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Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study

Mente A, O'Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A, et al.

Lancet, 2018 08 11;392(10146):496-506.
PMID: 30129465 DOI: 10.1016/S0140-6736(18)31376-X

BACKGROUND: WHO recommends that populations consume less than 2 g/day sodium as a preventive measure against cardiovascular disease, but this target has not been achieved in any country. This recommendation is primarily based on individual-level data from short-term trials of blood pressure (BP) without data relating low sodium intake to reduced cardiovascular events from randomised trials or observational studies. We investigated the associations between community-level mean sodium and potassium intake, cardiovascular disease, and mortality.
METHODS: The Prospective Urban Rural Epidemiology study is ongoing in 21 countries. Here we report an analysis done in 18 countries with data on clinical outcomes. Eligible participants were adults aged 35-70 years without cardiovascular disease, sampled from the general population. We used morning fasting urine to estimate 24 h sodium and potassium excretion as a surrogate for intake. We assessed community-level associations between sodium and potassium intake and BP in 369 communities (all >50 participants) and cardiovascular disease and mortality in 255 communities (all >100 participants), and used individual-level data to adjust for known confounders.
FINDINGS: 95 767 participants in 369 communities were assessed for BP and 82 544 in 255 communities for cardiovascular outcomes with follow-up for a median of 8·1 years. 82 (80%) of 103 communities in China had a mean sodium intake greater than 5 g/day, whereas in other countries 224 (84%) of 266 communities had a mean intake of 3-5 g/day. Overall, mean systolic BP increased by 2·86 mm Hg per 1 g increase in mean sodium intake, but positive associations were only seen among the communities in the highest tertile of sodium intake (p<0·0001 for heterogeneity). The association between mean sodium intake and major cardiovascular events showed significant deviations from linearity (p=0·043) due to a significant inverse association in the lowest tertile of sodium intake (lowest tertile <4·43 g/day, mean intake 4·04 g/day, range 3·42-4·43; change -1·00 events per 1000 years, 95% CI -2·00 to -0·01, p=0·0497), no association in the middle tertile (middle tertile 4·43-5·08 g/day, mean intake 4·70 g/day, 4·44-5.05; change 0·24 events per 1000 years, -2·12 to 2·61, p=0·8391), and a positive but non-significant association in the highest tertile (highest tertile >5·08 g/day, mean intake 5·75 g/day, >5·08-7·49; change 0·37 events per 1000 years, -0·03 to 0·78, p=0·0712). A strong association was seen with stroke in China (mean sodium intake 5·58 g/day, 0·42 events per 1000 years, 95% CI 0·16 to 0·67, p=0·0020) compared with in other countries (4·49 g/day, -0·26 events, -0·46 to -0·06, p=0·0124; p<0·0001 for heterogeneity). All major cardiovascular outcomes decreased with increasing potassium intake in all countries.
INTERPRETATION: Sodium intake was associated with cardiovascular disease and strokes only in communities where mean intake was greater than 5 g/day. A strategy of sodium reduction in these communities and countries but not in others might be appropriate.
FUNDING: Population Health Research Institute, Canadian Institutes of Health Research, Canadian Institutes of Health Canada Strategy for Patient-Oriented Research, Ontario Ministry of Health and Long-Term Care, Heart and Stroke Foundation of Ontario, and European Research Council.

Matched MeSH terms: Sodium, Dietary/administration & dosage; Sodium, Dietary/adverse effects
Fulltext Urinary Sodium and Potassium, and Risk of Ischemic and Hemorrhagic Stroke (INTERSTROKE): A Case-Control Study

Judge C, O'Donnell MJ, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, et al.

Am J Hypertens, 2021 04 20;34(4):414-425.
PMID: 33197265 DOI: 10.1093/ajh/hpaa176

BACKGROUND: Although low sodium intake (<2 g/day) and high potassium intake (>3.5 g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke.
METHODS: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes.
RESULTS: Compared with an estimated urinary sodium excretion of 2.8-3.5 g/day (reference), higher (>4.26 g/day) (odds ratio [OR] 1.81; 95% confidence interval [CI], 1.65-2.00) and lower (<2.8 g/day) sodium excretion (OR 1.39; 95% CI, 1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4.26 g/day) was significantly greater (P < 0.001) for intracerebral hemorrhage (ICH) (OR 2.38; 95% CI, 1.93-2.92) than for ischemic stroke (OR 1.67; 95% CI, 1.50-1.87). Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P = 0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1.58 g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke.
CONCLUSIONS: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for ICH than ischemic stroke. Our data suggest that moderate sodium intake-rather than low sodium intake-combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.

