The Science of Salt: A Regularly Updated Systematic Review of the Implementation of Salt Reduction Interventions (November 2015 to February 2016)

Trieu, Kathy; McLean, Rachael; Johnson, Claire; Santos, Joseph Alvin; Thout, Sudhir Raj; Campbell, Norm R.C.; Webster, Jacqui

doi:10.1111/jch.12909

Cited by 19 publications

(14 citation statements)

References 17 publications

(44 reference statements)

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“…Most studies (n = 22) came from just seven high‐income countries with two from two middle‐income countries. The low number of studies from low‐ and middle‐income countries is in line with our previous reviews and means that the applicability of findings generated from the current review may be limited in these settings. Further, compared to the 2015 review of salt reduction initiatives around the world which reported that 38 countries (28 high‐income and 10 middle‐income countries) have voluntary or mandatory sodium targets for foods, the current review shows that only eight of these countries (seven high‐income and one middle‐income countries) have available data on change to measure the food industry's progress to reduce the sodium content of products.…”

Section: Discussionsupporting

confidence: 78%

“…Most studies (n = 22) came from just seven high-income countries with two from two middle-income countries. The low number of studies from lowand middle-income countries is in line with our previous reviews [23][24][25][26][27] and means that the applicability of findings generated from the current review may be limited in these settings. Further, compared to the 2015 review of salt reduction initiatives around the world which interventions.…”

Section: Discussionsupporting

confidence: 73%

“…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%

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

Santos

Sparks

Thout

et al. 2019

J of Clinical Hypertension

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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.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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

Santos

Sparks

Thout

et al. 2019

J of Clinical Hypertension

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“…This supports the findings from previous studies which demonstrated that salt reduction initiatives are likely to be more effective if they are multicomponent and incorporate intervention activities at a structural level. 4,6 Second, in terms of method of outcome assessment, as described above, the studies used different approaches. Of the two studies that shown that they can provide an acceptable estimate of mean population salt consumption levels.…”

Section: Discussionmentioning

confidence: 99%

“…Studies published from March 2016 to August 2016 were screened for eligibility using the previously established inclusion and exclusion criteria. 6 In the current review, studies evaluating the impact of salt reduction interventions were appraised for risk of bias by two independent reviewers using a modified Cochrane risk of bias tool for nonrandomized trials of intervention studies. 4,7 Detailed appraisal and commentary were also performed on these studies.…”

Section: Methodsmentioning

confidence: 99%

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Santos

Trieu

Thout

et al. 2017

J of Clinical Hypertension

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This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available.None of the studies were conducted in low-or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries. | INTRODUCTIONHigh salt intake is one of the main contributors to premature death from cardiovascular diseases globally. of countries (China, Finland, France, England, and Ireland) had already achieved significant reductions in population salt intake. | METHODOLOGYA detailed description of the search strategy used to identify and screen studies in this review has been previously reported. In the current review, studies evaluating the impact of salt reduction interventions were appraised for risk of bias by two independent reviewers using a modified Cochrane risk of bias tool for nonrandomized trials of intervention studies. 4,7 Detailed appraisal and commentary were also performed on these studies. Other types of studies that provided information pertinent to the design, implementation, and assessment of salt reduction interventions were summarized in a table.These include (1) studies on monitoring and surveillance of salt intake;(2) salt content in foods; (3) consumers' knowledge, attitudes, and behaviors toward salt; (4) economic evaluation or modeling studies of salt reduction strategies; and (5) other studies related to implementation of salt reduction initiatives. | RESULTSThe MEDLINE search identified 3675 citations, of which 85 were considered potentially eligible for full review on the basis of their findings relevant to salt reduction interventions. Ultimately, a total of 40 studies met the inclusion criteria: four studies evaluated the impact of salt reduction interventions, 21 were surveillance or monitoring studies, five were modeling studies relating to salt reduction, and 10 other studies related to the implementation of salt reduction interventions (Figure 1). conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level. 9The method for evaluating the impact ...

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An impact of dietary intervention on blood pressures among diabetic and/or hypertensive patients with high cardiovascular disorders risk in northern Thailand by cluster randomized trial

Yokokawa

Yuasa

Nedsuwan

et al. 2020

J of Gen and Family Med

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BackgroundGlobal sodium intake remains above the recommended levels to control blood pressure (BP). We aimed to evaluate the efficacy of a dietary intervention on BP through salt reduction among community‐dwelling participants with high risk of cardiovascular disorders (CVD).MethodsThis cluster randomized trial (February 2012 to January 2013) included cooking instruction using the pocket salt meter among patients with diabetes and/or hypertension who were treated at health center in Thailand. Based on health centers, 8 clusters of eligible participants were randomly allocated to the 4 intervention and 4 control groups. Dietary intervention was performed at baseline, 1 month, and 3 months in intervention group. In both groups, systolic and diastolic BPs, and estimated 24 hours salt intake based on overnight urine samples were measured at baseline, 6 months, and 12 months.ResultsA total of 753 participants were enrolled (374 in the intervention group and 379 in the control group). In the mixed‐effects model, there were significant difference in SBP and estimated salt intake after adjusting covariates at 6 months (adjusted differences between groups [95% CI]; −7.55 [−5.61 to −9.49] mm Hg P < .01; −0.66 [−0.40 to −0.92] g/day P = .03). However, these differences were not observed at 12 months (adjusted differences between groups [95% CI]; −1.83 [0.34 to −4.00] mm Hg P = .48; −0.42 [−0.17 to −0.67] g/day P = .16). There were no differences in DBP in both follow‐ups.ConclusionsThese results may suggest the effectiveness of a visually based dietary intervention targeting salt intake reduction in short term, but the effectiveness discontinued in long term.Clinical trial number: The International Standard Randomized Controlled Trial Number Register (ISRCTN39416277) on January 3, 2012.

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The Science of Salt: A Regularly Updated Systematic Review of the Implementation of Salt Reduction Interventions (November 2015 to February 2016)

Cited by 19 publications

References 17 publications

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

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

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

An impact of dietary intervention on blood pressures among diabetic and/or hypertensive patients with high cardiovascular disorders risk in northern Thailand by cluster randomized trial

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