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Tag: Blood Pressure

  • Better cardiovascular health among middle-aged Black women linked to less decline in cognition

    Better cardiovascular health among middle-aged Black women linked to less decline in cognition

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    Better heart health was linked to less decline in mental processing speed and cognition among middle-aged Black women, although not among middle-aged white women, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

    Take care of your heart, and it will benefit your brain. Better cardiovascular health in women in their 40s is important to prevent later-life Alzheimer’s disease, dementia and to maintain independent living.”


    Imke Janssen, Ph.D., study lead author, professor of family and preventive medicine at Rush University Medical Center in Chicago

    Previous research has linked heart health to a lower risk of cognitive decline. This decline may begin years before the onset of dementia, Janssen explained. Questions that need to be answered include understanding when the cognitive benefits of heart health begin, whether they occur among people of different races and whether they affect different types of brain function including reasoning.

    In this study, researchers compared key heart health metrics, known as the American Heart Associations’ Life’s Essential 8, among middle-aged Black and white women to cognitive testing conducted on the women every one to two years over a 20-year period.

    Life’s Essential 8TM includes objectively measured weight, blood pressure, glucose, and cholesterol, as well as self-reported health behaviors such as eating healthy foods, being physically active, not smoking and getting enough sleep.

    The cognitive tests assessed processing speed and working memory. Processing speed is the pace at which the brain has accurate recognition of visual and verbal information and is necessary for daily activities such as driving. In this study, cognitive processing speed was assessed as quickly and accurately recognizing sets of numbers, objects, pictures or patterns. Working memory is the ability to remember and use small pieces of information for daily tasks, including remembering names and doing math.

    The study found differences in cognitive decline by race only in processing speed, not in working memory. Specifically:

    • Black women with lower heart health, based on the Life’s Essential 8 metrics, had a 10% decrease in processing speed over 20 years. Their scores were worse for all eight risk factors for heart disease, especially blood pressure and smoking.

    • In contrast, Black women with good heart health showed little decline in mental processing during the 20-year study.

    • Among white women with poorer heart health, processing speed did not decline.

    • Heart health did not affect working memory for Black or white women.

    “We were surprised that we did not find results like those of past studies, which showed cognitive decline in Black and white men and women, and found cardiovascular health to be more important for white adults rather than people in Black subgroups,” Janssen said. “We think these differences are due to the younger age of our participants, who began cognitive testing in their mid-40s, whereas previous studies started with adults about 10 to 20 years older. The next step is a clinical trial to confirm whether optimizing heart health in Black women at midlife may slow cognitive aging, maximize independence and reduce racial inequities in dementia risk.”

    Several limitations may have affected the study’s results. The study included women from a single study site and relied on self-reported measures of heart health, which may have been inaccurate. In addition, the study did not include measures that may account for racial differences in access to health care or the potential impact of structural racism on Black participants.

    Study background and details:

    • The study included 363 Black and 402 white women from the Chicago site of the Study of Women’s Health Across the Nation (SWAN).

    • The Chicago SWAN group started cognitive testing in 1997, when the women were between 42 and 52 years old. Cognitive testing continued every one to two years through 2017.

    • The analytic sample consisted of 765 women who provided 5,079 cognitive processing speed and 4,933 working memory assessments over the 20-year period. 

    • Heart health based on Life’s Essential 8 was assessed at time of enrollment only.

    Source:

    American Heart Association

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  • Unsheltered people are losing Medicaid in redetermination mix-ups

    Unsheltered people are losing Medicaid in redetermination mix-ups

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    Evans said she lost Medicaid coverage in September because she hadn’t received paperwork after moving from Great Falls, Montana. She has had to forgo the blood pressure medication she can no longer pay for since losing coverage. She has also had to put off needed dental work.

    “The teeth broke off. My gums hurt. There’s some times where I’m not feeling good, I don’t want to eat,” she said.

    Evans is one of about 130,000 Montanans who have lost Medicaid coverage as the state reevaluates everyone’s eligibility following a pause in disenrollments during the covid-19 pandemic. About two-thirds of those who were kicked off state Medicaid rolls lost coverage for technical reasons, such as incorrectly filling out paperwork. That’s one of the highest procedural disenrollment rates in the nation, according to a KFF analysis.

    Even unsheltered people like Evans are losing their coverage, despite state officials saying they would automatically renew people who should still qualify by using Social Security and disability data.

    As other guests filtered out of the shelter that February morning, Evans sat down in a spare office with an application counselor from Greater Valley Health Clinic, which serves much of the homeless population here, and recounted her struggle to reenroll.

    She said that she had asked for help at the state public assistance office, but that the staff didn’t have time to answer her questions about which forms she needed to fill out or to walk her through the paperwork. She tried the state’s help line, but couldn’t get through.

    “You just get to the point where you’re like, ‘I’m frustrated right now. I just have other things that are more important, and let’s not deal with it,’” she said.

    Evans has a job and spends her free time finding a place to sleep since she doesn’t have housing. Waiting on the phone most of the day isn’t feasible.

    There’s no public data on how many unhoused people in Montana or nationwide have lost Medicaid, but homeless service providers and experts say it’s a big problem.

