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攝取高鹽份會引致高血壓 增加中風機會

攝取高鹽份會引致高血壓 增加中風機會. Salt raises blood pressure, increasing the risk of stroke. 香港中文大學內科及藥物治療學系 及營養研究中心 Department of Medicine and Therapeutics and Centre for Nutritional Studies, The Chinese University of Hong Kong.

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攝取高鹽份會引致高血壓 增加中風機會

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  1. 攝取高鹽份會引致高血壓 增加中風機會 Salt raises blood pressure, increasing the risk of stroke 香港中文大學內科及藥物治療學系 及營養研究中心 Department of Medicine and Therapeutics and Centre for Nutritional Studies, The Chinese University of Hong Kong

  2. 甚麼是WASH?What is WASH? • 世界食鹽健康行動 World Action On Salt and Health (WASH) • 一個全球性的志願團體，於2005年在英國成立. A global voluntary group established in 2005 in UK • 427個的成員來自83個國家（主要是血壓科的專家）. 427 members from 83 countries (mainly experts in hypertension) China Iran Japan Korea Malaysia Nepal Pakistan Singapore

  3. 提高人民健康，在食品加工，烹飪，餐桌上逐步減少用鹽提高人民健康，在食品加工，烹飪，餐桌上逐步減少用鹽 Improve populations’ health by gradual salt reduction in processed foods, cooking, and at the table 政府 Government 食品工業 Food industry 公眾/家住烹調 Public/Home cooking • -幫助建立以科研實證為基礎的健康政策 Help in formulation of evidence based health policy • 與各國政府和衛生機構分享最佳的減鹽策略 • Share best practice for salt reduction strategies with Governments and health organizations worldwide • -與食品製造商在鹽與健康的科研實證上達到共識Reach a consensus with food manufacturers that strong evidence on salt and health • 作為一個全球性的監察Act as a global monitor • 游說國際食品公司制定及推行全球性的減鹽計劃 Persuade international food companies to employ a global salt reduction plan • 通過媒體宣傳和公眾教育，教育市民明白減少用鹽的重要性及方法，以達到減低鹽份攝取 Educate the public through media publicity and public health campaigns to achieve salt reduction 世界食鹽健康行動的使命和策略 WASH’s Mission and Strategies

  4. 2010年: 食鹽與你的健康 Year 2010: Salt and Your Health 2011年: 食鹽與男士健康 Year 2011: Salt and Men’s Health 世界食鹽關注週World Salt Awareness Week

  5. 世界食鹽關注週 2012World Salt Awareness Week 2012 • 2012年3月26日 – 4月1日 26th March – 1st April 2012 • 主題: 減低食鹽 – 防止中風 Theme: Reducing Salt – Preventing Stroke

  6. 有關鹽份攝取量和中風風險的全球性數據Global evidence on salt intake and stroke risk • 每年全球300萬婦女和250萬男性死於中風 Worldwide 3 million women and 2.5 million men die from stroke every year • 在發達國家，中風是第三大最常見的死亡原因 Stroke is thethird most common cause of death in developed countries • 高鹽份攝取量與較高中風風險有關聯 High salt intake is associated with higher risk of stroke • 高鹽份的攝取會令到血壓升高, 從而增加中風的風險 High salt intake raises blood pressure, which in turn increases risk of stroke

  7. 有關鹽份攝取量和血壓的全球性證據Global evidence on salt intake and blood pressure Reference and adapted from: Intersalt Cooperative Research Group 1988 舒張壓 收縮壓 尿液鈉質排出量 尿液鈉質排出量

  8. 有關血壓和中風風險的全球性證據Global evidence on blood pressure and stroke risk 中風風險 收縮壓 舒張壓 平均血壓 Reference and adapted from: MacMahon et al. 1990

  9. 有關鹽份攝取量和因中風死亡的全球性證據Global evidence on salt intake and deaths from stroke 每年因中風死亡人數 尿液鈉質排出量 Reference and adapted from: He et al. 2009

  10. 對鹽份攝取量的建議Recommended salt intake level 世界衛生組織 鹽份攝取量建議 - 每日少於5克 World Health Organization Recommended salt intake Less than 5 g/d 現時鹽份攝取量約每日10克 Current salt intake Around 10 g/d 減少5克鹽份攝取 5 g salt reduction 減低全球23%中風風險 Reduce stroke by 23% worldwide 每年救回125萬人的性命Save 1.25 million lives per year

