Dietary reference values for sodium

Total Polyphenol Contents and Mineral Profiles in Commercial Wellness Herbal Infusions: Evaluation of the Differences between Two Preparation Methods

The popularity of the consumption of wellness herbal teas is due to the many health-promoting properties they seem to possess. Modern preparation methods using coffee machines are also popular today. Therefore, the purpose of this research was to evaluate differences in infusions obtained by the traditional method using filters and by espresso coffee machines using pods. In this regard, different herbal materials were selected and purchased in two different types of herbal containers, and the corresponding infusions were analyzed for the contents of total polyphenols and mineral elements. Results showed that filter infusions had higher polyphenol and mineral contents than pod infusions, excluding Cd and Pb. For each of the plant materials used, differences due to the method of infusion preparation are highlighted. From a qualitative point of view, both methods of infusion preparation are valid, but the filter infusion method allows a higher transfer of minerals and polyphenols into the infusion, improving quality. The analyzed infusions can be safely consumed with respect to As, Cd, Pb, and Hg contents. Good amounts of polyphenols and Mn can be obtained by drinking a cup of any of the infusions analyzed, especially the mate infusion obtained by the filter technique, with amounts of 429 mg for polyphenols and 69.27% of the RDA for manganese.

Health Claims for Sports Drinks-Analytical Assessmentaccording to European Food Safety Authority's Scientific Opinion

In Europe, sports food supplements (SSFs) are subject to specific laws and regulations. Up to 70% of athletes are highly influenced by the information on the label or the advertisement of the SSF, which often does not correspond to the scientific evidence, such as health claims. The aim is to analyze such claims relating to sports drinks (SDs) in commercial messages. To this end, an observational and cross-sectional study was conducted based on the analysis of the content and degree of adequacy of the health claims indicated on the labelling or technical data sheet of the SDs with those established by the European legislation in force according to the European Food Safety Authority (EFSA). The SSFs were searched for via Amazon and Google Shopping. A total of 114 health claims were evaluated. No claim fully conformed with the recommendations. A total of 14 claims (n = 13 products) almost conformed to the recommendations; they were "Maintain endurance level in exercises requiring prolonged endurance", "Improve water absorption during physical exercise", and "Improved physical performance during high intensity, high duration physical exercise in trained adults", representing 12.3% of the total (n = 114). The vast majority of the claims identified indicated an unproven cause-effect and should be modified or eliminated, which amounts to food fraud towards the consumer.

Ecophysiological and nutritional characterisation of two morphotypes of Cakile maritima subsp. maritima Scop. from Puglia region, Southern Italy

Cakile maritima subsp. maritima Scop. (sea rocket) is a succulent halophyte with significant potential as a nutritious food source, being rich in essential nutrients such as vitamins, minerals, and antioxidants. This annual species exhibits two distinct leaf morphotypes: entire lamina (EL) and pinnatifid lamina (PL). Our understanding of their ecophysiological and nutritional profiles is still limited. The present study investigated the wild EL and PL sea rocket plants from southern Italy during their vegetative stage. The bio-morphological traits (leaf mass area-LMA, dry matter and chlorophyll concentrations), main inorganic ions, key antioxidants (carotenoids, anthocyanins, phenols, flavonoids, glucosinolates, vitamin C as ascorbic and dehydroascorbic acid), and antioxidant activity (by FRAP, DPPH, ABTS assays) were analyzed. Additionally, photosynthetic gas exchange and chlorophyll fluorescence were measured. PL plants showed thicker leaves (higher LMA) and greater accumulation of photo-protective pigments (carotenoids and anthocyanins), despite similar chlorophyll levels. The PL plants also demonstrated higher photosynthetic activity, transpiration rates, and stomatal conductance, with reduced non-photochemical quenching. The EL morphotype had higher cation (K, Mg, Ca, Na) and vitamin C (135.3 mg 100 g-1 FW) concentrations, while no significant disparities were observed between the morphotypes in phenolic concentration (208.5 mg g.a.e. 100 g-1 FW), flavonoids (71.5 mg q.e. 100 g-1 FW), or glucosinolates (61 mg g-1 FW). Interestingly, while the EL type had higher vitamin C, the PL morphotype showed superior antioxidant activity (FRAP, DPPH) and seems to be better adapted to water/nutrient scarcity typical of southern Italy. Both morphotypes offer potential as high-nutritional foods, however, future research should investigate the genotype-specific production of antioxidant compounds in EL and PL plants in response to environmental stresses, including salinity for potential exploitation as a new crop.

Elemental and Radiological Characterisation of Arbutus unedo L. Leaves and Tea: Impact of Preparation Method on Nutritional Risk/Benefit

The aim of this study was to characterise the elemental and radiological composition of strawberry tree (Arbutus unedo L.) leaves and tea preparations and compare it with commercial Uvin H herbal mixture, widely used in treatment of urinary tract infections. The concentration of 17 elements and the activity concentration of selected radionuclides were measured in strawberry tree leaves/Uvin H herbal mixture, as well as in herbal tea prepared by infusion or decoction of leaves for 5 or 10 min. In both leaves and tea preparations, Ca, K, Mg, and Na were the most abundant elements, while the lowest levels were measured for As, Co, Mo, and Se. Only 137Cs and 40K were detected in analysed leaves/herbal mixture, while the activity of radionuclides in tea preparations was below the detection limit. The maximum possible health benefits can be obtained by a 10-min decoction of leaves, which resulted in the highest total phenolic content and antioxidant activity and levels of K, Ca, Mg, Na, Fe, Mn, and Se in comparison to the other preparation methods evaluated in this study. The calculated intake of potentially toxic elements and radionuclides does not represent a health risk to consumers.

Explainable machine learning for predicting the geographical origin of Chinese Oysters via mineral elements analysis

The traceability of geographic origin is essential for guaranteeing the quality, safety, and protection of oyster brands. However, the current outcomes of traceability lack credibility as they do not adequately explain the model's predictions. Consequently, we conducted a study to evaluate the efficacy of utilizing explainable machine learning combined with mineral elements analysis. The study findings revealed that 18 elements have the ability to determine regional orientation. Simultaneously, individuals should pay closer attention to the potential risks associated with oyster consumption due to the regional differences in essential and toxic elements they contain. Light gradient boosting machine (LightGBM) model exhibited indistinguishable performance, achieving flawless accuracy, precision, recall, F1 score and AUC, with values of 96.77%, 96.43%, 98.53%, 97.32% and 0.998, respectively. The SHapley Additive exPlanations (SHAP) method was used to evaluate the output of the LightGBM model, revealing differences in feature interactions among oysters from different provinces. Specifically, the features Na, Zn, V, Mg, and K were found to have a significant impact on the predictive process of the model. Consistent with existing research, the use of explainable machine learning techniques can provide insights into the complex connections between important product attributes and relevant geographical information.

The viscosity-enhancing effect of carob bean gum and sodium carboxymethylcellulose when added to infant formula

Despite limited supporting evidence, the practice of thickening breast milk or infant formula with commercially available thickening agents is prevalent. This study explored the viscosity-enhancing impact of carob bean gum (CBG) and sodium carboxymethylcellulose (NaCMC) when added to infant formula at various concentrations and for different thickening durations. The findings indicate that thickening leads to an exponential increase in milk viscosity, from 25% of the recommended dosage onward. This suggests that minor adjustments in dosage can significantly impact formula thickness, underscoring the importance of accurately dosing and preparing infant milk. The considerable variability in viscosity also emphasizes the need for thoughtful selection of teat size, considering the energy expenditure of the sucking infant. When using 50% of the recommended CBG dose or 25% of NaCMC, the resulting viscosity matches that of a commercially available casein-based formula containing CBG for anti-regurgitation. In the case of CBG, a viscosity plateau is only reached after 30 min. Therefore, educating parents on the correct handling and preparation steps for CBG-thickened infant milk is crucial, including a 30-min waiting period to achieve the intended thickening effect.

