Reduce Sodium Intake Research Articles

Contribution of major food companies and their products to household dietary sodium purchases in Australia

BackgroundThe Australian federal government will soon release voluntary sodium reduction targets for 30 packaged food categories through the Healthy Food Partnership. Previous assessments of voluntary targets show variable industry engagement, and little is known about the extent that major food companies and their products contribute to dietary sodium purchases among Australian households.MethodsThe aim of this cross-sectional study was to identify the relative contribution that food companies and their products made to Australian household sodium purchases in 2018, and to examine differences in sodium purchases by household income level. We used 1 year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with database that contains product-specific sodium content for packaged foods and beverages (FoodSwitch). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Differences in per capita sodium purchases by income levels were assessed by 1-factor ANOVA. All analyses were modelled to the Australian population in 2018 using sample weights.ResultsSodium data were available from 7188 households who purchased 26,728 unique products and purchased just under 7.5 million food product units. Out of 1329 food companies, the top 10 accounted for 35% of unique products and contributed to 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, particularly driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased significantly more sodium from packaged products than high-income households per capita (452 mg/d, 95%CI: 363-540 mg/d, P < 0.001).ConclusionsA small number of food companies and food categories account for most of the dietary sodium purchased by Australian households. Prioritizing government engagement with these groups could deliver a large reduction in population sodium intake.

Dietary Potassium Downregulates Angiotensin-I Converting Enzyme, Renin, and Angiotensin Converting Enzyme 2.

BackgroundThe importance of dietary potassium in health and disease has been underestimated compared with that placed on dietary sodium. Larger effort has been made on reduction of sodium intake and less on the adequate dietary potassium intake, although natural food contains much more potassium than sodium. The benefits of a potassium-rich diet are known, however, the mechanism by which it exerts its preventive action, remains to be elucidated. With the hypothesis that dietary potassium reduces renal vasoconstrictor components of the renin-angiotensin system in the long-term, we studied the effect of high potassium diet on angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2.MethodsSprague Dawley male rats on a normal sodium diet received normal potassium (0.9%, NK) or high potassium diet (3%, HK) for 4 weeks. Urine was collected in metabolic cages for electrolytes and urinary volume measurement. Renal tissue was used to analyze angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2 expression. Protein abundance analysis was done by Western blot; gene expression by mRNA levels by RT-qPCR. Renal distribution of angiotensin-I converting enzyme and renin was done by immunohistochemistry and morphometric analysis in coded samples.ResultsHigh potassium diet (4 weeks) reduced the levels of renin, angiotensin-I converting enzyme, and angiotensin converting enzyme 2. Angiotensin-I converting enzyme was located in the brush border of proximal tubules and with HK diet decreased the immunostaining intensity (P < 0.05), decreased the mRNA (P < 0.01) and the protein levels (P < 0.01). Renin localization was restricted to granular cells of the afferent arteriole and HK diet decreased the number of renin positive cells (P < 0.01) and renin mRNA levels (P < 0.01). High potassium intake decreased angiotensin converting enzyme 2 gene expression and protein levels (P < 0.01).No morphological abnormalities were observed in renal tissue during high potassium diet.The reduced expression of angiotensin-I converting enzyme, renin, and angiotensin converting enzyme 2 during potassium supplementation suggest that high dietary potassium intake could modulate these vasoactive enzymes and this effects can contribute to the preventive and antihypertensive effect of potassium.

