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Special Issue "Salt and Health: A Public Health Issue"

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 June 2014)

Special Issue Editors

Guest Editor
Prof. Dr. Caryl Nowson (Website)

Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University Geelong Waurn Ponds Campus, Deakin University, Locked Bag 20000, Geelong Victoria 3220, Australia
Fax: +61 3 9244 6017
Interests: dietary mineral and electrolytes; nutrition related to cardiovascular disease and osteoporosis; elderly nutrition
Guest Editor
Dr. Carley Grimes

Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia

Special Issue Information

Submission

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. Papers will be published continuously (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are refereed through a peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed Open Access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1500 CHF (Swiss Francs).

Keywords

  • population salt reduction
  • salt reduction in the food supply
  • salt intake and health outcomes
  • salt and sodium
  • monitoring population salt intake
  • salt taste preferences in children
  • economic benefits of salt reduction
  • consumer knowledge of salt practices

Published Papers (10 papers)

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Research

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Open AccessArticle Consumer Knowledge, Attitudes and Salt-Related Behavior in the Middle-East: The Case of Lebanon
Nutrients 2014, 6(11), 5079-5102; doi:10.3390/nu6115079
Received: 21 July 2014 / Revised: 1 October 2014 / Accepted: 28 October 2014 / Published: 13 November 2014
Cited by 3 | PDF Full-text (264 KB) | HTML Full-text | XML Full-text
Abstract
Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association [...] Read more.
Sodium intake is high in Lebanon, a country of the Middle East region where rates of cardiovascular diseases are amongst the highest in the world. This study examines salt-related knowledge, attitude and self-reported behaviors amongst adult Lebanese consumers and investigates the association of socio-demographic factors, knowledge and attitudes with salt-related behaviors. Using a multicomponent questionnaire, a cross-sectional study was conducted in nine supermarkets in Beirut, based on systematic random sampling (n = 442). Factors associated with salt-related behaviors were examined by multivariate regression analysis. Specific knowledge and attitude gaps were documented with only 22.6% of participants identifying processed foods as the main source of salt, 55.6% discerning the relationship between salt and sodium, 32.4% recognizing the daily limit of salt intake and 44.7% reporting being concerned about the amount of salt in their diet. The majority of participants reported behavioral practices that increase salt intake with only 38.3% checking for salt label content, 43.7% reporting that their food purchases are influenced by salt content and 38.6% trying to buy low-salt foods. Knowledge, attitudes and older age were found to significantly predict salt-related behaviors. Findings offer valuable insight on salt-related knowledge, attitude and behaviors in a sample of Lebanese consumers and provide key information that could spur the development of evidence-based salt-reduction interventions specific to the Middle East. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessArticle An Evaluation of the Effects of the Australian Food and Health Dialogue Targets on the Sodium Content of Bread, Breakfast Cereals and Processed Meats
Nutrients 2014, 6(9), 3802-3817; doi:10.3390/nu6093802
Received: 1 July 2014 / Revised: 1 August 2014 / Accepted: 1 August 2014 / Published: 19 September 2014
