scholarly journals Sodium intake in Italy from 2008 to 2019: results of the CUORE Project-Health Examination Surveys

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Donfrancesco ◽  
C Lo Noce ◽  
O Russo ◽  
P Bellisario ◽  
D Galeone ◽  
...  

Abstract Background The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan 2014-2019, in collaboration with the Interdisciplinary Working group for Salt Reduction in Italy. To estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project. Methods Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from representative random samples of residents in all Italian Regions. A new survey was conducted in 2018-2019 involving random samples of residents in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the first seven regions examined in the 2018-2019 survey and the age range of 35-74 years. Results Within the 2008-2012 survey, mean level of sodium chloride per day in 642 men and 627 women were 10.6 g (10.3-11.0 g) and 8.0 g (7.7-8.3 g) respectively, whereas in the 2018-2019 survey the corresponding mean levels in 673 men and 709 women were 9.3 g (95% C.I.: 9.1-9.6 g) and 7.1 g (6.9-7.3 g), respectively. A sodium chloride intake level lower than the WHO recommended target of 5g/day (or 85 mmol/day) was detected in 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012 vs 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019. Conclusions These preliminary data show that the average habitual sodium intake in Italy is still higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives of MoH, facilitating the meeting of the WHO-NCD target. Key messages Habitual salt intake in the Italian general adult population is still higher than the recommended by the WHO. If confirmed, in the last ten years a reduction of habitual salt intake in Italian general adult population seems to be occurred.

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chiara Donfrancesco ◽  
Cinzia Lo Noce ◽  
Ornella Russo ◽  
Daniela Minutoli ◽  
Anna Di Lonardo ◽  
...  

Introduction: The WHO Global Action Plan for the Prevention of Non-Communicable Diseases (NCDs) recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Hypothesis: Agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. Within the NPP, initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators are implemented. In order to estimate the habitual salt intake and its trend in the general adult population, national surveys, funded by the MoH-CCM, are conducted within the CUORE Project. Methods: Baseline salt intake by the use of 24h urine collections was assessed in 2008-2012 from random samples of persons aged 35-79 years, resident in all Italian 20 Regions. A new survey is ongoing (2018-2019) involving random samples of persons aged 35-74 years, resident in 10 Regions. Urinary sodium excretion is assayed by a central lab at Federico II University of Naples, subjected to strict quality controls. Comparisons are made considering, for both periods, the seven regions examined up to now in the ongoing survey and the age range of 35-74 years. Results: Within the 2018-2019 survey, mean level of sodium chloride per day in 673 men and 709 women was 161 mmol (95% confidence interval: 156-166 mmol) and 122 mmol (119-126 mmol) respectively, whereas in the 2008-2012 survey the corresponding mean levels in 642 men and 627 women was 183 mmol (95% confidence interval: 178-189 mmol) and 140 mmol (135-144 mmol), respectively. A sodium chloride intake level within the WHO recommended upper level of 85 mmol (or 5 grams of salt) per day was detected in 9% (6-11%) of men and 24% (20-27%) of women examined in 2018-2019 vs 5% (3-6%) of men and 16% (13-19%) of women examined in 2008-2012. Conclusions: These preliminary data show that the average habitual sodium intake in Italy is still largely higher than recommended but a significant reduction seems to occur. These results fully justify and encourage the ongoing preventive initiatives for reduction of sodium intake and its monitoring in the population.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Donfrancesco ◽  
A Di Lonardo ◽  
D Minutoli ◽  
C Lo Noce ◽  
B Buttari ◽  
...  

Abstract Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends a 25% relative reduction in the prevalence of raised blood pressure (RBP) by 2025. Prevalence of RBP and mean blood pressure in the Italian general adult population measured in the 2018 CUORE Project-Health Examination Survey are presented to investigate if Italy can reach this target. Methods Within the health examination survey conducted in 2018-2019, representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women) were examined in 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure was measured by automated oscillometric device using standardized procedures and methods; mean level of two measurements are here considered. RBP is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or being under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM. Results Preliminary analysis shows that prevalence of RBP is 43% (95% C.I. 40-47) in men and 32% (29-36) in women. Prevalence of persons with raised blood pressure and not receiving pharmacological treatment is 19% (15-22) in men and 9% (5-12) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern Regions. Mean value of systolic blood pressure is 131 mmHg (130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women. Conclusions Preliminary data underline that RBP is commonly observed in the Italian adult population. However, in comparison to data measured within the CUORE Project 10 years earlier, prevalence of RBP and mean blood pressure are declining, facilitating the meeting of WHO-NCDs target. Key messages Raised blood pressure is commonly observed in the Italian general adult population. If confirmed, in the last ten years prevalence of raised blood pressure and mean blood pressure are declining in the Italian general adult population.


Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Chiara Donfrancesco ◽  
Renato Ippolito ◽  
Cinzia Lo Noce ◽  
Luigi Palmieri ◽  
Roberto Iacone ◽  
...  

Background: According to the recommendation of the High Level Group of the European Union within the “Gaining health: make healthy choices easy choice” Preventive Program of the Italian Ministry of Health, the agreement with bread makers' associations was signed for the gradual reduction of the salt content in bread. In Italy, information about habitual sodium and potassium intake is scanty. In order to monitor preventive actions of this Preventive Programme the MINISAL-GIRCSI Study is to assess the dietary intake of sodium and potassium in representative samples of the Italian adult population. Methods: Baseline data from 12 different random samples collected within the MINISAL-GIRCSI-Health Examination Survey started in 2008, with completed screening and laboratory determinations, were considered: 1196 men and 1231 women aged 35-79 years. Sodium and potassium daily intakes were assessed through 24-hour urine collection using standardized procedures. Determinations of sodium, potassium and creatinine were assessed in a centralized laboratory. Information on habit of adding salt to food and the consumption of high salt content food were collected through a questionnaire. Results: Mean of sodium chloride per day resulted 11 g in men and 8 g in women with a range of 1-27 g and 2-27 g respectively. Mean of potassium chloride per day resulted 5 g in men and 4 g in women with a range of 1-13 g and 1-9 g respectively. Mean of creatinine per day resulted 1463 mg in men and 942 mg in women. Mean of urine volume per day resulted 1861 ml in men and 1827 ml in women. In both men and women, higher intake of sodium chloride was found in Southern regions; no geographical differences were found for potassium chloride. Sodium and potassium chloride excretions were not found higher with increasing age. Most of persons (72%) eat three slices of bread per day and 22% eat cheese and processed meat more than 4 times per week. Thirteen percent of persons usually add salt during meals and 19% are usually thirsty after meals. Conclusions: Preliminary results show that Italian adult population take more than double of WHO recommended salt intake; this is typical in industrialized countries. Further analyses considering data from other Italian regions are needed to confirm these values. The prevention actions at population level should include recommendations for reducing salt intake.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Donfrancesco ◽  
E Profumo ◽  
B Buttari ◽  
C Lo Noce ◽  
D Minutoli ◽  
...  

Abstract Background The WHO Global Action Plan for the Prevention of Non-Communicable Disease (WHO-NCD) recommends to halt the rise of obesity by 2025. Obesity is largely preventable. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project to investigate if Italy can meet the WHO-NCD target. Methods Within the health examination survey conducted in 2018-2019, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI<30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (822 men and 869 women), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. A standardized questionnaire was used to collect data on educational level that was used as a proxy of socio-economic status. The survey is funded by the Italian Ministry of Health-CCM. Results In this preliminary analysis, mean level of BMI was 26.8 kg/m2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m2 (25.6-26.3) in women. Prevalence of obesity was 19% (16-22) in men and 22% (19-25) in women; prevalence of overweight was 45% (41-48) in men and 28% (25-31) in women. Obesity resulted significantly higher in persons with lower educational level (primary or middle school) vs those with higher education: 26% (20-31) vs 16% (13-19) in men and 33% (27-38) vs 17% (14-20) in women. Both in men and women prevalence of obesity was significantly higher in the Southern regions. Conclusions Preliminary data show that more than half of Italian adults are overweight/obese. However, in comparison to BMI measured in the CUORE Project 10 years earlier, the prevalence of people at normal weight is increasing, moving in the direction of the WHO-NCDs obesity target. Preventive actions at community level should be more incisive in the population at low socio-economic level. Key messages Mean BMI and prevalence of obesity in the Italian general adult population are still high. If confirmed, in the last ten years an increase of normal weight prevalence in the Italian general adult population seems to be occurred.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chiara Donfrancesco ◽  
Cinzia Lo Noce ◽  
Anna Di Lonardo ◽  
Daniela Minutoli ◽  
Brigitta Buttari ◽  
...  

