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Gender and obesity modify the impact of salt intake on blood pressure in children

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Abstract

Background

Most modifiable risk factors for high blood pressure (BP), such as obesity and salt intake, are imprinted in childhood and persist into adulthood. The aim of our study was to evaluate the intake of salt in children and to assess its impact on BP taking into account gender and nutritional status.

Methods

A total of 298 children aged 8–9 years were evaluated in a cross-sectional study. Anthropometric measurements and 24-h ambulatory monitoring were performed, and salt intake was determined by 24-h urinary sodium excretion.

Results

The average estimated salt intake among the entire cohort of children enrolled in the study was 6.5 ± 2.2 g/day, and it was significantly higher in boys than in girls (6.8 ± 2.4 vs. 6.1 ± 1.9 g/day, respectively; p = 0.018) and in overweight/obese children than in normal weight children (6.8 ± 2.4 vs. 6.1 ± 2.0 g/day, respectively; p = 0.006). Salt intake exceeded the upper limit of the US Dietary Reference Intake in 72 % of children. Daytime systolic BP increased by 1.00 mmHg (95 % confidence interval 0.40–1.59) per gram of daily salt intake in overweight/obese boys, but not in normal weight boys or in girls.

Conclusions

Our results demonstrate an extremely high salt intake among 8- to 9-year-old Portuguese children. Higher salt intake was associated with higher systolic BP in boys, specifically in those who were overweight/obese. Longitudinal studies are needed to further evaluate the causal relationship between obesity and high BP and the mechanism by which salt intake modulates this relationship. Nonetheless, based on our results, we urge that dietary salt reduction interventions, along with measures to fight the global epidemic of obesity, be implemented as early in life as possible.

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Acknowledgments

The authors gratefully acknowledge the contribution of all members of the research team and staff of G21.

Compliance with ethical standards

The ObiKid study was approved by the Ethics Committee of Centro Hospitalar São João, E.P.E. and Faculty of Medicine of the University of Porto and complies with the Helsinki Declaration and current national legislation. Written informed consent from parents [or their legal guardian(s)] and verbal assent from the children were obtained regarding the collection of information and biological samples.

Conflicts of interest

None of the authors have any financial or nonfinancial competing interests concerning the study reported here.

Sources of funding

This project was supported by FEDER funds from Programa Operacional Factores de Competitividade—COMPETE (FCOMP-01-0124-FEDER-028751) and by national funds from the Portuguese Foundation for Science and Technology, Lisbon, Portugal (PTDC/DTP-PIC/0239/2012). Liane Correia-Costa was supported by the Portuguese Foundation for Science and Technology (grant SFRH/SINTD/95898/2013), and Franz Schaefer was supported by the ERA-EDTA Research Programme and the KfH Foundation for Preventive Medicine.

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    Authors and Affiliations

    1. Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal

      Liane Correia-Costa, Dina Cosme, Carla Lopes, Alberto Caldas Afonso & Ana Azevedo

    2. Division of Pediatric Nephrology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal

      Liane Correia-Costa & Alberto Caldas Afonso

    3. Department of Pharmacology and Therapeutics, Faculty of Medicine of University of Porto, Porto, Portugal

      Dina Cosme, Manuela Morato, Teresa Sousa & António Albino-Teixeira

    4. Department of Internal Medicine, Centro Hospitalar São João, Porto, Portugal

      Luís Nogueira-Silva

    5. Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal

      Luís Nogueira-Silva & António Guerra

    6. Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Porto, Portugal

      Manuela Morato, Teresa Sousa & António Albino-Teixeira

    7. Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of Porto, University of Porto, Porto, Portugal

      Manuela Morato

    8. Division of Pediatric Cardiology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal

      Cláudia Moura, Cláudia Mota & José Carlos Areias

    9. Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal

      António Guerra

    10. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

      Franz Schaefer

    11. Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of University of Porto, Porto, Portugal

      Carla Lopes & Ana Azevedo

    12. Instituto de Saúde Pública da Universidade do Porto (ISPUP), Rua das Taipas n° 135, 4050-600, Porto, Portugal

      Liane Correia-Costa

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    1. Liane Correia-Costa
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    Correspondence to Liane Correia-Costa.

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    Liane Correia-Costa and Dina Cosme contributed equally to this work.

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    Correia-Costa, L., Cosme, D., Nogueira-Silva, L. et al. Gender and obesity modify the impact of salt intake on blood pressure in children. Pediatr Nephrol 31, 279–288 (2016). https://doi.org/10.1007/s00467-015-3210-7

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