Sodium Reduction Research Articles

Application of emerging non-thermal technologies to sodium reduction in ready-to-eat fish products

This study investigated the isolated and combined effect of UV-C (0.310 J/cm2) and high hydrostatic pressure (HHP; 300 MPa for 5 min at 25 °C) on the quality parameters of cooked fish batter with reduced salt content by 25% and 50%. The treatments did not affect sodium chloride concentration, redness, yellowness, cohesiveness, springiness, and resilience (p > 0.05). CON (100% sodium chloride - NaCl), UV25%, and HHP25% had similar cooking loss (CL), lightness, hardness, chewiness, and salty taste (p > 0.05). UV + HHP25% showed higher CL and lower salty taste compared to CON, UV25%, and HHP25% (p < 0.05). UV50% and HHP50% had higher CL, lightness, hardness and chewiness, and lower salty taste than CON, UV25%, and HHP25% (p < 0.05). UV + HHP50% showed the highest CL, hardness and chewiness, while the lowest salty taste and higher lightness than CON (p < 0.05). Therefore, UV-C at 0.310 J/cm2 or HHP at 300 MPa for 5 min is a potential alternative to developing ready-to-eat fish products reduced by 25% NaCl.

Modelling the impact of compliance with WHO salt recommendations on cardiovascular mortality in Russia

Abstract Funding Acknowledgements Type of funding sources: None. Introduction High salt intake is considered the primary diet-related risk factor (being responsible for 3 million deaths and 70 million DALYs), because of its association with NCDs, such as cardiovascular diseases (ischemic heart disease, stroke, and hypertension). The World Health Organization (WHO) recommended daily salt intake is known to be &amp;lt;5 g / day (2 g sodium per day). Despite strong evidence indicating that high salt intake relates to chronic diseases and mortality, most adults do not comply with dietary recommendations. The average amount of salt consumed per day is significantly higher and amounts to 11.35 g/day among Russian adults (2018). The purpose of this study is to model the impact of following the national salt consumption recommendations in decreasing N of death attributable to excessive salt consumption. Methods This study provides a health impact evaluation, which models the effect of sodium reduction on mortality associated with blood pressure and CVD in 2018 in Russia. Cardiovascular disease included coronary heart disease, stroke, hypertensive disease, heart failure, aortic aneurysm, pulmonary embolism and rheumatic heart disease. The observed salt intake from the Russian National Health Survey of 2018 was used to determine the reference (baseline) scenario and the counterfactual scenario considered that average salt consumption was reduced to 5g/day. A comparative risk assessment model, the Preventable Risk Integrated ModEl (PRIME) was used to estimate the deaths from cardiovascular diseases that could be averted or postponed based on the sodium recommendation scenario compared to the baseline scenario. The sensitivity of the model to the results from the meta-analyses was assessed with Monte Carlo simulations. Results In 2018, an estimated 104 602 (95%: 46 832, 154 233) deaths from CVDs could have been prevented if the average salt consumption had been reduced to 5 g/day in Russia. Coronary heart disease (CHD), stroke and hypertensive disease accounted for 97% of these deaths. The modelled reduction in deaths for coronary heart disease was 59 454, for stroke 37 306 and for hypertensive disease 4 833. Conclusion A considerable number of lives could be saved if Russians adhered to the national salt intake recommendations.

Mild sodium reduction in peritoneal dialysis solution improves hypertension in end stage kidney disease: a case-report study

