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Karim AB, Young SD, Hawrami KAM, Bailey EH. Iodine and selenium: Dietary sources and nutritional status of the population of the Kurdistan Region in Northern Iraq. J Trace Elem Med Biol 2024; 85:127495. [PMID: 39018676 DOI: 10.1016/j.jtemb.2024.127495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/08/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
AIM The primary aim of this study was to determine the selenium (Se) and iodine (I) food concentrations and dietary intake of the population living in the Kurdish controlled region of northern Iraq. We also assessed the extent to which iodised salt contributes to dietary iodine intake. METHODOLOGY Foods and samples of salt and drinking water were analysed, including 300 crops samples from 40 local farms. The results, supplemented by food composition data, were used to assess dietary Se and I intake for 410 volunteers using a semi-quantitative food questionnaire. To directly investigate the nutritional status of individuals, urine samples were also collected from participants. RESULTS Selenium intake was mainly supplied by protein and cereal sources. Calculated median dietary intake of Se was 62.7 µg d-1 (mean = 66.3 µg d-1) with c. 72 % of participants meeting or exceeding dietary reference intake recommendations for age. Median dietary intake of I, excluding salt consumption, was 94.6 µg d-1 (mean 100.2 µg d-1), increasing to 607.2 µg d-1 when salt (of which >90 % was iodized) was included. Salt intake was estimated to be c.13.5 g d-1 (5400 mg Na d-1) which greatly exceeds WHO recommended intake (< 2000 mg d-1 of Na). Urine iodine concentrations indicated that 98 % of school aged children had excessive iodine intake (≥300 µg L-1) and 80-90 % of all study participants had above average or excessive iodine intake (≥200 µg L-1). CONCLUSIONS Poultry and rice are the main sources of dietary Se to this population but around a third of children receive an inadequate Se intake. Fresh fruit and vegetables are the main sources of dietary I, but consumption of local foods cannot supply adequate I without iodised salt supplementation. Consumption of iodized salt well above recommended amounts is supplying this population with substantial iodine intake. Interventions to reduce salt intake would help to limit excessive iodine intake whilst also reducing cardio-vascular risks from Na consumption.
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Affiliation(s)
- A B Karim
- College of Applied Science, Sulaimani Polytechnic University, Sulaymaniyah, Iraq
| | - S D Young
- School of Biosciences, University of Nottingham, Gateway Building, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD, United Kingdom
| | - K A M Hawrami
- Technical Institute of Halabja, Sulaimani Polytechnic University, Sulaymaniyah, Iraq
| | - E H Bailey
- School of Biosciences, University of Nottingham, Gateway Building, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD, United Kingdom.
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Laxmi, Golmei P, Srivastava S, Kumar S. Single nucleotide polymorphism-based biomarker in primary hypertension. Eur J Pharmacol 2024; 972:176584. [PMID: 38621507 DOI: 10.1016/j.ejphar.2024.176584] [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: 01/07/2024] [Revised: 03/19/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
Primary hypertension is a multiplex and multifactorial disease influenced by various strong components including genetics. Extensive research such as Genome-wide association studies and candidate gene studies have revealed various single nucleotide polymorphisms (SNPs) related to hypertension, providing insights into the genetic basis of the condition. This review summarizes the current status of SNP research in primary hypertension, including examples of hypertension-related SNPs, their location, function, and frequency in different populations. The potential clinical implications of SNP research for primary hypertension management are also discussed, including disease risk prediction, personalized medicine, mechanistic understanding, and lifestyle modifications. Furthermore, this review highlights emerging technologies and methodologies that have the potential to revolutionize the vast understanding of the basis of genetics in primary hypertension. Gene editing holds the potential to target and correct any kind of genetic mutations that contribute to the development of hypertension or modify genes involved in blood pressure regulation to prevent or treat the condition. Advances in computational biology and machine learning enable researchers to analyze large datasets and identify complex genetic interactions contributing to hypertension risk. In conclusion, SNP research in primary hypertension is rapidly evolving with emerging technologies and methodologies that have the potential to transform the knowledge about genetic basis related to the condition. These advances hold promise for personalized prevention and treatment strategies tailored to an individual's genetic profile ultimately improving patient outcomes and reducing healthcare costs.
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Affiliation(s)
- Laxmi
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, M B Road, New Delhi, 110017, India
| | - Pougang Golmei
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, M B Road, New Delhi, 110017, India
| | - Shriyansh Srivastava
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, M B Road, New Delhi, 110017, India
| | - Sachin Kumar
- Department of Pharmacology, Delhi Institute of Pharmaceutical Sciences and Research, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, M B Road, New Delhi, 110017, India.
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3
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Gaines A, Shahid M, Coyle D, Barrett E, Hadjikakou M, Wu JHY, Taylor F, Pettigrew S, Neal B, Seferidi P. Switches in food and beverage product purchases can reduce greenhouse gas emissions in Australia. NATURE FOOD 2024; 5:524-532. [PMID: 38806695 PMCID: PMC11199139 DOI: 10.1038/s43016-024-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/05/2024] [Indexed: 05/30/2024]
Abstract
Switching between similar food and beverage products may reduce greenhouse gas emissions (GHGe). Here, using consumer data linked to 23,550 product-specific GHGe values, we estimated annual GHGe attributable to product purchases consumed at home in Australia and calculated reductions from specific switches. Potential changes to mean Health Star Rating, mean energy density and the proportion of ultraprocessed foods purchased were assessed. Approximately 31 million tonnes of GHGe were attributable to products consumed at home in 2019, the three highest contributors of GHGe being 'meat and meat products' (49%), 'dairy' (17%) and 'non-alcoholic beverages' (16%). Switching higher-emission products for 'very similar' lower-emission products could reduce total emissions by 26%. Switches to 'less similar' lower-emission products could lead to a 71% reduction. Switches had little impact on the average Health Star Rating, energy density of purchases and proportion of ultraprocessed foods purchased. Directing manufacturing and marketing towards lower-environmental-impact products and signposting such options to consumers are key.
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Affiliation(s)
- Allison Gaines
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
- The George Institute for Global Health, Sydney, New South Wales, Australia.
| | - Maria Shahid
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Daisy Coyle
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Eden Barrett
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Michalis Hadjikakou
- School of Life and Environmental Sciences, Centre for Integrative Ecology, Deakin University, Melbourne, Victoria, Australia
| | - Jason H Y Wu
- The George Institute for Global Health, Sydney, New South Wales, Australia
- School of Public Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fraser Taylor
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Bruce Neal
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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4
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Imamoto M, Takada T, Sasaki S, Onishi Y. Development of a Culinary Intervention (Cooking Class) for Salt Reduction in Japanese Home Cooking: Strategies and Assessment. AJPM FOCUS 2024; 3:100227. [PMID: 38736567 PMCID: PMC11081799 DOI: 10.1016/j.focus.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Introduction Culinary interventions (cooking classes) are a potential educational tool for salt reduction in the home diet, but their content has never been reported in detail. This study aimed to develop a cooking class for salt reduction, describe its rationale and structure so that other parties could replicate it, and preliminarily assess its impact on salt intake. Methods A multidisciplinary research team developed a cooking class package to reduce salt content in the Japanese home diet. The package comprised its developmental policy, teaching methodology, a menu and recipes, and an implementation manual and aimed to allow third parties to replicate and modify the content. The team took the following step-by-step developmental approach. First, traditional home meals were modeled to create strategies contributing to a target of 2 g salt/meal. Then, educational topics were developed through these strategies, and finally, a dietitian produced menus and prepared documents for the class. The impact of the cooking class was assessed in a nonrandomized study of community residents. The outcome was differences in urinary salt excretion before and after the intervention. General linear models were used to account for the possible confounders. Results The authors assumed 4-7 g salt/meal from analyzing typical Japanese home diets and developed 3 strategies: (1) restricting salt content in the main dish, (2) maintaining good tastes without salty dishes, and (3) balancing nutrition with low-salt dishes. On the basis of these strategies, the authors selected a total of 5 educational topics that participants could learn and apply at home: 1a, a simple and reliable technique to limit salt in a serving; 2a, excluding salty dishes; 2b, staple foods with notable flavor and aroma; 3a, flavoring without salt in side dishes; and 3b, ingredients that should be used intentionally. The team dietitian translated these educational topics into a menu and recipes for hands-on training and prepared a manual for conducting the class. The class developed using this approach was successfully overseen by a dietitian outside the research team. In the validation study, the intervention group (n=52) showed a greater decrease in urinary salt excretion than the control group (n=46), with an adjusted difference of -1.38 g (p=0.001). Conclusions The authors developed a cooking class package for salt reduction so that third parties could replicate and modify the class. The significant salt reduction noted in this study warrants further studies to apply this cooking class to other populations.
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Affiliation(s)
- Miyuki Imamoto
- Department of Food and Human Nutrition, Faculty of Human Life Science, Notre Dome Seishin University, Okayama, Japan
- Research Association for Applied Dietary and Physical Therapy (ADAPT), Ashiya, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Sho Sasaki
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Yoshihiro Onishi
- Research Association for Applied Dietary and Physical Therapy (ADAPT), Ashiya, Japan
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Jelaković B, Marinović Glavić M, Batinić Sermek M, Bilajac L, Bubaš M, Buzjak Služek V, Capak K, Drenjančević I, Gross Bošković A, Jelaković A, Jukić T, Kolarić Kravar S, Kralj V, Pećin I, Pollak L, Skoko-Poljak D, Stražanac D, Stupin A, Vasiljev V, Vidranski V, Reiner Ž. Croatian Action on Salt and Health (CRASH): On the Road to Success-Less Salt, More Health. Nutrients 2024; 16:1518. [PMID: 38794755 PMCID: PMC11124119 DOI: 10.3390/nu16101518] [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: 04/24/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The World Health Organization recommends adjusting salt intake as a part of the nine global targets to reduce premature mortality from non-communicable chronic diseases as a priority and the most cost-effective intervention. In 2006, the main aim of the Croatian Action on Salt and Health was to decrease salt intake by 16% because of its critical intake and consequences on human health. We have organized educative activities to increase awareness on salt harmfulness, define food categories of prime interest, collaborate with industries and determine salt intake (24 h urine sodium excretion). It was determined that the proportion of salt in ready-to-eat baked bread should not exceed 1.4%. In the period 2014-2022, salt in semi-white bread was reduced by 14%, 22% in bakery and 25% in the largest meat industry. Awareness of the harmfulness of salt on health increased from 65.3% in 2008 to 96.9% in 2023 and salt intake was reduced by 15.9-1.8 g/day (22.8% men, 11.7% women). In the last 18 years, a significant decrease in salt intake was achieved in Croatia, awareness of its harmfulness increased, collaboration with the food industry was established and regulatory documents were launched. However, salt intake is still very high, underlying the need for continuation of efforts and even stronger activities.
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Affiliation(s)
- Bojan Jelaković
- Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
- Croatian Hypertension League, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | | | | | - Lovorka Bilajac
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.B.); (V.V.)
- Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
- Teaching Institute of Public Health, 51000 Rijeka, Croatia
| | - Marija Bubaš
- Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (K.C.); (V.K.)
- Ministry of Health, 10000 Zagreb, Croatia;
| | - Vlatka Buzjak Služek
- Croatian Agency for Agriculture and Food, 31000 Osijek, Croatia; (V.B.S.); (A.G.B.); (D.S.)
| | - Krunoslav Capak
- Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (K.C.); (V.K.)
| | - Ines Drenjančević
- Department of Physiology and Immunology, Faculty of Medicine Osijek, University of Osijek, 31000 Osijek, Croatia; (I.D.); (A.S.)
