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Jiang K, He T, Ji Y, Zhu T, Jiang E. The perspective of hypertension and salt intake in Chinese population. Front Public Health 2023; 11:1125608. [PMID: 36875386 PMCID: PMC9981806 DOI: 10.3389/fpubh.2023.1125608] [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: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Salt intake is too high nowadays. It has been widely recognized that there is a close relationship between hypertension (HTN) and dietary salt intake. Investigations reveal that long-term high salt intake, mainly sodium intake, induces a relevant increase in blood pressure in hypertensive and normotensive individuals. According to most scientific evidence, a diet with high salt intake in public increases cardiovascular risk, salted-related HTN, and other HTN-associated outcomes. Given the clinical importance, this review aims to present the prevalence of HTN and trends in salt intake in the Chinese population and will comprehensively discuss the risk factors, causes, and mechanisms of the association between salt intake and HTN. The review also highlights the education of Chinese people regarding salt intake and the cost-effectiveness of salt reduction from a global perspective. Finally, the review will emphasize the need to customize the unique Chinese practices to reduce salt intake and how awareness changes people's eating lifestyle and helps adopt diet salt reduction strategies.
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Affiliation(s)
- Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tingting He
- Department of Basic Nursing, Henan Technical Institute, Zhengzhou, China
| | - Yongzhi Ji
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China.,Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
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Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. The health system barriers to a healthy diet in Iran. PLoS One 2023; 18:e0278280. [PMID: 36701325 PMCID: PMC9879474 DOI: 10.1371/journal.pone.0278280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. METHODS This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. RESULTS We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. CONCLUSION In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.
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Affiliation(s)
- Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin university of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Heath Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- * E-mail:
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Ngqangashe Y, Friel S. Regulatory governance pathways to improve the efficacy of Australian food policies. Aust N Z J Public Health 2022; 46:710-715. [PMID: 36047854 DOI: 10.1111/1753-6405.13284] [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: 01/01/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Effective regulatory governance, which entails the actors, processes and contexts within which policies are developed, designed and implemented, is crucial for food policies to improve food environments, consumer behaviour and diet-related health. OBJECTIVE To critically assess Australian food policies for the presence of necessary and sufficient regulatory governance conditions that have been shown to effect positive nutrition outcomes from food policies. METHODS We assessed the Australian National Association of Advertisers (AANA) Food and Beverage Advertising Code, Health Star Rating Front of Pack labelling system and Sodium reformulation under the Healthy Food Partnership (HFP). The policies were analysed for the presence/absence of five regulatory governance conditions - the extent of industry involvement, regulatory design, instrument design, monitoring and enforcement. RESULTS All three policies lack one or more regulatory governance conditions crucial for policy success. Each policy has high industry involvement, an absence of government-led policy-making underpinned by legislation and lacks comprehensive enforcement. Except for the Health Star Rating system, the policies did not have comprehensive monitoring - a necessary condition for policy success. PUBLIC HEALTH IMPLICATIONS The efficacy of these three policies can be enhanced by minimising industry involvement, improving government oversight and improving monitoring systems.
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Affiliation(s)
- Yandisa Ngqangashe
- Menzies Centre for Health Governance, School of Regulation and Global governance, Australian National University, Australian Capital Territory
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global governance, Australian National University, Australian Capital Territory
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Ngqangashe Y, Friel S, Schram A. The regulatory governance conditions that lead to food policies achieving improvements in population nutrition outcomes: a qualitative comparative analysis. Public Health Nutr 2021; 25:1-11. [PMID: 34874000 PMCID: PMC9991667 DOI: 10.1017/s1368980021004730] [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] [Received: 04/16/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify the regulatory governance factors that lead to food policies achieving improvements in food environment, consumer behaviour and diet-related health outcomes. DESIGN Qualitative comparative analysis (QCA) was used to investigate the relationship between regulatory governance conditions and population nutrition outcomes. The regulatory governance conditions examined entailed: high industry involvement in the policy process, regulatory design, policy instrument design, policy monitoring and enforcement. PARTICIPANTS n 29 policy cases in the policy areas of food reformulation, nutrition labelling, food taxation and food marketing. SETTING Policies implemented in thirteen countries. RESULTS Comprehensive monitoring was identified as a necessary regulatory governance condition for food policies to have an impact and was present in 94 % of policy cases that had a positive impact on nutrition outcomes. We identified two sufficient combinations of regulatory governance conditions. The first sufficient combination of conditions comprised an absence of high industry involvement in the policy process, combined with the presence of strict regulatory design, best-practice instrument design, and comprehensive monitoring and enforcement. Ninety-six percent of policy cases with positive impacts on nutrition outcomes displayed this combination. The second sufficient combination of conditions comprised an absensce of high industry involvement in the policy process, best practice instrument design and comprehensive monitoring. Eighty-two percent of policy cases with positive impacts on nutrition outcomes displayed this combination. CONCLUSION These findings show the importance of regulatory governance on policy outcomes. They suggest a need for more government-led nutrition policy processes and transparent monitoring systems that are independent from industry.