    Those assisting unsheltered people who have lost coverage say they spend much of their time helping people contact the Montana Medicaid office. Sorting through paperwork mistakes is also a headache, said Crystal Baker, a case manager at HRDC, a homeless shelter in Bozeman.

    “We’re getting mail that’s like, ‘Oh, this needs to be turned in by this date,’ and that’s already two weeks past. So, now we have to start the process all over again,” she said. “Now, they have to wait two to three months without insurance.”

    Montana health officials told NPR and KFF Health News in a statement that they provided training to help homeless service agencies prepare their clients for redetermination.

    Federal health officials have warned Montana and some other conservative states against disenrolling high rates of people for technicalities, also known as procedural disenrollment. They also warned states about unreasonable barriers to accessing help, such as long hold times on help lines. The Centers for Medicare & Medicaid Services said if states don’t reduce the rate of procedural disenrollments, the agency could force them to halt their redetermination process altogether. So far, CMS hasn’t taken that step.

    Charlie Brereton, the director of the Montana health department, resisted calls from Democratic state lawmakers to pause the redetermination process. Redetermination ended in January, four months ahead of the federal deadline.

    “I’m confident in our redetermination process,” Brereton told lawmakers in December. “I do believe that many of the Medicaid members who’ve been disenrolled were disenrolled correctly.

    Health industry observers say that both liberal-leaning and conservative-leaning states are kicking homeless people off their rolls and that the redetermination process has been chaotic everywhere. Because of the barriers that unsheltered people face, it’s easy for them to fall through the cracks.

    Margot Kushel, a physician and a homeless researcher at the University of California-San Francisco, said it may not seem like a big deal to fill out paperwork. But, she said, “put yourself in the position of an elder experiencing homelessness,” especially those without access to a computer, phone, or car.

    If they still qualify, people can usually get their Medicaid coverage renewed — eventually — and it may reimburse patients retroactively for care received while they were unenrolled.

    Kushel said being without Medicaid for any period can be particularly dangerous for people who are homeless. This population tends to have high rates of chronic health conditions.

    “Being out of your asthma medicine for three days can be life-threatening. If you have high blood pressure and you suddenly stop your medicine, your blood pressure shoots up, and your risk of having a heart attack goes way up,” she said.

    When people don’t understand why they’re losing coverage or how to get it back, that erodes their trust in the medical system, Kushel said.

    Evans, the homeless woman, was able to get help with her application and is likely to regain coverage.

    Agencies that serve unhoused people said it could take years to get everyone who lost coverage back on Medicaid. They worry that those who go without coverage will resort to using the emergency room rather than managing their health conditions proactively.

    Baker, the case manager at the Bozeman shelter, set up several callbacks from the state Medicaid office for one client. The state needed to interview him to make sure he still qualified, but the state never called.

    “He waited all day long. By the fifth time, it was so stressful for him, he just gave up,” she said.

    That client ended up leaving the Bozeman area before Baker could convince him it was worth trying to regain Medicaid.

    Baker worries his poor health will catch up with him before he decides to try again.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Replacing dinner calcium with breakfast intake could reduce heart disease risk, study finds

    Replacing dinner calcium with breakfast intake could reduce heart disease risk, study finds

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    In a recent study published in BMC Public Health, researchers investigated whether the quantity of calcium consumed at breakfast and dinner was associated with cardiovascular disease (CVD) in the general population.

    Study: Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003–2018. Image Credit: Goskova Tatiana/Shutterstock.comStudy: Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003–2018. Image Credit: Goskova Tatiana/Shutterstock.com

    Background

    Cardiovascular disease is the primary cause of mortality globally and the most prevalent chronic illness among individuals living in the United States.

    Calcium, a crucial dietary element, helps prevent and manage CVD by regulating blood vessels, muscular contraction, nerve transmission, hormone production, fat mass, blood pressure, and blood lipids. Circadian clocks in animals govern circadian rhythms, which are biological rhythmic patterns that last 24 hours.

    Diet is a significant external element that influences the synchronization of circadian clocks. Recent research indicates that calcium intake can influence physiological variations in circadian pacemaker-type neuronal cells and alter the expression of the biological clock genes.

    However, the relationship between calcium consumption at various times of the day and cardiovascular disease is unclear.

    About the study

    The present study examined the relationship between dietary calcium consumption at dinner and breakfast and CVD.

    The study comprised 36,164 United States individuals (17,456 males, 18,708 females, and 4,040 cardiovascular disease patients) from the 2013–2018 National Health and Nutrition Examination Surveys. They stratified the participants into five groups based on their calcium intakes from night and early morning meals.

    The study focused on the fraction of calcium consumption in night and morning meals (Δ=calcium intake from dinner /calcium intake from breakfast).

    The study’s endpoint was cardiovascular disease, based on a self-reported history of angina, heart failure, stroke, coronary artery disease, or heart attack.

    Potential confounders included age, sex, educational attainment, smoking status, physical activity, marital status, annual income, alcohol consumption, body mass index (BMI), high-density lipoprotein (HDL), uric acid (UA), total cholesterol (TC), hypertension, and type 2 diabetes (T2DM).

