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Ren Q, Xu D, Liang J, Cao Y, Zhang L, Ge S, Chen P. Poor vitamin D status was associated with increased appendicular fat deposition in US Adults: Data from 2011-2018 National Health and Nutrition Examination Survey. Nutr Res 2024; 121:108-118. [PMID: 38061321 DOI: 10.1016/j.nutres.2023.11.001] [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: 07/14/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 01/07/2024]
Abstract
The aim of the study was to explore the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and regional body fat deposition in 2011-2018 National Health and Nutrition Examination Survey participants aged 18 to 59 years. We hypothesized that serum 25(OH)D concentrations were negatively associated with total, appendicular, and truncal fat deposition. Serum 25(OH)D concentration was categorized into sufficient (≥75.0 nM), insufficient (50.0-74.9 nM), and deficient (<50.0 nM) groups. Fat mass (FM) was measured by dual-energy X-ray absorptiometry, and FM index (FMI) was calculated by dividing FM (kg) with height2 (m2). Multivariant linear regression and Granger causal analysis were performed to assess the causal relationship between vitamin D status and regional FMIs. Overall serum 25(OH)D concentrations were negatively associated with total (β = -0.029, standard error [SE] = 0.002), trunk (β = -0.015, SE = 0.001), arms (β = -0.004, SE = 3.09 × 10-4), and legs (β = -0.010, SE = 0.001) FMIs in all participants (P < .001, respectively); however, after stratified by vitamin D status and BMI, the negative associations were only observed in individuals with vitamin D deficiency and obesity. The causal analysis indicated that serum 25(OH)D concentrations may causally reduce the arms (F = 4.917, probability [P] = 0.007), legs (F = 5.783, P = 0.003), and total (F = 3.202, P = 0.041) FMIs except for trunk FMI but not vice versa. In conclusion, poor vitamin D status was associated with increased total and appendicular body fat deposition in US adults, particularly in participants with obesity.
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Affiliation(s)
- Qian Ren
- Department of Clinical Nutrition, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200233.
| | - Danfeng Xu
- Department of Clinical Nutrition, Huadong Hospital Affiliated to Fudan University, Shanghai, China, 200020
| | - Jinrong Liang
- Department of Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200233
| | - Yun Cao
- Department of Clinical Nutrition, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200233
| | - Lili Zhang
- Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200233
| | - Sheng Ge
- Department of Clinical Nutrition, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200233.
| | - Peizhan Chen
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 201821.
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Abdalla M, Bolen SD, Brettler J, Egan BM, Ferdinand KC, Ford CD, Lackland DT, Wall HK, Shimbo D. Implementation Strategies to Improve Blood Pressure Control in the United States: A Scientific Statement From the American Heart Association and American Medical Association. Hypertension 2023; 80:e143-e157. [PMID: 37650292 PMCID: PMC10578150 DOI: 10.1161/hyp.0000000000000232] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Hypertension is one of the most important risk factors that contribute to incident cardiovascular events. A multitude of US and international hypertension guidelines, scientific statements, and policy statements have recommended evidence-based approaches for hypertension management and improved blood pressure (BP) control. These recommendations are based largely on high-quality observational and randomized controlled trial data. However, recent published data demonstrate troubling temporal trends with declining BP control in the United States after decades of steady improvements. Therefore, there is a widening disconnect between what hypertension experts recommend and actual BP control in practice. This scientific statement provides information on the implementation strategies to optimize hypertension management and to improve BP control among adults in the United States. Key approaches include antiracism efforts, accurate BP measurement and increased use of self-measured BP monitoring, team-based care, implementation of policies and programs to facilitate lifestyle change, standardized treatment protocols using team-based care, improvement of medication acceptance and adherence, continuous quality improvement, financial strategies, and large-scale dissemination and implementation. Closing the gap between scientific evidence, expert recommendations, and achieving BP control, particularly among disproportionately affected populations, is urgently needed to improve cardiovascular health.
