Reduced Sodium Levels Research Articles

MIXED TOMATO AND SWEET STARFRUIT JUICE AGAINST THE FAMILY PLANNINGACCEPTOR'S BLOOD PRESSURE

Hypertension can be referred to as a condition when the systolic blood pressure exceeds 140 mmHg and the diastolic blood pressureexceeds 90 mmHg, as measured on two occasions with a five-minute interval, while the individual is in a state of sufficient rest andcalm. The use of 3-month injectable birth control containing progesterone can increase blood pressure. Increased blood pressure inbirth control participants can be overcome pharmacologically and non-pharmacologically. The aim of the investigation was to analyzethe administration of a mixture of tomato juice (Solanum lycopersicum) and star fruit (Averrhoa carambola L.) Against lowering bloodpressure in injectable Kb acceptors for 3 months. The research design used an experimental approach one group pretest and posttest.Sampling technique with purposive sampling, the number of samples is 30 people. The statistical test employed is the t-test. Theresearch showed 24 (80%) respondents had a decrease in blood pressure and 6 (20%) respondents had a fixed blood pressure withan average systole change of 130.00 mmHg and diastole 85.17 mmHg. The findings of Paired Samples T-Test obtained a significancevalue of 0.000 (p < 0.05) which means that there is an influence of giving a mixture of Tomato Juice (Solanum lycopersicum) and StarFruit (Averrhoa Carambola L.) At acceptor kb inject 3 months. This is influenced by the content of potassium as an antidiuretic so thatit can reduce sodium levels in the urine by the kidneys

Exogenous Hydrogen Sulfide Supplementation Alleviates the Salinity-Stress-Mediated Growth Decline in Wheat (Triticum aestivum L.) by Modulating Tolerance Mechanisms.

The impact of the exogenous supplementation of hydrogen sulfide (20 and 50 µM HS) on growth, enzyme activity, chlorophyll pigments, and tolerance mechanisms was studied in salinity-stressed (100 mM NaCl) wheat. Salinity significantly reduced height, fresh and dry weight, chlorophyll, and carotenoids. However, the supplementation of HS (at both concentrations) increased these attributes and also mitigated the decline to a considerable extent. The exogenous supplementation of HS reduced the accumulation of hydrogen peroxide (H2O2) and methylglyoxal (MG), thereby reducing lipid peroxidation and increasing the membrane stability index (MSI). Salinity stress increased H2O2, MG, and lipid peroxidation while reducing the MSI. The activity of nitrate reductase was reduced due to NaCl. However, the supplementation of HS alleviated the decline with obvious effects being seen due to 50 µM HS. The activity of antioxidant enzymes (superoxide dismutase, catalase, ascorbate peroxidase, and glutathione reductase) was assayed and the content of reduced glutathione (GSH) increased due to salt stress and the supplementation of HS further enhanced their activity. A decline in ascorbic acid due to salinity stress was alleviated due to HS treatment. HS treatment increased the endogenous concentration of HS and nitric oxide (NO) under normal conditions. However, under salinity stress, HS supplementation resulted in a reduction in HS and NO as compared to NaCl-treated plants. In addition, proline and glycine betaine increased due to HS supplementation. HS treatment reduced sodium levels, while the increase in potassium justified the beneficial role of applied HS in improving salt tolerance in wheat.

Changes in sodium levels in Australian packaged foods between 2014 and 2019: an interrupted time series analysis of the impact of the Victorian Salt Reduction Partnership’s media advocacy strategy