Use of Response Surface Methodology to Investigate the Effects of Sodium Chloride Substitution with Potassium Chloride on Dough’s Rheological Properties

Bakery products are one of the main sources of dietary sodium intake of the world’s population. During the last decade, sodium intake has increased worldwide and nowadays the World Health Organization recommends reducing sodium intake by up to 2 g Na/day. KCl is the leading substitute for reducing sodium in bakery products. Therefore, the main purpose of our study was to investigate the impact of sodium reduction on dough’s rheological properties by reformulating the dough recipe using two types of salts, namely NaCl and KCl, with different amounts added to wheat flour. In order to establish their combination for obtaining the optimum rheological properties of dough, the response surface methodology (RSM) by the Design Expert software was used. The effect of combined NaCl and KCl salts were made on mixing, viscometric and fermentation process by using Farinograph, Extensograph, Amylograph and Rheofermentometer devices. On dough’s rheological properties, KCl and NaCl presented a significant effect (p &lt; 0.01) on water absorption, stability, energy, dough resistance to extension, falling number and all Rheofermentometer-analyzed values. Mathematical models were achieved between independent variables, the KCl and NaCl amounts, and the dependent ones, dough rheological values. The optimal values obtained through RSM for the KCl and NaCl salts were of 0.37 g KCl/100 g and 1.31 g NaCl/100 g wheat flour, which leads to a 22% replacement of NaCl in the dough recipe.

Contribution of Major Food Companies and Their Products to Household Dietary Sodium Purchases in Australia

Abstract Objectives To support the work of the Australian federal governments proposed sodium reformulation targets, this study sought to identify the relative contribution that different food companies and their products make to household sodium purchases in Australia. We also examined differences in household sodium purchases from packaged foods and beverages by income level. Methods We used one year of grocery purchase data from a nationally representative consumer panel of Australian households who reported their grocery purchases (the Nielsen Homescan panel), combined with a packaged food and beverage database (FoodSwitch) that contains brand- and product-specific sodium information. Outcome measures were sodium purchases per capita (mg/day), sodium density (mg/1000 kcal), and purchase-weighted sodium content (mg/100 g). The top food companies and food categories were ranked according to their contribution to household sodium purchases. Per capita sodium purchases was estimated in household income strata. All analyses were modeled to the Australian population in 2018 using sample weights. Results Sodium data were available from 7188 households who purchased 26,728 unique products and, in total, just under 7.5 million units of foods and beverages. The total sodium acquired from packaged foods and beverages was 1443 mg/day per capita. Out of 1329 food companies, the top 10 accounted for 58% of all sodium purchased from packaged foods and beverages. The top three companies were grocery food retailers each contributing 12–15% of sodium purchases from sales of their private label products, particularly processed meat, cheese and bread. Out of the 67 food categories, the top 10 accounted for 73% of sodium purchased, driven by purchases of processed meat (14%), bread (12%) and sauces (11%). Low-income Australian households purchased substantially more sodium from packaged products than high-income households per capita (220 mg/d, 95% CI: 132–307 mg/d, P &amp;lt; 0.001). Conclusions A small number of food companies and food categories account for the majority of dietary sodium purchased by Australian households. There is an opportunity for governments to prioritize engagement and incentivize key companies and food categories to deliver a large reduction in sodium intake and reduce cardiovascular disease. Funding Sources National Health and Medical Research Council.

Sodium and Sugar Intake Comparison Among Participants of the USDA National School Lunch Program Versus Non-Participants Based on 2015–2016 NHANES Survey

