A one-quarter reduction in the salt content of bread can be made without detection

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers

OBJECTIVE

To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers.

DESIGN

A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data.

SETTING

Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online.

PARTICIPANTS

Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually.

RESULTS

Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality.

CONCLUSIONS

These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

Experience with 2 years' intervention to progressively reduce salt supply to kitchens in elderly care facilities-challenges and further research: post hoc analysis of the DECIDE-Salt randomized clinical trial

BACKGROUND

Progressive reduction of sodium intake is an attractive approach for addressing excessive salt intake, but evidence for this strategy in real practice is limited. We aimed to determine the feasibility, effectiveness, and safety of a progressive sodium intake reduction intervention in real-world setting.

METHODS

We randomized 48 residential elderly care facilities in China, with 1612 participants aged 55 years and older, to either progressive reduction (PR, 24 facilities) or no reduction (NR, 24 facilities) of the supply of study salt to the kitchens of these facilities for 2 years. The primary efficacy outcome was systolic blood pressure (SBP) at any scheduled follow-up visit. Secondary efficacy outcomes included diastolic blood pressure (DBP) at any scheduled follow-up visit, and major adverse cardiovascular events (comprising non-fatal stroke, non-fatal myocardial infarction, hospitalized non-fatal heart failure, or vascular death) and total mortality. The perception of food saltiness, the addition of out-of-study salt in meals, and 24-h urinary sodium excretion were used as process indicators.

RESULTS

Pre-specified analysis per randomization found no effect of the intervention on the 2-year overall mean systolic and diastolic blood pressure (SBP, DBP) and any other outcomes. However, post hoc analysis showed that the intervention effect on blood pressure varied over multiple follow-up visits (p for interaction < 0.046) and presented favorable differences at the 24-month visit (SBP =  - 3.0 mmHg, 95%CI =  - 5.6, - 0.5; p = 0.020; DBP =  - 2.0 mmHg, 95%CI - 3.4, - 0.63; p = 0.004). The effect on 24-h sodium was non-significant (- 8.4 mmol, 95%CI =  - 21.8 to 4.9, p = 0.216), though fewer participants with NR than with PR reported food tasting bland (odds ratio 0.46; 95%CI 0.29 to 0.73; p = 0.001). Reporting of bland food taste and other process measures indicated that intervention delivery and adherence were not fully achieved as designed.

CONCLUSIONS

The experience of this real-world study demonstrated that achieving acceptability and sustainability of the progressive sodium intake reduction strategy among older adults was challenging, but it has shown potential for effectiveness in these and potentially other residential settings if the lessons of DECIDE-Salt are applied in further studies.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03290716).

Global nutritional challenges of reformulated food: A review

Food reformulation, the process of redesigning processed food products to make them healthier, is considered a crucial step in the fight against noncommunicable diseases. The reasons for reformulating food vary, with a common focus on reducing the levels of harmful substances, such as fats, sugars, and salts. Although this topic is broad, this review aims to shed light on the current challenges faced in the reformulation of food and to explore different approaches that can be taken to overcome these challenges. The review highlights the perception of consumer risk, the reasons for reformulating food, and the challenges involved. The review also emphasizes the importance of fortifying artisanal food processing and modifying microbial fermentation in order to meet the nutrient requirements of people in developing countries. The literature suggests that while the traditional reductionist approach remains relevant and yields quicker results, the food matrix approach, which involves engineering food microstructure, is a more complex process that may take longer to implement in developing economies. The findings of the review indicate that food reformulation policies are more likely to succeed if the private sector collaborates with or responds to the government regulatory process, and further research is conducted to establish newly developed reformulation concepts from different countries. In conclusion, food reformulation holds great promise in reducing the burden of noncommunicable diseases and improving the health of people around the world.

Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial

There is a paucity of high-quality evidence on the effectiveness and safety of salt reduction strategies, particularly for older people, who have the most to benefit but are at higher risk of adverse effects. Here, we conducted a clinical trial in which 48 residential elderly care facilities in China (1,612 participants including 1,230 men and 382 women, 55 years or older) were cluster-randomized using a 2 × 2 factorial design to provision of salt substitute (62.5% NaCl and 25% KCl) versus usual salt and to a progressively restricted versus usual supply of salt or salt substitute for 2 years. Salt substitute compared with usual salt lowered systolic blood pressure (-7.1 mmHg, 95% confidence interval (CI) -10.5 to -3.8), meeting the primary outcome of the trial, whereas restricted supply compared with usual supply of salt or salt substitute had no effect on systolic blood pressure. Salt substitute also lowered diastolic blood pressure (-1.9 mmHg, 95% CI -3.6 to -0.2) and resulted in fewer cardiovascular events (hazard ratio (HR) 0.60, 95% CI 0.38-0.96), but had no effect on total mortality (HR 0.84, 95% CI 0.63-1.13). From a safety standpoint, salt substitute increased mean serum potassium and led to more frequent biochemical hyperkalemia, but was not associated with adverse clinical outcomes. In contrast, salt restriction had no effect on any study outcome. The results of this trial indicate that use of salt substitute, but not efforts to restrict salt supply, may achieve blood pressure lowering and deliver health benefits to residents of elderly care facilities in China. Clinicaltrials.gov registration: NCT03290716.

Consumer perception of salt-reduced bread with the addition of brown seaweed evaluated under blinded and informed conditions

BACKGROUND

Many consumers have a high salt intake and bread is a primary source because of its high rate of consumption. The inclusion of seaweeds has been proposed as an ingredient that could help reduce the salt content of food products. As such, the present study aimed to evaluate whether the amount of salt in bread could be reduced and the change in sensory properties be mitigated by the inclusion of brown seaweed. There were two different sensory trials conducted. In the first trial, participants (n = 102) evaluated bread made with brown seaweed (4% substitution for flour) with reduced amounts of salt (10%, 20%, 30%, 40% and 50%). The second trial asked participants (n = 98) to evaluate the control bread and the 20% salt-reduced bread in blinded and informed conditions. In both sensory trials, the breads samples were assessed using hedonic scales, just-about-right scales, and check-all-that-apply.

RESULTS

The results showed that the 10% and 20% salt-reduced breads were acceptable and associated with being soft, chewy and having no aftertaste. The other breads were associated with a dense, dry and strong aftertaste, along with not being salty enough for the consumers. When the breads were evaluated in informed conditions, the salt reduction label had a negative impact on the consumers' liking.

