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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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Vici G, Rosi A, Angelino D, Polzonetti V, Scazzina F, Pellegrini N, Martini D. Salt content of prepacked cereal-based products and their potential contribution to salt intake of the Italian adult population: Results from a simulation study. Nutr Metab Cardiovasc Dis 2024; 34:436-444. [PMID: 37788951 DOI: 10.1016/j.numecd.2023.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND AIMS High sodium intake is one of the main risk factors for noncommunicable diseases, and its consumption should be reduced. This study aimed to simulate changes in the daily salt intake of the Italian adult population based on consumption scenarios of prepacked cereal-based foods sold in Italy. METHODS AND RESULTS Information on food packages was retrieved from 2893 cereal-based products. Potential changes in salt intake were simulated based on food consumption scenarios that consider the daily consumption of cereal-based products suggested in the Italian Dietary Guidelines and their current daily consumption by Italian adults. The highest salt content was retrieved in bread (median, 25th-75th percentile: 1.3, 1.1-1.4 g/100 g) and bread substitutes (1.8, 1.0-2.2 g/100 g). If the suggested daily amounts were consumed, bread would contribute to 44% of the 5 g salt/day target, whereas bread substitutes, breakfast cereals, biscuits and sweet snacks would marginally contribute (1-2%). Compared to bread with median salt content, a -44% and +10% salt intake would be observed if products within the first and the last quartile of salt content were chosen, respectively. However, considering the actual intake of Italian consumers, bread would cover 25% and bread substitutes 7% of the daily salt target. CONCLUSION Food labels have a pivotal role and efforts are required to encourage consumers to use them to make healthy choices. Moreover, these results may contribute to setting sodium benchmarks in cereal-based products and encourage the food industry to reduce the salt content in the products.
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Affiliation(s)
- Giorgia Vici
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, 62032, Italy.
| | - Alice Rosi
- Department of Food and Drug, University of Parma, Parma, 43124, Italy.
| | - Donato Angelino
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, 64100, Italy.
| | - Valeria Polzonetti
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, 62032, Italy.
| | | | - Nicoletta Pellegrini
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100, Italy.
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), Università degli Studi di Milano, 20133 Milan, Italy.
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Ding X, Lv W, Liu Y, Long J, Li H, Ma A, Yang Y, Wang Z, Gao C. Sodium Content in Pre-Packaged Foods in China: A Food Label Analysis. Nutrients 2023; 15:4862. [PMID: 38068721 PMCID: PMC10708419 DOI: 10.3390/nu15234862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Sodium intake from pre-packaged foods is increasing in China and is well above the WHO recommendation of 5 g per day. The purpose of this study is to analyze the sodium content of pre-packaged foods collected by the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention (NINH, China CDC) in 20 provinces of China from 2017 to 2022. The proportion of pre-packaged foods that meet or exceed the low-sodium, medium-sodium, and high-sodium classifications were analyzed. The proportion of pre-packaged foods that meet and do not meet the WHO global sodium benchmarks and the difference in sodium content between these foods was also calculated. High-sodium foods include sauces, dips, and dressings (3896 mg/100 g), convenience foods (1578 mg/100 g), processed fish products (1470 mg/100 g), processed meat products (1323 mg/100 g), processed poultry products (1240 mg/100 g), snack foods (750 mg/100 g), processed egg products (741 mg/100 g), and fine dried noodles (602 mg/100 g). A large number of pre-packaged foods currently collected in China have a sodium content above sodium benchmarks. This study provided data to support the assessment of sodium intake from pre-packaged foods in the Chinese population and the implementation of comprehensive salt reduction strategies.
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Affiliation(s)
- Xin Ding
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
| | - Wanting Lv
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yang Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiewei Long
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Hanning Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Aiguo Ma
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
| | - Yuexin Yang
- Institute of Nutrition and Health, School of Public Health, Qingdao University, Qingdao 266071, China; (X.D.)
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Chinese Nutrition Society, Beijing 100053, China
| | - Zhu Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
| | - Chao Gao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Laboratory of Trace Element Nutrition of National Health Commission, Beijing 100050, China
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Marakis G, Marques Domingues A, Crispo A, Magriplis E, Vasara E, Kontopoulou L, Triantafyllou C, Skepastianos P, Papadopoulou SK, Rodopaios NE, Hassapidou M, Zampelas A, Cappuccio FP, Breda J. Pertinence of Salt-Related Knowledge and Reported Behaviour on Salt Intake in Adults: A Cross-Sectional Study. Nutrients 2023; 15:4114. [PMID: 37836397 PMCID: PMC10574173 DOI: 10.3390/nu15194114] [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: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.
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Affiliation(s)
- Georgios Marakis
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
| | - Ana Marques Domingues
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Anna Crispo
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
- Istituto Nazionale dei “Tumori Fondazione G. Pascale”, Via Mariano Semmola 52, 80131 Napoli, Italy
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Eleni Vasara
- School of Biology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece;
| | - Lamprini Kontopoulou
- Department of Nursing, University of Thessaly, Gaiopolis Campus, Larissa-Trikala Ring-Road, 41500 Larissa, Greece;
| | - Christos Triantafyllou
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
| | - Petros Skepastianos
- Department of Medical Laboratory Studies, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | | | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.H.)
| | - Antonis Zampelas
- Hellenic Food Authority, 124 Kifisias Av. & 2 Iatridou Str., 11526 Athens, Greece; (G.M.); (A.Z.)
