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调整膳食钠钾摄入量:“盐战”的终结?

Modifying Dietary Sodium and Potassium Intake: An End to the 'Salt Wars'?

机构信息

Department of Biomedicine, Aarhus University, Denmark (R.L.).

Now with Translational Genomics, AstraZeneca, Gothenburg, Sweden (R.L.).

出版信息

Hypertension. 2024 Mar;81(3):415-425. doi: 10.1161/HYPERTENSIONAHA.123.19487. Epub 2023 Oct 12.


DOI:10.1161/HYPERTENSIONAHA.123.19487
PMID:37823260
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10922153/
Abstract

Excessive salt intake raises blood pressure, but the implications of this observation for human health have remained contentious. It has also been recognized for many years that potassium intake may mitigate the effects of salt intake on blood pressure and possibly on outcomes such as stroke. Recent large randomized intervention trials have provided strong support for the benefits of replacing salt (NaCl) with salt substitute (75% NaCl, 25% KCl) on hard outcomes, including stroke. During the same period of time, major advances have been made in understanding how the body senses and tastes salt, and how these sensations drive intake. Additionally, new insights into the complex interactions between systems that control sodium and potassium excretion by the kidneys, and the brain have highlighted the existence of a potassium switch in the kidney distal nephron. This switch seems to contribute importantly to the blood pressure-lowering effects of potassium intake. In recognition of these evolving data, the United States Food and Drug Administration is moving to permit potassium-containing salt substitutes in food manufacturing. Given that previous attempts to reduce salt consumption have not been successful, this new approach has a chance of improving health and ending the 'Salt Wars'.

摘要

过量摄入盐会导致血压升高,但这一观察结果对人类健康的影响一直存在争议。多年来,人们也认识到钾的摄入可能会减轻盐对血压的影响,以及对中风等结果的影响。最近的大型随机干预试验为用盐替代物(75%氯化钠,25%氯化钾)代替盐(NaCl)对硬终点(包括中风)的益处提供了强有力的支持。在此期间,人们对身体如何感知和品尝盐以及这些感觉如何驱动盐的摄入有了更深入的了解。此外,对控制肾脏钠和钾排泄的系统之间复杂相互作用的新见解突出了肾脏远曲小管中钾开关的存在。这种开关似乎对钾摄入的降压作用有重要贡献。鉴于这些不断发展的数据,美国食品和药物管理局正在推动在食品制造中允许使用含钾的盐替代物。考虑到以前减少盐摄入量的尝试并未成功,这种新方法有可能改善健康状况并结束“盐战”。

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[8]
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[2]
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[3]
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Curr Nutr Rep. 2025-6-20

[4]
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[5]
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J Hum Hypertens. 2025-4

[6]
Dietary salt intake is not associated with risk of stroke: A Mendelian randomization study.

Medicine (Baltimore). 2024-12-20

[7]
High chloride induces aldosterone resistance in the distal nephron.

Acta Physiol (Oxf). 2025-1

[8]
Crucial Interactions between Altered Plasma Trace Elements and Fatty Acids Unbalance Ratio to Management of Systemic Arterial Hypertension in Diabetic Patients: Focus on Endothelial Dysfunction.

Int J Mol Sci. 2024-8-27

[9]
Hemodynamic Mechanisms Initiating Salt-Sensitive Hypertension in Rat Model of Primary Aldosteronism.

Physiol Res. 2024-4-18

本文引用的文献

[1]
Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial.

Nat Med. 2023-4

[2]
Adherence to Federal Dietary Recommendations for Total Fruit Consumption and the Intake of Underconsumed Nutrients: Findings from the National Health and Nutrition Examination Survey, 2015 to 2018.

J Nutr. 2023-5

[3]
Dissociation of sodium-chloride cotransporter expression and blood pressure during chronic high dietary potassium supplementation.

JCI Insight. 2023-3-8

[4]
The Proportion of Dietary Salt Replaced With Potassium-Enriched Salt in the SSaSS: Implications for Scale-Up.

Hypertension. 2023-5

[5]
Global Burden of Cardiovascular Diseases and Risks Collaboration, 1990-2021.

J Am Coll Cardiol. 2022-12-20

[6]
In Primary Aldosteronism Acute Potassium Chloride Supplementation Suppresses Abundance and Phosphorylation of the Sodium-Chloride Cotransporter.

Kidney360. 2022-11-24

[7]
In the general population, salt substitutes vs. regular salt reduce BP levels, CV outcomes, and mortality.

Ann Intern Med. 2022-12

[8]
Molecular and Cellular Mechanisms of Salt Taste.

Annu Rev Physiol. 2023-2-10

[9]
Blood pressure effects of sodium transport along the distal nephron.

Kidney Int. 2022-12

[10]
Effects of Short-Term Potassium Chloride Supplementation in Patients with CKD.

J Am Soc Nephrol. 2022-9

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