1
|
Holvik K, Abel MH, Holmen J, Krokstad S, Totland TH, Meyer HE. No change in 24-h sodium intake estimated from spot urine in Norwegian adults from 2006 to 2019: the population-based Trøndelag Health Study (HUNT). Public Health Nutr 2024; 27:e117. [PMID: 38602104 PMCID: PMC11036440 DOI: 10.1017/s136898002400082x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/06/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Monitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-h salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-2008 to 2017-2019 and to describe variations by sex, age and educational level. DESIGN Repeated cross-sectional studies. SETTING The population-based Trøndelag Health Study (HUNT). PARTICIPANTS In each of two consecutive waves (HUNT3: 2006-2008 and HUNT4: 2017-2019), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of Na, K and creatinine and age, sex and BMI, we estimated 24-h Na intake using the International Cooperative Study on Salt and Blood Pressure (INTERSALT) equation for the Northern European region. RESULTS Mean (95 % CI) estimated 24-h salt intakes in men were 11·1 (95 % CI 10·8, 11·3) g in HUNT3 and 10·9 (95 % CI 10·6, 11·1) g in HUNT4, P = 0·25. Corresponding values in women were 7·7 (95 % CI 7·5, 7·9) g and 7·7 (95 % CI 7·5, 7·9) g, P = 0·88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. CONCLUSIONS Estimated 24-h salt intake in adult men and women in mid-Norway did not change from 2006-2008 to 2017-2019.
Collapse
Affiliation(s)
- Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Marianne Hope Abel
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Jostein Holmen
- HUNT Research Center, Department of Public Health and Nursing,
Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Center, Department of Public Health and Nursing,
Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust,
Levanger, Norway
| | - Torunn Holm Totland
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
| | - Haakon E Meyer
- Department of Physical Health and Ageing, Norwegian Institute
of Public Health, 0213Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health
and Society, University of Oslo, Oslo,
Norway
| |
Collapse
|
2
|
O'Flaherty M, Sudharsanan N, Kypridemos C. Can the HEARTS initiative reduce the burden of cardiovascular disease? BMJ Evid Based Med 2024:bmjebm-2023-112590. [PMID: 38519119 DOI: 10.1136/bmjebm-2023-112590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Martin O'Flaherty
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Nikkil Sudharsanan
- Behavioural Science for Disease Prevention and Health Care, Technical University of Munich, Munchen, Bayern, Germany
| | - Chris Kypridemos
- Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| |
Collapse
|
3
|
Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
4
|
Ding X, Lv W, Liu Y, Long J, Li H, Ma A, Yang Y, Wang Z, Gao C. Sodium Content in Pre-Packaged Foods in China: A Food Label Analysis. Nutrients 2023; 15:4862. [PMID: 38068721 PMCID: PMC10708419 DOI: 10.3390/nu15234862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Sodium intake from pre-packaged foods is increasing in China and is well above the WHO recommendation of 5 g per day. The purpose of this study is to analyze the sodium content of pre-packaged foods collected by the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention (NINH, China CDC) in 20 provinces of China from 2017 to 2022. The proportion of pre-packaged foods that meet or exceed the low-sodium, medium-sodium, and high-sodium classifications were analyzed. The proportion of pre-packaged foods that meet and do not meet the WHO global sodium benchmarks and the difference in sodium content between these foods was also calculated. High-sodium foods include sauces, dips, and dressings (3896 mg/100 g), convenience foods (1578 mg/100 g), processed fish products (1470 mg/100 g), processed meat products (1323 mg/100 g), processed poultry products (1240 mg/100 g), snack foods (750 mg/100 g), processed egg products (741 mg/100 g), and fine dried noodles (602 mg/100 g). A large number of pre-packaged foods currently collected in China have a sodium content above sodium benchmarks. This study provided data to support the assessment of sodium intake from pre-packaged foods in the Chinese population and the implementation of comprehensive salt reduction strategies.
Collapse
Affiliation(s)
- Xin Ding
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
| | - Wanting Lv
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yang Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiewei Long
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Hanning Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
| | - Yuexin Yang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Chinese Nutrition Society, Beijing 100053, China
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
| | - Chao Gao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
| |
Collapse
|
5
|
Filler G, Dave S, Ritter V, Ross S, Viprakasit D, Hatch JE, Bjazevic J, Burton J, Gilleskie D, Gilliland J, Lin FC, Jain N, McClure JA, Razvi H, Bhayana V, Wang P, Coulson S, Sultan N, Denstedt J, Fearrington L, Diaz-Gonzalez de Ferris ME. In focus: perplexing increase of urinary stone disease in children, adolescent and young adult women and its economic impact. Front Med (Lausanne) 2023; 10:1272900. [PMID: 37937142 PMCID: PMC10626457 DOI: 10.3389/fmed.2023.1272900] [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: 08/10/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023] Open
Abstract
Background Urinary stone disease (USD) historically has affected older men, but studies suggest recent increases in women, leading to a near identical sex incidence ratio. USD incidence has doubled every 10 years, with disproportionate increases amongst children, adolescent, and young adult (AYA) women. USD stone composition in women is frequently apatite (calcium phosphate), which forms in a higher urine pH, low urinary citrate, and an abundance of urinary uric acid, while men produce more calcium oxalate stones. The reasons for this epidemiological trend are unknown. Methods This perspective presents the extent of USD with data from a Canadian Province and a North American institution, explanations for these findings and offers potential solutions to decrease this trend. We describe the economic impact of USD. Findings There was a significant increase of 46% in overall surgical interventions for USD in Ontario. The incidence rose from 47.0/100,000 in 2002 to 68.7/100,000 population in 2016. In a single United States institution, the overall USD annual unique patient count rose from 10,612 to 17,706 from 2015 to 2019, and the proportion of women with USD was much higher than expected. In the 10-17-year-old patients, 50.1% were girls; with 57.5% in the 18-34 age group and 53.6% in the 35-44 age group. The roles of obesity, diet, hormones, environmental factors, infections, and antibiotics, as well as the economic impact, are discussed. Interpretation We confirm the significant increase in USD among women. We offer potential explanations for this sex disparity, including microbiological and pathophysiological aspects. We also outline innovative solutions - that may require steps beyond typical preventive and treatment recommendations.
Collapse
Affiliation(s)
- Guido Filler
- Department of Paediatrics, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Sumit Dave
- Department of Surgery, Western University, London, ON, Canada
| | - Victor Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sherry Ross
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Davis Viprakasit
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph E. Hatch
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Jeremy Burton
- Department of Surgery, Western University, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Donna Gilleskie
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason Gilliland
- Department of Geography, Western University, London, ON, Canada
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Nina Jain
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Hassan Razvi
- Department of Surgery, Western University, London, ON, Canada
| | - Vipin Bhayana
- Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada
| | - Peter Wang
- Department of Surgery, Western University, London, ON, Canada
| | - Sherry Coulson
- Department of Paediatrics, Western University, London, ON, Canada
| | - Nabil Sultan
- Department of Medicine, Western University, London, ON, Canada
| | - John Denstedt
- Department of Surgery, Western University, London, ON, Canada
| | - Loretta Fearrington
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | |
Collapse
|
6
|
Vargas-Meza J, Gonzalez-Rocha A, Campos-Nonato I, Nilson EAF, Basto-Abreu A, Barquera S, Denova-Gutiérrez E. Effective and Scalable Interventions to Reduce Sodium Intake: a Systematic Review and Meta-Analysis. Curr Nutr Rep 2023; 12:486-494. [PMID: 37226030 DOI: 10.1007/s13668-023-00477-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW High-sodium intake is a main risk factor for increased blood pressure and cardiovascular disease, the leading cause of death worldwide. Reducing sodium intake at the population level is one of the most cost-effective strategies to address this. The aim of the present systematic review and meta-analysis are to examine data from recent studies that measure the effectiveness and scalability of interventions aimed at reducing sodium intake at both the population and individual level. RECENT FINDINGS Worldwide, sodium intake is higher than the World Health Organization recommendations. Structural interventions such as mandatory reformulation of foods, food labeling, taxes or subsidies, and communication campaigns have shown to be the most effective in reducing the population's sodium consumption. Interventions in education, particularly those that use a social marketing framework with short duration, food reformulation, and combined strategies, have the potential to decrease sodium intake.
