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Strazzullo P, Cairella G, D'Elia L, Scognamiglio U, Simonetti P. Time to define food salt targets in Italy starting with cereal-based products: A safe and practical way to reduce the heavy burden of cardiovascular disease. Nutr Metab Cardiovasc Dis 2024; 34:294-298. [PMID: 38242832 DOI: 10.1016/j.numecd.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND AND AIMS Excess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached. METHODS AND RESULTS In Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008-12 and 2018-19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt. Two recent studies conducted by the Italian Society of Human Nutrition "Young Working Group" have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO. CONCLUSIONS Italy has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers.
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Affiliation(s)
- Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy.
| | - Giulia Cairella
- Department of Prevention, Unit Local Health Roma 2, Rome, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Umberto Scognamiglio
- CREA-Council for Agricultural Research and Economics, Research Centre for Food and Nutrition, Rome, Italy
| | - Paolo Simonetti
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
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2
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D’Elia L, Strazzullo P. Dietary Salt Restriction and Adherence to the Mediterranean Diet: A Single Way to Reduce Cardiovascular Risk? J Clin Med 2024; 13:486. [PMID: 38256620 PMCID: PMC10816989 DOI: 10.3390/jcm13020486] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
The dietary restriction of salt intake and the adhesion to Mediterranean dietary patterns are among the most recommended lifestyle modifications for the prevention of cardiovascular diseases. A large amount of evidence supports these recommendations; indeed, several studies show that a higher adherence to Mediterranean dietary patterns is associated with a reduced risk of cardiovascular disease. Likewise, findings from observational and clinical studies suggest a causal role of excess salt intake in blood pressure increase, cardiovascular organ damage, and the incidence of cardiovascular diseases. In this context, it is also conceivable that the beneficial effects of these two dietary patterns overlap because Mediterranean dietary patterns are typically characterized by a large consumption of plant-based foods with low sodium content. However, there is little data on this issue, and heterogeneous results are available on the relationship between adherence to salt restriction and to Mediterranean dietary patterns. Thus, this short review focuses on the epidemiological and clinical evidence of the relationship between the adherence to Mediterranean dietary patterns and dietary salt restriction in the context of cardiovascular risk.
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Affiliation(s)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples Medical School, 80131 Naples, Italy;
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3
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Maximova K, Loyola Elizondo E, Rippin H, Breda J, Cappuccio FP, Hajihosseini M, Wickramasinghe K, Novik I, Pisaryk V, Sturua L, Akmatova A, Obreja G, Mustafo SA, Ekinci B, Erguder T, Shukurov S, Hagverdiyev G, Andreasyan D, Ferreira-Borges C, Berdzuli N, Whiting S, Fedkina N, Rakovac I. Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice: insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries. Public Health Nutr 2023; 26:s20-s31. [PMID: 36779266 PMCID: PMC10801379 DOI: 10.1017/s1368980023000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/28/2022] [Accepted: 02/03/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician's advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. DESIGN Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. SETTINGS Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). PARTICIPANTS Nationally representative samples of 30 455 adults aged 25-65 years. RESULTS HBP awareness, treatment and control varied substantially by education. The coverage of physician's advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician's advice on salt reduction. CONCLUSIONS There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries.
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Affiliation(s)
- Katerina Maximova
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ONM5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Enrique Loyola Elizondo
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - João Breda
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Francesco P Cappuccio
- WHO Collaborating Centre for Nutrition, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Irina Novik
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RSPC MT), Minsk, Belarus
| | - Vital Pisaryk
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health (RSPC MT), Minsk, Belarus
| | - Lela Sturua
- National Center for Disease Control and Public Health (NCDC) of Georgia, Tbilisi, Georgia
| | - Ainura Akmatova
- Department of Public Health, Ministry of Health, Bishkek, Kyrgyzstan
| | - Galina Obreja
- Department of Social Medicine and Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Saodat Azimzoda Mustafo
- State Research Institute of Gastroenterology, Ministry of Health and Social Protection of Population, Dushanbe, Republic of Tajikistan
| | - Banu Ekinci
- Department of Chronic Disease and Elderly Health, General Directorate of Public Health of Ministry of Health of Turkey, Ankara, Turkey
| | | | - Shukhrat Shukurov
- Central Project Implementation Bureau of the Health-3 Project, Tashkent, Uzbekistan
| | | | - Diana Andreasyan
- National Institute of Health, Ministry of Health, Yerevan, Armenia
| | - Carina Ferreira-Borges
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Nino Berdzuli
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Stephen Whiting
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Natalia Fedkina
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
| | - Ivo Rakovac
- World Health Organization European Office for the Prevention and Control of Non-Communicable Diseases (NCD Office), Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russia
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He Q, Zheng Q, Liu Y, Miao Y, Zhang Y, Xu T, Bai S, Zhao X, Yang X, Xu Z. High-Salt Diet Causes Defective Oocyte Maturation and Embryonic Development to Impair Female Fertility in Mice. Mol Nutr Food Res 2023; 67:e2300401. [PMID: 37863820 DOI: 10.1002/mnfr.202300401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Indexed: 10/22/2023]
Abstract
SCOPE High salinity has been reported to induce many human disorders in tissues and organs to interfere with their normal physiological functions. However, it is unknown how salinity affects the development of female germ cells. This study suggests that a high-salt diet (HSD) may weaken oocyte quality to impair female fertility in mice and investigates the underlying mechanisms. METHODS AND RESULTS C57BL/6 female mice are fed with a regular diet (Control) or a high-salt diet (HSD). Oocyte maturation, fertilization rate, embryonic development, and female fertility are evaluated. In addition, the spindle organization, actin polymerization, and kinetochore-microtubule attachment of oocytes are examined in both groups. Moreover, single-cell transcriptome data are used to demonstrate how HSD alters the transcript levels of genes. The observations confirm that HSD leads to female subfertility due to the deterioration of oocyte and embryo quality. The mechanism underlying reveals HSD compromises the oocytes' autophagy, apoptosis level, and mitochondrial function. CONCLUSION The work illustrates that a high concentration of salt diet results in oocyte meiotic arrest, fertilization failure, and early developmental defection that embryos undergo to reduce female fertility in mice by perturbing the level of autophagy and apoptosis, mitochondrial function in oocytes.
