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Background We investigated the synergistic effect of stress and habitual salt preference (SP) on blood pressure (BP) in the hospitalized Omicron-infected patients. Methods From 15,185 hospitalized Omicron-infected patients who reported having high BP or hypertension, we recruited 662 patients. All patients completed an electronic questionnaire on diet and stress, and were required to complete morning BP monitoring at least three times. Results The hypertensive group ( n  = 309) had higher habitual SP ( P  = 0.015) and COVID-19 related stress ( P  < 0.001), and had longer hospital stays (7.4 ± 1.5 days vs. 7.2 ± 0.5 days, P  = 0.019) compared with controls ( n  = 353). After adjusting for a wide range of covariates including Omicron epidemic-related stress, habitual SP was found to increase both systolic (4.9 [95% confidence interval (CI), 2.3–7.4] mmHg, P  < 0.001) and diastolic (2.1 [95%CI, 0.6–3.6] mmHg, P  = 0.006) BP in hypertensive patients, and increase diastolic BP (2.0 [95%CI, 0.2–3.7] mmHg, P  = 0.026) in the control group. 31 (8.8%) patients without a history of hypertension were discovered to have elevated BP during hospitalization, and stress was shown to be different in those patients ( P  < 0.001). In contrast, habitual SP was more common in hypertensive patients with uncontrolled BP, compared with patients with controlled BP ( P  = 0.002). Conclusions Habitual SP and psychosocial stress were associated with higher BP in Omicron-infected patients both with and without hypertension. Nonpharmaceutical intervention including dietary guidance and psychiatric therapy are crucial for BP control during the long COVID-19 period.

Australian children consume too much salt, primarily from processed foods where salt is often used to enhance flavour. Few studies have assessed children’s salt preference in commercially available foods. This study aims to assess (1) children’s preference and ability to discriminate between salt levels in two commercially available foods and (2) if preference or ability to discriminate between salt levels changes after an education program. Chips and corn flakes were tasted at three levels of salt concentration. Children ranked which they liked best (preference) and which was saltiest (ability to discriminate). The proportion of children across categorical responses was assessed (Chi squared and McNemar’s test) together with changes in preference and ability to discriminate between salt levels from timepoint 1 (T1) to timepoint 2 (T2). Ninety-two children (57% female, mean age 9.1 years (SD 0.8)) participated. At T1 approximately one-half and two-thirds of children preferred the highest salt chip and cornflake, respectively, (both p < 0.05). Fifty-seven percent and 63% of children identified the highest level of salt in chips and cornflakes as the saltiest, respectively. Preference and ability to discriminate between salt levels were unchanged between timepoints. Results support product reformulation to decrease salt content of foods provided to children.

We have previously identified that low responsiveness to antidepressive therapy is associated with higher aldosterone/cortisol ratio, lower systolic blood pressure, and higher salt preference. Glycyrrhiza glabra (GG) contains glycyrrhizin, an inhibitor of 11β-hydroxysteroid-dehydrogenase type-2 and antagonist of toll-like receptor 4. The primary hypothesis of this study is that food enrichment with GG extract results in decreased anxiety behavior and reduced salt preference under stress and non-stress conditions. The secondary hypothesis is that the mentioned changes are associated with altered gene expression of barrier proteins in the prefrontal cortex. Male Sprague-Dawley rats were exposed to chronic mild stress for five weeks. Both stressed and unstressed rats were fed a diet with or without an extract of GG roots for the last two weeks. GG induced anxiolytic effects in animals independent of stress exposure, as measured in elevated plus maze test. Salt preference and intake were significantly reduced by GG under control, but not stress conditions. The gene expression of the barrier protein claudin-11 in the prefrontal cortex was increased in control rats exposed to GG, whereas stress-induced rise was prevented. Exposure to GG-enriched diet resulted in reduced ZO-1 expression irrespective of stress conditions. In conclusion, the observed effects of GG are in line with a reduction in the activity of central mineralocorticoid receptors. The treatment with GG extract or its active components may, therefore, be a useful adjunct therapy for patients with subtypes of depression and anxiety disorders with heightened renin–angiotensin–aldosterone system and/or inflammatory activity.

