change per g sodium increase) compared with individuals without hypertension (1·22 mm Hg change per g; p interaction Interpretation Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets. Funding Full funding sources listed at end of paper (see Acknowledgments).
American Medical Association (AMA)
Sodium Excretion and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease
Mills K.T., Chen J., Yang W., Appel L.J., Kusek J.W., Alper A., Delafontaine P., Keane M.G., Mohler E., Ojo A., Rahman M., Ricardo A.C., Soliman E.Z., Steigerwalt S., Townsend R., et. al.
JAMA - Journal of the American Medical Association scimago Q1 wos Q1 , 
2016-05-24,  citations by CoLab: 187 ,  Abstract  
Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease (CVD) compared with the general population. Prior studies have produced contradictory results on the association of dietary sodium intake with risk of CVD, and this relationship has not been investigated in patients with CKD.To evaluate the association between urinary sodium excretion and clinical CVD events among patients with CKD.A prospective cohort study of patients with CKD from 7 locations in the United States enrolled in the Chronic Renal Insufficiency Cohort Study and followed up from May 2003 to March 2013.The cumulative mean of urinary sodium excretion from three 24-hour urinary measurements and calibrated to sex-specific mean 24-hour urinary creatinine excretion.A composite of CVD events defined as congestive heart failure, stroke, or myocardial infarction. Events were reported every 6 months and confirmed by medical record adjudication.Among 3757 participants (mean age, 58 years; 45% women), 804 composite CVD events (575 heart failure, 305 myocardial infarction, and 148 stroke) occurred during a median 6.8 years of follow-up. From lowest (
Oxford University Press
A Radical Sodium Reduction Policy Is Not Supported by Randomized Controlled Trials or Observational Studies: Grading the Evidence
Graudal N.
American Journal of Hypertension scimago Q2 wos Q2 , 
2016-01-27,  citations by CoLab: 26 ,  Abstract  
Several health institutions recommend sodium intake be reduced to below 2,300 mg, which means that 6-7 billion individuals should alter their diet to accommodate. Such a radical recommendation should be based on solid evidence. However, this review reveals that (i) there are no randomized controlled trials (RCTs) allocating individuals to below 2,300 mg and measuring health outcomes; (ii) RCTs allocating risk groups such as obese prehypertensive individuals and hypertensive individuals down to (but not below) 2,300 mg show no effect of sodium reduction on all-cause mortality; (iii) RCTs allocating individuals to below 2,300 mg show a minimal effect on blood pressure in the healthy population (less than 1mm Hg) and significant increases in renin, aldosterone, noradrenalin cholesterol, and triglyceride; and (iv) observational studies show that sodium intakes below 2,645 and above 4,945 mg are associated with increased mortality. Given that 90% of the worlds' population currently consumes sodium within the optimal range of 2,645-4,945 mg, there is no scientific basis for a public health recommendation to alter sodium intake.
Ovid Technologies (Wolters Kluwer Health)
Heart Disease and Stroke Statistics—2016 Update
Mozaffarian D., Benjamin E.J., Go A.S., Arnett D.K., Blaha M.J., Cushman M., Das S.R., de Ferranti S., Després J., Fullerton H.J., Howard V.J., Huffman M.D., Isasi C.R., Jiménez M.C., Judd S.E., et. al.
Circulation scimago Q1 wos Q1 , 
2015-12-17,  citations by CoLab: 3163 ,  Abstract  
Author(s): Writing Group Members; Mozaffarian, Dariush; Benjamin, Emelia J; Go, Alan S; Arnett, Donna K; Blaha, Michael J; Cushman, Mary; Das, Sandeep R; de Ferranti, Sarah; Despres, Jean-Pierre; Fullerton, Heather J; Howard, Virginia J; Huffman, Mark D; Isasi, Carmen R; Jimenez, Monik C; Judd, Suzanne E; Kissela, Brett M; Lichtman, Judith H; Lisabeth, Lynda D; Liu, Simin; Mackey, Rachel H; Magid, David J; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Muntner, Paul; Mussolino, Michael E; Nasir, Khurram; Neumar, Robert W; Nichol, Graham; Palaniappan, Latha; Pandey, Dilip K; Reeves, Mathew J; Rodriguez, Carlos J; Rosamond, Wayne; Sorlie, Paul D; Stein, Joel; Towfighi, Amytis; Turan, Tanya N; Virani, Salim S; Woo, Daniel; Yeh, Robert W; Turner, Melanie B; American Heart Association Statistics Committee; Stroke Statistics Subcommittee
Oxford University Press
Validation of the Spot Urine in Evaluating 24-Hour Sodium Excretion in Chinese Hypertension Patients
Han W., Sun N., Chen Y., Wang H., Xi Y., Ma Z.
American Journal of Hypertension scimago Q2 wos Q2 , 
2015-05-25,  citations by CoLab: 51 ,  Abstract  
The spot urine method as an alternative approach in estimating daily urine sodium excretion has been proposed for many years. Kawasaki has created an equation to predict daily urinary sodium excretion using second morning urine (SMU) samples which was obtained before breakfast after initial voiding upon arising. Tanaka has developed another equation by examining spot urine samples submitted at random times during the day. A newly published study proposed that the "PM sample," collected in the late afternoon or early evening before dinner, showed a stronger relationship with actual sodium excretion. We aimed to verify the effectiveness of these methods in evaluating 24-hour urinary sodium in Chinese hypertensive patients.A total of 334 hypertensive participants were eligible to participate in this study. A total of 222 patients provided qualified SMU samples, Post Meridiem (PM) samples, and complete 24-hour urine collections.Biases using the Kawasaki formula were 2.1 mmol/day for the SMU specimens; for the Tanaka equation, biases of SMU and PM samples were 21.1 and 30.1 mmol/day, respectively. The highest intraclass correlation coefficient (ICC) was 0.64 when the Kawasaki formula was used in PM specimens, with the lowest ICC 0.17 when it is used in SMUs.Spot urine method is acceptable for estimating 24-hour urinary sodium excretion in hypertensive individuals. Kawasaki's formula is useful for estimating population mean levels of sodium excretion from SMU, although it is not suitable for estimating individual sodium excretion.
