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Ferrari GT, Proserpio C, Stragliotto LK, Boff JM, Pagliarini E, Oliveira VRD. Salt reduction in bakery products: A critical review on the worldwide scenario, its impacts and different strategies. Trends Food Sci Technol 2022. [DOI: 10.1016/j.tifs.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Menyanu EK, Corso B, Minicuci N, Rocco I, Russell J, Ware LJ, Biritwum R, Kowal P, Schutte AE, Charlton KE. Salt and potassium intake among adult Ghanaians: WHO-SAGE Ghana Wave 3. BMC Nutr 2020; 6:54. [PMID: 33005430 PMCID: PMC7523323 DOI: 10.1186/s40795-020-00379-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Though Ghana has high hypertension prevalence, the country lacks current national salt consumption data required to build and enhance advocacy for salt reduction. We explored the characteristics of a randomly selected sub sample that had valid urine collection, along with matched survey, anthropometric and BP data (n = 839, mean age = 60y), from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE), Ghana Wave 3, n = 3053). We also investigated the relationship between salt intake and blood pressure (BP) among the cohort. BP was measured in triplicate and 24 h urine was collected for the determination of urinary sodium (Na), potassium (K), creatinine (Cr) and iodine levels. Hypertension prevalence was 44.3%. Median salt intake was 8.3 g/day, higher in women compared to men (8.6, interquartile range (IQR) 7.5 g/day vs 7.5, IQR 7.4 g/day, p < 0.01), younger participants (18-49 y) compared to older ones (50+ y) (9.7, IQR 7.9 g/day vs 8.1, IQR 7.1 g/day, p < 0.01) and those with higher Body Mass Index (BMI) (> 30 kg/m2) compared to a healthy BMI (18.5-24.9 kg/m2) (10.04, IQR 5.1 g/day vs 6.2, IQR 5.6 g/day, p < 0.01). More than three quarters (77%, n = 647) of participants had salt intakes above the WHO maximum recommendation of 5 g/d, and nearly two thirds (65%, n = 548) had daily K intakes below the recommended level of 90 mmol. Dietary sodium to potassium (Na: K) ratios above 2 mmol/mmol were positively associated with increasing BP with age. Population-based interventions to reduce salt intake and increase K consumption are needed.
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Affiliation(s)
- Elias K. Menyanu
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Barbara Corso
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Nadia Minicuci
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Ilaria Rocco
- Neuroscience Institute, National Research Council, Padova, Italy
| | - Joanna Russell
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard Biritwum
- Department of Community Health, University of Ghana, Accra, Ghana
| | - Paul Kowal
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
- World Health Organization (WHO), Geneva, Switzerland
| | - Aletta E. Schutte
- School of Public Health and Community Medicine, University of New South Wales; The George Institute for Global Health, Sydney, NSW 2052 Australia
- Hypertension in Africa Research Team, North-West University, Potchefstroom, 2520 South Africa
| | - Karen E. Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522 Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522 Australia
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Bhat S, Marklund M, Henry ME, Appel LJ, Croft KD, Neal B, Wu JHY. A Systematic Review of the Sources of Dietary Salt Around the World. Adv Nutr 2020; 11:677-686. [PMID: 31904809 PMCID: PMC7231587 DOI: 10.1093/advances/nmz134] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/11/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023] Open
Abstract
Excess salt intake contributes to hypertension and increased cardiovascular disease risk. Efforts to implement effective salt-reduction strategies require accurate data on the sources of salt consumption. We therefore performed a systematic review to identify the sources of dietary salt around the world. We systematically searched peer-reviewed and gray literature databases for studies that quantified discretionary (salt added during cooking or at the table) and nondiscretionary sources of salt and those that provided information about the food groups contributing to dietary salt intake. Exploratory linear regression analysis was also conducted to assess whether the proportion of discretionary salt intake is related to the gross domestic product (GDP) per capita of a country. We identified 80 studies conducted in 34 countries between 1975 and 2018. The majority (n = 44, 55%) collected data on dietary salt sources within the past 10 y and were deemed to have a low or moderate risk of bias (n = 75, 94%). Thirty-two (40%) studies were judged to be nationally representative. Populations in Brazil, China, Costa Rica, Guatemala, India, Japan, Mozambique, and Romania received more than half of their daily salt intake from discretionary sources. A significant inverse correlation between discretionary salt intake and a country's per capita GDP was observed (P < 0.0001), such that for every $10,000 increase in per capita GDP, the amount of salt obtained from discretionary sources was lower by 8.7% (95% CI: 5.1%, 12%). Bread products, cereal and grains, meat products, and dairy products were the major contributors to dietary salt intake in most populations. There is marked variation in discretionary salt use around the world that is highly correlated with the level of economic development. Our findings have important implications for the type of salt-reduction strategy likely to be effective in a country.
