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Funder: Dutch Kidney Foundation, AIMS: A potassium replete diet is associated with lower blood pressure (BP) and lower risk of cardiovascular disease (CVD). Whether these associations differ between men and women and whether they depend on daily sodium intake is unknown. METHODS AND RESULTS: An analysis was performed in 11 267 men and 13 696 women from the EPIC-Norfolk cohort. Twenty-four hour excretion of sodium and potassium, reflecting intake, was estimated from sodium and potassium concentration in spot urine samples using the Kawasaki formula. Linear and Cox regression were used to explore the association between potassium intake, systolic BP (SBP), and CVD events (defined as hospitalization or death due to CVD). After adjustment for confounders, interaction by sex was found for the association between potassium intake and SBP (P < 0.001). In women, but not in men, the inverse slope between potassium intake and SBP was steeper in those within the highest tertile of sodium intake compared with those within the lowest tertile of sodium intake (P < 0.001 for interaction by sodium intake). Both in men and women, higher potassium intake was associated with a lower risk of CVD events, but the hazard ratio (HR) associated with higher potassium intake was lower in women than in men [highest vs. lowest potassium intake tertile: men: HR 0.93, 95% confidence interval (CI) 0.87-1.00; women: HR 0.89, 95% CI 0.83-0.95, P = 0.033 for interaction by sex]. CONCLUSION: The association between potassium intake, SBP, and CVD events is sex specific. The data suggest that women with a high sodium intake in particular benefit most from a higher potassium intake with regard to SBP.

Background Sodium, potassium, and the balance between these 2 nutrients are associated with hypertension and cardiovascular disease, and prevalence of these conditions increases with age. However, limited information is available on these intakes among older adults. Objective Our aim was to explore the socioeconomic and health factors associated with usual sodium and potassium intakes and the sodium to potassium (Na:K) ratio of older adults. Design This was a cross-sectional, secondary analysis of the 2011-2012, 2013-2014, and 2015-2016 National Health and Nutrition Examination Survey. Participants/setting This study included the data of 5,104 adults 50 years and older, with at least one reliable 24-hour dietary recall and an estimated glomerular filtration rate ≥60 mL/min/1.73 m2. Main outcome measures Sodium and potassium intake, as absolute intake, density (per 1,000 kcal) and ratio of Na:K intake. Statistical analyses We used t tests and χ2 tests to examine significant differences in intakes on a given day by characteristics. Linear and logistic regression models were used to assess associations of socioeconomic and health characteristics with usual sodium and potassium intakes, determined using the National Cancer Institute method. Results Only 26.2% of participants consumed Conclusions Participants consumed too much sodium and not enough potassium, based on current recommendations. A higher Na:K ratio was significantly associated with established risk factors for cardiovascular disease. The study findings suggest that more research on cardiovascular health should include both sodium and potassium, as well as balance between these nutrients.

The paper aims to review the available data about the main mechanisms enabling improvement or accelerating vascular ageing due to food choices, considering recent experimental and clinical data, and emphasising potential implications for clinical practice and therapy. The main food choices which will be discussed are diets rich in fruits and vegetables, the Mediterranean diet, polyunsaturated fatty acids, cocoa, caffeine, tea, meat, dairy products, sodium, and potassium intake.

Urinary sodium-to-potassium ratios are known to be high in preschoolers, but there are no reports comparing these ratios with those of the children's mothers. The aim of this study was to investigate the association between the urinary sodium-to-potassium ratios of mothers and their preschool children under the hypothesis that the ratio is equivalent between the two. We evaluated 297 preschoolers aged four to five attending six kindergartens (four in northern Japan, two in southern Japan), and we also evaluated the children's mothers. We asked the participants to take morning first urine samples for 2 consecutive days in the spring and autumn of the same year (four samples per participant) and to fill out a dietary questionnaire. There was a correlation between the urinary sodium-to-potassium ratios of preschoolers and those of their mothers. However, in a comparison between the preschoolers and their mothers overall, higher values were found in the preschoolers [preschoolers: 4.6 (3.5-6.3) mmol/L/g·Cr; mothers: 4.3 (3.9-4.7) mmol/L/g·Cr, p = 0.003]. These results correlated with the urinary sodium-to-potassium ratios estimated from the dietary questionnaire. The preschoolers showed high sodium and low potassium intake consumption compared to the mothers. Interestingly, these were found to differ by region and gender. In conclusion, the urinary sodium-to-potassium ratio in Japanese preschoolers is related to and higher than that of their mothers. It is important to educate children, their parents, childcare professionals, and society as a whole about proper salt restriction and potassium supplementation, as well as to improve the food environment.

Background: Approximately one-third of adults in Trinidad and Tobago have high blood pressure (hypertension). Excessive consumption of sodium (Na+) is a known risk factor for hypertension. Aim: We investigated Na+ and potassium (K+) intakes and their correlates in a multi-ethnic Caribbean population. Method: Volunteers completed a self-administered questionnaire comprising socio-demographic items, physical activity (PA) and a semiquantitative food frequency questionnaire. Foods eaten were classified by level of processing using the NOVA classification system and analysed for Na+ and K+ levels using appropriate dietary analysis software. The study was approved by the University of the West Indies at Saint Augustine Ethics Committee. Results: 11,783 adults participated in the study. Approximately 83.2% of total calories, 79% of Na+ and 40% of K+ was derived from the consumption of highly processed foods. Median daily Na+ and K+ intakes were 2759 mg and 2853 mg, respectively. Na+ intakes showed significant nonlinear increases with age ( p < 0.001) and body mass index (BMI) ( p < 0.001), and non-linear decreases with educational attainment ( p < 0.001). K+ intakes showed significant nonlinear decreases with age ( p < 0.001) and BMI ( p < 0.001), and linear increases with educational attainment ( p < 0.001). Males had higher intakes of Na+ and K+ than females. Na+: K+ was lower among persons participating in moderate to high intensity PA ≥ 150 minutes/week compared to those participating in such activities < 150 minutes/week. Conclusion: Socio-demographic factors were significantly correlated with Na+ and K+ intakes among participants and must be considered in strategies aimed at achieving healthy intakes of these nutrients.

Background The collection of weighed food records (WFR) is a gold standard for dietary assessment. We propose using the 24-h recall method combined with a portable camera and a food atlas (24hR-camera). This combination overcomes the disadvantages of the 24-h dietary recall method. Our study examined the validity of the 24hR-camera method against WFR by comparing the results. Methods Study subjects were 30 Japanese males, aged 31–58 years, who rarely cook and reside in the Tokyo metropolitan area. For validation, we compared the estimated food intake (24hR-camera method) and weighed food intake (WFR method). The 24hR-camera method uses digital photographs of all food consumed during a day, taken by the subjects, and a 24-h recall questionnaire conducted by a registered dietitian, who estimates food intake by comparing the participant’s photographs with food atlas photographs. The WFR method involves a registered dietitian weighing each food item prepared for the subject to consume and any leftovers. Food intake was calculated for each food group and nutrient using the 24hR-camera vs. weighed methods. Results Correlation coefficients between the estimated vs. weighed food intake were 0.7 or higher in most food groups but were low in food groups, such as oils, fats, condiments, and spices. The estimated intake of vegetables was significantly lower for the 24hR-camera method compared to the WFR method. For other food groups, the percentages of the mean difference between estimated vs. weighed food intake were -22.1% to 5.5%, with no significant differences between the methods (except for algae, which had a very low estimated intake). The correlation coefficients between the two methods were 0.774 for energy, and 0.855, 0.769, and 0.763 for the macronutrients, proteins, lipids, and carbohydrates, respectively, demonstrating high correlation coefficients: greater than 0.75. The correlation coefficients between the estimated vs. weighed for salt equivalents and potassium intake were 0.583 and 0.560, respectively, but no significant differences in intake were observed. Conclusions The 24hR-camera method satisfactorily estimated the intake of energy and macronutrients (except salt equivalents and potassium) in Japanese males and was confirmed as a useful method for dietary assessment.

