1910 Mo Il consumo di sodio e potassio e ipertensione Alberto Morganti U.O. Medicina Generale e...

1910 Mo1910 Mo

Il consumo di sodio e potassio e ipertensioneIl consumo di sodio e potassio e ipertensione

Alberto MorgantiAlberto Morganti

U.O. Medicina Generale e Centro Ipertensione ArteriosaU.O. Medicina Generale e Centro Ipertensione Arteriosa

Ospedale San Giuseppe, UniversitOspedale San Giuseppe, Universitàà di Milano di Milano

Congresso Nazionale ASIAMCongresso Nazionale ASIAM

Riccione, 16-18 Maggio 2014Riccione, 16-18 Maggio 2014

2077 Mo2077 Mo

Progressi nel Trattamento dell’Ipertensione ArteriosaProgressi nel Trattamento dell’Ipertensione Arteriosa

19401940• Dieta iposodica (Kemper)Dieta iposodica (Kemper)• Simpaticectomia lombodorsaleSimpaticectomia lombodorsale

19501950• Simpaticolitici (Reserpina, Simpaticolitici (Reserpina,

Guanetidina)Guanetidina)• Vasodilatatori (Idralazina)Vasodilatatori (Idralazina)• Diuretici tiazidiciDiuretici tiazidici

19601960• Bloccanti recettori beta-adrenergiciBloccanti recettori beta-adrenergici• Antialdosteronici (Spironolattoni)Antialdosteronici (Spironolattoni)

19701970• Bloccanti recettori alfa-adrenergiciBloccanti recettori alfa-adrenergici• ACE inibitoriACE inibitori

19801980• CalcioantagonistiCalcioantagonisti

19901990• Bloccanti recettori angiotensina II Bloccanti recettori angiotensina II

(Sartani)(Sartani)

20002000• Inibitori diretti della reninaInibitori diretti della renina

2929 Mo2929 Mo INTERSALT Cooperative Research Group, BMJ 1988; 297: 319-328INTERSALT Cooperative Research Group, BMJ 1988; 297: 319-328

Salt intake and the rise in blood pressure with ageSalt intake and the rise in blood pressure with age

Incr

ease

in S

BP

wit

h ag

e (m

mH

g/y)

Incr

ease

in S

BP

wit

h ag

e (m

mH

g/y)

Urinary sodium excretion (gr salt/day)Urinary sodium excretion (gr salt/day)

INTERSALT StudyINTERSALT StudyData from 52 centersData from 52 centersr = 0.566r = 0.566p < 0.001p < 0.001

INTERSALT StudyINTERSALT StudyData from 52 centersData from 52 centersr = 0.566r = 0.566p < 0.001p < 0.001

1.41.4

1.21.2

1.01.0

0.80.8

0.60.6

0.40.4

0.20.2

0.00.0

-0.2-0.200 33 66 99 1212 1515

2930 Mo2930 Mo Perry and Beevers, J Human Hypertens 1992; 6: 23-25Perry and Beevers, J Human Hypertens 1992; 6: 23-25

Relationship between salt intake and death from strokeRelationship between salt intake and death from stroke

Dea

ths

from

str

oke

(per

10

Dea

ths

from

str

oke

(per

1066 p

er y

ear)

per

yea

r)


Data from 12 EU countriesData from 12 EU countriesr = 0.832r = 0.832p < 0.001p < 0.001

Data from 12 EU countriesData from 12 EU countriesr = 0.832r = 0.832p < 0.001p < 0.001

22102210

18101810

14801480

12101210

990990

810810

670670

5505507.57.5 8.08.0 9.09.0 9.59.5 10.010.0 10.510.58.58.5

2936 Mo2936 Mo

Mechanisms whereby high sodium intake may cause CVDMechanisms whereby high sodium intake may cause CVD

Increase in BPIncrease in BP

LVH, ventricular fibrosisLVH, ventricular fibrosis

Diastolic dysfunctionDiastolic dysfunction

Endothelial dysfunctionEndothelial dysfunction

Increased vascular oxidative stressIncreased vascular oxidative stress

Increased mitogenic responsesIncreased mitogenic responses

Increased urinary calcium excretionIncreased urinary calcium excretion

NephrocalcinosisNephrocalcinosis

ProteinuriaProteinuria

2909 Mo2909 Mo

Meta-analysis of prospective studies comparing the effects of Meta-analysis of prospective studies comparing the effects of higher vs lower salt intake on incident CV events and strokehigher vs lower salt intake on incident CV events and stroke

