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Aim: Nocturia impairs the quality of life in patients with type 2 diabetes mellitus. Although sodium glucose co‐transporter 2 inhibitors (SGLT2i) such as tofogliflozin increase urine volume, their impact on nocturia, in conjunction with dietary salt restriction, is less clear. Materials and Methods: This multicenter, open‐label, randomized, parallel‐group trial included 80 subjects with type 2 diabetes and nocturia. The patients were divided into two groups: one receiving tofogliflozin, the shortest half‐life, without salt restriction, and the other receiving both tofogliflozin and dietary salt restriction. The primary endpoint was nocturia frequency at 12 weeks. The secondary outcomes included changes in daytime urination frequency, urine volume, and home blood pressure. Results: At 12 weeks, there were no significant differences in nocturia changes between both groups. Nocturia frequency did not change in the tofogliflozin without salt restriction group from 1.5 ± 0.8 to 1.3 ± 1.1 times per night (P = 0.297), and significantly decreased from 1.6 ± 1.0 to 1.3 ± 0.7 times per night in the tofogliflozin and dietary salt restriction group (P = 0.049). There was a trend toward increased urine volume and frequency during the daytime in the group with salt restriction, indicating a time‐shift effect of the short half‐life tofogliflozin and salt restriction on urinary time. Conclusions: The frequency of nocturia after tofogliflozin did not increase. Tofogliflozin reduced nocturia when combined with salt restriction. Furthermore, daytime urine volume and frequency showed an increasing trend, suggesting a shift in urine production to daytime hours due to the short half‐life of tofogliflozin. Dietary modifications can enhance the therapeutic benefits of tofogliflozin in managing nocturia in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]

There is emerging evidence to suggest that diet and dietary interventions can have an impact on heart failure (HF) outcomes. Currently, the restriction of salt intake is the only dietary advice that is consistently guideline-recommended for the management of HF despite conflicting evidence for its efficacy. Dietary components that have been investigated in people with HF include middle-chain triglyceride (MCT) oil, beta-hydroxybutyrate (BHB) salts, ketone esters and coenzyme Q10 (CoQ10). Supplementation with these components is thought to be cardioprotective possibly due to an increase in myocardial energy production. There have been research studies on the effectiveness of The Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean Diet (MedDiet) in the treatment of HF, but with conflicting results. The ketogenic diet (KD) has come to the forefront of interest due to evidence indicating its effectiveness in addressing the metabolic shift that occurs in HF. However, there is a lack of randomised controlled trials (RCT) centred around the KD. In any dietary intervention, factors such as adherence and compliance affect the validity of the results. Malnutrition, sarcopenia and/or cardiac cachexia can be present in the more advanced stages of heart failure. Nutritional screening, assessment and support/intervention are important aspects of treatment in the advanced stages of heart failure. Furthermore, HF management through dietary intervention is further complicated by the presence of comorbidities, such as diabetes mellitus (DM) and coronary artery disease (CAD). Long-term studies on the use of dietary modifications in people with HF are warranted to ascertain their efficacy, safety and side effects. [ABSTRACT FROM AUTHOR]

Primary aldosteronism is an endocrine disorder caused by excessive production of aldosterone by the adrenal glands, and is recognized as the most important cause of endocrine hypertension. With specific therapy, this type of hypertension is potentially curable. In the general population, high salt intake increases the risk for cardiovascular diseases like stroke. In populations with aldosterone excess, observational and experimental data suggest that aldosterone-induced organ damage requires a combination of high dietary salt intake and high plasma aldosterone, i.e., plasma aldosterone levels inappropriately high for salt status. Therefore, understanding the relationship between plasma aldosterone levels and dietary salt intake and the nature of their combined effects is crucial for developing effective prevention and treatment strategies. In this review, we present an update on findings about primary aldosteronism and salt intake and the underlying mechanisms governing their interaction. [ABSTRACT FROM AUTHOR]

Background: Patient education for the management of chronic kidney disease (CKD) is attracting attention. Therefore, this study aimed to analyze changes in body weight, uric acid, and estimated-glomerular filtration rate (eGFR) in patients with CKD after a group-based education during admission. Methods: Overall, 157 patients with CKD, who were discharged from the nephrology department of our hospital between January 2015 and October 2019, received group-based education or individual-based education by nurses at admission. Deltas of body weight, uric acid, and eGFR, 6 months from baseline, were compared between group- and individual-based education using the Wilcoxon rank sum test. Results: In total, 60 patients receiving group-based education (G group, n =35) or individual-based education (I group, n =25) during admission were included in this retrospective study. The patient characteristics at baseline were as follows: age mean, 72 ± SD 9; 16 females and 44 males; body weight, 62 ± 17 kg; eGFR median, 21 (IQR: 14, 29) mL/min/1.73 m2; UA, 7 (6.1, 7.5) mg/dL; and estimated intake of salt 6.9 (6.2, 8.4) g/day. Delta eGFR (mL/min/1.73 m2) was -1 (-3, 3) for G group and -1 (-2.5, 2) for I group (p = 0.8039). Delta body weight (kg) was -0.4 (-1.6, 0) for G group and 0 (-0.45, 0.95) for I group (p = 0.0597). Delta uric acid (mg/dL) was -1.1 (-1.6, 0.1) for G group and -0.2 (-1.1, 0.5) for I group (p = 0.0567). In patients with higher sodium intake (≥ 117.4 mEq/day), delta body weight was significantly lower in the group-based education group than in the individual-based education group (p = 0.0398). Conclusions: A comprehensive group-based education in patients with CKD may effectively suppress body weight and uric acid in 6 months along with less frequent diuretic use. [ABSTRACT FROM AUTHOR]

