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Alonso S, Tan M, Wang C, Kent S, Cobiac L, MacGregor GA, He FJ, Mihaylova B. Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England: A Modeling Study. Hypertension 2021; 77:1086-1094. [PMID: 33641370 PMCID: PMC7968966 DOI: 10.1161/hypertensionaha.120.16649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is available in the text. The United Kingdom was among the first countries to introduce a salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified salt intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level salt intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level salt intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710–84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390–112 260) premature strokes, generating 542 850 (95% CI, 529 020–556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570–£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050–88 470) premature IHD cases, 126 010 (95% CI, 118 600–126 460) premature strokes and achieve £1260 million (95% CI, £1180–£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the salt reduction program to achieve further reductions in population salt intake and CVD burden should be a high priority.
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Affiliation(s)
- Sergi Alonso
- From the Institute of Population Health Sciences (S.A., B.M.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Monique Tan
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Changqiong Wang
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Seamus Kent
- National Institute for Health and Clinical Excellence, London, United Kingdom (S.K.)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, United Kingdom (L.C., B.M.)
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Feng J He
- Wolfson Institute of Preventive Medicine (M.T., C.W., G.A.M., F.J.H.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Borislava Mihaylova
- From the Institute of Population Health Sciences (S.A., B.M.), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.,Nuffield Department of Population Health, University of Oxford, United Kingdom (L.C., B.M.)
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Smith BT, Hack S, Jessri M, Arcand J, McLaren L, L’Abbé MR, Anderson LN, Hobin E, Hammond D, Manson H, Rosella LC, Manuel DG. The Equity and Effectiveness of Achieving Canada's Voluntary Sodium Reduction Guidance Targets: A Modelling Study Using the 2015 Canadian Community Health Survey-Nutrition. Nutrients 2021; 13:nu13030779. [PMID: 33673550 PMCID: PMC7997239 DOI: 10.3390/nu13030779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background: High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada’s voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods: We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey—Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results: In children aged 2–8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: −45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9–18 (96 mg/day, 95%CI: −149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: −30,327; female: −45 mg/day, 95%CI: −141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians’ are above the CDRR thresholds. Conclusion: Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.
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Affiliation(s)
- Brendan T. Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- Correspondence:
| | - Salma Hack
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
| | - Mahsa Jessri
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada;
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Heather Manson
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- ICES, Toronto, ON K1Y 4E9, Canada;
| | - Douglas G. Manuel
- ICES, Toronto, ON K1Y 4E9, Canada;
- Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, ON K1H 8L6, Canada
- Health Analysis Division, Statistics Canada, Ottawa, ON K1A 0T6, Canada
- Department of Family Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
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103
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Urinary sodium excretion and dietary sources of sodium intake in community-dwelling Chinese adults aged 50 years and over. Public Health Nutr 2021; 24:1861-1868. [PMID: 33602374 DOI: 10.1017/s1368980021000811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined Na intake and identified the major food sources of Na in healthy Chinese adults aged ≥50 years in Hong Kong. DESIGN Participants who completed a baseline assessment of a randomised controlled trial assessing the effectiveness of exercise and nutrition supplementation on improving physical and cognitive functions were included. A single 24-h urine sample and a 3-d diet record were used to measure urinary Na excretion and dietary intake, respectively. The compliances to the WHO (<5 g/d) and China Nutrition Society (<6 g/d) recommendations for salt intake were assessed based on the urinary Na excretion. The relative contribution of sixteen food groups to the dietary Na intake was expressed as percentages. Associations between food groups and urinary Na excretion were analysed using multiple linear regression. SETTING Community facilities. PARTICIPANTS Totally, 114 healthy Chinese adults (mean age 60·6 years, 55 % women). RESULTS The mean urinary Na excretion over 24-h was 2876·6 ± 1249·4 mg/d (7·3 ± 3·2 g salt/d). Overall, 22·8 % of participants met the WHO recommendation and 34·2 % met the Chinese Nutrition Society recommendation for salt intake. The major food sources of dietary Na intake were condiments (42·4 %), cereals and their products (16·8 %) and soups (13·5 %). Higher intakes of seafood and nuts were associated with lower urinary Na excretion. CONCLUSIONS Public health strategies should target healthy Chinese adults in Hong Kong to modify the current patterns of Na intake. Targeting condiments, cereals and their products and soups will be an important strategy to reduce their Na intake.
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104
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Sun Y, Luo R, Li Y, He FJ, Tan M, MacGregor GA, Liu H, Zhang P. App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation. JMIR Res Protoc 2021; 10:e19430. [PMID: 33565991 PMCID: PMC7904395 DOI: 10.2196/19430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/15/2020] [Accepted: 01/06/2021] [Indexed: 01/30/2023] Open
Abstract
Background The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID) DERR1-10.2196/19430
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Affiliation(s)
- Yuewen Sun
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Rong Luo
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Yuan Li
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Feng J He
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Monique Tan
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Graham A MacGregor
- Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, Australia
| | - Puhong Zhang
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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105
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A Successful Pilot Experiment of Salt Reduction in Tunisian Bread: 35% Gradual Decrease of Salt Content without Detection by Consumers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041590. [PMID: 33567538 PMCID: PMC7915252 DOI: 10.3390/ijerph18041590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
As bread is the most consumed food by the Tunisian population and the major source of salt, a pilot experiment of salt reduction in bread was begun in Bizerte city. Salt analysis in bread collected from Bizerte city was done with the Volhard titration method. A one-way Anova test was carried out to assess salt content changes over time. Application of the salt reduction programme allowed a gradual decrease of salt content in bread by 35% during three years without detection by Tunisian consumers. The salt concentration in bread was then reduced from 1.7 ± 0.2 g/100 g to 1.1 ± 0.1 g/100 g (p < 0.0001). The establishment of an effective salt reduction strategy with lifestyle education is needed to reduce hypertension, which is the primary cause of death in Tunisia.
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106
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Chattu VK, Pooransingh S, Allahverdipour H. Global health diplomacy at the intersection of trade and health in the COVID-19 era. Health Promot Perspect 2021; 11:1-4. [PMID: 33758749 PMCID: PMC7967129 DOI: 10.34172/hpp.2021.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
Global health diplomacy has gained significant importance and undoubtedly remained high on the agendas of many nations, regional and global platforms amid the coronavirus disease 2019 (COVID-19) pandemic. Many countries have realized the importance of the health sector and the value of a healthy workforce. However, there is little control on issues related to trade that impact on human health due to the dominance of profit-oriented business lobbies. A balance, however, needs to be struck between economic profits and a healthy global population. This paper aimed to highlight the importance of building capacity in global health diplomacy, especially during the COVID-19 pandemic so that health personnel may effectively negotiate on the multisectoral stage to secure the resources they need. The recent proposal to waive off certain provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement for the prevention, containment and treatment of COVID-19 by India and South Africa at the World Trade Organization (WTO) presents an important opportunity for all governments to unite and stand up for public health, global solidarity, and equitable access at the international level so that both developed and developing nations may enjoy improved health outcomes related to the COVID-19 pandemic.
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Affiliation(s)
- Vijay Kumar Chattu
- Division of Occupational Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada.,Institute of International Relations, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shalini Pooransingh
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Hamid Allahverdipour
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, 14711, Iran
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107
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Gressier M, Swinburn B, Frost G, Segal AB, Sassi F. What is the impact of food reformulation on individuals' behaviour, nutrient intakes and health status? A systematic review of empirical evidence. Obes Rev 2021; 22:e13139. [PMID: 33022095 DOI: 10.1111/obr.13139] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 01/22/2023]
Abstract
Food reformulation aimed at improving the nutritional properties of food products has long been viewed as a promising public health strategy to tackle poor nutrition and obesity. This paper presents a review of the empirical evidence (i.e., modelling studies were excluded) on the impact of food reformulation on food choices, nutrient intakes and health status, based on a systematic search of Medline, Embase, Global Health and sources of grey literature. Fifty-nine studies (in 35 papers) were included in the review. Most studies examined food choices (n = 27) and dietary intakes (n = 26). The nutrients most frequently studied were sodium (n = 32) and trans fatty acids (TFA, n = 13). Reformulated products were generally accepted and purchased by consumers, which led to improved nutrient intakes in 73% of studies. We also conducted two meta-analyses showing, respectively, a -0.57 g/day (95%CI, -0.89 to -0.25) reduction in salt intake and an effect size for TFA intake reduction of -1.2 (95% CI, -1.79 to -0.61). Only six studies examined effects on health outcomes, with studies on TFA reformulation showing overall improvement in cardiovascular risk factors. For other nutrients, it remains unclear whether observed improvements in food choices or nutrient intakes may have led to an improvement in health outcomes.
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Affiliation(s)
- Mathilde Gressier
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK.,Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
| | | | - Gary Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Alexa B Segal
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College London, London, UK
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108
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Dietary sodium:potassium ratio and CVD risk factors among Japanese adults: a retrospective cross-sectional study of pooled data from the National Health and Nutrition Survey, 2003-2017. Br J Nutr 2021; 125:79-91. [PMID: 32674745 DOI: 10.1017/s000711452000269x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Few studies have reported associations between the Na:K ratio and risk factors related to CVD among the general population in Asian countries. This study aimed to investigate the dietary Na:K ratio association with CVD risk factors among Japanese adults. This retrospective cross-sectional study included 48 800 Japanese participants (19 386 men and 29 414 women) aged ≥20 years, registered in the 2003-2017 National Health and Nutrition Survey. Multivariate OR and 95 % CI for risk of hypertension, high glycated HbA1c levels, hypercholesterolaemia, low serum levels of HDL-cholesterol and high non-HDL-cholesterol levels according to the Na:K ratio were estimated using logistic regression models. Dietary Na:K ratio decreased for both men and women from 2003 to 2017. Higher Na:K ratio and higher hypertension prevalence were observed (multivariate OR (fifth v. first quintiles) 1·27, 95 % CI 1·15, 1·40; Pfor trend < 0·001 for men and 1·12, 95 % CI 1·01, 1·23; Pfor trend = 0·007 for women). Higher Na:K ratio was associated with higher prevalence of high HbA1c levels in men (multivariate OR 1·56, 95 % CI 1·24, 1·96). Prevalence of low HDL-cholesterol levels was increased with higher Na:K ratio (Pfor trend =0·002 for men and <0·001 for women). No significant associations were found between Na:K ratio and hypercholesterolaemia in men or high non-HDL-cholesterol levels in both men and women. Our findings suggest that dietary Na:K ratio is associated with several CVD risk factors among Japanese adults.