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, 31000 Osijek, Croatia
| | - Andrea Gross Bošković
- Croatian Agency for Agriculture and Food, 31000 Osijek, Croatia; (V.B.S.); (A.G.B.); (D.S.)
| | - Ana Jelaković
- Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.B.); (V.V.)
| | - Tomislav Jukić
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | | | - Verica Kralj
- Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (K.C.); (V.K.)
| | - Ivan Pećin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department for Metabolic Diseases, University Hospital Center, 10000 Zagreb, Croatia;
| | - Lea Pollak
- Department for Food Supplements, Biologically Active and Psychoactive Substances, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | | | - Danijela Stražanac
- Croatian Agency for Agriculture and Food, 31000 Osijek, Croatia; (V.B.S.); (A.G.B.); (D.S.)
| | - Ana Stupin
- Department of Physiology and Immunology, Faculty of Medicine Osijek, University of Osijek, 31000 Osijek, Croatia; (I.D.); (A.S.)
- Scientific Centre of Excellence for Personalized Health Care, University of Osijek, 31000 Osijek, Croatia
| | - Vanja Vasiljev
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.B.); (V.V.)
| | - Valentina Vidranski
- Department of Clinical Chemistry, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Željko Reiner
- Department for Metabolic Diseases, University Hospital Center, 10000 Zagreb, Croatia;
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
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Freedman LS, Wang CY, Commins J, Barrett B, Midthune D, Dodd KW, Carroll RJ, Kipnis V. Can sodium and potassium measured in timed voids be used as reference instruments for validating self-report instruments? Results from a urine calibration study. Am J Clin Nutr 2024; 119:1321-1328. [PMID: 38403166 PMCID: PMC11130648 DOI: 10.1016/j.ajcnut.2024.02.013] [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: 11/01/2023] [Revised: 01/24/2024] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Sodium and potassium measured in 24-h urine collections are often used as reference measurements to validate self-reported dietary intake instruments. OBJECTIVES To evaluate whether collection and analysis of a limited number of urine voids at specified times during the day ("timed voids") can provide alternative reference measurements, and to identify their optimal number and timing. METHODS We used data from a urine calibration study among 441 adults aged 18-39 y. Participants collected each urine void in a separate container for 24 h and recorded the collection time. For the same day, they reported dietary intake using a 24-h recall. Urinary sodium and potassium were analyzed in a 24-h composite sample and in 4 timed voids (morning, afternoon, evening, and overnight). Linear regression models were used to develop equations predicting log-transformed 24-h urinary sodium or potassium levels using each of the 4 single timed voids, 6 pairs, and 4 triples. The equations also included age, sex, race, BMI (kg/m2), and log creatinine. Optimal combinations minimizing the mean squared prediction error were selected, and the observed and predicted 24-h levels were then used as reference measures to estimate the group bias and attenuation factors of the 24-h dietary recall. These estimates were compared. RESULTS Optimal combinations found were as follows: single voids-evening; paired voids-afternoon + overnight (sodium) and morning + evening (potassium); and triple voids-morning + evening + overnight (sodium) and morning + afternoon + evening (potassium). Predicted 24-h urinary levels estimated 24-h recall group biases and attenuation factors without apparent bias, but with less precision than observed 24-h urinary levels. To recover lost precision, it was estimated that sample sizes need to be increased by ∼2.6-2.7 times for a single void, 1.7-2.1 times for paired voids, and 1.5-1.6 times for triple voids. CONCLUSIONS Our results provide the basis for further development of new reference biomarkers based on timed voids. CLINICAL TRIAL REGISTRY clinicaltrials.gov as NCT01631240.
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Affiliation(s)
- Laurence S Freedman
- Information Management Services Inc., Rockville, MD, United States; Biostatistics and Biomathematics Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Chia-Yih Wang
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, United States
| | - John Commins
- Information Management Services Inc., Rockville, MD, United States
| | - Brian Barrett
- Information Management Services Inc., Rockville, MD, United States
| | - Douglas Midthune
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Kevin W Dodd
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, TX, United States
| | - Victor Kipnis
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, United States
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Kurćubić VS, Lević S, Pavlović V, Mihailović R, Nikolić A, Lukić M, Jovanović J, Danilović B, Milinković M, Oz F, Heinz V, Tomasevic I. Manufacture of Low-Na White Soft Brined Cheese: Effect of NaCl Substitution with a Combination of Na-K Salts on Proximate Composition, Mineral Content, Microstructure, and Sensory Acceptance. Foods 2024; 13:1381. [PMID: 38731752 PMCID: PMC11083042 DOI: 10.3390/foods13091381] [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: 04/04/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
All over the world, especially in Western societies, table salt intake that is inordinately higher than the acceptable level has been observed. An excess of Na in the human diet, mostly from processed foods, is becoming the "number one killer", leading to increased blood pressure. Therefore, the food industry is faced with a need to reduce Na in human nutrition in an effort to raise public health protection to a higher level. In this study, a commercially available combination of Na/K salts (COMB) at different concentrations was used as a NaCl substitute in the production of a modified, healthier, Na-reduced cheese. Samples of the modified low-Na white soft-brined cheese (WSBC) were produced by adding four different concentrations of COMB to production lots PL-1 to PL-4, and the control (CON) samples were prepared by salting with the usual, non-reduced concentration of NaCl. The effects of NaCl replacement on the physical-chemical parameters, major- and micro-elements, and microstructural and sensory properties of the WSBC were investigated. The obtained results indicated that there was no significant influence on the ash content, pH, and aw. The Na and K levels differed among treatments (p < 0.001). The lowest Na level in this study was recorded in PL-4 (only COMB was added) and was 334.80 ± 24.60 mg/100 g. According to the Na content, WSBC PL4 can be labeled with the nutrient claim "reduced amount of Na". A significant difference (p < 0.05) was noticed in overall acceptance between the CON and PL-4, with no statistically significant difference found amongst other WSBC production lots. The replacement of NaCl resulted in a slightly greater firmness of the WSBC. The results confirm the possibility of producing low-Na WSBC when optimal amounts of a suitable mineral salt are used as a substitute for NaCl, thus reducing the risk of high Na intake in the human body through the consumption of evaluated cheese.
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Affiliation(s)
- Vladimir S Kurćubić
- Faculty of Agronomy, Department of Food Technology, University of Kragujevac, Cara Dušana 34, 32000 Čačak, Serbia
| | - Steva Lević
- Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
| | - Vlada Pavlović
- Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
| | - Ružica Mihailović
- Veterinary Specialist Institute Kraljevo, Žička 34, 36000 Kraljevo, Serbia
| | - Aleksandra Nikolić
- Department of Sensory and Physical Testing with Parasitology, Institute for Meat Hygiene and Technology, Kaćanskog 13, 11000 Belgrade, Serbia
| | - Mirjana Lukić
- Department of Sensory and Physical Testing with Parasitology, Institute for Meat Hygiene and Technology, Kaćanskog 13, 11000 Belgrade, Serbia
| | - Jelena Jovanović
- Department of Sensory and Physical Testing with Parasitology, Institute for Meat Hygiene and Technology, Kaćanskog 13, 11000 Belgrade, Serbia
| | - Bojana Danilović
- Faculty of Technology, University of Niš, Bulevar Oslobođenja 124, 16000 Leskovac, Serbia
| | - Mira Milinković
- Institute of Land, Teodora Drajzera 7, 11000 Belgrade, Serbia
| | - Fatih Oz
- Faculty of Agriculture, Ataturk University, Erzurum 25240, Türkiye
| | - Volker Heinz
- DIL German Institute of Food Technology, Prof.-von-Klitzing-Str. 7, D-49610 Quakenbrück, Germany
| | - Igor Tomasevic
- Faculty of Agriculture, University of Belgrade, Nemanjina 6, 11080 Belgrade, Serbia
- DIL German Institute of Food Technology, Prof.-von-Klitzing-Str. 7, D-49610 Quakenbrück, Germany
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8
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Farzadfar F, Yousefi M, Jafari-Khounigh A, Khorrami Z, Haghdoost A, Shadmani FK. Trend and projection of non-communicable diseases risk factors in Iran from 2001 to 2030. Sci Rep 2024; 14:8092. [PMID: 38582931 PMCID: PMC10998837 DOI: 10.1038/s41598-024-58629-z] [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: 10/15/2023] [Accepted: 04/01/2024] [Indexed: 04/08/2024] Open
Abstract
This study aims to investigate the trends and project the major risk factors of Non-communicable Diseases (NCDs) in Iran. We obtained the trend of prevalence of main risk factors related to NCDs in 30 to 70-year-old-individuals. The data were extracted from WHO STEP wise approach to NCDs risk factor surveillance (STEPS) survey. Also,the previous studies conducted at national and subnational levels from 2001 to 2016 were employed. The prevalence of risk factors was projected by 2030 using Bayesian Model Averaging (BMA) and Spatio-temporal model stratified by sex and province. The percent change for the age-standardized prevalence of smoking in men between 2001 and 2016 was calculated to be - 27.0. Also, the corresponding values for the risk factors of diabetes, hypertension, obesity and overweight, physical inactivity (PI), and mean of salt intake were - 26.1, 29.0, 70.0, 96.8, 116.6, and 7.5, respectively. It is predicted that smoking and these risk factors will undergo a change to show values of - 1.26, 38.7, 43.7, 2.36, and 15.3 by 2030, respectively. The corresponding values in women for the time interval of 2001-2016 were - 27.3, 26.3, 82.8, 1.88, 75.2, and 4.2, respectively. Plus, projections indicate that the 2030 variation values are expected to be - 25.0, 16.7, 37.5, 28.7, 26.7, and 10.9 respectively. This study showed that the prevalence of four risk factors of PI, overweight and obesity, hypertension, and diabetes is increasing in Iran. Therefor, it is necessary to carry out effective interventions to adopt a healthy lifestyle and reduce the risk factors.
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Affiliation(s)
- Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yousefi
- Department of Mathematics and Statistics, Memorial University of Newfoundland, St John's, NL, Canada
| | - Ali Jafari-Khounigh
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Khosravi Shadmani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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9
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Zhang W, Neupane D, Zhao Z, Jiang B, Zhang M, Zhang X, Huang Z, Li C, Sharman JE, Hu C, Ye P, Wang L. Knowledge and practices related to salt consumption in China: findings from a national representative cross-sectional survey. J Hum Hypertens 2024; 38:155-167. [PMID: 37857758 PMCID: PMC10844095 DOI: 10.1038/s41371-023-00861-7] [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: 08/30/2022] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Abstract
There is limited information on the knowledge and practice of salt-reduction in China. The purpose of this study was to describe the status of the knowledge and practice of salt-reduction among the Chinese population from a nationally representative survey stratified according to hypertension status. The association between hypertensive status and salt-reduction knowledge and practice was calculated using multivariate hierarchical logistic regression adjusting for related confounders. The study included 179,834 participants; 51.7% were women, and the mean age was 44 years. The levels of overall salt-reduction knowledge (7.9%) and practice (37.1%) were low. The percentage of the use of salt-control spoons and low-sodium salt was 10.7% and 12.2%. The aging population (≥60 years) had the lowest levels of salt-reduction knowledge (5.7%) than other age groups (P < 0.0001). People living in rural areas (OR = 0.64; 95% CI: 0.51, 0.81) had lower odds of using salt-control spoons. Females (OR = 1.23; 95% CI: 1.10, 1.36) had higher odds of using salt-control spoons. People living in rural areas (OR = 0.48; 95% CI: 0.36, 0.63) had lower odds of using low-sodium salt. Females (OR = 1.26; 95% CI: 1.13, 1.41) and people living in the southern region (OR = 1.43; 95% CI: 1.11, 1.83) had higher odds of using low-sodium salt. Our work highlights the need to promote education related to hypertension, salt-reduction knowledge and methods among the public and the need to strengthen strategies for the popularization of salt-reduction knowledge and practices among males, people living in rural areas, people living in the northern region and the aging population in China.