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Affiliation(s)
- Yandisa Ngqangashe
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Coombs Extension Building 8, Fellows Road, Australian National University, Acton, 2601Canberra, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Coombs Extension Building 8, Fellows Road, Australian National University, Acton, 2601Canberra, Australia
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Coombs Extension Building 8, Fellows Road, Australian National University, Acton, 2601Canberra, Australia
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Song Y, Li Y, Guo C, Wang Y, Huang L, Tan M, He FJ, Harris T, MacGregor GA, Ding J, Dong L, Liu Y, Wang H, Zhang P, Ma Y. Cross-sectional comparisons of sodium content in processed meat and fish products among five countries: potential for feasible targets and reformulation. BMJ Open 2021; 11:e046412. [PMID: 34649844 PMCID: PMC8559105 DOI: 10.1136/bmjopen-2020-046412] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Reducing sodium intake has been identified as a highly cost-effective strategy to prevent and control high blood pressure and reduce cardiovascular mortality. This study aims to compare the sodium content in processed meat and fish products among five countries, which will contribute to the evidence-base for feasible strategies of sodium reduction in such products. METHODS Sodium content on product labels of 26 500 prepackaged products, 19 601 meat and 6899 fish, was collected in supermarkets from five countries using the FoodSwitch mobile application from 2012 to 2018. To be specific, it was 1898 products in China, 885 in the UK, 5673 in Australia, 946 in South Africa and 17 098 in the USA. Cross-sectional comparisons of sodium levels and proportions meeting 2017 UK sodium reduction targets were conducted using Kruskal-Wallis H and the χ2 test, respectively across the five countries. RESULTS The results showed that processed meat and fish products combined in China had the highest sodium level (median 1050 mg/100 g, IQR: 774-1473), followed by the USA, South Africa, Australia, with the lowest levels found in UK (432 mg/100 g, IQR: 236-786) (p<0.001). Similar variations, that is, a twofold to threefold difference of sodium content between the highest and the lowest countries were found among processed meat and fish products separately. Large sodium content variations were also found in certain specific food subcategories across the five countries, as well as across different food subcategories within each country. CONCLUSION Processed meat and fish products differ greatly in sodium content across different countries and across different food subcategories. This indicates great potential for food producers to reformulate the products in sodium content, as well as for consumers to select less salted food.