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 11855 Athens, Greece;
| | - Francesco P. Cappuccio
- Medical School, University of Warwick, Coventry CV4 7AL, UK;
- WHO Collaborating Centre for Nutrition, Warwick Medical School, Coventry CV4 7AL, UK
| | - João Breda
- WHO Athens Quality of Care and Patient Safety Office, Ploutarchou 3, 10675 Athens, Greece; (A.M.D.); (A.C.); (C.T.)
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Angelino D, Dinu M, Gandossi B, Pellegrini N, Martini D. Processing and Nutritional Quality of Breakfast Cereals Sold in Italy: Results from the Food Labelling of Italian Products (FLIP) Study. Nutrients 2023; 15:nu15082013. [PMID: 37111232 PMCID: PMC10145012 DOI: 10.3390/nu15082013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to compare the level of processing (as assessed by the NOVA classification) and the nutritional quality (as assessed by nutrition values, Nutri-Score and NutrInform battery) of breakfast cereals currently on the Italian market. A total of 349 items were found, mostly belonging to the NOVA 4 group (66.5%) and to Nutri-Score C and A (40% and 30%, respectively). The NOVA 4 products showed the highest energy, total fat, saturates, and sugar content per 100 g and had the highest number of items with Nutri-Score C (49%) and D (22%). Conversely, NOVA 1 products had the highest content of fibre and protein, the lowest amounts of sugars and salt, and 82% of them were Nutri-Score A, while few Nutri-Score B and C were found. Differences were attenuated when products were compared for their NutrInform battery, with NOVA 4 items showing only slightly fuller batteries for saturated fats, sugar, and salt than NOVA 1 and NOVA 3 products. Overall, these results suggest that the NOVA classification partially overlaps with systems based on the nutritional quality of foods. The lower nutritional quality of NOVA 4 foods may at least partially explain the association found between the consumption of ultra-processed foods and the risk of chronic diseases.
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Affiliation(s)
- Donato Angelino
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, 64100 Teramo, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Barbara Gandossi
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy
| | - Nicoletta Pellegrini
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy
| | - Daniela Martini
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy
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Ropero AB, Borrás F, Rodríguez M, Beltrá M. Nutritional Description of Organic and Conventional Food Products in Spain: The BADALI Project. Nutrients 2023; 15:nu15081876. [PMID: 37111095 PMCID: PMC10144859 DOI: 10.3390/nu15081876] [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: 03/20/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Organic food and drink is undoubtedly a growing market. Consumers perceive organic food as healthy, and nutrition claims (NCs) and fortification may add to this perception. Whether this is true is still a matter of controversy, particularly for organic food products. We present here the first comprehensive study of large samples of six specific organic food types, analysing the nutritional quality (nutrient composition and "healthiness") as well as the use of NCs and fortification. In parallel, a comparison with conventional food is also carried out. For this purpose, the Food Database of products in the Spanish market, BADALI, was used. Four cereal-based and two dairy-substitute food types were analysed. Our results show that as many as 81% of organic foods are considered "less healthy" by the Pan American Health Organization Nutrient Profile Model (PAHO-NPM). Organic foods present a slightly improved nutrient profile compared to conventional foods. However, many of the differences, though statistically significant, are nutritionally irrelevant. Organic foods use NCs very frequently, more than conventional foods, with very little micronutrient fortification. The main conclusion of this work is that consumers' perception that organic food products are healthy is unfounded from a nutritional point of view.
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Affiliation(s)
- Ana B Ropero
- Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain
| | - Fernando Borrás
- Department of Statistics, Mathematics and Informatics, Miguel Hernández University, 03202 Elche, Spain
| | - Marta Rodríguez
- Polytechnic School of Orihuela, Miguel Hernández University, 03202 Elche, Spain
| | - Marta Beltrá
- Institute of Bioengineering, Miguel Hernández University, 03202 Elche, Spain
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The Update of the Italian Food Composition Database of Gluten-Free Products and Its Application in Food-Based Dietary Guidelines Menus. Nutrients 2022; 14:nu14194171. [PMID: 36235823 PMCID: PMC9571138 DOI: 10.3390/nu14194171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
Complete food composition databases (FCDBs) on gluten-free (GF) foods are needed to assess the nutrient intakes of celiac disease patients. The aim of the present work was to update the previously developed version of the Italian GF-FCDB and to apply it to a theoretical GF diet. The updated GF-FCDB includes the composition of 108 GF cereal-based foods, as sold, in terms of energy and macro- and micro-nutrients, imputed using food label information combined with the standard recipe approach. Three scenarios (i.e., refined, mixed, and wholegrain cereals) of the weekly guideline menu for the general Italian population were analyzed for energy and nutrient content in a theoretical dietary assessment using traditional gluten-containing (GC) foods and the corresponding GF substitutes. All GF menus were higher than the corresponding GC menus in polyunsaturated fatty acids, linoleic acid, and vitamin E. Zinc was lower in GF than in GC menus only in the wholegrain-cereal scenario. Thanks to the application of the updated GF-FCDB including a comprehensive list of micronutrients, we observed that it is possible for celiac disease patients to meet nutrient requirements by simply substituting GC with GF cereal-based products following recommendations for the general population.
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