Lower sodium intake and Cognitive Function in Older Adults

J Nutr Health Aging. 2017;21(3):276-283. doi: 10.1007/s12603-016-0766-2.

Association between Dietary Sodium Intake and Cognitive Function in Older Adults.

Rush TM1, Kritz-Silverstein D, Laughlin GA, Fung TT, Barrett-Connor E, McEvoy LK.
Author information

Abstract
OBJECTIVE:

To examine the association of dietary sodium intake with cognitive function in community-dwelling older adults.
DESIGN:

Cross-sectional study.
SETTING:

Southern California community.
PARTICIPANTS:

White men (n=373) and women (n=552), aged 50-96 years from the Rancho Bernardo Study, a longitudinal study of cardiovascular disease risk factors and healthy aging.

MEASUREMENTS:

During the 1992-1996 research clinic visit, a food frequency questionnaire was used to determine daily sodium intake; cognitive function was assessed with Trails Making Test, part B (Trails B), Mini-Mental State Exam (MMSE), and Verbal Fluency Test (VFT); and medical, clinical and demographic information was obtained. Linear regression was used to assess the association between calorie-adjusted sodium intake and cognitive test scores with adjustment for demographic, behavioral and health measures. Logistic regression examined the odds of having cognitive impairment by sodium intake.

RESULTS:

Lower sodium intake was associated with poorer performance on Trails B (p=0.008) and MMSE (p=0.003) after controlling for age, sex, and education. Associations did not differ by sex, but there was a significant interaction by age for the Trails B: older (≥80 years), but not younger, adults showed worse performance with lower sodium intake (p=0.03). Associations remained significant after additional adjustment for smoking, alcohol intake, exercise, body weight, cardiovascular risk factors, kidney function, diuretic medication use, and diet quality. Lower daily sodium intake was associated with increased odds of cognitive impairment on the MMSE (score < 26; OR per SD decrease = 1.12, 95% CI 1.08, 1.16).

Concluson: Lower sodium intake was associated with worse cognitive function in older community-dwelling adults. For the maintenance of cognitive health, older adults may be advised to avoid very low sodium diets.

yoly wrote:J Nutr Health Aging. 2017;21(3):276-283. doi: 10.1007/s12603-016-0766-2.

Association between Dietary Sodium Intake and Cognitive Function in Older Adults.

Rush TM1, Kritz-Silverstein D, Laughlin GA, Fung TT, Barrett-Connor E, McEvoy LK.
Author information

Abstract
OBJECTIVE:

To examine the association of dietary sodium intake with cognitive function in community-dwelling older adults.
DESIGN:

Cross-sectional study.
SETTING:

Southern California community.
PARTICIPANTS:

White men (n=373) and women (n=552), aged 50-96 years from the Rancho Bernardo Study, a longitudinal study of cardiovascular disease risk factors and healthy aging.

MEASUREMENTS:

During the 1992-1996 research clinic visit, a food frequency questionnaire was used to determine daily sodium intake; cognitive function was assessed with Trails Making Test, part B (Trails B), Mini-Mental State Exam (MMSE), and Verbal Fluency Test (VFT); and medical, clinical and demographic information was obtained. Linear regression was used to assess the association between calorie-adjusted sodium intake and cognitive test scores with adjustment for demographic, behavioral and health measures. Logistic regression examined the odds of having cognitive impairment by sodium intake.

RESULTS:

Lower sodium intake was associated with poorer performance on Trails B (p=0.008) and MMSE (p=0.003) after controlling for age, sex, and education. Associations did not differ by sex, but there was a significant interaction by age for the Trails B: older (≥80 years), but not younger, adults showed worse performance with lower sodium intake (p=0.03). Associations remained significant after additional adjustment for smoking, alcohol intake, exercise, body weight, cardiovascular risk factors, kidney function, diuretic medication use, and diet quality. Lower daily sodium intake was associated with increased odds of cognitive impairment on the MMSE (score < 26; OR per SD decrease = 1.12, 95% CI 1.08, 1.16).

