UPDATED!! Time to end the war on Salt?

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

Moderators: JeffN, carolve, Heather McDougall

Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Dec 31, 2014 10:38 am

viewtopic.php?f=22&t=45784

Interesting comments on salt - from Dr McD's youTube page

Jeff,

Some interesting comments on low salt diets in this recording.

He says low salt diets can be just an dangerous as too much - that the sodium/potassium ratio is the real issue and too little sodium
can cause increased mortality (increases insulin resistance, increases vascular tone...)... says are most are safe up to 6g per day.

I am not trying to re-start the war on salt... but I prefer a little salt.. as I think most do and found this to be good news about what I thought was a bad habit.... :)

https://www.youtube.com/watch?v=rVK5fLtPQKI


The McDougall diet is a low(er) sodium diet and our recommendations are very similar and I teach my guidelines in several classes during the 10-day program. We both agree that, for those who want, if you remove the salt from the food, you can add some at the table and still not over do it. His position is often misrepresented.

Quoting from Dr McDougall's most recent book, the Starch Solution:

"Adding a half teaspoon of salt at the table to your starch-based meals over the course of a day adds about 1,110 milligrams of sodium, for a daily total of about 1600 milligrams, 700 milligrams below the 2010 USDA Dietary Guidelines of less than 2,300 milligrams daily,"

That is identical to my guidelines and can only be achieved by greatly minimizing and/or avoiding added salt in the food. If adding a 1/2 tsp, which is 1110, brings you to 1600, that means you will be getting about 490 in the food. A natural diet with no added salt/sodium will provide about 350-500 mg. So, the only way to do this is to consume food with no added salt, which gives you the 350-500, then add in the 1/2 tsp (1110) and you are at around 1600.

The recent speaker at the ASW, whose video was recently uploaded and circulated, does not represent the McDougall program or his views but as is the case with many ASW speakers, they are invited to present their opinions which may differ from Dr McDougall's.

The discussion covers all the studies that "appear" to show some harm in lower intakes and why that is and why it is not applicable to us or most of the population. About 90-99% of Americans take in too much sodium and would benefit from a reduction. Less than 1%, who are in a unique situation, may be harmed from a lower intake. The visual of the bar chart near the end of the discussion puts this in a perspective.

As I said above, we actually do serve a low(er) sodium diet at the 10-day program and have some who are asked to follow even a lower sodium diet. Dr McD just does not want you to be afraid of adding some at the table if you find it necessary to enjoy the food.

All of this is covered in the discussion above

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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Jan 31, 2015 12:02 pm

Another study suggesting that excessive salt intake is harmful and the elevated BP it causes is simply one of numerous pathophysiological effects it promotes. This new study shows salt toxicity directly harms the kidney and does so at least in part by activating the renin-angiotensin system which then promotes fibrotic changes in the kidney that almost certainly speed up the progression of renal damage/disease.

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A Salt-Induced Reno-Cerebral Reflex Activates Renin-Angiotensin Systems and Promotes CKD Progression
J Am Soc Nephrol. 2015 Jan 29. pii: ASN.2014050518.
http://www.ncbi.nlm.nih.gov/pubmed/2563 ... t=Abstract

Abstract

Salt intake promotes progression of CKD by uncertain mechanisms. We hypothesized that a salt-induced reno-cerebral reflex activates a renin-angiotensin axis to promote CKD. Sham-operated and 5/6-nephrectomized rats received a normal-salt (0.4%), low-salt (0.02%), or high-salt (4%) diet for 2 weeks. High salt in 5/6-nephrectomized rats increased renal NADPH oxidase, inflammation, BP, and albuminuria. Furthermore, high salt activated the intrarenal and cerebral, but not the systemic, renin-angiotensin axes and increased the activity of renal sympathetic nerves and neurons in the forebrain of these rats. Renal fibrosis was increased 2.2-fold by high versus low salt, but intracerebroventricular tempol, losartan, or clonidine reduced this fibrosis by 65%, 69%, or 59%, respectively, and renal denervation or deafferentation reduced this fibrosis by 43% or 38%, respectively (all P<0.05). Salt-induced fibrosis persisted after normalization of BP with hydralazine. These data suggest that the renal and cerebral renin-angiotensin axes are interlinked by a reno-cerebral reflex that is activated by salt and promotes oxidative stress, fibrosis, and progression of CKD independent of BP.