Massachusetts Medical Society
Cardiovascular Risk and Events in 17 Low-, Middle-, and High-Income Countries
Yusuf S., Rangarajan S., Teo K., Islam S., Li W., Liu L., Bo J., Lou Q., Lu F., Liu T., Yu L., Zhang S., Mony P., Swaminathan S., Mohan V., et. al.
New England Journal of Medicine scimago Q1 wos Q1 , 
2014-08-27,  citations by CoLab: 676 ,  Abstract  
More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown.We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years.The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P
Massachusetts Medical Society
Association of Urinary Sodium and Potassium Excretion with Blood Pressure
Mente A., O'Donnell M.J., Rangarajan S., McQueen M.J., Poirier P., Wielgosz A., Morrison H., Li W., Wang X., Di C., Mony P., Devanath A., Rosengren A., Oguz A., Zatonska K., et. al.
New England Journal of Medicine scimago Q1 wos Q1 , 
2014-08-13,  citations by CoLab: 670 ,  Abstract  
Higher levels of sodium intake are reported to be associated with higher blood pressure. Whether this relationship varies according to levels of sodium or potassium intake and in different populations is unknown.We studied 102,216 adults from 18 countries. Estimates of 24-hour sodium and potassium excretion were made from a single fasting morning urine specimen and were used as surrogates for intake. We assessed the relationship between electrolyte excretion and blood pressure, as measured with an automated device.Regression analyses showed increments of 2.11 mm Hg in systolic blood pressure and 0.78 mm Hg in diastolic blood pressure for each 1-g increment in estimated sodium excretion. The slope of this association was steeper with higher sodium intake (an increment of 2.58 mm Hg in systolic blood pressure per gram for sodium excretion >5 g per day, 1.74 mm Hg per gram for 3 to 5 g per day, and 0.74 mm Hg per gram for
Massachusetts Medical Society
Urinary Sodium and Potassium Excretion, Mortality, and Cardiovascular Events
O'Donnell M., Mente A., Rangarajan S., McQueen M.J., Wang X., Liu L., Yan H., Lee S.F., Mony P., Devanath A., Rosengren A., Lopez-Jaramillo P., Diaz R., Avezum A., Lanas F., et. al.
New England Journal of Medicine scimago Q1 wos Q1 , 
2014-08-13,  citations by CoLab: 698 ,  Abstract  
The optimal range of sodium intake for cardiovascular health is controversial.We obtained morning fasting urine samples from 101,945 persons in 17 countries and estimated 24-hour sodium and potassium excretion (used as a surrogate for intake). We examined the association between estimated urinary sodium and potassium excretion and the composite outcome of death and major cardiovascular events.The mean estimated sodium and potassium excretion was 4.93 g per day and 2.12 g per day, respectively. With a mean follow-up of 3.7 years, the composite outcome occurred in 3317 participants (3.3%). As compared with an estimated sodium excretion of 4.00 to 5.99 g per day (reference range), a higher estimated sodium excretion (≥ 7.00 g per day) was associated with an increased risk of the composite outcome (odds ratio, 1.15; 95% confidence interval [CI], 1.02 to 1.30), as well as increased risks of death and major cardiovascular events considered separately. The association between a high estimated sodium excretion and the composite outcome was strongest among participants with hypertension (P=0.02 for interaction), with an increased risk at an estimated sodium excretion of 6.00 g or more per day. As compared with the reference range, an estimated sodium excretion that was below 3.00 g per day was also associated with an increased risk of the composite outcome (odds ratio, 1.27; 95% CI, 1.12 to 1.44). As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a reduced risk of the composite outcome.In this study in which sodium intake was estimated on the basis of measured urinary excretion, an estimated sodium intake between 3 g per day and 6 g per day was associated with a lower risk of death and cardiovascular events than was either a higher or lower estimated level of intake. As compared with an estimated potassium excretion that was less than 1.50 g per day, higher potassium excretion was associated with a lower risk of death and cardiovascular events. (Funded by the Population Health Research Institute and others.).
BMJ
Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality
He F.J., Pombo-Rodrigues S., MacGregor G.A.