Matched MeSH terms: Sodium, Dietary
The effect of thyroxine on the renal function of asphyxiated neonates

Rostenberghe, H.V., Haider, D., Abdullah, Y., Amir, H., Abdul Razak, A.R.

Malaysian Journal of Paediatrics and Child Health, 1998;10(2):19-23.
MyJurnal

Thyroxine has been shown to have a beneficial effect on renal function in cases of impending renal failure in ani-mal studies.'5 Studies of the use of thyroxine in humans in impending renal failure are scarce. The aim of this study was to assess the effect of oral thyroxine on the renal function of asphyxiated term neonates who often have renal impairment.
A randomised control trial was conducted, involving 30 term asphyxiated neonates. The study group (n=15) was given thyroxine (50 pg) orally on days 1, 2 and 3 of life and placebo was given to the control group (n=15). Renal function was studied on day 1 and day 4 of life. The two groups did not differ significantly as regards gestational age, birth weight, severity of asphyxia, preg-nancy or delivery complications, fluids administered and drugs used. There was no significant difference in urine output, creatinine clearance and fractional excretion of sodium on day 1 but there was a trend towards a worse renal function on day 1 in the treatment group. The creatinine clearance was significantly better in the treat-ment group on day 4 (p = 0.017). Urine output and fractional excretion of sodium on day 4 were better in the treatment group but the differences did not reach statistical significance (p = 0.14 and 0.057 respectively). Statistical analysis on the differences between day 4 and day 1 showed statistical significance only for creatinine clearance: creatinine clearance day 4 minus creatinine clearance day 1 was 52.6 (±32.4) for the thyroxine group and 7.3 (±7.8) for the controls (p= 0.006).
These data support the hypothesis that thyroxine may have a significant beneficial effect on the renal function in term neonates with perinatal asphyxia. Thyroxine may be proven useful in future for patients with impending renal failure.

Matched MeSH terms: Sodium, Dietary
Fulltext The association between body weight status, sodium intake and blood pressure with intraocular pressure among orang asli adolescents in Semenyih, Selangor

Nurulain Asri, Tasneem Shaari, Mohd Zaki Awg Isa

Journal of Optometry, Eye and Health Research, 2020;2(1):48-56.
MyJurnal

Abnormal intraocular pressure (IOP) if left untreated it can lead to glaucoma and permanent vision loss. However, the correlation between IOP and body weight status, sodium intake, and blood pressure (BP) are unclear among adolescents. This cross-sectional study aimed to determine the relationship between body weight status, sodium intake, and BP with IOP among orang Asli adolescents. A total sample of 50 adolescents of Orang Asli aged 13 to 17 participated in this study. Three days' dietary intake was recorded through 24-hour diet recall to determine the sodium intake. The questionnaire was administered to acquire socio-demographic information, and measurements Body Mass Index (BMI) and BP were done according to standard protocols, and IOP was measured using Tonopen. Data obtained involving 40% boys and 60% girls. Two boys (4%) were underweight, 13 boys (26%) and 17 (34%) girls were normal weight, 4 (8%) boys and 11 (22%) girls were overweight, 1 (2%) boy and 2 (4%) girls were obese. Sixty percent of subjects have exceeded the Lowest-Observed-Adverse-Effect-Level (LOAEL) of 2300 mg of sodium intake. Hypertension stage 1 was found higher than hypertension stage 2 in male and female subjects, with 38% of the female have stage 1 hypertension compared to only 14% in male subjects. 98% of subjects have normal IOP and only 2% of subjects have high IOP. There was a significant association between BMI and IOP (p

Matched MeSH terms: Sodium, Dietary
The applicability of using a protease extracted from cashew fruits (Anacardium occidentale), as possible meat tenderizer: An experimental design approach

