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Rigutto-Farebrother J, Zimmermann MB. Salt Reduction and Iodine Fortification Policies Are Compatible: Perspectives for Public Health Advocacy. Nutrients 2024; 16:2517. [PMID: 39125397 PMCID: PMC11314281 DOI: 10.3390/nu16152517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Cardiovascular diseases account for almost 18 million deaths annually, the most of all non-communicable diseases. The reduction of dietary salt consumption is a modifiable risk factor. The WHO recommends a daily sodium intake of <2000 mg but average consumption exceeds this in many countries globally. Strategies proposed to aid effective salt reduction policy include product reformulation, front of pack labelling, behavioural change campaigns and establishing a low-sodium-supportive environment. Yet, salt for household and processed food use is, in countries wholly or partially adopting a universal salt iodisation policy, the principal vehicle for population-wide iodine fortification. With salt reduction policies in place, there is concern that iodine deficiency disorders may re-emerge. Recognising the urgency to tackle the rising prevalence of NCDs yet not risk the re-emergence and detrimental effect of inadequate iodine intakes, this review lays out the feasibility of integrating both salt reduction and salt iodine fortification strategies. Reducing the burden of health risks associated with an excessive sodium intake or inadequate iodine through population-tailored, cost-effective strategies involving salt is both feasible and achievable, and represents an opportunity to improve outcomes in public health.
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Affiliation(s)
- Jessica Rigutto-Farebrother
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- Laboratory of Nutrition and Metabolic Epigenetics, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
| | - Michael B. Zimmermann
- Human Nutrition Laboratory, Institute of Food, Nutrition and Health, ETH Zürich, 8092 Zürich, Switzerland
- MRC Human Immunology Unit, MRC Wetherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
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Alhazmi A, Hawash MM, Ali H, Narapureddy BR, Aziz F. Knowledge, attitudes, and practices related to dietary salt among older adults in Abha, Saudi Arabia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:53. [PMID: 38650019 PMCID: PMC11036643 DOI: 10.1186/s41043-024-00545-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
The need to foster successful aging has intensified with the aging of the global population. This study aimed to assess the knowledge, attitudes, and practices (KAP) concerning dietary salt consumption and to investigate the correlations between sociodemographic variables and salt-related KAP. A structured interview was administered to a cohort of 200 older adults in Abha City, Saudi Arabia, recruited through a convenience sampling approach. The evaluation of salt-related KAP revealed widespread low knowledge (91.5%) as participants scored less than 3, negative attitudes (85.5%) scored less than 12, and predominantly unsatisfactory practices (69.5%) with scores less than 26. Noteworthy differences emerged between participants with poor overall KAP (81.5%) and those with good KAP (18.5%). Significantly weak negative correlations were found between age (r=-0.212), marital status (-0.236), and body mass index (-0.243) with overall KAP. Further examination revealed a significantly weak positive correlation between attitude and practice (r = 0.141). KAP scores show a highly significant positive correlation with overall KAP scores (r = 0.169, 0.352, 0.969). The uncovered correlations contribute to a valuable understanding of the complex dynamics surrounding salt-related KAP. This understanding guides the design of targeted interventions, such as health education programs, promoting successful aging and public health outcomes.
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Affiliation(s)
- Amani Alhazmi
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia.
| | - Manal Mohammed Hawash
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
- Department of Gerontological Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Haroon Ali
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Bayapa Reddy Narapureddy
- Department of Public Health, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Farah Aziz
- Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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Zhang W, Neupane D, Zhao Z, Jiang B, Zhang M, Zhang X, Huang Z, Li C, Sharman JE, Hu C, Ye P, Wang L. Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey. J Hum Hypertens 2024; 38:155-167. [PMID: 37857758 PMCID: PMC10844095 DOI: 10.1038/s41371-023-00861-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.
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Affiliation(s)
- Wenrong Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Jiang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Caihong Hu
- Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Pengpeng Ye
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Yang S, Ma X, Huang Y, Lin B, Zhang L, Miao S, Zheng B, Deng K. Comprehensive Effects of Potassium Lactate, Calcium Ascorbate and Magnesium Chloride as Alternative Salts on Physicochemical Properties, Sensory Characteristics and Volatile Compounds in Low-Sodium Marinated Beef. Foods 2024; 13:291. [PMID: 38254592 PMCID: PMC10814945 DOI: 10.3390/foods13020291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The search for alternative salt formulations similar to sodium chloride and their effect on marinated meat products is of great significance to the low-sodium meat processing industry. The main purpose of this study was to investigate the effect of partially replacing sodium chloride with potassium lactate, calcium ascorbate, and magnesium chloride on the sodium content, water activity and distribution, protein solubility, microstructure, sensory characteristics and volatile flavor compounds in low-sodium marinated beef. The sodium content in the test group decreased up to 28% compared to 100% in the sodium chloride group C1. The formulation including 60% sodium chloride and a total of 40% compound alternative salts in groups F1 and F2 increased their myofibril fragmentation index and promoted the disruption of the myogenic fiber structure. Group F1 (the ratio of potassium lactate, calcium ascorbate and magnesium chloride was 2:1:1) performed higher solubility of myofibrillar proteins and lower transverse relaxation value than group F2 detected by low-field nuclear magnetic resonance, which indicated that F1 formulation was beneficial to promote the solubility of myofibrillar proteins and attenuate the water mobility of marinated beef. Moreover, group F1 had a more similar microstructure and more similar overall sensory attributes to group C1 according to the scanning electron microscopy. The sensory evaluation showed higher peak intensity and response values of volatile flavor compounds than group C1 and C2 (only 60% sodium chloride) when detected using gas chromatography-ion mobility spectrometry technology, which indicated that the compound alternative salts of group F1 can improve the lower quality of low-sodium marinated beef and perform similar attributes to the C1 sample regarding moisture distribution and microstructure and even performs better than it with regards to flavor. Therefore, the F1 formula possessed greater potential for application in low-sodium marinated meat products.