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Affiliation(s)
- Qinyuan He
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Department of Obstetrics and Gynecology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210003, China
| | - Qiutong Zheng
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Maternal and Child Health Care Hospital of Wuxi, Wuxi, Jiangsu, 214002, China
| | - Yanping Liu
- Center of Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, 215006, China
| | - Yilong Miao
- College of Animal Science and Technology, Nanjing Agricultural University, Nanjing, Jiangsu, 210095, China
| | - Yumeng Zhang
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Ting Xu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Shufen Bai
- Department of Obstetrics and Gynecology, Nanjing Pukou District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, 210000, China
| | - Xia Zhao
- Department of Reproductive Medicine, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, 210009, China
| | - Xiaojun Yang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Zhice Xu
- Institute for Fetology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Maternal and Child Health Care Hospital of Wuxi, Wuxi, Jiangsu, 214002, China
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Heller B, Reiter FP, Leicht HB, Fiessler C, Bergheim I, Heuschmann PU, Geier A, Rau M. Salt-Intake-Related Behavior Varies between Sexes and Is Strongly Associated with Daily Salt Consumption in Obese Patients at High Risk for MASLD. Nutrients 2023; 15:3942. [PMID: 37764734 PMCID: PMC10534674 DOI: 10.3390/nu15183942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes a significant burden on Westernized regions. The Western diet, high in salt intake, significantly contributes to disease development. However, there are a lack of data on salt literacy and salt intake among MASLD patients in Germany. Our study aims to analyze daily salt intake and salt-intake-related behavior in MASLD patients. METHODS 234 MASLD patients were prospectively included. Daily salt intake and salt-intake-related behavior were assessed via a food frequency questionnaire (FFQ-DEGS) and a salt questionnaire (SINU). Statistical analyses were performed using SPSS. RESULTS Mean daily salt intake was higher in men than in women (7.3 ± 5 g/d vs. 5.3 ± 4 g/d; p < 0.001). There was significant agreement between increased daily salt intake (>6 g/d) and the behavioral salt index (SI) (p < 0.001). Men exhibited higher SI scores compared to women, indicating lower awareness of salt in everyday life. Multivariate analysis identified specific salt-intake-related behaviors impacting daily salt consumption. CONCLUSIONS Our study reveals a strong link between daily salt intake and salt-intake-related behavior, highlighting sex-specific differences in an MASLD cohort. To enhance patient care in high-cardiovascular-risk populations, specific behavioral approaches may be considered, including salt awareness, to improve adherence to lifestyle changes, particularly in male patients.
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Affiliation(s)
- Bianca Heller
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Florian P. Reiter
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Hans Benno Leicht
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | - Ina Bergheim
- Department of Nutritional Sciences, Molecular Nutritional Science, University of Vienna, 1040 Vienna, Austria
| | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, Julius-Maximilians-University of Würzburg, 97080 Würzburg, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Monika Rau
- Division of Hepatology, Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
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Sugimoto M, Tajiri E, Nakashima N, Sakamoto T. Effects of Using a Perforated Spoon on Salt Reduction When Consuming Ramen Noodles: A Randomized Crossover Study of Japanese Male University Students. Nutrients 2023; 15:2864. [PMID: 37447190 DOI: 10.3390/nu15132864] [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: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Salt reduction is a public health priority for the Japanese population. We focused on the effect of salt reduction by changing eating utensils to reduce salt consumption. As a test meal, we used ramen, which is commonly eaten by Japanese individuals and has a high salt content. In this randomized crossover study, we hypothesized that eating ramen with a perforated spoon would reduce the quantity of ramen soup and salt consumed compared to using a regular spoon without holes. Soup intake, after-meal fullness, and deliciousness were compared between eating with chopsticks and a regular spoon, and with chopsticks and a perforated spoon. In total, 36 male university students (mean age, 20.7 [standard deviation, 1.8] years) were included in the analyses. The median salt intake (25th and 75th percentiles) was significantly lower with perforated spoons (1.8 [1.5, 4.3] g) than with regular spoons (2.4 [1.8, 4.8] g; p = 0.019). There were no significant differences in after-meal fullness or deliciousness for both spoon conditions (p > 0.05). For young men, the soup intake when eating ramen with a perforated spoon was lower than that with a regular spoon; this suggests a reduction in salt intake.