Ahmad MN, Shuhaimen MS, Normaya E, Omar MN, Iqbal A, Ku Bulat KH

J Texture Stud, 2020 10;51(5):810-829.
PMID: 32401337 DOI: 10.1111/jtxs.12529

Meat tenderness is one of the most important organoleptic properties in determining consumer acceptance in meat product marketability. Therefore, an effective meat tenderization method is sought after by exploring plant-derived proteolytic enzymes as meat tenderizer. In this study, a novel protease from Cashew was identified as a new alternative halal meat tenderizer. The extraction of cashew protease was optimized using response surface methodology (R2 = 0.9803) by varying pH, CaCl2 concentration, mixing time, and mass. pH 6.34, 7.92 mM CaCl2 concentration, 5.51 min mixing time, and 19.24 g sample mass were the optimal extraction conditions. There was no significant difference (n = 3; p

Matched MeSH terms: Sodium, Dietary
Study of low salt diet in hypertensive patients with chronic kidney disease

Koh KH, Wei-Soon LH, Jun L, Lui-Sian LN, Hui-Hong CT

Med J Malaysia, 2018 12;73(6):376-381.
PMID: 30647207

INTRODUCTION: The efficacy of blood pressure (BP) reduction with salt restriction in CKD subjects and its sustainability is not well established.
METHODS: We enrolled 75 hypertensive patients with CKD into one-month salt restricting diet. 24-hour urinary sodium and potassium was measured to verify their salt intake followed by 1½ year follow-up.
RESULTS: Their creatinine clearance was 43 ± standard deviation 33ml/min/1.73m2. Urinary Na excretion (24HUNa) was 173±129mmol/day, reducing to 148±81 by 31±6 day. Mean, systolic and diastolic BP (MBP, SBP, DBP) were reduced from 102±9 to 97±11 (p<0.001), 148±10 to 139±16 (p<0.001), 78±12 to 75±12 mmHg (p=0.012) respectively. Moderate correlations were shown between reductions in 24-hour urinary Na and MBP, SBP, DBP: r=0.366, 0.260, 0.365; p=0.001, 0.025, 0.001; whereas 24-hour urinary Na-K ratio showed mild correlation. Subjects have some tendency to drift back to previous Na intake profile in follow-up and thus repetitive education is necessary. In subanalysis, 34 subjects with baseline 24HUNa >150 mmol/day, benefited significantly with MBP, SBP, DBP reduction from 102±9 to 95±9 (p=0.001), 146±10 to 135±14 mmHg (p=0.001), 80±11 to 75±11 mmHg (p=0.002) in line with 24HUNa reduction from 253±154 to 163±87mmol/day (p=0.004) and urinary protein-creation ratio reduction from geometric mean of 95 to 65 g/mol. Thirty five subjects with 24HUNa reduction of >20mmol/day have significant reduction in MBP, SBP, DBP: -8 vs -2, -15 vs -4, -5 vs -2 mmHg (p=0.027, 0.006, 0.218) and urinary protein-creatinine ratio: -82 vs 2g/mol (p=0.030) compared to the other forty subjects.
CONCLUSION: Quantification of 24-hour urinary Na helps in predicting potential antihypertensive effect with dietary salt reduction of CKD subjects. Salt restriction reduces BP especially in patients with estimated daily sodium intake of >150mmol/day. Reduction in sodium intake beyond 20mmol/day reduced both BP and proteinuria.

Matched MeSH terms: Sodium, Dietary/administration & dosage*
Special focus on the role of α(1D)-adrenoreceptors in the assessment of renal tubular sodium re-absorptive responses in spontaneously hypertensive rats subjected to high sodium diet

Kazi RN, Sattar MA, Abdullah NA, Khan MA, Rathore HA, Abdulla MH, et al.

