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Zhang P, Zhang J, Rosewarne E, Li Y, Dong L, He FJ, Brown M, Pettigrew S, Yamamoto R, Nishida C, Liu A, Yang X, Zhang B, Ding G, Wang H. Setting sodium targets for pre-packaged foods in China - an exploratory study. Front Nutr 2023; 10:1231979. [PMID: 38024347 PMCID: PMC10646300 DOI: 10.3389/fnut.2023.1231979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Setting sodium targets for pre-packaged food has been a priority strategy for reducing population sodium intake. This study aims to explore the attitudes and considerations of researchers and key stakeholders toward implementing such policy in China. Methods An exploratory study comprising a survey and a focus group discussion was conducted among 27 purposively selected participants including 12 researchers, 5 consumers, 4 administrators, 3 industry association representatives and 3 food producers. The survey/discussion covered the key questions considered when developing/promoting sodium targets. Free-text responses were manually classified and summarized using thematic analysis. Results Two-thirds of the participants supported target-setting policy. Researchers and administrators were most supportive, and food producers and associations were least supportive. Adapted WHO food categorization framework was well accepted to underpin target-setting to ensure international comparability and applicability for Chinese products. Maximum values were the most agreed target type. The WHO benchmarks were thought to be too ambitious to be feasible given the current food supply in China but can be regarded as long-term goals. Initially, a reduction of sodium content by 20% was mostly accepted to guide the development of maximum targets. Other recommendations included implementing a comprehensive strategy, strengthening research, engaging social resources, establishing a systematic monitoring/incentive system, maintaining a fair competitive environment, and developing a supportive information system. Target-setting policy was acceptable by most stakeholders and should be implemented alongside strategies to reduce discretionary salt use. Discussion Our findings provide detailed guidance for the Chinese government when developing a target-setting strategy. The methods and results of this study also provide meaningful references for other countries to set sodium targets for pre-packaged foods and implement other salt reduction strategies simultaneously.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health, Beijing, China
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Emalie Rosewarne
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Le Dong
- The George Institute for Global Health, Beijing, China
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mhairi Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simone Pettigrew
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rain Yamamoto
- Standards and Scientific Advice on Food and Nutrition Unit, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Chizuru Nishida
- Safe, Healthy and Sustainable Diet Unit, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Aidong Liu
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
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2022 World Hypertension League, Resolve To Save Lives and International Society of Hypertension dietary sodium (salt) global call to action. J Hum Hypertens 2022:10.1038/s41371-022-00690-0. [PMID: 35581323 PMCID: PMC9110933 DOI: 10.1038/s41371-022-00690-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022]
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Nilson EAF, Pearson-Stuttard J, Collins B, Guzman-Castillo M, Capewell S, O'Flaherty M, Jaime PC, Kypridemos C. Estimating the health and economic effects of the voluntary sodium reduction targets in Brazil: microsimulation analysis. BMC Med 2021; 19:225. [PMID: 34583695 PMCID: PMC8479920 DOI: 10.1186/s12916-021-02099-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Excessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure. Brazil has implemented voluntary sodium reduction targets with food industries since 2011. This study aimed to analyse the potential health and economic impact of these sodium reduction targets in Brazil from 2013 to 2032. METHODS We developed a microsimulation of a close-to-reality synthetic population (IMPACTNCD-BR) to evaluate the potential health benefits of setting voluntary upper limits for sodium content as part of the Brazilian government strategy. The model estimates CVD deaths and cases prevented or postponed, and disease treatment costs. Model inputs were informed by the 2013 National Health Survey, the 2008-2009 Household Budget Survey, and high-quality meta-analyses, assuming that all individuals were exposed to the policy proportionally to their sodium intake from processed food. Costs included costs of the National Health System on CVD treatment and informal care costs. The primary outcome measures of the model are cardiovascular disease cases and deaths prevented or postponed over 20 years (2013-2032), stratified by age and sex. RESULTS The study found that the application of the Brazilian voluntary sodium targets for packaged foods between 2013 and 2032 could prevent or postpone approximately 110,000 CVD cases (95% uncertainty intervals (UI): 28,000 to 260,000) among men and 70,000 cases among women (95% UI: 16,000 to 170,000), and also prevent or postpone approximately 2600 CVD deaths (95% UI: - 1000 to 11,000), 55% in men. The policy could also produce a net cost saving of approximately US$ 220 million (95% UI: US$ 54 to 520 million) in medical costs to the Brazilian National Health System for the treatment of CHD and stroke and save approximately US$ 71 million (95% UI: US$ 17 to170 million) in informal costs. CONCLUSION Brazilian voluntary sodium targets could generate substantial health and economic impacts. The reduction in sodium intake that was likely achieved from the voluntary targets indicates that sodium reduction in Brazil must go further and faster to achieve the national and World Health Organization goals for sodium intake.