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Salt sensitivity of blood pressure in childhood and adolescence. Pediatr Nephrol 2022; 37:993-1005. [PMID: 34327584 DOI: 10.1007/s00467-021-05178-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
Although moderation of sodium intake is recommended population-wide, it remains uncertain who benefits from salt restriction. Salt sensitivity refers to changes in blood pressure in response to sodium intake and may occur with or without hypertension. Unfortunately, there is no practical way to assess salt sensitivity in daily practice. Assessment of salt sensitivity even in research studies is challenging with varying protocols utilized which may contribute to differing results. Building on studies in animals and adults, risk factors and conditions associated with salt sensitivity have been identified in the pediatric and young adult populations. This review presents the limited evidence linking obesity, low birth weight, diabetes, chronic kidney disease, and race/ethnicity with salt sensitivity in children, adolescents, and young adults. The impact of stress on sodium handling is also reviewed. The influence of age on the timing of introduction of dietary salt restriction and the long-term influence of salt sensitivity on risk for hypertension are considered. Lastly, interventions other than salt restriction that may improve salt sensitivity and may inform recommendations to families are reviewed.
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Song J, Brown MK, Cobb LK, Jacobson MF, Ide N, MacGregor GA, He FJ. Delayed Finalization of Sodium Targets in the United States May Cost Over 250 000 Lives by 2031. Hypertension 2022; 79:798-808. [PMID: 35184613 DOI: 10.1161/hypertensionaha.121.18475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) proposed 2- and 10-year voluntary sodium-reduction targets for >150 packaged- and prepared-food categories in 2016 and finalized the short-term targets in 2021. METHODS We modeled the health benefits of implementing the newly finalized sodium targets, and the net health losses because of the 4.3-year delay in finalizing the sodium targets in different compliance scenarios in adults aged ≥30, using the National Health and Nutrition Examination Survey (NHANES) 2015 to 2016 cycle. The health impact was estimated by multiplying the projected reduction in population sodium intake by the annual health benefits resulting from every 1000-mg reduction in daily sodium intake. RESULTS Under certain assumptions, the FDA's finalization of the short-term targets in Oct 2021 and possible finalization of the long-term targets by April 2024 is projected to save up to 445 979 (95% CI, 17 349-787 352) lives in the coming 10 years. The net number of unnecessary deaths because of FDA's delay is projected to be as high as 264 644 (95% CI, 10 295-467 215) according to our prediction. CONCLUSIONS These findings highlight the enormous health costs due to the FDA's delay in finalizing the sodium-reduction targets, and the great potential health benefits of industry compliance with the FDA's finalization of its short- and long-term targets in the coming 10 years.
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Affiliation(s)
- Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Mhairi K Brown
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City (L.K.C., N.I.)
| | | | - Nicole Ide
- Resolve to Save Lives, An Initiative of Vital Strategies, New York City (L.K.C., N.I.)
| | - Graham A MacGregor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
| | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (J.S., M.K.B., G.A.M., F.J.H.)
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Estimated reductions in added sugar intake among U.S. children and youth in response to sugar reduction targets. J Acad Nutr Diet 2022; 122:1455-1464.e5. [PMID: 35182788 PMCID: PMC10280787 DOI: 10.1016/j.jand.2022.02.008] [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: 05/30/2021] [Revised: 01/03/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2021, the National Salt and Sugar Reduction Initiative (NSSRI) released voluntary sugar reduction targets for packaged foods and drinks in the United States (U.S). OBJECTIVE The objectives of this study were to describe trends in added sugar intake from NSSRI foods and beverages among children and youth and estimate possible reductions if industry were to meet the targets. DESIGN This study consisted of cross-sectional and trend analyses of demographic and 24-hour dietary recall data from eight survey cycles (2003-2004 to 2017-2018) of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS/SETTING The study sample included 23,248 children and youth (aged 2-19 years). MAIN OUTCOME MEASURES The main outcome measure was the percent of daily calories from added sugar for foods and beverages in NSSRI categories. STATISTICAL ANALYSES PERFORMED Foods and beverages reported by participants were mapped to one of the NSSRI's categories or coded as a non-NSSRI item. Trends over time in added sugar intake were assessed using regression models. To assess possible reductions in added sugar intake if industry were to meet the targets, sales-weighted mean percent reductions for 2023 and 2026 targets were applied to NSSRI items in the 2017-2018 NHANES data. Results were examined overall and by demographic characteristics. RESULTS From 2003-2004 to 2017-2018, added sugar intake from NSSRI foods and beverages declined, but consumption remained high. In 2017-2018, NSSRI categories accounted for 70% of U.S. child and youth added sugar intake. If industry met the NSSRI targets, U.S. children and youth would consume 7% (2023 targets) to 21% (2026 targets) less added sugar. CONCLUSIONS While added sugar intake from NSSRI foods and drinks has declined over the past decade, added sugar intake from all sources remains high and consumption of added sugar from certain NSSRI categories has remained steady over time. If met, the NSSRI targets are expected to result in meaningful reductions in added sugar intake for U.S. children and youth.
