Pediatric Nephrology

, Volume 30, Issue 9, pp 1389–1396 | Cite as

Salt intake in children and its consequences on blood pressure

  • Sebastiano A. G. Lava
  • Mario G. Bianchetti
  • Giacomo D. Simonetti
Review

Abstract

Sodium is the most abundant extracellular cation and therefore pivotal in determining fluid balance. At the beginning of life, a positive sodium balance is needed to grow. Newborns and preterm infants tend to lose sodium via their kidneys and therefore need adequate sodium intake. Among older children and adults, however, excessive salt intake leads to volume expansion and arterial hypertension. Children who are overweight, born preterm, or small for gestational age and African American children are at increased risk of developing high blood pressure due to a high salt intake because they are more likely to be salt sensitive. In the developed world, salt intake is generally above the recommended intake also among children. Although a positive sodium balance is needed for growth during the first year of life, in older children, a sodium-poor diet seems to have the same cardiovascular protective effects as among adults. This is relevant, since: (1) a blood pressure tracking phenomenon was recognized; (2) the development of taste preferences is important during childhood; and (3) salt intake is often associated with the consumption of sugar-sweetened beverages (predisposing children to weight gain).

Keywords

Salt Sodium Blood pressure Hypertension Tracking Salt sensitivity 

Notes

Conflict of interest

None.