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Affiliation(s)
- Maiko Sugimoto
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
- Public Health and Disease Prevention Division, Ariake Public Health Center, Kumamoto Prefectural Government, 1004-1, Iwasaki, Tamana, Kumamoto 865-0016, Japan
| | - Eri Tajiri
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
| | - Nana Nakashima
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
| | - Tatsuaki Sakamoto
- Graduate School of Environmental & Symbiotic Sciences, Prefectural University of Kumamoto, 3-1-100, Tsukide, Higashi-ku, Kumamoto 862-8502, Japan
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Spiteri G, Monaco MGL, Carta A, Torroni L, Taus F, Verlato G, Porru S. Reduction of Excessive Dietary Sodium Consumption: Effectiveness of a Prevention Intervention among Health Workers in a Large Italian Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085478. [PMID: 37107760 PMCID: PMC10138373 DOI: 10.3390/ijerph20085478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
Excessive salt consumption is one of the leading causes of high blood pressure. Worldwide salt intake largely exceeds the WHO recommended amount. This study aimed to evaluate the prevalence of high salt consumers and the effectiveness of a short-term workplace educational intervention among health workers. An online survey, assessing daily salt consumption through the MINISAL-SIIA questionnaire, was sent to the 4911 health workers employed by the University Hospital of Verona, Italy. Health workers who had a high (total score ≥ 10) or moderate (total score = 8/9) salt consumption associated with obesity or arterial hypertension were invited to undergo a medical examination and a short individual counselling session. A total of 1665 health workers (34.0%) completed the online questionnaire; 40.9% and 12.6% had moderate and high salt intake, respectively. High salt intake was more prevalent in men, current and past smokers, and obese and overweight subjects. In 95 participants completing the clinical phase, median daily salt consumption decreased from 10 (p25-p75 8-11) to 7 g (6-8) (p < 0.001), systolic blood pressure from 130 (120-140) to 120 (120-130) mmHg and weight from 78 (62-87) to 75 (62-86) kg. More than half of health workers had an excessive salt intake. However, a brief educational intervention in the healthcare working setting can substantially reduce unhealthy dietary habits, fostering weight loss and blood pressure control. Studies with a longer follow-up are needed to evaluate the persistence over time of these effects.
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Affiliation(s)
- Gianluca Spiteri
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
| | - Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Correspondence: ; Tel.: +39-045-812-3946
| | - Angela Carta
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Lorena Torroni
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Francesco Taus
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Giuseppe Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Stefano Porru
- Occupational Medicine Unit, University Hospital of Verona, 37134 Verona, Italy
- Section of Occupational Health, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
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Jiménez Rodríguez A, Palomo Cobos L, Rodríguez Martín A, Fernández del Valle P, Novalbos-Ruiz JP. [Correlations between dietary salt intake and 24-h urine sodium excretion in a sample of the urban population of Cáceres]. Aten Primaria 2023; 55:102513. [PMID: 36401891 PMCID: PMC9676135 DOI: 10.1016/j.aprim.2022.102513] [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: 07/07/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Excessive salt intake is associated with higher levels of AHT and prevalence of cardiovascular diseases. WHO recommends consuming less than 5 g/day of salt (equivalent to 2 g Na+/day). Identifying foods and behaviours with greater contribution to excess intake would facilitate preventive dietary advice. DESIGN Observational study. SITE: Urban Health Center in Cáceres. MAIN MEASUREMENTS We estimated salt consumption using two food consumption frequency (FFQ) questionnaires, one generic and one with high Na+ content, and a 24 h follow-up survey. We use the Evalfinut program for nutritional evaluation of the diet. We analyzed correlations between estimated salt intake and 24-h urine sodium elimination (gold standard). RESULTS 92% of the population had consumption higher than the recommendations with intakes equivalent to 9.5 g/day of salt (3.7 g/d of Na+). When sodium intake is determined by the Na+/K+ ratio, 79.54% have high intakes. Sodium elimination follows a slightly increasing trend with BMI. The perception of salt consumption is low, 56.3% consider it "adequate". 32.4% add salt to food once served. FFQ underestimate Na+ intake and targeted surveys provide higher values. The correlation between FFQ and Na+ urinary elimination is weak. CONCLUSION We must reduce salt intake by increasing the perception of consumption, improving knowledge about the salt content in food and identifying target patients of the health council.