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Moran AJ, Wang J, Sharkey AL, Dowling EA, Curtis CJ, Kessler KA. US Food Industry Progress Toward Salt Reduction, 2009-2018. Am J Public Health 2022; 112:325-333. [PMID: 35080946 PMCID: PMC8802589 DOI: 10.2105/ajph.2021.306571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives. To determine the extent to which reductions in sodium during the National Salt Reduction Initiative (NSRI) target-setting period (2009-2014) continued after 2014. Methods. We used the NSRI Packaged Food Database, which links products in the top 80% of US packaged food sales to nutrition information, to assess the proportion of products meeting the NSRI targets and the sales-weighted mean sodium density (mg/100 g) of 54 packaged food categories between 2009 and 2018. Results. There was an 8.5% sales-weighted mean reduction in sodium between 2009 and 2018. Most change occurred between 2009 and 2012, with little change in subsequent years. The proportion of packaged foods meeting the 2012 and 2014 targets increased 48% and 45%, respectively, from 2009 to 2012, with no additional improvements through 2018. Conclusions. Food manufacturers reduced sodium in the early years of the NSRI, but progress slowed after 2012. Public Health Implications. The US Food and Drug Administration just released 2.5-year voluntary sodium targets for packaged and restaurant food. Continued assessment of industry progress and further target setting by the Food and Drug Administration is crucial to reducing sodium in the food supply.
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Affiliation(s)
- Alyssa J. Moran
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Jiangxia Wang
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Andrea L. Sharkey
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Erin A. Dowling
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Christine Johnson Curtis
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Kimberly A. Kessler
- Alyssa J. Moran and Jiangxia Wang are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andrea L. Sharkey, Erin A. Dowling, Christine Johnson Curtis, and Kimberly A. Kessler are with the New York City Department of Health and Mental Hygiene, Long Island City, NY
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Smith BT, Hack S, Jessri M, Arcand J, McLaren L, L’Abbé MR, Anderson LN, Hobin E, Hammond D, Manson H, Rosella LC, Manuel DG. The Equity and Effectiveness of Achieving Canada's Voluntary Sodium Reduction Guidance Targets: A Modelling Study Using the 2015 Canadian Community Health Survey-Nutrition. Nutrients 2021; 13:nu13030779. [PMID: 33673550 PMCID: PMC7997239 DOI: 10.3390/nu13030779] [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: 01/05/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background: High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada’s voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods: We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey—Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results: In children aged 2–8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: −45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9–18 (96 mg/day, 95%CI: −149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: −30,327; female: −45 mg/day, 95%CI: −141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians’ are above the CDRR thresholds. Conclusion: Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels.