Hypertension is a major cause of cardiovascular disease and overall mortality. High dietary salt intake is one of the key risk factors for hypertension and in 2017, it was one of the three leading dietary risk factors for death and disability adjusted life years globally. Despite the efforts to change this behaviour, salt consumption still exceeds the recommendations. One of the main determinants of food intake, and potentially salt, is taste. Taste perception may be genetically determined, however research exploring the associations between genetics, salt taste perception and salt intake is scarce. This may be of special importance in younger adult populations where increased preference for salt is suggested. Therefore, the aim of this study was to explore the associations between genetics, salt taste perception (taste threshold and preference) and salt intake in young adults. This study was approved by the St Mary's University Ethics Sub-Committee. Forty-two participants (18–35 years, 67% female and 33% male) completed the study. Salt taste thresholds were identified using the British Standards Institution sensory analysis method (BS ISO 3972:2011) and preference for salty taste by asking participants how salty they usually prefer to eat their food using a Likert scale. Salt intake, expressed as mg sodium/1000 kcal, was measured using a five-step multiple pass 24-hour recall for one day of the week and one weekend day. Participants were genotyped for two genetic variants in the SCNN1B and TRPV1 genes, which code for ion channels expressed in taste cells. Multiple regression analysis was performed including SCNN1B and TRPV1 variants, salt taste threshold and preference as predictor variables and sodium intake (mg/1000 kcal) as the dependent variable. Statistical significance was set at p < 0.05. Participants were normal weight (Body Mass Index 23.8 ± 3.7 kg/m2), predominantly Caucasian with salt intake 7.5 ± 2.7 g per day, reflecting current intakes in the UK. Regression model including genetics, thresholds and preference for salty taste explained 54% of the variance (p = 0.028). In this model, TRPV1 variant rs8065080 [β = 422, confidence interval (50, 794), p = 0.030] and salt preference [β = 618, confidence interval (258, 978), p = 0.004] were indicated as predictors of sodium intake. These findings suggest that genetics and preference for salty taste may be drivers of salt intake in younger populations. If replicated, this information may in the future be used in designing more personalised approaches in changing this behaviour.

INTRODUCTION: Dietary salt reduction of Americans has been a focus of public health initiatives for more than 40 years primarily due to the association between high salt intake and development of hypertension. Despite past efforts, salt intake of Americans has remained at levels well above dietary recommendations, likely due in part to the hedonic appeal of salty taste. As such, in 2010, the Institute of Medicine (IOM) suggested a strategy of gradual salt reduction of processed foods, the primary source of Americans’ dietary salt intake, via an approach intended to minimize its impact on consumer acceptability of lower-sodium foods. METHODS: This brief review discusses the ontogeny and development of human salty taste preference, the role of experience in shifting salt preference, and sources of dietary salt. Our current understanding of shifting human salty taste preference is discussed within the context of potential opportunities and challenges in reducing salt intake of Americans via the IOM’s suggested strategy. RESULTS: Gaps in the research that both limit our ability to predict effectiveness of gradual salt reduction and that need be addressed before a strategy to shift salt preference can realistically be implemented were identified. CONCLUSIONS: Our current understanding of shifting salt preference suggests that a strategy focused on reducing salt in processed foods has potential for success due to the strong association between salt intake and preference; however, because the IOM’s strategy has not been tested directly, effectiveness remains unresolved. IMPLICATIONS: It may be imprudent to extrapolate from existing relatively short-term studies to conclude that gradually reducing salt in the food supply would be effective for both reducing salt intake and salt preference of a national population.