BackgroundThe Victorian Salt Reduction Partnership (VSRP) implemented a media advocacy strategy (intervention) to stimulate food manufacturers to reduce sodium levels across targeted Australian packaged foods between 2017 and 2019. This study assessed changes in sodium levels of targeted and non-targeted packaged foods during the intervention (2017 to 2019) compared to before the intervention (2014 to 2016) in Australia.MethodsAnnually collected branded-food composition data from 2014 to 2019 were used. Interrupted time series analyses was conducted to compare the trend in sodium levels in packaged foods during the intervention (2017–2019) to the trend in the pre-intervention period (2014–2016). The difference between these trends was derived to estimate the effect of the intervention.ResultsA total of 90,807 products were included in the analysis, of which 14,743 were targeted by the intervention. The difference in before and during intervention trends between targeted and non-targeted food categories was 2.59 mg/100 g (95% CI: -13.88 to 19.06). There was a difference in the pre-intervention slope (2014, 2015, 2016) and intervention slope (2017, 2018, 2019) for four of 17 targeted food categories. There was a decrease in sodium levels (mg/100 g) in one food category: frozen ready meals (-13.47; 95% CI: -25.40 to -1.53), and an increase in three categories: flat bread (20.46; 95% CI: 9.11 to 31.81), plain dry biscuits (24.53; 95% CI: 5.87 to 43.19), and bacon (44.54; 95% CI: 6.36 to 82.72). For the other 13 targeted categories, the difference in slopes crossed the line of null effect.ConclusionsThe VSRP’s media advocacy strategy did not result in a meaningful reduction in sodium levels of targeted packaged food products during the intervention years compared to trends in sodium levels before the intervention. Our study suggests media advocacy activities highlighting the differences in sodium levels in packaged food products and industry meetings alone are not sufficient to lower average sodium levels in packaged foods in the absence of government leadership and measurable sodium targets.

Sodium content of menu items in New York City chain restaurants following enforcement of the sodium warning icon rule, 2015-2017.

In 2016, New York City (NYC) began enforcing a sodium warning regulation at chain restaurants, requiring placement of an icon next to any menu item containing ≥2,300 mg sodium. As menu labeling may improve menu nutritional composition, we investigated whether sodium content of menu items changed following enforcement of the sodium warning icon. All menu offerings at 10 quick-service (QSR) and 3 full-service (FSR) chain restaurants were photographed in 2015 (baseline) and 2017 (follow-up) and matched to nutritional information from restaurant websites; items were categorized as being available at both baseline and follow-up, or at only one timepoint. Linear and logistic regression models, respectively, assessed changes in calculated mean sodium-per-serving per menu item and the odds of an item containing ≥2,300 mg sodium. At baseline, mean per-serving sodium content was 2,160 mg at FSR and 1,070 mg at QSR, and 40.6% of FSR items and 7.2% of QSR items contained ≥2,300 mg sodium per serving. Sodium content did not differ when comparing all items offered at follow-up to all offered at baseline (21 mg, 95% CI: -60,101), or when comparing new versus discontinued items (17 mg, 95% CI: -154, 187). At follow-up, there was no change in the overall likelihood of items requiring a warning icon (OR = 1.32, 95% CI: 0.97,1.79), or when comparing new versus discontinued items (OR = 2.08, 95% CI: 1.02,4.24) (p = 0.04, not significant following Bonferroni correction for multiple analyses). Our findings that the sodium content of menu items did not change following the sodium warning icon regulation underscore difficulties in reducing sodium levels in restaurants; however, our results may be limited by follow-up data collection occurring less than one year post-enforcement. It may take additional time and similar action from other jurisdictions for restaurants to reduce the sodium content of menu items.

RF32 | PSUN50 Hypertriglyceridemia as an Independent Risk Factor on Outcomes of Admissions for SIADH

Abstract Introduction The syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) is one of the most significant causes of potentially life-threatening hyponatremia. Hypertriglyceridemia (HTG), on the other hand, is one of the few disorders that spuriously reduce sodium levels and should be ruled out in the evaluation of patients with hyponatremia. Very scant literature exists on the coexistence of both conditions, and even less literature compares outcomes in patients with concomitant SIADH and HTG. Method We extracted data from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years were excluded. We then sub-divided the cohort based on the presence/absence of a secondary diagnosis of HTG. Outcomes compared include inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of comorbid septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), and acute pulmonary edema (PE) between the subgroups. An adjustment was made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results There were 39,110 hospitalizations involving patients with SIADH as the reason for the admission in 2019. Of these hospitalizations, 41.8% had comorbid HTG. A higher proportion of SIADH hospitalizations involved females, with no significant difference between both cohorts (61 vs 62.7%, p=0.119). Patients with HTG had a higher mean age (75.8±11.1 vs 70.4±14.4 years, p<0.001), a higher proportion of CCI >2, and a higher proportion of ethnic minorities compared to patients without HTG. Hospitalizations for SIADH with comorbid HTG were associated with lower adjusted odds ratio (aOR) for mortality (0.7 vs 1.4% in patients with HTG, aOR: 0.42, p<0.001), reduced LOS (4.9 vs 5 days, p=0.002), and reduced THC (10,263 vs 11,013 US$, p=0.005). There was no difference in the odds of comorbid septic shock, CVA, AMI, PE, ARF or AKI. Conclusions Interestingly, comorbid HTG lowered odds of mortality, LOS, and THC amongst patients hospitalized for SIADH. More studies should be carried out to investigate this rather paradoxical relationship with a view to defining a better understanding and devising more therapeutic strategies for both conditions. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:48 p.m. - 12:53 p.m.

