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Tremblay A, Gagné MP, Pérusse L, Fortier C, Provencher V, Corcuff R, Pomerleau S, Foti N, Drapeau V. Sodium and Human Health: What Can Be Done to Improve Sodium Balance beyond Food Processing? Nutrients 2024; 16:1199. [PMID: 38674889 PMCID: PMC11054196 DOI: 10.3390/nu16081199] [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: 03/21/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Sodium plays a key role in the regulation of water balance and is also important in food formulation due to its contribution to the taste and use in the preservation of many foods. Excessive intake of any essential nutrient is problematic and this seems to be particularly the case for sodium since a high intake makes it the nutrient most strongly associated with mortality. Sodium intake has been the object of recommendations by public health agencies such as the WHO and this has resulted in efforts by the food industry to reduce the sodium content of packaged foods, although there is still room for improvement. The recent literature also emphasizes the need for other strategies, e.g., regulations and education, to promote adequate sodium intake. In the present paper, we also describe the potential benefits of a global healthy lifestyle that considers healthy eating but also physical activity habits that improve body functionality and may help to attenuate the detrimental effects of high sodium intake on body composition and cardiometabolic health. In conclusion, a reduction in sodium intake, an improvement in body functioning, and educational interventions promoting healthy eating behaviours seem to be essential for the optimal regulation of sodium balance.
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Affiliation(s)
- Angelo Tremblay
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Marie-Pascale Gagné
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Louis Pérusse
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Catherine Fortier
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Endocrinology and Nephrology Axis, CHU de Québec Research Center, Université Laval, Québec, QC G1V 0A6, Canada
| | - Véronique Provencher
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
- School of Nutrition, Université Laval, Québec, QC G1V 0A6, Canada
| | - Ronan Corcuff
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Sonia Pomerleau
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Nicoletta Foti
- Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada; (M.-P.G.); (R.C.); (S.P.); (N.F.)
| | - Vicky Drapeau
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada; (L.P.); (C.F.); (V.D.)
- Centre Nutrition, Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada;
- Quebec Heart and Lung Institute Research Center, Quebec, QC G1V 4G5, Canada
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Yan YY, Chan LML, Wang MP, Kwok JYY, Anderson CS, Lee JJ. Technology-supported behavior change interventions for reducing sodium intake in adults: a systematic review and meta-analysis. NPJ Digit Med 2024; 7:72. [PMID: 38499729 PMCID: PMC10948864 DOI: 10.1038/s41746-024-01067-y] [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: 07/24/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
The effects of technology-supported behavior change interventions for reducing sodium intake on health outcomes in adults are inconclusive. Effective intervention characteristics associated with sodium reduction have yet to be identified. A systematic review and meta-analysis were conducted, searching randomized controlled trials (RCTs) published between January 2000 and April 2023 across 5 databases (PROSPERO: CRD42022357905). Meta-analyses using random-effects models were performed on 24-h urinary sodium (24HUNa), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Subgroup analysis and meta-regression of 24HUNa were performed to identify effective intervention characteristics. Eighteen RCTs involving 3505 participants (51.5% female, mean age 51.6 years) were included. Technology-supported behavior change interventions for reducing sodium intake significantly reduced 24HUNa (mean difference [MD] -0.39 gm/24 h, 95% confidence interval [CI] -0.50 to -0.27; I2 = 24%), SBP (MD -2.67 mmHg, 95% CI -4.06 to -1.29; I2 = 40%), and DBP (MD -1.39 mmHg, 95% CI -2.31 to -0.48; I2 = 31%), compared to control conditions. Interventions delivered more frequently (≤weekly) were associated with a significantly larger effect size in 24HUNa reduction compared to less frequent interventions (>weekly). Other intervention characteristics, such as intervention delivery via instant messaging and participant-family dyad involvement, were associated with larger, albeit non-significant, effect sizes in 24HUNa reduction when compared to other subgroups. Technology-supported behavior change interventions aimed at reducing sodium intake were effective in reducing 24HUNa, SBP, and DBP at post-intervention. Effective intervention characteristics identified in this review should be considered to develop sodium intake reduction interventions and tested in future trials, particularly for its long-term effects.
