Perceptions and Feasibility of Actions Related to Sodium Reduction among Restaurant Owners and Cooks in Seongnam, South Korea: Comparison According to Stages of Behavioral Change

With the increase in meals eaten outside the home, sodium reduction in restaurant foods is essential for reducing sodium intake. This study aimed to assess the stages of behavioral change for reducing sodium and the differences in perceptions among restaurant staff by stage. Restaurant owners and cooks (n = 313) in Seongnam, South Korea were surveyed on their stage of behavioral change, practices, and perceptive factors related to sodium reduction in restaurant meals using a questionnaire. The proportion of behavioral change by stage was 20.4% in the maintenance and action (MA) stage, 32.3% in the preparation (P) stage, and 47.3% in the pre-preparation (PP) stage, which included contemplation and pre-contemplation stages. The items that represent differences among the groups were recognition of social environment for sodium reduction, practice of weighing condiments and measuring salinity, and feasibility of actions related to low-sodium cooking. Logistic regression analysis was used to estimate odds ratios for practice and perceptive factors by using stage of behavioral change as the independent variable. Factors associated with being in the MA stage were weighing condiments, measuring salinity, and high feasibility of actions related to low-sodium cooking. Recognition of sodium labeling and anticipation of better taste by reducing sodium increased the odds of being in the P stage rather than the PP stage. These results suggest that customized stepwise education and support are needed for the efficacy of restaurant-based sodium reduction programs.

Approaches for Implementing Healthy Food Interventions in Settings With Limited Resources: A Case Study of Sodium Reduction Interventions in Emergency Food Programs Addressing Food Insecurity

Purpose This study describes how recipients of the Centers for Disease Control and Prevention funded Sodium Reduction in Communities Program (SRCP) worked with emergency food programs to improve access to healthy food to address chronic conditions. Design SRCP recipients partnered with emergency food programs to implement sodium reduction strategies including nutrition standards, procurement practices, environmental strategies, and behavioral economics approaches. Setting SRCP recipients and emergency food programs in Washington County and Benton County, Arkansas and King County, Washington. Subjects SRCP recipient staff, emergency food program staff, and key stakeholders. Measures We conducted semi-structured interviews with key stakeholders and systematic review of program documents. Analysis Data were analyzed using effects matrices for each recipient. Matrices were organized using select implementation science constructs and compared in a cross-case analysis. Results Despite limited resources, emergency food programs can implement sodium reduction interventions which may provide greater access to healthy foods and lead to reductions in health disparities. Emergency food programs successfully implemented sodium reduction interventions by building on the external and internal settings; selecting strategies that align with existing processes; implementing change incrementally and engaging staff, volunteers, and clients; and sustaining changes. Conclusion Findings contribute to understanding the ways in which emergency food programs and other organizations with limited resources have implemented public health nutrition interventions addressing food insecurity and improving access to healthy foods. These strategies may be transferable to other settings with limited resources.

Identification of Foods To Monitor The Sodium Content of Processed Foods for Developing a Sodium Reduction Program in The Philippines

Background In response to the global target for reduction in salt intake, several countries have implemented population sodium reduction strategies. These strategies include identification of major sources of sodium in the diet and reformulation of a set number of products available on the market. This study aimed to identify processed foods that can be targeted for reformulation and whose sodium content can be monitored over time in order to reduce sodium intake in the Philippines. The objectives were to: 1) Estimate per capita sodium intake from minimally processed and processed food groups by income quintile and urban/rural location; 2) Identify foods that contribute to the variance in per capita sodium intake that can be used as indicators for monitoring the sodium content of Philippine processed foods. One-day household food weighing data covering 4880 households from the 2008 National Nutrition Survey was used. Per capita sodium consumption from processed and minimally processed food categories and percentiles of sodium intake from these categories by income quintile and urban/rural location were obtained. The percentage contribution of different food categories to mean per capita sodium intake was calculated. Specific foods that contributed to the variance in sodium intake among Filipinos were identified. Results Foods which significantly accounted for 99.4% of the variance in sodium intake were 13 types of processed foods and 2 types of minimally processed foods. The category Processed Soup, Sauces, and Flavor Enhancers contributed the greatest proportion to per capita sodium intake. Specific processed foods that contributed to the variance in per capita sodium intake were instant noodles, traditional fermented condiments and sauces, dried and processed meat, fish, and poultry products, salted eggs, white bread and pan de sal (a traditional Filipino bread), wheat and egg noodles, crispy cereal chips and extruded snacks, butter and margarine, cheese, and chocolate-based beverages. Conclusion Identifying processed foods that significantly contribute to sodium intake, followed by reformulating and monitoring the sodium content of these foods over time should be considered as one strategy to reduce sodium intake in the Philippines.

Impact of Dietary Sodium Reduction on the Development of Obesity and Type 2 Diabetes in db/db Mice

The impact of dietary sodium reduction on mouse models of type 2 diabetes is not well understood. Therefore, we analyzed the effect of a low-salt diet on obesity and parameters of type 2 diabetes in db/db mice. Five-week-old male db/db and lean db/m mice were fed a normal salt (0.19% Na+, NS) or a low-salt diet (<0.03% Na+, LS) for 5 weeks. Body and organ weight and parameters of glucose and insulin tolerance were analyzed. Plasma levels of steroids were determined by liquid chromatography tandem mass spectrometry. Body weight, glucose, and insulin tolerance were not affected by LS. The amount of gonadal adipose tissue showed a trend to be increased by LS whereas liver, pancreas, kidney, heart, and adrenal weight remained unaffected. LS reduced urinary sodium-to-creatinine ratio but did not affect plasma Na+ levels in both genotypes. Plasma and urinary potassium-to-creatinine ratio did not differ in all groups of mice. Aldosterone as a major determinant of changes in dietary sodium remained unaffected by LS in db/db mice as well as further investigated steroid hormones. The present study showed reduced sodium-to-creatinine ratio, but no additional effects of dietary sodium reduction on major metabolic parameters and steroid levels in obese and hyper-glycemic db/db mice.

Cross-sectional comparisons of sodium content in processed meat and fish products among five countries: potential for feasible targets and reformulation

IntroductionReducing sodium intake has been identified as a highly cost-effective strategy to prevent and control high blood pressure and reduce cardiovascular mortality. This study aims to compare the sodium content in processed meat and fish products among five countries, which will contribute to the evidence-base for feasible strategies of sodium reduction in such products.MethodsSodium content on product labels of 26 500 prepackaged products, 19 601 meat and 6899 fish, was collected in supermarkets from five countries using the FoodSwitch mobile application from 2012 to 2018. To be specific, it was 1898 products in China, 885 in the UK, 5673 in Australia, 946 in South Africa and 17 098 in the USA. Cross-sectional comparisons of sodium levels and proportions meeting 2017 UK sodium reduction targets were conducted using Kruskal-Wallis H and the χ2 test, respectively across the five countries.ResultsThe results showed that processed meat and fish products combined in China had the highest sodium level (median 1050 mg/100 g, IQR: 774–1473), followed by the USA, South Africa, Australia, with the lowest levels found in UK (432 mg/100 g, IQR: 236–786) (p<0.001). Similar variations, that is, a twofold to threefold difference of sodium content between the highest and the lowest countries were found among processed meat and fish products separately. Large sodium content variations were also found in certain specific food subcategories across the five countries, as well as across different food subcategories within each country.ConclusionProcessed meat and fish products differ greatly in sodium content across different countries and across different food subcategories. This indicates great potential for food producers to reformulate the products in sodium content, as well as for consumers to select less salted food.