Impacts of a national strategy to reduce population salt intake in England: serial cross sectional study

Adherence to hemodialysis dietary sodium recommendations: influence of patient characteristics, self-efficacy, and perceived barriers

OBJECTIVE

To identify characteristics of hemodialysis patients most likely to experience difficulty adhering to sodium restrictions associated with their dietary regimen.

DESIGN

Secondary analysis using baseline data from an ongoing randomized clinical trial examining the effects of a technology-supported behavioral intervention on dietary sodium intake in hemodialysis patients.

SETTING

Thirteen dialysis centers in southwestern Pennsylvania.

SUBJECTS

We included 122 participants (61% women; 48% African American) aged 61 ± 14 years undergoing maintenance, intermittent hemodialysis for end-stage renal disease.

MAIN OUTCOME MEASURES

Normalized dietary sodium intake, adjusted interdialytic weight gain, perceived problems, and self-efficacy for restricting dietary sodium.

RESULTS

Younger participants were more likely to report problems managing their hemodialysis diet and low self-efficacy for restricting sodium intake. Consistent with these findings, younger participants had a higher median sodium intake and higher average adjusted interdialytic weight gain. Females reported more problems managing their diet. Race, time on dialysis, and perceived income adequacy did not seem to influence outcome measures.

CONCLUSION

Our findings suggest that patients who are younger and female encounter more difficulty adhering to the hemodialysis regimen. Hence, there may be a need to individualize counseling and interventions for these individuals. Further investigation is needed to understand the independent effects of age and gender on adherence to hemodialysis dietary recommendations and perceived self-efficacy.

Impact of the UK voluntary sodium reduction targets on the sodium content of processed foods from 2006 to 2011: analysis of household consumer panel data

OBJECTIVE

In 2006 the UK Food Standards Agency (FSA) introduced voluntary sodium reduction targets for more than 80 categories of processed food. Our aim was to determine the impact of these targets on the sodium content of processed foods in the UK between 2006 and 2011.

METHOD

Household consumer panel data (n>18,000 households) were used to calculate crude and sales-weighted mean sodium content for 47,337 products in 2006 and 49,714 products in 2011. Two sample t-tests were used to compare means. A secondary analysis was undertaken to explore reformulation efforts and included only products available for sale in both 2006 and 2011.

RESULTS

Between 2006 and 2011 there was an overall mean reduction in crude sodium content of UK foods of -26 mg/100g (p ≤ 0.001), equivalent to a 7% fall (356 mg/100g to 330 mg/100g). The corresponding sales-weighted reduction was -21 mg/100g (-6%). For products available for sale in both years the corresponding reduction was -23 mg/100g (p<0.001) or -7%.

CONCLUSION

The UK FSA voluntary targets delivered a moderate reduction in the mean sodium content of UK processed foods between 2006 and 2011. Whilst encouraging, regular monitoring and review of the UK sodium reduction strategy will be essential to ensure continued progress.

Estimativa de consumo de sódio pela população brasileira, 2008-2009

OBJETIVO: Atualizar estimativas sobre consumo de sódio no Brasil.MÉTODOS: Foram utilizados dados da Pesquisa de Orçamentos Familiares 2008-2009. Realizou-se a conversão em nutrientes dos registros de aquisição de alimentos dos domicílios brasileiros por meio de tabelas de composição de alimentos. Foram calculadas a disponibilidade média de sódio/pessoa/dia e a disponibilidade média ajustada para um consumo energético diário de 2.000 kcal. Calculou-se a contribuição de grupos de alimentos selecionados para o total de sódio disponível para consumo no domicílio e comparou-se com aqueles da Pesquisa de Orçamentos Familiares 2002-2003.RESULTADOS: A quantidade diária de sódio disponível para consumo nos domicílios brasileiros foi de 4,7 g para ingestão diária de 2.000 kcal, mantendo-se mais de duas vezes superior ao limite recomendado de ingestão desse nutriente. A maior parte do sódio disponível para consumo provém do sal de cozinha e de condimentos à base de sal (74,4%), mas a fração proveniente de alimentos processados com adição de sal aumentou linear e intensamente com o poder aquisitivo domiciliar (12,3% do total de sódio no quinto inferior da distribuição da renda por pessoa e 27,0% no quinto superior). Observou-se redução na contribuição de sal e condimentos à base de sal (76,2% para 74,4%) e dos alimentos in natura ou processados sem adição de sal (6,6% para 4,8%) e aumento dos alimentos processados com adição de sal (15,8% para 18,9%) e dos pratos prontos (1,4% para 1,6%) na comparação com a Pesquisa de Orçamentos Familiares 2002-2003.CONCLUSÕES: O consumo de sódio no Brasil mantém-se em níveis acima da recomendação máxima para esse nutriente em todas as macrorregiões e classes de renda brasileiras. Observou-se estabilidade na disponibilidade domiciliar total de sódio e aumento na fração proveniente dos alimentos processados com adição de sal e dos pratos prontos, na comparação de 2008-2009 com 2002-2003.

