Erratum: Report of the Working Group for Dietary Salt Reduction of the Japanese Society of Hypertension: (2) Assessment of Salt Intake in the Management of Hypertension

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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Identifying the inhibitory factors of dietary salt reduction in women: a qualitative study, Yazd, Iran

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-01-2020-0003 ◽

2020 ◽

Vol 13 (5) ◽

pp. 485-498

Author(s):

Seyed Saeed Mazloomy Mahmoodabad ◽

Ali Akbar Vaezi ◽

Tahere Soltani ◽

Azadeh Nadjarzadeh ◽

Seyedeh Mahdieh Namayandeh ◽

...

Keyword(s):

Health Care ◽

Family Support ◽

Health Care Professionals ◽

Salt Intake ◽

Dietary Salt ◽

Salt Reduction ◽

Content Type ◽

Positive Effects ◽

Inhibitory Factors ◽

Yazd City

Purpose Increased dietary salt content is one of the effective factors of hypertension and a major public health challenge globally. Although the positive effects of dietary salt reduction on health are universally accepted, people can hardly reduce their salt intake. The purpose of this study is to identify the inhibitory factors of dietary salt reduction among 20–65-year-old women in Yazd City, Iran. Design/methodology/approach This study was conducted using a deductive content analysis approach based on the communication for the behavioral impact (COMBI) framework. The purposeful sampling method was applied with maximum variation in terms of different educational levels, age groups, occupational status and residential areas to select the participants. Snowball sampling was used to select health-care professionals. Furthermore, semi-structured interviews and focus-group discussions were conducted with 31 local women and 11 health-care professionals working in the City until data saturation was achieved. Data were analyzed using Graneheim and Landsman’s method. Findings After data analysis, 617 initial codes were extracted over the perceived barriers. After merging similar codes, 223 codes were extracted. The barriers were classified into five main categories of family, personal, organizational, educational and socio-cultural barriers. Originality/value Based on the COMBI framework, the results demonstrated that the most important barriers for reducing salt intake were negative attitude toward restrictions on dietary salt intake, insufficient and incorrect beliefs about the health risk of salt, lack of family support, inadequate health literacy and low self-efficacy in Yazd City. Among these barriers, lack of family support was considered as the most effective factor in reducing salt consumption. So, by focusing on this area and providing the community with the required education, the amount of salt consumed by families can be reduced.

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Barriers of dietary salt reduction among hypertensive patients: a cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203907 ◽

2020 ◽

Vol 7 (9) ◽

pp. 3459

Author(s):

Mariyam Khwaja

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Lifestyle Modification ◽

Cross Sectional Study ◽

Sectional Study ◽

Dietary Salt ◽

Cross Sectional ◽

Salt Reduction ◽

Hypertensive Patients ◽

Dietary Salt Intake

Background: Healthy dietary practice is an important lifestyle modification and one of the key adjuncts to pharmacotherapy in management of hypertension. A modest reduction in salt intake of 5 gm/day lowered blood pressure by 7/4 mmHg diastolic in hypertensive patients. Despite knowledge about the ill consequences, many people continue to consume high levels of salt in their diet. To motivate people to reduce salt in their diet, a solid understanding of barriers encountered by those under salt reduction recommendation is necessary. Hence, this study was conducted with the aim of identifying the barriers to dietary salt reduction among hypertensive patients.Methods: A community based cross sectional study was conducted on a sample of 356 hypertensive patients in field practice areas (urban and rural) in Department of Community Medicine, JNMC, AMU, Aligarh. A pretested semi-structured questionnaire was used for the study. Compliance to dietary salt intake was assessed by calculating average salt intake per person per day. The tenets of health belief model were used to examine the key determinants of human behavior. Analysis was done by using correlation, proportions, chi-square and multiple linear regression.Results: 31.4% of the participants took salt <5 gm per day. A significant association was noticed with area, religion, social class, family size, perceived benefits and perceived susceptibility. A significant positive correlation was seen with total adherence score and family size.Conclusions: A lot of barriers hinder the compliance to dietary salt reduction. Health Education stressing the role of salt reduction in control of blood pressure is recommended.

