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Bioavailability of potassium from potatoes and potassium gluconate: A randomized dose response trial
Abstract
Background:
The bioavailability of potassium should be considered in setting requirements, but to our knowledge, the bioavailability from individual foods has not been determined. Potatoes provide 19-20% of potassium in the American diet.
Objective:
We compared the bioavailability and dose response of potassium from nonfried white potatoes with skin [targeted at 20, 40, and 60 milliequivalents (mEq) K] and French fries (40 mEq K) with potassium gluconate at the same doses when added to a basal diet that contained ∼60 mEq K.
Design:
Thirty-five healthy, normotensive men and women with a mean ± SD age of 29.7 ± 11.2 y and body mass index (in kg/m(2)) of 24.3 ± 4.4 were enrolled in a single-blind, crossover, randomized controlled trial. Participants were partially randomly assigned to the order of testing for nine 5-d interventions of additional potassium as follows: 0 (control; repeated at phases 1 and 5), 20, 40, and 60 mEq K/d consumed as a potassium gluconate supplement or as unfried potato or 40 mEq K from French fries completed at phase 9. The bioavailability of potassium was determined from the area under the curve (AUC) of serial blood draws and cumulative urinary excretion during a 24-h period and from a kinetic analysis. The effects of the potassium source and dose on the change in blood pressure and augmentation index (AIx) were determined.
Results:
The serum potassium AUC increased with the dose (P < 0.0001) and did not differ because of the source (P = 0.53). Cumulative 24-h urinary potassium also increased with the dose (P < 0.0001) and was greater with the potato than with the supplement (P < 0.0001). The kinetic analysis showed the absorption efficiency was high across all interventions (>94% ± 12%). There were no significant differences in the change in blood pressure or AIx with the treatment source or dose.
Conclusions:
The bioavailability of potassium is as high from potatoes as from potassium gluconate supplements. Future studies that measure the effect of dietary potassium on blood pressure will need to evaluate the effect of various dietary sources on potassium retention and in both normal and hypertensive populations. This trial was registered at clinicaltrials.gov as NCT01881295.
... Tis was attributed to several factors such as antinutrients, both soluble and insoluble dietary fbers, and calcium which impact negatively zinc and iron bioaccessibility. Lower bioaccessibility for K (60-85%) was reported in comparison to vitamin C (80-90%) from spinach, kale, banana, and kiwi [21]. Elevated calcium dialyzable levels (20-30%) were found in kale, cabbage, and soybean sprouts and attributed to low phytate, oxalate, and dietary fber levels. ...
... Te mean bioaccessible amounts and percentages of vitamins C, B 1 , B 2 , and B 3 from leaves and tubers of cassava are displayed in Table 3. Te percentage bioaccessibility of vitamin C ranged between 43% (raw Kibandameno leaves) and 85% (boiled Tajirika tubers). Tis falls below the percentage bioaccessibility ranges of 80-90% from spinach, kale, banana, and kiwi in the works of MacDonald et al. [21]. Bioaccessibility of vitamins B 1 , B 2, and B 3 ranged between 27 and 81%. ...
... Bioaccessibility of potassium ranged between 50% (raw Tajirika leaves) and 84% (boiled Tajirika tubers) falling within the range found in spinach, kale, banana, and kiwi (MacDonald and coworkers (2016)). Te authors explain that to some extent, matrix efects reduce potassium absorption from unprocessed vegetables [21]. It was observed that the percentage bioaccessibility of minerals was signifcantly higher (P < 0.001) in processed tubers than in processed leaves ( Table 4) while noting that cassava leaves have higher levels of antinutrients than cassava tubers [6]. ...
Manihot esculenta Crantz (cassava) is an important food crop in developing nations, with its tubers and leaves being a source of ascorbic acid, thiamin, riboflavin, and niacin (vitamins) and calcium, iron, potassium, and zinc (minerals). Malnutrition prevalence in some Kenyan Counties that relied on cassava-based diets has partly been attributed to processing methods and/or nutrient bioaccessibility. The study area Kilifi County grows Kibandameno and Tajirika cassava varieties and is on record for high prevalence of undernutrition. The levels of vitamins and minerals, and their bioaccessibility in raw, boiled, and deep-fried tubers, and pounded then boiled leaves of Kibandameno and Tajirika cassava varieties were studied. Digestion was done using static gastrointestinal digestion prior to the determination of vitamins (by HPLC) and minerals (by AAS and AES). Bioaccessibility of both vitamins and minerals was significantly higher (P<0.001) in boiled followed by deep-fried and lowest in raw tubers. Bioaccessibility ranged between 27% (Fe)–85% (vitamin C) in boiled, 20% (Fe)–79% (vitamin B1) in deep-fried, and 15% (Fe)–(72% (K) in raw tubers. Bioaccessibility in processed leaves was significantly higher (P<0.001) than in raw. This ranged between 11% (Fe)–81% (vitamin B1) in processed and between 8% (Fe)–67% (K) in raw leaves. Processing therefore significantly reduced levels of ascorbic acid, thiamin, riboflavin, niacin, calcium, iron, potassium, and zinc in raw tubers and leaves of Kibandameno and Tajirika Manihot esculenta Crantz varieties. Their bioaccessibility however significantly increased, being higher in tubers than in leaves.
... Recently, the interest in the bioavailability of dietary potassium has been re-discovered even though the results are not yet satisfying. Some authors carried out in vivo studies using low and high K intake and measuring K urine excretion [16,17]. Urinary K is being considered as a measurement that generally underestimate dietary K intake [18][19][20]. ...
... Urinary K is being considered as a measurement that generally underestimate dietary K intake [18][19][20]. For example, McDonald-Clarke et al. [16], observed high to similar bioavailability of K from white unfried potatoes as from fried French potatoes supplemented with K-gluconate, showing the greater K bioavailability from potatoes compared with that of K-gluconate. The same authors showed that frying did not change K bioavailability in processed food. ...
... These authors hypothesized that these differences could be due to the different cellular structure of plant food, confirming the fundamental role of plant cell wall. The authors concluded that the bioaccessibility of K in unprocessed plant foods resulted lower than that of processed plant food, likely due to the disruption of cell wall by heat process in contrast to results obtained by McDonald-Clarke et al. [16]. ...
Hyperkalemia is a major concern in chronic kidney disease and in end-stage renal disease, representing a predictor of hospitalization and mortality. To prevent and treat hyperkalemia, dietary management is of great clinical interest. Currently, the growing use of plant-based diets causes an increasing concern about potassium load in renal patients. The aim of this study was to assess the bioaccessibility of potassium in vegetables, concerning all aspects of the plants (fruit, flower, root, tuber, leaf and seed) and to what extent different boiling techniques affect potassium content and bioaccessibility of plant-based foods. Bioaccessibility was evaluated by an in vitro digestion methodology, resembling human gastro-intestinal tract. Potassium content was higher in seeds and leaves, despite it not being possible to define a common “rule” according to the type of organ, namely seed, leaf or fruit. Boiling reduced potassium content in all vegetables excluding carrot, zucchini, and cauliflower; boiling starting from cold water contributed to a greater reduction of the potassium content in potato, peas, and beans. Bioaccessibility after in vitro digestion ranged from 12 (peas) to 93% (tomato) regardless of species and organs. Higher bioaccessibility was found in spinach, chicory, zucchini, tomato, kiwi, and cauliflower, and lower bioaccessibility in peas. Potassium from leaf resulted in the highest bioaccessibility after digestion; as a whole potassium bioaccessibility in the fruits and vegetables studied was 67% on average, with differences in relation to the different organs and species. Further, considering the method of boiling to reduce potassium content, these data indicate that the effective potassium load from plant-based foods may be lower than originally expected. This supports the clinical advices to maintain a wide use of plant-based food in the management of renal patients.
... Generally, requirements for any nutrient are based on replacing losses from the body, adding in any demand for growth, and adjusting for absorption from the diet. However, recommended intakes for potassium were based on absorption from supplements because the first bioavailability study in any food, i.e., potato, was only recently reported [6]. The aims of this review are to discuss what is known about potassium bioavailability and metabolism and some of the consequences of deficiency. ...
... In a recent study conducted by Macdonald and colleagues, researchers aimed to assess and compare the bioavailability of potassium from potato sources (non-fried white potatoes, French fries) and a potassium supplement (potassium gluconate) [6] Thirty-five healthy men and women (29.7˘11.2 years, 24.3˘4.4 ...
... In addition, these analyses suggest a relationship between an optimal potassium dose range (between 1900 and 3700 mg/day) and BP lowering of approximately 2-6 mmHg in SBP and 2-4 mmHg in DBP [59]. However, this was not confirmed in the previously described dose-response bioavailability study, although all participants were normotensive and duration was short [6]. ...
Potassium is an essential nutrient. It is the most abundant cation in intracellular fluid where it plays a key role in maintaining cell function. The gradient of potassium across the cell membrane determines cellular membrane potential, which is maintained in large part by the ubiquitous ion channel the sodium-potassium (Na+-K+) ATPase pump. Approximately 90% of potassium consumed (60–100 mEq) is lost in the urine, with the other 10% excreted in the stool, and a very small amount lost in sweat. Little is known about the bioavailability of potassium, especially from dietary sources. Less is understood on how bioavailability may affect health outcomes. Hypertension (HTN) is the leading cause of cardiovascular disease (CVD) and a major financial burden ($50.6 billion) to the US public health system, and has a significant impact on all-cause morbidity and mortality worldwide. The relationship between increased potassium supplementation and a decrease in HTN is relatively well understood, but the effect of increased potassium intake from dietary sources on blood pressure overall is less clear. In addition, treatment options for hypertensive individuals (e.g., thiazide diuretics) may further compound chronic disease risk via impairments in potassium utilization and glucose control. Understanding potassium bioavailability from various sources may help to reveal how specific compounds and tissues influence potassium movement, and further the understanding of its role in health.
... The bioavailability of potassium from food additives can be as high as 100% [64,65]. Picard [65] and MacDonald-Clarke et al. [66] also found that the bioavailability of potassium from fruits and vegetables is 50-60%, compared to 90% from animal protein and 95% from additives. Only a few studies show how well the various forms of potassium contained in dietary supplements are absorbed. ...
... Only a few studies show how well the various forms of potassium contained in dietary supplements are absorbed. A dose-response study showed that people absorb about 94% of the potassium gluconate in supplements, and the absorption rate is similar to that of potassium from potatoes [66]. ...
