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      Sodio y Enfermedad Cardiovascular: Contexto en Latinoamérica

      book-review

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          Abstract

          Las enfermedades cardiovasculares (ECV) son la principal causa de morbi-mortalidad en Latinoamérica (LA). La ingesta excesiva de sodio constituye uno de los principales factores de riesgo para estas enfermedades. Se han demostrado efectos positivos de la disminución del consumo de sodio sobre los niveles de presión arterial, aparición de ECV, riesgo de infarto y mortalidad a nivel poblacional. En LA, los datos de ingesta de sal/sodio en la mayoría de los casos no son recientes y se han obtenido utilizando diversas metodologías. No obstante, los reportes indican que la ingesta en la región supera los valores y metas de reducción recomendadas por organismos internacionales. En Argentina, Brasil, Chile, Cuba, Colombia, Costa Rica, Uruguay, México, Venezuela y Paraguay se han implementado estrategias que promueven la reducción de la ingesta de sal/sodio. La Organización Panamericana de la Salud (OPS) ha recomendado la estrategia de disminución en la ingesta de sal/sodio a nivel poblacional. El objetivo del presente trabajo fue revisar la evidencia epidemiológica que sustenta dicha estrategia para la disminución de las ECV. De igual forma, se pretende revisar las principales acciones implementadas en LA con el fin de dar cumplimiento a esta meta de reducción del consumo de sal/sodio.

          Translated abstract

          Sodium Intake and Cardiovascular Disease in the Latin American Context. Cardiovascular diseases (CVD) are the main causes of morbidity and mortality in Latin America (LA). A high sodium intake is one of main risk factors for CVD. Strategies aiming to decrease sodium intake has been shown health benefits as reduction of blood pressure, and incidence of CVD at the population level. Data of salt/sodium intake in most LA countries is not up dated and it has been estimated by different methodologies. Nevertheless, it is highly possible that current salt/sodium intake in LA exceeds recommended goals from international organizations. Argentina, Brazil, Chile, Cuba, Colombia, Costa Rica, Uruguay, México Venezuela and Paraguay have implemented strategies to reduce salt/sodium intake at population level; as has been recommended by Pan American Health Organization (PAHO) recommend. The aim of this review was to identify epidemiologic evidence behind sodium reduction strategy to reduce and prevent CVD. Additionally, this review intended to describe main implemented actions in LA.

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          Most cited references28

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          Implications of small reductions in diastolic blood pressure for primary prevention.

          N R Cook (1995)
          To estimate the impact of small reductions in the population distribution of diastolic blood pressure (DBP), such as those potentially achievable by population-wide lifestyle modification, on incidence of coronary heart disease (CHD) and stroke. Published data from the Framingham Heart Study, a longitudinal cohort study, and from the National Health and Nutrition Examination Survey II, a national population survey, were used to examine the impact of a population-wide strategy aimed at reducing DBP by an average of 2 mm Hg in a population including normotensive subjects. White men and women aged 35 to 64 years in the United States. Incidence of CHD and stroke, including transient ischemic attacks (TIAs). Data from overviews of observational studies and randomized trials suggest that a 2-mm Hg reduction in DBP would result in a 17% decrease in the prevalence of hypertension as well as a 6% reduction in the risk of CHD and a 15% reduction in risk of stroke and TIAs. From an application of these results to US white men and women aged 35 to 64 years, it is estimated that a successful population intervention alone could reduce CHD incidence more than could medical treatment for all those with a DBP of 95 mm Hg or higher. It could prevent 84% of the number prevented by medical treatment for all those with a DBP of 90 mm Hg or higher. For stroke (including TIAs), a population-wide 2-mm Hg reduction could prevent 93% of events prevented by medical treatment for those with a DBP of 95 mm Hg or higher and 69% of events for treatment for those with a DBP of 90 mm Hg or higher. A combination strategy of both a population reduction in DBP and targeted medical intervention is most effective and could double or triple the impact of medical treatment alone. Adding a population-based intervention to existing levels of hypertension treatment could prevent an estimated additional 67,000 CHD events (6%) and 34,000 stroke and TIA events (13%) annually among all those aged 35 to 64 years in the United States. A small reduction of 2 mm Hg in DBP in the mean of the population distribution, in addition to medical treatment, could have a great public health impact on the number of CHD and stroke events prevented. Whether such DBP reductions can be achieved in the population through lifestyle interventions, in particular through sodium reduction, depends on the results of ongoing primary prevention trials as well as the cooperation of the food industry, government agencies, and health education professionals.
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            Cost-effectiveness of interventions to reduce dietary salt intake.

            To evaluate population health benefits and cost-effectiveness of interventions for reducing salt in the diet. Proportional multistate life-table modelling of cardiovascular disease and health sector cost outcomes over the lifetime of the Australian population in 2003. The current Australian programme of incentives to the food industry for moderate reduction of salt in processed foods; a government mandate of moderate salt limits in processed foods; dietary advice for everyone at increased risk of cardiovascular disease and dietary advice for those at high risk. Costs measured in Australian dollars for the year 2003. Health outcomes measured in disability-adjusted life years (DALY) averted over the lifetime. Mandatory and voluntary reductions in the salt content of processed food are cost-saving interventions under all modelled scenarios of discounting, costing and cardiovascular disease risk reversal (dominant cost-effectiveness ratios). Dietary advice targeting individuals is not cost-effective under any of the modelled scenarios, even if directed at those with highest blood pressure risk only (best case median cost-effectiveness A$100 000/DALY; 95% uncertainty interval A$64 000/DALY to A$180 000/DALY). Although the current programme that relies on voluntary action by the food industry is cost-effective, the population health benefits could be 20 times greater with government legislation on moderate salt limits in processed foods. Programmes to encourage the food industry to reduce salt in processed foods are highly recommended for improving population health and reducing health sector spending in the long term, but regulatory action from government may be needed to achieve the potential of significant improvements in population health.
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              Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion

              (1988)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                alan
                Archivos Latinoamericanos de Nutrición
                ALAN
                Sociedad Latinoamericana de Nutrición
                0004-0622
                December 2015
                : 65
                : 4
                : 206-215
                Affiliations
                [1 ] Universidad de Antioquia Colombia
                Article
                S0004-06222015000400001
                2b2d4d16-7959-4199-9b01-7f981823507b

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0622&lng=en
                Categories
                NUTRITION & DIETETICS

                Nutrition & Dietetics
                Sal,sodio,enfermedad cardiovascular,Latinoamérica,reducción de sodio,Salt,sodium,Cardiovascular Disease,Latin America,sodium reduction

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