Kidney-brain connection may help drive chronic kidney disease
Study's findings suggest new targets to preserve kidney function
American Society of Nephrology.
29-JAN-2015

http://www.eurekalert.org/pub_releases/ ... 012315.php

Highlights

Salt intake accelerated kidney scarring in rats with chronic kidney disease by activating a brain-kidney connection called the renin-angiotensin axis that interlinks the damaged kidney and brain by afferent and efferent sympathetic nerves.
Targeting these nerves reduced salt-induced kidney scarring.

Washington, DC (January 29, 2015) -- In addition to affecting blood pressure, high-salt intake can promote kidney function decline in patients with chronic kidney disease. A study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) reveals that the effects of salt consumption on the kidneys are mediated at least in part by brain-kidney interactions. The findings suggest new strategies for protecting patients' kidney health.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Fri Feb 13, 2015 8:44 pm

The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. The SODIUM-HF (Study of Dietary Intervention Under 100 mmol in Heart Failure): A pilot study.
Colin-Ramirez E, McAlister FA, Zheng Y, Sharma S, Armstrong PW, Ezekowitz JA.
Am Heart J. 2015 Feb;169(2):274-281.e1. doi: 10.1016/j.ahj.2014.11.013. Epub 2014 Nov 20.
PMID:25641537
http://www.ahjonline.com/article/S0002-8703(14)00721-2/fulltext
http://www.ahjonline.com/article/S0002-8703(14)00721-2/pdf

Abstract

AIMS: To determine the feasibility of conducting a randomized controlled trial comparing a low-sodium to a moderate-sodium diet in heart failure (HF) patients.

METHODS AND RESULTS: Patients with HF (New York Heart Association classes II-III) were randomized to low (1500 mg/d) or moderate-sodium (2300 mg/d) diet. Dietary intake was evaluated using 3-day food records. The end points were changes in quality of life as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and B-type natriuretic peptide (BNP) levels from baseline to 6 months of follow-up presented as medians [25th, 75th percentiles]. Thirty-eight patients were enrolled (19/group). After 6 months, median sodium intake declined from 2137 to 1398 mg/d in the low-sodium and from 2678 to 1461 mg/d in the moderate-sodium diet group. Median BNP levels in the low-sodium diet group declined (216-71 pg/mL, P = .006), whereas in the moderate-sodium diet group, there was no change in BNP (171-188 pg/mL, P = .7; P = .17 between groups). For 6 months, median KCCQ clinical score increased in both groups (63-75 [P = .006] in the low-sodium diet group and 66-73 [P = .07] in the moderate-sodium group; P = .4 between groups). At 6 months, a post hoc analysis based on the dietary sodium intake achieved (> or </=1500 mg/d) in all patients showed an association between a sodium intake </=1500 mg/d and improvement in BNP levels and KCCQ scores.

CONCLUSIONS: A dietary intervention restricting sodium intake was feasible, and achievement of this sodium goal was associated with lower BNP levels and improved quality of life in patients with HF.


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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Mon Mar 02, 2015 5:41 pm

http://ajcn.nutrition.org/content/101/3 ... tract?etoc

Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study
Am J Clin Nutr March 2015 vol. 101 no. 3 440-448

Abstract

Background: Excess sodium intake is associated with high blood pressure, a major risk factor for cardiovascular disease (CVD). It is unknown whether decreasing sodium intake to <2300 mg/d has an effect on CVD or all-cause mortality.

Objective: The objective was to assess whether reductions in sodium intake to <2300 mg/d were associated with either an increased or a decreased risk of fatal and nonfatal CVD and all-cause mortality.