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Affiliation(s)
- Wenrong Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zhenping Zhao
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Jiang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mei Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao Zhang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chun Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Caihong Hu
- Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Pengpeng Ye
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Limin Wang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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Mazzuca G, Artusa S, Pietrobelli A, Di Cara G, Piacentini G, Pecoraro L. The Future for the Children of Tomorrow: Avoiding Salt in the First 1000 Days. CHILDREN (BASEL, SWITZERLAND) 2024; 11:98. [PMID: 38255411 PMCID: PMC10814202 DOI: 10.3390/children11010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
It is widely known that optimal nutrition in the first 1000 days of life positively impacts the child's development throughout adulthood. In this setting, salt should not be added to complementary feeding. In developed countries, salt intake is generally higher than recommended for children. Excessive salt intake is the major determinant of hypertension and is associated with several cardiovascular outcomes. Therefore, pediatricians have a key role in raising awareness among parents to avoid salt consumption in the first 1000 days of life to ensure better health for their children. Starting from a review of the literature published in PubMed/MedLine regarding the short- and long-term consequences of salt consumption during the first 1000 days of life, our comprehensive review aims to analyze the beneficial effects of avoiding salt at such a vulnerable stage of life as the first 1000 days. Obesity, hypertension, increased salt sensitivity, high sweet drink consumption, increased mortality, and morbidity persisting in adult age represent the principal consequences of a higher salt intake during the first 1000 days of life.
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Affiliation(s)
- Giorgia Mazzuca
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Silvia Artusa
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Angelo Pietrobelli
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Giuseppe Di Cara
- Department of Pediatrics, University of Perugia, 06129 Perugia, Italy
| | - Giorgio Piacentini
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
| | - Luca Pecoraro
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, 37126 Verona, Italy; (G.M.)
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11
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Risso D, DunnGalvin G, Saxena S, Doolan A, Spence L, Karnik K. Gastrointestinal tolerance of D-allulose in children: an acute, randomised, double-blind, placebo-controlled, cross-over study. Food Funct 2024; 15:411-418. [PMID: 38099623 DOI: 10.1039/d3fo04210c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
D-Allulose, a low-calorie sugar, provides an attractive alternative to added sugars in food and beverage products. There is however limited data on its gastrointestinal (GI) tolerance, with only two studies in adults, and no studies in children to date. We therefore performed an acute, randomised, double-blind, placebo-controlled, cross over study designed to determine, for the first time, the GI tolerance of 2 doses of D-allulose (2.5 g per 120 ml and 4.3 g per 120 ml) in young children. The primary tolerance endpoint was the difference in the number of participants experiencing at least one stool that met a Type 6 or Type 7 description on the Bristol Stool Chart, within 24 hours after study product intake. Secondary endpoints included the assessment of stool frequency, stool consistency, and the presence of GI symptoms. Only one participant in the low dose group experienced a stool type 6 or 7, while no participants experienced a stool type 6 or 7 in the high dose group. A statistically significant difference in the change in stool frequency compared to placebo in the high dose group (p = 0.044) was found, with no significant difference between the groups for stool consistency and no participants experienced unusual stool frequency. All the encountered adverse events were non-serious, either mild or moderate, and there were no serious adverse events. All in all, D-allulose was tolerated well in children, making this ingredient a good candidate to reformulate commercially produced goods by replacing added sugars with lower caloric content.
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Affiliation(s)
- Davide Risso
- Tate & Lyle PLC, 5 Marble Arch, W1H 7EJ, London, UK.
| | | | - Sameer Saxena
- Atlantia Food Clinical Trials, Heron House, Blackpool, Cork, Ireland
| | - Andrea Doolan
- Atlantia Food Clinical Trials, Heron House, Blackpool, Cork, Ireland
| | - Lisa Spence
- School of Public Health, Indiana University Bloomington, Indiana, USA
| | - Kavita Karnik
- Tate & Lyle PLC, 5 Marble Arch, W1H 7EJ, London, UK.
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12
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Allais O, Enderli G, Sassi F, Soler LG. Effective policies to promote sugar reduction in soft drinks: lessons from a comparison of six European countries. Eur J Public Health 2023; 33:1095-1101. [PMID: 37695274 PMCID: PMC10710323 DOI: 10.1093/eurpub/ckad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Many countries have sought to incentivise soft drinks manufacturers to reduce sugar in their products as part of efforts to address a growing prevalence of obesity. Are their policies effective? METHODS Using a difference-in-differences design, we compared trends in the sugar content of 10 695 new sugar-sweetened beverages (SSB) launched between 2010 and 2019 in six European markets, including the UK and France (taxes designed to incentivise reformulation), the Netherlands (policy based on voluntary agreements to reduce sugar), Germany, Italy and Spain (no national policies). RESULTS The announcement in 2016 and adoption in 2018 of the UK tax led to yearly reductions in average sugar content of 17% (95% CI: 15-19%) to 31% (13-48%) between 2016 and 2019, compared to 2015, while the 2018 French tax produced a 6% (95% CI: 5-7%) sugar reduction only in 2018, compared to 2017, shortly after it was redesigned to provide a stronger incentive for reformulation. Voluntary agreements implemented in the Netherlands in 2014 led to an 8% (95% CI: 4-13%) sugar reduction only in 2015, compared to 2013. CONCLUSION The analysis supports the conclusions that sugar reductions in new SSBs have been greater in countries that have adopted specific policies to encourage them; a sugar-based tax design encourages more sugar reductions than a volume-based tax design; the tax rate and the amount of the tax reduction from switching to the next lower tier in a sugar-based tax design may be critical to incentivize reformulation.
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Affiliation(s)
- Olivier Allais
- INRAE, AgroParisTech, PSAE, University Paris-Saclay, Palaiseau, France
| | - Géraldine Enderli
- INRAE, CNRS, Laboratoire Interdisciplinaire Sciences Innovations Sociétés (LISIS), Université Gustave Eiffel, Noisy-le-Grand, France
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
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13
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Kwong EJL, Whiting S, Bunge AC, Leven Y, Breda J, Rakovac I, Cappuccio FP, Wickramasinghe K. Population-level salt intake in the WHO European Region in 2022: a systematic review. Public Health Nutr 2023; 26:s6-s19. [PMID: 36263661 PMCID: PMC10801383 DOI: 10.1017/s136898002200218x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/06/2022] [Accepted: 09/20/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The WHO recommends that adults consume less than 5 g of salt per day to reduce the risk of CVD. This study aims to examine the average population daily salt intake in the fifty-three Member States of the WHO European Region. DESIGN A systematic review was conducted to examine the most up-to-date salt intake data for adults published between 2000 and 2022. Data were obtained from peer-reviewed and grey literature, WHO surveys and studies, as well as from national and global experts. SETTING The fifty-three Member States of the WHO European Region. PARTICIPANTS People aged 12 years or more. RESULTS We identified fifty studies published between 2010 and 2021. Most countries in the WHO European Region (n 52, 98 %) reported salt intake above WHO recommended maximum levels. In almost all countries (n 52, 98 %), men consume more salt than women, ranging between 5·39 and 18·51 g for men and 4·27 and 16·14 g for women. Generally, Western and Northern European countries have the lowest average salt intake, whilst Eastern European and Central Asian countries have the highest average. Forty-two percentage of the fifty-three countries (n 22) measured salt intake using 24 h urinary collection, considered the gold standard method. CONCLUSIONS This study found that salt intakes in the WHO European Region are significantly above WHO recommended levels. Most Member States of the Region have conducted some form of population salt intake. However, methodologies to estimate salt intake are highly disparate and underestimations are very likely.
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Affiliation(s)
- Edwin Jit Leung Kwong
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Whiting
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
| | - Anne Charlotte Bunge
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Yana Leven
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
| | - Joao Breda
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Ivo Rakovac
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
| | | | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, Moscow125009, Russian Federation
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Xing XY, Zhao Y, Sam NB, Xu JQ, Chen YJ, Xu W, Wang HD, Liu ZR, Pan HF. Salt reduction behavior of adults in Anhui province in 2019: a cross-sectional survey of 3,378 participants. Front Public Health 2023; 11:1242969. [PMID: 37908687 PMCID: PMC10613982 DOI: 10.3389/fpubh.2023.1242969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
Objective A high-sodium diet is an important risk factor for hypertension in the Chinese population, which can increase the risk of cardiovascular and cerebrovascular diseases. Although a large number of related studies have been carried out in Anhui province, clear, effective salt reduction interventions and policies that can be widely promoted have not yet been formed. This study sought to understand the prevalence and precise measures of salt reduction behavior, the variables affecting salt reduction behavior, and the reasons why salt reduction behavior was not practiced in Anhui Province, China. Methods The total number of participants in the study was 3,378. Using a multi-stage stratified cluster random sampling method, residents between the ages of 18 and 69 years in 10 counties and districts were selected from March to October 2019. A survey questionnaire and physical measurements were given to each participant. The influencing factors of residents' salt reduction behavior were examined using a multi-factor unconditional logistic regression analysis. The chi-squared (χ2) test was used to analyze the implementation of salt reduction behaviors among different age groups and gender, the factors influencing the implementation of salt reduction measures, and the reasons for not implementing salt reduction measures. Results A history of hypertension was associated with salt reduction strategies (P = 0.014). Patients with hypertension were more likely to adopt salt reduction behaviors than those without hypertension (OR = 1.218, P = 0.040). The influence of eating out on the adoption of salt-reduction measures varied by age group (χ2 = 50.463, P < 0.001) and gender (χ2 = 81.348, P < 0.001). Conclusion In summary, residents of the Anhui Province are not very knowledgeable about salt reduction. Age, gender, education level, hypertension, and marital status are the main determinants. Our findings have significant implications for policymakers who want to devise salt reduction strategies.
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Affiliation(s)
- Xiu-Ya Xing
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Yan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation and Immunity-Mediated Diseases, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Napoleon Bellua Sam
- Department of Medical Research and Innovation, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Jing-Qiao Xu
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Ye-Ji Chen
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Wei Xu
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Hua-Dong Wang
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Zhi-Rong Liu
- Department of Chronic Non-Communicable Disease Prevention and Control, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- Institute of Kidney Disease, Inflammation and Immunity-Mediated Diseases, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
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15
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Krušič S, Hristov H, Hribar M, Lavriša Ž, Žmitek K, Pravst I. Changes in the Sodium Content in Branded Foods in the Slovenian Food Supply (2011-2020). Nutrients 2023; 15:4304. [PMID: 37836588 PMCID: PMC10574098 DOI: 10.3390/nu15194304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
High sodium intake is the leading diet-related risk factor for mortality globally. Many countries have introduced policies to support the reformulation of foods and to reduce sodium intake, mainly on a voluntary basis, but there are limited data available about the long-term efficiency of such measures. Slovenia implemented salt reduction policies for the period of 2010-2020; these policies also included the voluntary reformulation of foods with the lowering of sodium content. This study's aim was to explore the nationally representative branded food datasets collected in the years 2011, 2015, 2017, and 2020 to investigate the changes in the sodium content in prepacked branded foods. The study was conducted with datasets collected from food labels using standard food monitoring studies and included all the major retailers. Differences in market shares were adjusted by sales weighting, which was conducted using the yearly sales data provided by the major retailers. The food categories with a major contribution to the overall sales of sodium in prepacked branded foods were processed meat and derivatives (19.0%), canned vegetables (7.1%), water (6.7%), bread (7.2%), and cheese (6.3%). Considering the available food products, a notable decreasing sodium content trend was observed in biscuits, breakfast cereals, pizza, and spreads. Year-to-year differences were much less expressed after the correction for market share differences, and neutral trends were most frequently highlighted. This indicates that sodium was less frequently reduced in market-leading products. The study results revealed that very limited progress in sodium food reformulation was achieved in the 10-year period, indicating the need for more efficient policy approaches. The study demonstrated the importance of the systematic monitoring of the food supply for the evaluation of food policies.
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Affiliation(s)
- Sanja Krušič
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
| | - Hristo Hristov
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
| | - Maša Hribar
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
| | - Živa Lavriša
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
| | - Katja Žmitek
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
- VIST–Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
| | - Igor Pravst
- Nutrition Institute, Koprska Ulica 98, SI-1000 Ljubljana, Slovenia; (S.K.); (H.H.); (M.H.); (Ž.L.); (K.Ž.)