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Determinants of dietary salt intake in adults: A protocol for Scoping Review

10.1101/2021.08.15.21262091 ◽

2021 ◽

Author(s):

Raunaq Singh Nagi ◽

Pankaj Prasad ◽

Sanjeev Kumar

Keyword(s):

Scoping Review ◽

English Language ◽

Salt Intake ◽

Data Extraction ◽

Relevant Literature ◽

Exclusion Criterion ◽

Dietary Salt ◽

Salt Reduction ◽

Dietary Salt Intake ◽

Factors Associated

AbstractObjectiveThe objective of this scoping review is to methodically review the current literature and identify the factors/determinants of dietary salt consumption in adults.IntroductionHigh dietary salt intake has been identified as a risk factor for non-communicable diseases and conditions. Despite continuous and rigorous efforts, dietary salt intake still remain above the recommended adult daily dose of 5g, both locally and globally. This indicates existence of unidentified or unaddressed behavioural factors that diminish efficiency of salt reduction efforts targeted towards public.Inclusion CriteriaThis review will include global literature dealing with factors associated with dietary salt intake in adults. Qualitative, quantitative and ecological studies on behavioural, psychosocial and environmental factors associated with awareness regarding dietary salt intake and barrier to its reduction will be considered. Studies published only in English language, without any limits on date of publication will be considered for this review.MethodsA comprehensive search across databases namely, MEDLINE, ScienceDirect, JSTOR, ERIC, DOAJ and OATD will be carried out to retrieve and identify relevant literature. Two reviewers will screen the titles followed by abstracts and subsequently full-length texts according to the inclusion and exclusion criterion, removing unrelated studies and finally compiling and extracting information from chosen studies in data extraction forms. Descriptive statistics will be used to represent the data. Thematic analysis of extracted data using deductive approach will be conducted.

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Knowledge, attitudes and perception on dietary salt reduction of two communities in Grahamstown, South Africa

Nutrition and Health ◽

10.1177/0260106016685725 ◽

2017 ◽

Vol 23 (1) ◽

pp. 33-38 ◽

Cited By ~ 4

Author(s):

Fadzai Mushoriwa ◽

Nick Townsend ◽

Sunitha Srinivas

Keyword(s):

South Africa ◽

South African ◽

Salt Intake ◽

Dietary Salt ◽

The South ◽

Consumer Awareness ◽

Salt Reduction ◽

Attitudes And Practices ◽

Awareness Campaigns ◽

Knowledge Attitudes And Practices

Introduction: Dietary salt reduction has been identified as a cost effective way of addressing the global burden of non-communicable diseases (NCDs), particularly cardiovascular diseases. The World Health Organization has recommended three main strategies for achieving population-wide salt reduction in all member states: food reformulation, policies and consumer awareness campaigns. In 2013, the South African Ministry of Health announced the mandatory salt reduction legislation for the food manufacturing sector. These were set to come into effect on 30 June 2016. This decision was influenced by the need to reduce the incidence of NCDs and the fact that processed food is the source of 54% of the salt consumed in the South African diet. However, with discretionary salt also being a significant contributor, there is need for consumer awareness campaigns. The aim of this study was to assess the knowledge, attitudes and practices of guardians and cooks at two non-governmental organisations based in Grahamstown, South Africa, towards dietary salt reduction. Method: Data was collected through observation and explorative, voice-recorded semi-structured interviews and transcribed data was analysed using NVivo®. Results: At both centres, salt shakers were not placed on the tables during mealtimes. Only 14% the participants perceived their personal salt intake to be a little. No participants were aware of the recommended daily salt intake limit or the relationship between salt and sodium. Only five out of the 19 participants had previously received information on dietary salt reduction from sources such as healthcare professionals and the media. Conclusion: The results from the first phase of this study highlighted gaps in the participants’ knowledge, attitudes and practices towards dietary salt reduction. The aim of the second phase of the research is to design and implement a context specific and culturally appropriate educational intervention on dietary salt reduction.

