Consumo de sal em adultos do Estudo ELSA-Brasil: influência do diabetes e da síndrome metabólica

Abstract

Cardiometabolic diseases are included among chronic non-communicable diseases (NCDs). NCDs include cardiovascular diseases, metabolic syndrome, and type II diabetes mellitus, which impact global public health because they have high rates of mortality and morbidity. Over the last decades, people have increased their consumption of ultra-processed foods, especially those rich in fat and salt, and performed less physical activity, these being modifiable risk factors that contribute to a significant scenario of metabolic and cardiovascular changes. Salt, when consumed in excess, leads to metabolic changes and is especially associated with increased blood pressure, which is a risk factor for major cardiovascular events. However, the association between its consumption and other cardiometabolic disorders remains controversial. In this context, the main aim of the present study was to evaluate salt consumption in participants of the ELSA-Brasil study and compare it with the presence or absence of metabolic syndrome or diabetes. The ELSA-Brasil study comprises a cohort of 15,105 Brazilian adults, aged between 35 and 74 years. To meet the proposed aim, individuals with previous cardiovascular disease (myocardial infarction, stroke, heart surgery, rheumatic heart disease, and coronary revascularization) and those who did not have a validated urine collection, a parameter necessary to estimate salt consumption, were excluded from our analyses. Thus, 11,982 adults were included in the analyzes after undergoing clinical and anthropometric evaluation. In addition, daily salt intake was estimated by sodium excretion in urine collected during 12 hours. Initially, the objective was to compare salt consumption among adults with and without diabetes and to assess whether the simultaneous presence of diabetes and arterial hypertension is associated with high consumption. The main findings demonstrated that daily salt consumption was higher in individuals with diabetes than in non-diabetics, regardless of sex, and was increased in participants with fasting glucose greater than 126 mg/dL but similar among participants with fasting blood glucose below 100 mg/dL and between 100-126mg/dL, regardless of sex and blood pressure status. However, in individuals with the concomitant presence of diabetes and hypertension, salt consumption was higher compared to all other groups. Furthermore, a progressive increase in the prevalence of hypertension was observed with increasing salt consumption among women with diabetes, but not among men. Subsequently, the aim was to assess whether individuals with metabolic syndrome (MS) had a high salt intake and which components of the metabolic syndrome diagnosis could be independently related to salt consumption. The main findings demonstrated that salt consumption was higher in individuals with MS compared to individuals without MS and showed a progressive increase with the accumulation of MS criteria, regardless of sex. Also, participants with high waist circumference and high blood pressure had a higher salt intake, and the combination of these factors was associated with even higher consumption, regardless of the presence or absence of MS. Thus, the main findings of this thesis demonstrate that conditions such as diabetes, arterial hypertension, and increased waist circumference are associated with higher salt consumption, emphasizing the importance of strategies aimed at reducing this consumption, especially in this group of individuals who are at increased risk for developing cardiovascular disease.