Sodium Reduction in Bouillon: Targeting a Food Staple to Reduce Hypertension in Sub-saharan Africa.

Bouillon cubes are a staple ingredient used in Sub-saharan African countries providing flavor enhancement to savory foods. Bouillon has been identified as a vehicle for fortification to overcome micronutrient deficiencies in Sub-saharan Africa. However, bouillon has a high sodium content (and in addition with other foods) contributes to dietary sodium intake above recommended guidelines. High dietary sodium intake is a key risk factor for hypertension and cardiovascular disease (CVD). Africa has the highest rates of hypertension and CVD globally with nearly half the adult population above 25 years affected. This review presents current state of research on sodium reduction strategies in bouillon. The key challenge is to reduce sodium levels while maintaining optimal flavor at the lowest possible production cost to ensure bouillon continues to be affordable in Sub-saharan Africa. To produce lower sodium bouillon with acceptable flavor at low cost will likely involve multiple sodium reduction strategies; direct reduction in sodium, sodium replacement and saltiness boosting flavor technologies. Efforts to reduce the sodium content of bouillon in Sub-saharan Africa is a worthwhile strategy to: (i) lower the overall sodium consumption across the population, and (ii) deliver population-wide health benefits in a region with high rates of hypertension and CVD.

Effect of Salt Substitution on Cardiovascular Events and Death

BackgroundSalt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on cardiovascular and safety outcomes are uncertain.MethodsWe conducted an open-label, cluster-randomized trial involving persons from 600 villages in rural China. The participants had a history of stroke or were 60 years of age or older and had high blood pressure. The villages were randomly assigned in a 1:1 ratio to the intervention group, in which the participants used a salt substitute (75% sodium chloride and 25% potassium chloride by mass), or to the control group, in which the participants continued to use regular salt (100% sodium chloride). The primary outcome was stroke, the secondary outcomes were major adverse cardiovascular events and death from any cause, and the safety outcome was clinical hyperkalemia.ResultsA total of 20,995 persons were enrolled in the trial. The mean age of the participants was 65.4 years, and 49.5% were female, 72.6% had a history of stroke, and 88.4% a history of hypertension. The mean duration of follow-up was 4.74 years. The rate of stroke was lower with the salt substitute than with regular salt (29.14 events vs. 33.65 events per 1000 person-years; rate ratio, 0.86; 95% confidence interval [CI], 0.77 to 0.96; P=0.006), as were the rates of major cardiovascular events (49.09 events vs. 56.29 events per 1000 person-years; rate ratio, 0.87; 95% CI, 0.80 to 0.94; P<0.001) and death (39.28 events vs. 44.61 events per 1000 person-years; rate ratio, 0.88; 95% CI, 0.82 to 0.95; P<0.001). The rate of serious adverse events attributed to hyperkalemia was not significantly higher with the salt substitute than with regular salt (3.35 events vs. 3.30 events per 1000 person-years; rate ratio, 1.04; 95% CI, 0.80 to 1.37; P=0.76).ConclusionsAmong persons who had a history of stroke or were 60 years of age or older and had high blood pressure, the rates of stroke, major cardiovascular events, and death from any cause were lower with the salt substitute than with regular salt. (Funded by the National Health and Medical Research Council of Australia; SSaSS ClinicalTrials.gov number, NCT02092090.)

