1
|
A Program Evaluation of a Dietary Sodium Reduction Research Consortium of Five Low- and Middle-Income Countries in Latin America. Nutrients 2022; 14:nu14204311. [PMID: 36296995 PMCID: PMC9606855 DOI: 10.3390/nu14204311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016-2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations.
Collapse
|
2
|
Cateriano-Arévalo E, Saavedra-Garcia L, Ponce-Lucero V, Miranda JJ. Applying Customer Journey Mapping in Social Marketing to Understand Salt-Related Behaviors in Cooking. A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413262. [PMID: 34948870 PMCID: PMC8701153 DOI: 10.3390/ijerph182413262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
Worldwide, salt consumption exceeds the World Health Organization’s recommendation of a daily intake of 5 g. Customer journey mapping is a research method used in market research to understand customer behaviors and experiences and could be useful in social marketing as well. This study aimed to explore the potential of customer journey mapping to better understand salt-related behaviors performed during the preparation of household cooking. We tracked the journey of four women in their kitchens for approximately two hours to observe the preparation of lunch. Individual journey maps were created, one for each woman, that were composited into a single journey map. We found that customer journey mapping was a suitable research method to understand how food preparers made decisions around adding salt and artificial seasonings at each stage of the journey. In contrast to the interviewee’ responses, it was observed that the four women added salt and artificial seasonings consistently and incrementally with little control and without any standard measure. In this study, we demonstrate the utility of customer journey mapping in a novel context and nudge social marketers to include this tool in their repertory of research methods to understand human behavior.
Collapse
Affiliation(s)
- Erik Cateriano-Arévalo
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru; (E.C.-A.); (L.S.-G.); (J.J.M.)
| | - Lorena Saavedra-Garcia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru; (E.C.-A.); (L.S.-G.); (J.J.M.)
| | - Vilarmina Ponce-Lucero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru; (E.C.-A.); (L.S.-G.); (J.J.M.)
- Correspondence: ; Tel.: +511-241-69-78
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru; (E.C.-A.); (L.S.-G.); (J.J.M.)
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| |
Collapse
|
3
|
Yin X, Tian M, Sun L, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Chu H, Pearson SA, Neal B, Liu H. Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients 2021; 13:nu13093225. [PMID: 34579109 PMCID: PMC8471368 DOI: 10.3390/nu13093225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
- School of Public Health, Harbin Medical University, Harbin 150081, China
- Correspondence: ; Tel.: +86-(0)451-8750-2881
| | - Lingli Sun
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Mark D. Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - J. Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, 75236 Uppsala, Sweden
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Laura K. Cobb
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY 10005, USA;
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China;
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW 2050, Australia
| |
Collapse
|
4
|
Jachimowicz K, Winiarska-Mieczan A, Baranowska-Wójcik E, Bąkowski M. Pasta as a Source of Minerals in the Diets of Poles; Effect of Culinary Processing of Pasta on the Content of Minerals. Foods 2021; 10:foods10092131. [PMID: 34574240 PMCID: PMC8467960 DOI: 10.3390/foods10092131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Pasta is a product that requires culinary processing which can affect the content of minerals in the finished product. The study aimed to examine how cooking pasta (1) in salted water (1 teaspoon-16 g of salt per 1 litre of water) or unsalted water and (2) rinsing cooked pasta with running water affects the content of minerals. Thirty-five samples of six types of pasta were analysed. The content of minerals was determined using the ICP-OES method. Retention of minerals in the cooked pasta was calculated. Taking the culinary treatment into account, the intake of minerals with pasta was assessed for children, adolescents, and adults, and the values were compared with the recommendations for the population of Poland. The analysed culinary factors had a statistically significant influence on the content of minerals. Adding salt to water when cooking pasta significantly increased the content of Na in the product, which in turn was negatively correlated with the content of other minerals. When pasta was cooked in unsalted water, it contained less Na and more other minerals than pasta cooked in salted water. Rinsing of pasta reduced the content of all minerals. Pasta is an important source of Mg, Cu, and Mn in the diet of Poles. These ingredients are particularly important to ensure correct development and functioning of the human body. The best method of culinary treatment of pasta is cooking in unsalted water without rinsing.