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Affiliation(s)
- Shujie Yang
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
| | - Xiaoli Ma
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
| | - Yanfeng Huang
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
| | - Boyue Lin
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
| | - Longtao Zhang
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
| | - Song Miao
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
- Teagasc Food Research Centre, Food Chemistry and Technology Department, Moorepark, Fermoy, P61 C996 Co. Cork, Ireland
| | - Baodong Zheng
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
| | - Kaibo Deng
- College of Food Science, Fujian Agriculture and Forestry University, Fuzhou 350002, China; (S.Y.); (X.M.); (Y.H.); (B.L.); (L.Z.); (B.Z.)
- China-Ireland International Cooperation Centre for Food Material Science and Structure Design, Fuzhou 350002, China;
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Chan CMJ, Dickens BSL, Chong MFF. Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore. Public Health Nutr 2023; 26:2802-2814. [PMID: 37921207 PMCID: PMC10755448 DOI: 10.1017/s1368980023002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/27/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. DESIGN A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling. SETTING The survey was conducted in Singapore. PARTICIPANTS Participants were recruited from the Singapore Population Health Study Online Panel. RESULTS Participants' mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products. CONCLUSIONS Findings highlighted substantial gaps in participants' knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.
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Affiliation(s)
- Cindy Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 117549Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Ropero AB, Borrás F, Rodríguez M, Beltrá M. Nutritional Description of Organic and Conventional Food Products in Spain: The BADALI Project. Nutrients 2023; 15:nu15081876. [PMID: 37111095 PMCID: PMC10144859 DOI: 10.3390/nu15081876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Organic food and drink is undoubtedly a growing market. Consumers perceive organic food as healthy, and nutrition claims (NCs) and fortification may add to this perception. Whether this is true is still a matter of controversy, particularly for organic food products. We present here the first comprehensive study of large samples of six specific organic food types, analysing the nutritional quality (nutrient composition and "healthiness") as well as the use of NCs and fortification. In parallel, a comparison with conventional food is also carried out. For this purpose, the Food Database of products in the Spanish market, BADALI, was used. Four cereal-based and two dairy-substitute food types were analysed. Our results show that as many as 81% of organic foods are considered "less healthy" by the Pan American Health Organization Nutrient Profile Model (PAHO-NPM). Organic foods present a slightly improved nutrient profile compared to conventional foods. However, many of the differences, though statistically significant, are nutritionally irrelevant. Organic foods use NCs very frequently, more than conventional foods, with very little micronutrient fortification. The main conclusion of this work is that consumers' perception that organic food products are healthy is unfounded from a nutritional point of view.
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Affiliation(s)
- Ana B Ropero
- Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain
| | - Fernando Borrás
- Department of Statistics, Mathematics and Informatics, Miguel Hernández University, 03202 Elche, Spain
| | - Marta Rodríguez
- Polytechnic School of Orihuela, Miguel Hernández University, 03202 Elche, Spain
| | - Marta Beltrá
- Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain
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Evaluation of a Salt-Reduction Consumer Awareness Campaign Targeted at Parents Residing in the State of Victoria, Australia. Nutrients 2023; 15:nu15040991. [PMID: 36839348 PMCID: PMC9964045 DOI: 10.3390/nu15040991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
From 2015 to 2020 a state-wide salt-reduction initiative was launched in Victoria, Australia, including an awareness campaign focused on parents with children <18 years of age. To evaluate the impact of the campaign on salt-related knowledge, attitudes and behaviors (KABs) we have assessed trends in salt-related KAB pre- and post-delivery of the campaign in parents, as well as within the wider adult population. Cross-sectional surveys of adults aged 18-65 years were undertaken pre- (2015: n = 821 parents; n = 1527 general sample) and post-campaign (2019: n = 935 parents; n = 1747 general sample). KABs were assessed via an online survey. Data were analyzed with regression models and adjusted for covariates. Among parents, around one-quarter of salt-related KABs shifted in a positive direction, but changes were small: there was a 6% (95% CI 2, 11%) increase in the percentage who knew the main source of salt in the diet and reductions in the percentage who reported placing a salt shaker on the table (-8% (95%CI -12, -3)) and that their child added salt at the table (-5% (95% -9, -0.2)). Among the wider adult sample, even fewer shifts in KAB were observed, with some behaviors worsening at follow-up. These findings indicate that this consumer awareness campaign had minimum impact.
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Ojangba T, Boamah S, Zhang L, Wang Z, Osei R. Effects of sodium chloride (NaCl) partial substitution by potassium chloride (KCl) in combination with high pressure on sensory and chemical properties of beef sausage during cold storage at 4°C. CYTA - JOURNAL OF FOOD 2022. [DOI: 10.1080/19476337.2022.2138979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Theodora Ojangba
- College of Food Science and Engineering, Gansu Agricultural University, Lanzhou, China
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
| | - Solomon Boamah
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
| | - Li Zhang
- College of Food Science and Engineering, Gansu Agricultural University, Lanzhou, China
| | - Zhuo Wang
- College of Food Science and Engineering, Gansu Agricultural University, Lanzhou, China
| | - Richard Osei
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
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Effect of Ultrasound Combined with Glycerol-Mediated Low-Sodium Curing on the Quality and Protein Structure of Pork Tenderloin. Foods 2022; 11:foods11233798. [PMID: 36496606 PMCID: PMC9737799 DOI: 10.3390/foods11233798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Considering the hazards of high salt intake and the current status of research on low-sodium meat products, this study was to analyze the effect of ultrasound combined with glycerol-mediated low-sodium salt curing on the quality of pork tenderloin by analyzing the salt content, water activity (aw), cooking loss, and texture. The results of scanning electron microscope (SEM) analysis, Raman spectroscopy, ultraviolet fluorescence, and surface hydrophobicity were proposed to reveal the mechanism of the effect of combined ultrasound and glycerol-mediated low sodium salt curing on the quality characteristics of pork tenderloin. The results showed that the co-mediated curing could reduce salt content, aw, and cooking loss (p < 0.05), improve texture and enhance product quality. Compared with the control group, the co-mediated curing increased the solubility of the myofibrillar protein, improved the surface hydrophobicity of the protein, increased the content of reactive sulfhydryl groups (p < 0.05), and changed the protein structure. The SEM results showed that the products treated using a co-mediated curing process had a more detailed and uniform pore distribution. These findings provide new insights into the quality of ultrasonic-treated and glycerol-mediated low-salt cured meat products.
