KUHINJSKA SOL – SKRIVENI OTROV U SVAKODNEVNOJ HRANI

Bojan Jelaković, Vedran Premužić, Berislav Skupnjak, Željko Reiner

Sažetak. Velik broj epidemioloških, evolucijskih i kliničkih istraživanja potvrđuje da je kuhinjska sol bitan čimbenik koji određuje visinu arterijskog tlaka (AT), a time i prevalenciju arterijske hipertenzije (AH). Epidemiološkim istraživanjima uočeno je da jedino uz prekomjeran unos kuhinjske soli dolazi do porasta AT sa starenjem. Osim što determinira AT, pojačan unos soli i nezavisno pridonosi oštećenju ciljnih organa. Opažena je povezanost s koronarnom bolesti, hipertrofijom lijeve klijetke, cerebrovaskularnim inzultom, mikroalbuminurijom. Kuhinjska sol, tj. NaCl mijenjajući odnos vazoaktivnih čimbenika u stijenci krvne žile, utječući na ekspresiju receptora za angiotenzin II i što je osobito bitno povećavajući agregabilnost trombocita, izravno se upleće u proces aterotrombogeneze. S kliničkog, a i javnozdravstvenog stajališta osobito su bitni podaci koje nam pružaju intervencijska istraživanja i koji bjelodano potvrđuju korist smanjivanja unosa NaCl. Ta se korist očituje ne samo u snižavanju AT i smanjivanju kardiovaskularnog morbiditeta i mortaliteta nego i u poboljšanju ukupnog zdravlja jer se zna da je prekomjeran unos kuhinjske soli čimbenik rizika i za osteoporozu, nefrolitijazu, karcinom želuca i nazofarinksa itd. Premda je bilo radova koji su unijeli sumnju da bi redukcija unosa kuhinjske soli mogla biti štetna zbog aktivacije kontraregulacijskih mehanizama, znatno veći broj autora je dokazao da umjerena redukcija unosa nije povezana s povećanim rizikom, već naprotiv. Smanjenje unosa kuhinjske soli treba provoditi u sklopu ostalih promjena načina života, primarno uz smanjenje tjelesne mase i povećane tjelesne aktivnosti. Uz redukciju unosa NaCl potrebno je paziti na ostale elektrolite i mikroelemente koji su također važni kamenčići mozaika zdravog življenja. Velika je odgovornost na institucijama vlasti i proizvođačima hrane jer se danas više od 70% NaCl unosi u organizam putem već pripremljene ili polugotove hrane.

Summary. A large number of epidemiologic, evolutionary and clinical studies have confirmed that table salt is a significant factor in determining the blood pressure (BP) level, and thereby in the prevalence of arterial hypertension (AH). It has been observed in epidemiologic studies that BP increases with age only if accompanied by excessive table salt intake. In addition to affecting BP, increased salt intake independently contributes to target organ damage. Correlation has also been observed between coronary artery disease, left ventricular hypertrophy, cerebrovascular insult, microalbuminuria. Table salt, i.e. NaCl, is directly involved in the process of atherothrombogenesis by changing the relation between vasoactive factors in the blood vessel wall, by affecting the expression of receptor for angiotensin II and, which is particularly important, by elevating platelet aggregability. From clinical and public health aspects, the data obtained in interventional studies are particularly important, as well as those that apparently confirm the benefit of restricting NaCl intake. This benefit is manifested not only in decreased BP and reduction in cardiovascular morbidity and mortality, but also in improved total health as it is known that excessive table salt intake is also a risk factor for osteoporosis, nephrolithiasis, gastric and nasopharyngeal carcinoma, etc. Although there were some studies that raised doubt about the fact that reduced table salt intake could be harmful due to activation of counter-regulative mechanisms, a substantially higher number of authors demonstrated that moderate intake reduction was not associated with the increased risk but rather the contrary. Table salt intake restriction should be performed as part of other lifestyle changes, primarily weight loss and increased physical activity. During NaCl intake reduction, it is necessary to pay attention to other electrolytes and microelements that are also important stones in the mosaic of healthy living. Gooverment authorities and food manufacturers bear heavy responsibility as ready or half-cooked food accounts for over 70% of NaCl intake into the body.