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Affiliation(s)
- Brendan T. Smith
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- Correspondence:
| | - Salma Hack
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
| | - Mahsa Jessri
- Food, Nutrition and Health Program, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON L1H 7K4, Canada;
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4Z6, Canada;
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Child Health Evaluative Sciences, Sickkids Research Institute, Toronto, ON M5G 0A4, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Heather Manson
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON M5G 1V2, Canada; (S.H.); (E.H.); (H.M.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
- ICES, Toronto, ON K1Y 4E9, Canada;
| | - Douglas G. Manuel
- ICES, Toronto, ON K1Y 4E9, Canada;
- Ottawa Hospital Research Institute, Clinical Epidemiology, Ottawa, ON K1H 8L6, Canada
- Health Analysis Division, Statistics Canada, Ottawa, ON K1A 0T6, Canada
- Department of Family Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Bruyère Research Institute, Ottawa, ON K1R 6M1, Canada
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Musicus AA, Kraak VI, Bleich SN. Policy Progress in Reducing Sodium in the American Diet, 2010–2019. Annu Rev Nutr 2020; 40:407-435. [DOI: 10.1146/annurev-nutr-122319-040249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Most Americans consume dietary sodium exceeding age-specific government-recommended targets of 1,500–2,300 mg/day per person. The majority (71%) of US dietary sodium comes from restaurant and packaged foods. Excess sodium intake contributes to hypertension and cardiovascular disease, which is the leading cause of death in the United States. This review summarizes evidence for policy progress to reduce sodium in the US food supply and the American diet. We provide a historical overview of US sodium-reduction policy (1969–2010), then examine progress toward implementing the 2010 National Academy of Medicine (NAM) sodium report's recommendations (2010–2019). Results suggest that the US Food and Drug Administration made no progress in setting mandatory sodium-reduction standards, industry made some progress in meeting voluntary targets, and other stakeholders made some progress on sodium-reduction actions. Insights from countries that have significantly reduced population sodium intake offer strategies to accelerate US progress toward implementing the NAM sodium-reduction recommendations in the future.
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Affiliation(s)
- Aviva A. Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
| | - Vivica I. Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115, USA
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Simulating the impact of sodium reduction from packaged foods on population sodium intake in US adults and children. Public Health Nutr 2019; 23:488-495. [PMID: 31566172 DOI: 10.1017/s1368980019002696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To simulate the impact that Na reductions in food categories that are the largest contributors to dietary Na intake would have on population Na intake from packaged foods among US adults and children. DESIGN 24 h Dietary recall data were used. For each store-bought packaged food product reported by participants, we generated sales-weighted Na content at the median and 25th percentile using Nutrition Facts Panel data from 193 195 products purchased by US households. The impact that Na reductions would have on population Na intake, overall and by sociodemographic subgroup, was examined. SETTINGS US households. PARTICIPANTS Children aged 2-18 years (n 2948) and adults aged >18 years (n 4878), 2011-2012 National Health and Nutrition Examination Survey. RESULTS Na intake from packaged foods was 1258 (se 21) mg for adults and 1215 (se 35) mg for children. Top-ten packaged food group sources contributed 67 % of Na intake. For adults and children, there was a decrease of 8·7 % (109 mg) and 8·0 % (97 mg), respectively, in Na intake if the top-ten sources reduced Na from the median to the 25th percentile. Although absolute reduction in intake varied between sociodemographic subgroups, significant differences were not observed. CONCLUSIONS The study demonstrated that if Na reduction shifted the top-ten packaged food group sources of dietary Na intake from the median to 25th percentile, population Na intake would be reduced by 9 % in US adults and children. These findings will help inform the US government's Na reduction targets, as well as policy makers' understanding of differences in intake of critical sub-populations in the USA.
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Ahuja JKC, Li Y, Haytowitz DB, Bahadur R, Pehrsson PR, Cogswell ME. Assessing Changes in Sodium Content of Selected Popular Commercially Processed and Restaurant Foods: Results from the USDA: CDC Sentinel Foods Surveillance Program. Nutrients 2019; 11:E1754. [PMID: 31366099 PMCID: PMC6723387 DOI: 10.3390/nu11081754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022] Open
Abstract
This report provides an update from the U.S. Department of Agriculture - Centers for Disease Control and Prevention Sentinel Foods Surveillance Program, exploring changes in sodium and related nutrients (energy, potassium, total and saturated fat, and total sugar) in popular, sodium-contributing, commercially processed and restaurant foods with added sodium. In 2010-2013, we obtained 3432 samples nationwide and chemically analyzed 1654 composites plus label information for 125 foods, to determine baseline laboratory and label sodium concentrations, respectively. In 2014-2017, we re-sampled and chemically analyzed 43 of the Sentinel Foods (1181 samples), tested for significant changes of at least ±10% (p < 0.05), in addition to tracking changes in labels for 108 Sentinel Foods. Our results show that the label sodium levels of a majority of the Sentinel Foods had not changed since baseline (~1/3rd of the products reported changes, with twice as many reductions as increases). Laboratory analyses of the 43 Sentinel Foods show that eight foods had significant changes (p < 0.05); sodium content continues to be high and variable, and there was no consistent pattern of changes in related nutrients. Comparisons of changes in labels and laboratory sodium shows consistency for 60% of the products, i.e., similar changes (or no changes) in laboratory and label sodium content. The data from this monitoring program may help public health officials to develop strategies to reduce and monitor sodium trends in the food supply.
