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Amerzadeh M, Takian A, Pouraram H, Akbari Sari A, Ostovar A. The health system barriers to a healthy diet in Iran. PLoS One 2023; 18:e0278280. [PMID: 36701325 PMCID: PMC9879474 DOI: 10.1371/journal.pone.0278280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/11/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Decreasing calories, salt, sugar and fat intake is considered the golden solution to reduce obesity and cardiovascular diseases (CVDs) related to unhealthy diet. This study aimed to investigate the health system induced barriers to a healthy diet in Iran. METHODS This is a qualitative health policy analysis. We collected data through 30 semi-structured, face-to-face interviews with purposefully identified experts, including policy-makers, top-level managers and related stakeholders. All interviews were transcribed verbatim, and analyzed with qualitative content analysis, facilitated by MAXQDA 11 software. RESULTS We identified six categories of barriers: structural problems within the Ministry of Health and Medical Education (MoHME), i.e. Supreme Council of Health and Food Security (SCHFS); the MoHME's inadequate stewardship of public health, the short life of the deputy of social affairs within the MoHME and its possible impact on the National Health Assembly; inefficient traffic lights labelling for foods; lack of adequate policies and guidelines for monitoring restaurants and fast foods and insufficient incentive policies for the food industry. CONCLUSION In line with the World Health Organization (WHO) Global Action Plan, in 2015, Iran defined its roadmap for prevention and control of NCDs, i.e. some nutritional interventions. However, different stakeholders including MoHME and other sectors need to provide series of interventions to change people's approach about food choice so that they might reduce the consumption of foods with excessive salt, fat and sugar.
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Affiliation(s)
- Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin university of Medical Sciences, Qazvin, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Heath Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- * E-mail:
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Du W, Wang H, Zhang J, Zhang X, Wei N, Li Y, Tan M, Zhang P, He FJ. Sodium content of restaurant dishes in China: a cross-sectional survey. Nutr J 2022; 21:10. [PMID: 35177072 PMCID: PMC8851779 DOI: 10.1186/s12937-022-00762-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Sodium intake in China is extremely high and eating in restaurants is increasingly popular. Little research has explored the sodium level of restaurant dishes. The present study aims to assess the content and sources of sodium in Chinese restaurants. Methods Cross-sectional data were obtained from the baseline survey of the Restaurant-based Intervention Study (RIS) in 2019. A total of 8131 best-selling restaurant dishes with detailed recipes from 192 restaurants in China were included. Sodium content per 100 g and per serving were calculated according to the Chinese Food Composition Table. The proportion of restaurant dishes exceeding the daily sodium reference intake level in a single serving and the major sources of sodium were determined. Results Median sodium content in restaurant dishes were 487.3 mg per 100 g, 3.4 mg per kcal, and 2543.7 mg per serving. For a single serving, 74.9% of the dishes exceeded the Chinese adults’ daily adequate intake for sodium (AI, 1500 mg per day), and 62.6% of dishes exceeded the proposed intake for preventing non-communicable chronic diseases (PI, 2000 mg per day). Cooking salt was the leading source of sodium in Chinese restaurant dishes (45.8%), followed by monosodium glutamate (17.5%), food ingredients (17.1%), soy sauce (9.4%), and other condiments/seasonings (10.2%). More types of salted condiments/seasonings use were related to higher sodium level. Conclusions The sodium levels in Chinese restaurant dishes are extremely high and variable. In addition to cooking salt, other salted condiments/seasonings also contribute a large proportion of sodium. Coordinated sodium reduction initiatives targeting the main sources of sodium in restaurant dishes are urgently needed.
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Affiliation(s)
- Wenwen Du
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Huijun Wang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China.
