A study on the early metabolic effects of salt and fructose consumption: the protective role of water

Nuri Baris Hasbal; Cicek Nur Bakir; Said Incir; Dimitrie Siriopol; Laura G Sanchez-Lozada; Miguel A Lanaspa; Richard J Johnson; Mehmet Kanbay

doi:10.1038/s41440-024-01686-8

A study on the early metabolic effects of salt and fructose consumption: the protective role of water

Hypertens Res. 2024 May 15. doi: 10.1038/s41440-024-01686-8. Online ahead of print.

Authors

Nuri Baris Hasbal¹, Cicek Nur Bakir², Said Incir³, Dimitrie Siriopol⁴, Laura G Sanchez-Lozada⁵, Miguel A Lanaspa⁶, Richard J Johnson⁶, Mehmet Kanbay⁷

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Koc University School of Medicine, İstanbul, Turkey. nhasbal@ku.edu.tr.
² Koc University School of Medicine, Istanbul, Turkey.
³ Department of Biochemistry, Koc University School of Medicine, Istanbul, Turkey.
⁴ Department of Nephrology, "Saint John the New" County Hospital, Stefan cel Mare University, Suceava, Romania.
⁵ Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología "Ignacio Chavez", Mexico City, Mexico.
⁶ Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
⁷ Division of Nephrology, Department of Internal Medicine, Koc University School of Medicine, İstanbul, Turkey.

PMID: 38750219
DOI: 10.1038/s41440-024-01686-8

Abstract

Increasing serum osmolality has recently been linked with acute stress responses, which over time can lead to increased risk for obesity, hypertension, and other chronic diseases. Salt and fructose are two major stimuli that can induce acute changes in serum osmolality. Here we investigate the early metabolic effects of sodium and fructose consumption and determine whether the effects of sodium or fructose loading can be mitigated by blocking the change in osmolality with hydration. Forty-four healthy subjects without disease and medication were recruited into four groups. After overnight fasting, subjects in Group 1 drank 500 mL of salty soup, while those in Group 2 drank 500 mL of soup without salt for 15 min. Subjects in Group 3 drank 500 mL of 100% apple juice in 5 min, while subjects in Group 4 drank 500 mL of 100% apple juice and 500 mL of water in 5 min. Blood pressure (BP), plasma sodium, and glucose levels were measured every 15 min in the first 2 h. Serum and urine osmolarity, serum uric acid, cortisol, fibroblast growth factor 21 (FGF21), aldosterone, adrenocorticotropic hormone (ACTH) level, and plasma renin activity (PRA) were measured at the baseline and 2 h. Both acute intake of salt or fructose increased serum osmolality (maximum ∼4 mOsm/L peaking at 75 min) associated with a rise in systolic and diastolic BP, PRA, aldosterone, ACTH, cortisol, plasma glucose, uric acid, and FGF21. Salt tended to cause greater activation of the renin-angiotensin-system (RAS), while fructose caused a greater rise in glucose and FGF21. In both cases, hydration could prevent the osmolality and largely block the acute stress response. Acute changes in serum osmolality can induce remarkable activation of the ACTH-cortisol, RAS, glucose metabolism, and uric acid axis that is responsive to hydration. In addition to classic dehydration, salt, and fructose-containing sugars can activate these responses. Staying well hydrated may provide benefits despite exposure to sugar and salt. More studies are needed to investigate whether hydration can block the chronic effects of sugar and salt on disease.

Keywords: Blood pressure; Fructose; Osmolality; Salt.