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109
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Coyle D, Shahid M, Dunford E, Ni Mhurchu C, Mckee S, Santos M, Popkin B, Trieu K, Marklund M, Neal B, Wu J. Estimating the potential impact of Australia's reformulation programme on households' sodium purchases. BMJ Nutr Prev Health 2021; 4:49-58. [PMID: 34308112 PMCID: PMC8258059 DOI: 10.1136/bmjnph-2020-000173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND On average, Australian adults consume 3500 mg sodium per day, almost twice the recommended maximum level of intake. The Australian government through the Healthy Food Partnership initiative has developed a voluntary reformulation programme with sodium targets for 27 food categories. We estimated the potential impact of this programme on household sodium purchases (mg/day per capita) and examined potential differences by income level. We also modelled and compared the effects of applying the existing UK reformulation programme targets in Australia. METHODS This study used 1 year of grocery purchase data (2018) from a nationally representative consumer panel of Australian households (Nielsen Homescan) that was linked with a packaged food and beverage database (FoodSwitch) that contains product-specific sodium information. Potential reductions in per capita sodium purchases were calculated and differences across income level were assessed by analysis of variance. All analyses were modelled to the Australian population in 2018. RESULTS A total of 7188 households were included in the analyses. The Healthy Food Partnership targets covered 4307/26 728 (16.1%) unique products, which represented 22.3% of all packaged foods purchased by Australian households in 2018. Under the scenario that food manufacturers complied completely with the targets, sodium purchases will be reduced by 50 mg/day per capita, equivalent to 3.5% of sodium currently purchased from packaged foods. Reductions will be greater in low-income households compared with high-income households (mean difference -7 mg/day, 95% CI -4 to -11 mg/day, p<0.001). If Australia had adopted the UK sodium targets, this would have covered 9927 unique products, resulting in a reduction in per capita sodium purchases by 110 mg/day. CONCLUSION The Healthy Food Partnership reformulation programme is estimated to result in a very small reduction to sodium purchases. There are opportunities to improve the programme considerably through greater coverage and more stringent targets.
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Affiliation(s)
- Daisy Coyle
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Shahid
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Dunford
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cliona Ni Mhurchu
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Sarah Mckee
- Client Services, The Nielsen Company Australia, Sydney, New South Wales, Australia
| | - Myla Santos
- Client Services, The Nielsen Company Australia, Sydney, New South Wales, Australia
| | - Barry Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathy Trieu
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Matti Marklund
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Bruce Neal
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Epidemiology & Biostatistics, Imperial College London, London, UK
| | - Jason Wu
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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110
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Xing T, Xu Y, Qi J, Xu X, Zhao X. Effect of high intensity ultrasound on the gelation properties of wooden breast meat with different NaCl contents. Food Chem 2021; 347:129031. [PMID: 33508587 DOI: 10.1016/j.foodchem.2021.129031] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/25/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
The current study was conducted to investigate the effect of different high intensity ultrasound (HIU) amplitudes on the gelation properties of wooden breast (WB) meat batter prepared with 1% and 2% NaCl. Results indicated that HIU effectively enhanced the water holding capacity (WHC) of WB at 1% and 2% NaCl, and enabled WB to obtain better WHC than the normal. The thermal stability of WB was affected by HIU, and the difference of G'end between WB and normal was reduced at 2% NaCl. HIU continuously decreased the particle size of WB at 1% NaCl, whereas opposite trends were observed at 2% NaCl. In addition, HIU transformed α-helix structure of WB to random coil at 1% NaCl, whereas to β-sheet structure at 2% NaCl. Overall, HIU can be utilized to improve the gelation properties of WB meat with the potential to produce low- and common-salt gel-type meat products.
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Affiliation(s)
- Tong Xing
- College of Animal Science and Technology, Key Laboratory of Animal Origin Food Production and Safety Guarantee of Jiangsu Province, Jiangsu Collaborative Innovation Center of Meat Production and Processing, Quality and Safety Control, Joint International Research Laboratory of Animal Health and Food Safety, National Experimental Teaching Demonstration Center of Animal Science, Nanjing Agricultural University, Nanjing 210095, China
| | - Ying Xu
- Anhui Engineering Laboratory for Agro-products Processing, College of Tea & Food Science and Technology, Anhui Agricultural University, Hefei, 230036, China
| | - Jun Qi
- Anhui Engineering Laboratory for Agro-products Processing, College of Tea & Food Science and Technology, Anhui Agricultural University, Hefei, 230036, China
| | - Xinglian Xu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China
| | - Xue Zhao
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, China.
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111
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Lobo CP, Ferreira TAPDC. Hedonic thresholds and ideal sodium content reduction of bread loaves. Food Res Int 2021; 140:110090. [PMID: 33648305 DOI: 10.1016/j.foodres.2020.110090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022]
Abstract
Global public policies have advocated strategies for reducing sodium consumption due to the high incidence of non-communicable chronic diseases (NCDs) worldwide. The objectives of this study were to identify the bread loaves sodium content considered as ideal by the consumers and determine hedonic thresholds. In this descriptive cross-sectional study, 114 consumers evaluated the ideal sodium content in bread loaves by the Just About Right (JAR) test, (first sensorial stage) studying four decreased levels of sodium (10%, 20%, 30%, 40%) from the mean values observed from bread in 11 food composition tables from various regions of the world, and Brazil. This ideal sodium content was used as the control in pairwise acceptance tests with five other reduced-sodium samples of bread loaves (10%, 30%, 50%, 70%, 100% of reduction from the control), and hedonic threshold tests were performed with 156 consumers (a second stage sensorial test of five sessions). The data from the JAR were analyzed by a regression analysis graph and correlated with the consumption of salt and family income range by a Principal Component Analysis with a 5% significance level. In the Hedonic Threshold tests, each paired session was analyzed by Student's t-test (test t), and an adjusted regression graph was built. The Compromised Acceptance Threshold (CAT) was performed, where the calculated t corresponded to the tabulated t. In the Hedonic Rejection Threshold (HRT), the hedonic scale five ("indifferent" term) was considered. The average sodium content of bread marketed in different regions of the world was 457 mg Na/100 g of bread, and the ideal sodium content observed was 395 mg Na/100 g of bread. The gender, age and income family rates as well as attitudes and knowledge regarding the salt consumption of the trial consumers were not directly related to the evaluations of the bread loaves in the JAR test, according to the Principal Components Analysis at p ≤ 0.05. From this ideal content, a 42% reduction was possible according to the CAT test (267 mg Na/100 g of bread), and more reductions were acceptable until an 85% (to 58 mg Na/100 g of bread) reduction, as the samples began to be rejected according to HRT test. These findings demonstrated that this methodology can be applied to sodium reduction product formulations and bread as a food matrix. With this kind of methodology, it is possible to provide to the bakery industry a methodology to know a safe region to work on food reformulations and subsidize the formulation of new products without compromising consumer acceptability, in addition to meeting the demand for safer food.
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Affiliation(s)
- Cláudia Pires Lobo
- Universidade Federal de Goiás - UFG, School of Nutrition, Goiânia, GO, Brazil
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112
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Balanova YA, Kontsevaya AV, Karamnova NS, Mukaneeva DK, Drapkina OM. Population-based Cardiovascular Disease Prevention Measures Aimed at Reducing Salt Intake: Analysis of International Strategies and Prospects for Implementation in the Russian Federation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-12-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
High salt intake is an important risk factor for cardiovascular diseases (CVD), closely related to the level of blood pressure in the population. The purpose of the review: to study population-based interventions for CVD prevention, aimed at reducing salt intake; to assess the potential for their implementation in the Russian Federation. We presented population-based strategies for dietary salt intake reduction used in different countries. The main components of strategies aimed to correct this risk factor in the Russian Federation were identified. The main components of the population-based approach to reducing salt intake are: determining population salt consumption, identifying sources of salt in the diet, monitoring of salt content in products, engaging with the food industry, consumer awareness campaigns, changes in product labeling, tax measures. An integrated approach to the problem is the most successful. Measures which were highly effective have not yet been fully implemented in the Russian Federation. At the moment, taxation of high-salt foods and tax subsidies for healthy food are not applied. Food manufacturers are not sufficiently involved - there are no legislatively introduced measures to reduce salt through food reformulation. Firstly it has to be applied to diet-forming products that are consumed daily, such as bakery and dairy products, and meat products.
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Affiliation(s)
- Yu. A. Balanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Mukaneeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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113
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Projected effects on salt purchases following implementation of a national salt reduction policy in South Africa. Public Health Nutr 2020; 24:4614-4621. [PMID: 33357250 DOI: 10.1017/s1368980020005273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with. DESIGN This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content. SETTING South Africa. PARTICIPANTS The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018. RESULTS Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels. CONCLUSIONS A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases.
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Noubiap JJ. The implementation of salt reduction strategies should be sped up in Africa: a shout from Morocco. Pan Afr Med J 2020; 37:340. [PMID: 33738028 PMCID: PMC7934187 DOI: 10.11604/pamj.2020.37.340.27388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Tomitani N, Wanthong S, Roubsanthisuk W, Buranakitjaroen P, Hoshide S, Kario K. Differences in ambulatory blood pressure profiles between Japanese and Thai patients with hypertension /suspected hypertension. J Clin Hypertens (Greenwich) 2020; 23:614-620. [PMID: 33225613 PMCID: PMC8029532 DOI: 10.1111/jch.14107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 12/20/2022]
Abstract
Ethnic differences in the profiles of hypertension and cardiovascular risk have been reported between Asians and Westerners. However, blood pressure (BP) profiles and the risk factors for cardiovascular disease might differ even among different Asian populations because of the diversity of cultures, foods, and environments. We retrospectively examined differences in 24-h BP profiles between 1051 Japanese (mean age, 62.5 ± 12.4 years; medicated hypertension, 75.7%) and 804 Thai (mean age, 56.9 ± 18.5 years; medicated hypertension, 65.6%) by using the Japanese and Thai ambulatory BP monitoring (ABPM) databases, in order to check the BP control status in treated hypertensives and to inform the clinical diagnosis of hypertension. The two populations had similar office systolic BP (SBP) (142.7 ± 20.0 vs 142.3 ± 20.6 mm Hg, p = .679). However, the Japanese population had higher 24-hr average and daytime SBP, and the Thai population had higher nighttime SBP even after adjusting for cardiovascular risk factors (all p < .05). Greater morning BP surge was observed in Japanese (31.2 vs 22.8 mm Hg, p < .001). Regarding nocturnal BP dipping status, the prevalence of riser status (higher nighttime than daytime SBP) was higher in the Thai population (30.5% vs 10.9%). These findings suggest that a substantial difference in 24-hr BP profiles exists between even neighboring countries in Asia.