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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A Town-Level Comprehensive Intervention Study to Reduce Salt Intake in China: Cluster Randomized Controlled Trial. Nutrients 2022; 14:nu14214698. [PMID: 36364960 PMCID: PMC9654622 DOI: 10.3390/nu14214698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
We determined whether a town-level comprehensive intervention program could lower the salt intake of a population. The parallel, cluster randomized controlled trial was carried out between October 2018 and January 2020 in 48 towns from 12 counties across 6 provinces in China. All participants were asked to complete the 24 h urine collections, anthropometric measurements and questionnaires at the baseline and one-year post-intervention survey. A total of 2693 participants aged 18 to 75 years were recruited at the baseline. A total of 1347 individuals in 24 towns were allocated to the intervention group and the others were allocated to the control group. Valid information from 2335 respondents was collected in the follow-up survey. The 24-h urinary sodium excretion was 189.7 mmol/24 h for the intervention group and 196.1 mmol/24 h for the control group at baseline. At a one-year follow-up, the mean effect of salt intake did not show a significant change (p = 0.31) in the intervention group compared to the control group. However, the mean result of potassium excretion in the intervention group increased by 2.18 mmol/24 h (85.03 mg/24 h) (p = 0.004) and systolic blood pressure decreased by 2.95 mmHg (p < 0.001). The salt-related knowledge and attitude toward salt reduction improved significantly in the intervention group (p < 0.05). A longer period of intervention and follow-up assessment might be needed to evaluate the long-term effectiveness of the program on salt reduction.
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Moliterno P, Donangelo CM, Borgarello L, Oviedo L, Nogara R, Olascoaga A, Boggia J. Salt-related practices and its association with 24-hour urinary sodium excretion in an Uruguayan population cohort. Rev Panam Salud Publica 2022; 46:e180. [PMID: 36320202 PMCID: PMC9595218 DOI: 10.26633/rpsp.2022.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives. To evaluate the association between knowledge, attitudes, and behavior (KAB) towards sodium use and sodium intake measured by 24-hour urinary collection in an adult cohort from Uruguay (Genotype Phenotype and Environment of Hypertension Study, GEFA-HT-UY). Methods. In a cross-sectional study (n = 159), a single 24-hour urinary sample, participants' physical, biochemical and blood pressure measurements and questionnaire data were collected. The association between KAB and 24-hour urinary sodium excretion was assessed using general linear models. Results. Mean age of participants was 49.8±15.5 years, 67.9% were women, and mean 24-hour urinary sodium excretion was 3.6±1.7 g/day. Although 90.6% of participants exceeded the maximum recommended intake as indicated by urinary sodium excretion, more than half misperceived their actual intake, reporting consuming “the right amount.” Almost three-quarters of the participants reported being concerned about the amount of sodium in their diet, but only 52.8% reported taking action to control it. Lack of procedural knowledge was observed. There was no association between KAB and sodium use and intake assessed by 24-hour urinary sodium excretion. Conclusions. The lack of association between KAB towards the use of sodium and intake measured by 24-hour urinary excretion reflects the need to support people with opportunities and motivations to reduce sodium consumption. Structural actions to promote an adequate food environment, such as the effective implementation of the front-of-package nutrition labeling in Uruguay, are positive steps.
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Affiliation(s)
- Paula Moliterno
- Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay
| | | | - Luciana Borgarello
- Laboratorio de Patología Clínica, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Leticia Oviedo
- Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Romina Nogara
- Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Alicia Olascoaga
- Laboratorio de Patología Clínica, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - José Boggia
- Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
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Salt-Related Knowledge, Attitudes, and Behaviors and Their Relationship with 24-Hour Urinary Sodium Excretion in Chinese Adults. Nutrients 2022; 14:nu14204404. [PMID: 36297088 PMCID: PMC9611823 DOI: 10.3390/nu14204404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/17/2022] Open
Abstract
Salt intake in China is very high, which increases the risk of hypertension and cardiovascular disease. This study aimed to assess the levels of salt-related knowledge, attitudes, and behaviors (KABs) and the factors that influence them and to explore the relationship between the scores of salt-related KAB and 24-h urinary sodium excretion. In 2018, we collected data from 5453 individuals aged 18-75 years from six provinces in China. A face-to-face survey was carried out, focusing on the KAB related to salt reduction. All participants were asked to collect one 24-h urine sample. Of the 5453 participants, 5352 completed urine collection. The mean score for overall KAB was 31.27 (SD = 9.18), which was composed of three elements: knowledge 4.80 (SD = 5.14), attitude 9.33 (SD = 3.93), and behavior 17.14 (SD = 4.43). The average 24-h urinary sodium excretion was 187.70 (SD = 77.48) mmol, which was equivalent to a urinary sodium excretion of 4.32 (SD = 1.78) g/d. We found that salt-related knowledge, attitude, behavior, and overall KAB scores were all inversely associated with 24-h urinary sodium excretion. For every one-point increase in the KAB score, the 24-h urinary sodium excretion decreased by 0.851 mmol (95% CI: -1.095, -0.602). We also found that location (rural/urban), sex, age, and education are associated with salt-related KAB scores. These results suggest that large-scale health education is needed to reduce salt intake in the Chinese population. In particular, efforts should be focused on reaching those who live in rural areas with low educational levels and older people.
