ABC | Volume 113, Nº3, September 2019

Original Article Salt Preference is Linked to Hypertension and not to Aging Patrícia Teixeira Meirelles Villela, Eduardo Borges de-Oliveira, Paula Teixeira Meirelles Villela, Jose Maria Thiago Bonardi, Rodrigo Fenner Bertani, Julio Cesar Moriguti, Eduardo Ferriolli, Nereida K. C. Lim a Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (FMRP-USP) - Divisão de Clínica Médica Geral e Geriatria, Ribeirão Preto, SP – Brazil Mailing Address: Nereida Kilza da Costa Lima • Hospital das Clínicas de Ribeirão Preto - Avenida Bandeirantes, 3.900. Postal Code: 14049-900, Vila Monte Alegre, Ribeirão Preto, SP – Brazil E-mail: nereida@fmrp.usp.br Manuscript received September 25, 2018, revised manuscript November 28, 2018, accepted January 16, 2019 DOI: 10.5935/abc.20190157 Abstract Background: Seasoning is one of the recommended strategies to reduce salt in foods. However, only a few studies have studied salt preference changes using seasoning. Objectives: The aim of this study was to compare preference for salty bread, and if seasoning can change preference in hypertensive and normotensive, young and older outpatients. Methods: Outpatients (n= 118) were classified in four groups: older hypertensive subjects (OH) (n= 32), young hypertensive (YH) (n = 25); older normotensive individuals (ON) (n = 28), and young normotensive (YN) (n = 33). First, volunteers random tasted bread samples with three different salt concentrations. After two weeks, they tasted the same types of breads, with seasoning added in all. Blood pressure (BP), 24-hour urinary sodium and potassium excretion (UNaV, UKV) were measured twice. Analysis: Fisher exact test, McNamer’s test and ANCOVA. Statistical significance: p < 0.05. Results: Systolic BP, UNaV, and UKV were greater in HO and HY and they had a higher preference for saltier samples than normotensive groups (HO: 71.9%, HY: 56% vs. NO: 25%, NY; 6%, p<0.01). With oregano, hypertensive individuals preferred smaller concentrations of salt, with reduced choice for saltier samples (HO: 71.9% to 21.9%, and HY: 56% to 16%, p = 0.02), NO preferred the lowest salt concentration sample (53.6% vs. 14.3%, p < 0.01), and NY further increased the preference for the lowest one (63.6% vs. 39.4%, p = 0.03). Conclusions: Older and younger hypertensive individuals prefer and consume more salt than normotensive ones, and the seasoned bread induced all groups to choose food with less salt. Salt preference is linked to hypertension and not to aging in outpatients. (Arq Bras Cardiol. 2019; 113(3):392-399) Keywords: Aged; Aging; Salt Tolerance; Food Preferences; Sodium Chloride,Dietary/adverse effects; Flavoring Agents. Introduction Although the relationship between high salt intake and hypertension is well established 1-4 and salt consumption by the world population is known to be higher than recommended, 4-7 only a few studies have assessed the preference for salty foods and studied the preference changes using seasoning among hypertensive and normotensive individuals. 8,9 Many countries are adopting different strategies to reduce salt intake by the population worldwide. The current public health recommendations in most countries are to reduce salt intake from about 9-12 g/day to 5-6 g/day. 10-12 The 2010 World Health Organizations (WHO) 3 global status report on non- communicable diseases urged member states to take immediate actions to reduce salt intake. To this end, the WHO recommended a 30% reduction in salt intake by 2025, with an eventual target of 5 g per day for adults and lower levels for children based on calorie intake. 13 Sodium chloride is added to processed foods for palatability, preservation and processing reasons. 14,15 One of the recommended steps to lower salt intake by the Food and Drugs Administration 16 is to flavor food with pepper and other herbs and spices instead of salt. Villela et al. 9 compared the preference for salty foods between elderly hypertensive and normotensive subjects and showed that hypertensive individuals prefer and consume more salty foods than normotensive individuals. Some studies have shown that older people prefer more pronounced flavors than young people since the number of papillae and taste buds decreases with age. 17,18 The INTERSALT study 19 suggested a strong relation between salt intake and a progressive increase in blood pressure (BP) with age up to 4mmHg per year for a 6 g/day salt intake. A reduction in salt intake is therefore likely to attenuate the rise of BP with aging, in addition to having an immediate BP lowering effect. 20 Since raised BP throughout its range is a major cause of cardiovascular disease, a reduction in salt intake, if it lowered BP, would reduce cardiovascular risk. 1 Scientific research on this topic is scarce and only a limited number of studies have been performed in an experimental real-life setting. 14 The aim of the present study was to compare the preference for salty foods among elderly and young individuals and hypertensive and normotensive ones and to determine if 392