    Following confounder adjustment, the researchers used logistic regression to calculate the odds ratios (OR) for the relationship between the calcium intake percentage at night and morning and cardiovascular disease.

    They used dietary replacement models to investigate changes in cardiovascular disease risk by replacing 5.0% calcium from dinner with calcium consumption in the morning.

    The team conducted home interviews with individuals and collected data at a mobile testing facility. They excluded individuals under 20 years, pregnant women, those with incomplete data, those consuming more than 4,500 kcal per day, and those using calcium supplements.

    They assessed dietary consumption using a 24-hour diet recall completed on two non-consecutive days. They assessed nutrient intake using the Food and Nutrient Database for Dietary Studies recommendations by the United States Department of Agriculture. They performed sensitivity studies to investigate the validity of the study findings.

    Results and discussion

    Individuals in the uppermost quartile showed a higher likelihood of having cardiovascular disease than those in the lowermost quintile, with adjusted OR values of cardiovascular disease of 1.2.

    While keeping total calcium consumption constant, substituting a 5.0% calcium consumption from dinner meals with calcium consumption at breakfast reduced CVD risk by 6.0%.

    Breakfast meals with morning snacks or dinner meals with evening snacks reduced CVD risk by 6% (OR, 0.9). Compared to the lowermost quintile, having breakfast and morning snacks as breakfast or dinner and evening snacks as dinner in the uppermost Δ quintile significantly reduced CVD risk, with adjusted ORs of 1.1 and 1.1, respectively.

    Consuming dinner with evening snacks and breakfast with morning snacks yielded an adjusted OR of 1.1. Among overweight and obese individuals, the adjusted odds ratio of cardiovascular disease in the uppermost Δ quintile was 1.2 after adjusting for various confounding variables.

    The circadian clock governs several cardiovascular processes, including endothelial function, thrombus development, blood pressure, and heart rate. Basic helix-loop-helix ARNT-like protein 1 (Bmal1), a primary clock gene, regulates calcium absorption and metabolism.

    Sleep periods improve calcium retention capability. Circadian rhythm influences the inflammatory nuclear factor kappa B (NFκB) pathway, metabolism, and immune system adaptability.

    The study found that those in the top percentile of calcium consumption at dinner and breakfast are more likely to develop cardiovascular disease. The findings imply that allocating calcium intake to both meals is critical.

    The study demonstrated a positive correlation between the Δ value and cardiovascular disease risk. Replacing 5.0% of calcium consumption from dinner meals with the same amount at breakfast reduced CVD risk by 6.0%. However, further research is required to corroborate these findings across races and nations.

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  • Public health efforts urged to reduce sodium in packaged foods

    Public health efforts urged to reduce sodium in packaged foods

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    In a recent review article published in Nutrients, researchers explored the dual role of sodium in water balance regulation and food formulation, noting its significant association with mortality due to excessive intake.

    Their conclusions underscore the importance of reducing sodium intake, promoting a global healthy lifestyle that includes both dietary adjustments and physical activity, and implementing educational interventions to optimize sodium balance and overall health.

    ​​​​​​​Study: Effect of active-duty military service on neonatal birth outcomes: a systematic review. Image Credit: beats1/Shutterstock.com​​​​​​​Study: Effect of active-duty military service on neonatal birth outcomes: a systematic review. Image Credit: beats1/Shutterstock.com

    Need to control sodium intake

    Sodium, crucial for extracellular fluid regulation and food science, poses risks when overconsumed. Global studies reveal high intake levels with associated cardiovascular risks.

    This has made reducing sodium in processed foods a global priority for public health agencies, and efforts are underway to reduce sodium in processed foods. While theoretical solutions exist, practical implementation requires addressing multiple factors such as taste, texture, and cost, highlighting ongoing efforts in food processing.

    The reduction or replacement of sodium in processed foods presents complex technological challenges. Strategies include reducing added salt, replacing sodium chloride with alternative salts or ingredients, and optimizing salt distribution for enhanced perception.

    However, global progress in reducing sodium intake has been low, and multidisciplinary approaches involving health professionals are needed to address this health challenge effectively.

    The Canadian government took initiatives to manage the excess sodium intake, including voluntary reduction targets and front-of-pack labeling regulations. Still, these efforts showed mixed success, suggesting that more than voluntary measures alone may be necessary and necessitate broader interventions.

    Possible solutions involve reducing sodium content in processed foods through policy interventions and enhancing individuals’ capacity to manage sodium intake, primarily through the guidance of health professionals such as dietitians.

    Dietary interventions

    Processed foods, notably prepackaged or prepared items, significantly contribute to sodium intake in the diet, with staples like processed meats, cheese, and bread being major sources.

    Studies indicate that reducing salt content in bread does not necessarily impact sales, suggesting potential for sodium reduction without compromising consumer acceptance, aligning with efforts to address excessive sodium intake.

    The Dietary Approaches to Stop Hypertension (DASH) diet, recommended for hypertensive patients, emphasizes potassium-rich foods while limiting the intake of sodium and saturated fats. Clinical studies consistently show its effectiveness in reducing blood pressure, even in individuals with type 2 diabetes.