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Affiliation(s)
| | | | - 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
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Patrícia Constante Jaime
- Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
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Ngqangashe Y, Goldman S, Schram A, Friel S. A narrative review of regulatory governance factors that shape food and nutrition policies. Nutr Rev 2021; 80:200-214. [PMID: 34015107 DOI: 10.1093/nutrit/nuab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/14/2021] [Accepted: 03/03/2021] [Indexed: 01/23/2023] Open
Abstract
Food composition, marketing restrictions, nutrition labeling, and taxation policies are recommended for preventing diet-related noncommunicable diseases. In view of the increasing but variable adoption of food policies globally, this narrative review examines the actors, regulatory frameworks, and institutional contexts that shape the development, design, and implementation of these policies. We found a diverse range of actors using various strategies, including advocacy, framing, and evidence generation to influence policy agendas. We identified diverse regulatory designs used in the formulation and implementation of the policies: command and control state regulation for taxes and menu labels, quasi-regulation for sodium reformulation, and co-regulation and industry self-regulation for food marketing policies. Quasi-regulation and industry self-regulation are critiqued for their voluntary nature, lack of independence from the industry, and absence of (or poor) monitoring and enforcement systems. The policy instrument design and implementation best practices highlighted in this review include clear policy goals and rigorous standards that are adequately monitored and enforced. Future research should examine how these combinations of regulatory governance factors influence policy outcomes.
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Affiliation(s)
- Yandisa Ngqangashe
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharni Goldman
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ashley Schram
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Y. Ngqangashe, S. Goldman, A. Schram, and S. Friel are with the Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
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Ayed C, Lim M, Nawaz K, Macnaughtan W, Sturrock CJ, Hill SE, Linforth R, Fisk ID. The role of sodium chloride in the sensory and physico-chemical properties of sweet biscuits. FOOD CHEMISTRY-X 2021; 9:100115. [PMID: 33511340 PMCID: PMC7817490 DOI: 10.1016/j.fochx.2021.100115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
Salt is included in many foods which consumers do not regard as salty. This "hidden-salt" may offer functional benefits but is often overlooked in sodium reduction strategies. This study investigated its role in shortbread-like sweet biscuits (1.05 g NaCl/100 g). Sensory tests revealed significant flavour and texture differences after a salt reduction of 33% (0.86 g/ 100 g). This was explained by differences in the partitioning of hydrophobic aroma compounds into the headspace and a significant impact on structure. Texture analysis and X-ray-µCT measurements revealed a reduced hardness with larger and more air cells in salt-reduced biscuits. It is suggested that salt impacts on cereal proteins by altering their aggregation around flour particles and at bubble walls and that slower water loss occurs in salted matrices during baking. Hence, this study revealed the key properties significantly affected by salt reduction and proposes an explanation which will help to develop a targeted "hidden-salt" reduction strategy.