Salt Intake of Children and Adolescents: Influence of Socio-Environmental Factors and School Education

(1) Background: The aim of this study was to investigate the salt consumption by children and adolescents from the Silesian Province (Poland), taking into account the region's dietary traditions and the age of the students+. (2) Methods: 300 students aged 10-18 from different types of schools were enrolled in the study and divided into groups in terms of school, sex, and the state of their nutrition. A survey questionnaire about dietary habits, including the frequency and serving size with respect to 12 salty products, was used. On the basis of the frequency and the amount of consumed products, as well as the data on salt content, the amount of total daily intake of salt was estimated. (3) Results: The mean daily intake of salt by children and adolescents was 1.083 g (0.433 g of sodium); children aged 10-12 consumed the highest amount of salt (1.296 g/day) compared to pupils aged 13-15 (1.131 g of sodium) and adolescents aged 16-18 (0.863 g/day). (4) Conclusions: With age, as a result of various factors, the consumption of salt declines. The parents' impact and the familial socio-environmental factors begin to wane, and other factors start to have influence, e.g., school education of a healthy lifestyle and health behavior of peers.

Sodium - a systematic review for Nordic Nutrition Recommendations 2023

Blood pressure (BP) rises along with increasing sodium intake from early childhood to late adulthood, and leads to hypertension among most men and women living in Nordic and Baltic countries. Elevated BP is the leading global risk factor for premature deaths and disability-adjusted life-years. A reduction in sodium intake is essential in the prevention of hypertension in individuals, in the lowering of BP levels, in the treatment of hypertensive individuals, and in decreasing risks associated with elevated BP. There is a progressive linear dose-response relationship between sodium intake and BP beginning from a sodium intake of less than 0.8 g/day. Sodium reduction decreases BP linearly by a dose-response manner down to a sodium intake level of less than 2 g/day. Randomised intervention studies with a duration of at least 4 weeks confirm the efficiency and safety of reducing blood sodium intake to a level of less than 2 g/day. Results from prospective cohort studies show that higher sodium intake is positively associated with an increased risk of stroke and cardiovascular events and mortality among the general adult population, and the associations are linear in studies using proper sodium assessment methods. Analyses assessing sodium intake using at least two 24-h urine samples have shown a linear positive relationship between sodium intake and the risk of a cardiovascular event or death. Based on an overall evaluation of the available data, a limitation of the sodium intake to 2.0 g/day is suggested for adults. The optimal sodium intake level would be probably about 1.5 g/day. Sodium intake recommended for children can be extrapolated from the recommended sodium intake for adults. According to national dietary surveys, the average sodium intakes in Nordic countries range in adult men from 3.6 to 4.4 g/day and in adult women from 2.6. to 3.2 g/day, and in Baltic countries in men from 2.6 to 5.1 g/day and in women from 1.8 to 3.6 g/day.

Reducing Dietary Sodium and Improving Human Health 2.0

This Special Issue of Nutrients, "Reducing Dietary Sodium and Improving Human Health 2 [...].

Effects of "Football and Nutrition for Health" program on body composition, physical fitness, eating behaviours, nutritional knowledge, and psychological status among 7 to 10 years school children

Introduction

Noncommunicable diseases and obesity are between the major health threat due to consumption of unhealthy foods and limited time spent on physical activities, a situation of particular concern among children. Since children spend most of their time at school, this study intends to investigate the effect of a school intervention program, which combines recreational football and nutrition education, on body composition, physical fitness, physical activity, blood pressure and heart rate, eating behaviours, nutritional knowledge, and psychological status in elementary school children.

Methods

A total of 67 children, between 7 and 10 years old, were allocated into three groups: the Football Group (FG) which held 2 weekly sessions of 60 min of recreational football, the Nutrition and Football Group (NFG) which held 2 sessions per week of 60 min of recreational football plus 60 min of nutritional education and the Control Group (CG) which maintained its usual curriculum. The intervention lasted 12 weeks. All measurements were collected before and after the intervention.

Results

Intervention groups significantly (p < 0.05) improved BMI Z-score, rest heart rate, horizontal jump and shuttle test, physical activity level, and psychosocial health. The NFG group significantly decreased (p < 0.05) waist-to-height ratio and blood pressure, and significantly increased (p < 0.05) nutritional knowledge, fruit, and fish consumption. While FG significantly decreased (p < 0.05) the percentage of fat mass and significantly increased (p < 0.05) muscle mass and performance in the 20 m sprint.

Discussion

The results have shown to improve nutritional status, explosive strength, aerobic and neuromuscular fitness, as well as increase the level of physical activity. The nutritional education sessions contributed to increase nutritional knowledge and to improve the consumption of healthy food groups in a ludic-educational way. The "Football and Nutrition for Health" program was able to induce short-term improvements in several health markers, highlighting the role of the school curriculum in children's health.

Safety of monosodium salt of l-5-methyltetrahydrofolic acid as a novel food pursuant to Regulation (EU) 2015/2283 and the bioavailability of folate from this source in the context of Directive 2002/46/EC, Regulation (EU) No 609/2013 and Regulation (EC) No 1925/2006

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on monosodium salt of l-5-methyltetrahydrofolic acid (5-MTHF) as a novel food (NF) pursuant to Regulation (EU) 2015/2283 and to address the bioavailability of folate from this source in the context of Directive 2002/46/EC, Regulation (EU) No 609/2013 and Regulation (EC) No 1925/2006. The NF is produced by chemical synthesis and consists of at least 95% (w/w) of 5-MTHF and 4%-5% (w/w) of sodium. It is proposed to be used as a partial or complete substitute to folic acid and other sources of added folate in a number of food categories. The production process, composition, specifications and stability of the NF do not raise safety concerns. When used as an ingredient in different food matrices, proper processing/storage conditions need to be considered to preserve the stability of the NF. Regarding bioavailability, the Panel considers that the NF readily dissociates into Na and l-methylfolate ions, which subsequently are absorbed and enter the circulation. Thus, the bioavailability of 5-MTHF from the NF is comparable to that of other currently authorised salts of 5-MTHF. The Panel considers that the consumption of the NF is not nutritionally disadvantageous as long as the combined intake of the NF and the other supplemental forms of folate under their authorised conditions of use is below the ULs established for the different age groups of the general population. The Panel concludes that the NF is safe under the proposed conditions of use. The Panel also concludes that the NF is a source from which folate is bioavailable.

Effect of sea tangle extract on the quality characteristics of reduced-salt, low-fat sausages using pre-rigor muscle during refrigerated storage

OBJECTIVE

The aim of this study was to investigate quality characteristics of reduced-salt, low-fat pork sausage (PS) using pre-rigor muscle and sea tangle extract (STE) to reduce salt level of sausages during refrigerated storage.

METHODS

Pork ham was prepared with pre-rigor and post-rigor muscle from the local market. Sausages using post-rigor muscle were manufactured with the 1.5% of salt content, and samples with pre-rigor muscle were processed by different salt concentrations (0.8%). Accordingly, PSs were prepared in 4 treatments (REF, PS with 1.5% of salt using post-rigor muscle; CTL, PS with 0.8% of salt using pre-rigor muscle; TRT1, PS with 0.8% of salt and 5% of STE using pre-rigor muscle; TRT2, PS with 0.8% of salt and 10% of STE using pre-rigor muscle). For the evaluation of quality characteristics and shelf-life of reduced-salt PS, pH and color values, cooking loss (%), expressible moisture (%), textural properties, lipid oxidation (thiobarbituric reactive substances), protein denaturation (volatile basic nitrogen), and microbiological analysis (total plate counts and Enterobacteriaceae counts) were determined.