    Despite challenges like high sodium preference in certain populations, DASH diet implementation through counseling and support strategies can aid in sodium reduction and hypertension management.

    Generating awareness of using salt-free seasonings, herbs, and spices can allow individuals to enhance food flavor without adding salt, potentially reducing sodium intake while maintaining taste satisfaction.

    Clinical studies suggest that replacing salt with low-sodium-salt substitutes (LSSS) may decrease sodium intake and slightly reduce blood pressure and cardiovascular risk. Still, concerns exist about potential adverse effects, particularly in high-risk populations, including people with chronic kidney disease.

    Research highlights the role of gut microbiota in cardiometabolic health, with studies showing the benefits of Lactobacillus rhamnosus probiotic supplementation on body composition and cardiometabolic markers.

    Recent findings suggest a link between gut microbiota depletion, high sodium intake, and blood pressure regulation, offering promise for microbiota-targeted interventions to improve sodium homeostasis.

    Digital platforms, like social media and electronic brochures, effectively supported a salt reduction initiative in the United Arab Emirates, with social media groups showing the most significant decrease in salt intake.

    Smartphone apps offer potential for DASH diet adherence, although their clinical effectiveness remains uncertain, emphasizing the need for further research and app improvement to maximize their public health impact.

    Mindful eating practices, such as those in the Mindfulness-Based Blood Pressure Reduction program, may improve compliance with low-sodium diets by promoting awareness of food choices.

    Improvement in emotional regulation can also mitigate the consumption of comfort foods that are high in sodium.

    Integrating these dietary strategies into interventions may effectively reduce sodium intake, complementing population-based approaches like policies to reduce salt and enhancing food labeling practices.

    Physical fitness and activity

    Recent findings suggest a complex interplay between body composition, aerobic fitness, and sodium intake, particularly in females. Interaction effects revealed a less favorable body composition profile in females with high sodium intake and low fitness levels.

    Mediation analysis indicated that both aerobic fitness and sodium intake mediate the association between body fitness and the genetic risk of obesity.

    Additionally, maintaining regular physical activity levels may mitigate the harmful impacts of high sodium intake, possibly through mechanisms like sweat sodium loss and reduced salt sensitivity.

    These insights advocate promoting physical activity alongside dietary sodium reduction strategies to achieve optimal sodium balance and metabolic health. Further research is warranted to elucidate the underlying mechanisms.

    Conclusions

    In summary, the crucial role of sodium in body homeostasis necessitates careful management to avoid cardiometabolic issues. While progress has been made in reducing sodium in processed foods, achieving optimal balance requires multifaceted interventions.

    These include nutritional counseling, lifestyle changes like increased physical activity, and potential microbiota modifications to promote sodium balance and overall health.

    Journal reference:

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  • Is spousal cardiovascular disease associated with an increased risk for depression?

    Is spousal cardiovascular disease associated with an increased risk for depression?

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    Cardiovascular disease (CVD) is among the leading causes of illness and death in the current age. While CVD has long been linked to the onset of depression, not much is known about whether the spouses of those affected are more likely to become depressed after such events.

    A study recently published in JAMA Network Open explored this topic, laying the foundation for future prospective studies in this field.

    Study: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.comStudy: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.com

    Depression and health

    Depression has become 65% more prevalent, and it stands as the predominant mental health disorder worldwide, not only diminishing quality of life but also adversely affecting overall health.

    Depression is associated with a higher risk of CVD, dementia, poor cognition, and death.

    How is CVD linked to depression?

    CVD and depression are both more common in people who are obese, and both share inflammation in the immune system. When someone suffers a CVD event such as a stroke or a heart attack, the family also suffers from mental stress, anxiety, and even depression.

    The current study was designed to explore the association between CVD and depression at the household level. The data came from a national database maintained by the Japan Health Insurance Association (JHIA).

    This included about 40% of the Japanese working-age population or 30 million individuals in this age group.

    What did the study show?

    The researchers found that among nearly 278,000 married couples matched for important characteristics, the vast majority (95%) reported a CVD-related event in the male partner. The mean age of the patients was 58 years.

    Those whose spouses had a CVD event were more likely to be diabetic, hypertensive, or depressed compared to the other group. The spousal group had an increased cumulative incidence of depression, between 4% to 5% for males and females, respectively.

    For spouses between 20 and 59 years, about 4% of spouses became depressed vs 3% of those aged 60 years or more.

    New-onset depression was observed in nearly 2% of individuals. Spousal risk for depression after a CVD was 13% higher than in the group without such an event.

    This did not show any change by age, sex, income, or a previous CVD history.

    However, depression risk was higher by 13% to 15% after spousal stroke or heart failure, but not after a heart attack.

    Other potentially confounding factors included smoking, drinking, exercise, or whether the index patient was using drugs to reduce blood pressure. None of these showed any impact on the risk of depression in the spouse, however.

    The researchers also checked for the possible interaction of these results with the spouse’s health status.

