Consumo de sal, estilos de vida, y exceso de peso en pacientes hipertensos atendidos en un servicio de Cardiología de un hospital ecuatoriano de especialidades

Walter Adalberto González García, Ruth Adriana Yaguachi Alarcón

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Introducción: En la adultez se arrastran los hábitos alimentarios adquiridos en las edades tempranas de la vida que se reflejarán (se quiera o no) en el estado de salud del sujeto. En consecuencia, el estado de salud en las edades adultas está ligado directamente al consumo de alimentos y los estilos de vida adquiridos en la niñez. Objetivo: Determinar las asociaciones entre el consumo de sal, los estilos de vida, y el riesgo cardiovascular (RCV) de los pacientes atendidos en la consulta de Cardiología de un hospital ecuatoriano de especialidades. Locación del estudio: Hospital “Dr. Abel Gilbert Pontón”, sito en la ciudad de Guayaquil (Provincia de Guayas, República del Ecuador). Diseño del estudio: Transversal, analítico. Serie de estudio: Cuatrocientos cuatro pacientes (Mujeres: 63.1%; Edad promedio: 53.5 ± 13.5 años; Edad ≥ 60 años: 36.1%). Métodos: A los pacientes participantes se les realizó una evaluación antropométrica orientada al reconocimiento del exceso de peso y el RCV, un cuestionario dietético dirigido a establecer la cuantía del ingreso corriente de sal común, y un interrogatorio estructurado acerca de los estilos de vida y la práctica de ejercicio físico. Resultados: El exceso de peso (IMC ≥ 25  Kg.m-2) afectó al 61.6% de la serie de estudio. Por el contrario, el 90.1% presentó valores del ICT > 0.5. De acuerdo con la actividad física, los sujetos encuestados se distribuyeron como sigue: Leve: 77.5%; Moderada: 20.8%; Intensa: 1.7%; respectivamente. El consumo de sal añadida a los alimentos una vez preparados fue referido por el 83.2% de los encuestados. Fue prevalente el consumo de alimentos conocidos como fuentes ocultas de sal: Embutidos y enlatados: 67.8%; Pan: 93.1%. Conclusiones: En los pacientes atendidos en un Servicio hospitalario de Cardiología predominan el exceso de peso, la obesidad abdominal, la poca actividad física, y el consumo desproporcionado de sal. Estos hallazgos colocan a los sujetos examinados en riesgo incrementado de daño cardiovascular. Urge intervenir los factores antes mencionados, a fin de reducir el RCV, y mejorar el pronóstico de la evolución de la enfermedad hipertensiva.

Palabras clave

Exceso de peso; Obesidad; Antropometría; Encuestas dietéticas; Riesgo cardiovascular; Sal; Sedentarismo

Referencias

Donini LM, Savina C, Cannella C. Eating habits and appetite control in the elderly: The anorexia of aging. Int Psychogeriatr 2003;15:73-87.

Donini LM. Control of food intake in aging. En: Food for the aging population. Second Edition. Woodhead Publishing Series in Food Science, Technology and Nutrition. London: 2017. pp. 25-55.

Kennedy BK, Berger SL, Brunet A, Campisi J, Cuervo AM, Epel ES; et al. Aging: A common driver of chronic diseases and a target for novel interventions. Cell 2014;159:709-13.

Ford DW, Jensen GL, Hartman TJ, Wray L, Smiciklas-Wright H. Association between dietary quality and mortality in older adults: A review of the epidemiological evidence. J Nutr Gerontol Geriatr 2013;32:85-105.

McNaughton S A, Bates CJ, Mishra GD. Diet quality is associated with all-cause mortality in adults aged 65 years and older. J Nutr 2011;142:320-5.

Tourlouki E, Matalas AL, Panagiotakos DB. Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: A review of evidence. Clin Intervent Aging 2009;4:319. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2722871/. Fecha de última visita: 4 de Marzo del 2018.

World Health Organization. World report on ageing and health. Geneva: 2015. Disponible en: https://www.cabdirect.org/cabdirect/abstract/20163387519. Fecha de última visita: 6 de Febrero del 2018.

Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L; et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA 2017;317:165-82.

Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Canad J Cardiol 2015;31:569-71.

Bromfield S, Muntner P. High blood pressure: the leading global burden of disease risk factor and the need for worldwide prevention programs. Curr Hypertens Rep 2013;15:134-6.

