The Dietary Approaches to Stop Hypertension (DASH) eating pattern in special populations.

The Dietary Approaches to Stop Hypertension (DASH) trial showed that a diet rich in fruits, vegetables, low-fat dairy products with reduced total and saturated fat, cholesterol, and sugar-sweetened products effectively lowers blood pressure in individuals with prehypertension and stage I hypertension. Limited evidence is available on the safety and efficacy of the DASH eating pattern in special patient populations that were excluded from the trial. Caution should be exercised before initiating the DASH diet in patients with chronic kidney disease, chronic liver disease, and those who are prescribed renin-angiotensin-aldosterone system antagonist, but these conditions are not strict contraindications to DASH. Modifications to the DASH diet may be necessary to facilitate its use in patients with chronic heart failure, uncontrolled diabetes mellitus type II, lactose intolerance, and celiac disease. In general, the DASH diet can be adopted by most patient populations and initiated simultaneously with medication therapy and other lifestyle interventions.

Sodium and potassium balance depends on αENaC expression in connecting tubule.

Mutations in α, β, or γ subunits of the epithelial sodium channel (ENaC) can downregulate ENaC activity and cause a severe salt-losing syndrome with hyperkalemia and metabolic acidosis, designated pseudohypoaldosteronism type 1 in humans. In contrast, mice with selective inactivation of αENaC in the collecting duct (CD) maintain sodium and potassium balance, suggesting that the late distal convoluted tubule (DCT2) and/or the connecting tubule (CNT) participates in sodium homeostasis. To investigate the relative importance of ENaC-mediated sodium absorption in the CNT, we used Cre-lox technology to generate mice lacking αENaC in the aquaporin 2-expressing CNT and CD. Western blot analysis of microdissected cortical CD (CCD) and CNT revealed absence of αENaC in the CCD and weak αENaC expression in the CNT. These mice exhibited a significantly higher urinary sodium excretion, a lower urine osmolality, and an increased urine volume compared with control mice. Furthermore, serum sodium was lower and potassium levels were higher in the genetically modified mice. With dietary sodium restriction, these mice experienced significant weight loss, increased urinary sodium excretion, and hyperkalemia. Plasma aldosterone levels were significantly elevated under both standard and sodium-restricted diets. In summary, αENaC expression within the CNT/CD is crucial for sodium and potassium homeostasis and causes signs and symptoms of pseudohypoaldosteronism type 1 if missing.

High sodium intake enhances insulin-stimulated glucose uptake in rat epididymal adipose tissue

Objective: This study investigated the effect of different sodium content diets on rat adipose tissue carbohydrate metabolism and insulin sensitivity. Methods and Procedures: Male Wistar rats were fed on normal- (0.5% Na+; NS), high- (3.12% Na+; HS), or low-sodium (0.06% Na+; LS) diets for 3, 6, and 9 weeks after weaning. Blood pressure (BP) was measured using a computerized tail-cuff system. An intravenous insulin tolerance test (ivITT) was performed in fasted animals. At the end of each period, rats were killed and blood samples were collected for glucose and insulin determinations. The white adipose tissue (WAT) from abdominal and inguinal subcutaneous (SC) and periepididymal (PE) depots were weighed and processed for adipocyte isolation and measurement of in vitro rates of insulin-stimulated 2-deoxy-d-[H-3]-glucose uptake (2DGU) and conversion of -[U-C-14]-glucose into (CO2)-C-14. Results: After 6 weeks, HS diet significantly increased the BP, SC and PE WAT masses, PE adipocyte size, and plasma insulin concentration. The sodium dietary content did not influence the whole-body insulin sensitivity. A higher half-maximal effective insulin concentration (EC50) from the dose - response curve of 2DGU and an increase in the insulin-stimulated glucose oxidation rate were observed in the isolated PE adipocytes from HS rats. Discussion: The chronic salt overload enhanced the adipocyte insulin sensitivity for glucose uptake and the insulin-induced glucose metabolization, contributing to promote adipocyte hypertrophy and increase the mass of several adipose depots, particularly the PE fat pad.