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Affiliation(s)
| | | | - Amelia Rodríguez Martín
- Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, España
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Manzano-Felipe MÁ, Cruz-Cobo C, Bernal-Jiménez MÁ, Santi-Cano MJ. Validation of the General and Sport Nutrition Knowledge Questionnaire (GeSNK) in Spanish Adolescents. Nutrients 2022; 14:nu14245324. [PMID: 36558482 PMCID: PMC9786199 DOI: 10.3390/nu14245324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The General and Sport Nutrition Knowledge Questionnaire (GeSNK) is an instrument that has been developed and validated to assess the level of nutrition knowledge in adolescents and young adults. The aim of the present study was to validate the GeSNK questionnaire in a group of Spanish adolescents in the framework of a Nutrition Education Programme in Secondary Schools in Andalusia, Spain. This cross-sectional questionnaire validation study was developed in two phases: translation-cultural adaptation and validation. A total of 305 adolescents aged 11 to 17 years, studying from the first to the third year of compulsory secondary education, participated on a voluntary basis. The GeSNK questionnaire consists of 62 items: 29 items for the General Nutrition section and 33 items for the Sports Nutrition section. Cronbach's alpha coefficient for the complete questionnaire (GeSNK Total) was: 0.934; for the GeSNK General Nutrition section it was 0.918; and for the GeSNK Sports Nutrition section it was 0.856. The stability measured by the correlation coefficient for the General Nutrition section was 0.406 (p = 0.000); for the Sports Nutrition section it was 0.198 (p = 0.017); and for GeSNK Total the stability was 0.545 (p = 0.000). The questionnaire also demonstrated adequate construct validity. We therefore conclude that the Spanish version of the GeSNK questionnaire is a valid instrument to measure the level of knowledge in general nutrition and sports nutrition in adolescents.
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Affiliation(s)
- María Ángeles Manzano-Felipe
- Primary Health Care District of Bay of Cádiz-La Janda, 11006 Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain
| | - Celia Cruz-Cobo
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
| | - María Ángeles Bernal-Jiménez
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
| | - María José Santi-Cano
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, 11009 Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), 11009 Cádiz, Spain
- Faculty of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-956-019042; Fax: +34-956-015685
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10
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Arab A, Zabibah RS, Alshahrani SH, Karimi E, Askari G, Khorvash F. Is there a relationship between 24-hour urinary sodium and potassium and mental health in migraine patients?: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31037. [PMID: 36281190 PMCID: PMC9592346 DOI: 10.1097/md.0000000000031037] [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] [Indexed: 11/06/2022] Open
Abstract
There is a lack of evidence and consensus in terms of the association between dietary intake of sodium (Na) and potassium (K) with mental health. By using 24-hours urinary samples as the gold standard method, we conducted a study to explore the association between dietary intake of Na and K with parameters of mental health including depression, anxiety, and stress among an Iranian population diagnosed with migraine. In the present study, 262 subjects (20-50 years old), with a confirmed diagnosis of migraine were enrolled. Mental health was investigated by the Depression, Anxiety, and Stress Scales (DASS-21) questionnaire. Dietary intake of Na and K was estimated by means of a 24-hour urine sample. Multinomial logistic regression analysis was implemented and odds ratio (OR) with 95% confidence interval (CI) was stated. After controlling for potential confounders, the 24-hour urinary Na was associated significantly with the risk of depression (OR = 0.55, 95% CI: 0.30, 1.00; P = .053). After adjustment for confounders, those in the highest tertile of the 24-hour urinary Na/K ratio had lower odds for having depression (OR = 0.54, 95% CI: 0.31, 0.93; P = .027), and marginally significantly lower risk of anxiety (OR = 0.58, 95% CI: 0.31, 1.06; P = .079) and stress (OR = 0.56, 95% CI: 0.31, 1.02; P = .061). In conclusion, higher 24-hour urine Na was associated with a significantly lower risk of depression. Moreover, the 24-hour Na/K ratio was significantly associated with lower risk of depression, anxiety, and stress.