BMJ Open scimago Q1 wos Q1 Open Access , 
2014-04-15,  citations by CoLab: 313 ,  Abstract  
Objectives To determine the relationship between the reduction in salt intake that occurred in England, and blood pressure (BP), as well as mortality from stroke and ischaemic heart disease (IHD).Design Analysis of the data from the Health Survey for England.Setting and participants England, 2003 N=9183, 2006 N=8762, 2008 N=8974 and 2011 N=4753, aged ≥16 years.Outcomes BP, stroke and IHD mortality.Results From 2003 to 2011, there was a decrease in mortality from stroke by 42% (p<0.001) and IHD by 40% (p<0.001). In parallel, there was a fall in BP of 3.0±0.33/1.4±0.20 mm Hg (p<0.001/p<0.001), a decrease of 0.4±0.02 mmol/L (p<0.001) in cholesterol, a reduction in smoking prevalence from 19% to 14% (p<0.001), an increase in fruit and vegetable consumption (0.2±0.05 portion/day, p<0.001) and an increase in body mass index (BMI; 0.5±0.09 kg/m2, p<0.001). Salt intake, as measured by 24 h urinary sodium, decreased by 1.4 g/day (p<0.01). It is likely that all of these factors (with the exception of BMI), along with improvements in the treatments of BP, cholesterol and cardiovascular disease, contributed to the falls in stroke and IHD mortality. In individuals who were not on antihypertensive medication, there was a fall in BP of 2.7±0.34/1.1±0.23 mm Hg (p<0.001/p<0.001) after adjusting for age, sex, ethnic group, education, household income, alcohol consumption, fruit and vegetable intake and BMI. Although salt intake was not measured in these participants, the fact that the average salt intake in a random sample of the population fell by 15% during the same period suggests that the falls in BP would be largely attributable to the reduction in salt intake rather than antihypertensive medications.Conclusions The reduction in salt intake is likely to be an important contributor to the falls in BP from 2003 to 2011 in England. As a result, it would have contributed substantially to the decreases in stroke and IHD mortality.
Oxford University Press
Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality: A Meta-Analysis
Graudal N., Jürgens G., Baslund B., Alderman M.H.
American Journal of Hypertension scimago Q2 wos Q2 , 
2014-03-20,  citations by CoLab: 308 ,  Abstract  
The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (215 mmol).The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta-analyses.No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82-0.99; CVDEs: HR = 0.90, 95% CI = 0.82-0.99) and increased in high sodium vs. usual sodium intake (ACM: HR = 1.16, 95% CI = 1.03-1.30; CVDEs: HR = 1.12, 95% CI = 1.02-1.24). In population representative samples adjusted for multiple confounders, the HR for ACM was consistently decreased in usual sodium vs. low sodium intake (HR = 0.86; 95% CI = 0.81-0.92), but not increased in high sodium vs. usual sodium intake (HR = 1.04; 95% CI = 0.91-1.18). Within the usual sodium intake range, the number of events was stable (high usual sodium vs. low usual sodium: HR = 0.98; 95% CI = 0.92-1.03).Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.
Ovid Technologies (Wolters Kluwer Health)
Validation and comparison of three formulae to estimate sodium and potassium excretion from a single morning fasting urine compared to 24-h measures in 11 countries
Mente A., O’Donnell M.J., Dagenais G., Wielgosz A., Lear S.A., McQueen M.J., Jiang Y., Xingyu W., Jian B., Calik K.B., Akalin A.A., Mony P., Devanath A., Yusufali A.H., Lopez-Jaramillo P., et. al.
Journal of Hypertension scimago Q1 wos Q1 , 
2014-02-25,  citations by CoLab: 172 ,  Abstract  
Although 24-h urinary measure to estimate sodium and potassium excretion is the gold standard, it is not practical for large studies. We compared estimates of 24-h sodium and potassium excretion from a single morning fasting urine (MFU) using three different formulae in healthy individuals.We studied 1083 individuals aged 35-70 years from the general population in 11 countries. A 24-h urine and MFU specimen were obtained from each individual. A subset of 448 individuals repeated the measures after 30-90 days. The Kawasaki, Tanaka, and INTERSALT formulae were used to estimate urinary excretion from a MFU specimen.The intraclass correlation coefficient (ICC) between estimated and measured sodium excretion was higher with Kawasaki (0.71; 95% confidence interval, CI: 0.65-0.76) compared with INTERSALT (0.49; 95% CI: 0.29-0.62) and Tanaka (0.54; 95% CI: 0.42-0.62) formulae (P
Found 250
By date By citations
American Medical Association (AMA)
Sodium Reduction Legislation and Urinary Sodium and Blood Pressure in South Africa
Gaziano T., Kapaon D., du Toit J.D., Crowther N.J., Wade A.N., Fabian J., Riumallo-Herl C., Roberts-Toler F.C., Gómez-Olivé X., Tollman S.
JAMA Cardiology scimago Q1 wos Q1 , 
2025-02-05,  citations by CoLab: 0 ,  Abstract  
ImportanceReductions in dietary salt are associated with blood pressure reductions; however, national governments that have passed laws to reduce sodium intake have not measured these laws’ impact.ObjectiveTo determine if South African regulations restricting sodium content in processed foods were associated with reductions in sodium consumption and blood pressure.Design, Setting, and ParticipantsThe HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) study is a population-based cohort study among adults aged 40 years or older randomly selected from individuals living in rural Mpumalanga Province in South Africa. This study incorporated 3 waves of data (2014/2015, 2018/2019, and 2021/2022) from the HAALSI study to examine how 24-hour urine sodium (24HrNa) excretion changed among a population-based cohort following mandatory sodium regulations. Spot urine samples were collected across 3 waves, and data analysis was performed from 2023 to 2024.ExposuresSouth African regulations introduced in 2013 that reduced levels for the maximum amount of sodium in milligrams per 100 mg of food product by 25% to 80% across 13 processed food categories by 2019.Main Outcomes and Measures24HrNa was estimated using the INTERSALT equation, and generalized estimating equations were used to assess changes in sodium excretion and blood pressure.ResultsAmong 5059 adults 40 years or older, mean (SD) age was 62.43 years (13.01), and 2713 participants (53.6%) were female. Overall mean (SD) estimated 24HrNa excretion at baseline was 3.08 g (0.78). There was an overall reduction in mean 24HrNa excretion of 0.22 g (95% CI, −0.27 to −0.17; P &amp;lt; .001) between the first 2 waves and a mean reduction of 0.23 g (95% CI, −0.28 to −0.18; P &amp;lt; .001) between the first and third waves. The reductions were larger when analysis was restricted to those with samples in all 3 waves (−0.26 g for both waves 2 and 3 compared to wave 1). Every gram of sodium reduction was associated with a −1.30 mm Hg reduction (95% CI, 0.65-1.96; P = .00) in systolic blood pressure. The proportion of the study population that achieved ideal sodium consumption (&amp;lt;2 g per day) increased from 7% to 17%.Conclusion and RelevanceIn this cohort study, following South African regulations limiting sodium in 13 categories of processed foods, there was a significant reduction in 24HrNa excretion among this rural South African population, which was sustained with reductions in blood pressure consistent with levels of sodium excreted. These results support the potential health effects anticipated by effective implementation of population-based salt reformulation policies.