The role of cost-effectiveness analysis in developing nutrition policy

Concern about the overconsumption of unhealthy foods is growing worldwide. With high global rates of noncommunicable diseases related to poor nutrition and projections of more rapid increases of rates in low- and middle-income countries, it is vital to identify effective but low-cost interventions. Cost-effectiveness studies show that individually targeted dietary interventions can be effective and cost-effective, but a growing number of modeling studies suggest that population-wide approaches may bring larger and more sustained benefits for population health at a lower cost to society. Mandatory regulation of salt in processed foods, in particular, is highly recommended. Future research should focus on lacunae in the current evidence base: effectiveness of interventions addressing the marketing, availability, and price of healthy and unhealthy foods; modeling health impacts of complex dietary changes and multi-intervention strategies; and modeling health implications in diverse subpopulations to identify interventions that will most efficiently and effectively reduce health inequalities.

Mortality benefits from US population-wide reduction in sodium consumption: projections from 3 modeling approaches

Computer simulations have been used to estimate the mortality benefits from population-wide reductions in dietary sodium, although comparisons of these estimates have not been rigorously evaluated. We used 3 different approaches to model the effect of sodium reduction in the US population over the next 10 years, incorporating evidence for direct effects on cardiovascular disease mortality (method 1), indirect effects mediated by blood pressure changes as observed in randomized controlled trials of antihypertension medications (method 2), or epidemiological studies (method 3).The 3 different modeling approaches were used to model the same scenarios: scenario A, gradual uniform reduction totaling 40% over 10 years; scenario B, instantaneous 40% reduction in sodium consumption sustained for 10 years to achieve a population-wide mean of 2200 mg/d; and scenario C, instantaneous reduction to 1500 mg sodium per day sustained for 10 years. All 3 methods consistently show a substantial health benefit for reductions in dietary sodium under each of the 3 scenarios tested. A gradual reduction in dietary sodium over the next decade (scenario A) as might be achieved with a range of proposed public health interventions would yield considerable health benefits over the next decade, with mean effects across the 3 models ranging from 280 000 to 500 000 deaths averted. Projections of instantaneous reductions illustrate the maximum benefits that could be achieved (0.7-1.2 million deaths averted in 10 years). Under 3 different modeling assumptions, the projected health benefits from reductions in dietary sodium are substantial.

Fewer adults add salt at the table after initiation of a national salt campaign in the UK: a repeated cross-sectional analysis

In 2003, the UK Food Standards Agency and the Department of Health began attempts to reduce national salt intakes via reformulation of processed foods and a consumer awareness campaign on the negative impacts of salt on health. The present study uses large nationally representative samples of households in England to assess whether discretionary salt use was affected by the national salt reduction campaign. Large cross-sectional datasets from the Health Survey for England were used to analyse trends in adults adding salt at the table between 1997 and 2007. Since 1997, there has been a steady decline in salt use at the table. Ordinal logistic regression analysis controlling for age, sex, total household income, region, ethnicity and background trends revealed that the reduction in salt use was significantly greater after the campaign (OR 0·58; 95% CI 0·54, 0·63). Women (OR 0·71; 95% CI 0·68, 0·74), non-white ethnic groups (OR 0·69; 95% CI 0·62, 0·77), high-income households (OR 0·75; 95% CI 0·69, 0·82), middle-income households (OR 0·79; 95% CI 0·75, 0·84) and households in central (OR 0·90; 95% CI 0·84, 0·98) or the south of England (OR 0·82; 95% CI 0·77, 0·88) were less likely to add salt at the table. The results extend previous evidence of a beneficial response to the salt campaign by demonstrating the effect on salt use at the table. Future programmatic and research efforts may benefit from targeting specific population groups and improving the evidence base for evaluating the impact of the campaign.