The Effect of the Education Program on the Adherence Intention to the Dietary Sodium Restriction and the Amount of Sodium Intake in Patients With Chronic Heart Failure

Abstract Objectives Dietary sodium restriction guidelines are controversial due to a lack of studies assessing their effect on heart failure outcomes. An important aspect of this problem is the effectiveness of behavioral nutrition interventions to reduce patients’ sodium intake. We systematically reviewed randomized controlled trials (RCTs) of sodium restricted diets and descriptive studies relating mediators of behavior to successful adherence to sodium restricted diets in patients with heart failure. Methods We queried PubMed, CINAHL, and Cochrane databases with relevant search terms for studies published in English January 2000-December 2018. Included were RCTs of interventions for heart failure patients, with sodium restriction as a primary or secondary outcome, and quantitative and qualitative descriptive studies of adherence to sodium restricted diets. Included studies may or may not have reported clinical outcomes (health events, quality of life, etc.). Reviewers noted setting, methods, and outcomes as well as theoretical mediators of dietary behavior change in included studies. We then compared behavioral mediators addressed by the RCTs and behavioral mediators identified in the descriptive studies. Results Of 638 studies identified, 445 were excluded by title. 2 reviewers assessed 60 abstracts and included 36 studies in this analysis: 10 RCTs and 26 descriptive studies. 6 of 10 intervention RCTs were successful, but no interventions achieved the recommended 1500 mg/day sodium intake (mean for all studies 3271 mg/day). Interventions that reduced sodium intake were behaviorally focused, were delivered by an RN and/or RD, and included individual feedback and counseling. RCTs intervened only through knowledge, skills, and social support. Behavioral mediators identified in descriptive studies included perceived risk, perceived benefits, outcome expectations, cultural norms, social norms, social support, taste preferences, determinism, self-efficacy, knowledge, skills, and habits. These were not included in the RCTs, which signifies a mismatch between evidence-based moderators of behavior and intervention designs. Conclusions RCTs have been unable to achieve the recommended goal of 1500 mg/day of sodium. More effective interventions should consider evidence-based mediators, rather than focusing on knowledge and skills. Funding Sources Dr. Burgermaster received funding from NHLBI T32 training grant.

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The Effects of Short-Term Changes in Sodium Intake on Plasma Marinobufagenin Levels in Patients with Primary Salt-Sensitive and Salt-Insensitive Hypertension

Nutrients ◽

10.3390/nu13051502 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1502

Author(s):

Katarzyna Łabno-Kirszniok ◽

Agata Kujawa-Szewieczek ◽

Andrzej Wiecek ◽

Grzegorz Piecha

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Sodium Intake ◽

Left Ventricular ◽

Primary Hypertension ◽

Dietary Sodium ◽

Sodium Restriction ◽

Short Term ◽

Salt Loading ◽

Dietary Sodium Restriction

Increased marinobufagenin (MBG) synthesis has been suggested in response to high dietary salt intake. The aim of this study was to determine the effects of short-term changes in sodium intake on plasma MBG levels in patients with primary salt-sensitive and salt-insensitive hypertension. In total, 51 patients with primary hypertension were evaluated during acute sodium restriction and sodium loading. Plasma or serum concentrations of MBG, natriuretic pro-peptides, aldosterone, sodium, potassium, as well as hematocrit (Hct) value, plasma renin activity (PRA) and urinary sodium and potassium excretion were measured. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed at baseline. In salt-sensitive patients with primary hypertension plasma MBG correlated positively with diastolic blood pressure (ABPM) and serum NT-proANP concentration at baseline and with serum NT-proANP concentration after dietary sodium restriction. In this subgroup plasma MBG concentration decreased during sodium restriction, and a parallel increase of PRA was observed. Acute salt loading further decreased plasma MBG concentration in salt-sensitive subjects in contrast to salt insensitive patients. No correlation was found between plasma MBG concentration and left ventricular mass index. In conclusion, in salt-sensitive hypertensive patients plasma MBG concentration correlates with 24-h diastolic blood pressure and dietary sodium restriction reduces plasma MBG levels. Decreased MBG secretion in response to acute salt loading may play an important role in the pathogenesis of salt sensitivity.

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Dietary Sodium Restriction in Heart Failure: A Recommendation Worth its Salt? ∗

JACC Heart Failure ◽

10.1016/j.jchf.2015.10.003 ◽

2016 ◽

Vol 4 (1) ◽

pp. 36-38 ◽

Cited By ~ 5

Author(s):

Scott L. Hummel ◽

Matthew C. Konerman

Keyword(s):

Heart Failure ◽

Dietary Sodium ◽

Sodium Restriction ◽

Dietary Sodium Restriction

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Adrenergic control of renin during dietary sodium deprivation in conscious dogs

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1989.256.6.e863 ◽

1989 ◽

Vol 256 (6) ◽

pp. E863-E871 ◽

Cited By ~ 1

Author(s):

H. Hisa ◽

Y. H. Chen ◽

K. J. Radke ◽

J. L. Izzo ◽

C. D. Sladek ◽

...