Dietary electrolyte balance for broiler chickens under moderately high ambient temperatures and relative humidities

Cobb male broiler chicks (1,000) on new litter were used to evaluate effects of dietary electrolyte balance [DEB; Na+K-Cl, milliequivalents (mEq) per kilogram] under tropical summer conditions. Corn-soybean meal-based mash diets had salt (NaCl) alone or in combination with one or more supplements: sodium bicarbonate (NaHCO3), ammonium chloride (NH4Cl), or potassium bicarbonate (KHCO3). A completely randomized design, with five starter and grower feed treatments (control: 145, then 130 mEq/kg; or 0, 120, 240, or 360 mEq/kg throughout) and four replicate pens (1.5 x 3.2 m) per treatment (50 chicks per pen), was used. Diets were analyzed for Na, K, and Cl for confirmation. There were no significant (P < 0.05) effects of treatments on mortality or processing parameters. Water intake increased linearly with increasing DEB, giving higher litter moistures and lower rectal temperatures. Blood HCO3 and pH increased with the highest DEB (360 mEq/kg) causing respiratory alkalosis. The DEB of 240 mEg/kg gave best weight gain and feed conversion ratio, and ideal DEB predicted by regression analyses were 186 and 197 mEq/kg from 0 to 21 d of age and 236 and 207 mEq/kg of feed from 0 to 42 d, respectively. These DEB corresponded to estimated (interpolated) values in predicted optimal 186 to 197 mEq/kg starter of Na 0.38 to 0.40% and Cl 0.405 to 0.39% (K = 0.52%), in 207 to 236 mEq/kg starter, Na 0.409 to 0.445% and Cl 0.326 to 0.372% Cl (K = 0.52%), and in grower Na 0.41 to 0.445%, Cl 0.315 to 0.267% (K = 0.47%).

Dietary electrolyte balance for broiler chickens exposed to thermoneutral or heat-stress environments

Ross male broiler chicks (n = 480) on new litter were used in a randomized block design with two blocks (environmental rooms) and four treatments having four replicate pens (1.0 × 2.5 m; 15 chicks) each to evaluate dietary electrolyte balance (DEB; P < 0.05). Two rooms were 1) thermoneutral (Weeks 1 through 6, with decreasing maximum from 32 to 25°C and minimum from 28 to 19°C; relative humidity 49 to 58%) and 2) cyclic daily heat stress (Weeks 1 and 2, thermoneutral; Weeks 2 through 6, maximum temperatures 35, 35, 33, and 33°C, respectively; and minimum temperatures 23, 20, 19, and 19°C, respectively; relative humidity 51 to 54%). The DEB treatments (0, 140, 240, or 340 mEq Na + K - Cl/kg) had NaHCO3 plus NH4Cl, or KHCO3, or both added to corn-soybean meal mash basal diets with 0.30% salt (NaCl). In the thermoneutral room, DEB 240 increased 42-d weight gain and 44-d lymphocyte percentage and decreased heterophil percentage and heterophil to lymphocyte ratio compared to the DEB 40 treatment. The DEB 240 diets had 0.35 and 0.35% Na and 0.37% and 0.29% Cl in starter (0.75% K) and grower (0.67% K) diets, respectively. No DEB treatment differences were found in the heat stress room. For combined rooms, 42-d feed intake was higher for DEB 240 than for DEB 40. The 21-d weight gain was higher for DEB 240 than for DEB 40 or 140; and 21-d feed/gain was lower for DEB 40 than for DEB 340. The predicted maximum point of inflection for 21- and 42-d weight gains were DEB 250 and 201, with highest 42-d feed intake at 220.