Background Sodium intake in the USA exceeds recommendations. The replacement of added sodium chloride (NaCl) with potassium chloride (KCl) provides a potential strategy to reduce sodium intake. Objective The purpose of this study was to quantitatively estimate changes in intakes of sodium and potassium by the US population assuming use of potassium-based NaCl replacers in top dietary sodium sources. Methods Data collected in the What We Eat in America (WWEIA) component of the 2015–2016 and 2009–2010 NHANES were used to identify top-ranking sources of dietary sodium among the population aged 2 y and older based on contributions from food categories aligning with the FDA draft guidance for voluntary sodium reduction. Predicted nutrient intakes were estimated in models assuming total and feasible and practical (F&P) replacement of added NaCl with KCl in foods and ingredients within the top food sources of sodium. An expert elicitation was conducted to collect information on the F&P KCl replacement of added NaCl. Results Using 2015–2016 consumption data, the total replacement of added NaCl with KCl in the 18 top-ranking sources of dietary sodium results in a predicted sodium intake of 2004 mg/d from the replacement of 1406 mg/d sodium with 1870 mg/d potassium as KCl. Modeled F&P replacement predicted sodium intakes of 3117 mg/d (range of 2953 to 3255 mg/d) from the replacement of 294 mg/d sodium (155 to 457 mg/d) with 390 mg/d potassium (206 to 608 mg/d). Similar results are seen with 2009–2010 data. Conclusions The F&P replacement of NaCl with KCl in top-ranking sources of dietary sodium modeled in this study can result in decreased sodium to a level consistent with the short-term intake goal targeted by the FDA of 3000 mg/d, with the mean potassium intake remaining in the range recommended for the apparently healthy population.

Purpose We aimed to validate myfood24-Germany, a web-based 24-h dietary recall (24HDR), by comparing its performance with a weighed dietary record (WDR) and biomarkers. Methods 97 adults (77% female) completed a 3-day WDR with a 24-h urine collection on day 3, followed by at least one 24HDR with myfood24-Germany (corresponding to day 3 of the WDR). Intake of energy and 32 nutrients assessed by myfood24-Germany and the WDR for the same day were compared (method comparison). Intakes of protein and potassium assessed by myfood24-Germany/WDR were compared with intake estimated from urinary biomarkers for protein and potassium (biomarker comparison). Results In the method comparison, significant correlations were found for energy and all tested nutrients (range 0.45–0.87). There was no significant difference between both methods in the assessed mean energy and macronutrient intake. However, myfood24-Germany underestimated mean intake of 15 nutrients. In the biomarker comparison, protein intake reported by myfood24-Germany/WDR was on average 10%/8% lower than estimated by biomarker. There was no significant difference in mean potassium intake assessed by myfood24-Germany/WDR and biomarker. However, a shared bias in the assessment of potassium intake was observed for both instruments. Concordance correlation coefficients (pc) and weighted Kappa coefficients (κ) confirmed good agreement with the biomarker estimates for myfood24-Germany/WDR in case of protein (pc = 0.58/0.66, κ = 0.51/0.53) and moderate agreement in case of potassium (pc = 0.44/0.51; κ = 0.30/0.33). Conclusion Our results suggest that myfood24-Germany is of comparable validity to traditional dietary assessment methods.

Background and aims Low potassium intake, in addition to high sodium, has been associated with higher risk of hypertension and CVD. The Study assessed habitual potassium intake and sodium/potassium ratio of the Italian adult population from 2008 to 2012 to 2018–2019 based on 24-h urine collection, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU’ SALUTE national surveys. Methods and results Data were from cross-sectional surveys of randomly selected age-and-sex stratified samples of resident persons aged 35–74 years in 10 (out of 20) Italian regions. Urinary electrolyte and creatinine measurements were performed in a central laboratory. Analyses considered 942 men and 916 women, examined in 2008–2012, and 967 men and 1010 women, examined in 2018–2019. In 2008–2012, the age-standardized mean of potassium intake (urinary potassium accounts for 70% of potassium intake) was 3147 mg (95% CI 3086–3208) in men and 2784 mg (2727–2841) in women, whereas in 2018–2019, it was 3043 mg (2968–3118) and 2561 mg (2508–2614) respectively. In 2008–2012, age-adjusted prevalence of persons with an adequate potassium intake (i.e. ≥ 3510 mg/day) was 31% (95% CI 28–34%) for men and 18% (16–21%) for women; in 2018–2019, it was 26% (23–29%) and 12% (10–14%) respectively. The sodium/potassium ratio significantly decreased both in men and women. Conclusions The average daily potassium intake of the Italian general adult population remains lower than the WHO and EFSA recommended level. These results suggest the need of a revision to strengthen initiatives for the promotion of an adequate potassium intake at the population level.

Objective Several recent publications, including an expert summary on hyperkalemia management, have encouraged plant-based foods for patients with chronic kidney disease (CKD) and highlighted the impact of potassium additives on total potassium intake. The aim of this research brief was to investigate if and/or how current recommendations for low-potassium diet may incorporate these new recommendations. Design and Methods Using a geographical approach, each province's and territory's government health and renal program (where applicable) website was reviewed for resources on dietary potassium restriction. All handouts/booklets/printable webpages were obtained and reviewed. Results Eighteen resources from 6 provincial health agencies in Canada were included. Six additional resources from national agencies were also included, 4 from Canada and 2 from the United States. The 5 most commonly restricted foods were bananas, potatoes, oranges, cantaloupe, and avocados. All resources recommended restriction of fruits and vegetables, 67% recommended restriction of dairy products, 57% recommended restriction of whole grain products, 62% recommended restrictions of plant-based proteins, and 67% mentioned restriction of other foods (such as coffee, tea, and chocolate), 28% mentioned restriction of potassium additives in ultraprocessed foods. Conclusion Low-potassium diets primarily restrict fruits and vegetables while the least common restriction is ultraprocessed food. Several recent publics have recommended a greater focus on ultraprocessed versus unprocessed food for hyperkalemia management. These new recommendations differ from current teaching materials that predominately restrict plant-based foods to manage hyperkalemia in CKD. Updates will likely be needed to current resources to reflect new recommendations.

