This investigation is the pioneering analysis of long-term dietary salt intake on metabolism, BP, BP variability, anxiety, and cognition in aged female rats. A high-salt diet, double the standard, was utilized to mirror clinically relevant excessive salt consumption and its effects were compared to a low-salt diet and a control diet. We observed the impact of varying salt diets on plasma lipids, levels and variability of BP and HR, anxiety, and cognition, but not body weights, blood glucose, blood sodium, and blood potassium. Specifically, intake of a low-salt diet led to a significant reduction in BP levels but an increase in BP variability starting from the eighth week of the diet onset. Moreover, HR levels and variability were notably higher with the low-salt diet. Furthermore, aged female rats were more anxiety with low-salt diets at the fourth week. However, the anxiety with low-salt diets was getting to improve starting from the eighth week, although no significant differences were detected. Moreover, there was a trend that low salt diets worsened the short-term memory while improved long-term memory. Furthermore, plasma lipids decreased significantly in aged female rats on high-salt diets compared to those on low-salt diets.
We previously found that high salt intake exerts broader systemic impacts on aged male rats, such as decreasing body weight and blood glucose levels.6 Contrarily, in this study, varying dietary salt did not influence body weights and blood glucose levels in aged female rats, suggesting that aged females may be less responsive to dietary salt compared to aged males regarding the abovementioned aspects. However, plasma lipid levels were significantly higher in aged female rats on a low-salt diet compared to those on a high-salt diet. Additionally, aged female rats had significantly higher plasma lipid levels than aged male rats,6 suggesting sex-specific lipids metabolic response to dietary salt. Moreover, blood sodium, potassium, and sodium-to-potassium ratio were similar across groups in aged female rats. Our previous study observed that a high-salt diet did not notably impact blood sodium levels in young adult male rats, but even a normal salt diet significantly elevated blood sodium levels in aged male rats.6 However, no discernible changes were identified in blood potassium levels or sodium-to-potassium ratios across the groups in male rats either.6 This implies that sodium regulation mechanisms may be compromised in aged male rats, but not in aged female rats. Furthermore, the absence of significant variations in blood potassium levels or sodium-to-potassium ratios across groups suggests that potassium regulation might be less sensitive to dietary salt in both sexes.
Numerous studies have demonstrated a strong correlation between high BP and excessive dietary salt intake.6,10 Although elevated salt consumption can cause a temporary rise in BP, it appears to have minimal long-term effects.6,11 This suggests potential compensatory mechanisms that might offset the short-term benefits of sodium reduction.6,7 Furthermore, in our previous study, while young adult male rats showed an initial BP increase from a high-salt diet, this change was not significant and did not persist over time.6 Additionally, aged male rats did not experience significant BP increase with a high-salt diet, indicating that the impact of salt on hypertension may vary with age or other long-term factors.6
Clinical studies on sex differences in BP reveal that young women typically exhibit lower BP and muscle sympathetic nerve activity (MSNA) than young men.12,13 In contrast, postmenopausal women often display higher BP and MSNA levels, alongside increased hypertension prevalence, compared to age-matched men.12,13 This variance might be due to the reduced sensitivity to alpha-adrenergic receptors and an enhanced beta-adrenergic-mediated vasodilation in younger women, which declines post-menopause.12,14,15 Consequently, older women exhibit higher peripheral resistance and hypertension rates. Research, such as the DASH-Sodium study, indicates that women experience more significant BP reductions with salt restriction than men.12,16 Other studies show varied responses to salt intake, with some suggesting greater salt sensitivity in women, although findings are inconsistent.12 In this research, it was observed that a high-salt diet did not elevate BP levels in aged female rats, paralleling results seen in aged male rats.6 Similarly, aged female rats on a low-salt diet demonstrated significantly reduced BP. These findings align with those in human females and in both young and aged male rats,6 indicating no sex-specific responses to salt-induced BP changes. However, our studies suggest that age may influence the effects of dietary salt on BP levels.