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Affiliation(s)
- Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rahman S. Zabibah
- Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | | | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Han B, Li C, Zhou Y, Zhang M, Zhao Y, Zhao T, Hu D, Sun L. Association of Salt-Reduction Knowledge and Behaviors and Salt Intake in Chinese Population. Front Public Health 2022; 10:872299. [PMID: 35509508 PMCID: PMC9058069 DOI: 10.3389/fpubh.2022.872299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Excessive salt intake is causally associated with an increased risk of cardiovascular disease. Salt-reduction strategies have been rapidly deployed across China since 2017. This study aimed to investigate the association of salt-reduction knowledge and behaviors and salt intake in Chinese population. Study Design This study was a national cross-sectional study in China. Methods This cross-sectional study was based on data collected during a Chinese adult chronic disease and nutrition surveillance program in 2018 with 7,665 study participants. Salt intake was assessed by calculating 24 h urine sodium from morning urine samples. Logistic regression and mean impact value (MIV) based on the back propagation (BP) artificial neural network were used to screen the potential influencing factors. Results A total of 7,665 participants were included in the analysis, with an average age of 54.64 ± 13.26 years, and with men accounting for 42.6%. Only 19.3% of the participants were aware of the Chinese Dietary Guidelines, and only 7.3% of them could accurately identify the level of salt intake recommended in the Chinese Dietary Guidelines. Approximately 41% of the participants adopted salt-reduction behaviors, among whom the number of participants who used less salt when cooking was the highest, and the number of participants who used low sodium salt was the lowest. In the logistic regression, only "No extra salt was added at the table" group showed the effect of salt-reduction, the odds ratio (OR) being 0.78 (95% confidence interval [CI]: 0.64-0.95). The MIV result based on the BP neural network showed that the most important salt-reduction behavior was using less salt when cooking, while reducing eating-out behavior and using salt-limiting tools were the least important. Conclusion The research shows that the popularization of salt-reduction knowledge and behaviors can reduce the population's salt intake. However, there is still considerable scope for promoting salt-reduction knowledge and behaviors, while the promotion of salt-reduction tools and low-sodium salt still needs to be strengthened.
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Affiliation(s)
- Bing Han
- Section of Chronic and Noncommunicable Diseases Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Chuancang Li
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yabing Zhou
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mengge Zhang
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ting Zhao
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Liang Sun
- Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou, China
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12
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Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults. Nutrients 2021; 14:nu14010061. [PMID: 35010935 PMCID: PMC8747036 DOI: 10.3390/nu14010061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03–3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.
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13
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Sonuch P, Kantachuvesiri S, Vathesatogkit P, Lappichetpaiboon R, Chailimpamontri W, Thokanit NS, Aekplakorn W. Estimation of sodium consumption by novel formulas derived from random spot and 12-hour urine collection. PLoS One 2021; 16:e0260408. [PMID: 34855776 PMCID: PMC8639059 DOI: 10.1371/journal.pone.0260408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
The gold standard for estimating sodium intake is 24h urine sodium excretion. Several equations have been used to estimate 24h urine sodium excretion, however, a validated formula for calculating 24h urine sodium excretion from 12h urine collection has not yet been established. This study aims to develop novel equations for estimating 24h urine sodium excretion from 12h and random spot urine collection and also to validate existing spot urine equations in the Thai population. A cross-sectional survey was carried out among 209 adult hospital personnel. Participants were asked to perform a 12h daytime, 12h nighttime, and a random spot urine collection over a period of 24 hours. The mean 24h urine sodium excretion was 4,055±1,712 mg/day. Estimated urine sodium excretion from 3 different equations using random spot urine collection showed moderate correlation and agreement with actual 24h urine sodium excretion (r = 0.54, P<0.001, ICC = 0.53 for Kawasaki; r = 0.57, P<0.001, ICC = 0.44 for Tanaka; r = 0.60, P<0.001, ICC = 0.45 for INTERSALT). Novel equations for predicting 24h urine sodium excretion were then developed using variables derived from 12h daytime urine collection, 12h nighttime urine collection, random spot urine collection, 12h daytime with random spot urine collection, and 12h nighttime with random spot urine collection which showed strong correlation and agreement with actual measured values (r = 0.88, P<0.001, ICC = 0.87; r = 0.83, P<0.001, ICC = 0.81; r = 0.67, P<0.001, ICC = 0.62; r = 0.90, P<0.001, ICC = 0.90; and r = 0.83, p<0.001, ICC = 0.82 respectively). Bland-Altman plots indicated good agreement between predicted values and actual 24h urine sodium excretion using the new equations. Newly derived equations from 12h daytime and 12h nighttime urine collection with or without casual spot urine collection were able to accurately predict 24h urine sodium excretion.
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Affiliation(s)
- Pitchaporn Sonuch
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Kantachuvesiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Thai Lowsalt Network, The Nephrology Society of Thailand, Bangkok, Thailand
| | - Prin Vathesatogkit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Nintita Sripaiboonkij Thokanit
- Ramathibodi Comprehensive Cancer Center, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Iacone R, Iaccarino Idelson P, Russo O, Donfrancesco C, Krogh V, Sieri S, Macchia PE, Formisano P, Lo Noce C, Palmieri L, Galeone D, Rendina D, Galletti F, Di Lenarda A, Giampaoli S, Strazzullo P. Iodine Intake from Food and Iodized Salt as Related to Dietary Salt Consumption in the Italian Adult General Population. Nutrients 2021; 13:3486. [PMID: 34684487 PMCID: PMC8537510 DOI: 10.3390/nu13103486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022] Open
Abstract
Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25-79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008-2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008-2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.