Background: Primary aldosteronism (PA) is a frequent cause of hypertension. Aldosterone excess together with high dietary salt intake aggravates cardiovascular damage, despite guideline‐recommended mineralocorticoid receptor antagonist (MRA) treatment. Objectives: To investigate the antihypertensive impact of a moderate dietary salt restriction and associated physiological changes, including mental well‐being. Methods: A total of 41 patients with PA on a stable antihypertensive regimen—including MRA—followed a dietary salt restriction for 12 weeks with structured nutritional training and consolidation by a mobile health app. Salt intake and adherence were monitored every 4 weeks using 24‐h urinary sodium excretion and nutrition protocols. Body composition was assessed by bioimpedance analysis and mental well‐being by validated questionnaires. Results: Dietary salt intake significantly decreased from 9.1 to 5.2 g/d at the end of the study. In parallel, systolic (130 vs. 121 mm Hg) and diastolic blood pressure (BP) (84 vs. 81 mm Hg) improved significantly. Patients' aptitude of estimating dietary salt content was refined significantly (underestimation by 2.4 vs. 1.4 g/d). Salt restriction entailed a significant weight loss of 1.4 kg, improvement in pulse pressure (46 vs. 40 mm Hg) and normalization of depressive symptoms (PHQD scale, p < 0.05). Salt restriction, cortisol after dexamethasone suppression test and dosage of renin‐angiotensin‐aldosterone‐system (RAAS) blockers were independently associated with BP reduction. Conclusion: A moderate restriction of dietary salt intake in patients with PA substantially reduces BP and depressive symptoms. Moreover, the findings underline that a sufficient RAAS blockade seems to augment the effects of salt restriction on BP and cardiovascular risk. [ABSTRACT FROM AUTHOR]

Dietary salt intake is a long-debated issue. Increased sodium intake is associated with high blood pressure, leading to salt-sensitive hypertension. Excessive salt intake leads to arterial stiffness in susceptible individuals via impaired nitric oxide action and increased endothelin-1 expression, overactivity of the renal sympathetic nervous system and also via aldosterone-independent activation of the mineralocorticoid receptor. Salt restriction in such individuals reduces blood pressure (BP) values. The optimal level of salt restriction that leads to improved cardiovascular outcomes is still under debate. Current BP and dietary guidelines recommend low sodium intake for the general population. However, a specific category of patients does not develop arterial hypertension in response to sodium loading. In addition, recent research demonstrates the deleterious effects of aggressive sodium restriction, even in heart failure patients. This mini review discusses current literature data regarding the advantages and disadvantages of salt restriction and how it impacts the overall health status. [ABSTRACT FROM AUTHOR]

Purpose: The World Health Organization recommends reduction of salt intake to < 5 g/day and the use of iodized salt to prevent iodine deficiency states. A high prevalence of excess salt consumption and an inadequate iodine intake has been previously shown in an Italian pediatric population. It was appropriate, therefore, to analyse in the same population the relationship occurring between salt consumption and iodine intake. Methods: The study population was made of 1270 children and adolescents. Estimates of salt consumption and iodine intake were obtained by measuring 24 h urinary sodium and iodine excretion. Results: The iodine intake increased gradually across quartiles of salt consumption independently of sex, age and body weight (p < 0.001). Median iodine intake met the European Food Safety Authority adequacy level only in teenagers in the highest quartile of salt consumption (salt intake > 10.2 g/day). We estimated that approximately 65–73% of the total iodine intake was derived from food and 27–35% from iodized salt and that iodized salt made actually only 20% of the total salt intake. Conclusion: In this pediatric population, in face of an elevated average salt consumption, the use of iodized salt was still insufficient to ensure an adequate iodine intake, in particular among teenagers. In the perspective of a progressive reduction of total salt intake, the health institutions should continue to support iodoprophylaxis, in the context of the national strategies for salt reduction. In order for these policies to be successful, in addition to educational campaigns, it is needed that the prescriptions contained in the current legislation on iodoprophylaxis are made compelling through specific enforcement measures for all the involved stakeholders. [ABSTRACT FROM AUTHOR]

Aim: To compare chronic heart failure patients with reduced ejection fraction (cHFrEF) who stated to comply with salt restriction in their diets versus those who did not. Methods: Patients without salt restriction were compared to those with salt restriction regarding HF-related hospitalization (HFrH) and all-cause mortality (ACM) before and after propensity score (PS) matching analysis. Results: The study included a total of 723 patients. 136 of them stated not to comply with salt restriction, 587 of them stated to comply with salt restriction. More frequent HFrH were observed in patients without salt restriction compared to those with salt restriction (75% vs. 62.9%, p=0.007), though, ACM was similar in both groups (29.4% vs 27.6%, p=0.672). After PS matching, HFrH during follow-up remained more frequent in those without salt restriction compared to those with salt restriction (73.7% vs 59.3%, p=0.019) but ACM was not different in both groups (30.5% vs 29.7%, p=0.887). Noncompliance to dietary salt restriction was found as one of the independent predictors of HFrH. Conclusion: In cHFrEF outpatients, noncompliance to dietary salt restriction does not seem to increase the risk for ACM but it poses an increased risk for HFrH. [ABSTRACT FROM AUTHOR]