Introduction: Hypertension is a major risk factor for coronary heart disease, chronic kidney disease, ischaemic and haemorrhagic stroke. The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) target by 2025 for hypertension is a 25% relative reduction in the prevalence of raised blood pressure. Hypothesis: Prevalence of raised blood pressure in adults has declined in high-income countries over the past few decades; the CUORE project surveys have shown this trend also in Italy from the 1980s to the 2010s. This preliminary analysis aims to assess mean level of blood pressure and prevalence of raised blood pressure in the Italian general adult population using the data collected within the CUORE Project-health examination survey. Methods: Within the ongoing survey, started in 2018, mean of blood pressure and prevalence of raised blood pressure are assessed in random samples of resident population, aged 35-74 years, stratified by age and sex (men 822 and women 869), from 8 Italian Regions from the Northern, Central and Southern Italy. Blood pressure is measured three times consecutively by automated oscillometric device using standardized procedures and methods. Mean level of first two measurements are here considered. Raised blood pressure is defined as systolic and/or diastolic blood pressure equal or greater than 140/90 mmHg or under specific drug treatment. The survey is funded by the Italian Ministry of Health-CCM. Results: Preliminary analysis shows a mean value of systolic blood pressure of 131 mmHg (95% C.I.130-132) in men and 122 mmHg (121-123) in women. Mean value of diastolic blood pressure is 77 mmHg (76-78) in men and 73 mmHg (72-74) in women. Prevalence of raised blood pressure is 43.3% (39.9-46.7) in men and 32.4% (29.2-35.5) in women. In men prevalence of persons with raised blood pressure and untreated is 18.5% (14.6-22.3) and 8.6% (5.4-11.7) in women. In men and women prevalence of raised blood pressure is significantly higher in the Southern regions. Conclusions: Preliminary data of first 8 Regions (out of 10 which should be examined) underline that raised blood pressure is widely present in the Italian adult population. In comparison to data measured within the CUORE Project 10 years earlier, a decrease of mean level of blood pressure and prevalence of raised blood pressure seems to occur facilitating the meeting of WHO-NCDs target.


Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3486
Author(s):  
Roberto Iacone ◽  
Paola Iaccarino Idelson ◽  
Ornella Russo ◽  
Chiara Donfrancesco ◽  
Vittorio Krogh ◽  
...  

Since the Italian iodoprophylaxis strategy is based on the use of iodized salt, we assessed the relationship between dietary salt consumption and iodine intake in the Italian adult population. We estimated the relative contribution given by the use of iodized salt and by the iodine introduced by foods to the total iodine intake. The study population included 2219 adults aged 25–79 years (1138 men and 1081 women) from all Italian regions, participating to the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and examined for sodium and iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary sodium and total iodine intake were assessed by the measurement of 24 h urinary excretion, while the EPIC questionnaire was used to evaluate the iodine intake from food. Sodium and iodine intake were significantly and directly associated, upon accounting for age, sex, and BMI (Spearman rho = 0.298; p < 0.001). The iodine intake increased gradually across quintiles of salt consumption in both men and women (p < 0.001). The European Food Safety Authority (EFSA) adequacy level for iodine intake was met by men, but not women, only in the highest quintile of salt consumption. We estimated that approximately 57% of the iodine intake is derived from food and 43% from salt. Iodized salt contributed 24% of the total salt intake, including both discretionary and non-discretionary salt consumption. In conclusion, in this random sample of the Italian general adult population examined in 2008–2012, the total iodine intake secured by iodized salt and the iodine provision by food was insufficient to meet the EFSA adequate iodine intake.


Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Chiara Donfrancesco ◽  
Cinzia Lo Noce ◽  
Elisabetta Profumo ◽  
Brigitta Buttari ◽  
Daniela Minutoli ◽  
...  