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Affiliation(s)
- Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Sirisawat Wanthong
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weranuj Roubsanthisuk
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peera Buranakitjaroen
- Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Menyanu E, Corso B, Minicuci N, Rocco I, Zandberg L, Baumgartner J, Russell J, Naidoo N, Biritwum R, Schutte AE, Kowal P, Charlton K. Salt-reduction strategies may compromise salt iodization programs: Learnings from South Africa and Ghana. Nutrition 2020; 84:111065. [PMID: 33450677 DOI: 10.1016/j.nut.2020.111065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Universal salt iodization has been adopted by many countries to address iodine deficiency. More recently, salt-reduction strategies have been widely implemented to meet global salt intake targets of <5 g/d. Compatibility of the two policies has yet to be demonstrated. This study compares urinary iodine excretion (UIE) according to 24-h urinary sodium excretion, between South Africa (SA) and Ghana; both countries have implemented universal salt iodization, but in Ghana no salt-reduction legislation has been implemented. METHODS Participants from the World Health Organization's Study on Global Ageing and Adult Health Wave 3, with survey and valid 24-h urinary data (Ghana, n = 495; SA, n = 707), comprised the sample. Median 24-h UIE was compared across salt intake categories of <5, 5-9 and >9 g/d. RESULTS In Ghana, median sodium excretion indicated a salt intake of 10.7 g/d (interquartile range [IQR] = 7.6), and median UIE was 182.4 µg/L (IQR = 162.5). In SA, both values were lower: median salt = 5.6 g/d (IQR = 5.0), median UIE = 100.2 µg/L (IQR = 129.6). UIE differed significantly across salt intake categories (P < 0.001) in both countries, with positive correlations observed in both-Ghana: r = 0.1501, P < 0.0011; South Africa: r = 0.4050, P < 0.0001. Participants with salt intakes <9 g/d in SA did not meet the World Health Organization's recommended iodine intake of 150 µg/d, but this was not the case in Ghana. CONCLUSIONS Monitoring and surveillance of iodine status is recommended in countries that have introduced salt-reduction strategies, in order to prevent reemergence of iodine deficiency.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Lizelle Zandberg
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa
| | - Jeannine Baumgartner
- Centre for Excellence in Nutrition, North West University, Potchefstroom, South Africa; Human Nutrition Laboratory, Department of Health Sciences and Technology, Institute of Food, Nutrition and Health, Zurich, Switzerland
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nirmala Naidoo
- World Health Organization, Data, Analytics and Delivery for Impact Division, Geneva, Switzerland
| | | | - Aletta E Schutte
- School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paul Kowal
- Chiang Mai University, Research Institute for Health Sciences, Chiang Mai, Thailand; World Health Organization, SAGE, Geneva, Switzerland
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.
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Dodd R, Santos JA, Tan M, Campbell NRC, Ni Mhurchu C, Cobb L, Jacobson MF, He FJ, Trieu K, Osornprasop S, Webster J. Effectiveness and Feasibility of Taxing Salt and Foods High in Sodium: A Systematic Review of the Evidence. Adv Nutr 2020; 11:1616-1630. [PMID: 32561920 PMCID: PMC7666895 DOI: 10.1093/advances/nmaa067] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/05/2020] [Accepted: 05/12/2020] [Indexed: 01/04/2023] Open
Abstract
Diets high in salt are a leading risk for death and disability globally. Taxing unhealthy food is an effective means of influencing what people eat and improving population health. Although there is a growing body of evidence on taxing products high in sugar, and unhealthy foods more broadly, there is limited knowledge or experience of using fiscal measures to reduce salt consumption. We searched peer-reviewed databases [MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] and gray literature for studies published between January 2000 and October 2019. Studies were included if they provided information on the impact on salt consumption of: taxes on salt; taxes on foods high in salt, and taxes on unhealthy foods defined to include foods high in salt. Studies were excluded if their definition of unhealthy foods did not specify high salt or sodium. We found 18 relevant studies, including 15 studies reporting the effects of salt taxes through modeling (8), real-world evaluation (4), experimental design (2), or review of cost-effectiveness (1); 6 studies providing information relevant to country implementation of salt taxes; and 2 studies reporting stakeholder perceptions toward salt taxation. Although there is some evidence on the potential effectiveness and cost-effectiveness of salt taxation, especially from modeling studies, uptake of salt taxation is limited in practice. Some modeling studies suggested that food taxes can have unintended outcomes such as reduced consumption of healthy foods, or increased consumption of unhealthy, untaxed substitutes. In contrast, modeling studies that combined taxes for unhealthy foods with subsidies found that the benefits were increased. Modeling suggests that taxing all foods based on their salt content is likely to have more impact than taxing specific products high in salt given that salt is pervasive in the food chain. However, the limited experience we found suggests that policy-makers favor taxing specific products.
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Affiliation(s)
- Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Cliona Ni Mhurchu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City, NY, USA
| | | | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sutayut Osornprasop
- Global Practice on Health, Nutrition, and Population, The World Bank, Washington, DC, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Al-Mawali A, D'Elia L, Jayapal SK, Morsi M, Al-Shekaili WN, Pinto AD, Al-Kharusi H, Al-Balushi Z, Idikula J, Al-Harrasi A, Cappuccio FP. National survey to estimate sodium and potassium intake and knowledge attitudes and behaviours towards salt consumption of adults in the Sultanate of Oman. BMJ Open 2020; 10:e037012. [PMID: 33099493 PMCID: PMC7590363 DOI: 10.1136/bmjopen-2020-037012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/28/2020] [Accepted: 08/30/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate population sodium and potassium intakes and explore knowledge, attitudes and behaviour (KAB) towards the use of salt in adults in the Sultanate of Oman. DESIGN National cross-sectional population-based survey. SETTING Proportional random samples, representative of Omani adults (18 years or older), were obtained from all governorates of the Sultanate of Oman. PARTICIPANTS Five hundred and sixty-nine (193 men, 376 women; 18 years or older) were included in the analysis (response rate 57%). Mean age was 39.4 years (SD 13.1). Participants attended a screening including demographic, anthropometric and physical measurements. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed dietary sodium, potassium and creatinine by 24-hour urinary sodium (UNa), potassium (UK) and creatinine (UCr) excretions. We collected KAB by a questionnaire on an electronic tablet. RESULTS Mean UNa was 144.3 (78.8) mmol/day, equivalent to 9.0 g of salt/day and potassium excretion 52.6 (32.6) mmol/day, equivalent to 2.36 g/day, after adjusting for non-urinary losses. Men ate significantly more sodium and potassium than women. Only 22% of the sample had a salt intake below the WHO recommended target of 5 g/day and less than 10% met WHO targets for potassium excretion (>90 mmol/day). While 89.1% of those interviewed knew that consuming too much salt could cause serious health problems and only 6.9% felt they were using too much added salt, one in two participants used always or often salt, salty seasonings or salty sauces in cooking or when preparing food at home. CONCLUSIONS In the Sultanate of Oman, salt consumption is higher and potassium consumption lower than recommended by WHO, both in men and in women. The present data provide, for the first time, evidence to support a national programme of population salt reduction to prevent the increasing burden of cardiovascular disease in the area.
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Affiliation(s)
- Adhra Al-Mawali
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
- The Research Council, Seeb, Oman
| | - Lanfranco D'Elia
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | | | - Magdi Morsi
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | - Avinash D Pinto
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | | | - John Idikula
- Centre of Studies & Research, Ministry of Health, Muscat, Oman
| | | | - Francesco P Cappuccio
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Division of Medicine, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
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Anderson P, Jané Llopis E, O'Donnell A, Manthey J, Rehm J. Impact of low and no alcohol beers on purchases of alcohol: interrupted time series analysis of British household shopping data, 2015-2018. BMJ Open 2020; 10:e036371. [PMID: 33046462 PMCID: PMC7552865 DOI: 10.1136/bmjopen-2019-036371] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/02/2020] [Accepted: 06/29/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To assess the impact of new low and no alcohol beers and reformulated beers in Great Britain on household purchases of grams of alcohol. DESIGN Interrupted time series analysis. SETTING Purchase data from Kantar Worldpanel's household shopping panel for 2015-2018. PARTICIPANTS 64 286 British households. INTERVENTIONS Introduction of new no and low alcohol beers during 2017-2018 and reformulation of existing beers to contain less alcohol during 2018. MAIN OUTCOME MEASURES Average alcoholic strength of beer and number of grams of alcohol purchased by households. RESULTS As assessed by British household purchase data, 46 new low and no alcohol beer products were introduced during 2015-2018, with a step-jump in volume purchased occurring at the beginning of March 2017 (event 1). During 2015-2018, 33 beer products were reformulated to contain less alcohol, with a step-jump in volume purchased occurring during mid-March 2018 (event 2). Interrupted time series analyses found a combined associated impact of both events with relative reductions of alcohol by volume of beer between 1.2% and 2.3%; purchases of grams of alcohol within beer between 7.1% and 10.2%; and purchases of grams of alcohol as a whole between 2.6% and 3.9%. The reductions were greater for reformulation than for the introduction of new low and no alcohol products. Reductions were independently higher for younger age groups of shoppers and for households that bought the most alcohol. CONCLUSIONS Even though the events were associated with significant beneficial changes, the volume of purchases of new low and no alcohol beer products (2.6% of the volume of all beers purchased during 2018) and of new reformulated beer products (6.9% of the volume of all beers purchased during 2018) was very small. This indicates that there are future opportunities to increase the volume of such products so as to reduce the harm done by alcohol.
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Affiliation(s)
- Peter Anderson
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jané Llopis
- ESADE Business School, Ramon Llull University, Barcelona, Spain
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jürgen Rehm
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Vergeer L, Vanderlee L, Sacks G, Robinson E, Mackay S, Young L, Mulligan C, L'Abbé MR. The Development and Application of a Tool for Quantifying the Strength of Voluntary Actions and Commitments of Major Canadian Food Companies to Improve the Nutritional Quality of Their Products. Curr Dev Nutr 2020; 4:nzaa151. [PMID: 33134791 PMCID: PMC7580911 DOI: 10.1093/cdn/nzaa151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Canada's food supply is high in nutrients of public health concern, contributing to poor diet quality and increased noncommunicable disease risk. Food companies shape the healthfulness of the food supply, yet little is known about companies' voluntary actions and commitments concerning product (re)formulation. OBJECTIVE This study aimed to develop and apply a tool for quantifying the strength of voluntary actions and commitments of major food companies in Canada to improve the healthfulness of their products. METHODS Twenty-two top packaged food and beverage companies were selected based on Canadian market share. Recent actions and/or commitments to reduce energy/portion sizes, sodium, saturated fat, trans fat, and sugars were identified from company websites and public documents, verified by company representatives (where possible), and scored based on breadth of application across the product portfolio, magnitude(s) of reduction, measurability, nutritional significance, national/global applicability, and transparency using the Food Company Reformulation scoring tool. Companies offering beverages only (n = 4) were not assessed for sodium, saturated fat, or trans fat (re)formulation. RESULTS Seventeen of 22 companies reported reductions and/or commitments concerning sodium (72.2%, n = 13/18), trans fat (61.1%, n = 11/18), sugars (59.1%, n = 13/22), saturated fat (55.6%, n = 10/18), and/or energy/portion sizes (50.0%, n = 11/22). Scores ranged from 0/155 to 122/155 for food companies (median = 49/155) and 0/65 to 42/65 for beverage companies (median = 17/65). Companies generally performed best for sodium reduction (median = 21/32; range = 0-32) and poorest for energy/portion-size reductions (median = 2/30; range = 0-24). Multinational companies had significantly higher total scores than domestic companies (P = 0.004). Higher total scores were associated with greater market shares in the beverage manufacturing sector (P = 0.04), but not packaged food (P = 0.50). CONCLUSIONS Many of Canada's leading food companies report limited or no action to reduce nutrients of concern in their products, suggesting a need for government intervention and strengthened accountability mechanisms to encourage alignment of reformulation efforts with government and expert recommendations.