CONCLUSION

The research emphasizes that salt-reduced labels influence consumers' sensory perception. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Eater-oriented knowledge framework for reducing salt and dietary sodium intake (scoping review)

Salt and dietary sodium are ubiquitously present in daily food practices and, at the same time, reducing salt intake presents an important public health issue. Given such an ambivalent position of salt in human diet, we argue that public health guidelines toward dietary sodium reduction require an eater-oriented knowledge framework. In this article we are making the first steps toward a flexible interdisciplinary database which would include nutritional, socio-economic, cultural, material, and socio-psychological determinants of salt consumption for comprehensive public health campaigns. We employ an explorative scoping review of academic articles and reports, limiting our review to the original data on salt or sodium consumption published in English or French between 2000 and 2022. We describe salt consumption as research object, identifying its representation in different research fields, data sources, methodologies, samples, and links with nutritional recommendations. We synthesize existing approaches via four eater-oriented categories: Socio-demographic and cultural descriptors of salt consumers; Knowledge, attitudes, and beliefs on nutritional norms; Salt practices associated with dietary or medical regimes; Salt materialities: interactions and contexts. In each category, we identify the dominant relational features, i.e., what kind of 'eater-salt' relation is being put forward. We thus build an interdisciplinary documentary base of dietary sodium consumption factors. We discuss the results, suggesting that comprehensive nutritional policies for global salt reduction require interdisciplinary eater-oriented data frameworks.

Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach

Background

Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran.

Methods

We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1: n = 50, round 2: n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking.

Results

Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives.

Conclusion

MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.

Dietary Effects of Introducing Salt-Reduced Bread with and without Dietary Counselling-A Cluster Randomized Controlled Trial

Successful strategies for policy makers and the food industry are required to reduce population salt intake. A 4-month cluster randomized controlled trial was conducted to evaluate whether the provision of salt-reduced bread with or without dietary counselling affected the dietary intake of selected food groups, energy, macronutrients, sodium, and potassium. Eighty-nine families (n = 309) consisting of minimum one parent and one child were assigned to receive bread gradually reduced in salt content alone (Intervention A), combined with dietary counselling (Intervention B), or bread with regular salt content (control). Food intake was recorded for seven consecutive days at baseline and follow-up. Salt intake was reduced in both Intervention A (−1.0 g salt/10 MJ, p = 0.027) and Intervention B (−1.0 g salt/10 MJ, p = 0.026) compared to the control. Consumption of bread and both total and salt-rich bread fillings remained similar between groups, while ‘cheese and cheese products’ were reduced in Intervention A (−38%, p = 0.011). Energy intake and macronutrient distribution were not affected in Intervention A, but Intervention B resulted in a higher energy intake (512 kJ, p = 0.019) and a lower energy % (E%) from saturated fat (−1.0 E%, p = 0.031) compared to the control. In conclusion, provision of salt-reduced bread both with and without dietary counselling successfully reduced dietary salt intake without adversely affecting the dietary nutritional quality.

Insights into the flavor perception and enhancement of sodium-reduced fermented foods: A review

Salt (sodium chloride, NaCl) is a vital ingredient in fermented foods, which affects their safety, texture, and flavor characteristics. Recently, the demand for reduced-sodium fermented foods has increased, as consumers have become more health-conscious. However, reducing sodium content in fermented foods may negatively affect flavor perception, which is a critical quality attribute of fermented foods for both the food industry and consumers. This review summarizes the role of salt in the human body and foods and its role in the flavor perception of fermented foods. Current sodium reduction strategies used in the food industry mainly include the direct stealth reduction of NaCl, substituting NaCl with other chloride salts, and structure modification of NaCl. The odor-induced saltiness enhancement, application of starter cultures, flavor enhancers, and non-thermal processing technology are potential strategies for flavor compensation of sodium-reduced fermented foods. However, reducing sodium in fermented food is challenging due to its specific role in flavor perception (e.g., promoting saltiness and volatile compound release from food matrices, inhibiting bitterness, and changing microflora structure). Therefore, multiple challenges must be addressed in order to improve the flavor of low-sodium fermented foods. Future studies should thus focus on the combination of several strategies to compensate for the deficiencies in flavor resulting from sodium reduction.

Effect of Monosodium Glutamate on Salt and Sugar Content Reduction in Cooked Foods for the Sensory Characteristics and Consumer Acceptability

Three different types of typical Korean foods were studied to investigate the effect of monosodium glutamate (MSG) on the sensory characteristics and hedonic perception of sodium- or sugar-reduced samples. The first consumer test (n = 300) was conducted to evaluate the overall liking (OL) of the samples containing four different levels of salt and sugar contents without added MSG, while the second consumer test (n = 300) was designed to examine the effects of MSG on the samples containing reduced salt and sugar contents with the lowest observed OL in the first consumer test. The results showed that the intensity of the umami taste and saltiness of the samples increased, whereas sourness and bitterness were suppressed with added MSG. The samples with the lowest salt contents were observed to be acceptable to consumers after MSG addition, indicating a 23% reduction in sodium intake. Bitterness was partially masked, while sweetness, umami taste, and saltiness were the main factors affecting the OL after MSG addition. However, no consistent results of added MSG on the sensory attributes of samples with reduced sugar contents were observed, possibly indicating that the effect of umami taste on sweetness depends on the MSG concentration used or the type of food studied. This study could be beneficial to researchers who want to know the optimal level of MSG required to reduce the sodium or sugar contents in cooked food.

Reducing Sodium Content in Cheeses While Increasing Salty Taste and Fat Perception Using Aroma

Excess salt (NaCl) and fat intake are major causes of chronic diseases, but reducing such components without affecting acceptability is a major challenge. Here, we set out to examine whether added aroma in lower salt cheese can enhance saltiness and fat perception. Low-salt cheese samples were grated through a homogenizer, and then aroma solution, sardine aroma (salt-associated), butter aroma (fat-associated) and a mix of sardine and butter aromas were added. The results confirmed that grating changes cheese texture, leading to induced taste perception. In addition, a significant saltiness enhancement was induced by sardine aroma and to a lesser extent by butter aroma, while significant fat perception enhancement was only induced by blended aroma. These findings show that aroma addition can be a strategy to compensate for sodium reduction in commercial cheese. Concerning fat perception, the addition of aroma can be a good strategy to compensate for low-fat in commercial cheeses. However, the mechanisms involved seem complex and need to be elucidated.