Design: This observational prospective study of the PREvención con DIeta MEDiterránea (PREDIMED) trial included 3982 participants at high CVD risk. Sodium intake was evaluated with a validated food-frequency questionnaire and categorized as low (<1500 mg/d), intermediate (≥1500 to ≤2300 mg/d), high (>2300 to ≤3400 mg/d), or very high (>3400 mg/d). Subsequently, 1-y and 3-y changes in sodium intake were calculated. Multivariate relative risks were assessed by using Cox proportional hazards ratios. Marginal structural models with inverse probability weighting were used to test the effect of changes in sodium intake and the Mediterranean diet (MedDiet).

Results: We documented 125 CVD events and 131 deaths after a 4.8-y median follow-up. Sodium intake <2300 mg/d was associated with a lower risk of all-cause mortality: 48% (HR: 0.52; 95% CI: 0.30, 0.91; P = 0.02) and 49% (HR: 0.51; 95% CI: 0.26, 0.98; P = 0.04) after 1 and 3 y, respectively. Increasing sodium intake after 1 y was associated with a 72% (HR: 1.72; 95% CI: 1.01, 2.91; P = 0.04) higher risk of CVD events. The incidence rate of CVD was reduced for those who reduced their sodium intake and were randomly assigned to MedDiet interventions [4.1/10,000 (95% CI: 3.1, 8.0) compared with 4.4/10,000 (95% CI: 2.7, 12.4) person-years; P = 0.002].

Conclusions: Decreasing sodium intake to <2300 mg/d was associated with a reduced risk of all-cause mortality, whereas increasing the intake to >2300 mg/d was associated with a higher risk of CVD. Our observational data suggest that sodium intake <2300 mg/d was associated with an enhanced beneficial effect of the MedDiet on CVD. These results should be interpreted with caution, and other confirmatory studies are necessary. This study was registered at controlled-trials.com as 35739639.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Mar 11, 2015 4:05 am

Dietary Sodium and Health: More Than Just Blood Pressure
William B. Farquhar, PhD∗; David G. Edwards, PhD∗; Claudine T. Jurkovitz, MD†; William S. Weintraub, MD†
J Am Coll Cardiol. March 17, 2015,65(10):1042-1050 doi:10.1016/j.jacc.2014.12.039

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5098396/

ABSTRACT

Sodium is essential for cellular homeostasis and physiological function. Excess dietary sodium has been linked to elevations in blood pressure (BP). Salt sensitivity of BP varies widely, but certain subgroups tend to be more salt sensitive. The mechanisms underlying sodium-induced increases in BP are not completely understood but may involve alterations in renal function, fluid volume, fluid-regulatory hormones, the vasculature, cardiac function, and the autonomic nervous system. Recent pre-clinical and clinical data support that even in the absence of an increase in BP, excess dietary sodium can adversely affect target organs, including the blood vessels, heart, kidneys, and brain. In this review, the investigators review these issues and the epidemiological research relating dietary sodium to BP and cardiovascular health outcomes, addressing recent controversies. They also provide information and strategies for reducing dietary sodium.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Mar 26, 2015 9:19 am

"No study that met inclusion criteria found harm from lowering dietary salt."


The Science of Salt: A Systematic Review of Clinical Salt Studies 2013 to 2014.
Johnson C, Raj TS, Trudeau L, Bacon SL, Padwal R, Webster J, Campbell N.
J Clin Hypertens (Greenwich). 2015 Mar 19. doi: 10.1111/jch.12529. [Epub ahead of print]
PMID:25789451
http://onlinelibrary.wiley.com/doi/10.1 ... 12529/full
http://onlinelibrary.wiley.com/doi/10.1 ... .12529/pdf

Abstract

The authors provided a systematic review of the clinical and population health impact of increased dietary salt intake during 1 year.

Randomized controlled trials or cohort studies or meta-analyses on the effect of sodium intake were examined from Medline searches between June 2013 to May 2014.

Quality indicators were used to select studies that were relevant to clinical and public health.

A total of 213 studies were reviewed, of which 11 (n=186,357) were eligible.