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Affiliation(s)
- Laura Vergeer
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lana Vanderlee
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- École de Nutrition, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Pavillon des Services, Quebec City, Quebec, Canada
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Deakin University, Burwood, Victoria, Australia
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Deakin University, Burwood, Victoria, Australia
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Grafton, Auckland, New Zealand
| | - Leanne Young
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Grafton, Auckland, New Zealand
| | - Christine Mulligan
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Nomura S, Yoneoka D, Tanaka S, Ishizuka A, Ueda P, Nakamura K, Uneyama H, Hayashi N, Shibuya K. Forecasting disability-adjusted life years for chronic diseases: reference and alternative scenarios of salt intake for 2017-2040 in Japan. BMC Public Health 2020; 20:1475. [PMID: 32993606 PMCID: PMC7526266 DOI: 10.1186/s12889-020-09596-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan's disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040. METHODS We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan's National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017-2040, we modelled the three diseases using the data for 1990-2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases. RESULTS In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden. CONCLUSIONS The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.
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Affiliation(s)
- Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Daisuke Yoneoka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Shiori Tanaka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Aya Ishizuka
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Peter Ueda
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Keiji Nakamura
- Graduate School of Environmental and Information Studies, Tokyo City University, Yokohama, Japan
- Ajinomoto Co., Inc., Tokyo, Japan
| | | | - Naoki Hayashi
- Ajinomoto Co., Inc., Tokyo, Japan
- Department of Applied Biological Chemistry, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Institute for Population Health, King's College London, London, UK
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Musicus AA, Kraak VI, Bleich SN. Policy Progress in Reducing Sodium in the American Diet, 2010–2019. Annu Rev Nutr 2020; 40:407-435. [DOI: 10.1146/annurev-nutr-122319-040249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500–2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969–2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010–2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.
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Affiliation(s)
- Aviva A. Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
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He FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:632-647. [PMID: 32057379 DOI: 10.1016/j.jacc.2019.11.055] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022]
Abstract
There is strong evidence for a causal relationship between salt intake and blood pressure. Randomized trials demonstrate that salt reduction lowers blood pressure in both individuals who are hypertensive and those who are normotensive, additively to antihypertensive treatments. Methodologically robust studies with accurate salt intake assessment have shown that a lower salt intake is associated with a reduced risk of cardiovascular disease, all-cause mortality, and other conditions, such as kidney disease, stomach cancer, and osteoporosis. Multiple complex and interconnected physiological mechanisms are implicated, including fluid homeostasis, hormonal and inflammatory mechanisms, as well as more novel pathways such as the immune response and the gut microbiome. High salt intake is a top dietary risk factor. Salt reduction programs are cost-effective and should be implemented or accelerated in all countries. This review provides an update on the evidence relating salt to health, with a particular focus on blood pressure and cardiovascular disease, as well as the potential mechanisms.
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Affiliation(s)
- Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Rosewarne E, Trieu K, Farrand C, Reimers J, Potter J, Davidson C, Darrigan N, Joldeski E, Armstrong S, Webster J. Unpack the Salt: an evaluation of the Victorian Salt Reduction Partnership's media advocacy activities to highlight the salt content of different foods. Nutr J 2020; 19:102. [PMID: 32938464 PMCID: PMC7495894 DOI: 10.1186/s12937-020-00621-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Australians are consuming almost double the recommended maximum salt intake. The Victorian Salt Reduction Partnership was established to coordinate efforts to reduce salt intake in the state of Victoria. As part of an intervention strategy, media advocacy strategies were used to raise public awareness and stimulate industry and government action on salt reduction. This study aimed to evaluate the Victorian Salt Reduction Partnership's media advocacy activities by determining the extent to which activities contributed to the overall strategy aims and the effectiveness of the activities in gaining media and industry engagement. METHODS A framework for evaluating media advocacy strategies used in complex public health interventions was used to guide this evaluation. Media advocacy activities were monitored and documented throughout the intervention period. A content analysis of media release press statements was performed. Indicators of media coverage (media items, cumulative audience reach, advertising space rate) and food industry engagement (number of meetings, number and type of follow up actions) were tracked. RESULTS Six media releases were issued between March 2017 and November 2018 on different processed food categories including breads, cooking sauces, ready meals, dips and crackers, processed meats and Asian-style sauces. Three main themes were identified in the qualitative analysis of the press statements: general information on salt and health, salt levels in foods, and calls to action for consumers, industry and/or government. These themes were aligned with the overall intervention strategy. Media items (print and online news, radio and TV) generated by each release ranged from 36 to 274, and cumulative audience reach (opportunities to see) ranged from 2.3 to 7.5 million Australians per release. One to three food manufacturers were met with per media release. CONCLUSIONS Disseminating sodium-monitoring data through media releases can be used as a tool to gain access to the media and reach consumers with salt reduction messages, and to engage food manufacturers in discussions about salt reduction. Characteristics of media advocacy activities, including alignment with the overall strategy, and external factors outside the of control of the program implementers, can influence media and industry engagement. When planning future nutrition interventions that include media advocacy activities, internal and external factors impacting outcomes, should be considered, documented and evaluated.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Clare Farrand
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation, Melbourne, VIC, 3053, Australia
| | - Jane Potter
- Victorian Health Promotion Foundation, Melbourne, VIC, 3053, Australia
| | - Chelsea Davidson
- National Heart Foundation of Australia, Melbourne, VIC, 3008, Australia
| | - Natasha Darrigan
- National Heart Foundation of Australia, Melbourne, VIC, 3008, Australia
| | | | - Sian Armstrong
- National Heart Foundation of Australia, Melbourne, VIC, 3008, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
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125
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Okada C, Takimoto H. Development of a screening method for determining sodium intake based on the Dietary Reference Intakes for Japanese, 2020: A cross-sectional analysis of the National Health and Nutrition Survey, Japan. PLoS One 2020; 15:e0235749. [PMID: 32931497 PMCID: PMC7491721 DOI: 10.1371/journal.pone.0235749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Although assessing nutrient intake through dietary surveys is desirable, it can be effort- and time-intensive. We aimed to develop a brief screening method for determining sodium intake in order to raise public awareness regarding the Dietary Reference Intakes for Japanese (DRI-J) 2020. Methods Using data from the 2015 National Health and Nutrition Survey, we compared dietary behaviours obtained from a self-administered questionnaire according to sodium intake, which was assessed from one-day dietary records by a semi-weighed method. Participants were divided into 4 groups based on the reference values of sodium (salt equivalent) shown in the DRI-J. We also randomly divided the participants into development and validation groups, and used logistic regression analysis to identify predictive factors for sex-specific DRI-J (<7.5 g/day in men and <6.5 g/day in women) and above-average intakes (≥10 g/day in men and women). Results Among the 6,172 Japanese individuals aged ≥20 years old, participants with lower sodium intake were found to use nutrition labels and had a lower frequency of eating out than those with higher intakes (P for difference < .001). Our final model for predicting sodium intake included adjusted sex, age, dietary behaviours, and consumption of mainly processed foods. In the development group, areas under the receiver operating characteristics curves were 0.747 and 0.741 for adherence to sex-specific DRI-J and above-average intake, respectively. The corresponding values in the validation group were 0.734 and 0.730, respectively. Conclusions This method could easily identify sodium intake using dietary behaviours and specific food consumption, and is expected to be widely useful for health and nutrition education in Japan.
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Affiliation(s)
- Chika Okada
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
- * E-mail:
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McGrattan A, Mohan D, Chua PW, Mat Hussin A, Soh YC, Alawad M, Bin Kassim Z, Bin Mohd Ghazali AN, Stephan B, Allotey P, Reidpath DD, Robinson L, Siervo M. Feasibility and acceptability of a dietary intervention study to reduce salt intake and increase high-nitrate vegetable consumption among middle-aged and older Malaysian adults with elevated blood pressure: a study protocol. BMJ Open 2020; 10:e035453. [PMID: 32859661 PMCID: PMC7454174 DOI: 10.1136/bmjopen-2019-035453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Global population ageing is one of the key factors linked to the projected rise of dementia incidence. Hence, there is a clear need to identify strategies to overcome this expected health burden and have a meaningful impact on populations' health worldwide. Current evidence supports the role of modifiable dietary and lifestyle risk factors in reducing the risk of dementia. In South-East Asia, changes in eating and lifestyle patterns under the influence of westernised habits have resulted in significant increases in the prevalence of metabolic, cardiovascular and neurodegenerative non-communicable diseases (NCDs). Low vegetable consumption and high sodium intake have been identified as key contributors to the increased prevalence of NCDs in these countries. Therefore, nutritional and lifestyle strategies targeting these dietary risk factors are warranted. The overall objective of this randomised feasibility trial is to demonstrate the acceptability of a dietary intervention to increase the consumption of high-nitrate green leafy vegetables and reduce salt intake over 6 months among Malaysian adults with raised blood pressure. METHODS AND ANALYSIS Primary outcomes focus on feasibility measures of recruitment, retention, implementation and acceptability of the intervention. Secondary outcomes will include blood pressure, cognitive function, body composition and physical function (including muscle strength and gait speed). Adherence to the dietary intervention will be assessed through collection of biological samples, 24-hour recall and Food Frequency Questionnaire. A subgroup of participants will also complete postintervention focus groups to further explore the feasibility considerations of executing a larger trial, the ability of these individuals to make dietary changes and the barriers and facilitators associated with implementing these changes. ETHICS AND DISSEMINATION Ethical approval has been obtained from Monash University Human Research Ethics Committee and Medical Research and Ethics Committee of Malaysia. Results of the study will be disseminated via peer-reviewed publications and presentations at national and international conferences.ISRCTN47562685; Pre-results.