    They examined the body mass index (BMI), blood pressure, cholesterol levels, blood sugar concentrations, and kidney function. They found that the same increased risk was manifested after controlling for these factors.

    The study corroborates the depressive effect of a spousal CVD event, which could involve a need to be a caregiver for the sick spouse.

    This could mean inevitable lifestyle alterations, lack of other social interactions, sleep disruptions, and lack of exercise. All these are associated with chronic mental stress, which increases with the level and duration of caregiving.

    Financial problems due to the forced loss of employment to manage the spouse’s needs, with additional caregiving-related costs, are another source of stress.

    Finally, grief at the loss of a spouse or distress related to the stay of the loved one in the intensive care unit may trigger depression.

    Conclusions

    “These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.”

    By paying attention to possible confounders such as a history of other diseases, individual practice of healthy habits, and physical health parameters, the study fills a knowledge gap and provides stronger evidence.

    Community-level and multidisciplinary clinical support systems should be studied as a possible intervention to reduce this risk for spouses of CVD patients through a wide-spectrum preventive care approach.

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  • Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

    Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

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    Rutgers Health researchers have found that hypertensive disorders in pregnancy are strongly associated with fatal cardiovascular disease for up to a year after birth.

    Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy -; chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia -; all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure.

    Eclampsia, a condition whereby hypertensive disorders cause seizures, was associated with a nearly 58-fold increase in fatal cardiovascular disease, according to a study published in Paediatric and Perinatal Epidemiology.

    “Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School. “This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum.”

    The researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, but that number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

    We’ve gotten better at predicting, diagnosing, and treating preeclampsia in this country, so the risk of death is falling for any individual patient with that condition.”


    Cande Ananth, Chief of the Division of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School and senior author of the study

    Unfortunately, Ananth noted, the sharp increase in the number of patients who develop chronic hypertension has more than offset the improved ability to treat it.

    “Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain,” he said. “While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals.”

    Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications, the study authors said. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke.

    Guidelines for ongoing care for up to one year after delivery are needed for each hypertensive disorder, the researchers conclude.

    Source:

    Journal reference:

    Lee, R., et al. (2024). Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy. Paediatric and Perinatal Epidemiology. doi.org/10.1111/ppe.13055.

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  • The global quest for the right balance of sodium and potassium in the diet

    The global quest for the right balance of sodium and potassium in the diet

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    In a recent review published in the journal Hypertension Research, a group of authors compared global dietary sodium and potassium intake guidelines with Japan’s, highlighting the importance of customized recommendations to cultural dietary practices to address non-communicable diseases (NCDs).

    Mini Review: Global guidelines recommendations for dietary sodium and potassium intake. Image Credit: Degimages / ShutterstockMini Review: Global guidelines recommendations for dietary sodium and potassium intake. Image Credit: Degimages / Shutterstock

    Background 

    Due to unhealthy eating habits, NCDs have been identified as a global health concern that causes high mortality rates. The intake of sodium and potassium must be regulated in order to avoid any possible adverse effects on the human body, such as hypertension and heart diseases, among others. Further research is needed to customize dietary guidelines to cultural and regional eating habits, ensuring they are both effective and culturally sensitive in reducing NCDs globally.

    Global sodium intake recommendations

    Sodium intake guidelines are different globally and tend to be suited to regional dietary habits as well as health objectives, as stated by major health organizations.

    The World Health Organization’s (WHO’s) approach

    In 2012, the WHO set sodium intake guidelines for adults and children in order to achieve better health outcomes. It suggests that adults should consume a maximum of 2.0 grams of sodium per day, while children’s sodium levels should be adjusted on the basis of relative energy requirements. This guidance, backed by strong epidemiological and clinical research, seeks to reduce cardiovascular diseases by advocating for a global lower sodium intake.

    American Heart Association (AHA) and American College of Cardiology (ACC) ‘s guidelines 

    In 2011, the AHA recommended reducing daily sodium intake to 1.5 grams to manage blood pressure, especially among adults at risk of hypertension. Subsequent studies affirm the importance of limiting salt intake in preventing heart disease. Despite some debate over the rigor of this limit, the AHA and ACC maintain a recommended limit of 1.5 grams, aiming for even lower intakes in certain populations.

    Insights from the Dietary Guidelines for Americans (DGA)

    The 2020-2025 DGA advocates for a varied, nutrient-dense diet and specifies sodium intake limits based on age and risk factors. With a general recommendation of 2.3 grams daily, it advises further reduction to 1.5 grams for those at heightened risk of hypertension, emphasizing personalization in dietary choices.

    The European Food Safety Authority (EFSA)’s Recommendations

    In 2019, the EFSA updated its sodium intake guidelines to 2.0 grams per day for adults, aligning with the need to maintain sodium balance and support overall health. These guidelines, intended to inform policy and health advice within the European Union, also specify intake levels for children and special populations.

    Japan’s unique dietary guidelines

    Japan’s dietary guidelines reflect its specific nutritional context and historical dietary patterns. With a higher sodium intake goal compared to many countries, influenced by traditional food preferences, Japan aims to reconcile its guidelines with global recommendations while considering cultural and dietary practices. The guidelines suggest a gradual reduction in sodium intake, advocating for a balanced approach to align more closely with international standards.