Abstract Objectives The National School Lunch Program (NSLP) surveys the overall health and well-being of participants nationwide. To address rising obesity rates in the US, the USDA implemented revisions in 2010 to the NSLP targeting sodium and sugar intake reduction. Our objective was to compare intake of sodium and sugar between NSLP participants and non-NSLP participants. Methods Data from 2015–2016 NHANES survey were analyzed, which is after the implementations of the USDA revisions. All children (4–15 years) with two 24-hr dietary recalls were included. Mean intake for sugar and sodium were computed between the 2 recalls. NSLP participants were those who reported 2–5 school lunches per week whereas those reporting one school lunch per week or none were considered as not participating. Analyses were stratified by the following ages groups: 4–8y; 9–13y; and 14–15y. ANCOVA, adjusted for gender, was used to compare normalized intakes of sugar and sodium. Results A total of 1370 children were included (49% were females). Sugar intake was similar between NSLP or non-NSLP participants in children 4–8y. In children 9–13y, sugar intake was higher in NSLP participants (101 ± 2.31 g/d) versus non-NSLP participants (95.2 ± 1.94 g/d; P = 0.010) but lower in children 14–15y in NSLP participants (95.7 ± 2.44 g/d) versus non-NSLP participants (106 ± 2.67 g/d; P = 0.022). Sodium intake was higher in NSLP participants (2731 ± 8.64 mg/d) versus non-NSLP participants (2583 ± 9.69 mg/d; P = 0.020) in children 4–8y and also in children 9–13y (NSLP participants 3097 ± 10.4 mg/d; non-NSLP participants 2852 ± 8.07; P &amp;lt; 0.001) but only lower among NSLP participants (3102 ± 10.3 mg/d) versus non-NSLP participants (3240 ± 12.4 mg/d; P = 0.002) in children 14–15y. Conclusions The effects of the new NSLP recommendations are conflicting compared with children not participating in the program. Sugar and sodium intakes were generally higher among NSLP participants between the ages of 9–13 years old. This suggests that despite recommendations to reduce sodium and sugar intake among school children, these nutrients might still be of concern. In short, this study indicates that a greater investment on education is needed and that further research should assess the effect of changes on NSLP recommendations through time. Funding Sources Florida International University.

Mapping Dietary Sodium Reduction Policies and Initiatives in the Region of the Americas

Abstract Objectives To map existing country policies addressing population dietary sodium reduction in the Americas; to identify policy gaps in the region following what is outlined in the World Health Organization (WHO) “Best Buys” most cost-effective recommendations for the prevention and control of diet-related noncommunicable diseases (NCDs); and to discuss priorities for future work in the Region. Methods This study used mixed methods to analyze data from 34 countries. Data were collected through a structured review, of mostly national official sources, to identify current policies in place to reduce population sodium intake. Also, responses from the last Pan American Health Organization (PAHO) online Survey on National Initiatives for Sodium Reduction in the Americas were included. Finally, country profiles were prepared and sent to each country's Public Health Agency for validation and comments. Results Almost all countries (n = 23/34) had a recommendation to reduce salt intake included in policies related to NCDs. Only six countries had specific and comprehensive policies to reduce sodium intake, and only one of them was a National Law. Adoption of the WHO “Best Buys” in national policies included: reformulation of food products with voluntary (n = 9/34) and mandatory targets (n = 2/34); establishment of a supportive environment in public institutions (n = 14/34); and implementation of front-of-pack labelling (n = 5/34). Some countries have implemented regulations restricting marketing of foods high in sodium to children (n = 5/34); nutritional labelling that includes sodium content, either voluntary (n = 9/34) or mandatory (n = 10/34); and no country has yet implemented taxes on high sodium foods. Conclusions In recent years, there has been a significant advance in policies to reduce sodium intake in the Region of the Americas. However, this review identified that the level of implementation in practice is complex to assess and quite heterogeneous. Reducing sodium consumption is a cost-effective intervention that can save many lives, by preventing and reducing the burden of diet related NCD's. Therefore, a further call to action is needed for governments to accelerate efforts in order to meet the 2025 global target of a 30% relative reduction in mean population intake of sodium. Funding Sources Pan American Health Organization (PAHO/WHO).

Current Sodium Intakes in the United States and the Modeled Effects of Glutamate Incorporation Into Select Savory Products

Abstract Objectives Most Americans have dietary sodium intakes that far exceed recommendations. Given the association of high sodium with hypertension, strategies to reduce sodium intakes are an important public health target. Glutamates, such as monosodium glutamate, represent a potential strategy to reduce overall intakes while preserving product palatability; therefore, this project aimed to model sodium replacement with glutamates. Methods The National Cancer Institute Method was used to estimate current sodium intakes, as well as intakes resulting from glutamate substitution (25–45%) in a limited set of food groups for which substitution is possible. Data sets for individuals aged ³1 year enrolled in the U.S. National Health and Nutrition Examination Survey 2013–2016 (n = 161,83) were used in these analyses. Glutamate substitution of U.S. Department of Agriculture food codes was modeled by conservatively altering estimates of sodium intake reductions derived from the published peer-reviewed literature. Results The addition of glutamates to certain food categories has the potential to reduce the population's sodium intake by approximately 3% overall and by 7–8% among consumers of ≥1 product category in which glutamates were substituted for sodium chloride. Conclusions Although using glutamates to substitute the amount of sodium among certain food groups may show modest effects on intakes across the population, it is likely to have a more substantial effect on individuals who consume specific products. Funding Sources Ajinomoto.