Background: Hypertensive urgency is a common presentation in the emergency room (ER). Current practice guidelines suggest that it is not necessary to meet a strict blood pressure (BP) target in ER. But patients should achieve the BP goal within weeks or a few months. However, there is limited data on the follow-up BP outcome and its determinants. Objective: To evaluate factors associated with successful BP control for hypertensive urgency patients after a 12-week treatment. Materials and Methods: A retrospective cohort study conducted at a university hospital in the Northeast of Thailand from 1st January 2012 to 31st December 2016. We enrolled hypertensive urgency patients who visited ER and received standard treatment and followed-up in the Hypertensive Crisis Clinic for 12 weeks. Results: A successful BP control (<140/90 mmHg) was observed in 129 patients (56.1%). The factor that associated with a successful BP control was the achievement of three-lifestyle modification including medication adherence, aerobic exercise, and salt restriction (OR 1.79; 95% CI, 1.01 to 3.19; p = 0.048), not the baseline BP, number of medication, and underlying diseases. Conclusion: Lifestyles modification was an effective strategy to achieve a targeted BP in the hypertensive urgency patient. Therefore, patients should be educated and encouraged to have healthy lifestyles. [ABSTRACT FROM AUTHOR]

The Na/K ratio is considered to be a useful index, the monitoring of which allows an effective Na reduction and K increase, because practical methods (self-monitoring devices and reliable individual estimates from spot urine) are available for assessing these levels in individuals. An intervention trial for lowering the Na/K ratio has demonstrated that a reduction of the Na/K ratio mainly involved Na reduction, with only a small change in K. The present study aimed to clarify the relationship between dietary Na intake and the urinary Na/K molar ratio, using standardized low- and high-salt diets, with an equal dietary K intake, to determine the corresponding Na/K ratio. Fourteen healthy young adult volunteers ingested low-salt (3 g salt per day) and high-salt (20 g salt per day) meals for seven days each. Using a portable urinary Na/K meter, participants measured their spot urine at each voiding, and 24-h urine was collected on the last day of each diet period. On the last day of the unrestricted, low-salt, and high-salt diet periods, the group averages of the 24-h urine Na/K ratio were 4.2, 1.0, and 6.9, while the group averages of the daily mean spot urine Na/K ratio were 4.2, 1.1, and 6.6, respectively. The urinary Na/K ratio tracked changes in dietary salt intake, and reached a plateau approximately three days after each change in diet. Frequent monitoring of the spot urine Na/K ratio may help individuals adhere to an appropriate dietary Na intake. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate blood pressure (BP) control and salt intake in hypertensive outpatients treated at a general hospital and to examine the relationship between their lifestyles and amount of salt intake. Subjects comprised 429 hypertensive patients (206 males, 223 females, and average age of 71 ± 11 years). We estimated 24-hour salt excretion using spot urine samples and assessed lifestyle using a self-description questionnaire. Average clinic BP and the number of antihypertensive drugs were 132 ± 11/73 ± 8 mmHg and 1.8 ± 0.9, respectively. In all subjects, average estimated salt intake was 9.2 ± 2.8 g/day and the rate of achievement of the estimated salt intake of <6 g/day was 11.2%. In patients with chronic kidney disease or cardiovascular disease, these values were 8.6 ± 2.6 g/day and 15.5%, and 9.1 ± 3.3 g/day and 18.2%, respectively. Estimated salt intake was lower in patients living alone than in those with a family. In a multivariate analysis, estimated salt intake correlated positively with body mass index and negatively with age. Among patients with an excessive salt intake (≥10 g/day), 75.2% answered that they made an effort to reduce their salt intake. The amount of food and processed food consumption correlated with estimated salt intake. In conclusion, the rate of achievement of salt restriction was low in hypertensive patients treated at a general hospital. It may be important to provide data on actual salt intake and guide salt restriction in the individual management of hypertension. [ABSTRACT FROM AUTHOR]

