Sodium Reduction Research Articles

The Jamaica Salt Consumption Study Protocol: Sodium Intake; Sodium Content in Restaurant Foods; Knowledge, Attitudes, and Practices; Spot Urine Sodium Validation.

Excess dietary salt consumption is a major contributor to hypertension and cardiovascular disease. Public education programs on the dangers of high salt intake, and population level interventions to reduce the salt content in foods are possible strategies to address this problem. In Jamaica, there are limited data on the levels of salt consumption and the population's knowledge and practices with regards to salt consumption. This study therefore aims to obtain baseline data on salt consumption, salt content in foods sold in restaurants, and evaluate knowledge, attitudes, and practices of Jamaicans regarding salt consumption. The study is divided into four components. Component 1 will be a secondary analysis of data on urinary sodium from spot urine samples collected as part of a national survey, the Jamaica Health and Lifestyle Survey 2016-2017. Component 2 will be a survey of chain and non-chain restaurants in Jamaica, to estimate the sodium content of foods sold in restaurants. Component 3 is another national survey, this time on a sample 1,200 individuals to obtain data on knowledge, attitudes and practices regarding salt consumption and estimation of urinary sodium excretion. Component 4 is a validation study to assess the level of agreement between spot urine sodium estimates and 24-hour urinary sodium from 120 individuals from Component 3. This study will provide important baseline data on salt consumption in Jamaica and will fulfil the first components of the World Health Organization SHAKE Technical Package for Salt Reduction. The findings will serve as a guide to Jamaica's Ministry of Health and Wellness in the development of a national salt reduction program. Findings will also inform interventions to promote individual and population level sodium reduction strategies as the country seeks to achieve the national target of a 30% reduction in salt consumption by 2025.

Switching the World’s Salt Supply—Learning from Iodization to Achieve Potassium Enrichment

Sodium is an essential dietary component, but excess sodium intake can lead to high blood pressure and an increased risk of cardiovascular disease. Many national and international bodies, including the World Health Organization, have advocated for population-wide sodium reduction interventions. Most have been unsuccessful due to inadequate sodium reduction by food industry and difficulties in persuading consumers to add less salt to food. Recent research highlights potassium-enriched salt as a new, feasible, acceptable, and scalable approach to reducing the harms caused by excess sodium and inadequate potassium consumption. Modeling shows that a global switch from regular salt to potassium-enriched salt has the potential to avert millions of strokes, heart attacks, and premature deaths worldwide each year. There will be many challenges in switching the world’s salt supply to potassium-enriched salt, but the success of universal salt iodization shows that making a global change to the manufacture and use of salt is a tractable proposition. This in-depth review of universal salt iodization identified the importance of a multisectoral effort with strong global leadership, the support of multilateral organizations, engagement with the salt industry, empowered incountry teams, strong participation of national governments, understanding the salt supply chain, and a strategic advocacy and communication plan. Key challenges to the implementation of the iodization program were costs to government, industry, and consumers, industry concerns about consumer acceptability, variance in the size and capabilities of salt producers, inconsistent quality control, ineffective regulation, and trade-related regulatory issues. Many of the opportunities and challenges to universal salt iodization will likely also be applicable to switching the global salt supply to iodized and potassium-enriched salt.

Use of the WHO Nutrient Profile Model for Food Marketing Regulation in Germany: Feasibility and Public Health Implications

Introduction: Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM). Germany’s Federal Ministry of Food and Agriculture plans to use this model in proposed new food marketing legislation, but it has not yet been tested in Germany. The present study therefore assesses the feasibility and implications of implementing the WHO NPM in Germany. Methods: We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market drawn from Open Food Facts, a publicly available product database. We calculated the share of products permitted for marketing to children based on the WHO NPM, both under current market conditions and for several hypothetical reformulation scenarios. We also assessed effects of adaptations to and practical challenges in applying the WHO NPM. Results: The median share of products permitted for marketing to children across the model’s 22 product categories was 20% (interquartile range (IQR) 3–59%) and increased to 38% (IQR 11–73%) with model adaptations for fruit juice and milk proposed by the German government. With targeted reformulation (assuming a 30% reduction in fat, sugar, sodium, and/or energy), the share of products permitted for marketing to children increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt and cream, ready-made and convenience foods, and savoury plant-based foods) but changed less in the remaining categories. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others. Conclusion: The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with appropriate adaptations and procedural provisions.