The effect of uric acid and urinary sodium excretion on prehypertension: a nationwide population-based study

BackgroundThis study examined the effect of serum uric acid (SUA) level and urinary sodium excretion on blood pressure as well as their combined effect on prehypertension in a Korean population.MethodData from the 7th Korea National Health and Nutrition Examination Survey for adults (≥ 19 years of age) were used. The participants were classified into two groups, normotension and prehypertension, according to the JNC-7 definition. Logistic regression was carried out and adjusted for traditionally regarded confounders of blood pressure. All analyses considered a complex sampling design. A multivariate analysis was performed on subgroups defined according to their SUA level and urinary sodium excretion.ResultsThe 4200 participants were divided into normotension (n = 2646) and prehypertension (n = 1554) groups. In the univariate analysis, patient age, male sex, concurrent comorbidity (diabetes mellitus, cardiovascular disease, stroke, dyslipidemia, and chronic kidney disease), uric acid, and urinary sodium excretion were associated with prehypertension. After adjusting for baseline covariates, both the SUA level and urinary sodium excretion were significant predictors of incident prehypertension (SUA, per 1 mg/dL increase, odds ratio [OR] 1.216, 95% confidence interval [95% CI] 1.131–1.309; urinary sodium excretion, per 1 g/day increase, OR 1.067, 95% CI 1.019–1.117). Additionally, simultaneously higher tertiles of SUA and urinary sodium excretion resulted in higher ORs for prehypertension.ConclusionIncreased SUA is a significant risk marker for the development of prehypertension in normotensives. Simultaneously high SUA and urinary sodium excretion amplified the effect on the development of prehypertension. Our findings suggest that lowering SUA levels and reducing sodium intake will contribute to preventing hypertension.

SAT-550 Changes in Albuminuria Precede Dietary Sodium-Dependent Changes in BP During Aging - a Longitudinal Study

Background: Hypertension (HT) is a well-established independent risk factor for adverse cardiovascular and renal (CVR) outcomes and a high salt (HS) diet is the main cause for high blood pressure (BP). Despite extensive research focusing on HT, surprisingly there are no longitudinal studies assessing the long-term effects of HS. Aims: This study aimed (1) to evaluate the timing of onset for changes in CVR health during long-term sodium loading and (2) to assess whether salt restriction can prevent these effects. Methods: C57BL/6 mice were randomized to HS, moderate (NS) or low (LS) salt diet and followed longitudinally for 50 weeks (wks). BP, urinary albumin/creatinine ratio (AC), plasma aldosterone (PA) and renin activity (PRA) were assessed monthly. At the end of the study, renal artery resistance and left ventricular (LV) parameters were measured by ultrasound and echocardiogram. Renal AT1 expression (Western Blot) and activity (IHQ) were quantified. Results: At the beginning of the study, there were no differences in BP and AC between the three dietary groups. Relative to wk 1, BP (mmHg) in the HS group was higher in wk 21 (131±1.7 vs. 115±3.0, p= 0.05). Sodium restriction delayed this increase: SBP was higher in wk 41 in the NS group compared to the wk 1 (128±3.4 vs. 115±6.4, p= 0.05) but did not reach significance in the LS group until the end of the study. Similarly, relative to wk 1, AC (µg/mg) only in the HS group reached significantly higher levels in wk 17 (44±4.2, p<0.05). Again, sodium restriction delayed the occurrence of renal damage. AC reached significance in wks 25 and 41 for NS and LS (35±1.1 and 42±2.6 respectively, p<0.05 vs. baseline). Interestingly, the changes in AC always preceded the changes in BP, irrespective of diet. PA and PRA were appropriately activated by dietary salt restriction and suppressed by aging. The aging-induced suppression appeared stronger for PA than for PRA in the HS group only. Long-term sodium loading (HS) induced increased renal resistance, which was prevented in the LS but not in the NS group. Relative to HS, the LV mass index and cardiac output were lower in the NS and LS groups (p<0.05). LV volume indices and ejection fraction did not differ between groups. Renal AT1 protein expression and activation status (IHQ) were decreased in the sodium restricted group. Conclusions: Our study showed that long-term exposure to HS induced a progressive increase in BP and AC in mice. Importantly, these changes were delayed by long-term reduction in sodium intake. Interestingly, changes in AC preceded those in BP, irrespective of diet. Cardiac parameters suggest a sodium-induced eccentric cardiac hypertrophy in the older age, which was prevented by sodium restriction. One possible mechanism behind these effects is the overactivation of the AT1 receptor pathway.

