#Sodium Intake and All-Cause #Mortality Over 20 Years in the Trials of Hypertension Prevention

http://content.onlinejacc.org/article.aspx?articleid=2557459

Conclusions We found an increased risk of mortality for high-sodium intake and a direct relationship with total mortality, even at the lowest levels of sodium intake. These results are consistent with a benefit of reduced sodium and sodium/potassium intake on total mortality over a 20-year period.

Sources of #Sodium in US Adults From 3 Geographic Regions
http://circ.ahajournals.org/content/135/19/1775

Sodium added to food outside the home was the leading source of sodium, accounting for more than two thirds (70.9%) of total sodium intake in the sample. Although the proportion of sodium from this source was smaller in some subgroups, it was the leading contributor for all subgroups. Contribution ranged from 66.3% for those with a high school level of education or less to 75.0% for those 18 to 29 years of age. Sodium inherent to food was the next highest contributor (14.2%), followed by salt added in home food preparation (5.6%) and salt added to food at the table (4.9%). Home tap water consumed as a beverage and dietary supplement and nonprescription antacids contributed minimally to sodium intake (<0.5% each).

Conclusions: Sodium added to food outside the home accounted for ≈70% of dietary sodium intake. This finding is consistent with the 2010 Institute of Medicine recommendation for reduction of sodium in commercially processed foods as the primary strategy to reduce sodium intake in the United States.

Association of Estimated #Sodium Intake With Adverse #Cardiac Structure and Function From the HyperGEN Study

http://www.onlinejacc.org/content/70/6/715?sso=1&sso_redirect_count=1&access_token=

This study sought to determine whether examination of left ventricular longitudinal strain (LS), circumferential strain, and e′ velocity can provide insight into thresholds for the detrimental effects of estimated sodium intake (ESI) on subclinical cardiovascular disease.

ESI >3.7 g/day was associated with larger left atrial and left ventricular dimensions (p < 0.05). After adjusting for speckle-tracking analyst, image quality, study site, age, sex, smoking status, alcohol use, daily blocks walked, diuretic use, estimated glomerular filtration rate, left ventricular mass, ejection fraction, and wall motion score index, ESI >3.7 g/day was associated with both strain parameters and e′ velocity (p < 0.05 for all comparisons), but ESI ≤3.7 g/day was not (p > 0.05 for all comparisons). There were significant interactions by potassium excretion for circumferential strain. Mediation analysis suggested that systolic blood pressure explained 14% and 20% of the indirect effects between ESI and LS and e′ velocity, respectively, whereas serum aldosterone explained 19% of the indirect effects between ESI and LS.

Conclusions ESI >3.7 g/day is associated with adverse cardiac remodeling and worse systolic strain and diastolic e′ velocity

Effects of #Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart #Failure
Proposal of a Novel Mechanism of Action
http://jamanetwork.com/journals/jamacardiology/article-abstract/2646533

The beneficial effect of SGLT2 inhibitors on heart failure cannot be explained by their actions on glycemic control or as osmotic diuretics. Instead, in the kidneys, SGLT2 functionally interacts with the sodium-hydrogen exchanger, which is responsible for the majority of sodium tubular reuptake following filtration. The activity of sodium-hydrogen exchanger is markedly increased in patients with heart failure and may be responsible for both resistance to diuretics and to endogenous natriuretic peptides. In addition, in the heart, empagliflozin appears to inhibit sodium-hydrogen exchange, which may in turn lead to a reduction in cardiac injury, hypertrophy, fibrosis, remodeling, and systolic dysfunction. Furthermore, the major pathophysiological derangements of heart failure and a preserved ejection fraction may be mitigated by the actions of SGLT2 inhibitors to reduce blood pressure, body weight, and fluid retention as well as to improve renal function. The benefits of spironolactone in patients with heart failure with either a reduced or a preserved ejection fraction may also be attributable to the actions of the drug to inhibit the sodium-hydrogen exchange mechanism

#Sodium intake and the risk of type 2 #diabetes and Latent Autoimmune Diabetes in Adults (LADA)
http://www.abstractsonline.com/pp8/#!/4294/presentation/6091

It has been suggested that salt (sodium chloride) may increase the risk of T2D, hypothetically through an effect on insulin resistance and/or by way of promoting hypertension and weight gain. Whether sodium intake is related to onset of autoimmune diabetes has not been investigated. However, experimental studies have shown that excessive sodium intake may initiate an autoimmune reaction by enhancing the production of TH17 cells which are highly proinflammatory. We aimed to study, for the first time, whether sodium intake is associated with an increased risk of LADA

Sodium intake was associated with an increased risk of LADA (OR per gr/day; 1.73, 95% CI; 1.23-2.43); comparing the highest to lowest tertile of sodium intake indicated an OR of 2.19 (95% CI; 1.33-3.61) (Table 1). The risk was even more pronounced for LADA patients with high risk HLA genotypes; an almost four-fold (OR 3.87, 95% CI 1.87-8.01) increased risk was seen in the high consumers. We could also confirm that sodium intake was associated with an increased risk of T2D (OR per gr/day; 1.43, 95% CI; 1.09-1.88).