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Affiliation(s)
- Andrea McGrattan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Devi Mohan
- Global Public Health. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Johor, Malaysia
| | - Pei Wei Chua
- Global Public Health. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Johor, Malaysia
| | - Azizah Mat Hussin
- Kampus Cawangan Institute of Medical Science Technology, Universiti Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Yee Chang Soh
- Global Public Health. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Johor, Malaysia
| | - Mawada Alawad
- Global Public Health. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Johor, Malaysia
| | - Zaid Bin Kassim
- District Health Office, Pejabat Kesihatan Daerah (PKD) Segamat, Segamat, Johor, Malaysia
| | | | - Blossom Stephan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Pascale Allotey
- Global Public Health. Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Daniel D Reidpath
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Segamat, Johor, Malaysia
- International Centre for Diarrhoeal Disease Research, ICDDR,B, Dhaka, Bangladesh
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham, Nottingham, UK
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Sacks G, Robinson E, Cameron AJ, Vanderlee L, Vandevijvere S, Swinburn B. Benchmarking the Nutrition-Related Policies and Commitments of Major Food Companies in Australia, 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176118. [PMID: 32842662 PMCID: PMC7504100 DOI: 10.3390/ijerph17176118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/05/2023]
Abstract
The food industry has an important role to play in efforts to improve population diets. This study aimed to benchmark the comprehensiveness, specificity and transparency of nutrition-related policies and commitments of major food companies in Australia. In 2018, we applied the Business Impact Assessment on Obesity and Population Level Nutrition (BIA-Obesity) tool and process to quantitatively assess company policies across six domains. Thirty-four companies operating in Australia were assessed, including the largest packaged food and non-alcoholic beverage manufacturers (n = 19), supermarkets (n = 4) and quick-service restaurants (n = 11). Publicly available company information was collected, supplemented by information gathered through engagement with company representatives. Sixteen out of 34 companies (47%) engaged with data collection processes. Company scores ranged from 3/100 to 71/100 (median: 40.5/100), with substantial variation by sector, company and domain. This study demonstrated that, while some food companies had made commitments to address population nutrition and obesity-related issues, the overall response from the food industry fell short of global benchmarks of good practice. Future studies should assess both company policies and practices. In the absence of stronger industry action, government regulations, such as mandatory front-of-pack nutrition labelling and restrictions on unhealthy food marketing, are urgently needed.
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Affiliation(s)
- Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
- Correspondence: ; Tel.: +61-0-39-251-7105
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
| | - Adrian J. Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia; (E.R.); (A.J.C.)
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada;
| | | | - Boyd Swinburn
- School of Population Health, The University of Auckland, Auckland 1142, New Zealand;
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Ide N, Ajenikoko A, Steele L, Cohn J, J. Curtis C, Frieden TR, Cobb LK. Priority Actions to Advance Population Sodium Reduction. Nutrients 2020; 12:nu12092543. [PMID: 32842580 PMCID: PMC7551205 DOI: 10.3390/nu12092543] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022] Open
Abstract
High sodium intake is estimated to cause approximately 3 million deaths per year worldwide. The estimated average sodium intake of 3.95 g/day far exceeds the recommended intake. Population sodium reduction should be a global priority, while simultaneously ensuring universal salt iodization. This article identifies high priority strategies that address major sources of sodium: added to packaged food, added to food consumed outside the home, and added in the home. To be included, strategies needed to be scalable and sustainable, have large benefit, and applicable to one of four measures of effectiveness: (1) Rigorously evaluated with demonstrated success in reducing sodium; (2) suggestive evidence from lower quality evaluations or modeling; (3) rigorous evaluations of similar interventions not specifically for sodium reduction; or (4) an innovative approach for sources of sodium that are not sufficiently addressed by an existing strategy. We identified seven priority interventions. Four target packaged food: front-of-pack labeling, packaged food reformulation targets, regulating food marketing to children, and taxes on high sodium foods. One targets food consumed outside the home: food procurement policies for public institutions. Two target sodium added at home: mass media campaigns and population uptake of low-sodium salt. In conclusion, governments have many tools to save lives by reducing population sodium intake.
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129
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Tekle DY, Santos JA, Trieu K, Thout SR, Ndanuko R, Charlton K, Hoek AC, Huffman MD, Jan S, Webster J. Monitoring and implementation of salt reduction initiatives in Africa: A systematic review. J Clin Hypertens (Greenwich) 2020; 22:1355-1370. [PMID: 32770701 PMCID: PMC7496579 DOI: 10.1111/jch.13937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
This systematic review aims to document salt consumption patterns and the implementation status and potential impact of salt reduction initiatives in Africa, from studies published between January 2009 and November 2019. Studies were sourced using MEDLINE, Embase, Cochrane Library electronic databases, and gray literature. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. Twelve studies measured population salt intake, 11 examined salt level in foods, 11 assessed consumer knowledge, attitudes, and behaviors, 1 study evaluated a behavior change intervention, and 3 studies modeled potential health gains and cost savings of salt reduction interventions. The population salt intake studies determined by 24‐hour urine collections showed that the mean (SD) salt intake in African adults ranged from 6.8 (2.2) g to 11.3 (5.4) g/d. Salt levels in foods were generally high, and consumer knowledge was fairly high but did not seem to translate into salt lowering behaviors. Modeling studies showed that interventions for reducing dietary sodium would generate large health gains and cost savings for the health system. Despite this evidence, adoption of population salt reduction strategies in Africa has been slow, and dietary consumption of sodium remains high. Only South Africa adopted legislation in 2016 to reduce population salt intake, but success of this intervention has not yet been fully evaluated. Thus, rigorous evaluation of the salt reduction legislation in South Africa and initiation of salt reduction programs in other African countries will be vital to achieving the targeted 30% reduction in salt intake by 2025.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Rhoda Ndanuko
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Karen Charlton
- Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Annet C Hoek
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Abstract
OBJECTIVE To describe the Na concentration of pre-packaged foods available in Hong Kong. DESIGN The Na concentrations (mg/100 g or mg/100 ml or per serving) of all pre-packaged foods available for sale in major supermarket chains in Hong Kong were obtained from the 2017 Hong Kong FoodSwitch database. Median and interquartile range (IQR) of Na concentration for different food groups and the proportion of foods and beverages considered low and high Na (<120 mg/100 g or mg/100 ml and >600 mg/100 g or mg/100 ml, respectively) were determined. SETTING Hong Kong. PARTICIPANTS Not applicable. RESULTS We analysed 11 518 pre-packaged products. 'Fruit and vegetables (including table salt)' had the highest variability in Na concentration ranging from 0 to 39 000 mg/100 g, followed by 'sauces, dressings, spreads and dips' ranging from 0 to 34 130. The latter also had the highest median Na concentration (mg/100 g or mg/100 ml) at 1180 (IQR 446-3520), followed by meat and meat products (median 800, IQR 632-1068) and snack foods (median 650, IQR 453-926). Fish and fish products (median 531, 364-791) and meat and meat products (median 444, IQR 351-593) had the highest Na concentration per serving. Overall, 46·7 and 26·7 % of products were low and high in Na, respectively. CONCLUSIONS Our results can serve as a baseline for food supply interventions in Hong Kong. We have identified several food groups as priority areas for reformulation, demonstrating the potential of such initiatives to improve the healthiness of the food supply in Hong Kong.
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Dehmer SP, Cogswell ME, Ritchey MD, Hong Y, Maciosek MV, LaFrance AB, Roy K. Health and Budgetary Impact of Achieving 10-Year U.S. Sodium Reduction Targets. Am J Prev Med 2020; 59:211-218. [PMID: 32532672 PMCID: PMC7768612 DOI: 10.1016/j.amepre.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study estimates the health, economic, and budgetary impact resulting from graduated sodium reductions in the commercially produced food supply of the U.S., which are consistent with draft U.S. Food and Drug Administration voluntary guidance and correspond to Healthy People 2020 objectives and the 2015-2020 Dietary Guidelines for Americans. METHODS Reduction in mean U.S. dietary sodium consumption to 2,300 mg/day was implemented in a microsimulation model designed to evaluate prospective cardiovascular disease-related policies in the U.S. POPULATION The analysis was conducted in 2018-2020, and the microsimulation model was constructed using various data sources from 1948 to 2018. Modeled outcomes over 10 years included prevalence of systolic blood pressure ≥140 mmHg; incident myocardial infarction, stroke, cardiovascular disease events, and cardiovascular disease-related mortality; averted medical costs by payer in 2017 U.S. dollars; and productivity. RESULTS Reducing sodium consumption is expected to reduce the number of people with systolic blood pressure ≥140 mmHg by about 22% and prevent approximately 895.2 thousand cardiovascular disease events (including 218.9 thousand myocardial infarctions and 284.5 thousand strokes) and 252.5 thousand cardiovascular disease-related deaths over 10 years in the U.S. Savings from averted disease costs are expected to total almost $37 billion-most of which would be attributed to Medicare ($18.4 billion) and private insurers ($13.4 billion)-and increased productivity from reduced disease burden and premature mortality would account for another $18.2 billion in gains. CONCLUSIONS Systemic sodium reductions in the U.S. food supply can be expected to produce substantial health and economic benefits over a 10-year period, particularly for Medicare and private insurers.
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Affiliation(s)
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Menyanu E, Baatiema L, Charlton K, Wilson M, Aikins ADG, Russell J. Towards Population Salt Reduction to Control High Blood Pressure in Ghana: A Policy Direction. Curr Dev Nutr 2020; 4:nzaa084. [PMID: 32851200 PMCID: PMC7438700 DOI: 10.1093/cdn/nzaa084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 01/29/2023] Open
Abstract
Although population salt reduction is considered a "best buy" in addressing hypertension and cardiovascular disease, Ghana shares a high hypertension burden with a seemingly high salt consumption. This article discusses best practices in reducing population salt intake and provides preliminary data on salt and potassium intake, as well as the process to develop a road map and identification of actions needed to support the development of a strategic national document towards salt reduction in Ghana. In February 2019, a 2-d stakeholder meeting was held with government agencies, researchers, nongovernmental organizations, civil society organizations, and international partners to deliberate on salt reduction strategies and interventions needed in the face of rising hypertension and other noncommunicable diseases (NCDs) in Ghana. Recommendations were developed from the stakeholder meeting and are being considered for inclusion in the revision of Ghana's national NCD policy.