Recent studies reported the critical role of the intrauterine environment of a fetus in growth or the development of disease in adulthood. In this article we discussed the implications of salt restriction in growth of a fetus and the development of growth-related disease in adulthood. Salt restriction causes retardation of fatal growth or intrauterine death thereby leading to low birth weight or decreased birth rate. Such retardation of growth along with the upregulation of the renin angiotensin system due to salt restriction results in the underdevelopment of cardiovascular organs or decreases the number of the nephron in the kidney and is responsible for onset of hypertension in adulthood. In addition, gestational salt restriction is associated with salt craving after weaning. Moreover, salt restriction is associated with a decrease in insulin sensitivity. A series of alterations in metabolism due to salt restriction are probably mediated by the upregulation of the renin angiotensin system and an epigenetic mechanism including proinflammatory substances or histone methylation. Part of the metabolic disease in adulthood may be programmed through such epigenetic changes. The modification of gene in a fetus may be switched on through environment factors or life style after birth. The benefits of salt restriction have been assumed thus far; however, more precise investigation is required of its influence on the health of fetuses and the onset of various diseases in adulthood. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetic kidney disease (DKD) is the most common cause of end-stage renal failure, and the prevention of its progression has been a topic of discussion. Methods: Sixty type 2 DKD patients were retrospectively evaluated for 1 year. Factors independently affecting the annual Ccr decline were examined by multivariable linear regression analysis. Patients were further divided into 2 groups based on their degree of renal function, and between-group differences at study initiation were evaluated. Results: Ccr values were 21.0 ± 11.8 mL/min/1.73 m at study initiation, and 15.7 ± 10.9 mL/min/1.73 m after 1 year of observation. The multivariable linear regression analysis indicated salt intake (standardized coefficient: −0.34, P = 0.010) and urinary protein excretion (standardized coefficient: −0.33, P = 0.011) to be factors independently affecting the annual Ccr decline. Although decliners (−9.8 ± 4.7 mL/min/1.73 m/year) had a significantly higher salt intake than non-decliners (−1.1 ± 3.8 mL/min/1.73 m/year) at study initiation, this difference disappeared at the end of the study as a result of intensive dietary education. In 21 decliners with an additional year of follow-up, the annual Ccr decline significantly improved from −10.1 ± 5.3 to −5.3 ± 7.4 mL/min/1.73 m/year ( P = 0.02). Conclusion: Salt intake and urinary protein excretion were associated with annual Ccr decline in type 2 DKD patients. Furthermore, dietary education covering salt intake may have positively affected the change in Ccr. [ABSTRACT FROM AUTHOR]

Among the several methods used to assess salt intake, estimating 24 h urinary salt excretion by spot urine seems appropriate for clinical practice. In this study, we investigated variability in urinary salt excretion using spot urine in hypertensive outpatients. Participants included 200 hypertensive patients who underwent spot urinary salt excretion at least three times during the observation period. Mean urinary salt excretion and the coefficient of the variation were 8.62 ± 1.96 g/day and 19.0 ± 10.2%, respectively. In the analysis of participants who underwent assessment of urinary salt excretion at least eight times (n = 54), a significant reduction in mean urinary salt excretion was found at the 5th measurement. On the contrary, the coefficient of the variation of urinary salt excretion continued to increase until the 5th measurement, and became stable thereafter. Mean urinary salt excretion was positively correlated with mean clinic diastolic blood pressure (r = 0.27,p < 0.05). Clinic diastolic blood pressure in the high urinary salt excretion group (≥10 g/day) was significantly higher than that of the low group (76.2 ± 7.5 vs 73.4 ± 8.3 mmHg,p < 0.05). Mean urinary salt excretion in summer was significantly lower than that of the other seasons (7.75 ± 1.94 vs 9.09 ± 2.68 (spring), 8.72 ± 2.12 (autumn), 8.92 ± 2.17 (winter) g/day,p < 0.01). In conclusion, repeated measurements of urinary salt excretion using spot urine are required to assess daily salt intake of hypertensive patients. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic. Subjects included 330 patients, with a mean age of 69 ± 12 years, who were followed at a hypertension clinic and 200 patients, with a mean age of 67 ± 11 years, who were followed at a general clinic. We estimated 24-h salt excretion using spot urine samples and checked the awareness of salt intake using a self-description questionnaire. The number of antihypertensive drugs available at the hypertension clinic was significantly higher than that at the general clinic (2.2 ± 1.1 versus 1.6 ± 0.9, p < 0.01); however, no significant difference was observed in office systolic blood pressure between the two groups. Urinary salt excretion was significantly lower at the hypertension clinic than at the general clinic (8.7 ± 2.5 versus 9.3 ± 2.5 g/d, p < 0.01). The rate of achievement of salt intake <6 g/d was 15% at the hypertension clinic and 6% at the general clinic. In patients with excessive salt intake (≥10 g/d), 28% of patients at the hypertensive clinic and 23% at the general clinic thought that their salt intake was low. Urinary salt excretion in hypertensive patients was lower at a hypertensive clinic than at a general clinic. This may be due to the professional nutritional guidance at the hypertension clinic. However, most patients could not comply with the guidelines, and the awareness of salt restriction in patients with excessive salt intake was low. [ABSTRACT FROM AUTHOR]

Background/aim: To investigate the effect of dietary salt restriction on bloodpressure levels, total sodium removal, andhydration status of peritoneal dialysis (PD) patients. Materials and methods: Thirty-one stable PD patients who consulted a renal dietitian monthly for dietary recommendations, including restricted salt intake <5 g/day, and education about hypertension and hypervolemia were included in this study. Baseline and third month clinical and laboratory findings, bioelectrical impedance analysis results, and urinary and peritoneal sodium removal values were recorded. Results: The mean age of the patients was 47.6 years and the mean time on PD was 39.6 months. The mean total sodium removal decreased slightly from 139.4 ± 69.1 to 136.2 ± 64.8 mmol/day (P > 0.05) for the whole sample, and from 164.3 ± 70.9 to 154.2 ± 72.3 mmol/day (P > 0.05) forthe hypertensive subgroup (n: 17). Systolic bloodpressure (from 134.3 ± 20.1 to 127.2 ± 19.5 mmHg, P: 0.01), diastolic bloodpressure (from 83.2 ± 12.0 to 77.4 ± 10.5 mmHg, P: 0.01) and total body water (from 39.2 ± 10.9 to 38.3 ± 9.3 L, P: 0.04) decreased significantly. Conclusion: We demonstrated that even a little reduction in daily dietary sodium intake caused significant decreases in blood pressure levels and fluid overload. [ABSTRACT FROM AUTHOR]

