DIETARY SALT INTAKE IN PREGNANCY AND HYPERTENSIVE PREGNANCY DISORDERS – NARRATIVE REVIEW

Salt is crucial for human health, but it`s excess is associated with the development of many diseases including arterial hypertension which is a major feature of hypertensive pregnancy disorders (HPDs). Maternal nutrition during pregnancy can affect cardiometabolic disease development during pregnancy and later in life, but it can also affect fetal growth and disease development in adulthood. Recent studies suggest that excessive salt intake often combined with low potassium intake throughout pregnancy, can suppress renin-angiotensin-aldosterone system (RAAS) with adverse effects on fetoplacental development and can increase the risk of HPDs. Although salt restriction has been considered potentially harmful in the non-pharmacological treatment of arterial hypertension in pregnancy and current guidelines do not recommend it during pregnancy to prevent HPDs, especially gestational hypertension and the development of preeclampsia, its role should be reconsidered in light of the recent evidence. However, one key question remains: How much salt, upper and lower limit of daily intake, in a balanced diet is not harmful in uncomplicated pregnancies as well as HPDs in general

Epidemiologija arterijske hipertenzije u Hrvatskoj i svijetu

Arterijska hipertenzija (AH) jedan je od najvažnijih sprečivih (preventabilnih) uzroka prijevremenog umiranja i jedan od najvećih javnozdrastvenih problema današnjice u svijetu. Prevalencija AH je veća nego ranije i kreće se oko 40% u odraslim populacijama europskih zemalja, dok je u Sjedinjenim Američkim Državama značajno niža. Prema rezultatima studije “Epidemiologija arterijske hipertenzije u Hrvatskoj (EH-UH)” prevalencija AH u Hrvatskoj je 37,5%. AH je učestalija u žena nego u muškaraca, što se podudara s većinom drugih zemalja diljem svijeta, uključujući SAD u kojem se bilježi značajniji porast prevalencije AH u žena, kao i u zemljama bivših socijalističkih ekonomija. Žene u Hrvatskoj svjesnije su od muškaraca, češće se liječe i u većem broju postižu kontrolu AT-a unatoč prosječno nižem stupnju obrazovanja, višem ITM-u i nižim mjesečnim primanjima. U Hrvatskoj se liječi nešto više hipertoničara od europskog prosjeka, ali manje nego u SAD-u i Kanadi. Kontrola AH u Hrvatskoj je iznad europskog prosjeka, izuzev nešto bolje kontrole u Španjolskoj i Engleskoj. Kao i u većine europskih zemalja, Hrvatska ima sličnu distribuciju AT-a i AH uz lošije rezultate u usporedbi sa SAD-om i Kanadom koji su iako daleko ispred nas, i dalje u velikoj mjeri ugroženi visokim brojem radno onesposobljenih ljudi zbog posljedica koje nosi AH u obliku povećane kardiovaskularne smrtnosti i pobola. Stoga su osvješćivanje problema, rano otkrivanje AH osobito u određenim segmentima populacije, prihvaćanje zdravih životnih navika te redovito uzimanje terapije ključni u postizanju bolje kontrole AT-a, a time i boljeg i dužeg života

DIETARY SALT INTAKE IN PREGNANCY AND HYPERTENSIVE PREGNANCY DISORDERS – NARRATIVE REVIEW

Salt is crucial for human health, but it`s excess is associated with the development of many diseases including arterial hypertension which is a major feature of hypertensive pregnancy disorders (HPDs). Maternal nutrition during pregnancy can affect cardiometabolic disease development during pregnancy and later in life, but it can also affect fetal growth and disease development in adulthood. Recent studies suggest that excessive salt intake often combined with low potassium intake throughout pregnancy, can suppress renin-angiotensin-aldosterone system (RAAS) with adverse effects on fetoplacental development and can increase the risk of HPDs. Although salt restriction has been considered potentially harmful in the non-pharmacological treatment of arterial hypertension in pregnancy and current guidelines do not recommend it during pregnancy to prevent HPDs, especially gestational hypertension and the development of preeclampsia, its role should be reconsidered in light of the recent evidence. However, one key question remains: How much salt, upper and lower limit of daily intake, in a balanced diet is not harmful in uncomplicated pregnancies as well as HPDs in general