Danaei G, Finucane MM, Lin JK, Singh GM, Paciorek CJ, Cowan MJ; et al. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. The Lancet 2011;377 (9765):568-77.

Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K; et al. Global disparities of hypertension pprevalence and control. Clinical Perspective: A systematic analysis of population-based studies from 90 countries. Circulation 2016;134:441-50.

Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ; et al. Worldwide trends in blood pressure from 1975 to 2015: A pooled analysis of 1479 population-based measurement studies with 19.1 million participants. The Lancet 2017;389(10064):37-55.

Weiner JS, Lourie JA. Human biology. A guide to field methods. International Biological Program. Handbook number 9. Blackwell Scientific Publications. Oxford: 1969.

Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Second Edition. Human Kinetics Books. Champaign [Illinois]: 1991. pp 44-47.

Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J 1972;3(826):566-9.

WHO Working Group. Use and interpretation of anthropometric indicators of nutritional status. Bulletin WHO 1986;64:929-41.

Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A; et al. Waist circumference and abdominal sagittal diameter: Best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460-8.

Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk- A review of the literature. Eur J Clin Nutr 2010;64:16-23.

De León Medrano DL, Muñoz Muñoz MG, Ochoa C. La antropometría en el reconocimiento del riesgo cardiovascular. RCAN Rev Cubana Aliment Nutr 2017;27:167-88.

Seidel JC, Deurenberg P. Fat distribution of overweight persons in relation to morbidity and subjective health. Int J Obesity 1985;9:363-74.

Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev 2010;23: 247-69.

Institute of Medicine of the National Academies. Food and Nutrition Board: Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington DC: 2002. Disponible en: http://www.nap.edu/books/0309085373/html/. Fecha de última visita: 3 de Febrero del 2018.

Brooks GA, Butte NF, Rand WM, Flatt JP, Caballero B. Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 2004;79(5 Suppl):S921-S930.

Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: Implications for public health. Int J Epidemiol 2009;38:791-813.

Liu K, Cooper R, Mckeever J, Makeever P, Byington R, Soltero I; et al. Assessment of the association between habitual salt intake and high blood pressure: Methodological problems. Am J Epidemiol 1979;110:219-26.

Kaplan NM. The deadly quartet: Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Inter Med 1989;149:1514-20.

Doll S, Paccaud F, Bovet P, Burnier M, Wietlisbach V. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes Related Metab Dis 2002;26:48-57.

Rossi A, Dikareva A, Bacon SL, Daskalopoulou SS. The impact of physical activity on mortality in patients with high blood pressure: A systematic review. J Hypertens 2012;30:1277-88.

Blair SN. Physical inactivity: The biggest public health problem of the 21st century. Brit J Sports Med 2009;43:1-2.

Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehab 2007;14:12-7.

Webster JL, Dunford EK, Neal BC. A systematic survey of the sodium contents of processed foods. Am J Clin Nutr 2009;91:413-20.

He FJ, MacGregor GA. Reducing population salt intake worldwide: From evidence to implementation. Prog Cardiovasc Dis 2010;52:363-82.

World Health Organization. Reducing salt intake in populations. Report of a WHO forum and technical meeting, 5-7 October 2006. Paris [France]: 2007. Disponible en: http://apps.who.int/iris/bitstream/handle/10665/43653/9789241595377_eng.pdf?sequence=1. Fecha de última visita: 7 de Enero del 2018.

Wilson PW, Hoeg JM, D'Agostino RB, Silbershatz H, Belanger AM, Poehlmann H; et al. Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid stenosis. N Engl J Med 1997;337:516-22.

Mertens IL, van Gaal LF. Overweight, obesity, and blood pressure: The effects of modest weight reduction. Obes Res 2000;8:270-8.

Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, West DS; et al. Long-term weight loss and changes in blood pressure: Results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 2001;134:1-11.

Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR; et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 2006; 144:485-95.

Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: A randomized controlled trial. JAMA 2007;297:2081-91.

Kokkinos PF, Narayan P, Colleran JA, Pittaras A, Notargiacomo A, Reda D, Papademetriou V. Effects of regular exercise on blood pressure and left ventricular hypertrophy in African-American men with severe hypertension. N Engl J Med 1995;333:1462-7.

Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. Canad J Cardiol 2007;23:437-43.

He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: A meta-analysis of randomized trials. Implications for public health [Letter to the Editor]. J Human Hypertens 2002;16: 761

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