General health and oral health are very closely related. This study aimed to analyze the nutritional factors associated with the number of present teeth in Korean elderly adults. A total of 6,356 individuals were surveyed from the sixth Korean National Health and Nutrition Examination Survey conducted from 2013–2015. The number of existing teeth was divided into three categories: 0–10, 11–20, and over 21, and the nutrition survey covers eating habits, food frequency and food intake using face-to-face interviews. Multiple logistic regression analysis was performed to evaluate the association between nutrient intake and the number of existing teeth after adjusting for socio-demographic factors and general and oral health behaviors and status. As age increases, the number of teeth decreases. Individuals with more teeth had a significantly higher mean daily intake of protein, calcium, phosphorus, potassium and riboflavin (p

Background Angiotensin II type 1 receptor blockers (ARBs) lower blood pressure (BP) and proteinuria and reduce renal disease progression in many—but not all—patients. Reduction of dietary sodium intake improves these effects of ARBs. Dietary potassium intake affects BP and proteinuria. We set out to address the effect of potassium intake on BP and proteinuria response to losartan in non-diabetic proteinuric chronic kidney disease (CKD) patients. Methods We performed a post hoc analysis of a placebo-controlled interventional cross-over study in 33 non-diabetic proteinuric patients (baseline mean arterial pressure and proteinuria: 105 mmHg and 3.8 g/day, respectively). Patients were treated for 6 weeks with placebo, losartan and losartan/hydrochlorothiazide (HCT), combined with a habitual (∼200 mmol/day) and low-sodium (LS) diet ( Results Mean potassium intake was stable during all six treatment periods. Losartan and losartan/HCT lowered BP and proteinuria in all treatment groups. Patients with high potassium intake showed no difference in the BP effects compared with patients with low potassium intake. The antiproteinuric response to losartan monotherapy and losartan combined with HCT during the habitual sodium diet was significantly diminished in patients with high potassium intake (20% versus 41%, P = 0.011; and 48% versus 64%, P = 0.036). These differences in antiproteinuric response abolished when shifting to the LS diet. Conclusions In proteinuric CKD patients, the proteinuria, but not BP-lowering response to losartan during a habitual high-sodium diet was hampered during high potassium intake. Differences disappeared after sodium status change by LS diet.

We examined the association between dietary potassium intake and all-cause and cause-specific mortality among community-dwelling older adults. Potassium intake was assessed with a food frequency questionnaire administered to 1,363 older adults (mean age 71.0 ± 10.6 years). Cox proportional hazard regressions estimated hazard ratios for sex-specific quintiles of calorie-adjusted potassium in relation to all-cause and cause-specific (cardiovascular disease, CVD, and stroke) mortality, adjusting for numerous covariates. There were 855 deaths (63% mortality) during the 20-year follow-up. Relative to the third quintile, potassium intake in the lowest quintile only was associated with increased risk of all-cause mortality (fully-adjusted hazard ratio 1.33; 95% CI 1.06, 1.67). Potassium intake was not significantly associated with CVD or stroke mortality. These results suggest that low potassium intake is associated with increased risk of mortality independent of overall health status. Ensuring adequate potassium in the diet may be an important strategy for reducing risk of earlier mortality among older adults.

Objective:The present study aimed to estimate the consumption of Na and K and to assess salt-related knowledge, attitude and behaviour among adults in Addis Ababa, Ethiopia.Design:A community-based cross-sectional study was conducted. Estimates of Na and K intake were made using repeated multiple-pass 24-h dietary recall as well as using random urine. The usual intake of Na and K from the 24-h dietary recall was determined using the National Cancer Institute methodology. Estimated 24-h Na and K excretion was calculated using International Cooperative Study on Salt, Other Factors, and Blood Pressure and Tanaka formula.Settings:Addis Ababa, the capital city of Ethiopia.Participants:Individuals aged 20 years and above residing in the city.Result:The mean Na and K intake estimated using the diet recall data was 3·0 (0·9) g/d and 1·9 (0·6) g/d, respectively. Based on the urine analysis, the estimated mean Na and K intakes were 3·3 (0·7) g/d and 1·9 (0·4) g/d, respectively. Moreover, the analysis showed that the mean Na:K ratio was 2·5 (1·4). The daily intake of K was below the recommended amount for all study participants. More than 98 % and 90 % of participants had an excess intake of Na and Na:K ratio, respectively.Conclusion:We found a high prevalence of inadequate K intake as well as excess intake of Na resulting in an increased prevalence of excess Na:K ratio. Thus, interventions targeting to decrease Na intake and to increase K intake are needed.

Background: It is a matter of debate whether sodium and potassium intake are associated with heart disease. Further, the mechanisms underlying associations of sodium and potassium intake with cardiac events, if any, are not fully understood.Objectives: We examined cross-sectional associations of 24-h urinary sodium excretion (UNaE) and potassium excretion (UKE), as estimates of their intakes, with high-sensitivity cardiac troponins T (hs-cTnT) and I (hs-cTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP), which are markers of cardiomyocyte injury and cardiac dysfunction.Methods: We included 2961 participants from the population-based Maastricht Study (mean +/- SD age 59.8 +/- 8.2 y, 51.9% men), who completed the baseline survey between November 2010 and September 2013. Associations were examined with restricted cubic spline linear regression analyses and ordinary linear regression analyses, adjusted for demographics, lifestyle, and cardiovascular disease (CVD) risk factors.Results: Median [QR] 24-h UNaE and UKE were 3.7 (2.8-4.71 g/24 h and 3.0 12.4-3.61 g/24 h, respectively. After adjustment for potential confounders, 24-h UNaE was not associated with hs-cTnT, hs-cTnI, and NT-proBNP concentrations. In contrast, after adjustment for potential confounders, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. For example, as compared with the third/median quintile of 24-h UKE (range: 2.8-3.2 g/24 h), participants in the first quintile (range: 0.5-2.3 g/24 h) had 1.05 (95% CI: 0.99, 1.11) times higher hs-cTnT and 1.14 (95% CI: 1.03, 1.26) times higher NT-proBNP. Associations were similar after further adjustment for estimated glomerular filtration rate, albuminuria, blood pressure, and serum potassium.Conclusions: Twenty-four-hour UNaE was not associated with the studied cardiac biomarkers. In contrast, lower 24-h UKE was nonlinearly associated with higher hs-cTnT and NT-proBNP. This finding supports recommendations to increase potassium intake in the general population. In addition, it suggests that cardiac dysfunction and/or cardiomyocyte injury may underlie previously reported associations of lower potassium intake with CVD mortality.

Background: Potassium intake deficiency is a chronic issue in the US and many other countries. Possible causes of the deficiency are understudied.Objective: This study examined potassium deficiency...

Background Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. Objectives We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. Methods We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. Results 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.