Uromodulin - poveznica između natriurije i dnevnog ritma arterijskog tlaka kod predhipertoničara

Although changes in dietary sodium intake alter blood pressure (BP) in salt-sensitive individuals, pathophysiological mechanisms are still unknown. It has been reported that uromodulin is involved in sodium tubular transport, and genome-wide association studies pointed to UMOD gene as one of the most important gene candidates for arterial hypertension. Our aim was to analyze urinary uromodulin, salt intake and BP in 326 young middle-aged subjects (mean age 36±8 years, 49.4% male). In a subgroup of 175 individuals, ambulatory blood pressure monitoring and echocardiogram were performed. Uromodulin was determined by ELISA. According to the JNC-7 criteria, subjects were classified as optimal BP (n=103, men 72%), prehypertension (PHT) (n=143, men 43%) and hypertension (HT) (n= 80, men 38%). There were no differences in age, salt intake, estimated glomerular filtration rate, sodium excretion and uromodulin among BP groups. However, in PHT subjects, uromodulin was positively associated with fractional sodium excretion and negatively with 24-h sodium excretion and diastolic BP dip. These findings point to the effect of uromodulin on sodium reabsorption along the nephron and consequently circadian BP alteration in prehypertensives.Promjene u dnevnom unosu kuhinjske soli u osoba osjetljivih na sol utječu na arterijski tlak (AT), ali točan patofiziološki mehanizam još nije u potpunosti razjašnjen. Cilj ove studije je bio istražiti izlučivanje uromodulina (UM) i natrija mokraćom i povezanost s AT u mlađih odraslih osoba. U 326 ispitanika (medijan dobi 36, IQR 18-48, 64,6% muškarci) analizirani su uzorci krvi i mokraće uzeti natašte i izmjeren je AT u ordinaciji, a kod 175 ispitanika učinjeno je kontinuirano mjerenje arterijskoga tlaka. UM je određen metodom ELISA. Prema klasifikaciji JNC-7 optimalni AT, predhipertenzija (PHT) i hipertenzija (HT) su dijagnosticirani u 103 (72% m), 143 (43% m) i 80 (38% m) ispitanika. Nije bilo razlike u dobi, unosu kuhinjske soli, procijenjenoj stopi glomerularne filtracije niti u izlučivanju natrija i UM mokraćom između kategorija AT. Uočena je pozitivna povezanost UM s frakcijskom ekskrecijom natrija, a negativna s 24-satnom natriurijom i noćnim sniženjem dijastoličkoga AT u PHT. Ovi rezultati upućuju na povezanost UM s tubularnom reapsorpcijom natrija i promjenama dnevnoga ritma AT u predhipertoničara

Knowledge, Attitude and Practice About Salt Intake in Croatian Continental Rural Population

High salt intake is important risk factor for hypertension, cardiovascular and cerebrovascular diseases. The aim of this study was to investigate knowledge, attitude and practice regarding salt intake in rural population in continental Croatia. Data were obtained by standardized questionnaire in 928 adult subjects (586 women and 342 men). Results have shown low level of awareness (~60%) of salt risk. Women were more aware about the harmful effects of salt and could identify some food with higher concentration of salt. Participants were not aware through which food is the highest salt intake. Our results urge the need for national projects and public health campaigns that would raise the awareness of salt intake, need for health education particularly for rural population. Food industry and nutritionists should become partners in this initiative

Endemska nefropatija u Hrvatskoj [Endemic nephropathy in Croatia]

Endemic nephropathy (EN) is a chronic tubulointerstitial aristolochic acid nephropathy (AAN) affecting residents of the certain villages in the valleys of the major tributaries of the Danube river in the south-east Europe including Croatia. Patients with EN have a significantly higher incidence of transitional cell carcinoma of the ureter than the general population. A-T transversion of the p53 gene is now considered to be a mutational "signature" of aristolochic acid, which is a cause of endemic nephropathy. Currently used diagnostic criteria for EN are outdated, uneven (three types of criteria) and are not in agreement with proposed new guidelines for kidney diseases. Therefore, based on current knowledge and expertise of a group of scientists and experts from all countries with EN as well as world where AAN has been reported, new diagnostic criteria and the new classification of the population of endemic villages were created at a symposium on EN. EN presents a major public health problem and current knowledge about this disease as well as new diagnostic criteria should help us in its early detection and treatment and maybe in a near future its eradication