Elsevier
Mitochondrial Dysfunction of Astrocyte Induces Cell Activation under High Salt Condition
Qiu Y., Lu G., Zhang S., Minping L., Xue X., Junyu W., Zheng Z., Qi W., Guo J., Zhou D., Huang H., Deng Z.
Heliyon scimago Q1 wos Q1 Open Access , 
2024-12-01,  citations by CoLab: 0 , 
Eurasian clinical practice guidelines for dietary management of cardiovascular diseases (2024)
Starodubova A.V., Chazova I.E., Tutelyan V.A., Nikityuk D.B., Pavlovskaya E.V., Kislyak O.A., Blinova N.V., Brumberg A.A., Bubnova M.G., Varaeva Y.R., Gapparova K.M., Grinevich V.B., Gromova M.A., Demidova T.Y., Derbeneva S.A., et. al.
Eurasian heart journal Open Access , 
2024-11-22,  citations by CoLab: 0 ,  Abstract  
Eurasian clinical practice guidelines for dietary management of cardiovascular diseases include actual healthy diet recommendations and modern dietary approaches for prevention and treatment of cardiovascular diseases. Nutritional assessment and interventions based on pathogenesis of atherosclerosis and cardiovascular diseases are presented.Modern nutritional and dietary recommendations for patients with arterial hypertension, coronary heart disease, chronic heart failure, heart rhythm disorders, dyslipidemia and gout are summarized in present recommendations. Particular attention is paid to the dietary management of cardiovascular patients with obesity and/or diabetes mellitus. This guide would be interesting and intended to a wide range of readers, primarily cardiologists, dietitians and nutritionists, general practitioners, endocrinologists, and medical students.
Springer Nature
Usage of table salt and risk of all-cause and cardiovascular disease mortality among patients with diabetes: a national population-based cohort study
Wang Y., Chen H.
Diabetology and Metabolic Syndrome scimago Q1 wos Q2 Open Access , 
2024-11-10,  citations by CoLab: 0 ,  PDF,  Abstract  
A lower dietary sodium intake has been associated with a reduced risk of cardiovascular disease (CVD) mortality in the general population. However, the evidence is less clear in diabetic patients. The study aims to investigate whether the usage of table salt is associated with all-cause and CVD mortality among individuals with diabetes. In this prospective cohort study, participants with diabetes from the U.S. National Health and Nutritional Examination Survey (NHANES) 2003–2018 were included. Weighted linear regression models were employed to assess the association between the usage of table salt and dietary sodium intake. Weighted Cox proportional hazards regression models were used to assess the association between the usage of table salt and all-cause and CVD mortality. This cohort study included data from 6,258 participants in analysis. During 44,035 person-years of follow-up, 1,504 deaths from all-causes and 427 from CVD were documented. Not using table salt was significantly associated with lower dietary sodium intake, with a β of -192.60 (95% CI, -297.01 to -88.18) mg. A higher risk of all-cause and CVD mortality was observed in the group of participants not using table salt among patients with diabetes. Compared with participants using table salt, the hazard ratios for all-cause mortality were 1.18 (95% CI, 1.03 to 1.35), and for CVD were 1.48 (95 CI, 1.16 to 1.90) for participants not using table salt. The subgroup analysis revealed a significantly stronger link between the usage of table salt and all-cause mortality in participants with CVD (P for interaction = 0.004). This study indicated that not using table salt was associated with a lower dietary sodium intake, and an increased risk of all-cause and CVD mortality among individuals with diabetes. Interventional studies are needed to determine more beneficial relevant approaches to dietary management in diabetes care.
Oxford University Press
Dietary salt, vascular dysfunction, and cognitive impairment
Faraco G.
Cardiovascular Research scimago Q1 wos Q1 , 
2024-10-21,  citations by CoLab: 0 ,  Abstract  
Abstract Excessive salt consumption is a major health problem worldwide leading to serious cardiovascular events including hypertension, heart disease, and stroke. Additionally, high-salt diet has been increasingly associated with cognitive impairment in animal models and late-life dementia in humans. High-salt consumption is harmful for the cerebral vasculature, disrupts blood supply to the brain, and could contribute to Alzheimer’s disease pathology. Although animal models have advanced our understanding of the cellular and molecular mechanisms, additional studies are needed to further elucidate the effects of salt on brain function. Furthermore, the association between excessive salt intake and cognitive impairment will have to be more thoroughly investigated in humans. Since the harmful effects of salt on the brain are independent by its effect on blood pressure, in this review, I will specifically discuss the evidence, available in experimental models and humans, on the effects of salt on vascular and cognitive function in the absence of changes in blood pressure. Given the strong effects of salt on the function of immune cells, I will also discuss the evidence linking salt consumption to gut immunity dysregulation with particular attention to the ability of salt to disrupt T helper 17 (Th17) cell homeostasis. Lastly, I will briefly discuss the data implicating IL-17A, the major cytokine produced by Th17 cells, in vascular dysfunction and cognitive impairment.