Introduction: Obesity is associated to an increased risk of hypertension, non-communicable diseases (NCDs), such as diabetes, coronary heart disease, stroke, and cancers, and conditions including obstructive sleep apnoea and osteoarthritis. Obesity is largely preventable and one of the WHO Global Action Plan for the Prevention of NCDs targets is to halt its rise. Hypothesis: Between 2000 and 2016, obesity trends showed a steady increase in all WHO regions and income groups. This preliminary analysis aims to assess mean level of BMI and prevalence of obesity in the Italian general adult population using the data collected within the CUORE Project-health examination survey. Methods: Within the ongoing survey started in 2018, mean of BMI and prevalence of obesity (BMI>=30 kg/m 2 ) and overweight (25<=BMI<30 kg/m 2 ) were assessed in random samples of resident population, aged 35-74 years, stratified by age and sex (men 822 and women 869), from 8 Italian Regions in Northern, Central and Southern Italy. Weight and height were measured using standardized methodologies. A standardized questionnaire was used to collect data on education and physical inactivity. The survey is funded by the Italian Ministry of Health-CCM. Results: Mean values of BMI resulted 26.8 kg/m 2 (95% C.I. 26.5-27.1) in men and 25.9 kg/m 2 (25.6-26.3) in women. Prevalence of obesity was 19.0% (16.3-21.7) in men and 21.7% (19.0-24.5) in women; prevalence of overweight was 44.5% (41.1-47.9) in men and 28.4% (25.4-31.4) in women. Obesity levels resulted significantly higher in persons with lower education (primary or high school) vs those with higher level of education: 25.6% (20.0-31.1) vs 16.0% (13.0-19.0) in men and 32.5% (27.0-37.9) vs 16.7% (13.6-19.7) in women. Prevalence of physical inactivity during leisure time was 31.9 % (28.7-35.1) in men and 41.4% (38.2-44.7) in women. Both in men and women the prevalence of obesity was significantly higher in the Southern regions, likewise physical inactivity. Conclusions: Preliminary data of the first 8 Regions (out of 10 to be examined in the on-going survey) underline that more than half of Italian adults are in excess of weight. In comparison to data measured within the CUORE Project 10 years earlier, a slight increasing of normal weight men seems to occur moving in the direction of the WHO-NCDs obesity target.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Donfrancesco ◽  
P Bellisario ◽  
D Galeone ◽  
C Lo Noce ◽  
O Russo ◽  
...  

Abstract Issue The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI). Description of the problem According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls. Results The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months. Lessons In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025. Key messages In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Donfrancesco ◽  
C Lo Noce ◽  
E Profumo ◽  
D Minutoli ◽  
A Di Lonardo ◽  
...  

Abstract Background Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project. Methods Mean of BMI and prevalence of obesity (BMI &gt; =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee. Results In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively. Conclusions Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025. Key messages Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.


Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1529
Author(s):  
Roberto Iacone ◽  
Paola Iaccarino Idelson ◽  
Pietro Formisano ◽  
Ornella Russo ◽  
Cinzia Lo Noce ◽  
...  

Monitoring the population iodine status is essential for iodine deficiency eradication. This study assessed the average dietary iodine intake and the iodine status of a random sample of the Italian general adult population. The study population included 2378 adults aged 35–79 years (1229 men and 1149 women) from all 20 Italian regions, participating in the Osservatorio Epidemiologico Cardiovascolare/Health Examination Survey 2008–2012 (OEC/HES), and were examined for iodine intake in the framework of the MINISAL-GIRCSI Programme. Dietary iodine intake was assessed by the measurement of 24 h urinary iodine excretion. The median daily iodine intake of the whole population was lower (96 µg/d, interquartile range 51–165) than the daily adequate iodine intake according to both EFSA and WHO recommendation (150 µg/d), with a significantly lower value among women (85 µg/d) compared with men (111 µg/d). Iodine intake diminished with age and increased with BMI (body mass index) in male but not in female participants, without achieving the adequate intake in any sex, age, or BMI category. In this random sample of Italian general adult population examined in 2008–2012, iodine intake still remained lower than the recommended values despite the implementation of a strategy of iodoprophylaxis based on salt iodization in 2005. These data represent a valuable reference for future monitoring of iodine status in our country.


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