| | - Jiguo Zhang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Xiaofan Zhang
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Nan Wei
- The National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Rd, Beijing, China
| | - Yuan Li
- The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, China
| | - Monique Tan
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, EC1M-6BQ, London, UK
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, China
| | - Feng J He
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, EC1M-6BQ, London, UK
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Ahn SH, Kwon JS, Kim K, Kim HK. Perceptions and Feasibility of Actions Related to Sodium Reduction among Restaurant Owners and Cooks in Seongnam, South Korea: Comparison According to Stages of Behavioral Change. Nutrients 2021; 13:nu13124375. [PMID: 34959927 PMCID: PMC8707999 DOI: 10.3390/nu13124375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
With the increase in meals eaten outside the home, sodium reduction in restaurant foods is essential for reducing sodium intake. This study aimed to assess the stages of behavioral change for reducing sodium and the differences in perceptions among restaurant staff by stage. Restaurant owners and cooks (n = 313) in Seongnam, South Korea were surveyed on their stage of behavioral change, practices, and perceptive factors related to sodium reduction in restaurant meals using a questionnaire. The proportion of behavioral change by stage was 20.4% in the maintenance and action (MA) stage, 32.3% in the preparation (P) stage, and 47.3% in the pre-preparation (PP) stage, which included contemplation and pre-contemplation stages. The items that represent differences among the groups were recognition of social environment for sodium reduction, practice of weighing condiments and measuring salinity, and feasibility of actions related to low-sodium cooking. Logistic regression analysis was used to estimate odds ratios for practice and perceptive factors by using stage of behavioral change as the independent variable. Factors associated with being in the MA stage were weighing condiments, measuring salinity, and high feasibility of actions related to low-sodium cooking. Recognition of sodium labeling and anticipation of better taste by reducing sodium increased the odds of being in the P stage rather than the PP stage. These results suggest that customized stepwise education and support are needed for the efficacy of restaurant-based sodium reduction programs.
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Affiliation(s)
- So-Hyun Ahn
- Department of Food and Nutrition, Shingu College, Seongnam 13174, Korea; (S.-H.A.); (J.-S.K.)
| | - Jong-Sook Kwon
- Department of Food and Nutrition, Shingu College, Seongnam 13174, Korea; (S.-H.A.); (J.-S.K.)
| | - Kyungmin Kim
- Department of Food and Nutrition, Baewha Women’s University, Seoul 03039, Korea;
| | - Hye-Kyeong Kim
- Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon 14662, Korea
- Correspondence:
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Oliveira ASD, Dantas NM, Pinto-E-Silva MEM. Consumer acceptance and salty taste intensity of culinary preparations in a food service in the city of São Paulo. JOURNAL OF CULINARY SCIENCE & TECHNOLOGY 2020. [DOI: 10.1080/15428052.2018.1507857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lassen AD, Trolle E, Bysted A, Knuthsen P, Andersen EW. The Salt Content of Lunch Meals Eaten at Danish Worksites. Nutrients 2018; 10:nu10101367. [PMID: 30249979 PMCID: PMC6213428 DOI: 10.3390/nu10101367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Monitoring levels of sodium (salt) in meals consumed out-of-home is needed to support effective implementation of salt-reduction strategies. The objective of the study was to examine lunch salt intake at 15 worksite canteens and to compare with results from a comparable study conducted 10 years before. A duplicate-portion-technique with subsequent chemical analysis was used to quantify 240 customers’ lunch salt intake. Estimated mean salt intake was 2.6 g/meal (95% Cl: 2.2 to 3.0 g/meal) and 0.78 g/100 g (95% Cl: 0.69 to 0.88 g/100 g). Salt intake measured both as g per meal and per 100 g was found to be significantly higher for male compared with female participants (+0.10 g/100 g, 95% Cl: +0.02 to +0.17 g/100 g, p = 0.011). Compared with the study conducted 10 years before, there was a significantly lower estimated salt intake of 0.5 g/meal (95% CI: −0.8 to −0.2 g/meal, p = 0.001), suggesting a possible reduction in canteen lunch salt intake during a 10-year period. Still, 40% of the meals exceeded the Nordic Keyhole label requirements of maximum 0.8 g salt per 100 g for ready meals. A further reduction of salt intake is warranted to comply with salt reduction targets.
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Affiliation(s)
- Anne D Lassen
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Ellen Trolle
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Anette Bysted
- Research Group for Bioactives ⁻ Analysis and Application, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Pia Knuthsen
- Division of Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, DK-2800 Lyngby, Denmark.
| | - Elisabeth W Andersen
- Danish Cancer Society Research Center, Statistics and Pharmacoepidemiology, DK-2100 Copenhagen, Denmark.