Strazzullo P et al., BMJ 2009; 339: b4547Strazzullo P et al., BMJ 2009; 339: b4547

StudiesStudies

1414

1414

Follow-upFollow-up(years)(years)

3.5-193.5-19

3.5-193.5-19

RRRR

1.171.17

1.231.23

SampleSamplesizesize

104.933104.933

154.282154.282

EventsEvents

5.1615.161

5.3435.343

Sodium Sodium differencedifference

(mmol/day)(mmol/day)

40-15040-150

84-15084-150

PP

0.020.02

0.010.01

CV diseasesCV diseases

StrokeStroke

5 gr/day reduction in salt intake can avert a quarter million deaths from stroke and three million 5 gr/day reduction in salt intake can avert a quarter million deaths from stroke and three million deaths from CV disease each year throughout the worlddeaths from CV disease each year throughout the world

2922 Mo2922 Mo

Hazard Ratio for CVD by mean daily sodium excretionHazard Ratio for CVD by mean daily sodium excretionin prehypertensive individualsin prehypertensive individuals

Cook NR et al., Circulation 2014; 129: 981-989Cook NR et al., Circulation 2014; 129: 981-989

Data from TOPH I and TOPH II StudiesData from TOPH I and TOPH II Studies

n = 2275, F.U. 10-15 yrsn = 2275, F.U. 10-15 yrs193 CV events193 CV eventsMean NaMean Na++ excretion 3630 mg/day excretion 3630 mg/day

n = 2275, F.U. 10-15 yrsn = 2275, F.U. 10-15 yrs193 CV events193 CV eventsMean NaMean Na++ excretion 3630 mg/day excretion 3630 mg/day

2020

1010

55

22

11

0.50.5

0.20.2

Haz

ard

Rat

ioH

azar

d R

atio

10001000 20002000 30003000 40004000 50005000 60006000 70007000 80008000 90009000

Na excretion (mg/day)Na excretion (mg/day)

2931 Mo2931 Mo Joossens JV et al., J Epidemiol 1996; 25: 494-504Joossens JV et al., J Epidemiol 1996; 25: 494-504

Relationship between salt intake and death from stomach cancerRelationship between salt intake and death from stomach cancer

Dea

ths

from

sto

mac

h ca

ncer

(pe

r 10

Dea

ths

from

sto

mac

h ca

ncer

(pe

r 10

55 per

yea

r) p

er y

ear)


Data from 21 countriesData from 21 countriesr = 0.702r = 0.702p < 0.001p < 0.001

Data from 21 countriesData from 21 countriesr = 0.702r = 0.702p < 0.001p < 0.001

180180

160160

140140

120120

6060

4040

2020

0066 77 99 1010 1313 141488

8080

100100

1111 1212

2910 Mo2910 Mo D’Elia L et al., JACC 2011; 57: 1210-1219D’Elia L et al., JACC 2011; 57: 1210-1219

StudiesStudies

1111

66

44

KK++ difference difference(mmol/day)(mmol/day)

10-6810-68

19-6819-68

22-5022-50

MenMen

0.810.81

--

0.910.91

SampleSamplesizesize

233.606233.606

81.61281.612

62.45362.453

EventsEvents

7.0667.066

3.0583.058

2.4972.497

RRRR

0.790.79

0.920.92

0.850.85

PP

0.010.01

n.s.n.s.

0.30.3

StrokeStroke

CADCAD

WomenWomen

0.700.70

--

0.650.65

CVDCVD

Meta-analysis of prospective studies comparing the effects of Meta-analysis of prospective studies comparing the effects of higher vs lower potassium intake on incident stroke, CAD and CVDhigher vs lower potassium intake on incident stroke, CAD and CVD

2928 Mo2928 Mo He FJ et al., J Human Hypertens 2002; 16: 761-770He FJ et al., J Human Hypertens 2002; 16: 761-770

Relationship between moderate daily urinary sodium reduction and Relationship between moderate daily urinary sodium reduction and changes in blood pressure in normotensive and hypertensive subjectschanges in blood pressure in normotensive and hypertensive subjects