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Affiliation(s)
- Roberto Iacone
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Paola Iaccarino Idelson
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (V.K.); (S.S.)
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (V.K.); (S.S.)
| | - Paolo Emidio Macchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Pietro Formisano
- Department of Translational Medical Science, Federico II University of Naples Medical School, 80131 Naples, Italy;
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Daniela Galeone
- Italian Ministry of Health, Center for Disease Prevention and Control, 00161 Rome, Italy;
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
| | - Andrea Di Lenarda
- ANMCO, Italian Association of Hospital Cardiology, 50121 Florence, Italy;
- Cardiovascular Center, University Hospital and Health Services, 34122 Trieste, Italy
| | - Simona Giampaoli
- Former Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (D.R.); (F.G.); (P.S.)
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15
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Malavolti M, Naska A, Fairweather-Tait SJ, Malagoli C, Vescovi L, Marchesi C, Vinceti M, Filippini T. Sodium and Potassium Content of Foods Consumed in an Italian Population and the Impact of Adherence to a Mediterranean Diet on Their Intake. Nutrients 2021; 13:2681. [PMID: 34444841 PMCID: PMC8401684 DOI: 10.3390/nu13082681] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Marcella Malavolti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy; (M.M.); (C.M.); (L.V.); (T.F.)
| | - Androniki Naska
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece;
| | - Susan J. Fairweather-Tait
- Norwich Medical School, University of East Anglia, Norwich Research Park, James Watson Road, Norwich NR4 7UQ, UK;
| | - Carlotta Malagoli
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy; (M.M.); (C.M.); (L.V.); (T.F.)
| | - Luciano Vescovi
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy; (M.M.); (C.M.); (L.V.); (T.F.)
| | - Cristina Marchesi
- Head Office, Direzione Generale, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy; (M.M.); (C.M.); (L.V.); (T.F.)
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy; (M.M.); (C.M.); (L.V.); (T.F.)
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16
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Yang Y, Wang J, Ma J, Shi W, Wu J. Comparison of Salt-Related Knowledge and Behaviors Status of WeChat Users between 2019 and 2020. Nutrients 2021; 13:2141. [PMID: 34206633 PMCID: PMC8308297 DOI: 10.3390/nu13072141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022] Open
Abstract
In order to identify the status of salt-related knowledge and behavior of the residents who were active in WeChat software between 2019 and 2020, 10-day salt-related surveys were conducted in 2019 and 2020 based on the WeChat public platform of China Healthy Lifestyle for All Campaign. Distribution and scores of salt-related knowledge, salt reduction behavior and high-salt intake behavior between 2019 and 2020 were compared. Data of 2109 participants in 2019 and 12,732 participants in 2020 were left for analysis. Overall, 88.2% of participants in 2019 had a willingness to reduce the amount of cooking salt in their households, significantly lower than 90.2% in 2020 (p-value < 0.05). In 2019 and 2020, over 80% of the participants knew fine dried noodles contain salt, but less than 30% knew ice cream contains salt. Over 78% of participants chose 5 g or 6 g for the maximum daily salt intake of healthy adults, and about 98% of participants knew that excessive salt intake would increase the risk of hypertension in both years. The percentage of participants who used salt measuring spoons asked restaurants to use less salt, read the sodium content on the nutrition facts table, chose foods with low sodium content and regularly used low-sodium salt, were 36.1%, 45.0%, 44.1%, 40.3% and 35.8% in 2019, and the percentage increased significantly to 46.4%, 49.2%, 50.8%, 47.1% and 43.4% in 2020 (all p-value < 0.05). The percentage of people regularly eating pickled mustard tubers, salted vegetables and sauce foods or using high-salt condiments also increased from 2019 to 2020. The median of salt-related knowledge scores, salt reduction behavior scores and high-salt intake behavior scores were 11, 2, 5 points in 2019, and 10, 3, 5 points in 2020, respectively. Compared to 2019, the salt-related knowledge score was relatively lower, while the salt reduction behavior score and high-salt intake behavior score were relatively higher in 2020. Besides, the score of salt-related knowledge and behaviors differed in different gender, age and hypertension groups. The COVID-19 epidemic may have influenced the salt-related knowledge and behaviors status of WeChat users in China. Promotion and education of salt-related knowledge and online behavior intervention are still needed, particularly for male and hypertension patients in the future.
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Affiliation(s)
- Yibing Yang
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jinglei Wang
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jixiang Ma
- Shandong Center for Disease Control and Prevention, Jinan 250014, China;
| | - Wenhui Shi
- Office of Non-Communicable Disease and Aging Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (Y.Y.); (J.W.)