- VIST–Faculty of Applied Sciences, Gerbičeva Cesta 51A, SI-1000 Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, SI-1000 Ljubljana, Slovenia
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Bhaskar SMM. Editorial: Digital strategies to reduce salt consumption. Front Public Health 2023; 11:1244216. [PMID: 37860796 PMCID: PMC10584306 DOI: 10.3389/fpubh.2023.1244216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW, Australia
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South West Sydney Local Health District, Liverpool, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
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17
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Karlsson K, Rådholm K, Dunford E, Wu JHY, Neal B, Sundström J. Sodium content in processed food items in Sweden compared to other countries: a cross-sectional multinational study. Front Public Health 2023; 11:1182132. [PMID: 37361177 PMCID: PMC10287089 DOI: 10.3389/fpubh.2023.1182132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Background Dietary sodium has a dose-response relationship with cardiovascular disease, and sodium intake in Sweden exceeds national and international recommendations. Two thirds of dietary sodium intake comes from processed foods, and adults in Sweden eat more processed foods than any other European country. We hypothesized that sodium content in processed foods is higher in Sweden than in other countries. The aim of this study was to investigate sodium content in processed food items in Sweden, and how it differs from Australia, France, Hong Kong, South Africa, the United Kingdom and the United States. Methods Data were collected from retailers by trained research staff using standardized methods. Data were categorized into 10 food categories and compared using Kruskal-Wallis test of ranks. Sodium content in the food items was compared in mg sodium per 100 g of product, based on the nutritional content labels on the packages. Results Compared to other countries, Sweden had among the highest sodium content in the "dairy" and "convenience foods" categories, but among the lowest in "cereal and grain products," "seafood and seafood products" and "snack foods" categories. Australia had the overall lowest sodium content, and the US the overall highest. The highest sodium content in most analyzed countries was found in the "meat and meat products" category. The highest median sodium content in any category was found among "sauces, dips, spreads and dressings" in Hong Kong. Conclusion The sodium content differed substantially between countries in all food categories, although contrary to our hypothesis, processed foods overall had lower sodium content in Sweden than in most other included countries. Sodium content in processed food was nonetheless high also in Sweden, and especially so in increasingly consumed food categories, such as "convenience foods".
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Affiliation(s)
- Karin Karlsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Rådholm
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elizabeth Dunford
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Zhang P, Sun J, Li Y, Li Y, Sun Y, Luo R, Nie X, Li L, Liu Y, He FJ. An mHealth-based school health education system designed to scale up salt reduction in China (EduSaltS): A development and preliminary implementation study. Front Nutr 2023; 10:1161282. [PMID: 37139455 PMCID: PMC10149706 DOI: 10.3389/fnut.2023.1161282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
Background High-salt diet is an important risk factor for several non-communicable diseases. School-based health education has been found effective in reducing salt intake among children and their families in China. However, no such interventions have been scaled up in the real world. For this purpose, a study was launched to support the development and scale-up of an mHealth-based system (EduSaltS) that integrated routine health education and salt reduction and was delivered through primary schools. This study aims to elaborate the framework, development process, features, and preliminary scaling-up of the EduSaltS system. Methods The EduSaltS system evolved from previously successfully tested interventions to reduce family salt intake by empowering schoolchildren through school health education. EduSaltS was designed by following the WHO's conceptual framework for developing a scaling-up strategy which accounted for the nature of the innovation, the capacity of the implementing organizations, the characteristics of the environment, the resources available, and type of scaling up. The system was then developed step by step from determination of online platform architecture, definition of component interventions and activities, development of specific educational materials and tools, to the development of the online/offline hybridized system. The system was tested and refined by a pilot in two schools and a preliminary scale-up in two cities in China. Results EduSaltS was developed as an innovative health education system, including an online WeChat-based education platform, a set of offline activities, and an actual administrative website showing the progress and setting the system. The WeChat platform could be installed on users' smartphones to automatically deliver 20 sessions of five-minute well-structured cartoon video classes, followed by other online interactive activities. It also helps support project implementation and real-time performance evaluation. As a first-stage roll-out, a one-year course has been successfully implemented among 54,538 children and their families from 209 schools in two cities, and the average course completion rate was 89.1%. Conclusion As an innovative mHealth-based health education system, EduSaltS was developed based on successfully tested interventions and an appropriate framework for scaling up. The early-stage roll-out has shown its preliminary scalability, and further evaluation is ongoing.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health, Beijing, China
| | - Jingwen Sun
- The George Institute for Global Health, Beijing, China
| | - Yinghua Li
- Chinese Center for Health Education, Beijing, China
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
| | - Yuewen Sun
- The George Institute for Global Health, Beijing, China
| | - Rong Luo
- The George Institute for Global Health, Beijing, China
| | - Xueqiong Nie
- Chinese Center for Health Education, Beijing, China
| | - Li Li
- Chinese Center for Health Education, Beijing, China
| | - Yu Liu
- School of Computing Science and Engineering, Beihang University, Beijing, China
| | - Feng J He
- Barts and The London School of Medicine and Dentistry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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19
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Spiteri G, Monaco MGL, Carta A, Torroni L, Taus F, Verlato G, Porru S. Reduction of Excessive Dietary Sodium Consumption: Effectiveness of a Prevention Intervention among Health Workers in a Large Italian Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085478. [PMID: 37107760 PMCID: PMC10138373 DOI: 10.3390/ijerph20085478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
Excessive salt consumption is one of the leading causes of high blood pressure. Worldwide salt intake largely exceeds the WHO recommended amount. This study aimed to evaluate the prevalence of high salt consumers and the effectiveness of a short-term workplace educational intervention among health workers. An online survey, assessing daily salt consumption through the MINISAL-SIIA questionnaire, was sent to the 4911 health workers employed by the University Hospital of Verona, Italy. Health workers who had a high (total score ≥ 10) or moderate (total score = 8/9) salt consumption associated with obesity or arterial hypertension were invited to undergo a medical examination and a short individual counselling session. A total of 1665 health workers (34.0%) completed the online questionnaire; 40.9% and 12.6% had moderate and high salt intake, respectively. High salt intake was more prevalent in men, current and past smokers, and obese and overweight subjects. In 95 participants completing the clinical phase, median daily salt consumption decreased from 10 (p25-p75 8-11) to 7 g (6-8) (p < 0.001), systolic blood pressure from 130 (120-140) to 120 (120-130) mmHg and weight from 78 (62-87) to 75 (62-86) kg. More than half of health workers had an excessive salt intake. However, a brief educational intervention in the healthcare working setting can substantially reduce unhealthy dietary habits, fostering weight loss and blood pressure control. Studies with a longer follow-up are needed to evaluate the persistence over time of these effects.
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Affiliation(s)
- Gianluca Spiteri
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
| | - Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Correspondence: ; Tel.: +39-045-812-3946
| | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Lorena Torroni
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Francesco Taus
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Giuseppe Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
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20
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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21
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Trieu K, Coyle DH, Rosewarne E, Shahid M, Yamamoto R, Nishida C, Neal B, He FJ, Marklund M, Wu JHY. Estimated Dietary and Health Impact of the World Health Organization's Global Sodium Benchmarks on Packaged Foods in Australia: a Modeling Study. Hypertension 2023; 80:541-549. [PMID: 36625256 DOI: 10.1161/hypertensionaha.122.20105] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In 2021, the World Health Organization (WHO) set sodium benchmarks for packaged foods to guide countries in setting feasible and effective sodium reformulation programs. We modeled the dietary and health impact of full compliance with the WHO's sodium benchmarks in Australia and compared it to the potential impact of Australia's 2020 sodium reformulation targets. METHODS We used nationally representative data on food and sodium intake, sodium levels in packaged foods, and food sales volume to estimate sodium intake pre- and post-implementation of the WHO and Australia's sodium benchmarks for 24 age-sex groups. Using comparative risk assessment models, we then estimated the potential deaths, incidence, and disability-adjusted life years averted from cardiovascular disease, chronic kidney disease, and stomach cancer based on the reductions in sodium intake. RESULTS Compliance with the WHO's sodium benchmarks for packaged foods in Australia could lower mean adult sodium intake by 404 mg/day, corresponding to a 12% reduction. This could prevent about 1770 deaths/year (95% uncertainty interval 1168-2587), corresponding to 3% of all cardiovascular disease, chronic kidney disease, and stomach cancer deaths in Australia, and prevent some 6900 (4603-9513) new cases, and 25 700 (17 655-35 796) disability-adjusted life years/year. Compared with Australian targets, the WHO benchmarks will avert around 3 and a half times more deaths each year (1770 versus 510). CONCLUSIONS Substantially greater health impact could be achieved if the Australian government strengthened its current sodium reformulation program by adopting WHO's more stringent and comprehensive sodium benchmarks.
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Affiliation(s)
- Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Maria Shahid
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.)
| | - Rain Yamamoto
- World Health Organization, Geneva, Switzerland (R.Y., C.N.)
| | | | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Department of Epidemiology and Biostatistics, Imperial College London, United Kingdom (B.N.)
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (F.J.H.)
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (M.M.)
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (K.T., D.H.C., E.R., M.S., B.N., M.M., J.H.Y.W.).,School of Population Health, University of New South Wales, Australia (J.H.Y.W.)
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22
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Lorén N, Niimi J, Höglund E, Albin R, Rytter E, Bjerre K, Nielsen T. Sodium reduction in foods: Challenges and strategies for technical solutions. J Food Sci 2023; 88:885-900. [PMID: 36658676 DOI: 10.1111/1750-3841.16433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/02/2022] [Accepted: 12/06/2022] [Indexed: 01/21/2023]
Abstract
In many parts of the world, sodium consumption is higher than recommended levels, representing one of the most important food-related health challenges and leading to considerable economical costs for society. Therefore, there is a need to find technical solutions for sodium reduction that can be implemented by food producers and within food services. The aims of this review are to discuss the barriers related to sodium reduction and to highlight a variety of technical solutions. The barriers relate to consumer perception, microbiology, processing, and physicochemistry. Existing technical solutions include inhomogeneous salt distribution, coated salt particles, changing particle sizes and forms, surface coating, multisensory combinations, sodium replacements, double emulsions, adapted serum release by microstructure design, and adapted brittleness by microstructure design. These solutions, their implementation and the associated challenges, and applicable product categories are described. Some of these solutions are ready for use or are in their early development stages. Many solutions are promising, but in most cases, some form of adaptation or optimization is needed before application in specific products, and care must always be taken to ensure food safety. For instance, further research and innovation are required in the dynamic evolution of saltiness perception, consumer acceptance, the binding and migration of sodium, juiciness, microbiological safety, and the timing of salt addition during processing. Once implemented, these solutions will undoubtedly support food producers and food services in reducing sodium content and extend the application of the solutions to different foods.
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Affiliation(s)
- Niklas Lorén
- RISE Agriculture and Food, Göteborg, Sweden.,Department of Physics, Chalmers University of Technology, Göteborg, Sweden
| | - Jun Niimi
- RISE Material and Surface Design, Göteborg, Sweden
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23
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Mizutani M, Tashiro J, Sugiarto H, Maftuhah, Riyanto, Mock J, Nakayama K. Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling. Nutr Health 2023; 29:85-95. [PMID: 35014883 DOI: 10.1177/02601060211057624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants' frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.
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Affiliation(s)
- Mayumi Mizutani
- Department of Public Health Nursing, 88369Mie University Graduate School of Medicine, Tsu, Mie, Japan.,Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Junko Tashiro
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Heri Sugiarto
- 188408Indramayu College of Health Science, Indramayu, West Java, Indonesia
| | - Maftuhah
- 118942Syarif Hidayatullah State Islamic University Jakarta, Tangerang Selatan, Banten, Indonesia
| | - Riyanto
- 188408Indramayu College of Health Science, Indramayu, West Java, Indonesia
| | - Jeremiah Mock
- Institute for Health & Aging and Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Kazuhiro Nakayama
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
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24
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Harun Z, Shahar S, You YX, Manaf ZA, Majid HA, Chia YC, Haron H, Michael V, Sukiman NS, Taib AFM, He FJ, Brown MK. Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries. Health Res Policy Syst 2023; 21:17. [PMID: 36759869 PMCID: PMC9910255 DOI: 10.1186/s12961-023-00965-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries. METHODS This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12. RESULTS All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax. CONCLUSIONS Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.