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Affiliation(s)
- Yuzhu Song
- Department of nutrition and food hygiene, Hebei Medical University, Shijiazhuang, China
| | - Yuan Li
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
- Faculty of Medicine, University of New South Wales, Australia, Sydney, New South Wales, Australia
| | - Chunlei Guo
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | | | - Liping Huang
- Food Policy, The George Institute for Global Heath, Sydney, New South Wales, Australia
| | - Monique Tan
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Terry Harris
- Discovery Vitality, Johannesburg, South Africa, South African, South Africa
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jingmin Ding
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | - Le Dong
- Peking University Health Science Centre, The George Institute for Global Health, Beijing, China
| | - Yu Liu
- School of Computing, Beihang University, Beijing, China
| | - Huijun Wang
- Chinese Center for Disease Control and Prevention National Institute for Nutrition and Health, Beijing, China
| | - Puhong Zhang
- Faculty of Medicine, University of New South Wales, Australia, Sydney, New South Wales, Australia
- Diabetes Program, The George Institute at Peking University Health Science Center, Beijing, China
| | - Yuxia Ma
- Department of nutrition and food hygiene, Hebei Medical University, Shijiazhuang, China
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Ngqangashe Y, Goldman S, Schram A, Friel S. A narrative review of regulatory governance factors that shape food and nutrition policies. Nutr Rev 2021; 80:200-214. [PMID: 34015107 DOI: 10.1093/nutrit/nuab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 01/23/2023] Open
Abstract
Food composition, marketing restrictions, nutrition labeling, and taxation policies are recommended for preventing diet-related noncommunicable diseases. In view of the increasing but variable adoption of food policies globally, this narrative review examines the actors, regulatory frameworks, and institutional contexts that shape the development, design, and implementation of these policies. We found a diverse range of actors using various strategies, including advocacy, framing, and evidence generation to influence policy agendas. We identified diverse regulatory designs used in the formulation and implementation of the policies: command and control state regulation for taxes and menu labels, quasi-regulation for sodium reformulation, and co-regulation and industry self-regulation for food marketing policies. Quasi-regulation and industry self-regulation are critiqued for their voluntary nature, lack of independence from the industry, and absence of (or poor) monitoring and enforcement systems. The policy instrument design and implementation best practices highlighted in this review include clear policy goals and rigorous standards that are adequately monitored and enforced. Future research should examine how these combinations of regulatory governance factors influence policy outcomes.
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Affiliation(s)
- Yandisa Ngqangashe
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharni Goldman
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashley Schram
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
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Buse K, Aftab W, Akhter S, Phuong LB, Chemli H, Dahal M, Feroz A, Hofiani S, Pradhan NA, Anwar I, Skhiri HA, El Ati J, Giang KB, Puri M, Noormal B, Rabbani F, Hawkes S. The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach. Health Policy Plan 2020; 35:503-521. [PMID: 32091080 PMCID: PMC7225567 DOI: 10.1093/heapol/czz175] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.
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Affiliation(s)
- Kent Buse
- UNAIDS, Avenue Appia 20, 1211 Genève, Switzerland
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sadika Akhter
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Linh Bui Phuong
- Center for Population Health Sciences, Hanoi University of Public Health, No. 1A, Duc Thang Street, Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - Haroun Chemli
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007, Tunis, Tunisia
| | - Minakshi Dahal
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sayad Hofiani
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Iqbal Anwar
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Hajer Aounallah Skhiri
- Faculty of Medicine of Tunis, University of Tunis El-Manar, Rue de la Faculte de Medecine, Tunis, Tunisia
- National Health Institute, Ministry of Health, 5/7 Rue El Khartoum, Diplomat, Bloc IV, 10ème étage, le Belvédère 1002 Tunis, Tunisia
| | - Jalila El Ati
- National Institute of Nutrition and Food Technology, SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Kim Bao Giang
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung, Dong da District, Hanoi, Vietnam
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Bashir Noormal
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sarah Hawkes
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH5, UK
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Xian J, Zeng M, Zhu R, Cai Z, Shi Z, Abdullah AS, Zhao Y. Design and implementation of an intelligent monitoring system for household added salt consumption in China based on a real-world study: a randomized controlled trial. Trials 2020; 21:349. [PMID: 32317000 PMCID: PMC7171770 DOI: 10.1186/s13063-020-04295-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high intake of salt is a major risk factor for cardiovascular diseases. Despite decades of effort to reduce salt consumption, the salt intake in China is still considerably above the recommended level. Thus, this study aims to design and implement an intelligent household added salt monitoring system (SALTCHECKER) to monitor and control added salt consumption in Chinese households. METHODS A randomized controlled trial will be conducted among households to test the effect of a SALTCHECKER in Chongqing, China. The test modalities are the SALTCHECKER (with a smart salt checker and a salt-limiting WeChat mini programme) compared to a salt checker (with only a weighing function). The effectiveness of the system will be investigated by assessing the daily added salt intake of each household member and the salt consumption-related knowledge, attitude and practice (KAP) of the household's main cook. Assessments will be performed at baseline and at 3 and 6 months. DISCUSSION This study will be the first to explore the effect of the household added salt monitoring system on the reduction in salt intake in households. If the intelligent monitoring system is found to be effective in limiting household added salt consumption, it could provide scientific evidence on reducing salt consumption and preventing salt-related chronic diseases. TRIAL REGISTRATION Chinese clinical trial registry (Primary registry in the World Health Organization registry network): ChiCTR1800018586. Date of registration: September 25, 2018.