    Potassium intake guidelines: Bridging global recommendations

    WHO’s perspective on potassium

    The WHO emphasizes potassium’s role in countering the adverse effects of high sodium intake, recommending a daily intake of at least 3.51 grams for adults. This guideline, supported by a comprehensive review of scientific evidence, underscores potassium’s importance in cardiovascular health.

    ACC/AHA and Potassium

    The ACC/AHA guidelines suggest enhancing potassium intake within a balanced diet to prevent cardiovascular diseases. While specific targets are not strongly emphasized, the recommendation is to consume 3.5 to 5.0 grams from potassium-rich foods daily, underscoring the nutrient’s role in heart health.

    DGA on potassium

    Echoing the importance of potassium, the 2020-2025 DGA recommends adult intake levels of 2.6 grams for women and 3.4 grams for men, promoting potassium-rich foods to support blood pressure management and reduce disease risk.

    EFSA’s potassium intake recommendations

    The EFSA, updating its guidelines based on recent evidence, sets the adult potassium intake at 3.5 grams daily. This guidance aims to inform health policies and advice, highlighting the ongoing need for research to further understand potassium’s health impacts.

    Japan’s approach to potassium intake

    In line with efforts to address high sodium consumption, Japan’s guidelines also advocate for increased potassium intake, especially from fruits and vegetables. This reflects an awareness of the balance between sodium and potassium intake in promoting health and preventing lifestyle-related diseases.

    Comparative analysis and the path forward

    The review of sodium and potassium intake guidelines reveals a global consensus on limiting sodium and enhancing potassium intake for health benefits. However, regional differences in dietary patterns necessitate tailored approaches to guideline implementation. Japan’s guidelines, for instance, illustrate the challenges and opportunities in aligning national recommendations with global standards. Countries like Japan are committed to public health by continuously revising dietary guidelines and adapting global recommendations to local contexts. This ongoing dialogue between global and national health recommendations underscores the complexity of dietary guideline formulation and the importance of culturally sensitive, evidence-based approaches to dietary policy.

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  • Meat or not to meat? Study challenges health claims of plant-based substitutes

    Meat or not to meat? Study challenges health claims of plant-based substitutes

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    Plant-based meat analogs (PBMA) have grown in popularity, but few studies have assessed their health effects. A recent American Journal of Clinical Nutrition study analyzed the effects of animal-based meat diets (ABMD) relative to PBMA diets (PBMD) on cardiometabolic health. This study was conducted in Singapore and included adults with an elevated risk of diabetes.

    Study: Plant-based meat analogues (PBMAs) and their effects on cardiometabolic health: An 8-week randomized controlled trial comparing PBMAs with their corresponding animal-based foods. Image Credit: dropStock / ShutterstockStudy: Plant-based meat analogues (PBMAs) and their effects on cardiometabolic health: An 8-week randomized controlled trial comparing PBMAs with their corresponding animal-based foods. Image Credit: dropStock / Shutterstock

    Background

    Plant-based diets (PBDs) have been shown to positively impact cardiometabolic health due to the presence of a wide range of bioactive constituents, e.g., vitamins, dietary fibers, carotenoids, and so on. Despite the advantages, long-term compliance by habitual omnivores can be complex because meat consumption is deeply rooted in culture, history, and societal norms.

    PBMAs, developed from sustainable plant-based sources, aim to ape the organoleptic attributes of their animal-based counterparts. With their growing popularity, it is important to critically evaluate their health effects relative to a typical omnivorous diet. In particular, there is a scarcity of research within an Asian dietary context.

    About this Study

    Addressing the aforementioned gap in the literature, the current study aimed to assess the impacts of ABMD and PBMD on cardiometabolic health among Singaporeans with an elevated risk of type 2 diabetes mellitus (T2DM). The central hypothesis was that substitutions with PBMA would lead to better cardiometabolic health and lower risks stemming from non-communicable diseases.

    This was an 8-week parallel design randomized controlled trial with 89 participants. Among them, 44 were instructed to switch to fixed quantities of PBMAs, and the remaining switched to animal-based meats corresponding to the PBMAs. The primary outcome variable was LDL-cholesterol, and the secondary outcomes comprised other risk factors for cardiometabolic diseases (e.g., glucose and fructosamine) and dietary data. Within a sub-population, the secondary outcome also consisted of a measure of ambulatory blood pressure at baseline and post-intervention and continuous glucose monitoring for 14 days.

    Study Findings

    No significant effects were noted on the lipid-lipoprotein profile; however, both dietary regimes were associated with lower fructosamine and higher HOMA-β over time. No apparent differences were noted between the ABMD and the PBMD groups. The results did not show any clear benefits of PBMD on cardiometabolic health relative to ABMD.

    The subpopulation that underwent glucose monitoring reported more effective glycemic management in the ABMD group. Ambulatory blood pressure also showed modest improvements after an ABMD but not a PBMD. These findings suggest that the health benefits of PBDs should not be conflated with PBMDs. This is because PBMDs are distinct from PBDs in terms of nutrition and impact on cardiometabolic health.