Yakugaku Zasshi, 2011 Mar;131(3):431-6.
PMID: 21372540

α(1D)-adrenoceptors are involved in the genesis/maintenance of hypertension in spontaneously hypertensive rats (SHR). This study aims to investigate the role of α(1D)-adrenoceptors in the antinatriuretic and antidiuretic responses in SHR subjected to high sodium (SHRHNa) and normal sodium (SHRNNa) intake for six weeks. Renal inulin clearance study was performed in which the antinatriuretic and antidiuretic responses to phenylephrine were examined in the presence and absence of α(₁D)-adrenoceptors blocker BMY7378. Data, mean±S.E.M. were subjected to ANOVA with significance at p<0.05. Results show that feeding SHR for six weeks with high salt did not cause any change in blood pressure. SHRHNa had higher (all p<0.05) urine flow rate (UFR), fractional and absolute excretion of sodium (FE(Na) and U(Na)V) compared to SHRNNa. Phenylephrine infusion produced significant reduction in UFR, FE(Na) and U(Na)V in both SHRHNa and SHRNNa. The antidiuretic and antinatriuretic responses to phenylephrine in both groups were attenuated in the presence of BMY7378. Moreover, the antidiuretic and antinatriuretic responses to phenylephrine and BMY7378 were independent on any significant changes in renal and glomerular hemodynamics in both groups. Thus we conclude that high sodium intake did not bring any further increase in blood pressure of SHR, however, it results in exaggerated natriuresis and diuresis in SHRHNa. Irrespective of dietary sodium changes, α₁-adrenoceptors are involved in mediating the antinatriuretic and antidiuretic responses to phenylephrine in SHR. Further, high sodium intake did not significantly influence the functionality of α(₁D)-adrenoceptors in mediating the adrenergically induced antinatriuresis and antidiuresis.

Matched MeSH terms: Sodium, Dietary/administration & dosage*
Fulltext Sodium intake in Malaysian adults: validation of estimations by dietary and spot urine excretion methods versus 24-hour urine excretion

Mohamad Hasnan Ahmad, Fatimah Othman, Azli Baharudin, Cheong Siew Man, Muslimah Yusof, Rashidah Ambak, et al.

International Journal of Allied Health Sciences, 2018;2(3):489-498.
MyJurnal

There are several methods available for assessment of sodium intake, including dietary and urinary excretion, which are fraught with methodological difficulties. Therefore, the aim of this study was to validate dietary and urinary excretion methods against 24-hour urinary excretion method in estimating sodium intake in Malaysian adults. A cross-sectional study has been carried out between November to December 2015. About 1568 adults aged 18 to 59 years old have participated from 16 study sites located in the 13 states and two federal territories of Malaysia. The study collected basic socio-demographic data and habitual dietary intake by Food Frequency Questionnaire (FFQ). Respondents were also asked to complete a two-day food intake diary (2FD) and collect their 24-hours urine and spot urine using standard protocols. A total of 1116 adults successfully completed the survey, yielding a response rate of 71%. Sodium intake from 24-hour urine excretion was estimated at 2585.9mg/day which is above the recommendation by World Health Organization (WHO). The 2FD showed the nearest mean estimate to the reference method but the spot urine with Tanaka’s predictive equation showed the least bias. The estimation of sodium from spot urine alone or with Kawasaki’s predictive equation and FFQ method showed poor mean estimates and a large bias compared to the reference method. The 2FD and spot urine with Tanaka’s prediction equation can be good alternatives for estimating daily sodium intake at the population level but not at the individual level.

Matched MeSH terms: Sodium, Dietary
Fulltext Sodium intake assessed by 24-h urine excretion and its relationship with anthropometric measurements in Malaysian adults

Sallehuddin SM, Ambak R, Othman F, Aziz NSA, Palaniveloo L, Nor NSM, et al.

J Health Popul Nutr, 2021 05 31;40(Suppl 1):9.
PMID: 34059153 DOI: 10.1186/s41043-021-00234-1

BACKGROUND: Sodium intake is associated with anthropometric measurement including weight, waist circumference (WC), and body mass index (BMI). Higher intake of sodium is usually linked to higher risk of obesity among adults globally, especially in developing countries. This study aims to explore the probable relationship between sodium intake by 24-h urine excretion assessment and anthropometric measurement of adults in Malaysia.
METHODS: A cross-sectional study was conducted from October 2017 to March 2018 using a multi-stage stratified sampling method among Malaysian adults aged 18 years old and above. Sodium intake was determined by 24-h urinary sodium excretion, estimated from the respondents' 24-h urinary sample. Height was obtained based on standard protocol. Weight and WC were measured twice using validated anthropometric equipment and BMI was calculated according to World Health Organization (WHO) 1998 classification. Descriptive analysis was done to describe socio-demographic characteristics. A simple linear regression and multiple linear regression tests were done to assess the relationship of 24-h urinary excretion and anthropometric measurement. All statistical analysis was done using SPSS version 22.0.
RESULTS: Of 1047 interviewed respondents, 798 respondents had done the 24-h urine collection (76.0% response rate). Majority was between 40 and 59 years old (43.5%) and married (77.7%). Simple linear regression showed a significant positive linear association between 24-h urinary excretion and household income, WC, and obese group. In the multivariate analysis, it was indicated that, an increase of 1 unit of BMI will significantly increase the sodium intake by 129.20 mg/dl and an increase of 1 cm of WC will significantly increase the sodium intake by 376.45 mg/dl.
CONCLUSION: Our study showed a positive significant relationship between sodium intake estimated by 24-h urinary sodium excretion and BMI of Malaysian adults. More research is suggested on how sodium control can potentially contribute to obesity prevention.