RESULTS

The pH and temperature of pre-rigor raw pork ham were higher than those of post-rigor pork ham. Hardness of TRT2 was higher than that of REF or CTL. TRT2 had higher gumminess and chewiness than CTL. TRT1 and TRT2 had lower volatile basic nitrogen than CTL. Total plate counts of TRT2 were lower than those of CTL. Expressible moisture values of TRT1 and TRT2 were similar to those of REF. The addition of STE into PS improved functional properties and shelf-life of PS.

CONCLUSION

Reduced-salt PS containing pre-rigor muscle and STE had similar functional properties to those of regular-salt ones, while containing approximately 47% less salt compared to regular-salt level.

Safety of 3'-sialyllactose (3'-SL) sodium salt produced by a derivative strain (Escherichia coli NEO3) of E. coli W (ATCC 9637) as a Novel Food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on 3'-sialyllactose (3'-SL) sodium salt as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF is mainly composed of the human-identical milk oligosaccharide (HiMO) 3'-SL (sodium salt), but it also contains sialic acid, d-glucose, d-lactose, 3'-sialyllactulose and 6'-sialyllactose sodium salts and a small fraction of other related saccharides. The NF is produced by fermentation by a genetically modified strain (Escherichia coli NEO3) of E. coli W (ATCC 9637). The information provided on the identity, manufacturing process, composition and specifications of the NF does not raise safety concerns. The applicant intends to add the NF to a variety of foods, including infant formula and follow-on formula, food for special medical purposes and food supplements (FS). The target population is the general population. The applicant applies for the same uses and use levels as already assessed for 3'-SL sodium salt produced by a genetically modified strain of E. coli K-12 DH1, with the exception for the use in FS, which is proposed to be higher (from 0.5 to 1.0 g/day) in individuals from 3 years of age. Since the NF as a food ingredient would be consumed at the same extent as the already assessed 3'-SL sodium salt, no new estimates of the intakes have been carried out. The Panel notes that the maximum daily intake of 3'-SL from the proposed use of the NF in FS for individuals from 3 years of age (1.0 g/day) is lower than the estimated highest mean daily intake of 3'-SL in breastfed infants. FS are not intended to be used if other sources of 3'-SL are consumed on the same day. The Panel concludes that the NF is safe under the proposed conditions of use.

Does the Mediterranean Dietary Pattern Promote Lower Sodium Urinary Excretion in Children?

An adequate sodium intake is related to various health benefits. Parallelly, the Mediterranean diet (MD) is a dietary pattern known for its many positive impacts on health. Nonetheless, the association between adherence to the MD and sodium urinary excretion is scarce, even more in children. This study aimed to assess the association between MD adherence and the excretion of sodium, as a proxy of intake. This cross-sectional analysis comprised 295 children (46.8% females, aged 7-11 years, mean age: 8.53 ± 0.73 years) from 20 schools within Porto, Portugal. MD adherence was evaluated utilizing the alternate Mediterranean score (aMED). Higher scores denote a healthier dietary pattern (0-8). Sodium excretion was estimated by 24-h urine collection. The association between adherence to MD and Na excretion was estimated by logistic regression, adjusting for confounders. Children in the higher sodium excretion group had a higher intake of legumes, a higher body mass index and parents with lower education levels compared to children in the lower sodium excretion group. In logistic regression analysis, sodium urinary excretion was not associated with higher MD adherence, even after adjustment for confounders. High MD adherence could not be associated with lower sodium excretion in children.

Climate-Nutrient-Crop Model: Novel Insights into Grain-Based Food Quality

Mineral nutrients spatiotemporally participate in the biosynthesis and accumulation of storage biopolymers, which directly determines the harvested grain yield and quality. Optimizing fertilizer nutrient availability improves the grain yield, but quality aspects are often underestimated. We hypothesize that extensive mineral nutrients have significant effects on the biosynthesis, content, and composition of storage proteins, ultimately determining physicochemical properties and food quality, particularly in the context of climate change. To investigate this, we hierarchized 16 plant mineral nutrients and developed a novel climate-nutrient-crop model to address the fundamental question of the roles of protein and starch in grain-based food quality. Finally, we recommend increasing the added value of mineral nutrients as a socioeconomic strategy to enhance agro-food profitability, promote environmental sustainability, and improve climate resilience.

Analysis of the Gut Microbiome and Dietary Habits in Metastatic Melanoma Patients with a Complete and Sustained Response to Immunotherapy

Immunotherapy has improved the prognosis of metastatic melanoma patients, although most patients do not achieve a complete response. While specific gut microbiome and dietary habits might influence treatment success, there is a lack of concordance between the studies, potentially due to dichotomizing patients only into responders and non-responders. The aim of this study was to elucidate whether metastatic melanoma patients with complete and sustained response to immunotherapy exhibit differences in gut microbiome composition among themselves, and whether those differences were associated with specific dietary habits. Shotgun metagenomic sequencing revealed that patients who exhibited a complete response after more than 9 months of treatment (late responders) exhibited a significantly higher beta-diversity (p = 0.02), with a higher abundance of Coprococcus comes (LDA 3.548, p = 0.010), Bifidobacterium pseudocatenulatum (LDA 3.392, p = 0.024), and lower abundance of Prevotellaceae (p = 0.04) compared to early responders. Furthermore, late responders exhibited a different diet profile, with a significantly lower intake of proteins and sweets and a higher intake of flavones (p < 0.05). The research showed that metastatic melanoma patients with a complete and sustained response to immunotherapy were a heterogeneous group. Patients with a late complete response exhibited microbiome and dietary habits which were previously associated with an improved response to immunotherapy.

Prevalence of Cardiovascular Risk Factors and Related Medical and Lifestyle Interventions Among Italian Cardiovascular Specialists: A Proof-of-Concept Study

INTRODUCTION

Physicians and researchers in the cardiovascular field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically examined.

AIM

To assess awareness of self-exposure to cardiovascular risk factors and related management among cardiovascular specialists.

METHODS

During the National Conference of the Italian Society of Hypertension (October 2022), a pilot observational study on consecutive volunteer cardiovascular specialists was conducted. Participants underwent standard sitting and standing blood pressure (BP) measurements and answered a questionnaire regarding modifiable/non modifiable cardiovascular risk factors and related treatments. Based on self-declarations and actual measurements, BP was classified as optimal, normal, high-normal BP, and new hypertension in untreated participants, and as treated/untreated pre-existing hypertension. Controlled hypertension was defined as BP < 140/90 mmHg; age-adjusted lower targets were also applied, according to guidelines.

RESULTS

In total, 62 participants (30 F, mean age 43.2 ± 14.8 years) were enrolled; 79% reported regular physical activity; 53% of women and 38% of men were on a low-salt diet. After smoke (19.4%), dyslipidemia was the second most common risk factor (17.7%), often occurring with high BP (26.3%) and left untreated (36.7%). Pre-existing hypertension (11.3%) was often uncontrolled (57.1%) and associated with non-adherence to guidelines-directed lifestyle recommendations. About one in 12 participants was unaware of having high measured BP values.

CONCLUSIONS

Despite the specific professional exposure, a margin for improvement in self cardiovascular risk factors awareness and management remains in this exploratory sample of cardiovascular specialists. This pilot research anticipates forthcoming, larger studies during national and international conferences.