Collapse
Affiliation(s)
- Karolina Jachimowicz
- Department of Bromatology and Food Physiology, University of Life Sciences in Lublin, Akademicka St. 13, 20-950 Lublin, Poland;
- Correspondence:
| | - Anna Winiarska-Mieczan
- Department of Bromatology and Food Physiology, University of Life Sciences in Lublin, Akademicka St. 13, 20-950 Lublin, Poland;
| | - Ewa Baranowska-Wójcik
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Sciences in Lublin, Skromna St. 8, 20-704 Lublin, Poland;
| | - Maciej Bąkowski
- Institute of Animal Nutrition and Bromatology, University of Life Sciences in Lublin, Akademicka St. 13, 20-950 Lublin, Poland;
| |
Collapse
|
5
|
Yin X, Liu H, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Li KC, Pearson SA, Neal B, Tian M. Availability, Formulation, Labeling, and Price of Low-sodium Salt Worldwide: Environmental Scan. JMIR Public Health Surveill 2021; 7:e27423. [PMID: 33985938 PMCID: PMC8319774 DOI: 10.2196/27423] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/19/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Regular salt is about 100% sodium chloride. Low-sodium salts have reduced sodium chloride content, most commonly through substitution with potassium chloride. Low-sodium salts have a potential role in reducing the population's sodium intake levels and blood pressure, but their availability in the global market is unknown. Objective The aim of this study is to assess the availability, formulation, labeling, and price of low-sodium salts currently available to consumers worldwide. Methods Low-sodium salts were identified through a systematic literature review, Google search, online shopping site searches, and inquiry of key informants. The keywords “salt substitute,” “low-sodium salt,” “potassium salt,” “mineral salt,” and “sodium reduced salt” in six official languages of the United Nations were used for the search. Information about the brand, formula, labeling, and price was extracted and analyzed. Results A total of 87 low-sodium salts were available in 47 out of 195 (24%) countries worldwide, including 28 high-income countries, 13 upper-middle-income countries, and 6 lower-middle-income countries. The proportion of sodium chloride varied from 0% (sodium-free) to 88% (as percent of weight; regular salt is 100% sodium chloride). Potassium chloride was the most frequent component with levels ranging from 0% to 100% (potassium chloride salt). A total of 43 (49%) low-sodium salts had labels with the potential health risks, and 33 (38%) had labels with the potential health benefits. The median price of low-sodium salts in high-income, upper-middle-income, and lower-middle-income countries was US $15.00/kg (IQR 6.4-22.5), US $2.70/kg (IQR 1.7-5.5), and US $2.90/kg (IQR 0.50-22.2), respectively. The price of low-sodium salts was between 1.1 and 14.6 times that of regular salts. Conclusions Low-sodium salts are not widely available and are commonly more expensive than regular salts. Policies that promote the availability, affordability, and labeling of low-sodium salts should increase uptake, helping populations reduce blood pressure and prevent cardiovascular diseases. International Registered Report Identifier (IRRID) RR2-10.1111/jch.14054
Collapse
Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | - J Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura K Cobb
- Resolve to Save Lives, Initiative of Vital Strategies, New York City, NY, United States
| | - Ka Chun Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,School of Public Health, Imperial College London, London, United Kingdom
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| |
Collapse
|
6
|
Blanco-Metzler A, Núñez-Rivas H, Vega-Solano J, Montero-Campos MA, Benavides-Aguilar K, Cubillo-Rodríguez N. Household Cooking and Eating out: Food Practices and Perceptions of Salt/Sodium Consumption in Costa Rica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031208. [PMID: 33572878 PMCID: PMC7908278 DOI: 10.3390/ijerph18031208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 01/01/2023]
Abstract
This research aims to study the food practices and perceptions related to excessive consumption of salt/sodium when cooking and eating outside the home in a study population representing the wide intergenerational and sociocultural diversity of Costa Rica. Key communities from around the country, cultural experts, and key informants were selected. Four qualitative research techniques were applied. Data was systematized based on the Social Ecological Model. Women are generally in charge of cooking and family food purchases. Salt is perceived as a basic ingredient, used in small amounts that can be reduced-but not eliminated-when cooking. Changes in food preparations and emotions associated with the consumption of homemade food with salt were identified. The population likes to eat out, where the establishments selected depend mainly on age group and income. Beyond cultural and geographical differences, age aspects are suggested as being the main differentiators, in terms of use of salt, seasonings, and condiments in the preparation of food at home, the recipes prepared, and the selection of establishments in which to eat out. The deeply rooted values and meanings associated with salt in food indicate that the implementation of salt reduction strategies in Costa Rica is challenging.