Collapse
Affiliation(s)
- Jorge Vargas-Meza
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
- El Poder del Consumidor A.C., Ciudad de México, México
| | - Alejandra Gonzalez-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Ismael Campos-Nonato
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Eduardo Augusto Fernandes Nilson
- Nucleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
- Programa de Alimentação, Nutrição e Cultura, Oswaldo Cruz Foundation (Fiocruz), Brasilia, Brazil
| | - Ana Basto-Abreu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México.
| |
Collapse
|
7
|
Zhang X, Zhang P, Shen D, Li Y, He FJ, Ma J, Yan W, Gao Y, Jin D, Deng Y, Guo F, Yan S, Song J, MacGregor GA, Wu J. Effect of home cook interventions for salt reduction in China: cluster randomised controlled trial. BMJ 2023; 382:e074258. [PMID: 37620015 PMCID: PMC10448250 DOI: 10.1136/bmj-2022-074258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To determine the effects of salt reduction interventions designed for home cooks and family members. DESIGN Cluster randomised controlled trial. SETTING Six provinces in northern, central, and southern China from 15 October 2018 to 30 December 2019. PARTICIPANTS 60 communities from six provinces (10 communities from each province) were randomised; each community comprised 26 people (two people from each of 13 families). INTERVENTIONS Participants in the intervention group received 12 month interventions, including supportive environment building for salt reduction, six education sessions on salt reduction, and salt intake monitoring by seven day weighed record of salt and salty condiments. The control group did not receive any of the interventions. MAIN OUTCOME MEASURE Difference between the two groups in change in salt intake measured by 24 hour urinary sodium during the 12 month follow-up. RESULTS 1576 participants (775 (49.2%) men; mean age 55.8 (standard deviation 10.8) years) from 788 families (one home cook and one other adult in each family) completed the baseline assessment. After baseline assessment, 30 communities with 786 participants were allocated to the intervention group and 30 communities with 790 participants to the control group. During the trial, 157 (10%) participants were lost to follow-up, and the remaining 706 participants in the intervention group and 713 participants in the control group completed the follow-up assessment. During the 12 month follow-up, the urinary sodium excretion decreased from 4368.7 (standard deviation 1880.3) mg per 24 hours to 3977.0 (1688.8) mg per 24 hours in the intervention group and from 4418.7 (1973.7) mg per 24 hours to 4330.9 (1859.8) mg per 24 hours in the control group. Compared with the control group, adjusted mixed linear model analysis showed that the 24 hour urinary sodium excretion in the intervention group was reduced by 336.8 (95% confidence interval 127.9 to 545.7) mg per 24 hours (P=0.002); the systolic and diastolic blood pressures were reduced by 2.0 (0.4 to 3.5) (P=0.01) and 1.1 (0.1 to 2.0) mm Hg (P=0.03), respectively; and the knowledge, attitude, and behaviours in the intervention group improved significantly. CONCLUSIONS The community based salt reduction package targeting home cooks and family members was effective in lowering salt intake and blood pressure. This intervention has the potential to be widely applied in China and other countries where home cooking remains a major source of salt intake. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800016804.
Collapse
Affiliation(s)
- Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
- The George Institute for Global Health, Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Danyang Shen
- Beijing Center for Diseases Control and Prevention, Beijing, China
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Wei Yan
- Jiangxi Center for Disease Control and Prevention, Nanchang, China
| | - Yifu Gao
- Hebei Center for Disease Control and Prevention, Shi Jiazhuang, China
| | - Donghui Jin
- Hunan Center for Disease Control and Prevention, Changsha, China
| | - Ying Deng
- Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fangming Guo
- Qinghai Center for Disease Control and Prevention, Xining, China
| | - Shichun Yan
- Heilongjiang Center for Disease Control and Prevention, Haerbin, China
| | - Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jing Wu
- Chinese Center for Disease Control and Prevention, Beijing, China
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
8
|
Banzrai C, Bosookhuu O, Yadamsuren E, Dambasuren B, Turbat S, Erdenedalai T, Myadagsuren M, Munkhtur U, Baatar K, Boldbayar P, Avirmed T, Badrakh B, Ouyang M, Chen X, Wang X, Anderson CS. Incidence and outcomes for stroke in Ulaanbaatar, Mongolia, during 2019-21: a prospective population-based study. Lancet Glob Health 2023; 11:e942-e952. [PMID: 37119831 DOI: 10.1016/s2214-109x(23)00130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND In the absence of reliable data to quantify the burden of stroke, we aimed to determine the incidence and outcome of stroke through the conduct of a prospective population-based study in Ulaanbaatar, Mongolia, during 2019-21. METHODS All cases of stroke were identified through surveillance of multiple overlapping sources of hospitalised, ambulatory, and deceased individuals, using standardised diagnostic criteria in adult (aged ≥16 years) residents of the six urban districts of Ulaanbaatar, Mongolia (population person-years, N=1 896 965) between Jan 1, 2019, and Dec 31, 2020. Data on sociodemography, medical history, and management were collected. Crude and standardised incidence were calculated for first-ever stroke and its major pathological subtypes, and reported with 95% CIs. Outcomes were 28-day case fatality ratios and functional recovery on the modified Rankin scale at 90 days and 1 year. FINDINGS 3803 strokes in 3738 patients were identified, of which 2962 were first-ever incident cases (mean age 59 years [SD 13], 1161 [39·2%] females). Annual incidence of first-ever stroke (per 100 000) was 156·1 (95% CI 150·5-161·8) on a crude basis, 171·6 (157·5-185·6) when age-adjusted to the Mongolian population, and 140·3 (136·7-143·9) when age-adjusted to the world population. World-adjusted incidence of pathological subtypes were 66·6 (95% CI 64·8-68·3) for ischaemic stroke, 54·5 (53·0-56·1) for intracerebral haemorrhage, and 18·7 (18·3-19·1) for subarachnoid haemorrhage. Men were twice as likely to suffer ischaemic stroke and intracerebral haemorrhage as women, but the risks were similar for subarachnoid haemorrhage; these patterns were consistent across age-groups. The predominant risk factors were hypertension seen in 1363 (63·1%) of 2161, smoking in 596 (26·8%) of 2220, regular alcohol consumption in 533 (24·0%) of 2220, obesity in 342 (16·1%) of 2125, and diabetes in 282 (12·7%) of 2220. There was little use (0·9%) of thrombolysis for acute ischaemic stroke, partly due to delays in presentation after the onset of symptoms (median 16·0 h [IQR 3·0-48·0]). The 28-day case-fatality rate was 36·1% (95% CI 34·3-37·9) overall, and 14·8% (12·8-16·7) for ischaemic stroke, 52·9% (49·9-55·8) for intracerebral haemorrhage, and 54·3% (49·4-59·1) for subarachnoid haemorrhage. Corresponding figures for poor functional outcome at 1-year, defined by scores of 3-6 for death or dependency on the mRS, were 61·6% (95% CI 59·8-63·4), 47·5% (44·7-50·3), 77·0% (74·5-79·5), and 61·8% (57·0-66·5), respectively. INTERPRETATION The urban population of Ulaanbaatar, Mongolia, has a high incidence of stroke, particularly for intracerebral haemorrhage and subarachnoid haemorrhage, from which half of patients die within 1 month and more than two-thirds are either dead or dependent at 90 days. Although the overall incidence of stroke is similar to other countries, it occurs at a mean age of 60 years, which is at least 10 years younger than in high-income countries. These epidemiological data can inform the implementation of future programmes and scale-up activities for the primary and secondary prevention of stroke, and in the organisation of systems of care. FUNDING Science and Technology Foundation of the Ministry of Education, Culture, and Science of Mongolia and The George Institute for Global Health.
Collapse
Affiliation(s)
- Chimeglkham Banzrai
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Neurology, Ach Medical University, Ulaanbaatar, Mongolia
| | - Oyungerel Bosookhuu
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Neurology, Ach Medical University, Ulaanbaatar, Mongolia
| | - Erdenechimeg Yadamsuren
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Bolormaa Dambasuren
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Sarantsetseg Turbat
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Tuguldur Erdenedalai
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mandakhnar Myadagsuren
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Uuriintuya Munkhtur
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Khandsuren Baatar
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Punsaldulam Boldbayar
- Department of Neurology, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Tovuudorj Avirmed
- School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Burmaajav Badrakh
- Department of Neurology, Ach Medical University, Ulaanbaatar, Mongolia
| | - Menglu Ouyang
- The George Institute for Global Health, University of New South Wales, Sydney NSW, Australia
| | - Xiaoying Chen
- The George Institute for Global Health, University of New South Wales, Sydney NSW, Australia
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney NSW, Australia
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney NSW, Australia; The George Institute for Global Health, Beijing, China.
| |
Collapse
|
9
|
Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1305] [Impact Index Per Article: 1305.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
10
|
Mounsey S, Waqa G, McKenzie B, Reeve E, Webster J, Bell C, Thow AM. Strengthening implementation of diet-related non-communicable disease prevention strategies in Fiji: a qualitative policy landscape analysis. Global Health 2022; 18:79. [PMID: 36050736 PMCID: PMC9434519 DOI: 10.1186/s12992-022-00859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji’s food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically. Results Opportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence. Conclusion Diet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00859-9.