These studies confirmed a causal relationship between increasing dietary salt and increased blood pressure and an association between several adverse health outcomes and increased dietary salt. A new association between salt intake and renal cell cancer was published. No study that met inclusion criteria found harm from lowering dietary salt.

The findings of this systematic review are consistent with previous data relating increased dietary salt to increased blood pressure and adverse health outcomes.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Apr 14, 2015 5:56 am

Effect of sodium restriction on blood pressure of unstable or uncontrolled hypertensive patients in primary care.
De Keyzer W, Tilleman K, Ampe J, De Henauw S, Huybrechts I.
Nutr Res Pract. 2015 Apr;9(2):180-5. doi: 10.4162/nrp.2015.9.2.180. Epub 2015 Feb 6.
PMID:25861425
http://www.ncbi.nlm.nih.gov/pmc/article ... rt=classic
http://www.ncbi.nlm.nih.gov/pmc/article ... -9-180.pdf

Abstract

BACKGROUND/OBJECTIVES: The aims of the present study are: 1) to quantify sodium consumption of patients with unstable or uncontrolled hypertension, 2) to investigate if reduced sodium intake can lower BP in these patients, and 3), to assess the acceptability and feasibility of this approach.

SUBJECTS/METHODS: This study included 25 adults (age: 50+ years) with frequently elevated BP or patients with uncontrolled, uncomplicated hypertension despite drug treatment in a general practice setting. BP and salt intake (24h urinary excretion and food records) were measured at baseline and after a sodium reduced diet.

RESULTS: Mean (±SD) systolic (SBP) over diastolic (DBP) blood pressure (mmHg) at baseline was 150.7 (±9.5)/84.149 (±5.6). Mean urinary sodium excretion was 146 mmol/24h. A reduction of 28 mmol sodium excretion decreased SBP/DBP to 135.5 (±13.0)/82.5 (±12.8) (P < 0.001). After one month of no dietary advice, only in 48%, SBP was still </=140 mmHg.

CONCLUSION: Assessment of sodium intake using food records, 24h urine collections and probing questions to identify use of sodium containing supplements or drugs are essential for tailored advice targeted at sodium intake reduction. The results of the present study indicate that reduced sodium intake can lower BP after 4 weeks in unstable or uncontrolled hypertensive patients.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Mon Jun 01, 2015 1:30 pm

Association between 24 h urinary sodium and potassium excretion and the metabolic syndrome in Chinese adults: the Shandong and Ministry of Health Action on Salt and Hypertension (SMASH) study.
Br J Nutr. 2015 Mar;113(6):996-1002. doi: 10.1017/S0007114514003833. Epub 2015 Mar 6.
PMID: 25743698

Abstract
The association of 24 h urinary Na and potassium excretion with the risk of the metabolic syndrome (MetS) has not been studied in China. The aim of the present study was to examine this association by analysing the data from 1906 study participants living in north China. To this end, 24 h urine samples were collected. Of the 1906 participants, 471 (24·7 %) had the MetS. The mean urinary Na and K excretion was 228·7 and 40·8 mmol/d, respectively. After multivariate adjustment, the odds of the MetS significantly increased across the increasing tertiles of urinary Na excretion (1·00, 1·40 and 1·54, respectively). For the components of the MetS, the odds of central obesity, elevated blood pressure and elevated TAG, but not the odds of low HDL-cholesterol and elevated fasting glucose, significantly increased with the successive tertiles of urinary Na excretion. Furthermore, for every 100 mmol/d increase in urinary Na excretion, the odds of the MetS, central obesity, elevated blood pressure and elevated TAG was significantly increased by 29, 63, 22 and 21 %, respectively. However, urinary K excretion was not significantly associated with the risk of the MetS. These findings suggest that high Na intake might be an important risk factor for the MetS in Chinese adults
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Wed Jul 29, 2015 3:18 pm

Self-reported Adherence to a Low-Sodium Diet and Health Outcomes in Patients With Heart Failure.
J Cardiovasc Nurs. 2015 Aug 20.

http://www.ncbi.nlm.nih.gov/pubmed/26296246

Abstract

BACKGROUND:
Most clinicians rely on patients' self-report of following a low-sodium diet to determine adherence of patients with heart failure (HF). Whether self-reported adherence to a low-sodium diet is associated with cardiac event-free survival is unclear.