Potential Contribution to Dietary Reference Intake (DRI) of Agar Extracted from Gelidium latifolium (Gelidiaceae, Rhodophyta) as a Mineral Source

Ca, Na, Mg, K, P, Fe, Zn, Mn, V, Cr, Ni, Cu, Mo, and Se were determined in agar obtained seasonally from Gelidium latifolium in coast of Black Sea, using the inductively coupled plasma mass spectroscopy. Also, the potential contribution of the agar to the dietary reference intakes (DRIs) was evaluated according to the Basic Nutritional Requirements Guideline released by the Institute of Medicine and the Official Journal of the European Union. The results show that agar extracted from G. latifolium could be used as a food supplement to help meet the DRIs of certain essential minerals and trace elements. In the study, the most dominant macro and micro elements were found to be potassium (K), calcium (Ca), sodium (Na), iron (Fe), and manganese (Mn), respectively. The Na/K ratio of the agar obtained seasonally was found to be below the maximum limits recommended by international organizations (Na/K ≤ 0.6). The Ca/Mg ratio was calculated between 1.44 and 1.55 throughout the year. The Ca/Mg and K/Na ratios were not reflected highly significant difference between seasons. Ion quotient values for extracted agar were between 0.36 and 40.54, so they can reduce hypertension, preeclampsia, and heart disease in human beings. Accordingly, extracted agar from G. latifolium red seaweed were of high quality and safety and might be used in the field of nutrition.

Nutritional profiling and contaminant levels of five underutilized fish species in Norway

Exploring and making use of underutilized marine resources can be a sustainable approach to achieve future demands of fish consumption by the ever-growing population. Five species, namely European plaice (Pleuronectes platessa), European flounder (Platichthys flesus), lemon sole (Microstomus kitt), megrim (Lepidorhombus whiffiagonis), and thornback ray (Raja clavate), often captured as by-catch in Norway, were characterized for their nutritional value and potential accumulation of hazardous components. The proximate composition, protein profile, fatty acid profile as well as essential and toxic trace elements and polychlorinated biphenyls (PCBs) were analyzed. Digestible indispensable amino acid (DIAA) ratios and scores (DIAAS) and contributions of omega-3 fatty acids to the diet were calculated. Analysis on proximate composition revealed low fat contents of 0.74 to 1.25% and sufficient protein contents between 16.9 and 24% in the five species. Results of DIAA indicate a profitable distribution, with contributions exceeding the daily intake recommendations for an adult person related to a 200 g fillet. Moreover, findings on the distribution of eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) showed remarkable results, considering that the investigated species are lean fish. All five investigated fish exceed the recommended average daily intake level (AI) of EPA + DHA in a 200 g portion. As to toxic trace elements and PCBs, no significantly elevated levels were found considering a portion size of 200 g. Consequently, the nutritional quality of the investigated fish can be regarded as profitable with overall low potential health risks.

Global Comparison of Nutrient Reference Values, Current Intakes, and Intake Assessment Methods for Sodium among the Adult Population

Excess sodium intake is a risk factor for non-communicable diseases (NCDs), such as cardiovascular diseases and hypertension. Therefore, many countries have set nutrient reference values for sodium, specifically for the prevention of NCDs, and intake is routinely monitored by nutrition surveys. In this review, we aimed to compare the global nutrient reference values and national intakes of sodium, along with the methods of intake assessment used. Data were obtained for Australia, Canada, Ireland, Japan, the UK, the US, and the European Food Safety Authority (EFSA), where information was accessible online in English or Japanese. We collected the following information regarding sodium intake: the term used for reference values to prevent NCDs; year when reference values were established or revised; reference values to prevent NCDs; target NCDs; designation of nutrition survey; method for estimating intake; and average intake. The reference values ranged from 2,000 mg (Australia and EFSA) to 2,953 mg (Japan). Sodium intake ranged from 2,431 mg (Australia) to 3,958 mg (Japan). Out of seven countries/institutions, five used dietary assessment, and two used sodium urinary excretion for estimating dietary sodium intake. Among the dietary assessment methods, the 24-h dietary recall was most frequently used. National sodium intake exceeded the reference values in all countries, and reduction of sodium intake remains a global challenge.

Prevalence of nutritional inadequacy in children aged 12-36 months: EPACI Portugal 2012

Adequate nutritional intake in the first years of life is crucial for future health. The purpose of this study is to assess the adequacy of nutritional intake in Portuguese toddlers. The EPACI Portugal 2012 is a cross-sectional study of a representative sample of toddlers (n = 2230), aged between 12 and 36 months. Data on diets were collected by trained interviewers. The current analysis included 853 children with full data from 3-day food diaries completed by parents/caregivers. Intakes of energy, macro- and micronutrients were estimated through Statistical Program to Assess Dietary Exposure (SPADE). Nutritional adequacy was evaluated using Dietary Reference Values established by the European Food Safety Authority. A large proportion of children exceeded the recommended energy intake. The median daily protein intake was 4.7 g/kg/day, five times more than that recommended. About 9% and 90% of the children consumed a lower proportion of energy than the lower limit of the Reference Intake range for carbohydrates and fat, respectively. Around a third consumed less fibre and magnesium and 100% less vitamin D than the recommended Adequate Intake (AI). Almost a third consumed less vitamin A than the recommended Average Requirement (AR) and 86% of the children showed excessive sodium consumption. Portuguese toddlers consumed a low proportion of energy from fat, had energy and protein intakes above the recommendations and excessive intakes of sodium, and inadequate intakes of vitamin A. Every child consumed less than the recommended AI for vitamin D.

Sodium reduction in foods: Challenges and strategies for technical solutions

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.

Nutri-Score: Its Benefits and Limitations in Children's Feeding

Reducing the burden of noncommunicable diseases (NCDs) is one of the top priorities of public health policies worldwide. One of the recognized means of achieving this objective is to improve the diet quality. The Nutri-Score (N-S) is a [five-color-A, B, C, D, E letters] front-of-pack labeling logo intended to help consumers quickly identify the healthier prepackaged foods within a food category. Available studies have shown that the N-S is an efficient tool to achieve this aim in terms of consumers' awareness, perception, understanding, and purchasing and that its use may help to reduce the prevalence of NCDs. The N-S is currently implemented on a voluntary basis in 7 European countries and a discussion is underway within the European Commission to achieve a harmonized mandatory label. However, no study on the putative impact of the N-S on children's dietary patterns and health is available. The N-S is not applicable to infants' and young children's formulas and to specific baby foods, the compositions of which are already laid down in European Union regulations. The N-S does not replace age-appropriate dietary guidelines. As children consume an increasing number of adult type and processed foods, the relevance of the N-S for children should be evaluated considering the children's high specific requirements, especially in younger children. This is especially necessary for fitting fat and iron requirements, whereas protein-rich foods should be better framed. Moreover, efforts should be made to inform on how to use the N-S and in education on healthy diets.

Dietary Intake of Salt from Meat Products in Serbian Population

Salt intake above 5 g/day correlates with prevalence of hypertension and cardiovascular diseases (CVD). CVD, the leading cause of mortality and morbidity in Europe, account for 45% of all deaths, while, in Serbia in 2021, CVD accounted for 47.3%. The objective was to investigate salt content labelled on meat products from the Serbian market and estimate dietary exposure to salt from meat products in the Serbian population using consumption data. Data on salt content were collected from 339 meat products and classified in eight groups. Consumption data were collected using the EFSA EU Menu methodology (2017-2021) from 576 children and 3018 adults (145 pregnant women) in four geographical regions of Serbia. The highest salt content was in dry fermented sausages and dry meat, average 3.78 ± 0.37 g/100 g and 4.40 ± 1.21 g/100 g, respectively. The average intake of meat products is 45.21 ± 39.0 g/day and estimated daily salt intake from meat products per person is 1.192 g, which is 24% of the daily recommended amount. The actual meat product consumption and content of salt in meat products in Serbia present a risk factor for development of CVD and related comorbidities. A targeted strategy, policy and legislation for salt reduction are needed.