Concluson: Lower sodium intake was associated with worse cognitive function in older community-dwelling adults. For the maintenance of cognitive health, older adults may be advised to avoid very low sodium diets.

If you check out the latest research, a low salt diet for most (not all) is a bigger health hazard than a higher salt diet. That being said, most of the cliched dross pushed by the so called experts (dietitians) is complete baloney. The eat five a day, eat plenty of fibre, booze limits etc. none of it based on real science, mostly dragged out of thin air. How many people put so much salt on their food it becomes a serious health hazard, for most it would become inedible, before salt become a hazard.

"Science" which isn't does two things - it takes things which might apply to a specific minority and applies them to the entire population, and it ignores things that actually DO apply to the entire population when they are not profitable for the Sponsors.

I thought this was entertaining - thanks to Robb Wolf for retweeting it

Evolution of evidence-based medicine to detect evidence mutations

http://journals.sagepub.com/doi/full/10.1177/0141076814555936

pdf downloadable

Eddie wrote:

yoly wrote:J Nutr Health Aging. 2017;21(3):276-283. doi: 10.1007/s12603-016-0766-2.

Association between Dietary Sodium Intake and Cognitive Function in Older Adults.

Rush TM1, Kritz-Silverstein D, Laughlin GA, Fung TT, Barrett-Connor E, McEvoy LK.
Author information

Abstract
OBJECTIVE:

To examine the association of dietary sodium intake with cognitive function in community-dwelling older adults.
DESIGN:

Cross-sectional study.
SETTING:

Southern California community.
PARTICIPANTS:

White men (n=373) and women (n=552), aged 50-96 years from the Rancho Bernardo Study, a longitudinal study of cardiovascular disease risk factors and healthy aging.

MEASUREMENTS:

During the 1992-1996 research clinic visit, a food frequency questionnaire was used to determine daily sodium intake; cognitive function was assessed with Trails Making Test, part B (Trails B), Mini-Mental State Exam (MMSE), and Verbal Fluency Test (VFT); and medical, clinical and demographic information was obtained. Linear regression was used to assess the association between calorie-adjusted sodium intake and cognitive test scores with adjustment for demographic, behavioral and health measures. Logistic regression examined the odds of having cognitive impairment by sodium intake.

RESULTS:

Lower sodium intake was associated with poorer performance on Trails B (p=0.008) and MMSE (p=0.003) after controlling for age, sex, and education. Associations did not differ by sex, but there was a significant interaction by age for the Trails B: older (≥80 years), but not younger, adults showed worse performance with lower sodium intake (p=0.03). Associations remained significant after additional adjustment for smoking, alcohol intake, exercise, body weight, cardiovascular risk factors, kidney function, diuretic medication use, and diet quality. Lower daily sodium intake was associated with increased odds of cognitive impairment on the MMSE (score < 26; OR per SD decrease = 1.12, 95% CI 1.08, 1.16).

Concluson: Lower sodium intake was associated with worse cognitive function in older community-dwelling adults. For the maintenance of cognitive health, older adults may be advised to avoid very low sodium diets.

If you check out the latest research, a low salt diet for most (not all) is a bigger health hazard than a higher salt diet. That being said, most of the cliched dross pushed by the so called experts (dietitians) is complete baloney. The eat five a day, eat plenty of fibre, booze limits etc. none of it based on real science, mostly dragged out of thin air. How many people put so much salt on their food it becomes a serious health hazard, for most it would become inedible, before salt become a hazard.

It is notoriously difficult to prove very much from a study like the above.  
Other studies out there suggest the opposite, that high sodium causes  cognitive decline.   My sister liked salt, but it didn't stop her dying of dementia! However, she was on a low salt diet at the time because she stopped eating when she was put in a home! Latterly she stopped drinking and there was no future in it.
It didn't cost my brother in law much she was only in the  nursing home for 12 weeks.
You can't ask the demented how much salt their eating, my sister couldn't remember my last sentence a few seconds before!

