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Strauss-Kruger M, Wentzel-Viljoen E, Ware LJ, Van Zyl T, Charlton K, Ellis S, Schutte AE. Early evidence for the effectiveness of South Africa's legislation on salt restriction in foods: the African-PREDICT study. J Hum Hypertens 2023; 37:42-49. [PMID: 35091704 DOI: 10.1038/s41371-021-00653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 01/31/2023]
Abstract
South Africa was among the first countries to adopt mandatory regulation in 2016 to lower the salt content in processed foods, aiming to reduce population salt intake to <5 g/day. To assess the effectiveness of this regulation in 20-30 year-old adults, we determined the change in salt intake over a mean follow-up time of 4.56-years spanning the implementation of the regulation. This observational study included baseline (2013-2016; N = 668; 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data (2018-ongoing; N = 311; 25.4 ± 3.05 years; 51.1% black; 43.4% men) for participants of the African-PREDICT study. Salt intake was estimated from 24-h urinary sodium excretion. Median salt intake at baseline (N = 668) was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [7.26 g/day (5.30)] [unadjusted median: -0.82 g/day]. After adjusting for baseline salt intake to address regression to the mean, the mean salt reduction was -1.2 g/day. The greatest reductions were in men [mean difference: -1.47 g/day], black adults [mean difference: -2.04 g/day], and participants from low [mean difference: -1.89 g/day] or middle [mean difference: -1.84 g/day] socio-economic status groups, adjusting for baseline salt intake. Our preliminary findings suggest that South Africa's salt regulation has been effective in lowering salt intake in young adults by ~1.2 g salt/day. Our study supports the effectiveness of upstream interventions to lower population salt intake, particularly for vulnerable groups who may typically consume more processed foods. It needs to be determined if the legislation has the anticipated population health gains.
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Affiliation(s)
- Michél Strauss-Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa
| | | | - Lisa J Ware
- DSI-NRF Centre of Excellence in Human Development and SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tertia Van Zyl
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, 2520, South Africa
| | - Karen Charlton
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW, 2522, Australia
| | - Suria Ellis
- Pure and Applied Analytics, North-West University, Potchefstroom, 2520, South Africa
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2520, South Africa. .,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, 2520, South Africa. .,DSI-NRF Centre of Excellence in Human Development and SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa. .,School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia. .,The George Institute for Global Health, Sydney, NSW, 2042, Australia.
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Formulation and Evaluation of Chitosan/NaCl/Maltodextrin Microparticles as a Saltiness Enhancer: Study on the Optimization of Excipients for the Spray-Drying Process. Polymers (Basel) 2021; 13:polym13244302. [PMID: 34960854 PMCID: PMC8706731 DOI: 10.3390/polym13244302] [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: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Spray-dried chitosan/NaCl/maltodextrin microparticles have the potential to be used to enhance saltiness; however, its notable hygroscopicity results in handling and storage problems, thus limiting its application. In the present study, we attempted to introduce maltodextrin, microcrystalline cellulose (MCC), and waxy starch (WS) as excipients into the spray drying formulation of microparticles to reduce the cohesiveness and caking behavior and improve the yield simultaneously by ameliorating the moisture absorption tendency. The prepared microparticles showed a spherical appearance and had particle sizes ranging from 6.29 to 7.64 μm, while the sizes of the NaCl crystals embedded in the microparticles were 0.36 to 1.24 μm. The crystalline reflections of WS and MCC were retained in the microparticles after the spray-drying process. The handling properties were assessed to be acceptable. The formulation with only maltodextrin as the excipient showed a high moisture absorption rate of 2.83 g/100 g·h and a caking strength of 3.27 kg. The addition of MCC and WS significantly reduced the hygroscopic rate and caking strength. The spray-dried products provided better saltiness perception than native NaCl; as such, they may be promising for seasoning dry food products to achieve sodium intake reduction in the food industry.
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Pearson-Stuttard J, Kypridemos C, Collins B, Mozaffarian D, Huang Y, Bandosz P, Capewell S, Whitsel L, Wilde P, O’Flaherty M, Micha R. Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis. PLoS Med 2018; 15:e1002551. [PMID: 29634725 PMCID: PMC5892867 DOI: 10.1371/journal.pmed.1002551] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/09/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sodium consumption is a modifiable risk factor for higher blood pressure (BP) and cardiovascular disease (CVD). The US Food and Drug Administration (FDA) has proposed voluntary sodium reduction goals targeting processed and commercially prepared foods. We aimed to quantify the potential health and economic impact of this policy. METHODS AND FINDINGS We used a microsimulation approach of a close-to-reality synthetic population (US IMPACT Food Policy Model) to estimate CVD deaths and cases prevented or postponed, quality-adjusted life years (QALYs), and cost-effectiveness from 2017 to 2036 of 3 scenarios: (1) optimal, 100% compliance with 10-year reformulation targets; (2) modest, 50% compliance with 10-year reformulation targets; and (3) pessimistic, 100% compliance with 2-year reformulation targets, but with no further progress. We used the National Health and Nutrition Examination Survey and high-quality meta-analyses to inform model inputs. Costs included government costs to administer and monitor the policy, industry reformulation costs, and CVD-related healthcare, productivity, and informal care costs. Between 2017 and 2036, the optimal reformulation scenario achieving the FDA sodium reduction targets could prevent approximately 450,000 CVD cases (95% uncertainty interval: 240,000 to 740,000), gain approximately 2.1 million discounted QALYs (1.7 million to 2.4 million), and produce discounted cost savings (health savings minus policy costs) of approximately $41 billion ($14 billion to $81 billion). In the modest and pessimistic scenarios, health gains would be 1.1 million and 0.7 million QALYS, with savings of $19 billion and $12 billion, respectively. All the scenarios were estimated with more than 80% probability to be cost-effective (incremental cost/QALY < $100,000) by 2021 and to become cost-saving by 2031. Limitations include evaluating only diseases mediated through BP, while decreasing sodium consumption could have beneficial effects upon other health burdens such as gastric cancer. Further, the effect estimates in the model are based on interventional and prospective observational studies. They are therefore subject to biases and confounding that may have influenced also our model estimates. CONCLUSIONS Implementing and achieving the FDA sodium reformulation targets could generate substantial health gains and net cost savings.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Yue Huang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdansk, Poland
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Laurie Whitsel
- American Heart Association, Washington, District of Columbia, United States of America
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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