To determine the potential bioavailability of macroelements (Ca, Mg, P, K), probiotic ice cream samples (Lactaseibacillus paracasei L-26, Lactobacillus casei 431, Lactobacillus acidophilus LA-5, Lactaseibacillus rhamnosus and Bifidobacterium animalis ssp. lactis BB-12) from sheep’s milk with inulin, apple fiber and inulin, or apple fiber and control samples were submitted to in vitro digestion in the mouth, stomach and small intestine. The bioavailability of calcium in the ice cream samples ranged from 40.63% to 54.40%, whereas that of magnesium was 55.64% to 44.42%. The highest bioavailability of calcium and magnesium was shown for the control samples. However, adding 4% inulin reduced the bioavailability of calcium by about 3–5% and magnesium only by about 5–6%. Adding 4% apple fiber reduced the bioavailability of calcium by as much as 6–12% and magnesium by 7–8%. The highest bioavailability of calcium was determined in ice cream with L. paracasei, and the highest bioavailability of magnesium was determined in ice cream with L. casei. The bioavailability of phosphorus in ice cream ranged from 47.82% to 50.94%. The highest bioavailability of phosphorus (>50%) was in sheep ice cream fermented by B. animalis. In the control ice cream, the bioavailability of potassium was about 60%. In ice cream with inulin, the bioavailability of potassium was lower by 3–4%, and in ice cream with apple fiber, the bioavailability of potassium was lower by up to 6–9%. The bioavailability of potassium was significantly influenced only by the addition of dietary fiber. The results of the study confirmed the beneficial effect of bacteria on the bioavailability of Ca, Mg and P.
... [14][15] The already tenuous case for dietary fiber is made more concerning by an important outlier in the research. 16 In this feeding trial, potassium (782, 1564, and 2346 mg/d) from unfried potatoes, fried potatoes, and potassium gluconate was added to a background diet containing 2346 mg/day. Contrary to expectations, the vast majority of additional potassium from potatoes was recovered in urine (95%), similar to potassium gluconate, regardless of dose. ...
... What is more, these relatively high doses of carbohydrates and alkali were still unable to prevent increases in plasma potassium concentrations. 10,13 As for dietary fiber, even if the aforementioned potato study is ignored 16 and it is assumed that the changes in potassium excretion are entirely caused by lowering potassium bioavailability, the observed dose-response relationship (25 mg potassium/g fiber) 14 is small compared with the ratio of potassium and fiber in most high-potassium plant foods (eg, 138 mg potassium/g fiber in bananas; US Department of Agriculture National Database no. 9040). ...
Diet therapy for hyperkalemia in people with chronic kidney disease (CKD) has shifted considerably in recent years with the observations that reported potassium intake is weakly, or not at all, associated with plasma potassium levels in this population. One of the lingering debates is whether dietary potassium presents a risk of hyperkalemia in the postprandial state. Although there is general agreement about the need for additional research, the commentary by Varshney et al contends that the available research sufficiently demonstrates that high-potassium plant foods do not pose a risk of postprandial hyperkalemia. Others argue that this remains unsettled science. Although the traditional approach of providing people with CKD lists of high-potassium foods to limit or avoid may be unnecessary, those at high risk of hyperkalemia should be encouraged to consume balanced meals and control portions, at least until some of the key research gaps in this area are resolved. This editorial critiques the analyses offered by Varshney et al and explains the rationale for a more cautious approach to care.
... In the US, potatoes are the most commonly consumed vegetable, accounting for 21 % of all vegetable intake (3) . They are a rich and bioavailable source of potassium, dietary fibre and other key nutrients such as magnesium that may benefit cardiometabolic health (4) . There is substantial evidence that these nutrients play roles in the prevention of elevated blood pressure (5,6) and other adverse cardiometabolic health outcomes (7) . ...
... There are several mechanisms by which potatoes could benefit cardiometabolic health outcomes. The potassium derived from potatoes is highly bioavailable (4) . Since dietary potassium in observational studies of adults has been inversely associated with blood pressure (5) , greater flow-mediated dilation (30) and CVD occurrence (6,31) , potatoes could provide cardiovascular benefits. ...
Some consider potatoes to be unhealthy vegetables that may contribute to adverse cardiometabolic health outcomes. We evaluated the association between potato consumption (including fried and non-fried types) and three key cardiometabolic outcomes among middle-aged and older adults in the Framingham Offspring Study. We included 2523 subjects ≥30 years of age with available dietary data from 3-d food records. Cox-proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for hypertension, type 2 diabetes or impaired fasting glucose (T2DM/IFG), and elevated triglycerides, adjusting for anthropometric, demographic and lifestyle factors. In the present study, 36 % of potatoes consumed were baked, 28 % fried, 14 % mashed, 9 % boiled and the rest cooked in other ways. Overall, higher total potato intake (≥4 v . <1 cup-equivalents/week) was not associated with risks of T2DM/IFG (HR 0⋅97, 95 % CI 0⋅81, 1⋅15), hypertension (HR 0⋅95; 95 % CI 0⋅80, 1⋅12) or elevated triglycerides (HR 0⋅99, 95 % CI 0⋅86, 1⋅13). Stratified analyses were used to evaluate effect modification by physical activity levels and red meat consumption, and in those analyses, there were no adverse effects of potato intake. However, when combined with higher levels of physical activity, greater consumption of fried potatoes was associated with a 24 % lower risk (95 % CI 0⋅60, 0⋅96) of T2DM/IFG, and in combination with lower red meat consumption, higher fried potato intake was associated with a 26 % lower risk (95 % CI 0⋅56, 0⋅99) of elevated triglycerides. In this prospective cohort, there was no adverse association between fried or non-fried potato consumption and risks of T2DM/IFG, hypertension or elevated triglycerides.
... It is often unrecognized that meat products contain nearly as much or more potassium than many fruits and vegetables, especially when potassium additives are used in enhanced meats or processed foods, resulting in a 2-to threefold increase in potassium content [6,23]. In addition, potassium in plant foods (50-60%) is absorbed to a lesser extent, compared to animal sources (80%) and additives (100%) [24][25][26]. Second, we found no association between dietary potassium intake and serum potassium, which is in line with observational studies in the adult CKD and HD population and a recent meta-analysis [5-7, 9, 27-29]. ...
... Potassium is not ingested in isolation, but as part of a meal, in which other nutrients influence potassium distribution and excretion [6]. Plant sources have the advantage that they promote intracellular potassium deposition because of their alkaline and insulin-stimulating properties [6,[24][25][26]33]. Moreover, the accompanying fiber content in plant-based foods has been described to have a protective effect on serum potassium as it improves constipation, hereby facilitating fecal potassium excretion [4]. ...
Background
Fruit and vegetable intake is commonly discouraged in children with chronic kidney disease (CKD) to avoid hyperkalemia. However, direct evidence in support of this widespread practice is lacking. Furthermore, the resultant restricted fiber exposure may deprive CKD patients from potential health benefits associated with the latter. Therefore, we investigated associations between dietary potassium intake, fiber intake, and serum potassium levels in pediatric CKD.Methods
This study is a longitudinal analysis of a 2-year, prospective, multi-institutional study, following children with CKD at 3-month intervals. At each visit, dietary potassium and fiber intake were assessed, using 24-h recalls and 3-day food records. On the same occasion, serum potassium concentrations were determined. Associations between dietary potassium intake, dietary fiber intake, and serum potassium concentrations were determined using linear mixed models.ResultsFifty-two CKD patients (7 transplant recipients, none on dialysis) aged 9 [4;14] years with an estimated glomerular filtration rate (eGFR) of 49 [25;68] mL/min/1.73 m2 were included. For every g/day decrease in dietary potassium intake, the estimated mean daily fiber intake was 5.1 g lower (95% confidence interval (CI), 4.3–5.9 g/day; p < 0.001). Neither dietary potassium intake (p = 0.40) nor dietary fiber intake (p = 0.43) was associated with circulating potassium in a model adjusted for time point, eGFR, treatment with a renin–angiotensin–aldosterone system blocker, serum bicarbonate concentration, and body surface area.Conclusions
Dietary potassium and fiber intake are closely related but were not associated with circulating potassium levels in pediatric CKD.Graphical abstractA higher-resolution version of the graphical abstract is available as Supplementary information.
... Храни, богати на калий, като плодове и зеленчуци са основната цел на тези ограничения. Въпреки че общият прием на калий не е силно свързан със серумните нива на калий, приемът на калий от определени храни като картофи е свързан с по-висок риск от хиперкалиемия, което подчертава важността на внимателното управление на хранителните източници на калий при пациенти с ХБЗ (20,17). ...
Introduction: Chronic kidney disease (CKD) affects approximately 13% of the adult population worldwide and represents a significant health problem. In recent years, the morbidity and mortality associated with kidney diseases have increased significantly, and by 2040 these diseases are expected to become the fifth leading cause of disease burden. Potassium is an important electrolyte that plays an essential role in the proper functioning of the kidneys and must be maintained within reference limits to prevent dyskalemia conditions. Management of dyskalemia is key in CKD and requires the application of appropriate pharmacological and non-pharmacological approaches. Aim: The objective is to review the possibilities of maintaining potassium balance through nutrition, as potassium balance is important for managing dyskalemia and reducing the risk of complications in patients with CKD. Material and Methods: The review included publications related to CKD, potassium, dyskalemia, and dietary approaches to managing the condition, based on evidence from scientific databases. The search was performed using the following keywords in English: chronic kidney disease, potassium, dyskalemia, diet foods, low potassium foods, hyperkalemia, hypokalemia, diet. Results: The review shows that dietary interventions, including the restriction of potassium-containing foods and the selection of appropriate cooking methods, effectively control potassium balance in patients with CKD. Replacing common salt with potassium-fortified substitutes may reduce cardiovascular risks but requires caution in these patients due to the risk of hyperkalemia. Conclusions: Effective management of potassium balance in patients with CKD requires an integrated approach with dietary and medical interventions. Individualized dietary strategies tailored to the stage of the disease are key to preventing complications and improving quality of life.
... In contrast, the bioavailability of K + from processed foods with K + -containing additives was much greater at 90-100% [23,24]. Hence, in children with hyperkalemia, foods containing K + additives must be avoided in the first instance before restricting fresh foods. ...
Dyskalemias are often seen in children with chronic kidney disease (CKD). While hyperkalemia is common, with an increasing prevalence as glomerular filtration rate declines, hypokalemia may also occur, particularly in children with renal tubular disorders and those on intensive dialysis regimens. Dietary assessment and adjustment of potassium intake is critically important in children with CKD as hyperkalemia can be life-threatening. Manipulation of dietary potassium can be challenging as it may affect the intake of other nutrients and reduce palatability. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) for the dietary management of potassium in children with CKD stages 2-5 and on dialysis (CKD2-5D). We describe the assessment of dietary potassium intake, requirements for potassium in healthy children, and the dietary management of hypo-and hyperkalemia in children with CKD2-5D. Common potassium containing foods are described and approaches to adjusting potassium intake that can be incorporated into everyday practice discussed. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.