Collapse
Affiliation(s)
- Sarah Mounsey
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia.
| | - Gade Waqa
- Fiji National University, Suva, Fiji
| | - Briar McKenzie
- The George Institute, City Road, Newtown, NSW, Australia
| | | | - Jacqui Webster
- The George Institute, City Road, Newtown, NSW, Australia
| | - Colin Bell
- School of Medicine and Global Obesity Centre, Geelong Waurn Ponds Campus, Deakin University, Melbourne, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, City Road, Sydney, NSW, 2006, Australia
| |
Collapse
|
11
|
Abstract
OBJECTIVE This study assessed the cost-effectiveness of the Centers for Disease Control and Prevention's (CDC's) Sodium Reduction in Communities Program (SRCP). DESIGN We collected implementation costs and performance measure indicators from SRCP recipients and their partner food service organisations. We estimated the cost per person and per food service organisation reached and the cost per menu item impacted. We estimated the short-term effectiveness of SRCP in reducing sodium consumption and used it as an input in the Prevention Impact Simulation Model to project the long-term impact on medical cost savings and quality-adjusted life-years gained due to a reduction in CVD and estimate the cost-effectiveness of SRCP if sustained through 2025 and 2040. SETTING CDC funded eight recipients as part of the 2016-2021 round of the SRCP to work with food service organisations in eight settings to increase the availability and purchase of lower-sodium food options. PARTICIPANTS Eight SRCP recipients and twenty of their partners. RESULTS At the recipient level, average cost per person reached was $10, and average cost per food service organisation reached was $42 917. At the food service organisation level, median monthly cost per food item impacted by recipe modification or product substitution was $684. Cost-effectiveness analyses showed that, if sustained, the programme is cost saving (i.e. the reduction in medical costs is greater than the implementation costs) in the target population by $1·82 through 2025 and $2·09 through 2040. CONCLUSIONS By providing evidence of the cost-effectiveness of a real-world sodium reduction initiative, this study can help inform decisions by public health organisations about related CVD prevention interventions.
Collapse
|
12
|
Song J, Brown MK, Cobb LK, Jacobson MF, Ide N, MacGregor GA, He FJ. Delayed Finalization of Sodium Targets in the United States May Cost Over 250 000 Lives by 2031. Hypertension 2022; 79:798-808. [PMID: 35184613 DOI: 10.1161/hypertensionaha.121.18475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City (L.K.C., N.I.)
| | | | - Nicole Ide
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City (L.K.C., N.I.)
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| |
Collapse
|
13
|
Zeng Y, Xu Z, Rao Y. Predicting the effectiveness of interventions on population-level sodium reduction: A simulation modeling study. Health Sci Rep 2022; 5:e540. [PMID: 35284655 PMCID: PMC8900977 DOI: 10.1002/hsr2.540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 01/03/2023] Open
Abstract
Background and Aims Interventions that significantly reduce dietary sodium intake are anticipated to decrease gastric cancer (GCa) burden. However, the optimal restriction strategies remain unknown at present. This study aims to understand where and to what extent policies modifying sodium consumption change the distribution of GCa burden, and the effects of potential salt reduction strategies in China. Methods The synthetic population in this microscopic simulation study is close to reality. We incorporated estimates of dietary patterns and GCa risk into the model of excess salt consumption. These estimates and simulated population were obtained from the China Health and Nutrition Survey, Global Burden of Disease Project, and the sixth census of China's National Bureau of Statistics, respectively. Results In the no intervention scenario, we estimated that disease burdens due to excess sodium intake would be at 472.9 million disability-adjusted life years (DALYs) nationally between 2010 and 2030 (95% credible interval [CrI]: 371.1-567.7). The GCa burden caused by high sodium is projected to have a disproportionate impact on the central and southern provinces of China (9.2 and 4.5 million DALYs, respectively). Implementing a cooking salt substitute strategy would be expected to avoid a larger portion of GCa burden (about 67.2%, 95% CrI: 66.8%-67.6%) than the salt-restriction spoon program (about 16.7%, 95% CrI: 16.1%-17.4%). Conclusion Dietary salt reduction policy is very powerfully effective in reducing the GCa burden overall. It is expected that proposed salt substitutes are more effective than traditional salt-restriction spoons to avoid increased inequality.
Collapse
Affiliation(s)
- Yiping Zeng
- Department of Management Science and EngineeringBusiness School, Sichuan UniversityChengduChina
| | - Zeshui Xu
- Department of Management Science and EngineeringBusiness School, Sichuan UniversityChengduChina
| | - Yu Rao
- Department of BioengineeringFood Science and Bioengineering School, Xihua UniversityChengduChina
| |
Collapse
|
14
|
Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2499] [Impact Index Per Article: 1249.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
15
|
Webster J, Waqa G, Thow AM, Allender S, Lung T, Woodward M, Rogers K, Tukana I, Kama A, Wilson D, Mounsey S, Dodd R, Reeve E, McKenzie BL, Johnson C, Bell C. Scaling-up food policies in the Pacific Islands: protocol for policy engagement and mixed methods evaluation of intervention implementation. Nutr J 2022; 21:8. [PMID: 35105346 PMCID: PMC8807012 DOI: 10.1186/s12937-022-00761-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is a crisis of non-communicable diseases (NCDs) in the Pacific Islands, and poor diets are a major contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food systems. Pacific Island leaders have adopted a range of food policies and regulations to improve diets. This includes taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increasing evidence for the effectiveness of such policies globally, there is a lack of local context-specific evidence about how to implement them effectively in the Pacific. METHODS Our 5-year collaborative project will test the feasibility and effectiveness of policy interventions to reduce salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and monitoring of evidence-informed interventions. Specific objectives are to: (1) conduct policy landscape analysis to understand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomarkers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies to reduce salt and sugar consumption; (4) evaluate the impact, process and cost effectiveness of implementing these policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support scale-up of future interventions. DISCUSSION The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes.
Collapse
Affiliation(s)
- Jacqui Webster
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia.
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Steven Allender
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Thomas Lung
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia.,George Institute for Global Health, Oxford University, Oxford, UK.,Johns Hopkins University, Baltimore, USA
| | - Kris Rogers
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | | | - Ateca Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - Donald Wilson
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, Fiji National University, Suva, Fiji
| | - Sarah Mounsey
- Menzies Centre for Health Policy, The University of Sydney, Sydney, Australia
| | - Rebecca Dodd
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Erica Reeve
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Briar Louise McKenzie
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Claire Johnson
- George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, New South Wales, 2046, Australia
| | - Colin Bell
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, Australia
| |
Collapse
|
16
|
Vinitha K, Sethupathy P, Moses J, Anandharamakrishnan C. Conventional and emerging approaches for reducing dietary intake of salt. Food Res Int 2022; 152:110933. [DOI: 10.1016/j.foodres.2021.110933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/08/2021] [Accepted: 12/28/2021] [Indexed: 01/14/2023]
|
17
|
Moran AJ, Wang J, Sharkey AL, Dowling EA, Curtis CJ, Kessler KA. US Food Industry Progress Toward Salt Reduction, 2009-2018. Am J Public Health 2022; 112:325-333. [PMID: 35080946 PMCID: PMC8802589 DOI: 10.2105/ajph.2021.306571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives. To determine the extent to which reductions in sodium during the National Salt Reduction Initiative (NSRI) target-setting period (2009-2014) continued after 2014. Methods. We used the NSRI Packaged Food Database, which links products in the top 80% of US packaged food sales to nutrition information, to assess the proportion of products meeting the NSRI targets and the sales-weighted mean sodium density (mg/100 g) of 54 packaged food categories between 2009 and 2018. Results. There was an 8.5% sales-weighted mean reduction in sodium between 2009 and 2018. Most change occurred between 2009 and 2012, with little change in subsequent years. The proportion of packaged foods meeting the 2012 and 2014 targets increased 48% and 45%, respectively, from 2009 to 2012, with no additional improvements through 2018. Conclusions. Food manufacturers reduced sodium in the early years of the NSRI, but progress slowed after 2012. Public Health Implications. The US Food and Drug Administration just released 2.5-year voluntary sodium targets for packaged and restaurant food. Continued assessment of industry progress and further target setting by the Food and Drug Administration is crucial to reducing sodium in the food supply.