Matched MeSH terms: Sodium, Dietary*
Fulltext Sodium intake among normotensive health staff assessed by 24-hour urinary excretion: a cross-sectional study

Rashidah, A., Yeo, P.S., Noor Ani, A., Muhammad Fadhli, M.Y., Tahir, A., Feisul Idzwan, M., et al.

Malays J Nutr, 2014;20(3):317-326.
MyJurnal

Introduction: High sodium consumption over an extended period of time has been associated with hypertension, stroke, cardiovascular disease, renal damage, and other adverse health effects. This study aimed to determine urinary sodium excretion and consequently estimate dietary sodium consumption among normotensive health staff in Malaysia. Methods: A cross-sectional study was conducted to acquire data on sodium excretion among normotensive Ministry of Health staff aged 20 - 56 years (mean age 35.08, SD 9.78) in 14 states and a research institute. Respondents were recruited using quota sampling. Data collection was conducted from December 2011 to February 2012. A single urine sample was collected over 24 hours for sodium concentrations and calculated as 95.0% of total daily sodium intake. Results: Among the 471 enrolled respondents, 445 (94.0%) provided complete information on socio-demography and urine samples. Mean urine sodium excretion was 142.0 mmol/day (SD 71.7), which is equivalent to 3429 mg sodium/day or 8.7 gm of salt intake (1.75 teaspoon, which exceeds the Malaysian recommendation of 2000 mg sodium/day by 1.7 times. About 79.0% (n=353) of respondents (88.0% male and 73.0% female) had daily sodium consumption that was above the recommendation. Excretion was significantly higher among males at 161.7 mmol/day (SD 78.1) (3726 mg sodium/day) than females, 125.3 mmolfday (SD 61.1) (2875 mg/day). There was a positive, low correlation between BMl and sodium intake (r=0.216, p

Matched MeSH terms: Sodium, Dietary
Fulltext Salt intakes and salt reduction initiatives in Southeast Asia: a review

Batcagan-Abueg AP, Lee JJ, Chan P, Rebello SA, Amarra MS

Asia Pac J Clin Nutr, 2013;22(4):490-504.
PMID: 24231008 DOI: 10.6133/apjcn.2013.22.4.04

Increased dietary sodium intake is a modifiable risk factor for cardiovascular disease. The monitoring of population sodium intake is a key part of any salt reduction intervention. However, the extent and methods used for as-sessment of sodium intake in Southeast Asia is currently unclear. This paper provides a narrative synthesis of the best available evidence regarding levels of sodium intake in six Southeast Asian countries: Indonesia, Malaysia, Philippines, Singapore, Thailand, Vietnam, and describes salt reduction measures being undertaken in these countries. Electronic databases were screened to identify relevant articles for inclusion up to 29 February 2012. Reference lists of included studies and conference proceedings were also examined. Local experts and researchers in nutrition and public health were consulted. Quality of studies was assessed using a modified version of the Downs and Black Checklist. Twenty-five studies fulfilled the inclusion criteria and were included in this review. Full texts of 19 studies including government reports were retrieved, with most studies being of good quality. In-sufficient evidence exists regarding salt intakes in Southeast Asia. Dietary data suggest that sodium intake in most SEA countries exceeded the WHO recommendation of 2 g/day. Studies are needed that estimate sodium intake using the gold standard 24-hour urinary sodium excretion. The greatest proportion of dietary sodium came from added salt and sauces. Data on children were limited. The six countries had salt reduction initiatives that differed in specificity and extent, with greater emphasis on consumer education.

Matched MeSH terms: Sodium, Dietary/administration & dosage*; Sodium, Dietary/adverse effects
Role of norepinephrine & angiotensin II in the neural control of renal sodium & water handling in spontaneously hypertensive rats

Salman IM, Sattar MA, Ameer OZ, Abdullah NA, Yam MF, Salman HM, et al.