  11. 中風的類型 Types of stroke • 缺血性中風 (凝塊) Ischemic stroke (Clot) • 因腦血管阻塞而導致腦細胞缺血 Blockage of blood vessels in the brain • 約佔中風病患的87% Makes up approximately 87% of all strokes • 出血性中風 (出血) Hemorrhagic stroke (Bleeding) • 因腦血管破裂引起腦內出血 Ruptured blood vessel with bleeding inside the brain Reference and adapted from: National Stroke Association

  12. 中風的危險因素 Risk factors for stroke • 高血壓 • Hypertension • 是出血性中風的 • 主要危險因素 • major risk factor for hemorrhagic stroke 不可改變的因素: 年老，家族病史，曾有中風記錄 Non-modifiable: Increasing age, family history, previous stroke 高膽固醇High cholesterol 糖尿病Diabetes mellitus 中風Stroke 吸煙Smoking 壓力 Stress 缺乏運 動Physical inactivity 肥胖 Obesity 透過危險因素管理，高達80％的中風是可以預防的！ Up to 80%of all strokes are preventable through risk factor management! Reference: Gorelick et al. 1995

  13. 香港的情況 Situation in Hong Kong 中風是香港第四大的主要死亡原因，亦是最常見導致身體傷殘的疾病 Stroke is the forth leading cause of death and most common cause of physical disabilities in Hong Kong 每年有20,000多宗因中風而入院的個案，當中亦有3,000多人因中風而死亡 There are more than 20,000 hospital admissions and 3,000 people died from stroke every year 在2010年，共有3,423人死於中風，佔所有死亡人數的8.0％ In 2010, there were 3,423 deaths from stroke, accounting for 8.0% of all deaths Reference: Department of Health 2010, 2011

  14. 照顧中風患者的成本Cost of caring for stroke patients • 在2010年，每年照顧香港65歲或以上中風 • 患者的直接和間接成本估計達 $80億港元 • The estimated annual direct and indirect cost of stroke for stroke patient aged 65+ was • HK$ 8 billion in 2010 • 到2036年，成本將增加至$220億港元 • By 2036, the cost would increase to around • HK$ 22 billion • 這些僅為照顧中風病人的部分成本 • These estimates only include part of the costs • involved in caring for stroke patients

  15. 中風發病率的趨勢 Trends in stroke incidence 整體的缺血性中風發病率有下降的趨勢，但這種情況並不適用於中年人仕（35-44歲) An overall decreasing trend was shown for ischemic stroke incidence, but this pattern did not apply to the middle aged population (aged 35-44) 中年人仕的出血性中風發病率有上升的趨勢。這可能是由於高血壓患病率的增加所引致 Hemorrhagic stroke incidence increased among the middle aged. This increase may be due to the increased trends in prevalence of hypertension Reference: Chau et al. 2011

  16. 中風發病率的趨勢 Trends in stroke incidence *The age-adjusted rates used WHO world standard population as the standard. Data source: Chau et al. 2011 Remarks: Incidence rates were calculated based on hospital admission statistics Hemorrhagic stroke was identified by ICD9: 431-432 Ischemic stroke was identified by ICD9: 433, 434, 436 and 437

  17. 高血壓患病率的趨勢 Trends in prevalence of hypertension Data source: Cardiovascular risk factor prevalence survey 1995/1996 Population health survey 2003/2004 Remarks: Hypertension : Doctor-diagnosed and “undiagnosed but measured” hypertension (had a measured systolic blood pressure ≥ 140 mmHg, and/or had a measured diastolic blood pressure ≥ 90 mmHg)

  18. 警號趨勢Alarming trends 中年人仕的出血性中風發病率有上升的趨勢，強調血壓控制對預防缺血性和出血性中風的重要性The rising trend in incidence of hemorrhagic stroke in the middle aged highlights the importance of population control of hypertension in the prevention of both ischemic and hemorrhagic stroke

  19. 1毫克鈉=2.5毫克鹽（0.0025克鹽） 1 mg Sodium = 2.5 mg Salt (0.0025 g Salt)例如: 2400毫克鈉= 6克鹽 i.e. 2400mg Sodium = 6 g Salt 鈉對鹽的轉換 Conversion of Sodium to Salt

  20. 我們飲食中的鹽來自何處？ Where in our diet does salt come from? 11% 12% 77% Occurs Naturally in Foods Added at the Table or in Cooking Restaurant/Processed Food 在很多地區, 大部份進食的食物也是加工或在餐館裏食用 In regions where most food is processed or eaten in restaurants • 12%來自天然 12% natural content of foods • “隱藏”鹽份: 77%來自加工食物(製造商和餐廳) “hidden” salt: 77% from processed food – (manufacturers and restaurants) • “有意識”鹽份: 11% [在餐桌上 (5%) 和烹飪時添加(6%)] “conscious” salt: 11% [added at the table (5%) and in cooking (6%)] J Am College of Nutrition. 1991;10:383-93.