IntroductionBlood Pressure (BP) control is largely unsatisfied in End Stage Kidney Disease (ESKD) principally due to sodium retention. Peritoneal Dialysis (PD) is the most common type of home dialysis, using a peritoneal membrane to remove sodium, though sodium removal remains challenging.MethodsThis is a case-study reporting two consecutive ESKD patients treated by a novel peritoneal PD solution with a mildly reduced sodium content (130 mmol/L) to treat hypertension.ResultsIn the first case, a 78-year-old woman treated by Continuous Ambulatory PD (CAPD) with standard solution (three 4 h-dwells per day 1.36% glucose 132 mmol/L) showed resistant hypertension confirmed by ambulatory blood pressure monitoring (ABPM), reporting 24 h-BP: 152/81 mmHg, day-BP:151/83 mmHg and night-ABP: 153/75 mmHg, with inversion of the circadian systolic BP rhythm (1.01), despite use of three anti-hypertensives and a diuretic at adequate doses. No sign of hypervolemia was evident. We then switched from standard PD to low-sodium solution in all daily dwells. A six-months low-sodium CAPD enabled us to reduce diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), restoring the circadian BP rhythm, with no change in ultrafiltration or residual diuresis. Diet and drug prescription were unmodified too.The second case was a 61-year-old woman in standard CAPD (three 5 h-dwells per day) suffering from hypertension confirmed by ABPM (mean 24 h-ABP: 139/84 mmHg; mean day-ABP:144/88 mmHg and mean night-ABP:124/70 mmHg). She was switched from 132-Na CAPD to 130-Na CAPD, not changing dialysis schedule. No fluid expansion was evident. During low-sodium CAPD, antihypertensive therapy (amlodipine 10 mg and Olmesartan 20 mg) has been reduced until complete suspension. After 6 months, we repeated ABPM showing a substantial reduction in mean 24 h-ABP (117/69 mmHg), mean diurnal ABP (119/75 mmHg) and mean nocturnal ABP (111/70 mmHg). Ultrafiltration and residual diuresis remained unmodified. No side effects were reported in either cases.ConclusionsThis case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.

Knowledge, perception, and practice related to sodium intake among Malaysian adults: findings from the Malaysian Community Salt Study (MyCoSS)

BackgroundExcessive intake of sodium is a major public health concern. Information on knowledge, perception, and practice (KPP) related to sodium intake in Malaysia is important for the development of an effective salt reduction strategy. This study aimed to investigate the KPP related to sodium intake among Malaysian adults and to determine associations between KPP and dietary sodium intake.MethodsData were obtained from Malaysian Community Salt Survey (MyCoSS) which is a nationally representative survey with proportionate stratified cluster sampling design. A pre-tested face-to-face questionnaire was used to collect information on socio-demographic background, and questions from the World Health Organization/Pan American Health Organization were adapted to assess the KPP related to sodium intake. Dietary sodium intake was determined using single 24-h urinary sodium excretion. Respondents were categorized into two categories: normal dietary sodium intake (< 2000 mg) and excessive dietary sodium intake (≥ 2000 mg). Out of 1440 respondents that were selected to participate, 1047 respondents completed the questionnaire and 798 of them provided valid urine samples. Factors associated with excessive dietary sodium intake were analyzed using complex sample logistic regression analysis.ResultsMajority of the respondents knew that excessive sodium intake could cause health problems (86.2%) and more than half of them (61.8%) perceived that they consume just the right amount of sodium. Overall, complex sample logistic regression analysis revealed that excessive dietary sodium intake was not significantly associated with KPP related to sodium intake among respondents (P > 0.05).ConclusionThe absence of significant associations between KPP and excessive dietary sodium intake suggests that salt reduction strategies should focus on sodium reduction education includes measuring actual dietary sodium intake and educating the public about the source of sodium. In addition, the relationship between the authority and food industry in food reformulation needs to be strengthened for effective dietary sodium reduction in Malaysia.

Physicochemical design rules for the formulation of novel salt particles with optimised saltiness

Novel sodium reduction strategies are urgently required by the food industry. We hypothesised that redesigning salt crystals (size, density, hydrophobicity and flow properties) will offer a new route to increase saltiness and therefore reduce sodium. Eight salts were compared with different physicochemical properties, the resultant particles were characterised and adhesion to product, loss in-pack, rate of dissolution and ultimately saltiness perception were evaluated. Principle findings included that particle adhesion was driven by particle size (r = -0.85, p = 0.008), bulk density (r = -0.80, p = 0.017) and flow properties (r = 0.77, p = 0.015); loss in-pack was associated with particle size and hydrophobicity of the salt particle while dissolution and/or saltiness perception was also driven by particle size and hydrophobicity of the salt particle. The findings offer a new set of design rules for future ingredient design for the food and flavour industries.

Effect of NaCl Replacement by other Salts on the Quality of Bísaro Pork Sausages (PGI Chouriça de Vinhais).