Collapse
Affiliation(s)
- Alyssa J. Moran
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Jiangxia Wang
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Andrea L. Sharkey
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Erin A. Dowling
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christine Johnson Curtis
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Kimberly A. Kessler
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| |
Collapse
|
18
|
Vidaña-Pérez D, Braverman-Bronstein A, Zepeda-Tello R, Camacho-García-Formentí D, Colchero MA, Rivera-Dommarco JA, Popkin BM, Barrientos-Gutierrez T. Equitability of Individual and Population Interventions to Reduce Obesity: A Modeling Study in Mexico. Am J Prev Med 2022; 62:105-113. [PMID: 34446315 DOI: 10.1016/j.amepre.2021.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. METHODS Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. RESULTS The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. CONCLUSIONS Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.
Collapse
Affiliation(s)
- Dèsirée Vidaña-Pérez
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Rodrigo Zepeda-Tello
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - M Arantxa Colchero
- Center for Health Services Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; UNC Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
19
|
The impact of baseline potassium intake on the dose-response relation between sodium reduction and blood pressure change: systematic review and meta-analysis of randomized trials. J Hum Hypertens 2021; 35:946-957. [PMID: 33674705 DOI: 10.1038/s41371-021-00510-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 02/03/2023]
Abstract
Sodium and potassium appear to interact with each other in their effects on blood pressure with potassium supplementation having a greater blood pressure lowering-effect when sodium intake is high. Whether the effect of sodium reduction on blood pressure varies according to potassium intake levels is unclear. We carried out a systematic review and meta-analysis to examine the impact of baseline potassium intake on blood pressure response to sodium reduction in randomized trials in adult populations, with sodium and potassium intake estimated from 24-h urine samples. We included 68 studies involving 5708 participants and conducted univariable and multivariable meta-regression. The median intake of baseline potassium was 67.7 mmol (Interquartile range: 54.6-76.4 mmol), and the mean reduction in sodium intake was 128 mmol (95% CI: 107-148). Multivariable meta-regression that included baseline 24-h urinary potassium excretion, age, ethnicity, baseline blood pressure, change in 24-h urinary sodium excretion, as well as the interaction between baseline 24-h urinary potassium excretion and change in 24-h urinary sodium excretion did not identify a significant association of baseline potassium intake levels with the blood pressure reduction achieved with a 50 mmol lowering of sodium intake (p > 0.05 for both systolic and diastolic blood pressure). A higher starting level of blood pressure was consistently associated with a greater blood pressure reduction from reduced sodium consumption. However, the nonsignificant findings may subject to the limitations of the data available. Additional studies with more varied potassium intake levels would allow a more confident exclusion of an interaction.
Collapse
|
20
|
Santos JA, Tekle D, Rosewarne E, Flexner N, Cobb L, Al-Jawaldeh A, Kim WJ, Breda J, Whiting S, Campbell N, Neal B, Webster J, Trieu K. A Systematic Review of Salt Reduction Initiatives Around the World: A Midterm Evaluation of Progress Towards the 2025 Global Non-Communicable Diseases Salt Reduction Target. Adv Nutr 2021; 12:1768-1780. [PMID: 33693460 PMCID: PMC8483946 DOI: 10.1093/advances/nmab008] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
In 2013, the WHO recommended that all member states aim to reduce population salt intake by 30% by 2025. The year 2019 represents the midpoint, making it a critical time to assess countries' progress towards this target. This review aims to identify all national salt reduction initiatives around the world in 2019, and to quantify countries' progress in achieving the salt reduction target. Relevant data were identified through searches of peer-reviewed and gray literature, supplemented with responses from prefilled country questionnaires sent to known country leads of salt reduction or salt champions, WHO regional representatives, and international experts to request further information. Core characteristics of each country's strategy, including evaluations of program impact, were extracted and summarized. A total of 96 national salt reduction initiatives were identified, representing a 28% increase in the number reported in 2014. About 90% of the initiatives were multifaceted in approach, and 60% had a regulatory component. Approaches include interventions in settings (n= 74), food reformulation (n = 68), consumer education (n = 50), front-of-pack labeling (n = 48), and salt taxation (n = 5). Since 2014, there has been an increase in the number of countries implementing each of the approaches, except consumer education. Data on program impact were limited. There were 3 countries that reported a substantial decrease (>2 g/day), 9 that reported a moderate decrease (1-2 g/day), and 5 that reported a slight decrease (<1 g/day) in the mean salt intake over time, but none have yet met the targeted 30% relative reduction in salt intake from baseline. In summary, there has been an increase in the number of salt reduction initiatives around the world since 2014. More countries are now opting for structural or regulatory approaches. However, efforts must be urgently accelerated and replicated in other countries and more rigorous monitoring and evaluation of strategies is needed to achieve the salt reduction target.
Collapse
Affiliation(s)
- Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Dejen Tekle
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Nadia Flexner
- University of Toronto, Toronto, Ontario, Canada
- Pan American Health Organization—World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Laura Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City, NY, USA
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Warrick Junsuk Kim
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Joao Breda
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Stephen Whiting
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| |
Collapse
|
21
|
Filler G, Salerno F, McIntyre CW, de Ferris MEDG. Animal, Human, and 23Na MRI Imaging Evidence for the Negative Impact of High Dietary Salt in Children. CURRENT PEDIATRICS REPORTS 2021; 9:110-117. [PMID: 34567839 PMCID: PMC8449209 DOI: 10.1007/s40124-021-00249-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF THE REVIEW Conditions typically prevalent in adults such as hypertension, kidney stones, osteoporosis, and chronic kidney disease are increasing among adolescents and young adults (AYA). The purpose of this review is to describe the association of these conditions to a high salt diet among pediatric patients. RECENT FINDINGS We present animal, human, and 23Na MRI evidence associated with the negative impact of high dietary salt in children. Special focus is placed on novel 23Na MRI imaging which reveals the important concept of a third compartment for sodium storage in soft tissue. Finally, we make recommendations on who should not be on a low salt diet. SUMMARY A high salt intake predisposes children and AYA to considerable morbidity. We exhort the reader to engage in advocacy efforts to curve the incidence and prevalence of high salt-related life-limiting conditions.
Collapse
Affiliation(s)
- Guido Filler
- Departments of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON E3-206N6A 5W9 Canada
- Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
| | - Fabio Salerno
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
- Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Christopher William McIntyre
- Departments of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON E3-206N6A 5W9 Canada
- Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
- Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | | |
Collapse
|
22
|
Yin X, Liu H, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Li KC, Pearson SA, Neal B, Tian M. Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan. JMIR Public Health Surveill 2021; 7:e27423. [PMID: 33985938 PMCID: PMC8319774 DOI: 10.2196/27423] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/19/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. Objective The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. Results A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Conclusions Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. International Registered Report Identifier (IRRID) RR2-10.1111/jch.14054
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - J Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura K Cobb
- Resolve to Save Lives, Initiative of Vital Strategies, New York City, NY, United States
| | - Ka Chun Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Public Health, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| |
Collapse
|
23
|
Park HK, Lee Y, Kang BW, Kwon KI, Kim JW, Kwon OS, Cobb LK, Campbell NRC, Blakeman DE, Kim CI. Progress on sodium reduction in South Korea. BMJ Glob Health 2021; 5:bmjgh-2019-002028. [PMID: 32404470 PMCID: PMC7228482 DOI: 10.1136/bmjgh-2019-002028] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction High dietary sodium is a leading contributor to hypertension, and hypertension is the leading underlying cause of death globally. There is a robust body of evidence supporting the health benefits of sodium reduction. Sodium intake in South Korea is high, with about half the population consuming >4000 mg/day, twice the recommended upper limit. Methods In 2012, South Korea implemented its National Plan to Reduce Sodium Intake, with a goal of reducing population sodium consumption by 20%, to 3900 mg/day, by 2020. The plan included five key components: (1) a consumer awareness campaign designed to change food consumption behaviours; (2) increased availability of low-sodium foods at schools and worksites; (3) increased availability of low-sodium meals in restaurants; (4) voluntary reformulation of processed foods to lower sodium content; and (5) development of low-sodium recipes for food prepared at home. Monitoring and evaluation included tracking sodium intake and sources of dietary sodium using the Korea National Health and Nutrition Examination Survey. Results By 2014, South Korea had reduced dietary sodium consumption among adults by 23.7% compared to a survey conducted in 2010 prior to implementation of a nationwide salt reduction campaign that used this comprehensive, multipronged approach. The reductions in sodium intake were accompanied by reductions in population blood pressure and hypertension prevalence. Although causal associations between the sodium reduction programme and reduced sodium intake cannot be made, the declines occurred with the introduction of the programme. Conclusion Multicomponent interventions have great potential to reduce population sodium intake. Lessons learnt from South Korea could be applied to other countries and are likely very relevant to other Asian countries with similar food sources and consumption profiles.