Purpose: A salt preference questionnaire may be a convenient and cost-effective method for predicting salt intake; however, the influence of salt preference on daily salt intake is unclear. This study aimed at revealing the effectiveness of the salt preference question in determining the daily salt intake in primary care outpatients. Patients and methods: This cross-sectional study included 1,075 outpatients (men, n=436, 40.6%) at six primary care institutions in Japan. Primary outcomes included a salty food preference assessed by using one question and a daily salt intake, assessed using early morning second urine samples. Multivariate analyses determined the relationships between the salt intake and the two salt preference levels. Results: The mean age was 67.6±14.6 years, and 594 (55.3%) preferred salty foods. The daily salt intake was 12.3±4.0 g per day and 11.4±3.7 g per day in the salt preference and nonsalt preference groups, respectively (P,0.001). A salt intake ,10 g per day was consumed by 169 (28.5%) and 181 (37.6%) patients (P=0.001), respectively, and ,6 g salt per day was consumed by 28 (4.7%) and 26 (5.4%) patients (P=0.606), respectively. The patients who preferred salty foods consumed a significantly larger amount of salt per day than those who did not prefer salty foods (β coefficient, 0.621; 95% confidence interval [CI], 0.146-1.095). There was no difference in the number of patients who consumed ,10 g salt per day (adjusted odds ratio [ad-OR], 1.29; 95% CI, 0.99-1.69) or ,6 g salt per day (ad-OR, 1.39; 0.90-1.69) between the groups. Conclusion: Preference for salty foods was positively associated with daily salt intake. However, daily salt intake was not always appropriate, even in the patients who did not prefer salty foods. Behavioral interventions for salt restriction after an assessment of daily salt intake are necessary for primary care patients, regardless of their preference for salty foods. [ABSTRACT FROM AUTHOR]

Although salt restriction is very important for the management of blood pressure (BP), it is difficult to maintain low salt intake in hypertensive patients. The purpose of the present study is to investigate comparatively the characteristics of hypertensive patients with good or poor compliance to long-term salt restriction. Subjects included 248 hypertensive patients who underwent successful 24-h home urine collection for >5 times with the observation period of 9.4 years in average. When the subjects were categorized based on the mean 24-h urinary salt excretion during the observation period to the groups with good (<8 g/day) or poor (10 g/day or more) compliance to long-term salt restriction, subjects with poor compliance were more frequently to be male, younger and had higher BMI than those with good compliance. Although there were no significant differences in BP and the number of antihypertensive drugs between the subjects with good and poor compliance, the subjects with poor compliance were given more diuretics, more frequently complicated with diabetes mellitus and hyperuricemia and had higher urinary protein excretion than those with good compliance. Thus, strict nutritional intervention and the management of BP as well as the complicated cardiovascular risk are important for the patients with poor compliance to salt restriction. [ABSTRACT FROM AUTHOR]

Aims European and American guidelines have recommended salt and fluid restriction for patients with chronic heart failure (CHF) despite scarce scientific evidence. Therefore, we investigated the effects of salt and fluid restriction in patients with CHF. Methods and results Ninety-seven stable patients in NYHA class II–IV, on optimal medication, with previous signs of fluid retention, treated with either >40 mg (NYHA III–IV) or >80 mg (NYHA II–IV) of furosemide daily were randomized to either individualized salt and fluid restriction or information given by the nurse-led heart failure clinics, e.g. be aware not to drink too much and use salt with caution, and followed for 12 weeks. Fluid was restricted to 1.5 L and salt to 5 g daily, and individualized dietary advice and support was given. The 24 h dietary recall procedure, urine collection on three consecutive days, and para-aminobenzoic acid 80 mg t.i.d. was used to assess adherence to diet and completeness of urine collection. The primary endpoint was a composite variable consisting of NYHA class, hospitalization, weight, peripheral oedema, quality of life (QoL), thirst, and diuretics. Results After 12 weeks, significantly more patients in the intervention than in the control group improved on the composite endpoint (51% vs. 16%; P < 0.001), mostly owing to improved NYHA class and leg oedema. No negative effects were seen on thirst, appetite, or QoL. Conclusion Individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or QoL in patients with moderate to severe CHF and previous signs of fluid retention. [ABSTRACT FROM AUTHOR]

Background: A few studies have explored the effects of disclosure of genetic testing results on chronic disease predisposition. However, these effects remain unclear in cases of hypertension. Reducing salt intake is an important nonpharmacological intervention for hypertension. We investigated the effects of genetic testing for salt sensitivity on salt restriction behavior using hypothetical genetic testing results. Methods: We conducted a crossectional study using a selfcompleted questionnaire. We enrolled consecutive outpatients who visited primary care clinics and small hospitals between September and December 2009 in Japan. We recorded the patients' baseline characteristics and data regarding their salt restriction behavior, defined as reducing salt intake before and after disclosure of hypothetical salt sensitivity genetic test results. Behavioral stage was assessed according to the fivestage transtheoretical model. After dividing subjects into salt restriction and no salt restriction groups, we compared their behavioral changes following positive and negative test results and analyzed the association between the respondents' characteristics and their behavioral changes. Results: We analyzed 1562 participants with a mean age of 58 years. In the no salt restriction group, which included patients at the precontemplation, contemplation, and preparation stages, 58.7% stated that their behavioral stage progressed after a positive test result, although 29.8% reported progression after a negative result (P < 0.001). Conversely, in the salt restriction group, which included patients at the active and maintenance stages, 9.2% stated that they would quit restricting salt intake following a negative test result, and 2.2% reported they would quit following a positive result (P < 0.001). Age < 65 years (adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.12-2.71), female gender (adjusted OR 1.84; CI 1.29-2.62), graduation from college or university (adjusted OR 1.66; CI 1.11-2.49), and desire for genetic testing (adjusted OR 4.53; CI 3.13-6.57) were associated with progression of behavioral stage in the no salt restriction group. Conversely, salt preference (adjusted OR 2.13; CI 1.31-3.49) was associated with quitting salt restriction in the salt restriction group. Conclusion: Patients in the no salt restriction group show the possibility of progression from the behavioral stage to the action stage after testing positive for salt sensitivity. Conversely, patients in the salt restriction group, particularly those with a salt preference, would quit salt restriction after testing negative. [ABSTRACT FROM AUTHOR]