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Affiliation(s)
- Elias Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Leonard Baatiema
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Michael Wilson
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama De-Graft Aikins
- Noncommunicable Diseases Support Center for Africa, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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133
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Chacko S, Jeemon P. Role of family support and self-care practices in blood pressure control in individuals with hypertension: results from a cross-sectional study in Kollam District, Kerala. Wellcome Open Res 2020; 5:180. [PMID: 33305010 PMCID: PMC7713892 DOI: 10.12688/wellcomeopenres.16146.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Despite the availability of effective drugs, blood pressure (BP) control rate is sub-optimal in individuals with hypertension in low- and middle-income countries (LMICs). The role of self-care in the management of BP is less studied in LMIC settings. Methods: We conducted a community-based, cross-sectional study in individuals with hypertension in Kollam district, Kerala. A multistage cluster sampling method was used for the selection of study participants. We measured self-care by using an adapted Hypertension Self-Care Activity Level Effects (H-SCALE) scale. Descriptive statistics were used to summarise the data and logistic regression analysis was conducted to identify factors associated with BP control. Results: In total, 690 individuals with hypertension (women=60%) and a mean age of 57±8 years participated in the study. More than half (54%) of the participants were adherent to anti-hypertensive medications. However, the adherence rate was much lower for the dietary approach to stop hypertension (DASH) diet (12.8%), recommended level of physical activity (24%) and weight management (11.4%). Overall BP control was achieved in two of five individuals (38.4%, 95% CI: 34.7-42.0%). Among self-care activities, adherence to medications (AOR: 1.8, 95% CI: 1.3-2.5), DASH diet (AOR: 1.5, 95% CI: 1.0-2.4), and non-smoking status (AOR: 3.3, 95% CI: 1.7-6.4) were associated with control of BP. Additionally, good family support to self-care (AOR: 1.9, 95% CI: 1.1-3.1) was associated with better control of BP. Conclusion: In individuals with hypertension, the BP control rate is achieved in two of five individuals. Adoption of self-care activities are sub-optimal. Both family support and adherence to self-care activities are associated with BP control. Family based interventions to improve adherence to self-care activities could have a significant public health impact in achieving better population-level BP control rates in Kerala, India.
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Affiliation(s)
- Susanna Chacko
- Achutha Menon Centre for Health Sciences Studies, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Sciences Studies, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
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A Comprehensive Study on the Influence of Sodium Chloride on the Technological Quality Parameters of Soft Wheat Dough. Foods 2020; 9:foods9070952. [PMID: 32709125 PMCID: PMC7404662 DOI: 10.3390/foods9070952] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
This study aimed at understanding how the presence or absence of NaCl influences dough rheological performance of soft wheat cvs. currently used in the Italian bread manufacturing industry as a scientific support to national health strategies to reduce the use of NaCl in bread. For this reason 176 flour samples belonging to 41 soft wheat cvs. currently cultivated in Italy, were analyzed for their protein content, Zeleny sedimentation value, and by means of the Chopin Alveograph and Brabender Farinograph, with no salt and with 1.5% salt addition (average salt content in Italian bread). Three selected cvs. (Aubusson, Bolero, and Blasco) were additionally studied by means of the Rapid Visco Analyzer (RVA) at three levels of salt addition (0%, 1.5% and 3.0%). The fermentation behaviour of the cvs. Aubusson and Blasco was also studied by means of a Rheofermentometer under the same conditions. The results of our study confirmed the role of salt in strengthening the wheat gluten network (up to 86%), and thus the gas retention of dough and in affecting yeast activity. However, it also definitely proved that careful cultivar selection can help in overcoming technical challenges in reduced-salt bread manufacturing and eventually, it opens the path to wheat breeding for reduced-salt bread baking.
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135
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Martínez Arroyo A, Corvalán Aguilar C, Palma Molina X, Ceballos Sanchez X, Fisberg RM. Dietary Patterns of Adolescents from the Chilean Growth and Obesity Cohort Study Indicate Poor Dietary Quality. Nutrients 2020; 12:E2083. [PMID: 32674402 PMCID: PMC7400834 DOI: 10.3390/nu12072083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022] Open
Abstract
Diet during adolescence can have lasting effects on nutritional status, health, and development. We hypothesized that dietary patterns with low-quality nutrition are associated with overweightness. We collected data for 882 Chilean adolescents from the Growth and Obesity Cohort Study (mean age: 12 years). Dietary intake was assessed through 24-h recalls and weight status data were obtained during clinical visits. Dietary patterns were obtained through exploratory factor analysis. Multiple logistic regression models were used to examine cross-sectional associations between dietary patterns and overweight (BMI z-score ≥ 1SD). Four dietary patterns were identified: "Breakfast/Light dinner", "Natural foods", "Western", and "Snacking". "Breakfast/Light dinner", "Western", and "Snacking" patterns provided higher energy and excess nutrients (sodium, saturated fat, and added sugar). Moreover, adolescents with higher adherence to "Western" or " Snacking" patterns (third tertile) had higher odds of being classified as overweight (OR = 1.67; 95%CI: 1.103-2.522 and OR = 1.86; 95%CI: 1.235-2.792, respectively) than those with lower adherence (first tertile). "Natural foods" pattern was also associated with overweightness (OR = 1.83; 95%CI: 1.219-2.754). These dietary patterns were associated with overconsumption of nutrients of public health concern. Three of the four main dietary patterns were associated with overweightness. These results highlight the need of prioritizing adolescents on obesity prevention strategies.
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Affiliation(s)
- Angela Martínez Arroyo
- School of Nutrition and Dietetics, Faculty of Pharmacy, University of Valparaíso, Valparaíso 2360102, Chile; (A.M.A.); (X.P.M.); (X.C.S.)
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
| | - Camila Corvalán Aguilar
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7830420, Chile;
| | - Ximena Palma Molina
- School of Nutrition and Dietetics, Faculty of Pharmacy, University of Valparaíso, Valparaíso 2360102, Chile; (A.M.A.); (X.P.M.); (X.C.S.)
| | - Ximena Ceballos Sanchez
- School of Nutrition and Dietetics, Faculty of Pharmacy, University of Valparaíso, Valparaíso 2360102, Chile; (A.M.A.); (X.P.M.); (X.C.S.)
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil
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136
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Charlton KE, Schutte AE, Wepener L, Corso B, Kowal P, Ware LJ. Correcting for Intra-Individual Variability in Sodium Excretion in Spot Urine Samples Does Not Improve the Ability to Predict 24 h Urinary Sodium Excretion. Nutrients 2020; 12:nu12072026. [PMID: 32650384 PMCID: PMC7400094 DOI: 10.3390/nu12072026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 01/11/2023] Open
Abstract
Given a global focus on salt reduction efforts to reduce cardiovascular risk, it is important to obtain accurate measures of salt intake on a population level. This study determined firstly whether adjustment for intra-individual variation in urinary sodium (Na) excretion using three repeated 24 h collections affects daily estimates and whether the use of repeated spot urine samples results in better prediction of 24 h Na compared to a single collection. Twenty three community-dwelling men and women from South Africa (mean age 59.7 years (SD = 15.6)) participating in the World Health Organization Study on global AGEing and adult health (WHO-SAGE) Wave 3 study collected 24 h and spot early morning urine samples over three consecutive days to assess urinary Na excretion. INTERSALT, Tanaka, and Kawasaki prediction equations, with either average or adjusted spot Na values, were used to estimate 24 h Na and compared these against measured 24 h urinary Na. Adjustment was performed by using the ratio of between-person (sb) and total (sobs) variability obtained from repeated measures analysis of variance. Sensitivity of the equations to predict daily urinary Na values below 5 g salt equivalent was calculated. The sb/sobs for urinary Na using three repeated samples for spot and 24 h samples were 0.706 and 0.798, respectively. Correction using analysis of variance for 3 × 24 h collections resulted in contraction of the upper end of the distribution curve (90th centile: 157 to 136 mmoL/day; 95th centile: 220 to 178 mmoL/day). All three prediction equations grossly over-estimated 24 h urinary Na excretion, regardless of whether a single spot urine or repeated collections corrected for intra-individual variation were used. Sensitivity of equations to detect salt intake equivalent values of ≤5 g/day was 13% for INTERSALT, while the other two equations had zero sensitivity. Correcting for intra-individual variability in Na excretion using three 24 h urine collections contracted the distribution curve for high intakes. Repeated collection of spot samples for urinary Na analysis does not improve the accuracy of predicting 24 h Na excretion. Spot urine samples are not appropriate to detect participants with salt intakes below the recommended 5 g/day.