Ch

ange

in S

BP

(m

mH

g)C

han

ge in

SB

P (

mm

Hg)

Reduction in urinary sodiumReduction in urinary sodium

-12-12

-10-10

-8-8

-6-6

-4-4

-2-2

00

22

44

3030 5050 7070 9090 110110 130130 (mmol/24h)(mmol/24h)

(g/day of salt)(g/day of salt)22 33 44 55 66 77

NormotensivesNormotensives(n = 13 studies)(n = 13 studies)

HypertensivesHypertensives(n = 16 studies)(n = 16 studies)

2914 Mo2914 Mo

Effects of dietary sodium reduction on blood pressureEffects of dietary sodium reduction on blood pressurein subjects with resistant hypertension in subjects with resistant hypertension

Pimenta E et al., Hypertension 2009; 54: 475-481Pimenta E et al., Hypertension 2009; 54: 475-481

High saltHigh salt

Low saltLow salt

PP

OfficeOfficeSBPSBP

(mmHg)(mmHg)

146146

123123

0.010.01

WeightWeight(kg)(kg)

91.591.5

90.190.1

0.050.05

Sodium Sodium excretionexcretion

(mmol/day)(mmol/day)

252252

4646

0.0010.001

Data from 12 pts randomized to cross-over evaluation of low (50 mmol) and high (250 mmol) Data from 12 pts randomized to cross-over evaluation of low (50 mmol) and high (250 mmol) sodium diets for 7 days separated by 2 weeks w.o. periodsodium diets for 7 days separated by 2 weeks w.o. period

OfficeOfficeDBPDBP

(mmHg)(mmHg)

8484

7575

0.010.01

ABPMABPMSBPSBP

(mmHg)(mmHg)

150150

130130

0.010.01

ABPM ABPM DBPDBP

(mmHg)(mmHg)

8282

7373

0.010.01

BNPBNP(pg/ml)(pg/ml)

3838

1414

0.010.01

Effect on SBP and DBP of reduced sodium intake Effect on SBP and DBP of reduced sodium intake and the DASH dietand the DASH diet

2912 Mo2912 Mo Sacks FM et al., NEJM 2001; 344: 3-10Sacks FM et al., NEJM 2001; 344: 3-10

Systolic Blood PressureSystolic Blood PressureSystolic Blood PressureSystolic Blood Pressure Diastolic Blood PressureDiastolic Blood PressureDiastolic Blood PressureDiastolic Blood Pressure

HigherHigher IntermediateIntermediate LowerLower

Sodium IntakeSodium Intake

120120

125125

130130

135135mmHgmmHg



7575

8080

8585mmHgmmHg

-5.9

-2.1

-4.6

-1.3

-1.7

-5.0

-2.2

-2.9

-1.1

-2.4

-0.6

-1.0

-2.5

-1.0

Controldiet

DASHdiet

Controldiet

DASHdiet

mmol/daymmol/day 144/141144/141 107/106107/106 67/6467/64

Effect on SBP of reduced dietary sodium intake Effect on SBP of reduced dietary sodium intake during the control diet and DASH diet in subgroups of subjectsduring the control diet and DASH diet in subgroups of subjects

2911 Mo2911 Mo Sacks FM et al., NEJM 2001; 344: 3-10Sacks FM et al., NEJM 2001; 344: 3-10

-12-12

-10-10

-8-8

-6-6

-4-4

-2-2

00

22ChangeChange in SBPin SBP(mmHg)(mmHg) ** ** **

**††

‡‡

‡‡ ‡‡

‡‡

‡‡‡‡

-8-8

-6-6

-4-4

-2-2

00

22ChangeChange in SBPin SBP(mmHg)(mmHg)

Blacks Blacks with HTwith HT

OthersOtherswith HTwith HT

Blacks Blacks withoutwithout

HTHT

OthersOtherswithoutwithout

HTHT

MenMen WomenWomen

******

†† ‡‡

‡‡

* P < 0.05; † P < 0.01; ‡ P < 0.001* P < 0.05; † P < 0.01; ‡ P < 0.001

Control dietControl diet

High to intermediate High to intermediate sodium intakesodium intakeHigh to low High to low sodium intakesodium intake