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14
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Spence C. Behavioural Nudges, Physico-Chemical Solutions, and Sensory Strategies to Reduce People’s Salt Consumption. Foods 2022; 11:foods11193092. [PMID: 36230166 PMCID: PMC9563062 DOI: 10.3390/foods11193092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 11/26/2022] Open
Abstract
This narrative historical review examines the wide range of approaches that has been trialled/suggested in order to reduce the consumption of salt. While sodium is an essential micronutrient, there is widespread evidence that high levels of consumption are leading to various negative health outcomes. This review summarises the evidence relating to the various approaches that have been put forward to date to help reduce salt consumption over the years, while also highlighting a number of important questions that remains for future research. Solutions to reducing salt consumption include everything from the gradual reduction in salt in foods through to the reduction in the number/size of holes in saltshakers (what one might consider a behavioural nudge). Physico-chemical solutions have included salt replacers, such as monosodium glutamate (MSG) through to the asymmetric distribution of salt in processed (e.g., layered) foods. A wide range of sensory approaches to modulating expected and perceived saltiness have also been suggested, including the use of salty aromas, as well as suggesting the use of colour cues, sonic seasoning, and even textural primes. It is currently unclear whether different salty aromas can be combined to increase odour-induced taste enhancement (OITE) effectiveness. In the years ahead, it will be interesting to assess how long such solutions remain effective, as well as whether different solutions can be combined to help reduce salt consumption without having to compromise on taste/flavour
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Affiliation(s)
- Charles Spence
- Department of Experimental Psychology, New Radcliffe House, University of Oxford, Oxford OX2 6BW, UK
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15
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Perez-Cueto FJ, Rini L, Faber I, Rasmussen MA, Bechtold KB, Schouteten JJ, De Steur H. How barriers towards plant-based food consumption differ according to dietary lifestyle: Findings from a consumer survey in 10 EU countries. Int J Gastron Food Sci 2022. [DOI: 10.1016/j.ijgfs.2022.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Gomes ATDS, Gabe KT, Jaime PC. Development and validation of an instrument to assess Brazilians' knowledge, perceptions, and behaviors toward salt and sodium. J Clin Hypertens (Greenwich) 2022; 24:555-565. [PMID: 35389562 PMCID: PMC9106076 DOI: 10.1111/jch.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
This study aimed to develop and validate an instrument to assess Brazilian adults' knowledge, perceptions, and behaviors (KPB) toward salt and sodium. Based on a PAHO/WHO questionnaire, a new instrument was developed and evaluated by 11 experts, generating item and scale-level content validity indexes (I-CVI and S-CVI, respectively). Face validity was verified through a focus group with eight participants, followed by an operational test with 36 interviewees. Exploratory factor analysis (EFA) was used to determine the construct validity, and Cronbach's α coefficient was calculated to analyze instrument's reliability, using data collected via telephone from a probabilistic sample of 422 adults. The generated solutions were analyzed from theoretical and statistical significance perspectives, which supported the determination of the best model. Remaining items were scored, with higher scores related to healthier practices. A descriptive analysis was performed considering the data from the 422-adult sample. I-CVIs (0.73-1), S-CVIs (0.93; 0.97) and the interviewees' analysis indicated that items are representative and clear, in addition to being suitable for application to the target audience. Tests confirmed sample adequacy to perform the EFA (KMO = 0.82; Bartlett's sphericity test, p < .001). The final validated model, with 16 items, sufficiently explained the variance and presented good reliability (Cronbach's α = 0.81; 95% CI 0.79 - 0.84). Women, older individuals, and with higher education had significantly higher scores, regardless of chronic diseases diagnosis (p < .001). This instrument is ready to be applied and easily reproduced, contributing to the assessment of KPB toward salt and sodium in Brazil.
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Affiliation(s)
- Alícia Tavares da Silva Gomes
- Programa de Pós‐Graduação em Nutrição em Saúde PúblicaSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
| | - Kamila Tiemann Gabe
- Programa de Pós‐Graduação em Nutrição em Saúde PúblicaSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
| | - Patricia Constante Jaime
- Center for Epidemiological Research in Nutrition and Health (NUPENS)School of Public HealthUniversity of São PauloSão PauloSPBrazil
- Nutrition DepartmentSchool of Public HealthUniversity of São PauloSão PauloSPBrazil
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17
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Chávarro Bermeo FE, Arteaga Diaz JM, Roth Deubel AN. Política mundial de yodación de sal: desafíos. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n6.98302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo Identificar los desafíos que conlleva la implementación de la política mundial de yodación de sal para el consumo humano.
Métodos Se realizó una revisión de la literatura publicada entre el año 2000 y 2021 en PubMed, con los términos MeSH yodo, política pública, cloruro de sodio y los términos complementarios yodo/deficiencia, exceso. Se obtuvieron 141 artículos y se revisaron 50 aplicando como criterio de inclusión el abordaje de la implementación de la política de yodación.
Resultados Se identificaron siete desafíos: sostenibilidad de la política, eliminar la brecha entre la explotación y la comercialización de la sal, prevenir la fortificación indiscriminada de los alimentos, promover la educación sobre la ingesta de sal yodada, controlar la ingesta excesiva de yodo, equilibrar la ingesta óptima de yodo con la reducción del consumo de cloruro de sodio y producir suficiente información oficial sobre la política.