Sugar, salt and fat reduction of bakery products

From the health viewpoint, consumers monitor their food uptake in terms of both quality and quantity, due to awareness of the link between food ingredients and health. Accordingly, many people tend to buy healthy food products that are low in or free of sugar, salt and fat. However, in baked products, the sugar, fat and salt are needed to create unique characteristics. The role of sugar, salt and fat in baked products is discussed in this chapter to understand their functions. The understanding is necessary to design proper techniques to reduce the amount of sugar, salt and fat. Ingredients and additives that can substitute for fat, sugar and salt in bakery characteristics are reviewed in terms of their advantages and disadvantages. In addition, alternative processes to reduce the use of fat, sugar and salt are proposed in this chapter.

Mechanism-based strategies to prevent salt sensitivity and salt-induced hypertension

High-salt diets are a major cause of hypertension and cardiovascular (CV) disease. Many governments are interested in using food salt reduction programs to reduce the risk for salt-induced increases in blood pressure and CV events. It is assumed that reducing the salt concentration of processed foods will substantially reduce mean salt intake in the general population. However, contrary to expectations, reducing the sodium density of nearly all foods consumed in England by 21% had little or no effect on salt intake in the general population. This may be due to the fact that in England, as in other countries including the U.S.A., mean salt intake is already close to the lower normal physiologic limit for mean salt intake of free-living populations. Thus, mechanism-based strategies for preventing salt-induced increases in blood pressure that do not solely depend on reducing salt intake merit attention. It is now recognized that the initiation of salt-induced increases in blood pressure often involves a combination of normal increases in sodium balance, blood volume and cardiac output together with abnormal vascular resistance responses to increased salt intake. Therefore, preventing either the normal increases in sodium balance and cardiac output, or the abnormal vascular resistance responses to salt, can prevent salt-induced increases in blood pressure. Suboptimal nutrient intake is a common cause of the hemodynamic disturbances mediating salt-induced hypertension. Accordingly, efforts to identify and correct the nutrient deficiencies that promote salt sensitivity hold promise for decreasing population risk of salt-induced hypertension without requiring reductions in salt intake.

Delayed Finalization of Sodium Targets in the United States May Cost Over 250 000 Lives by 2031

BACKGROUND

The US Food and Drug Administration (FDA) proposed 2- and 10-year voluntary sodium-reduction targets for >150 packaged- and prepared-food categories in 2016 and finalized the short-term targets in 2021.

METHODS

We modeled the health benefits of implementing the newly finalized sodium targets, and the net health losses because of the 4.3-year delay in finalizing the sodium targets in different compliance scenarios in adults aged ≥30, using the National Health and Nutrition Examination Survey (NHANES) 2015 to 2016 cycle. The health impact was estimated by multiplying the projected reduction in population sodium intake by the annual health benefits resulting from every 1000-mg reduction in daily sodium intake.

RESULTS

Under certain assumptions, the FDA's finalization of the short-term targets in Oct 2021 and possible finalization of the long-term targets by April 2024 is projected to save up to 445 979 (95% CI, 17 349-787 352) lives in the coming 10 years. The net number of unnecessary deaths because of FDA's delay is projected to be as high as 264 644 (95% CI, 10 295-467 215) according to our prediction.

CONCLUSIONS

These findings highlight the enormous health costs due to the FDA's delay in finalizing the sodium-reduction targets, and the great potential health benefits of industry compliance with the FDA's finalization of its short- and long-term targets in the coming 10 years.

Compendium of sodium reduction strategies in foods: A scoping review

In response to health concerns generated by increased sodium intake, many new approaches have been studied to reduce the sodium content in processed food. It has been suggested that reducing sodium in the food supply may be the most appropriate solution. The aim of this scoping review was to establish what sodium reduction strategies are effective in maintaining acceptable sensory qualities for various food industry applications. Studies that evaluate and report on the effectiveness of a sodium reduction strategy relevant to food and included outcomes detailing how the strategies were received by human subjects using sensory data are included, as well as book chapters, literature reviews, and patents focusing on sodium reduction strategies. Only those published in English and since 1970 were included. Literature was obtained through Scopus, PubMed, EBSCOhost, and ScienceDirect databases, whereas patents were obtained through US Patent Trademark Office, Google Patents, and PATENTSCOPE databases. Two-hundred and seventy-seven primary studies, 27 literature reviews, 10 book chapters, and 143 patents were selected for inclusion. Data extracted included details such as analytical methods, broad and specific treatment categories, significant outcomes, and limitations among other material. Sodium reduction methods were categorized as either salt removal, salt replacement, flavor modification, functional modification, or physical modification. Although salt removal and salt replacement were the majority of included studies, future research would benefit from combining methods from other categories while investigating the impact on sensory characteristics, technological aspects, and consumer perception of the strategy.

Levels of Salt Reduction in Bread, Acceptability and Purchase Intention by Urban Mozambican Consumers

Excess sodium (Na) consumption is implicated in several health problems, particularly hypertension, and bread is an important dietary source. We aimed to analyze perception of salt, acceptability, and purchase intention of low-salt and unsalted white bread by consumers in Mozambique. Sensory evaluation was performed using a triangular test (N = 42) to perceive if differences in saltiness were detected when comparing low-salt and unsalted with salt-reduced white bread. Nine-point hedonic and five-point purchase intention scales were used to measure acceptability and purchase intention, respectively (N = 120). Difference in saltiness was not detected when fresh white bread with 282 mg Na/100 g vs. 231 mg Na/100 g and 279 mg Na/100 g vs. 123 mg Na/100 g were compared. Difference in saltiness was not detected when comparing unsalted vs. 64 mg Na/100 g, while differences were detected when unsalted vs. 105 mg Na/100 g and unsalted vs. 277 mg Na/100 g were compared. Overall acceptability and purchase intention were not affected by reductions of Na in bread. A reduction of up to more than 50% of Na was not perceived and a small level of Na was not distinguished from unsalted bread. Consumers were shown to accept and be willing to buy both unsalted and salt-reduced bread, suggesting that Na can be reduced from current levels.

Preference and perception of low-sodium burger

BACKGROUND/OBJECTIVES

Various sodium reduction policies have been implemented. However, there are limitations in the aspect of actual field applicability and efficiency. For effective sodium reduction, cooperation with the field is required and consumer preference must be considered. Thus, this study aimed to develop a low-sodium burger considering field applicability and consumer preference.