Diabetic patients have a 1,5 to 3 times higher risk of developing hypertension compared to non-diabetics. The proportion of hypertension in Indonesia in patients with DM is 51.8%. This study aims to determine the relationship between sodium and potassium intake, nutritional status, and physical activity with the incidence of blood pressure in DM patients in Pesanggrahan District Health Center. The study design used was cross-sectional, with a sample of 99 patients obtained from the purposive sampling method. The results showed that the average patient was 57 years old, female, and had been suffering from diabetes for five years. The average sodium and potassium intake are 2401 mg and 1460 mg respectively. The proportion of diabetic patients at the Pesanggrahan District Health Center who had high blood pressure was 83,8% and 78,8% of patients have central obesity, while 75,8% fall into the category of low physical activity. Based on the chi-square test, there is a significant relationship (p=0,000) between sodium intake, nutritional status, and physical activity with systolic blood pressure. There was a significant relationship between sodium intake, nutritional status, and physical activity with diastolic blood pressure (p= 0,000, 0,023, and 0,000). Keywords: blood pressure, diabetes mellitus, nutrient intake, nutritional status, physical activity

OBJECTIVES Hypertension phenotypes differ between Africans and Europeans, with a greater prevalence of low renin salt-sensitive hypertension and greater predisposition to adverse cardiac remodelling in Africans. To elucidate the roles of inheritance and environment in determining hypertension phenotypes in sub-Saharan Africans and white-Europeans, we compared phenotypes in white individuals in the UK (n = 132) and in African individuals in the UK (n = 158) and Nigeria (n = 179). METHODS Biochemistry, blood pressure, left ventricular structure (echocardiography) and 24-h urinary collections of sodium and potassium were measured. RESULTS Twenty-four-hour urinary sodium/potassium ratio was lower in individuals living in Europe (both African and white: 2.32 ± 0.15 and 2.28 ± 0.17) than in individuals in Nigeria (4.09 ± 0.26, both P

BACKGROUND: Hypertension is an important public health problem. Overweight and high salt intake are risk factors for its development. OBJECTIVE: To evaluate the association between salt taste sensitivity threshold (STST) and blood pressure (BP) in healthy adults. DESIGN AND SETTING: Cross-sectional study conducted in a private institution. METHODS: 104 healthy adults (aged 18-59 years) were evaluated. Sociodemographic, clinical and dietary data were collected. Nutritional status and BP were assessed using body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). STST was assessed using graded saline solutions with sodium chloride concentrations ranging from 0.228 to 58.44 g/l. Identification of salty taste in solutions ≥ 3.652 g/l was used as the cutoff point for high STST. RESULTS: Participants with high STST presented higher daily average intakes for energy (2017.4 ± 641.5 versus 1650.5 ± 357.7 kcal/day; P = 0.01) and sodium (3070.2 ± 1195.1 versus 2435.2 ± 963.6 mg/day; P = 0.01) and higher BMI (P = 0.008) and WC (P = 0.002). After adjustment for age, sex, sodium and potassium intake, WC and family history of hypertension, the averages for SBP and DBP in subjects with high STST were higher than in those with normal STST (SBP: 138.2 ± 1.7 versus 119.7 ± 0.9 mmHg; P < 0.001; DBP: 81.2 ± 1.9 versus 75.1 ± 1.0 mmHg; P = 0.008). CONCLUSION: High STST was associated with elevated blood pressure in healthy adults, regardless of other risk factors for hypertension.

Population studies have demonstrated an association between sodium (Na) and po-tassium (K) intake and levels of blood pressure (BP) and cholesterol. The aim of this study was to describe the dietary intake and distribution of Na and K in Mexicans, and their as-sociation with metabolic risk outcomes. We analyzed a national survey that included 4,219 participants. Dietary information was obtained through a 24-hour recall. Foods and beverages were classified based on the degree of processing. BP and biomarkers in blood and urine were measured. The mean intake (mg/d) of Na was 1512 in pre-schoolchildren, 2844 in schoolchildren, 3743 in adolescents, and 3132 in adults. The mean intake of K was 1616 in pre-schoolchildren, 2256 in schoolchildren, 2967 in adolescents, and 3401 in adults. Processed and ultra-processed foods (UPF) contribute to sodium intake: 49% in preschool and schoolchildren, 47% in adolescents, and 39% in adults. Adults in the fourth quartile of sodium intake had lower serum concentrations of cholesterol (181.4 mg/dL) and HDL-c (35.5 mg/dL). The Mexican population has high Na and low K intakes. There is a relationship between Na sodium consumption and cholesterol, and LDL levels. UPF contributes to almost 40% of the sodium consumed by Mexicans.

Accurate assessments of potassium intake in children are important for the early prevention of CVD. Currently, there is no simple approach for accurate estimation of potassium intake in children. We aim to evaluate the accuracy of 24-h urinary potassium excretion (24UKV) estimation in children using three common equations: the Kawasaki, Tanaka and Mage formulas, in a hospital-based setting. A total of 151 participants aged 5–18 years were initially enrolled, and spot urine samples were collected in the whole 24-h duration to measure the concentrations of potassium and creatinine. We calculated the mean difference, absolute and relative difference and misclassification rate between measured 24UKV and the predicted ones using Kawasaki, Tanaka and Mage formulas in 129 participants. The mean measured 24UKV was 1193·3 mg/d in our study. Mean differences between estimated and measured 24UKV were 1215·6, −14·9 and 230·3 mg/d by the Kawasaki, Tanaka and Mage formulas, respectively. All estimated 24UKV were significantly different from the measured values in all the time point (all P < 0·05), except for the predicted values from Tanaka formula using morning, afternoon and evening spot urine. The proportions with relative differences over 40 % were 87·2%, 32·5% and 47·3 % for Kawasaki, Tanaka and Mage formulas, respectively. Misclassification rates were 91·5 % for Kawasaki, 44·4 % for Tanaka and 58·9 % for Mage formula at the individual level. Our findings showed that misclassification could occur on the individual level when using Kawasaki, Tanaka and Mage formulas to estimate 24UKV from spot urine in the child population.

Current U.S. dietary guidelines recommend a daily potassium intake of 3400 mg/day for men and 2600 mg/day for women. Sub-optimal access to nutrient-rich foods may limit potassium intake and increase cardiometabolic risk. We examined the association of neighborhood characteristics related to food availability with potassium intake in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). 13,835 participants completed a 24-h dietary recall assessment and had complete covariates. Self-reported potassium intake was calibrated with an objective 24-h urinary potassium biomarker, using equations developed in the SOL Nutrition &amp, Physical Activity Assessment Study (SOLNAS, N = 440). Neighborhood population density, median household income, Hispanic/Latino diversity, and a retail food environment index by census tract were obtained. Linear regression assessed associations with 24-h potassium intake, adjusting for individual-level and neighborhood confounders. Mean 24-h potassium was 2629 mg/day based on the SOLNAS biomarker and 2702 mg/day using multiple imputation and HCHS/SOL biomarker calibration. Compared with the lowest quartile of neighborhood population density, living in the highest quartile was associated with a 26% lower potassium intake in SOLNAS (adjusted fold-change 0.74, 95% CI 0.59–0.94) and a 39% lower intake in HCHS/SOL (adjusted fold-change 0.61 95% CI 0.45–0.84). Results were only partially explained by the retail food environment. The mechanisms by which population density affects potassium intake should be further studied.

Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.

Few studies have assessed the association between sodium (Na) and potassium (K) and migraine headaches. In this study, we aimed to examine the relationship between 24-hour urine Na and K intakes and clinical findings of migraine in an Iranian sample. In this cross-sectional study, 262 participants, aged 20–50 years, were included with a body mass index (BMI) of 18·5–30 kg/m2 and a diagnosis of migraine. One 24-hour urine sample was collected from each subject to estimate the Na and K intakes. The clinical features of migraine, including frequency, duration, severity, Migraine Headache Index Score (MHIS), and Headache Impact Test (HIT) score, were assessed. Besides, a multiple linear regression analysis was performed, and beta estimates and the corresponding 95% confidence intervals (CIs) were reported. Overall, 224 women and 38 men, with a mean age of 36·10 years and BMI of 25·55 kg/m2 comprised our study population. After controlling for potential confounders, the 24-hour urine Na was positively associated with a longer headache duration (β = 0·29; 95% CI: 0·06, 0·53) in the group with the highest urine Na levels as compared to the group with the lowest levels. After adjustments for potential confounders, an increase of 13·05 in the MHIS was observed when the 24-hour urine Na level increased from the first to the third tertile (β = 13·05; 95% CI: 1·70, 24·41). Our findings suggested that a higher 24-hour urine Na level was positively associated with a longer duration of migraine headaches and a higher MHIS.