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Affiliation(s)
- Zaliha Harun
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Yee Xing You
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- School of Chiropractor, AECC University College, Parkwood Campus, Parkwood Road, Bournemouth, Dorset, BH5 2DF, United Kingdom
| | - Yook Chin Chia
- Department of Medical Sciences, School of Medical and Life Sciences, Sunway University, 47500, Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Hasnah Haron
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Viola Michael
- Allied Health Sciences Division, Ministry of Health Malaysia, Level 2, Block A, Chancery Place Main Building, Jalan Diplomatik 2, Precinct Diplomatik, Precinct 15, 62050, Putrajaya, Malaysia
| | - Noor Shahida Sukiman
- Dietetic Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Aida Farzana Mohamad Taib
- Nutritional Sciences Programme, Centre for Healthy Ageing and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
| | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, United Kingdom
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25
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Sanuade OA, Alfa V, Yin X, Liu H, Ojo AE, Shedul GL, Ojji DB, Huffman MD, Orji IA, Okoli RCB, Akor B, Ripiye NR, Eze H, Okoro CE, Van Horn L, Tripathi P, Ojo TM, Trieu K, Neal B, Hirschhorn LR. Stakeholder perspectives on Nigeria's national sodium reduction program: Lessons for implementation and scale-up. PLoS One 2023; 18:e0280226. [PMID: 36638099 PMCID: PMC9838847 DOI: 10.1371/journal.pone.0280226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/26/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND To reduce excess dietary sodium consumption, Nigeria's 2019 National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of Non-communicable Diseases includes policies based on the World Health Organization SHAKE package. Priority actions and strategies include mandatory sodium limits in processed foods, advertising restrictions, mass-media campaigns, school-based interventions, and improved front-of-package labeling. We conducted a formative qualitative evaluation of stakeholders' knowledge, and potential barriers as well as effective strategies to implement these NMSAP priority actions. METHODS From January 2021 to February 2021, key informant interviews (n = 23) and focus group discussions (n = 5) were conducted with regulators, food producers, consumers, food retailers and restaurant managers, academia, and healthcare workers in Nigeria. Building on RE-AIM and the Consolidated Framework for Implementation Research, we conducted directed content qualitative analysis to identify anticipated implementation outcomes, barriers, and facilitators to implementation of the NMSAP sodium reduction priority actions. RESULTS Most stakeholders reported high appropriateness of the NMSAP because excess dietary sodium consumption is common in Nigeria and associated with high hypertension prevalence. Participants identified multiple barriers to adoption and acceptability of implementing the priority actions (e.g., poor population knowledge on the impact of excess salt intake on health, potential profit loss, resistance to change in taste) as well as facilitators to implementation (e.g., learning from favorable existing smoking reduction and advertising strategies). Key strategies to strengthen NMSAP implementation included consumer education, mandatory and improved front-of-package labeling, legislative initiatives to establish maximum sodium content limits in foods and ingredients, strengthening regulation and enforcement of food advertising restrictions, and integrating nutrition education into school curriculum. CONCLUSION We found that implementation and scale-up of the Nigeria NMSAP priority actions are feasible and will require several implementation strategies ranging from community-focused education to strengthening current and planned regulation and enforcement, and improvement of front-of-package labeling quality, consistency, and use.
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Affiliation(s)
- Olutobi A. Sanuade
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, United States of America
| | - Vanessa Alfa
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - 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
| | - Adedayo E. Ojo
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Mark D. Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Blessing Akor
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nanna R. Ripiye
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Helen Eze
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Clementina Ebere Okoro
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Priya Tripathi
- Stanley Manne Children’s Research Institute, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Robert J Havey Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Jiang K, He T, Ji Y, Zhu T, Jiang E. The perspective of hypertension and salt intake in Chinese population. Front Public Health 2023; 11:1125608. [PMID: 36875386 PMCID: PMC9981806 DOI: 10.3389/fpubh.2023.1125608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Salt intake is too high nowadays. It has been widely recognized that there is a close relationship between hypertension (HTN) and dietary salt intake. Investigations reveal that long-term high salt intake, mainly sodium intake, induces a relevant increase in blood pressure in hypertensive and normotensive individuals. According to most scientific evidence, a diet with high salt intake in public increases cardiovascular risk, salted-related HTN, and other HTN-associated outcomes. Given the clinical importance, this review aims to present the prevalence of HTN and trends in salt intake in the Chinese population and will comprehensively discuss the risk factors, causes, and mechanisms of the association between salt intake and HTN. The review also highlights the education of Chinese people regarding salt intake and the cost-effectiveness of salt reduction from a global perspective. Finally, the review will emphasize the need to customize the unique Chinese practices to reduce salt intake and how awareness changes people's eating lifestyle and helps adopt diet salt reduction strategies.
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Affiliation(s)
- Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tingting He
- Department of Basic Nursing, Henan Technical Institute, Zhengzhou, China
| | - Yongzhi Ji
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tao Zhu
- Department of Geriatrics, Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China.,Department of Scientific Research, Scope Research Institute of Electrophysiology, Kaifeng, China
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Pouraram H, Afshani F, Ladaninejad M, Siassi F. What do we Need to Start a Multimedia Salt Reduction Campaign? Int J Prev Med 2023; 14:28. [PMID: 37033276 PMCID: PMC10080572 DOI: 10.4103/ijpvm.ijpvm_485_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 10/27/2022] [Indexed: 04/11/2023] Open
Abstract
As reports of the first national study reveal, Iranian salt intake reaches 9.52 g/day (two times more than recommended by World Health Organization). Meanwhile ignoring the consequences of high salt intake has led to an increased rate of cardiovascular diseases (CVD), stroke, stomach cancer, osteoporosis, obesity, etc., To tackle these threatening issues, a nationwide intervention campaign could be an effective solution based on global experiences. A review of previous work in Iran shows that despite numerous efforts conducted in the prevention of CVDs, they were not well reflected in worldwide sources. Furthermore, a comprehensive campaign was not implemented particularly concerning the salt reduction in Iran. As a result, we first reviewed the major successful initiatives conducted in reducing salt intake around the world and Iran. Then we introduced the components of a comprehensive social marketing campaign along with customized actions related to Iranian nutrition habits, their attitude, and behavior toward salt consumption. These employed components were SWOT analysis, identifying target group, determining communication goals and objectives based on models and theories, planning executive plan, designing communication messages and materials, media planning and promotional actions, and determining campaign budget plus monitoring and evaluation.
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Affiliation(s)
- Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Address for correspondence: Dr. Hamed Pouraram, Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farideh Afshani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ladaninejad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Siassi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Prof. Fereydoun Siassi, No: 44, Hojjatdoust Alley, Naderi ST, Keshavarz BLVD, PO BOX: 1455-6117, Tehran, Iran. E-mail:
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Flexner N, Christoforou AK, Bernstein JT, Ng AP, Yang Y, Fernandes Nilson EA, Labonté MÈ, L'Abbe MR. Estimating Canadian sodium intakes and the health impact of meeting national and WHO recommended sodium intake levels: A macrosimulation modelling study. PLoS One 2023; 18:e0284733. [PMID: 37163471 PMCID: PMC10171671 DOI: 10.1371/journal.pone.0284733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/09/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. OBJECTIVE This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d-driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. METHODS Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey-Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. RESULTS Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869-3,687), 3,252 (95% UI 1,380-5,321), and 5,296 (95% UI 2,190-8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. CONCLUSION Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets.
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Affiliation(s)
- Nadia Flexner
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Jodi T Bernstein
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alena P Ng
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Yahan Yang
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Eduardo A Fernandes Nilson
- Center for Epidemiological Research on Health and Nutrition, University of São Paulo, São Paulo, State of São Paulo, Brazil
| | - Marie-Ève Labonté
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Quebec, Canada
| | - Mary R L'Abbe
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Anwar F, Omar Asar T, Al-Abassi FA, Kumar V, Alhayyani S. Natural sea salt in diet ameliorates better protection compared to table salt in the doxorubicin-induced cardiac remodeling. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2022.2154491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Firoz Anwar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turky Omar Asar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biology, College of Science and Arts at Alkamil, University of Jeddah, Jeddah, Saudi Arabia
| | - Fahad A. Al-Abassi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Vikas Kumar
- Natural Product Drug Discovery Laboratory, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Sam Higginbottom Institute of Agriculture, Technology & Sciences, Allahabad, Uttar Pradesh, India
| | - Sultan Alhayyani
- Department of Chemistry, College of Sciences & Arts, King Abdulaziz University, Rabigh, Saudi Arabia
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Mental associations with salt among Uruguayan consumers. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2022.104684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Xue X, Li W, Xie M, Wang D, Li D, Xin P, Zheng W, Jiang G. High sodium diet intake and cardiovascular diseases: An attributable death study in Tianjin, China. J Clin Hypertens (Greenwich) 2022; 25:30-37. [PMID: 36445722 PMCID: PMC9832237 DOI: 10.1111/jch.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022]
Abstract
There is clear evidence that high sodium intake is associated with many health issues including hypertension and cardiovascular diseases (CVDs). Several national and worldwide studies have estimated deaths from CVDs attributable to high sodium. But how to evaluate the impact of high sodium intake on diseases using regional routine monitoring and investigation data is necessary and important. Our study aimed to quantitatively evaluate the high sodium intake attributed to CVDs deaths based on the routine monitoring data from China National Nutrition and Health Survey (CNNHS) in Tianjin, China. The population attributable fractions (PAF) were calculated by comparing the observed systolic blood pressure (SBP) distribution with the theoretical minimum or counterfactual distribution by sex and age groups. The results showed that CVDs deaths due to elevated SBP were 22728 (95% uncertainty intervals: 22679-23050), accounting for 62.8% of total CVDs deaths. According to sodium intake recommended by World Health Organization (WHO), PAF of CVDs deaths attributable to high sodium diet in our study was 14.6% of total CVDs deaths, accounting for 5228 (95% UI: 5005-5998) cases. The dietary sodium intake of residents is nearly three times than sodium intake recommended by WHO. If sodium intake was reduced to reference level, the potential avoidable CVD deaths attributable to the SBP-raising effect were more than 5200 among adults 25 aged and over in Tianjin. This evaluation method can be extended to other cities.
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Affiliation(s)
- Xiao‐Dan Xue
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Wei Li
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Mei‐Qiu Xie
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - De‐Zheng Wang
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Dan‐Dan Li
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Peng Xin
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Wen‐Long Zheng
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
| | - Guo‐Hong Jiang
- Department of Noncommunicable Disease Control and PreventionTianjin Centers for Disease Control and PreventionTianjinChina
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Sacchi R, Corrado G, Basile B, Mandarello D, Ambrosino ML, Paduano A, Savarese M, Caporaso N, Aponte M, Genovese A. Effect of Salt Addition and Fermentation Time on Phenolics, Microbial Dynamics, Volatile Organic Compounds, and Sensory Properties of the PDO Table Olives of Gaeta (Italy). MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27228100. [PMID: 36432200 PMCID: PMC9698976 DOI: 10.3390/molecules27228100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
'Oliva di Gaeta' is almost certainly the most important and well-known PDO denomination for table olives in Italy. Their production is based on a specific two-stage trade preparation called the 'Itrana' method. In this work, we investigated how variations in the duration of the initial water fermentation (i.e., 15 and 30 days) and the salt concentration (i.e., 6% and 8% NaCl) influence the chemical features, microbial dynamics, polyphenols, volatile organic compounds, and sensory features of 'Oliva di Gaeta'. The time of the addition of salt did not affect the final concentration in the brine, but a longer initial water fermentation (before salt addition) led to lower pH values. The bacterial count constantly increased until the salt addition (i.e., either 15 or 30 days), while the yeast population peaked on day 30. Generally, the two different salt concentrations did not affect the count of microorganisms at the end of fermentation, with the only exception being a higher lactic acid bacteria count for the treatment with 6% salt added at 30 days. At commercial maturity, the crucial bitter tastant oleuropein was not completely removed from the drupes, and differences in salt concentration and the length of the first-stage water fermentation did not influence its content at the end of olive curing. Richer volatile profiles of olives were detected with higher-salt treatments, while the combination of low salt and early saline treatment provided a more distinct profile. Longer initial water fermentation caused a small increase in some phenolic compounds (e.g., iso-verbascoside, verbascoside, and hydroxytyrosol-glucoside). A panel test indicated that salt application at 30 days resulted in a more "Sour" and "Bitter" taste, irrespective of the salt concentration. The low salt concentration coupled with the late saline treatment resulted in more "Fruity" notes, probably due to the higher production of esters by lactobacilli. The slightly bitter perception of the olives was consistent with the partial removal of oleuropein. Our work revealed the characteristics of the 'Itrana' method and that the variation in salt concentration and its time of application changes parameters ranging from the microbial dynamics to the sensory profile. Specifically, our data indicate that 6% NaCl coupled with a longer initial water fermentation is the most different condition: it is less effective in blocking microbial growth but, at the same time, is more potent in altering the nutritional (e.g., polyphenols) and sensorial qualities (e.g., bitterness and fruitiness) of 'Oliva di Gaeta'.