Background/Aims: Obesity and high salt intake are major risk factors for hypertension and cardiometabolic diseases. Obese individuals often consume more dietary salt. We aim to examine the neurophysiologic effects underlying obesity-related high salt intake. Methods: A multi-center, random-order, double-blind taste study, SATIETY-1, was conducted in the communities of four cities in China; and an interventional study was also performed in the local community of Chongqing, using brain positron emission tomography/computed tomography (PET/CT) scanning. Results: We showed that overweight/obese individuals were prone to consume a higher daily salt intake (2.0 g/day higher compared with normal weight individuals after multivariable adjustment, 95% CI, 1.2-2.8 g/day, P < 0.001), furthermore they exhibited reduced salt sensitivity and a higher salt preference. The altered salty taste and salty preference in the overweight/obese individuals was related to increased activity in brain regions that included the orbitofrontal cortex (OFC, r = 0.44, P= 0.01), insula (r = 0.38, P= 0.03), and parahippocampus (r = 0.37, P= 0.04). Conclusion: Increased salt intake among overweight/obese individuals is associated with altered salt sensitivity and preference that related to the abnormal activity of gustatory cortex. This study provides insights for reducing salt intake by modifying neural processing of salty preference in obesity.

Few studies have examined the association between Japanese diet and mortality outcomes. We analysed the relationship between a healthy Japanese diet and all-cause and cause-specific mortality using the database from the National Integrated Project for Prospective Observation of Non-Communicable Diseases and its Trends in the Aged, 1980. At baseline in 1980, data were collected on study participants aged ≧30 years from randomly selected areas in Japan. We defined a measure of a healthy reduced-salt Japanese diet based on seven components from FFQ. The total score ranged from 0 to 7, with 0 being least healthy and 7 being most healthy. Participants were divided into approximate tertiles of dietary scores (0–2, 3 and 4–7 scores). After excluding participants with co-morbidities, we followed 9086 participants (44 % men) for 19 years. There were 1823 all-cause and 654 cardiovascular deaths during the follow-up. With the dietary score group 0–2 serving as a reference, the Cox multivariate-adjusted hazard ratios for groups with scores 3 and 4–7 were 0·92 (95 % CI 0·83, 1·04) and 0·78 (95 % CI 0·70, 0·88) for all-cause mortality (trend P  < 0·0001), and 0·91 (95 % CI 0·75, 1·10) and 0·80 (95 % CI 0·66, 0·97) for cardiovascular mortality (trend P  = 0·022). Adherence to a healthy reduced-salt Japanese diet was associated with an approximate 20 % lower rate of all-cause and cardiovascular mortality.

Background/Objectives: As salt preference is known to cause hypertension (HTN), the present study was conducted to assess the impact of preference for salt on sympathovagal imbalance in prehypertensives by spectral analysis of heart rate variability (HRV). Subjects/Methods: Body mass index (BMI), basal heart rate, blood pressure (BP), rate pressure product and spectral indices of HRV such as total power (TP), normalized low frequency power (LFnu), normalized high frequency power (HFnu), ratio of low frequency power to high frequency power (LF-HF ratio), mean heart rate, square root of the mean squared differences of successive normal to normal (NN) intervals, the number of interval differences of successive NN intervals >50 ms (NN50) and the proportion derived by dividing NN50 by the total number of NN intervals were assessed in 555 subjects divided into four groups: Group 1, normotensives no-salt-preference subjects ( n =260); Group 2, normotensives salt-preference subjects ( n =185); Group 3, prehypertensives no-salt-preference subjects ( n =25); and Group 4, prehypertensives salt-preference subjects ( n =89). Sympathovagal balance was analyzed and contribution of individual factor to sympathovagal imbalance was assessed by regression analysis. Results: LFnu was significantly increased ( P =0.009), whereas TP and HFnu were significantly decreased ( P =0.024 and 0.007, respectively) in the salt-preference groups compared with the no-salt-preference groups. LF-HF ratio, the sensitive indicator of sympathovagal balance, was significantly increased ( P <0.0001) in salt-preference subjects compared with no-salt-preference subjects. In regression analysis, the link of LF-HF ratio to HTN status was found to be more prominent in the salt-preference group ( P =0.000) compared with the no-salt-preference group ( P =0.004). BMI had no significant contribution ( P =0.818) to LF-HF ratio in salt-preference subjects. Conclusions: Salt preference is associated with sympathovagal imbalance caused by sympathetic overactivity and vagal withdrawal. Sympathovagal imbalance is more intense in salt-preferring prehypertensives compared with salt-preferring normotensives. Sympathovagal imbalance in salt-preferring subjects is independent of BMI. Thus, salt-preferring subjects should be encouraged to restrict salt intake to maintain their sympathovagal balance and BP homeostasis.

