Salt Reduction

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Graham A Macgregor - One of the best experts on this subject based on the ideXlab platform.

  • Salt Reduction to prevent hypertension and cardiovascular disease jacc state of the art review
    Journal of the American College of Cardiology, 2020
    Co-Authors: Feng J He, Graham A Macgregor
    Abstract:

    Highlights •Our current high Salt intake is among the top 3 dietary risk factors worldwide. •Population-wide Reduction in Salt intake lowers population BP and alleviates the burden of CVD and other chronic diseases. •Paradoxical findings from methodologically flawed studies should not be used to refute the strong evidence on the benefits of Salt Reduction. •Worldwide Salt-Reduction efforts should be reinforced to save millions of people dying unnecessarily from stroke and heart disease each year.

  • social support social network and Salt Reduction behaviours in children a substudy of the school eduSalt trial
    BMJ Open, 2019
    Co-Authors: Xiangxian Feng, Haijun Wang, Jing Zhang, Wuxiang Xie, Yunjian Yin, Jianhui Yuan, Graham A Macgregor
    Abstract:

    OBJECTIVES Healthy behaviour changes, such as reducing Salt intake, are important to prevent lifestyle-related diseases. Social environment is a major challenge to achieve such behaviours, but the explicit mechanisms remain largely unknown. We investigated whether social networks of children were associated with their behaviours to reduce Salt intake. DESIGN An ancillary study of a school-based cluster randomised controlled trial to reduce Salt intake in children and their families (School-EduSalt), in which Salt intake of children was significantly reduced by 25%. SETTING 14 primary schools in urban Changzhi, northern China. PARTICIPANTS 603 children aged 10-12 years in the intervention arm. PRIMARY AND SECONDARY OUTCOME MEASURES We developed a score assessing Salt-Reduction behaviours (SRB score) of children based on self-administered questionnaires. The SRB score was validated by the changes in Salt intake measured by 24-hour urine collection in a random sample of 135 children. A 1-unit increase in SRB score was associated with a 0.31 g/day greater Reduction in Salt intake during the trial (95% CI 0.06 to 0.57, p=0.016). RESULTS Children from families with more family members not supporting Salt Reduction had significantly lower SRB scores (p<0.0001). Children from a class with a smaller size and from a class with more friendship connections, as well as children having more friends within the class all showed higher SRB scores (all p<0.05). Children whose school teachers attended the intervention programme more frequently also had higher SRB scores (p=0.043). CONCLUSION Social networks were associated with the behaviours to reduce Salt intake in children. Future Salt-Reduction programmes may benefit from strategies that actively engage families and teachers, and strategies that enhance interconnectivity among peers. TRIAL REGISTRATION NUMBER NCT01821144; post-results.

  • effect of longer term modest Salt Reduction on blood pressure
    Cochrane Database of Systematic Reviews, 2013
    Co-Authors: Graham A Macgregor
    Abstract:

    Background A Reduction in Salt intake lowers blood pressure (BP) and, thereby, reduces cardiovascular risk. A recent meta-analysis by Graudal implied that Salt Reduction had adverse effects on hormones and lipids which might mitigate any benefit that occurs with BP Reduction. However, Graudal's meta-analysis included a large number of very short-term trials with a large change in Salt intake, and such studies are irrelevant to the public health recommendations for a longer-term modest Reduction in Salt intake. We have updated our Cochrane meta-analysis.   Objectives To assess (1) the effect of a longer-term modest Reduction in Salt intake (i.e. of public health relevance) on BP and whether there was a dose-response relationship; (2) the effect on BP by sex and ethnic group; (3) the effect on plasma renin activity, aldosterone, noradrenaline, adrenaline, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides. Search methods We searched MEDLINE, EMBASE, Cochrane Hypertension Group Specialised Register, Cochrane Central Register of Controlled Trials, and reference list of relevant articles. Selection criteria We included randomised trials with a modest Reduction in Salt intake and duration of at least 4 weeks. Data collection and analysis Data were extracted independently by two reviewers. Random effects meta-analyses, subgroup analyses and meta-regression were performed. Main results Thirty-four trials (3230 participants) were included. Meta-analysis showed that the mean change in urinary sodium (reduced Salt vs usual Salt) was -75 mmol/24-h (equivalent to a Reduction of 4.4 g/d Salt), the mean change in BP was -4.18 mmHg (95% CI: -5.18 to -3.18, I 2=75%) for systolic and -2.06 mmHg (95% CI: -2.67 to -1.45, I 2=68%) for diastolic BP. Meta-regression showed that age, ethnic group, BP status (hypertensive or normotensive) and the change in 24-h urinary sodium were all significantly associated with the fall in systolic BP, explaining 68% of the variance between studies. A 100 mmol Reduction in 24 hour urinary sodium (6 g/day Salt) was associated with a fall in systolic BP of 5.8 mmHg (95%CI: 2.5 to 9.2, P=0.001) after adjusting for age, ethnic group and BP status. For diastolic BP, age, ethnic group, BP status and the change in 24-h urinary sodium explained 41% of the variance between studies. Meta-analysis by subgroup showed that, in hypertensives, the mean effect was -5.39 mmHg (95% CI: -6.62 to -4.15, I 2=61%) for systolic and -2.82 mmHg (95% CI: -3.54 to -2.11, I 2=52%) for diastolic BP. In normotensives, the mean effect was -2.42 mmHg (95% CI: -3.56 to -1.29, I 2=66%) for systolic and -1.00 mmHg (95% CI: -1.85 to -0.15, I 2=66%) for diastolic BP. Further subgroup analysis showed that the decrease in systolic BP was significant in both whites and blacks, men and women. Meta-analysis of hormone and lipid data showed that the mean effect was 0.26 ng/ml/hr (95% CI: 0.17 to 0.36, I 2=70%) for plasma renin activity, 73.20 pmol/l (95% CI: 44.92 to 101.48, I 2=62%) for aldosterone, 31.67 pg/ml (95% CI: 6.57 to 56.77, I 2=5%) for noradrenaline, 6.70 pg/ml (95% CI: -0.25 to 13.64, I 2=12%) for adrenaline, 0.05 mmol/l (95% CI: -0.02 to 0.11, I 2=0%) for cholesterol, 0.05 mmol/l (95% CI: -0.01 to 0.12, I 2=0%) for LDL, -0.02 mmol/l (95% CI: -0.06 to 0.01, I 2=16%) for HDL, and 0.04 mmol/l (95% CI: -0.02 to 0.09, I 2=0%) for triglycerides. Authors' conclusions A modest Reduction in Salt intake for 4 or more weeks causes significant and, from a population viewpoint, important falls in BP in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. With Salt Reduction, there is a small physiological increase in plasma renin activity, aldosterone and noradrenaline. There is no significant change in lipid levels. These results provide further strong support for a Reduction in population Salt intake. This will likely lower population BP and, thereby, reduce cardiovascular disease. Additionally, our analysis demonstrates a significant association between the Reduction in 24-h urinary sodium and the fall in systolic BP, indicating the greater the Reduction in Salt intake, the greater the fall in systolic BP. The current recommendations to reduce Salt intake from 9-12 to 5-6 g/d will have a major effect on BP, but are not ideal. A further Reduction to 3 g/d will have a greater effect and should become the long term target for population Salt intake.

  • effect of modest Salt Reduction on blood pressure urinary albumin and pulse wave velocity in white black and asian mild hypertensives
    Hypertension, 2009
    Co-Authors: M Marciniak, Elisabeth Visagie, Nirmala D Markandu, Vidya Anand, Neil R Dalton, Graham A Macgregor
    Abstract:

    A Reduction in Salt intake lowers blood pressure. However, most previous trials were in whites with few in blacks and Asians. Salt Reduction may also reduce other cardiovascular risk factors (eg, u...

  • effect of modest Salt Reduction on blood pressure urinary albumin and pulse wave velocity in white black and asian mild hypertensives
    Hypertension, 2009
    Co-Authors: Feng J He, M Marciniak, Elisabeth Visagie, Nirmala D Markandu, Vidya Anand, Neil R Dalton, Graham A Macgregor
    Abstract:

    A Reduction in Salt intake lowers blood pressure. However, most previous trials were in whites with few in blacks and Asians. Salt Reduction may also reduce other cardiovascular risk factors (eg, urinary albumin excretion, arterial stiffness). However, few well-controlled trials have studied these effects. We carried out a randomized double-blind crossover trial of Salt restriction with slow sodium or placebo, each for 6 weeks, in 71 whites, 69 blacks, and 29 Asians with untreated mildly raised blood pressure. From slow sodium to placebo, urinary sodium was reduced from 165±58 (±SD) to 110±49 mmol/24 hours (9.7 to 6.5 g/d Salt). With this Reduction in Salt intake, there was a significant decrease in blood pressure from 146±13/91±8 to 141±12/88±9 mm Hg ( P P P P

Wu Yangfeng - One of the best experts on this subject based on the ideXlab platform.