DASH dietDASH diet

Effects of graded reduction in sodium intake in nonhypertensive and Effects of graded reduction in sodium intake in nonhypertensive and hypertensive patients older than 45 years of agehypertensive patients older than 45 years of age

2913 Mo2913 Mo Bray GA et al., Am J Cardiol 2004; 94: 222-227Bray GA et al., Am J Cardiol 2004; 94: 222-227

NonhypertensiveNonhypertensiveNonhypertensiveNonhypertensive HypertensiveHypertensiveHypertensiveHypertensive



115115

120120

125125

130130mmHgmmHg



125125

135135

145145mmHgmmHg

-6.7

-2.9

-4.1

-1.2

-1.6

-5.0

-2.5

-8.0

--2.1

-6.0

-1.6

-5.1

-7.5

-6.7

Controldiet

DASHdiet

Controldiet

DASHdiet

140140

130130

2932 Mo2932 Mo Hofman A et al., JAMA 1983; 250: 370-373Hofman A et al., JAMA 1983; 250: 370-373

Long-term effects of salt restriction in newborn babiesLong-term effects of salt restriction in newborn babies

Dif

fere

nce

s in

SB

P (

mm

Hg)

Dif

fere

nce

s in

SB

P (

mm

Hg)

AgeAge

Double blindDouble blind Usual saltUsual salt

Usual saltUsual salt

Reduced saltReduced salt

11

00

-1-1

-2-2

-3-3

-4-455

wkswks99

wkswks1313

wkswks1717

wkswks2121

wkswks2525

wkswks(n = 476)(n = 476)

1515yrsyrs

(n = 167)(n = 167)

P < 0.01P < 0.01 P < 0.02P < 0.02

2908 Mo2908 Mo

Meta-analysis of moderate salt intake reductionMeta-analysis of moderate salt intake reductionin normotensive and hypertensive subjectsin normotensive and hypertensive subjects

He FJ and MacGregor GA, Lancet 2011; 378: 380-382He FJ and MacGregor GA, Lancet 2011; 378: 380-382

TrialsTrials

Reduction in salt intake (gr/day)Reduction in salt intake (gr/day)

Fall in SBP (mmHg)Fall in SBP (mmHg)

Fall in DBP (mmHg)Fall in DBP (mmHg)

Reduction in overall mortality (all causes)Reduction in overall mortality (all causes)

Reduction in CVD eventsReduction in CVD events

Reduction in CVD mortalityReduction in CVD mortality

NormotensiveNormotensive

33

2.02.0

-1.1-1.1

-0.8-0.8

10%10%

29%29%

HypertensiveHypertensive

33

2.32.3

-4.1-4.1

-3.7-3.7

4%4%

16%16%

31%31%

2917 Mo2917 Mo

Projected estimates of comparative effect of various population Projected estimates of comparative effect of various population interventions on annual reductions in cardiovascular eventsinterventions on annual reductions in cardiovascular events

Bobbins-Domingo K et al., NEJM 2010; 362: 590-599Bobbins-Domingo K et al., NEJM 2010; 362: 590-599

InterventionIntervention

Salt reductionSalt reduction1 g/day1 g/day

Low estimateLow estimate

3 g/day3 g/dayLow estimateLow estimate

Smoking cessationSmoking cessation

Weight lossWeight loss

Incidence of Incidence of CHDCHD

22.00022.000

66.00066.000

41.00041.000

59.00059.000

TotalTotalMIMI

20.00020.000

58.00058.000

92.00092.000

61.00061.000

Incidence ofIncidence ofstrokestroke

13.00013.000

37.00037.000

32.00032.000

5.6005.600

Death fromDeath fromany causeany cause

17.00017.000

51.00051.000

84.00084.000

36.00036.000

Reduction in absolute number of eventsReduction in absolute number of events

2921 Mo2921 Mo

Projected estimates of the cost and effectiveness of salt reduction and Projected estimates of the cost and effectiveness of salt reduction and hypertension treatment annually and cumulatively, 2010-2019 in UShypertension treatment annually and cumulatively, 2010-2019 in US


InterventionIntervention

Reduction in dietary saltReduction in dietary salt1 g/day1 g/day

Low estimateLow estimate3 g/day3 g/day


Hypertension treatmentHypertension treatment

Gradual reduction in dietary salt, 2010-2019Gradual reduction in dietary salt, 2010-20191 g/day1 g/day

