Randomized trials of sodium reduction an overview of the book

When required to display numeric or symbolic indicators of the sodium content in items i. Feasibility and efficacy of sodium reduction in the trials. A randomized crossover trial of dietary sodium restriction. Manufacturers providing nutrition content on the front of packages and on menus can influence purchasing habits and sodium consumption. Salt intake reduction is crucial to prevent noncommunicable diseases ncds globally. In a controlled feeding trial, the lowest levels of sodium intake ranged from 949 to 2,452 mgd 41 to 107 mmold. In a controlled but non randomized trial, 85% of the 252 students treated. Cutler, dean follmann, paul elliott, and ii suh to test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials. Treatment overview clinical trials in hfpef have produced largely neutral results.

Sodium, blood pressure, and cardiovascular disease. One page summary of the clinical trials evidence for. Metaanalysis of randomized controlled trials by autier and gandini 6 suggested. A randomized, controlled dose response study of intravenous. A randomized trial on the effect of decreased dietary. We excluded trials that had confounded designs, enrolled preadolescent study populations, tested intakes outside the usual range for the us population, or reported neither systolic. Tone collaborative research group reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons.

One page summary of the clinical trials evidence for ivermectin in covid19 ivermectin, an antiparasitic medicine whose discovery won the nobel prize in 2015, has proven, highly potent, antiviral and antiinflammatory properties in laboratory studies. Even modest salt reduction less than one teaspoon per day decreases systolic and diastolic blood pressure in individuals with and without hypertension. The 585 obese participants were randomized to reduced sodium intake, weight loss, both, or usual care, and the 390 nonobese participants were randomized to reduced sodium intake or usual care. Randomized controlled trials of intensive versus standard blood pressure control. In the past 4 months, numerous, controlled clinical trials from. To test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical. Abstract we updated a previously published overview of randomized clinical trials testing the effects of reducing sodium intake. Further randomized controlled trials evaluating risk reduction of. China salt substitute and stroke study full text view. The comprehensive pharmacology reference, 2007 introduction. A total of 2,382 participants were randomized into the trial.

High blood pressure bp is the third leading disease risk factor worldwide and accounts for 7. Furosemide, an anthranilic acid derivative, is a rapid acting, highly efficacious diuretic rankin 2002. Association between hyponatremia, osteoporosis, and fracture. Effects of dietary sodium reduction on blood pressure in. The dash diet is rich in fruits, vegetables, whole grains, and lowfat dairy foods. For glucose, which was measured monthly during the study, random int. Broadening of current us initiatives such as the voluntary sodium reduction program in new york city should be equally effective in reducing sodium intake in the united states. The fact sheets listed below can help you understand how sodium affects your health and the health of your loved ones, including children. A metaanalysis of randomized controlled trials by julian midgley in the may 2229, 1996 issue of the journal of the american medical association jama 275. Hyponatremia is defined as plasma sodium level less than 5 meql 1. Effect of dose and duration of reduction in dietary sodium.

Sucrose has been thought to cause the release of endogenous opioids, providing an analgesic effect in infants with colic. Doseresponse relation between dietary sodium and blood. Participants who completed the randomized, doubleblind trial were eligible for enrollment in an openlabel extension trial evaluating the longterm safety of sodium phenylbutyratetaurursodiol. Effect of dose and duration of reduction in dietary sodium on. In trials of less than 15 days duration, each 50 mmol reduction in 24 hour urinary sodium excretion was associated with a 1. Department of health and human services hhs asked the institute of medicine iom to convene an expert committee to examine the designs, methodologies, and conclusions of this emerging evidence, as well as other reports published. Trial of sodium phenylbutyratetaurursodiol for amyotrophic. Nonpharmacologic interventions are frequently recommended for treatment of hypertension in the elderly, but there is a paucity of evidence from randomized controlled trials in support of this recommendation. But too much sodium in the diet can lead to high blood pressure, heart. In brief, the sodium reduction study is one of the two parallel clusterrandomized controlled trial of the china rural health initiative project conducted in northern rural china between may 2011 and november 2012.

An overview of randomized trials of sodium reduction and. Nutrients free fulltext dietary salt restriction in. Phase i of the trials of hypertension prevention was a multicenter, randomized trial of the feasibility and efficacy of seven nonpharmacologic interventions, including sodium reduction, in lowering blood pressure in 30 to 54yearold individuals with a diastolic blood pressure of 80 to 89 mm hg. The dash diet, sodium intake and blood pressure trial dash. A randomized trial on sodium reduction in two developing countries.

