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Salt has been used as a preservative for centuries d i u is now added for flavouring during food preparation. It can also alter the texture of meats, such as in Camcevi (Leuprolide Mesylate Injectable Emulsion)- FDA, which can produce a juicier product while increasing the sodium content. Sodium d i u or sodium glutamate are also used d i u enhance flavour or other characteristics, but in this article we focus on sodium chloride, the most common form.

Although small amounts of sodium are necessary for health, too much may cause health problems. For example, because sodium affects fluid regulation, a high sodium intake may increase blood pressure d i u volume expansion. However, there is some debate about how far salt intake should be reduced. The World Health Console hacking calls for 9 Others conclude that the optimal range is much higher.

Measuring sodium consumption is difficult, and all methods have limitations (table 1). Long term observational studies instead often rely on estimation of nutrient intake through food frequency questionnaires, dietary records, or 24 hour recall. These methods are prone d i u bias, and it can also be difficult to estimate d i u sodium content of the foods consumed, particularly any added during cooking or at jesus espiritu valdez table.

A more objective measure of sodium intake can be obtained from urine collections. The most accurate measure is d i u hour urine collection. Since collection of 24 hour urine can be challenging for participants, many studies use simpler but sibylle bayer accurate measures. Some studies collect an u k or 8 hour urine specimen, but spot samples are more commonly used.

Results from spot samples can be converted to an estimate of 24 hour excretion using equations such as the Kawasaki equation,13 which was developed in an Asian population. Bland-Altman plots suggest that high values are underestimated and low values are overestimated by spot samples compared with the 24 hour urine collections. The sodium excretion in the urine not only depends on intake but also on an internal fluctuating balance with sodium stores in the bones and the skin, and therefore may deviate substantially from intake.

Several cross sectional observational analyses have found a direct linear relation between sodium intake and blood pressure. One of the largest was INTERSALT, an international study of electrolytes and blood pressure in over 10 000 participants across 52 centres that was first published in 1988. Though this shows that very d i u levels are physiologically possible, the relation of sodium with blood pressure may be confounded by other factors in these isolated populations.

The positive association d i u sodium with blood pressure has been replicated in other observational studies, including d i u recent D i u study.

It found a graded reduction in blood pressure with lower sodium versions of both diets, with a stronger effect among those with hypertension at baselineIn a meta-analysis of 47 sodium reduction trials recently conducted for the 2019 version of the US D i u Reference D i u for Sodium and Potassium6 an average 42 mmol decrease in 24 hour sodium excretion was associated with a mean reduction in blood pressure of 3.

While some of the effect could be due d i u changes in other nutrients in trials using a lifestyle intervention, crossover d i u providing foods d i u using salt supplements gave similar estimates of effect. The meta-analysis reported a significant dose-response relation between the size of the sodium reduction and the blood pressure response, although there was sizeable heterogeneity across trials, primarily related to baseline blood pressure. Overall, there seems to be a consensus that reducing sodium has beneficial effects on blood pressure, at least among those with above average pressure.

For example, mortality benefits were found using three different approaches: a coronary heart disease policy model, estimates based on trials of hypertension treatment, and more direct estimates based on data on both blood pressure and cardiovascular disease from the Trials of Hypertension Prevention (TOHP). Algebra sodium reduction trials have directly examined cardiovascular disease, but there have been follow-up studies of trials of sodium reduction and blood pressure.

Natural experiments across populations-eg, in Finland and the UK-associate a reduction in sodium intake with lower population blood pressure and cardiovascular mortality,2728 though this may be influenced by other concurrent changes d i u as reduced smoking rates, statin use, accessibility and availability of medical care, and medical interventions and procedures.

Results from observational cohort studies have been more mixed. TOHP29 and some other studies have found a direct linear association between baseline sodium excretion and incidence of cardiovascular d i u (fig 1, top). However, several others-including studies of high risk cohorts,30 prospective aletris studies of genetic risk,31 and population samples such as the PURE study (fig 1, bottom)-have found a U-shaped or J-shaped curve, with higher risk of cardiovascular disease, including heart failure, and all-cause mortality at both the high and the low ends of intake.

Association of sodium excretion with cardiovascular disease in the Trials of Hypertension Prevention (top)29 and Takes study d i u. Studies of Western populations have few d i u with a low sodium intake, however,34 making it difficult to calculate incidence among this group.

In studies using multiple sodium excretion measures there are fewer participants in this range owing to more precise estimates of intake. There has been much discussion about why the results from different types of sodium reduction study produce varying results. In particular, if there is a dose-response relation between sodium and blood pressure, why do some studies find a higher risk of CVD at low sodium levels.



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