Effect of Dietary Sodium on Blood Pressure

Dietary sodium recommendations are debated partly due to variable blood pressure (BP) response to sodium intake. Furthermore, the BP effect of dietary sodium among individuals taking antihypertensive medications is understudied. To examine the distribution of within-individual BP response to dietary sodium, the difference in BP between individuals allocated to consume a high- or low-sodium diet first, and whether these varied according to baseline BP and antihypertensive medication use. Prospectively allocated diet order with crossover in community-based participants enrolled between April 2021 and February 2023 in 2 US cities. A total of 213 individuals aged 50 to 75 years, including those with normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%), attended a baseline visit while consuming their usual diet, then completed 1-week high- and low-sodium diets. High-sodium (approximately 2200 mg sodium added daily to usual diet) and low-sodium (approximately 500 mg daily total) diets. Average 24-hour ambulatory systolic and diastolic BP, mean arterial pressure, and pulse pressure. Among the 213 participants who completed both high- and low-sodium diet visits, the median age was 61 years, 65% were female and 64% were Black. While consuming usual, high-sodium, and low-sodium diets, participants' median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (IQR, 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. The commonly used threshold of a 5 mm Hg or greater decline in mean arterial pressure between a high-sodium and a low-sodium diet classified 46% of individuals as "salt sensitive." At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% CI, 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Adverse events were mild, reported by 9.9% and 8.0% of individuals while consuming the high- and low-sodium diets, respectively. Dietary sodium reduction significantly lowered BP in the majority of middle-aged to elderly adults. The decline in BP from a high- to low-sodium diet was independent of hypertension status and antihypertensive medication use, was generally consistent across subgroups, and did not result in excess adverse events. ClinicalTrials.gov Identifier: NCT04258332.

Abstract 17418: Daily Intake of Fruits and Vegetables Moderates the Effect of a Nutrition Intervention on Symptom Burden in Patients With Heart Failure

Introduction: Patients with heart failure (HF) often remain symptomatic after optimization of medical treatment. Complementary interventions may reduce symptom burden. We conducted a 6-month randomized controlled trial of a nutrition intervention (NIHFT) to reduce fluid overload, oxidative stress, and inflammation, which are major pathologic pathways underlying HF symptoms.Aims: 1) To examine the effects of NIHFT on HF symptom burden (i.e., shortness of breath, edema, and fatigue); and 2) to determine if intake of fruits and vegetables, primary sources of antioxidants and anti-inflammatories, moderated the effect of the NIHFT on HF symptom burden. Methods: Patients with HF (n=116) with complete baseline data were included (61% male, 63±12 years old, 64% NYHA III/IV). Intervention group received 1) individualized educational intervention for sodium reduction that included promoting fruit and vegetable intake, 2) daily low sodium tomato or vegetable juice, and 3) omega-3 supplementation (1050 mg EPA, 150 mg DHA/capsule/day) for 6 months. Symptom burden was measured by the Memorial Symptom Assessment Scale-HF at baseline and 3 and 6-month. Daily intake of fruits and vegetables at baseline was dichotomized (≤1 vs ≥2 servings/day). A linear mixed-effect model was used. Results: There was no direct effect of the NIHFT on symptom burden. However, baseline intake of fruits and vegetables moderated the effect of the intervention on overall symptom burden scores (beta estimate= -4.67, SE=1.89, P=0.015). Reduction in symptom burden was greater among patients with lower baseline fruit and vegetable intake compared to those with higher intake. Among the subscales (i.e., frequency, severity, and distress) of overall symptom burden, frequency (beta estimate= -1.63, SE=0.66, P=0.014) and severity (beta estimate= -1.81, SE=0.61, P=0.004) were significantly moderated by the intake of fruits and vegetables. Conclusions: The findings indicate that the nutrition intervention was more effective in reducing symptom burden for patients with lower baseline intake of fruits and vegetables. This suggests that increased fruit and vegetable intake may further reduce HF symptom burden in patients on optimal medication therapy.