Reduction of salt intake through bread requires reliable monitorization when the control of a large number of samples is in order. The use of flame photometry is attractive; however, the usual dry-ash sample pretreatment is fastidious. Direct dissolution of bread sodium in water is a good alternative. A good correlation between results from these two sample preparation methods was obtained for sodium quantification in nine different types of bread. The proposed method was applied to the quantification of sodium in 48 bread samples of randomly chosen from local market to evaluate compliance with legislation requirements (lower than 550 mg sodium per 100 g of bread-Lei no. 75/2009). [ABSTRACT FROM AUTHOR]

A common form of biased reporting is to avoid quoting evidence that contradicts the authors'' interpretation of scientific data. Against this background the recommendations by the Institute of Medicine of the National Academies of USA (IOM) regarding a population-based policy of salt restriction have been reviewed. It is suggested that the recommendations may not be valid since some important evidence has not been included in the IOM analysis. [ABSTRACT FROM AUTHOR]

Strict volume control strategy provides better cardiac functions and control of hypertension in dialysis patients. We investigated the effect of this strategy on mortality and technique failure in peritoneal dialysis patients over a 10-year period. 243 patients were enrolled. Strict volume control by dietary salt restriction and ultrafiltration was applied. Mean systolic and diastolic blood pressures decreased from 138.4 ± 29.9 and 86.3 ± 16.8 to 114.9 ± 32.3 and 74.7 ± 18.3 mm Hg, respectively. Overall and cardiovascular mortality rates were 48.4 and 29.6 per 1,000 patient-years, respectively. In multivariate analysis, age, diabetes and baseline serum albumin level were independent predictors of overall mortality, and age, diabetes and baseline serum calcium of cardiovascular mortality. Residual diuresis and peritoneal equilibration test values were not related to mortality. Strict volume control leads to lower mortality than comparable series in the literature. Technique survival is better during the first 3 years, but not after 5 years. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Hypertension is a risk factor for cardiovascular morbidity and mortality. Hypertension affects the majority of haemodialysis (HD) patients. However, in the absence of prospective data, accurate assessment of blood pressure (BP) and the level to which BP should be targeted remain still to be defined. A direct relationship between volume status and BP as well as between hypervolaemia and morbidity and mortality in HD patients indicates that normovolaemia is the key therapeutic target. Dry-weight reduction by additional ultrafiltration (even in the absence of clinical signs of volume overload) combined with daily dietary salt restriction or individually lowered dialysate sodium is recommended. Strict volume control allows marked reduction of antihypertensive drug treatment or makes it even unnecessary. Long, slow, home HD or frequent, short HD sessions or nocturnal HD also result in reduction of BP and left ventricular hypertrophy in end-stage renal disease patients. It will be interesting to see which recommendations will come from a conference sponsored by the Kidney Disease: Improving Global Outcomes on optimal BP treatment target in relation to end-organ damage and outcomes in HD patients, on antihypertensive drugs and on non-pharmacological therapies are to be considered in achieving BP targets in this population based on a paucity of prospective data. [ABSTRACT FROM AUTHOR]

The evaluation of patients with resistant hypertension should be directed toward confirming true treatment resistance, identifying the causes contributing to treatment resistance (including secondary causes of hypertension), and documenting target-organ damage. Treatment of resistant hypertension is aimed at reversing lifestyle factors contributing to treatment resistance, accurately diagnosing and appropriately treating secondary causes of hypertension, and effectively using multidrug regimens. Lifestyle changes, pharmacologic therapies, and nonpharmacologic therapies have all shown benefits in patients with resistant hypertension, but much additional knowledge is needed to better identify and treat these patients. [ABSTRACT FROM AUTHOR]