Indian J Med Res, 2010 Jun;131:786-92.
PMID: 20571167

A wealth of information concerning the essential role of renal sympathetic nerve activity (RSNA) in the regulation of renal function and mean arterial blood pressure homeostasis has been established. However, many important parameters with which RSNA interacts are yet to be explicitly characterized. Therefore, the present study aimed to investigate the impact of acute renal denervation (ARD) on sodium and water excretory responses to intravenous (iv) infusions of either norepinephrine (NE) or angiotensin II (Ang II) in anaesthetized spontaneously hypertensive rats (SHR).

Matched MeSH terms: Sodium, Dietary*
Processed foods and the nutrition transition: evidence from Asia

Baker P, Friel S

Obes Rev, 2014 Jul;15(7):564-77.
PMID: 24735161 DOI: 10.1111/obr.12174

This paper elucidates the role of processed foods and beverages in the 'nutrition transition' underway in Asia. Processed foods tend to be high in nutrients associated with obesity and diet-related non-communicable diseases: refined sugar, salt, saturated and trans-fats. This paper identifies the most significant 'product vectors' for these nutrients and describes changes in their consumption in a selection of Asian countries. Sugar, salt and fat consumption from processed foods has plateaued in high-income countries, but has rapidly increased in the lower-middle and upper-middle-income countries. Relative to sugar and salt, fat consumption in the upper-middle- and lower-middle-income countries is converging most rapidly with that of high-income countries. Carbonated soft drinks, baked goods, and oils and fats are the most significant vectors for sugar, salt and fat respectively. At the regional level there appears to be convergence in consumption patterns of processed foods, but country-level divergences including high levels of consumption of oils and fats in Malaysia, and soft drinks in the Philippines and Thailand. This analysis suggests that more action is needed by policy-makers to prevent or mitigate processed food consumption. Comprehensive policy and regulatory approaches are most likely to be effective in achieving these goals.

Matched MeSH terms: Sodium, Dietary/adverse effects
Fulltext Preliminary study of the nutritional content of Malaysian edible bird’s nest

Norhayati, M.K., Azman, O., Wan Nazaimoon, W.M.

Malays J Nutr, 2010;16(3):389-396.
MyJurnal

Malaysian edible bird’s nests (EBN) are from the swiflet species, Aerodromus fuciphagus. The objective of this study was to determine and compare the nutrient composition of EBN obtained from different parts of Peninsular Malaysia, collected at three different harvesting seasons, to four commercial brands. A total of 18 raw, unprocessed EBN samples from the North, South and East Coast zones of Peninsular Malaysia and duplicate samples of 4 commercial brands (processed) of EBN samples were analysed. The protein and mineral contents of unprocessed EBN samples between zones and harvesting seasons were comparable. Mean (± SEM) protein content of unprocessed EBN was 61.5 ± 0.6 g/100g and the top four minerals detected were calcium, sodium, magnesium and potassium with mean (± SEM) concentration of 553.1 ± 19.5 mg/100g, 187.9 ± 10.4 mg/100g, 92.9 ± 2.0 mg/100g and 6.3 ± 0.4 mg/100g respectively. Sialic acid content ranged between 0.7 to 1.5%, and remained comparable between samples from different zones and harvesting seasons. The commercial brands were found to contain higher amounts of calcium, sodium, magnesium, potassium and phosphorus compared to unprocessed EBN, warranting further investigation and verification with more samples. Since the nutrient contents of EBN may be affected by seasonal variations and even breeding sites, it is recommended that a more comprehensive study be conducted involving more samples and breeding sites as such data are important to ensure sustainability of the EBN industry in this country.