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Allemandi LA, Flexner N, Nederveen L, Gomes FDS. Building capacity in reducing population dietary sodium intake in the Americas. Rev Panam Salud Publica 2022; 46:e198. [DOI: 10.26633/rpsp.2022.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Objective.
To present some resources developed as part of the technical support of the Pan American Health Organization (PAHO) to Member States to reduce population dietary sodium intake, and to discuss the main challenges and opportunities to accelerate action toward sodium intake reduction in the Americas.
Methods.
Sources of information include a mapping of salt reduction policies conducted in 2019, reports from working group meetings, interviews conducted in 2020 and 2021 in seven countries, and technical documents developed around the Updated PAHO Regional Sodium Reduction Targets.
Results.
These tools show that, despite progress, challenges to succeed in this agenda persist. Priority given to sodium reduction is low in most countries, with insufficient resource allocation. There is a lack of intersectoral coordinated action, and a systemic approach to food systems is commonly missing. Surveillance mechanisms of sodium intake are insufficient, and industry interference in policy processes is commonly identified, undermining policy progress and success. There are also important regional opportunities to address these challenges. These include common ground for future collaborations by updating, strengthening, and complementing these existing tools, and technical and financial support for data generation.
Conclusions.
PAHO is committed to continue to support countries in the process of promoting, implementing, and monitoring cost-effective sodium reduction interventions. One key policy priority in this agenda is the adoption of the Updated PAHO Regional Sodium Reduction Targets with a mandatory approach, together with the comprehensive and complementary implementation of other strategies. Strong political will and commitment of countries will be critical to translate goals into concrete achievements in the Americas.
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Affiliation(s)
| | - Nadia Flexner
- Pan American Health Organization, Washington, D.C., United States of America
| | - Leo Nederveen
- Pan American Health Organization, Washington, D.C., United States of America
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A Town-Level Comprehensive Intervention Study to Reduce Salt Intake in China: Cluster Randomized Controlled Trial. Nutrients 2022; 14:nu14214698. [PMID: 36364960 PMCID: PMC9654622 DOI: 10.3390/nu14214698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
We determined whether a town-level comprehensive intervention program could lower the salt intake of a population. The parallel, cluster randomized controlled trial was carried out between October 2018 and January 2020 in 48 towns from 12 counties across 6 provinces in China. All participants were asked to complete the 24 h urine collections, anthropometric measurements and questionnaires at the baseline and one-year post-intervention survey. A total of 2693 participants aged 18 to 75 years were recruited at the baseline. A total of 1347 individuals in 24 towns were allocated to the intervention group and the others were allocated to the control group. Valid information from 2335 respondents was collected in the follow-up survey. The 24-h urinary sodium excretion was 189.7 mmol/24 h for the intervention group and 196.1 mmol/24 h for the control group at baseline. At a one-year follow-up, the mean effect of salt intake did not show a significant change (p = 0.31) in the intervention group compared to the control group. However, the mean result of potassium excretion in the intervention group increased by 2.18 mmol/24 h (85.03 mg/24 h) (p = 0.004) and systolic blood pressure decreased by 2.95 mmHg (p < 0.001). The salt-related knowledge and attitude toward salt reduction improved significantly in the intervention group (p < 0.05). A longer period of intervention and follow-up assessment might be needed to evaluate the long-term effectiveness of the program on salt reduction.
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Gupta AK, Carroll TE, Chen Y, Liang W, Cobb LK, Wang Y, Zhang J, Chen Y, Guo X, Mullin S, Murukutla N. 'Love with Less Salt': evaluation of a sodium reduction mass media campaign in China. BMJ Open 2022; 12:e056725. [PMID: 36223966 PMCID: PMC9562322 DOI: 10.1136/bmjopen-2021-056725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study examines the impact of a salt reduction campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change relating to salt consumption in two provinces of China. METHODS In 2019, the 'Love with Less Salt' campaign ran on China Central Television and on local television channels in Shandong and Anhui provinces. Data for this study come from two representative household surveys conducted among a sample of adults aged 25-65 years in Shandong and Anhui provinces: precampaign (n=2000) and postcampaign (n=2015). Logistic regression was performed to estimate the effects of the campaign on knowledge, attitudes, intentions, behaviours and barriers to behaviour change. RESULTS Overall, 13% of postcampaign respondents recalled seeing the campaign, and reactions towards the campaign were positive. Postcampaign respondents were more likely to plan to reduce their purchase of foods high in salt than precampaign respondents (OR=1.45, p=<0.05). Campaign-aware respondents were significantly more likely than campaign-unaware respondents to report higher levels of knowledge, attitudes and behaviours regarding salt reduction. CONCLUSIONS Findings reveal that salt reduction mass media campaigns can be an effective public health tool to support efforts to reduce salt consumption in China. Continued and sustained mass media investments are likely to be effective in addressing high salt consumption nationwide.
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Affiliation(s)
| | - Tom E Carroll
- Vital Strategies, Sydney, New South Wales, Australia
| | - Yu Chen
- Vital Strategies, Beijing, China
| | | | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, New York, USA
| | - Yichao Wang
- Beijing Haisi Aide Technology Co Ltd, Beijing, China
| | - Juan Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yeji Chen
- Anhui Provincial Center for Disease Control and Prevention, Hefei, Anhui, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China
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Rosewarne E, Santos JA, Hart AC, Trieu K, Tekle D, Ide N, Jones A, Ni Mhurchu C, Webster J. Review of national nutrition standards with salt-related criteria for publicly funded institutions around the world. Nutr Rev 2022; 81:647-657. [PMID: 36206178 PMCID: PMC10170325 DOI: 10.1093/nutrit/nuac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Creating healthy food environments through nutrition standards for publicly funded institutions (eg, schools, workplaces, and hospitals) provides an important opportunity to improve population diets. OBJECTIVE This study aimed to identify countries with national nutrition standards for publicly funded institutions that included salt-related criteria and to describe and summarize these initiatives. DATA SOURCES Peer-reviewed and grey literature was searched to December 2019, including MEDLINE, CENTRAL, Embase, TRoPHI, LILACS, Web of Science, Cochrane Public Health Group Specialised Register, and Effective Public Health Practice Project Database. In addition, a questionnaire was sent to country contacts and salt-reduction experts, and a targeted search on relevant government websites was conducted. DATA EXTRACTION Key characteristics of the national nutrition standards for publicly funded institutions were extracted, including name, governance, institution type, implementation status, and details of food and nutrient criteria. DATA ANALYSIS Nutrition standards were analyzed by World Health Organization region, World Bank income level, institution type, type of criteria, regulatory approach, and method of application. Sixty-six countries were identified as having national nutrition standards that included salt-related criteria for at least one publicly funded institution. Standards were more prevalent in the European Region, high-income countries, and schools compared to other regions, income levels, and institution types, respectively. Most standards were mandatory and contained nutrition criteria pertaining to both foods and nutrients. CONCLUSION Nutrition standards have the potential to significantly improve diets, but there is considerable scope to develop and implement nutrition standards more effectively using the new World Health Organization Action Framework.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph A Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ashleigh C Hart
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Dejen Tekle
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole Ide
- Resolve to Save Lives, New York City, New York, USA
| | - Alexandra Jones
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.,National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
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Changes in the salt content of packaged foods sold in supermarkets between 2015-2020 in the United Kingdom: A repeated cross-sectional study. PLoS Med 2022; 19:e1004114. [PMID: 36197915 PMCID: PMC9581353 DOI: 10.1371/journal.pmed.1004114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/19/2022] [Accepted: 09/21/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excess consumption of salt is linked to an increased risk of hypertension and cardiovascular disease. The United Kingdom has had a comprehensive salt reduction programme since 2003, setting a series of progressively lower, product-specific reformulation targets for the food industry, combined with advice to consumers to reduce salt. The aim of this study was to assess the changes in the sales-weighted mean salt content of grocery foods sold through retail between 2015 and 2020 by category and company. METHODS AND FINDINGS Information for products, including salt content (g/100 g), was collected online from retailer websites for 6 consecutive years (2015 to 2020) and was matched with brand-level retail sales data from Euromonitor for 395 brands. The sales-weighted mean salt content and total volume of salt sold were calculated by category and company. The mean salt content of included foods fell by 0.05 g/100 g, from 1.04 g/100 g in 2015 to 0.90 g/100 g in 2020, equivalent to -4.2% (p = 0.13). The categories with the highest salt content in 2020 were savoury snacks (1.6 g/100 g) and cheese (1.6 g/100 g), and the categories that saw the greatest reductions in mean salt content over time were breakfast cereals (-16.0%, p = 0.65); processed beans, potatoes, and vegetables (-10.6%, p = 0.11); and meat, seafood, and alternatives (-9.2%, p = 0.56). The total volume of salt sold fell from 2.41 g per person per day to 2.25 g per person per day, a reduction of 0.16 g or 6.7% (p = 0.54). The majority (63%) of this decrease was attributable to changes in mean salt content, with the remaining 37% accounted for by reductions in sales. Across the top 5 companies in each of 9 categories, the volume of salt sold decreased in 26 and increased in 19 cases. This study is limited by its exclusion of foods purchased out of the home, including at restaurants, cafes, and takeaways. It also does not include salt added at the table, or that naturally occurring in foods, meaning the findings underrepresent the population's total salt intake. The assumption was also made that the products matched with the sales data were entirely representative of the brand, which may not be the case if products are sold exclusively in convenience stores or markets, which are not included in this database. CONCLUSIONS There has been a small decline in the salt content of foods and total volume of salt sold between 2015 and 2020, but observed changes were not statistically significant so could be due to random variations over time. We suggest that mandatory reporting of salt sales by large food companies would increase the transparency of how individual businesses are progressing towards the salt reduction targets.
