The Science of Salt: A Regularly Updated Systematic Review of Salt and Health Outcomes (August to November 2015)

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119

The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low‐quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24‐hour dietary sodium ingestion, single complete 24‐hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non‐consecutive complete 24‐hour urine collections obtained over a series of days that reflect the usual short‐term variations in dietary pattern were recommended. Multiple 24‐hour urine collections over several years were recommended to estimate an individual's usual long‐term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low‐quality research on dietary sodium/salt should not be funded, conducted, or published.

Section: Discussionmentioning

confidence: 99%

Section: Setting Recommendationmentioning

confidence: 99%

The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) position statement on the use of 24‐hour, spot, and short duration (<24 hours) timed urine collections to assess dietary sodium intake

Campbell

Tan

et al. 2019

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119

“…[7][8][9][10][11] In addition, two annual systematic reviews incorporating studies published between 2013 and 2015 were published. 4,12 To date there have been five periodic systematic reviews published-three focused on evaluating the implementation of salt reduction strategies identified as part of the Science of Salt Weekly systematic review series, with a view to informing future implementation of interventions to lower population salt consumption, 7,8,11 and two summarizing the volume of studies reporting on the effects of salt intake on health outcomes.…”

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confidence: 99%

“…4,12 To date there have been five periodic systematic reviews published-three focused on evaluating the implementation of salt reduction strategies identified as part of the Science of Salt Weekly systematic review series, with a view to informing future implementation of interventions to lower population salt consumption, 7,8,11 and two summarizing the volume of studies reporting on the effects of salt intake on health outcomes. 9,10 The reviews evaluating intervention studies provide important recommendations for the implementation of salt reduction strategies including government commitment, the need for multicomponent interventions extending the focus beyond targeting consumer behavior, and using standardized methodologies to rigorously monitor the salt content of processed foods. Additionally, the need for greater emphasis on external validity, and an evaluation framework that supports both scientific robustness and external validity is highlighted as an important element in providing further evidence of effectiveness in real-world situations.…”

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confidence: 99%

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (September 2016–February 2017)

Johnson

Santos

McKenzie

et al. 2017

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This periodic review aims to identify, summarize, and appraise studies relating to the implementation of salt reduction strategies that were published between September 2016 and February 2017. A total of 41 studies were included as relevant to the design, assessment, and implementation of salt reduction strategies, and a detailed appraisal was conducted on the seven studies that evaluated the impact of salt reduction strategies. Of these, three were national studies or included large populations and four were conducted in communities with small participant sample sizes. Each study used a different strategy for reducing salt intake varying from category-specific sodium targets for packaged food to use of a low-sodium salt substitute to behavior change interventions. Four studies found statistically significant decreases in dietary salt intake and one study showed statistically significant decreases in mean sodium density of packaged food products. Four of the seven studies used either spot or 24-hour urine samples to measure dietary salt intake and five were conducted in East or Southeast Asia-two of which were in low-and middle-income countries. Study quality varied among the seven studies and all except one had one or more risks related to bias.

“…As part of this initiative, regularly updated systematic reviews on the relationship between salt and health outcomes, and the implementation of salt reduction interventions are being published in the Journal of Clinical Hypertension. 16 To date, 11 studies (six on the relationship of salt and health outcomes [17][18][19][20][21][22] and five related to the implementation of salt reduction interventions [23][24][25][26][27] ) have been published. The last implementation review was the first to employ a thematic approach focusing on studies that reported knowledge, attitudes, and behaviors relating to salt.…”

Section: Introductionmentioning

confidence: 99%

The Science of Salt: A global review on changes in sodium levels in foods

Santos

Sparks

Thout

et al. 2019

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This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty‐four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n = 8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (−36 mg/100 g, 95% CI −51 to −20 mg/100 g) and in five food categories—breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty‐two of the 24 studies were from high‐income countries, limiting the applicability of the findings to lower resource settings.