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Special Issue "Reducing Dietary Sodium and Improving Human Health"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 June 2017)

Special Issue Editor

Guest Editor
Dr. Jacqui Webster

The George Institute for Global Health, POB M201, Missenden Rd, Camperdown, NSW 2050, Australia
Website | E-Mail

Special Issue Information

Dear Colleagues,

This Special Issue of Nutrients, entitled “Reducing Dietary Sodium and Improving Human Health”, welcomes the submission of manuscripts either describing original research or reviewing scientific literature related to salt reduction. Manuscripts should focus on population interventions for reducing dietary sodium and we are particularly interested in innovative approaches to changing the food environment and/or consumer behaviour. Manuscripts that discuss theoretical models informing the design of interventions for reducing dietary sodium are also welcome, as are studies from low or lower middle income countries.

Potential topics may include, but are not limited to:

  • Development/evaluation of regional or national strategies to reduce population salt intake
  • Methodological issues related to measuring salt consumption patterns
  • Use of policy or legislative approaches to reduce salt consumption
  • Design and/or assessment of impact of behavioural change programs
  • Modelling of the impact of interventions on salt intake and health outcomes

Dr. Jacqui Webste
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • salt
  • sodium
  • population interventions
  • behaviour change
  • food environment
  • evaluation
  • health outcomes
  • policy

Published Papers (8 papers)