Low estimateLow estimate3 g/day3 g/day


Reduction in Reduction in health care costs health care costs

(billions of dollars)(billions of dollars)

4.14.1

12.112.1

14.214.2

18.918.9

56.956.9

Cost saved per dollar Cost saved per dollar spent on intervention spent on intervention

(dollars)(dollars)

15.415.4

45.245.2

7.07.0

21.221.2

2933 Mo2933 Mo Asaria P et al., Lancet 2007; 370: 2044-2053Asaria P et al., Lancet 2007; 370: 2044-2053

Potential impact on CVD & estimated costPotential impact on CVD & estimated costSalt reduction vs tobacco controlSalt reduction vs tobacco control

N°

of C

VD

dea

ths

N°

of C

VD

dea

ths

aver

etd

(x1

0av

eret

d (

x1066 ))

15% reduction in15% reduction insalt intakesalt intake

20% reduction in20% reduction insmoking prevalencesmoking prevalence

An

nu

al c

ost

per

An

nu

al c

ost

per

per

son

(U

S$)

per

son

(U

S$)

1010

88

66

44

22

00

0.300.30

0.200.20

0.100.10

0.000.00

2920 Mo2920 Mo

Daily sodium and potassium excretion in hypertensive patientsDaily sodium and potassium excretion in hypertensive patientsData from the MINISAL-SIIA Study ProgramData from the MINISAL-SIIA Study Program

Galletti F et al., J Hypertens 2014; 32: 48-56Galletti F et al., J Hypertens 2014; 32: 48-56

Sodium excretion (mmol/day)Sodium excretion (mmol/day)Sodium excretion (mmol/day)Sodium excretion (mmol/day) Potassium excretion (mmol/day)Potassium excretion (mmol/day)Potassium excretion (mmol/day)Potassium excretion (mmol/day)

Data from 1232 hypertensive patients (age range 19-89 yrs) from 47 centersData from 1232 hypertensive patients (age range 19-89 yrs) from 47 centersRecommended sodium intake 85 mmol = 2 gr/day, and 5 gr of salt, potassium intake 100 mmol = 3.9 gr/dayRecommended sodium intake 85 mmol = 2 gr/day, and 5 gr of salt, potassium intake 100 mmol = 3.9 gr/day

00

4040

8080

120120

160160

200200

0

20

40

60

80

100

MenMenn = 631n = 631

WomenWomenn = 601n = 601



10.1 gr salt10.1 gr salt90% > WHO90% > WHO

8.1 gr salt8.1 gr salt81% > WHO81% > WHO 2.5 gr2.5 gr

92% < WHO92% < WHO2.1 gr2.1 gr

95% < WHO95% < WHO

2919 Mo2919 Mo

Average daily salt intake in male and female AmericansAverage daily salt intake in male and female Americans

Appel LJ and Anderson LAM, NEJM 2010; 362: 650-652Appel LJ and Anderson LAM, NEJM 2010; 362: 650-652

00

22

44

66

88

1010

1212

2-4 2-4 4-8 4-8 9-13 9-13 14-1814-18 19-3019-30 31-5031-50 51-7051-70 ≥ ≥ 7171

MalesMales

FemalesFemales

Salt

inta

ke (

g/d

ay)

Salt

inta

ke (

g/d

ay)

Age (yr)Age (yr)

5.85.8(2300 mg sodium)(2300 mg sodium)

3.83.8(1500 mg sodium)(1500 mg sodium)

2925 Mo2925 Mo Galletti F et al., J Hypertens 2014; 32: 48-56Galletti F et al., J Hypertens 2014; 32: 48-56

Mean sodium / potassium excretion ratio in hypertensive patientsMean sodium / potassium excretion ratio in hypertensive patientsData from the MINISAL-SIIA Study ProgramData from the MINISAL-SIIA Study Program

Data from 1232 hypertensive patients from 47 centersData from 1232 hypertensive patients from 47 centersRecommended sodium / potassium ratio: 0.85Recommended sodium / potassium ratio: 0.85

00

11

22

33

44



2.992.99

2.712.71

1.5% < 0.851.5% < 0.851.7% < 0.851.7% < 0.85

2924 Mo2924 Mo

MenMenIIIIIIIIIIIIIVIVP < P <

WomenWomenIIIIIIIIIIIIIVIVP <P <

SodiumSodium(mmol)(mmol)