MATERIALS/METHODS

Focus group interviews and in-depth interviews on the sodium reduction measures were conducted with nine professionals in related fields to discuss practical methods for sodium reduction from September 7 to 21, 2018. By reflecting the interview results, a burger using a low-sodium sauce was developed, and preference analysis for sodium in the burger sauces and finished products was performed. The consumer preference for low-sodium burgers was evaluated on 51 college students on November 12, 2018.

RESULTS

The results of the professional interview showed that it is desirable to practice sodium reduction gradually, and by reflecting this, the burger sauce was prepared by adjusting the ratio of refined salt to 15%, 30%, and 50%. The sodium content of the burger using low-sodium sauce was 399 mg/100 g in the control group, 362 mg/100 g in the H1 group, and 351.5 mg/100 g in the H2 group, showing a 9.3–11.9% decrease in sodium in the H1 and H2 groups. The preference evaluation on the low-sodium burgers showed a higher preference for burgers with 9.3–11.9% sodium reduction, which did not affect the overall taste.

CONCLUSIONS

This study examined the potential for sodium reduction in the franchise foodservice industry. An approximate 10% sodium reduction resulted in an increase in consumer preference without affecting the strength of the taste. Thus, if applied gradually, sodium reduction at practical levels could increase the consumer preference without changing the taste or quality and could be applied in the franchise foodservice industry.

Factors Associated With the Use of a Salt Substitute in Rural China

IMPORTANCE

Lowering sodium intake reduces blood pressure and may reduce the risk of cardiovascular diseases. The use of reduced-sodium salt (a salt substitute) may achieve sodium reduction, but its effectiveness may be associated with the context of its use.

OBJECTIVE

To identify factors associated with the use of salt substitutes in rural populations in China within the Salt Substitute and Stroke Study, a large-scale cluster randomized trial.

DESIGN, SETTING, AND PARTICIPANTS

This sequential mixed-methods qualitative evaluation, conducted from July 2 to August 28, 2018, in rural communities across 3 provinces in China, included a quantitative survey, collection of 24-hour urine samples, and face-to-face interviews. A random subsample of trial participants, selected from the 3 provinces, completed the quantitative survey (n = 1170) and provided urine samples (n = 1025). Interview respondents were purposively selected from the intervention group based on their different ranges of urinary sodium excretion levels. Statistical analysis was performed from September 18, 2018, to February 22, 2019.

EXPOSURES

The intervention group of the Salt Substitute and Stroke Study was provided with the free salt substitute while the control group continued to use regular salt.

MAIN OUTCOMES AND MEASURES

Knowledge, attitudes, and behaviors regarding the use of the salt substitute were measured using quantitative surveys, and urinary sodium levels were measured using 24-hour urine samples. Contextual factors were explored through semistructured interviews and integrated findings from surveys and interviews.

RESULTS

A total of 1170 individuals participated in the quantitative survey. Among the 1025 participants with successful urine samples, the mean (SD) age was 67.4 (7.5) years, and 502 (49.0%) were female. The estimated salt intake of participants who believed that high salt intake was good for health was higher; however, it was not significantly different (0.84 g/d [95% CI, -0.04 to 1.72 g/d]) from those who believed that high salt intake was bad for health. Thirty individuals participated in the qualitative interviews (18 women [60.0%]; mean [SD] age, 70.3 [6.0] years). Quantitative and qualitative data indicated high acceptability of and adherence to the salt substitute. Contextual factors negatively associated with the use of the salt substitute included a lack of knowledge about the benefits associated with salt reduction and consumption of high-sodium pickled foods. In addition, reduced antihypertensive medication was reported by a few participants using the salt substitute.

CONCLUSIONS AND RELEVANCE

This study suggests that lack of comprehensive understanding of sodium reduction and salt substitutes and habitual consumption of high-sodium foods (such as pickled foods) were the main barriers to the use of salt substitutes to reduce sodium intake. These factors should be considered in future population-based, sodium-reduction interventions.

Decreasing Salt in Hospital Meals Reduced Energy Intake in Elderly Japanese Inpatients

Japanese salt consumption is high, about 10 g salt/d. Low salt intake reduces the risk of hypertension and cardiovascular disease. However, saltiness is an important taste in daily meals, greatly influencing eating habits. When hospital admission is short-term, reducing salt supply may have an adverse effect on food intake. The aim of this study is to find the effect of sudden change in dietary salt content on energy intake in elderly Japanese inpatients. The study is an observational study of 83 patients and was conducted in a hospital in Tokyo, Japan. The research period was three weeks, and included 8 g salt/d meals for the 1st week, 7 g salt/d meals for the 2nd week, and 7 g salt/d meals with total 1 g/d salt packs that patients were allowed to use freely for the 3rd week. The energy supply satisfied the individuals' energy requirements and was the same throughout the three weeks. Nutrition surveys and blood pressure measurements during the three weeks were conducted by dietitians and nurses, respectively. The results showed that energy intake of patients was reduced by about 90 kcal/d in the 2nd week compared with the 1st week and increased about 130 kcal/d in the 3rd week compared with the 2nd week. Blood pressure did not change during the research period. When high salt intake has become a habit, reducing salt supply suddenly in a short time period may lead to decreased energy intake in elderly inpatients but does not affect blood pressure.

Dietary Modelling to Explore the Impact of Potassium Chloride Replacement for Sodium in Bread for Adults with Chronic Kidney Disease

Food manufacturers are increasingly substituting potassium chloride (KCl) in food products so as to reduce the sodium chloride content. Bread and bread products are common staple foods in many Western households and are a target for recipe reformulation using KCl. Given that chronic kidney disease (CKD) is a medical condition of global importance that requires dietary potassium restriction in the later stages, we sought to evaluate the impact and safety of varying levels of KCl substitution in bread products. We undertook a secondary analysis of dietary data from the National Nutrition and Physical Activity Survey 2011–2012 for 12,152 participants (154 participants with CKD). The sodium chloride content in bread and bread-based products was substituted with 20%, 30%, and 40% of KCl. The contribution of these alterations in the dietary potassium intake to the total daily potassium intake were then examined. The replacement of sodium in bread with varying amounts of KCl (20%, 30%, and 40%) resulted in one third of people with CKD exceeding the safe limits for dietary potassium consumption (31.8%, 32.6%, and 33%, respectively). KCl substitution in staple foods such as bread and bread products have serious and potentially fatal consequences for people who need to restrict dietary potassium. Improved food labelling is required for consumers to avoid excessive consumption.