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Affiliation(s)
- Yong Yang Yan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lily Man Lee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jung Jae Lee
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Ferguson TS, Webster-Kerr K, Tulloch-Reid MK, Bennett NR, Ho J, Davidson T, Grant A, Gordon-Johnson KA, Govia I, Soares-Wynter S, Younger-Coleman N, McKenzie J, Walker E, Anderson S, Edwards S, Spence S. The Jamaica Salt Consumption Study Protocol: Sodium Intake; Sodium Content in Restaurant Foods; Knowledge, Attitudes, and Practices; Spot Urine Sodium Validation. F1000Res 2023; 11:721. [PMID: 38264475 PMCID: PMC10804057 DOI: 10.12688/f1000research.122619.2] [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] [Accepted: 11/22/2023] [Indexed: 01/25/2024] Open
Abstract
Background Excess dietary salt consumption is a major contributor to hypertension and cardiovascular disease. Public education programs on the dangers of high salt intake, and population level interventions to reduce the salt content in foods are possible strategies to address this problem. In Jamaica, there are limited data on the levels of salt consumption and the population's knowledge and practices with regards to salt consumption. This study therefore aims to obtain baseline data on salt consumption, salt content in foods sold in restaurants, and evaluate knowledge, attitudes, and practices of Jamaicans regarding salt consumption. Methods The study is divided into four components. Component 1 will be a secondary analysis of data on urinary sodium from spot urine samples collected as part of a national survey, the Jamaica Health and Lifestyle Survey 2016-2017. Component 2 will be a survey of chain and non-chain restaurants in Jamaica, to estimate the sodium content of foods sold in restaurants. Component 3 is another national survey, this time on a sample 1,200 individuals to obtain data on knowledge, attitudes and practices regarding salt consumption and estimation of urinary sodium excretion. Component 4 is a validation study to assess the level of agreement between spot urine sodium estimates and 24-hour urinary sodium from 120 individuals from Component 3. Discussion This study will provide important baseline data on salt consumption in Jamaica and will fulfil the first components of the World Health Organization SHAKE Technical Package for Salt Reduction. The findings will serve as a guide to Jamaica's Ministry of Health and Wellness in the development of a national salt reduction program. Findings will also inform interventions to promote individual and population level sodium reduction strategies as the country seeks to achieve the national target of a 30% reduction in salt consumption by 2025.
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Affiliation(s)
- Trevor S. Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | | | - Marshall K. Tulloch-Reid
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Nadia R. Bennett
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - James Ho
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Tamu Davidson
- Chronic Disease and Injury Department, Surveillance, Disease Prevention & Control Division, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Kelly-Ann Gordon-Johnson
- Caribbean Regional Office, Centers for Disease Control and Prevention, United States Embassy, Kingston 6, Jamaica
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Suzanne Soares-Wynter
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Novie Younger-Coleman
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Joette McKenzie
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Evelyn Walker
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston 7, Jamaica
| | - Simon Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill, Bridgetown, St. Michael, BB11115, Barbados
| | | | - Simone Spence
- Ministry of Health and Wellness, Kingston 5, Jamaica
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Vargas-Meza J, Gonzalez-Rocha A, Campos-Nonato I, Nilson EAF, Basto-Abreu A, Barquera S, Denova-Gutiérrez E. Effective and Scalable Interventions to Reduce Sodium Intake: a Systematic Review and Meta-Analysis. Curr Nutr Rep 2023; 12:486-494. [PMID: 37226030 DOI: 10.1007/s13668-023-00477-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW High-sodium intake is a main risk factor for increased blood pressure and cardiovascular disease, the leading cause of death worldwide. Reducing sodium intake at the population level is one of the most cost-effective strategies to address this. The aim of the present systematic review and meta-analysis are to examine data from recent studies that measure the effectiveness and scalability of interventions aimed at reducing sodium intake at both the population and individual level. RECENT FINDINGS Worldwide, sodium intake is higher than the World Health Organization recommendations. Structural interventions such as mandatory reformulation of foods, food labeling, taxes or subsidies, and communication campaigns have shown to be the most effective in reducing the population's sodium consumption. Interventions in education, particularly those that use a social marketing framework with short duration, food reformulation, and combined strategies, have the potential to decrease sodium intake.
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Affiliation(s)
- Jorge Vargas-Meza
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
- El Poder del Consumidor A.C., Ciudad de México, México
| | - Alejandra Gonzalez-Rocha
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Ismael Campos-Nonato
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Eduardo Augusto Fernandes Nilson
- Nucleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
- Programa de Alimentação, Nutrição e Cultura, Oswaldo Cruz Foundation (Fiocruz), Brasilia, Brazil
| | - Ana Basto-Abreu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, México
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México
| | - Edgar Denova-Gutiérrez
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Avenida Universidad #655, Cuernavaca, México.
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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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