I remember an early study indicated that the increase in crime tracked the purchase of refrigerators almost exactly!


Why would anyone want to cut out sodium if they do not have hypertension, heart disease or diabetes? They exclude these categories usually from these studies in the final analysis.

No doctor I have come across has recommended a blanket low sodium diet for those not affected by sodium. Nobody has ever told my wife to cut out sodium!  I tell her to eat more because I do not want her to trigger he renin/aldo system into producing more aldosterone.  

If you have hypertension or had diabetes your heart could be impaired, and doctors prescribe the appropriate drugs accordingly to block renin or an aldosterone antonist. Any doctor who doesn't follow the science and believed high sodium doesn't matter in this situation would be criminal.

Derek

Some new research suggests plasma Na is correlated with BP in a large sample.

A major drive to higher PNa is P aldosterone. And maybe salt intake.

Arterioscler Thromb Vasc Biol. 2017 Mar;37(3):598-606. doi: 10.1161/ATVBAHA.116.308413. Epub 2016 Dec 29.
Cross-Sectional Positive Association of Serum Lipids and Blood Pressure With Serum Sodium Within the Normal Reference Range of 135-145 mmol/L.
Gao S1, Cui X1, Wang X1, Burg MB1, Dmitrieva NI2.
Author information
Abstract
OBJECTIVE:
Serum sodium concentration is maintained by osmoregulation within normal range of 135 to 145 mmol/L. Previous analysis of data from the ARIC study (Atherosclerosis Risk in Communities) showed association of serum sodium with the 10-year risk scores of coronary heart disease and stroke. Current study evaluated the association of within-normal-range serum sodium with cardiovascular risk factors.
APPROACH AND RESULTS:
Only participants who did not take cholesterol or blood pressure medications and had sodium within normal 135 to 145 mmol/L range were included (n=8615), and the cohort was stratified based on race, sex, and smoking status. Multiple linear regression analysis of data from ARIC study was performed, with adjustment for age, blood glucose, insulin, glomerular filtration rate, body mass index, waist to hip ratio, and calorie intake. The analysis showed positive associations with sodium of total cholesterol, low-density lipoprotein cholesterol, and total cholesterol to high-density lipoprotein cholesterol ratio; apolipoprotein B; and systolic and diastolic blood pressure. Increases in lipids and blood pressure associated with 10 mmol/L increase in sodium are similar to the increases associated with 7 to 10 years of aging. Analysis of sodium measurements made 3 years apart demonstrated that it is stable within 2 to 3 mmol/L, explaining its association with long-term health outcomes. Furthermore, elevated sodium promoted lipid accumulation in cultured adipocytes, suggesting direct causative effects on lipid metabolism.
CONCLUSIONS:
Serum sodium concentration is a cardiovascular risk factor even within the normal reference range. Thus, decreasing sodium to the lower end of the normal range by modification of water and salt intake is a personalizable strategy for decreasing cardiovascular risks.

More new research suggesting a possible "blood pressure paradox"


Patients with both Type 2 diabetes and acute heart failure face a significantly lower risk of death but a higher risk of heart failure-related hospitalizations if they had high systolic blood pressure on discharge from the hospital compared to those with normal blood pressure, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.

Previous studies have linked high blood pressure with worse health outcomes among people with Type 2 diabetes and among people with heart failure. The new study--the first to assess blood pressure and health outcomes in patients who have both Type 2 diabetes and acute heart failure--found that those with a systolic blood pressure above 150 mmHg were 45 percent less likely to die but 47 percent more likely to be hospitalized for heart failure during a 12-month follow-up period.

Systolic blood pressure is the top number in blood pressure readings and indicates the amount of pressure exerted on artery walls when the heart beats. It is measured in millimeters of mercury (mmHg) and is often used as a marker for cardiovascular risk.