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Affiliation(s)
- Saiuj Bhat
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Matti Marklund
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The Friedman School of Nutrition and Policy, Tufts University, Boston, MA, USA
| | - Megan E Henry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Kevin D Croft
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce Neal
- The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Jason H Y Wu
- The George Institute for Global Health, Newtown, New South Wales, Australia
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Sources of dietary sodium and implications for a statewide salt reduction initiative in Victoria, Australia. Br J Nutr 2020; 123:1165-1175. [PMID: 31992370 DOI: 10.1017/s000711452000032x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In Victoria, Australia, a statewide salt reduction partnership was launched in 2015. The aim was to measure Na intake, food sources of Na (level of processing, purchase origin) and discretionary salt use in a cross-section of Victorian adults prior to a salt reduction initiative. In 2016/2017, participants completed a 24-h urine collection (n 338) and a subsample completed a 24-h dietary recall (n 142). Participants were aged 41·2 (sd 13·9) years, and 56 % were females. Mean 24-h urinary excretion was 138 (95 % CI 127, 149) mmol/d for Na. Salt equivalent was 8·1 (95 % CI 7·4, 8·7) g/d, equating to about 8·9 (95 % CI 8·1, 9·6) g/d after 10 % adjustment for non-urinary losses. Mean 24-h intake estimated by diet recall was 118 (95 % CI 103, 133) mmol/d for Na (salt 6·9 (95 % CI 6·0, 7·8 g/d)). Leading dietary sources of Na were cereal-based mixed dishes (12 %), English muffins, flat/savoury/sweet breads (9 %), regular breads/rolls (9 %), gravies and savoury sauces (7 %) and processed meats (7 %). Over one-third (38 %) of Na consumed was derived from discretionary foods. Half of all Na consumed came from ultra-processed foods. Dietary Na derived from foods was obtained from retail stores (51 %), restaurants and fast-food/takeaway outlets (28 %) and fresh food markets (9 %). One-third (32 %) of participants reported adding salt at the table and 61 % added salt whilst cooking. This study revealed that salt intake was above recommended levels with diverse sources of intake. Results from this study suggest a multi-faceted salt reduction strategy focusing on the retail sector, and food reformulation would most likely benefit Victorians and has been used to inform the ongoing statewide salt reduction initiative.
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Margerison C, Riddell LJ, McNaughton SA, Nowson CA. Associations between dietary patterns and blood pressure in a sample of Australian adults. Nutr J 2020; 19:5. [PMID: 31937324 PMCID: PMC6961350 DOI: 10.1186/s12937-019-0519-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Investigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults. METHODS Usual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used. RESULTS Complete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m2) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P < 0.001). CONCLUSIONS In this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.
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Affiliation(s)
- Claire Margerison
- Deakin University Institute for Physical Activity and Nutrition, Locked Bag 20000, Waurn 11 Ponds, Geelong, VIC, 3220, Australia.
| | - Lynnette J Riddell
- Deakin University Institute for Physical Activity and Nutrition, Locked Bag 20000, Waurn 11 Ponds, Geelong, VIC, 3220, Australia
| | - Sarah A McNaughton
- Deakin University Institute for Physical Activity and Nutrition, Locked Bag 20000, Waurn 11 Ponds, Geelong, VIC, 3220, Australia
| | - Caryl A Nowson
- Deakin University Institute for Physical Activity and Nutrition, Locked Bag 20000, Waurn 11 Ponds, Geelong, VIC, 3220, Australia
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Dietary Intake and Sources of Potassium in a Cross-Sectional Study of Australian Adults. Nutrients 2019; 11:nu11122996. [PMID: 31817767 PMCID: PMC6949933 DOI: 10.3390/nu11122996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
A diet rich in potassium is important to reduce the risk of cardiovascular disease. This study assessed potassium intake; food sources of potassium (including NOVA level of processing, purchase origin of these foods); and sodium-to-potassium ratio (Na:K) in a cross-section of Australian adults. Data collection included 24-h urines (n = 338) and a 24-h diet recall (subsample n = 142). The mean (SD) age of participants was 41.2 (13.9) years and 56% were females. Mean potassium (95%CI) 24-h urinary excretion was 76.8 (73.0–80.5) mmol/day compared to 92.9 (86.6–99.1) by 24-h diet recall. Na:K was 1.9 (1.8–2.0) from the urine excretion and 1.4 (1.2–1.7) from diet recall. Foods contributing most to potassium were potatoes (8%), dairy milk (6%), dishes where cereal is the main ingredient (6%) and coffee/coffee substitutes (5%). Over half of potassium (56%) came from minimally processed foods, with 22% from processed and 22% from ultraprocessed foods. Almost two-thirds of potassium consumed was from foods purchased from food stores (58%), then food service sector (15%), and fresh food markets (13%). Overall, potassium levels were lower than recommended to reduce chronic disease risk. Multifaceted efforts are required for population-wide intervention—aimed at increasing fruit, vegetable, and other key sources of potassium intake; reducing consumption of processed foods; and working in supermarket/food service sector settings to improve the healthiness of foods available.