Background Investigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults. Methods Usual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used. Results Complete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m2) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P Conclusions In this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.

ObjectiveA healthy diet is associated with reduced risk for stroke, myocardial infarction, cancer and death. We examined the prevalence of a healthy diet in patients with a recent stroke or transient ischaemic attack (TIA).MethodsWe recruited a convenience sample of 95 patients with a recent ischaemic stroke or TIA. Using information from a 125-item Food Frequency Questionnaire, we calculated dietary quality and the percentage of patients meeting recommended daily intake (RDI) for common macronutrients and elements.ResultsThe mean age of patients was 66 years (SD: 16) and 46% were women. 39 patients (41%) were classified as having a healthy diet (35% of men and 48% of women). The majority of patients were within the RDI for carbohydrates (56.8%), total fat (61.1%), long-chain n-3 fats (68.4%), polyunsaturated fats (79.0%) and protein (96.8%). Very few patients consumed the recommended intake for sodium (25.3%), and even fewer consumed the RDI for potassium (4.2%), with the majority of patients consuming too much sodium and too little potassium.ConclusionWe found that most patients with recent stroke or TIA were not following a healthy diet before their stroke event. For most patients, sodium intake was much above and potassium intake was much below RDI.

Background Understanding measurement error in sodium and potassium intake is essential for assessing population intake and studying associations with health outcomes. Objective The aim of this study was to compare sodium and potassium intake derived from 24-h dietary recall (24HDR) with intake derived from 24-h urinary excretion (24HUE). Design Data were analyzed from 776 nonpregnant, noninstitutionalized US adults aged 20-69 y who completed 1-to-2 24HUE and 24HDR measures in the 2014 NHANES. A total of 1190 urine specimens and 1414 dietary recalls were analyzed. Mean bias was estimated as mean of the differences between individual mean 24HDR and 24HUE measurements. Correlations and attenuation factors were estimated using the Kipnis joint-mixed effects model accounting for within-person day-to-day variability in sodium excretion. The attenuation factor reflects the degree to which true associations between long-term intake (estimated using 24HUEs) and a hypothetical health outcome would be approximated using a single 24HDR: values near 1 indicate close approximation and near 0 indicate bias toward null. Estimates are reported for sodium, potassium, and the sodium: potassium (Na/K) ratio. Model parameters can be used to estimate correlations/attenuation factors when multiple 24HDRs are available. Results Overall, mean bias for sodium was -452 mg (95% CI: -646, -259), for potassium -315 mg (CI: -450, -179), and for the Na/K ratio -0.04 (CI: -0.15, 0.07, NS). Using 1 24HDR, the attenuation factor for sodium was 0.16 (CI: 0.09, 0.21), for potassium 0.25 (CI:0.16, 0.36), and for the Na/K ratio 0.20 (CI: 0.10, 0.25). The correlation for sodium was 0.27 (CI: 0.16, 0.37), for potassium 0.35 (CI: 0.26, 0.55), and for the Na/K ratio 0.27 (CI: 0.13, 0.32). Conclusions Compared with 24HUE, using 24HDR underestimates mean sodium and potassium intake but is unbiased for the Na/K ratio. Additionally, using 24HDR as a measure of exposure in observational studies attenuates the true associations of sodium and potassium intake with health outcomes.

Background and aims: Bread is considered as one of the important sources of sodium in the Iranian diet and salt is the main source of sodium, which is used to produce bread. The assessment of dietary intake is a reliable method that shows nutritional problems in the community. Therefore, the purpose of this study was to evaluate the intake of salt, sodium, and potassium through bread consumption. Methods: In the present study, 451 samples of different types of bread were tested, sent to the Food Control Laboratory for health control, and the amount of salt, sodium, and potassium was determined by potentiometric and flame-photometric methods, respectively. In addition, the amounts of salt, sodium, and potassium intake were evaluated based on their average concentration in different types of bread and per capita consumption of bread. Finally, the status of salt, sodium, and potassium intake was investigated by comparing their recommended daily allowance (RDA) and sodium/potassium ratio and sodium to caloric intake. Results: Based on the results, the concentrations of salt, sodium, and potassium were 1.95%, 769%, and 108% (mg per 100 g of bread), respectively. Furthermore, per capita consumption of bread was 320 g/d and the average intake of salt, sodium, and potassium through bread consumption was 4.03 g, 1588 mg, and 223 mg/d, respectively. Moreover, 79% of sodium RDA was received through bread consumption. In these breads, the ratio of sodium to potassium, as well as that of sodium to calorie was 12.07 (mmol/mmol) and 2 mg/calories, respectively. Conclusion: In general, the results showed that the intake of sodium and salt by using bread is more than that of their RDA. Accordingly, the ratio of sodium to potassium and sodium to caloric intake is higher than the permitted limit in these conditions, which provides the basis for the incidence of cardiovascular diseases. Therefore, strong monitoring of bread producing units is necessary.

The occurrence of hypertension is influenced by combined actions of genetic and environmental factors. Among environmental factors, high salt intake is considered as one of the most important and critical dietary factors. High salt intake is closely related to the incidence and mortality of cardiac and cerebrovascular events, as well as ventricular hypertrophy, renal damage, and other target organ damages. The existing data show that the daily sodium salt intake of Chinese population is significantly higher than that of European and American populations, and it generally exceeds the standard. Therefore, sodium and potassium intake in patients with hypertension should be actively assessed to carry out targeted treatment, which is an important strategy in blood pressure management. According to the characteristics of high prevalence of hypertension, high sodium salt intake, and low blood pressure control rate in China, Chinese Medical Association Hypertension Professional Committee believes that it is necessary to promote salt restriction and formulate the assessment of salt intake and clinical process of blood pressure management according to the current status of sodium intake.