Hindbrain mineralocorticoid mechanisms on sodium appetite

Aldosterone acting on the brain stimulates sodium appetite and sympathetic activity by mechanisms that are still not completely clear. In the present study, we investigated the effects of chronic infusion of aldosterone and acute injection of the mineralocorticoid receptor (MR) antagonist RU 28318 into the fourth ventricle (4th V) on sodium appetite. Male Wistar rats (280-350 g) with a stainless-steel cannula in either the 4th V or lateral ventricle (LV) were used. Daily intake of 0.3 M NaCl increased to 46 ± 15 and 130 ± 6 ml/24 h after 6 days of infusion of 10 and 100 ng/h of aldosterone into the 4th V (intake with vehicle infusion: 2 ± 1 ml/24 h). Water intake fell slightly and not consistently, and food intake was not affected by aldosterone. Sodium appetite induced by diuretic (furosemide) combined with 24 h of a low-sodium diet fell from 12 ± 1.7 ml/2 h to 5.6 ± 0.8 ml/2 h after injection of the MR antagonist RU 28318 (100 ng/2 μl) into the 4th V. RU 28318 also reduced the intake of 0.3 M NaCl induced by 9 days of a low-sodium diet from 9.5 ± 2.6 ml/2 h to 1.2 ± 0.6 ml/2 h. Infusion of 100 or 500 ng/h of aldosterone into the LV did not affect daily intake of 0.3 M NaCl. The results are functional evidence that aldosterone acting on MR in the hindbrain activates a powerful mechanism involved in the control of sodium appetite. © 2013 the American Physiological Society.

Renal tubular NEDD4-2 deficiency causes NCC-mediated salt-dependent hypertension.

The E3 ubiquitin ligase NEDD4-2 (encoded by the Nedd4L gene) regulates the amiloride-sensitive epithelial Na+ channel (ENaC/SCNN1) to mediate Na+ homeostasis. Mutations in the human β/γENaC subunits that block NEDD4-2 binding or constitutive ablation of exons 6-8 of Nedd4L in mice both result in salt-sensitive hypertension and elevated ENaC activity (Liddle syndrome). To determine the role of renal tubular NEDD4-2 in adult mice, we generated tetracycline-inducible, nephron-specific Nedd4L KO mice. Under standard and high-Na+ diets, conditional KO mice displayed decreased plasma aldosterone but normal Na+/K+ balance. Under a high-Na+ diet, KO mice exhibited hypercalciuria and increased blood pressure, which were reversed by thiazide treatment. Protein expression of βENaC, γENaC, the renal outer medullary K+ channel (ROMK), and total and phosphorylated thiazide-sensitive Na+Cl- cotransporter (NCC) levels were increased in KO kidneys. Unexpectedly, Scnn1a mRNA, which encodes the αENaC subunit, was reduced and proteolytic cleavage of αENaC decreased. Taken together, these results demonstrate that loss of NEDD4-2 in adult renal tubules causes a new form of mild, salt-sensitive hypertension without hyperkalemia that is characterized by upregulation of NCC, elevation of β/γENaC, but not αENaC, and a normal Na+/K+ balance maintained by downregulation of ENaC activity and upregulation of ROMK.

Fração de excreção de sódio, osmolaridade e densidade urinária em recém-nascidos prematuros alimentados com leite humano de banco adicionado de suplemento

Objective: This research was performed with the objective of investigating the renal effects on premature newborn infants of fortifying banked donor human milk. Methods: Clinical intervention trial, of the before-and-after type, involving 28 premature newborn infants split into two groups by postconceptional age at the start of the study: GI < 34 weeks (n = 14) and GII ≥ 34 weeks (n = 14), and assessed at three sample points: S1, on unfortified donor human milk, S2, after 3 days, and S3, after 10-13 days on fortified donor human milk. Nutrient intake, weight gain, fractional sodium excretion, urinary osmolality and specific density were compared with two-way ANOVA for repeated measures. Results: Fluids, energy and sodium intakes were similar for both groups, and weight gain was satisfactory. Among the preterms with < 34 weeks postconceptional age, serum sodium was lower at the end of the study and the fractional sodium excretion was elevated at the start and at the end of the study (S1 = 2.11±1.05; S2 = 1.25±0.64; S3 = 1.62±0.88), with a significant difference in relation to GII (S1 = 1.34±0.94; S2 = 0.90±0.54; S3 = 0.91±0.82). Osmolality and urinary specific density were normal, with no differences between groups or collection dates. Conclusions: No adverse effects on the renal function of these preterms were detected as a result of being fed fortified donor human milk. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Resposta pressórica, hormonal e vascular ao treinamento físico aeróbico supervisionado em hipertensos essenciais não medicados

