Reduced dietary salt for prevention of cardiovascular disease

: Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear. : To assess in adults the long term effects (mortality, cardiovascular events, blood pressure, quality of life, weight, urinary sodium excretion, other nutrients and use of anti-hypertensive medications) of advice to restrict dietary sodium using all relevant randomised controlled trials. : The Cochrane Library, MEDLINE, EMBASE, bibliographies of included studies and related systematic reviews were searched for unconfounded randomised trials in healthy adults aiming to reduce sodium intake over at least 6 months. Attempts were made to trace unpublished or missed studies and authors of all included trials were contacted. There were no language restrictions. : Inclusion decisions were independently duplicated and based on the following criteria: 1) randomisation was adequate; 2) there was a usual or control diet group; 3) the intervention aimed to reduce sodium intake; 4) the intervention was not multifactorial; 5) the participants were not children, acutely ill, pregnant or institutionalised; 6) follow-up was at least 26 weeks; 7) data on any of the outcomes of interest were available. : Decisions on validity and data extraction were made independently by two reviewers, disagreements were resolved by discussion or if necessary by a third reviewer. Random effects meta-analysis, sub-grouping, sensitivity analysis and meta-regression were performed. : Three trials in normotensives (n=2326), five in untreated hypertensives (n=387) and three in treated hypertensives (n=801) were included, with follow up from six months to seven years. The large, high quality (and therefore most informative) studies used intensive behavioural interventions. Deaths and cardiovascular events were inconsistently defined and reported; only 17 deaths equally distributed between intervention and control groups occurred. Systolic and diastolic blood pressures were reduced at 13 to 60 months in those given low sodium advice as compared with controls (systolic by 1.1 mm Hg, 95% CI 1.8 to 0.4, diastolic by 0.6 mm hg, 95% CI 1.5 to -0.3), as was urinary 24 hour sodium excretion (by 35.5 mmol/ 24 hours, 95% CI 47.2 to 23.9). Degree of reduction in sodium intake and change in blood pressure were not related. People on anti-hypertensive medications were able to stop their medication more often on a reduced sodium diet as compared with controls, while maintaining similar blood pressure control. : Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.<br/

Dietary reference values for sodium

Following a request from the European Commission, the EFSA Panel&nbsp;on Nutrition, Novel Foods and Food Allergens (NDA) derived dietary reference values (DRVs) for sodium. Evidence from balance studies on sodium and on the relationship between sodium intake and health outcomes, in particular cardiovascular disease (CVD)-related endpoints and bone health, was reviewed. The data were not sufficient to enable an average requirement (AR) or population reference intake (PRI) to be derived. However, by integrating the available evidence and associated uncertainties, the Panel&nbsp;considers that a sodium intake of 2.0&nbsp;g/day represents a level of sodium for which there is sufficient confidence in a reduced risk of CVD in the general adult population. In addition, a sodium intake of 2.0&nbsp;g/day is likely to allow most of the general adult population to maintain sodium balance. Therefore, the Panel&nbsp;considers that 2.0&nbsp;g sodium/day is a safe and adequate intake for the general EU population of adults. The same value applies to pregnant and lactating women. Sodium intakes that are considered safe and adequate for children are extrapolated from the value for adults, adjusting for their respective energy requirement and including a growth factor, and are as follows: 1.1&nbsp;g/day for children aged 1\u20133&nbsp;years, 1.3&nbsp;g/day for children aged 4\u20136&nbsp;years, 1.7&nbsp;g/day for children aged 7\u201310&nbsp;years and 2.0&nbsp;g/day for children aged 11\u201317&nbsp;years, respectively. For infants aged 7\u201311&nbsp;months, an Adequate Intake (AI) of 0.2&nbsp;g/day is proposed based on upwards extrapolation of the estimated sodium intake in exclusively breast-fed infants aged 0\u20136&nbsp;months

Hydrobiologie van de Polder Westzaan

HYDROBIOLOGIE OF THE “POLDER WESTZAAN”. Investigations into the macrofauna and water quality of a brackish water area in the Dutch province North-Holland. Part I. Water quality of the “Polder Westzaan”. From February till June 1974 macrofauna samples were taken with monthly intervalls at 9 Stations scattered in the “Polder Westzaan”, municipality Zaanstad (for position of the Stations see map). In three of the Stations samples were also taken in July, August, and September. From March till October 1974 the 02-saturations percentage and the water temperature were measured and water samples were taken at monthly intervalls. These water samples were analysed by the Dienst Milieuhygiene Zaanstad for the presence of Cl-, nitrate, nitrite, Ammonium, phoshate, sulphate, and heavy metals as well as for the pH; total hardness and COD values. Conclusions: Stations G5 and G7 “Het Guisveld” gives a highly polluted impression, especially when we consider the high COD,PO3- 4, and NH4+ -values. Likewise Station W6 (situated in the “Westzijderveld”) makes a polluted impression, especially because of its high NO-2 -percentage. – According to the saprobical index of Pantle and Buck (1955) all stations must be considered as β-mesosaprobic. – According to the saprobical index of Zelinka & Marvan (1961) most stations are poly-to α-mesosaprobic. Stations R5 and R7 (“De Reef”) and Station W7 (“Westzijderveld”) have a more βmesosaprobic to α-mesosaprobic character. – Station W6, according to both indices, is the most saprobic Station. – According to the species-diversity- index of Shannon (see Odum, 1971) Stations R5 and R7 (“De Reef”) are the most diverse, Station W 6 the least diverse. – The polder is poor in species. A number of taxa, including Chironomus spec., Tubifex tubifex, Gammarus tigrinus and Neomysis integer appear frequently in very large numbers. Many taxa are only found occasionally. A possible explanation may be found in: a) the oligohaline character of the water (mean Chlorinity above 850 mg/l) with strong fluctuations (from 225 to 1370 mg/l). b) the almost total absence of higher water plants. c) the serious pollution of the polder. Part II. Methodological investigations in two brackish water ditches. In these experiments the relations between the composition of a macrofauna-sample and the actual place of sampling in an uniform ditch (as far as water quality is concerned) as well as the sampling distance were investigated. Macrofauna- (samples were taken in 28 Stations distributed along both banks of a ditch in “De Reef” (september, 1974) and in 16 Stations distributed along both banks of a ditch in the province of Friesland (October, 1974). Conclusions: – The composition of a macrofauna sample is not highly dependant on the place of sampling within the same ditch. – The differences found between samples taken at the opposite banks appear to be of no greater importance than the mutual differences between the samples taken at the same bank. – No significant increase in species number was found when comparing samples taken over a length of 4 or 6 meter with those taken over a length of only 2 meter. – The actual place of sampling (in a uniform ditch) has the smallest influence on the composition of the fauna sample if the sampling methods are standardized. – To obtain the best representative sample it is recommended to sample in several places of the same ditch over relatively short distances. More technical suggestions are made. – Comparing the saprobic valuation, according to the Zelinka & Marvan-index of the individual samples with that of the total catch, one finds out that the first valuation can show a perversion of the reality because of the small number of species involved

Klinische en experimenteele waarnemingen over alcoholtolerantie

Uitgaande van de gedachte, dat de lever een belangrijke rol speelt bij de oxydatie van alcohol werd een onderzoek ingesteld naar de alcoholtolerantie bij ziekten van de lever. Er werd eenmaal een bepaalde hoeveelheid alcohol gegeven en daarna werd op regelmatige tijden het alcoholgehalte van het bloed bepaald met de methode van Widmark. ... Zie: Samenvatting