Strategies to reduce sodium levels in European seabass sausages

Considering the increasing demand towards “ready-to-cook” processed seafood products, recognised as being potential contributors to high sodium (Na) intake by consumers, this study aimed to assess the effect of sodium chloride (NaCl) reduction on physicochemical, microbiological and sensory properties of European seabass (Dicentrarchus labrax) sausages stored in chilling conditions during 5 weeks. Three formulations were tested in comparison with a control (100% NaCl, CTR): (i) 50% NaCl+50% ME (oleoresins microcapsules) (F1); (ii) 50% NaCl+50% KCl (F2); and (iii) only 50% NaCl (F3). The NaCl reduction mainly affected the texture and the salty taste, resulting in softer and perceived as less salty sausages after processing. However, hardness differences disappeared after 5 weeks. It seems that an antioxidant protection was obtained in sausages formulated with oleoresins microcapsules. No or low growth of psychrotrophic and mesophilic bacteria was observed (≤2.40 log CFU/g). Decreasing NaCl content and/or partially replacing it (50%) by KCl or oleoresins microcapsules seem to be suitable solutions to reduce Na (30.9–36.3%) levels, while maintaining the chilled sausages quality for 5 weeks. The partial replacement of NaCl by KCl also allows obtaining a product richer in K (997.2 mg/100 g), which ingestion may contribute for a cardiovascular protective effect.

Thermodynamic description of the chemical leavening in biscuits

In this paper we describe the chemical reactions of leavening agents in baking biscuits on a sound thermodynamic basis. The model is part in a sequel targetted at physical understanding of biscuit baking with the purpose of reformulation of biscuits with respect to sucrose and sodium levels. The chemical leavening gases, CO2 and NH3, originate from the dissociation of sodium and ammonium bicarbonate. Next to water vapour, these produced gases create gas bubbles in the biscuit dough. The concentrations of the leavening agents and added salt lead to high ionic strength. Consequently, the activities of ions participating in the leavening reaction deviate strongly from ideality. The non-idealities are described using the Pitzer equations. The values of many parameters of the Pitzer model and equilibrium constants are obtained from the strong developed field of CO2 sequestering in ammonia solutions. The model describing the chemical reactions is coupled to a cell model describing the expansion of gas bubbles. Model simulations show that most of the produced gas originates from the bicarbonate, and the ammonium contributes significantly less. The functionality of ammonium as leavening agent is not quite clear, but it may help in reducing sodium levels.

Bio-therapeutics effects of probiotic strain on the gastrointestinal health of severely acute malnourished children

The core objective was to evaluate the effect of probiotic fortification at three phases of formula milk administration in malnourished children. A dose related effect was determined in 30 severely acute malnourished children (6-59 months) in a double-blind, randomized design. According to the results, serum albumin levels, treatment T2 (6 billion cfu) has significantly increased albumin levels (3.7g/dL) and the effect of phase-III (Plumpy'nut) was found to be better. Results regarding sodium levels showing probiotic-dose have significant effect (P≤0.05) in phases as well. Moreover, the effect of T1 i.e. 3 billion cfu of probiotics has significantly reduced sodium levels (141.8mmol/L) vs. others and the effect of phase-II was better on reducing sodium levels. which is further confirmed in terms of reduced erythrocyte sedimentation rate levels at phase-III (29.566 vs. phase-II, 41.3 and phase-I, 46.533 mm/h). Conclusively, the effect of 6 billion cfu at phase-III was more effective on blood parameters.