Collapse
Affiliation(s)
- Hye-Kyung Park
- Director, Center for Children's Foodservice Management, Osong, Republic of Korea
| | - Yoonna Lee
- Department of Food & Nutrition, Shingu College, Seongnam, Republic of Korea
| | - Baeg-Won Kang
- Korea Ministry of Food and Drug Safety, Osong-eup, Republic of Korea
| | - Kwang-Il Kwon
- Nutrition & Functional Food Research Team, Korea Ministry of Food and Drug Safety, Osong-eup, Republic of Korea
| | - Jong-Wook Kim
- ICT Management & Statistics Office, Korea Ministry of Food and Drug Safety, Osong-eup, Republic of Korea
| | - Oh-Sang Kwon
- Imported Food Safety Policy Bureau, Korea Ministry of Food and Drug Safety, Osong-eup, Republic of Korea
| | - Laura K Cobb
- Cardiovascular Health Initiative, Resolve to Save Lives, New York, New York, USA
| | | | - Drew E Blakeman
- Cardiovascular Health Initiative, Resolve to Save Lives, New York, New York, USA
| | - Cho-Il Kim
- Executive Director, Korea Health Industry Development Institute, Cheongju, Republic of Korea
| |
Collapse
|
24
|
Smith BT, Hack S, Jessri M, Arcand J, McLaren L, L’Abbé MR, Anderson LN, Hobin E, Hammond D, Manson H, Rosella LC, Manuel DG. The Equity and Effectiveness of Achieving Canada's Voluntary Sodium Reduction Guidance Targets: A Modelling Study Using the 2015 Canadian Community Health Survey-Nutrition. Nutrients 2021; 13:nu13030779. [PMID: 33673550 PMCID: PMC7997239 DOI: 10.3390/nu13030779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background: High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada’s voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods: We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey—Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results: In children aged 2–8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: −45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9–18 (96 mg/day, 95%CI: −149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: −30,327; female: −45 mg/day, 95%CI: −141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians’ are above the CDRR thresholds. Conclusion: Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.
Collapse
Affiliation(s)
- Brendan T. Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- Correspondence:
| | - Salma Hack
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
| | - Mahsa Jessri
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada;
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Heather Manson
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- ICES, Toronto, ON K1Y 4E9, Canada;
| | - Douglas G. Manuel
- ICES, Toronto, ON K1Y 4E9, Canada;
- Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, ON K1H 8L6, Canada
- Health Analysis Division, Statistics Canada, Ottawa, ON K1A 0T6, Canada
- Department of Family Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
| |
Collapse
|
25
|
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
26
|
Wang L, Du J, Cao W, Sun S. Trends of stroke attributable to high sodium intake at the global, regional, and national levels from 1990 to 2019: a population-based study. Neurol Res 2020; 43:474-481. [PMID: 33377423 DOI: 10.1080/01616412.2020.1867950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: High sodium intake is associated with a higher risk of stroke. However, global patterns and trends in the stroke burden attributable to high sodium intake have not been systematically assessed.Methods: We used the numbers and age-standardized mortality rate (ASMR), and disability-adjusted life years (DALYs) rate (ASDR) of the stroke burden attributable to high sodium intake by sex, socio-demographic index (SDI), and country, obtained from the Global Burden of Disease Study (GBD) 2019. We calculated the estimated annual percentage changes (EAPCs) to assess the trends of ASMR and ASDR of the disease burden attributable to high sodium intake between 1990 and 2019. We further calculated the contribution of changes in population growth, population aging, and mortality or DALYs to changes in total stroke deaths and DALYs.Results: From 1990 to 2019, the global burden of stroke attributable to high sodium intake changed significantly, from a universal burden in Asia and Europe to one that mainly affected some countries in Asia and Oceania. This change was due to the combined effects of demographic changes and changes in mortality or DALY rates. For countries in Asia and Oceania, the effects of population aging and population growth outweighed the effects of declining mortality and DALY rates, resulting in an absolute increase in strokes attributable to high sodium intake.Conclusion: Although the age-standardized global stroke burden attributable to high sodium intake has declined from 1990 to 2019, the burdens in some Asia and Oceania countries, particularly China, remain high.
Collapse
Affiliation(s)
- Lina Wang
- Department of Neurology, Xi'an Ninth Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Jianqiang Du
- Key Laboratory of Biomedical Information Engineering of Education Ministry, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Gallani MC, Proulx-Belhumeur A, Almeras N, Després JP, Doré M, Giguère JF. Development and Validation of a Salt Food Frequency Questionnaire (FFQ-Na) and a Discretionary Salt Questionnaire (DSQ) for the Evaluation of Salt Intake among French-Canadian Population. Nutrients 2020; 13:nu13010105. [PMID: 33396829 PMCID: PMC7824404 DOI: 10.3390/nu13010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/20/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
We assessed the reliability and validity of a Salty Food Frequency Questionnaire for Sodium (FFQ-Na) and a Discretionary Salt Questionnaire (DSQ) developed for the French-Canadian population. The reliability was evaluated according to temporal stability over a 7-15 day interval (n = 36). Validity was evaluated by testing the tools against a 24-h urine sodium excretion (24 h Uri-Na) and a 3-day food record, and this at individual and group levels (n = 164). The intra-class coefficients (ICC) values for the test-retest of the DSQ, the FFQ-Na and the two questionnaires combined were 0.73, 0.97 and 0.98 respectively. Correlations of the FFQ-Na with the 24 h Uri-Na and the 3-day food record were 0.3 (p < 0.001) and 0.35 (p < 0.001) respectively. The DSQ showed no significant correlation with the reference measures. The correlation between the two methods combined were 0.29 (p < 0.001) with the 24 h Uri-Na and 0.31 (p < 0.001) with the 3-day food record. The results of Bland-Altman indicated that for the combined questionnaires, there was a bias of measurement (underestimation of intake), but it was constant for every level of intake according to the reference measures. Finally, the cross-classification indicated an acceptable proportion of agreement, but a rate between 20% and 30% of classification in the opposite quartile. In conclusion, the developed tools are reliable and showed some facets of validity.
Collapse
Affiliation(s)
- Maria Cecilia Gallani
- Faculté des Sciences Infirmières, Université Laval, Québec, QC G1V 0A6, Canada; (A.P.-B.); (M.D.); (J.-F.G.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada;
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 405710)
| | - Alexandra Proulx-Belhumeur
- Faculté des Sciences Infirmières, Université Laval, Québec, QC G1V 0A6, Canada; (A.P.-B.); (M.D.); (J.-F.G.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada;
| | - Natalie Almeras
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada;
- Département de Kinésiologie, Faculté de Médicine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Jean-Pierre Després
- Département de Kinésiologie, Faculté de Médicine, Université Laval, Québec, QC G1V 0A6, Canada;
- VITAM—Centre de Recherche en Santé Durable, Québec, QC G1J 0A4, Canada
| | - Michel Doré
- Faculté des Sciences Infirmières, Université Laval, Québec, QC G1V 0A6, Canada; (A.P.-B.); (M.D.); (J.-F.G.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada;
| | - Jean-François Giguère
- Faculté des Sciences Infirmières, Université Laval, Québec, QC G1V 0A6, Canada; (A.P.-B.); (M.D.); (J.-F.G.)
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC G1V 4G5, Canada;
| |
Collapse
|
28
|
Wenzel M, Haffer H, Wang P, Richter M, Chun FKH, Kornberger A, Beiras-Fernandez A. Influence of an Early Application of Mammalian Target of Rapamycin Inhibitors Everolimus and Sirolimus on Acute Vascular Inflammatory Responses After Ischemia-Reperfusion Injury. EXP CLIN TRANSPLANT 2020; 19:50-57. [PMID: 33272162 DOI: 10.6002/ect.2020.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Ischemia-reperfusion injury is correlated with a substantial inflammatory response. Inflammation triggers the migration of cells through vessel endothelium and leads to serious tissue injury. Our hypothesis was that an early application of mammalian target of rapamycin inhibitors has an impact on human vessels after ischemia-reperfusion injury. MATERIALS AND METHODS After exposure to ischemia for 5 hours, human vessels (veins and arteries) from 20 patients were reperfused for 120 minutes in an in vitro bioreactor with heparinized human blood after oxygenation and warming to 37 °C. The vessels were treated with mammalian target of rapamycin inhibitor everolimus (5 ng/mL, n = 7) or sirolimus (10 ng/mL, n = 6). As a control group, untreated human vessels were reperfused (n = 7). During the reperfusion period, blood samples were collected continuously (after 0, 15, 30, 60, 120 minutes); vessel biopsies were performed at the end. Oxygen consumption was measured during reperfusion to determine vessel viability. Inflammatory markers (interleukin 6, tumor necrosis factor α, vascular endothelial growth factor) were analyzed in blood samples. To quantify vascular inflammation, we investigated the expression of CD11 and CD31. RESULTS Physiological oxygen consumption and pH values verified vessel viability. After reperfusion, interleukin 6 and vascular endothelial growth factor levels were significantly increased in the control group over time, whereas everolimus and sirolimus showed no significant differences. Furthermore, tumor necrosis factor α level increased significantly in the sirolimus group, whereas the everolimus and control groups showed constant values. A significant decrease of expression of CD11b and CD31 in both mammalian target of rapamycin inhibitor cohorts compared with control cohort was investigated. CONCLUSIONS Early use of mammalian target of rapamycin inhibitors may limit an inflammatory rise of interleukin 6 and vascular endothelial growth factor after ischemia-reperfusion injury and could be associated with a restriction in vascular cell transmigration.