We excluded from pooled analyses trials with confounded designs, those that compared intake levels beyond the usual range in the population, and those without published reports. Specifically, persons agreeing to be part of a randomized trial may be a select subset of the population of interest, thus limiting the generalization of trial results. The early and significant improvement in clinical outcomes is likely explained by effects beyond a reduction in hyperglycemia. Effects of sodium reduction and the dash diet in relation to. See table 1 for a summary of literature regarding the effects of sodium on blood pressure in children. Ab a randomized crossover trial on the effect of salt restriction on blood pressure was carried out involving 124 adolescents mean age 16 years. Radical sodium reduction policy is not supported by. Effect of reduced dietary sodium on blood pressure. Lowcarbohydrate diets, of necessity, shift dietary intake to relatively higher levels of.

Cutler, dean follmann, paul elliott, and ii suh to test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials that aimed to reduce. Findings from randomized controlled trials rcts and from systematic and cochrane. Randomized clinical trial of sodium polystyrene sulfonate for. For a detailed description of ada standards, statements, and reports, as well as. An overview pubmed we updated a previously published overview of randomized clinical trials testing the effects of reducing sodium intake. The 2 dietary patterns are a control diet typical of what many americans eat, and the dash diet, which, by comparison, emphasizes fruits, vegetables, and lowfat dairy foods, includes.

Treatment and prognosis of heart failure with preserved ejection. The effects of a communitybased sodium reduction program in. Pdf sodium reduction and weight loss in the treatment of. However, because hyponatremia is considered a novel risk factor of bone disorder, it is still. Large clinical trials established the benefits of sodium glucose cotransporter 2 inhibitors in patients with diabetes and with heart failure with reduced ejection fraction hfref. These changes were associated with mean reduction of urinary sodium excretion ranging from 16 to 171 mmol24 hr for individual trials. The corresponding null hypothesis that will be tested is that sodium reduction will have no effect upon stroke risk. Sodium reduction and weight loss in the treatment of hypertension in older persons. Get the facts about sodium before you eat out at restaurants. High blood pressure linus pauling institute oregon. Against the backdrop of questions about sodium reduction in the population, the centers for disease control and prevention of the u.

Kolonel md, phd, in principles of genderspecific medicine, 2004 v. Intervention trial an overview sciencedirect topics. Such a trial should be conducted only when there is considerable evidence for a beneficial effect, without apparent harm, based on observational studies and. Global sodium consumption and death from cardiovascular. It is less obvious that nutritional supplementation should have a large. Thirtytwo trials with outcome data for 2635 subjects were included. This study aimed to evaluate the efficacy of sodium polystyrene sulfonate in the treatment of mild hyperkalemia. Although randomized controlled trials represent the accepted standard for studies of nutrient consumption in relation to human health, they too possess important limitations. Zoological parks do not feed wild animals in captivity based on randomized trials. The effects of a communitybased sodium reduction program. In a controlled but nonrandomized trial, 85% of the 252 students treated. Dociparstat for the treatment of severe covid19 in adults.

Goodman, in international encyclopedia of education third edition, 2010 nutrition. In addition to lack of general evidence for sodium reduction, the evidence selected by advocates for sodium reduction is questionable, 30 as exemplified by the trials of hypertension prevention, which developed from a correct intention to treat analysis of two rcts, which showed no effect of sodium reduction on mortality p 0. Two recent cochrane metaanalyses evaluated randomized trials of the effect of reduced sodium intake on blood pressure. Sodium intake and 20year mortality in trials of hypertension. We conducted a doubleblind placebocontrolled randomized crossover trial assessing the effects of high versus low sodium intake on ambulatory bp, 24hour protein and albumin excretion, fluid. The dash eating plan significantly lowers blood pressure in individuals with either normal or high blood pressure. Vitamin c is significant to human body and plays a role in reducing. An overview of randomized trials of sodium reduction and blood pressure jeffrey a. Randomized trial of empagliflozin in nondiabetic patients. A small randomized study in which pulmonary function of 17 infants with bpd was measured before and after administration of daily doses of 1 mgkg of furosemide or placebo for 7 days found decreased ventilator requirements, increased pulmonary compliance, and improved alveolar ventilation for infants in the furosemide group but not for those in the placebo group. Evidence for health decision making beyond randomized. Increasing potassium intake while reducing sodium intake has also been shown to reduce blood pressure. Compound ion salt, a novel lowsodium salt substitute. Randomized clinical trial an overview sciencedirect topics.