... Once the infant is taking a mixed diet, the use of renalspecific low potassium IF instead of whey-dominant IF allows for the inclusion and greater variety of high potassium foods. Processed foods containing potassium additives should be avoided as they provide an unnecessary source of potassium with high (90-100%) bioavailability [90,91]. ...
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2-5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
... Educating children and their caregivers to scrutinize food labels and avoid products featuring "potassium" in the ingredient list is pivotal. As with phosphate, these inorganic food additives have high (90-100%) bioavailability [63,64] and are an unnecessary source of dietary potassium. ...
While it is widely accepted that the nutritional management of the infant with chronic kidney disease (CKD) is paramount to achieve normal growth and development, nutritional management is also of importance beyond 1 year of age, particularly in toddlers, to support the delayed infantile stage of growth that may extend to 2–3 years of age. Puberty is also a vulnerable period when nutritional needs are higher to support the expected growth spurt. Inadequate nutritional intake throughout childhood can result in failure to achieve full adult height potential, and there is an increased risk for abnormal neurodevelopment. Conversely, the rising prevalence of overweight and obesity among children with CKD underscores the necessity for effective nutritional strategies to mitigate the risk of metabolic syndrome that is not confined to the post-transplant population. Nutritional management is of primary importance in improving metabolic equilibrium and reducing CKD-related imbalances, particularly as the range of foods eaten by the child widens as they get older (including increased consumption of processed foods), and as CKD progresses. The aim of this review is to integrate the Pediatric Renal Nutrition Taskforce (PRNT) clinical practice recommendations (CPRs) for children (1–18 years) with CKD stages 2–5 and on dialysis (CKD2–5D). We provide a holistic approach to the overall nutritional management of the toddler, child, and young person. Collaboration between physicians and pediatric kidney dietitians is strongly advised to ensure comprehensive and tailored nutritional care for children with CKD, ultimately optimizing their growth and development.
Graphical abstract
... Remarkably, potato is packaged in nutrients, such as water, starch, high-quality protein, dietary fiber, vitamins (mainly vitamins C and B6), minerals (potassium, iron, magnesium, calcium, and zinc), health-promoting phytochemicals (phenolic acids, anthocyanins, carotenoids, and flavonoids) (Bassoli et al., 2008;Ezekiel et al., 2013;Campos and Ortiz, 2020;BNV and GVS, 2023) and low in antinutrients such as phytic acid and tannins, thereby enhancing the bioavailability of minerals (Camire et al., 2009). Furthermore, interventional studies confirmed that vitamin C and potassium found in potatoes are highly bioavailable (Kondo et al., 2012;Macdonald-Clarke et al., 2016). ...
Environmental data are rapidly accruing on the unsustainability of diets based on animal products, such as dairy and meats. Shifting to alternative sources of protein is inevitable given an increase in the projected global population and protein demand. Left unchecked, a collision between food security and sustainability is imminent. Potatoes could be the strategic food and cash crop to harmonize food security and sustainability worldwide. Recently, there has been a growing interest in extracting proteins from the byproduct of the potato starch industry known as potato fruit juice. These proteins are garnering attention due to their nutritional value, characterized by a well-balanced amino acid profile, as well as their functional properties including emulsifying, foaming, and gelling capabilities. Moreover, these proteins are considered to be less allergenic than some other protein sources. Extracting potato protein, which is sourced as a byproduct, reduces food loss and waste, thereby eliminating pathogenic microorganisms from the environment and mitigating greenhouse gas emissions. Ethiopia is a major potato producer in East Africa. Potatoes help the country increase household income, ensure food security and revenue generation, and produce starch. However, Ethiopia’s potato starch industry has not yet begun protein extraction, despite the vital role of the proteins and the country’s huge cultivation potential. Furthermore, the global potato protein market is experiencing significant growth. This information urgently calls for innovative approaches to assess the impact of extracting protein from potatoes produced in Ethiopia. Therefore, this perspective article has two main objectives. First, to scan the extent of potato production in Ethiopia in relation to environmental sustainability and the economy. Second, to provide prospects on the impact of extracting protein isolate from potatoes produced in Ethiopia on environmental sustainability, Ethiopia’s economy, and human health.
... 19,62,63 Macdonald-Clarke and colleagues' 2016 study did show a potassium bioavailability of greater than 94% in potatoes, a value more similar to the bioavailabilities of animal foods and potassium additives/salts, which have values between 70% and 100% (Fig 1). 3,61,64,65 However, a recent in vitro study on bioavailability of potassium by Ceccanti and colleagues shows a lower bioavailability from potatoes. 66 Across most studies on this issue, it appears that the potassium bioavailability appears to be around 65% for unprocessed plant foods. ...
... [16][17][18] However, more research is needed to determine if dietary fiber can lower potassium bioavailability. 19 The intake of foods with potassium additives, such as ultraprocessed foods, and those containing low-sodium salt substitutes or potassium preservatives is an important hidden source of potassium. A 100-g intake of enhanced meat could add 300-575 mg of potassium because of its preservatives. ...
Potassium disorders are one of the most common electrolyte abnormalities in patients with chronic kidney disease (CKD), contributing to poor clinical outcomes. Maintaining serum potassium levels within the physiologically normal range is critically important in these patients. Dietary potassium restriction has long been considered a core strategy for the management of chronic hyperkalemia in patients with CKD. However, this has been challenged by recent evidence suggesting a paradigm shift toward fostering more liberalized, plant-based dietary patterns. The advent of novel potassium binders and an improved understanding of gastrointestinal processes involved in potassium homeostasis (e.g., gastrointestinal potassium wasting) may facilitate a paradigm shift and incorporation of heart-healthy potassium-enriched food sources. Nevertheless, uncertainty regarding the risk-benefit of plant-based diets in the context of potassium management in CKD remains, requiring well-designed clinical trials to determine the efficacy of dietary potassium manipulation toward improvement of clinical outcomes in patients with CKD.
... Like any other nutrient, variation in potassium content was present across varieties, which ranged from about 355 to 823 mg/100 g FW (Casanas et al. 2002;Rivero et al. 2003). Macdonald et al. (2016) have reported that the bioavailability of potassium is as high in potatoes as in potassium gluconate supplements. ...
Potato is the most consumed vegetable across the world. It is a highly nutritious crop constituting important nutrients such as vitamin C, B6, iron, potassium, antioxidants, phytochemicals and dietary fibre that are essential for human health. Despite being loved by most people, there are many speculations about its impact on health, due to its high glycemic index. Potatoes have been tagged as causative agent for obesity and type 2 diabetes. Hence, this review provides a comprehensive view of the potato’s nutrient content, its variation due to genotype, environmental factors and different methods to minimize nutrient loss during storage and cooking conditions. Additionally, insights into various approaches for reducing the glycemic index and the potential of potato to tackle energy requirements and malnutrition for current and future generations are also discussed.
... Recommended intake values have been generated from data using supplementation rather than foods, with limited studies looking into the bioavailability of potassium from food sources (30). Potassium from potatoes has been shown to be like that of potassium gluconate supplements but with limited data in other food sources (31). ...
Background
A “balanced, adequate, and varied diet” is recommended as the basis of nutritionally sound diet by the World Health Organisation and national public health agencies. Huel is a proprietary, on-the-go, powdered, plant based food, providing all 26 essential vitamins and minerals, protein, essential fats, carbohydrate, fibre, and phytonutrients.
Objectives
Assessing the effect of solely consuming Huel on micronutrient status, dietary intake and markers of health was achieved through a 4-week intervention of solely Huel powder.
Methods
Habitual energy intake was assessed through a one-week lead in period with healthy adult participants (aged 18 or over) logging their food intake, after which only Huel was consumed for 4 weeks. Blood samples and body composition was assessed before and after the lead in week as well the end of the intervention. Thirty participants were recruited with 20 (11 females, median age 31, range 22–44) completing the study, 19 sets of blood samples were collected. 22 blood markers were analysed along with weight, BMI, waist circumference, visceral adipose tissue (VAT), and body composition. All blood micronutrients, except for Thyroid Stimulating Hormone and choline were sent to Royal Victoria Infirmary NHS, Newcastle Laboratory (Newcastle upon Tyne, United Kingdom) for analysis.
Results
Fourteen of the parameters significantly changed over the course of the study with circulating haemoglobin, iron, vitamins B12 and D as well as selenium significantly increasing (p < 0.05). HbA1c, total and non-HDL cholesterol, vitamins A and E, potassium, BMI, VAT, and waist circumference all significantly decreased (p < 0.05) post intervention.
Conclusion
Although energy intake decreased during the intervention period, the adherence to recommended micronutrient intake, as quantified by the dietary Total Adherence Score, significantly increased which tallies with the preservation or improvement of micronutrient status. This study potentially demonstrates that consuming only Huel for 4 weeks does not negatively affect micronutrient status.
... Once the infant is taking a mixed diet, the use of renalspecific low potassium IF instead of whey-dominant IF allows for the inclusion and greater variety of high potassium foods. Processed foods containing potassium additives should be avoided as they provide an unnecessary source of potassium with high (90-100%) bioavailability [90,91]. ...
The nutritional management of children with chronic kidney disease (CKD) is of prime importance in meeting the challenge of maintaining normal growth and development in this population. The objective of this review is to integrate the Pediatric Renal Nutrition Taskforce clinical practice recommendations for children with CKD stages 2–5 and on dialysis, as they relate to the infant from full term birth up to 1 year of age, for healthcare professionals, including dietitians, physicians, and nurses. It addresses nutritional assessment, energy and protein requirements, delivery of the nutritional prescription, and necessary dietary modifications in the case of abnormal serum levels of calcium, phosphate, and potassium. We focus on the particular nutritional needs of infants with CKD for whom dietary recommendations for energy and protein, based on body weight, are higher compared with children over 1 year of age in order to support both linear and brain growth, which are normally maximal in the first 6 months of life. Attention to nutrition during infancy is important given that growth is predominantly nutrition dependent in the infantile phase and the growth of infants is acutely impaired by disruption to their nutritional intake, particularly during the first 6 months. Inadequate nutritional intake can result in the failure to achieve full adult height potential and an increased risk for abnormal neurodevelopment. We strongly suggest that physicians work closely with pediatric renal dietitians to ensure that the infant with CKD receives the best possible nutritional management to optimize their growth and development.
... After this trial period, participants were assigned to a random order (24 possible sequences) of four 16-day dietary potassium interventions including a control diet of 2300 mg/d (~60 mmol/d), and three phases of an additional 1000 mg/d (3300 mg/d(~85 mmol/d) total) of potassium in the form of potatoes (baked, boiled; no additional fat), French fries, or a K-gluconate supplement. Potassium gluconate was chosen due to its organic anion and measured bioavailability in our previous study [30]. Study phases were separated by a washout period (≥2 weeks). ...