Progress on sodium reduction in South Korea

IntroductionHigh dietary sodium is a leading contributor to hypertension, and hypertension is the leading underlying cause of death globally. There is a robust body of evidence supporting the health benefits...

Dietary Potassium Intake Remains Low and Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991–2015 Trends

Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. Sodium intake decreased from 6.3 g/d in 1991 to 4.1g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7g/d in 1991 and 1.5g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.

Interactive effect of high sodium intake with increased serum triglycerides on hypertension.

BackgroundA high salt diet is associated with the development of hypertension, one of the most important cardiovascular risk factors. A reduction in sodium intake seems to have an effect on increasing serum triglycerides (TGs). Elevated TGs are independently linked to cardiovascular risk. However, there is limited evidence of a possible interactive effect of sodium intake and serum TGs on high blood pressure (BP).MethodsWe conducted a nationwide, population-based interaction analysis using the Kawasaki method for estimating 24-h urinary sodium excretion (e24hUNaEKawasaki) as a candidate indicator of dietary sodium intake. All native Koreans aged 20 years or older without significant medical illness were eligible for inclusion.ResultsA total of 16936 participants were divided into quintiles according to their e24hUNaEKawasaki results. Participants in the highest quintile were more obese and hypertensive and had higher white blood cell count, lower hemoglobin, greater glycemic exposure, and poor lipid profiles compared to the same parameters of individuals in other quintiles. Linear regression revealed that e24UNaEKawasaki was related to systolic BP, diastolic BP, and TGs. Multiple logistic regression, adjusted for dietary sodium intake and various conventional risk factors for chronic vascular diseases, showed that both e24UNaEKawasaki and TGs were significant predictors of hypertension. Our interaction analysis demonstrated that increased sodium intake was associated with higher risk of hypertension in participants with elevated TGs than in those without (adjusted RERI = 0.022, 95% CI = 0.017–0.027; adjusted AP = 0.017, 95% CI = 0.006–0.028; adjusted SI = 1.010, 95% CI = 1.007–1.014).ConclusionOur findings suggest that the interaction between a high salt diet and elevated TGs may exert synergistic biological effects on the risk of hypertension.

ELBW infants receive inadvertent sodium load above the recommended intake.