1851851741741711711561560.010.01

1451451431431271271321320.010.01

Galletti F et al., J Hypertens 2014; 32: 48-56Galletti F et al., J Hypertens 2014; 32: 48-56

Sex specific daily sodium and potassium excretion by quartiles of Sex specific daily sodium and potassium excretion by quartiles of age and BMI - Data from the MINISAL-SIIA Study Programage and BMI - Data from the MINISAL-SIIA Study Program

PotassiumPotassium(mmol)(mmol)

6262666666665858n.s.n.s.

5959585855555050

0.010.01

AgeAge

SodiumSodium(mmol)(mmol)

1651651631631731731851850.010.01

1241241261261481481521520.010.01

PotassiumPotassium(mmol)(mmol)

6262616165656464n.s.n.s.

5454535357576060

0.020.02

BMIBMI

2934 Mo2934 Mo

Strategy for reducing saltStrategy for reducing salt

He FJ, MacGregor G, J Human Hypertens 2009; 23: 363-384He FJ, MacGregor G, J Human Hypertens 2009; 23: 363-384

SourceSource

Table / Cooking (15%)Table / Cooking (15%)

Natural (5%)Natural (5%)

Food industry (80%)Food industry (80%)

g/dayg/day

1.4 g1.4 g

0.6 g0.6 g

7.5 g7.5 g

ReductionReductionneededneeded

40% reduction40% reduction

No reductionNo reduction

40% reduction40% reduction

Target intakeTarget intakeg/dayg/day

0.9 g0.9 g

0.6 g0.6 g

4.5 g4.5 g

Salt intakeSalt intake

Total 9.5 gTotal 9.5 g Total 6.0 gTotal 6.0 g

2926 Mo2926 Mo Galletti F et al., J Hypertens 2014; 32: 48-56Galletti F et al., J Hypertens 2014; 32: 48-56

Effects of doctor’s advice about salt reduction in ItalyEffects of doctor’s advice about salt reduction in ItalyData from the MINISAL-SIIA Study ProgramData from the MINISAL-SIIA Study Program

n = 1232 hypertensive patients from 47 centersn = 1232 hypertensive patients from 47 centers

Patients receiving advicePatients receiving advice

Patients not receiving advicePatients not receiving advice

Patients adhering to advicePatients adhering to advice

Patients not adhering to advicePatients not adhering to advice

53%53%

47%47%

31%31%

69%69%

Sodium excretionSodium excretion(mmol/day)(mmol/day)

159.7159.7

156.1156.1

149.4149.4

171.2171.2** p < 0.001p < 0.001

2935 Mo2935 Mo

The commercial importance of salt in processed foodThe commercial importance of salt in processed food

He FJ, MacGregor G, J Human Hypertens 2009; 23: 363-384He FJ, MacGregor G, J Human Hypertens 2009; 23: 363-384

SaltSalt

ProducersProducers

Food industryFood industry

Highly salted processed foodHighly salted processed food(80% of total intake)(80% of total intake)

ThirstThirst

Soft drinksSoft drinksMineral waterMineral water

ProfitProfit

Meat products - Salt addedMeat products - Salt added

Increase in weight Increase in weight by water bindingby water binding

ProfitProfit

Salt addictionSalt addiction

Demand for Demand for salty foodsalty food

ProfitProfit

2916 Mo2916 Mo

Raccomandazioni della Società Internazionale dell’Ipertensione (ISH) Raccomandazioni della Società Internazionale dell’Ipertensione (ISH) per ridurre il consumo di sale dieteticoper ridurre il consumo di sale dietetico

The ISH and WHL Executive Boards, J Hypertens 2014; 32: 446-447The ISH and WHL Executive Boards, J Hypertens 2014; 32: 446-447

Sviluppare programmi di informazioni sui rischi della dieta ricca di saleSviluppare programmi di informazioni sui rischi della dieta ricca di sale

Utilizzare i media per raggiungere il grande pubblicoUtilizzare i media per raggiungere il grande pubblico

Ridurre il contenuto di sale in tutti i cibi preparatiRidurre il contenuto di sale in tutti i cibi preparati