"Current guidelines for patients with Type 2 diabetes suggest that systolic blood pressure should be lower than 140 mmHg, and lower than 130 mmHg in some individuals," said Charbel Abi Khalil, MD, PhD, assistant professor of medicine and genetic medicine at Weill Cornell Medicine and cardiology consultant at the heart hospital, Hamad Medical Corporation in Doha, Qatar, and the study's lead author. "However, patients with both Type 2 diabetes and acute heart failure have a distinct pathophysiology of the heart and may benefit from different guidelines."

Doctors typically prescribe medications and lifestyle changes as needed to lower blood pressure to a recommended range in patients with Type 2 diabetes. Although the study results show significantly better survival among patients with higher systolic blood pressure, Abi Khalil noted that further studies, such as a randomized controlled trial, would be needed before changing medical guidelines for managing blood pressure for patients with both Type 2 diabetes and acute heart failure.

The researchers analyzed health records of 2,492 patients with Type 2 diabetes among 5,005 individuals who were hospitalized with acute heart failure in seven Middle Eastern countries: Oman, Saudi Arabia, Yemen, Kuwait, United Arab Emirates, Qatar and Bahrain. Based on the systolic blood pressure recorded on patients' hospital discharge papers, they divided patients into four blood pressure levels: below 120 mmHg (low blood pressure), 120-129 mmHG (normal), 130-149 mmHG (moderate) and above 150 mmHG (high). They then analyzed mortality and subsequent heart failure-related hospitalizations over the course of one year following the initial heart failure hospitalization.

Rates of death and hospitalization among people with low or moderate systolic blood pressure were not significantly different from the rates observed in those with normal blood pressure. People with high blood pressure showed a significantly lower rate of death and higher rate of hospitalizations compared to those with normal blood pressure, even after the researchers adjusted the analysis to account for age, gender, smoking, cholesterol, heart rate, creatinine (a marker of kidney function) and left ventricle ejection fraction (a marker of heart function).

Abi Khalil said the findings echo other studies in which cardiovascular risk factors have been linked with outcomes that seem counterintuitive. For example, higher body mass index, which is usually associated with worse health outcomes in people with heart disease, is linked with better survival in patients with Type 2 diabetes and heart failure, leading to the notion of an "obesity paradox."

"We could be looking at a 'blood pressure paradox' if our findings are confirmed by future studies," Abi Khalil said.

Although the study shows association and not cause and effect, Abi Khalil pointed to several factors that might help explain the findings. One is that patients with Type 2 diabetes, heart failure and high blood pressure could be more likely to regularly visit cardiologists and diabetes specialists; this frequent follow-up could facilitate the successful implementation of treatment regimens and allow early diagnosis of other health problems that might arise.

The study was an analysis of the Gulf-CARE registry, which is conducted under the auspices of the Gulf Heart Association and funded by Servier, a French pharmaceutical company.

https://www.eurekalert.org/pub_releases/2017-03/acoc-fsh030617.php

Hi Graham, It is well known that better results in heart failure are achieved in the elderly with a bp above 130 systolic. However since sodium due Conn's has caused my heart problems and only on Eplerenone I shall have to up my carbs to get bp up. BMI 21.8. Will just have watch out I don't get RH again. T2D is the least of my worries. Bloods 4.7 potassium, 137 sodium, creatinine 84,gfr 77.

Derek wrote:Hi Graham,  It is well known that better results in heart failure are achieved in the elderly with  a bp above  130 systolic. However since sodium due Conn's has caused my heart problems and only on Eplerenone I shall have to up my carbs to get bp up.  BMI 21.8.  Will just have watch out I don't get RH again.  T2D is the least of my worries. Bloods  4.7 potassium, 137 sodium, creatinine 84,gfr 77.

Yes you have a lot to consider must be a tricky balancing act I've got it easy by comparison

Used to be that acceptable BP was 100+your age. Recently I saw a more subtle version of this but can't remember the calculation.