BackgroundA common recommendation for the treatment of hypertension is dietary salt intake restriction. However, dietary salt is one of the major sources of iodine. This study evaluated the association between dietary salt restriction and iodine deficiency among adults in the United States.MethodsMultiple regression models, which controlled for confounders, were used to evaluate the association between hypertension conditions, salt restriction and iodine deficiency among 996 men and 960 women in the blood pressure and iodine subsamples of the 2001-2004 waves of the National Health and Nutrition Examination Surveys (NHANES).ResultsHigh proportions of men (24.96%) and women (40.42%) were iodine deficient. Current hypertension or having a history of hypertension among men and women did not associate significantly with iodine deficiency or high iodine status, compared with those without current or history of hypertension. Compared with men not restricting dietary salt, salt restriction did not associate significantly with iodine deficiency among men. Compared with women not restricting dietary salt, women who were restricting dietary salt associated with significantly lower urinary iodine concentration (UIC), P = 0.01, and were more likely to be iodine deficient, adjusted odds ratios, 1.79, P = 0.03.ConclusionsSalt restriction associated with iodine deficiency among women but not men. Alternative sources of iodine should be suggested to persons who are consuming low levels of iodine such as women if they need to restrict dietary salt intake. Among those iodine deficient, health professionals should enquire about salt restriction.American Journal of Hypertension (2010). doi:10.1038/ajh.2010.120 [ABSTRACT FROM AUTHOR]

The purpose of the present study was to investigate the long-term compliance with salt restriction and blood pressure (BP) control status in Japanese hypertensive outpatients. Subjects included 103 patients, 59 women and 44 men, mean age 67 ± 9 years, who underwent successful 24-h home urine collection more than 10 times over an interval of 5 years. Urinary salt, potassium, and creatinine were measured. During the follow-up period (average 8.6 years), participants underwent urine collection 11.4 times in average. Urinary salt excretion at the last visit was significantly lower than that of the first visit (8.2 ± 3.1 vs. 9.6 ± 3.7 g/day; p < 0.01). The achievement of urinary salt excretion <6 g/day increased from 18.5% at the first visit to 26.2% at the last visit. Similarly, BP at the last visit was significantly lower than that of the first visit (130 ± 14/69 ± 11 vs. 145 ± 17/86 ± 12 mmHg; p < 0.01). The achievement rate of BP <140/90 mmHg and <130/85 mmHg also increased significantly during this period (39.2% to 70.8% and 13.7% to 39.6%, respectively, p < 0.01). Results suggest that urinary salt excretion decreased by repeated measurements using 24-h home urine collection. Lifestyle modification including weight loss as well as the intensive antihypertensive treatment contributed to the improved BP control during this period. [ABSTRACT FROM AUTHOR]

The importance of salt restriction in the treatment of patients with renal disease has remained highly controversial. In the following we marshal the current evidence that salt plays a definite role in the genesis of hypertension and target organ damage, point to practical problems of salt restriction, and report on novel pathomechanisms of how salt affects blood pressure and causes target organ damage. [ABSTRACT FROM AUTHOR]

Objectives: Ménière's disease (MD) is poorly understood with respect to its etiology, pathophysiology, clinical course, and treatment. Furthermore, in the absence of controlled clinical studies, empiric treatments have been used with varying degrees of success. In this paper, the authors review the current medical management of MD. Study Design: Literature review. Results: Because of a dearth of well-controlled studies, the medical management of MD remains empirical and is largely restricted to lifestyle changes, pharmacotherapy, and office-based procedures. The development of transtympanic therapies represents a true therapeutic advance that has largely supplanted surgical intervention. A treatment algorithm for acute and chronic medical management is reviewed. Conclusions: Despite absence of a complete understanding of MD, medical management or its natural history leads to control of vertigo in the majority of patients. Basic research is needed to understand its pathophysiology so that directed therapies can be developed and can be tested in well-controlled clinical trials. [ABSTRACT FROM AUTHOR]

We investigated a simple device to monitor daily salt intake at home and examined the relationship between salt excretion and morning blood pressure in order to enable patients to better manage daily salt intake and hypertension. The correlation between 24-h urinary salt excretion and measured value with salt monitor from overnight urine was significant (n=224, r=0.72, P<0.001). A total of 46 volunteers participated for more than 3 weeks by measuring daily salt intake and morning blood pressure. The relationship between predicted daily salt excretion and blood pressure was examined with use of 3-day moving average. Mean salt excretion and systolic blood pressure (SBP) significantly decreased by the end of the trial (i.e., salt excretion decreased from 158±31 to 149±30 mmol/day and SBP from 137±17 to 133±16 mm Hg). Of 46 participants, 18 (39%) had a significant correlation between predicted daily salt excretion and blood pressure (r>0.4, P<0.05, n>21), indicating sodium sensitivity. An additional 17% had a positive correlation that did not reach statistical significance (0.2

Background. Nephrogenic ascites refers to the condition of refractory ascites of unknown aetiology and occurs mainly in patients with end‐stage renal disease who are undergoing haemodialysis. Despite many treatment modalities, nephrogenic ascites remains difficult to control and has a poor prognosis. [ABSTRACT FROM PUBLISHER]

We developed a model of volume contraction in rabbits by using a furosemide/low-salt diet to follow changes, if any, in proximal tubule Na+/H+ exchanger 3 (NHE3) mRNA and brush-border protein. The rabbits' plasma renin, aldosterone, and urine sodium content confirmed the volume-contracted state. RNase protection assays demonstrated increases in treated-animal NHE3 mRNA as a percentage of control with 172 ± 23, 154 ± 15, 153 ± 14, and 141 ± 7 (SE) % (P < 0.05) at 1, 5, 10, and 31 days, respectively. Western analysis of brush-border membrane with NHE3 antibody revealed increased immunoreactivity in treated animals as a percentage of control with 120 ± 30, 190 ± 59, 307 ± 72, and 427 ± 41% (P < 0.05) at 1, 5, 10, and 31 days, respectively. There was no significant difference in serum potassium, bicarbonate, and cortisol in control vs. experimental animals. These data suggest that there is chronic upregulation of NHE3 in the volume-contracted state. [ABSTRACT FROM AUTHOR]

