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Hyperosmolarity and Increased Serum Sodium Concentration Are Risks for Developing Hypertension Regardless of Salt Intake: A Five-Year Cohort Study in Japan.

ABSTRACT: The potential contribution of serum osmolarity in the modulation of blood pressure has not been evaluated. This study was done to examine the relationship between hyperosmolarity and hypertension in a five-year longitudinal design. We enrolled 10,157 normotensive subjects without diabetes who developed hypertension subsequently as determined by annual medical examination in St. Luke's International Hospital, Tokyo, between 2004 and 2009. High salt intake was defined as >12 g/day by a self-answered questionnaire and hyperosmolarity was defined as >293 mOsm/L serum osmolarity, calculated using serum sodium, fasting blood glucose, and blood urea nitrogen. Statistical analyses included adjustments for age, gender, body mass index, smoking, drinking alcohol, dyslipidemia, hyperuricemia, and chronic kidney disease. In the patients with normal osmolarity, the group with high salt intake had a higher cumulative incidence of hypertension than the group with normal salt intake (8.4% versus 6.7%, p = 0.023). In contrast, in the patients with high osmolarity, the cumulative incidence of hypertension was similar in the group with high salt intake and in the group with normal salt intake (13.1% versus 12.9%, p = 0.84). The patients with hyperosmolarity had a higher incidence of hypertension over five years compared to that of the normal osmolarity group (p < 0.001). After multiple adjustments, elevated osmolarity was an independent risk for developing hypertension (OR (odds ratio), 1.025; 95% CI (confidence interval), 1.006-1.044), regardless of the amount of salt intake. When analyzed in relation to each element of calculated osmolarity, serum sodium and fasting blood glucose were independent risks for developing hypertension. Our results suggest that hyperosmolarity is a risk for developing hypertension regardless of salt intake.

SUBMITTER: Kuwabara M

PROVIDER: S-EPMC7284783 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Hyperosmolarity and Increased Serum Sodium Concentration Are Risks for Developing Hypertension Regardless of Salt Intake: A Five-Year Cohort Study in Japan.

Kuwabara Masanari M Kanbay Mehmet M Niwa Koichiro K Ae Ryusuke R Andres-Hernando Ana A Roncal-Jimenez Carlos A CA Garcia Gabriela G Sánchez-Lozada Laura Gabriela LG Rodriguez-Iturbe Bernardo B Hisatome Ichiro I Lanaspa Miguel A MA Johnson Richard J RJ

Nutrients 20200514 5

The potential contribution of serum osmolarity in the modulation of blood pressure has not been evaluated. This study was done to examine the relationship between hyperosmolarity and hypertension in a five-year longitudinal design. We enrolled 10,157 normotensive subjects without diabetes who developed hypertension subsequently as determined by annual medical examination in St. Luke's International Hospital, Tokyo, between 2004 and 2009. High salt intake was defined as >12 g/day by a self-answer ...[more]

PMID: 32423124

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Project description:IntroductionDiscretionary salt (added in cooking at home or at the table) is a source of sodium and iodine in New Zealand. The amount of discretionary salt consumed in a population has implications on policies regarding sodium and iodine. Sodium intake from discretionary salt intake has not been quantified in New Zealand. The aim of this study was to estimate the proportion of total sodium that comes from discretionary salt in adults using the lithium-tagged salt method.MethodsA total of 116 healthy adults, who were not pregnant or breastfeeding, regularly consume home-cooked meals and use salt during cooking or at the table, aged 18-40 years from Dunedin, New Zealand were recruited into the study. The study took place over a 9-day period. On Day 1, participants were asked to collect a baseline 24-h urine to establish their normal lithium output. From Day 2 to Day 8, normal discretionary salt was replaced with lithium-tagged salt. Between Day 6 and Day 8, participants collected another two 24-h urine samples. A 24-h dietary recall was conducted to coincide with each of the final two 24-h urine collections. Urinary sodium was analysed by Ion-Selective Electrode and urinary lithium and urinary iodine were analysed using Inductively Coupled Plasma Mass Spectrometry. The 24-h dietary recall data was entered into Xyris FoodWorks 10. All statistical analysis were conducted using Stata 17.0.ResultsA total of 109 participants with complete 24-h urine samples were included in the analysis. From the 24-h urine collections, the median urinary excretion of sodium and iodine was 3,222 mg/24 h (25th, 75th percentile: 2516, 3969) and 112 μg/24 h (82, 134). The median estimated sodium intake from discretionary salt was 13% (25th, 75th percentile: 7, 22) of the total sodium intake or 366 mg/24 h (25th, 75th percentile: 186, 705).ConclusionThe total sodium intake was higher than the suggested dietary target of 2,000 mg/day. In this sample of healthy adults 18 to 40 years old, 13% of total sodium intake derived from discretionary salt. Discretionary salt is an additional source of iodine if iodised salt is used. Policies to reduce sodium intake is recommended to include a range of strategies to target discretionary and non-discretionary sources of salt and will need to take into account the contribution of iodine from discretionary salt intake.

