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      Achieving Salt Restriction in Chronic Kidney Disease

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          Abstract

          There is consistent evidence linking excessive dietary sodium intake to risk factors for cardiovascular disease and chronic kidney disease (CKD) progression in CKD patients; however, additional research is needed. In research trials and clinical practice, implementing and monitoring sodium intake present significant challenges. Epidemiological studies have shown that sodium intake remains high, and intervention studies have reported varied success with participant adherence to a sodium-restricted diet. Examining barriers to sodium restriction, as well as factors that predict adherence to a low sodium diet, can aid researchers and clinicians in implementing a sodium-restricted diet. In this paper, we critically review methods for measuring sodium intake with a specific focus on CKD patients, appraise dietary adherence, and factors that have optimized sodium restriction in key research trials and discuss barriers to sodium restriction and factors that must be considered when recommending a sodium-restricted diet.

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          Most cited references79

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          Development, validation and utilisation of food-frequency questionnaires - a review.

          The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record). A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts. Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text. FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.
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            EBPG guideline on nutrition.

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              Relative contributions of dietary sodium sources.

              Information on the relative contributions of all dietary sodium (Na) sources is needed to assess the potential efficacy of manipulating the component parts in efforts to implement current recommendations to reduce Na intake in the population. The present study quantified the contributions of inherently food-borne, processing-added, table, cooking, and water sources in 62 adults who were regular users of discretionary salt to allow such an assessment. Seven-day dietary records, potable water collections, and preweighted salt shakers were used to estimate Na intake. Na added during processing contributed 77% of total intake, 11.6% was derived from Na inherent to food, and water was a trivial source. The observed table (6.2%) and cooking (5.1%) values may overestimate the contribution of these sources in the general population due to sample characteristics, yet they were still markedly lower than previously reported values. These findings, coupled with similar observations from other studies, indicate that reduction of discretionary salt will contribute little to moderation of total Na intake in the population.
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                Author and article information

                Journal
                Int J Nephrol
                Int J Nephrol
                IJN
                International Journal of Nephrology
                Hindawi Publishing Corporation
                2090-214X
                2090-2158
                2012
                23 December 2012
                : 2012
                : 720429
                Affiliations
                1Nutrition and Dietetics Department, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia
                2School of Human Movement Studies, University of Queensland, Blair Drive, St Lucia, Brisbane, QLD 4072, Australia
                3Department of Nephrology, Princess Alexandra Hospital, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia
                Author notes
                *Emma J. McMahon: e.hall5@ 123456uq.edu.au

                Academic Editor: Siren Sezer

                Article
                10.1155/2012/720429
                3540779
                23320173
                51a8ece4-9724-4b7d-be96-2deeb6683c67
                Copyright © 2012 Emma J. McMahon et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 July 2012
                : 29 October 2012
                Categories
                Review Article

                Nephrology
                Nephrology

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