Furthermore, BPV refers to the fluctuations in BP over time and is emerging as a separate cardiovascular risk factor, independent of MBP levels.17 Higher variability has been linked to greater arterial stiffness and an increased risk of cardiovascular events and cognitive impairment.17 Research on the effects of dietary salt on BPV in women remains sparse, with most studies focusing on short-term rather than long-term BPV. Evidence indicate that men generally exhibit higher MBP, whereas women experience greater BPV.18,19 For instance, a study involving 52,911 participants from Italian community pharmacies found that men had higher average 24-hour BP levels, while women showed greater variability.18 Another study revealed that while men displayed higher short-term BPV, it was not affected by dietary factors.20 This difference in BPV may relate to age differences at the time of measurement, with one study beginning at age 14 and following up for 15 years, and another enrolling participant around 73.7 years old, well beyond the protective effects of estrogen in women.17
Our previous study showed that both high and low salt diets increased BPV in young adult male rats while a low-salt diet reduced BPV in aged male rats.6 In this study, we found that low-salt diets increased the BPV in aged female rats, which might be due to the greater BP reducing effect caused by low-salt diets. These findings suggest that salt restriction could potentially be beneficial for reducing BPV in aged male rats but not in aged female rats, indicating sex-dependent responses to salt restriction.
Moreover, the observed increase in HR among the aged female rats on low-salt diets may be due to the baroreflex. This rise in HR could be a compensatory mechanism to maintain cardiac output when blood volume is perceived to be lower. It may also reflect a shift in autonomic balance towards sympathetic predominance, as the body adjusts to a lower sodium state. Over time, as the body adapts to the low-salt diet, homeostatic mechanisms may recalibrate, leading to the normalization of HR.
The initial increase in anxiety levels associated with the low-salt diet could be linked to the stress response to a significant change in dietary intake. Sodium is known to play a role in the regulation of the stress response and behavior. Research has indicated that sodium restriction can be anxiogenic, leading to increased anxiety in both human and animal models.21 This reaction may be mediated by the renin-angiotensin-aldosterone system (RAAS), which is sensitive to changes in sodium balance. It is also possible that dietary sodium could affect brain neurotransmitter levels,22 which are involved in the regulation of mood and anxiety. Interestingly, the study suggests that by the eighth week, anxiety levels began to decrease in the low-salt diet group. This improvement could indicate a habituation effect, where the initial stress response diminishes as the body and brain become accustomed to the new dietary environment. It aligns with the concept of neuroplasticity, where the brain's structure and function can change in response to environmental factors, including diet.23
The impact of dietary salt intake on cognitive functions in humans has been primarily studied through longitudinal investigations in aging populations, with varied results. For example, a three-year prospective study of 1,262 adults aged 67 to 84 found that reduced salt consumption at baseline was associated with enhanced cognitive function.6,24 Notably, this relationship was only observed in participants with lower levels of physical activity at baseline, and there was no correlation between salt intake and cognitive function in more active individuals. Conversely, two prospective studies found no link between dietary salt intake and cognitive decline. The first study by Nowak et al.25 included 1,194 adults with a mean age of 74 ± 3 years and a follow-up period of 6.9 years, while the second study by Haring et al. 26 included 6,426 women aged 65 to 79 with a median follow-up of 9.1 years. The latter study particularly noted that salt intake did not affect the risk of cognitive impairment in hypertensive women, suggesting a possible indirect effect of salt on cognition through vascular function changes.6
While findings from human studies have varied, most animal studies have consistently demonstrated negative cognitive effects from a high-salt diet.6 However, these studies primarily focus on young-adult male animals subjected to extremely high-salt diets.3,6 It is important to note that these animal studies implemented exceptionally high levels of salt intake, ranging from 8 to 20 times higher than a normal salt diet, limiting the applicability of these findings to clinical settings.6
In our previous findings, we observed that both high- and low-salt diets did not have any significant influence on short-term or long-term memory in young adult male rats.6 In contrast, aged male rats exhibited a decrease in short-term memory but showed an enhancement in long-term memory when subjected to either control or low-salt diets. The high-salt diet had no noticeable impact on short-term memory but resulted in impairment in long-term memory in aged male rats.6
In this study, we found that a low-salt diet may lead to decreased short-term memory but improved long-term memory in aged female rats, aligning with our previous research in aged male rats.6 This trend suggests that dietary salt could play an important role in the brain's ability to form and retain long-term memories, which has profound implications for human health, especially as it pertains to aging and the risk of cognitive decline. Cognitive decline is a major concern in aging populations, often leading to conditions such as dementia and Alzheimer's disease. Memory impairment is a hallmark of these conditions, deeply affecting the quality of life.