  • Does education level affect the efficacy of a community based Salt Reduction program? - A post-hoc analysis of the China Rural Health Initiative Sodium Reduction Study (CRHI-SRS)
    2016
    Co-Authors: Wang Xin, Li Xian, Vaartjes Ilonca, Neal Bruce, Bots, Michiel L., Hoes, Arno W., Wu Yangfeng
    Abstract:

    Background: Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary Salt Reduction program was affected by the level of education of participants. Methods: The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of Salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province. Results: Daily Salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to Salt (all p > 0.05). Conclusions: The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations. Trial registration: The trial was registered with clinicaltrial.gov (NCT01259700)

  • Does education level affect the efficacy of a community based Salt Reduction program? - A post-hoc analysis of the China Rural Health Initiative Sodium Reduction Study (CRHI-SRS)
    BMC PUBLIC HEALTH, 2016
    Co-Authors: Wang Xin, Li Xian, Vaartjes Ilonca, Neal Bruce, Bots, Michiel L., Hoes, Arno W., Wu Yangfeng
    Abstract:

    Background: Whether educational level influences the effects of health education is not clearly defined. This study examined whether the impact of a community-based dietary Salt Reduction program was affected by the level of education of participants. Methods: The China Rural Health Initiative Sodium Reduction Study (CRHI-SRS) was a cluster-randomized controlled trial conducted in 120 villages from five Northern Chinese provinces. The intervention comprised a village-wide health education program and availability of Salt substitute at village shops. 24-h urine samples were collected among 1903 participants for primary evaluation of the intervention effect. A post-hoc analysis was done to explore for heterogeneity of intervention effects by education level using generalized estimating equations. All models were adjusted for age, sex, body mass index and province. Results: Daily Salt intake was lower in intervention than in control at all educational levels with no evidence of a difference in the effect of the intervention across different levels of education. P value for the interaction term between education level and the intervention was 0.35. There was likewise no evidence of an interaction for effects of the intervention on potassium intake (p = 0.71), the sodium to potassium ratio (p = 0.07), or knowledge and behaviors related to Salt (all p > 0.05). Conclusions: The study suggests that the effects of the intervention were achieved regardless of the level of education and that the intervention should therefore be broadly effective in rural Chinese populations.National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services; National Center for Chronic Disease prevention and Health Promotion [HHSN268200900027C]; United Health Group Chronic Disease Initiative; Developing World Support of the University Medical Center Utrecht; China Scholarship CouncilSCI(E)PubMedSSCIARTICLEywu@georgeinstitute.org.cn17591

  • Effect of Salt Reduction on iodine status assessed by 24 hour urinary iodine excretion in children and their families in northern China: a substudy of a cluster randomised controlled trial
    BMJ OPEN, 2016
    Co-Authors: He, Feng J., Feng Xiangxian, Zhang Jing, Wu Yangfeng, Ma Yuan, Zhang Wanqi, Lin Laixiang, Guo Xiaohui, Niu Wenyi, Macgregor, Graham A.
    Abstract:

    Objective: To study the effect of Salt Reduction on iodine status and to determine whether iodine consumption was still adequate after Salt Reduction in a population where universal Salt iodisation is mandatory. Design: A substudy of a cluster randomised controlled trial, with schools randomly assigned to either the intervention or the control group. Setting: 28 primary schools in Changzhi, northern China. Participants: 279 children in grade 5 of primary school (mean age: 10.1); 553 adults (age: 43.8). Intervention: Children were educated about the harmful effects of Salt and how to reduce Salt intake using the schools' usual health education lessons. Children then delivered the message to their families. The duration was 1 school term (approximate to 3.5 months). Main outcome measure: Difference between the intervention and control groups in the change of iodine intake as measured by repeat 24 hour urinary iodine from baseline to the end of the trial. Results: At baseline, the mean Salt intake was 7.0 +/- 2.5 g/day in children and 11.7 +/- 4.4 g/day in adults and the median iodine intake was 165.1 mu g/day (IQR: 122.6-216.7) and 280.7 mu g/day (IQR: 205.1-380.9) in children and adults, respectively. At the end of the study, Salt and iodine decreased in the intervention compared with control group. The mean effect on Salt for intervention versus control was -1.9 g/day (95% CI -2.6 to -1.3) in children and -2.9 g/day (95% CI -3.7 to -2.2) in adults. The mean effect on iodine was -19.3% (95% CI -29.4% to -7.7%) in children and -11.4% (95% CI -20.3% to -1.5%) in adults. Conclusions: With approximate to 25% Reduction in Salt intake, there was a significant Reduction in iodine consumption in northern China where Salt is iodised. Despite this, iodine intake was still adequate, and well above the estimated average requirement. Our findings indicate that reducing Salt to the WHO's target-30% Reduction by 2025-will not compromise iodine status.UK Medical Research Council [MR/J015903/1]; GACD (Global Alliance for Chronic Disease) Hypertension Programme; National Natural Science Foundation of China [81330064, 81273057]SCI(E)PubMedARTICLEf.he@qmul.ac.uk; wqzhang126@126.com9e011168

Takuya Tsuchihashi - One of the best experts on this subject based on the ideXlab platform.