To determine total sodium load, including inadvertent load, during the first 2 postnatal weeks, and its influence on serum sodium, morbidity, and mortality in extremely low birth weight (ELBW, birth weight <1000 g) infants and to calculate sodium replacement models. Retrospective data analysis on ELBW infants with a gestational age <28 + 0/7 weeks. Ninety patients with a median birth weight of 718 g and a median gestational age of 24 + 6/7 weeks were included. Median sodium intake during the first 2 postnatal weeks was 10.2 mmol/kg/day, which was significantly higher than recommended (2-5 mmol/kg/day). Sodium intake did not affect the risk for hypernatremia. Each mmol of sodium intake during the first postnatal week was associated with an increased risk of bronchopulmonary dysplasia (45%) and higher-grade intraventricular hemorrhage (31%), during the second postnatal week for necrotizing enterocolitis (19%), and during both postnatal weeks of mortality (13%). Calculations of two sodium replacement models resulted in a decrease in sodium intake during the first postnatal week of 3.2 and 4.0 mmol/kg/day, respectively. Sodium load during the first 2 postnatal weeks of ELBW infants was significantly higher than recommended owing to inadvertent sodium intake and was associated with a higher risk of subsequent morbidity and mortality, although the study design does not allow conclusions on causality. Replacement of 0.9% saline with alternative carrier solutions might reduce sodium intake. Sodium intake in ELBW infants during the first 2 postnatal weeks was twofold to threefold higher than recommended; this was mainly caused by inadvertent sodium components. High sodium intake is not related to severe hypernatremia but might be associated with a higher morbidity in terms of BPD, IVH, and NEC. Inadvertent sodium load can be reduced by replacing high sodium-containing carrier solutions with high levels of sodium with alternative hypotonic and/or balanced fluids, model based.

Sodium Intake and Target Organ Damage in Hypertension-An Update about the Role of a Real Villain.

Salt intake is too high for safety nowadays. The main active ion in salt is sodium. The vast majority of scientific evidence points out the importance of sodium restriction for decreasing cardiovascular risk. International Guidelines recommend a large reduction in sodium consumption to help reduce blood pressure, organ damage, and cardiovascular risk. Regulatory authorities across the globe suggest a general restriction of sodium intake to prevent cardiovascular diseases. In spite of this seemingly unanimous consensus, some researchers claim to have evidence of the unhealthy effects of a reduction of sodium intake, and have data to support their claims. Evidence is against dissenting scientists, because prospective, observational, and basic research studies indicate that sodium is the real villain: actual sodium consumption around the globe is far higher than the safe range. Sodium intake is directly related to increased blood pressure, and independently to the enlargement of cardiac mass, with a possible independent role in inducing left ventricular hypertrophy. This may represent the basis of myocardial ischemia, congestive heart failure, and cardiac mortality. Although debated, a high sodium intake may induce initial renal damage and progression in both hypertensive and normotensive subjects. Conversely, there is general agreement about the adverse role of sodium in cerebrovascular disease. These factors point to the possible main role of sodium intake in target organ damage and cardiovascular events including mortality. This review will endeavor to outline the existing evidence.

Sodium-induced inflammation-an invisible player in resistant hypertension.

The purpose of this review was to discuss the role of sodium and inflammation in the pathophysiology of hypertension and the observed different hemodynamic effects of drugs. The Pathway-2 study revealed that similar reductions in vascular resistance after spironolactone and doxazosin resulted in opposite effects on sodium balance, water retention, and hemodynamic parameters. These and other clinical findings were bridged to recent experimental and physiological data. Tissue sodium accumulation in salt-sensitive individuals due to endothelial glycocalyx dysfunction causes macrophage infiltration, vascular inflammation, and local changes in angiotensin-2 and aldosterone concentrations. This inflammatory cascade leads to factor XII-related coagulation disorders with neutrophil extracellular trap formation (NETosis). This model of sodium-induced microcirculation impairment was used to explain the differences in central hemodynamic parameters after spironolactone or doxazosin treatment in resistant hypertension. Hypertension treatment by induced sodium removal or reduced sodium intake should reduce endothelial glycocalyx dysfunction, inflammation, NETosis, and coagulation disorders, leading to improved vascular health and cardiac diastolic function.