SAGE
Is fluid retention a cardiovascular risk factor?
Blankfield R.P.
Clinical Hemorheology and Microcirculation scimago Q3 wos Q3 , 
2024-10-18,  citations by CoLab: 1 ,  Abstract  
Endothelial dysfunction, the earliest manifestation of atherosclerosis, can be initiated by both biochemicals and biomechanical forces. Atherosclerosis occurs predominantly at arterial branch points, arterial bifurcations and the curved segments of great arteries. These are the regions that blood flows turbulently. Turbulence promotes endothelial dysfunction by reducing shear stress upon endothelial cells. The endothelial glycocalyx mediates the effect of shear stress upon the endothelium. A mathematical analysis of cardiovascular hemodynamics demonstrates that fluid retention increases turbulence of blood flow. While there is no empirical data confirming this relationship, fluid retention is associated with adverse cardiovascular events. Every medical condition that causes fluid retention is associated with increased risk of both atherosclerotic cardiovascular disease and venous thromboembolic disease. In addition, most medications that cause fluid retention are associated with increased adverse cardiovascular effects. Calcium channel blockers (CCBs) and pioglitazone are exceptions to this generalization. Even though data regarding CCBs and pioglitazone contradict the hypothesis that fluid retention is a cardiovascular risk factor, these medications have favorable cardiovascular properties which may outweigh the negative effect of fluid retention. Determining whether or not fluid retention is a cardiovascular risk factor would require empirical data demonstrating a relationship between fluid retention and turbulence of blood flow. While this issue should be relevant to cardiovascular researchers, clinicians and patients, it is especially pertinent to the pharmaceutical industry. Four-dimensional magnetic resonance imaging and vector flow Doppler ultrasound have the capability to quantify turbulence of blood flow. These technologies could be utilized to settle the matter.
Ovid Technologies (Wolters Kluwer Health)
Association between early menarche and hypertension in pre and postmenopausal women: Baependi Heart Study
Martinho L.C., Zaniqueli D., Andreazzi A.E., Oliveira C.M., Pereira A.C., Alvim R.D.
Journal of Hypertension scimago Q1 wos Q1 , 
2024-10-16,  citations by CoLab: 0 ,  Abstract  
Background: Early menarche has been associated with an increased risk of arterial hypertension. Whether the association between early menarche and hypertension is independent of menopausal status is unknown. This study aimed to investigate the association between early menarche and hypertension in pre and postmenopausal women. Methods: This cross-sectional study analyzed data from 1406 women aged 18–100. Age at menarche, menopause status, hemodynamic, anthropometric, and biochemical data were collected by using standard protocols. Menarche <12 years was defined as early menarche. Systolic blood pressure ≥140 mmHg and/or diastolic ≥90 mmHg and/or intake of antihypertensive medication, were used as criteria for hypertension. Results: In total, 21.3% of women had early menarche (<12 years), and the frequency of hypertension was 38.7%. Premenopausal women with early menarche had a 58% higher chance of developing hypertension, even after adjusting for age, obesity, and smoking [odds ratio (OR) 1.58; (95% confidence interval, CI 1.016–2.461)]. In postmenopausal women, age, obesity, and diabetes mellitus were predictors of hypertension, while early menarche was not. Conclusion: The odds of hypertension were higher with early menarche, but only in women of reproductive age. In postmenopausal women, the physiological changes inherent to aging and the presence of more comorbidities, such as diabetes, might overlap the influence of early menarche on hypertension.
Springer Nature
Does casual urine Na/K ratio predict 24 h urine Na/K ratio in treated hypertensive patients? Comparison between casual urine voided in the morning vs. 24 h urine collected on the previous day
Arakawa K., Tominaga M., Sakata S., Tsuchihashi T.
Hypertension Research scimago Q2 wos Q1 , 
2024-10-12,  citations by CoLab: 1 ,  Abstract  
The urine sodium-to-potassium (Na/K) ratio is associated with blood pressure and cardiovascular diseases. A single urine sample is preferable for determining the Na/K ratio in clinical practice. We evaluated whether the Na/K ratio measured using morning casual urine samples predicts the ratio measured using the preceding 24 h urine sample in patients with hypertension. The study included 187 hypertensive patients (mean age 66.1 years, 52.4% female) whose Na and K concentrations were measured both in 24 h (24Na/K) and casual urine the next morning (CNa/K). The Na/K ratios were 3.54 ± 1.5 in 24NaK and 2.63 ± 1.9 in CNa/K. The two estimates showed a significant positive correlation (r = 0.49, p < 0.0001), and (CNa/K-24Na/K)/24Na/K was −23.5 ± 44.4%. In the Bland–Altman plot, the mean difference was −0.91. When CNa/K was divided into three groups, <2 (low), 2–4 (medium), and ≥4 (high), the overall agreement with 24Na/K was 46.0% (86 of 187). The low group had 24.4% agreement and 75.6% underestimation (24Na/K > CNa/K); the medium group had 60.8% agreement, 30.5% underestimation, and 8.7% overestimation (24Na/K < CNa/K); and the high group had 71.8% agreement and 28.2% overestimation. These results indicate that CNa/K and 24Na/K were significantly correlated; however, CNa/K was generally lower than 24Na/K, particularly at Na/K levels < 2. Further efforts should be made to address the validity of using casual urine Na/K ratios in hypertension management practices.