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Affiliation(s)
- Karen Elizabeth Charlton
- School of Medicine, University of Wollongong, Wollongong 2522, Australia
- Illawarra Health and Medical Research Institute, Wollongong 2522, Australia
- Correspondence: ; Tel.: +61-2-42214754
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney 2052, Australia;
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Leanda Wepener
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom 2520, South Africa;
| | - Barbara Corso
- Neuroscience Institute, National Research Council, 35121 Padova, Italy;
| | - Paul Kowal
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand;
- World Health Organization (WHO), CH-1211 Geneva 27, Switzerland
| | - Lisa Jayne Ware
- SA MRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg 2013, South Africa;
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Rosewarne E, Hoek AC, Sacks G, Wolfenden L, Wu J, Reimers J, Corben K, Moore M, Ni Mhurchu C, Webster J. A comprehensive overview and qualitative analysis of government-led nutrition policies in Australian institutions. BMC Public Health 2020; 20:1038. [PMID: 32605547 PMCID: PMC7325668 DOI: 10.1186/s12889-020-09160-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/22/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Institutions are a recommended setting for dietary interventions and nutrition policies as these provide an opportunity to improve health by creating healthy food environments. In Australia, state and territory governments encourage or mandate institutions in their jurisdiction to adopt nutrition policies. However, no work has analysed the policy design across settings and jurisdictions. This study aimed to compare the design and components of government-led institutional nutrition policies between Australian states and territories, determine gaps in existing policies, and assess the potential for developing stronger, more comprehensive policies. METHODS Government-led institutional nutrition policies, in schools, workplaces, health facilities and other public settings, were identified by searching health and education department websites for each Australian state and territory government. This was supplemented by data from other relevant stakeholder websites and from the Food Policy Index Australia website. A framework for monitoring and evaluating nutrition policies in publicly-funded institutions was used to extract data and a qualitative analysis of the design and content of institutional nutrition policies was performed. Comparative analyses between the jurisdictions and institution types were conducted, and policies were assessed for comprehensiveness. RESULTS Twenty-seven institutional nutrition policies were identified across eight states and territories in Australia. Most policies in health facilities and public schools were mandatory, though most workplace policies were voluntary. Twenty-four included nutrient criteria, and 22 included guidelines for catering/fundraising/advertising. While most included implementation guides or tools and additional supporting resources, less than half included tools/timelines for monitoring and evaluation. The policy design, components and nutrient criteria varied between jurisdictions and institution types, though all were based on the Australian Dietary Guidelines. CONCLUSIONS Nutrition policies in institutions present an opportunity to create healthy eating environments and improve population health in Australia. However, the design of these policies, including lack of key components such as accountability mechanisms, and jurisdictional differences, may be a barrier to implementation and prevent the policies having their intended impact.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gary Sacks
- Deakin University, Melbourne, Victoria, 3125, Australia
| | - Luke Wolfenden
- University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Jason Wu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation, 15-31 Pelham Street, Melbourne, Victoria, 3053, Australia
| | - Kirstan Corben
- Victorian Health Promotion Foundation, 15-31 Pelham Street, Melbourne, Victoria, 3053, Australia
| | - Michael Moore
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
- The University of Auckland, Auckland, 1142, New Zealand
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
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138
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Anderson P, Jané Llopis E, Rehm J. Evaluation of Alcohol Industry Action to Reduce the Harmful Use of Alcohol: Case Study from Great Britain. Alcohol Alcohol 2020; 55:424-432. [PMID: 32419026 DOI: 10.1093/alcalc/agaa029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe a case study in the British market of one of the global beer-producing companies that has set a target to increase the proportion of its products with an alcohol by volume (ABV) of 3.5% or less, and to reduce the mean ABV of its beer products. METHODS Descriptive statistics and time-series analyses using Kantar Worldpanel's British household purchase data for 2015-2018. RESULTS As assessed by British household purchase data, 15.7% of the company's beer products had an ABV of 3.5% or less in 2018, compared with 8.8% in 2015. The mean ABV of its beer products dropped from 4.69 in 2015 to 4.55 in 2018. Associated with these changes, the increase in purchased grams of alcohol in all beer that occurred during 2015-2016 (standardized coefficient = 0.007), plateaued during 2017 (standardized coefficient = -0.006) and decreased during 2018 (standardized coefficient = -0.034). Similar findings applied to the purchased grams of alcohol in beer other than ABI beer, suggesting some switching from other beer products to ABI products; and in all alcohol, suggesting, on balance, no overall switching to higher strength products. Greater decreases in purchases were found in the younger age groups, the highest purchasing households in terms of grams of alcohol, class groups D and E, and Scotland; there was no clear pattern by household income. CONCLUSIONS The proportion of the company's beer purchased in Great Britain that had an ABV of 3.5% or less increased since the launch of the target, and the mean ABV of its beer products decreased. The changes were associated with reduced purchases of grams of alcohol within its beer products. The associated reductions in purchases of alcohol in all beer and in all alcohol products suggest no evidence of overall switching to other higher strength beer or alcohol products. Other beer-producing companies should undertake similar initiatives. A regulatory tax environment should be introduced to ensure a level-playing field favouring lower alcohol concentration across all beer and other alcohol products.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht HA 6221, The Netherlands
| | - Eva Jané Llopis
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht HA 6221, The Netherlands.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.,ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona 08034, Spain
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden 01087, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow 119146, Russian Federation.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario ON M5S 2S1, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario ON M5S, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario ON M5T 1RB, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario ON M5T 3M7, Canada
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139
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Coyle DH, Shahid M, Dunford EK, Mhurchu CN, Mckee S, Santos M, Popkin BM, Trieu K, Marklund M, Taylor F, Neal B, Wu JHY. Contribution of major food companies and their products to household dietary sodium purchases in Australia. Int J Behav Nutr Phys Act 2020; 17:81. [PMID: 32576211 PMCID: PMC7310483 DOI: 10.1186/s12966-020-00982-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/08/2020] [Indexed: 12/21/2022] Open
Abstract
Background The Australian federal government will soon release voluntary sodium reduction targets for 30 packaged food categories through the Healthy Food Partnership. Previous assessments of voluntary targets show variable industry engagement, and little is known about the extent that major food companies and their products contribute to dietary sodium purchases among Australian households. Methods The aim of this cross-sectional study was to identify the relative contribution that food companies and their products made to Australian household sodium purchases in 2018, and to examine differences in sodium purchases by household income level. We used 1 year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with database that contains product-specific sodium content for packaged foods and beverages (FoodSwitch). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Differences in per capita sodium purchases by income levels were assessed by 1-factor ANOVA. All analyses were modelled to the Australian population in 2018 using sample weights. Results Sodium data were available from 7188 households who purchased 26,728 unique products and purchased just under 7.5 million food product units. Out of 1329 food companies, the top 10 accounted for 35% of unique products and contributed to 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, particularly driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased significantly more sodium from packaged products than high-income households per capita (452 mg/d, 95%CI: 363-540 mg/d, P < 0.001). Conclusions A small number of food companies and food categories account for most of the dietary sodium purchased by Australian households. Prioritizing government engagement with these groups could deliver a large reduction in population sodium intake.
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Affiliation(s)
- Daisy H Coyle
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.
| | - Maria Shahid
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Elizabeth K Dunford
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | | | | | - Barry M Popkin
- Department of Nutrition, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kathy Trieu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fraser Taylor
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, UNSW, Level 5, 1 King St Newtown, Sydney, Australia
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140
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SANTOS FFD, DANTAS NM, SIMONI NK, PONTES LS, PINTO-e-SILVA MEM. Are foods naturally rich in glutamic acid an alternative to sodium reduction? FOOD SCIENCE AND TECHNOLOGY 2020. [DOI: 10.1590/fst.08819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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141
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Xu A, Ma J, Guo X, Wang L, Wu J, Zhang J, Bai Y, Xu J, Lu Z, Xu Z, Zhang X, Ding G, Hong Y, Du F, Wu Y, Yan L, Tang J, Cai X, Dong J, Xu C, Ren J, Chen X, Gao C, Zhang B, Yang Q, Moolenaar R, Cai Y, Jackson SL, Xie G, Yu S, Cui J, Wang Z, Zhao L, Ju L, Shen D, Yun S, Liang X, Bi Z, Wang Y. Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016. JAMA Intern Med 2020; 180:877-886. [PMID: 32338717 PMCID: PMC7186913 DOI: 10.1001/jamainternmed.2020.0904] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. OBJECTIVE To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. INTERVENTIONS Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. MAIN OUTCOMES AND MEASURES The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. RESULTS Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. CONCLUSIONS AND RELEVANCE The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.
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Affiliation(s)
- Aiqiang Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiyu Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Zhongji Xu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fengjun Du
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liuxia Yan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junli Tang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xiaoning Cai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Dong
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Chunxiao Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jie Ren
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xi Chen
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Congcong Gao
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Moolenaar
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ying Cai
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Beijing, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Cui
- China National Salt Industry Company Limited, Beijing, China
| | - Zengwu Wang
- Division of Preventive and Community Health, National Center for Cardiovascular Disease, The State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Danyang Shen
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shumei Yun
- Missouri Department of Mental Health, Jefferson City
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
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Zhang X, Hu X, Ma J, Zhang P, Li Y, Luo R, He FJ, MacGregor GA, Wang J, Yin Z. Cluster randomised controlled trial of home cook intervention to reduce salt intake in China: a protocol study. BMJ Open 2020; 10:e033842. [PMID: 32385058 PMCID: PMC7228508 DOI: 10.1136/bmjopen-2019-033842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Salt intake in China is twice the upper limit recommended by the WHO, and nearly 80% of salt is added during cooking. This study will develop a package of salt reduction interventions targeting home cooks and evaluate its effectiveness and feasibility for scale-up. METHODS AND ANALYSIS A cluster randomised controlled trial design is adopted in this study, which will be conducted in six provinces covering northern, central and southern China. For each province, 10 communities/villages (clusters) with 13 families (one cook and one adult family member) will be selected in each cluster for evaluation. In total, 780 home cooks and 780 adult family members will be recruited. The home cooks in the intervention group will be provided with the intervention package, including community-based standardised offline and online health education and salt intake monitoring. The duration of the intervention will be 1 year. The primary outcome is the difference between the intervention and control group in change in salt intake as measured by 24 hours urinary sodium from baseline to the end of the trial. The secondary outcome is the difference between the two groups in the change in salt-related knowledge, attitude and practice and blood pressure (BP). ETHICS AND DISSEMINATION The study has been approved by The Queen Mary Research Ethics Committee (QMERC2018/13) and Institutional Review Board of the Chinese Center for Disease Control and Prevention (No. 201801). The study findings will be disseminated widely through conference presentations and peer-reviewed publications and the general media. TRIAL REGISTRATION NUMBER ChiCTR1800016804.
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Affiliation(s)
- Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Hu
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinglei Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaoxue Yin
- Chinese Center for Disease Control and Prevention, Beijing, China
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143
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Bhat S, Marklund M, Henry ME, Appel LJ, Croft KD, Neal B, Wu JHY. A Systematic Review of the Sources of Dietary Salt Around the World. Adv Nutr 2020; 11:677-686. [PMID: 31904809 PMCID: PMC7231587 DOI: 10.1093/advances/nmz134] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/11/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023] Open
Abstract
Excess salt intake contributes to hypertension and increased cardiovascular disease risk. Efforts to implement effective salt-reduction strategies require accurate data on the sources of salt consumption. We therefore performed a systematic review to identify the sources of dietary salt around the world. We systematically searched peer-reviewed and gray literature databases for studies that quantified discretionary (salt added during cooking or at the table) and nondiscretionary sources of salt and those that provided information about the food groups contributing to dietary salt intake. Exploratory linear regression analysis was also conducted to assess whether the proportion of discretionary salt intake is related to the gross domestic product (GDP) per capita of a country. We identified 80 studies conducted in 34 countries between 1975 and 2018. The majority (n = 44, 55%) collected data on dietary salt sources within the past 10 y and were deemed to have a low or moderate risk of bias (n = 75, 94%). Thirty-two (40%) studies were judged to be nationally representative. Populations in Brazil, China, Costa Rica, Guatemala, India, Japan, Mozambique, and Romania received more than half of their daily salt intake from discretionary sources. A significant inverse correlation between discretionary salt intake and a country's per capita GDP was observed (P < 0.0001), such that for every $10,000 increase in per capita GDP, the amount of salt obtained from discretionary sources was lower by 8.7% (95% CI: 5.1%, 12%). Bread products, cereal and grains, meat products, and dairy products were the major contributors to dietary salt intake in most populations. There is marked variation in discretionary salt use around the world that is highly correlated with the level of economic development. Our findings have important implications for the type of salt-reduction strategy likely to be effective in a country.
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Affiliation(s)
- Saiuj Bhat
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Matti Marklund
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The Friedman School of Nutrition and Policy, Tufts University, Boston, MA, USA
| | - Megan E Henry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin D Croft
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce Neal
- The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Jason H Y Wu
- The George Institute for Global Health, Newtown, New South Wales, Australia
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144
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Elias M, Laranjo M, Potes ME, Agulheiro-Santos AC, Fernandes MJ, Garcia R, Fraqueza MJ. Impact of a 25% Salt Reduction on the Microbial Load, Texture, and Sensory Attributes of a Traditional Dry-Cured Sausage. Foods 2020; 9:E554. [PMID: 32370036 PMCID: PMC7278657 DOI: 10.3390/foods9050554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Catalão is a Portuguese dry-cured traditional sausage, highly appreciated for its distinctive sensory properties. The aim of this study was to evaluate the impact of a 25% salt reduction on Catalão manufactured with either purebred Alentejano (Al) or crossbred Iberian × Duroc (IDr) pork meat, on its physicochemical and microbiological stability, texture parameters, and sensory attributes. No significant effect of salt reduction or genotype was observed for pH, aW, and microbiological parameters. PUFA content was significantly higher for Al Catalão, particularly due to the content in linoleic and linolenic fatty acids. IDr 3% NaCl samples had the highest mean n6/n3 PUFA ratio, and the highest mean values for the atherogenicity and thrombogenicity indices, showing that both genotype and salt content influence these nutritional indices. Texture profile of Catalão was significantly influenced by salt content and genotype. Al samples were less adhesive, cohesive, and easier to chew. Low-salt Catalão was harder, more adhesive, and less cohesive, with lower resilience and higher chewiness values. Regarding sensory attributes, salt content influenced the product aroma, with reduced-salt sausages being evaluated as significantly less aromatic. Overall, a 25% salt reduction did not have a significant impact on the quality, stability, and sensory evaluation of Catalão.