Cited by 16 | PDF Full-text (542 KB) | HTML Full-text | XML Full-text
Abstract
The Australian Food and Health Dialogue set sodium reduction targets for three food categories (breads, ready-to-eat breakfast cereals and processed meats) to be achieved by December, 2013. Sodium levels for 1849 relevant packaged foods on the shelves of Australian supermarkets between 2010 [...] Read more.
The Australian Food and Health Dialogue set sodium reduction targets for three food categories (breads, ready-to-eat breakfast cereals and processed meats) to be achieved by December, 2013. Sodium levels for 1849 relevant packaged foods on the shelves of Australian supermarkets between 2010 and 2013 were examined. Changes in mean sodium content were assessed by linear mixed models, and the significance of differences in the proportion of products meeting targets was determined using chi-squared or McNemar’s tests. The mean sodium level of bread products fell from 454 to 415 mg/100 g (9% lower, p < 0.001), and the proportion reaching target rose from 42% to 67% (p < 0.005). The mean sodium content of breakfast cereals also fell substantially from 316 to 237 mg/100 g (25% lower, p < 0.001) over the study period. The decline in mean sodium content of bacon/ham/cured meats from 1215 to 1114 mg/100 g (8% lower, p = 0.001) was smaller, but associated with a rise in the proportion meeting the target from 28% to 47%. Declines in mean sodium content did not appreciably differ between companies that did and did not make public commitments to the targets. These data show that the Australian food industry can reduce salt levels of processed foods and provide a strong case for broadening and strengthening of the Food and Health Dialogue (FHD) process. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessArticle Assessing the Average Sodium Content of Prepacked Foods with Nutrition Declarations: The Importance of Sales Data
Nutrients 2014, 6(9), 3501-3515; doi:10.3390/nu6093501
Received: 27 June 2014 / Revised: 18 August 2014 / Accepted: 22 August 2014 / Published: 4 September 2014
Cited by 3 | PDF Full-text (254 KB) | HTML Full-text | XML Full-text
Abstract
Processed foods are recognized as a major contributor to high dietary sodium intake, associated with increased risk of cardiovascular disease. Different public health actions are being introduced to reduce sodium content in processed foods and sodium intake in general. A gradual reduction [...] Read more.
Processed foods are recognized as a major contributor to high dietary sodium intake, associated with increased risk of cardiovascular disease. Different public health actions are being introduced to reduce sodium content in processed foods and sodium intake in general. A gradual reduction of sodium content in processed foods was proposed in Slovenia, but monitoring sodium content in the food supply is essential to evaluate the progress. Our primary objective was to test a new approach for assessing the sales-weighted average sodium content of prepacked foods on the market. We show that a combination of 12-month food sales data provided by food retailers covering the majority of the national market and a comprehensive food composition database compiled using food labelling data represent a robust and cost-effective approach to assessing the sales-weighted average sodium content of prepacked foods. Food categories with the highest sodium content were processed meats (particularly dry cured meat), ready meals (especially frozen pizza) and cheese. The reported results show that in most investigated food categories, market leaders in the Slovenian market have lower sodium contents than the category average. The proposed method represents an excellent tool for monitoring sodium content in the food supply. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Figures

