Reducing Sodium Intake in Community Meals Programs: Evaluation of the Sodium Reduction in Communities Program, Arkansas, 2016-2019

The incidence, mortality and disease burden of cardiovascular diseases in China: a comparative study with the United States and Japan based on the GBD 2019 time trend analysis

Background

Cardiovascular diseases (CVDs) are not only the primary cause of mortality in China but also represent a significant financial burden. The World Health Organization highlight that as China undergoes rapid socioeconomic development, its disease spectrum is gradually shifting towards that of developed countries, with increasing prevalence of lifestyle-related diseases such as ischemic heart disease and stroke. We reviewed the rates and trends of CVDs incidence, mortality and disability-adjusted life years (DALYs) burden in China and compared them with those in the United States (US) and Japan for formulating CVDs control policies.

Methods

Data on CVDs incidence, death and DALYs in China, the US and Japan were obtained from the GBD 2019 database. The Joinpoint regression model was used to analyze the trends in CVDs incidence and mortality in China, the US and Japan, calculate the annual percentage change and determine the best-fitting inflection points.

Results

In 2019, there were approximately 12,341,074 new diagnosed cases of CVDs in China, with 4,584,273 CVDs related deaths, causing 91,933,122 DALYs. The CVDs age-standardized incidence rate (ASIR) in China (538.10/100,000) was lower than that in the US and globally, while age-standardized death rate (ASDR) (276.9/100,000) and age-standardized DALY rate (6,463.47/100,000) were higher than those in the two regions. Compared with the US and Japan, from 1990 to 2019, the CVDs incidence rate in China showed an increasing trend, with a lower annual decrease in ASDR and a younger age structure of disease burden. Furthermore, the disease spectrum in China changed minimally, with stroke, ischemic heart disease, and hypertensive heart disease being the top three leading CVDs diseases in terms of incidence and disease burden, also being the major causes of CVDs in the US and Japan.

Conclusion

The prevention and control of CVDs is a global issue. The aging population and increasing unhealthy lifestyles will continue to increase the burden in China. Therefore, relevant departments in China should reference the established practices for CVDs control in developed countries while considering the diversity of CVDs in different regions when adjusting national CVDs control programs.

The association between provider encouragement and sodium consumption behaviors

OBJECTIVE

To explore and describe the associations between provider encouragement and four sodium consumption behaviors.

METHODS

We analyzed a 2016 Internet panel survey dataset of 954 socio-demographically diverse adults (age ≥18 years) living in Los Angeles County. Behaviors analyzed were current status of watching one's salt/sodium intake, frequency of adding salt to food, frequency of using a food/Nutrition Facts label to decide what food to purchase, and frequency of changing one's mind about buying a food product due to its sodium content. Multivariable logistic regression analyses examined the relationship between doctor/health professional (provider) encouragement and these sodium-related behaviors, controlling for self-reported health status and sociodemographic characteristics.

RESULTS

Provider encouragement was positively associated with three of the four sodium consumption behaviors examined: currently watching salt/sodium intake (AOR=7.27, 95% CI=3.97-13.34); frequently using a food/Nutrition Facts label (AOR=1.70, 95% CI=1.09-2.64); and frequently changing one's mind about buying a food product due to its sodium content (AOR=2.29, 95% CI=1.45-3.63).

CONCLUSIONS

Provider encouragement appears to have a salutary impact on sodium consumption among residents.

PRACTICE IMPLICATIONS

Provider encouragement may represent an underutilized strategy for counseling patients about cardiovascular health and about the benefits of reducing sodium consumption.

Reducing Sodium Content of Foods Served in Arkansas's Largest School District: Evaluation of the Sodium Reduction in Communities Program

Purpose and Objectives

The Centers for Disease Control and Prevention’s Sodium Reduction in Communities Program aims to reduce dietary sodium intake through policy, systems, and environmental approaches. The objective of our study was to evaluate changes in sodium levels over 5 years (2016–2021) in food served in school lunches as an outcome of a Sodium Reduction in Communities program in Arkansas’s largest school district.

Intervention Approach

We collaborated with Springdale Public Schools (SPS) to reduce dietary sodium intake in school lunches through increased implementation of 1) food service guidelines, 2) procurement practices, 3) food preparation practices, and 4) environmental strategies. These activities were maintained from year 1 through year 5. Implementation priorities were informed each year by evaluation findings from the preceding year.

Evaluation Methods

We collected lunch service records and information on nutritional content of menu items for the 30 schools under the direction of SPS’s Child Nutrition Department. We used a pretest–posttest quantitative evaluation design to analyze annual changes in the sodium content of meals, from baseline through year 5.

Results

From baseline through year 1, SPS reduced sodium served per diner, per entrée offered, and per entrée served. These reductions were maintained from baseline through 5 years of follow-up. Mean sodium per 1,000 kcal per diner served was 1,740 mg at baseline and was lower in each of the 5 follow-up years: 1,488 mg (14% decrease) in year 1; 1,495 mg (14% decrease) in year 2; 1,612 mg (7% decrease) in year 3; 1,560 mg (10% decrease) in year 4; and 1,532 mg (12% decrease) in year 5. Energy served per diner remained stable.

Implications for Public Health

Our study provides evidence for sustained sodium reduction strategies in a large ethnically and socioeconomically diverse school district, pointing to the potential benefit of implementing similar strategies in other school districts. The study also shows how program evaluation can be used to support sustainability.