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Affiliation(s)
- Miguel Elias
- MED-Mediterranean Institute for Agriculture, Environment and Development, IIFA-Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; (M.E.); (M.L.); (M.E.P.); (A.C.A.-S.); (R.G.)
- Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal
| | - Marta Laranjo
- MED-Mediterranean Institute for Agriculture, Environment and Development, IIFA-Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; (M.E.); (M.L.); (M.E.P.); (A.C.A.-S.); (R.G.)
| | - Maria Eduarda Potes
- MED-Mediterranean Institute for Agriculture, Environment and Development, IIFA-Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; (M.E.); (M.L.); (M.E.P.); (A.C.A.-S.); (R.G.)
- Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal
| | - Ana Cristina Agulheiro-Santos
- MED-Mediterranean Institute for Agriculture, Environment and Development, IIFA-Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; (M.E.); (M.L.); (M.E.P.); (A.C.A.-S.); (R.G.)
- Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal
| | - Maria José Fernandes
- CIISA-Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal;
| | - Raquel Garcia
- MED-Mediterranean Institute for Agriculture, Environment and Development, IIFA-Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; (M.E.); (M.L.); (M.E.P.); (A.C.A.-S.); (R.G.)
- Departamento de Fitotecnia, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal
| | - Maria João Fraqueza
- CIISA-Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal;
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145
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Salt-Related Knowledge, Attitudes and Behaviors (KABs) among Victorian Adults Following 22-Months of a Consumer Awareness Campaign. Nutrients 2020; 12:nu12051216. [PMID: 32357458 PMCID: PMC7282017 DOI: 10.3390/nu12051216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
The Australian population consumes more salt than recommended and this increases the risk of raised blood pressure and cardiovascular disease. In 2015, a state-wide initiative was launched in the Australian state of Victoria to reduce population salt intake. This study examines whether salt-related knowledge, attitudes and behaviors (KABs) of Victorian adults changed following the first 22 months of a consumer awareness campaign targeting parents. Repeated cross-sectional surveys of adults (18–65 years) recruited from research panels. Analyses were weighted to reflect the Victorian population. In both surveys mean age of participants (1584 in 2015 and 2141 in 2018) was 41 years, and 51% were female. This includes 554 parents/caregivers in 2015 and 799 in 2018. Most indicators of KAB remained unchanged. Among parents/caregivers the percentage who agreed limiting salt in their child’s diet was important increased by 8% (p = 0.001), and there was a 10% reduction in the percentage who reported placing a saltshaker on the table and a 9% reduction in those who reported their child added salt at the table (both p < 0.001). Some small adverse effects on other indicators were also observed. During the first 22 months of a salt reduction consumer awareness campaign, there were limited changes in KAB overall, however the target audience reported positive changes regarding their children, which aligned with the campaign messages.
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146
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Antúnez L, Alcaire F, Giménez A, Ares G. Can sodium warnings modify preferences? A case study with white bread. Food Res Int 2020; 134:109239. [PMID: 32517900 DOI: 10.1016/j.foodres.2020.109239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
Abstract
Several studies have shown that the inclusion of front of pack nutritional warnings is a potentially effective strategy to encourage consumers to avoid products with high content of nutrients associated with non-communicable diseases. In this context, the present work aimed at exploring consumers' reaction towards sodium reduction in the context of the implementation of warnings in three scenarios: package evaluation, tasting and intention to re-purchase the product after tasting, using white bread as case study. A total of 171 consumers participated in the study that encompassed four parts. Firstly, consumers received two bread samples with different salt content (2.00% and 1.38% salt) under blind conditions and were asked to rate their overall liking and to indicate the one they preferred. Then, they were asked to look at four bread packages differing in graphic design and the presence of warnings. They had to rate their expected liking and to indicate the one they would purchase. Finally, consumers were asked to try the bread they had previously chosen, to assess their overall liking and to indicate their willingness to purchase it again. Salt content significantly affected consumer hedonic reaction towards the breads. Two consumer segments with different preference for the salt content in bread were identified: 58% of consumers preferred the bread with 2.00% salt while 42% preferred breads with 1.38% salt. However, when looking at the packages the majority of consumers in both groups selected bread packages that did not feature warnings. In addition, after having tried the bread, most consumers were willing to buy the bread they had previously chosen again, which is promising in terms of reaching sustainable changes towards lower salt levels. Results from the present work suggest that, in the case of bread, nutritional warnings have potential to shift consumers' preferences to lower sodium content, even after trying the products.
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Affiliation(s)
- Lucía Antúnez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP. 91000 Pando, Canelones, Uruguay.
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP. 91000 Pando, Canelones, Uruguay
| | - Ana Giménez
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP. 91000 Pando, Canelones, Uruguay
| | - Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP. 91000 Pando, Canelones, Uruguay
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147
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Zhang P, He FJ, Li Y, Li C, Wu J, Ma J, Zhang B, Wang H, Li Y, Han J, Luo R, He J, Li X, Liu Y, Wang C, Tan M, MacGregor GA, Li X. Reducing Salt Intake in China with "Action on Salt China" (ASC): Protocol for Campaigns and Randomized Controlled Trials. JMIR Res Protoc 2020; 9:e15933. [PMID: 32271155 PMCID: PMC7180507 DOI: 10.2196/15933] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Salt intake in China is over twice the maximum recommendation of the World Health Organization. Unlike most developed countries where salt intake is mainly derived from prepackaged foods, around 80% of the salt consumed in China is added during cooking. OBJECTIVE Action on Salt China (ASC), initiated in 2017, aims to develop, implement, and evaluate a comprehensive and tailored salt reduction program for national scaling-up. METHODS ASC consists of six programs working in synergy to increase salt awareness and to reduce the amount of salt used during cooking at home and in restaurants, as well as in processed foods. Since September 2018, two health campaigns on health education and processed foods have respectively started, in parallel with four open-label cluster randomized controlled trials (RCTs) in six provinces across China: (1) app-based intervention study (AIS), in which a mobile app is used to achieve and sustain salt reduction in school children and their families; (2) home cook-based intervention study (HIS), in which family cooks receive support in using less salt; (3) restaurant-based intervention study (RIS) targeting restaurant consumers, cooks, and managers; and (4) comprehensive intervention study (CIS), which is a real-world implementation and evaluation of all available interventions in the three other RCTs. To explore the barriers, facilitators, and effectiveness of delivering a comprehensive salt reduction intervention, these RCTs will last for 1 year (stage 1), followed by nationwide implementation (stage 2). In AIS, HIS, and CIS, the primary outcome of salt reduction will be evaluated by 24-hour urinary sodium excretion in 6030 participants, including 5436 adults and 594 school children around 8-9 years old. In RIS, the salt content of meals will be measured by laboratory food analysis of the 5 best-selling dishes from 192 restaurants. Secondary outcomes will include process evaluation; changes in knowledge, attitude, and practice on salt intake; and economic evaluation. RESULTS All RCTs have been approved by Queen Mary Research Ethics Committee and the Institutional Review Boards of leading institutes in China. The research started in June 2017 and is expected to be completed around March 2021. The baseline investigations of the four RCTs were completed in May 2019. CONCLUSIONS The ASC project is progressing smoothly. The intervention packages and tailored components will be promoted for salt reduction in China, and could be adopted by other countries. TRIAL REGISTRATION Chinese Clinical Trial Registry. AIS: ChiCTR1800017553; https://tinyurl.com/vdr8rpr. HIS: ChiCTR1800016804; https://tinyurl.com/w8c7x3w. RIS: ChiCTR1800019694; https://tinyurl.com/uqkjgfw. CIS: ChiCTR1800018119; https://tinyurl.com/s3ajldw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15933.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Changning Li
- Surveillance Department, Chinese Center for Health Education, Beijing, China
| | - Jing Wu
- The National Center for Chronic and Noncommunicable Disease Control and Prevention, The Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jixiang Ma
- Chronic Diseases and Aging Health Management Division, The Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- National Institute for Nutrition and Health, The Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, The Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yinghua Li
- Surveillance Department, Chinese Center for Health Education, Beijing, China
| | - Junhua Han
- Food Policy, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jing He
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Yu Liu
- School of Computing, Beihang University, Beijing, China
| | - Changqiong Wang
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Xinhua Li
- Chinese Center for Disease Control and Prevention, Beijing, China
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148
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Lima NKDC. Dietary Salt Reduction: Illusion or Reality? Arq Bras Cardiol 2020; 114:562-563. [PMID: 32267331 PMCID: PMC7792740 DOI: 10.36660/abc.20200155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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149
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Sodium content of bread from bakeries in Maputo, Mozambique: trends between 2012 and 2018. Public Health Nutr 2020; 23:1098-1102. [DOI: 10.1017/s1368980019003951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012.Design:Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries.Setting:City of Maputo, capital of Mozambique.Results:In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4–538·8) and 389·8 (248·0–609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % – the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7–5·4 meticais in the mean price per 100 g of white bread.Conclusions:The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.
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150
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Mantzouridou FT, Mastralexi A, Filippidou M, Tsimidou MZ. Challenges in the Processing Line of Spanish Style cv. Chalkidiki Green Table Olives Spontaneously Fermented in Reduced NaCl Content Brines. EUR J LIPID SCI TECH 2020. [DOI: 10.1002/ejlt.201900453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fani Th Mantzouridou
- Laboratory of Food Chemistry and Technology, School of Chemistry Aristotle University of Thessaloniki Thessaloniki 541 24 Greece
| | - Aspasia Mastralexi
- Laboratory of Food Chemistry and Technology, School of Chemistry Aristotle University of Thessaloniki Thessaloniki 541 24 Greece
| | - Maria Filippidou
- Laboratory of Food Chemistry and Technology, School of Chemistry Aristotle University of Thessaloniki Thessaloniki 541 24 Greece
| | - Maria Z. Tsimidou
- Laboratory of Food Chemistry and Technology, School of Chemistry Aristotle University of Thessaloniki Thessaloniki 541 24 Greece
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