The implications of a low-salt diet on long-term memory enhancement observed in the study could suggest a protective or restorative effect of reduced sodium intake against cognitive decline. This finding adds to the narrative that modifiable lifestyle factors, such as diet, play a crucial role in the maintenance of cognitive health. It provides a promising avenue for non-pharmacological intervention strategies that could be implemented to mitigate the risks of age-related cognitive disorders. Furthermore, the study's implications extend beyond the sphere of individual health and into public health policy and dietary recommendations. With the growing evidence that diet can significantly impact cognitive functions, there is a clear need for guidelines that consider the neuroprotective potential of dietary choices.27 Such guidelines could be particularly beneficial for populations already at risk of cognitive decline, such as the elderly or those with a family history of neurodegenerative diseases.
To the best of our knowledge, our research is among the first to investigate the long-term effects of varying levels of dietary salt on metabolism, cardiovascular, and cognitive health in aged female rats. Our study followed rigorous methodological standards, including randomized assignment, double-blind procedures, and video-recorded behavioral assessments. Nonetheless, the findings should be interpreted within the context of the study's limitations. A significant limitation is the lack of insights into the potential mechanisms that may explain the observed sex-specific effects of salt intake on the relationship between metabolism, cardiovascular, and cognitive function in aged female and male rats.
Sodium restriction has been shown to reduce sympathetic vascular transduction.28 The autonomic profile of women is characterized by a reduced sympathetic influence on BP, which is partially mediated by estrogen.20,29 Women's sympathetic nerves have a decreased ability to induce vasoconstriction, likely due to augmented beta-adrenergic vasodilator effects compared to men.20,30 Estrogen attenuates the RAAS, shifting the pressure-natriuresis curve to the left and decreasing BP.20 This sex difference may also be influenced by changes in neuronal nitric oxide synthase (NOS), as NOS inhibitors allow greater BP increase in response to angiotensin II in females, while having no effect in males.31,32 Estrogen also reduces endothelin levels, which promotes renal vasoconstriction and sodium absorption.32
Moreover, gut microbiota dysregulation was strongly associated with 24-hour ambulatory BP in women but not men, which may be mediated through propionic acid33 and arachidonic acid.34 The immune system also contributes to sex differences in hypertension. Regulatory T cells protect against the development of hypertension and are particularly important for BP control in females.35 Testosterone affects BP differently in men and women. High testosterone levels have been associated with increased BP in post-menopausal women,36 while the reverse trend is observed in men.32,37 The mineralocorticoid receptor-renal epithelial Na+ channel axis is the primary determinant of excessive renal sodium reabsorption and an attractive antihypertensive target in female rats with angiotensin II-induced hypertension, but not in males.38 Thus, future research should aim to examine the prospective mechanisms underlying these sex differences.
Overall, this study contributes to a better understanding of how dietary choices, particularly salt intake, can have multifaceted effects on metabolism, cardiovascular, and cognitive function in aged female rats. Our study emphasizes the need for a greater understanding of sex differences in cardiovascular disease and cognitive decline risk factors and the development of tailored strategies for prevention and treatment. It also highlights the value of using female animal models in research to better understand the unique cardiometabolic and cognitive health challenges faced by women, especially after menopause.