Potassium supplementation has been associated with reduced urinary calcium (Ca) excretion and increased Ca balance. Dietary interventions assessing the impact of potassium on bone are lacking. In this secondary analysis of a study designed primarily to determine blood pressure effects, we assessed the effects of potassium intake from potato sources and a potassium supplement on urinary Ca, urine pH, and Ca balance. Thirty men (n = 15) and women (n = 15) with a mean ± SD age and BMI of 48.2 ± 15 years and 31.4 ± 6.1 kg/m2, respectively, were enrolled in a cross-over, randomized control feeding trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300 mg/day (~60 mmol/day) of potassium, and three phases of an additional 1000 mg/day (3300 mg/day(~85 mmol/day) total) of potassium in the form of potatoes (baked, boiled, or pan-heated), French fries (FF), or a potassium (K)-gluconate supplement. Calcium intake for all diets was approximately 700–800 mg/day. Using a mixed model ANOVA there was a significantly lower urinary Ca excretion in the K-gluconate phase (96 ± 10 mg/day) compared to the control (115 ± 10 mg/day; p = 0.027) and potato (114 ± 10 mg/day; p = 0.033). In addition, there was a significant difference in urinary pH between the supplement and control phases (6.54 ± 0.16 vs. 6.08 ± 0.18; p = 0.0036). There were no significant differences in Ca retention. An increased potassium intake via K-gluconate supplementation may favorably influence urinary Ca excretion and urine pH. This trial was registered at ClinicalTrials.gov as NCT02697708.
... shown an apparent absorption of potassium being greater than 85%. 39,40 A possible explanation for these discordant findings is the variable fecal excretion of potassium found in plant-based foods, particularly in the setting of reduced renal function. The fiber content of foods affects stool volume and frequency, which will affect fecal potassium excretion. ...
Emerging research suggests that a more liberalized diet, specifically a more plant‐based diet resulting in liberalization of potassium intake, for people receiving hemodialysis is necessary and the benefits outweigh previously thought risks. If the prescribed hemodialysis diet is to be liberalized, the need to illuminate and prevent potential pitfalls of a liberalized potassium diet is warranted. This paper explores such topics as partial to full adherence to a liberalized diet and its consequences if any, the advantages of a high‐fiber intake, the theoretical risk of anemia when consuming a more plant‐dominant diet, the potential benefits against renal acid load and effect on metabolic acidosis with increased fruit and vegetable intake, the putative change in serum potassium levels, carbohydrate quality, and the healthfulness of meat substitutes. The benefits of a more plant‐based diet for the hemodialysis population are multifold; however, the possible pitfalls of this type of diet must be reviewed and addressed upon meal planning in order to be avoided.
... In contrast, the bioavailability of K + from processed foods with K + -containing additives was much greater at 90-100% [23,24]. Hence, in children with hyperkalemia, foods containing K + additives must be avoided in the first instance before restricting fresh foods. ...
Dyskalemias are often seen in children with chronic kidney disease (CKD). While hyperkalemia is common, with an increasing prevalence as glomerular filtration rate declines, hypokalemia may also occur, particularly in children with renal tubular disorders and those on intensive dialysis regimens. Dietary assessment and adjustment of potassium intake is critically important in children with CKD as hyperkalemia can be life-threatening. Manipulation of dietary potassium can be challenging as it may affect the intake of other nutrients and reduce palatability. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) for the dietary management of potassium in children with CKD stages 2–5 and on dialysis (CKD2–5D). We describe the assessment of dietary potassium intake, requirements for potassium in healthy children, and the dietary management of hypo- and hyperkalemia in children with CKD2–5D. Common potassium containing foods are described and approaches to adjusting potassium intake that can be incorporated into everyday practice discussed. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. These CPRs will be regularly audited and updated by the PRNT.
... Of note, while inorganic phosphorus is often claimed to be 90-100% bioavailable, this figure appears to be based on in vitro digestibility studies that do not account for limitations in phosphorus absorption [11][12][13]. Likewise, whole fruit and vegetables, and whole grains have been found in some studies to increase stool potassium output, a finding that may be due to reduced potassium absorption from dietary fiber [14][15][16]. Protein equivalence in PEW risk is more complicated, as protein requirements encompass absolute protein needs, as well as needs for essential amino acids (EAAs). ...
... Daily consumption of vegetables covers approx. 20% of the daily requirement for potassium, i.e. an important component reducing the risk of oral cancer(21,22). A level of 22.50 g K·kg − 1 in dry matter of potato tubers was reported by Wadas et al.(23). ...
Background
Nutrition is one of the major determinants of human health. Consuming plant foods provides not only nutrients but also bioactive substances that reduce disease. The health of the oral cavity is determined by the quality of food, including vegetable food.Objective
To study the effects of macro and microelements in vegetables on the status of mineralised dental tissues in relation to the hygiene and nutritional habits in 15-year-old adolescents living in Lublin Province and Lviv Oblast.Methods
The chemical composition of plants was assessed (macro and microelements) of carrots and potatoes, vegetables consumed by 15-year-old inhabitants of Poland and Ukraine. The status of mineralised dental tissues was assessed based on caries severity expressed by the mean D3MFT number and the SIC index value. Another part of the study was a socio-medical survey focused on assessment of patients' eating habits.The respondents answered questions about the frequency of consumption of fruit and vegetables and fruit juices.ResultsThe chemical composition of plants depended on the species and place of cultivation. The present study showed higher caries frequency in the group of the 15-year-olds living in Kraśnik, i.e. 88% vs. 75% in the group from Chervonograd. The intensity of caries measured by the mean D3MFT value in the 15-year-old teenagers from Chervonograd who declared everyday consumption of fresh vegetables and fruit was 3.77, and from Krasnik 5.17.Conclusion
The present results show that carrots are a good source of microelements for humans, whereas potatoes provide potassium and calcium. The impact of the frequency of consuming plant products on the health of the oral cavity, which depended on the place of youth research.
... Salting foods and discarding the liquid from the food materials induces sodium (Na + ) for potassium (K + ) exchange and reduces the potassium content of foods (Stone et al. 2016). It has been observed that higher consumption of cereal and processed foods, and lower consumption of fruits and vegetables has led to a diet lower in potassium and higher in sodium (Macdonald-Clarke et al. 2016). ...
Food nutrients play a vital role in the existence, sustenance, and evolution of all forms of life including human, and their adequacy largely depends on their chemical type, intake, and bioavailability. While knowledge on the bioavailability of ingested components is essential to estimate the quantity of nutrient that must be supplied to meet the minimum daily requirements, safety and bio–efficacy is critical for nutrient acceptability. Safety limits are imposed by regulatory agencies to restrict and regulate intake of nutrients to avoid possible adverse effects. With increased enforcement of regulations, the food industry is subjected to stringent scrutiny to ensure food quality and safety. Worldwide, viz. FAO/WHO, FDA, CFDA, EFSA and other regulatory agencies, and FSSAI in India aims at protecting the health of the public through strengthening the measures for assurance of food safety. Aspects relating to essential nutrients and their health effects, bioavailability, safety and regulations are discussed in this chapter.
... Potassium is almost completely absorbed from dietary sources, although matrix effects may hinder potassium absorption from unprocessed vegetables and fruits to some extent. Estimates of bioavailability range between 60 and 85% from such sources (130,131). Little is known about factors that promote or inhibit the absorption of potassium from individual dietary sources (132). ...
In order to fully exploit the nutrient density concept, thorough understanding of the biological activity of single nutrients in their interaction with other nutrients and food components from whole foods is important. This review provides a narrative overview of recent insights into nutrient bioavailability from complex foods in humans, highlighting synergistic and antagonistic processes among food components for two different food groups, i.e., dairy, and vegetables and fruits. For dairy, bioavailability of vitamins A, B2, B12 and K, calcium, phosphorous, magnesium, zinc and iodine are discussed, whereas bioavailability of pro-vitamin A, folate, vitamin C and K, potassium, calcium, magnesium and iron are discussed for vegetables and fruits. Although the bioavailability of some nutrients is fairly well-understood, for other nutrients the scientific understanding of uptake, absorption, and bioavailability in humans is still at a nascent stage. Understanding the absorption and bioavailability of nutrients from whole foods in interaction with food components that influence these processes will help to come to individual diet scores that better reflect absorbable nutrient intake in epidemiologic studies that relate dietary intake to health outcomes. Moreover, such knowledge may help in the design of foods, meals, and diets that aid in the supply of bioavailable nutrients to specific target groups.
... Naismith and Braschi [51] showed that there is a lower bioavailability of potassium from fruits and vegetables as compared to animal foods and juices. However, other studies have shown that there was no difference in serum potassium following the consumption of similar amounts of potassium in the form of potatoes or potassium gluconate [52]. Presumably, the addition of potassium to the food label will provide many food manufacturers with motivation to further increase potassium in processed foods. ...
According to the American Heart Association (AHA) and the American College of Cardiology (ACC), hypertension is defined as systolic blood pressure (SBP) ≥130 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. In the United States, among people ≥18 years of age, the prevalence of hypertension was 29% in 2015–2016, with the highest prevalence among those ≥60 years of age (63%) and the non-Hispanic Black population (40%). However, these numbers could be expected to increase with recent changes in BP classifications. A reduction of blood pressure toward normal levels is important, as prolonged hypertension and diabetes mellitus are the leading causes of chronic kidney disease (CKD), and prolonged uncontrolled hypertension may lead to end-stage kidney disease.
... Fruits and vegetables are naturally rich in potassium. The potassium in foods 106,107 and in inorganic salts [108][109][110] seems to be completely absorbed by the proximal intestinal tract. Net absorption, however, depends on intestinal secretion and faecal volume. ...
Traditional dietary recommendations for patients with chronic kidney disease (CKD) focus on the quantity of nutrients consumed. Without appropriate dietary counselling, these restrictions can result in a low intake of fruits and vegetables and a lack of diversity in the diet. Plant nutrients and plant-based diets could have beneficial effects in patients with CKD: increased fibre intake shifts the gut microbiota towards reduced production of uraemic toxins; plant fats, particularly olive oil, have anti-atherogenic effects; plant anions might mitigate metabolic acidosis and slow CKD progression; and as plant phosphorus has a lower bioavailability than animal phosphorus, plant-based diets might enable better control of hyperphosphataemia. Current evidence suggests that promoting the adoption of plant-based diets has few risks but potential benefits for the primary prevention of CKD, as well as for delaying progression in patients with CKD G3–5. These diets might also help to manage and prevent some of the symptoms and metabolic complications of CKD. We suggest that restriction of plant foods as a strategy to prevent hyperkalaemia or undernutrition should be individualized to avoid depriving patients with CKD of these potential beneficial effects of plant-based diets. However, research is needed to address knowledge gaps, particularly regarding the relevance and extent of diet-induced hyperkalaemia in patients undergoing dialysis.