Conclusion: Our findings suggest that high sodium intake may be a risk factor for LADA, especially in carriers of high risk HLA genotypes. We could also confirm an association between sodium intake and T2D. If confirmed in other populations, these findings may have important implications in the primary prevention of diabetes with adult onset

#Sodium Restriction in Heart #Failure: Benefit or Harm?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947770/

Current guidelines vary in the recommended amount of dietary sodium intake for heart failure (HF) patients. Observational studies and the hypertension literature support the concept that sodium restriction improves HF outcomes. In contrast, several randomized controlled trials imply that dietary sodium restriction can cause harm through hypovolemia and increased neurohormonal activation. Data from hypertensive animal models and humans suggest that dietary sodium intake may need to be individually tailored based on HF severity and the physiologic response to sodium loading. Future studies must assess interactions between sodium intake, fluid intake, and diuretics to match clinical practice and improve safety. More information is needed in multiple areas, including accurate measurement of sodium intake, implementation of dietary changes in HF patients, and establishment of biomarkers that predict response to changes in sodium intake. Additional research is urgently needed to determine the true impact of the most commonly recommended self-care strategy in HF

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Association Between Use of #Sodium-Glucose Cotransporter 2 Inhibitors, #Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 #Diabetes

https://jamanetwork.com/journals/jama/fullarticle/2678616

SGLT-2 inhibitors (absolute RD, −0.8%; HR, 0.79 95% CrI, 0.69 to 0.91) and GLP-1 agonists (absolute RD, −0.5%; HR, 0.85 95% CrI, 0.77 to 0.94) were significantly associated with lower CV mortality than were the control groups. SGLT-2 inhibitors were significantly associated with lower rates of HF events (absolute RD, −1.1%; HR, 0.62 95% CrI, 0.54 to 0.72) and MI (absolute RD, −0.6%; HR, 0.86 95% CrI, 0.77 to 0.97) than were the control groups. GLP-1 agonists were associated with a higher risk of adverse events leading to trial withdrawal than were SGLT-2 inhibitors (absolute RD, 5.8%; HR, 1.80 95% CrI, 1.44 to 2.25) and DPP-4 inhibitors (absolute RD, 3.1%; HR, 1.93 95% CrI, 1.59 to 2.35).

Conclusions and Relevance In this network meta-analysis, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with lower mortality than DPP-4 inhibitors or placebo or no treatment. Use of DPP-4 inhibitors was not associated with lower mortality than placebo or no treatment

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Effect of low- #sodium salt substitutes on blood pressure, detected #hypertension, stroke and mortality

https://heart.bmj.com/content/early/2019/01/18/heartjnl-2018-314036

LSSS decreased SBP (MD −7.81 mm Hg, 95% CI −9.47 to –6.15, p<0.00001) and DBP (MD −3.96 mm Hg, 95% CI −5.17 to –2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD −35.82 mmol/day, 95% CI −57.35 to –14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes.

Conclusions LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes.

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#Sodium and #Potassium #Dietary Reference Intake Values Updated in New Report; Introduces New Category for Sodium Based on Chronic Disease Risk Reduction

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=25353&_ga=2.210673559.303896039.1551797918-1521275022.1551797918

The updated sodium AIs are 110 mg daily for infants 0-6 months; 370 mg daily for infants 7-12 months; 800 mg daily for children ages 1-3; 1,000 mg daily for ages 4-8; 1,200 mg daily for ages 9-13; and 1,500 mg daily for ages 14 and older. There remains limited evidence on sodium intakes below 1,500 mg per day for adults, which prevented the committee that conducted the study from considering further reductions in the sodium AI.

For individuals ages 14 and older, the CDRR recommendation is to reduce sodium intakes if above 2,300 mg per day.

The updated potassium AIs are 400 mg daily for infants 0-6 months; 860 mg daily for infants 7-12 months; 2,000 mg daily for children ages 1-3; and 2,300 mg daily for ages 4-8. The potassium AIs for other age groups range from 2,300 to 3,400 mg per day, based on sex and life-stage groups.

Dietary #Potassium Intake Remains Low and #Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991–2015 Trends

..Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers.

Conclusions

Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.

https://bit.ly/2R8KYst

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Effect of dose and duration of reduction in dietary #sodium on blood #pressure levels: systematic review and meta-analysis of randomised trials

... Each 50 mmol reduction in 24 hour sodium excretion was associated with a 1.10 mm Hg (0.66 to 1.54; P<0.001) reduction in SBP and a 0.33 mm Hg (0.04 to 0.63; P=0.03) reduction in DBP. Reductions in blood pressure were observed in diverse population subsets examined, including hypertensive and non-hypertensive individuals. For the same reduction in 24 hour urinary sodium there was greater SBP reduction in older people, non-white populations, and those with higher baseline SBP levels. In trials of less than 15 days’ duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1.05 mm Hg (0.40 to 1.70; P=0.002) SBP fall, less than half the effect observed in studies of longer duration (2.13 mm Hg; 0.85 to 3.40; P=0.002). Otherwise, there was no association between trial duration and SBP reduction.

Conclusions The magnitude of blood pressure lowering achieved with sodium reduction showed a dose-response relation and was greater for older populations, non-white populations, and those with higher blood pressure. Short term studies underestimate the effect of sodium reduction on blood pressure.

https://bit.ly/2wIggzF

Dietary #Sodium Intake and Risk of Incident Type 2 #Diabetes

https://2medical.news/2023/11/09/dietary-sodium-intake-and-risk-of-incident-type-2-diabetes/

Effect of Dietary #Sodium on Blood #PressureA Crossover Trial

https://2medical.news/2023/11/16/effect-of-dietary-sodium-on-blood-pressurea-crossover-trial/

#Sodium Intake and #Atopic Dermatitis

https://2medical.news/2024/06/13/sodium-intake-and-atopic-dermatitis/