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Harris RM, Rose AMC, Hambleton IR, Howitt C, Forouhi NG, Hennis AJM, Samuels TA, Unwin N. Sodium and potassium excretion in an adult Caribbean population of African descent with a high burden of cardiovascular disease. BMC Public Health 2018; 18:998. [PMID: 30092782 PMCID: PMC6085702 DOI: 10.1186/s12889-018-5694-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background High sodium diets with inadequate potassium and high sodium-to-potassium ratios are a known determinant of hypertension and cardiovascular disease (CVD). The Caribbean island of Barbados has a high prevalence of hypertension and mortality from CVD. Our objectives were to estimate sodium and potassium excretion, to compare estimated levels with recommended intakes and to identify the main food sources of sodium in Barbadian adults. Methods A sub-sample (n = 364; 25–64 years) was randomly selected from the representative population-based Health of the Nation cross-sectional study (n = 1234), in 2012–13. A single 24-h urine sample was collected from each participant, following a strictly applied protocol designed to reject incomplete samples, for the measurement of sodium and potassium excretion (in mg), which were used as proxy estimates of dietary intake. In addition, sensitivity analyses based on estimated completeness of urine collection from urine creatinine values were undertaken. Multiple linear regression was used to examine differences in sodium and potassium excretion, and the sodium-to-potassium ratio, by age, sex and educational level. Two 24-h recalls were used to identify the main dietary sources of sodium. All analyses were weighted for the survey design. Results Mean sodium excretion was 2656 (2488–2824) mg/day, with 67% (62–73%) exceeding the World Health Organization (WHO) recommended limit of 2000 mg/d. Mean potassium excretion was 1469 (1395–1542) mg/d; < 0.5% met recommended minimum intake levels. Mean sodium-to-potassium ratio was 2.0 (1.9–2.1); not one participant had a ratio that met WHO recommendations. Higher potassium intake and lower sodium-to-potassium ratio were independently associated with age and tertiary education. Sensitivity analyses based on urine creatinine values did not notably alter these findings. Conclusions In this first nationally representative study with objective assessment of sodium and potassium excretion in a Caribbean population in over 20 years, levels of sodium intake were high, and potassium intake was low. Younger age and lower educational level were associated with the highest sodium-to-potassium ratios. These findings provide baseline values for planning future policy interventions for non-communicable disease prevention.
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Affiliation(s)
- Rachel M Harris
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Angela M C Rose
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian R Hambleton
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Christina Howitt
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anselm J M Hennis
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - T Alafia Samuels
- The George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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McKenzie B, Santos JA, Trieu K, Thout SR, Johnson C, Arcand J, Webster J, McLean R. The Science of Salt: A focused review on salt-related knowledge, attitudes and behaviors, and gender differences. J Clin Hypertens (Greenwich) 2018; 20:850-866. [PMID: 29722131 PMCID: PMC8031068 DOI: 10.1111/jch.13289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
The aim of the current review was to examine the scope of studies published in the Science of Salt Weekly that contained a measure of self-reported knowledge, attitudes, and behavior (KAB) concerning salt. Specific objectives were to examine how KAB measures are used to evaluate salt reduction intervention studies, the questionnaires used, and whether any gender differences exist in self-reported KAB. Studies were reviewed from the commencement of Science of Salt Weekly, June 2013 to the end of August 2017. Seventy-five studies had relevant measures of KAB and were included in this review, 13 of these were salt-reduction intervention-evaluation studies, with the remainder (62) being descriptive KAB studies. The KAB questionnaires used were specific to the populations studied, without evidence of a best practice measure. 40% of studies used KAB alone as the primary outcome measure; the remaining studies used more quantitative measures of salt intake such as 24-hour urine. Only half of the descriptive studies showed KAB outcomes disaggregated by gender, and of those, 73% showed women had more favorable KAB related to salt. None of the salt intervention-evaluation studies showed disaggregated KAB data. Therefore, it is likely important that evaluation studies disaggregate, and are appropriately powered to disaggregate all outcomes by gender to address potential disparities.