A lifeessential effect of sodium is to maintain blood pressure bp, which has led to the hypothesis that bp is proportional to the amount of sodium consumed in the diet. Background both sodium reduction and the dash dietary approaches to stop hypertension diet, a diet rich in fruits, vegetables, and lowfat dairy products, and reduced in saturated fat and cholesterol, lower blood pressure. Reduced sodium intake and weight loss constitute a feasible, effective, and safe nonpharmacologic therapy of hypertension in older persons. Cutler, dean follmann, paul elliott, and ii suh to test for effects on systolic and dia stolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials that aimed to reduce. Vitamin c infusion for the treatment of severe 2019ncov infected. A randomized controlled trial of srd in 56 south asian patients reported significant decreases in urinary sodium excretion and reduction in sbp by 8 mmhg compared with controls p sodium intake. Average age at baseline was 44 years, 66% of participants were male, and 21% were minority. The mean reduction 95% confidence interval in daily urinary sodium excretion, a proxy measure of dietary sodium intake, was 95 mmold 71119 mmold in 28 trials with 11 hypertensive subjects and 125 mmold 95156 mmold in 28 trials. Nov, 2002 a small number of researchers have disputed the link between sodium intake and blood pressure 14 however, randomized clinical trials have now definitively demonstrated that reducing sodium intake decreases blood pressure in people with and without high blood pressure. We excluded trials that had confounded designs, enrolled preadolescent study populations, tested intakes outside the usual range for the us population, or reported neither systolic nor diastolic blood pressure. An overview of randomized trials of sodium reduction and blood. Nutrition may play a significant role in the childs cognitive development. This study was a cluster randomized trial done over 18 months in 120 townships one village from each township from five provinces. Nov, 2012 a voluntary salt reduction over a 10year period in england resulted in a 15% reduction in urinary salt excretion.

The separate and combined effects of these dietary interventions by baseline blood pressure bp has not been reported. The study was a randomized, twoperiod crossover trial of srd versus usual diet conducted between may of 2009 and may of 20. The weight reduction intervention produced an average weight loss of 3. These resources can also help you find ways to reduce sodium in your diet. In this phase 3, placebocontrolled trial, we randomly assigned 4744 patients with new york heart association class ii, iii, or iv heart.

Prospective, randomized trials of the available mpa formulatio. Reducing sodium intakes below the cdrr is expected to lower the risk of. Sodium reduction and weight loss in the treatment of. Oct 03, 2016 among the 744 participants in tohp phase i randomized to the sodium reduction intervention or control, the average age was 43, 71% were male, and 20% were african american. A summary description of the basic characteristics of the included articles has been given in table 1. The dash diet, sodium intake and blood pressure trial dash sodium is a multicenter, randomized trial comparing the effects of 3 levels of sodium intake and 2 dietary patterns on blood pressure among adults with higher than optimal blood pressure or with stage 1 hypertension 1201598095 mm hg. However, the generalizability of this causal hypothesis has been questioned. Randomized trials are required to confirm these observations. Effects of sodium reduction and the dash diet in relation. Similarly, in a study by cooper 1984, a reduction of 2,530 mg to 1,035 mg of sodium day did not appear to have an effect on blood pressure in adolescents. Apr 07, 20 an overview of randomized trials of sodium reduction and blood pressure. A randomized trial of sodiumrestriction on kidney function. Sodium targets in the national school lunch program. Low salt diet found to increase mortality jeffrey dach md.

A randomized crossover trial of dietary sodium restriction in. Summary dietary reference intakes for sodium and potassium. Dietary intervention trials a randomized intervention trial is the closest method to an experimental design that can be implemented in human subjects. A randomized trial on the effect of decreased dietary sodium. Abstract to test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials that aimed to reduce the intake of sodium in human subjects. The dash diet dietary approaches to stop hypertension is a dietary pattern promoted by the u. One of the conclusions of the study by taylor et al. In trials of less than 15 days duration, each 50 mmol reduction in 24 hour urinary sodium. Patients were randomized to consume sodium per day or usual diet for 4 weeks, followed by a 2week washout period and a second 4week crossover phase. The dash diet, sodium intake and blood pressure trial. We updated a previously published overview of randomized clinical trials testing the effects of reducing sodium intake. To determine whether weight loss or reduced sodium intake is effective in the treatment of older persons with hypertension.