Open AccessArticle Accuracy of Canadian Food Labels for Sodium Content of Food
Nutrients 2014, 6(8), 3326-3335; doi:10.3390/nu6083326
Received: 27 May 2014 / Revised: 1 August 2014 / Accepted: 7 August 2014 / Published: 22 August 2014
Cited by 2 | PDF Full-text (380 KB) | HTML Full-text | XML Full-text
Abstract
The accuracy of the Nutrition Facts table (NFt) has a significant impact on Canadian efforts to reduce dietary sodium and monitor sodium content in foods. This study assessed the accuracy of sodium (and calories, trans fat, saturated fat, sugar) reported on the [...] Read more.
The accuracy of the Nutrition Facts table (NFt) has a significant impact on Canadian efforts to reduce dietary sodium and monitor sodium content in foods. This study assessed the accuracy of sodium (and calories, trans fat, saturated fat, sugar) reported on the NFt for selected foods and beverages in Canada. The Canadian Food Inspection Agency (CFIA) sampled over 1000 foods and beverages from supermarkets, bakeries, and restaurants across Canada between January 2006 and December 2010. The samples were analyzed in CFIA laboratories. Results were requested for products with ≥1 of the following nutrients tested: sodium, calories, saturated fat, trans fat, and sugar. Differences between the label and laboratory values were calculated for each product. Overall, 16.7% (n = 169) of products were “unsatisfactory” with laboratory values exceeding ±20% of the NFt value. Sodium had the highest number of unsatisfactory products (n = 49, 18.4%) and trans fat had the lowest number of unsatisfactory products (n = 16, 4.3%). The proportion of unsatisfactory products for saturated fat, calories, and sugar was 15.8%, 14.2%, and 12.9%, respectively. All of the unsatisfactory products had excess nutrient content relative to the NFt. Sodium and calories were consistently underreported (p < 0.05), while NFt values for the other nutrients were not statistically different than laboratory values. Increased monitoring of NFt sodium values is recommended in order to increase consumer confidence in this nutrition tool, to encourage industry to accurately report nutrient content and to continue using the NFt to guide research, education, and policy development. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessArticle Target Salt 2025: A Global Overview of National Programs to Encourage the Food Industry to Reduce Salt in Foods
Nutrients 2014, 6(8), 3274-3287; doi:10.3390/nu6083274
Received: 16 July 2014 / Revised: 7 August 2014 / Accepted: 11 August 2014 / Published: 21 August 2014
Cited by 31 | PDF Full-text (193 KB) | HTML Full-text | XML Full-text
Abstract
Reducing population salt intake has been identified as a priority intervention to reduce non-communicable diseases. Member States of the World Health Organization have agreed to a global target of a 30% reduction in salt intake by 2025. In countries where most salt [...] Read more.
Reducing population salt intake has been identified as a priority intervention to reduce non-communicable diseases. Member States of the World Health Organization have agreed to a global target of a 30% reduction in salt intake by 2025. In countries where most salt consumed is from processed foods, programs to engage the food industry to reduce salt in products are being developed. This paper provides a comprehensive overview of national initiatives to encourage the food industry to reduce salt. A systematic review of the literature was supplemented by key informant questionnaires to inform categorization of the initiatives. Fifty nine food industry salt reduction programs were identified. Thirty eight countries had targets for salt levels in foods and nine countries had introduced legislation for some products. South Africa and Argentina have both introduced legislation limiting salt levels across a broad range of foods. Seventeen countries reported reductions in salt levels in foods—the majority in bread. While these trends represent progress, many countries have yet to initiate work in this area, others are at early stages of implementation and further monitoring is required to assess progress towards achieving the global target. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessArticle Estimation of 24-Hour Urinary Sodium Excretion Using Spot Urine Samples
Nutrients 2014, 6(6), 2360-2375; doi:10.3390/nu6062360
Received: 9 March 2014 / Revised: 20 May 2014 / Accepted: 28 May 2014 / Published: 20 June 2014
Cited by 7 | PDF Full-text (2885 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24–70 [...] Read more.
The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24–70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24–70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual’s 24-HUNa. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)