Background: Advances have been made in the medical management of congestive heart failure. However, there is concern that these changes may not be transmitted to the heart failure population in the community. Other impediments to improved prognosis, such as failure to apply non-pharmacological strategies and poor patient comprehension may also be prevalent in the community.Aims: The purpose of this study was to assess physician practice and patient knowledge in a heart failure population admitted to a University Hospital in Ireland.Methods: Patients admitted with a primary diagnosis of heart failure were studied. Estimation of ejection fraction was used to subdivide the population into heart failure with impaired and normal systolic function. Patients' course in hospital was noted with reference to management by cardiology or internal medicine, use of angiotensin-converting enzyme inhibition therapy and digoxin and application of dietary and rehabilitative services. Patient knowledge was assessed by questionnaire.Results: Eighty patients were included in this study. Two-thirds of the population had impaired systolic function. The majority of patients were managed by internal medicine physicians, and this population was older and more likely to have normal systolic function. Prescription of converting enzyme inhibitor therapy was more frequently used in cardiology-managed patients (96 vs. 70%, P<0.05). Neither group applied dietary or rehabilitative advice to a significant level. Patient comprehension was poor, especially with regard to understanding of medicine and the value of weight measurement.Conclusion: The above data demonstrate a lack of use of rehabilitative and dietary services and poor patient knowledge. These deficiencies may play a role in determining outlook and may impede the expected improvement in prognosis that has been witnessed in large randomised studies. [ABSTRACT FROM AUTHOR]

Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25–79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008–2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake. [ABSTRACT FROM AUTHOR]

To examine the effect of genetic variance on blood pressure, sodium homeostasis, and its regulatory determinants, we studied 37 pairs of monozygotic twins and 18 pairs of dizygotic twins under conditions of volume expansion and contraction. We found that, in addition to blood pressure and body size, sodium excretion in response to provocative maneuvers, glomerular filtration rate, the renin-angiotensin system, and the sympathetic nervous system are influenced by genetic variance. To elucidate the interaction of genetic factors and an environmental influence, namely, salt intake, we restricted dietary sodium in 44 families of twin children. In addition to a modest decrease in blood pressure, we found heterogeneous responses in blood pressure indicative of sodium sensitivity and resistance which were normally distributed. Strong parent-offspring resemblances were found in baseline blood pressures which persisted when adjustments were made for age and weight. Further, mother-offspring resemblances were observed in the change in blood pressure with sodium restriction. We conclude that the control of sodium homeostasis is heritable and that the change in blood pressure with sodium restriction is familial as well. These data speak to the interaction between the genetic susceptibility to hypertension and environmental influences which may result in its expression. [ABSTRACT FROM AUTHOR]

Abundant clinical and epidemiological data suggest that hypertension, or high blood pressure is a disease of high prevalence in industrialized societies, with cardiovascular morbidity and mortality directly related to the level of blood pressure. Although efficacious pharmacologic approaches to the control of high blood pressure are available, concern about risk versus benefit in the use of antihypertensive drug therapy for patients with mild hypertension has led to renewed interest in nonpharmacologic interventions. In the U.S.A. the National High Blood Pressure Education Program, an organization comprised of research scientists and a variety of other professionals concerned with the control of high blood pressure, has through a consensus process, recommended some nonpharmacologic approaches to the treatment of hypertension. The pros and cons of nutritional interventions, exercise and biobehavioural treatments are discussed. Nonpharmacologic recommendations in the treatment of hypertension for which there appear to be sufficient requisite data include weight reduction for the obese, moderate sodium restriction (although this is controversial) and restriction of alcohol consumption to less than 57 g of ethanol daily [ABSTRACT FROM PUBLISHER]

In 16 essential hypertensives on a program of energy restriction (800 kcal/day) with and without simultaneous salt restriction, the effects on blood pressure and intracellular Na and Ca in red blood cells were studied. A decrease in blood pressure and intracellular free Na and Ca was only observed in the cases of simultaneous energy and salt restriction. The beneficial effect of weight reduction in hypertension thus depends on a diminished salt intake and is probably mediated by changes in intracellular free Ca. [ABSTRACT FROM AUTHOR]

The possible increase in total and low-density lipoprotein cholesterol following severe restriction of dietary NaCl was reported in 1990 and and 1991 from three experiments, one in the United States and two in Germany. Each of these experiments lasted only 1 week. To evaluate the clinical side effects we analyzed data collected from patients who completed a course of NaCl-restricted weight reduction at the Duke Diet and Fitness Center. Observations of lipid changes are not available for periods of less than 3 weeks; however, we were able to collect data on lipid and lipoprotein changes from 556 participants 25 days after they were referred for weight reduction. Total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels returned to normal in the majority of obese patients. In our slightly longer observation period in patients on a 1000 mg NaCl restricted diet we found no evidence of hyperlipidemic side effects. We believe that the hyperlipidemia resulting from severe sodium restriction in non-hypertensive, normal-weight individuals is not relevant to the problem of nonpharmacological and diuretic treatment of obese hypertensive patients. In clinically healthy, normal-weight, normotensive individuals severe salt restriction serves no practical or therapeutic purpose. [ABSTRACT FROM AUTHOR]