Keyword(s):

Sodium Intake ◽

Conscious Dogs ◽

Dietary Sodium ◽

Sodium Restriction ◽

Adrenergic Stimulation ◽

Sodium Diet ◽

Low Sodium Diet ◽

Low Sodium ◽

Dietary Sodium Restriction

These experiments evaluated the contribution of alpha- and beta-adrenergic stimulation to plasma renin activity (PRA) during early and long-term dietary sodium restriction, compared with normal sodium intake. Uninephrectomized conscious dogs with catheters in the aorta, vena cava, and remaining renal artery were studied during normal sodium diet (approximately 70 meq/day), after 2-3 days of low-sodium diet (5-7 meq/day), and after greater than or equal to 2 wk of low-sodium diet. Direct renal arterial (ira) infusion of phenoxybenzamine plus propranolol decreased PRA by similar proportions (39-48%) during all three states of dietary sodium intake. The PRA achieved after adrenergic blockade remained higher (P less than 0.05) during early and long-term sodium restriction than during normal sodium intake. The effect on PRA of ira infusion of propranolol alone was not different from that of phenoxybenzamine plus propranolol during normal or low-sodium diet, and the magnitude of decrease in PRA during low-sodium diet was the same whether propranolol (1 microgram.kg-1.min-1) was infused ira or intravenously. In summary, beta-adrenergic stimulation accounts for similar proportions of PRA during early and long-term dietary sodium restriction and during normal sodium intake. Renal alpha-adrenoceptors appear to play little or no role in control of PRA under these conditions.

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American Association of Heart Failure Nurses Best Practices paper: Literature synthesis and guideline review for dietary sodium restriction

Heart & Lung ◽

10.1016/j.hrtlng.2015.03.003 ◽

2015 ◽

Vol 44 (4) ◽

pp. 289-298 ◽

Cited By ~ 1

Author(s):

Carolyn Miller Reilly ◽

Kelley M. Anderson ◽

Linda Baas ◽

Eva Johnson ◽

Terry A. Lennie ◽

...

Keyword(s):

Heart Failure ◽

Best Practices ◽

American Association ◽

Dietary Sodium ◽

Sodium Restriction ◽

Literature Synthesis ◽

Dietary Sodium Restriction

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Dietary Sodium Restriction Increases the Risk of Misinterpreting Mild Cases of Primary Aldosteronism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-1963 ◽

2016 ◽

Vol 101 (11) ◽

pp. 3989-3996 ◽

Cited By ~ 26

Author(s):

Rene Baudrand ◽

Francisco J. Guarda ◽

Jasmine Torrey ◽

Gordon Williams ◽

Anand Vaidya

Keyword(s):

Primary Aldosteronism ◽

Sodium Intake ◽

Plasma Renin ◽

Dietary Sodium ◽

Sodium Restriction ◽

Positive Screen ◽

Serum Aldosterone ◽

Optimal Screening ◽

Dietary Sodium Restriction ◽

Aldosterone To Renin Ratio

Context: The aldosterone to renin ratio (ARR) is recommended to screen for primary aldosteronism (PA). Objective: To evaluate whether dietary sodium restriction results in misinterpretation of PA screening. Participants: Untreated hypertensives with ARR more than 20 on a high dietary sodium intake (HS) were also evaluated on a low dietary sodium intake (LS) (n = 241). Positive screening for PA was defined as: plasma renin activity (PRA) less than or equal to 1.0 ng/mL · h with serum aldosterone more than or equal to 6 ng/dL. PA was confirmed by a 24-hour urinary aldosterone excretion more than or equal to 12 mcg with urinary sodium more than 200 mmol. Results: Only 33% (79/241) of participants with an ARR more than 20 had a positive PA screen on HS. On LS, 56% (44/79) of these participants no longer met criteria for positive PA screening. When compared with participants with positive PA screening on both diets, participants with a positive screen on HS but negative on LS exhibited a significantly higher PRA on both diets. Remarkably, of the 48/79 participants who had PA confirmed, 52% had negative PA screening on LS. The distinguishing feature of these participants with “discordant” screening results was a larger rise in PRA on LS resulting in normalization of the ARR and higher Caucasian race prevalence. Conclusions: Sodium restriction is recommended in hypertension; however, it can significantly raise PRA, normalize the ARR, and result in false interpretation of PA screening. Milder phenotypes of PA, where PRA is not as suppressed, are most susceptible to dietary sodium influences on renin and ARR. Optimal screening for PA should occur under conditions of HS.

