Making salt-reduced products more appealing to consumers: impact of front-of-pack messages on liking and table salt use over time

AbstractObjectiveThe current study investigated the impact of different front-of-pack messages on liking, salt perception and table salt use of salt-reduced soups over repeated consumption.DesignIn a between-subjects design, participants consumed a chicken noodle soup five times over 3 weeks. Participants were assigned to one of five experimental conditions and were categorized into three ‘Interest in Salt Reduction’ groups based on their self-reported interest in salt reduction. They consumed a regular-salt soup or a 30 % salt-reduced soup, either with or without a front-of-pack message (nutritional, sensory or social based). Liking, salt perception and table salt use were measured at each consumption.SettingCentral location test.SubjectsBritish consumers (n 493) aged 24–65 years.ResultsThe soups remained stable in liking over repeated consumption, with no significant differences between the experimental conditions. However, liking did differ among the different Interest in Salt Reduction groups: the ‘not aware, no action’ group liked salt-reduced soups with a nutritional message the most, whereas the ‘aware and action’ group liked salt-reduced soups with a social message the most. There was no change in the amount of table salt added as people got more familiar with the salt-reduced soups, suggesting a strong role for habit in table salt use.ConclusionsIt mattered whether consumers were thinking about reducing their salt intake or not: a communication message tailored to a country’s interest in reducing salt is recommended to motivate consumers to lower their salt intake.

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Salt Intake in Nigeria: a nationwide population survey

European Heart Journal ◽

10.1093/ehjci/ehaa946.2866 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.N Odili ◽

B.S Chori ◽

B Danladi ◽

P.C Nwakile ◽

J.O Ogedengbe ◽

...

Keyword(s):

Salt Intake ◽

Sodium Intake ◽

Population Analysis ◽

Cost Effective ◽

Rural Site ◽

Urban Site ◽

Funding Source ◽

Salt Reduction ◽

High Salt Intake ◽

The Impact

Abstract Background Population wide salt reduction programmes are cost effective strategies for control of cardiovascular diseases (CVDs). Obtaining a nationwide salt consumption data in a multi-cultural setting as Nigeria's is key for proper implementation and monitoring of such strategy. Methods We measured sodium in 24-hour urine of free-living adult Nigerians selected from an urban and a rural site each from the 6 geopolitical zones of Nigeria to evaluate patterns of salt intake and its associations with blood pressures (BP). Results Across the 12 sites, sodium intake ranged from 97.9 in the rural South-South to 210 mmol/day in the urban site of the same zone. Overall, the median (IQR) daily sodium intake was 143.5 (97.8) mmol; with higher (p=0.0028) levels among the urban 149.7 (113.8) compared to the rural 133.1 (105.2) dwellers. Overall, 20% of the subjects consumed less than the recommended 2g (86mmol) of sodium daily. After adjustment for age, sex and BMI; sodium intake and BP (systolic and diastolic) were positively associated in 8 out of the 12 sites; significantly so in 2 (p<0.05) for systolic. Within population analysis; which included 973 individuals, increasing sodium intake tended (not significantly) to increase SBP but decrease DBP. However, among subjects whose sodium intake was in excess of 257mmol/day, a 100 mmol/day increase in sodium intake was significantly (p=0.04) associated with a 3.3 mmHg increase in SBP. Conclusion Salt intake among Nigerians is higher than the recommended. The impact of sodium intake on BP appears to be evident only among individuals with high salt intake. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Wellcome Trust

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Assessment of Sodium Knowledge and Urinary Sodium Excretion among Regions of the United Arab Emirates: A Cross-Sectional Study

Nutrients ◽

10.3390/nu12092747 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2747

Author(s):

Amjad H. Jarrar ◽

Lily Stojanovska ◽

Vasso Apostolopoulos ◽

Leila Cheikh Ismail ◽

Jack Feehan ◽

...