Ovid Technologies (Wolters Kluwer Health)
Genetic Variance in Heparan Sulfation Is Associated With Salt Sensitivity
Oppelaar J.J., Ferwerda B., Romman M.A., Sahebdin G.N., Zwinderman A.H., Galenkamp H., Boekholdt S.M., van den Born B.H., Olde Engberink R.H., Vogt L.
Hypertension scimago Q1 wos Q1 , 
2024-10-01,  citations by CoLab: 0 ,  Abstract  
BACKGROUND: High heritability of salt sensitivity suggests an essential role for genetics in the relationship between sodium intake and blood pressure (BP). The role of glycosaminoglycan genes, which are crucial for salinity tolerance, remains to be elucidated. METHODS: Interactions between 54 126 variants in 130 glycosaminoglycan genes and daily sodium excretion on BP were explored in 20 420 EPIC-Norfolk (European Prospective Investigation Into Cancer in Norfolk) subjects. The UK Biobank (n=414 132) and the multiethnic HELIUS study (Healthy Life in an Urban Setting; n=2239) were used for validation. Afterward, the urinary glycosaminoglycan composition was studied in HELIUS participants (n=57) stratified by genotype and upon dietary sodium loading in a time-controlled crossover intervention study (n=12). RESULTS: rs2892799 in NDST3 (heparan sulfate N-deacetylase/N-sulfotransferase 3) showed the strongest interaction with sodium on mean arterial pressure (false discovery rate 0.03), with higher mean arterial pressure for the C allele in high sodium conditions. Also, rs9654628 in HS3ST5 (heparan sulfate-glucosamine 3-sulfotransferase 5) showed an interaction with sodium on systolic BP (false discovery rate 0.03). These interactions were multiethnically validated. Stratifying for the rs2892799 genotype showed higher urinary expression of N-sulfated heparan sulfate epitope D0S0 for the T allele. Conversely, upon dietary sodium loading, urinary D0S0 expression was higher in participants with stable BP after sodium loading, and sodium-induced effects on this epitope were opposite in individuals with and without BP response to sodium. CONCLUSIONS: The C allele of rs2892799 in NDST3 exhibits higher BP in high sodium conditions when compared with low sodium conditions, whereas no differences were detected for the T allele. Concomitantly, both alleles demonstrate distinct expressions of D0S0, which, in turn, correlates with sodium-mediated BP elevation. These findings underscore the potential significance of genetic glycosaminoglycan variation in human BP regulation.
IMR Press
Association of Adding Salt to Foods and Potassium Intake with Incident Atrial Fibrillation in the UK Biobank Study
Joung B., Sung J., Cho Y., Lee J.H., Kim N., Kim H.N., Kim D., Jang E., Park J.S., Park B.E., Yang P., Park Y.J.
Reviews in Cardiovascular Medicine scimago Q2 wos Q3 Open Access , 
2024-09-19,  citations by CoLab: 0 ,  Abstract  
Background: High sodium and low potassium consumption are related to hypertension and cardiovascular disease. We aimed to determine the relationship between the frequency of salt addition and potassium consumption with the risk of new-onset atrial fibrillation (AF). Methods: Our study used the UK Biobank cohort, which included over 500,000 individuals enrolled from the United Kingdom between 2006 and 2010. This study involved 416,868 participants who filled out the dietary recall regarding the frequency of salt addition. Results: During follow-up, 19,164 (4.6%) developed AF. The incidence of new-onset AF was increased based on the frequency of salt addition (never/rarely 3.83; always 4.72 per 1000 person-years). Compared with the group that never/rarely added salt, those adding salt always were at significantly higher risk of incident AF after adjusting for multiple variables (hazard ratio (HR) 1.15; 95% confidence interval (CI) 1.06–1.24), and additional adjustment of dietary and total energy consumption (HR 1.37; 95% CI 1.08–1.73). In the subgroup analysis, the risk of AF incident according to the frequency of salt addition significantly increased in low urine potassium levels compared to high (p for interaction = 0.046). In the subgroup analysis for AF patients, higher salt addition frequency was related to increased all-cause mortality. Conclusions: Our study demonstrated that adding salt to foods more frequently increases the risk of incident AF, even after adjusting for dietary and total energy consumption. In the high urine potassium group, the impact of high sodium consumption on incident AF was attenuated.
Wiley
Effect of sodium bicarbonate with ultrasound on reduced‐salt Chaozhou beef meatballs quality: Physicochemical and sensory properties
You Q., Mao R., Yuan Y., Zhang L., Tian X., Xu X.
Food Bioengineering scimago Q3 Open Access , 
2024-09-11,  citations by CoLab: 0 ,  PDF,  Abstract  
AbstractThis study aimed to create a reduced‐salt version of Chaozhou beef meatballs (CBMs) by employing ultrasound treatment (0 and 30 min) combined with sodium bicarbonate (0%, 0.15%, and 0.3%). The ultrasound‐assisted sodium bicarbonate treatment significantly enhanced pH, salt‐soluble protein solubility (SSP), water‐holding capacity (WHC), and storage modulus (G′) of the CBMs (p < 0.05). Specifically, after treatment, the increase in pH value promoted the solubilization of SSP, with the content increasing from 28.23% to 56.53%. Moreover, the initial relaxation times (T21 and T22) were shortened, indicating a decrease in water mobility, as evidenced by an increase in WHC from 85% to 87%. Furthermore, the ultrasound treatment effectively facilitated protein unfolding, increased β‐sheet secondary structure content, augmented hydrogen and disulfide bond proportions, and resulted in a denser and more uniform gel structure. Consequently, the hardness of the CBMs was significantly improved (p < 0.05). Sensory evaluation revealed that the treated reduced‐salt CBMs were comparable to those produced by conventional methods. Therefore, combining sodium bicarbonate with ultrasound treatment is a viable approach to mitigate the negative effects of reduced salt content and produce high‐quality reduced‐salt CBMs.