    When comparing PBMAs with their corresponding animal-based foods, vast differences were noted in the macro- and micro-nutrient profiles. The ABMD group showed higher dietary protein, and in terms of micronutrients, PBMAs were higher in sodium. Potassium and calcium were also found to be higher in some PBMAs.

    The better results concerning the glycemic index in the ABMD group could be driven by the lower carbohydrate and higher protein consumption relative to the PBMD group. Here, protein bioavailability was not assessed, but existing research has shown weakened absorption and digestion of PBMA proteins compared to animal-based meats. This leads to differential insulin secretion and production of gut hormones.

    The selection and assessment of widely available and popular contemporary PBMAs is a key strength of this study. The mode of intervention was also flexible to enable the assessment of broader dietary consequences following a switch to PBMD. Furthermore, the strictly regulated setting, where provision and consumption of food happened at specific times, contributed to the influence of confounders to be minimized. 

    Conclusions

    In sum, despite the growing popularity of PBMAs as a source of alternative protein, the results documented here do not support the hypothesis of superior cardiometabolic health benefits linked to PBMDs relative to an omnivorous diet comprising animal-based meats. 

    Incorporating PBMAs into the diet could affect nutritional intake and potentially compromise glycemic management. This implies that the health benefits of PBDs should not be conflated with PBMD because PBMDs are distinct from PBDs in terms of their nutrition and impact on cardiometabolic health.

    The results documented here provide a stimulus and motivation for the food industry to research and develop the next generation of PBMAs with greater nutritional attributes and bioaccessibility. The current focus is on organoleptic properties, and expanding the remit to consider nutrition and sustainability is expected to benefit producers and consumers alike.

    Journal reference:

    • Kiat Toh. et al. (2024) Plant-based meat analogues (PBMAs) and their effects on cardiometabolic health: An 8-week randomized controlled trial comparing PBMAs with their corresponding animal-based foods. The American Journal of Clinical Nutrition. DOI: 10.1016/j.ajcnut.2024.04.006, https://www.sciencedirect.com/science/article/pii/S0002916524003964

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  • MADs show comparable blood pressure reduction to CPAP in hypertensive patients with sleep apnea

    MADs show comparable blood pressure reduction to CPAP in hypertensive patients with sleep apnea

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    People with hypertension and obstructive sleep apnea were no less likely to see their blood pressure drop over six months if they used a mandibular advancement device (MAD), which is inserted onto the teeth similar to a bite guard. compared to a continuous positive airway pressure (CPAP) device, according to research featured at the American College of Cardiology’s Annual Scientific Session. Hypertension, or high blood pressure, is a common risk factor for cardiovascular disease. People with obstructive sleep apnea experience frequent sleep interruptions due to the airway closing periodically during sleep. Since obstructive sleep apnea can cause or worsen hypertension, medical guidelines recommend the use of a CPAP machine to help keep airways open by delivering pressurized air through the mouth and nose.

    MADs are designed to help keep the airway open by repositioning the lower jaw and moving the tongue forward. Previous studies have shown that CPAP devices outperform MADs in terms of apnea-hypopnea index, the standard metric used to measure sleep apnea severity. However, there is evidence that MADs may be better tolerated than CPAP, which some people find too uncomfortable or cumbersome for sustained use.

    In this study, MADs were found non-inferior in terms of change in the average 24-hour ambulatory mean blood pressure at six months and they resulted in a larger reduction across multiple secondary blood pressure parameters compared with CPAP. According to researchers, higher adherence among people assigned to use the MAD device could help explain the findings.

    Looking at the totality of evidence available in the literature, it is still reasonable to say that CPAP is the first-line treatment until we have more data on the MAD. However, for patients who truly cannot tolerate or accept using a CPAP, we should be more open minded in looking for an alternative therapy such as a MAD, which based on our study, numerically had a better blood pressure reduction in patients compared with a CPAP.”


    Ronald Lee Chi-Hang, MD, professor of medicine at Yong Loo Lin School of Medicine, National University of Singapore, senior consultant in the department of cardiology at National University Heart Centre, Singapore, and one of the study authors

    For the study, 321 people with uncontrolled hypertension and high cardiovascular risk underwent a sleep study to determine whether they had obstructive sleep apnea. Of these, 220 people were found to have moderate to severe obstructive sleep apnea and were randomly assigned to receive a MAD or CPAP device. Participants were instructed to use their assigned device for six months while sleeping to the degree that they could tolerate it. Both devices had built-in trackers that recorded use.

    At six months, people assigned to the MAD group experienced a drop in 24-hour ambulatory mean blood pressure that was 1.64 mmHg larger, on average, than those assigned to CPAP, meeting the threshold for non-inferiority and the trial’s primary endpoint. Compared with the CPAP group, the MAD group also showed a larger between-group reduction in all ambulatory blood pressure measures, especially nighttime blood pressure when the devices were being used, and an increased proportion of patients achieving a systolic blood pressure below 120 mmHg by the end of the study. None of the participants experienced symptomatic hypotension.