Keyword(s):

United Arab Emirates ◽

Sodium Excretion ◽

Salt Intake ◽

Urinary Sodium Excretion ◽

World Health ◽

High Potassium ◽

Cross Sectional ◽

Salt Reduction ◽

High Salt Intake ◽

The Impact

Non-communicable diseases (NCDs) such as cardiovascular disease, cancer and diabetes, are increasing worldwide and cause 65% to 78% of deaths in the Gulf Cooperation Council (GCC). A random sample of 477 healthy adults were recruited in the United Arab Emirates (UAE) in the period March–June 2015. Demographic, lifestyle, medical, anthropometric and sodium excretion data were collected. A questionnaire was used to measure knowledge, attitude and practice regarding salt. Mean sodium and potassium excretion were 2713.4 ± 713 mg/day and 1803 ± 618 mg/day, respectively, significantly higher than the World Health Organization (WHO) recommendations for sodium (2300 mg/day) and lower for potassium (3150 mg/day). Two-thirds (67.4%) exceeded sodium guidelines, with males 2.6 times more likely to consume excessively. The majority of the participants add salt during cooking (82.5%) and whilst eating (66%), and 75% identified processed food as high source of salt. Most (69.1%) were aware that excessive salt could cause disease. Most of the UAE population consumes excess sodium and insufficient potassium, likely increasing the risk of NCDs. Despite most participants being aware that high salt intake is associated with adverse health outcomes, this did not translate into salt reduction action. Low-sodium, high-potassium dietary interventions such as the Mediterranean diet are vital in reducing the impact of NCDs in the UAE.

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P1691Impact of dose and duration of dietary salt reduction on blood pressure levels: systematic review and meta-analysis of randomised trials

European Heart Journal ◽

10.1093/eurheartj/ehz748.0446 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Huang ◽

K Trieu ◽

S Yoshimura ◽

M Woodward ◽

N Campbell ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Diastolic Blood Pressure ◽

Sodium Excretion ◽

Salt Intake ◽

Meta Analysis ◽

Dietary Salt ◽

Baseline Blood Pressure ◽

Salt Reduction ◽

The Impact

Abstract Background Authoritative medical and public health agencies in most countries advise to reduce population dietary salt intake to under 5–6 g/day as a strategy for preventing high blood pressure and cardiovascular disease. However, there is still dispute about whether salt reduction should be adopted by all populations. In addition, the effect of duration of dietary salt reduction has not been sufficiently investigated. Purpose To understand the effect of dietary salt reduction on blood pressure and the impact of intervention duration. Methods A systematic review and meta-analysis was conducted. Randomized controlled trials that allocated participants to low and high salt intake, without confounding from unequal concomitant interventions, were included. We excluded studies done in individuals younger than 18 years, pregnant women, individuals with renal disease or heart failure, and studies with sodium excretion estimated from spot urine. Random effect meta-analysis was used to generate pooled estimates of the effect on 24-hour urinary sodium excretion, systolic and diastolic blood pressure. Multivariate meta-regression was used to quantify the dose response effect of dietary salt on blood pressure change and to understand the impact of the intervention duration. Results 125 studies were included with 162 data points extracted. Ninety-nine data points (61%) had interventions under 4 weeks. Overall, 24-hour urinary sodium excretion changed by −141 mmol (95% CI: −156; −126), systolic blood pressure changed by −4.4 mm Hg (95% CI: −5.2; −3.7) and diastolic blood pressure changed by −2.4 mm Hg (95% CI: −2.9; −1.9). Sodium reduction resulted in a significant decrease of systolic blood pressure in all subgroups except in participants with low baseline sodium intake (<109 mmol) (Figure 1). Each 100 mmol reduction of sodium was associated with 2.7 mm Hg (95% CI: 1.0; 4.4; p=0.002) reduction of systolic blood pressure and 1.2 mm Hg (95% CI: 0.0; 2.4; p=0.046) reduction of diastolic blood pressure after adjusting for intervention duration, age, sex, race, baseline blood pressure, baseline sodium intake and interaction between age and baseline blood pressure. For the same amount of salt reduction, a 10 mm Hg higher baseline systolic blood pressure would result in 2.5 mm Hg greater reduction of systolic blood pressure. There is not enough evidence to show the impact of intervention duration. Figure 1 Conclusions Our meta-analysis showed that sodium reduction could reduce blood pressure in all adult populations regardless of age, sex and race. The effect of salt reduction on systolic blood pressure increases with higher baseline blood pressure. Further studies, designed to investigate the impact of intervention duration, are needed to understand the significance of the duration. Acknowledgement/Funding None

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Salt reduction in bread: Is it enough? Preliminary results of a HIA in Portugal

European Journal of Public Health ◽

10.1093/eurpub/ckz187.027 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Santos ◽

P Braz ◽

A Costa ◽

L Costa ◽

M Santos ◽

...