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Du X, Fang L, Xu J, Chen X, Bai Y, Wu J, Wu L, Zhong J. The association of knowledge, attitudes and behaviors related to salt with 24-h urinary sodium, potassium excretion and hypertensive status. Sci Rep 2022; 12:13901. [PMID: 35974077 PMCID: PMC9381520 DOI: 10.1038/s41598-022-18087-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/04/2022] [Indexed: 11/12/2022] Open
Abstract
To understand the association between sodium and potassium consumption levels, hypertension and knowledge, attitudes and behaviors (KAB) toward salt and the commitment to effective sodium reduction and potassium supplementation to achieve the purpose of suppressing hypertension. A stratified multistage random sampling method was used to obtain a representative provincial sample of 7512 residents aged 18-69 years through a cross-sectional survey by the Salt Reduction and Hypertension Prevention Project (SRHPP) in Zhejiang Province of China in 2017-2018. A screening including demographic, anthropometric, salt-related KAB and physical measurements was implemented, and 24-h urine of approximately 1/5 of the participants was collected and tested. The mean age was 44.8 years, 50.1% were women, 44.0% lived in urban areas, and hypertension or prehypertension accounted for approximately 35.0%. The mean 24-h urinary sodium and potassium excretion were 3848.5 (1661.1) mg/d and 1491.1 (710.9) mg/d, respectively. KAB in urban areas was generally more favorable than in rural areas, women were better than men, and the optimal blood pressure group was better than the other two groups (P < 0.05). However, the awareness and correct use rate of salt-restricted spoons, low-sodium salt and nutrition labeling were lower. A multivariable linear regression model indicated that KAB had a smaller effect on sodium (two indicators effective for promoting sodium reduction) and a greater effect on potassium (six indicators effective for promoting potassium supplementation) and mainly focused on knowledge and behavior indicators. A multivariable logistic regression model indicated that mastering more knowledge and taking active measures could effectively reduce the transition to hypertension, even if the individual was already in prehypertension. There is much room for improvement of salt-related KAB in the Chinese population. A clear association indicates that KAB can help to reduce sodium and supplement potassium, especially potassium, and help to suppress the development of hypertension. The role of beliefs in KAB should be fully valued and improved, similar to knowledge and behaviors. This study provides important evidence and insight into China's efforts to meet the targets of salt reduction and hypertension prevention.
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Affiliation(s)
- Xiaofu Du
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Le Fang
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Xiangyu Chen
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China
| | - Lin Wu
- Department of Medical College, Jinhua Polytechnic, No. 888 Haitang West Road, JinHua, 321017, China
| | - Jieming Zhong
- Department of Chronic Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou, 310051, China.
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Barcenilla C, Álvarez-Ordóñez A, López M, Alvseike O, Prieto M. Microbiological Safety and Shelf-Life of Low-Salt Meat Products—A Review. Foods 2022; 11:foods11152331. [PMID: 35954097 PMCID: PMC9367943 DOI: 10.3390/foods11152331] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 11/16/2022] Open
Abstract
Salt is widely employed in different foods, especially in meat products, due to its very diverse and extended functionality. However, the high intake of sodium chloride in human diet has been under consideration for the last years, because it is related to serious health problems. The meat-processing industry and research institutions are evaluating different strategies to overcome the elevated salt concentrations in products without a quality reduction. Several properties could be directly or indirectly affected by a sodium chloride decrease. Among them, microbial stability could be shifted towards pathogen growth, posing a serious public health threat. Nonetheless, the majority of the literature available focuses attention on the sensorial and technological challenges that salt reduction implies. Thereafter, the need to discuss the consequences for shelf-life and microbial safety should be considered. Hence, this review aims to merge all the available knowledge regarding salt reduction in meat products, providing an assessment on how to obtain low salt products that are sensorily accepted by the consumer, technologically feasible from the perspective of the industry, and, in particular, safe with respect to microbial stability.
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Affiliation(s)
- Coral Barcenilla
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, University of León, 24071 León, Spain
- Correspondence: ; Tel.: +34-987-291245
| | - Avelino Álvarez-Ordóñez
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, University of León, 24071 León, Spain
- Institute of Food Science and Technology, University of León, 24007 León, Spain
| | - Mercedes López
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, University of León, 24071 León, Spain
- Institute of Food Science and Technology, University of León, 24007 León, Spain
| | - Ole Alvseike
- Animalia—Norwegian Meat and Poultry Research Centre, NO-0513 Oslo, Norway
| | - Miguel Prieto
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, University of León, 24071 León, Spain
- Institute of Food Science and Technology, University of León, 24007 León, Spain
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Greenwald RP, Childs L, Pachón H, Timmer A, Houston R, Codling K. Comparison of Salt Iodization Requirements in National Standards with Global Guidelines. Curr Dev Nutr 2022; 6:nzac116. [PMID: 35957741 PMCID: PMC9362757 DOI: 10.1093/cdn/nzac116] [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: 02/14/2022] [Revised: 05/15/2022] [Accepted: 07/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background Food fortification is the addition of 1 or more micronutrients to commonly consumed foods and is utilized by many countries as a public health intervention to prevent and control micronutrient deficiencies. As iodine deficiency was a major public health issue globally, the WHO developed evidence-based guidelines for the fortification of salt with iodine. The implementation of salt iodization has been highly successful in reducing iodine deficiency disorders worldwide and is recommended as the main strategy to prevent iodine deficiency. Objectives This analysis compared salt iodization requirements specified in countries' salt standards with WHO 2014 Guidelines on salt fortification. Methods For countries with mandatory salt iodization legislation, data from the Global Fortification Data Exchange regarding iodine amounts and iodine compounds, to be added to salt per the country standard and corresponding national salt intake quantities, were compared with 2014 WHO Guidelines. Results As of 4 September 2021, 110 countries with mandatory salt iodization legislation had national salt standards that specified iodine amounts and compounds and salt intake data. All but 1 specified at least 1 recommended iodine compound, but the majority specified higher iodine amounts in salt standards than indicated in the guidelines, taking salt consumption levels into account. Our analysis did not find excess iodine intake as a result; however, we did not have data on the extent of compliance with national salt standards. Conclusions Existing iodization requirements in salt standards appear to be appropriate for most countries. Countries in which iodine amounts in salt standards are significantly higher than those recommended in the 2014 Guidelines, in particular those with low compliance with national standards or excess iodine intake, may wish to review program process and output indicators and assess whether current iodine amounts in standards would result in excessive intake if implementation was improved.
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Affiliation(s)
| | - Lana Childs
- Emory University, Atlanta, GA, USA
- Global Fortification Data Exchange, Atlanta, GA, USA
| | - Helena Pachón
- Emory University, Atlanta, GA, USA
- Global Fortification Data Exchange, Atlanta, GA, USA
- Food Fortification Initiative, Atlanta, GA, USA
| | | | | | - Karen Codling
- Global Fortification Data Exchange, Atlanta, GA, USA
- Iodine Global Network, Ontario, Canada
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De Assis FS, Rebellato AP, Pallone JAL, Behrens JH. Salt reduction in potato chips using microparticulated salt and spices: A sensory study with consumers. J SENS STUD 2022. [DOI: 10.1111/joss.12772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fernanda Santos De Assis
- Department of Food Science and Nutrition, School of Food Engineering University of Campinas Campinas Brazil
| | - Ana Paula Rebellato
- Department of Food Science and Nutrition, School of Food Engineering University of Campinas Campinas Brazil
| | | | - Jorge Herman Behrens
- Department of Food Science and Nutrition, School of Food Engineering University of Campinas Campinas Brazil
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Jarrar AH, Al Dhaheri AS, Lightowler H, Cheikh Ismail L, Al-Meqbaali F, Bataineh MF, Alhefeiti A, Albreiki M, Albadi N, Alkaabi S, Thondre PS. Using Digital Platform Approach to Reduce Salt Intake in a Sample of UAE Population: An Intervention Study. Front Public Health 2022; 10:860835. [PMID: 35685760 PMCID: PMC9172248 DOI: 10.3389/fpubh.2022.860835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading causes of mortality globally, accounting for more deaths than all other causes combined. World Health Organization launched its initiative in 2013 to reduce the intake of salt, the number of countries that have national sodium reduction strategies reached to 89 countries in 2017. In 2020, a study conducted in UAE showed more than 65% of the population exceeded WHO recommendations for salt intake. This study aimed to measure effectiveness of using digital platform approach to deliver educational materials to facilitate salt reduction in a sample of UAE population. Methods A controlled parallel intervention study was conducted in 2020. A sample of 121 participants completed the study and fulfilled the inclusion criteria with female to male ratio of (0.95:1.05). Participants were distributed randomly into three groups Control group, WhatsApp group, and Electronic Brochures group. Educational materials were distributed among participants of WhatsApp and Electronic brochures groups for 6-weeks. 24-h urinary excretion for sodium, potassium and creatinine, were measured in addition to KAP questionnaire and physical activity on two occasions at baseline and endpoint after 10-weeks (6-weeks of educational intervention). Results Both intervention groups showed a reduction in sodium with 278 mg (p < 0.001) for WhatsApp group (n = 41) and 169 mg (p < 0.018) for Electronic brochures group (n = 41), while Control group didn't show any significant change. Moreover, the percentage of participants exceeding WHO recommendation of sodium intake was significantly reduced at the end of intervention, (p = 0.004). WhatsApp group was more efficient in the percentage of reduction of participants exceeding WHO recommendation compared with baseline, with p = 0.023. A significant reduction in the practice toward adding salt during cooking, use of table salt, adding salt before tasting the foods and use of chicken stocks for both intervention groups was noted with p < 0.05. Intervention groups showed a significant improvement (p < 0.001) in Food and Health related knowledge after 6-weeks of intervention. Conclusion The digital platform approach such as WhatsApp and Electronic Brochure were effective in salt reduction. This study proves that UAE population is ready to reduce salt intake with appropriate education materials and easy delivery approach.
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Affiliation(s)
- Amjad H. Jarrar
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
- *Correspondence: Amjad H. Jarrar
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Helen Lightowler
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Fatima Al-Meqbaali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Mo'ath F. Bataineh
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
- Department of Sport Rehabilitation, Faculty of Physical Education and Sport Science, Hashemite University, Zarqa, Jordan
| | - Aseilah Alhefeiti
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Maithah Albreiki
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Nouf Albadi
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Salama Alkaabi
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Pariyarath S. Thondre
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
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Microbial Safety and Sensory Analyses of Cold-Smoked Salmon Produced with Sodium-Reduced Mineral Salts and Organic Acid Salts. Foods 2022; 11:foods11101483. [PMID: 35627053 PMCID: PMC9141012 DOI: 10.3390/foods11101483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 12/10/2022] Open
Abstract
Cold-smoked (CS) salmon contains high levels of sodium salts, and excess dietary sodium intake is associated with an array of health complications. CS salmon may also represent a food safety risk due to possible presence and growth of the foodborne pathogen Listeria monocytogenes which may cause fatal human infections. Here we determine how reformulated CS salmon using commercial sodium-reduced salt replacers containing KCl (e.g., Nutek, Smart Salt, SOLO-LITE) and acetate-based preservative salts (Provian K, proviant NDV) affect sensory properties, quality, and microbial safety. Initial sensory screening of sodium-reduced CS salmon was followed by L. monocytogenes growth analyses in selected variants of reformulated CS salmon, and finally by analyses of CS salmon variants produced in an industrial smokehouse. Projective mapping indicated overall minor sensory changes in sodium-replaced samples compared with a conventional product with NaCl. Growth of L. monocytogenes was temperature-dependent (4 °C vs. 8 °C storage) with similar growth in sodium-reduced and conventional CS salmon. The addition of 0.9% of the preservative salts Provian K or Provian NDV gave up to 4 log lower L. monocytogenes counts in both sodium-reduced and conventional cold-smoked salmon after 29 days of chilled storage. No changes in pH (range 6.20−6.33), aw levels (range 0.960−0.973), or weight yield (96.8 ± 0.2%) were evident in CS salmon with salt replacers or Provian preservative salts. Analyses of CS salmon produced with selected mineral salt and preservative salt combinations in an industrial salmon smokery indicated marginal differences in sensory properties. Samples with the preservative salt Provian NDV provided L. monocytogenes growth inhibition and low-level total viable counts (<2.8 log/g) dominated by Photobacterium and Carnobacterium during storage. Production of sodium-reduced CS salmon with inhibiting salts provides a simple method to achieve a healthier food product with increased food safety.