Conclusión La yodación universal de la sal es una política que requiere mayor sensibilidad a las situaciones locales de cada país para mitigar efectivamente el problema de salud pública de los desórdenes por deficiencia y exceso en la ingesta de yodo alrededor del mundo.
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18
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Song J, Brown MK, Tan M, MacGregor GA, Webster J, Campbell NRC, Trieu K, Ni Mhurchu C, Cobb LK, He FJ. Impact of color-coded and warning nutrition labelling schemes: A systematic review and network meta-analysis. PLoS Med 2021; 18:e1003765. [PMID: 34610024 PMCID: PMC8491916 DOI: 10.1371/journal.pmed.1003765] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/11/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Suboptimal diets are a leading risk factor for death and disability. Nutrition labelling is a potential method to encourage consumers to improve dietary behaviour. This systematic review and network meta-analysis (NMA) summarises evidence on the impact of colour-coded interpretive labels and warning labels on changing consumers' purchasing behaviour. METHODS AND FINDINGS We conducted a literature review of peer-reviewed articles published between 1 January 1990 and 24 May 2021 in PubMed, Embase via Ovid, Cochrane Central Register of Controlled Trials, and SCOPUS. Randomised controlled trials (RCTs) and quasi-experimental studies were included for the primary outcomes (measures of changes in consumers' purchasing and consuming behaviour). A frequentist NMA method was applied to pool the results. A total of 156 studies (including 101 RCTs and 55 non-RCTs) nested in 138 articles were incorporated into the systematic review, of which 134 studies in 120 articles were eligible for meta-analysis. We found that the traffic light labelling system (TLS), nutrient warning (NW), and health warning (HW) were associated with an increased probability of selecting more healthful products (odds ratios [ORs] and 95% confidence intervals [CIs]: TLS, 1.5 [1.2, 1.87]; NW, 3.61 [2.82, 4.63]; HW, 1.65 [1.32, 2.06]). Nutri-Score (NS) and warning labels appeared effective in reducing consumers' probability of selecting less healthful products (NS, 0.66 [0.53, 0.82]; NW,0.65 [0.54, 0.77]; HW,0.64 [0.53, 0.76]). NS and NW were associated with an increased overall healthfulness (healthfulness ratings of products purchased using models such as FSAm-NPS/HCSP) by 7.9% and 26%, respectively. TLS, NS, and NW were associated with a reduced energy (total energy: TLS, -6.5%; NS, -6%; NW, -12.9%; energy per 100 g/ml: TLS, -3%; NS, -3.5%; NW, -3.8%), sodium (total sodium/salt: TLS, -6.4%; sodium/salt per 100 g/ml: NS: -7.8%), fat (total fat: NS, -15.7%; fat per 100 g/ml: TLS: -2.6%; NS: -3.2%), and total saturated fat (TLS, -12.9%; NS: -17.1%; NW: -16.3%) content of purchases. The impact of TLS, NS, and NW on purchasing behaviour could be explained by improved understanding of the nutrition information, which further elicits negative perception towards unhealthful products or positive attitudes towards healthful foods. Comparisons across label types suggested that colour-coded labels performed better in nudging consumers towards the purchase of more healthful products (NS versus NW: 1.51 [1.08, 2.11]), while warning labels have the advantage in discouraging unhealthful purchasing behaviour (NW versus TLS: 0.81 [0.67, 0.98]; HW versus TLS: 0.8 [0.63, 1]). Study limitations included high heterogeneity and inconsistency in the comparisons across different label types, limited number of real-world studies (95% were laboratory studies), and lack of long-term impact assessments. CONCLUSIONS Our systematic review provided comprehensive evidence for the impact of colour-coded labels and warnings in nudging consumers' purchasing behaviour towards more healthful products and the underlying psychological mechanism of behavioural change. Each type of label had different attributes, which should be taken into consideration when making front-of-package nutrition labelling (FOPL) policies according to local contexts. Our study supported mandatory front-of-pack labelling policies in directing consumers' choice and encouraging the food industry to reformulate their products. PROTOCOL REGISTRY PROSPERO (CRD42020161877).
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Affiliation(s)
- Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mhairi K. Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Monique Tan
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Graham A. MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Norm R. C. Campbell
- Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Alberta, Canada
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, University of New South Wales, Newtown, Australia
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Laura K. Cobb
- Resolve to Save Lives, Vital Strategies, New York City, New York, United States of America
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom
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19
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Current Knowledge and Behavior towards Salt Reduction among Hong Kong Citizens: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189572. [PMID: 34574497 PMCID: PMC8472437 DOI: 10.3390/ijerph18189572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/22/2022]
Abstract
Excessive dietary salt intake is prevalent in the Hong Kong community. Over the last decade, the Hong Kong Special Administrative Region Government has been actively promoting community participation to reduce salt intake. The aim of this study was to investigate the current knowledge levels and behaviors relating to dietary salt intake among Hong Kong adults. This cross-sectional survey involved 426 adults in Hong Kong. The findings of this study identified areas of knowledge deficit in the recommended upper limit of daily salt intake for an adult set by World Health Organization (n = 295, 69.2%) indicated a lack of awareness that the overconsumption of salt could cause coronary heart disease (n = 233, 54.7%). Disengagement with salt reduction behavior, such as rarely/never checking the sodium or salt content listed on the food label (n = 252, 59.2%) and rarely/never purchasing food labelled with low salt or no salt content (n = 292, 68.9%), was reported. Excessive salt intake in dietary habits remains an under-recognized non-communicable disease threat by Hong Kong citizens, indicating ineffective responsive risk communication. There is a need to refine existing salt reduction initiatives to aid in making appropriate decisions regarding dietary salt intake among Hong Kong citizens.