Review

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Open AccessReview Current Levels of Salt Knowledge: A Review of the Literature
Nutrients 2014, 6(12), 5534-5559; doi:10.3390/nu6125534
Received: 21 July 2014 / Revised: 3 November 2014 / Accepted: 6 November 2014 / Published: 1 December 2014
Cited by 4 | PDF Full-text (233 KB) | HTML Full-text | XML Full-text
Abstract
High salt intake increases the risk of hypertension and cardiovascular diseases. Given the role of knowledge as a determinant of food intake, this paper aims to review the current levels of salt knowledge and the association between salt knowledge and dietary salt [...] Read more.
High salt intake increases the risk of hypertension and cardiovascular diseases. Given the role of knowledge as a determinant of food intake, this paper aims to review the current levels of salt knowledge and the association between salt knowledge and dietary salt intake and salt-related dietary practices in the general population. Twenty two studies were included in the review. In general, the studies showed consumers were able to identify the health risks associated with high salt intake. However, knowledge of recommended daily intakes, understanding of the relationships between salt and sodium and foods that contribute most salt to the diet were poor. Four of the five studies which examined the relationships between salt knowledge and salt-related dietary practices reported significant associations. Two important gaps in the current literature were identified. First, there is a need for a robustly validated tool to examine salt knowledge and its impact on salt intake. Second, a comprehensive salt knowledge assessment should include assessment of procedural, as well as declarative, knowledge. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessReview Measuring Population Sodium Intake: A Review of Methods
Nutrients 2014, 6(11), 4651-4662; doi:10.3390/nu6114651
Received: 17 July 2014 / Revised: 5 October 2014 / Accepted: 14 October 2014 / Published: 28 October 2014
Cited by 18 | PDF Full-text (138 KB) | HTML Full-text | XML Full-text
Abstract
Reduction of population sodium intake has been identified as a key initiative for reduction of Non-Communicable Disease. Monitoring of population sodium intake must accompany public health initiatives aimed at sodium reduction. A number of different methods for estimating dietary sodium intake are [...] Read more.
Reduction of population sodium intake has been identified as a key initiative for reduction of Non-Communicable Disease. Monitoring of population sodium intake must accompany public health initiatives aimed at sodium reduction. A number of different methods for estimating dietary sodium intake are currently in use. Dietary assessment is time consuming and often under-estimates intake due to under-reporting and difficulties quantifying sodium concentration in recipes, and discretionary salt. Twenty-four hour urinary collection (widely considered to be the most accurate method) is also burdensome and is limited by under-collection and lack of suitable methodology to accurately identify incomplete samples. Spot urine sampling has recently been identified as a convenient and affordable alternative, but remains highly controversial as a means of monitoring population intake. Studies suggest that while spot urinary sodium is a poor predictor of 24-h excretion in individuals, it may provide population estimates adequate for monitoring. Further research is needed into the accuracy and suitability of spot urine collection in different populations as a means of monitoring sodium intake. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)
Open AccessReview To Legislate or Not to Legislate? A Comparison of the UK and South African Approaches to the Development and Implementation of Salt Reduction Programs
Nutrients 2014, 6(9), 3672-3695; doi:10.3390/nu6093672
Received: 19 July 2014 / Revised: 19 August 2014 / Accepted: 25 August 2014 / Published: 16 September 2014
Cited by 7 | PDF Full-text (899 KB) | HTML Full-text | XML Full-text
Abstract
The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt [...] Read more.
The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)

Other

Jump to: Research, Review

Open AccessCommentary Are Reductions in Population Sodium Intake Achievable?
Nutrients 2014, 6(10), 4354-4361; doi:10.3390/nu6104354
Received: 31 July 2014 / Revised: 26 September 2014 / Accepted: 6 October 2014 / Published: 16 October 2014
Cited by 1 | PDF Full-text (98 KB) | HTML Full-text | XML Full-text
Abstract
The vast majority of Americans consume too much sodium, primarily from packaged and restaurant foods. The evidence linking sodium intake with direct health outcomes indicates a positive relationship between higher levels of sodium intake and cardiovascular disease risk, consistent with the relationship [...] Read more.
The vast majority of Americans consume too much sodium, primarily from packaged and restaurant foods. The evidence linking sodium intake with direct health outcomes indicates a positive relationship between higher levels of sodium intake and cardiovascular disease risk, consistent with the relationship between sodium intake and blood pressure. Despite communication and educational efforts focused on lowering sodium intake over the last three decades data suggest average US sodium intake has remained remarkably elevated, leading some to argue that current sodium guidelines are unattainable. The IOM in 2010 recommended gradual reductions in the sodium content of packaged and restaurant foods as a primary strategy to reduce US sodium intake, and research since that time suggests gradual, downward shifts in mean population sodium intake are achievable and can move the population toward current sodium intake guidelines. The current paper reviews recent evidence indicating: (1) significant reductions in mean population sodium intake can be achieved with gradual sodium reduction in the food supply, (2) gradual sodium reduction in certain cases can be achieved without a noticeable change in taste or consumption of specific products, and (3) lowering mean population sodium intake can move us toward meeting the current individual guidelines for sodium intake. Full article
(This article belongs to the Special Issue Salt and Health: A Public Health Issue)

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