... In the proposed BPE synthesis, the formation of Cu 2 O species is only possible in the presence of potassium gluconate, which has multiple roles: as an electrolyte (to increase the conductivity of the solution); as a complexing agent (C 12 H 22 CuO 14 ); and, most importantly, as a reducing agent, allowing for the generation of Cu + ions. Potassium gluconate is a low-cost food supplement and assists several functions of the body (e.g., it is used to regulate potassium levels in the blood [34]). Herein, we exploit the gluconate as an essential reactant in the synthesis of nanostructured Cu 2 O. ...
Cuprous oxide (Cu2O) was synthesized for the first time via an open bipolar electrochemistry (BPE) approach and characterized in parallel with the commercially available material. As compared to the reference, Cu2O formed through a BPE reaction demonstrated a decrease in particle size; an increase in photocurrent; more efficient light scavenging; and structure-correlated changes in the flat band potential and charge carrier concentration. More importantly, as-synthesized oxides were all phase-pure, defect-free, and had an average crystallite size of 20 nm. Ultimately, this study demonstrates the impact of reaction conditions (e.g., applied potential, reaction time) on structure, morphology, surface chemistry, and photo-electrochemical activity of semiconducting oxides, and at the same time, the ability to maintain a green synthetic protocol and potentially create a scalable product. In the proposed BPE synthesis, we introduced a common food supplement (potassium gluconate) as a reducing and complexing agent, and as an electrolyte, allowing us to replace the more harmful reactants that are conventionally used in Cu2O production. In addition, in the BPE process very corrosive reactants, such as hydroxides and metal precursors (required for synthesis of oxides), are generated in situ in stoichiometric quantity, providing an alternative methodology to generate various nanostructured materials in high yields under mild conditions.
... Potato chips, one of the most popular snacks in the United States, lack the proper nutrition because of their high fat and carbohydrate content. Except for potassium, which potatoes provide 19% to 20% of our recommended daily intake, consumers do not obtain any other significant nutritional value from potatoes and their products (Macdonald-Clarke et al., 2016). Enriching potato with antioxidants may increase their nutritional attributes. ...
This studied tested the feasibility of producing vacuum fried potato chips enriched with antioxidants by introducing green tea extract using vacuum impregnation (VI) technology. Total phenolic content (TPC) was used to find the optimal VI parameters. Sliced potatoes were fried under vacuum at 110, 120, or 140 °C from 20 to 720 s to test the thermal degradability of the TPC. Three frying systems were also compared: vacuum frying (VF), dual‐step (DS) frying, and atmospheric frying (AF). Green tea concentration of 5%, vacuum time of 10 min, and a pressure of 80 kPa gave the maximum TPC of 196.11 ± 15.41 mg GAE/100 g of dry matter. Samples fried at 120 °C showed an overall greater phenolic retention capacity compared to the chips fried at 140 and 110 °C. Using the optimal VI and VF parameters (140 °C, 100 s), the three frying systems were then compared. Samples fried using the AF system contained twice as much the oil content as those fried using the VF or DS systems. VF chips had the highest percentage in TPC increase (209%) while AF chips had the lowest (163%). A consumer panel found the samples fried under AF more acceptable and were given the highest scores for all quality. VI had a negative effect on the color scoring of the participants (they were dark). Overall, VI is a suitable precursor of VF to create potato chips with a high phenolic content.
Practical Application
Vacuum impregnated potato chips with green tea extract have potential for manufacture of functional snacks that may influence the public into consuming phenol‐rich fruit and vegetable snack.
... Supplementation with 2300 mg (60 mmol) of potassium gluconate added to a controlled diet containing 2300 mg (60 mmol/d) of potassium increased the plasma concentration from 3.6 to 4.1 mmol/L, but the increase was transient, lasting for approximately 4 hours, and followed immediately by increased renal potassium excretion. 71 These findings suggest that the body is able to efficiently adapt to high potassium intake and that potassium supplementation may be a potential strategy to mitigate the deleterious effects of high sodium intake in Americans. Nevertheless, the adverse effects of potassium loading have not been previously evaluated in the context of diets low in sodium. ...
Increased intake of potassium should be promoted to reduce the risk of cardiovascular disease and stroke and to protect against bone loss, but confidence in recommended intakes depends on the strength of the evidence. All public health recommendations are considerably higher than current average intakes. Evidence on which current potassium intake recommendations for the United States, Europe, and globally have limitations. More recent evidence reviewed by the Agency for Healthcare Research and Quality affirms that more evidence is needed to define specific values for optimal potassium intakes. Potassium requirements undoubtedly vary with a number of factors including energy needs, race, and intake of sodium.
Healthcare professionals are consistently bombarded with conflicting messages about the role of diet in bone health. Yet, few resources are available that compile the broad scope of dietary factors that influence bone health. This article evaluates the evidence on the association of diet and exercise with bone health, with the aim to provide a resource for healthcare professionals and researchers in the field. This review also highlights gaps in knowledge, provides dialogue around why some studies exhibit conflicting outcomes, and showcases why many remaining questions likely cannot be answered with the current evidence to date. The best evidence to date supports obtaining recommended dairy and calcium intakes for building bone in early life and mitigating bone loss with age. However, nutrients do not solely work in isolation, and there is growing evidence that many other nutrients and dietary bioactives play a synergistic role in supporting bone health. Large randomized controlled trials, particularly in traditionally underserved subpopulations (eg, people of color, transgender individuals, older adults, etc), are needed to fully elucidate the effects of diet and exercise on bone health across the lifespan.
In 2019, “Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report” was published. This consensus report, however, did not provide an easy way to illustrate to subjects with prediabetes (SwPs) how to follow a correct dietary approach. The purpose of this review is to evaluate current evidence on optimum dietary treatment of SwPs and to provide a food pyramid for this population. The pyramid built shows that everyday consumption should consist of: whole-grain bread or potatoes eaten with their skins (for fiber and magnesium) and low glycemic index carbohydrates (GI < 55%) (three portions); fruit and vegetables (5 portions), in particular, green leafy vegetables (for fiber, magnesium, and polyphenols); EVO oil (almost 8 g); nuts (30 g, in particular, pistachios and almonds); three portions of dairy products (milk/yogurt: 300–400 g/day); mineral water (almost 1, 5 L/day for calcium intake); one glass of wine (125 mL); and three cups of coffee. Weekly portions should include fish (four portions), white meat (two portions), protein plant-based food (four portions), eggs (egg portions), and red/processed meats (once/week). At the top of the pyramid, there are two pennants: a green one means that SwPs need some personalized supplementation (if daily requirements cannot be satisfied through diet, vitamin D, omega-3, and vitamin B supplements), and a red one means there are some foods and factors that are banned (simple sugar, refined carbohydrates, and a sedentary lifestyle). Three to four times a week of aerobic and resistance exercises must be performed for 30–40 min. Finally, self-monitoring innovative salivary glucose devices could contribute to the reversion of prediabetes to normoglycemia.
Although St-Jules et al have presented the case for postprandial hyperkalemia with food, including plant foods, there (still) is little to no direct evidence supporting the occurrence of postprandial hyperkalemia, mostly due to a lack of studies performed exclusively using food. Food is different than salts or supplements, and it is likely that a banana behaves differently than potassium salts. A growing body of evidence supports the use of plant foods without causing hyperkalemia in patients with kidney disease. Currently, only 1 study has reported on the postprandial effects of hyperkalemia. In this study, there was a substantial reduction in the instances of postprandial hyperkalemia in participants consuming a diet that included more plant foods and more fiber. At the time of this writing, there is no evidence to support risk or safety of certain foods with regard to postprandial hyperkalemia, and additional research is warranted.
The quality parameters that must be added as breeding objectives to
yield in the production environment are determined by the final usage of new
cultivars. As a staple meal, the potato's nutritional content is vital. As a
vegetable sold for money, its cooking quality, texture, taste, and flavour are
important. Its processing quality is determined by the producers of French
fries, chips (crisps), and other processed goods. Finally, the value of potato
starch for various applications in the starch business is determined by its
composition. Broad-end usage can be further broken down into
subcategories such market class, cooking technique, and processed food
type. Each end use and manufacturing setting must have a unique breeding
programme, with some breeding objectives shared but others specific.
Finding the most vital features is essential for success since only a limited
number of traits may see significant improvement. Additionally, it is
necessary to translate breeding objectives for quality characteristics into
selection criteria for use on the restricted number of tubers from yield trials
and evaluation plots, as well as for some traits, after storage and
cooking/processing.
Traditionally, diets for kidney disease were low in potassium. This recommendation was based on outdated research and often wrong assumptions that do not reflect current evidence. In fact, studies conducted over the past decades show patients with CKD including kidney failure do not benefit from restriction of plant foods relative to control. Generally, dietary potassium does not correlate with serum potassium, and we posit that this is due to the effects of fiber on colonic potassium absorption, the alkalinizing effect of fruits and vegetables on metabolic acidosis, and the bioavailability of dietary potassium in plant foods. Also, consumption of plant foods may provide pleiotropic benefits to patients with CKD. Emerging dietary recommendations for kidney health should be devoid of dietary potassium restrictions from plant foods so that patient-centered kidney recipes can be encouraged and promoted.
The modern diet is closely linked to the consumption of processed foods, causing an increase in the intake of salt, simple sugars, phosphorus and added potassium. This excess intake is associated with an increased risk of obesity, diabetes, hypertension and chronic kidney disease (CKD). CKD, which according to data from the ENRICA study affects 15% of the population, magnifies its impact due to the higher prevalence of diabetes and hypertension and due to limitations in the management of sodium and phosphorus. The intake of these products far exceeds the established recommendations, assuming 72% of total sodium, 25%–35% of phosphorus, 12%–18% of potassium and exceeding 10% of the caloric intake in simple sugars. Measures are necessary to reduce their contribution through nutritional advice, labeling review, education campaigns on healthy habits, fees and institutional actions that involve food safety agencies, industry, distribution and scientific societies.
Dietary treatment in chronic kidney disease (CKD) recommends limiting the consumption of foods rich in potassium to reduce risk of hyperkalemia. Currently, the increased supply of processed foods on the market could be a new “hidden” source of potassium for these patients, which is causing concern among health professionals who treat them. The aim of this study was to check which EU authorized food additives contain potassium, its conditions of use and classified them according to their risk for CKD patients. In addition, the frequency of appearance of potassium additives in processed foods in a European sample through the analysis of 715 products labeling from France, Germany, and Spain were evaluated. Results showed 41 potassium-containing additives allowed in the European Union, but only 16 were identified, being the most frequent: E202; E252, E340, E450, E452, E508, and E950. The 37.6% of the processed products analyzed contained at least one potassium additive. The food categories that showed the greatest presence of additives were breaded products, meat derivatives, non-alcoholic beverage, ready-to-eat products, and cereal derivatives. Potassium additives are widely distributed in processed foods and therefore pose a risk of hidden sources of potassium in CKD dietary management. These results could be really useful for developing educational tools for CKD patients.