Concerned about the trend to reduce salt consumption, the meat industry has been increasing the strategies to produce and commercialize products where the reduction or even the replacement of NaCl is an important goal. The aim of this study was to test the effect of partial NaCl replacement by KCl and Sub4Salt® on the quality of pork sausages. Three different formulations (NaCl + KCl, NaCl + Sub4Salt®, and KCl + Sub4Salt®) were considered and compared to the control (2% NaCl). Physicochemical properties, chemical composition, and microbiological and sensory characteristics were evaluated. The replacement of NaCl did not affect pH, water activity (aw) or its chemical composition after eight or 16 days ripening time, while a significant sodium reduction was achieved. The oxidation index expressed in TBARS was also not affected by the NaCl substitution and varied between 0.01 to 0.04 of malonaldehyde (MDA) per kg of sample. Similarly, the NaCl replacement did not change the microbiological quality of the sausages, and the production of healthier meat sausages had also no significant effect on their sensory characteristics. Therefore, according to the results obtained, it is viable and a good strategy for the meat industry to produce “reduced sodium content” sausages without affecting their traditional quality.

Serum sodium and eplerenone use in patients with a myocardial infarction and left ventricular dysfunction or heart failure: insights from the EPHESUS trial.

Sodium changes are common in myocardial infarction (MI) complicated with left ventricular systolic dysfunction (LVSD) and/or heart failure (HF). Sodium handling is fine-tuned in the distal nephron, were eplerenone exhibits some of its pleotropic effects. Little is known about the effect of eplerenone on serum sodium and the prognostic relevance of sodium alterations in patients with MI complicated with LVSD and/or HF. The EPHESUS trial randomized 6632 patients to either eplerenone or placebo. Hyponatremia and hypernatremia were defined as sodium < 135mmol/L or > 145mmol/L, respectively. Linear mixed models and time updated Cox regression analysis were used to determine the effect of eplerenone on sodium changes and the prognostic importance of sodium changes, respectively. The primary outcomes were all-cause mortality and a composite of cardiovascular (CV) mortality and CV-hospitalization. A total of 6221 patients had a post-baseline sodium measurement, 797 patients developed hyponatremia (mean of 0.2 events/per patient) and 1476 developed hypernatremia (mean of 0.4 events/per patient). Patients assigned to eplerenone had a lower mean serum sodium over the follow-up (140 vs 141mmol/L; p < 0.0001) and more often developed hyponatremia episodes (15 vs 11% p = 0.0001) and less often hypernatremia episodes (22 vs. 26% p = 0.0003). Hyponatremia, but not hypernatremia was associated with adverse outcome for all outcome endpoints in the placebo group but not in the eplerenone group (interaction p value < 0.05 for all). Baseline sodium values did not influence the treatment effect of eplerenone in reducing the various endpoints (interaction p value > 0.05 for all). Development of new-onset hyponatremia following eplerenone initiation did not diminish the beneficial eplerenone treatment effect. Eplerenone induces minor reductions in serum sodium. The beneficial effect of eplerenone was maintained regardless of the baseline serum sodium or the development of hyponatremia. Sodium alterations should not refrain clinicians from prescribing eplerenone to patients who had an MI complicated with LVSD and/or HF. ClinicalTrials.gov identifier: NCT00232180. Serum sodium and eplerenone use in patients with a myocardial infarction and left ventricular dysfunction or heart failure: insights from the EPHESUS trial.

Synergistic effect of pequi waste extract, UV-C radiation and vacuum packaging on the quality characteristics of goat Minas Frescal cheese with sodium reduction

This study aimed to evaluate the effects of pequi waste extract (PWE), isolated and combined with preservation methods, on the physicochemical and bacteriological quality of goat Minas Frescal cheese with salt replacer (75% NaCl and 25% KCl). After manufactured, the cheeses were packed in aerobic packages, vacuum package (VP) and vacuum package + UV-C radiation, with and without PWE and stored at 4 °C for 21 days. Physicochemical properties, proteolysis, lipid oxidation and bacteriological quality were evaluated. No negative influence was observed on starter culture viability after any treatment tested or PWE addition to the cheese. VP and UV-C promoted higher maintenance of chemical composition, color and texture values, and the interaction with PWE was also positive for chemical composition and acidity. However, PWE increases proteolysis and decreases texture parameters. UV-C radiation increased lipid oxidation and affected the acidity, while VP + PWE retard this oxidative process. This combination led to the best growth rate for Lactococcus, besides slight color change. In conclusion, PWE and VP combination can be a promising alternative as a preservative method of nutritional quality without strong changes in the physicochemical quality of cheese. Further studies evaluating the sensory attributes of these cheeses should be performed.