Keyword(s):

Blood Pressure ◽

Statistical Difference ◽

Salt Intake ◽

Statistical Significance ◽

Systolic Pressure ◽

Health Impact ◽

World Health ◽

Salt Reduction ◽

Aggregated Data ◽

The Impact

Abstract Issue Health Impact Assessment (HIA) is a methodology that aims at assessing the impact of policies in health. A pilot HIA is in progress to kick off the implementation of this methodology in Portugal with the support of the World Health Organization (WHO). In this context, the impact of a nation-wide policy that intends to achieve a maximum of 1 g of salt/100 gr in bread is under assessment. Description of the issue In 2017, Portugal approved a protocol between the industry and other stakeholders to gradually decrease the amount of salt in bread, as this is the main source of salt intake. The purpose of this study was to assess the impact in blood pressure from current (1.4 gr) to 1 g (29% reduction) of salt in bread. Data from two different surveys regarding blood pressure and salt intake was gathered. We estimated the decrease in blood pressure with respect to current average values according to sex, age, education and region. Results It is expected that a reduction of 29% in salt intake through bread contributes to a general decrease in systolic pressure for normotensive people (from 120.4mmHg to 120.0mmHg, p = 0.85) and hypertensive people (from 151.0mmHg to 150.1mmHg, p = 0.68), although not statistically significant. Older hypertensive individuals (65 to 75 years) are the group with the largest benefit (152.8mmHg to 152.0mmHg) but no statistical difference was found. Disaggregation by sex, region and education also didn’t show any statistical difference. Lessons The impact in blood pressure from a 29% reduction in salt intake from bread seems very small. We found no statistical significance between the current and expected values in blood pressure either for total or group stratification. The absence of statistical effect might be due to sample size as our sources only allowed us to work with aggregated data. Key messages Quality and access to data is needed to assess impact of policies. to increase effects in blood pressure either salt reduction from bread must be larger or a wider range of products should be considered.

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Understanding Barriers and Enablers to State Action on Salt: Analysis of Stakeholder Perceptions of the VicHealth Salt Reduction Partnership

Nutrients ◽

10.3390/nu11010184 ◽

2019 ◽

Vol 11 (1) ◽

pp. 184 ◽

Cited By ~ 2

Author(s):

Briar McKenzie ◽

Kathy Trieu ◽

Carley Grimes ◽

Jenny Reimers ◽

Jacqui Webster

Keyword(s):

Food Industry ◽

Salt Intake ◽

Action Plan ◽

Intervention Strategy ◽

Inductive Method ◽

Salt Reduction ◽

Barriers And Enablers ◽

The Government ◽

Research Organisations ◽

The Impact

The Victorian Salt Reduction Partnership (VicSalt Partnership) was launched in 2015, bringing together health and research organisations to develop an action plan for salt reduction interventions at a state level. A comprehensive evaluation was designed to assess the impact of the resulting four-year intervention strategy. As part of the process evaluation, semi-structured interviews were undertaken with stakeholders in March–May 2017, to understand perceived barriers and enablers to effective strategy implementation. Data were coded in relation to the key topic areas of the interviews with an inductive method used to analyse themes within topics. Seventeen stakeholders were contacted, 14 completed an interview; five from state government or statutory agencies, four from non-government funded organisations, four from research organisations and one from the food industry. Twelve were members of the VicSalt Partnership and two were informal collaborators. Most stakeholders viewed the VicSalt Partnership as a positive example of working collaboratively, and said this was essential for raising awareness of the importance of salt reduction with consumers, the food industry, and the government. Challenges relating to engaging the food industry and federal government through a state-led initiative were identified. New approaches to overcome this, such as forming clear “asks” to government and committing industry to “pledges” on reformulation were suggested. Stakeholder interviews and qualitative analysis have provided a range of important insights into barriers and enablers, many of which have already been used to strengthen intervention implementation. The evaluation of the VicSalt Partnership is ongoing and the program is expected to provide a wealth of lessons for state-led interventions to reduce salt intake in Australia and globally.

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Health impact assessment of salt reduction in bread in Portugal: a pilot study

10.1101/2021.12.20.21267610 ◽

2021 ◽

Author(s):

Joana Santos ◽

Joana Alves ◽

Paula Braz ◽

Roberto Brazao ◽

Alexandra Costa ◽

...