Springer Nature
Left ventricular structure and function in relation to sodium dietary intake and renal handling in untreated Chinese patients
Cheng Y., Chan C., Xu T., Chen Y., Ding F., Li Y., Wang J.
Hypertension Research scimago Q2 wos Q1 , 
2024-09-09,  citations by CoLab: 3 ,  Abstract  
Whether left ventricular structure and function is associated with sodium dietary intake and renal handling while considering blood pressure (BP) remains unclear. Consecutive untreated patients referred for ambulatory BP monitoring were recruited. Standard echocardiography was performed to measure left ventricular structure and function. Fractional excretion of lithium (FELi) and fractional distal reabsorption rate of sodium (FDRNa) were calculated as markers of proximal and distal tubular sodium handling, respectively. The 952 participants (51.0% women; mean age, 50.8 years) included 614 (64.5%) ambulatory hypertension and 103 (10.8%) left ventricular hypertrophy. There were significant interactions of urinary sodium excretion with FELi (P ≤ 0.045), but not FDRNa (P ≥ 0.36), in relation to left ventricular posterior wall thickness (LVPW), mass (LVM) and mass index (LVMI), but not functional measurements. Only in tertile 1 of FELi, the multivariate-adjusted regression coefficients for urinary sodium excretion reached statistical significance (P ≤ 0.049), being 0.16 ± 0.05 mm, 4.32 ± 1.48 g, and 1.64 ± 0.83 g/m2 for LVPW, LVM and LVMI, respectively. In mutually adjusted analyses, the regression coefficient for LVMI was statistically significant for FELi, FDRNa and 24-h systolic BP, being –2.17 ± 0.49, –1.95 ± 0.54, and 2.99 ± 0.51 g/m2, respectively (P < 0.001). Multivariable analysis of variance showed that sodium renal handling indexes (P ≥ 0.14), but not sodium urinary excretion (P = 0.007), were similarly as 24-h BP associated with LVMI. Heat maps on left ventricular hypertrophy provided a graphical confirmation of the findings. Sodium dietary intake and renal handling interact to be associated with left ventricular structure. Renal handling indexes were similarly in size as, jointly in action with and independently of 24-h BP.
Oxford University Press
2024 ESC Guidelines for the management of elevated blood pressure and hypertension
McEvoy J.W., McCarthy C.P., Bruno R.M., Brouwers S., Canavan M.D., Ceconi C., Christodorescu R.M., Daskalopoulou S.S., Ferro C.J., Gerdts E., Hanssen H., Harris J., Lauder L., McManus R.J., Molloy G.J., et. al.
European Heart Journal scimago Q1 wos Q1 , 
2024-08-30,  citations by CoLab: 202 , 
MDPI
Fermented Fish Products: Balancing Tradition and Innovation for Improved Quality
Li H., Li G., Bi Y., Liu S.
Foods scimago Q1 wos Q1 Open Access , 
2024-08-16,  citations by CoLab: 0 ,  PDF,  Abstract  
The flavor profile of fermented fish products is influenced by the complex interplay of microbial and enzymatic actions on the raw materials. This review summarizes the various factors contributing to the unique taste and aroma of these traditional foods. Key ingredients include locally sourced fish species and a variety of spices and seasonings that enhance flavor while serving as cultural markers. Starter cultures also play a critical role in standardizing quality and accelerating fermentation. Flavor compounds in fermented fish are primarily derived from the metabolism of carbohydrates, lipids, and proteins, producing a diverse array of free amino acids, peptides, and volatile compounds such as aldehydes, ketones, alcohols, and esters. The fermentation process can be shortened by certain methods to reduce production time and costs, allowing for faster product turnover and increased profitability in the fermented fish market. Fermented fish products also show potent beneficial effects. This review highlights the importance of integrating traditional practices with modern scientific approaches. Future research directions to enhance the quality of fermented fish products are suggested.
Silicea - Poligraf, LLC
Nutritional status and the risk of cardiovascular events. Results of a 6-year prospective follow-up of the ESSE-RF study cohort
Karamnova N.S., Kapustina A.V., Kutsenko V.A., Shvabskaya O.B., Balanova Y.A., Evstifeeva S.E., Imaeva A.E., Kotova M.B., Maksimov S.A., Muromtseva G.A., Kulakova N.V., Kalachikova O.N., Chernykh T.M., Belova O.A., Artamonova G.V., et. al.