Despite medical, dietary, and lifestyle recommendations and drug advancements, hypertension persists as among the most prevalent noncommunicable diseases in the US population, and control remains elusive. Uncontrolled hypertension may increase the risk of serious illness from various other health challenges, including cardiovascular and renal responses. Adoption of a healthy diet is a consistent core element of lifestyle modifications that are recommended for mitigation of hypertension. The dietary sodium-to-potassium ratio is recognized as having promising potential in the regulation of blood pressure. In fact, the understanding of the relation between this ratio and blood pressure was documented as a key evidence gap in the 2019 National Academies of Sciences, Engineering, and Medicine report that revised recommended intake levels for both sodium and potassium. Although notable animal and human evidence supports this point, fundamental to developing a specific dietary recommendation for a sodium-to-potassium ratio is a well-designed human intervention trial. The successful translatability of such a trial will require careful consideration of study elements, including the study population, duration, blood pressure measurement, and dietary intervention, among other factors. This paper addresses these decision points and serves as supporting documentation for a research group or organization with the interest and means to address this important data gap, which will undoubtedly be foundational for advancing dietary guidance and would inform the next iteration of Dietary Reference Intakes for sodium and potassium.
The intended end uses of new cultivars determine the quality criteria that need to be added as breeding objectives to yield in the production environments. Nutritional value will be important for the potato as a staple food; cooking quality, texture, taste and flavour will be important for the potato as a vegetable sold for cash; processing quality will be defined by the manufacturers of French fries, chips (crisps) and other processed products and the composition of the potato starch will determine its value for different uses in the starch industry. This chapter considers the challenges of translating these breeding objectives into selection criteria and methods of measurement for use on the tubers from assessment plots and yield trials, both immediately after harvest and after storage. Tuber appearance and freedom from internal defects are also selection criteria. Mineral and vitamin biofortification, beneficial phytochemicals, steroidal glycoalkaloids and acrylamide formation are also considered.
Resumen
La alimentación moderna está estrechamente vinculada al consumo de alimentos procesados, originando un aumento en la ingesta de sal, azúcares simples, fósforo y potasio añadidos. Este aporte excesivo se asocia a un mayor riesgo de obesidad, diabetes, hipertensión y enfermedad renal crónica (ERC). La ERC, que según datos del estudio ENRICA afecta al 15% de la población, magnifica su repercusión por la mayor prevalencia de diabetes e hipertensión y por las limitaciones en el manejo del sodio y del fósforo. La ingesta de estos productos supera ampliamente las recomendaciones establecidas, suponiendo un 72% del sodio total, un 25-35% del fósforo, un 12-18% de potasio y más del 10% del aporte calórico en azúcares simples. Son necesarias medidas para disminuir su aporte a través de consejo nutricional, revisión del etiquetado, campañas de educación en hábitos saludables, tasas y actuaciones institucionales que impliquen a las agencias de seguridad alimentaria, industria, distribución y sociedades científicas.
Potassium (K) is the most abundant cation in intracellular fluid where it plays a key role in maintaining cell function. The majority of K consumed (60–100 mmol day ⁻¹ ) is lost in the urine, with the remaining excreted in the stool, and a very small amount lost in sweat. Little is known about the bioavailability of K, especially from dietary sources. Less is understood on how bioavailability may affect health outcomes. Potassium is an essential nutrient that has been labeled a shortfall nutrient by recent Dietary Guidelines for Americans Advisory Committees. Increases in K intake have been linked to improvements in cardiovascular and other metabolic health outcomes. There is growing evidence for the association between K intake and blood pressure (BP) reduction in adults; hypertension (HTN) is the leading cause of the cardiovascular disease (CVD) and a major financial burden (US$53.2 billion) to the US public health system and has a significant impact on all-cause morbidity and mortality worldwide. Evidence is also accumulating for the protective effect of adequate dietary K on age-related bone loss and glucose control. Understanding the benefit of K intake from various sources may help to reveal how specific compounds and tissues influence K movement within the body, and further the understanding of its role in health.
In patients with advanced stage chronic kidney disease (CKD), progressive kidney function decline leads to an increased risk of hyperkalemia (serum potassium >5.0 or >5.5 mEq/L). Medications such as renin–angiotensin–aldosterone system (RAAS) inhibitors pose an additional hyperkalemia risk, especially in patients with CKD. When hyperkalemia develops, clinicians often recommend a diet that is lower in potassium content. This review discusses the barriers to adherence to a low-potassium diet, and the impact of dietary restrictions on adverse clinical outcomes. Accumulating evidence indicates that a diet that incorporates potassium-rich foods has multiple health benefits, which may also be attributable to the other vitamin, mineral, and fiber content of potassium-rich foods. These benefits include blood pressure reductions and reduced risks of cardiovascular disease and stroke. High-potassium foods may also prevent CKD progression and reduce mortality risk in patients with CKD. Adjunctive treatment with the newer potassium-binding agents, patiromer and sodium zirconium cyclosilicate, may allow for optimal RAAS inhibitor therapy in patients with CKD and hyperkalemia, potentially making it possible for patients with CKD and hyperkalemia to liberalize their diet. This may allow them the health benefits of a high-potassium diet without the increased risk of hyperkalemia, although further studies are needed.
As the potato is a major food crop, improving the nutritional value of its tubers will contribute to the United Nations “2030 Agenda for Sustainable Development”, provided potato production is also increased. Realistic targets for conventional breeding are the following: ensuring tuber steroidal glycoalkaloids do not exceed 20 mg 100 g⁻¹ fresh-weight; reducing acrylamide formation in crisps (chips) and French fries below benchmark levels of 750 and 500 μg kg⁻¹, respectively; reducing glycaemic index by increasing the amount of resistant starch; increasing protein quantity and quality; and increasing the concentrations of the minerals iron and zinc and the vitamins B9 and C. Red-fleshed and purple-fleshed potatoes contain anthocyanins which are antioxidants and yellow-fleshed and orange-fleshed ones contain the carotenoids lutein and zeaxanthin which protect against macular eye degeneration. Genetic variation exists for all of these traits among modern cultivars and Andean landraces; but some traits lack rapid screens for use in breeding, and there are still issues over bioavailability of some nutrients. Genetic engineering can be used to control glycoalkaloid concentrations and acrylamide-forming potential; to increase dietary fibre through the introduction of inulins from globe artichoke; to increase protein quality and quantity by tuber-specific expression of a seed protein, Amaranth Albumin 1, from Amaranthus hypochondriacus; and to alter carotenoid biosynthesis to produce beta-carotene, the precursor of vitamin A (Golden Potatoes), or astaxanthin, a feed additive in aquaculture.
Hyperkalemia and hyperphosphatemia are common metabolic disturbances in chronic kidney disease. Management may include instructions on a low-potassium or low-phosphorus diet, respectively. Low-phosphorus diet teaching includes information on phosphorus additives in addition to naturally occurring phosphorus food sources. Phosphorus additives are known to be more bioavailable compared with naturally occurring phosphorus. The concentration of phosphorus can also be much higher in processed foods compared with whole foods. Similar considerations may also be needed for dietary potassium teaching. The use of potassium additives in processed foods is growing, and when additives are used, the potassium concentration far exceeds naturally occurring potassium. Evidence also suggests, much like phosphate, potassium additives are more bioavailable than potassium found in whole foods. Clinicians and patients need to be aware of these changes in the food source to ensure potassium diet teaching is effective and safe.
The purpose of this meta-analysis was to establish the time for achievement of maximal blood pressure (BP) efficacy of a sodium reduction (SR) intervention and the relation between the amount of SR and the BP response in individuals with hypertension and normal BP. Relevant studies were retrieved from a pool of 167 randomized controlled trials (RCTs) published in the period 1973-2010 and integrated in meta-analyses. Fifteen relevant RCTs were included in the maximal efficacy analysis. After initiation of sodium reduction (range: 55-118 mmol/d), there were no significant differences in systolic blood pressure (SBP) or diastolic blood pressure (DBP) between measurements at weeks 1 and 2 (∆SBP: -0.18 mmHg/∆DBP: 0.12 mmHg), weeks 1 and 4 (∆SBP: -0.50 mmHg/∆DBP: 0.35 mmHg), weeks 2 and 4 (∆SBP: -0.20 mmHg/∆DBP: -0.10 mmHg), weeks 2 and 6 (∆SBP: -0.50 mmHg/∆DBP: -0.42 mmHg), and weeks 4 and 6 (∆SBP: 0.39 mmHg/∆DBP: -0.22 mmHg). Eight relevant RCTs were included in the dose-response analysis, which showed that within the established usual range of sodium intake [<248 mmol/d (5700 mg/d)], there was no relation between the amount of SR (range: 136-188 mmol) and BP outcome in normotensive populations [∆SBP: 0.99 mm Hg (95% CI: 2.12, 4.10), P = 0.53; ∆DBP: -0.49 mm Hg (95% CI: -4.0, 3.03), P = 0.79]. In contrast, prehypertensive and hypertensive populations showed a significant dose-response relation (range of sodium reduction: 77-140 mmol/d) [∆SBP: 6.87 mmHg (95% CI: 5.61, 8.12, P < 0.00001); ∆DBP: 3.61 mmHg (95% CI: 2.83, 4.39, P < 0.00001)]. Consequently, the importance of kinetic and dynamic properties of sodium reduction, as well as baseline BP, should probably be considered when establishing a policy of sodium reduction.
© 2015 American Society for Nutrition.
Studies indicate high sodium and low potassium intake can increase blood pressure suggesting the ratio of sodium-to-potassium may be informative. Yet, limited studies examine the association of the sodium-to-potassium ratio with blood pressure and hypertension.
We analyzed data on 10,563 participants aged ≥20 years in the 2005-2010 National Health and Nutrition Examination Survey who were neither taking anti-hypertensive medication nor on a low sodium diet. We used measurement error models to estimate usual intakes, multivariable linear regression to assess their associations with blood pressure, and logistic regression to assess their associations with hypertension.