Background: The number of patients with Multiple Sclerosis (MS) is increasing in Iran. Studies have shown that high sodium chloride (salt) and low potassium intake are associated with the development of MS. High physiological salt concentrations can lead to the induction of Interleukin-17 (IL-17) accompanied by the excessive generation of helper T-17 cells (Th-17). This cytokine plays a critical role in the pathogenesis of autoimmune diseases. This is while potassium supplementation has a blocking effect on IL-17 production. Objectives: Because of the role of salt and potassium in Th 17 development, we hypothesized that sodium chloride (NaCl) would be higher and potassium (K) would be lower in MS patients than healthy controls. Therefore, we investigated the association between salt and potassium intake with MS in Isfahan City population, Iran. Materials & Methods: A case-control study containing 23 patients and 23 healthy controls was performed in Isfahan City, Iran, 2016. NaCl and K levels were measured in 24-h urine. Using the Chi-square test, the patients’ laboratory values were compared with the healthy controls. The level of significance was set at P

This cross-sectional study aimed to assess 24-h urinary sodium and potassium excretion in children and the relationships with their family excretion. Using the baseline data of a randomized trial conducted in three cities of China in 2018, a total of 590 children (mean age 8.6 ± 0.4 years) and 1180 adults (mean age 45.8 ± 12.9 years) from 592 families had one or two complete 24-h urine collections. The average sodium, potassium excretion and sodium-to-potassium molar ratio of children were 2180.9 ± 787.1 mg/d (equivalent to 5.5 ± 2.0 g/d of salt), 955.6 ± 310.1 mg/d and 4.2 ± 1.7 respectively, with 77.1% of the participants exceeding the sodium recommendation and 100% below the proposed potassium intake. In mixed models adjusting for confounders, every 1 mg/d increase in sodium excretion of adult family members was associated with a 0.11 mg/d (95% CI: 0.06 to 0.16, p &lt, 0.0001) increase in sodium excretion of children. The family-child regression coefficient corresponds to 0.20 mg/d (95% CI: 0.15 to 0.26, p &lt, 0.0001) per 1 mg/d in potassium and to 0.36 (95% CI: 0.26 to 0.45, p &lt, 0.0001) in sodium-to-potassium molar ratio. Children in China are consuming too much sodium and significantly inadequate potassium. The sodium, potassium excretion and sodium-to-potassium ratio of children are associated with their family excretions in small to moderate extent. Efforts are warranted to support salt reduction and potassium enhancement in children through comprehensive strategies engaging with families, schools and food environments.

Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.

The identification of sodium and potassium intake in youths is an important step to preventing the increase of blood pressure in childhood. We examined food intake and estimated mineral intake using a brief-type self-administered diet history questionnaire (BDHQ) to test its validity as a comparison with urinary excretion in Japanese youths. The subjects were 5th and 8th graders (n = 2377), who completed the BDHQ and permitted the use of their overnight urine specimens. Sodium intake was poorly associated with sodium excretion (Rho = 0.048), and the coefficients of dietary potassium and a sodium-to-potassium molar ratio were 0.091–0.130. Higher soybean paste (miso) intake and pickles were significantly associated with higher sodium excretion (p ≤ 0.005). However, these foods were positively associated with potassium excretion (p = 0.002–0.012), and not associated with an excreted sodium-to-potassium ratio. Fruits and dairy products were positively associated (p ≤ 0.048), whereas beverages were negatively associated with potassium excretion (p ≤ 0.004). The association of the sodium-to-potassium ratio was opposite to that of potassium (p ≤ 0.001). The choice of foods, potassium, and the sodium-to-potassium ratio assessed using the BDHQ are available as part of health education for youths, but the assessment of sodium intake in population levels should be carefully conducted.

The first month of lactation is a vulnerable nutritional period for the mother. Our aims were (1) to evaluate the nutritional status of breastfeeding women in the first month of lactation, and (2) to explore different aspects of nutrition and lifestyle through a multidimensional approach. A total of 30 healthy breastfeeding women were enrolled in this study. Dietary pattern was assessed through a 72-hour dietary recall questionnaire (days 7 and 28 postpartum) and data were compared with Dietary Recommendation Values (DRV), and through the Adherence to Healthy Food Pyramid (HFP) questionnaire (day 28). Anthropometric parameters were evaluated by bioimpedance. Using factor analysis, nutritional dimensions were extracted, and linear regression models were used to analyze the association between anthropometric parameters and dimensions. Compared to the DRV, women showed insufficient energy, water, vitamin D, and potassium intake and excessive proteins, vitamins B1, B2, B3, B6, B12, and iron intake. We observed a moderate adherence to the HFP, with women being high in the fruits, vegetables, and oil categories, and low adherence to the physical activity, dairy products, and hydration categories. The nutritional dimension, including the HFP categories of physical activity, hydration, and animal protein intake together, was negatively associated with body weight (β = −3.7 ± 1.7, p-value = 0.047). In conclusion, during the first month postpartum, breastfeeding women exhibited several nutritional imbalances and poor physical activity negatively influencing anthropometric parameters. We propose a multidimensional approach to assess the nutritional status of breastfeeding women as a tool to detect specific deficiencies, allowing for personalized counseling.

Sodium and potassium intake in hypertensive patients in China is not clear. The authors aimed to investigate the distribution of sodium and potassium intake in hypertensive patients in China, and to analyze the relationship between sodium and potassium intake and blood pressure. The study was performed in 130 hospitals from 23 provinces across China from 2016 to 2019. Finally, 9501 hypertensive patients average aged 54 years were included. 24 h urinary sodium and potassium excretion were measured. Distribution of urinary electrolytes were described according to age, gender and region. The association between urinary electrolytes and blood pressure was analyzed by multivariate linear regression. Hypertensive patients exhibited an average 24 h urinary sodium and potassium excretion of 156.7 ± 81.5 mmol/d and 39.2 ± 20.2 mmol/d (equivalent to sodium chloride of 9.2 g/d, potassium chloride of 2.9 g/d), sodium/potassium ratio (median) of 4.14 (2.92,5.73). Urinary electrolytes were lower in women than men (sodium: 171.1 vs 138.7, p

Inadequate sodium and potassium dietary intakes are associated with major, yet preventable, health consequences. Local public health interventions can be facilitated and informed by fine-scale geospatial analyses. In this study, we assess the existence of spatial clustering (i.e., an unusual concentration of individuals with a specific outcome in space) of estimated sodium (Na), potassium (K) intakes, and Na:K ratio in the Bus Santé 1992–2018 annual population-based surveys, including 22,495 participants aged 20–74 years, residing in the canton of Geneva, using the local Moran’s I spatial statistics. We also investigate whether socio-demographic and food environment characteristics are associated with identified spatial clustering, using both global ordinary least squares (OLS) and local geographically weighted regression (GWR) modeling. We identified clear spatial clustering of Na:K ratio, Na, and K intakes. The GWR outperformed the OLS models and revealed spatial variations in the associations between explanatory and outcome variables. Older age, being a woman, higher education, and having a lower access to supermarkets were associated with higher Na:K ratio, while the opposite was seen for having the Swiss nationality. Socio-demographic characteristics explained a major part of the identified clusters. Socio-demographic and food environment characteristics significantly differed between individuals in spatial clusters of high and low Na:K ratio, Na, and K intakes. These findings could guide prioritized place-based interventions tailored to the characteristics of the identified populations.

On average, black individuals are widely believed to be more sensitive than white individuals to blood pressure (BP) effects of changes in salt intake. However, few studies have directly compared the BP effects of changing salt intake in black versus white individuals. In this narrative review, we analyze those studies and note that when potassium intake substantially exceeds the recently recommended US dietary goal of 87 mmol/day, black adults do not appear more sensitive than white adults to BP effects of short-term or long-term increases in salt intake (from an intake ≤50 mmol/day up to 150 mmol/day or more). However, with lower potassium intakes, racial differences in salt sensitivity are observed. Mechanistic studies suggest that racial differences in salt sensitivity are related to differences in vascular resistance responses to changes in salt intake mediated by vasodilator and vasoconstrictor pathways. With respect to cause and prevention of racial disparities in salt sensitivity, it is noteworthy that 1) on average, black individuals consume less potassium than white individuals and 2) consuming supplemental potassium bicarbonate, or potassium rich foods can prevent racial disparities in salt sensitivity. However, the new US dietary guidelines reduced the dietary potassium goal well below the amount associated with preventing racial disparities in salt sensitivity. These observations should motivate research on the impact of the new dietary potassium guidelines on racial disparities in salt sensitivity, the risks and benefits of potassium-containing salt substitutes or supplements, and methods for increasing consumption of foods rich in nutrients that protect against salt-induced hypertension.

