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      Increment in Dietary Potassium Predicts Weight Loss in the Treatment of the Metabolic Syndrome

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          Abstract

          Background: In the treatment of obesity/metabolic syndrome, dietary measures traditionally focus on reducing carbohydrate/fat-related caloric intake. The possibility that changes in potassium consumption may be related to the achieved weight loss has not been previously explored. Methods: Sixty-eight participants, with a mean age of 51.6 ± 11.0 years (F/M—30/38), who fulfilled the ATPIII criteria for the metabolic syndrome (MS) were enrolled into a 1-year intensive multidisciplinary program. Nutritional recommendation consisted of a moderate low calorie/high protein Mediterranean diet. Baseline assessment included clinical and biochemical profiling, and body composition. Nutritional components were registered over 7 days before and at the end of 1 year of treatment. Results: Mean baseline body mass index (BMI) was 35 ± 4 kg/m², which declined by 9.4 ± 0.1% after one year of combined intervention. Linear stepwise regression analysis revealed that 45% of the predicted variance of the % decline in BMI was related to increased consumption of dietary potassium (β = −0.865) and caproic acid (β = −0.423) and reduction in the consumption of dietary vitamin B6 (β = 0.542), calcium (β = 0.335), total carbohydrates (β = 0.239) and total caloric intake (β = 0.238; p < 0.001). Notably, the strongest correlate of the decline in BMI was the increase in dietary potassium intake (β = −0.865). Subjects whose achieved decrease in BMI was above the average ( n = 30) increased potassium intake by 25% as compared to an increase in dietary potassium intake of only 3% by those whose decline in BMI was below the average ( n = 36; p < 0.05). The change in dietary potassium was related to the percent increase in dietary protein (r = 0.433; p < 0.001). Conclusion: An increase in dietary potassium consumption is a previously unrecognized predictor of the achieved reduction in BMI in a weight-loss-oriented multidisciplinary intervention in obesity/MS. Prospective trials are underway to confirm this post-hoc finding.

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          Most cited references19

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          Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study.

          Although the DASH (Dietary Approaches to Stop Hypertension) diet has been shown to lower blood pressure (BP) in short-term feeding studies, it has not been shown to lower BP among free-living individuals, nor has it been shown to alter cardiovascular biomarkers of risk. To compare the DASH diet alone or combined with a weight management program with usual diet controls among participants with prehypertension or stage 1 hypertension (systolic BP, 130-159 mm Hg; or diastolic BP, 85-99 mm Hg). Randomized, controlled trial in a tertiary care medical center with assessments at baseline and 4 months. Enrollment began October 29, 2003, and ended July 28, 2008. Overweight or obese, unmedicated outpatients with high BP (N = 144). Usual diet controls, DASH diet alone, and DASH diet plus weight management. The main outcome measure is BP measured in the clinic and by ambulatory BP monitoring. Secondary outcomes included pulse wave velocity, flow-mediated dilation of the brachial artery, baroreflex sensitivity, and left ventricular mass. Clinic-measured BP was reduced by 16.1/9.9 mm Hg (DASH plus weight management); 11.2/7.5 mm (DASH alone); and 3.4/3.8 mm (usual diet controls) (P < .001). A similar pattern was observed for ambulatory BP (P < .05). Greater improvement was noted for DASH plus weight management compared with DASH alone for pulse wave velocity, baroreflex sensitivity, and left ventricular mass (all P < .05). For overweight or obese persons with above-normal BP, the addition of exercise and weight loss to the DASH diet resulted in even larger BP reductions, greater improvements in vascular and autonomic function, and reduced left ventricular mass. clinicaltrials.gov Identifier: NCT00571844.
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            Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials.

            To assess the effects of supplementation with oral potassium on blood pressure in humans. Meta-analysis of randomized controlled trials. English-language articles published before July 1995. Thirty-three randomized controlled trials (2609 participants) in which potassium supplementation was the only difference between the intervention and control conditions. Using a standardized protocol, 2 of us independently abstracted information on sample size, duration, study design, potassium dose, participant characteristics, and treatment results. By means of a random-effects model, findings from individual trials were pooled, after results for each trial were weighted by the inverse of its variance. An extreme effect of potassium in lowering blood pressure was noted in 1 trial. After exclusion of this trial, potassium supplementation was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic blood pressure of -3.11 mm Hg (-1.91 to -4.31 mm Hg) and -1.97 mm Hg (-0.52 to -3.42 mm Hg), respectively. Effects of treatment appeared to be enhanced in studies in which participants were concurrently exposed to a high intake of sodium. Our results support the premise that low potassium intake may play an important role in the genesis of high blood pressure. Increased potassium intake should be considered as a recommendation for prevention and treatment of hypertension, especially in those who are unable to reduce their intake of sodium.
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              Sodium and potassium intakes among US adults: NHANES 2003-2008.

              The American Heart Association (AHA), Institute of Medicine (IOM), and US Departments of Health and Human Services and Agriculture (USDA) Dietary Guidelines for Americans all recommend that Americans limit sodium intake and choose foods that contain potassium to decrease the risk of hypertension and other adverse health outcomes. We estimated the distributions of usual daily sodium and potassium intakes by sociodemographic and health characteristics relative to current recommendations. We used 24-h dietary recalls and other data from 12,581 adults aged ≥20 y who participated in NHANES in 2003-2008. Estimates of sodium and potassium intakes were adjusted for within-individual day-to-day variation by using measurement error models. SEs and 95% CIs were assessed by using jackknife replicate weights. Overall, 99.4% (95% CI: 99.3%, 99.5%) of US adults consumed more sodium daily than recommended by the AHA ( 1500 mg/d, and 60.4% consumed >3000 mg/d-more than double the recommendation. Overall, <2% of US adults and ~5% of US men consumed ≥4700 mg K/d (ie, met recommendations for potassium). Regardless of recommendations or sociodemographic or health characteristics, the vast majority of US adults consume too much sodium and too little potassium.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                02 June 2019
                June 2019
                : 11
                : 6
                : 1256
                Affiliations
                Thhe Sagol Center for Epigenetics of Aging and Metabolism, the Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv-Sourasky Medical Center; Sackler Faculty of Medicine, Tel Aviv University, 6423906 Tel Aviv, Israel; bruryat@ 123456tlvmc.gov.il (B.T.); jessicasack8@ 123456gmail.com (J.S.); yaron5@ 123456orange.net.il (M.Y.); gabish@ 123456tlvmc.gov.il (G.S.); buchasaf@ 123456gmail.com (A.B.); lbenhaim1@ 123456gmail.com (L.B.H.); yonitm@ 123456tlvmc.gov.il (Y.M.); galina.shenkerman@ 123456gmail.com (G.S.); yaelso@ 123456tlvmc.gov.il (Y.S.); gabi.shefer@ 123456gmail.com (L.S.); mirim@ 123456tlvmc.gov.il (M.M.)
                Author notes
                [* ]Correspondence: naftalis@ 123456tlvmc.gov.il or nafstern66@ 123456gmail.com ; Tel.:+972-36973732
                Article
                nutrients-11-01256
                10.3390/nu11061256
                6627830
                31159504
                57602e40-df7d-457b-8b39-3f740a74bdc9
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 April 2019
                : 30 May 2019
                Categories
                Article

                Nutrition & Dietetics
                dietary potassium,metabolic syndrome,weight loss
                Nutrition & Dietetics
                dietary potassium, metabolic syndrome, weight loss

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