References

  1. 1.
    Pickering TG (2002) The history and politics of salt. J Clin Hypertens (Greenwich) 4:226–228CrossRefGoogle Scholar
  2. 2.
    Kotchen TA, Cowley AW Jr, Frohlich ED (2013) Salt in health and disease–a delicate balance. N Engl J Med 368:1229–1237CrossRefPubMedGoogle Scholar
  3. 3.
    Ritz E, Mehls O (2009) Salt restriction in kidney disease–a missed therapeutic opportunity? Pediatr Nephrol 24:9–17PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Hill LL (1990) Body composition, normal electrolyte concentrations, and the maintenance of normal volume, tonicity, and acid-base metabolism. Pediatr Clin N Am 37:241–256Google Scholar
  5. 5.
    Forbes GB, Lewis AM (1956) Total sodium, potassium and chloride in adult man. J Clin Invest 35:596–600PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Finberg L, Kravath RE, Hellerstein S (1993) Water and electrolytes in pediatrics—physiology, pathophysiology and treatment, 2nd edn. Saunders, Philadelphia, pp 68–69Google Scholar
  7. 7.
    Holtback U, Aperia AC (2003) Molecular determinants of sodium and water balance during early human development. Semin Neonatol 8:291–299CrossRefPubMedGoogle Scholar
  8. 8.
    Wadei HM, Textor SC (2012) The role of the kidney in regulating arterial blood pressure. Nat Rev Nephrol 8:602–609CrossRefPubMedGoogle Scholar
  9. 9.
    Rocchini AP, Key J, Bondie D, Chico R, Moorehead C, Katch V, Martin M (1989) The effect of weight loss on the sensitivity of blood pressure to sodium in obese adolescents. N Engl J Med 321:580–585CrossRefPubMedGoogle Scholar
  10. 10.
    Frisoli TM, Schmieder RE, Grodzicki T, Messerli FH (2011) Beyond salt: lifestyle modifications and blood pressure. Eur Heart J 32:3081–3087CrossRefPubMedGoogle Scholar
  11. 11.
    Khundmiri SJ (2014) Advances in understanding the role of cardioglycosides in renal control of salt homeostasis. J Endocrinol. doi: 10.1530/JOE-13-0613 PubMedGoogle Scholar
  12. 12.
    Simonetti GD, Mohaupt MG, Bianchetti MG (2012) Monogenic forms of hypertension. Eur J Pediatr 171:1433–1439CrossRefPubMedGoogle Scholar
  13. 13.
    Meneton P, Jeunemaitre X, de Wardener HE, MacGregor GA (2005) Links between dietary salt intake, renal salt handling, blood pressure, and cardiovascular diseases. Physiol Rev 85:679–715CrossRefPubMedGoogle Scholar
  14. 14.
    Titze J (2014) Sodium balance is not just a renal affair. Curr Opin Nephrol Hypertens 23:101–105CrossRefPubMedGoogle Scholar
  15. 15.
    Marvar PJ, Gordon FJ, Harrison DG (2009) Blood pressure control: salt gets under your skin. Nat Med 15:487–488CrossRefPubMedGoogle Scholar
  16. 16.
    Guignard JP (1982) Renal function in the newborn infant. Pediatr Clin N Am 29:777–790Google Scholar
  17. 17.
    Herin P, Aperia A (1994) Neonatal kidney, fluids, and electrolytes. Curr Opin Pediatr 6:154–157CrossRefPubMedGoogle Scholar
  18. 18.
    Gattineni J, Baum M (2013) Developmental changes in renal tubular transport-an overview. Pediatr Nephrol. doi: 10.1007/s00467-013-2666-6 PubMedCentralPubMedGoogle Scholar
  19. 19.
    Al-Dahhan J, Haycock GB, Nichol B, Chantler C, Stimmler L (1984) Sodium homeostasis in term and preterm neonates. III. Effect of salt supplementation. Arch Dis Child 59:945–950PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Marrero NM, He FJ, Whincup P, MacGregor GA (2014) Salt intake of children and adolescents in South London: consumption levels and dietary sources. Hypertension 63:1026–1032CrossRefPubMedGoogle Scholar
  21. 21.
    He FJ, Marrero NM, MacGregor GA (2008) Salt and blood pressure in children and adolescents. J Hum Hypertens 22:4–11CrossRefPubMedGoogle Scholar
  22. 22.
    Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, Loustalot F, Dai S, Gunn JP, Tian N, Cogswell ME, Merritt R (2012) Sodium intake and blood pressure among US children and adolescents. Pediatrics 130:611–619CrossRefPubMedGoogle Scholar
  23. 23.
    Brown IJ, Tzoulaki I, Candeias V, Elliott P (2009) Salt intakes around the world: implications for public health. Int J Epidemiol 38:791–813CrossRefPubMedGoogle Scholar
  24. 24.
    He FJ, MacGregor GA (2006) Importance of salt in determining blood pressure in children: meta-analysis of controlled trials. Hypertension 48:861–869CrossRefPubMedGoogle Scholar
  25. 25.
    Birch LL, Fisher JO (1998) Development of eating behaviors among children and adolescents. Pediatrics 101:539–549PubMedGoogle Scholar
  26. 26.
    Miersch A, Vogel M, Gausche R, Siekmeyer W, Pfaffle R, Dittrich K, Kiess W (2013) Blood pressure tracking in children and adolescents. Pediatr Nephrol 28:2351–2359CrossRefPubMedGoogle Scholar
  27. 27.
    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F (2013) 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31:1281–1357CrossRefPubMedGoogle Scholar
  28. 28.
    Wilson DKC, Coulon S (2011) Influence of dietary electrolytes on childhood blood pressure. In: Flynn JT, Ingelfinger JR, Portman RJ (eds) Pediatric hypertension, 2nd edn. Springer, New York, pp 259–289CrossRefGoogle Scholar
  29. 29.
    Sasaki N (1979) The salt factor in apoplexy and hypertension: epidemiological studies in Japan. In: Yamori Y (ed) Prophylactic approach to hypertensive diseases. Raven, New York, pp 467–474Google Scholar