Reducing phosphate in low sodium and low‐cost meat emulsions: A healthier approach

This study investigated the effect of reducing sodium chloride (NaCl) and phosphate in meat emulsion models added of chloride salt substitutes (KCl and CaCl2) on the physicochemical characteristics and microstructure of meat emulsions containing high content of mechanically deboned poultry meat (MDPM). Ten treatments were performed containing NaCl, KCl, CaCl2, or blend of these salts, with the same ionic strength were used to substitute of the NaCl, and 0.25% or 0.5% sodium tripolyphosphate (STPP). The treatments containing CaCl2 contributed negatively to the formation and stability of the batter. KCl promoted physicochemical characteristics similar to NaCl. It was possible to reduce 50% of the STPP content without negatively affecting the functional properties. The results of blends containing NaCl, KCl, and CaCl2 can be useful to reduce the content of sodium and phosphate in emulsified products with a high content of MDPM resulting in a healthier and more accessible cost for consumers. Practical applications There is a growing demand for the development of healthier meat products, being the reduction of sodium and phosphate content one of the main challenges, mainly in matrices with high content of mechanically deboned meat. It was evidenced that the reduction of NaCl content maintaining the STPP content did not promote major impact on the characteristics of meat emulsions with high content of MDPM. Replacing NaCl by KCl proved to be a good option to reduce the sodium content in meat emulsions.

Components Associated With Saltiness Potentiation in Frankfurters Made With Traditionally Brewed Soy Sauce

Salt is a critical ingredient in processed meat and poultry products because of its multiple functions that affect product quality and safety. Although salt is a functional ingredient in food products, sodium reduction continues to be an important topic within the food industry due to interests in reducing dietary sodium intake. Previous work has shown that soy sauce addition may potentiate saltiness perception in processed meats and thus allow for novel formulations with reduced sodium content. Two studies were conducted to further elucidate these effects. First, trained panel sensory char- acteristics, relevant quality parameters, and selected chemical profiles were determined comparing frankfurters containing flake salt and traditionally brewed soy sauce. Seven aqueous compounds were found to be more abundant (P &amp;lt; 0.001) in the soy sauce – containing treatment, and 56 volatile compounds were identified. Principal component analysis of the sensory and selected chemical profiles led to the consideration that ethyl hexanoate (EHEX) may be a causative agent of the saltiness-potentiating phenomenon. Thus, a second study further evaluated concentrations of EHEX, revealing that trained sensory panelists perceived frankfurters containing EHEX as saltier (P &amp;lt; 0.05) and these frankfurters had higher scores for fermented/sour aromatic score (P &amp;lt; 0.05) than the control (Control: 100% NaCl from flake salt). This research demon- strated the ability of EHEX to potentiate saltiness in frankfurters with minimal effects on quality.

ARTERIAL HYPERTENSION MANAGEMENT TRENDS IN PAKISTAN; CROSS-SECTIONAL OBSERVATIONAL STUDY OF A SAMPLE OF PAKISTANI DOCTORS

Abstract Objective: To look at the practice trends regarding Hypertension in Pakistani doctors and to find out the weak links in our diagnosis, management, care and followup. Design and method: Study Setting: The study was conducted on 600 doctors practicing in different cities of Pakistan. These doctors came from all professional spheres, Fresh Graduates, Post graduate trainee, Consultants (of all ranks) and Family Physicians etc. Study Design: Observational cross-sectional. Study Population and Sampling Technique: We used cluster random sampling method to collect data. Results: Only 146 (24.3%) were following the guidelines while 235 (39.2%) were measuring it too early or 148 (24.6%) were measuring too late. Seventy one (11.8%) of the surveyed individual did not respond to this question. According to latest guidelines, - A heart-healthy diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, that facilitates achieving a desirable weight is recommended for adults with elevated BP or hypertension. Sodium reduction is recommended for adults with elevated BP or hypertension. Only 3.7% doctors talked about DASH diet in survey questionnaire, and not all the doctors are advising salt reduction to hypertensive patients comprising only 70.2%. Only 2.5% doctors are advising to increase water intake and even alarming is that advising smoking cessation to hypertensive patients is talked about by only 4.3% of doctors. Desired BP control is a difficult task even in developed countries. In Pakistan less than 3 % have adequate control Table 3 shows the responses to our inquiry - Grade each of the following separately which is in your opinion the most likely cause of inadequate BP control; from 1–5 (1 being somewhat common cause, and 5 being leas t common cause). The response shows the wide range of issues that we have regarding controlling the blood pressure. Conclusions: Issues in our society are multi-factorial. Need to emphasize to the physicians the importance of Continuance Medical Education and improving your practice skills. Also need to reach out to patients by all current mediums so they may be able to better understand the risks a person is under when he/she develop hypertension.