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20
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D'Addario L, Kuo T, Robles B. Do knowledge about sodium, health status by self-report, and having hypertension predict sodium consumption behaviors among Southern California hospital employees? Transl Behav Med 2021; 11:1254-1263. [PMID: 33755177 DOI: 10.1093/tbm/ibaa148] [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: 11/13/2022] Open
Abstract
Little is known about factors that shape sodium consumption behaviors among hospital employees targeted by recent federally funded, sodium-related policy, systems, and environmental change interventions. To address this gap in health promotion practice, we assessed the influence of sodium-related knowledge and attitudes, and health status by self-report on the sodium consumption behaviors of hospital employees targeted by the Los Angeles County Sodium Reduction Initiative. Cross-sectional surveys were administered to 1,213 hospital employees at four Southern California hospitals between 2016 and 2018. Logistic regression models examined the associations between five key sodium consumption behaviors and independent variables of interest (i.e., knowledge and attitudes about sodium, self-reported general health status, and self-reported lifetime hypertension diagnosis), controlling for covariates (i.e., sociodemographic characteristics, body mass index, the type of hospital from which participants were recruited, and the median household income in the hospital's zip code). 1,213 hospital employees completed the survey (completion rate = 50%). The belief that salt intake is harmful was associated with four of five sodium consumption behaviors, while adequate sodium intake knowledge and self-reported "good health" were associated with three of the behaviors. Hypertension diagnosis was associated with only one. Understanding sodium consumption behaviors among healthcare workers can help hospitals improve their employees' health through the promotion of healthier food environments in the workplace and changes in institutional practices.
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Affiliation(s)
- Lia D'Addario
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, USA.,Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
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21
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Kim TK, Yong HI, Jung S, Kim HW, Choi YS. Effect of reducing sodium chloride based on the sensory properties of meat products and the improvement strategies employed: a review. JOURNAL OF ANIMAL SCIENCE AND TECHNOLOGY 2021; 63:725-739. [PMID: 34447950 PMCID: PMC8367399 DOI: 10.5187/jast.2021.e74] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 01/12/2023]
Abstract
Many consumers are concerned about the high levels of salt intake owing to the accompanied risk of chronic diseases. Due to this dietary concern, the food industry has recommended the reduction of salt content in many products. However, the addition of salt to meat products improves their quality and sensory properties, including saltiness, color, juiciness, and texture. Because quality deteriorations could induce decreased sensory scores owing to salt reductions, the challenges involved in improving the quality of reduced-salt meat products have been addressed. During the development of low-salt meat products, it is important to reduce sodium content and address the problems that arise with this reduction. Modified salt, organic acids, amino acids, nucleotides, hydrocolloids, high-pressure, ultrasound, electric pulsed field, and irradiation have been suggested as strategies to replace or reduce sodium content, and sensory scores could be improved by these strategies. Therefore, when developing a low-salt meat product, several perspectives must be considered and the latest technologies that could resolve this problem should be adopted.
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Affiliation(s)
- Tae-Kyung Kim
- Research Group of Food Processing, Korea
Food Research Institute, Wanju 55365, Korea
| | - Hae In Yong
- Research Group of Food Processing, Korea
Food Research Institute, Wanju 55365, Korea
| | - Samooel Jung
- Division of Animal and Dairy Science,
Chungnam National University, Daejeon 34134, Korea
| | - Hyun-Wook Kim
- Department of Animal Science &
Biotechnology, Gyeongnam National University of Science and
Technology, Jinju 52725, Korea
| | - Yun-Sang Choi
- Research Group of Food Processing, Korea
Food Research Institute, Wanju 55365, Korea
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22
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Yang Y, Wang J, Ma J, Shi W, Wu J. Comparison of Salt-Related Knowledge and Behaviors Status of WeChat Users between 2019 and 2020. Nutrients 2021; 13:2141. [PMID: 34206633 PMCID: PMC8308297 DOI: 10.3390/nu13072141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022] Open
Abstract
In order to identify the status of salt-related knowledge and behavior of the residents who were active in WeChat software between 2019 and 2020, 10-day salt-related surveys were conducted in 2019 and 2020 based on the WeChat public platform of China Healthy Lifestyle for All Campaign. Distribution and scores of salt-related knowledge, salt reduction behavior and high-salt intake behavior between 2019 and 2020 were compared. Data of 2109 participants in 2019 and 12,732 participants in 2020 were left for analysis. Overall, 88.2% of participants in 2019 had a willingness to reduce the amount of cooking salt in their households, significantly lower than 90.2% in 2020 (p-value < 0.05). In 2019 and 2020, over 80% of the participants knew fine dried noodles contain salt, but less than 30% knew ice cream contains salt. Over 78% of participants chose 5 g or 6 g for the maximum daily salt intake of healthy adults, and about 98% of participants knew that excessive salt intake would increase the risk of hypertension in both years. The percentage of participants who used salt measuring spoons asked restaurants to use less salt, read the sodium content on the nutrition facts table, chose foods with low sodium content and regularly used low-sodium salt, were 36.1%, 45.0%, 44.1%, 40.3% and 35.8% in 2019, and the percentage increased significantly to 46.4%, 49.2%, 50.8%, 47.1% and 43.4% in 2020 (all p-value < 0.05). The percentage of people regularly eating pickled mustard tubers, salted vegetables and sauce foods or using high-salt condiments also increased from 2019 to 2020. The median of salt-related knowledge scores, salt reduction behavior scores and high-salt intake behavior scores were 11, 2, 5 points in 2019, and 10, 3, 5 points in 2020, respectively. Compared to 2019, the salt-related knowledge score was relatively lower, while the salt reduction behavior score and high-salt intake behavior score were relatively higher in 2020. Besides, the score of salt-related knowledge and behaviors differed in different gender, age and hypertension groups. The COVID-19 epidemic may have influenced the salt-related knowledge and behaviors status of WeChat users in China. Promotion and education of salt-related knowledge and online behavior intervention are still needed, particularly for male and hypertension patients in the future.