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Affiliation(s)
- Charfedinne Ayed
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Mui Lim
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Khatija Nawaz
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - William Macnaughtan
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Craig J Sturrock
- Hounsfield Facility, School of Biosciences, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Sandra E Hill
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Robert Linforth
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
| | - Ian D Fisk
- Division of Food, Nutrition and Dietetics, University of Nottingham Sutton Bonington Campus, Loughborough LE12 5RD, United Kingdom
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Nilson EAF, Spaniol AM, Santin RDC, Silva SA. Estratégias para redução do consumo de nutrientes críticos para a saúde: o caso do sódio. CAD SAUDE PUBLICA 2021; 37Suppl 1:e00145520. [DOI: 10.1590/0102-311x00145520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022] Open
Abstract
Doenças crônicas não transmissíveis correspondem à principal causa de morte no mundo e têm a alimentação inadequada como um de seus principais fatores de risco modificáveis, destacando-se o consumo excessivo de sódio e sua associação com doenças cardiovasculares, mediadas pela pressão arterial. Este estudo avaliou o impacto de diferentes cenários de políticas para a redução do consumo de sódio com base em alimentos processados e ultraprocessados na prevenção de mortes por desfechos cardiovasculares na população adulta no Brasil. Foram utilizados dados secundários, de relatórios e bases públicas do Sistema Único de Saúde e de inquéritos populacionais. Foram analisados os impactos, até 2027, de três cenários: manutenção das atuais metas voluntárias, e dois cenários mandatórios, considerando as menores metas nas Américas e as menores metas mundiais. Para a análise das mortes prevenidas ou adiadas com base no consumo de sódio em tais cenários foi utilizado o Preventable Risk Integrated ModEl (PRIME). Em 2027, mais de 72 mil mortes seriam atribuíveis ao excesso de sódio e as metas voluntárias resultariam na prevenção ou adiamento de até 4.001 (intervalos de 95% de incerteza - II95%: 1.611-6.563) mortes, e os cenários mandatórios resultariam na prevenção de 9.704 (II95%: 3.955-15.665) e 15.561 (II95%: 6.350-25.096) mortes por doenças cardiovasculares, considerando as menores metas regionais e internacionais, respectivamente. Os achados sugerem que a manutenção de metas voluntárias tem impacto limitado quando comparada a cenários possíveis e mais restritivos de redução do teor de sódio em alimentos processados e ultraprocessados, e reforçam a necessidade de adoção de medidas com maior efetividade no país.
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Yeo C, Ahmed S, Oo AM, Koura A, Sanghvi K, Yeo D. COVID-19 and Obesity-the Management of Pre- and Post-bariatric Patients Amidst the COVID-19 Pandemic. Obes Surg 2020; 30:3607-3609. [PMID: 32385668 PMCID: PMC7210102 DOI: 10.1007/s11695-020-04670-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Charleen Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Saleem Ahmed
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aung Myint Oo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aaryan Koura
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kaushal Sanghvi
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Danson Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Sodium Content of Processed Foods Available in the Mexican Market. Nutrients 2018; 10:nu10122008. [PMID: 30572568 PMCID: PMC6316842 DOI: 10.3390/nu10122008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sodium intake is related to several adverse health outcomes, such as hypertension and cardiovascular diseases. Processed foods are major contributors to the population's sodium intake. The aim of the present study was to determine sodium levels in Mexican packaged foods, as well as to evaluate the proportion of foods that comply with sodium benchmark targets set by the United Kingdom Food Standards Agency (UK FSA) and those set by the Mexican Commission for the Protection of Health Risks (COFEPRIS). We also evaluated the proportion of foods that exceeded the Pan American Health Organization (PAHO) targets. METHODS This was a cross-sectional study that comprised data collected from the package of 2248 processed foods from selected supermarkets in Mexico. RESULTS Many processed food categories contained an excessive amount of sodium. Processed meats, ham, bacon and sausages, had the highest concentrations. The proportion of foods classified as compliant in our sample was lower for international targets (FSA UK and PAHO) compared to the Mexican COFEPRIS criteria. CONCLUSIONS These data provided a critical baseline assessment for monitoring sodium levels in Mexican processed foods.