EARLY EVIDENCE FOR THE EFFECTIVENESS OF SOUTH AFRICA'S LEGISLATION ON SALT RESTRICTION IN FOODS: THE AFRICAN-PREDICT STUDY

Objective: South Africa was one of the first countries to adopt mandatory regulation in 2016 to lower the salt content of a wide range of processed foods. To assess the effectiveness of this regulation, we determined the change in salt intake of young adults over a mean follow-up time of 4.56-years spanning the implementation of the regulation. Since young populations have a higher salt intake, salt reduction may have a greater long-term impact as a preventative strategy in this age group. Design and method: This study included baseline (N = 668; aged 24.9 ± 3 years; 47.8% black; 40.7% men) and follow-up data for the first 311 participants (aged 29.9 ± 3.09 years; 51.1% black; 43.4% men) tracked over time as part of the African-PREDICT study. Participants had baseline data before 30th June 2016, and follow-up from 2018 - 2020. Estimated salt intake at baseline and follow-up was calculated from 24-hour urinary sodium excretion. Results: The median salt intake of the population (N = 668) at baseline was 7.88 g/day (IQR: 5.67). In those followed (N = 311), salt intake reduced from baseline [median (IQR): 7.91 g/day (5.83)] to follow-up [median (IQR): 7.26 g/day (5.30)] in the total group [median difference (IQR): -0.82 g/day (7.02); p = 0.007], with a greater reduction observed in black adults [N = 159, median difference (IQR): -1.35 g/day (7.91); p = 0.003]. Reduced salt intake was more pronounced in black adults from a low (p = 0.007) and middle socio-economic status (p = 0.009), compared to a high socio-economic status (p = 0.27). Conclusions: Our preliminary findings suggest that South Africa's mandatory salt reduction regulation for processed foods has been effective in lowering salt intake in young adults by a magnitude of ∼0.82 g salt/day. Our study supports the effectiveness of “upstream” sodium reduction interventions at population level that may impact on the health and economic burden of countries.

Do knowledge about sodium, health status by self-report, and having hypertension predict sodium consumption behaviors among Southern California hospital employees?

Little is known about factors that shape sodium consumption behaviors among hospital employees targeted by recent federally funded, sodium-related policy, systems, and environmental change interventions. To address this gap in health promotion practice, we assessed the influence of sodium-related knowledge and attitudes, and health status by self-report on the sodium consumption behaviors of hospital employees targeted by the Los Angeles County Sodium Reduction Initiative. Cross-sectional surveys were administered to 1,213 hospital employees at four Southern California hospitals between 2016 and 2018. Logistic regression models examined the associations between five key sodium consumption behaviors and independent variables of interest (i.e., knowledge and attitudes about sodium, self-reported general health status, and self-reported lifetime hypertension diagnosis), controlling for covariates (i.e., sociodemographic characteristics, body mass index, the type of hospital from which participants were recruited, and the median household income in the hospital's zip code). 1,213 hospital employees completed the survey (completion rate = 50%). The belief that salt intake is harmful was associated with four of five sodium consumption behaviors, while adequate sodium intake knowledge and self-reported "good health" were associated with three of the behaviors. Hypertension diagnosis was associated with only one. Understanding sodium consumption behaviors among healthcare workers can help hospitals improve their employees' health through the promotion of healthier food environments in the workplace and changes in institutional practices.