Don't Take it With a Grain of Salt

Background: Currently, sodium consumption of Canadians (2760 mg/day) exceeds the 2300 mg/day tolerable upper level putting Canadians at risk for hypertension and cardiovascular disease. Voluntary sodium reformulation strategies have been implemented in Canada, the United Kingdom (UK), United States (US) to reduce sodium intake from processed foods. The potential for sodium reformulation to reduce sodium intake across socioeconomic position (SEP) is not well understood. The objective of this study was to evaluate the extent to which fully achieving sodium reformulation targets for processed foods outlined in the Canada, UK, US strategies would decrease population and social inequities in sodium intake in Canadian adults. &#x0D; Design: A cross-sectional study was conducted using the 2015 Canadian Community Health Survey–Nutrition (n=13,519 participants aged ≥19 years, 53% females). Foods from the 24-hour dietary recall were matched to each country’s sodium reduction categories and target sodium levels were applied. Multivariable linear regressions were used to estimate mean sodium intake for the population and across SEP indicators (educational attainment, household food security, and household income adequacy quintiles). &#x0D; Results: Achieving Canada’s targets would reduce average sodium intake by 228 mg/day (95%CI: 196,260) compared to baseline. UK’s sodium targets would achieve greater reductions, decreasing average sodium intake by 270 mg/day (95%CI: 242,299). The US sodium targets would increase average sodium intake by 98 mg/day (95%CI: 64,132). Achieving sodium reformulation targets resulted in greater reductions in sodium intake in men, and in lower SEP groups. For example, educational inequalities in sodium intake observed at baseline were reduced in men [Canada: (RD: 148 mg/day, 95%CI: -30,327); UK: (RD: 152 mg/day, 95%CI: -43,347)] and eliminated in women. &#x0D; Conclusion: Achieving targets outlined in Canada and UK’s voluntary sodium reformulation strategies would significantly reduce mean sodium intake in Canadians. This study demonstrated the potential for reducing social inequities in sodium intake and health.

Abstract P169: Randomized Controlled Trial Comparing a Self-guided vs. Dietitian-led Approach Using Web-based Tools to Lower Blood Pressure: Study Design and Rationale

Background: Weight loss, consumption of a Dietary Approaches to Stop Hypertension (DASH) dietary pattern, reduced sodium intake, and increased physical activity have been shown to lower systolic blood pressure (SBP). Use of website or smartphone-based tools could be potentially scalable solutions to improve lifestyle behaviors and lower SBP, but little data exists to support their use in clinical practice. Methods: In an ongoing single-center, 2-arm, randomized controlled trial, we compare the efficacy of a dietitian-guided approach vs. a self-guided approach in lowering 24-hour SBP in overweight/obese patients with 24-hour SBP 120-160 mmHg on 0-1 BP medication. As part of standard of care, participants with outpatient SBP ≥ 130 mmHg are identified using Geisinger electronic health record data and through Geisinger Health Plan’s health and wellness program and invited to complete 24-hour ambulatory BP monitoring (ABPM). Qualifying participants are then invited to a research visit to sign informed consent and for data collection, including a web-based food frequency questionnaire (Viocare®), which provides personalized recommendations to improve dietary quality. After a 2-week run-in period in which participants must regularly log data into www.bmiq.com, a comprehensive weight management program, and a smartphone app (Lose It!), participants are randomized 1:1 to a self-guided arm or a dietitian-led arm. All participants are instructed to use the website and app, and the dietitian-led arm additionally receives weekly telephone calls from registered dietitian nutritionists, trained in motivational interviewing. The primary outcome is 3-month change in 24-hour SBP. Other outcomes include changes in other ABPM measures, total healthy eating index-2015 (HEI) score, weight, waist circumference, metabolic equivalent of task-minutes per week (International Physical Activity Questionnaire short form), and study satisfaction. Results: Out of 210 patients who have thus far completed ABPM, 128 were eligible for the trial, 85 consented for the trial, and 78 were randomized after completing the run-in period. In a preplanned interim analysis of the first 34 randomized patients, 28 (82%) completed the 3-month study visit. Mean (SD) changes from baseline to 3 months were: -8.0 mmHg (9.9) for 24-hour SBP, -5.4 kg (4.5) for weight, -6.1 cm (7.4) for waist circumference, and 11.2 units (12.0) for HEI score. Conclusions: Confirmation of elevated BP using ABPM may provide an opportunity to engage patients in making lifestyle modifications, as more than 60% of eligible patients after 24-hour ABPM screening were successfully randomized into the trial. Completion of the study is expected by the end of 2020 and will determine the efficacy of a self-directed vs. dietitian-led approach to lower 24-hour SBP using web-based tools.