Evaluation of significance of hyponatremia in hypothyroidism in an urban female population of Eastern India: A cross-sectional study

Background: Hypothyroid patients may have reduced sodium levels, but the strength of such a link is still not clearly defined. Aims: This study aims to evaluate the significance of hyponatremia in hypothyroidism in an urban young female population of eastern India. Materials and Methods: This cross-sectional study was conducted on 200 hypothyroid patients in Burdwan Medical College in a period of 12 months after taking Institutional Ethical Clearance. 100 controls were taken for the study. Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and sodium levels were estimated. The individuals were age matched. The computer software Statistical Package for the Social Sciences, version 16.0 was used for analyzing data. Results: 200 hypothyroid patients were enrolled for the study. 31 hypothyroid patients presented with reduced serum sodium level (15.5%). Significant difference was observed between controls and hypothyroid patients for mean TSH (P < 0.0001), mean FT4 (P < 0.0001), and mean sodium (P < 0.0001). No significant difference of age was observed between two groups. Serum sodium level was negatively correlated with TSH (r: -0.59, P < 0.00001), and serum sodium was positively correlated with serum FT4 (r: 0.29, P: <0.0000). Conclusions: Hypothyroid females in reproductive age group may have significant decrease in serum sodium levels as compared to normal individuals, and serum sodium needs to be estimated in hypothyroid patients for better management of patients.

Technological and sensory analysis of beef burger replacing NaCl with KCl and flavor enhancer

High sodium consumption may increase the risk of hypertension. ANVISA has proposed reducing sodium levels in food, but this may reduce consumer acceptance. This study investigated the technological and sensory profile of samples of beef burger replacing NaCl with KCl added flavor enhancers, namely: CON (100% NaCl), F50 (50% NaCl and KCl + PuraQ®Arome NA4), and F60 (40% NaCl and 60% KCl + PuraQ®Arome NA4). Physicochemical, technological, microbiological and sensory parameters of the formulations were evaluated. There was no difference between formulations in microbiological, physicochemical and technological parameters. For color analysis, F60 reduced to the coordinate a* and raised b* compared to the CON. In sensory analysis, F60 reduced the flavor attribute compared to the CON. PuraQ® minimized the salty perception of the F50, however, but did not avoid the residual flavor in the F60. The principal component analysis associated the attributes with the formulations as follows: succulent and ideal seasoning (CON), soft and without salt (F50), and salty and residual flavor (F60). It was concluded that the reduction of 50% of NaCl added enhancer was better accepted by consumers, being a promising strategy in reducing sodium in burgers.

Sodium in different processed and packaged foods: Method validation and an estimative on the consumption.

Excessive sodium (Na) consumption can lead to serious health problems such as hypertension, and cardiovascular and renal diseases. Therefore, the food industry in worldwide has been trying to reduce sodium levels in processed products. The aim of this study was to validate a method and quantify sodium in processed and packaged foods and to estimate its ingestion in the consumption. In the first step, for choose the adequate analytical procedure different samples preparations (mineralization) were evaluated as wet and dry ash mineralization, as well as CsCl concentration to suppress chemical interferences for apply FAAS technique. The best performance conditions were applied for the analytical method validation: mineralization by wet digestion and adding 0.1% CsCl, which characterized the method as simple and low cost. The method was validated and was applied in 12 different processed food matrices (5 brands, 3 batches), including products of vegetable and animal origins, different majority components and interferences for Na evaluation. The results showed that sausage, hamburger, ham, bread, tomato sauce, ketchup, mustard, mayonnaise and mashed potato were classified as high-sodium foods, with mean values above 460mg 100g-1. It was verified that 68% of the samples were regarded as having high sodium content and the maximum value found was 2851mg 100g-1 for a sample of mashed potatoes. In addition, it was found that 38% of the samples presented differences in Na concentration when compared to content declared on the label. It is also observed that is possible different sodium ingestion according the combinations of processed and packaged foods in the same meal and, in this case, the sodium consumption is above than the daily value as recommended by the regulatory agencies. It was concluded that the majority of processed and packaged foods presented high sodium concentration even with efforts of the food industry to reduce the levels of this mineral and its remains an important public health problem.

FDA Sodium Reduction Targets and the Food Industry: Are There Incentives to Reformulate? Microsimulation Cost-Effectiveness Analysis.