Russian Journal of Cardiology scimago Q4 Open Access , 
2024-08-15,  citations by CoLab: 0 ,  Abstract  
Research data indicate an increase in the risk of cardiovascular events (CVEs) with unhealthy diet.Aim. To assess the impact of diet on the development of cardiovascular events in the Russian population.Material and methods. The prospective cohort included representative samples of 10 Russian regions (n=17175, 6767 men and 10408 women aged 25-64 years), examined in 2012-2014 as part of the ESSE-RF study. The diet was studied by the frequency of consumption of the main food groups. The vital status of the cohort was clarified every 2 years. The follow-up period was 6 years. Kaplan-Meier survival curves were used to analyze survival, and the Cox proportional hazards model was used to assess the risk of CVEs.Results. Analysis of Kaplan-Meier curves showed better survival before the CVEs in the general population with daily consumption of cottage cheese (p=0,0029), cheese (p=0,00017), red meat (p=0,036) and the presence of the healthy eating model in the diet (p=0,013). A decrease in survival before the CVE onset was noted with excess salt intake (ESI) in the diet (p=0,0038) and the habit of adding salt to food (p=0,0032).Among men, a decrease in survival before the CVE onset was noted with ESI (p=0,018) and the habit of adding salt to food (p=0,047), and an increase — with regular consumption of red meat (p=0,00027). Among women, daily consumption of red meat (p=0,038), cheese (p=0,026), cottage cheese (p=0,019), as well as rare consumption of fatty dairy products (sour cream/cream) (p=0,04) delay the CVE onset. In the general population, in a univariate Cox proportional hazards analysis, daily cheese consumption and healthy eating model significantly reduce the risk of CVEs — 0,74 (0,61-0,89) and 0,78 (0,65-0,94), respectively, and excess salt and adding salt to food increase the CVE risk — 1,33 (1,12-1,59) and 1,33 (1,111,58), respectively. However, after introducing correction for socio-demographic indicators and risk factors, the significance is lost. In men, adding salt to food significantly increases the risk of cardiovascular events as follows: odds ratio 1,34 (1,04-1,73). Other eating habits are significant only in univariate analysis and lose their significance after introducing corrections.Conclusion. Adding salt to food significantly increases the risk of cardiovascular events among men of active working age.

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Nutrients
Nutrients, 13, 5.2%
Journal of Hypertension
Journal of Hypertension, 11, 4.4%
Hypertension
Hypertension, 10, 4%
Journal of Human Hypertension
Journal of Human Hypertension, 8, 3.2%
Journal of Clinical Hypertension
Journal of Clinical Hypertension, 8, 3.2%
Hypertension Research
Hypertension Research, 7, 2.8%
The Lancet
The Lancet, 7, 2.8%
European Heart Journal
European Heart Journal, 7, 2.8%
British Journal of Nutrition
British Journal of Nutrition, 4, 1.6%
Nutrition Research and Practice, 4, 1.6%
Journal of Clinical Medicine
Journal of Clinical Medicine, 3, 1.2%
Frontiers in Endocrinology
Frontiers in Endocrinology, 3, 1.2%
Frontiers in Nutrition
Frontiers in Nutrition, 3, 1.2%
European Journal of Clinical Nutrition
European Journal of Clinical Nutrition, 3, 1.2%
Kidney International Reports
Kidney International Reports, 3, 1.2%
Journal of Nutrition
Journal of Nutrition, 3, 1.2%
Cardiovascular Research
Cardiovascular Research, 3, 1.2%
BMJ
BMJ, 3, 1.2%
Annals of Internal Medicine
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Journal of the American Heart Association
Journal of the American Heart Association, 2, 0.8%
International Journal of Environmental Research and Public Health
International Journal of Environmental Research and Public Health, 2, 0.8%
Frontiers in Public Health
Frontiers in Public Health, 2, 0.8%
CME
CME, 2, 0.8%
Nature Reviews Nephrology
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MMW Fortschritte der Medizin
MMW Fortschritte der Medizin, 2, 0.8%
Scientific Reports
Scientific Reports, 2, 0.8%
Kidney International
Kidney International, 2, 0.8%
Journal of Renal Nutrition
Journal of Renal Nutrition, 2, 0.8%
Clinical Nutrition ESPEN
Clinical Nutrition ESPEN, 2, 0.8%
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Elsevier
Elsevier, 45, 18%
Springer Nature
Springer Nature, 42, 16.8%
Ovid Technologies (Wolters Kluwer Health)
Ovid Technologies (Wolters Kluwer Health), 28, 11.2%
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Oxford University Press
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Wiley
Wiley, 12, 4.8%
Frontiers Media S.A.
Frontiers Media S.A., 11, 4.4%
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American Medical Association (AMA), 6, 2.4%
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American Society for Nutrition
American Society for Nutrition, 5, 2%
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Cambridge University Press, 5, 2%
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BMJ, 5, 2%
XMLink, 3, 1.2%
American College of Physicians
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American Physiological Society
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Royal Society of Chemistry (RSC)
Royal Society of Chemistry (RSC), 2, 0.8%
Silicea - Poligraf, LLC
Silicea - Poligraf, LLC, 2, 0.8%
Non-profit organization Nephrology, 2, 0.8%
The Korean Society of Community Nutrition, 2, 0.8%
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The Endocrine Society, 1, 0.4%
Massachusetts Medical Society
Massachusetts Medical Society, 1, 0.4%
PeerJ
PeerJ, 1, 0.4%
IOP Publishing
IOP Publishing, 1, 0.4%
Public Library of Science (PLoS)
Public Library of Science (PLoS), 1, 0.4%
CMA Impact Inc.
CMA Impact Inc., 1, 0.4%
Nippon-Shinzobyo-Gakkai/Japanese College of Cardiology, 1, 0.4%
American Chemical Society (ACS)
American Chemical Society (ACS), 1, 0.4%
American Association for the Advancement of Science (AAAS)
American Association for the Advancement of Science (AAAS), 1, 0.4%
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