Collapse
Affiliation(s)
- Mike Wenzel
- From the Department of Urology, Goethe University Hospital Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | |
Collapse
|
29
|
Bann D, Fluharty M, Hardy R, Scholes S. Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016. BMC Med 2020; 18:338. [PMID: 33203396 PMCID: PMC7672962 DOI: 10.1186/s12916-020-01800-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High blood pressure (BP) is a key modifiable determinant of cardiovascular disease and a likely determinant of other adverse health outcomes. While socioeconomic inequalities in BP are well documented, it remains unclear (1) how these inequalities have changed across time, given improvements over time in the detection and treatment of high BP (hypertension); (2) whether BP inequalities are present below and above hypertension treatment thresholds; and (3) whether socioeconomic position (SEP) across life has cumulative effects on BP. We sought to address these gaps using evidence from two complementary sources: birth cohort and repeated cross-sectional datasets. METHODS We used three British birth cohort studies-born in 1946, 1958, and 1970-with BP measured at 43-46 years (in 1989, 2003, and 2016), and 21 repeated cross-sectional datasets-the Health Survey for England (HSE), with BP measured among adults aged ≥ 25 years (1994-2016). Adult education attainment was used as an indicator of SEP in both datasets; childhood father's social class was used as an alternative indicator of (early life) SEP in cohorts. Adjusting for the expected average effects of antihypertensive medication use, we used linear regression to quantify SEP differences in mean systolic BP (SBP), and quantile regression to investigate whether inequalities differed across SBP distributions-below and above hypertension treatment thresholds. RESULTS In both datasets, lower educational attainment was associated with higher SBP, with similar absolute magnitudes of inequality across the studied period. Differences in SBP by education (Slope Index of Inequality) based on HSE data were 3.0 mmHg (95% CI 1.8, 4.2) in 1994 and 4.3 mmHg (2.3, 6.3) in 2016. Findings were similar for diastolic BP (DBP) and survey-defined hypertension. Inequalities were found across the SBP distribution in both datasets-below and above the hypertension threshold-yet were larger at the upper tail; in HSE, median SBP differences were 2.8 mmHg (1.7, 3.9) yet 5.6 mmHg (4.9, 6.4) at the 90th quantile. Adjustment for antihypertensive medication use had little impact on the magnitude of inequalities; in contrast, associations were largely attenuated after adjustment for body mass index. Finally, cohort data suggested that disadvantage in early and adult life had cumulative independent associations with BP: cohort-pooled differences in SBP were 5.0 mmHg (3.8, 6.1) in a score combining early life social class and own education, yet were 3.4 mmHg (2.4, 4.4) for education alone. CONCLUSION Socioeconomic inequalities in BP have persisted from 1989 to 2016 in Britain/England, despite improved detection and treatment of high BP. To achieve future reductions in BP inequalities, policies addressing the wider structural determinants of high BP levels are likely required, particularly those curtailing the obesogenic environment-targeting detection and treatment alone is unlikely to be sufficient.
Collapse
Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK.
| | - Meg Fluharty
- Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK
| | - Rebecca Hardy
- CLOSER, Social Research Institute, University College London, London, UK
| | - Shaun Scholes
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
30
|
He FJ, Tan M, Ma Y, MacGregor GA. Salt Reduction to Prevent Hypertension and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:632-647. [PMID: 32057379 DOI: 10.1016/j.jacc.2019.11.055] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022]
Abstract
There is strong evidence for a causal relationship between salt intake and blood pressure. Randomized trials demonstrate that salt reduction lowers blood pressure in both individuals who are hypertensive and those who are normotensive, additively to antihypertensive treatments. Methodologically robust studies with accurate salt intake assessment have shown that a lower salt intake is associated with a reduced risk of cardiovascular disease, all-cause mortality, and other conditions, such as kidney disease, stomach cancer, and osteoporosis. Multiple complex and interconnected physiological mechanisms are implicated, including fluid homeostasis, hormonal and inflammatory mechanisms, as well as more novel pathways such as the immune response and the gut microbiome. High salt intake is a top dietary risk factor. Salt reduction programs are cost-effective and should be implemented or accelerated in all countries. This review provides an update on the evidence relating salt to health, with a particular focus on blood pressure and cardiovascular disease, as well as the potential mechanisms.
Collapse
Affiliation(s)
- Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Yuan Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
31
|
Dehmer SP, Cogswell ME, Ritchey MD, Hong Y, Maciosek MV, LaFrance AB, Roy K. Health and Budgetary Impact of Achieving 10-Year U.S. Sodium Reduction Targets. Am J Prev Med 2020; 59:211-218. [PMID: 32532672 PMCID: PMC7768612 DOI: 10.1016/j.amepre.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study estimates the health, economic, and budgetary impact resulting from graduated sodium reductions in the commercially produced food supply of the U.S., which are consistent with draft U.S. Food and Drug Administration voluntary guidance and correspond to Healthy People 2020 objectives and the 2015-2020 Dietary Guidelines for Americans. METHODS Reduction in mean U.S. dietary sodium consumption to 2,300 mg/day was implemented in a microsimulation model designed to evaluate prospective cardiovascular disease-related policies in the U.S. POPULATION The analysis was conducted in 2018-2020, and the microsimulation model was constructed using various data sources from 1948 to 2018. Modeled outcomes over 10 years included prevalence of systolic blood pressure ≥140 mmHg; incident myocardial infarction, stroke, cardiovascular disease events, and cardiovascular disease-related mortality; averted medical costs by payer in 2017 U.S. dollars; and productivity. RESULTS Reducing sodium consumption is expected to reduce the number of people with systolic blood pressure ≥140 mmHg by about 22% and prevent approximately 895.2 thousand cardiovascular disease events (including 218.9 thousand myocardial infarctions and 284.5 thousand strokes) and 252.5 thousand cardiovascular disease-related deaths over 10 years in the U.S. Savings from averted disease costs are expected to total almost $37 billion-most of which would be attributed to Medicare ($18.4 billion) and private insurers ($13.4 billion)-and increased productivity from reduced disease burden and premature mortality would account for another $18.2 billion in gains. CONCLUSIONS Systemic sodium reductions in the U.S. food supply can be expected to produce substantial health and economic benefits over a 10-year period, particularly for Medicare and private insurers.
Collapse
Affiliation(s)
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
32
|
Abstract
Expensive and extensive studies on the epidemiology of excessive Na intake and its pathology have been conducted over four decades. The resultant consensus that dietary Na is toxic, as well as the contention that it is less so, ignores the root cause of the attractiveness of salted food. The extant hypotheses are that most Na is infiltrated into our bodies via heavily salted industrialised food without our knowledge and that mere exposure early in life determines lifelong intake. However, these hypotheses are poorly evidenced and are meagre explanations for the comparable salt intake of people worldwide despite their markedly different diets. The love of salt begins at birth for some, vacillates in infancy, climaxes during adolescent growth, settles into separate patterns for men and women in adulthood and, with age, fades for some and persists for others. Salt adds flavour to food. It sustains and protects humans in exertion, may modulate their mood and contributes to their ailments. It may have as yet unknown benefits that may promote its delectability, and it generates controversy. An understanding of the predilection for salt should allow a more evidence-based and effective reduction of the health risks associated with Na surfeit and deficiency. The purpose of this brief review is to show the need for research into the determinants of salt intake by summarising the little we know.