  21. 資料來自食物安全中心及營養研究中心 Sources from Centre for Food Safety and Centre for Nutritional Studies 香港常見的含鈉/鹽的食品Sodium/Salt Content of Common Foods in Hong Kong

  22. 中式點心Chinese Dim Sum

  23. 粥/飯類 Congee/ Rice

  24. 粉/麵 Noodles

  25. 包/三文治 Bread/ Sandwich

  26. 零食/涼果/街頭食品 Snack/ Preserved Dried Fruit/ Street Food

  27. 西式快餐店 Western Style Fast Food Restaurant

  28. 沙爹牛肉麵= 6.08 克鹽 Satay Beef Noodles= 6.08g salt 碟頭飯 (牛腩飯) = 5.44克鹽 Beef Brisket Rice =5.44g salt 早餐和午餐鹽攝取量 Salt intake from breakfast and lunch 11.52克 11.52g

  29. 怎樣?How?

  30. 家裡用餐Eating at Home 在餐桌上的食物不要添加鹽。 Do not add salt to your food at the table. 選用低鈉或不加鹽的食品，如選用罐頭食品，先以清水除去其中所含的鈉。 Choose Low Sodium or no added salt food, if canned food is a selection, use water to rinse the sodium content. 避免或減少醬汁如豉油, 茄汁, 沙茶醬, 沙律醬。 Avoid or reduce the amount of sauces such as soy sauce, ketchup, brown sauce and salad dressings 選購新鮮或急凍蔬菜和肉類。Choose fresh or frozen vegetable and meat 在烹調蔬菜時，用麥芽醋來代替鹽。 Add a splash of malt vinegar to vegetables instead of salt. 使用義大利黑醋，蘋果酒或米醋作為替代沙律醬。 Use balsamic, cider or rice vinegars on salads as an alternative dressing. 烹調時加入新鮮的生薑，大蒜，辣椒，蔥以増加味道。 Add fresh ginger, garlic, chili and spring onions to your cooking to add more flavor 烹調前預先醃好魚或肉。 Marinade fish or meat prior to cooking. 減少進食高鹽份小食如薯片、牛肉乾、涼果等。 Reduce the intake of high salt content snack, e.g. Chips, Beef Jerky, Preserved Dried Fruit, etc.

  31. 出外用餐 Eating Out 注意高鹽份量的煮食方式(如蠔油、麵豉、辣椒醬、南乳、腐乳、泡菜、卥水及椒鹽等) 。 Aware of high-salt cooking dishes (such as oyster sauce, miso, chili sauce, fermented red bean curd , fermented soya beancurd, kimchi, Lo Shui, salt and pepper, etc.) 在點菜時要求少鹽，如牛排，烤魚或雞肉. 這類食物可以少放鹽。可以要求廚師甚至不加鹽，在餐桌上可以加入檸檬汁和黑胡椒。 Asking for less salt to be added to food is easier with some dishes like steaks, grilled fish or chicken which can be prepared and cooked with less salt. Ask for no salt to be added by the chef and then give it a squeeze of lemon and a grinding of black pepper at the table. 避免吃多獻汁的餸菜。Avoid sauces from dishes. 避免飲用湯麵的湯。Avoid the soup from soup noodles.

  32. 出外用餐Eating Out 在“健康的選擇” 中，也要注意隱藏的鹽份- 沙律往往有增加鹽份，如：小麵包片，橄欖，奶酪，醬汁， 醃製肉類/蔬菜，臘肉，熏鮭魚等Beware of hidden salt in  ‘healthy options’ – Salads often have many salty additions, such as: croutons, olives, cheese, dressing, marinated meat/vegetables, cured meat, smoked salmon, etc. 注意你的醃料和調味汁 – 要求餐廳把​​任何醬汁另上，讓你可以品嚐及選擇份量。 Aware your marinades and sauces – Ask for any sauces served with your meal to be ‘on the side’ so that you can taste them and choose how much you want with your food. 不要添加鹽於未試過的食物。 NEVER add salt to your food without tasting it first.