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Marinangeli CPF, Curran J, Barr SI, Slavin J, Puri S, Swaminathan S, Tapsell L, Patterson CA. Enhancing nutrition with pulses: defining a recommended serving size for adults. Nutr Rev 2018; 75:990-1006. [PMID: 29202192 PMCID: PMC5914352 DOI: 10.1093/nutrit/nux058] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pulses, defined as dry-harvested leguminous crops, include several varieties of beans, peas, lentils, and chickpeas. There is no consensus around a recommended serving size of pulses within a balanced diet, which prevents the development of transregional strategies that rely on consistent messaging to drive increases in consumption. The purpose of this review is to define and disseminate an appropriate target for a minimum serving size of pulses on any given day that can be used in international or collaborative strategies to promote the consumption of pulses. Relevant data were reviewed to examine dietary guidelines across jurisdictions, determine consumption levels of pulses across the globe, evaluate the nutritional composition of pulses in the context of dietary nutrient insufficiency, and assess the impact of pulses on dietary quality. Across a variety of pulses, 100 g of cooked pulses aligned with most regional serving sizes for pulses and provides significant levels of nutrients that are underconsumed by specific age-sex groups. Moreover, 100 g of pulses provides a number of nutrients that qualify for nutrient content claims under regional regulatory frameworks. The data demonstrate that 100 g or 125 mL (0.5 metric cup) of cooked pulses is a reasonable target for aligning strategies that promote the dietary and nutritional attributes of these legumes.
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Affiliation(s)
| | | | - Susan I Barr
- Department of Food, Nutrition & Health and the Department of Human Nutrition, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota, USA
| | - Seema Puri
- Institute of Home Economics, University of Delhi, New Delhi, India
| | - Sumathi Swaminathan
- St Johns Research Institute, Division of Nutrition, Bangalore, Karnataka, India
| | - Linda Tapsell
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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Nilson EAF, Spaniol AM, Gonçalves VSS, Moura I, Silva SA, L'Abbé M, Jaime PC. Sodium Reduction in Processed Foods in Brazil: Analysis of Food Categories and Voluntary Targets from 2011 to 2017. Nutrients 2017; 9:nu9070742. [PMID: 28704932 PMCID: PMC5537856 DOI: 10.3390/nu9070742] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 01/10/2023] Open
Abstract
Non-communicable diseases, including cardiovascular diseases, are responsible for over 70% of deaths in Brazil. Currently, over 25% of Brazilian adults are diagnosed as hypertensive; overall, current dietary sodium intake in Brazil (4700 mg/person) is over twice the international recommendations, and 70-90% of adolescents and adults consume excessive sodium. National sodium reduction strategies consider the main dietary sources of sodium to be added salt to foods, foods consumed outside of the household, and sodium in processed foods. The national voluntary strategy for sodium reduction in priority food categories has been continuously monitored over a 6-year period (2011-2017) and there was a significant 8-34% reduction in the average sodium content of over half food categories. Different food categories have undergone differing reductions in sodium over time, aiding gradual biannual targets to allow industries to develop new technologies and consumers to adapt to foods with less salt. By 2017, most products of all food categories had met the regional targets proposed by the Pan American Health Organization, showing that voluntary sodium reduction strategies can potentially contribute to food reformulation. Nevertheless, regulatory approaches may still be necessary in the future in order to reach all food producers and to allow stronger enforcement to meet more stringent regional targets.
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Affiliation(s)
- Eduardo A F Nilson
- Ministry of Health of Brazil, Brasilia 70058-900, Brazil.