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
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17
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Role of dietary sodium/potassium ratio in the blood pressure rise with age: novel evidence from the Coronary Artery Risk Development in Young Adults study. J Hypertens 2021; 39:1549-1551. [PMID: 34155158 DOI: 10.1097/hjh.0000000000002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Iacone R, Iaccarino Idelson P, Formisano P, Russo O, Lo Noce C, Donfrancesco C, Macchia PE, Palmieri L, Galeone D, di Lenarda A, Giampaoli S, Strazzullo P. Iodine Intake Estimated by 24 h Urine Collection in the Italian Adult Population: 2008-2012 Survey. Nutrients 2021; 13:1529. [PMID: 34062834 PMCID: PMC8147380 DOI: 10.3390/nu13051529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/16/2022] Open
Abstract
Monitoring the population iodine status is essential for iodine deficiency eradication. This study assessed the average dietary iodine intake and the iodine status of a random sample of the Italian general adult population. The study population included 2378 adults aged 35-79 years (1229 men and 1149 women) from all 20 Italian regions, participating in the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008-2012 (OEC/HES), and were examined for iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary iodine intake was assessed by the measurement of 24 h urinary iodine excretion. The median daily iodine intake of the whole population was lower (96 µg/d, interquartile range 51-165) than the daily adequate iodine intake according to both EFSA and WHO recommendation (150 µg/d), with a significantly lower value among women (85 µg/d) compared with men (111 µg/d). Iodine intake diminished with age and increased with BMI (body mass index) in male but not in female participants, without achieving the adequate intake in any sex, age, or BMI category. In this random sample of Italian general adult population examined in 2008-2012, iodine intake still remained lower than the recommended values despite the implementation of a strategy of iodoprophylaxis based on salt iodization in 2005. These data represent a valuable reference for future monitoring of iodine status in our country.
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Affiliation(s)
- Roberto Iacone
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (P.S.)
| | - Paola Iaccarino Idelson
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (P.S.)
| | - Pietro Formisano
- Department of Translational Medical Science, Federico II University of Naples Medical School, 80131 Naples, Italy;
| | - Ornella Russo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (P.S.)
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.L.N.); (C.D.); (L.P.); (S.G.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.L.N.); (C.D.); (L.P.); (S.G.)
| | - Paolo Emidio Macchia
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (P.S.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.L.N.); (C.D.); (L.P.); (S.G.)
| | - Daniela Galeone
- Center for Disease Prevention and Control, Italian Ministry of Health, 00161 Rome, Italy;
| | - Andrea di Lenarda
- ANMCO, Italian Association of Hospital Cardiology, 50121 Florence, Italy;
- S.C. Cardiovascolare e Medicina dello Sport, Ospedale Maggiore di Trieste, 34122 Trieste, Italy
| | - Simona Giampaoli
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.L.N.); (C.D.); (L.P.); (S.G.)
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, 80131 Naples, Italy; (O.R.); (P.E.M.); (P.S.)
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Fanelli E, Ravetto Enri L, Pappaccogli M, Fasano C, Di Monaco S, Pignata I, Baratta F, Eula E, Masera G, Mana M, Rabbia F, Brusa P, Veglio F. Knowledge on arterial hypertension in general population: Results from a community pharmacy screening program. Nutr Metab Cardiovasc Dis 2021; 31:1081-1086. [PMID: 33618921 DOI: 10.1016/j.numecd.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/14/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUNDS AND AIMS Hypertension is a risk factor for renal, cardiovascular and cerebrovascular diseases. It is responsible for a large proportion of overall morbidity and mortality every year. Hypertension-mediated organ damage is largely not reversible. For these reasons, prevention has primary importance: sensibilization of population on hypertension-related consequences is essential for therapeutic adherence and reduction of unhealthy lifestyle behaviour. This study aimed to evaluate awareness about hypertension among community pharmacies customers. METHODS AND RESULTS A questionnaire about hypertension was collected by 2731 customers from 94 community pharmacies in North West Italy, during a hypertension screening program. Hypertension awareness was unsatisfactory in a large proportion of the sample, with only 15% of subjects having an overall good level of knowledge. Furthermore, lower awareness was associated to higher blood pressure values (132/79 ± 19/11 mmHg vs 128/78 ± 18/10 mmHg, p < 0.001) and subjects resulted hypertensive or uncontrolled despite antihypertensive therapy, presented worse questionnaire scores (4.7 ± 1.9 vs 4.9 ± 2.0, p = 0.03). CONCLUSION Knowledge about hypertension is largely unsatisfactory among population. Community pharmacies may play as a setting for health education and hypertension screening.
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Affiliation(s)
- Elvira Fanelli
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | | | - Marco Pappaccogli
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Chiara Fasano
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Silvia Di Monaco
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Irene Pignata
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Francesca Baratta
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Elisabetta Eula
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Masera
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Franco Rabbia
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Paola Brusa
- Department of Drug Science and Technology, University of Turin, Turin, Italy
| | - Franco Veglio
- Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
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20
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Razavi AC, Dyer A, Jones M, Sapin A, Caraballo G, Nace H, Dotson K, Razavi MA, Harlan TS. Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education. Nutrients 2020; 12:E3632. [PMID: 33255901 PMCID: PMC7761274 DOI: 10.3390/nu12123632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.