PURPOSES:
To determine (1) whether self-reported is concordant with adherence to a low-sodium diet measured by food diaries and 24-hour urinary sodium excretion and (2) whether self-reported adherence to a low-sodium diet predicts cardiac event-free survival.

METHODS:
Adherence to a low-sodium diet was measured using 3 measures in 119 HF patients: (1) self-reported adherence, 1 item from the Self-care of Heart Failure Index scale; (2) a 3-day food diary; (3) 24-hour urinary sodium excretion. Patients were followed up for a median of 297 days to determine cardiac hospitalization or emergency department visit. One-way analysis of variance and Cox regression were used to address our purposes.

RESULTS:
Self-reported adherence was concordant with adherence to a low-sodium diet measured by food diaries and 24-hour urinary sodium excretion. Thirty-one patients who reported they always follow a low-sodium diet had an average sodium intake less than 3 g/d (F = 5.07, P = .002) and 3.3 g of a mean 24-hour urinary sodium excretion (F = 3.393, P = .020). Patients who reported they never or rarely follow a low-sodium diet had 4.7 times greater risk of having cardiac events than did those who always followed a low-sodium diet (P = .017).

CONCLUSION:
Self-reported adherence to a low-sodium diet predicted cardiac event-free survival demonstrating clinicians can use this as an indicator of adherence.
PMID: 26296246



Dietary Sodium Consumption Predicts Future Blood Pressure and Incident Hypertension in the Japanese Normotensive General Population

J Am Heart Assoc. 2015; 4: e001959
doi: 10.1161/JAHA.115.001959

Full text
http://m.jaha.ahajournals.org/content/4/8/e001959.full

Abstract

Background
Although there is a close relationship between dietary sodium and hypertension, the concept that persons with relatively high dietary sodium are at increased risk of developing hypertension compared with those with relatively low dietary sodium has not been studied intensively in a cohort.

Methods and Results
We conducted an observational study to investigate whether dietary sodium intake predicts future blood pressure and the onset of hypertension in the general population. Individual sodium intake was estimated by calculating 24‐hour urinary sodium excretion from spot urine in 4523 normotensive participants who visited our hospital for a health checkup. After a baseline examination, they were followed for a median of 1143 days, with the end point being development of hypertension. During the follow‐up period, hypertension developed in 1027 participants (22.7%). The risk of developing hypertension was higher in those with higher rather than lower sodium intake (hazard ratio 1.25, 95% CI 1.04 to 1.50). In multivariate Cox proportional hazards regression analysis, baseline sodium intake and the yearly change in sodium intake during the follow‐up period (as continuous variables) correlated with the incidence of hypertension. Furthermore, both the yearly increase in sodium intake and baseline sodium intake showed significant correlations with the yearly increase in systolic blood pressure in multivariate regression analysis after adjustment for possible risk factors.

Conclusions
Both relatively high levels of dietary sodium intake and gradual increases in dietary sodium are associated with future increases in blood pressure and the incidence of hypertension in the Japanese general population.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Aug 25, 2015 5:54 pm

News From the Centers for Disease Control and Prevention
August 25, 2015
More Health Advice Needed to Cut US Sodium Intake
JAMA. 2015;314(8):763. doi:10.1001/jama.2015.9917.

About half of nearly 200,000 US adults reported in a recent survey that they’re watching their salt intake or reducing it, but only 1 in 5 said a health professional advised them to cut back. The data are from the 2013 Behavioral Risk Factor Surveillance System telephone survey, which for the first time has provided state-level estimates of sodium intake among the general population.

Survey participants in 26 states, the District of Columbia, and Puerto Rico answered questions about sodium intake. The percentage of adults who said they’ve lowered their salt consumption ranged from 38.7% in Utah to 73.4% in Puerto Rico. Only 13.5% of participants in Minnesota said a health professional suggested they cut their sodium intake, compared with 41.4% in Puerto Rico (Fang J et al. MMWR Morb Mortal Wkly Rep. 2015;64[25]:695-698).