A low dietary sodium dose is associated with a more pronounced aldosterone response in normotensive than in hypertensive individuals

In this comprehensive meta-regression analysis encompassing 79 randomized controlled trials, we observed that in populations assigned to a high sodium intake level exceeding 94 mmol, there was no discernible link between plasma aldosterone levels and sodium intake. However, among populations with normal blood pressure subjected to a lower sodium intake, falling below 111 mmol (N = 1544), the association between sodium intake and plasma aldosterone levels manifested as a decrease of 192 pg/ml per 100 mmol of sodium (95% CI − 303 to − 81). In hypertensive populations (N = 1145), this association was less pronounced, with a reduction of 46 pg/ml per 100 mmol sodium, (95% CI − 112 to 20). Furthermore, in normotensive populations the plasma aldosterone increase associated with a decrease in sodium intake was 70 pg/ml per 100 mmol sodium (95% CI 27 to 113). In hypertensive populations, the observed increase was more modest, at 30 pg/ml per 100 mmol sodium, (95% CI 6.8 to 54). A limitation of this study lies in the absence of individual participant data. Our analysis included adjustments for potential effect-modifiers, encompassing bias estimation, which did not substantially alter these associations. One perspective of the present results may be to prompt a reconsideration of current sodium reduction recommendations.

Application of Umami Tastants for Sodium Reduction in Food: An Evidence Analysis Center Scoping Review.

Sodium chloride intake far exceeds the guidelines from health and regulatory agencies. Acknowledging the positive relationship between sodium intake and blood pressure, interest in substances that assist in sodium reduction, while contributing a savory taste such as umami, are highly investigated. The objective of this scoping review was to identify and characterize studies investigating umami tastants on sodium reduction in food, with the goal of informing future research. A literature search was conducted in Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, EBSCO PsycInfo, PROSPERO, National Institutes of Health RePORTER, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform and completed in March 2022 to identify peer-reviewed publications among adults (18 years and older) with interventions focusing on umami tastants to reduce sodium content. The literature search identified 52 studies, among which monosodium glutamate was the most studied umami tastant or food. Furthermore, most of the research on umami was represented through cross-sectional sensory studies to determine acceptability of foods with part of the original sodium chloride replaced with umami tastants. Only 1 study investigated the use of an umami tastant on overall daily sodium intake. To assist individuals in adhering to sodium reduction intake goals set forth by regulatory agencies and their guiding policies, these findings indicated that additional research on umami tastants, including systematic reviews and prospective trials, is warranted. In these prospective studies, both intermediate outcomes (ie, dietary pattern changes, daily dietary intake of sodium, and blood pressure) and hard outcomes (ie, incidence of hypertension or stroke, as well as cardiovascular composite outcomes) should be considered.

Temel Kurutma Tekniklerinin Kişniş Yaprağının Renk, Protein ve Mineral İçeriği Üzerine Etkisi