Evaluation of Chemical and Sensory Characteristics of Sauerkraut Juice Powder and its Application in Food

Sauerkraut juice is rich in bioactive compounds; however, it is considered a byproduct of the production process. An innovative solution was found through the process of spray-drying to obtain sauerkraut juice powder. The aim of this study was to evaluate chemical and sensory characteristics of sauerkraut juice powder (SJP) and its application in foodstuffs. For SJP, total phenol content, antiradical activity, and nutritional value were determined, and the results showed that SJP is rich in minerals, especially calcium and potassium, as well as organic acids and vitamin C. SJP contains 12% NaCl and a total phenol content of 359.54 mg GAE 100 g^-1 dw. SJP has umami attributes, such as sweet, sour, and salty. Sensory tests-descriptive, rate-all-that-apply, overall liking, and volatile profile determination-were carried out separately in SJP experimental samples with olive oil and sour cream. Among the sweet, sour, and salty flavours, garlic, yogurt, and mayonnaise were also mentioned. In the detection of volatile compounds, leafy and grassy green aromas with light almond were identified in the samples with olive oil and butter and rancid cheese and fishy/amine odours were identified in samples with sour cream. There were significant differences in the overall likability of samples, but the experimental samples with SJP were more popular than control samples; therefore, SJP may be used as a salt alternative in food applications.

Safety of 6'-sialyllactose (6'-SL) sodium salt produced by derivative strains of Escherichia coli BL21 (DE3) as a novel food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on 6'-sialyllactose (6'-SL) sodium salt as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF is mainly composed of the human-identical milk oligosaccharide (HiMO) 6'-SL, but it also contains d-lactose, 6'-sialyllactulose, sialic acid, N-acetyl-d-glucosamine and a small fraction of other related oligosaccharides. The NF is produced by fermentation with two genetically modified strains of Escherichia coli BL21 (DE3), the production strain and the optional degradation strain. The information provided on the identity, manufacturing process, composition and specifications of the NF does not raise safety concerns. The applicant intends to add the NF to a variety of foods, including infant formula and follow-on formula, food for special medical purposes and food supplements. The target population is the general population. In some scenarios at the maximum use levels, the estimated intakes per kg body weight were higher than the high average natural intake of 6'-SL from human milk. However, given the intrinsic nature of human milk oligosaccharides (HMOs), the wide range of intakes from human milk, and considering that infants are naturally exposed to similar amounts of these substances, the Panel considers that the consumption of the NF at the proposed conditions of use does not raise safety concerns. The intake of 6'-SL in breastfed infants on a body weight basis is also expected to be safe for other population groups. The intake of other carbohydrate-type compounds structurally related to 6'-SL is also considered of no safety concern. Food supplements are not intended to be used if other foods with added 6'-SL or human milk are consumed on the same day. The Panel concludes that the NF is safe under the proposed conditions of use.

Sodium Content in Cereal-Based Products Sold in Italy: How Far Are We from the Global Benchmarks?

Reformulation of food products is one of the measures needed for reducing salt consumption. Accordingly, the World Health Organization (WHO) recently proposed global sodium benchmarks for different food categories to be used for setting national policies. Therefore, the sodium content of cereal-based products currently sold in Italy was compared with the WHO benchmarks, highlighting those categories primarily needing a reformulation. To this aim, the sodium content and several declarations (i.e., nutrition and health claims, organic or gluten free declaration) were retrieved from 2917 cereal-based products sold on the Italian market. All “minimally processed breakfast cereals” had a sodium content below the benchmark, while “flatbreads” and “leavened bread” had the highest percentage of items above the respective sodium benchmarks. Flatbreads and “crackers/savory biscuits” showed the highest median delta values from the respective benchmarks of 360 and 278 mg/100 g, respectively. Large variability in terms of percentage of products with sodium content above the benchmark was observed within the same categories, as well as among products with different declarations. A large number of food products currently sold on the Italian market have a sodium content above the benchmark. This result suggests the need to reformulate many food products currently on the market to achieve the WHO/United Nations (UN) objective of 30% global reduction in sodium intake by 2025.

Bioaccessibility of Macrominerals and Trace Elements from Tomato (Solanum lycopersicum L.) Farmers’ Varieties

Traditional farmers’ varieties of tomato grown under extensive farming techniques are considered delicious and healthy foods and are preferred by local consumers. Tomatoes are an important component of a healthy diet, as they provide essential micronutrients, including minerals, which are vital to healthy development, disease prevention, and wellbeing. Given the considerable dietary intake of tomatoes and the scarcity of information about the bioaccessibility of inorganic constituents in this fruit, this study was carried out to evaluate the content and bioaccessibility of minerals (macro- and microelements) in tomato farmers’ varieties widely cultivated in northeastern Portugal homegardens. Among the macroelements, K stood out as the most abundant mineral in the studied varieties, followed by Mg, Ca, and Na. Regarding the microelements, while the yellow tomato had higher concentrations of Fe and Cu, the round tomato had more Zn and Mn. The in vitro bioaccessibility assessment showed that, among the macroelements, Mg was more bioaccessible than Ca and K when all the tomato varieties were considered together. Among the microelements, Cu seemed to be the most bioaccessible. Although the contribution of a 100 g serving of the studied tomato farmers’ varieties to the dietary reference intakes (DRIs) of minerals is relatively low, this food could contribute to reaching these mineral requirements, as it is included in the diet of most of the population, especially in Mediterranean regions.

Validity of the Food Frequency Questionnaire-Estimated Intakes of Sodium, Potassium, and Sodium-to-Potassium Ratio for Screening at a Point of Absolute Intake among Middle-Aged and Older Japanese Adults

Using Food Frequency Questionnaires (FFQs) to compare dietary references for screening has been in high demand. However, FFQs have been widely used for ranking individuals in a population based on their dietary intake. We determined the validity of sodium (salt equivalent) intake, potassium intake, and sodium-to-potassium (Na/K) ratio obtained using the FFQ for identifying individuals who deviated from the dietary reference intakes (DRIs) measured using multiple 24-h urinary excretion measurements or 12-day weighed food records (WFR). This study included 235 middle-aged subjects. The correlation coefficients (CCs) between the FFQ and WFR estimates were mostly moderate (0.24−0.54); the CCs between the FFQ and 24-h urinary excretion measurements were low or moderate (0.26−0.38). Values of area under the receiver-operating curve (AUC) at the point of DRIs for salt equivalent or potassium were >0.7 with the WFR as the reference standard and 0.60−0.76 with the 24-h urinary excretion as the reference standard. Using both standard measures, the AUC for the Na/K ratio was <0.7. The accuracy of salt equivalent and potassium intake estimation using the FFQ to determine absolute intake point was comparable to that using WFR, allowing for quantified error, but not as good as that of 24-h urinary excretion.