The investigators noted that Puerto Rico residents may have fared well in sodium reduction because their hypertension rate is high—42.3% compared with 31.4% nationally. People living in the South, where the prevalence of hypertension also is high, were more likely to reduce salt intake than people residing in other US regions. In fact, in every jurisdiction surveyed, more people with hypertension acted to reduce their sodium consumption than those who didn’t have the condition.

However, 20% to 50% of survey participants with hypertension in various states reported doing nothing to cut back, and 38% to 68% said they hadn’t been counseled by a health professional to do so. Most adults without hypertension said they hadn’t cut back on sodium, nor had they been advised to do so.

The average daily sodium consumption is an estimated 3592 mg, much higher than the Healthy People 2020 target maximum of 2300 mg daily. “The data in this report highlight the opportunity to increase the proportion of health care professionals who advise their patients to reduce sodium intake and the proportion of US adults who take action to reduce sodium intake,” the investigators wrote.

News From the Centers for Disease Control and Prevention Section Editor: Rebecca Voelker, MSJ.



Sodium Intake Among U.S. Adults - 26 States, the District of Columbia, and Puerto Rico, 2013.
Fang J, Cogswell ME, Park S, Jackson SL, Odom EC.
MMWR Morb Mortal Wkly Rep. 2015 Jul 3;64(25):695-8.
PMID:26135590

Free Article
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6425a3.htm

Abstract

Excess sodium intake is a major risk factor for hypertension, and subsequently, heart disease and stroke, the first and fifth leading causes of U.S. deaths, respectively. During 2011-2012, the average daily sodium intake among U.S. adults was estimated to be 3,592 mg, above the Healthy People 2020 target of 2,300 mg. To support strategies to reduce dietary sodium intake, 2013 Behavioral Risk Factor Surveillance System (BRFSS) data from states and territories that implemented the new sodium-related behavior module were assessed. Across 26 states, the District of Columbia (DC), and Puerto Rico, 39%-73% of adults reported taking action (i.e., watching or reducing sodium intake) (median = 51%), and 14%-41% reported receiving advice from a health professional to reduce sodium intake (median = 22%). Compared with adults without hypertension, a higher percentage of adults with self-reported hypertension reported taking action and receiving advice to reduce sodium intake. For states that implemented the module, these results can serve as a baseline to monitor the effects of programs designed to reduce sodium intake.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Mon Sep 14, 2015 7:44 pm

Dietary sodium intake and prediction of cardiovascular events.
Äijälä M, Malo E, Santaniemi M, Bloigu R, Silaste ML, Kesäniemi YA, Ukkola O.
Eur J Clin Nutr. 2015 Sep;69(9):1042-7. doi: 10.1038/ejcn.2015.40. Epub 2015 Mar 25.
PMID:25804269
http://www.nature.com/ejcn/journal/v69/ ... 1540a.html
http://www.nature.com/ejcn/journal/v69/ ... 01540a.pdf

Abstract

BACKGROUND/OBJECTIVES: The association of dietary sodium and cardiovascular disease (CVD), as well as the reduction of sodium intake in the prevention of CVD, has been under debate. To study whether sodium consumption has a role as a risk factor for fatal and non-fatal CVD.

SUBJECTS/METHODS: A well-defined population-based cohort of 1045 subjects collected between 1991 and 1993 (mean age 51.4 years) was used with approximately 19 years' follow-up. At the baseline, 716 subjects filled in a 1-week food follow-up diary, which was used to calculate the daily sodium intake (mg/1000 kcal).

