Abstract
Reformulation of bread in terms of salt content remains an important measure to help achieve a reduction in salt intake in the population and for the prevention of hypertension and elevated blood pressure (BP). Our fundamental studies on the reduction of salt on dough and bread characteristics showed that wheat breads produced with 0.3 g salt/100 g (“low-salt”) were found to be comparable quality to that produced with the typical level of salt (1.2%). This food-based intervention trial examined, using a 5 week cross-over design, the potential for inclusion of “low-salt” bread as part of a pragmatic reduced-salt diet on BP, markers of bone metabolism, and plasma lipids in 97 adults with slightly to moderately elevated BP. Assuming all sodium from dietary intake was excreted through the urine, the intake of salt decreased by 1.7 g/day, on average, during the reduced-salt dietary period. Systolic BP was significantly lower (by 3.3 mmHg on average; p < 0.0001) during the reduced-salt dietary period compared to the usual-salt dietary period, but there was no significant difference (p = 0.81) in diastolic BP. There were no significant differences (p > 0.12, in all cases) in any of the urinary- or serum-based biochemical indices of calcium or bone metabolism or in plasma lipids between the two periods. In conclusion, a modest reduction in dietary salt intake, in which the use of “low-salt” (i.e., 0.3 g/100g) bread played a key role along with dietary advice, and led to a significant, and clinically meaningful, decrease in systolic, but not diastolic, BP in adults with mildly to moderately elevated BP.
Highlights
Cardiovascular disease (CVD) is the leading global cause of mortality, accounting for just under a third of deaths [1,2]
CVD, especially heart attack and stroke [3,4]. This is of concern given that, based on 2008 data, the global prevalence of raised blood pressure (BP) amongst adults over 25 years is around 40% [2], and is estimated to cause 9.4 million deaths every year — more than half of the estimated 17 million annual deaths caused by total CVD [5]
In terms of treatment effects, the mean daily urinary sodium output during the reduced-salt dietary period was significantly lower (p < 0.0001) than that during the usual dietary period, and assuming all sodium from dietary intake was excreted through the urine, the intake of salt decreased by 1.7 g/day, on average, during the reduced-salt dietary period
Summary
Cardiovascular disease (CVD) is the leading global cause of mortality, accounting for just under a third of deaths [1,2]. With the estimate of CVD-related annual deaths projected to rise to 23.3 million by 2030, the burden of morbidity and mortality from hypertension and related cardiovascular diseases is currently one of the most urgent public health problems globally [6]. While a number of dietary factors play a significant role in the prevention of hypertension and the maintenance of normal BP [7], salt reduction has been identified as one of the most cost-effective interventions for reducing the burden of CVD with the potential for saving millions of lives each year [8]. The WHO’s prioritization of salt reduction in the early
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