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Aromatic l-amino acid decarboxylase : histochemical localization in rat kidney and lack of effect of dietary potassium or sodium loading on enzyme distribution

Utilizing a mono-specific antiserum produced in rabbits to hog kidney aromatic L-amino acid decarboxylase (AADC), the enzyme was localized in rat kidney by immunoperoxidase staining. AADC was located predominantly in the proximal convoluted tubules; there was also weak staining in the distal convoluted tubules and collecting ducts. An increase in dietary potassium or sodium intake produced no change in density or distribution of AADC staining in kidney. An assay of AADC enzyme activity showed no difference in cortex or medulla with chronic potassium loading. A change in distribution or activity of renal AADC does not explain the postulated dopaminergic modulation of renal function that occurs with potassium or sodium loading.

Effect of dietary sodium restriction on taste perception of sodium chloride

The effect of dietary sodium restriction on perceived intensity of and preference for the taste of salt was evaluated in 76 adults, 25-49 years, with diastolic blood pressure between 79-90 mmHg. Participants were volunteers from clinical Hypertension Prevention Trials (HPT), at the University of California, Davis and the University of Minnesota, Minneapolis. Participants followed one of four HPT diets: 1600 mg Na+/day (NA, n=lS), 1600 mg Na+ plus 3200 mg K+/day (NK, n=lS), 1600 mg Na+/day plus energy restriction to achieve weight loss (NW, n=l3) and weight loss only (WT, n=l3). All participants attended regularly scheduled nutri­tion intervention meetings designed to help them achieve the HPT dietary goals. A fifth, no-intervention group, consisted of 20, no-diet-change controls CCN). Sodium, potassium and energy intakes were monitored by analysis of single, 24-hour food records and corresponding overnight urine speci­mens, obtained at baseline and after 12 and 24 weeks of intervention. Hedonic responses to sodium chloride in a prepared cream of green bean soup were assessed by two methods : 1) scaling of like/dislike for an NaCl concentration series on 10-cm graphie line scales and 2) ad libitum mixing of unsalted and salted soups to maximum level of liking. Salt content of the mixes was analyzed by sodium ion-selective electrode. The concentration series was also rated for perceived saltiness­intensity on similar graphie line scales. Tests were conducted at base­line and after approximately 1, 3, 6, 8, 10, 13 and 24 weeks of intervention. Reduction in sodium intake and excretion in NA, NK and NW partici­pants was accompanied by a shift in preference toward less saltiness in soup. The pattern of hedonic responses changed over time: scores for high NaCl concentrations decreased progressively while scores for low concentrations increased. Hedonic maxima shifted fran a concentration of 0.55% at the onset to 0.1-0.2% added NaCl at week 24. During the same time period, the preferred concentration of ad libitum mixes declined 50%. These shifts occurred independently of changes in salti­ness intensity ratings, potassium or energy intakes, and were consistent across the two participating study sites. Like/dislike and sd. libitum responses were similar after 13 and 24 weeks of diet, as were measures of sodium intake and excretion. These findings suggest that after three months of sodium restriction, preference for salt had readjusted to a lower level, reflective of lower sodium intake. Mechanisms underlying the change in preference are unclear, but may include sensory, context, physiological as well as behavioral effects. In contrast, few changes were noted within WT and CN groups. The pattern of hedonic responses varied little in controls while the WT group showed increased liking for mid-range NaCl concentrations. Small, but significant fluctuations in ad libitum mix concentration occurred in both of these groups, but the differences appeared to be random rather than systematic. The results of this study indicate that preference for the taste of salt declines progressively toward a new baseline following reductions in sodium intake. These alterations may enhance maintenance of low­sodium diets for the treatment and prevention of hypertension. Further investigation is needed to establish the degree to which long-term com­pliance is contingent upon variation in salt taste preference.