The average usual intakes of sodium, potassium and sodium-to-potassium ratio were 3,569 mg/d, 2,745 mg/d, and 1.41, respectively. All three measures were significantly associated with systolic blood pressure, with an increase of 1.04 mmHg (95% CI, 0.27-1.82) and a decrease of 1.24 mmHg (95% CI, 0.31-2.70) per 1,000 mg/d increase in sodium or potassium intake, respectively, and an increase of 1.05 mmHg (95% CI, 0.12-1.98) per 0.5 unit increase in sodium-to-potassium ratio. The adjusted odds ratios for hypertension were 1.40 (95% CI, 1.07-1.83), 0.72 (95% CI, 0.53-0.97) and 1.30 (95% CI, 1.05-1.61), respectively, comparing the highest and lowest quartiles of usual intake of sodium, potassium or sodium-to-potassium ratio.
Our results provide population-based evidence that concurrent higher sodium and lower potassium consumption are associated with hypertension.
Vegetables, especially white potatoes, provide significant levels of key nutrients of concern, such as potassium and dietary fiber. Per capita availability (PCA) data for vegetables-often used as a proxy for vegetable consumption-show that vegetable consumption, including consumption of white potatoes, declined in the past decade. Using dietary data for participants in the NHANES 2009-2010, we examined total vegetable, white potato, and French-fried potato consumption among all age-gender groups as well as mean energy, potassium, and dietary fiber intakes. Mean total energy intake for the US population (≥2 y old) was 2080 kcal/d, with white potatoes and French-fried potatoes providing ∼4% and ∼2% of total energy, respectively. Individuals who consumed white potatoes had significantly higher total vegetable and potassium intakes than did nonconsumers. In addition, the proportion of potassium and dietary fiber contributed by white potatoes was higher than the proportion that they contributed to total energy. Among white potato consumers aged 14-18 y, white potatoes provided ∼23% of dietary fiber and ∼20% of potassium but only ∼11% of total energy in the diet. The nutrient-dense white potato may be an effective way to increase total vegetable consumption and potassium and dietary fiber intake.
Potatoes have the highest daily per capita consumption of all vegetables in the U.S. diet. Pigmented potatoes contain high concentrations of antioxidants, including phenolic acids, anthocyanins, and carotenoids. In a single-dose study six to eight microwaved potatoes with skins or a comparable amount of refined starch as cooked biscuits was given to eight normal fasting subjects; repeated samples of blood were taken over an 8 h period. Plasma antioxidant capacity was measured by ferric reducing antioxidant power (FRAP). A 24 h urine was taken before and after each regimen. Urine antioxidant capacity due to polyphenol was measured by Folin reagent after correction for nonphenolic interferences with a solid phase (Polyclar) procedure. Potato caused an increase in plasma and urine antioxidant capacity, whereas refined potato starch caused a decrease in both; that is, it acted as a pro-oxidant. In a crossover study 18 hypertensive subjects with an average BMI of 29 were given either six to eight small microwaved purple potatoes twice daily or no potatoes for 4 weeks and then given the other regimen for another 4 weeks. There was no significant effect of potato on fasting plasma glucose, lipids, or HbA1c. There was no significant body weight increase. Diastolic blood pressure significantly decreased 4.3%, a 4 mm reduction. Systolic blood pressure decreased 3.5%, a 5 mm reduction. This blood pressure drop occurred despite the fact that 14 of 18 subjects were taking antihypertensive drugs. This is the first study to investigate the effect of potatoes on blood pressure. Thus, purple potatoes are an effective hypotensive agent and lower the risk of heart disease and stroke in hypertensive subjects without weight gain.
Limited data are available on the source of usual nutrient intakes in the United States. This analysis aimed to assess contributions of micronutrients to usual intakes derived from all sources (naturally occurring, fortified and enriched, and dietary supplements) and to compare usual intakes to the Dietary Reference Intake for U.S. residents aged ≥2 y according to NHANES 2003-2006 (n = 16,110). We used the National Cancer Institute method to assess usual intakes of 19 micronutrients by source. Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all). However, more of the population had total usual intakes below the EAR for vitamins A, C, D, and E (34, 25, 70, and 60%, respectively), calcium (38%), and magnesium (45%). Only 3 and 35% had total usual intakes of potassium and vitamin K, respectively, greater than the adequate intake. Enrichment and/or fortification largely contributed to intakes of vitamins A, C, and D, thiamin, iron, and folate. Dietary supplements further reduced the percentage of the population consuming less than the EAR for all nutrients. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for most nutrients, whereas 10.3 and 8.4% of the population had intakes greater than the UL for niacin and zinc, respectively. Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake.
To evaluate the efficacy of daily potassium intake on decreasing blood pressure in non-medicated normotensive or hypertensive patients, and to determine the relationship between potassium intake, sodium-to-potassium ratio and reduction in blood pressure.
Mixed-effect meta-analyses and meta-regression models.
Medline and the references of previous meta-analyses.
Randomized controlled trials with potassium supplementation, with blood pressure as the primary outcome, in non-medicated patients.
Fifteen randomized controlled trials of potassium supplementation in patients without antihypertensive medication were selected for the meta-analyses (917 patients). Potassium supplementation resulted in reduction of SBP by 4.7 mmHg [95% confidence interval (CI) 2.4-7.0] and DBP by 3.5 mmHg (95% CI 1.3-5.7) in all patients. The effect was found to be greater in hypertensive patients, with a reduction of SBP by 6.8 mmHg (95% CI 4.3-9.3) and DBP by 4.6 mmHg (95% CI 1.8-7.5). Meta-regression analysis showed that both increased daily potassium excretion and decreased sodium-to-potassium ratio were associated with blood pressure reduction (P < 0.05). Increased total daily potassium urinary excretion from 60 to 100 mmol/day and decrease of sodium-to-potassium ratio were shown to be necessary to explain the estimated effect.
Potassium supplementation is associated with reduction of blood pressure in patients who are not on antihypertensive medication, and the effect is significant in hypertensive patients. The reduction in blood pressure significantly correlates with decreased daily urinary sodium-to-potassium ratio and increased urinary potassium. Patients with elevated blood pressure may benefit from increased potassium intake along with controlled or decreased sodium intake.
Potassium is the most abundant cation in the intracellular fluid, and maintaining the proper distribution of potassium across the cell membrane is critical for normal cell function. Long-term maintenance of potassium homeostasis is achieved by alterations in renal excretion of potassium in response to variations in intake. Understanding the mechanism and regulatory influences governing the internal distribution and renal clearance of potassium under normal circumstances can provide a framework for approaching disorders of potassium commonly encountered in clinical practice. This paper reviews key aspects of the normal regulation of potassium metabolism and is designed to serve as a readily accessible review for the well informed clinician as well as a resource for teaching trainees and medical students.
A large-area high sensitivity liquid scintillation whole-body counter was used to measure total body potassium by 40K determination in a number of subjects. These values were compared with measurements based upon exchangeable potassium (Ke) measured at various time intervals up to 70 hr after oral and intravenous administration of 42K. Exchangeable potassium calculated from specific activity of urine at 24 hr averaged 85% of the total body potassium and at 48 hr 90%, and even at 70 hr Ke was usually less than total body potassium. Addition of KCl load during the experiment caused no alteration in the specific activity of urinary potassium. Specific activity of potassium in red blood cells was about half that in urine and plasma. Most of the body potassium (about 85%) exchanges rapidly with a half time of less than 7 hr. The difference between the total body potassium and Ke appears to be due to the small proportion of the body potassium that exchanges relatively slowly, with a half time averaging 77 hr.
A crossover study was performed in 28, healthy, male volunteers to determine the bioavailability of potassium from a suspension containing microencapsulated potassium chloride compared with that from a marketed microencapsulated potassium chloride capsule and a marketed potassium chloride solution. The 20‐day study consisted of four, five‐day periods. In three of the periods, a single, 40‐mEq dose of one of the potassium formulations was administered; no drug treatment was given in the remaining period so that the amount of potassium contributed by dietary sources could be determined. Meals were served that provided controlled amounts of potassium and sodium.
Bioavailability was represented by cumulative amount of K ⁺ excreted in urine 24 and 48 hours after drug administration. The rate of absorption was calculated from excretion rates during each of the intervals of urine collection on Days 4. The pattern of excretion exhibited by the solution indicated rapid absorption and elimination. The potassium from the suspension and the capsules was excreted more slowly and over a longer period, indicating that the potassium content from these formulations was not being dumped. No statistically significant differences between the suspension and the capsules were found. The extent of absorption of K ⁺ was similar from all three products, and the potassium from the suspension was found to be fully bioavailable when compared with the liquid and the capsule.
The bioavailability of a new sustained-release potassium chloride (KCl) tablet, designed for once-a-day dosing, was compared to a KCl elixir using urinary excretion data. The study utilized 25 male volunteers dosed in a crossover design in a dietary/activity-controlled environment. The regimens consisted of a total of 80 mEq of potassium in three equally divided doses of elixir every 6 hr and a single 80-mEq dose using four 20-mEq sustained-release (SR) tablets. The mean time to maximum rate of potassium urinary excretion was 2.2 hr for the first elixir dose and 5.5 hr after the SR tablet (P less than 0.01), thereby supporting the prolonged-release properties of this formulation. After correction for baseline urinary potassium excretion, the mean total 24-hr urinary potassium excretion was 42.18 mEq for the elixir and 40.41 mEq for the SR tablet. The results indicate that the absorption pattern from the SR tablet is equal to three doses of KCl elixir dosed 6 hr apart.
A model is developed to describe the distribution and excretion of potassium at arbitrary times during or after intake by ingestion or injection. The movement of K is tracked in greater detail than in previous models and is described in terms of anatomical compartments rather than the hypothetical, mathematically derived pools often considered. Parameter values are derived for a typical resting healthy adult male. Because of its anatomically realistic framework, the model may be used as a point of departure for modelling the behaviour of K in various subgroups of the population under less ideal conditions.
Twenty eight adults, 12 men and 16 women, participated in a 1-yr study designed to assess daily nutrient intake accurately. All subjects lived at home, consumed self-chosen diets, and maintained a detailed daily dietary record throughout the year. During four 7-day balance studies, one in each season of the year, meals, beverages, urine, and feces were analyzed for sodium and potassium content by atomic absorption spectrometry. Total intakes averaged 3.4 g/day for sodium and 2.8 g/day for potassium. The Na:K ratio for all diets analyzed averaged 1.3. Nutrient densities of sodium and potassium were 1.8 and 1.5 g/1000 kcal, respectively. Apparent absorptions of sodium and potassium were 98 and 85%, respectively, and did not change significantly over the wide range of intakes. Average urinary excretions of sodium and potassium were 86 and 77% of total intake, respectively. Mean metabolic balances were positive for sodium, +0.47 g/day, and potassium, +0.28 g/day. The data of this study provide useful information concerning the dietary intakes, excretions, and balances of sodium and potassium for adults based on analytic determination.