Objective: This study describes the association between taste preference for salt and actual salt intake, thus guiding and refining personal and public health campaigns designed to lower salt intake in China. Methods: A cross-sectional survey of 1489 residents aged 18 to 69 years was conducted in 2017 in China. A multistage random sampling strategy was used, and a combination of questionnaires and physical and laboratory measurements were conducted to collect baseline characteristics and knowledge, attitudes, and behavior (KAB) related to salt. A 24 h urine collection was obtained for sodium and potassium excretion analysis. Participants were divided into two groups, light taste preference and salty taste preference, according to their answer to the question “Compared to others, how do you think your taste preference is for salt?”. Results: The mean age of the 1489 participants was 46.26 years, 48.9% were males, over 1/3 (35.7%) were identified as hypertensive, and 317 (21.3%) self-reported a salty taste preference. The mean of 24 h urinary sodium excretion was 167.32 mmol/24 h, corresponding to 9.79 g salt/d intake, and the sodium-to-potassium ratio (Na/K) was 4.90. The 24 h urinary sodium excretion of salty taste preference (177.06 mmol/24 h) was significantly higher than that of light taste preference (164.69 mmol/24 h). The multiple logistic regression analysis showed that the salty taste preference group had significantly higher 24 h urinary sodium (ORa(95%CI) = 1.004(1.002–1.006)), diastolic blood pressure (DBP), proportion of greasy food preference, and drinking levels, but lower potassium excretion, response levels to most KAB questions, and regular physical activity compared to the light taste preference group. Conclusion: Self-reported taste preference for salt predicted actual salt intake, which was verified by 24 h urinary sodium monitoring. Taste preference for salt could be used as a proxy for intake in terms of targeted salt intake, nutrition, and health education.

A salt preference questionnaire may be a convenient and cost-effective method for predicting salt intake; however, the influence of salt preference on daily salt intake is unclear. This study aimed at revealing the effectiveness of the salt preference question in determining the daily salt intake in primary care outpatients. This cross-sectional study included 1,075 outpatients (men, n=436, 40.6%) at six primary care institutions in Japan. Primary outcomes included a salty food preference assessed by using one question and a daily salt intake, assessed using early morning second urine samples. Multivariate analyses determined the relationships between the salt intake and the two salt preference levels. The mean age was 67.6±14.6 years, and 594 (55.3%) preferred salty foods. The daily salt intake was 12.3±4.0 g per day and 11.4±3.7 g per day in the salt preference and nonsalt preference groups, respectively (P<0.001). A salt intake <10 g per day was consumed by 169 (28.5%) and 181 (37.6%) patients (P=0.001), respectively, and <6 g salt per day was consumed by 28 (4.7%) and 26 (5.4%) patients (P=0.606), respectively. The patients who preferred salty foods consumed a significantly larger amount of salt per day than those who did not prefer salty foods (β coefficient, 0.621; 95% confidence interval [CI], 0.146-1.095). There was no difference in the number of patients who consumed <10 g salt per day (adjusted odds ratio [ad-OR], 1.29; 95% CI, 0.99-1.69) or <6 g salt per day (ad-OR, 1.39; 0.90-1.69) between the groups. Preference for salty foods was positively associated with daily salt intake. However, daily salt intake was not always appropriate, even in the patients who did not prefer salty foods. Behavioral interventions for salt restriction after an assessment of daily salt intake are necessary for primary care patients, regardless of their preference for salty foods.