Matched MeSH terms: Sodium, Dietary
Fulltext Plasma total antioxidant capacity (TAC) in obese Malaysian subjects

Lim SH, Fan SH, Say YH

Malays J Nutr, 2012 Dec;18(3):345-54.
PMID: 24568075 MyJurnal

INTRODUCTION: There is a pressing need to better understand the complex biochemical pathways that lead to the pathogenesis of obesity. Increased oxidative stress and decreased antioxidant capacity have been identified to be associated with obesity. Therefore, the objectives of this study were to determine the plasma total antioxidant capacity (TAC) levels of Malaysian subjects and to evaluate its potential association with obesity and related anthropometric measurements.
METHODS: Plasma TAC of 362 multi-ethnic Malaysian subjects from the Kampar Health Clinic (138 males, 224 females; 124 ethnic Malays, 152 Chinese, 86 Indians; 192 non-obese, 170 obese) was measured using Trolox equivalent antioxidant capacity (TEAC) 96-well plate assay.
RESULTS: Plasma TAC was significantly lower in obese subjects (M +/- SE = 292 +/- 10.4 micromol/L) compared to non-obese subjects (397 +/- 8.58 micromol/L), whereas it was significantly higher in males and those in the 21-30 age group. Those with salty food preference and practising a strict vegetarian diet also had significantly higher plasma TAC. However, no association was found for other dietary habits (coffee intake) and lifestyle factors (physical activity, smoking). Plasma TAC was also significantly negatively correlated with diastolic blood pressure, waist and hip circumferences, weight, body mass index, total body fat, % subcutaneous fat, visceral fat level, resting metabolism and % skeletal muscle.
CONCLUSION: Plasma TAC was found to be associated with obesity, strict vegetarian practice, salty food preference and all obesity anthropometric indicators, except systolic blood pressure and pulse rate. Obese people have decreased plasma TAC indicating a compromised systemic antioxidant defence and increased oxidative stress.

Matched MeSH terms: Sodium, Dietary
Fulltext Nutritional, phytochemical and pharmacological properties of Canarium odontophyllum miq. (Dabai) fruit

Tan, Chin Xuan, Azrina Azlan

The Pertanika Journal of Scholarly Research Reviews, 2016;2(1):80-94.
MyJurnal

Canarium odontophyllum Miq. fruit, popularly recognized as dabai fruit in Sarawak, is a
seasonal fruit found in the tropical rainforest of East Malaysia. A dabai fruit can be divided into
several anatomical parts, and different parts of the fruit have different valuable phytochemicals. Due
to the lack of promotion, dabai fruit is viewed as nutritionally inferior fruit by the public. On the
contrary, the fruit is rich in nutrients such as protein, fat, carbohydrates, sodium, calcium and iron.
Many phytochemicals have been detected from different parts of dabai fruit, and these molecules have
been linked to beneficial properties such as hypolipidemic, anti-atherosclerotic, anti-cholinesterase,
antimicrobial and potentially anti-diabetic. The aim of this article is to review research studies on this
fruit in order to provide adequate baseline information for commercial exploitation as well as for
future studies.

Matched MeSH terms: Sodium, Dietary
Fulltext Mineral composition and pasting properties of banana pseudo-stem flour from Musa acuminata X balbisiana cv. Awak grown locally in Perak, Malaysia

Ho, L.H., Noor Aziah, A.A., Rajeev Bhat

International Food Research Journal, 2012;19(4):1479-1485.
MyJurnal

The banana pseudo-stem is not currently utilised in the food industry. The aim of this research was to investigate the chemical and pasting profile of banana pseudo-stem flour (BPF). Wheat flour were substituted with BPF (0, 5, 15 and 30%) and the pasting profile were determined. Results from mineral analysis showed that the levels of sodium (Na), potassium (K), calcium (Ca), magnesium (Mg) and phosphorus (P) were higher than those of iron (Fe), zinc (Zn) and manganese (Mn). The BPF had a 0.04% total titratable acidity (TTA) and a total soluble solid (TSS) of 1.30⁰ Brix with pH 5.41. BPF contained 28.26% total starch, 12.81% resistant starch and a total digestible starch value of 15.45%. An increased substitution level of BPF into wheat flour significantly (p

Matched MeSH terms: Sodium, Dietary
Metering Self-Reported Adherence to Clinical Outcomes in Malaysian Patients With Hypertension: Applying the Stages of Change Model to Healthful Behaviors in the CORFIS Study

Karupaiah T, Wong K, Chinna K, Arasu K, Chee WS

Health Educ Behav, 2015 Jun;42(3):339-51.
PMID: 25512075 DOI: 10.1177/1090198114558588