Collapse
Affiliation(s)
- Micah Leshem
- School of Psychological Sciences, The University of Haifa, Haifa3498838, Israel
| |
Collapse
|
33
|
Liu H, Huffman MD, Trieu K. The role of contextualisation in enhancing non-communicable disease programmes and policy implementation to achieve health for all. Health Res Policy Syst 2020; 18:38. [PMID: 32303249 PMCID: PMC7164194 DOI: 10.1186/s12961-020-00553-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
The September 2019 United Nations’ High-Level Meeting renewed political commitments to invest in universal health coverage by strengthening health systems, programmes and policies to achieve ‘health for all’. This Political Declaration is relevant to addressing the increasing global burden of non-communicable diseases, but how can evidence-based programmes and policies be meaningfully implemented and integrated into local contexts? In this Commentary, we describe how the process of contextualisation and associated tools, such as ecological frameworks, implementation research frameworks, health system indicators, effective system strengthening strategies and evidence mapping databases with priority-setting, can enhance the implementation and integration of non-communicable disease prevention and control policies and programmes. Examples across health platforms include (1) population approaches to reducing excess sodium intake, (2) fixed-dose combination therapy for cardiovascular disease prevention and control, and (3) health systems strengthening for improving the quality and safety of cardiovascular care. Contextualisation is needed to transfer evidence into locally relevant and impactful policies and programmes. The systematic and comprehensive use of contextualisation tools leverages key implementation research principles to achieve ‘health for all’.
Collapse
Affiliation(s)
- Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Preventive Medicine and Center for Global Cardiovascular Health, Northwestern University's Feinberg School of Medicine, Chicago, United States of America
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
34
|
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4861] [Impact Index Per Article: 1215.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
Collapse
|
35
|
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5341] [Impact Index Per Article: 1068.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
36
|
He FJ, MacGregor GA. Role of salt intake in prevention of cardiovascular disease: controversies and challenges. Nat Rev Cardiol 2019; 15:371-377. [PMID: 29713009 DOI: 10.1038/s41569-018-0004-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to <5 g daily. This recommendation has been challenged by several studies, including cohort studies, which have suggested a J-shaped relationship between salt intake and CVD risk. However, these studies had severe methodological problems, such as reverse causality and measurement error due to assessment of salt intake by spot urine. Consequently, findings from such studies should not be used to derail vital public health policy. Gradual, stepwise salt reduction as recommended by the WHO remains an achievable, affordable, effective, and important strategy to prevent CVD worldwide. The question now is how to reduce population salt intake. In most developed countries, salt reduction can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. The UK has pioneered a successful salt-reduction programme by setting incremental targets for >85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings.
Collapse
Affiliation(s)
- Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Graham A MacGregor
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
37
|
Wamba AA, Takah NF, Johnman C. The impact of interventions for the primary prevention of hypertension in Sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0219623. [PMID: 31323041 PMCID: PMC6641142 DOI: 10.1371/journal.pone.0219623] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The prevalence of hypertension is highest in the African Region with 46% of adults aged 25 and above diagnosed with hypertension, while the lowest prevalence of 35% is found in the Americas. There is sparse evidence on the approaches used to prevent hypertension in Sub-Saharan Africa and the effectiveness of these approaches. It is therefore imperative that a systematic review; which synthesises all the available evidence on the approaches and their impact is conducted to inform public health policy and practice. OBJECTIVE To synthesise evidence on the interventions used for the primary prevention of hypertension in Sub-Saharan Africa and to evaluate the effectiveness of these interventions in reducing blood pressure, hypertension prevalence and the risk factors for hypertension. METHODS AND RESULTS This systematic review was reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographic databases were searched on the 4th-17th of January 2018 from 1970 to January 2018 and on the 5th of May 2019 from 1970 to May 2019, for studies focusing on the primary prevention of hypertension in communities in Sub-Saharan Africa. A narrative synthesis was conducted based on study interventions and outcomes. Also, a meta-analysis was carried out using pooled mean differences; using a random effects model of generic inverse variance option in RevMan. A total of 854 studies were identified after deduplication, with thirteen studies meeting the inclusion criteria. Six studies with varying interventions and methodologies observed a significant pooled reduction in systolic blood pressure of -3.3mmHg (95%CI -4.64 to -1.96) and a reduction of -2.26mmHg (95%CI -6.36 to 1.85) in diastolic blood pressure, which was not statistically significant (p = 0.28). Also, moderate to significant heterogeneity was observed (I2 = 68% and 99%) for the systolic and diastolic blood pressure respectively. Intervention and study design accounted for 100% heterogeneity for both systolic and diastolic blood pressure (r2 = 100%). CONCLUSION Health promotion and interventions targeting various risk factors of hypertension and, salt consumption restriction interventions have been employed in Sub-Saharan Africa with varying levels of success. We recommend that higher quality studies and a meta-analysis are needed to evaluate the impact of these interventions and to inform public health policy and practice.
Collapse
Affiliation(s)
- Akosua A. Wamba
- Emergency Department, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Noah F. Takah
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cathy Johnman
- Institute of Health and Well-being, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
38
|
Laverty AA, Kypridemos C, Seferidi P, Vamos EP, Pearson-Stuttard J, Collins B, Capewell S, Mwatsama M, Cairney P, Fleming K, O'Flaherty M, Millett C. Quantifying the impact of the Public Health Responsibility Deal on salt intake, cardiovascular disease and gastric cancer burdens: interrupted time series and microsimulation study. J Epidemiol Community Health 2019; 73:881-887. [PMID: 31320459 PMCID: PMC6820143 DOI: 10.1136/jech-2018-211749] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/27/2022]
Abstract
Background In 2011, England introduced the Public Health Responsibility Deal (RD), a public-private partnership (PPP) which gave greater freedom to the food industry to set and monitor targets for salt intakes. We estimated the impact of the RD on trends in salt intake and associated changes in cardiovascular disease (CVD) and gastric cancer (GCa) incidence, mortality and economic costs in England from 2011–2025. Methods We used interrupted time series models with 24 hours' urine sample data and the IMPACTNCD microsimulation model to estimate impacts of changes in salt consumption on CVD and GCa incidence, mortality and economic impacts, as well as equity impacts. Results Between 2003 and 2010 mean salt intake was falling annually by 0.20 grams/day among men and 0.12 g/d among women (P-value for trend both < 0.001). After RD implementation in 2011, annual declines in salt intake slowed statistically significantly to 0.11 g/d among men and 0.07 g/d among women (P-values for differences in trend both P < 0.001). We estimated that the RD has been responsible for approximately 9900 (interquartile quartile range (IQR): 6700 to 13,000) additional cases of CVD and 1500 (IQR: 510 to 2300) additional cases of GCa between 2011 and 2018. If the RD continues unchanged between 2019 and 2025, approximately 26 000 (IQR: 20 000 to 31,000) additional cases of CVD and 3800 (IQR: 2200 to 5300) cases of GCa may occur. Interpretation Public-private partnerships such as the RD which lack robust and independent target setting, monitoring and enforcement are unlikely to produce optimal health gains.
Collapse
Affiliation(s)
- Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.,MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Paul Cairney
- Department of History and Politics, University of Stirling, Stirling, Scotland
| | - Kate Fleming
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
39
|
Effect of Formulation, Labelling, and Taxation Policies on the Nutritional Quality of the Food Supply. Curr Nutr Rep 2019; 8:240-249. [DOI: 10.1007/s13668-019-00289-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
40
|
Morris RC, Pravenec M, Šilhavý J, DiCarlo SE, Kurtz TW. Small Amounts of Inorganic Nitrate or Beetroot Provide Substantial Protection From Salt-Induced Increases in Blood Pressure. Hypertension 2019; 73:1042-1048. [PMID: 30917704 PMCID: PMC6458074 DOI: 10.1161/hypertensionaha.118.12234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To reduce the risk of salt-induced hypertension, medical authorities have emphasized dietary guidelines promoting high intakes of potassium and low intakes of salt that provide molar ratios of potassium to salt of ≥1:1. However, during the past several decades, relatively few people have changed their eating habits sufficiently to reach the recommended dietary goals for salt and potassium. Thus, new strategies that reduce the risk of salt-induced hypertension without requiring major changes in dietary habits would be of considerable medical interest. In the current studies in a widely used model of salt-induced hypertension, the Dahl salt-sensitive rat, we found that supplemental dietary sodium nitrate confers substantial protection from initiation of salt-induced hypertension when the molar ratio of added nitrate to added salt is only ≈1:170. Provision of a low molar ratio of added nitrate to added salt of ≈1:110 by supplementing the diet with beetroot also conferred substantial protection against salt-induced increases in blood pressure. The results suggest that on a molar basis and a weight basis, dietary nitrate may be ≈100× more potent than dietary potassium with respect to providing substantial resistance to the pressor effects of increased salt intake. Given that leafy green and root vegetables contain large amounts of inorganic nitrate, these findings raise the possibility that fortification of salty food products with small amounts of a nitrate-rich vegetable concentrate may provide a simple method for reducing risk for salt-induced hypertension.