Performance of Apple Pomace for Gluten-Free Bread Manufacture: Effect on Physicochemical Characteristics and Nutritional Value

Apple pomace has been proposed as a quality enhancer for gluten-free bread, but its composition and physicochemical features differ significantly depending on the apple cultivar. The objective of this article was to characterize apple pomace powder (APP) from certain varieties from the Basque Country and to study the feasibility of adding it to gluten-free bread, focusing on physicochemical and nutritional aspects. APP was obtained by washing, drying and grinding, and it was added at 0, 5, 6 and 8%, together with other ingredients, such as gluten-free flours, corn starch and whey protein. APP had a reddish-grey coloration (L* 56.49 ± 1.39, a* 11.07 ± 0.47, b* 27.69 ± 1.76), pH 4.19 ± 0.15 and Aw 0.235 ± 0.084. Pomace powder was used successfully in higher amounts than experiences reported before. Key physicochemical parameters such as specific volume (≥2.5 cm3/g) and cohesiveness or resilience values (0.538 and 0.378, respectively) suggested good acceptability for gluten-free breads with 8% APP. Additionally, breads were a source of antioxidant potential (437.66 ± 38.95 µM DPPHeq/g APP), fiber (80.13 ± 6.07 g/100 g) and micronutrients such as Cu, Mg, Mn and Fe. In conclusion, local apple varieties are a good source of raw material for gluten-free bread manufacture, which offers a solution for environmental pollution and may contribute to boosting the circular economy.

Microbial Safety and Sensory Analyses of Cold-Smoked Salmon Produced with Sodium-Reduced Mineral Salts and Organic Acid Salts

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.

Commercial Baby Foods Aimed at Children up to 36 Months: Are They a Matter of Concern?

Proper nutrition in infancy and early childhood is crucial to ensuring optimal child development, growth, and better health outcomes later in life. The nutrient profile model proposed by WHO/Europe aims to assess the nutritional quality and promotional/marketing aspects of commercial baby foods aimed at children up to 36 months. We used commercial data from 191 baby foods collected between March 2021 and July 2021, from eight supermarket chains in the Lisbon Metropolitan area. According to the model specifications and the NOVA classification system, we assessed the nutritional quality and promotion aspects and the degree of processing, respectively. The presence of at least one sugar-contributing ingredient was found in 34.0% of the products; 13.9% of products listed sugars and 15.0% listed fruit juices or concentrates as an ingredient. The claim “No added sugar” was present in 69.6% of products. Only 35.1% of products comply with all the nutritional requirements of the model. Concerning processing classification, 61.8% of products were ultra-processed, and about 57.0% were indicated for children < 12 months. These findings reinforce the importance of implementing measures to ensure that commercial foods for infants are marketed appropriately and to promote foods with a lower degree of processing.

Safety of 3'-sialyllactose (3'-SL) sodium salt produced by derivative strains of Escherichia coli BL21 (DE3) as a Novel Food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on 3'-sialyllactose (3'-SL) sodium salt as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF is mainly composed of the human-identical milk oligosaccharide (HiMO) 3'-SL, but it also contains d-lactose, 3'-sialyllactulose, sialic acid, N-acetyl-d-glucosamine and a small fraction of other related oligosaccharides. The NF is produced by fermentation with two genetically modified strains of Escherichia coli BL21 (DE3), the production strain and the optional degradation strain. The information provided on the manufacturing process, composition and specifications of the NF does not raise safety concerns. The applicant intends to add the NF to a variety of foods, including infant formula and follow-on formula, food for infants and young children, food for special medical purposes and food supplements. The target population is the general population. The anticipated daily intake of 3'-SL from both proposed and combined (authorised and proposed) uses at their respective maximum use levels in all population categories does not exceed the highest intake level of 3'-SL from human milk in infants on a body weight basis. The intake of 3'-SL in breastfed infants on a body weight basis is expected to be safe also for other population groups. The intake of other carbohydrate-type compounds structurally related to 3'-SL is also considered of no safety concern. Food supplements are not intended to be used if other foods with added 3'-SL or human milk are consumed on the same day. The Panel concludes that the NF is safe under the proposed conditions of use.

Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver scientific advice related to nutrient profiling for the development of harmonised mandatory front‐of‐pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods. This Opinion is based on systematic reviews and meta‐analyses of human studies on nutritionally adequate diets, data from the Global Burden of Disease framework, clinical practice guidelines, previous EFSA opinions and the priorities set by EU Member States in the context of their Food‐Based Dietary Guidelines and associated nutrient/food intake recommendations. Relevant publications were retrieved through comprehensive searches in PubMed. The nutrients included in the assessment are those likely to be consumed in excess or in inadequate amounts in a majority of European countries. Food groups with important roles in European diets have been considered. The Panel concludes that dietary intakes of saturated fatty acids (SFA), sodium and added/free sugars are above, and intakes of dietary fibre and potassium below, current dietary recommendations in a majority of European populations. As excess intakes of SFAs, sodium and added/free sugars and inadequate intakes of dietary fibre and potassium are associated with adverse health effects, they could be included in nutrient profiling models. Energy could be included because a reduction in energy intake is of public health importance for European populations. In food group/category‐based nutrient profiling models, total fat could replace energy in most food groups owing to its high‐energy density, while the energy density of food groups with low or no fat content may be well accounted for by the inclusion of (added/free) sugars. Some nutrients may be included in nutrient profiling models for reasons other than their public health importance, e.g. as a proxy for other nutrients of public health importance, or to allow for a better discrimination of foods within the same food category.

Salt-Related Knowledge, Attitudes and Behavior in an Intervention to Reduce Added Salt When Cooking in a Sample of Adults in Portugal

(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.

Sodium Intake and Risk of Hypertension: A Systematic Review and Dose-Response Meta-analysis of Observational Cohort Studies

PURPOSE OF THE REVIEW

To assess the relationship between sodium intake and hypertension risk in cohort studies, based on a systematic review up to January 21, 2022, that also employed a dose-response meta-analysis.

RECENT FINDINGS

Dose-response analysis of available cohort studies (n = 11), using a dietary intake or urinary sodium excretion of 2 g/day as the reference category, showed an excess risk starting at 3 g/day. However, we found a linear relationship across the entire range of sodium exposure in an analysis restricted to studies that used 24 h urinary sodium excretion information and had a low risk of bias. This review confirms prior findings based on experimental studies and identified an almost linear relationship between sodium intake/excretion and hypertension risk in cohort studies, reinforcing the validity of recommendations to prevent cardiovascular disease through the reduction of sodium intake in both normotensive and hypertensive adults.

Increasing Seaweed Consumption in the Netherlands and Portugal and the Consequences for the Intake of Iodine, Sodium, and Exposure to Chemical Contaminants: A Risk-Benefit Study

Background: Seaweed has a high potential for nourishing the future planet. However, besides being beneficial, it also contains adverse components; this poses the question whether consumption of seaweed foods overall contributes beneficially or detrimentally to human health, and hence if their consumption should be promoted or restricted. Methods: This study evaluated the impact of substituting regular foods with seaweed foods in the diet, both in terms of nutritional quality (via iodine and sodium) and food safety (via arsenic, cadmium, lead, and mercury). Food consumption data from the Netherlands and Portugal (adults aged >18 years) were used, in which 10% of the amounts of pasta, bacon, and lettuce consumed were replaced by seaweed-derived products made from kelp (Saccharina latissima). Using Monte Carlo Risk Assessment software (MCRA), long-term nutrient intake and exposure to contaminants were assessed. The results obtained for the Netherlands and Portugal were compared with data from Japan, a country that has a high natural consumption of seaweed. Results: This low-tier risk-benefit study reveals that an increased seaweed consumption (as assessed by the 10% replacement with seaweed products) has no consequences in terms of intake of sodium and exposure to cadmium, lead, and mercury, and the associated (absence of) adverse health aspects. The alternative scenario almost doubled the mean iodine intake in the Netherlands (to 300 μg/day) and Portugal (to 208 μg/day) and increased the average exposure to arsenic levels in the Netherlands (to 1.02 μg/kg bw/day) and Portugal (to 1.67 μg/kg bw/day). Conclusion: The intake of iodine and exposure to arsenic in the Netherland and Portugal were certainly higher due to the modeled increase of seaweed foods. If seaweed consumption increases close to the 10% substitution, the public health consequences thereof may trigger further research.

Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.

High Adherence to Mediterranean Diet Is Not Associated with an Improved Sodium and Potassium Intake

Prevention and control of hypertension and cerebro-cardiovascular diseases are associated with adequate sodium and potassium intake and adherence to a Mediterranean dietary pattern. The aim of this study was to assess the association between adherence to a Mediterranean diet (MD) and the excretion of sodium and potassium as surrogate measures of intake. This is a cross-sectional analysis as part of a larger study (the iMC SALT randomized controlled trial) among workers of a public university. A food frequency questionnaire was used to assess the adherence to MD, using the alternative Mediterranean diet (aMED) score; sodium and potassium excretions were estimated by 24-h urine collections. Sociodemographic and other lifestyle characteristics were also obtained. The associations between the adherence to MD and Na and K excretion were calculated by logistic regression, adjusting for confounding variables. From the 109 selected participants, seven were excluded considering urine screening and completeness criteria, leaving a final sample of 102 subjects (48% male, average age 47 years). Mean sodium and potassium excretion were 3216 mg/day and 2646 mg/day, respectively. Sodium and potassium excretion were significantly higher in men, but no differences were found according to different levels of MD adherence. In logistic regression analysis, sodium, potassium, and sodium-to-potassium ratio urinary excretion tertiles were not associated with MD adherence (low/moderate versus high), even after adjustment for confounding variables. A high adherence to MD was thus not associated with a different level of sodium and potassium intake.

The Nordic Nutrition Recommendations 2022 - prioritisation of topics for de novo systematic reviews

Background

As part of the process of updating national dietary reference values (DRVs) and food-based dietary guidelines (FBDGs), the Nordic Nutrition Recommendations 2022 project (NNR2022) will select a limited number of topics for systematic reviews (SRs).

Objective

To develop and transparently describe the results of a procedure for prioritisation of topics that may be submitted for SRs in the NNR2022 project.

Design

In an open call, scientists, health professionals, national food and health authorities, food manufacturers, other stakeholders and the general population in the Nordic and Baltic countries were invited to suggest SR topics. The NNR2022 Committee developed scoping reviews (ScRs) for 51 nutrients and food groups aimed at identifying potential SR topics. These ScRs included the relevant nominations from the open call. SR topics were categorised, ranked and prioritised by the NNR2022 Committee in a modified Delphi process. Existing qualified SRs were identified to omit duplication.

Results

A total of 45 nominations with suggestion for more than 200 exposure-outcome pairs were received in the public call. A number of additional topics were identified in ScRs. In order to omit duplication with recently qualified SRs, we defined criteria and identified 76 qualified SRs. The NNR2022 Committee subsequently shortlisted 52 PI/ECOTSS statements, none of which overlapped with the qualified SRs. The PI/ECOTSS statements were then graded 'High' (n = 21), 'Medium' (n = 9) or 'Low' (n = 22) importance, and the PI/ECOTSS statements with 'High' were ranked in a Delphi process. The nine top prioritised PI/ECOTSS included the following exposure-outcome pairs: 1) plant protein intake in children and body growth, 2) pulses/legumes intake, and cardiovascular disease and type 2 diabetes, 3) plant protein intake in adults, and atherosclerotic/cardiovascular disease and type 2 diabetes, 4) fat quality and mental health, 5) vitamin B12 and vitamin B12 status, 6) intake of white meat (no consumption vs. high consumption and white meat replaced with red meat), and all-cause mortality, type 2 diabetes and risk factors, 7) intake of n-3 LPUFAs from supplements during pregnancy, and asthma and allergies in the offspring, 8) nuts intake and cardiovascular disease (CVD) and type 2 diabetes in adults, 9) dietary fibre intake (high vs. low) in children and bowel function.

Discussion

The selection of topics for de novo SRs is central in the NNR2022 project, as the results of these SRs may cause adjustment of existing DRVs and FBDGs. That is why we have developed this extensive process for the prioritisation of SR topics. For transparency, the results of the process are reported in this publication.

Conclusion

The principles and methodologies developed in the NNR2022 project may serve as a framework for national health authorities or organisations when developing national DRVs and FBDGs. This collaboration between the food and health authorities in Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden represents an international effort for harmonisation and sharing of resources and competence when developing national DRVs and FBDGs.

Safety of mung bean protein as a novel food pursuant to Regulation (EU) 2015/2283

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on mung bean protein as a novel food (NF) pursuant to Regulation (EU) 2015/2283. The NF, which is the subject of the application, is mung bean protein extracted from seeds of the plant Vigna radiata. The NF is proposed to be used as a food ingredient added to 'protein products, excluding products covered in category 1.8'. The target population is the general population. The maximum estimated intake of the NF is 758 and 260 mg/kg body weight (bw) per day in children and adults, respectively. The major constituents of this NF are protein (~85%), fat (3-4%) and moisture (3-5.5%). The NF is rich in protein which is well digestible and provides sufficient amounts of most essential amino acids but only limited amounts of sulfur-containing amino acids. The Panel notes that the cumulative exposure to the minerals analysed does not raise concern. The reported values for the levels of antinutritional factors in the NF are comparable to those in other foodstuffs. The Panel considers that taking into account the composition of the NF and the proposed conditions of use, consumption of the NF is not nutritionally disadvantageous. No toxicological studies with the NFs were provided by the applicant; however, the Panel considers that no toxicological studies are required on this NF. This NF has the potential capacity to sensitise individuals and to induce allergic reactions in individuals allergic to soybean, peanuts, lupin and to birch pollen. The Panel considers that the NF, i.e. mung bean protein, is safe at the proposed conditions of use.

Estimating the health and economic effects of the voluntary sodium reduction targets in Brazil: microsimulation analysis

BACKGROUND

Excessive sodium consumption is one of the leading dietary risk factors for non-communicable diseases, including cardiovascular disease (CVD), mediated by high blood pressure. Brazil has implemented voluntary sodium reduction targets with food industries since 2011. This study aimed to analyse the potential health and economic impact of these sodium reduction targets in Brazil from 2013 to 2032.

METHODS

We developed a microsimulation of a close-to-reality synthetic population (IMPACTNCD-BR) to evaluate the potential health benefits of setting voluntary upper limits for sodium content as part of the Brazilian government strategy. The model estimates CVD deaths and cases prevented or postponed, and disease treatment costs. Model inputs were informed by the 2013 National Health Survey, the 2008-2009 Household Budget Survey, and high-quality meta-analyses, assuming that all individuals were exposed to the policy proportionally to their sodium intake from processed food. Costs included costs of the National Health System on CVD treatment and informal care costs. The primary outcome measures of the model are cardiovascular disease cases and deaths prevented or postponed over 20 years (2013-2032), stratified by age and sex.

RESULTS

The study found that the application of the Brazilian voluntary sodium targets for packaged foods between 2013 and 2032 could prevent or postpone approximately 110,000 CVD cases (95% uncertainty intervals (UI): 28,000 to 260,000) among men and 70,000 cases among women (95% UI: 16,000 to 170,000), and also prevent or postpone approximately 2600 CVD deaths (95% UI: - 1000 to 11,000), 55% in men. The policy could also produce a net cost saving of approximately US$ 220 million (95% UI: US$ 54 to 520 million) in medical costs to the Brazilian National Health System for the treatment of CHD and stroke and save approximately US$ 71 million (95% UI: US$ 17 to170 million) in informal costs.