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Affiliation(s)
- Jinli Xian
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Mao Zeng
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Rui Zhu
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zhengjie Cai
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China.,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan, 215347, Jiangsu Province, China.,Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,School of Medicine, Department of General Internal Medicine, Boston University Medical Center, Boston, MA, 02118, USA
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Yixueyuan Road, Yuzhong District Chongqing, Chongqing, 400016, CN, China. .,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, 400016, China. .,The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China. .,Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Reeve B, Gostin LO. "Big" Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies Comment on "Addressing NCDs: Challenges From Industry Market Promotion and Interferences". Int J Health Policy Manag 2019; 8:450-454. [PMID: 31441282 PMCID: PMC6706978 DOI: 10.15171/ijhpm.2019.30] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/11/2019] [Indexed: 01/08/2023] Open
Abstract
The food, tobacco and alcohol industries have penetrated markets in low- and middle-income countries (LMICs), with a significant impact on these countries' burden of noncommunicable diseases (NCDs). Tangcharoensathien and colleagues describe the aggressive marketing of unhealthy food, alcohol and tobacco in LMICs, as well as key tactics used by these industries to resist laws and policies designed to reduce behavioural risk factors for NCDs. This commentary expands on the recommendations made by Tangcharoensathien and colleagues for preventing or managing conflicts of interest and reducing undue industry influence on NCD prevention policies and laws, focusing on the needs of LMICs. A growing body of research proposes ways to design voluntary industry initiatives to make them more effective, transparent and accountable, but governments should also consider whether collaboration with health-harming industries is ever appropriate. More fundamentally, mechanisms for identifying, managing and mitigating conflicts of interest and reducing industry influence must be woven into - and supported by - broader governance and regulatory structures at both national and international levels.
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Affiliation(s)
- Belinda Reeve
- The University of Sydney Law School, Sydney, NSW, Australia
| | - Lawrence O. Gostin
- O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
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10
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He L, Liu YJ, Zheng T, Tan ZJ. Effect of high-salt diet on health: Relationship with intestinal microflora. Shijie Huaren Xiaohua Zazhi 2018; 26:143-149. [DOI: 10.11569/wcjd.v26.i3.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Salt is the most basic and commonly used seasoning agent in daily diet. It is an important part of all kinds of food and plays a vital role in food preparation and preservation. People are increasingly in pursuit of a healthy diet to reduce the incidence of dietary-related diseases and to improve their health. Salt intake and related diseases have become the focus of research, and salt intake is considered the main factor for a healthy diet. This paper reviews the progress in research of the effect of high-salt diet on health with regard to intestinal microbiota, metabolic pathogenicity, and epidemiological investigation, and other aspects of salt consumption. Cardiovascular, endocrine, and other chronic diseases have been associated with high salt diet. A better understanding of the effect of high salt intake on health can improve the prevention and treatment of chronic diseases and provide new ideas for the development of scientific diet programs.
