Excessive consumption of dietary sodium (salt) is a significant, independent risk factor for new-onset heart failure, according to a report from Vanderbilt Health.

In a group of predominantly Black and low-income people from the southeastern United States, consuming a population average of about 4,200 milligrams of dietary sodium a day (the recommended maximum is 2,300 milligrams) was associated with a 15% increase in the risk of incident (new) cases of heart failure.

“Even modest reductions in sodium consumption may significantly reduce the burden of heart failure in this high-risk population,” the researchers reported March 17 in the Journal of the American College of Cardiology: Advances.

Reducing dietary salt consumption is not a simple matter, however, cautioned the paper’s corresponding author, Deepak Gupta, MD, MSCI, associate professor of Medicine and director of the Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC).

Multilevel, public health strategies may be required to address grocery store availability and limited transportation options that make it difficult for residents of many low-income, high-risk communities to access healthier food options, Gupta said.

Leonie Dupuis, MD, a third-year resident physician in internal medicine at Vanderbilt Health, is first author of the paper, which analyzed dietary and health records of more than 25,300 participants in the federally funded Southern Community Cohort Study.

The SCCS has tracked the health of predominantly Black and low-income residents of 12 southeastern states since 2001. Most of them were enrolled in this and other studies through community health centers.

Average daily sodium consumption in this group was 4,269 milligrams per day, well above the daily, 2,300-milligram limit recommended by federal dietary guidelines.

The increased risk of heart failure linked to sodium was independent of sociodemographic factors, including diet quality and caloric intake, as well as health conditions such as high blood pressure and high lipid blood levels.

Heart failure contributes to 425,000 deaths in the United States each year. The cost of caring for the estimated 1 million new cases of heart failure diagnosed annually runs into the tens of billions of dollars.

Even a modest reduction in dietary salt, to 4,000 milligrams a day or less, could reduce heart failure cases by 6.6% over 10 years, the researchers predicted. That would translate into fewer deaths from heart failure and a nearly $2-billion-a-year reduction in national health expenditures.

Co-authors of the paper are Meng Xu, MS, Audrey White, MD, Debra Dixon, MD, MS, Jane Ferguson, PhD, Xiao-Ou Shu, PhD, Danxia Yu, PhD, and Loren Lipworth, ScD. The SCCS is supported by National Cancer Institute grants R01CA092447, U01CA202979 and 3R01CA029447, with additional research support from National Institutes of Health grants R01HL133860, R01HL153607, K23HL168331, P30HS029767 and R38HL167237.

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Plant-based diets have become popular for their health and environmental benefits. 

However, these benefits may vary based on the quality of the plant foods and other foods that make up the diet. A recent study at VUMC analyzed the association of plant-based diet patterns with mortality in over 77,000 mostly Black and low-income participants in the Southern Community Cohort Study, which started in 2002.  

Dietary intakes were assessed using a validated, 89-item food frequency questionnaire. The investigators generated three measures to assess the association of diet and risk of premature death: an overall plant-based diet index (PDI) that included both healthy plant foods (such as whole grains, fruits and vegetables) and unhealthy plant foods (such as fruit juices, refined grains and potatoes); a healthy plant-based diet index (hPDI); and an unhealthy plant-based diet index (uPDI).  

The study follow-up was through 2022 with a median duration of almost 17 years. The investigators identified over 26,000 deaths during the duration of the study. The highest PDI and hPDI scores were associated with reduced mortality; while the highest uPDI scores were associated with elevated mortality. 

The findings were reported in the The American Journal of Clinical Nutrition, a journal of the American Society for Nutrition. They show a strong association between high quality plant-based diets and reduced mortality rate among low-income populations, suggesting that efforts to promote diets high in healthy plant foods and low in animal foods could improve health outcomes. 

Wei Zheng, MD, PhD, MPH, the Anne Potter Wilson Professor of Medicine and director of the Vanderbilt Epidemiology Center, is the corresponding author of the study. Fangcheng Yuan, a graduate student in the PhD Program in Epidemiology, is the first author. 

This work was supported by the National Cancer Institute, part of the National Institutes of Health (grant U01CA202979).

Guillermo Sanchez, PhD, is a staff scientist in the lab of Nick Zachos, PhD, associate professor of Surgery and Cell and Developmental Biology at Vanderbilt University.

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Walking fast for just 15 minutes per day reduced the risk of death in a large study group of mostly low-income participants. 

The research findings, published July 29 in the American Journal of Preventive Medicine, support promoting brisk walking as a strategy for improving health outcomes in all communities. 

Although the health benefits of walking are widely recognized, there has been limited research on the effect of factors such as walking pace on mortality, particularly in low-income and Black populations, said the study’s senior author, Wei Zheng, MD, PhD, MPH, the Anne Potter Wilson Professor of Medicine and director of the Vanderbilt Epidemiology Center. 

“This is one of the few studies to quantify the effect of daily walking on mortality in a low-income and predominantly Black U.S. population,” said Zheng, who also directs the Division of Epidemiology at Vanderbilt University Medical Center. “By demonstrating the benefits of fast walking — which is a low-cost and largely accessible activity — we provide direct evidence to inform targeted public health interventions and policies to improve health outcomes.” 

The study analyzed data from the Southern Community Cohort Study (SCCS), which enrolled about 85,000 participants ages 40-79 between 2002 and 2009. Most participants (86%) were recruited in collaboration with community health centers serving low-income populations across 12 southeastern states. Participants provided baseline information, including daily walking pace and time, demographic and lifestyle factors, and medical history, using structured questionnaires. 

The current study, led by first author Lili Liu, PhD, MPH, included data from 79,856 of the SCCS participants (racial groups: 66% Black, 30% white, 4% other). In the baseline survey, participants reported the average amount of time per day (in minutes) they typically spend “walking slowly (such as moving around, walking at work, walking the dog or engaging in light exercise)” and “walking fast (such as climbing stairs, brisk walking or exercising).”

The cohort was linked to the National Death Index to obtain vital status and cause of death information through Dec. 31, 2022. Over a median follow-up of 16.7 years, 26,862 deaths occurred. 

The researchers found that fast walking as little as 15 minutes per day was associated with a nearly 20% reduction in total mortality. Slow walking more than three hours per day was associated with a smaller reduction in mortality. The benefit of fast walking remained strong even after accounting for other lifestyle factors, such as leisure-time physical activity levels. 

In addition to reducing premature death from all causes, fast walking reduced death specifically from cardiovascular diseases — the No. 1 cause of death in the United States. The researchers suggested that fast walking might reduce cardiovascular mortality by improving the heart’s efficiency and output, and by reducing the prevalence of obesity and its associated cardiovascular risks such as hypertension and high cholesterol. 

“Brisk walking offers a convenient, accessible and low-impact activity that individuals of all ages and fitness levels can use to improve general health and cardiovascular health specifically,” Zheng said. 

The authors acknowledge that self-reported data on daily walking may have included other types of physical activity, which could introduce misclassification errors. Also, the physical activity data was only collected at baseline, so changes over time could not be considered. The study’s long follow-up and large sample size contribute to “robust and reliable estimates,” they noted. 

Other VUMC co-authors are Guochang Jia, PhD, Martha Shrubsole, PhD, Wanqing Wen, MD, MPH, and Staci Sudenga, PhD. The research was supported in part by the National Institutes of Health (grant U01CA202979).

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