Dare chiare indicazioni sul contenuto di sale dei cibiDare chiare indicazioni sul contenuto di sale dei cibi

Ostacolare i consumi di cibi e bevande ad alto contenuto di saleOstacolare i consumi di cibi e bevande ad alto contenuto di sale

Garantire che i cibi a basso contenuto di sale siano qualitativamente Garantire che i cibi a basso contenuto di sale siano qualitativamente i migliori, economicamente accessibili e disponibili ovunquei migliori, economicamente accessibili e disponibili ovunque

2923 Mo2923 Mo

Daily sodium and potassium excretion in an Italian cohort of adult Daily sodium and potassium excretion in an Italian cohort of adult individuals - Data from the MINISAL Study Programindividuals - Data from the MINISAL Study Program

Donfrancesco C et al., Nutr Metab Cardiovasc Dis 2013; 23: 850-856Donfrancesco C et al., Nutr Metab Cardiovasc Dis 2013; 23: 850-856

Sodium excretionSodium excretion

Potassium excretionPotassium excretion

MenMen

WomenWomen

MenMen

WomenWomen

nn

11141114

10981098

nn

11141114

10981098

Salt (gr)Salt (gr)

10.910.9

8.58.5

KK++ (gr) (gr)

2.52.5

2.12.1

> WHO > WHO recomm. (%)recomm. (%)

9797

8787

< WHO < WHO recomm. (%)recomm. (%)

9696

9999

Data from 2216 adult individuals (age range 35-79) from 12 Italian regionsData from 2216 adult individuals (age range 35-79) from 12 Italian regionsRecommended sodium intake 85 mmol = 2 gr of sodium and 5 gr of salt and 100 mmol potrassium = 3.8 grRecommended sodium intake 85 mmol = 2 gr of sodium and 5 gr of salt and 100 mmol potrassium = 3.8 gr

mmol/daymmol/day

189189

147147

mmol/daymmol/day

6363

5555

2915 Mo2915 Mo

Association between BMI and Association between BMI and daily urinary sodium and potassium excretion in mendaily urinary sodium and potassium excretion in men

Donfrancesco C et al., Nutr Metab Cardiovasc Dis 2013; 23: 850-856Donfrancesco C et al., Nutr Metab Cardiovasc Dis 2013; 23: 850-856

00

5050

100100

150150

200200

250250

11 22 33 44 55

mm

ol/2

4hm

mol

/24h

BMI quintilesBMI quintiles

24h urinary sodium24h urinary sodium

24h urinary potassium24h urinary potassium

2927 Mo2927 Mo Tuomilehto J et al., Lancet 2001; 357: 848-851Tuomilehto J et al., Lancet 2001; 357: 848-851

Increased risk of death related to a 6 g/day increase in salt intakeIncreased risk of death related to a 6 g/day increase in salt intake

Data from 2436 individuals (age range 25-64 yrs) adjusted for age, smoking, cholesterol, SBP and BMIData from 2436 individuals (age range 25-64 yrs) adjusted for age, smoking, cholesterol, SBP and BMI*** p < 0.001 compared to lower salt intake*** p < 0.001 compared to lower salt intake

0.500.50

0.750.75

1.001.00

1.251.25

1.501.50

1.751.75CHD deathCHD deathCHD deathCHD death CVD deathCVD deathCVD deathCVD death All deathAll deathAll deathAll death

Lower salt intakeLower salt intakeHigher salt intakeHigher salt intake

Haz

ard

Rat

ioH

azar

d R

atio

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2918 Mo2918 Mo

Projected effects of reducing salt intake by 3 gr/day in USProjected effects of reducing salt intake by 3 gr/day in US

CHD:CHD:

Stroke:Stroke:

MI:MI:

Death from any cause:Death from any cause:

QA life years:QA life years:

Cost saving:Cost saving:


60.000-120.000 60.000-120.000 lessless

32.000- 66.000 32.000- 66.000 lessless

54.000- 99.000 54.000- 99.000 lessless

44.000- 92.000 44.000- 92.000 lessless

194.000-392.000 194.000-392.000 lessless

10-24 billions10-24 billions

Data are calculated as new cases/yearData are calculated as new cases/year

1910 Mo Il consumo di sodio e potassio e ipertensione Alberto Morganti U.O. Medicina Generale e...

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