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Salt intake was higher among males and those with high BMI and waist circumference: introduction to the Malaysian Community Salt Survey (MyCoSS), a population-based salt intake survey in Malaysia

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00229-y ◽

2021 ◽

Vol 40 (S1) ◽

Author(s):

Rashidah Ambak ◽

Feng J He ◽

Fatimah Othman ◽

Viola Michael ◽

Muhammad Fadhli Mohd Yusoff ◽

...

Keyword(s):

Blood Pressure ◽

Waist Circumference ◽

Sample Size ◽

Salt Intake ◽

Daily Intake ◽

Successful Implementation ◽

Dietary Salt ◽

Ministry Of Health ◽

Salt Reduction ◽

Dietary Salt Intake

Abstract Background Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population. Methods MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey. Results Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference. Conclusion Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS’s findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population.

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Perspectives of the public on reducing population salt intake in Ireland

Public Health Nutrition ◽

10.1017/s1368980015002530 ◽

2015 ◽

Vol 19 (7) ◽

pp. 1327-1335 ◽

Cited By ~ 8

Author(s):

Áine Regan ◽

Christine Liran Shan ◽

Patrick Wall ◽

Áine McConnon

Keyword(s):

Online Survey ◽

Salt Intake ◽

High Salt ◽

Attitudes And Beliefs ◽

Dietary Salt ◽

Cross Sectional ◽

Salt Reduction ◽

Dietary Salt Intake ◽

The Public ◽

The Government

AbstractObjectiveAs countries struggle to meet the set targets for population salt intake, there have been calls for more regulated approaches to reducing dietary salt intake. However, little is known about how the public perceives various salt reduction policies; an important line of investigation given that the implementation and success of these policies often depend on public sentiment. We investigated the attitudes and beliefs of consumers towards salt reduction and their support for thirteen different government-led salt reduction policies.DesignA cross-sectional online survey measured participants’ knowledge, beliefs and attitudes in relation to salt reduction.SettingThe survey was carried out with participants from the Republic of Ireland.SubjectsFive hundred and one participants recruited via a market research agency completed the survey.ResultsWe found that the vast majority of participants supported eleven of the government-led salt reduction policies, which included measures such as education, labelling and salt restriction in foods (both voluntary and regulated, across a range of settings). The two proposed fiscal policies (subsidising low-salt foods and taxing high-salt foods) received less support in comparison, with the majority of participants opposed to a tax on high-salt foods. A series of multiple regressions revealed that individual attitudes and beliefs related to health and salt were stronger predictors of support than sociodemographic factors, lifestyle or knowledge.ConclusionsThe study provides an important evidence base from which policy makers may draw when making decisions on future policy steps to help achieve national salt targets.

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Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England

Hypertension ◽

10.1161/hypertensionaha.120.16649 ◽

2021 ◽

Vol 77 (4) ◽

pp. 1086-1094

Author(s):

Sergi Alonso ◽

Monique Tan ◽

Changqiong Wang ◽

Seamus Kent ◽

Linda Cobiac ◽

...

Keyword(s):

Health Care ◽

Salt Intake ◽

Health Care Cost ◽

Adult Population ◽

Population Level ◽

World Health ◽

Dietary Salt ◽

Salt Reduction ◽

Life Years ◽

Reduction Program

The United Kingdom was among the first countries to introduce a salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified salt intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level salt intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level salt intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710–84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390–112 260) premature strokes, generating 542 850 (95% CI, 529 020–556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570–£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050–88 470) premature IHD cases, 126 010 (95% CI, 118 600–126 460) premature strokes and achieve £1260 million (95% CI, £1180–£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the salt reduction program to achieve further reductions in population salt intake and CVD burden should be a high priority.

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