Strengthening Knowledge to Practice on Effective Salt Reduction Interventions in Low- and Middle-Income Countries

PURPOSE OF REVIEW

The objective of this review was to consolidate available published information on the implementation and evaluation of salt reduction interventions in low- and middle-income countries (LMICs).

RECENT FINDINGS

The Science of Salt database (made up of studies identified in a weekly Medline search) was used to retrieve articles related to the implementation of salt reduction interventions from June 2013 to February 2020. Studies that measured the effects of the interventions in LMICs, based on four outcome measures-salt intake; sodium levels in foods; knowledge, attitudes, and behaviours (KABs) towards salt; and blood pressure-were included. Results were summarised overall and according to subgroups of intervention type, duration, sample size, country's income class, and regional classification. The review identified 32 studies, representing 13 upper middle-income and four lower middle-income countries. The main salt reduction interventions were education, food reformulation, and salt substitution; and many interventions were multi-faceted. More studies reported a positive effect of the interventions (decreased salt intake (12/17); lower sodium levels in foods or compliance with agreed targets (6/6); improved KAB (17/19); and decreased blood pressure (10/14)) than a null effect, and no study reported a negative effect of the intervention. However, many studies were of small scale and targeted specific groups, and none was from low-income countries. Consumer education, food reformulation, and salt substitution, either alone or in combination, were effective in their target populations. Supporting scale-up of salt reduction interventions in LMICs is essential to cover broader populations and to increase their public health impact.

Strategies for Reducing Sodium Intake in Bakery Products, a Review

Nowadays, the dietary sodium chloride intake is higher than the daily recommended levels, especially due to its prominent presence in food products. This may cause an increase of high blood pressure leading to cardiovascular diseases. Cereal products, and in particular bread, are the main source of salt in human diet. However, salt is a critical ingredient in bread making, and its reduction can have a negative impact on bread quality. This review focuses on physiological role of sodium chloride, its effect on the human body and legislative recommendations on its consumption. Moreover, it presents sodium chloride effects on the bread making from the technological and sensory point of view and presents different options for salt reduction in foods focusing on bakery products. It may be concluded that salt reduction in bread making while maintaining dough rheological properties, yeast fermentation rate, bread quality through its loaf volume, color, textural properties, sensory characteristics is difficult to be achieved due to sodium chloride’s multifunctional role in the bread-making process. Several strategies have been discussed, focusing on sodium chloride replacement with other type of salts, dry sourdough and flavor enhancers.

Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England: A Modeling Study

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The United Kingdom was among the first countries to introduce a salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified salt intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level salt intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level salt intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710–84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390–112 260) premature strokes, generating 542 850 (95% CI, 529 020–556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570–£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050–88 470) premature IHD cases, 126 010 (95% CI, 118 600–126 460) premature strokes and achieve £1260 million (95% CI, £1180–£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the salt reduction program to achieve further reductions in population salt intake and CVD burden should be a high priority.

Influence of Intrinsic and Extrinsic Food Attributes on Consumers' Acceptance of Reformulated Food Products: a Systematic Review

Introduction

Reducing the salt, sugar and fat content of food is recognised worldwide as one of the strategies available for reducing the incidence of obesity and non-communicable diseases. The food industry has a major influence on achieving these goals by preserving intrinsic (chemical and sensory properties) and modifying extrinsic (food packaging and other external information) food attributes that can influence purchasing decisions. This article is a literature review of studies that analyse the influence of intrinsic and/or extrinsic attributes on consumer product preference and purchasing decisions.

Methods

A keyword search for relevant studies was conducted using Web of Science, an interdisciplinary electronic resource. Articles from other sources were also included and systematically reviewed.

Results

The search string identified 266 results. Thirty-eight articles were included in the final analysis and coded according to intrinsic and extrinsic food attributes, reformulated nutrient, food category, condition, research methods, consumer response, study location and sample size. There are several authors investigating the effect of intrinsic rather than extrinsic product attributes. Most research deals with processed foods in the category of milk and dairy products, followed by sweetened fruit juices, meat products, sweets and bread. Salt content is the attribute most often reduced, followed by sugar and fat.

Conclusions

Consumers find it hard to swap potential health benefits for hedonic attributes. When evaluating products in expected conditions, they usually rate the reformulated product more highly than the conventional one, while in informed conditions they usually choose the regular product. When products are labelled with a traffic light or nutritional warnings, consumers opt for a reformulated product, even in informed conditions. This review highlights the heterogeneity between food groups, and the fact that many factors influence consumers’ product preferences and purchasing decisions. The product should be analysed as a whole and tested in blind, expected and informed conditions, as each individual factor represents a phase of the consumer purchasing decision. The extent of nutrient reduction should be determined by calculating the difference threshold, and the industry should reformulate products gradually based on how consumers detect the reduction.

Implementing the national strategy of salt reduction in Morocco: the baker´s perspective

Introduction

Morocco launched a national salt reduction strategy in 2019. The commitment of bakeries is key in the success of this strategy. However, the evaluation of such a commitment is not yet done. This study aims to examine knowledge of bakers about the national strategy of salt reduction and evaluate their commitment in implementing the specific recommendation related to salt reduction in bread.

Methods

a quantitative exploratory study targeted bakeries (N=432) from all the administrative regions of Morocco. Data was collected using a questionnaire composed of three sections: knowledge of bakers related to national strategy of salt, current contribution of bakers in implementing the national strategy and future commitment towards implementing the national strategy.

Results

about 73% (n=317) bakers lack of knowledge about the recommendations on the progressive reduction of the salt content in bread. Radio and TV were the most used sources to obtain information by bakers (45.2% (n=52) and 35.6% (n=41) respectively). None of the bakers was informed about the process of gradual reduction of salt content in bread, and none of them was committed to it. A total of 60.32% (n=252) of bakeries do not respect the national recommendations of 10g of salt/Kg of flour while 89.6% (n=387) of bakers express their interest in getting committed to the process in the next 2 years.

Conclusion

increasing the knowledge of bakers is highly recommended to guarantee their commitment toward contributing to the strategy of reducing salt in bread. Dissemination of messages via TV and radio could be appropriate.