Collapse
Affiliation(s)
- R. Curtis Morris
- Department of Medicine, University of California, San Francisco, San Francisco, USA, 94143
| | - Michal Pravenec
- Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic, 14220
| | - Jan Šilhavý
- Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic, 14220
| | - Stephen E. DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, USA, 48824
| | - Theodore W. Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, USA, 94107-0134
| |
Collapse
|
41
|
Are You What You Eat? FUTURE FOODS 2019. [DOI: 10.1007/978-3-030-12995-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
42
|
Basto-Abreu A, Braverman-Bronstein A, Camacho-García-Formentí D, Zepeda-Tello R, Popkin BM, Rivera-Dommarco J, Hernández-Ávila M, Barrientos-Gutiérrez T. Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study. PLoS Med 2018; 15:e1002664. [PMID: 30289898 PMCID: PMC6173390 DOI: 10.1371/journal.pmed.1002664] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/31/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity. METHODS AND FINDINGS Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term. CONCLUSIONS Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.
Collapse
Affiliation(s)
- Ana Basto-Abreu
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | | | | | - Rodrigo Zepeda-Tello
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - Barry M. Popkin
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | | | - Mauricio Hernández-Ávila
- University Center of Los Altos, Tepatitlan de Morelos, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | | |
Collapse
|
43
|
Sustainable Public Procurement Policies on Promoting Scientific and Technological Innovation in China: Comparisons with the U.S., the UK, Japan, Germany, France, and South Korea. SUSTAINABILITY 2018. [DOI: 10.3390/su10072134] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
44
|
Functional foods for augmenting nitric oxide activity and reducing the risk for salt-induced hypertension and cardiovascular disease in Japan. J Cardiol 2018; 72:42-49. [PMID: 29544657 DOI: 10.1016/j.jjcc.2018.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/24/2022]
Abstract
High salt intake is one of the major dietary determinants of hypertension and cardiovascular disease in Japan and throughout the world. Although dietary salt restriction may be of clinical benefit in salt-sensitive individuals, many individuals may not wish, or be able to, reduce their intake of salt. Thus, identification of functional foods that can help protect against mechanistic abnormalities mediating salt-induced hypertension is an issue of considerable medical and scientific interest. According to the "vasodysfunction" theory of salt-induced hypertension, the hemodynamic abnormality initiating salt-induced increases in blood pressure usually involves subnormal vasodilation and abnormally increased vascular resistance in response to increased salt intake. Because disturbances in nitric oxide activity can contribute to subnormal vasodilator responses to increased salt intake that often mediate blood pressure salt sensitivity, increased intake of functional foods that support nitric oxide activity may help to reduce the risk for salt-induced hypertension. Mounting evidence indicates that increased consumption of traditional Japanese vegetables and other vegetables with high nitrate content such as table beets and kale can promote the formation of nitric oxide through an endothelial independent pathway that involves reduction of dietary nitrate to nitrite and nitric oxide. In addition, recent studies in animal models have demonstrated that modest increases in nitrate intake can protect against the initiation of salt-induced hypertension. These observations are: (1) consistent with the view that increased intake of many traditional Japanese vegetables and other nitrate rich vegetables, and of functional foods derived from such vegetables, may help maintain healthy blood pressure despite a high salt diet; (2) support government recommendations to increase vegetable intake in the Japanese population.
Collapse
|
45
|
Webster J, Pillay A, Suku A, Gohil P, Santos JA, Schultz J, Wate J, Trieu K, Hope S, Snowdon W, Moodie M, Jan S, Bell C. Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji. Nutrients 2018; 10:nu10020155. [PMID: 29385758 PMCID: PMC5852731 DOI: 10.3390/nu10020155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.
Collapse
MESH Headings
- Costs and Cost Analysis
- Cyclonic Storms
- Diet, Healthy/economics
- Diet, Healthy/ethnology
- Diet, Sodium-Restricted/economics
- Diet, Sodium-Restricted/ethnology
- Fast Foods/adverse effects
- Fast Foods/analysis
- Fast Foods/economics
- Fiji
- Focus Groups
- Food Industry/economics
- Food, Preserved/adverse effects
- Food, Preserved/analysis
- Food, Preserved/economics
- Health Knowledge, Attitudes, Practice/ethnology
- Health Plan Implementation/economics
- Health Promotion/economics
- Humans
- Hypertension/economics
- Hypertension/ethnology
- Hypertension/etiology
- Hypertension/prevention & control
- Information Dissemination
- Nutrition Surveys/economics
- Patient Compliance/ethnology
- Program Evaluation
- Public-Private Sector Partnerships/economics
- Sodium Chloride, Dietary/adverse effects
- Sodium Chloride, Dietary/analysis
Collapse
Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Arleen Suku
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Paayal Gohil
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Jillian Wate
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Silvia Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Colin Bell
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| |
Collapse
|
46
|
Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji. Nutrients 2017; 9:nu9121350. [PMID: 29231897 PMCID: PMC5748800 DOI: 10.3390/nu9121350] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022] Open
Abstract
Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3, p = 0.115). Sub-analysis showed a statistically significant reduction in female salt intake in the Central Division but no differential impact in relation to age or ethnicity. Whilst the low response rate means it is not possible to draw firm conclusions about these changes, the population salt intake in Fiji, at 10.3 g/day, is still twice the World Health Organization's (WHO) recommended maximum intake. This project also assessed iodine intake levels in women of child-bearing age and found that they were within recommended guidelines. Existing policies and programs to reduce salt intake and prevent iodine deficiency need to be maintained or strengthened. Monitoring to assess changes in salt intake and to ensure that iodine levels remain adequate should be built into future surveys.
Collapse
|
47
|
Cogswell ME, Patel SM, Yuan K, Gillespie C, Juan W, Curtis CJ, Vigneault M, Clapp J, Roach P, Moshfegh A, Ahuja J, Pehrsson P, Brookmire L, Merritt R. Modeled changes in US sodium intake from reducing sodium concentrations of commercially processed and prepared foods to meet voluntary standards established in North America: NHANES. Am J Clin Nutr 2017; 106:530-540. [PMID: 28701299 DOI: 10.3945/ajcn.116.145623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/08/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Approximately 2 in 3 US adults have prehypertension or hypertension that increases their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. Approximately 9 in 10 Americans consume excess sodium (≥2300 mg/d). Voluntary sodium standards for commercially processed and prepared foods were established in North America, but their impact on sodium intake is unclear.Objective: We modelled the potential impact on US sodium intake of applying voluntary sodium standards for foods.Design: We used NHANES 2007-2010 data for 17,933 participants aged ≥1 y to model predicted US daily mean sodium intake and the prevalence of excess sodium intake with the use of the standards of the New York City's National Salt Reduction Initiative (NSRI) and Health Canada for commercially processed and prepared foods. The Food and Nutrient Database for Dietary Studies food codes corresponding to foods reported by NHANES participants were matched to NSRI and Health Canada food categories, and the published sales-weighted mean percent reductions were applied.Results: The US population aged ≥1 y could have reduced their usual daily mean sodium intake of 3417 mg by 698 mg (95% CI: 683, 714 mg) by applying NSRI 2014 targets and by 615 mg (95% CI: 597, 634 mg) by applying Health Canada's 2016 benchmarks. Significant reductions could have occurred, regardless of age, sex, race/ethnicity, income, education, or hypertension status, up to a mean reduction in sodium intake of 850 mg/d in men aged ≥19 y by applying NSRI targets. The proportion of adults aged ≥19 y who consume ≥2300 mg/d would decline from 88% (95% CI: 86%, 91%) to 71% (95% CI: 68%, 73%) by applying NSRI targets and to 74% (95% CI: 71%, 76%) by applying Health Canada benchmarks.Conclusion: If established sodium standards are applied to commercially processed and prepared foods, a significant reduction of US sodium intake could occur.
Collapse
Affiliation(s)
- Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA
| | - Sheena M Patel
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA
| | - Keming Yuan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA
| | - WenYen Juan
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD
| | - Christine J Curtis
- Bureau of Chronic Disease Prevention and Tobacco Control, Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Michel Vigneault
- Bureau of Food Surveillance and Science Integration, Health Products and Food Branch, Food Directorate, Health Canada, Government of Canada, Ottawa, Ontario, Canada
| | - Jenifer Clapp
- Bureau of Chronic Disease Prevention and Tobacco Control, Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Paula Roach
- Bureau of Food Surveillance and Science Integration, Health Products and Food Branch, Food Directorate, Health Canada, Government of Canada, Ottawa, Ontario, Canada
| | | | - Jaspreet Ahuja
- Nutrient Data Laboratory, Agricultural Research Service, USDA, Beltsville, MD
| | - Pamela Pehrsson
- Nutrient Data Laboratory, Agricultural Research Service, USDA, Beltsville, MD
| | - Lauren Brookmire
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD
| | - Robert Merritt
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA
| |
Collapse
|