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Research

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Open AccessArticle Emerging Disparities in Dietary Sodium Intake from Snacking in the US Population
Nutrients 2017, 9(6), 610; doi:10.3390/nu9060610
Received: 17 May 2017 / Revised: 7 June 2017 / Accepted: 13 June 2017 / Published: 17 June 2017
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Abstract
Background: The US population consumes dietary sodium well in excess of recommended levels. It is unknown how the contribution of snack foods to sodium intake has changed over time, and whether disparities exist within specific subgroups of the US population. Objective: To examine
[...] Read more.
Background: The US population consumes dietary sodium well in excess of recommended levels. It is unknown how the contribution of snack foods to sodium intake has changed over time, and whether disparities exist within specific subgroups of the US population. Objective: To examine short and long term trends in the contribution of snack food sources to dietary sodium intake for US adults and children over a 37-year period from 1977 to 2014. Methods: We used data collected from eight nationally representative surveys of food intake in 50,052 US children aged 2–18 years, and 73,179 adults aged 19+ years between 1977 and 2014. Overall, patterns of snack food consumption, trends in sodium intake from snack food sources and trends in food and beverage sources of sodium from snack foods across race-ethnic, age, gender, body mass index, household education and income groups were examined. Results: In all socio-demographic subgroups there was a significant increase in both per capita sodium intake, and the proportion of sodium intake derived from snacks from 1977–1978 to 2011–2014 (p < 0.01). Those with the lowest household education, Non-Hispanic Black race-ethnicity, and the lowest income had the largest increase in sodium intake from snacks. While in 1977–1978 Non-Hispanic Blacks had a lower sodium intake from snacks compared to Non-Hispanic Whites (p < 0.01), in 2011–2014 they had a significantly higher intake. Conclusions: Important disparities are emerging in dietary sodium intake from snack sources in Non-Hispanic Blacks. Our findings have implications for future policy interventions targeting specific US population subgroups. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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Open AccessArticle Know Your Noodles! Assessing Variations in Sodium Content of Instant Noodles across Countries
Nutrients 2017, 9(6), 612; doi:10.3390/nu9060612
Received: 11 April 2017 / Revised: 5 June 2017 / Accepted: 8 June 2017 / Published: 16 June 2017
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Abstract
Reducing salt intake is a cost-effective public health intervention to reduce the global burden of non-communicable disease (NCDs). Ultra-processed foods contribute ~80% of dietary salt in high income countries, and are becoming prominent in low-middle income countries. Instant noodle consumption is particularly high
[...] Read more.
Reducing salt intake is a cost-effective public health intervention to reduce the global burden of non-communicable disease (NCDs). Ultra-processed foods contribute ~80% of dietary salt in high income countries, and are becoming prominent in low-middle income countries. Instant noodle consumption is particularly high in the Asia Pacific region. The aim of this study was to compare the sodium content of instant noodles sold worldwide to identify potential for reformulation. Analysis was undertaken for 765 instant noodle products from 10 countries using packaged food composition databases of ultra-processed foods compiled by the Global Food Monitoring Group (GFMG) and national shop survey data. Sodium levels were high and variable, within and between countries. Instant noodles in China had the highest mean sodium content (1944 mg/100 g; range: 397–3678/100 g) compared to New Zealand (798 mg/100 g; range: 249–2380 mg/100 g). Average pack size ranged from 57 g (Costa Rica) to 98 g (China). The average packet contributed 35% to 95% of the World Health Organization recommended daily salt intake of <5 g. Forty-one percent of products met the Pacific Island (PICs) regional sodium targets, 37% met the South Africa 2016 targets, and 62% met the UK 2017 targets. This study emphasises a need for stronger regulation and closer monitoring to drive rigorous reformulation of salt in ultra-processed foods. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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Open AccessArticle Changes in the Sodium Content of Australian Processed Foods between 1980 and 2013 Using Analytical Data
Nutrients 2017, 9(5), 501; doi:10.3390/nu9050501
Received: 14 March 2017 / Revised: 10 May 2017 / Accepted: 12 May 2017 / Published: 15 May 2017
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Abstract
The objective of this study was to obtain analytical data on the sodium content of a range of processed foods and compare the levels obtained with their label claims and with published data of the same or equivalent processed foods in the 1980s
[...] Read more.
The objective of this study was to obtain analytical data on the sodium content of a range of processed foods and compare the levels obtained with their label claims and with published data of the same or equivalent processed foods in the 1980s and 1990s to investigate the extent of any change in sodium content in relation to reformulation targets. The sodium contents of 130 Australian processed foods were obtained by inductively coupled plasma optical emission spectrometry (ICP-OES) analysis and compared with previously published data. The sodium content between 1980 and 2013 across all products and by each product category were compared. There was a significant overall sodium reduction of 23%, 181 mg/100 g (p <0.001, 95% CI (Confidence Interval), 90 to 272 mg/100 g), in Australian processed foods since 1980, with a 12% (83 mg/100 g) reduction over the last 18 years. The sodium content of convenience foods (p < 0.001, 95% CI, 94 to 291 mg/100 g) and snack foods (p = 0.017, 95% CI, 44 to 398 mg/100 g) had declined significantly since 1980. Meanwhile, the sodium contents of processed meats (p = 0.655, 95% CI, −121 to 190) and bread and other bakery products (p = 0.115, 95% CI, −22 to 192) had decreased, though not significantly. Conversely, the sodium content of cheese (p = 0.781, 95% CI, −484 to 369 mg/100 g) had increased but also not significantly. Of the 130 products analysed, 62% met Australian reformulation targets. Sodium contents of the processed foods and the overall changes in comparison with previous data indicate a decrease over the 33 years period and suggest that the Australian recommended reformulation targets have been effective. Further sodium reduction of processed foods is still required and continuous monitoring of the reduction of sodium levels in processed foods is needed. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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Open AccessArticle Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area—The Salt Intake in Northern Greece (SING) Study
Nutrients 2017, 9(4), 417; doi:10.3390/nu9040417
Received: 13 March 2017 / Revised: 6 April 2017 / Accepted: 20 April 2017 / Published: 22 April 2017
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Abstract
A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies
[...] Read more.
A reduction in population sodium (as salt) consumption is a global health priority, as well as one of the most cost-effective strategies to reduce the burden of cardiovascular disease. High potassium intake is also recommended to reduce cardiovascular disease. To establish effective policies for setting targets and monitoring effectiveness within each country, the current level of consumption should be known. Greece lacks data on actual sodium and potassium intake. The aim of the present study was therefore to assess dietary salt (using sodium as biomarker) and potassium intakes in a sample of healthy adults in northern Greece, and to determine whether adherence to a Mediterranean diet is related to different sodium intakes or sodium-to-potassium ratio. A cross-sectional survey was carried out in the Thessaloniki greater metropolitan area (northern Greece) (n = 252, aged 18–75 years, 45.2% males). Participants’ dietary sodium and potassium intakes were determined by 24-hour urinary sodium and potassium excretions. In addition, we estimated their adherence to Mediterranean diet by the use of an 11-item MedDietScore (range 0–55). The mean sodium excretion was 175 (SD 72) mmol/day, equivalent to 4220 (1745) mg of sodium or 10.7 (4.4) g of salt per day, and the potassium excretion was 65 (25) mmol/day, equivalent to 3303 (1247) mg per day. Men had higher sodium and potassium excretions compared to women. Only 5.6% of the sample had salt intake <5 g/day, which is the target intake recommended by the World Health Organization. Mean sodium-to-potassium excretion ratio was 2.82 (1.07). There was no significant difference in salt or potassium intake or their ratio across MedDietScore quartiles. No significant relationships were found between salt intake and adherence to a Mediterranean diet, suggesting that the perception of the health benefits of the Mediterranean diet does not hold when referring to salt consumption. These results suggest the need for a larger, nation-wide survey on salt intake in Greece and underline the importance of continuation of salt reduction initiatives in Greece. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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Open AccessArticle The Sodium Content of Processed Foods in South Africa during the Introduction of Mandatory Sodium Limits
Nutrients 2017, 9(4), 404; doi:10.3390/nu9040404
Received: 9 March 2017 / Revised: 7 April 2017 / Accepted: 17 April 2017 / Published: 20 April 2017
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Abstract
Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading
[...] Read more.
Background: In June 2016, the Republic of South Africa introduced legislation for mandatory limits for the upper sodium content permitted in a wide range of processed foods. We assessed the sodium levels of packaged foods in South Africa during the one-year period leading up to the mandatory implementation date of the legislation. Methods: Data on the nutritional composition of packaged foods was obtained from nutrition information panels on food labels through both in-store surveys and crowdsourcing by users of the HealthyFood Switch mobile phone app between June 2015 and August 2016. Summary sodium levels were calculated for 15 food categories, including the 13 categories covered by the sodium legislation. The percentage of foods that met the government’s 2016 sodium limits was also calculated. Results: 11,065 processed food items were included in the analyses; 1851 of these were subject to the sodium legislation. Overall, 67% of targeted foods had a sodium level at or below the legislated limit. Categories with the lowest percentage of foods that met legislated limits were bread (27%), potato crisps (41%), salt and vinegar flavoured snacks (42%), and raw processed sausages (45%). About half (49%) of targeted foods not meeting the legislated limits were less than 25% above the maximum sodium level. Conclusion: Sodium levels in two-thirds of foods covered by the South African sodium legislation were at or below the permitted upper levels at the mandatory implementation date of the legislation and many more were close to the limit. The South African food industry has an excellent opportunity to rapidly meet the legislated requirements. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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Open AccessArticle Effect of 25% Sodium Reduction on Sales of a Top‐Selling Bread in Remote Indigenous Australian  Community Stores: A Controlled Intervention Trial
Nutrients 2017, 9(3), 214; doi:10.3390/nu9030214
Received: 19 December 2016 / Accepted: 21 February 2017 / Published: 28 February 2017
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Abstract
Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top‐selling bread affected sales in 26 remote Indigenous community
[...] Read more.
Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top‐selling bread affected sales in 26 remote Indigenous community stores. After a 23‐week baseline period, 11 control stores received the regular‐salt bread (400 mg Na/100 g) and 15 intervention stores received the reduced‐salt version (300 mg Na/100 g) for 12‐weeks. Sales data were collected to examine difference between groups in change from baseline to follow‐up (effect size) in sales (primary outcome) or sodium density, analysed using a mixed model. There was no significant effect on market share (−0.31%; 95% CI −0.68, 0.07; p = 0.11) or weekly dollars ($58; −149, 266; p = 0.58). Sodium density of all purchases was not significantly reduced (−8 mg Na/MJ; −18, 2; p = 0.14), but 25% reduction across all bread could significantly reduce sodium (−12; −23, −1; p = 0.03). We found 25% salt reduction in a top‐selling bread did not affect sales in remote Indigenous community stores. If achieved across all breads, estimated salt intake in remote Indigenous Australian communities would be reduced by approximately 15% of the magnitude needed to achieve population salt targets, which could lead to significant health gains at the population‐level. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
Open AccessArticle The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India
Nutrients 2017, 9(2), 144; doi:10.3390/nu9020144
Received: 19 December 2016 / Revised: 24 January 2017 / Accepted: 3 February 2017 / Published: 16 February 2017
Cited by 1 | PDF Full-text (241 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated
[...] Read more.
Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants’ physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87–9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake—less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55–9.87 g/day) versus less-educated (9.34, 8.57–10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)