Collapse
Affiliation(s)
- Adriana Blanco-Metzler
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos 4-2250, Costa Rica; (H.N.-R.); (J.V.-S.); (M.A.M.-C.); (K.B.-A.)
- Correspondence: ; Tel.: +506-22799911
| | - Hilda Núñez-Rivas
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos 4-2250, Costa Rica; (H.N.-R.); (J.V.-S.); (M.A.M.-C.); (K.B.-A.)
| | - Jaritza Vega-Solano
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos 4-2250, Costa Rica; (H.N.-R.); (J.V.-S.); (M.A.M.-C.); (K.B.-A.)
| | - María A. Montero-Campos
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos 4-2250, Costa Rica; (H.N.-R.); (J.V.-S.); (M.A.M.-C.); (K.B.-A.)
| | - Karla Benavides-Aguilar
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos 4-2250, Costa Rica; (H.N.-R.); (J.V.-S.); (M.A.M.-C.); (K.B.-A.)
| | - Nazareth Cubillo-Rodríguez
- Project Consultant, International Development Research Centre (IDRC), Llorente de Tibas 11303, Costa Rica;
| |
Collapse
|
7
|
Layeghiasl M, Malekzadeh J, Shams M, Maleki M. Using Social Marketing to Reduce Salt Intake in Iran. Front Public Health 2020; 8:207. [PMID: 32582611 PMCID: PMC7289950 DOI: 10.3389/fpubh.2020.00207] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/05/2020] [Indexed: 01/21/2023] Open
Abstract
Objectives: WHO has recommended that the average salt intake must be <5 grams per day. However, people consume salt much more in many countries. In this study, we design and implement an intervention based on social marketing model to reduce salt consumption in Yasuj, Iran. Materials and Methods: This study employed a quasi-experimental pretest-posttest with control group design which consisted of a formative research (qualitative-quantitative) and an interventional phase. To collect the qualitative data, six focus group discussions by participating of 66 people were established. The qualitative data were analyzed manually using directed content analysis. In quantitative study, 166 people aged 25-50 years completed a KAP questionnaire, and their average salt intake was determined through measuring sodium in their urine sample. By analyzing the data, marketing mix components were determined for designing an intervention. An educational package (including posters for installing in the kitchen, pamphlets, phone counseling, four educational classes, and brief interventions done by physicians and other health personnel) focused on reducing salt intake and using alternatives was developed. For one month, program was implemented for intervention group. Two months later, KAP survey and measuring the urine sodium were repeated for intervention and control groups. The data was compared for two groups, before and after the intervention by using independent t-test, paired t-tests and repeated measures ANOVA. Results: The qualitative findings showed that most participants agreed that the salt intake was high in Iran. Most of them recommended home-based and family-driven strategies to reduce salt intake, offered using healthier alternatives for salt, and recognized physicians and health care providers in healthcare facilities as the most important to encourage people to reduce salt intake. After the intervention, the mean and standard deviation of KAP were improved significantly in intervention group. The mean salt intake decreased significantly by 3.01 ± 2.38 in the intervention group and repeated measures ANOVA showed significant change over time (P < 0.001) and a significant difference between two groups (P = 0.04). Also, the interaction between time and group was significant (P = 0.001). Conclusion: The mean salt intake among the study population was approximately three times more than the level recommended by the WHO. The social marketing-based intervention succeeded in reducing the salt intake of the study subjects by ~3 grams on average.
Collapse
Affiliation(s)
- Mehdi Layeghiasl
- Department of Health Education and Promotion, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janmohamad Malekzadeh
- Department of Nutrition, Yasuj University of Medical Sciences, Yasuj, Iran.,Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohsen Shams
- Department of Health Education and Promotion, School of Health, Yasuj University of Medical Sciences, Yasuj, Iran.,Iranian Social Marketing Association, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mostafa Maleki
- Iranian Social Marketing Association, Yasuj University of Medical Sciences, Yasuj, Iran.,Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|