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Affiliation(s)
- Alexander C. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Amber Dyer
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Matthew Jones
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Alexander Sapin
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Graciela Caraballo
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Heather Nace
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Kerri Dotson
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
| | - Michael A. Razavi
- Goldring Center for Culinary Medicine, Tulane University School of Medicine, New Orleans, LA 70119, USA; (A.D.); (M.J.); (A.S.); (H.N.); (M.A.R.)
| | - Timothy S. Harlan
- George Washington University Culinary Medicine Program, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA; (G.C.); (K.D.); (T.S.H.)
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21
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Rosi A, Ferraris C, Guglielmetti M, Meroni E, Charron M, Menta R, Manini F, Di Gioia V, Martini D, Erba D. Validation of a General and Sports Nutrition Knowledge Questionnaire in Italian Early Adolescents. Nutrients 2020; 12:nu12103121. [PMID: 33066020 PMCID: PMC7600562 DOI: 10.3390/nu12103121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 01/14/2023] Open
Abstract
To the best of our knowledge, no specific questionnaires on sports nutrition knowledge (NK) have been validated so far in Italian early adolescents. The aim of the present study was to validate a short (26-item) general and sports NK questionnaire in a group of Italian early adolescents. To this aim, the questionnaire was administered to 264 subjects for analysis of internal consistency, and in a subgroup (n = 39) for evaluating the reliability over time. The questionnaire revealed good overall internal consistency and reliability (Cronbach’s α = 0.684) and a highly significant correlation over time (r = 0.977, p < 0.001). Comparison with other validated questionnaires is tricky, because the previous questionnaires were validated in different populations, such as middle or late adolescents or adults, with a higher number of items compared to our questionnaire. Furthermore, data on adolescent NK in Italy are very limited. This study provides a brief, feasible, and validated questionnaire that can be used for investigating sports NK in young subjects. It could be used for evaluating the efficacy of education on general and sports nutrition in both the general population and athletes, and for investigating the relationship between NK and different sports in early adolescence.
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Affiliation(s)
- Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, 43125 Parma, Italy;
| | - Cinzia Ferraris
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (C.F.); (M.G.)
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Monica Guglielmetti
- Human Nutrition and Eating Disorder Research Center, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (C.F.); (M.G.)
| | - Erika Meroni
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20122 Milan, Italy;
| | - Melanie Charron
- Soremartec Italia Srl, Ferrero Group, 12051 Alba (CN), Italy; (M.C.); (R.M.); (F.M.)
| | - Roberto Menta
- Soremartec Italia Srl, Ferrero Group, 12051 Alba (CN), Italy; (M.C.); (R.M.); (F.M.)
| | - Federica Manini
- Soremartec Italia Srl, Ferrero Group, 12051 Alba (CN), Italy; (M.C.); (R.M.); (F.M.)
| | - Vito Di Gioia
- Federazione Italiana Giuoco Calcio, 00198 Rome, Italy;
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence: (D.M.); (D.E.)
| | - Daniela Erba
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence: (D.M.); (D.E.)
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Hu C, Zhang M, Zhang W, Zhang X, Zhao Z, Huang Z, Li C, Wang L. Salt-Related Knowledge, Behaviors, and Associated Factors Among Chinese Adults - China, 2015. China CDC Wkly 2020; 2:678-683. [PMID: 34594737 PMCID: PMC8393003 DOI: 10.46234/ccdcw2020.188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 12/03/2022] Open
Abstract
What is already known about this topic? Excessive salt intake is an important risk factor for hypertension and cardiovascular diseases (CVDs). The amount of salt intake of Chinese is one of the highest all over the world. At a national level, the awareness of maximum daily salt intake recommended by the “Dietary Guidelines of Chinese residents” had not been reported. What is added by this report? This is the first nationally representative study about awareness of maximum daily salt intake in China. In 2015, the awareness rate of maximum daily salt intake and behavior rate of salt reduction among Chinese adults aged 18 years old and above was 6.1% and 37.3%, respectively. The awareness rate of maximum daily salt intake and behavior rate of salt reduction was low among adult residents in China. What are the implications for public health practice? To increase the behavior rate of salt reduction in China, awareness of the maximum daily salt intake needs to be strengthened to Chinese residents, especially in rural areas or for people with low education levels and low incomes.
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Affiliation(s)
- Caihong Hu
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Mei Zhang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Wenrong Zhang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Xiao Zhang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Zhenping Zhao
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Zhengjing Huang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Chun Li
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Limin Wang
- Division of NCD and Risk Factor Surveillance, National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
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23
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Lima NKDC. Dietary Salt Reduction: Illusion or Reality? Arq Bras Cardiol 2020; 114:562-563. [PMID: 32267331 PMCID: PMC7792740 DOI: 10.36660/abc.20200155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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