RESULTS: The baseline sodium intake correlated significantly with age (rs=0.117, P=0.002), BMI (rs=0.216, P=0.000), waist circumference (rs=0.268, P=0.000), smoking (rs=0.144, P=0.000), alcohol consumption (rs=0.111, P=0.003), systolic blood pressure (rs=0.106, P=0.005) and low-density lipoprotein (LDL) cholesterol (rs=0.081, P=0.033). Those who had cardiovascular events in the follow-up consumed more sodium at the baseline (mean 2010.4 mg/1000 kcal/day, s.d. 435.2, n=101) compared with the subjects without events (mean 1849.9 mg/1000 kcal/day, s.d. 361.2, n=589; t-test; P=0.001). The incidence of cardiovascular events was greater in the highest quartile (22.1%) than in the lower quartiles (first 11.0%, second 9.9% and third 15.6%; X(2); P=0.005). Cox regression analysis showed that sodium intake as a continuous variable predicts CVD events (P=0.031) independently when age, sex, smoking, alcohol consumption, systolic blood pressure, LDL cholesterol and waist circumference were added as covariates. This predictive role is seen especially in the group of subjects on hypertensive medication (P=0.001).

CONCLUSIONS: Dietary sodium intake is a significant independent predictor of cardiovascular events in the study population,
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Oct 03, 2015 10:44 am

High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis: A Cross Sectional and Case Control Analysis Within the SUN Cohort.
Medicine (Baltimore). 2015 Sep;94(37):e0924. doi: 10.1097/MD.0000000000000924.
Salgado E1, Bes-Rastrollo M, de Irala J, Carmona L, Gómez-Reino JJ.


Abstract
Sodium intake is a potential environmental factor for immune-mediated inflammatory diseases. The aim of this study is to investigate the association of sodium intake with rheumatoid arthritis.We performed a cross-sectional study nested in a highly educated cohort investigating dietary habits as determinants of disease. Daily sodium intake in grams per day was estimated from a validated food frequency questionnaire. We identified prevalent self-reported cases of rheumatoid arthritis. Logistic regression models were used to estimate the odds ratio for rheumatoid arthritis by sodium intake adjusting for confounders. Linear trend tests and interactions between variables were explored. Sensitivity analyses included age- and sex-matched case-control study, logistic multivariate model adjusted by residuals, and analysis excluding individuals with prevalent diabetes or cardiovascular disease.The effective sample size was 18,555 individuals (mean age 38-years old, 60% women) including 392 self-reported rheumatoid arthritis. Median daily sodium intake (estimated from foods plus added salt) was 3.47 (P25-75: 2.63-4.55) grams. Total sodium intake in the fourth quartile showed a significant association with rheumatoid arthritis (fully adjusted odds ratio 1.5; 95% CI 1.1-2.1, P for trend = 0.02). Never smokers with high sodium intake had higher association than ever smokers with high sodium intake (P for interaction = 0.007). Dose-dependent association was replicated in the case-control study.High sodium intake may be associated with a diagnosis of rheumatoid arthritis. This confirms previous clinical and experimental research.
PMID: 26376372
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Tue Oct 06, 2015 9:32 pm

Reported Amount of Salt Added to Food Is Associated with Increased All-Cause and Cancer-Related Mortality in Older Men in a Prospective Cohort Study.
Golledge J, Moxon JV, Jones RE, Hankey GJ, Yeap BB, Flicker L, Norman PE.
J Nutr Health Aging. 2015;19(8):805-11. doi: 10.1007/s12603-015-0483-2.
PMID: 26412284

Abstract

BACKGROUND:

The effect of dietary salt intake on important population outcomes such as mortality is controversial. The aim of this study was to examine the association between the dietary habit of adding salt to food and mortality in older men. Design, participants, setting and measurements: A risk factor questionnaire which contained a question about the dietary habit of adding salt to food was completed by 11742 community recruited older men between 1996 and 1999. The men were followed by means of the Western Australia Data Linkage System until November 30th 2010. Deaths due to cardiovascular diseases and cancers were identified using ICD-10 codes in the ranges I00-I99 and C00-D48, respectively. The association between the frequencies of adding salt to food and mortality was assessed using Kaplan Meier estimates and Cox proportional hazard analysis.