Effect of dietary supplementation with selenium-enriched yeast or sodium selenite on selenium tissue distribution and meat quality in beef cattle

The objective was to determine the concentration of total selenium (Se) and the proportion of total Se comprised as selenomethionine (SeMet) and selenocysteine (SeCys) in post mortem tissues of beef cattle offered diets containing graded additions of selenized enriched yeast (SY) [Saccharomyces cerevisae CNCM I-3060]), or sodium selenite (SS). Oxidative stability and tissue glutathione peroxidase (GSH-Px) activity of edible muscle tissue were assessed 10 d post-mortem. Thirty two beef cattle were offered, for a period of 112 d, a total mixed ration which had either been supplemented with SY (0, 0.15 or 0.35 mg Se/kg DM) or SS (0.15 mg Se/kg DM). At enrollment (0 d) and at 28, 56, 84 and 112 d following enrollment, blood samples were taken for Se and Se species determination, as well as whole blood GSH-Px activity. At the end of the study beef cattle were euthanized and samples of heart, liver, kidney, and skeletal muscle (LM and psoas major) were retained for Se and Se species determination. Tissue GSH-Px activity and thiobarbituric acid reactive substances (TBARS) were determined in skeletal muscle tissue (LM only). The incorporation into the diet of ascending concentrations of Se as SY increased whole blood total Se and the proportion of total Se comprised as SeMet, as well as GSH-Px activity. There was also a dose dependant response to the graded addition of SY on total Se and proportion of total Se as SeMet in all tissues and GSH-Px activity in skeletal muscle tissue. Furthermore, total Se concentration of whole blood and tissues was greater in those animals offered SY when compared with those receiving a comparable dose of SS, indicating an improvement in Se availability and tissue Se retention. Likewise, GSH-Px activity in whole blood and LM was greater in those animals offered SY when compared with those receiving a comparable dose of SS. However, these increases in tissue total Se and GSH-Px activity appeared to have little or no effect in meat oxidative stability.

Effects of dietary supplementation with selenium enriched yeast or sodium selenite on selenium tissue distribution and meat quality in lambs

The objective was to determine the concentration of total selenium (Se) and the proportion of total Se comprised as selenomethionine (SeMet) and selenocysteine (SeCys), as well as meat quality in terms of oxidative stability in post mortem tissues of lambs offered diets with an increasing dose rate of selenized enriched yeast (SY), or sodium selenite (SS). Fifty lambs were offered, for a period of 112 d, a total mixed ration which had either been supplemented with SY (0, 0.11, 0.21 or 0.31 mg/kg DM to give total Se contents of 0.19, 0.3, 0.4 and 0.5 mg Se/kg DM for treatments T1, T2, T3 and T4, respectively) or SS (0.11 mg/kg DM to give 0.3 mg Se/kg DM total Se [T5]). At enrolment and at 28, 56, 84 and 112 d following enrolment, blood samples were taken for Se and Se species determination, as well as glutathione peroxidase (GSH-Px) activity. At the end of the study lambs were euthanased and samples of heart, liver, kidney, and skeletal muscle were retained for Se and Se species determination. Tissue GSH-Px activity and thiobarbituric acid reactive substances (TBARS) were determined in Longissimus Thoracis. The incorporation into the diet of ascending concentrations of Se as SY increased whole blood total Se and the proportion of total Se comprised as SeMet, and erythrocyte GSH-Px activity. Comparable doses of SS supplementation did not result in significant differences between these parameters. With the exception of kidney tissue, all other tissues showed a dose dependant response to increasing concentrations of dietary SY, such that total Se and SeMet increased. Selenium content of Psoas Major was higher in animals fed SY when compared to a similar dose of SS, indicating improvements in Se availability and retention. There were no significant treatment effects on meat quality assessments GHS-Px and TBARS, reflecting the lack of difference in the proportion of total Se that was comprised as SeCys. However, oxidative stability improved marginally with ascending tissue Se content, providing an indication of a linear dose response whereby TBARS improved with ascending SY inclusion.