Is a Consumer Perception of Salt Modification a Sensory or a Behavioural Phenomenon? Insights from a Bread Study

Salt plays a major role in food manufacturing and affects the technological and sensory properties of foods. At the same time, high dietary salt intake increases the risk of cardiovascular diseases and represents a considerable public health concern. In many populations, bread is a major contributor to salt intake and is therefore targeted by health policies recommending salt reduction reformulations. However, producers are often reluctant to reduce salt content due to fears of potential negative effects on consumer acceptability and drops in sales. The present work aims to assess the effect of salt content on consumers’ hedonic liking and perception of saltiness intensity, as well as the interaction of these two. The study was conducted using two market-leading bread types (white and multigrain) and bread samples with the national average (reference), reduced (−15%) and increased (+10%) salt levels. A sensory evaluation study (n = 200) was done including a questionnaire on attitudes and behaviour regarding bread and salt, enabling the exploration of individual differences in reactions to modified levels of salt content. The latter only affected hedonic liking for the multigrain sample with 15% salt reduction but not for others, which discloses the importance of the bread matrix; and it did not affect the perception of saltiness intensity. Penalty analysis revealed that perceived non-optimal saltiness results in significantly penalised hedonic liking scores. Segmentation based on perceived saltiness disclosed the explanatory importance of underlying consumer behaviour dimensions which should be considered in designing bread reformulations.

Contribution of major food companies and their products to household dietary sodium purchases in Australia

Background

The Australian federal government will soon release voluntary sodium reduction targets for 30 packaged food categories through the Healthy Food Partnership. Previous assessments of voluntary targets show variable industry engagement, and little is known about the extent that major food companies and their products contribute to dietary sodium purchases among Australian households.

Methods

The aim of this cross-sectional study was to identify the relative contribution that food companies and their products made to Australian household sodium purchases in 2018, and to examine differences in sodium purchases by household income level. We used 1 year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with database that contains product-specific sodium content for packaged foods and beverages (FoodSwitch). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Differences in per capita sodium purchases by income levels were assessed by 1-factor ANOVA. All analyses were modelled to the Australian population in 2018 using sample weights.

Results

Sodium data were available from 7188 households who purchased 26,728 unique products and purchased just under 7.5 million food product units. Out of 1329 food companies, the top 10 accounted for 35% of unique products and contributed to 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, particularly driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased significantly more sodium from packaged products than high-income households per capita (452 mg/d, 95%CI: 363-540 mg/d, P < 0.001).

Conclusions

A small number of food companies and food categories account for most of the dietary sodium purchased by Australian households. Prioritizing government engagement with these groups could deliver a large reduction in population sodium intake.

Impact of a sodium-reduced bread intervention with and without dietary counseling on sodium intake-a cluster randomized controlled trial among Danish families

BACKGROUND/OBJECTIVES

Excessive intake of sodium is a dietary risk factor for morbidity and mortality. Currently, intake of sodium is much higher than the recommended level in most western countries, and effective strategies to reduce population sodium intake are lacking. The objective of the present study was to investigate the effect of two different sodium reduction strategies on the intake of sodium, potassium, and the sodium to potassium ratio among Danish families SUBJECTS/METHODS: The study was a 4-month, single-blinded, cluster randomized controlled trial with a parallel design. Eighty-nine healthy Danish families, with a minimum of one child and one parent (n = 309), were randomly assigned to receive sodium-reduced bread (Intervention A), sodium-reduced bread and dietary counseling (Intervention B) or regular sodium bread (Control). The primary outcome was change in daily sodium intake, measured by 24-h urinary sodium excretion. Secondary outcomes included changes in dietary potassium and the sodium to potassium ratio.

RESULTS

No significant differences in daily sodium intake were observed in the two intervention groups compared with the control. When analyzing the results separately for children and adults, a reduction in dietary sodium of 0.6 g/day (-1.0, -0.2), p = 0.005 occurred among adults in intervention B compared with control.

CONCLUSIONS

This study demonstrates that providing sodium-reduced bread in combination with dietary counseling is an effective strategy to reduce dietary sodium among adults, but the effect is lacking in children. The study was not able to show significant effects when providing sodium-reduced bread alone in neither adults nor children.

Sodium content of bread from bakeries in Maputo, Mozambique: trends between 2012 and 2018

Objective:

To assess the Na content and price of bread available in bakeries in the city of Maputo in 2018 and describe trends since 2012.

Design:

Cross-sectional evaluation of bread sold in twenty bakeries in the city of Maputo. Three loaves of white and three loaves of brown bread were collected from each bakery when available, and Na contents were quantified by flame photometry. To assess trends, samples of white bread collected in 2012 and analysed using the same methodology were compared with samples of white bread collected in 2018 from the same bakeries.

Setting:

City of Maputo, capital of Mozambique.

Results:

In 2018, the mean (range) Na content in mg/100 g of white and brown breads were 419·1 (325·4–538·8) and 389·8 (248·0–609·0), respectively. Non-compliance with Na targets in bread according to the South African regulation (<380 mg/100 g) was observed in 70 % of white and 43 % of brown bread samples. A total of twelve bakeries had samples evaluated in both 2012 and 2018; among these, the mean Na content in white bread decreased by just over 10 % – the mean difference (95 % CI) was 46·6 mg/100 g (1·7, 91·5); and there was a significant increase of 3·7–5·4 meticais in the mean price per 100 g of white bread.

Conclusions:

The Na content of bread available in bakeries in the city of Maputo decreased in recent years despite the absence of a specific regulation in Mozambique.

Impact of sodium reduction strategies on volatile compounds, sensory properties and consumer perception in commercial wheat bread

The efficacy of two sodium reduction strategies in preserving sensory profile and consumer liking of yeasted wheat bread was tested, by combining sensory data, aroma compounds and consumer investigations. The use of (i) a reduced-sodium salt substitute, Pansalt® (NaCl 57%, other salts and minor ingredients) at 1.5%, and (ii) the heterogeneous NaCl distribution (average level of 1%) leading to enhanced saltiness by taste contrast, were compared with standard (1.5%) and reduced (1.0%) addition of NaCl. The heterogeneous NaCl distribution was effective in preserving saltiness. Salt substitution with Pansalt® was less effective but preserved the overall flavour. Higher amount of Maillard reaction volatile products, associated with more intense toasted odour of the crust, was found in breads with higher NaCl content. The consumer survey highlighted satisfactory results of Pansalt® use for 58% of the respondents (equal or higher liking and purchase intention). Heterogeneous salt distribution was effective for 31% of consumers.

