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Zhang P, Zhang J, Rosewarne E, Li Y, Dong L, He FJ, Brown M, Pettigrew S, Yamamoto R, Nishida C, Liu A, Yang X, Zhang B, Ding G, Wang H. Setting sodium targets for pre-packaged foods in China - an exploratory study. Front Nutr 2023; 10:1231979. [PMID: 38024347 PMCID: PMC10646300 DOI: 10.3389/fnut.2023.1231979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Setting sodium targets for pre-packaged food has been a priority strategy for reducing population sodium intake. This study aims to explore the attitudes and considerations of researchers and key stakeholders toward implementing such policy in China. Methods An exploratory study comprising a survey and a focus group discussion was conducted among 27 purposively selected participants including 12 researchers, 5 consumers, 4 administrators, 3 industry association representatives and 3 food producers. The survey/discussion covered the key questions considered when developing/promoting sodium targets. Free-text responses were manually classified and summarized using thematic analysis. Results Two-thirds of the participants supported target-setting policy. Researchers and administrators were most supportive, and food producers and associations were least supportive. Adapted WHO food categorization framework was well accepted to underpin target-setting to ensure international comparability and applicability for Chinese products. Maximum values were the most agreed target type. The WHO benchmarks were thought to be too ambitious to be feasible given the current food supply in China but can be regarded as long-term goals. Initially, a reduction of sodium content by 20% was mostly accepted to guide the development of maximum targets. Other recommendations included implementing a comprehensive strategy, strengthening research, engaging social resources, establishing a systematic monitoring/incentive system, maintaining a fair competitive environment, and developing a supportive information system. Target-setting policy was acceptable by most stakeholders and should be implemented alongside strategies to reduce discretionary salt use. Discussion Our findings provide detailed guidance for the Chinese government when developing a target-setting strategy. The methods and results of this study also provide meaningful references for other countries to set sodium targets for pre-packaged foods and implement other salt reduction strategies simultaneously.
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Affiliation(s)
- Puhong Zhang
- The George Institute for Global Health, Beijing, China
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jiguo Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Emalie Rosewarne
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Yuan Li
- The George Institute for Global Health, Beijing, China
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Le Dong
- The George Institute for Global Health, Beijing, China
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mhairi Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simone Pettigrew
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rain Yamamoto
- Standards and Scientific Advice on Food and Nutrition Unit, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Chizuru Nishida
- Safe, Healthy and Sustainable Diet Unit, Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Aidong Liu
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Xiaoguang Yang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Bing Zhang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- Key Laboratory of Trace Element Nutrition of National Health Commission, National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing, China
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Dong J, Yu X, Li X, Xiang S, Qin Y, Zhu S, Zheng J, Yan Y. Consistency between 3 days' dietary records and 24-h urine in estimating salt intake in children and adolescents. Front Public Health 2022; 10:1071473. [PMID: 36620268 PMCID: PMC9822649 DOI: 10.3389/fpubh.2022.1071473] [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: 10/16/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose This study aimed to evaluate the salt intake in boarding school students and the consistency between salt intake measurements based on 24-h urine and weighed dietary records over 3 consecutive days in this population. Methods This was a school-based cross-sectional study. Overweight (including obesity) or hypertensive students aged 6-14 years and their normal counterparts were recruited for this study at three boarding schools in China. Three consecutive 24-h urine samples were collected from all participants. During the collection period of 24-h urine, the weighed diet records were collected in children who had all three meals at the school canteens on weekdays. Incomplete 24-h urine or dietary records were excluded from the analysis. Results The median salt excretion was 6,218 [4,636, 8,290] mg by 24-h urine and 120 (82.2%) consumed excess salt among the participants. The median salt intake was 8,132 [6,348, 9,370] mg by dietary records and 112 (97.4%) participants consumed excess salt than recommended in participants who have all three meals in the school canteens. In children with complete dietary records and 24-h urine, the level of salt intake estimated by 24-h urine accounted for 79.6% of the dietary records. Conclusion Our study showed that boarding school students consumed excessive salt from school canteens. Thus, policies or strategies targeting school canteens are urgently needed. Weighed dietary records are recommended if feasible.
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Affiliation(s)
- Jie Dong
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China,*Correspondence: Jie Dong ✉
| | - Xiaoran Yu
- Department of Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xun Li
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | - Shiting Xiang
- Pediatrics Research Institute of Hunan Province, Hunan Children's Hospital, Changsha, China
| | | | - Shaolun Zhu
- The Middle School of Fengshu, Taoyuan, China
| | - Jie Zheng
- The Primary School of Qinglin, Taoyuan, China
| | - Yinkun Yan
- Department of Center for Non-communicable Disease Management, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Wieërs MLAJ, Mulder J, Rotmans JI, Hoorn EJ. Potassium and the kidney: a reciprocal relationship with clinical relevance. Pediatr Nephrol 2022; 37:2245-2254. [PMID: 35195759 PMCID: PMC9395506 DOI: 10.1007/s00467-022-05494-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 10/26/2022]
Abstract
By controlling urinary potassium excretion, the kidneys play a key role in maintaining whole-body potassium homeostasis. Conversely, low urinary potassium excretion (as a proxy for insufficient dietary intake) is increasingly recognized as a risk factor for the progression of kidney disease. Thus, there is a reciprocal relationship between potassium and the kidney: the kidney regulates potassium balance but potassium also affects kidney function. This review explores this relationship by discussing new insights into kidney potassium handling derived from recently characterized tubulopathies and studies on sexual dimorphism. These insights reveal a central but non-exclusive role for the distal convoluted tubule in sensing potassium and subsequently modifying the activity of the sodium-chloride cotransporter. This is another example of reciprocity: activation of the sodium-chloride cotransporter not only reduces distal sodium delivery and therefore potassium secretion but also increases salt sensitivity. This mechanism helps explain the well-known relationship between dietary potassium and blood pressure. Remarkably, in children, blood pressure is related to dietary potassium but not sodium intake. To explore how potassium deficiency can cause kidney injury, we review the mechanisms of hypokalemic nephropathy and discuss if these mechanisms may explain the association between low dietary potassium intake and adverse kidney outcomes. We discuss if potassium should be repleted in patients with kidney disease and what role dietary potassium plays in the risk of hyperkalemia. Supported by data and physiology, we reach the conclusion that we should view potassium not only as a potentially dangerous cation but also as a companion in the battle against kidney disease.
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Affiliation(s)
- Michiel L. A. J. Wieërs
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jaap Mulder
- grid.5645.2000000040459992XDepartment of Pediatrics, Division of Pediatric Nephrology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.10419.3d0000000089452978Department of Pediatrics, Division of Pediatric Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joris I. Rotmans
- grid.10419.3d0000000089452978Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout J. Hoorn
- grid.5645.2000000040459992XDepartment of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Room Ns403, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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