Coriander leaves were weighed at 20 ± 0.02 g and dried with natural drying at shade, convective drying at 50°C and 1 m s-1 air velocity, and microwave drying at 200 and 800 W. The drying periods were led 4680, 630, 85, and 16.50 minutes for natural, 50°C, 200 W, and 800 W, respectively. Whereas energy consumption was not recorded in natural drying, energy consumption at 50°C, 200 W, and 800 W was recorded as 10.290, 0.283, and 0.220 kWh, respectively. The closest results to fresh leaves in terms of color parameters were measured at 800 W, followed by 200 W. Similarly, at 800 and 200 W, the most successful results were obtained with regard to calcium, magnesium, and iron. Also, it was analyzed that the chlorophyll content, protein, phosphorus, potassium, and zinc were preserved at the maximum level in the 800 W microwave drying method. Although all drying methods cause similar reductions for sodium, it was determined that manganese was well preserved at 200 W. Among the dried samples, the highest copper level was analyzed in natural drying and microwave drying at 800 W. To sum up, the most convenient drying technique for coriander leaves was 800 W in terms of drying and quality parameters.

Use of the WHO Nutrient Profile Model in Germany: feasibility and public health implications

Abstract Background Exposure to marketing for foods high in sugar, salt, and fat is considered a key risk factor for childhood obesity. To support efforts to limit such marketing, the World Health Organization Regional Office for Europe has developed a nutrient profile model (WHO NPM), published as second edition in March 2023. The German government plans to use this model in new food marketing legislation, but it has not yet been tested in Germany. Methods We applied the WHO NPM to a random sample of 660 food and beverage products across 22 product categories on the German market from Open Food Facts, a product database. We calculated the share of products permitted for marketing to children under current market conditions and for hypothetical reformulation scenarios. We assessed practical challenges in applying the WHO NPM and the effects of model adaptations. Results The median share of products permitted for marketing to children across the 22 categories was 20% (interquartile range (IQR) 3-59%) and increased to 38% (IQR 11-73%) with model adaptations proposed by the German government. With targeted reformulation (i.e. a 30% reduction in fat, sugar, sodium, and/or energy) the share increased substantially (defined as a relative increase by at least 50%) in several product categories (including bread, processed meat, yogurt, convenience foods, and savoury plant-based foods), but changed less in others. Practical challenges included the ascertainment of the trans-fatty acid content of products, among others. Conclusions The application of the WHO NPM in Germany was found to be feasible. Its use in the proposed legislation on food marketing in Germany seems likely to serve its intended public health objective of limiting marketing in a targeted manner specifically for less healthy products. It seems plausible that it may incentivise reformulation in some product categories. Practical challenges could be addressed with adaptations and procedural provisions. Key messages • The practical application of the WHO Europe Nutrient Profile Model 2023 edition to a random sample of food and beverage products on the German market was found to be feasible. • With targeted reformulation, the share of products permitted for marketing to children under the WHO Europe Nutrient Profile Model increases substantially.

Combined application of high-throughput sequencing and LC-MS-based lipidomics in the evaluation of microorganisms and lipidomics of restructured ham of different salted substitution

The optimization of processed meats through salt replacement using KCl and k-lactate may reduce the risk of chronic diseases through reduction in dietary sodium. The objective of this study was to investigate the changes and relationships between microbial and lipid metabolism during the fermentation of restructured duck ham with different salt substitutions. Lactobacillus and Staphylococcus were found to be the dominant bacterial species in the 30 % KCl + 70 % NaCl (w/w) and 25 % k-lactate + 75 % NaCl (w/w). The LefSe analysis showed that different biomarkers were present in different ham groups, and the PLS-DA showed that triglycerides (GL) and glycerophospholipids (GP) were the two classes with the highest abundance. Besides, the KEGG pathway analysis revealed that glycerophospholipid metabolism and triglyceride metabolism were also the main metabolic pathways. According to the correlation study, Staphylococcus, Halomonas, and Lactobacillus were mostly linked to the important metabolic pathways in restructured ham. Our findings serve as a foundation for quality assurance and product enhancement for low-salt restructured ham.