Current Sodium Intakes in the United States and the Modelling of Glutamate's Incorporation into Select Savory Products

Most Americans have dietary sodium intakes that far exceed recommendations. Given the association of high sodium with hypertension, strategies to reduce sodium intakes are an important public health target. Glutamates, such as monosodium glutamate, represent a potential strategy to reduce overall intakes while preserving product palatability; therefore, this project aimed to model sodium replacement with glutamates. The National Cancer Institute method was used to estimate current sodium intakes, and intakes resulting from glutamate substitution (25%–45%) in a limited set of food groups for which substitution is possible. Data sets for individuals aged ≥1 year enrolled in the U.S. National Health and Nutrition Examination Survey 2013–2016 (n = 16,183) were used in the analyses. Glutamate substitution in accordance with the U.S. Department of Agriculture’s food codes was modeled by conservatively altering estimates of sodium intake reductions derived from the published, peer-reviewed literature. The addition of glutamates to certain food categories has the potential to reduce the population’s sodium intake by approximately 3% overall and by 7%–8% among consumers of ≥1 product category in which glutamates were substituted for sodium chloride. Although using glutamates to substitute the amount of sodium among certain food groups may show modest effects on intakes across the population, it is likely to have a more substantial effect on individuals who consume specific products.

Trends in Dietary Sodium Intake in the United States and the Impact of USDA Guidelines: NHANES 1999-2016

BACKGROUND

Moderation in sodium consumption is recommended to reduce morbidity and mortality; however, trends in intake and the impact of guidelines have not been examined.

METHODS

Sodium intake data collected from 1999-2016 in the National Health and Nutrition Examination Surveys were analyzed. Trends in sodium intake for individuals aged 18 years or over and in subgroups based on age, sex, race and ethnicity, and sodium-sensitive chronic diseases were examined. Adherence to US Department of Agriculture guidelines was assessed. Multivariable regression analysis was performed to identify predictors of sodium intake from 2011-2016.

RESULTS

A total of 47,509 individuals (median age = 44.0 years, 48.3% male) were included in the study. Median sodium consumption was 3232 mg per day (95% confidence interval [CI], 3210-3255), increasing from 3156 mg per day (95% CI 3,038-3,273) in 1999-2000 to 3273 mg per day (95% CI, 3218-3328) in 2015-2016 (P < .001). Intake declined with age (3427 mg per day for individuals aged 18-50 years, 3101 mg per day for individuals aged 51-70 years, and 2620 mg per day for individuals aged ≥71 years; P < .001) and was greater in males than in females (3827 mg per day vs 2778 mg per day; P < .001). Caucasians, Hispanics, and African Americans consumed 3278, 3117, and 3027 mg of dietary sodium per day respectively (P < .001). Individuals with hypertension, diabetes mellitus, and chronic kidney disease consumed 3073, 3062, and 2658 mg of dietary sodium per day respectively. Population adherence to US Department of Agriculture recommendations declined from 34% to 23% and all high-risk subgroups had < 10% adherence. Daily total calories was the strongest predictor of sodium consumption (overall r² = 0.680).

CONCLUSION

Sodium intake has remained above recommended levels in all segments of the adult population and adherence to guidelines is poor. Novel interventions are needed to reduce sodium intake.

Salt content of sauces in the UK and China: cross-sectional surveys

OBJECTIVES

(1) To assess the changes in the salt content of sauces in the UK in the past 10 years; (2) to compare the salt content of sauces in China with equivalent products sold in the UK and (3) to calculate the proportion of sauce products meeting the salt targets set by the UK Department of Health (DoH).

DESIGN

Cross-sectional surveys from the nutrition information panels of sauces.

SETTING

Major retailers in London, Beijing and Shijiazhuang operating at data collection times.

MAIN OUTCOME MEASURE

Salt content of sauces.

RESULTS

Relative change in the median salt content of UK products ranged from -70.6% to +3.0% in sauces for which salt targets were set, whereas it ranged from -27.1% to +111.5% in sauces without targets. Median salt contents were on average 4.4-fold greater in Chinese sauces compared with their UK equivalents surveyed during the same period (2015-2017). Only 13.4% of the Chinese products met the UK 2017 salt targets, compared with 70.0% of UK products.

CONCLUSION

In the UK, the target-based approach contributed to the reduction in the salt content of sauces over the course of the past 10 years. Currently, large variations in salt content exist within the same categories of sauces and 70% of the products have met DoH's 2017 targets, demonstrating that further reductions are possible and lower salt targets should be set. In China, salt content of sauces is extremely high with similarly large variations within same categories of sauces, demonstrating the feasibility of reducing their salt content. As processed foods (including sauces) are expected to become an important contributor to salt intake in China, national salt reduction efforts such as setting salt targets would be a valuable, proactive strategy.

Cross-modal interactions as a strategy to enhance salty taste and to maintain liking of low-salt food: a review

Salt reduction in foods is becoming an important challenge to protect population health from severe diseases as recommended by different health agencies worldwide. Among the reduction strategies already evaluated in order to lower sodium salt content in foods, the use of cross-modal interactions between taste and odour, regardless of saltiness, was revealed to be a very promising method to improve saltiness perception. Cross-modal odour-taste interactions, as means to enhance salty taste in foods, is reviewed. Salt-related odours can enhance salty taste in water solutions containing a low level of sodium chloride through odour-induced changes in taste perception. Odour-induced saltiness perception enhancement (OISE) depends on salt concentration (intensity). OISE was also found to be effective in low salt content solid model cheese but was texture- and composition-dependent. A significant enhancement in saltiness perception induced by Comté cheese and sardine odours was observed only in model foods with soft textures. In ternary odour-sour-salty solutions, sourness additively enhanced saltiness perception with salt-related odours. Finally, in cream-based food systems, a strategy combining OISE and heterogeneous distribution of stimuli was found to compensate for a greater than 35% decrease in salt content without significant loss of acceptability. However, variation in the composition of the food matrix influenced aroma and salt release and consequently the overall saltiness perception. A better knowledge of the mechanisms involved in cross-modal perceptual interactions at the central level should allow for the optimization of their use as salt reduction strategies for healthier food design.