Policy Points The World Health Organization has recommended sodium reduction as a “best buy” to prevent cardiovascular disease (CVD). Despite this, Congress has temporarily blocked the US Food and Drug Administration (FDA) from implementing voluntary industry targets for sodium reduction in processed foods, the implementation of which could cost the industry around $16 billion over 10 years.We modeled the health and economic impact of meeting the two‐year and ten‐year FDA targets, from the perspective of people working in the food system itself, over 20 years, from 2017 to 2036.Benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, and the value of CVD‐related health gains and cost savings are together greater than the government and industry costs of reformulation. ContextThe US Food and Drug Administration (FDA) set draft voluntary targets to reduce sodium levels in processed foods. We aimed to determine cost effectiveness of meeting these draft sodium targets, from the perspective of US food system workers.MethodsWe employed a microsimulation cost‐effectiveness analysis using the US IMPACT Food Policy model with two scenarios: (1) short term, achieving two‐year FDA reformulation targets only, and (2) long term, achieving 10‐year FDA reformulation targets.We modeled four close‐to‐reality populations: food system “ever” workers; food system “current” workers in 2017; and subsets of processed food “ever” and “current” workers. Outcomes included cardiovascular disease cases prevented and postponed as well as incremental cost‐effectiveness ratio per quality‐adjusted life year (QALY) gained from 2017 to 2036.FindingsAmong food system ever workers, achieving long‐term sodium reduction targets could produce 20‐year health gains of approximately 180,000 QALYs (95% uncertainty interval [UI]: 150,000 to 209,000) and health cost savings of approximately $5.2 billion (95% UI: $3.5 billion to $8.3 billion), with an incremental cost‐effectiveness ratio (ICER) of $62,000 (95% UI: $1,000 to $171,000) per QALY gained. For the subset of processed food industry workers, health gains would be approximately 32,000 QALYs (95% UI: 27,000 to 37,000); cost savings, $1.0 billion (95% UI: $0.7bn to $1.6bn); and ICER, $486,000 (95% UI: $148,000 to $1,094,000) per QALY gained. Because many health benefits may occur in individuals older than 65 or the uninsured, these health savings would be shared among individuals, industry, and government.ConclusionsThe benefits of implementing the FDA voluntary sodium targets extend to food companies and food system workers, with the value of health gains and health care cost savings outweighing the costs of reformulation, although not for the processed food industry.

Bread Consumption Is Associated with Elevated Blood Pressure among Adults Living in Mexico City⁻A Sub-Analysis of the Tlalpan 2020 Study.

Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01–1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53–0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level.

Evaluation of Australian soup manufacturer compliance with national sodium reduction targets.

Packaged foods dominate Australia's food supply and are important contributors to nutrition-related disease. To help address this problem, the Food and Health Dialogue (FHD) was launched in 2009, setting voluntary sodium reduction targets for various categories of packaged foods. The aim of this study was to examine the food industry's progress and compliance with the FHD sodium reduction targets for soup products. Nutritional information was collected from product labels of all soup products available from four major Australian supermarkets annually between 2011 and 2014. Products were assigned to categories in line with those in the FHD. The proportion of soup products meeting sodium reduction targets was examined by (i) soup category; (ii) FHD participant status; and (iii) manufacturer. A 6% reduction in sodium levels in soups overall was found from 2011 to 2014 (P = 0.002). Significant reductions were observed for FHD participants (P < 0.05 for all) but not for non-participants. In 2014, 67% dry soups and 76% of wet soups met national sodium reduction targets. Despite the majority of soup products meeting the sodium reduction targets specified by the FHD, re-evaluation of the targets may be required to further reduce sodium levels in soups. Manufacturers participating in the FHD are likely to be driving sodium reductions in the Australian soup market, further highlighting the need for continued government leadership in this area to ensure all manufacturers are actively involved in the process.

Perceived Sodium Reduction Barriers Among Patients with Chronic Kidney Disease: Which Barriers Are Important and Which Patients Experience Barriers?