The relative availability of potassium from a controlled-release multiple-units tablet (Kalinorm) and a single-unit tablet (Slow-K) were compared in 13 volunteers on a low potassium diet (less than 30 mmol), by observing changes in urinary potassium excretion after administration of a single dose of 32 mmol potassium, either with or without water loading. Irrespective of procedure, the two products had the same extent of availability. The use of water loading, and special precautions about the level of dietary potassium and its composition when studying urinary potassium excretion, are discussed. It is suggested that water loading should be avoided when investigating the rate of potassium excretion.
When normal people ingest 90 mEq/day of K+ in their diet, they absorb about 90% of intake (81 mEq) and excrete an equivalent amount of K+ in the urine. Normal fecal K+ excretion averages about 9 mEq/day. The vast majority of intestinal K+ absorption occurs in the small intestine; the contribution of the normal colon to net K+ absorption and secretion is trivial. K+ is absorbed or secreted mainly by passive mechanisms; the rectum and perhaps the sigmoid colon have the capacity to actively secrete K+, but the quantitative and physiological significance of this active secretion is uncertain. Hyperaldosteronism increases fecal K+ excretion by about 3 mEq/day in people with otherwise normal intestinal tracts. Cation exchange resin by mouth can increase fecal K+ excretion to 40 mEq/day. The absorptive mechanisms of K+ are not disturbed by diarrhea per se, but fecal K+ losses are increased in diarrheal diseases by unabsorbed anions (which obligate K+), by electrochemical gradients secondary to active chloride secretion, and probably by secondary hyperaldosteronism. In diarrhea, total body K+ can be reduced by two mechanisms: loss of muscle mass because of malnutrition and reduced net absorption of K+; only the latter causes hypokalemia. Balance studies in patients with diarrhea are exceedingly rare, but available data emphasize an important role for dietary K+ intake, renal K+ excretion, and fecal K+ losses in determining whether or not a patient develops hypokalemia. The paradoxical negative K+ balance induced by ureterosigmoid anastomosis is described. The concept that fecal K+ excretion is markedly elevated in patients with uremia as an intestinal adaptation to prevent hyperkalemia is analyzed; we conclude that the data do not convincingly show the existence of a major intestinal adaptive response to chronic renal failure.
Potassium excretion exhibits a diurnal pattern, with most excretion occurring close to noon in humans. Each component of the K+ excretion rate [urinary K+ concentration ([K+]) and flow rate] was measured and back-calculated to reflect events in the cortical collecting duct (CCD). Our purpose was to determine to what extent each component contributed to this diurnal variation in each 2-h portion of the day. In humans, K+ excretion rose threefold from nadir (0600 h) to peak (1200-1400 h), 18 h after the principal intake of K+. The variation in K+ excretion was due almost exclusively to changes in [K+] in the terminal CCD ([K+]CCD) rather than via changes in flow rate. In rats, the bulk of K+ excretion occurred shortly after eating. Both components of K+ excretion rose after meals; the rise in the [K+]CCD (3.3-fold) predominated at earlier times, and the rise in flow rate occurred later and was primarily a result of a higher rate of excretion of urea. The rise in [K+]CCD did not correlate with aldosterone levels or administration. A very large rise in the [K+]CCD only occurred in the presence of bicarbonaturia; the transtubular potassium concentration gradient was now close to 15 in the morning and evening.
The development of new software or the refinement of existing software for new operating environments each calls for judicious balancing. On the one hand, we strive for simplicity, predictability, and operational protection as it is well recognized that software with these attributes will attract an audience of satisfied users. But, on the other hand, these attributes do not conjure a sense of power, efficiency, or flexibility, and these other properties are also appreciated by users, albeit a somewhat different group of users. The goal is to achieve a blend which isolates critical functionality, flexible control, and user support while meeting the needs of the broadest collection of serious users. In this chapter, we discuss the issues impacting the migration of SAAM to the Windows environment, the NIH WinSAAM Project, and we outline the steps taken to ensure its feasibility. In addition, we describe a new paradigm for software development and use which ensures the durability of the software for modeling.
Low potassium (K) intake and high prevalence of hypokalemia and hypokaliuria among rural dewellers in the northeast region of Thailand have been repeatedly reported and they were speculated to be in a state of low K status. In this communication we studied K balance of 10 rural (R) and 5 urban (U) male subjects in this region during a 10-day period of semi-free-living and eating group-selected diets. While K in intake, 24-h urine and feces were measured daily in all subjects, the direct measurement of K lost in sweat was made only in one subject coded R3. These parameters were then used to calculate the K balance. The results showed that mean K intakes were 1731 +/- 138 and 1839 +/- 145 mg/day for R and U subjects, respectively. Their mean K balances, calculated by subtracting the K excretions in 24-h urine (721 +/- 129 mg/day for R and 919 +/- 186 mg/day for U) and in feces (148 +/- 25 mg/day for R and 164 +/- 21 mg/day for U) from intakes, were +860 +/- 140 and +756 +/- 222 mg/day for R and U, respectively. In the subject R3, his mean K balances without and with subtracting the sweat K excretion (451 +/- 57 mg/day), were +847 +/- 373 and +396 +/- 344 mg/day, respectively. Regression of K balance versus intake indicated that R and U subjects needed K of 832 and 884 mg/day to stay in balance. Since the study was performed during the hot season (average temperature = 35.2 +/- 2.0 degrees C at 3 pm) and sweating was clearly observed (estimated sweat volume per day was 1927 +/- 420 ml for R and 1759 +/- 408 ml for U), therefore, K balance calculated without sweat K was overestimated. This was apparently seen in the subject R3 where he actually needed K of 1203 mg/day, instead of 814 mg/day calculated without sweat K, to stay in balance. The similarities in K balance data among the two groups suggested they both had the same food habit and K status. Our results indicate that any calculation for the levels of dietary K, or probably also for other minerals, to achieve the balance could be underestimated if loss via sweat is not taken into consideration.
Modifiable behavioral risk factors are leading causes of mortality in the United States. Quantifying these will provide insight into the effects of recent trends and the implications of missed prevention opportunities.
To identify and quantify the leading causes of mortality in the United States.
Comprehensive MEDLINE search of English-language articles that identified epidemiological, clinical, and laboratory studies linking risk behaviors and mortality. The search was initially restricted to articles published during or after 1990, but we later included relevant articles published in 1980 to December 31, 2002. Prevalence and relative risk were identified during the literature search. We used 2000 mortality data reported to the Centers for Disease Control and Prevention to identify the causes and number of deaths. The estimates of cause of death were computed by multiplying estimates of the cause-attributable fraction of preventable deaths with the total mortality data.
Actual causes of death.
The leading causes of death in 2000 were tobacco (435 000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected], and alcohol consumption (85 000 deaths; 3.5%). Other actual causes of death were microbial agents (75 000), toxic agents (55 000), motor vehicle crashes (43 000), incidents involving firearms (29 000), sexual behaviors (20 000), and illicit use of drugs (17 000).
These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.
This study was conducted to estimate the requirements of sodium (Na) and potassium (K) in Japanese young adults. From 1986 to 2000, 109 volunteers (23 males, 86 females), ranging from 18 to 28 y old, took part in 11 mineral balance studies after written informed consent had been obtained. The duration of the study periods ranged from 5 to 12 d, with a 2-4 d adaptation period. Foodstuffs used in each study were selected from those commercially available. The Na and K content of the diet, feces, urine and sweat were measured by atomic absorption spectrophotometer. The results of a study in which Na intake was 6.87 g/d (ca. 300 mmol/d), the highest of all the studies, showed apparent positive Na balances. In contrast, another study in which Na intake was 2.21 g/d (ca. 100 mmol/d), the lowest of all the studies, showed apparent negative Na balances. These two studies seemed to differ from the other studies, as shown by regression equations calculated from either data of all the studies (n= 109) or data that did not include the two studies (n=90). The dietary intakes of Na and K ranged between 38.56-142.23 and 26.77-74.42 mg/kg body weight (BW)/d, or 2.21-6.87 and 1.83-3.61 g/d, respectively in the complete data, and 43.71-96.40 and 26.77-63.70 mg/kg BW/d, or 3.06-4.06 and 1.83-2.68 g/d, respectively in the data that did not include the two studies. The intakes of the two minerals were positively correlated. Na intake (Intake) was correlated positively with apparent absorption (AA) of Na, which was also correlated with Na urinary output (Urine). In the data that did not include the two studies, Na balance (Balance) was not correlated significantly with either Na Intake (r2=0.005) or AA of Na (r2=0.006). However, analysis of all the data showed a significant correlation between Na Balance and both Na Intake (r2=0.361) and AA of Na (r2=0.360). In the complete data, the mean value and upper and lower limits of the 95% confidence interval for the regression equation between Intake and Balance for Na, when balance was equal to zero (i.e mean, upper and lower limits), were 55.824, 60.787 and 50.862 mg/ kg BW/d, respectively. K Intake was correlated positively with AA of K, which was also correlated with both Urine K and K Balance. There was a significant correlation between K Intake and K Balance in both the complete data (r2=0.213) and the data that did not include the two studies (r2 = 0.116). In all the cases, mean, upper and lower limits for K were 39.161, 41.782 and 36.540 mg/kg BW/d, respectively. Intakes of Na and K did not correlate with their respective AA rates (%). Within the ranges of K Intake in this study, K Balance was affected markedly by K Intake itself as well as by Na Intake. However, in the case of Na, when the data of the highest and lowest Na intake studies were excluded from the analysis, Na Balance did not correlate with Na Intake, whereas the data of all the studies showed Na Balance was affected strongly by Na Intake. The data of this study allowed the estimated average requirements (EARs) for both minerals to be derived.
To compare dermal electrolyte loss between whole body and regional patch methods in women during 24-h.
Dermal loss was collected in 6 healthy women mean age 27 +/- 4 years, while consuming 936 mg/d sodium, 1764 mg/d potassium, 696 mg/d calcium, and 152 mg/d magnesium. Twenty-four hour whole body dermal loss was collected using cotton suits by a washdown procedure. Twenty-four hour patch loss was collected from 8 patches placed on the legs, arms, and back.
Dermal loss from whole body was 108 +/- 110 mg/d sodium, 133 +/- 87 mg/d potassium, 103 +/- 22 mg/d calcium, and 35 +/- 13 mg/d magnesium. Electrolyte content from the 8 patches was similar among sites and ranged from 1.01-1.41 mg/d sodium, 0.35-0.83 mg/d potassium, 1.0-1.45 mg/d calcium, and 0.43-0.49 mg/d magnesium. Projections from patches to whole body by the ratio of body surface area appear to overestimate actual whole body losses by 3.2X for sodium and calcium, 3.6X for magnesium, and 1.3X for potassium.
Regional patch methods are more appropriate for relative comparisons than for accurately determining total daily dermal electrolyte losses.
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