Sodium content in meat products: suitability to labeling and the voluntary agreements

This study was undertaken to evaluate the sodium concentration in meat products, to ascertain their appropriateness for labels and agreements set up between the Health Ministry and the Brazilian Association of Food Industries. A total of 96 meat derivative samples (italian salami, chicken pate, cooked ham, ham, sausage, bologna, tuscan sausage and smoked mixed sausage) were collected from different brands and batches. Using flame emission spectroscopy, the samples were analyzed for sodium levels based on the official methodology. It was observed that 46.9% of the companies showed values in nutritional labeling to be noncompliant with the Brazilian legislation. In fact, 31.2% of the brands assessed failed to satisfy the sodium reduction target decided upon for 2017. The italian salami was the product with the higher sodium content present a average value among the brands of 1716.11 mg 100 g-1. It became evident that merely implementing voluntary agreements had failed to provide total adequacy in the sodium content of the meat products. There is also great need for the industries to be more engaged in finding substitutes to minimize the sodium levels in the foods, without inducing significant alterations in the physicochemical, microbiological and technological features of the products, apart from the higher inspection by the government agencies in terms of agreement compliance and population awareness.

The Effects of a Low Sodium Meal Plan on Blood Pressure in Older Adults: The SOTRUE Randomized Feasibility Trial.

Reduced sodium meal plans are recommended by the Centers of Disease Control to lower blood pressure in older adults; however, this strategy has not been tested in a clinical trial. The Satter House Trial of Reduced Sodium Meals (SOTRUE) was an individual-level, double-blind, randomized controlled pilot study of adults living in a congregate living facility subsidized by the Federal Department of Housing and Urban Development (HUD). Adults over age 60 years ate 3 isocaloric meals with two snacks daily for 14 days. The meal plans differed in sodium density (<0.95 vs. >2 mg/kcal), but were equivalent in potassium and macronutrients. Seated systolic BP (SBP) was the primary outcome, while urine sodium-creatinine ratio was used to measure compliance. Twenty participants were randomized (95% women; 95% white; mean age 78 ± 8 years), beginning in 7 October 2019. Retention was 100% with the last participant ending 4 November 2019. Mean baseline SBP changed from 121 to 116 mmHg with the typical sodium diet (−5 mmHg; 95% CI: −18, 8) and from 123 to 112 mmHg with the low sodium diet (−11 mmHg; 95% CI: −15.2, −7.7). Compared to the typical sodium meal plan, the low sodium meal plan lowered SBP by 4.8 mmHg (95% CI: −14.4, 4.9; p = 0.31) and urine sodium-creatinine ratio by 36% (−36.0; 95% CI: −60.3, 3.4; p = 0.07), both non-significant. SOTRUE demonstrates the feasibility of sodium reduction in federally mandated meal plans. A longer and larger study is needed to establish the efficacy and safety of low sodium meals in older adults.

Improved Sensitivity in Hydrophilic Interaction Liquid Chromatography-Electrospray-Mass Spectrometry after Removal of Sodium and Potassium Ions from Biological Samples.

Inorganic ions, such as sodium and potassium, are present in all biological matrices and are sometimes also added during sample preparation. However, these inorganic ions are known to hamper electrospray ionization -mass spectrometry (ESI-MS) applications, especially in hydrophilic interaction liquid chromatography (HILIC) where they are retained and can be detected as adducts and clusters with mobile phase components or analytes. The retention of inorganic ions leads to co-elution with analytes and as a result ion-suppression, extensive adduct formation and problems with reproducibility. In the presented work, a sample preparation method using cation exchange solid phase extraction (SPE) was developed to trap Na+ and K+ ions from human blood plasma and head and neck cancer cells for the analysis of small cationic, anionic as well as neutral organic analytes. The investigated analytes were small, hydrophilic compounds typically in focus in metabolomics studies. The samples were analyzed using full-scan HILIC-ESI-quadrupole time of flight (QTOF)-MS with an untargeted, screening approach. Method performance was evaluated using multivariate data analysis as well as relative quantifications, spiking of standards to evaluate linearity of response and post-column infusion to study ion-suppression. In blood plasma, the reduction of sodium and potassium ion concentration resulted in improved sensitivity increased signal intensity for 19 out of 28 investigated analytes, improved linearity of response, reduced ion-suppression and reduced cluster formation as well as adduct formation. Thus, the presented method has significant potential to improve data quality in metabolomics studies.