  33. 火腿雞蛋三明治 + 麥皮 = 1.83克鹽 Ham and Egg Sandwich + Oats = 1.83g salt 時菜肉片湯飯(- 湯) = 2.31克鹽 Slice pork and vegetable rice (without soup) = 2.31g salt 早餐和午餐鹽攝取量= 4.14克 Salt intake from breakfast and lunch = 4.14g 對VS +

  34. 認識食品標籤(食物營養標籤上會列出鈉的含量) UnderstandFood Labels(Food Labels list the amount of Sodium)

  35. 關於鹽的誤解 Salt myths 誤解: 用雞粉代替鹽煮食比較健康? myth: chicken powder healthier than salt for cooking?” 事實Facts: • 雖然雞粉鈉質含量較鹽為低, 但鈉質含量依然非常高。一茶匙雞粉的鈉質含量達800毫克。 Although the sodium content in chicken powder is lower than salt, it is still high. 1 tsp chicken powder contains 800mg sodium content. • 加上, 雞粉本身是有熱量的, 過量食用可令體重上升。 In addition, chicken powder contains calories, over intake will increase weight. • 無論是雞粉或鹽, 都應減少使用。 Chicken powder or salt, should be reduced. 誤解: 麵包或意粉等等, 都同米飯差唔多, 可以用嚟代替米飯? myth: Bread or spaghetti, etc are similar to rice, can these be replaced by rice? 事實Facts: • 不對. 麵包或意粉等在製作時, 都有可能加入了不少的鹽份。 No. During the food production process, salt most probably be added to it. • 購買時應先閱讀營養標籤。 Read nutrition label before purchase. • 還有很多食物都可能含有高鈉質如: 茄汁, 牛油, 餅乾等。 : There are many food that have high sodium content: e.g. Ketchup, butter, biscuits etc.

  36. 其他誤解(Other Misconceptions) 一些高鹽的食物，味道不鹹。早餐麥片，麵包，奶酪，餅乾和糕點都包含隱藏的鹽。 Some foods that are high in salt don't taste very salty. Breakfast cereals, bread, cheese, biscuits & cakes can all contain hidden salt. 海鹽和岩鹽不是比食鹽好。它仍然含有鈉，可以令血壓升高。 Sea salt & rock salt are no better for you than table salt.  It still contains sodium, which can put up our blood pressure. 少鹽並不代表少味。嘗試加入香草，黑胡椒，辣椒，大蒜，檸檬汁和酒。 Less salt doesn’t have to mean less flavor. Instead of salt, try adding herbs, black pepper, chili, garlic, lemon juice and wine. 不可能吃得過少的鹽。很多食物都含鹽，很難吃得過少。 It is unlikely that you eat too little.  Salt is in so many foods, it is hard to eat too little. 習慣少鹽食物，只需要幾個星期。 Getting used to food with less salt only takes a few weeks.  即使你不會有血壓高，但減少食用鹽是好的。血壓隨著年齡而增加，而且高鹽飲食會增加患上骨質疏鬆症，胃癌，腎臟病和肥胖症。 Even if you don’t have high blood pressure, it is still good to cut the salt.  Blood Pressure increases with age, plus a high salt diet is liked to osteoporosis, stomach cancer, kidney disease and obesity.

  37. 隨著時間鹽對降低血壓的影響 Effects of salt reduction on blood pressure over time Obarzanek E et al. Hypertension. 2003;42:459-67.

  38. 案例1 Case 1 • 韋先生， 64歲患有高血壓及服用降壓藥多年 Mr Wai, aged 64 with hypertension and on antihypertensive drugs for many years • 飲食習慣沒有改變前的血壓: BP before changing the diet habits:150/86 • 飲食習慣改變後的血壓: BP after changing the habits : • 第一星期 1 week:138/81 • 第二星期 2 week:130/78 • 第四星期 4 week:128/74 • 第八星期 8 week:114/65

  39. 案例2 Case 2 • 羅小姐, 22歲 Miss Lo, aged 22 • 家族病史: 父母有高血壓 Family medical history: parents are having HT • 飲食習慣沒有改變前的血壓: 154/95 BP before changing diet: 154/95 • 飲食習慣改變後的血壓: 136/80 BP after changing diet for one month: 136/80 • 現在的血壓: 119/74 Current BP: 119/74

  40. 總結 Conclusion 減少鹽份 = 降低血壓 = 減低中風的風險 Less salt = Lower blood pressure = Less risk of stroke