Objective:To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with.Design:This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content.Setting:South Africa.Participants:The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018.Results:Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels.Conclusions:A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.

The relationship between sodium intake and blood pressure is a well-studied phenomenon; however, the impact of sodium intake on cardiovascular disease risk and mortality is controversial. Recent studies conclude that weak evidence exists to support sodium restriction for the prevention of cardiovascular mortality in normotensive and hypertensive adults, suggesting that sodium restriction may be an ineffective strategy for disease prevention. Further evidence points to the importance of balancing sodium and potassium intake, a balance commonly achieved with a healthier diet containing greater quantities of fruits and vegetables. The purpose of this article is to highlight dietary strategies that may prove to be more effective in reducing cardiovascular disease risk. Limitations of current methods used to estimate nutrient intake are described as they relate to this topic. Further research is needed to advance understanding of various aspects of dietary intake that are health protective and allow for the development of more effective public education strategies.

Chronic kidney disease (CKD) is becoming a major public health problem worldwide, and excessive potassium intake is a health threat to patients with CKD. In this study, visible–short-wave near-infrared (Vis–SWNIR) spectroscopy and chemometric algorithms were investigated as nondestructive methods for assessing the potassium concentration in fresh lettuce to benefit the CKD patients’ health. Interactance and transmittance measurements were performed and the competencies were compared based on the multivariate methods of partial least-square regression (PLS) and support vector machine regression (SVR). Meanwhile, several preprocessing methods [first- and second-order derivatives in combination with standard normal variate (SNV)] and wavelength selection method of competitive adaptive reweighted sampling (CARS) were applied to eliminate noise and highlight the spectral characteristics. The PLS models yielded better prediction than the SVR models with higher correlation coefficients ([Formula: see text]) and residual predictive deviation (RPD), and lower root-mean-square error of prediction (RMSEP). Excellent prediction of green leaves was obtained by the interactance measurement with [Formula: see text], [Formula: see text][Formula: see text]mg/100[Formula: see text]g, and [Formula: see text]; while the transmittance spectra of petioles provided optimal prediction with [Formula: see text], [Formula: see text][Formula: see text]mg/100[Formula: see text]g, and RPD[Formula: see text]=[Formula: see text]3.34, respectively. Therefore, the results indicated that Vis–SWNIR spectroscopy is capable of intelligently detecting potassium concentration in fresh lettuce to benefit CKD patients around the world in maintaining and enhancing their health.

This study aimed to assess current level of sodium and potassium intake and their associations with blood pressure (BP) using the 24-hour urinary data in a large sample of China. Data from participants aged 18 to 75 years were collected as the baseline survey of Action on Salt China in 2018. Of 5454 adults, 5353 completed 24-hour urine collection. The average sodium, potassium excretion, and sodium-to-potassium molar ratio were 4318.1±1814.1 mg/d (equivalent to 11.0±4.6 g/d of salt), 1573.7±627.1 mg/d, and 5.0±2.1, respectively. After adjusting for potential confounding factors and correcting for regression dilution, each 1000-mg increase in sodium excretion was associated with increased systolic BP (1.32 mm Hg [95% CI, 0.92–1.81]) and diastolic BP (0.34 mm Hg [95% CI, 0.09–0.60]). Each 1000-mg increase in potassium excretion was inversely associated with systolic BP (−3.19 mm Hg [95% CI, −4.38 to −2.20]) and diastolic BP (−1.56 mm Hg [95% CI, −2.29 to −0.90]). Each unit increase in sodium-to-potassium molar ratio was associated with an increase of systolic BP by 1.21 mm Hg (95% CI, 0.91–1.60) and diastolic BP by 0.44 mm Hg (95% CI, 0.24–0.64). The relationships between sodium and BP mostly increase with the rise of BP quantiles. Potassium shows the opposite trend. The current sodium intake in Chinese adults remains high and potassium intake is low. Sodium and sodium-to-potassium ratio were positively associated with BP, whereas potassium was inversely associated with BP. Registration— URL: https://tinyurl.com/vdr8rpr ; Unique identifier: ChiCTR1800017553. URL: https://tinyurl.com/w8c7x3w ; Unique identifier: ChiCTR1800016804. URL: https://tinyurl.com/s3ajldw ; Unique identifier: ChiCTR1800018119.

Excessive salt intake and its impact on health is a public health problem in many regions of the world. The currently estimated dietary intake of salt among free-living adults is well above the WHO recommendations. Over the years, the number of residents in retirement homes has increased. Besides this, the nutrition of elderly people may be affected by physiological changes that occur with aging. The question is whether residents of retirement homes receive a more balanced diet, or whether the trend of excessive salt consumption continues even among institutionalised elderly people. Salt and potassium intake were assessed by measuring sodium and potassium excretion over 24 h in urine collected from a sample of residents of three retirement homes in the Gori&scaron, ka region, Slovenia. The average salt intake was 8.3 (2.9) g/day, which was significantly higher (p &lt, 0.001) in men than in women (10.1 (3.1) vs. 7.3 (2.2) g/day, respectively). The estimated total daily potassium intake was 2.6 (0.6) g/day in men and 2.0 (0.8) g/day in women (mean 2.2 (0.8) g/day). The ratio of sodium to potassium was 1.53 (0.48). The salt intake among residents of retirement homes in the Gori&scaron, ka region, especially in men, exceeds the WHO recommended daily intake of &lt, 5 g. The mean daily potassium intake was below the WHO recommendations of 3.5 g/day.

Reduced potassium (k+) intake has been linked to cardiovascular diseases. The underlying mechanisms remain unknown. Here, we investigate the effect of low (0%), normal (0.5%) and high K+ (5%) diet on the development of atherosclerosis and hypertensive cardiac damage. To induce atherosclerosis, apolipoprotein-deficient mice were infused with angiotensin (Ang) II (500ng/kg/min) for 28 days. Potassium treatment was initiated 2 weeks before Ang II infusion. Cardiac function was assessed by MRI. Levels of K+ in the serum and urine were significantly different between groups. The Ang II infused mice from the K+ low group had significantly higher atherosclerotic plaques in the aortic arch (21±3%) compared to K+ high (10±2%) and K+ normal (11±2%) groups. The atherosclerosis development was blood pressure independent since no differences in blood pressure between the groups were observed. Although heart to body-weight ratio did not differ between three groups, K+ low diet was associated with a lower ejection fraction rate and increased mRNA expression levels of cardiac ANP, BNP, collagen and fibronectin compared to the K+ normal and K+ high group. After Ang II infusion, assessment of aldosterone levels in urine showed significant higher aldosterone levels in the high K+ (214±72ng/24h) compared to normal K+ (26±6ng/24h) and low K+ (18±4ng/24h) groups. Aldosterone induced cardiovascular damage is known to be aggravated by sodium. To, evaluate whether high sodium diet unmask aldosterone mediated cardiovascular damage in the high K+ group, mice fed a high or normal K+ diet were additionally treated with high sodium (1% NaCl) in the drinking water. During Ang II treatment, high salt diet accelerated atherosclerosis in the aortic arch of both groups but no differences were observed between the high K+ high/high Na+ (41±7%) and normal K+/high Na+ (49±2%) group. In contrast, high K+/high Na+ group have significantly more severe cardiac hypertrophy compared to normal K+ high Na+ group (8.9±0.7 vs 6.4±0.7mg/g). These results were confirmed by MRI. K+ deficient diet induces atherosclerosis and cardiac damage during Ang II induced hypertension. K+ enriched diet exacerbates cardiac hypertrophy only under high Na+ conditions most likely in an aldosterone-dependent mechanism.