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Affiliation(s)
- Briar McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Sudhir Raj Thout
- The George Institute for Global Health India, Unit No. 301, Hyderabad, Telangana, India
| | - Claire Johnson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael McLean
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
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Pelzom D, Isaakidis P, Oo MM, Gurung MS, Yangchen P. Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey. BMC Public Health 2017; 17:975. [PMID: 29268747 PMCID: PMC5740865 DOI: 10.1186/s12889-017-4989-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bhutan is currently facing a double burden of non-communicable (NCDs) and communicable diseases, with rising trends of NCDs. The 2014 STEPS survey identified high prevalence of several NCD risk factors; however, associations with socio-demographic characteristics as well as clustering of risk factors were not assessed. This study aimed to determine the distribution and clustering of modifiable NCD risk factors among adults in Bhutan and their demographic and social determinants. METHODS This was secondary analysis of data from NCD Risk Factors WHO STEPS Survey 2014 in Bhutan. A weighted analysis was conducted to calculate the prevalence of NCD risk factors, and associations were explored using weighted log-binomial regression models. RESULTS This study included 2822 Bhutanese aged 18-69 years; 52% were 18-39 years, 62% were female, and 69% were rural resident. Prevalence of high salt intake, unhealthy diet and tobacco use were 99, 67 and 25% respectively. Raised blood pressure was the commonest (36%) modifiable biological risk factor followed by overweight (33%). The median NCD risk factors per person was 3 (Inter Quartile Range: 2-4); 52.5%% had > = 3 risk factors. A statistically significant difference was found between male vs. female in alcohol consumption(aPR 0.71, 95% CI: 0.53-0.97), low physical activity(aPR 2.06, 95% CI: 1.54-2.75), impaired fasting glycaemia(aPR 1.24, 95% CI: 1.01-1.52), and being overweight(aPR 1.46, 95% CI: 1.31-1.63). Low physical activity was more common among those with secondary and above education level vs. those without any formal education(aPR 1.71, 95% CI: 1.24-2.35), and among those residing in urban areas vs. those in rural(aPR 3.43, 95% CI: 2.27-5.18). Older participants and urban residents were more likely to have > = 3 NCD risk factors compared to younger(aPR 1.46, 95% CI: 1.35-1.58) and rural residents(aPR 1.21, 95% CI: 1.10-1.32). CONCLUSION Lifestyle modifications at the population level are urgently required in Bhutan as several NCD risk factors such as high salt intake, unhealthy diet, overweight, and high blood pressure were alarmingly high and frequently clustered. Moreover there is a need to consider policy and socio-political and economic factors that have undermined global and national progress to address the rise of NCDs and their risk factors in Bhutan as elsewhere.
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Affiliation(s)
- Dorji Pelzom
- Health Management and Information System Unit, Policy and Planning Division, Ministry of Health, P.O. 726, Thimphu, Bhutan.
| | - Petros Isaakidis
- Médecins Sans Frontières, Operational Research Unit, Luxembourg City, Luxembourg
| | - Myo Minn Oo
- International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
| | - Mongal Singh Gurung
- Health Management and Information System Unit, Policy and Planning Division, Ministry of Health, P.O. 726, Thimphu, Bhutan
| | - Pemba Yangchen
- Health Management and Information System Unit, Policy and Planning Division, Ministry of Health, P.O. 726, Thimphu, Bhutan
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Johnson C, Santos JA, McKenzie B, Thout SR, Trieu K, McLean R, Petersen KS, Campbell NR, Webster J. The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (September 2016-February 2017). J Clin Hypertens (Greenwich) 2017; 19:928-938. [PMID: 29024455 PMCID: PMC8031093 DOI: 10.1111/jch.13099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/08/2017] [Indexed: 11/10/2023]
Abstract
This periodic review aims to identify, summarize, and appraise studies relating to the implementation of salt reduction strategies that were published between September 2016 and February 2017. A total of 41 studies were included as relevant to the design, assessment, and implementation of salt reduction strategies, and a detailed appraisal was conducted on the seven studies that evaluated the impact of salt reduction strategies. Of these, three were national studies or included large populations and four were conducted in communities with small participant sample sizes. Each study used a different strategy for reducing salt intake varying from category-specific sodium targets for packaged food to use of a low-sodium salt substitute to behavior change interventions. Four studies found statistically significant decreases in dietary salt intake and one study showed statistically significant decreases in mean sodium density of packaged food products. Four of the seven studies used either spot or 24-hour urine samples to measure dietary salt intake and five were conducted in East or Southeast Asia-two of which were in low- and middle-income countries. Study quality varied among the seven studies and all except one had one or more risks related to bias.
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Affiliation(s)
- Claire Johnson
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
| | - Joseph A. Santos
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
| | - Briar McKenzie
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
| | | | - Kathy Trieu
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
| | - Rachael McLean
- Department of Preventive & Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Kristina S. Petersen
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
| | - Norm R.C. Campbell
- Department of MedicinePhysiology and Pharmacology and Community Health SciencesO'Brien Institute for Public HealthUniversity of CalgaryCalgaryABCanada
- Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
| | - Jacqui Webster
- The George Institute for Global HealthCamperdownNSWAustralia
- The University of New South WalesSydneyNSWAustralia
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