Effect of dietary supplementation with selenium-enriched yeast or sodium selenite on selenium tissue distribution and meat quality in commercial-line turkeys

The objective of this study was to determine the concentration of total selenium (Se) and proportions of total Se comprised as selenomethionine (SeMet) and selenocysteine (SeCys) in the tissues of female turkeys offered diets containing graded additions of selenized-enriched yeast (SY), or sodium selenite (SS). Oxidative stability and tissue glutathione peroxidase (GSH-Px) activity of breast and thigh muscle were assessed at 0 and 10 days post mortem. A total of 216 female turkey poults were enrolled in the study. A total of 24 birds were euthanized at the start of the study and samples of blood, breast, thigh, heart, liver, kidney and gizzard were collected for determination of total Se. Remaining birds were blocked by live weight and randomly allocated to one of four dietary treatments(n548 birds/treatment) that differed either in Se source (SY v. SS) or dose (Con [0.2 mg/kg total Se], SY-L and SS-L [0.3mg/kg total Se as SY and SS, respectively] and SY-H [0.45mg total Se/kg]). Following 42 and 84 days of treatment 24 birds per treatment were euthanized and samples of blood, breast, thigh, heart, liver, kidney and gizzard were retained for determination of total Se and the proportion of total Se comprised as SeMet or SeCys. Whole blood GSH-Px activity was determined at each time point. Tissue GSH-Px activity and thiobarbituric acid reactive substances were determined in breast and thigh tissue at the end of the study. There were responses (P,0.001) in all tissues to the graded addition of dietary Se, although rates of accumulation were highest in birds offered SY. There were notable differences between tissue types and treatments in the distribution of SeMet and SeCys, and the activity of tissue and erythrocyte GSH-Px (P,0.05). SeCys was the predominant form of Se in visceral tissue and SeMet the predominant form in breast tissue. SeCys contents were greater in thigh when compared with breast tissue. Muscle tissue GSH-Px activities mirrored SeCys contents. Despite treatment differences in tissue GSH-Px activity, there were no effects of treatment on any meat quality parameter.

Physiological responses of broiler chickens to heat stress and dietary electrolyte balance (sodium plus potassium minus chloride, milliequivalents per kilogram)

Individually caged male Cobb broilers (24), 44 d of age, were used to evaluate effects of heat stress (1 d of data collection) and dietary electrolyte balance (DEB; Na + K - Cl, mEq/kg from 1 d of age). During summer rearing, mortality was variable, but DEB 240 improved growth, feed conversion ratio, water intake, and waterrfeed ratio vs. DEB 0. The temperature sequence for heat stress was 24 to 32°C in 30 min, 32 to 36°C in 30 min, 36 to 37°C in 15 min, and 37 to 41°C in 45 min. Maximum temperature was held for 15, 60, 90, or 360 min for data collection (relative humidity averaged 42 ± 7%). Results from the same room before and after heat stress were analyzed by DEB (1-factor ANOVA) and before vs. after heat stress compared across DEB (2-sample t-test). Heat stress decreased blood Na, K, and pCO2, and lymphocytes but increased heterophils. Blood HCO3 rose, Cl declined, and hematocrit gave a concave pattern (lowest at DEB 120) as DEB increased. After heat stress, DEB O decreased blood Na and K, and DEB O and 120 levels decreased blood HCO3. After heat stress blood pCO2 and hemoglobin decreased with DEB 240, but it had highest pCO2, a key factor. The DEB 120 gave longest times to panting and prostration with DEB O and 240 results lower but similar statistically. In heat stress, DEB 360 was excessive, DEB 120 and 240 were favorable, and DEB 0 was intermediate based on hematology, panting, and prostration responses.