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Affiliation(s)
- Yibing Yang
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jinglei Wang
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, Jinan 250014, China;
| | - Wenhui Shi
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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23
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Marakis G, Katsioulis A, Kontopoulou L, Ehlers A, Heimberg K, Hirsch-Ernst KI, Langerholc T, Adamska H, Matyjaszczyk E, Silva KDR, Madumali KAC, Yeh TS, Chiou LJ, Lin MJ, Karpetas G, Weissenborn A. Knowledge, attitude and behaviour of university students regarding salt and iodine: a multicentre cross-sectional study in six countries in Europe and Asia. ACTA ACUST UNITED AC 2021; 79:68. [PMID: 33947465 PMCID: PMC8097851 DOI: 10.1186/s13690-021-00593-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Abstract
Background Strategies to reduce salt intake are encouraged to be implemented in parallel with those that aim to ensure iodine adequacy at the population level. The aim of the present study was to assess and compare knowledge, attitudes and behaviours related to salt and iodine among students in Europe and Asia. Methods A multicentre cross-sectional study was conducted with 2459 university students in total (42.7% males, median age 21 years) from four countries in Europe and two countries in Asia. Data were collected with the use of a self-administered questionnaire, and univariate and multivariate statistical analyses were performed to explore any association between variables. Results Only 6.5% of all participants knew the correct salt recommendations. Nearly a quarter of them (24.4%) found salt recommendations confusing and/or contradictory. There were significant differences between European and Asian participants, with those from Europe being better informed about salt recommendations, but significantly less knowledgeable about iodine. The reported frequency of use of salt and salt-containing sauces either at the table or for cooking, as well as knowledge about ways to reduce salt intake among those who indicated to make conscious efforts to do so, differed significantly between countries. Significant differences between countries were also observed with respect to the type of salt used, with about one third of all participants (34%) not being aware of the kind of salt they used. Conclusion The results of this survey highlight serious salt- and iodine-related knowledge gaps among university students in Europe and Asia. Raising awareness and conducting information campaigns is needed to promote changes in behaviour that would result in a reduction of salt intake and conscious use of iodised salt at the individual level. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00593-5.
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Affiliation(s)
- Georgios Marakis
- Nutrition and Food Standards Unit, Directorate of Risk Assessment and Nutrition, Hellenic Food Authority, Athens, Greece
| | | | | | - Anke Ehlers
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Katharina Heimberg
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | | | - Tomaž Langerholc
- Department of Microbiology, Biochemistry, Molecular Biology and Biotechnology, University of Maribor, Maribor, Slovenia
| | - Hanna Adamska
- Institute of Economic Sciences, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Ewa Matyjaszczyk
- Institute of Plant Protection-National Research Institute, Poznan, Poland
| | - K D Renuka Silva
- Department of Applied Nutrition, Wayamba University of Sri Lanka, Gonawila, Kuliyapitiya, Sri Lanka
| | - K A Chathurika Madumali
- Department of Applied Nutrition, Wayamba University of Sri Lanka, Gonawila, Kuliyapitiya, Sri Lanka
| | - Tai-Sheng Yeh
- Department of Food Science and Nutrition, Meiho University, Neipu, Pingtung, Taiwan
| | - Ling-Jan Chiou
- Department of Health Business Administration, Meiho University, Neipu, Pingtung, Taiwan
| | - Mei-Jen Lin
- Department of Animal Science, National Pingtung University of Science and Technology, Neipu, Pingtung, Taiwan
| | | | - Anke Weissenborn
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany.
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Technologies for the Production of Meat Products with a Low Sodium Chloride Content and Improved Quality Characteristics-A Review. Foods 2021; 10:foods10050957. [PMID: 33924794 PMCID: PMC8145339 DOI: 10.3390/foods10050957] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/17/2022] Open
Abstract
In recent years, consumer concerns regarding high levels of sodium chloride (NaCl) intake have increased, given the associated risk of cardiovascular disease. This has led food industries to consider lowering the use of sodium in food products. However, it is well known that the addition of NaCl to meat products enhances their quality, including water-holding capacity, emulsification capacity, juiciness, and texture. Thus, it is difficult to completely remove salt from meat products; however, it is possible to reduce the salt content using salt substitutes, flavor enhancers, textural enhancers, or other processing technologies. Several recent studies have also suggested that processing technologies, including hot-boning, high pressure, radiation, and pulsed electric fields, can be used to manufacture meat products with reduced salt content. In conclusion, as the complete removal of NaCl from food products is not possible, combined technologies can be used to reduce the NaCl content of meat products, and the appropriate technology should be chosen and studied according to its effects on the quality of the specific meat product.