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Effects of dietary sodium restriction and posture on plasma levels of atrial natriuretic peptide, aldosterone and free aldosterone in normal human pregnancy

Journal of Endocrinology ◽

10.1677/joe.0.1240507 ◽

1990 ◽

Vol 124 (3) ◽

pp. 507-513 ◽

Cited By ~ 22

Author(s):

E. A. P. Steegers ◽

Th. J. Benraad ◽

H. W. Jongsma ◽

A. C. I. T. L. Tan ◽

P. R. Hein

Keyword(s):

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Sodium Intake ◽

Plasma Concentrations ◽

Dietary Sodium ◽

Sitting Position ◽

Sodium Restriction ◽

Lateral Tilt ◽

Low Sodium ◽

Dietary Sodium Restriction

ABSTRACT The effects of dietary sodium restriction and posture on plasma concentrations of atrial natriuretic peptide (ANP), aldosterone and free aldosterone were investigated in ten women between weeks 29 and 33 of normal pregnancy. Hormone levels were studied during unrestricted sodium intake and on day 6 of a low sodium diet. On both occasions venous blood was obtained in the sitting as well as in the left lateral tilt position. Plasma concentrations of ANP during the unrestricted sodium intake were not raised compared with control values in healthy non-pregnant females. Recovery experiments showed no differences in the degradation of ANP in blood from pregnant and non-pregnant women. Plasma concentrations of ANP significantly decreased (by 32%) in response to the low sodium regime in both positions. Concentrations of aldosterone and free aldosterone (in women in the sitting position) increased twofold after sodium restriction. Mean values of ANP were higher in women in the left lateral tilt position that in those in the sitting position, but the difference was not significant. Concentrations of aldosterone and free aldosterone were significantly lower (by around 30%) in women in the left lateral tilt position compared with those in the sitting posture. Journal of Endocrinology (1990) 124, 507–513

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The effect of dietary sodium restriction on neurohumoral activity and renal dopaminergic response in patients with heart failure

European Journal of Heart Failure ◽

10.1016/j.ejheart.2003.11.020 ◽

2004 ◽

Vol 6 (5) ◽

pp. 593-599 ◽

Cited By ~ 44

Author(s):

Margarida Alvelos ◽

António Ferreira ◽

Paulo Bettencourt ◽

Paula Serrão ◽

Manuel Pestana ◽

...

Keyword(s):

Heart Failure ◽

Dietary Sodium ◽

Sodium Restriction ◽

Patients With Heart Failure ◽

Dietary Sodium Restriction

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Evidence related to sodium restriction in patients with heart failure

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2018-0874 ◽

2020 ◽

Vol 73 (4) ◽

Author(s):

Mailson Marques de Sousa ◽

Bernadete de Lourdes André Gouveia ◽

Taciana da Costa Farias Almeida ◽

Maria Eliane Moreira Freire ◽

Francisco de Assis Brito Pereira de Melo ◽

...

Keyword(s):

Heart Failure ◽

Sodium Intake ◽

Main Tool ◽

Dietary Sodium ◽

Protective Measure ◽

Sodium Restriction ◽

Low Sodium Diet ◽

Low Sodium ◽

Asymptomatic Patients ◽

Patients With Heart Failure

ABSTRACT Objectives: to analyze the scientific production about sodium restriction in patients with heart failure. Methods: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. Results: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. Conclusions: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

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Sodium intake and the effects of isoproterenol and exercise on plasma renin in man

Journal of Applied Physiology ◽

10.1152/jappl.1978.45.6.870 ◽

1978 ◽

Vol 45 (6) ◽

pp. 870-874 ◽

Cited By ~ 8

Author(s):

F. H. Leenen ◽

P. Boer ◽

G. G. Geyskes

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Sodium Intake ◽

Plasma Renin ◽

Dynamic Exercise ◽

Dietary Sodium ◽

Sodium Restriction ◽

Dietary Sodium Restriction

Changes in heart rate, blood pressure, and plasma renin activity (PRA) were assessed during infusion of increasing doses of isoproterenol and during increasing work loads of dynamic exercise in five normal young men. Studies were performed at three levels of dietary sodium restriction: normal, moderately, and more severely restricted. Isoproterenol induced the expected dose-related increases in heart rate, systolic blood pressure, and PRA and decreases in diastolic blood pressure. Changes in dietary sodium intake affected these changes only to a minor degree. Dynamic exercise also induced the expected work-load-related increases in heart rate, systolic blood pressure, and PRA and decreases in diastolic blood pressure. Also these changes were not significantly affected by changes in dietary sodium intake. Apparently dietary sodium restriction does not sensitize the renin-releasing mechanisms to sympathetic stimulation.

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