Feng J He - One of the best experts on this subject based on the ideXlab platform.

  • Salt Reduction to prevent hypertension and cardiovascular disease jacc state of the art review
    Journal of the American College of Cardiology, 2020
    Co-Authors: Feng J He, Graham A Macgregor
    Abstract:

    Highlights •Our current high Salt intake is among the top 3 dietary risk factors worldwide. •Population-wide Reduction in Salt intake lowers population BP and alleviates the burden of CVD and other chronic diseases. •Paradoxical findings from methodologically flawed studies should not be used to refute the strong evidence on the benefits of Salt Reduction. •Worldwide Salt-Reduction efforts should be reinforced to save millions of people dying unnecessarily from stroke and heart disease each year.

  • Effect of longer term modest Salt Reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials
    BMJ (Online), 2013
    Co-Authors: Feng J He, Jiafu Li, G. A. Macgregor
    Abstract:

    OBJECTIVE: To determine the effects of longer term modest Salt Reduction on blood pressure, hormones, and lipids. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Hypertension Group Specialised Register, Cochrane Central Register of Controlled Trials, and reference list of relevant articles. INCLUSION CRITERIA: Randomised trials with a modest Reduction in Salt intake and duration of at least four weeks. DATA EXTRACTION AND ANALYSIS: Data were extracted independently by two reviewers. Random effects meta-analyses, subgroup analyses, and meta-regression were performed. RESULTS: Thirty four trials (3230 participants) were included. Meta-analysis showed that the mean change in urinary sodium (reduced Salt v usual Salt) was -75 mmol/24 h (equivalent to a Reduction of 4.4 g/day Salt), and with this Reduction in Salt intake, the mean change in blood pressure was -4.18 mm Hg (95% confidence interval -5.18 to -3.18, I(2)=75%) for systolic blood pressure and -2.06 mm Hg (-2.67 to -1.45, I(2)=68%) for diastolic blood pressure. Meta-regression showed that age, ethnic group, blood pressure status (hypertensive or normotensive), and the change in 24 hour urinary sodium were all significantly associated with the fall in systolic blood pressure, explaining 68% of the variance between studies. A 100 mmol Reduction in 24 hour urinary sodium (6 g/day Salt) was associated with a fall in systolic blood pressure of 5.8 mm Hg (2.5 to 9.2, P=0.001) after adjustment for age, ethnic group, and blood pressure status. For diastolic blood pressure, age, ethnic group, blood pressure status, and the change in 24 hour urinary sodium explained 41% of the variance between studies. Meta-analysis by subgroup showed that in people with hypertension the mean effect was -5.39 mm Hg (-6.62 to -4.15, I(2)=61%) for systolic blood pressure and -2.82 mm Hg (-3.54 to -2.11, I(2)=52%) for diastolic blood pressure. In normotensive people, the figures were -2.42 mm Hg (-3.56 to -1.29, I(2)=66%) and -1.00 mm Hg (-1.85 to -0.15, I(2)=66%), respectively. Further subgroup analysis showed that the decrease in systolic blood pressure was significant in both white and black people and in men and women. Meta-analysis of data on hormones and lipids showed that the mean change was 0.26 ng/mL/h (0.17 to 0.36, I(2)=70%) for plasma renin activity, 73.20 pmol/L (44.92 to 101.48, I(2)=62%) for aldosterone, 187 pmol/L (39 to 336, I(2)=5%) for noradrenaline (norepinephrine), 37 pmol/L (-1 to 74, I(2)=12%) for adrenaline (epinephrine), 0.05 mmol/L (-0.02 to 0.11, I(2)=0%) for total cholesterol, 0.05 mmol/L (-0.01 to 0.12, I(2)=0%) for low density lipoprotein cholesterol, -0.02 mmol/L (-0.06 to 0.01, I(2)=16%) for high density lipoprotein cholesterol, and 0.04 mmol/L (-0.02 to 0.09, I(2)=0%) for triglycerides. CONCLUSIONS: A modest Reduction in Salt intake for four or more weeks causes significant and, from a population viewpoint, important falls in blood pressure in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. Salt Reduction is associated with a small physiological increase in plasma renin activity, aldosterone, and noradrenaline and no significant change in lipid concentrations. These results support a Reduction in population Salt intake, which will lower population blood pressure and thereby reduce cardiovascular disease. The observed significant association between the Reduction in 24 hour urinary sodium and the fall in systolic blood pressure, indicates that larger Reductions in Salt intake will lead to larger falls in systolic blood pressure. The current recommendations to reduce Salt intake from 9-12 to 5-6 g/day will have a major effect on blood pressure, but a further Reduction to 3 g/day will have a greater effect and should become the long term target for population Salt intake.