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Klassen AC, Sood S, Summers A, Perera U, Shuster M, Lopez JP, McCord A, Stokes J, White J, Wagner A. From Salt to Stroke-Evaluation of a Media Campaign for Sodium Reduction in Philadelphia. Front Public Health 2021; 8:619261. [PMID: 33520923 PMCID: PMC7844326 DOI: 10.3389/fpubh.2020.619261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
Excess dietary sodium contributes to the burden of chronic disease, including cardiovascular disease and stroke. Media-based health education campaigns are one strategy to raise awareness among populations at greater risk for stroke, including African Americans. During 2014–2015, the Philadelphia Department of Public Health conducted a health education campaign using radio, print news, and transit ads, to promote awareness of the link between dietary sodium, hypertension and stroke, and encourage reduced consumption of high sodium foods. Using a repeated cross-sectional design, street intercept surveys were conducted with ~400 Philadelphia residents representing the campaign's priority audience (African Americans ages 35–55) before and 6–13 weeks after the campaign, to evaluate both process (campaign exposure) and impact (recall of key health messages). Thirty percent of post-campaign respondents reported familiarity with one of the most engaging radio spots, and 17% provided accurate unaided recall of its key content, with greater recall among older respondents and frequent radio listeners. Forty-one percent of post-campaign respondents named stroke as a consequence of excess salt consumption, compared to only 17% of pre-campaign respondents, with greater awareness of the salt-stroke connection among those accurately recalling the radio spot from the campaign. Results suggest that priority populations for sodium reduction can be effectively reached through radio and transit campaigns. From a pragmatic perspective, street intercept surveys may offer one low resource strategy for evaluating public health education campaigns conducted by local health departments, especially among urban populations.
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Affiliation(s)
- Ann C Klassen
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Suruchi Sood
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Amber Summers
- Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Udara Perera
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Michelle Shuster
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Jessica P Lopez
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Andrea McCord
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Jared Stokes
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Joann White
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States
| | - Amanda Wagner
- Philadelphia Department of Public Health, Philadelphia, PA, United States
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Abstract
OBJECTIVE To evaluate associations between selected dietary concerns and eating practices and determine the association of these concerns/practices with demographic and socio-economic characteristics in a population from a large Brazilian city. DESIGN Population-based cross-sectional study. We investigated concerns regarding salt intake, the use of highly processed seasoning and the custom of reading the Na content on food labels. We also analysed concerns regarding the use of pesticides on food products and the practice of consuming organic foods. These variables were analysed according to sex, age group, schooling and income. Multivariate Poisson regression analysis was performed for the estimation of prevalence ratios. SETTING Campinas, state of São Paulo, Brazil. PARTICIPANTS The representative sample consisted of 1710 adults and seniors. RESULTS A total 62·3 % of the population were concerned with salt intake, 34·7 % did not use highly processed seasoning and 10·6 % checked the Na content on food labels; 27·5 % were concerned with pesticides and 26·5 % consumed organic foods. The practices analysed were associated with the respective concerns. Women and seniors had a better profile, except for reading Na content in both groups and the consumption of organic foods among seniors. The frequency of checking the Na content and consuming organic foods increased with the level of schooling. The higher income group had a better profile, except for concern with salt intake. CONCLUSIONS Considerable social differences were found regarding the dietary practices, and the practices were associated with concerns. The present findings underscore the need for different dietary counseling strategies targeting specific groups.
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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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Bryła P. Selected Predictors of the Importance Attached to Salt Content Information on the Food Packaging (a Study among Polish Consumers). Nutrients 2020; 12:nu12020293. [PMID: 31978975 PMCID: PMC7070683 DOI: 10.3390/nu12020293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/11/2020] [Accepted: 01/19/2020] [Indexed: 01/31/2023] Open
Abstract
This paper aims to identify selected antecedents of the importance attached to salt content information (ISCI) placed on food labels, on the basis of a representative survey of 1051 Polish consumers. The study was conducted with the use of the CAWI (Computer Assisted Web Interviews) method in 2018. Quota sampling was applied with reference to the following five criteria: sex, age, education, place of living (urban and rural areas), and region. In a multiple regression model, ISCI depends on the respondent’s: sex, age, evaluation of the quantity of nutrition claims, importance attached to nutrition claims, willingness to pay a price premium for products with nutrition claims, attention paid to health and nutrition claims, agreeing with the opinion that unreliable nutrition claims are a serious problem, evaluation of healthiness of one’s diet, self-rated knowledge about healthy nutrition, buying organic food, and reading front-of-package (FOP) labels during and after the purchase. The strongest effects on the importance attached to salt content information on the food packaging were displayed by the importance of nutrition claims, attention paid to nutrition and health claims, respondent’s age, FOP label reading at home, and agreeing that the use of unreliable nutrition claims is a serious problem.
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Affiliation(s)
- Paweł Bryła
- Department of International Marketing and Retailing, Faculty of International and Political Studies, University of Lodz, Narutowicza 59a, 90-131 Lodz, Poland
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Perez-Cueto FJA. An Umbrella Review of Systematic Reviews on Food Choice and Nutrition Published between 2017 and-2019. Nutrients 2019; 11:E2398. [PMID: 31591373 PMCID: PMC6836087 DOI: 10.3390/nu11102398] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 12/28/2022] Open
Abstract
The objective of this umbrella review was to provide an update on the latest knowledge in the field of food choice and nutrition. Databases Scopus and ISI-Web of Science were searched for "food choice" AND nutrition. Papers were included if they were systematic reviews published between January 2017 and August 2019 on any subpopulation group. In total, 26 systematic reviews were kept. Data were extracted with a predetermined grid including first author, publication year, country, population group, explanatory constructs (intervention focus) and reported outcomes. Common indicators for outcome measures on food choice and nutrition studies are nutrition knowledge, healthy food choices, food purchases and food and nutrient intake. The most common strategy implemented to alter food choice with a nutritional aim is nutrition education, followed by provision of information through labels. Among children, parent modelling is key to achieving healthy food choices. In general, combining strategies seems to be the most effective way to achieve healthier food consumption and to maintain good nutrition in all age groups.
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Affiliation(s)
- Federico J A Perez-Cueto
- University of Copenhagen, Department of Food Science, Section for Food Design and Consumer Behaviour, Rolighedsvej 26, 1958 Frederiksberg, Denmark.
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