Unos soli u seoskoj populaciji u Hrvatskoj – procjena korištenjem jednokratno skupljenog uzorka mokraće

Prekomjeran unos soli važan je i značajan čimbenik rizika za arterijsku hipertenziju, moždani udar, hipertrofiju lijeve klijetke, mikroalbuminuriju, bronhalnu astmu, osteoporozu, nefrolitijazu, i neke zloćudne tumore, kao što su rak želuca i nazofarinksa (1-12). Velik broj epidemioloških studija je pokazao da je unos soli danas u svijetu nekoliko puta viši od preporučenih 5 g dnevno prema trenutno važećim smjernicama Svjetske Zdrastvne Organizacije (SZO) (13). Iz navedenog se nameće potreba za nekim jednostanim, brzim i jefitinim metodama kojima bi se moglo procjeniti trenutno stanje unosa soli u nekoj populaciji. Dvadesetčetiri satni (24h) urin zlatni je standard za određivanje unosa soli (5,13,14). Međutim, ova je metoda nepraktična i teško izvodiva u javnozdrastvenim i velikim epidemiološkim istraživanjima, kao i javnozdravstvenim aktivnostima usmjerenim na sniženje arterijskog tlaka u zajednici. Stoga su Tanaka i sur. (14) utvrdili metodu procjene dnevnog unosa natrija (soli) iz jednokratno skupljenog uzorka urina. Cilj ovog istraživanja je bio procijena unosa soli u seoskoj populaciji kontinentalne Hrvatske pomoću Tanaka-Kawasakijeve metode

ENDEMIC NEPHROPATHY IN CROATIA

Endemska nefropatija (EN) kronična je tubulointersticijska nefropatija aristolohične kiseline (AAN) koja se javlja u stanovnika određenih sela u dolinama velikih pritoka Dunava na jugoistoku Europe uključujući i Hrvatsku. Oboljeli od EN-a imaju znatno veću učestalost karcinoma prijelaznog epitela mokraćovoda nego opća populacija. Danas se smatra da je A:T transverzija gena p53 »potpisna« mutacija za aristolohičnu kiselinu koja je uzrok endemske nefropatije. Postojeći kriteriji za EN su zastarjeli, neujednačeni (tri vrste kriterija) te nisu u skladu s novim preporukama za klasifikaciju bubrežnih bolesti. Stoga su na temelju sadašnjih znanja i stručnosti grupe znanstvenika i stručnjaka iz svih zemalja s EN-om, kao i svijeta u kojem je AAN opisan stvoreni novi dijagnostički kriteriji i nova klasifikacija stanovništva endemskih sela na simpoziju o EN-u. EN je velik javnozdravstveni problem pa bi nam sadašnja znanja o ovoj bolesti, kao i novi dijagnostički kriteriji trebali pomoći u njezinu ranom otkrivanju i liječenju, a možda u nekoj bližoj budućnosti i njezinoj eradikaciji.Endemic nephropathy (EN) is a chronic tubulointerstitial aristolochic acid nephropathy (AAN) affecting residents of the certain villages in the valleys of the major tributaries of the Danube river in the south-east Europe including Croatia. Patients with EN have a significantly higher incidence of transitional cell carcinoma of the ureter than the general population. A-T transversion of the p53 gene is now considered to be a mutational »signature« of aristolochic acid, which is a cause of endemic nephropathy. Currently used diagnostic criteria for EN are outdated, uneven (three types of criteria) and are not in agreement with proposed new guidelines for kidney diseases. Therefore, based on current knowledge and expertise of a group of scientists and experts from all countries with EN as well as world where AAN has been reported, new diagnostic criteria and the new classification of the population of endemic villages were created at a symposium on EN. EN presents a major public health problem and current knowledge about this disease as well as new diagnostic criteria should help us in its early detection and treatment and maybe in a near future its eradication