Effects of sodium nitrite reduction, removal or replacement on cured and cooked meat for microbiological growth, food safety, colon ecosystem, and colorectal carcinogenesis in Fischer 344 rats

Epidemiological and experimental evidence indicated that processed meat consumption is associated with colorectal cancer risks. Several studies suggest the involvement of nitrite or nitrate additives via N-nitroso-compound formation (NOCs). Compared to the reference level (120 mg/kg of ham), sodium nitrite removal and reduction (90 mg/kg) similarly decreased preneoplastic lesions in F344 rats, but only reduction had an inhibitory effect on Listeria monocytogenes growth comparable to that obtained using the reference nitrite level and an effective lipid peroxidation control. Among the three nitrite salt alternatives tested, none of them led to a significant gain when compared to the reference level: vegetable stock, due to nitrate presence, was very similar to this reference nitrite level, yeast extract induced a strong luminal peroxidation and no decrease in preneoplastic lesions in rats despite the absence of NOCs, and polyphenol rich extract induced the clearest downward trend on preneoplastic lesions in rats but the concomitant presence of nitrosyl iron in feces. Except the vegetable stock, other alternatives were less efficient than sodium nitrite in reducing L. monocytogenes growth.

Effect of processing (cutter versus continuous emulsifier) and sodium reduction on the physicochemical properties of bologna sausages.

Overcoming the impact of sodium reduction in the properties of emulsified sausages is a current challenge in the production of healthier meat products. Because the emulsifying process play a key role in the stability of sausages, the present study aimed to evaluate the effects of two mechanical emulsifying systems (cutter versus continuous emulsifier) and two levels of sodium chloride (2.50 and 1.25%) on the physicochemical characteristics of bologna sausages. A reduction of sodium increased the L* value and reduced the a* value, and also decreased the protein extraction yield in sausages produced in the cutter system. Moreover, the emulsion stability of reduced sodium batter was increased by cutter emulsification (F50C). On the other hand, the continuous emulsifier process did not decrease the extraction of myofibrillar proteins in F50E (sodium reduced treatment), resulting in minimal impact on emulsion stability and an increase in hardness in reduced-sodium sausages. Therefore, to produce low-sodium sausages, the continuous emulsifier was more effective producing batters with increased extracted myofibrillar proteins, improving the structure and functionality of myofibrillar proteins compared to the cutter process. © 2023 Society of Chemical Industry.

THU474 Primary Hyperaldosteronism As A Cause Of PTH Elevation After Parathyroid Surgery

Abstract Disclosure: W. Thi: None. A. Rao: None. Background: Primary hyperaldosteronism can cause hypercalciuria, parathyroid hormone (PTH) elevation due to secondary hyperparathyroidism, and reduce bone mineral density. Screening for primary hyperaldosteronism can be done with serum aldosterone-renin ratio (ARR). We report a case of recurrent hyperparathyroidism after parathyroid surgery. Workup identified primary hyperaldosteronism as the cause of recurrent hyperparathyroidism. Treatment with spironolactone normalized PTH levels. Case Presentation: A 59-year-old African-American female in the Columbia VA Health Care System presented with hypertension, hypokalemia, bone density loss, and elevated PTH with normal calcium, one year after resection of a right inferior parathyroid adenoma to treat primary hyperparathyroidism. The patient had uncontrolled hypertension with hypokalemia while on losartan and amlodipine. Serum calcium was 9.4mg/dl(8.4-10.2mg/dl), PTH 89.4 pg/ml(29.2-79.9pg/ml), albumin 3.8g/dl(3.5-5G/dl), vitamin D 34 ng/ml(&amp;gt;28.9ng/ml), aldosterone 9ng/dl(&amp;lt;/=28ng/dl), plasma renin activity 0.28ng/ml/h(0.25-5.82ng/ml/h), ARR 32. Treatment of the patient with potassium supplements corrected the hypokalemia to 3.7mmol/L (5-5.1mm/l), and ARR was 94 with aldosterone 17 ng/dl and PRA 0.18 ng/ml/h and 24-hour urine calcium 304mg/24h(35-250mg/24h). Based on the laboratory values, and the absence of adrenal nodules during a CT scan, a diagnosis of primary hyperaldosteronism due to idiopathic hyperplasia of the adrenal was made. Spironolactone was started and PTH levels dropped down to 64.8pg/ml and serum calcium remained normal 5 months after treatment was initiated. Discussion: Primary Hyperaldosteronism causes extravascular fluid volume expansion with a reduction in proximal tubular sodium and calcium reabsorption. Increased calcium and sodium delivery to distal segments of the nephron leads to sodium reabsorption by mineralocorticoids without reabsorbing calcium, resulting in hypocalcemia with concomitant secondary hyperparathyroidism. Bone loss results from direct mineralocorticoid receptor-mediated effects of aldosterone on osteoblasts and osteoclasts and indirectly from high PTH levels to promote bone resorption. Treatment of primary hyperaldosteronism can reverse bone loss and reduce fracture risk rate within 18-36 months. This case suggests that primary hyperaldosteronism be considered a cause of secondary hyperparathyroidism and successfully treated with mineralocorticoid receptor antagonists. Presentation: Thursday, June 15, 2023

Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews.

Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking. To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD. A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events. Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE. Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events. For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.

Study on the mechanism of soy protein isolate to improve quality of reduced-salt Hypophthalmichthys molitrix surimi gel: Focus on gel quality, protein structure, and in vitro digestibility

Excessive intake of sodium chloride may bring a series of diseases; as a result, reduced-salt surimi gels have gained growing popularity for sodium reduction. This paper studied soy protein isolate (SPI, 2.0%, 4.0%, and 6.0%, w/w) as a gel enhancer for reduced-salt silver carp surimi. Compared with the control (2.0% NaCl), the addition of SPI significantly increased (P < 0.05) the total SH content, hydrophobic interaction force, disulfide bond, hardness, gel strength, and water-holding capacity of the gels. During the thermal denaturation process, SPI and myofibrillar protein jointly participated in the formation of the gel network, resulting in a G′ value increase at 90 °C, forming a denser/more stable gel network structure. In vitro pepsin digestion results showed the digestibility of the reduced-salt gel with SPI was higher than that of the control. Therefore, appropriate SPI addition can improve the gel performance of reduced-salt surimi gel without affecting digestion and absorption.

Simulating changes in sodium within manufactured foods in the U.S.

Elevated sodium levels can lead to high blood pressure and an increased cardiovascular disease risk. Yet recent studies have emphasized the importance of the sodium/potassium ratio and its association with blood pressure. Within the U.S. population for ages ≥ 1 year old, sodium consumption averaged 3,397 mg/day, exceeding the Dietary Reference Intake (DRI) recommendation of 2,300 mg/day. Potassium mean daily intake for the same population was 2,497 mg/day with DRI recommendations of 2,600 mg/day for adult females and 3,400 mg/day for adult males. Using NHANES 2017–2018 day one 24-hour recall, 25% reduction of sodium in the following categories: deli meat sandwich, soup, pizza, and savory snacks were simulated. The 7,122 individuals were categorized into five age groups: 2–8 year old, 9–18 year old, 19–39 year old, 40–59 year old, and 60+ year old. Results showed a significant decrease in sodium consumption across all age groups (p < 0.001). In addition, changes in the sodium/potassium intake ratio were significant in all age groups (p < 0.001). This analysis demonstrates the possibility of achieving public health goals by changes in manufactured foods, which may be easier than individual behavior change.

Choice of creep or maintenance fluid type and their impact on total daily ICU sodium burden in critically ill patients: A systematic review and meta-analysis