Keyword(s):

Salt Intake ◽

Meta Analysis ◽

Salt Content ◽

Analysis Data ◽

Health Impact ◽

Portuguese Population ◽

Salt Reduction ◽

National Surveys ◽

Health Gains ◽

The Impact

Hypertension is a risk factor for cardiovascular diseases, which can be caused by excessive salt intake. In Portugal, one of the main foods to contribute to ingestion of salt is bread. Thus, a voluntary Protocol was signed between stakeholders with the aim to reduce salt content in bread by 2021. Herein, a retrospective HIA was carried out to assess the impact in blood pressure (BP) after this agreement. In order to find average values of salt intake and BP in Portuguese population, national surveys were used. Also, estimates of BP reduction and its size effects were calculated based upon meta-analysis data. It is expected that salt intake will be reduced mostly in individuals with low educational level, men, aged between 65-74 years old and residents in South region of Portugal. Results in hypertensive patients indicate that a higher effect on BP will occur in the same profile of individuals, except age (between 55 and 64 years old). However, the estimated effect is very low for all groups, suggesting that the Protocol will contribute to modest health gains. Complementary measures supported by HIA studies need to be adopted to actively promote salt intake reduction and effectively prevent hypertension.

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Health labelling can influence taste perception and use of table salt for reduced-sodium products

Public Health Nutrition ◽

10.1017/s136898001200064x ◽

2012 ◽

Vol 15 (12) ◽

pp. 2340-2347 ◽

Cited By ~ 39

Author(s):

Djin Gie Liem ◽

Fatemeh Miremadi ◽

Elizabeth H Zandstra ◽

Russell SJ Keast

Keyword(s):

No Reduction ◽

Taste Perception ◽

Table Salt ◽

Salt Reduction ◽

Subject Design ◽

Reduced Products ◽

Negative Effect ◽

Reduced Salt ◽

Taste Experience ◽

Heart Foundation

AbstractObjectiveTo investigate the effect of front-of-pack labels on taste perception and use of table salt for currently available and sodium-reduced soups.DesignWithin-subject design.SettingSensory laboratory.SubjectsParticipants (n 50, mean age 34·8 (sd 13·6) years) were randomly served nine soups (250 ml each) across 3 d. Servings differed in: (i) health label (i.e. no health label, reduced-salt label or Heart Foundation Tick); and (ii) sodium reduction (no reduction – benchmark, 15 % less sodium or 30 % less sodium). Before tasting, participants rated their expected salt intensity and liking. After tasting, participants rated their perceived salt intensity and liking, after which they could add salt to the soup to make it more palatable.ResultsReduced-salt labels generated a negative taste expectation and actual taste experience in terms of liking (P < 0·05) and perceived saltiness (P < 0·05). Perceived saltiness of sodium-reduced soups decreased more (P < 0·05), and consumers added more salt (P < 0·05), when soups carried the reduced-salt label. The tick logo and soups without health labels had no such influence on taste perception.ConclusionsEmphasizing salt reduction by means of a front-of-pack label can have a negative effect on taste perception and salt use, especially when consumers are able to taste differences between their regular soup and the sodium-reduced soup. Overall health logos which do not emphasize the reduction in salt are less likely to affect perceived salt intensity and therefore are viable solutions to indicate the healthiness of sodium-reduced products.

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Qual é o Impacto da Redução da Ingestão de Sal na Pressão Arterial? Análise da Revisão Sistemática Cochrane “Effect of longer-term modest salt reduction on blood pressure. He FJ, Li J, Macgregor GA. Cochrane Database Syst Rev. 2013 Apr 30;4:CD004937.

Acta Médica Portuguesa ◽

10.20344/amp.4943 ◽

2013 ◽

Vol 26 (5) ◽

pp. 490

Author(s):

Daniel Caldeira ◽

António Vaz-Carneiro ◽

João Costa

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Salt Intake ◽

Plasma Renin ◽

Cochrane Collaboration ◽

Salt Reduction ◽

Arterial Blood ◽

Cochrane Database ◽

The Impact

In the present article we evaluate and comment the systematic review from Cochrane Collaboration “Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2013 Apr 30;4:CD004937”.Clinical Question: What is the impact of long-term (≥ 4 weeks) modest salt (sodium chloride) reduction on arterial blood pressure?Conclusions: This systematic review concluded that a moderate reduction in salt intake (mean reduction -4.4 g per day) resulted in statistically significant decreases in blood pressure (BP) that may be helpful in normotensive (-2.42 mmHg systolic BP; -1.00 mmHg diastolic BP) and hypertensive patients (-5.39 mmHg systolic BP; -2.82 mmHg diastolic BP). There were slight increases in physiological plasma renin activity, aldosterone and norepinephrine, without significant changes in lipid profile.