RESULTS:

Median follow-up for survivors was 12.5 years (inter-quartile range 8.3-13.2 years). A total of 5399 deaths occurred of which the primary cause registered was cancer and cardiovascular disease in 1962 (36.3%) and 1835 (34.0%) men, respectively. The reported frequency of adding salt to food was strongly positively associated with all-cause (p<0.001), cancer-related (p<0.001) but not cardiovascular-related (p=0.649) mortality. Men reporting adding salt to their food always had a 1.12-fold (95% CI 1.05-1.20, p<0.001) and a 1.20-fold (95% CI 1.07-1.34, p=0.001) increased risk of all-cause and cancer-related mortality, respectively, after adjusting for other risk factors. Men reporting adding salt to their food sometimes had a 1.16-fold (95% CI 1.04-1.29, p=0.007) increased risk of cancer-related mortality after adjusting for other risk factors.

CONCLUSION:

A history of adding salt to food is associated with increased cancer-related mortality in older men.
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Thu Oct 08, 2015 11:33 am

FDA Sued for its Failure to Regulate Salt

CSPI Says Agency Unlawfully Delaying Action on 2005 Petition
October 8, 2015

http://www.cspinet.org/new/201510081.html

"The Center for Science in the Public Interest is taking the Food and Drug Administration to federal court over the agency’s failure to act on a 10-year-old petition asking the agency to reduce the excess salt—the main source of sodium—in the food supply. The nonprofit food safety and nutrition watchdog group says that the FDA’s failure to reduce the sodium in packaged and other foods is contributing to tens of thousands of premature deaths annually due to stroke, heart disease, and other health problems. The average American consumes about 3,650 milligrams of sodium per day, far in excess of the 2,300 milligram limit recommended by federal dietary guidelines, or the 1,500 milligram limit recommended for certain subgroups, including children, people over 50, African Americans, and people with hypertension, kidney disease, or diabetes.
“For more than 35 years, FDA has dragged its feet and refused to do anything to protect Americans from excess sodium in the food supply,” said CSPI President Michael F. Jacobson. “The government’s inaction condemns hundreds of thousands of Americans to early deaths due to preventable strokes and heart attacks.”

Read more...

http://www.cspinet.org/new/201510081.html
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Re: UPDATED!! Time to end the war on Salt?

Postby JeffN » Sat Oct 24, 2015 7:02 pm

Salty Food Preference and Intake and Risk of Gastric Cancer: The JACC Study.
Umesawa M, Iso H, Fujino Y, Kikuchi S, Tamakoshi A.
J Epidemiol. 2015 Oct 17. [Epub ahead of print]
PMID: 26477994 Free Article
https://www.jstage.jst.go.jp/article/je ... 50023/_pdf

Abstract

BACKGROUND:

High sodium intake is a potential risk factor of gastric cancer. However, limited information is available on the relationship between salty food preference or intake and risk of gastric cancer. The aim of the present study was to determine the association between these variables among the Japanese population.

METHODS:

Between 1988 and 1990, 15 732 men and 24 997 women aged 40-79 years old with no history of cancer or cardiovascular disease completed a lifestyle questionnaire that included information about food intake. The subjects were enrolled in the Japan Collaborative Cohort (JACC) Study for Evaluation of Cancer Risk Sponsored by Monbusho. After a median follow-up of 14.3 years, 787 incident gastric cancers were documented. We examined the associations between salty food preference and intake and gastric cancer incidence using the Cox proportional hazard model.

RESULTS:

The risk of gastric cancer among subjects with a strong preference for salty food was approximately 30% higher than among those who preferred normal-level salty food (hazard ratio [HR] 1.31; 95% confidence interval [CI], 1.02-1.67). The risk of gastric cancer in subjects who consumed 3 and =/>4 bowls/day of miso soup was approximately 60% higher than in those who consumed less miso soup (HR 1.67; 95% CI, 1.16-2.39 and HR 1.64; 95% CI, 1.11-2.42, respectively). Sodium intake correlated positively and linearly with risk of gastric cancer (P for trend = 0.002).

CONCLUSIONS:

The present study showed that salty food preference, consumption of large quantities of miso soup, and high sodium intake were associated with increased risk of gastric cancer among Japanese people.
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