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Affiliation(s)
- Jaspreet K C Ahuja
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, BARC-WEST, Beltsville, MD 20705, USA.
| | - Ying Li
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, BARC-WEST, Beltsville, MD 20705, USA
| | | | - Rahul Bahadur
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, BARC-WEST, Beltsville, MD 20705, USA
| | - Pamela R Pehrsson
- U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, 10300 Baltimore Ave, Bldg 005, BARC-WEST, Beltsville, MD 20705, USA
| | - Mary E Cogswell
- Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 4770 Buford Highway NE, Mail Stop F-73, Atlanta, GA 30341-3717, USA
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Federici C, Detzel P, Petracca F, Dainelli L, Fattore G. The impact of food reformulation on nutrient intakes and health, a systematic review of modelling studies. BMC Nutr 2019; 5:2. [PMID: 32153917 PMCID: PMC7050744 DOI: 10.1186/s40795-018-0263-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Unhealthy diet is a risk factor for adverse health outcomes. Reformulation of processed foods has the potential to improve population diet, but evidence of its impact is limited. The purpose of this review was to explore the impact of reformulation on nutrient intakes, health outcomes and quality of life; and to evaluate the quality of modelling studies on reformulation interventions. METHODS A systematic review of peer-reviewed articles published between January 2000 and December 2017 was performed using MEDLINE, ScienceDirect, Embase, Scopus, Cochrane, and the Centre for Reviews and Dissemination of the University of York. Additional studies were identified through informal searches on Google and specialized websites. Only simulation studies modelling the impact of food reformulation on nutrient intakes and health outcomes were included. Included articles were independently extracted by 2 reviewers using a standardized, pre-piloted data form, including a self-developed tool to assess study quality. RESULTS A total of 33 studies met the selected inclusion criteria, with 20, 5 and 3 studies addressing sodium, sugar and fats reformulation respectively, and 5 studies addressing multiple nutrients. Evidence on the positive effects of reformulation on consumption and health was stronger for sodium interventions, less conclusive for sugar and fats. Study features were highly heterogeneous including differences in methods, the type of policy implemented, the extent of the reformulation, and the spectrum of targeted foods and nutrients. Nonetheless, partial between-study comparisons show a consistent relationship between percentages reformulated and reductions in individual consumption. Positive results are also shown for health outcomes and quality of life measures, although comparisons across studies are limited by the heterogeneity in model features and reporting. Study quality was often compromised by short time-horizons, disregard of uncertainty and time dependencies, and lack of model validation. CONCLUSIONS Reformulation models highlight relevant improvements in diets and population health. While models are valuable tools to evaluate reformulation interventions, comparisons are limited by non-homogeneous designs and assumptions. The use of validated models and extensive scenario analyses would improve models' credibility, providing useful insights for policy-makers. REVIEW REGISTRATION A research protocol was registered within the PROSPERO database (ID number CRD42017057341).
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Affiliation(s)
- Carlo Federici
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Patrick Detzel
- Nestlé Research Center, Nestec SA, Lausanne, Switzerland
| | - Francesco Petracca
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
| | - Livia Dainelli
- Nestlé Research Center, Nestec SA, Lausanne, Switzerland
| | - Giovanni Fattore
- CeRGAS (Centre for Research on Health and Social Care Management), SDA Bocconi School of Management, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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