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Eating occasions and the contribution of foods to sodium and potassium intakes in adults. Public Health Nutr 2017; 21:317-324. [PMID: 29108531 DOI: 10.1017/s1368980017002968] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions. DESIGN Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). SETTING Nationally representative survey in Australia. SUBJECTS Male and female Australians aged 18-84 years (n 7818). RESULTS Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. CONCLUSIONS Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.
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Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, O'Donnell KM, Batterham MJ. Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults. Nutrition 2016; 33:285-290. [PMID: 27712964 DOI: 10.1016/j.nut.2016.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/05/2016] [Accepted: 07/09/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between sodium and potassium intakes and blood pressure (BP) in a clinical sample. METHODS Secondary analysis of baseline data from 328 participants (mean age: 43.6 ± 8 y, mean body mass index [BMI]: 32.4 ± 4.2 kg/m2, mean systolic BP [SBP]/diastolic BP [DBP]: 124.9 ± 14.5/73.3 ± 9.9 mm Hg) of the 12-mo HealthTrack randomized controlled weight loss trial was conducted. Resting BP and 24-h urine sodium and potassium were measured. Dietary intake was evaluated with 4-d food records and self-reported diet histories. RESULTS Urinary sodium was positively correlated (Spearman's rho) with SBP (r = 0.176; P = 0.001) and DBP (r = 0.150; P = 0.003). The ratio of sodium to potassium was positively correlated with SBP (r = 0.1; P = 0.035). Urinary sodium (F [4,323] = 20.381; P < 0.0005; adjusted R2 = 0.231) and sodium-to-potassium ratio (F[4,323] = 25.008; P < 0.0005; adjusted R2 = 0.227) significantly predicted SBP after controlling for age, sex, BMI, and hypertension medication use. Dietary sodium and potassium significantly predicted urinary sodium (B = 0.33, t = 4.032, P < 0.01) and potassium (B = 0.67, t = 8.537, P < 0.01) excretion, respectively, after adjustment for energy and BMI. Median dietary sodium intake was 3197 mg/d and median dietary potassium intake was 2886 mg/d. Cereal-based products and dishes were the major contributors (22%) to total sodium intake. CONCLUSIONS In the present study, a high dietary sodium intake and high sodium-to-potassium ratio predicted high SBP. This suggests a need to focus dietary advice on reduction of sources of sodium and increasing sources of potassium in weight loss interventions to improve BP control.
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Affiliation(s)
- Rhoda N Ndanuko
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia.
| | - Linda C Tapsell
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia
| | - Karen E Charlton
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia
| | - Katrina M O'Donnell
- School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, NSW, Australia
| | - Marijka J Batterham
- Statistical Consulting Service, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, NSW, Australia
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Nowson C, Lim K, Grimes C, O'Halloran S, Land MA, Webster J, Shaw J, Chalmers J, Smith W, Flood V, Woodward M, Neal B. Dietary Salt Intake and Discretionary Salt Use in Two General Population Samples in Australia: 2011 and 2014. Nutrients 2015; 7:10501-12. [PMID: 26694459 PMCID: PMC4690097 DOI: 10.3390/nu7125545] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/14/2015] [Accepted: 11/30/2015] [Indexed: 02/07/2023] Open
Abstract
The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.
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Affiliation(s)
- Caryl Nowson
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Karen Lim
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Carley Grimes
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Siobhan O'Halloran
- School of Exercise and Nutrition Sciences, Deakin University, Centre for Physical Activity and Nutrition Research, Locked Bag 20000, Waurn Ponds, Geelong VIC 3220 Melbourne, Australia.
| | - Mary Anne Land
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Jacqui Webster
- WHO Collaborating Centre on Population Salt Reduction, George Institute for Global Health, University of Sydney, Sydney 2050, Australia.
| | - Jonathan Shaw
- Clinical Diabetes and Epidemiology, Baker IDI Heart & Diabetes Institute, Melbourne 3004, Australia.
| | - John Chalmers
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
| | - Wayne Smith
- Environmental Health Branch, New South Wales Health, Sydney 2059, Australia.
| | - Victoria Flood
- Faculty of Health Sciences, University of Sydney, Sydney 2141, Australia.
- St Vincent's Health Network, Sydney, 2010, Australia.
| | - Mark Woodward
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
- Medical Sciences Division, University of Oxford, Oxford OX1 3BD, UK.
| | - Bruce Neal
- George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney 2050, Australia.
- Sydney Medical School, University of Sydney, Sydney 2050, Australia.
- School of Public Health, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK.
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