Sodium intake and blood pressure in children with clinical conditions: A systematic review with meta‐analysis

Abstract

Little is known on the effect of sodium intake on BP of children with clinical conditions. Our objective was therefore to review systematically studies that have assessed the association between sodium intake and BP in children with various clinical conditions. A systematic search of several databases was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies assessing the association between sodium intake and BP and involving children or adolescents between 0 and 18 years of age with any clinical condition were included. Out of the 6861 records identified, 51 full texts were reviewed, and 16 studies (10 experimental and 6 observational), involving overall 2902 children and adolescents, were included. Ten studies were conducted in children with elevated BP without identifiable cause, two in children with familial hypertension, one in children with at least one cardiovascular risk factor, one in children with chronic renal insufficiency, one in children with urolithiasis, and one in premature infants. A positive association between sodium intake and BP was found in all studies, except one. The meta‐analysis of six studies among children with elevated BP without identifiable cause revealed a difference of 6.3 mm Hg (95% CI 2.9‐9.6) and 3.5 mm Hg (95% CI 1.2‐5.7) in systolic and diastolic BP, respectively, for every additional gram of sodium intake per day. In conclusion, our results indicate that the BP response to salt is greater in children with clinical conditions, mainly hypertension, than in those without associated clinical conditions.

Further evidence that methods based on spot urine samples should not be used to examine sodium‐disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

“…Studies assessed for eligibility were meta‐analyses (n = 3), prospective cohort studies (n = 10), cross‐sectional studies (n = 9), post hoc analyses of RCT’s (n = 1), quasi‐experimental studies (n = 2), and modeling analyses (n = 2). Three studies assessed mortality outcomes, 22‐24 six studies assessed morbidity outcomes, 25‐30 15 studies assessed clinically relevant surrogate outcomes, 31‐45 including 12 that assessed blood pressure outcomes, 31‐34,38‐45 and three studies assessed physiologic outcomes 46‐48 . Of these studies, only two met the minimum methodological criteria for detailed critical appraisal (Table 1).…”

Diretrizes Brasileiras de Hipertensão Arterial – 2020

“…Estudos observacionais demonstram o efeito positivo de polifenóis do azeite de oliva. 705,719 Recomenda-se a dieta DASH, com ênfase no aumento de alimentos de origem vegetal e na redução da ingestão de açúcares e doces. Tal restrição de crescimento intrauterino, antecedente de internação em unidade de terapia intensiva (UTI) neonatal ou de cateterização umbilical pós-natal, cardiopatias congênitas operadas ou não, infecção urinária de repetição, hematúria ou proteinúria, nefrouropatias, transplante de órgãos sólidos, doença oncológica ou transplante de medula óssea, uso crônico de medicamentos com reconhecido efeito de elevação de PA, doenças sistêmicas associadas a HA (neurofibromatose, esclerose tuberosa, anemia falciforme, entre outras) e evidência de hipertensão intracraniana.…”

“…705 medida é especialmente eficaz na HA associada à obesidade (NE: B). [719][720][721] Recomenda-se ainda o controle de estresse nessa faixa etária, podendo ser utilizadas diferentes formas de meditação, mindfulness ou ioga (NE: C). 705…”

“…705,722 Sugere-se que, na HA secundária, a escolha do antihipertensivo seja feita em consonância com o princípio fisiopatológico envolvido, considerando as comorbidades presentes em cada caso. [719][720][721][722][723][724][725][726] Em pacientes com HA resistente, deve-se instituir maior redução da ingestão de sódio, além de pesquisa detalhada da utilização de substâncias ou alimentos que causam HA, detalhamento da adesão ao esquema terapêutico e otimização máxima deste esquema (NE: C). 705 Em caso de não resposta a monoterapia por mais de 6 meses, considera-se o encaminhamento ao especialista em HA na criança e no adolescente (NE: C).…”

Salt/Sodium Intake Estimation in Children and Adolescents of Costa Rica

“…Sodium reduction is an important strategy to reduce high blood pressure and help prevent cardiovascular disease. High salt intake has been associated with high blood pressure in both adults [47] [48] [49] and children [50] and there is evidence that high blood pressure can cause vascular damage starting at an early age [3] [51] [52] [53].…”