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Matsumoto M, Tajima R, Fujiwara A, Yuan X, Okada E, Takimoto H. Trends in dietary salt sources in Japanese adults: data from the 2007-2019 National Health and Nutrition Survey. Br J Nutr 2022; 129:1-14. [PMID: 35506184 PMCID: PMC9899568 DOI: 10.1017/s0007114522001416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 11/06/2022]
Abstract
Identifying trends in dietary salt sources is essential for effectively reducing salt/Na intake. This study aimed to examine the trends in dietary salt sources among Japanese adults using the 2007-2019 National Health and Nutrition Survey data collected from 95 581 adults aged ≥ 20 years. Dietary intake was estimated using the 1-d household-based dietary record. Foods reported as potential sources of salt intake in Japan and other countries were categorised into twenty-one groups. Salt intake for each food group was adjusted using the density method based on the energy intake. Trends in dietary salt intake based on food sources by sex and age groups (20-39 years, 40-59 years and ≥ 60 years) were analysed using the Joinpoint Regression Program. Salt intake for each age group in both men and women decreased from 2007 (5·3 g/1000 kcal-6·4 g/1000 kcal) to 2019 (4·9 g/1000 kcal-5·6 g/1000 kcal). The major dietary source of salt continued to be seasonings such as soya sauce and soyabean paste (approximately 70 %). Salt intake from seasonings decreased over time in adults aged ≥ 40 years but did not change in those aged 20-39 years. Additionally, a decreasing salt intake from unprocessed fish and shellfish and an increasing salt intake from unprocessed meat were observed across all age categories for both sexes. This study demonstrated that a strategy targeting different age groups may be needed to reduce salt consumption from seasonings among the Japanese population. Further studies on salt content in seasonings and continued monitoring of trends in dietary salt sources are required.
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Affiliation(s)
- Mai Matsumoto
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Ryoko Tajima
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Aya Fujiwara
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Xiaoyi Yuan
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Emiko Okada
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
| | - Hidemi Takimoto
- Department of Nutritional Epidemiology and Shokuiku, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo162-8636, Japan
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Rosewarne E, Santos JA, Trieu K, Tekle D, Mhurchu CN, Jones A, Ide N, Yamamoto R, Nishida C, Webster J. A Global Review of National Strategies to Reduce Sodium Concentrations in Packaged Foods. Adv Nutr 2022; 13:1820-1833. [PMID: 35485741 PMCID: PMC9526819 DOI: 10.1093/advances/nmac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 01/28/2023] Open
Abstract
Strategies to reduce sodium concentrations in packaged foods are effective and cost-effective approaches to reducing the burden of disease attributable to high sodium intakes. This review aimed to comprehensively describe, and explore characteristics of, national strategies to reduce sodium concentrations in packaged foods, and assess progress toward achieving national goals. A secondary aim was to understand the number, type, and variation of food category sodium targets set by countries compared with WHO global sodium benchmarks. National sodium reduction reformulation strategies were identified from a search of peer-reviewed and gray literature up to December 2019 supplemented by verified information from key contacts and experts up to December 2020. Key characteristics of countries' strategies were extracted, synthesized, and descriptively analyzed, including details of reformulation strategies and evaluation data. Country targets were mapped to the WHO global sodium benchmarks, and the number and variation of country sodium targets by WHO food categories were determined. Sixty-two countries had reformulation strategies to reduce sodium in packaged foods, and 19 countries had evaluated their reformulation strategies. Forty-three countries had sodium targets, which varied in type of targets (maximum sodium concentration: n = 26; maximum concentration plus relative reduction/average/sales-weighted average: n = 8; relative reduction: n = 7; average: n = 2), number of food category targets (range: n = 1 to 150), and regulatory approach (voluntary: n = 28; mandatory: n = 9; both: n = 6). Eight of 34 countries mapped to the WHO benchmarks had targets for just 1 specified food category (bread products). One-third of all countries were implementing national strategies to reduce sodium concentrations in packaged foods including establishing targets and/or processes for industry engagement. This review determined that there is scope to improve most countries' strategies. There has been limited progress in implementing and evaluating strategies between 2014 and 2019, and regional and income-level disparities persist. The WHO global sodium benchmarks present an important opportunity to accelerate reformulation action globally.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Joseph Alvin Santos
- 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
| | - Dejen Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Kurtz T, Pravenec M, DiCarlo S. Mechanism-based strategies to prevent salt sensitivity and salt-induced hypertension. Clin Sci (Lond) 2022; 136:599-620. [PMID: 35452099 PMCID: PMC9069470 DOI: 10.1042/cs20210566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
High-salt diets are a major cause of hypertension and cardiovascular (CV) disease. Many governments are interested in using food salt reduction programs to reduce the risk for salt-induced increases in blood pressure and CV events. It is assumed that reducing the salt concentration of processed foods will substantially reduce mean salt intake in the general population. However, contrary to expectations, reducing the sodium density of nearly all foods consumed in England by 21% had little or no effect on salt intake in the general population. This may be due to the fact that in England, as in other countries including the U.S.A., mean salt intake is already close to the lower normal physiologic limit for mean salt intake of free-living populations. Thus, mechanism-based strategies for preventing salt-induced increases in blood pressure that do not solely depend on reducing salt intake merit attention. It is now recognized that the initiation of salt-induced increases in blood pressure often involves a combination of normal increases in sodium balance, blood volume and cardiac output together with abnormal vascular resistance responses to increased salt intake. Therefore, preventing either the normal increases in sodium balance and cardiac output, or the abnormal vascular resistance responses to salt, can prevent salt-induced increases in blood pressure. Suboptimal nutrient intake is a common cause of the hemodynamic disturbances mediating salt-induced hypertension. Accordingly, efforts to identify and correct the nutrient deficiencies that promote salt sensitivity hold promise for decreasing population risk of salt-induced hypertension without requiring reductions in salt intake.
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Affiliation(s)
- Theodore W. Kurtz
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA 94017-0134, U.S.A
| | - Michal Pravenec
- Institute of Physiology, Czech Academy of Sciences, Prague 14220, Czech Republic
| | - Stephen E. DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, U.S.A
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Wang NX, Skeaff S, Cameron C, Fleming E, McLean RM. Sodium in the New Zealand diet: proposed voluntary food reformulation targets will not meet the WHO goal of a 30% reduction in total sodium intake. Eur J Nutr 2022; 61:3067-3076. [PMID: 35353200 PMCID: PMC9363297 DOI: 10.1007/s00394-022-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/02/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To simulate the potential impact of the HeartSAFE 2020 programme, a food reformulation initiative by the New Zealand (NZ) Heart Foundation, on sodium intake in the NZ adult population. METHODS A representative sample of NZ adults aged 15 years and older completed a 24-h diet recall survey, with 25% of participants completing a second diet recall, in the 2008/09 New Zealand Adult Nutrition Survey (n = 4721). These data were used to estimate sodium intakes of participants. The effect of altering the sodium content of 840 foods in 17 categories and 35 sub-categories included in the NZ HeartSAFE 2020 programme was simulated. The simulated sodium intake reductions in each food sub-category for the entire sample were calculated. Using sampling weights, simulated reductions in population sodium intake and by sociodemographic subgroups were also analysed. RESULTS Sodium intake from foods included in the HeartSAFE 2020 programme was 1307 mg/day (95% CI 1279, 1336) at baseline. After applying the HeartSAFE 2020 targets, potential sodium intake was 1048 mg/day (95% CI 1024, 1027). The absolute sodium reduction was 260 mg/day (95% CI 252, 268), corresponding to 20% sodium reduction for the foods included in the NZ HeartSAFE programme. CONCLUSION Current sodium targets featured in the NZ HeartSAFE programme will not meet the 30% sodium intake reduction set out by the WHO Global Action Plan. A more comprehensive strategy consistent with the WHO SHAKE Technical Package is needed to advance the goal of sodium intake reduction.
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Affiliation(s)
- Nan Xin Wang
- University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Sheila Skeaff
- University of Otago, Dunedin Campus, Dunedin, New Zealand
| | - Claire Cameron
- University of Otago, Dunedin Campus, Dunedin, New Zealand
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Aprilia GHS, Kim HS. Development of Strategies to Manufacture Low-Salt Meat Products – A
review. JOURNAL OF ANIMAL SCIENCE AND TECHNOLOGY 2022; 64:218-234. [PMID: 35530408 PMCID: PMC9039953 DOI: 10.5187/jast.2022.e16] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 12/03/2022]
Abstract
Urbanization is usually followed by changes in eating habits, with a specific
trend toward the consumption of ready-to-eat products, such as processed foods.
Among the latter, meat products are known contributors to high dietary sodium
owing to salt addition. Salt plays an essential role in maintaining the quality
of meat products in terms of acceptability and safety. However, an excessive
salt intake is linked to high blood pressure and cardiovascular diseases. Hence,
several studies have been competing for the discovery of salt alternatives
performing in a similar way as common salt. A number of replacements have been
proposed to reduce salt consumption in meat products while taking into account
consumer preferences. Unfortunately, these have resulted in poorer product
quality, followed by new adverse effects on health. This review addresses these
recent issues by illustrating some established approaches and providing insight
into further challenges in developing low-salt meat products.
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Affiliation(s)
| | - Hyeong Sang Kim
- School of Animal Life Convergence Science,
Hankyong National University, Anseong 17579, Korea
- Corresponding author: Hyeong Sang Kim, School of
Animal Life Convergence Science, Hankyong National University, Anseong 17579,
Korea. Tel: +82-31-670-5123, E-mail:
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Silva-Santos T, Moreira P, Pinho O, Padrão P, Norton P, Gonçalves C. Salt-Related Knowledge, Attitudes and Behavior in an Intervention to Reduce Added Salt When Cooking in a Sample of Adults in Portugal. Foods 2022; 11:foods11070981. [PMID: 35407068 PMCID: PMC8997494 DOI: 10.3390/foods11070981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Excessive salt intake is associated with an increased risk of hypertension and cardiovascular disease, so reducing it is critical. The main objective of this study was to verify whether one intervention to reduce added salt during cooking changed knowledge, attitudes and behavior (KAB) towards salt, and to analyze changes in the main sources of salt. (2) Methods: The intervention study was an 8-week randomized controlled trial with 97 workers from a public university. KAB in relation to salt were obtained through the WHO STEPwise questionnaire, and the main sources of salt were obtained by 24-h food recall and 24 h urinary sodium excretion over two days. (3) Results: After the intervention, participants in the intervention group reported a decrease in the addition of salt when cooking (p = 0.037), an increase in the percentage of subjects who avoided the consumption of processed foods (from 54.2% to 83.3%, p = 0.001), who looked for salt on food labels (from 18.8% to 39.6%, p = 0.013), and who bought low-salt food alternatives (from 43.8% to 60.4%, p = 0.039). However, there were no significant differences between the intervention group and the control group at baseline and post-intervention assessments. In the intervention group, after the intervention, the added salt decreased by 5%; food sources of salt such as the snacks and pizza group decreased by 7%, and the meat, fish and eggs group increased by 4%, but without statistical significance. (4) Conclusions: With innovative equipment for dosing salt when cooking, it is possible to change some dimensions of consumer behavior in relation to salt.
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Affiliation(s)
- Tânia Silva-Santos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (P.M.); (O.P.); (P.P.); (C.G.)
- EPI Unit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal;
- ITR—Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, 4050-600 Porto, Portugal
- Correspondence:
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (P.M.); (O.P.); (P.P.); (C.G.)
- EPI Unit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal;
- ITR—Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, 4050-600 Porto, Portugal
| | - Olívia Pinho
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (P.M.); (O.P.); (P.P.); (C.G.)
- LAQV-REQUIMTE—Laboratory of Bromatology and Hydrology, Faculty of Pharmacy, University of Porto, 5000-801 Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (P.M.); (O.P.); (P.P.); (C.G.)
- EPI Unit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal;
- ITR—Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, 4050-600 Porto, Portugal
| | - Pedro Norton
- EPI Unit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Occupational Health Service, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Carla Gonçalves
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal; (P.M.); (O.P.); (P.P.); (C.G.)
- EPI Unit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal;
- ITR—Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, 4050-600 Porto, Portugal
- CITAB—Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes and Alto Douro, 5000-801 Vila Real, Portugal
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