CONCLUSION

Brazilian voluntary sodium targets could generate substantial health and economic impacts. The reduction in sodium intake that was likely achieved from the voluntary targets indicates that sodium reduction in Brazil must go further and faster to achieve the national and World Health Organization goals for sodium intake.

Sodium Content of Foods Sold in the Spanish Market. Results from the BADALI Project

High sodium/salt intake is a risk factor for Non-Communicable Diseases (NCDs). Excess sodium intake has been associated with high coronary heart disease, stroke and high blood pressure. The sodium daily intake is above the recommendations in the world as well as in Spain. Reducing salt content in processed foods and ready meals is one of the main strategies for reducing sodium intake. The aim of the present work is to characterise the presence of sodium in foods sold in the Spanish market. We also study a possible shift in sodium content in products over the last few years. For this purpose, 3897 products included in the BADALI food database were analysed, classified into 16 groups (G). We found that 93.3% of all foods displayed the sodium/salt content in the nutrition declaration. Meat-processed and derivatives (G8) had the highest mean and median values for sodium content, followed by snacks (G15) and sauces (G14). Only 12.7% of foods were sodium-free (≤5 mg/100 g or 100 mL), 32.4% had very low sodium (≤40 mg/100 g or 100 mL) and 48.2% were low in sodium (≤120 mg/100 g or 100 mL). On the contrary, 47.2% were high in sodium according to the Pan American Health Organisation Nutrient Profile Model (PAHO-NPM), while there were 31.9% according to the Chile-NPM. The agreement between the two NPMs was considered 'substantial' (κ = 0.67). When sodium content was compared over the years, no decrease was observed. This analysis was performed in the entire food population, by food group and in matched products. Therefore, more effort should be made by all parties involved in order to decrease the sodium/salt intake in the population.

Effect of Salt Content Reduction on Food Processing Technology

Higher salt intake is associated with the risk of cardiovascular and kidney diseases, hypertension and gastric cancer. Salt intake reduction represents an effective way to improve people’s health, either by the right choice of food or by a reduction of added salt. Salt substitutes are often used and also herb homogenates are treated by high pressure technology. Salt reduction significantly influences the shelf life, texture, pH, taste, and aroma of cheese. The composition of emulsifying salts or starter cultures must be modified to enact changes in microbial diversity, protease activity and the ripening process. The texture becomes softer and aroma atypical. In bakery products, a salt reduction of only 20–30% is acceptable. Water absorption, dough development, length and intensity of kneading and stability of dough are changed. Gluten development and its viscoelastic properties are affected. The salt reduction promotes yeast growth and CO₂ production. Specific volume and crust colour intensity decreased, and the crumb porosity changed. In meat products, salt provides flavour, texture, and shelf life, and water activity increases. In this case, myofibrillar proteins’ solubility, water binding activity and colour intensity changes were found. The composition of curing nitrite salt mixtures and starter cultures must be modified.

Risk-Benefit Assessment of Cereal-Based Foods Consumed by Portuguese Children Aged 6 to 36 Months-A Case Study under the RiskBenefit4EU Project

Cereal-based foods, including breakfast (BC) and infant cereals (IC), are among the first solid foods introduced to infants. BC and IC are sources of macro and micronutrients that have beneficial effects on health, but can also be sources of harmful chemical and microbiological contaminants and nutrients that may lead to adverse health effects at high consumption levels. This study was performed under the RiskBenefit4EU project with the aim of assessing the health impact associated with consumption of BC and IC by Portuguese children under 35 months. Adverse effects associated with the presence of aflatoxins, Bacillus cereus, sodium and free sugars were assessed against the benefits of fiber intake. We applied a risk-benefit assessment approach, and quantified the health impact of changes in consumption of BC and IC from current to various alternative consumption scenarios. Health impact was assessed in terms of disability-adjusted life years. Results showed that moving from the current consumption scenario to considered alternative scenarios results in a gain of healthy life years. Portuguese children can benefit from exchanging intake of IC to BC, if the BC consumed has an adequate nutritional profile in terms of fiber, sodium and free sugars, with levels of aflatoxins reduced as much as possible.

Sodium and Potassium Content of Foods Consumed in an Italian Population and the Impact of Adherence to a Mediterranean Diet on Their Intake

High sodium and low potassium intakes are associated with increased levels of blood pressure and risk of cardiovascular diseases. Assessment of habitual dietary habits are helpful to evaluate their intake and adherence to healthy dietary recommendations. In this study, we determined sodium and potassium food-specific content and intake in a Northern Italy community, focusing on the role and contribution of adherence to Mediterranean diet patterns. We collected a total of 908 food samples and measured sodium and potassium content using inductively coupled plasma mass spectrometry. Using a validated semi-quantitative food frequency questionnaire, we assessed habitual dietary intake of 719 adult individuals of the Emilia-Romagna region. We then estimated sodium and potassium daily intake for each food based on their relative contribution to the overall diet, and their link to Mediterranean diet patterns. The estimated mean sodium intake was 2.15 g/day, while potassium mean intake was 3.37 g/day. The foods contributing most to sodium intake were cereals (33.2%), meat products (24.5%, especially processed meat), and dairy products (13.6%), and for potassium they were meat (17.1%, especially red and white meat), fresh fruits (15.7%), and vegetables (15.1%). Adherence to a Mediterranean diet had little influence on sodium intake, whereas potassium intake was greatly increased in subjects with higher scores, resulting in a lower sodium/potassium ratio. Although we may have underestimated dietary sodium intake by not including discretionary salt use and there may be some degree of exposure misclassification as a result of changes in food sodium content and dietary habits over time, our study provides an overview of the contribution of a wide range of foods to the sodium and potassium intake in a Northern Italy community and of the impact of a Mediterranean diet on intake. The mean sodium intake was above the dietary recommendations for adults of 1.5-2 g/day, whilst potassium intake was only slightly lower than the recommended 3.5 g/day. Our findings suggest that higher adherence to Mediterranean diet patterns has limited effect on restricting sodium intake, but may facilitate a higher potassium intake, thereby aiding the achievement of healthy dietary recommendations.

Modelling the Effect of Salt Concentration on the Fate of Listeria monocytogenes Isolated from Costa Rican Fresh Cheeses

"Turrialba cheese" is a Costa Rican fresh cheese highly appreciated due to its sensory characteristics and artisanal production. As a ready-to-eat dairy product, its formulation could support Listeria monocytogenes growth. L. monocytogenes was isolated from 14.06% of the samples and the pathogen was able to grow under all tested conditions. Due to the increasing demand for low-salt products, the objective of this study was to determine the effect of salt concentration on the growth of pathogen isolates obtained from local cheese. Products from retail outlets in Costa Rica were analyzed for L. monocytogenes. These isolates were used to determine growth at 4 °C for different salt concentration (0.5-5.2%). Kinetic curves were built and primary and secondary models developed. Finally, a validation study was performed using literature data. The R2 and Standard Error of fit of primary models were ranked from 0.964-0.993, and 0.197-0.443, respectively. An inverse relationship was observed between growth rate and salt concentration. A secondary model was obtained, with R2 = 0.962. The model was validated, and all values were Bf > 1, thus providing fail-safe estimations. These data were added to the free and easy-to-use predictive microbiology software "microHibro" which is used by food producers and regulators to assist in decision-making.