The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy.ResultsThe voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained).ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

The impact of baseline potassium intake on the dose-response relation between sodium reduction and blood pressure change: systematic review and meta-analysis of randomized trials.

Sodium and potassium appear to interact with each other in their effects on blood pressure with potassium supplementation having a greater blood pressure lowering-effect when sodium intake is high. Whether the effect of sodium reduction on blood pressure varies according to potassium intake levels is unclear. We carried out a systematic review and meta-analysis to examine the impact of baseline potassium intake on blood pressure response to sodium reduction in randomized trials in adult populations, with sodium and potassium intake estimated from 24-h urine samples. We included 68 studies involving 5708 participants and conducted univariable and multivariable meta-regression. The median intake of baseline potassium was 67.7 mmol (Interquartile range: 54.6-76.4 mmol), and the mean reduction in sodium intake was 128 mmol (95% CI: 107-148). Multivariable meta-regression that included baseline 24-h urinary potassium excretion, age, ethnicity, baseline blood pressure, change in 24-h urinary sodium excretion, as well as the interaction between baseline 24-h urinary potassium excretion and change in 24-h urinary sodium excretion did not identify a significant association of baseline potassium intake levels with the blood pressure reduction achieved with a 50 mmol lowering of sodium intake (p > 0.05 for both systolic and diastolic blood pressure). A higher starting level of blood pressure was consistently associated with a greater blood pressure reduction from reduced sodium consumption. However, the nonsignificant findings may subject to the limitations of the data available. Additional studies with more varied potassium intake levels would allow a more confident exclusion of an interaction.

Salicornia ramosissima as a salt substitute in the fermentation of white cabbage.

This research aimed to study the fermentation of white cabbage (Brassica oleracea) replacing salt, totally or partially, with halophyte Salicornia ramosissima, to reduce the sodium content in the final products. Three fermentation trials of cabbage were done: A with 2.91% salt (~ 1.15% Na) (control); B with salicornia (~ 1.56% salt equivalent, ~ 0.34% Na); and C with salt and salicornia (~ 1.94% salt equivalent, ~ 0.49% Na). The fermentation profile was followed by the physicochemical (pH, total acidity) and microbial parameters [mesophilic microorganisms (MM), lactic-acid bacteria (LAB), coliforms and fungi]. The content of phenolics and antioxidant activity in the fermented products were also measured. In all experiments, there was an increase, followed by a stabilization of the MM (5.5-7.2 Log CFU/g) and LAB populations (5.4-6.6 Log CFU/g) and a decrease of fungi and coliforms until they disappeared. A decrease in pH (< 4) and a rise in acidity (~ 1.0%) were observed throughout the fermentations. The phenolics and antioxidant activity increased during fermentation, being significantly higher in C (37.3mg/100g and 3.63mmol Trolox/100g, respectively). The fermentation of cabbage with salicornia results in the final products having similar microbial quality to the control, but with a reduction of sodium and an increase in the antioxidant activity.

Alkaline instant noodles: use of alkaline salts to reduce sodium and assessment of calcium bioaccessibility

Instant noodles originated in eastern nations and have been accepted due to its practicality and low cost. However, its high sodium content can lead to health problems. The present study aimed to reduce sodium and increase calcium levels in noodles. A control (N1: K2CO3+ Na2CO3) and three treatments with the addition of calcium carbonate in combination with alkaline salts such as potassium and sodium carbonates (N2: K2CO3+ CaCO3; N3: Na2CO3+ CaCO3; and N4: CaCO3) were studied. Two hydration methods were investigated, and the technological characterization and the calcium bioaccessibility of the different noodle formulations were determined. N4 did not fit into the alkaline noodle category due to its neutral pH. N2 and N4 showed a sodium reduction of around 28% and a significant increase in calcium content, with higher bioaccessible calcium. Significant changes were observed for the noodles made with the addition of different alkaline salts, with a light-yellow color and better texture than the control, which can be a positive aspect, once products with reduced nutrients usually present differentiated coloring. Therefore, the use of calcium carbonate may be a promising alternative to increase Ca intake and to reduce the sodium content of instant noodles.