Globally, average dietary sodium intake is double the recommended amount, whereas potassium is often consumed in suboptimal amounts. High sodium diets are associated with increased cardiovascular and renal disease risk, while potassium may have protective properties. Consequently, patients at risk of cardiovascular and renal disease are urged to follow these recommendations, but dietary adherence is often low due to high sodium and low potassium content in processed foods. Adequate monitoring of intake is essential to guide dietary advice in clinical practice and can be used to investigate the relationship between intake and health outcomes. Daily sodium and potassium intake is often estimated with 24-h sodium and potassium excretion, but long-term balance studies demonstrate that this method lacks accuracy on an individual level. Dietary assessment tools and spot urine collections also exhibit poor performance when estimating individual sodium and potassium intake. Collection of multiple consecutive 24-h urines increases accuracy, but also patient burden. In this narrative review, we discuss current approaches to estimating dietary sodium and potassium intake. Additionally, we explore alternative methods that may improve test accuracy without increasing burden.

Most U.S. adults consume too much sodium and not enough potassium (1,2). For apparently healthy U.S. adults aged ≥19 years, guidelines recommend reducing sodium intake that exceeds 2,300 mg/day and consuming at least 3,400 mg/day of potassium for males and at least 2,600 mg/day for females* (1). Reducing population-level sodium intake can reduce blood pressure and prevent cardiovascular diseases, the leading causes of death in the United States (1,3). Adequate potassium intake might offset the hypertensive effects of excessive sodium intake (1). Data from the 2015-2016 What We Eat in America (WWEIA) dietary interview component of the National Health and Nutrition Examination Survey (NHANES)† were analyzed to identify top food categories contributing to sodium and potassium intake for U.S. residents aged ≥1 year. During 2015-2016, 40% of sodium consumed came from the top 10 food categories, which included prepared foods with sodium added (e.g., deli meat sandwiches and pizza). Approximately 43% of potassium consumed was from 10 food categories, which included foods naturally low in sodium (e.g., unflavored milk, fruit, vegetables) and prepared foods. These results can inform efforts to encourage consumption of foods naturally low in sodium, which might have the dual benefit of reducing sodium intake and increasing potassium intake, contributing to cardiovascular disease prevention.

Diyetle fazla miktarda potasyum alımı sonrasında hiperkalemi nadir gelişen bir durumdur. Özellikle böbrek fonksiyon bozukluğu ve çoklu ilaç kullanımı olan hastalarda görülme ihtimali artabilir. Potasyum bozuklukları kardiyak etkilenime yol açtığından tanınmadığı veya tedavi edilmediği durumlarda hayatı tehdit eden kardiyak aritmiler görülebilir. Acil servisimize bulantı şikayeti ile gelen hastada hiperkalemi saptanmıştır. Hastanın anamnezi tekrar alındı ve diyetle aşırı miktarda muz tüketimi olduğu öğrenildi. Yaşlılarda ve ek hastalığı olan hastalarda potasyumun atılımı ile ilgili problemler olabileceği akılda tutulmalıdır. Hastamızın acil serviste tedavisi erken dönemde başlanarak ve potasyumu normal sınırlara düşürülmüştür. Hiperkalemi saptanan tüm hastalarda böbrek fonksiyon bozukluklarına ek olarak diyet alımı da sorgulanmalıdır., Hyperkalemia is a rare condition after the dietary intake of large amounts of potassium. It may be more likely to occur in patients with impaired renal function and multiple drug use. Since potassium disorders lead to cardiac effects, life-threatening cardiac arrhythmias may occur when they are not recognized or treated. We detected hyperkalemia in the patient who came to our emergency department with a complaint of nausea. The anamnesis of the patient was detailed, and it was learned that the patient had excessive consumption of bananas with diet. It should be borne in mind that there may be problems with excretion of potassium in the elderly and patients with additional diseases. Treatment of our patient in the emergency department was started early and potassium was reduced to normal limits. Dietary intake should be questioned in addition to kidney dysfunction in all patients with hyperkalemia.

OBJECTIVES: Metabolomic profiling is used to identify biological pathways and biomarkers for cardiovascular disease (CVD) and diabetes. Thus, metabolomics could be used to identify metabolic effects and demonstrate short-term efficacy of interventions designed to reduce longer-term risk of these conditions. Low potassium (K) intake has been linked to high blood pressure and increased CVD and diabetes risk. The effects of increasing K intake on metabolomic measures related to CVD and diabetes risk are not known. In this ancillary study, we tested the hypothesis that potassium chloride (KCl) supplementation would be associated with improvements in metabolomic biomarkers, such as branched-chain amino acids (BCAA) which are associated with CVD and diabetes risk. METHODS: We performed targeted mass-spectrometry-based metabolomic profiling of 60 metabolites on baseline and 12-week (end-of-study) plasma samples from 26 African-American participants with prediabetes randomized to KCl supplements vs. placebo. Principal component analysis (PCA) was used for dimensionality reduction. Univariate and multivariable analyses were used to assess differences between the two intervention arms in the changes in metabolomic factor scores and individual metabolites. RESULTS: In univariate comparisons, compared to placebo, a PCA factor composed of long-chain acylcarnitines (LCA) increased in the KCl arm (P = 0.02). In multivariable models adjusted for baseline factor score, age, and sex, this association with the LCA factor was no longer significant; but those taking KCl had significant reductions in the BCAA factor (P = 0.004) and in valine levels (P = 0.02). CONCLUSIONS: These results suggest that KCl supplementation may be associated with improvements in BCAA metabolism. Further studies among a larger population and with longer-term follow-up are warranted to verify these results and to determine if KCl supplementation may be an effective intervention for CVD and diabetes prevention. FUNDING SOURCES: NIH/Duke CTSA.

OBJECTIVES: The objectives of this study were to determine the dose-response relations and combined effects of sodium, potassium, magnesium and calcium on the risk of cardiovascular disease. METHODS: Data for 2362 30–64 year-old men and women free of CVD at baseline in the Framingham Offspring Study were included in these analyses. Cox proportional hazard models were used to investigate the association between categories of sodium, potassium, calcium, and magnesium intake and risk of incident CVD. Further, Cox models with restricted cubic spline functions were used to examine the dose-response relations of these minerals with CVD risk. RESULTS: Compared with higher sodium intakes (≥3500 mg), those with the lowest intakes (