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Affiliation(s)
- Lu He
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - You-Jia Liu
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Tao Zheng
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
| | - Zhou-Jin Tan
- Department of Microbiology, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China
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Food reformulation and nutritional quality of food consumption: an analysis based on households panel data in France. Eur J Clin Nutr 2017; 72:228-235. [PMID: 29269888 PMCID: PMC5842885 DOI: 10.1038/s41430-017-0044-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/12/2017] [Accepted: 10/08/2017] [Indexed: 12/03/2022]
Abstract
Background/objectives We aimed to quantify the contribution of food reformulation to changes in the nutritional quality of consumers’ food purchases, and compare it with the impact of substitutions made by consumers. Subjects/methods Using a brand-specific data set in France, we considered the changes in the nutrient content of food products in four food sectors over a 3-year period. These data were matched with data on consumers’ purchases to estimate the change in the nutritional quality of consumers’ purchases. This change was divided into three components: the reformulation of food products, the launching of new products and the consumers’ substitutions between products. Key nutrients were selected for each food group: breakfast cereals (sugar, fats, SFA, fiber, and sodium), biscuits and cakes (sugar, fats, SFA, and fiber), potato chips (fats, SFA, and sodium) and soft drinks (sugar). Results Product reformulation initiatives have improved existing products for most food group-nutrient pairs. In particular, the contribution of food reformulation to the change in nutritional quality of food purchases was strong in potato chips (the sales-weighted mean SFA and sodium contents decreased by 31.4% to 52.1% and 6.7% to 11.1%, respectively), and breakfast cereals (the sales-weighted mean sodium content decreased by 7.3% to 9.7%). Regarding the launching of new products, the results were ambiguous. Consumers’ substitutions between food items were not generally associated to an improvement in the nutritional quality of the food purchases. Conclusions Policies aiming to promote food reformulation may have greater impact than those promoting changes in consumer behavior.
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Monitoring the changes to the nutrient composition of fast foods following the introduction of menu labelling in New South Wales, Australia: an observational study. Public Health Nutr 2017; 21:1194-1199. [DOI: 10.1017/s1368980017003706] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study examined the energy (kilojoule) content of Australian fast-food menu items over seven years, before and after introduction of menu board labelling, to determine the impact of the introduction of the legislation.DesignAnalysis of the median energy contents per serving and per 100g of fast-food menu items. Change in energy content of menu items across the years surveyed and differences in energy content of standard and limited-time only menu items were analysed.SettingFive of Australia’s largest fast food chains: Hungry Jack’s, KFC, McDonald’s, Oporto and Red Rooster.SubjectsAll standard and limited-time only menu items available at each fast-food chain, collected annually for seven years, 2009–2015.ResultsAlthough some fast-food chains/menu item categories had significant increases in the energy contents of their menus at some time points during the 7-year period, overall there were no significant or systematic decreases in energy following the introduction of menu labelling (P=0·19 by +17 kJ/100 g, P=0·83 by +8 kJ/serving). Limited-time only items were significantly higher in median energy content per 100 g than standard menu items (+74 kJ/100 g, P=0·002).ConclusionsWhile reformulation across the entire Australian fast-food supply has the potential to positively influence population nutrient intake, the introduction of menu labelling legislation in New South Wales, Australia did not lead to reduced energy contents across the five fast-food chains. To encourage widespread reformulation by the fast-food industry and enhance the impact of labelling legislation, the government should work with industry to set targets for reformulation of nutrient content.
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Applying a Consumer Behavior Lens to Salt Reduction Initiatives. Nutrients 2017; 9:nu9080901. [PMID: 28820449 PMCID: PMC5579694 DOI: 10.3390/nu9080901] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023] Open
Abstract
Reformulation of food products to reduce salt content has been a central strategy for achieving population level salt reduction. In this paper, we reflect on current reformulation strategies and consider how consumer behavior determines the ultimate success of these strategies. We consider the merits of adopting a ‘health by stealth’, silent approach to reformulation compared to implementing a communications strategy which draws on labeling initiatives in tandem with reformulation efforts. We end this paper by calling for a multi-actor approach which utilizes co-design, participatory tools to facilitate the involvement of all stakeholders, including, and especially, consumers, in making decisions around how best to achieve population-level salt reduction.