The CORFIS (Community-Based Cardiovascular Risk Factors Intervention Strategies) program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in CORFIS patients with hypertension. Based on submitted diet and exercise records (n = 209), adherence to sodium reduction, regular exercise, and increasing fruit and vegetable intake behaviors were quantified against weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. Patients were categorized at 6 months into nonadherent/N-A (Precontemplation, Contemplation, and Preparation), newly adherent/NA (Action) and totally adherent/TA (Maintenance) groups. Self-reported adherence records did not meet recommended targets for healthful behaviors, but clinical benefits were achieved by adherent groups as indicated by effect size (Cohen's d) comparisons. SBP reduction was associated with adherence to sodium reduction in NA (d = 0.60, p < .001) and TA (d = 0.45, p < .001) compared to N-A (d = 0.13, p > .05). Marginally increasing fruit and vegetable consumption (Δ = 0.41 servings) resulted in sizeable reductions in weight for NA (d = 0.81, p < .001) > TA (d = 0.54, p < .001) > N-A (d = 0.21, p > .05) and in WC for NA (d = 0.68, p < .00) > TA (d = 0.53, p < .001) > N-A (d = 0.52, p > .05). Exercise behavior was least successful as pedometer counting was below 10,000 steps but sizeable weight and WC reductions were largest for NA (d = 0.71 and 0.79, respectively) > TA (d = 0.60 and 0.53, respectively) > N-A (d = 0.33 and 0.35, respectively). Patients reporting a shift to positive stages of change behaviors enjoyed clinically beneficial reductions in SBP, DBP, weight, and WC.

Matched MeSH terms: Sodium, Dietary
Fulltext Knowledge, perception, and practice related to sodium intake among Malaysian adults: findings from the Malaysian Community Salt Study (MyCoSS)

Cheong SM, Ambak R, Othman F, He FJ, Salleh R, Mohd Sallehudin S, et al.

J Health Popul Nutr, 2021 05 31;40(Suppl 1):5.
PMID: 34059162 DOI: 10.1186/s41043-021-00231-4

BACKGROUND: Excessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake.
METHODS: Data were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis.
RESULTS: Majority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05).
CONCLUSION: The absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

Matched MeSH terms: Sodium, Dietary*
Fulltext Is socio-demographic status, body mass index, and consumption of food away from home associated with high sodium intake among adults in Malaysia?: findings from the Malaysian Community Salt Survey (MyCoSS)

Salleh R, Ganapathy SS, Ibrahim Wong N, Cheong SM, Ahmad MH, Palaniveloo L, et al.

J Health Popul Nutr, 2021 05 31;40(Suppl 1):12.
PMID: 34059166 DOI: 10.1186/s41043-021-00236-z

BACKGROUND: Studies have shown that having away from home meals contributes to high sodium intake among young people and those who lived in urban areas. This study aimed to determine the association between dietary sodium intake, body mass index, and away from home meal consumption behaviour among Malaysian adults.
METHODS: MyCoSS was a cross-sectional household survey involving 1440 adults age 18 years and above. This study utilized stratified cluster sampling to obtain a nationally representative sample. Data was collected between October 2017 and March 2018. Socio-demographic information, dietary assessment using food frequency questionnaire (FFQ), and away from home meal consumption were assessed through a face-to-face interview by trained health personnel. Descriptive analysis and logistic regression were applied to identify the association of socioeconomic status and away from home meal consumption with dietary sodium intake.
RESULTS: A total of 1032 participants completed the FFQ, with a mean age of 48.8 + 15.6 years. Based on the FFQ, slightly over half of the participants (52.1%) had high sodium intake. Results showed that 43.6% of participants consumed at least one to two away from home meals per day, while 20.8% of them had their three main meals away from home. Participants aged less than 30 years old were the strongest predictor to consume more sodium (adjusted OR: 3.83; 95%CI: 2.23, 6.58) while those of Indian ethnicity had significantly lower sodium intake. Surprisingly, having three away from home meals per day was not associated with high dietary sodium intake, although a significant association (crude OR; 1.67, 95% CI: 1.19, 2.35) was found in the simple logistic regression. Obese participants were less likely to have high dietary sodium intake compared with the normal BMI participants in the final model.
CONCLUSION: Over half of the participants consumed sodium more than the recommended daily intake, especially those who consumed three away from home meals. However, there was no significant association between high sodium intake and having three away from home meals per day. The promotion of healthy cooking methods among the public must continue to be emphasized to reduce the dietary sodium intake among Malaysian adults.

Matched MeSH terms: Sodium, Dietary*

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