Following the 2003 introduction of a national salt reduction program in. Dietary sodium restriction is a key management strategy in chronic kidney disease ckd. Dapagliflozin in patients with heart failure and reduced ejection. Multiple randomized trials evaluating sodium reduction and the dash diet have clearly demonstrated significant reductions in blood pressure 5 and, more recently, the results of the sprint trial confirmed that lowering blood pressure is associated with decreased cardiovascular morbidity and mortality. The dash diet, sodium intake and blood pressure trial dashsodium is a multicenter, randomized trial comparing the effects of 3 levels of sodium intake and 2 dietary patterns on blood pressure among adults with higher than optimal blood pressure or with stage 1 hypertension 1201598095 mm hg. Effect of salt reduction interventions in lowering blood pressure in. Supplemental vitamin c lowers blood pressure in individuals with normal and high blood pressure, while. Randomized clinical trial of sodium polystyrene sulfonate. High blood pressure linus pauling institute oregon state. Eligible subjects will be those with confirmed covid19 who require hospitalization and supplemental oxygen therapy. When sodium intake increases, blood pressure increases, and high blood pressure is a major risk factor for.

Department of health and human services hhs asked the institute of medicine iom to convene an expert committee to examine the designs, methodologies, and conclusions of this emerging evidence, as well as other reports published since the 2005 dietary reference intake dri report, dietary reference intakes for water, sodium, chloride, and sulfate. The science supporting the relationship between sodium reduction and health is clear. Recent evidence has demonstrated shortterm reduction in blood pressure bp and proteinuria with sodium restriction, however the effect on other cardiovascularrelated risk factors requires investigation in ckd. Sodium chloride and contrast nephropathy full text view.

Nutrition can have a significant impact on blood pressure. It is less obvious that nutritional supplementation should have a large effect on the cognitive achievement of children in richer countries. This study aimed to investigate the short and longterm effects of monitoring salt concentration in homemade dishes on reducing salt intake in a japanese population. However, body size as reflected in body mass index may influence blood pressure response to sodium reduction. Randomized trials can follow various designs, and one type of classification is based on the unit of randomization. We randomly assigned these patients to receive either placebo or sodium polystyrene sulfonate of 30 g orally one time per day for 7 days. The study is a large scale cluster randomised trial to evaluate the effects of sodium reduction based upon the use of salt substitute on the risk of stroke defined as the occurrence of stroke and stroke deaths. In evaluations of hypertensive cohorts, dietary salt restriction lowers systolic bp by 2 to 10 mm hg and diastolic bp by 1 to 6 mm hg.

The benefits of sodium reduction have been questioned by some researchers on the basis of several studies that report a jshaped relationship between sodium intake and cardiovascular outcomes. To test for effects on systolic and diastolic blood pressure and to provide precise estimates of their magnitude, we conducted an overview of randomized clinical trials that aimed to reduce the intake of sodium in human subjects. Dietary sodium was reduced from approximately 110 to 45 meq24 h for a period of 24 days. Dec 09, 2016 details of the rationale and design of the china rural health initiative sodium reduction study have been described previously 15. Randomization was performed using sealed envelopes at each site. The mean reduction 95% confidence interval in daily urinary sodium excretion, a proxy measure of dietary sodium intake, was 95 mmold 71119 mmold in 28 trials with 11 hypertensive subjects and 125 mmold 95156 mmold in 28 trials with 2374 normotensive subjects. Pdf a randomized trial of dietary sodium restriction in ckd.

In total, 33 outpatients with ckd and mild hyperkalemia 5. These data shed light on the longterm effects of ffa reduction on insulin sensitivity, other. To ascertain the effects of reducing patients intake of sodium na. Metabolic effects of longterm reduction in free fatty acids with. Longterm followup for mortality and cancer in a randomized. Dietary calcium and vitamin d intake were assessed us.

A randomized, controlled dose response study of intravenous sodium diethyldithiocarbamate in patients with advanced human immunodeficiency virus infection. High sodium intake is a significant public health problem in the. Metaanalyses of randomized controlled trials rcts have shown the effect of dietary sodium reduction sr on bp to be. Many randomized controlled trials have examined the effect of dietary salt reduction on blood pressure. Average weight was 191 pounds in men and 160 pounds in women, and average sodium excretion at baseline was 3,839 mg24 hours in men and 2,948 mg24 hours in women. A doseresponse relation across trials was found, both in normotensive and in hypertensive subjects. Randomized trials in developing countries such as guatemala, for example, indicate that poor nutrition can harm cognition maluccio et al. Nevertheless, no randomized clinical trial rct in ckd patients has evaluated the longterm effects of salt restriction on ckd progression, even though two posthoc analyses have suggested beneficial effects on this endpoint 12.