Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling

Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants’ frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.

The Impact of Fullerenes as Doxorubicin Nano-Transporters on Metallothionein and Superoxide Dismutase Status in MCF-10A Cells

This study aimed to synthesise C60–DOX complexes followed by the analysis of their effect on the concentration of metallothionein (MT) as a non-enzymatic antioxidant and on the concentration and activity of superoxide dismutase (SOD) as an antioxidant enzyme in healthy human mammary MCF-10A cells. Dynamic light scattering and electrophoretic light scattering were used to establish the size and zeta potential of the complexes. The MT and SOD concentrations were determined using the ELISA method; SOD activity was determined by tetrazolium salt reduction inhibition. Lower MT concentration following exposure of cells to both DOX and C60 fullerene compared to the control sample was found. However, the concentration of this protein increased as a consequence of the C60–DOX complexes action on MCF-10A cells compared to the control. C60 used alone did not affect the concentration and activity of SOD in MCF-10A cells. Application of free DOX did not activate cellular antioxidant defence in the form of an increase in SOD concentration or its activity. In contrast treatment of cells with the C60–DOX complex resulted in a decrease in SOD1 concentration and a significant increase in SOD activity compared to cells treated with free DOX, C60 and control. Thus, it was found that C60–DOX complexes showed potential for protective effects against DOX-induced toxicity to MCF-10A cells.

Evaluation of salt content and effectiveness of excessive salt reduction methods in selected commercially available dried fish types in Sri Lanka

High salt intake elevates the risk of non-communicable diseases such as high blood pressure, cardiovascular diseases and stroke worldwide. Sri Lanka has recorded in 2010 as the country with highest average fish & fish products consumption in South Asia. In the current study, salt in ten types of commonly available dried fish namely; sprats, prawns, smoothbelly sardinella, queen fish, cat fish, sail fish, shark, skipjack tuna, Bombay duck and trenched sardinella was analyzed and determined salt reduction methods with minimal protein loss. Four salt reduction methods were tested; Method 1: washed with water at Room Temperature (RT) for five times; Method 2: washed with water for five times at RT and kept in hot water for 5min; Method 3: washed with water for five times at RT and boiled for 5min; Method 4: washed with water for five times at RT and kept in coconut water for 5min. Using Volhard method, sodium chloride was analyzed while protein was determined using Kjeldahl method. All four methods showed significant reduction of salt level in tested dried fish (p < 0.05). Among the tested salt reduction methods, Method 3 showed the highest salt reduction for all types of dried fish except smoothbelly sardinella and cat fish.The highest salt mean value of 28.8% was recorded in queen fish and the lowest mean value of 12.8% was recorded in smoothbelly sardinella. The highest protein loss was recorded in Method 3. To reduce considerable amount of salt, the easiest and fairly effective method is method 1 except for prawns and Shark. Although higher salt reduction showed in method 2 and 3, they are not recommended due to high protein loss, high energy expenditure and reduction of freshness of dried fish. Method 4 can be applied for all dried fish types because it is economical and reduces considerable amount of salt, removes less amount of protein comparatively. The results revealed that all tested dried fish except smoothbelly sardinella contain significantly high amount of salt (p < 0.05) than the standard value specified (12%) by the Sri Lanka Standards Institution (SLSI).Keywords: Dried fish, protein loss, salt-intake, salt reduction, non-communicable diseases

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

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.

Nutritional Content of Street Food and Takeaway Food Purchased in Urban Bosnia and Herzegovina

Street food (SF) and takeaway food (TAF) are important sources of out-of-home meals in urban Bosnia and Herzegovina, where diet-related non-communicable diseases are growing rapidly. This study aimed to characterise SF and TAF purchased in urban areas of Bosnia and Herzegovina, regarding customers’ characteristics and the nutritional composition of the foods and beverages. A cross-sectional study was conducted in Sarajevo and Banja Luka in 2017. SF (n = 194) and TAF vending sites (n = 154) were selected through random and systematic sampling. Data on the food items purchased and customers’ characteristics were collected by direct observation. Nutritional composition was estimated using data from chemical analyses of the foods most commonly available. Two-thirds of the customers observed (n = 755) were aged ≥35 years, half were women and 27.7% were overweight/obese. A total of 929 food items were purchased. The most commonly bought SFs were confectionery (30.5%), water (27.9%) and soft drinks/juices (22.2%). TAF customers purchased mostly savoury pastries (39.8%), breads (27.1%) and main dishes (21.4%). Almost half of customers purchased industrial food (i.e., pre-packaged foods and beverages produced by the food industry). The purchases presented median contents of 18.7 g of fat (39.6% saturated, 32.3% monounsaturated, 22.1% polyunsaturated, 1.5% trans), 838 mg of sodium and 285 mg of potassium. Saturated-fat contribution was higher in SF purchases (60.4% vs. 30.2%, p < 0.001), whereas TAF purchases presented higher trans-fat proportion (1.8% vs. 0.6%, p < 0.001), sodium (1241 vs. 89 mg, p < 0.001) and sodium-potassium ratio (6.1 vs. 0.6, p < 0.001). Generally, SF and TAF bought in Sarajevo and Banja Luka were rich in saturated and trans fatty-acids and sodium, and poor in potassium. Nutrition policies promoting use of healthier fats and salt reduction in SF and TAF may contribute to the prevention of diet-related diseases in these settings.

A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial

Background A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention’s effectiveness. Methods This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962

Effect of Salt Content Reduction on Food Processing Technology

Higher salt intake is associated with the risk of cardiovascular and kidney diseases, hypertension and gastric cancer. Salt intake reduction represents an effective way to improve people’s health, either by the right choice of food or by a reduction of added salt. Salt substitutes are often used and also herb homogenates are treated by high pressure technology. Salt reduction significantly influences the shelf life, texture, pH, taste, and aroma of cheese. The composition of emulsifying salts or starter cultures must be modified to enact changes in microbial diversity, protease activity and the ripening process. The texture becomes softer and aroma atypical. In bakery products, a salt reduction of only 20–30% is acceptable. Water absorption, dough development, length and intensity of kneading and stability of dough are changed. Gluten development and its viscoelastic properties are affected. The salt reduction promotes yeast growth and CO2 production. Specific volume and crust colour intensity decreased, and the crumb porosity changed. In meat products, salt provides flavour, texture, and shelf life, and water activity increases. In this case, myofibrillar proteins’ solubility, water binding activity and colour intensity changes were found. The composition of curing nitrite salt mixtures and starter cultures must be modified.