Utilizing Herbs and Microwave-Assisted Thermal Sterilization to Enhance Saltiness Perception in a Chicken Pasta Meal

This study was the first to evaluate the influence of herb addition in a complex food matrix processed by microwave-assisted thermal sterilization (MATS) system for potential salt reduction implications. In a chicken pasta meal, salt concentrations included 100% (full salt) and reduced salt variations (75%, 50%, and 25% of the original salt concentration) and for each meal, a version with and without herb addition. The influence of storage time on sensory perception and acceptance was investigated, along with the odor-induced saltiness enhancement (OISE). Trained sensory panel results showed that the addition of herbs to the chicken pasta meal increased the intensity of many flavors and led to an increased saltiness perception, demonstrating their congruency with salty taste. The addition of herbs allowed for a 50% salt reduction in a processed prepared meal while maintaining the same intensity of saltiness perception as determined by a trained panel and overall meal acceptance by consumers. The OISE was only significant for the 25% salt meal (P < 0.05) suggesting that the influence of herb addition on saltiness perception at lower salt concentrations was more influential than at higher salt concentrations. Over longer storage times, meals processed by MATS and stored at ambient temperature increased in aroma, taste, and flavor intensities as well as in acceptance of many meal attributes. This study contributed an additional strategy of product reformulation, specifically herb addition, to the portfolio of salt-reduction strategies for prepared meals using MATS. PRACTICAL APPLICATION: The addition of herbs to prepared meals (chicken pasta) may allow for up to a 50% reduction in salt content while maintaining the same saltiness intensity perception and overall consumer acceptance. This has important implications for the food industry as sodium reduction is a complex task. Furthermore, the additional herbs utilized in this study increased the intensity of certain aromas and flavors, and led to increased saltiness perception; these herbs could be considered in future salt reduction applications as this study demonstrates their congruency with salty taste.

Effect of a salt-reduction strategy on blood pressure and acceptability among customers of a food concessionaire in Lima, Peru

AIM

Limited information exists regarding the implementation of salt reduction strategies on collective food services, such as restaurants and food concessionaires. The present study aimed to assess the effect of a salt reduction strategy on blood pressure levels and food acceptability among customers of a food concessionaire.

METHODS

A quasi-experimental study with two phases was conducted. In the pre-intervention phase, the amount of salt used in food preparation was determined. In the intervention phase, a reduction of 20% in salt added to food preparations was implemented. Four hedonic tests and two blood pressure measurements were performed before and after the intervention implementation using standardised techniques. In addition, an evaluation of uneaten food was conducted daily on all customers' plates. Mixed linear regression models were generated to assess the effect of the intervention on blood pressure and acceptability.

RESULTS

A total of 71 workers were evaluated, mean age of 37.5 years, 57.8% females, who consumed the food of the concessionaire, on average, 4.4 (SD: 0.7) days per week. Systolic and diastolic blood pressure were reduced by 3.1 (P < 0.001) and 2.9 (P < 0.001) mmHg at the end of the study, respectively. The results of the hedonic tests and the uneaten food before and after the intervention did not vary significantly.

CONCLUSIONS

The reduction of 20% of salt added to food from a concessionaire had a positive impact on the reduction of customers' blood pressure without reducing food acceptability. This strategy could be implemented in other contexts.

Salt content of instant noodles in Malaysia: a cross-sectional study

OBJECTIVE

To determine the salt content in instant noodles sold in Malaysia.

STUDY DESIGN

A cross-sectional survey was done involving 707 different flavours and packaging of instant noodles sold in six hypermarkets and retailer chains in Malaysia and the corresponding brand's official websites in 2017.

METHODS

The salt content (gram per serving and per 100 g) was collected from the product packaging and corresponding brand's official website.

RESULTS

Of the 707 different packaging and flavours of instant noodles, only 62.1% (n=439) provided the salt content in their food label.The mean (±SD) salt per 100 g of instant noodles was 4.3±1.5 g and is nearly four times higher than the salt content of food classified in Malaysia as a high salt content (>1.2 g salt per 100 g). The salt content for instant noodle per packaging ranged from 0.7 to 8.5 g. 61.7% of the instant noodles exceeded the Pacific Salt Reduction Target, 11.8% exceeded the WHO recommended daily salt intake of <5.0 per day and 5.50% exceeded Malaysia Salt Action Target. 98% of instant noodles will be considered as high salt food according to the Malaysia Guidelines.The probability of the instant noodles without mixed flavour (n=324) exceeding the Pacific Salt Reduction Target was tested on univariate and multivariate analysis. Instant noodles with soup, Tom Yam flavour, pork flavour and other flavours were found to be predictors of instant noodles with the tendency to exceed Pacific Salt Reduction Target when compared with instant noodles without mixed flavours (p<0.05).

CONCLUSION

Only 62% of instant noodles displayed the salt content on their food label. Salt content in instant noodles is very high, with 90% exceeding the daily salt intake recommended by WHO. Prompt action from regulatory and health authorities is needed to reduce the salt content in instant noodles.

Effect of salt reduction on quality and acceptability of durum wheat bread

In the Mediterranean area, being pedoclimatic conditions more favorable to durum than common wheat cultivation, a bread-making tradition from durum wheat has been established. Durum wheat bread has a compact texture, with lower specific volume than common wheat bread. Due to health implications, several studies were carried out to reduce the content of NaCl in common wheat bread, however without considering durum wheat bread. The aim of this work was to assess the effect of salt reduction on quality and acceptability of durum wheat bread, with regard to specific volume, sensory features and aroma profile. Breads prepared with 5, 10, 15, 20 g/kg NaCl were submitted to consumer test. Control bread (20 g/kg salt) was the most appreciated, followed (greater than80% consumers) by bread with 10 g/kg salt, which showed a significantly (p < 0.05) higher specific volume, but lighter crust and weaker aroma (lower amounts of Maillard reaction products and fusel alcohols).

Salt Preference and Ability to Discriminate between Salt Content of Two Commercially Available Products of Australian Primary Schoolchildren

Australian children consume too much salt, primarily from processed foods where salt is often used to enhance flavour. Few studies have assessed children's salt preference in commercially available foods. This study aims to assess (1) children's preference and ability to discriminate between salt levels in two commercially available foods and (2) if preference or ability to discriminate between salt levels changes after an education program. Chips and corn flakes were tasted at three levels of salt concentration. Children ranked which they liked best (preference) and which was saltiest (ability to discriminate). The proportion of children across categorical responses was assessed (Chi squared and McNemar's test) together with changes in preference and ability to discriminate between salt levels from timepoint 1 (T1) to timepoint 2 (T2). Ninety-two children (57% female, mean age 9.1 years (SD 0.8)) participated. At T1 approximately one-half and two-thirds of children preferred the highest salt chip and cornflake, respectively, (both p < 0.05). Fifty-seven percent and 63% of children identified the highest level of salt in chips and cornflakes as the saltiest, respectively. Preference and ability to discriminate between salt levels were unchanged between timepoints. Results support product reformulation to decrease salt content of foods provided to children.