UNDURTI N DAS
UND Life Sciences, Battle Ground, USA

Abstract

Recent studies revealed that sodium (salt) and glucose (sugar including sucrose and fructose) have pro-inflammatory actions, enhance oxidative stress, and augment the production of cytokines IL-6, TNF-α and IL-17, and alter essential fatty acid metabolism and thus, participate in the pathobiology of insulin resistance, type 2 diabetes mellitus (T2DM), hypertension (HTN) and cardiovascular and autoimmune diseases. In this review, the molecular and biochemical actions of salt and glucose in the metabolism of essential fatty acids (EFAs), function of immunocytes especially TH17 cells and their role in the pathobiology of type 2 diabetes mellitus, hypertension and autoimmune diseases is discussed. In addition, interaction(s) between EFA metabolism and proliferation and function of TH17 cells and other immunocytes including macrophages and neutrophils is also elaborated. Based on these results, potential application of this knowledge in the management of diabetes mellitus, hypertension and autoimmune diseases is presented.

INTRODUCTION
It is estimated that about 50% of the population above the age of 45 years have HTN and another 10-20% of the population have T2DM (detected or undetected). Almost 50% of the patients who have T2DM have or develop HTN eventually. Those with T2DM and HTN are generally obese. Obesity, T2DM and HTN are associated with insulin resistance and low-grade systemic inflammation. Coronary heart disease (CHD) occurs in some, if not all, of the patients with insulin resistance, obesity, T2DM and HTN. Thus, all these conditions have overlapping features and one condition may lead to the other(s) (1, 2).

Of all the dietary factors that are known to influence the development of HTN and T2DM, salt, sugar (glucose, fructose, sucrose), potassium, essential fatty acids, minerals, trace elements, vitamins and total calorie intake are important (3). Salt influences the development of HTN in a subset of patients who have salt sensitive HTN, whereas potassium suppresses the pro-hypertensive action of salt (4). Sodium (salt) is an essential nutrient and its physiological need in adults is ~ 8–10 mmol/day (184–230 mg/day).
Higher int ...