- Global Health and Sustainability Program, University of Sao Paulo, Sao Paulo 01255-001, Brazil.
| | - Ana M Spaniol
- Ministry of Health of Brazil, Brasilia 70058-900, Brazil.
| | | | - Iracema Moura
- Ministry of Health of Brazil, Brasilia 70058-900, Brazil.
| | - Sara A Silva
- Ministry of Health of Brazil, Brasilia 70058-900, Brazil.
| | - Mary L'Abbé
- University of Toronto, Toronto, ON M5S 2E8, Canada.
| | - Patricia C Jaime
- Department of Nutrition, University of Sao Paulo, Sao Paulo 01255-001, Brazil.
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Nilson EAF, Spaniol AM, Gonçalves VSS, Oliveira ML, Campbell N, L'Abbé M, Jaime PC. The impact of voluntary targets on the sodium content of processed foods in Brazil, 2011-2013. J Clin Hypertens (Greenwich) 2017; 19:939-945. [PMID: 28664551 DOI: 10.1111/jch.13044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 02/05/2023]
Abstract
Brazilians consume excessive dietary sodium (4700 mg/d); hence, the reduction of dietary sodium intake has been a Brazilian government priority. A set of strategies has been implemented that includes food and nutrition education initiatives and the reduction in the sodium content of processed foods and foods consumed out of the households. Since 2011, the Ministry of Health has selected priority food categories that contribute to over 90% of sodium intake from processed foods and have set biannual voluntary targets for sodium reduction with food industries to encourage food reformulation. Three rounds of monitoring of the sodium content on food labels have been conducted for instant pasta, commercially produced breads, cakes and cake mixes, cookies and crackers, snacks, chips, mayonnaise, salt-based condiments, and margarine. Between 90% and 100% of the food products achieved the first targets in the 2011-2013 period, and the average sodium content of food categories was reduced from 5% to 21% in these first 2 years. These data show that with close monitoring and government oversight, voluntary targets to reduce the sodium content in processed foods can have a significant impact even in a short time frame. The Brazilian strategy will be continuously monitored to maximize its impact, and, if necessary in the future, a transition to regulatory approaches with stronger enforcement may be considered.
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Mendonça RDD, Lopes ACS, Pimenta AM, Gea A, Martinez-Gonzalez MA, Bes-Rastrollo M. Ultra-Processed Food Consumption and the Incidence of Hypertension in a Mediterranean Cohort: The Seguimiento Universidad de Navarra Project. Am J Hypertens 2017; 30:358-366. [PMID: 27927627 DOI: 10.1093/ajh/hpw137] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/14/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Some available evidence suggests that high consumption of ultra-processed foods (UPFs) is associated with a higher risk of obesity. Collectively, this association and the nutritional characteristics of UPFs suggest that UPFs might also be associated with hypertension. METHODS We prospectively evaluated the relationship between UPF consumption and the risk of hypertension in a prospective Spanish cohort, the Seguimiento Universidad de Navarra project. We included 14,790 Spanish adult university graduates who were initially free of hypertension at baseline who were followed for a mean of 9.1 years (SD, 3.9 years; total person-years: 134,784). UPF (industrial formulations of chemical compounds which, beyond substances of common culinary use such as salt, sugar, oils, and fats, include substances also derived from foods but not used in culinary preparations) consumption was assessed using a validated semi-quantitative 136-item food-frequency questionnaire. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for hypertension incidence. RESULTS During follow-up, 1,702 incident cases of hypertension were identified. Participants in the highest tertile of UPF consumption had a higher risk of developing hypertension (adjusted HR, 1.21; 95% CI, 1.06, 1.37; P for trend = 0.004) than those in the lowest tertile after adjusting for potential confounders. CONCLUSIONS In this large prospective cohort of Spanish middle-aged adult university graduates, a positive association between UPF consumption and hypertension risk was observed. Additional longitudinal studies are needed to confirm our results.
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Affiliation(s)
- Raquel de Deus Mendonça
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Departament of Nutrition, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
- CAPES Foundation, Ministry of Education of Brazil, Brasília, Brazil
| | | | - Adriano Marçal Pimenta
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Department of Maternal-Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
- Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Angel Martinez-Gonzalez
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
- Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain
- Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
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