Review

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Open AccessReview A Systematic Review of Fatalities Related to Acute Ingestion of Salt. A Need for Warning Labels?
Nutrients 2017, 9(7), 648; doi:10.3390/nu9070648
Received: 7 June 2017 / Revised: 16 June 2017 / Accepted: 20 June 2017 / Published: 23 June 2017
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Abstract
There are sporadic cases of fatalities from acutely eating salt. Yet, on social media, there are “challenges to” and examples of children and some adults acutely eating salt, and recently a charity advocated eating small amounts of salt to empathize with Syrian refugees.
[...] Read more.
There are sporadic cases of fatalities from acutely eating salt. Yet, on social media, there are “challenges to” and examples of children and some adults acutely eating salt, and recently a charity advocated eating small amounts of salt to empathize with Syrian refugees. We performed a systematic review of fatalities from ingesting salt to assess if relatively moderate doses of salt could be fatal. In 27 reports, there were 35 fatalities documented (19 in adults and 16 in children). The lethal dose was estimated to be less than 10 g of sodium (<5 teaspoons of salt) in two children, and less than 25 g sodium in four adults (<4 tablespoons of salt). The frequency of fatal ingestion of salt is not able to be discerned from our review. If investigation of the causes of hypernatremia in hospital records indicates salt overdose is relatively common, consideration could be given to placing warning labels on salt containers and shakers. Such warning labels can have the added advantage of reducing dietary salt consumption. Full article
(This article belongs to the Special Issue Reducing Dietary Sodium and Improving Human Health)
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