Abstract P352: Trend of Salt Consumption in Italy From 2008 to 2018: Preliminary Results of the Cuore Project

Introduction: The WHO Global Action Plan for the Prevention of Non-Communicable Diseases (NCDs) recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Hypothesis: Agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. Within the NPP, initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators are implemented. In order to estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project. Methods: Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from random samples of persons aged 35-79 years, resident in all Italian 20 Regions. A new survey is ongoing (2018-2019) involving random samples of persons aged 35-74 years, resident in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the seven regions examined up to now in the ongoing survey and the age range of 35-74 years. Results: Within the 2018-2019 survey, mean level of sodium chloride per day in 673 men and 709 women was 161 mmol (95% confidence interval: 156-166 mmol) and 122 mmol (119-126 mmol) respectively, whereas in the 2008-2012 survey the corresponding mean levels in 642 men and 627 women was 183 mmol (95% confidence interval: 178-189 mmol) and 140 mmol (135-144 mmol), respectively. A sodium chloride intake level within the WHO recommended upper level of 85 mmol (or 5 grams of salt) per day was detected in 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019 vs 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012. Conclusions: These preliminary data show that the average habitual sodium intake in Italy is still largely higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives for reduction of sodium intake and its monitoring in the population.

Impaired Fluid Intake, but Not Sodium Appetite, in Aged Rats Is Mediated by the Cyclooxygenase-Prostaglandin E2 Pathway.

Aging results in decreased fluid intake following dehydration and other dipsogenic stimuli; similar reductions in sodium intake have also been observed with aging. Given that cyclooxygenase (COX)-derived prostanoids are elevated in aged rats in the midbrain and proinflammatory prostanoids are known to decrease fluid intake in dehydrated rats, the aim of this study was to determine if the reductions of fluid intake and sodium intake in aging are mediated by proinflammatory eicosanoid signaling. Therefore, we examined the effect of acute COX inhibition in adult (4 months-old) and aged (30 months-old) rats prior to ingestive behavior challenges. COX inhibition, using acetylsalicylic acid (ASA), increased fluid intake in aged, but not adult, rats in response to 24-h dehydration. ASA had no effect on salt intake following sodium depletion and ASA did not change basal fluid or sodium consumption in either age group. Hypothalamic COX-1 and -2, prostaglandin E synthase (PGES) and inducible nitric oxide synthase (iNOS) mRNA expression were all elevated in aged animals, leading to elevated PGE2 levels. COX expression in the hypothalamus was reduced by ASA treatment in rats of both ages resulting in reduced PGE2 levels in aged ASA treated animals. These data indicate that the reduced fluid intake that occurs in aging is due to increased COX-PGE2-mediated inflammation. However, the reduced sodium intake in these animals appears to occur via an alternate mechanism.

Effects of Program Promoting Food Consumption for Sodium Reduction on Knowledge, Sodium Consumption Behaviors, and Urinary Sodium in Nursing Students: A Multi-Setting Study

OBJECTIVES: High sodium intake has been associated with a limited knowledge of sodium and inappropriate food consumption behaviors. This study aimed to examine effects of a program promoting sodium intake reduction on knowledge of sodium consumption, sodium consumption behaviors, and urinary sodium in nursing students. MATERIAL AND METHODS: Quasi-experimental design with one-group self-control was used. The participants were 173 Thai nursing students of three higher education institutions, who participated in a 4-week program promoting sodium intake reduction that employed four strategies for behavioral modification. Data were analysed using One-way ANOVA with repeated measures, multiple comparison, and Paired t-test. RESULT: After the program, knowledge was significantly higher while urinary sodium was lower than before the program and baseline. Sodium consumption behaviors were lower after the program than baseline. CONCLUSION: It is suggested that health teams apply this program to promote sodium intake reduction in nursing students and extend to other populations.