  • effect of modest Salt Reduction on blood pressure urinary albumin and pulse wave velocity in white black and asian mild hypertensives
    Hypertension, 2009
    Co-Authors: Feng J He, M Marciniak, Elisabeth Visagie, Nirmala D Markandu, Vidya Anand, Neil R Dalton, Graham A Macgregor
    Abstract:

    A Reduction in Salt intake lowers blood pressure. However, most previous trials were in whites with few in blacks and Asians. Salt Reduction may also reduce other cardiovascular risk factors (eg, urinary albumin excretion, arterial stiffness). However, few well-controlled trials have studied these effects. We carried out a randomized double-blind crossover trial of Salt restriction with slow sodium or placebo, each for 6 weeks, in 71 whites, 69 blacks, and 29 Asians with untreated mildly raised blood pressure. From slow sodium to placebo, urinary sodium was reduced from 165±58 (±SD) to 110±49 mmol/24 hours (9.7 to 6.5 g/d Salt). With this Reduction in Salt intake, there was a significant decrease in blood pressure from 146±13/91±8 to 141±12/88±9 mm Hg ( P P P P

  • effect of modest Salt Reduction on blood pressure a meta analysis of randomized trials implications for public health
    Journal of Human Hypertension, 2002
    Co-Authors: Feng J He, Graham A Macgregor
    Abstract:

    Two recent meta-analyses of randomised Salt Reduction trials have concluded that there is little purpose in reducing Salt intake in the general population. However, the authors, as with other previous meta-analyses, included trials of very short duration (eg 1 week or less) and trials of acute Salt loading followed by abrupt Reductions to very low Salt intake (eg from 20 to less than 1 g of Salt/day). These acute Salt loading and Salt depletion experiments are known to increase sympathetic tone, and with Salt depletion cause a rise in renin release and, thereby, plasma angiotensin II. These trials are not appropriate, therefore, for helping to inform public health policy, which is for a more modest Reduction in Salt intake, ie, from a usual intake of ≈10 to ≈5 g of Salt per day over a more prolonged period of time. We carried out a meta-analysis to assess the effect of a modest Salt Reduction on blood pressure. Our data sources were MEDLINE, EMBASE, Cochrane library, CINAHL, and the reference lists of original and review articles. We included randomised trials with a modest Reduction in Salt intake and a duration of 4 or more weeks. Meta-analysis, meta-regression, and funnel plots were performed. A total of 17 trials in hypertensives (n=734) and 11 trials in normotensives (n=2220) were included in our study. The median Reduction in 24-h urinary sodium excretion was 78 mmol (equivalent to 4.6 g of Salt/day) in hypertensives and 74 mmol in normotensives. The pooled estimates of blood pressure fall were 4.96/2.73±0.40/0.24 mmHg in hypertensives (P<0.001 for both systolic and diastolic) and 2.03/0.97±0.27/0.21 mmHg in normotensives (P<0.001 for both systolic and diastolic). Weighted linear regression analyses showed a dose response between the change in urinary sodium and blood pressure. A Reduction of 100 mmol/day (6 g of Salt) in Salt intake predicted a fall in blood pressure of 7.11/3.88 mmHg (P<0.001 for both systolic and diastolic) in hypertensives and 3.57/1.66 mmHg in normotensive individuals (systolic: P<0.001; diastolic: P<0.05). Our results demonstrate that a modest Reduction in Salt intake for a duration of 4 or more weeks does have a significant and, from a population viewpoint, important effect on blood pressure in both hypertensive and normotensive individuals. This meta-analysis strongly supports other evidence for a modest and long-term Reduction in population Salt intake, and would be predicted to reduce stroke deaths immediately by ≈14% and coronary deaths by ≈9% in hypertensives, and reduce stroke and coronary deaths by ≈6 and ≈4%, in normotensives, respectively.

Minoru Kawamura - One of the best experts on this subject based on the ideXlab platform.

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