Project description:BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy.ResultsThe voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (- 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (- 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (- 243,530 ₫ US$ -10.49; 0.074 QALYs gained).ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

Project description:OBJECTIVES:To estimate the effects of nationwide replacement of discretionary salt (used at table or during cooking) with potassium enriched salt substitute on morbidity and death from cardiovascular disease in China. DESIGN:Modelling study. SETTING:China. POPULATION:Adult population in China, and specifically individuals with chronic kidney disease (about 17 million people). INTERVENTIONS:Comparative risk assessment models were used to estimate the effects of a nationwide intervention to replace discretionary dietary salt with potassium enriched salt substitutes (20-30% potassium chloride). The models incorporated existing data and corresponding uncertainties from randomised trials, the China National Survey of Chronic Kidney Disease, the Global Burden of Disease Study, and the Chronic Kidney Disease Prognosis Consortium. MAIN OUTCOME MEASURES:Averted deaths from cardiovascular disease, non-fatal events, and disability adjusted life years from a reduction in blood pressure were estimated after implementation of potassium enriched salt substitution. In individuals with chronic kidney disease, additional deaths from cardiovascular disease related to hyperkalaemia from increased intake of potassium were calculated. The net effects on deaths from cardiovascular disease were estimated as the difference and ratio of averted and additional deaths from cardiovascular disease. RESULTS:Nationwide implementation of potassium enriched salt substitution could prevent about 461?000 (95% uncertainty interval 196?339 to 704?438) deaths annually from cardiovascular disease, corresponding to 11.0% (4.7% to 16.8%) of annual deaths from cardiovascular disease in China; 743?000 (305?803 to 1?273?098) non-fatal cardiovascular events annually; and 7.9 (3.3 to 12.9) million disability adjusted life years related to cardiovascular disease annually. The intervention could potentially produce an estimated 11?000 (6422 to 16?562) additional deaths related to hyperkalaemia in individuals with chronic kidney disease. The net effect would be about 450?000 (183?699 to 697?084) fewer deaths annually from cardiovascular disease in the overall population and 21?000 (1928 to 42?926) fewer deaths in individuals with chronic kidney disease. In deterministic sensitivity analyses, with changes to key model inputs and assumptions, net benefits were consistent in the total population and in individuals with chronic kidney disease, with averted deaths outweighing additional deaths. CONCLUSIONS:Nationwide potassium enriched salt substitution in China was estimated to result in a substantial net benefit, preventing around one in nine deaths from cardiovascular disease overall. Taking account of the risks of hyperkalaemia, a substantial net benefit was also estimated for individuals with chronic kidney disease.

Dataset Information

Hyperosmolarity and Increased Serum Sodium Concentration Are Risks for Developing Hypertension Regardless of Salt Intake: A Five-Year Cohort Study in Japan.

Publications

Hyperosmolarity and Increased Serum Sodium Concentration Are Risks for Developing Hypertension Regardless of Salt Intake: A Five-Year Cohort Study in Japan.

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