Dietary counseling to reduce moderate sodium intake. Concerns about the methods, evidence and feasibility of lowering sodium intake.
Dietary counseling to reduce moderate sodium intake. Concerns about the methods, evidence and feasibility of lowering sodium intake.
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DOI：
10.1016/j.eclinm.2023.102053
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发表时间：
2023-07
影响因子：
15.1
通讯作者：
He, F. J.
中科院分区：
文献类型：
--
作者：
Campbell, N. R. C.;Macgregor, G. A.;He, F. J.
史密斯等人。进行了一项为期 2 年的随机对照试验 (RCT)，研究了 6.5 小时减少钠摄入量的饮食建议对血压以及心血管 (CVD) 和肾脏疾病生物标志物的影响。 1 然而，人们对其评估尿钠的方法以及有关减少膳食钠的可行性和支持减少钠的证据的一些陈述表示担忧。 Smyth 等人使用的标准（至少 50% 预测肌酐排泄）评估 24 小时尿液收集的完整性是不寻常的，并且将大量不完整收集视为完整（例如，与 PABA 排泄标准 2 相比，至少 60-69% 预期的肌酐排泄对于检测不完整 24 小时尿液收集的敏感度仅为 8-49%）。我们不知道有任何相关的验证研究使用 24 小时尿肌酐在预测值的 50% 范围内。用于评估 24 小时尿液完整性的方法可能会对报告的钠排泄产生 2 倍以上的影响。 3 为了解释钠排泄数据，Smyth 等人。应使用标准方法（例如，肌酐排泄指数<0.7对于去除不完整收集最敏感）并在报告24小时尿钠排泄的每个时间点报告不完整24小时尿液的比率。 2 Smyth 等人在指出“观察性研究报告关于低钠摄入量与 CVD 和死亡率之间的关系的相互矛盾的发现，一些研究报告低钠摄入量（< 3 g/天）与中等摄入量相比风险更高”时，没有提供足够的背景信息，并且最近一项针对心力衰竭患者的大型随机对照试验并未报告低钠摄入量可降低 CVD 死亡风险。 1 Smyth 等人还指出，长期饮食建议研究对于将钠摄入量降低到 3000 毫克/天以下是无效的，这与将钠摄入量降低到每天 3000 毫克以下的饮食建议主要试验形成鲜明对比。 1, 4 基于饮食建议的随机对照试验荟萃分析显示，钠摄入量平均从 3646 毫克/天减少至 2690 毫克/天，CVD 降低 26%，CVD 与钠摄入量呈线性相关，降至 2300 毫克/天。 4 因此，将膳食钠降低至 3000 毫克/天以下并减少 CVD 的饮食建议是可行的。此外，对使用推荐的多次 24 小时尿液采集的队列研究进行分析发现，钠摄入量从 1846 毫克/天到 5230 毫克/天与 CVD 呈线性相关。 4 美国国家科学、工程和医学院以及 75 个国家和国际非政府组织均表示，低质量的研究，例如 Smyth 等人的队列研究。被认为显示较高的心血管疾病和较低的钠摄入量，是有关减少膳食钠对健康益处的争议的一个驱动因素，非政府组织也表示担心有关膳食钠的错误信息也是一个争议的驱动因素。 1, 4–6 根据 Smyth 等人的饮食建议，心力衰竭大型随机对照试验中膳食钠的变化。引用，将膳食钠从 2286 毫克/天减少到 1658 毫克/天，远低于 Smyth 等人。索赔不可行，并且降低与生活质量和 NYHA 心力衰竭功能分级的改善相关（尽管死亡率没有显着变化）。 7 Smyth 等人的研究。表明在当前的饮食环境下，个人很难长期维持较低的钠摄入量。因此，迫切需要并强烈建议采取上游干预措施（例如加工食品的强制性钠目标）来改善食品系统以减少钠摄入量。
Smyth et al. performed a 2-year randomized controlled trial (RCT) examining the impact of 6.5 h of dietary advice to reduce sodium intake on blood pressure and biological markers of cardiovascular (CVD) and renal disease. 1 However, there are concerns about their methods for assessing urinary sodium and some statements regarding the feasibility of reducing dietary sodium and the evidence supporting sodium reduction. The criteria used by Smyth et al.(at least 50% predicted creatinine excretion) to assess completeness of the 24 h urine collections is unusual and would have included a large number of incomplete collections as complete (eg, creatinine excretion of at least 60–69% of expected is only 8–49% sensitive to detect incomplete 24 h urine collections compared to the standard of PABA excretion 2). We are unaware of any relevant validation study using 24 h urine creatinine within 50% of predicted. The method used to assess completeness of 24 h urines can have a more than 2-fold impact on reported sodium excretion. 3 To allow interpretation of sodium excretion data, Smyth et al. should use a standard method (eg, creatinine excretion index< 0.7 is the most sensitive for removing incomplete collections) and report the rates of incomplete 24 h urines at each time point where they report 24 h urine sodium excretion. 2 Smyth et al., do not provide adequate context when stating that “observational studies report conflicting findings on the association of low sodium intake with CVD and mortality, with some studies reporting a higher risk at low intake (< 3 g/day) compared to moderate intake”, and that a recent large RCT in patients with heart failure did not report a lower risk of mortality of CVD with low sodium intake. 