    The adherence data revealed that over half (56.5%) of those who were assigned to use the MAD used the device for six or more hours per night on average over the study period, while under one-quarter (23.2%) of those assigned to CPAP did so.

    “The MAD patients simply used the device longer,” Chi-Hang said. “That also might explain why the blood pressure reduction at nighttime, when the patients are actually using it, had a better reduction in the MAD arm.”

    Adherence to the American Academy of Sleep Medicine’s recommendation of four or more hours of use in at least 70% of nights overall was similar between groups, with 69.4% of those in the MAD group and 64.3% of those in the CPAP group meeting this recommendation. Both groups saw a reduction in daytime sleepiness and the results showed no between-group differences in cardiovascular biomarkers.

    Overall, researchers said the results underscore the importance of treating sleep apnea as part of a broader effort to control hypertension and reduce cardiovascular risk.

    “People should be aware that over 400 million people globally have moderate-to-severe obstructive sleep apnea, and it is underdiagnosed and may be a contributing factor to their high blood pressure,” Chi-Hang said. “Especially for patients whose blood pressure is hard to control or who have a lot of excessive daytime sleepiness, [it is important to] go see a physician about sleep apnea and get treated if necessary.”

    Since the study was conducted in Singapore and most study participants were of East Asian descent, researchers said further studies in more diverse populations are necessary to determine whether the findings are generalizable to other racial and ethnic groups. Chi-Hang also said that the timing of the study, which was conducted during travel lockdowns during the COVID-19 pandemic, may have influenced the results by increasing adherence.

    The researchers plan to conduct further studies focused on comparing the impacts of the different types of devices on cognition.

    The study was funded by the Singapore Ministry of Health.

    This study was simultaneously published online in the Journal of the American College of Cardiology at the time of presentation.

    Chi-Hang will present the study, “Mandibular Advancement Device Versus CPAP for Blood Pressure Reduction in Obstructive Sleep Apnea and High Cardiovascular Risk—A Randomized Clinical Non-inferiority Trial,” on Saturday, April 6, 2024, at 4:15 p.m. ET / 20:15 UTC in the Thomas B. Murphy Ballroom 4.

    Source:

    American College of Cardiology

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  • Researchers awarded $1.9 million to develop wearable device for blood loss detection

    Researchers awarded $1.9 million to develop wearable device for blood loss detection

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    The Department of Defense awarded a little more than $1.9 million to a multidisciplinary team of researchers at the University of Arkansas and University of Arkansas for Medical Sciences to develop a wearable device that will assist with the early detection and monitoring of internal and external bleeding. The grant comes as part of the Department of Defense’s prestigious Congressionally Directed Medical Research Programs.

    Hemorrhagic shock is currently the leading cause of preventable death in casualty care settings. Existing methods often fail to detect blood loss until the onset of shock, which can be too late for some patients. This makes early detection and management of bleeding-related conditions critical to improving survival rates.

    The team is designing a mobile device that can detect blood pressure waveforms, which correlate with the volume of blood within the blood vessels, the “intravascular volume,” and can be used to determine if blood volume is falling due to hemorrhaging. This will enable first responders and hospital staff to get more accurate readings earlier and respond with better timed and more precisely calibrated care.

    The principal investigator on the four-year award is associate professor of biomedical engineering at the U of A, Morten Jensen, who also has a background in electrical and computer engineering and has worked in industry with sensor and signal analysis technologies. Jensen will be joined by Jingxian Wu, a U of A professor of electrical engineering, and Robert Saunders, an associate department head of electrical engineering and computer science. Hanna Jensen, an assistant professor in the Department of Surgery at UAMS and course director of the school’s cardiovascular module, will oversee the translational and clinical phases of the project.

    The proposed work will have three goals. First, the team will develop machine learning models and algorithms to analyze the pressure signals for blood loss detection. This involves optimizing learning algorithms with a small amount of data, developing real-time software and creating models based on physiological data. This will improve patient care by enabling accurate and efficient detection of blood loss.

    Second, they will prototype and develop a cost-effective wearable device for detecting blood loss. Finally, the team will test the device through clinical trials in a wearable configuration. The goal is to create a device that functions optimally, meets design parameters and performs accurately and reliably in real-world scenarios.

    Morten Jensen, who is a native of Denmark, said, “Our similar educational backgrounds make it very exciting to collaborate with Jingxian Wu and Robert Saunders. I also served in the Danish military and know first-hand the importance of reliable equipment that works fast and is lightweight.”

    Saunders, who is a first responder in Madison County with the volunteer fire department, will be tasked with constructing, and then shrinking down, the prototype. He noted that the device would be extremely useful when medics showed up to an incident with multiple casualties and a limited amount of saline (in Madison County, casualties may be as many as 20 minutes from the nearest hospital). The device would help first responders determine exactly who needs the fluid and how badly, optimizing the use of limited resources. The device would also remain attached to anyone involved in the incident in the event their blood pressure suddenly crashed due to a delayed reaction -; at which point, fluids could be immediately administered.

    Ultimately, the team’s goal is to develop a device that is less than an inch square and sells for less than $100. It would have a catheter that connects to a vein as well as a port to which an IV bag could be connected.

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