PurposeMaintenance and hidden/creep fluids are a major source of fluid and sodium intake in intensive care unit (ICU) patients. Recent research indicates that low versus high sodium content maintenance fluids could decrease fluid and sodium burden. We conducted a systematic review (SR) with meta-analysis to summarize the impact of maintenance fluid choice on total daily sodium in ICU patients. Materials and methodsSystematic literature search in Pubmed, Embase, the Cochrane Library and the.Clinical Trials registry. Only controlled clinical trials were included. Exclusion criteria: trials on resuscitation fluids, performed in the emergency department only and in pediatric patients. Primary objective was the reduction in mean total sodium intake with low versus high sodium content maintenance/creep fluids. ResultsFive studies (1105 patients) were included. Heterogeneity was high.Risk of bias was moderate. Mean daily sodium reduction was 117 mmol (95%Confidence Interval [CI] -174; −59; p < 0.001) with low versus high sodium content maintenance/creep fluids. Incidence of hyperchloremia was lower (OR 0.26; 95%CI 0.1; 0.64) with low sodium. There were no differences in the incidences of hyper−/hyponatremia and fluid balances. ConclusionUsing low sodium content maintenance/creep fluids substantially reduces daily sodium burden in adult ICU patients. Significant knowledge/research gaps exist regarding relevance and safety.Trial Registration: PROSPERO 2022 CRD42022300577 (February 2022).

Dietary Sodium Reduction Is Best for Reducing Blood Pressure: Controversies in Hypertension.

Dietary Sodium Reduction Is Best for Reducing Blood Pressure: Controversies in Hypertension.

Reduced Sodium in White Brined Cheese Production: Artificial Neural Network Modeling for the Prediction of Specific Properties of Brine and Cheese during Storage

Background: White brined cheese is one of the most frequently consumed cheeses that is accepted among a large group of consumers, which is largely related to its unique sensory properties, which are characterized by specific technological processes including ripening in the brine. Thus, white brined cheese contains a high amount of NaCl, and frequent consumption might lead to excessive sodium intake, which nowadays, presents a global problem. Consequently, food industries have developed reduced sodium products by substitutional salts. Furthermore, various studies have indicated that increased sodium intake via the diet can be associated with cardiovascular diseases, a risk of digestive system cancer, obesity, and other conditions. Calcium salts (citrate and lactate) are safe for human health and can be added to various foods according to the quantum satis rule. The present study aimed to partially replace NaCl with Ca-citrate and Ca-lactate in proportions of 25% and 50%. Additionally, the study presents the possibility of applying Artificial Neural Network (ANN) models for the prediction of some brine and cheese properties. Methods: White brined cheese with substitutional salts in brine (25% and 50% Ca-citrate and 25% and 50% Ca-lactate) were produced and compared to the control cheese ripened in conventionally applied NaCl brine. The acidity, total dissolved solids, salt amount, conductivity, color, and textural and sensory properties were determined over the 28 days of cold storage. Results: The substitution of NaCl with Ca-citrate and Ca-lactate is promising for sodium reduction in white brined cheese, whereby the physical and chemical properties remain acceptable. The best sensory score gain occurred with a substitution of 25% NaCl with Ca-citrate. Furthermore, ANN models can be employed to predict brine and cheese properties during storage.

Reducing Dietary Sodium Intake among Young Adults in Ghana: A Call to Action.

The positive association between excessive dietary sodium intake, hypertension, and cardiovascular disease (CVD) has been widely investigated in observational studies and clinical trials. Reducing sodium intake is a proven strategy to prevent hypertension and the onset of CVD, a major cause of morbidity and mortality globally. Africa has the youngest population globally, which is key to the continent's sustainable development. However, in Africa, the epidemics of hypertension and CVD negatively impact life expectancy and economic growth. Ghana, like other African countries, is no exception. The factors contributing to the increasing burden of CVD and excessive sodium consumption are multi-faceted and multi-level, including individual lifestyle, neighborhood and built environments, and socio-economic and health policies. Thus, the implementation of evidence-based interventions such as the World Health Organization Best Buys that target the multi-level determinants of sodium consumption is urgently needed in Ghana and other African countries. The aim of this commentary is to highlight factors that contribute to excessive sodium consumption. Second, the commentary will showcase lessons of successful implementation of sodium reduction interventions in other countries. Such lessons may help avert CVD in young adults in Ghana and Africa.