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Drop the Salt! Assessing the impact of a public health advocacy strategy on Australian government policy on salt

Public Health Nutrition ◽

10.1017/s1368980012004806 ◽

2012 ◽

Vol 17 (1) ◽

pp. 212-218 ◽

Cited By ~ 8

Author(s):

Jacqui Webster ◽

Elizabeth Dunford ◽

Sarah Kennington ◽

Bruce Neal ◽

Simon Chapman

Keyword(s):

Government Policy ◽

Salt Intake ◽

Stakeholder Analysis ◽

Australian Government ◽

Dietary Salt ◽

Potential Health ◽

Salt Reduction ◽

South Wales ◽

Public Health Advocacy ◽

The Impact

AbstractObjectiveIn 2007 the Australian Division of World Action on Salt and Health (AWASH) launched a campaign to encourage the Australian government to take action to reduce population salt intake. The objective of the present research was to assess the impact of the Drop the Salt! campaign on government policy.DesignA review of government activities related to salt reduction was conducted and an advocacy strategy implemented to increase government action on salt. Advocacy actions were documented and the resulting outcomes identified. An analysis of stakeholder views on the effectiveness of the advocacy strategy was also undertaken.SettingsAdvocacy activities were coordinated through AWASH at the George Institute for Global Health in Sydney.SubjectsAll relevant State and Federal government statements and actions were reviewed and thirteen stakeholders with known interests or responsibilities regarding dietary salt, including food industry, government and health organisations, were interviewed.ResultsStakeholder analysis affirmed that AWASH influenced the government's agenda on salt reduction and four key outputs were attributed to the campaign: (i) the Food Regulation Standing Committee discussions on salt, (ii) the Food and Health Dialogue salt targets, (iii) National Health and Medical Research Council partnership funding and (iv) the New South Wales Premier's Forum on Fast Foods.ConclusionsWhile it is not possible to definitively attribute changes in government policy to one organisation, stakeholder research indicated that the AWASH campaign increased the priority of salt reduction on the government's agenda. However, a coordinated government strategy on salt reduction is still required to ensure that the potential health benefits are fully realised.

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Innovative equipments to monitor and control salt usage during culinary

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.583 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Gonçalves ◽

O Pinho ◽

P Padrão ◽

T Silva-Santos ◽

S Abreu ◽

...

Keyword(s):

Salt Intake ◽

Salt Content ◽

Clinical Intervention ◽

Health Impact ◽

Salt Reduction ◽

Salt Consumption ◽

Catering Industry ◽

And Control ◽

The Impact ◽

At Home

Abstract Issue In Portugal, most of the salt consumed comes from the salt added during preparation/cooking. Therefore, it is urgent to introduce mechanisms to allow the quantification of the salt in foods, and the salt added during culinary. Description of the Problem To tackle salt reduction, we considered: having a portable and user-friendly instrument that measure salt content of foods; and controlling the amount of salt added to foods during culinary, assessing its impact on health. The first project was SALT QUANTI (co-funded by NORTE 2020), promoted by a consortium between EVOLEO Technologies and the University of Porto (finished in September 2018, duration 18 months); its major deliverable was to obtain a prototype of a portable device and the analytical procedure that enabled the analysis of salt content in foods/meals produced in catering kitchens, in less than 5 minutes. The second project was iMC SALT (supported by FCT, Grant POCI-01-0145-FEDER-029269), started in July 2018 (duration 36 months), aiming to develop prototypes for controlling the amount of salt added to foods during culinary, at home and catering, according international recommendations; one clinical intervention to assess the impact on health of the prototype at home is underway. Results The SALT QUANTI and iMC SALT prototypes showed good results in validation tests. The preliminary results of the health impact of the iMC SALT prototype will be presented at the conference. Lessons The implementation of innovative equipments to help consumers and catering industry to monitor or control the addition of salt during preparation of food or cooking are expected to be available soon and to be useful to consumers and catering industry to reduce salt intake. Key messages Innovative equipments may contribute to estimate salt in foods, and to reduce salt added during culinary. The implementation of an equipment to control culinary salt could be one valid approach to reduce salt consumption with impact on health.

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