1 Smyth et al., also state long term dietary advice studies are ineffective at reducing sodium below 3000 mg/day which contrasts with major trials of dietary advice that lowered sodium intake to less than 3000 mg/day. 1, 4 A meta-analysis of RCTs based on dietary advice had an average reduction in sodium intake from 3646 to2690 mg/day with a 26% reduction in CVD and a linear association of CVD with sodium intake down to 2300 mg/day. 4 Thus, dietary advice is feasible to lower dietary sodium below 3000 mg/day and reduces CVD. Furthermore, an analysis of cohort studies that used the recommended multiple 24 h urine collections found a linear association of sodium intake from 1846 to 5230 mg/day with CVD. 4 The National Academies of Science, Engineering and Medicine and 75 national and international nongovernmental organizations have stated that low quality research, such as the cohort studies Smyth et al. cited as showing higher CVD with lower sodium intake, are a driver of the controversy regarding the health benefits of reducing dietary sodium and that nongovernmental organizations have also expressed concern that misinformation about dietary sodium is also a driver of controversy. 1, 4–6 The change in dietary sodium in the large RCT in heart failure, based on dietary advice, that Smyth et al. cited, reduced dietary sodium from 2286 to 1658 mg/day, far lower than Smyth et al. claim is not feasible and the reduction was associated with an improvement in quality of life and NYHA functional class of heart failure (although mortality was not significantly changed). 7 The study by Smyth et al. shows that in the current food environment, it is difficult for individuals to sustain lower sodium intake long-term. Thus, upstream interventions,(eg, mandatory sodium targets for processed foods), are urgently needed and strongly recommended to improve the food system to reduce sodium intake.
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影响因子：
2.7
作者：
Campbell, Norm R. C.;Whelton, Paul K.;Orias, Marcelo;Wainford, Richard D.;Cappuccio, Francesco P.;Ide, Nicole;Neal, Bruce;Cohn, Jennifer;Cobb, Laura K.;Webster, Jacqui;Trieu, Kathy;He, Feng J.;McLean, Rachael M.;Blanco-Metzler, Adriana;Woodward, Mark;Khan, Nadia;Kokubo, Yoshihiro;Nederveen, Leo;Arcand, JoAnne;MacGregor, Graham A.;Owolabi, Mayowa O.;Lisheng, Liu;Parati, Gianfranco;Lackland, Daniel T.;Charchar, Fadi J.;Williams, Bryan;Tomaszewski, Maciej;Romero, Cesar A.;Champagne, Beatriz;L'Abbe, Mary R.;Weber, Michael A.;Schlaich, Markus P.;Fogo, Agnes;Feigin, Valery L.;Akinyemi, Rufus;Inserra, Felipe;Menon, Bindu;Simas, Marcia;Neves, Mario Fritsch;Hristova, Krassimira;Pullen, Carolyn;Pandeya, Sanjay;Ge, Junbo;Jalil, Jorge E.;Wang, Ji-Guang;Wideimsky, Jiri;Kreutz, Reinhold;Wenzel, Ulrich;Stowasser, Michael;Arango, Manuel;Protogerou, Athanasios;Gkaliagkousi, Eugenia;Fuchs, Flavio Danni;Patil, Mansi;Chan, Andy Wai-Kwong;Nemcsik, Janos;Tsuyuki, Ross T.;Narasingan, Sanjeevi Nathamuni;Sarrafzadegan, Nizal;Ramos, Maria Eugenia;Yeo, Natalie;Rakugi, Hiromi;Ramirez, Agustin J.;Alvarez, Guillermo;Berbari, Adel;Kim, Cho-il;Ihm, Sang-Hyun;Chia, Yook-Chin;Unurjargal, Tsolmon;Park, Hye Kyung;Wahab, Kolawole;McGuire, Helen;Dashdorj, Naranjargal J.;Ishaq, Mohammed;Ona, Deborah Ignacia D.;Mercado-Asis, Leilani B.;Prejbisz, Aleksander;Leenaerts, Marianne;Simao, Carla;Pinto, Fernando;Almustafa, Bader Ali;Spaak, Jonas;Farsky, Stefan;Lovic, Dragan;Zhang, Xin-Hua
通讯作者：
Zhang, Xin-Hua
影响因子：
4.9
作者：
Campbell, N. R. C.;He, F. J.;MacGregor, G. A.
通讯作者：
MacGregor, G. A.
影响因子：
15.1
作者：
Smyth, Andrew;Judge, ConorJudge;O'Donnell, Martin
通讯作者：
O'Donnell, Martin
影响因子：
2.8
作者：
Wielgosz, Andreas;Robinson, Christopher;Morrison, Howard
通讯作者：
Morrison, Howard
影响因子：
168.9
作者：
Ezekowitz, Justin A.;Colin-Ramirez, Eloisa;Zieroth, Shelley
通讯作者：
Zieroth, Shelley