  30. 30.
    Falkner B, Daniels SR (2004) Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension 44:387–388CrossRefPubMedGoogle Scholar
  31. 31.
    Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336:1117–1124CrossRefPubMedGoogle Scholar
  32. 32.
    Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER 3rd, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344:3–10Google Scholar
  33. 33.
    Geleijnse JM, Grobbee DE, Hofman A (1990) Sodium and potassium intake and blood pressure change in childhood. BMJ 300:899–902PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Wilson DK, Sica DA, Miller SB (1999) Effects of potassium on blood pressure in salt-sensitive and salt-resistant black adolescents. Hypertension 34:181–186CrossRefPubMedGoogle Scholar
  35. 35.
    He FJ, Marrero NM, MacGregor GA (2008) Salt intake is related to soft drink consumption in children and adolescents: a link to obesity? Hypertension 51:629–634CrossRefPubMedGoogle Scholar
  36. 36.
    Simonetti GD, Raio L, Surbek D, Nelle M, Frey FJ, Mohaupt MG (2008) Salt sensitivity of children with low birth weight. Hypertension 52:625–630CrossRefPubMedGoogle Scholar
  37. 37.
    Wang Y, Lobstein T (2006) Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes 1:11–25CrossRefPubMedGoogle Scholar
  38. 38.
    Bucher BS, Ferrarini A, Weber N, Bullo M, Bianchetti MG, Simonetti GD (2013) Primary hypertension in childhood. Curr Hypertens Rep 15:444–452CrossRefPubMedGoogle Scholar
  39. 39.
    Flynn J (2013) The changing face of pediatric hypertension in the era of the childhood obesity epidemic. Pediatr Nephrol 28:1059–1066CrossRefPubMedGoogle Scholar
  40. 40.
    de Boer MP, Ijzerman RG, de Jongh RT, Eringa EC, Stehouwer CD, Smulders YM, Serne EH (2008) Birth weight relates to salt sensitivity of blood pressure in healthy adults. Hypertension 51:928–932CrossRefPubMedGoogle Scholar
  41. 41.
    Palacios C, Wigertz K, Martin BR, Jackman L, Pratt JH, Peacock M, McCabe G, Weaver CM (2004) Sodium retention in black and white female adolescents in response to salt intake. J Clin Endocrinol Metab 89:1858–1863CrossRefPubMedGoogle Scholar
  42. 42.
    Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC (2010) Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med 362:485–493PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Dahl LK, Knudsen KD, Heine MA, Leitl GJ (1968) Effects of chronic excess salt ingestion. Modification of experimental hypertension in the rat by variations in the diet. Circ Res 22:11–18CrossRefPubMedGoogle Scholar
  44. 44.
    Hofman A, Hazebroek A, Valkenburg HA (1983) A randomized trial of sodium intake and blood pressure in newborn infants. JAMA 250:370–373CrossRefPubMedGoogle Scholar
  45. 45.
    Geleijnse JM, Hofman A, Witteman JC, Hazebroek AA, Valkenburg HA, Grobbee DE (1997) Long-term effects of neonatal sodium restriction on blood pressure. Hypertension 29:913–917CrossRefPubMedGoogle Scholar
  46. 46.
    Brion MJ, Ness AR, Davey Smith G, Emmett P, Rogers I, Whincup P, Lawlor DA (2008) Sodium intake in infancy and blood pressure at 7 years: findings from the Avon Longitudinal Study of Parents and Children. Eur J Clin Nutr 62:1162–1169CrossRefPubMedGoogle Scholar
  47. 47.
    Whitten CF, Stewart RA (1980) The effect of dietary sodium in infancy on blood pressure and related factors. Studies of infants fed salted and unsalted diets for five months at eight months and eight years of age. Acta Paediatr Scand Suppl 279:1–17PubMedGoogle Scholar
  48. 48.
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367:1747–1757CrossRefPubMedGoogle Scholar
  49. 49.
    Grimes CA, Riddell LJ, Campbell KJ, Nowson CA (2013) Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk. Pediatrics 131:14–21CrossRefPubMedGoogle Scholar
  50. 50.
    Rebholz CM, He J (2011) Urinary sodium excretion and cardiovascular disease mortality. JAMA 306:1083–1084, author reply 1086-1087CrossRefPubMedGoogle Scholar
  51. 51.
    Cook NR (2011) Urinary sodium excretion and cardiovascular disease mortality. JAMA 306:1085, author reply 1086-1087PubMedGoogle Scholar
  52. 52.
    Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerova J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovsky J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA (2011) Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA 305:1777–1785CrossRefPubMedGoogle Scholar
  53. 53.
    Bochud M, Guessous I, Bovet P (2011) Urinary sodium excretion and cardiovascular disease mortality. JAMA 306:1084, author reply 1086-1087CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2014

Authors and Affiliations

  • Sebastiano A. G. Lava
    • 1
    • 2
    • 3
  • Mario G. Bianchetti
    • 3
  • Giacomo D. Simonetti
    • 1
    • 2
    • 3
    • 4
  1. 1.Division of Pediatric NephrologyUniversity Children’s Hospital BernBernSwitzerland
  2. 2.University of BernBernSwitzerland
  3. 3.Pediatric Department of Southern SwitzerlandBellinzonaSwitzerland
  4. 4.Pediatric Nephrology UnitUniversity Children’s Hospital, InselspitalBernSwitzerland

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