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Abstract
The nutritional reformulation of processed food and beverage products has been promoted as an important means of addressing the nutritional imbalances in contemporary dietary patterns. The focus of most reformulation policies is the reduction in quantities of nutrients-to-limit - Na, free sugars, SFA, trans-fatty acids and total energy. The present commentary examines the limitations of what we refer to as 'nutrients-to-limit reformulation' policies and practices, particularly when applied to ultra-processed foods and drink products. Beyond these nutrients-to-limit, there are a range of other potentially harmful processed and industrially produced ingredients used in the production of ultra-processed products that are not usually removed during reformulation. The sources of nutrients-to-limit in these products may be replaced with other highly processed ingredients and additives, rather than with whole or minimally processed foods. Reformulation policies may also legitimise current levels of consumption of ultra-processed products in high-income countries and increased levels of consumption in emerging markets in the global South.
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Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health 2017; 13:34. [PMID: 28619031 PMCID: PMC5472958 DOI: 10.1186/s12992-017-0255-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable diseases (NCDs) represent a significant threat to human health and well-being, and carry significant implications for economic development and health care and other costs for governments and business, families and individuals. Risks for many of the major NCDs are associated with the production, marketing and consumption of commercially produced food and drink, particularly those containing sugar, salt and transfats (in ultra-processed products), alcohol and tobacco. The problems inherent in primary prevention of NCDs have received relatively little attention from international organizations, national governments and civil society, especially when compared to the attention paid to secondary and tertiary prevention regimes (i.e. those focused on provision of medical treatment and long-term clinical management). This may in part reflect that until recently the NCDs have not been deemed a priority on the overall global health agenda. Low political priority may also be due in part to the complexity inherent in implementing feasible and acceptable interventions, such as increased taxation or regulation of access, particularly given the need to coordinate action beyond the health sector. More fundamentally, governing determinants of risk frequently brings public health into conflict with the interests of profit-driven food, beverage, alcohol and tobacco industries. Materials We use a conceptual framework to review three models of governance of NCD risk: self-regulation by industry; hybrid models of public-private engagement; and public sector regulation. We analyse the challenges inherent in each model, and review what is known (or not) about their impact on NCD outcomes. Conclusion While piecemeal efforts have been established, we argue that mechanisms to control the commercial determinants of NCDs are inadequate and efforts at remedial action too limited. Our paper sets out an agenda to strengthen each of the three governance models. We identify reforms that will be needed to the global health architecture to govern NCD risks, including to strengthen its ability to consolidate the collective power of diverse stakeholders, its authority to develop and enforce clear measures to address risks, as well as establish monitoring and rights-based accountability systems across all actors to drive measurable, equitable and sustainable progress in reducing the global burden of NCDs.
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Affiliation(s)
| | | | - Sarah Hawkes
- Institute for Global Health, University College London, London, UK.
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Nowson C, Lim K, Grimes C, O'Halloran S, Land MA, Webster J, Shaw J, Chalmers J, Smith W, Flood V, Woodward M, Neal B. Dietary Salt Intake and Discretionary Salt Use in Two General Population Samples in Australia: 2011 and 2014. Nutrients 2015; 7:10501-12. [PMID: 26694459 PMCID: PMC4690097 DOI: 10.3390/nu7125545] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/14/2015] [Accepted: 11/30/2015] [Indexed: 02/07/2023] Open
Abstract
The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.
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Affiliation(s)
- Caryl Nowson
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Karen Lim
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Carley Grimes
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Siobhan O'Halloran
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Mary Anne Land
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Jacqui Webster
- WHO Collaborating Centre on Population Salt Reduction, George Institute for Global Health, University of Sydney, Sydney 2050, Australia.
| | - Jonathan Shaw
- Clinical Diabetes and Epidemiology, Baker IDI Heart & Diabetes Institute, Melbourne 3004, Australia.
| | - John Chalmers
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Wayne Smith
- Environmental Health Branch, New South Wales Health, Sydney 2059, Australia.
| | - Victoria Flood
- Faculty of Health Sciences, University of Sydney, Sydney 2141, Australia.
- St Vincent's Health Network, Sydney, 2010, Australia.
| | - Mark Woodward
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
- Medical Sciences Division, University of Oxford, Oxford OX1 3BD, UK.
| | - Bruce Neal
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK.
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