  41. References • Chau PH, Woo J, Goggins WB, Tse YK, Chan KC, Lo SV et al. (2011) Trends in stroke incidence in Hong Kong differ by stroke subtype. Cerebrovasc Dis 31:138-46. • Department of Health of Hong Kong Special Administrative Region. (2010) Cerebrovascular Disease. Available at: http://www.chp.gov.hk/en/content/9/25/58.html    • Department of Health of Hong Kong Special Administrative Region. (2011) Number of deaths by leading causes of death, 2001 – 2010. Available at: http://www.chp.gov.hk/en/data/4/10/27/380.html • Gorelick PB. (1995) Stroke Prevention. Arch Neurol 52: 347-355. • He FJ and MacGregor GA (2009) A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 23:363-384. • Intersalt Cooperative Research Group (1988) Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ 297:319-328. • MacMahon S, Peto R, Cutler J et al. (1990) Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765-774. • National Stroke Association website: http://www.stroke.org/site/PageNavigator/HOME • WASH website: http://www.worldactiononsalt.com/about/index.html • World Health Organization (2007) Reducing salt intake in populations: report of a WHO forum and technical meeting, 5-7 October 2006, Paris, France.

  42. 烹飪貼士 Cooking Tips • 生薑，芫茜 ，青檸果皮和果汁 – 可配羊肉或魚。 Ginger, coriander, lime rind and juice - great for lamb or fish. • 黑胡椒，辣椒和植物油 -可配牛肉。 Black pepper, chili and vegetable oil - great for beef. • 辣椒粉，大蒜，檸檬汁和植物油 -可配雞肉串。 Paprika, garlic, lemon juice and vegetable oil - great for chicken kebabs. • 切碎的新鮮蒔蘿，橄欖油和檸檬汁 -可配魚。 Chopped fresh dill, olive oil and lemon juice - great for fish. • 烹調蔬菜時輕輕煮熟以保留顏色和味道，並加入少許檸檬汁和新鮮黑胡椒。 Steam vegetables lightly to retain the color and taste and add a dash of lemon juice and freshly ground black pepper. • 使用自己烹調的肉汁或紅酒醬。 Make your own gravy or use red wine sauce instead. • 使用注入橄欖油，例如：大蒜，羅勒，辣椒，迷迭香來炒蔬菜或作沙律醬的一部分。 Use an infused olive oil, e.g. garlic, basil, chili or rosemary to sauté vegetables or as part of a salad dressing. • 使用檸檬草，新鮮芫茜和少量的麻油炒菜，而不用豉油。 Use lemon grass, fresh coriander and a small amount of sesame oil to flavor stir fries instead of soy sauce.

  43. 照顧中風患者的成本Cost of caring for stroke patients • Direct costs include 直接醫療損失包括 • Hospitalization 公立及私家醫院的入院(以留醫床位日數及成本計算) • Outpatient care 公立醫院普通科門診、專科門診和急症室的使用，以及私家醫生求診(以求診成本計算) • Rehabilitation services 復康服務 • 購置復康設備(以個案成本計算) • 復康日間醫院(以求診成本計算) • Community allied health services 社區專職醫療服務(以治療成本計算) • Direct costs also include institutional care 直接損失亦包括安老院舍護理服務 • Government subsidized institutional care places 政府資助的安老院舍服務(以宿位成本計算) • Private institutional care places 私家(私營)安老院舍服務(以宿位成本計算) • Indirect cost includes productivity lost from informal care 間接損失是非正式照顧者因照顧中風患者所造成生產力的損失(以每月主要職業收入中位數計算)

  44. 兒童鹽份建議攝取量Maximum salt intake for children Scientific Advisory Committee on Nutrition 2003

  45. 外國減鹽行動的例子(Overseas Salt Reduction Campaigns) • 英國 United Kingdom • 1996 Consensus Action on Salt and Health • 2003/2004 減鹽行動開展Salt reduction strategy started • Food Standard Agency • 游說食品工業逐步減少用鹽 (如每1至2年減少10-20%用鹽) • Negotiate with food industry to reduce the amount of salt added to foods gradually (e.g. 10-20% and repeated at 1- to 2-year interval) • 設立食物標籤制度 (顏色標記 – 綠色 (低鹽份), 黃色 (中度鹽份), 紅色 (高鹽份) • Food labeling system (color coding of green, amber and red for low, medium and high amounts of salt)

  46. 外國減鹽行動的例子(Overseas Salt Reduction Campaigns) 中國 (China) 2008 • 推出營養標籤新指引 • New guidelines for nutrition labeling on packaged foods for industry self-regulation • 不同持份者的學術交流會 • A scientific symposium was attended by key opinion leaders, policy makers, representatives from the China National Salt Corporation, Ministry of Health and the National Development and Reform Committee.

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