PurposeThe purposes of this study were to assess the importance of perceived sodium reduction barriers among patients with chronic kidney disease (CKD) and identify associated sociodemographic, clinical, and psychosocial factors.MethodA total of 156 patients with CKD completed a questionnaire assessing sodium reduction barriers (18 self-formulated items), depressive symptoms (Beck Depression Inventory), perceived autonomy support (Modified Health Care Climate Questionnaire), and self-efficacy (Partners in Health Questionnaire). Factor analysis was used to identify barrier domains. Correlation coefficients were computed to examine relationships between barrier domains and patient characteristics.ResultsNine barrier domains were identified. Barriers perceived as important were as follows: high sodium content in products, lack of sodium feedback, lack of goal setting and discussing strategies for sodium reduction, and not experiencing CKD-related symptoms (mean scores > 3.0 on 5-point scales, ranging from 1 ‘no barrier’ to 5 ‘very important barrier’). Other barriers (knowledge, attitude, coping skills when eating out, and professional support) were rated as moderately important (rated around midpoint), and the barrier ‘intrinsic motivation’ was rated as somewhat important (mean score = 1.9). Sodium reduction barrier domains were not associated with gender and kidney function, but were associated with age, level of education, number of comorbidities, perceived autonomy support, depressive symptoms, and self-efficacy (range r = 0.17–0.35). Patients with lower self-efficacy and perceived autonomy support scores experienced most sodium reduction barriers.ConclusionPatients with CKD experience multiple important sodium reduction barriers and could benefit from support strategies that target various sodium reduction barriers and strengthen beliefs regarding self-efficacy and autonomy support. Additionally, environmental interventions should be implemented to reduce sodium levels in processed foods.

Drinking Water Salinity and Raised Blood Pressure: Evidence from a Cohort Study in Coastal Bangladesh.

Background:Millions of coastal inhabitants in Southeast Asia have been experiencing increasing sodium concentrations in their drinking-water sources, likely partially due to climate change. High (dietary) sodium intake has convincingly been proven to increase risk of hypertension; it remains unknown, however, whether consumption of sodium in drinking water could have similar effects on health.Objectives:We present the results of a cohort study in which we assessed the effects of drinking-water sodium (DWS) on blood pressure (BP) in coastal populations in Bangladesh.Methods:DWS, BP, and information on personal, lifestyle, and environmental factors were collected from 581 participants. We used generalized linear latent and mixed methods to model the effects of DWS on BP and assessed the associations between changes in DWS and BP when participants experienced changing sodium levels in water, switched from “conventional” ponds or tube wells to alternatives [managed aquifer recharge (MAR) and rainwater harvesting] that aimed to reduce sodium levels, or experienced a combination of these changes.Results:DWS concentrations were highly associated with BP after adjustments for confounding factors. Furthermore, for each reduction in sodium in drinking water, systolic/diastolic BP was lower on average by , and odds of hypertension were lower by 14%. However, MAR did not consistently lower sodium levels.Conclusions:DWS is an important source of daily sodium intake in salinity-affected areas and is a risk factor for hypertension. Considering the likely increasing trend in coastal salinity, prompt action is required. Because MAR showed variable effects, alternative technologies for providing reliable, safe, low-sodium fresh water should be developed alongside improvements in MAR and evaluated in “real-life” salinity-affected settings. https://doi.org/10.1289/EHP659

“The safety of sodium reduction in the food supply: A cross-discipline balancing act”—Workshop proceedings

ABSTRACTThis workshop, jointly presented by the ILSI North America Technical Committees on Food Microbiology and Sodium, aimed to provide greater knowledge and appreciation of the opportunities and challenges facing the food industry in answering the public health community's call to reduce sodium levels in the food supply. One major challenge is finding effective substitutes for the various antimicrobial and functional roles that sodium plays across different food categories. Sodium plays a critical role in retarding the growth of pathogens and food spoilage bacteria. Moreover, taste is an important factor for consumers when they choose food products, and the flavor changes that occur when salt is reduced or replaced must be considered and ingredients and processes adjusted accordingly. The workshop provided a platform for a multidisciplinary discussion among the microbiology, food science, nutrition, and public health communities to share progress and propose solutions, including the formation of public-private partnerships, to develop coordinated and comprehensive strategies. This paper provides an overview of the issues raised, rather than a specific summary of workshop discussions. The Food and Drug Administration's Draft Guidance for Industry on voluntary sodium reduction and the 2015 US Dietary Guidelines for Americans were released subsequent to the workshop and are also discussed.

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment.

Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L). The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly.