Japan has undertaken extensive efforts to reduce dietary salt intake and prevent cardiovascular diseases. Although salt consumption has decreased over time, levels remain high, highlighting the need for continued promotion of low-salt food products through collaboration among government bodies, the food industry, academia, and other stakeholders. Effective policy development requires an environment that enables stakeholders to apply scientific evidence on the cost-effectiveness of salt reduction strategies. Our ongoing research focuses on developing simulation models to predict future public health and economic impacts, supporting the establishment of voluntary targets and evidence-based approaches. These strategies aim to lower salt intake, enhance health outcomes, and manage social security expenditures, thereby fostering sustainable development in an aging society.

Sodium is the major cation of extracellular fluid (ECF) and, because of its osmotic action, is involved in the regulation of ECF volume and blood pressure. The ingested sodium is almost completely absorbed by the intestine. Circulating sodium is filtered by the glomeruli and its renal tubular handling is responsible for the maintenance of sodium and water balance. Sodium deficiency is rare and occurs only in some medical conditions. High dietary sodium intake is associated with ECF volume expansion and is a leading risk factor for hypertension and cardiovascular diseases; it also adds to risk of gastric cancer, nephrolithiasis, reduced bone mineral density, and osteoporosis. Salt added while cooking and eating, the amount added during food transformation, and that occurring naturally in foods contribute to the dietary sodium intake. Additional small amounts of sodium may be occasionally acquired through oral or parenteral medications. The National Academy of Science, Engineering and Medicine set an adequate intake of 1.5 g and a chronic disease risk reduction intake of 2.3 g of sodium per day for the adult population. The European Food Safety Authority and the World Health Organization set a standard dietary target for sodium of 2 g/d (5 g of salt). Recent studies highlighted the relevance of salt intake reduction for all-cause mortality risk and, in particular, for stroke. Sodium also appears to affect the activity of the immune system by influencing the gut microbiota composition and the macrophage and lymphocyte differentiation.

Excessive salt consumption has been linked with the emergence of hypertension, which further leads to cardiovascular disease development among other medical conditions. This has resulted in leading world institutions such as the WHO coming up with relevant plans to minimize its use. Lower-middle-income countries (LMICs) have greatest burden of noncommunicable diseases (NCDs), with hypertension being a common condition. Reduction of salt intake is a great control measure in minimizing the rise in prevalence of hypertension or cardiovascular diseases. Many countries have agreed and even formulated their salt reduction policies as recommended by the WHO, however, the challenge is widely noted in implementation. Thus, few countries have been able to achieve the global WHO recommended standards of daily salt intake. Salt is the main source of sodium in our diets, which is an essential component responsible for the balance of the extracellular fluid volume but may lead to salt-induced hypertension when used excessively. The achievement of salt reduction is predicated on multiple factors such as knowledge, attitude and practice of the public. Therefore, localizing interventions with strategies such as public media campaigns, reformulation of processed foods (mandatory and voluntary) and front-of-packaging labelling awareness. Some of the reasons for failure in implementation include economic challenges, lack of visionary leadership, stakeholder struggles and poor planning and execution of strategies. This review aims to elaborate on the development of cardiovascular diseases or hypertension due to salt usage and the recent advancement regarding salt reduction policies. Further, we assess the need for proper implementation with the United Kingdom as a case study. In conclusion, most governments have made the right decisions in developing or recommending salt reduction strategies to the food industry. However, more focus is needed to ensure effective implementation of the plans.

To explore dietary salt-related knowledge, attitudes, and behaviors of New Zealand (NZ) adults aged 18-65 years and assess differences by demographic subgroups.

Cross-sectional online survey conducted between June 1, 2018 and August 31, 2018.

Participants were recruited in shopping malls, via social media, and a market research panel.

English-speaking adults residing in NZ.

An amended version of The Pan American and World Health Organization Knowledge, Attitudes, and Behaviors standardized survey tool was used. Demographic data (age, sex, ethnicity, and educational attainment) were also collected.

Descriptive statistics reported. Chi-square test for independence to assess differences by demographics.

The survey was completed by 1,131 adults (mean age 36 ± 15 years; n = 876 [78%] female; n = 661 [78%] NZ European/other; n = 210 [19%] Asian; n =164 [15%] Māori). In addition, 865 participants (83%) knew the primary dietary source of salt; 406 (40%) knew the recommended salt intake; 946 (95%) believed food manufacturers are responsible for sodium reduction; 563 (55%) supported government regulations; and 259 (26%) used food labels. Females and NZ European/other participants reported more favorable salt-reducing behaviors, such as avoiding fast-food and packaged, ready-to-eat foods (P < 0.001).

Improving salt-related knowledge, attitudes, and behaviors in NZ is particularly important for men, underserved populations, and adults aged 45-65 years. A multicomponent, national NZ salt reduction program based on research addressing engagement and effectiveness for at-risk groups is warranted.

International evidence shows that individuals from low socioeconomic positions (SEPs) consume a greater amount of salt than those from higher SEPs. This health inequality reflects a disproportionate effect of salt-reduction initiatives, and explains a higher prevalence of cardiovascular disease among the most vulnerable populations. Assessing this impact can help tailor implementation strategies in the future for the benefit of the whole population.

The aim was to systematically review the literature and assess the impact of salt-reduction initiatives on health and behavioral outcomes of adults by SEP.

The search strategy was conducted in 6 databases (CINAHL, Scopus, Embase, MEDLINE, PubMed, and Web of Science) using the terms sodium or salt, social class, policy, intervention or campaign. Peer-reviewed articles assessing salt-reduction interventions in adults reporting dietary or behavioral changes on salt consumption measurements by SEP were considered for inclusion. Articles in which salt intake data were not reported by SEP were excluded.

Two reviewers collected data independently using a predesigned electronic form. The AXIS and RoB 2 tools were used for critical appraisal.

Eight studies containing data from 111 548 adults were interpreted according to study design following a narrative synthesis approach.

Salt-reduction initiatives are effective at reducing the intake of salt and sodium in adults. When reporting the impact of these initiatives, research outcomes are generally not evaluated by SEP, representing a question yet to be explored.

A small number of articles that focused on the impact of salt-reduction interventions reported salt consumption measurements by SEP, indicating a critical gap in research. The limited evidence suggests potentially greater health benefits to be gained from the implementation of population-wide initiatives in adults of low SEP.

PROSPERO registration no. CRD42021238055.

The contemporary approach to nutrition increasingly considers the role of non-nutritive bioactive compounds in modulating the immune system and maintaining health. This article provides up-to-date insight into the immunomodulatory effects of selected bioactive compounds, including micro- and macronutrients, vitamins, as well as other health-promoting substances, such as omega-3 fatty acids, probiotics, prebiotics, postbiotics (including butyric acid and sodium butyrate), coenzyme Q10, lipoic acid, and plant-derived components such as phenolic acids, flavonoids, coumarins, alkaloids, polyacetylenes, saponins, carotenoids, and terpenoids. Micro- and macronutrients, such as zinc, selenium, magnesium, and iron, play a pivotal role in regulating the immune response and protecting against oxidative stress. Vitamins, especially vitamins C, D, E, and B, are vital for the optimal functioning of the immune system as they facilitate the production of cytokines, the differentiation of immunological cells, and the neutralization of free radicals, among other functions. Omega-3 fatty acids exhibit strong anti-inflammatory effects and enhance immune cell function. Probiotics, prebiotics, and postbiotics modulate the intestinal microbiota, thereby promoting the integrity of the intestinal barrier and communication between the microbiota and the immune system. Coenzyme Q10, renowned for its antioxidant attributes, participates in the protection of cells from oxidative stress and promotes energy processes essential for immune function. Sodium butyrate and lipoic acid exhibit anti-inflammatory effects and facilitate the regeneration of the intestinal epithelium, which is crucial for the maintenance of immune homeostasis. This article emphasizes the necessity of an integrative approach to optimal nutrition that considers not only nutritional but also non-nutritional bioactive compounds to provide adequate support for immune function. Without them, the immune system will never function properly, because it has been adapted to this in the course of evolution. The data presented in this article may serve as a foundation for further research into the potential applications of bioactive components in the prevention and treatment of diseases associated with immune dysfunction.

To address the growing burden of hypertension and related diseases, Nigeria seeks to reduce excess dietary sodium through policymaking. The current study aims to describe the levels and sources of dietary sodium intake among Nigerian adults to inform targeted policies for reducing sodium intake.

From June 2023 to July 2023, adults aged 18 to 70 years old were recruited from the Federal Capital Territory, Kano States, and Ogun States to participate in a population-based, cross-sectional non-communicable diseases survey. Data were also collected to assess levels and dietary sources of sodium through four 24-hour dietary recalls by trained study personnel with 90.7% response rate. Concurrent 24-hour urine sodium data were collected. The primary analyses included the distribution of sodium intake and sources of sodium, overall and by sex and state. Results were adjusted to the Nigerian population. Multivariate regression models evaluated associations between baseline sociodemographic factors and sodium intake.

Among 537 participants, 365 (68.0%) were female, and median (Interquartile range) age was 38 (27, 48) years. Adjusted median (IQR) daily sodium intake according to 24-hour dietary recalls was 3,803 (2,663, 5,085) mg per day with higher intake reported among males (males: 3,878 [2,663, 5,032] mg/dl; females: 3,415 [2,373, 4,689], p<.0001). Two-thirds (67.0%) of the sodium intake was from home-cooked meals. Nearly half (48.7%) of sodium came from discretionary sources, including 21.4% from bouillon. Salt and yaji spice added at the table accounted for 9.1% of sodium intake and was highest among females (18.8%) and males (13.7%) in Kano. On the other hand, sodium from street food was highest in males (35.9%) and females (34.2%) in Ogun. After adjustment, older participants and those with higher education had lower daily sodium intake compared to younger participants and those with less education, respectively. Results were similar when excluding individuals with cardiovascular disease or hypertension.

Adults in the Federal Capital Territory, Kano, and Ogun consume nearly twice the recommended level of dietary sodium. Most dietary sodium intake came from home cooked foods, nearly half of which came from discretionary sources, which has important policy implications for SHAKE package implementation.

Bakery products are considered as one of main dietary sources of sodium/salt in Slovenia. Our main objective was to assess the salt content in bread in Slovenia, focusing into different bread categories and sales channels. The data collected in 2022 was compared with year 2012.

A follow-up study on salt content of bread sold in Slovenia was conducted. Bread samples were purchased in large retail shops and smaller bakeries across 11 statistical regions of Slovenia. Sodium content was determined by inductively coupled plasma mass spectrometry; salt content was calculated by multiplying sodium content with 2.54, assuming all sodium corresponds to sodium chloride.

In 2022, 178 bread samples were purchased and analyzed. Weighted mean salt content in bread was 1.35 (95% CI 1.28-1.42) g/100 g in 2012, and 1.26 (95% CI 1.22-1.29) g/100 g in 2022, showing a 7% decrease. Notable differences in the salt content were observed between various bread subcategories and retail environments. In addition, a significant difference was observed between white wheat bread sold in large retail shops and smaller bakeries, where a higher salt content was observed.

While study results show small decrease in the salt content in bread in Slovenia in last decade, the salt reduction targets set by the WHO have not been met. Additional efforts are needed to stimulate bread reformulation with reducing salt content.

Maternal nutrition profoundly influences offspring health, impacting both prenatal and early postnatal development. Previous studies have demonstrated that maternal dietary habits can affect key developmental pathways in the offsprings, including those related to lung function and disease susceptibility. However, the sex-specific impact of a maternal high-salt diet (HSD) on offspring lung injury remains poorly understood.

This study aimed to investigate the sex-specific effects of maternal HSD on lung injury in mouse offsprings, focusing on pathways related to fibrosis, metabolism, immunity, and apoptosis.

Pregnant C57BL/6J mice were subjected to either normal or HSD conditions during gestation. Lung tissues from the male and female offsprings were analyzed using high-throughput RNA sequencing and bioinformatics tools to examine transcriptomic changes. Wet-lab validation, including Masson trichrome staining, immunofluorescence for α-SMA, and qRT-PCR for fibrotic markers (α-SMA, collagen I, Fn1, and TGF-β), was conducted to confirm fibrosis and other injury markers. Lung structure and weight were also evaluated to assess physical alterations due to maternal diet.

Maternal HSD significantly altered lung transcriptomes in a sex-specific manner. Male offsprings showed increased susceptibility to fibrosis, as confirmed by histological and molecular analyses, including elevated expression of α-SMA, collagen I, Fn1, and TGF-β. In contrast, female offsprings exhibited distinct changes in metabolic and immune pathways. These findings highlight the differential regulation of pulmonary injury mechanisms between male and female offsprings exposed to HSD.

Maternal HSD induces sex-specific lung injury in offsprings by disrupting critical pathways involved in fibrosis, metabolism, immunity, and apoptosis. The combination of transcriptomic and orthogonal data underscores the need for balanced maternal nutrition during pregnancy to promote long-term respiratory health in offsprings. These results provide new insights into the sex-specific vulnerabilities to lung disease arising from maternal diet.

This study aimed to estimate the quantity and trends of salt intake from industrial fermented dairy products, develop strategies to reduce salt content, and inform policymakers on promoting public health through healthier dairy options. A cross-sectional study was conducted on fermented dairy products. Seventy-nine random samples were selected, and the salt (NaCl %) content was determined by potentiometric titration after sample preparation and homogenization; also samples were analyzed for their moisture (oven drying method). Data analysis involved descriptive statistics and one-sample t-test. A comprehensive literature review on salt reduction strategies was also performed proposing a model for an optimized low-salt fermented dairy product. This study found high salt content in many fermented dairy products. Brined cheese had the highest salt level (7.57 g/100 g), while pizza processed cheese had the lowest (1.03 g/100 g). Probiotic yogurts contained less salt (0.29 g/100 g) than regular ones. Other products like doogh (1.04 g/100 g), kefir (0.63 g/100 g), and kashk (2.78 g/100 g) also contributed significantly to salt intake. Most products exceeded recommended salt limits. Consuming just one serving of these products often accounted for a substantial portion of the daily recommended salt intake (WHO: 5 g/day). This research emphasizes the need for reducing salt in fermented dairy products to improve public health. This study highlights the excessive salt content in many fermented dairy products, surpassing recommended daily intake levels. Therefore, to address this public health concern, a multi-faceted approach is necessary. For this purpose, Policymakers should implement stringent monitoring, enforce food labeling, and develop legislation to reduce salt content. Furthermore, the food industry must innovate to reduce salt while maintaining product quality and taste. On the other hand, consumer education and awareness campaigns are crucial for informed choices. Additionally, further research is needed to understand consumer perceptions and the long-term impact of salt-sustainable reduction strategies on dietary habits and public health.

Online grocery shopping is a growing source of food purchases in many countries. We investigated the effect of nudging consumers towards purchases of lower sodium products using a web browser extension.

This trial was conducted among individuals with hypertension who shopped for their groceries online in Australia. From July 2021 to June 2023, participants were randomised to use the SaltSwitch Online Grocery Shopping web browser extension or continue their usual grocery shopping for 12 weeks. The SaltSwitch extension modified a retailer's online shopping interface to suggest similar but lower sodium alternative products to those initially selected. The primary outcome was the difference in mean sodium density (mg sodium per 1000 kcal of energy) of packaged food purchases between the intervention and control groups.

We randomised 185 participants of average age 56.0 (SD 11.0) years. Most were women (64%), White (89%), had BMI > 25 kg/m2 (91%), and were taking anti-hypertensive medication (83%). Demographic and medical characteristics were similar across the randomised groups. 182 (98%) completed the trial. Over the 12-week intervention, the sodium density of groceries purchased by the intervention group compared to the control group was 204 mg/1000 kcal lower (95%CI, -352 to -56) (P = 0.01). The reduction in sodium density of purchases was apparent in weeks 1-4 and sustained through the end of the trial. 86% of participants in the intervention group made at least one switch to a lower sodium product. There were no detectable effects on blood pressure, spot urine sodium concentration, or other secondary outcomes across the 12-week study period.

Online shopping platforms provide a novel opportunity to support purchases of lower sodium foods. While the reductions in sodium density of purchases were moderate in size, population health benefits could nonetheless be large if they were sustained over time and at scale, with large and growing numbers of online grocery shoppers and a high prevalence of elevated blood pressure amongst adults.

ACTRN12621000642886.

The American Heart Association defines cardiovascular health in terms of four behaviors (smoking, diet, physical activity, and body weight) and three factors (plasma glucose, cholesterol, and blood pressure). By this definition, the prevalence of ideal cardiovascular health behaviors and factors (ICHBF) is negatively correlated with all-cause mortality and risks of cardiovascular and cerebrovascular diseases and malignancy.

To investigate the changing trends of cardiovascular and cerebrovascular health scores in the Kailuan study population from 2006 to 2011.

The Kailuan population data from three health checkups held in 2006-2007, 2008-2009, and 2010-2011 were analyzed, and the constituent ratios of cardiovascular and cerebrovascular health behaviors and factors at ideal, intermediate, and poor levels were calculated by using Huffman and Capewell method. Simultaneously, the cardiovascular and cerebrovascular health behavior and factor scores were calculated.

From 2006 to 2007, the proportion of people with ideal physical exercise, low salt diet, ideal body mass index, ideal total cholesterol level, no smoking, ideal blood sugar, and ideal blood pressure was 13.12%, 9.34%, 49.17%, 64.20%, 49.27%, 69.99%, and 20.55%, respectively, in men with a health score of 8.46, and 12.00%, 9.13%, 61.60%, 64.28%, 98.19%, 78.90% and 36.92% in women, with a score of 10.02. From 2008 to 2009, the proportion was 16.09%, 14.04%, 51.94%, 65.02%, 40.18%, 66.44%, and 17.04% in men, with a score of 8.18, and 16.860%, 17.360%, 64.010%, 67.433%, 98.220%, 76.370%, and 42.340% in women, with a score of 10.12. From 2010 to 2011, the proportion was 12.22%, 17.65%, 49.40%, 68.33%, 48.17%, 64.67%, and 14.68% in males, having a score of 8.21, while in females, the proportion was 11.83%, 18.09%, 49.40%, 67.85%, 98.82%, 74.52%, and 37.78%, with a score of 9.90.

The prevalence of ideal cardiovascular and cerebrovascular health behaviors and factors is low in the Kailuan study population due to inadequate scores of relevant health metrics.

An appropriate salt production methods must be implemented to increase salt production's quantity and quality. This paper was prepared to introduce and demonstrate a new method, namely a geomembrane-based salt production method, which can contribute directly to increasing the quantity and quality of people's salt production. This method can be applied quickly with simple equipment, so this method is easy to replicate in various salt production center areas. The results of statistical tests directly show that there is a fundamental difference between the quantity and quality of salt produced by salt farmers using conventional salt production methods and geomembrane-based salt production methods, where geomembrane-based salt production methods are capable of producing much higher quantities of salt production with better quality.•The geomembrane-based salt production method is easy to implement because it uses simple equipment and can be made independently by salt farmers.•Using a geomembrane in this method can prevent leaks in the salt crystallization pond and optimize heat from solar energy to optimize the quantity of salt production.•This method prevents direct contact of seawater with soil. The effect is that the quality of salt produced from geomembrane-based salt production methods is higher than conventional salt production methods.

The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated.

This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion.

We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the Šidák correction applied for multiple comparisons.

Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01).

Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods.

Recent studies have demonstrated a correlation between salt intake (SI) and various diseases. However, it remains uncertain whether the relationship between SI (including salt added to food and sodium levels in urine) and benign osteoarthritis is causal. To investigate this, we conducted a 2-sample Mendelian randomization (MR) analysis to estimate the causal impact of SI on osteoarthritis (OA). A genome-wide association study of salt added to food and sodium in urine was used as the exposure, while hip osteoarthritis, knee osteoarthritis, and rheumatoid arthritis were defined as the outcomes. Inverse variance weighting (IVW) was used to calculate causal estimates, and sensitivity analyses were performed using methods including weighted mode, weighted median, MR-Egger, and Bayesian weighted MR. All statistical analyses were conducted using R software. Our results, primarily based on the IVW method, support the existence of a causal relationship between salt added to food and knee osteoarthritis (KOA). Specifically, salt added to food was associated with a decreased risk of KOA (OR = 1.248, P = .024, 95% CI: 1.030-1.512). This study is the first MR investigation exploring the causal relationship between salt added to food and KOA, potentially providing new insights and a theoretical basis for the prevention and treatment of KOA in the future.

Potassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse.

The objective of this study was to summarize the label features of potassium-enriched salt products available worldwide.

A content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as "salt substitute" or "low sodium salt." Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized.

A total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (n = 15), no potassium (n = 5), or that were duplicates (n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use.

There was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.

Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India.

We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%.

In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective.

Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise.

WHO Country Office India.

Excess dietary sodium is a leading cause of death and disability globally. Because packaged foods are a major source of sodium in many countries, including Australia, mandatory limits for sodium might improve population health. We aimed to estimate the long-term health and economic effect of mandating such thresholds in Australia.

We used a multiple cohort, proportional, multistate, life table model to simulate the effect of mandating either the WHO global sodium benchmarks or the currently non-mandatory Australian Healthy Food Partnership (HFP) sodium targets. We compared maintaining the current sodium intake status quo with intervention scenarios, using nationally representative data on dietary intake, sodium in packaged foods, and food sales volume. Blood pressure and disease burden data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study. The effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted annually at 3%.

Compared with the status quo intervention, mandating the WHO benchmarks could be cost saving over the first 10 years (AUD$223 [95% uncertainty interval 82-433] million saved), with 2743 (1677-3976) cardiovascular disease deaths and 43 971 (26 892-63 748) incident cardiovascular disease events averted, and 11 174 (6800-16 205) HALYs gained. Over the population's lifetime, the intervention was cost effective (100·0% probability). Mandating the HFP sodium targets was also estimated to be cost effective (100·0% probability), but with 29% of the health benefits compared with the WHO benchmarks.

Our modelling study supports mandating sodium thresholds for packaged foods as a cost-effective strategy to prevent death and disease in Australia. Although making Australia's voluntary reformulation targets mandatory might save thousands of lives, mandating the WHO global benchmarks could yield substantially greater health gains.

None.

To assess the current Na levels in a variety of processed food groups and categories available in the Argentinean market to monitor compliance with the National Law and to compare the current Na content levels with the updated Pan American Health Organisation (PAHO) regional targets.

Observational cross-sectional study.

Argentina. Data were collected during March 2022 in the city of Buenos Aires in two of the main supermarket chains. We carried out a systematic survey of pre-packaged food products available in the food supply assessing Na content as reported in nutrition information panels.

We surveyed 3997 food products, and the Na content of 760 and 2511 of them was compared with the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of Na content. More than 90 % of the products included in the National Sodium Reduction Law were found to be compliant. Food groups with high median Na, such as meat and fish condiments, leavening flour and appetisers are not included in the National Law. In turn, comparisons with PAHO regional targets indicated that more than 50 % of the products were found to exceed the regional targets for Na.

This evidence suggests that it is imperative to update the National Sodium Reduction Law based on regional public health standards, adding new food groups and setting more stringent legal targets.

High dietary salt intake is a known risk factor for hypertension. However, Australians continue to consume excessive amounts of salt. The purpose of this study was to identify barriers, enablers and strategies to reduce salt in a sample of Australian adults with hypertension. This was a qualitative study. Participants were asked a set of open-ended questions during focus groups conducted between October 2020 and April 2021. Sessions were recorded and transcribed. Using an inductive approach, the transcript data from the focus groups were thematically analysed. This involved checking accuracy, becoming familiar with the data, coding responses based on questions, identifying themes through common patterns and validating themes by grouping similar questions that represented the data and study aim effectively. Thirty-one adults (55 % females) with high blood pressure participated in the focus group discussions. Participants demonstrated good knowledge of high blood pressure risk factors but lacked an understanding of recommended salt intake levels and sources of hidden salt. Challenges in reducing salt intake included the limited availability of low-salt commercial foods. Participants suggested improved food labelling and the use of technology-based interventions to promote healthier choices. Findings highlight the need for behavioural interventions, policy reforms and collaborations between the government, food industries and health organisations to address high salt intake in the population.

Dietary sodium (salt) reduction has been identified as a key public health intervention for reducing non-communicable diseases globally [...].

Umami substances have the potential to enhance the perception of saltiness and thus reduce sodium intake. Two sensory evaluation experiments were conducted, involving participants tasting salt solutions, and solutions with added umami substances at equal sodium concentrations. Umami substances included sodium glutamate (MSG), disodium inosinate (IMP), and the combination of them which has a synergistic effect and is a closer match to commonly-consumed foods. In Experiment 1, using the two-alternative forced-choice (2-AFC) method by 330 consumers, paired comparisons were conducted at three different sodium concentrations. The combination of MSG and IMP enhanced the perception of saltiness (p < .001 in the difference test), whereas presenting either umami substance in isolation failed to do so (p > .05 in the similarity test). Significant order effects occurred in paired comparisons. In Experiment 2, a two-sip time-intensity (TI) analysis with trained panellists verified these results and found that tasting MSG and IMP either simultaneously or successively enhanced saltiness perception at equal sodium concentrations. These findings indicate that the synergistic effect of umami substances may be the cause of saltiness enhancement, and represents a potential strategy for sodium reduction while satisfying the consumer demand for saltiness perception. Considering the application in food processing and in food pairing, umami substances can potentially be used to help to reduce salt intake in food consumption.

Reduction in salt intake improves blood pressure control and reduces the risk of hypertension and other noncommunicable diseases (NCDs). However, salt intake remains high among Nigerians. This study aimed to identify barriers and facilitators to salt reduction among hypertensive patients attending a family medicine clinic in southern Nigeria.

A focussed group discussion (FGD) exploring patients' perceptions of the barriers and facilitators to salt reduction was conducted with 8 groups of purposefully selected 74 hypertensives who consumed excess dietary salt, stratified by age and sex, using an FGD guide. Thematic analysis was then performed using Nvivo® version 12 pro. Ethical approval was obtained from Irrua Specialist Teaching Hospital (ISTH), and written informed consent was obtained from the patients before the FGD.

Respondents had a mean age of 51.96 ± 8.98 years. The majority were females (47, 63.5%) and had uncontrolled blood pressure (66, 89.2%). Five major themes were identified, from which several minor themes emerged. Respondents rated their overall health as good but expressed concerns about their poor blood pressure control. Identified barriers to salt reduction included family pressure, ignorance, ready availability and affordability of salt and lack of affordable alternatives. Facilitators of salt reduction were measuring the amount of cooking salt, removing salt from the dining table and providing substitutes. Respondents, however, expressed willingness to reduce their salt consumption.

The study identified barriers and facilitators to salt reduction. There is a need to create awareness of the safe amount of salt to be consumed and provide safe and readily available alternatives.

Evidence suggests low-sodium potassium-rich salt substitutes (LSSS) are effective in reducing blood pressure (BP). However, the health and economic impacts of LSSS in Indonesia are currently unknown.

We developed a proportional multistate lifetable Markov model to assess a government-led strategy implementing the use of LSSS compared to current regular salt consumption. BP data were derived from the Indonesian Basic Health Research Survey (RISKESDAS 2018), while epidemiological data were from the Global Burden of Disease 2019 study. We estimated implementation costs and the impact of changes in BP on disease events and healthcare costs, and incremental cost-effectiveness ratios. Outcomes were simulated over different time horizons for the 2019 Indonesian population overall, and by income quintiles. Probabilistic sensitivity analysis was done to capture uncertainty.

Over the first 10 years, LSSS could prevent 1.5 million non-fatal cardiovascular disease (CVD) events (8.3%-19.4% reduction) and 643,000 incident chronic kidney disease (CKD) cases (8.2% reduction), while averting over 200,000 CVD and CKD deaths (0.2%-5.2% reduction). This translated to over 24.6 million health-adjusted life years (HALYs) gained over the lifetime of the population, and reduced CVD-related health inequalities (concentration index, -0.075, 95% CI: -0.088 to -0.062). Implementation cost (US$ 1.2 billion [IDR 17.2 trillion] total; US$ 4.5 [IDR 63,665] per capita, as of July 2019) was outweighed by the net health expenditure savings (∼US$ 2 billion [IDR 27.7 trillion] total; US$ 7.3 [IDR 103,300] per capita) in the first 10 years. LSSS were cost-saving over the lifetime, and very cost-effective even with a high LSSS price.

Scaling the use of LSSS nationally could be a cost-saving strategy to prevent substantial cardiovascular and kidney disease burden in Indonesia.

Griffith University Postdoctoral Fellowship.

The Australian culturally and linguistically diverse (CALD) communities may be at higher risk of salt intake than recommended given the use of a combination of discretionary sources and exposure to processed foods within a western country. This survey aimed to understand the knowledge, attitudes, and behaviors toward dietary salt and the acceptability of salt substitutes in the CALD communities. An online cross-sectional survey was conducted among adults who self-reported being a part of a CALD community, which was defined as non-Indigenous cultural groups in Australia having cultural or linguistic connections with their overseas place of birth, ancestry or ethnic origin, religion, preferred language or language spoken at home. A total of 218 respondents opened the survey link. A total of 196 completed the entire survey. The majority of respondents (162, 83%) were aware that high salt intake causes serious health problems. Altogether 134 (69%) respondents were aware that there is a recommended amount for daily salt consumption although only 59 (44%) knew precise recommendations as <5 g salt per day. Around one quarter of the respondents rarely or never looked for ‟low in salt'' or ‟reduced salt'' messages on food labels when shopping. Over half specified they always or often added salt during cooking or preparing foods in the household. Almost 4 in 5 CALD respondents were willing to reduce their salt intake for health and 3 in 4 were open to trying a salt substitute. Further research into the utility of a salt substitute intervention in the Australian CALD community is warranted.

Excess salt and sugar consumption contribute to diseases, such as diabetes and hypertension. This study aimed to estimate salt and sugar intakes and main sources, in a population of adults in the Central Division of Fiji.

One adult per household was randomly selected to participate (n = 700). Sociodemographic characteristics; blood pressure, weight, and height; a 24-h diet recall; and spot-urine samples were collected, with 24-h urine samples from a sub-sample (n = 200). Sugar intake was estimated from the 24-h diet recalls and salt intake from the spot-urines. 24-hr diet recall was used to identify main sources of salt and sugar by food groups.

534 adults (response rate 76%, 50% women, mean age 42 years) participated. Salt intake was 8.8 g/day (95% CI, 8.7-9.0), and free sugar intake was 74.1 g/day (67.5-80.7), 16.1% of total energy intake (15.0-17.1%). Main sources of salt were mixed cooked dishes (40.9% (38.2-43.5)), and bread and bakery products (28.7% (26.5-31.0)). Main sources of sugar were table sugars, honey, and related products (24.3% (21.7-26.8)), non-alcoholic beverages (21.4% (18.8-24.0)) and bread and bakery products (18.0% (16.2-19.9)).

Salt and sugar intakes exceeded World Health Organization recommendations in this sample of adults. Given dietary sources were foods high in salt and sugar, along with the addition to food or drinks, interventions focused on behavior along with environmental strategies to encourage healthier choices are needed.

NHMRC and GACD grant APP1169322.

Pink salt and monosodium glutamate (MSG) are two typical food additives used in cooking to enhance flavour. However, excessive use of them has been associated to a variety of metabolic problems, including weight gain and hyperglycemia. The current study aimed to assess the metabolic changes caused by submaximal dosages of MSG and pink salt in experimental rats.

Twenty-four 120-150 g Wister rats of both sexes were divided into three groups: control, pink salt-treated (0.8 g/kg daily for three weeks), and MSG-treated (3.6 g/kg daily for three weeks). The body weight, amount of food and water consumed, and blood glucose levels of animals were measured and recorded as indicators of their metabolic changes. Furthermore, after salt treatments at intervals such as week 1, week 2, and week 3, the survival rate and general toxicity manifestations were determined. The results were statistically analysed using one-way ANOVA, with p < 0.05 being considered significant.

The study found that the group given a submaximal dose of MSG gained significantly more weight (p < 0.05), consumed more food and water, and had higher blood glucose levels than the control. Ninety percent of the MSG therapy group survived by the end of the third week, however, they suffered from negative effects like abdominal distention, respiratory problems, ptosis, and subcutaneous swelling. On the other hand, the consumption of food and drink was significantly (p < 0.05) increased upon the administration of pink salt. Only little changes were observed in the body weight, blood sugar levels, and general features (such as subcutaneous swelling, change in bowel colour, and loose stools). Additionally, it was shown that the survival rate remained unchanged, particularly after week 3.

According to study findings, MSG may induce metabolic issues, increasing the chance of death. While there was no discernible metabolic aberration linked to pink salt. Further research is required to fully understand the mechanism and consequences of these taste enhancers on the host system before pink salt can be deemed safe.

Switching regular salt (sodium chloride) to salt enriched with potassium chloride (25 % potassium chloride, 75 % sodium chloride) has been shown to reduce blood pressure and the risk of cardiovascular diseases. We sought to define the potential for the current production of sodium chloride and potassium chloride to support a global switch to the use of potassium-enriched salt.

We summarised data from geological surveys, government reports and trade organisations describing the global production and supply of sodium chloride and potash (the primary source of potassium chloride) and compared this to potential requirements for potassium-enriched salt.

Global.

Not applicable.

Approximately 280 million tonnes of sodium chloride were produced in 2020 with China and the USA the main producers. Global production of potash from which potassium chloride is extracted was about forty-four million tonnes with Canada, Belarus, Russia and China providing 77 % of the world's supply. There were forty-eight countries in which potassium-enriched salt is currently marketed with seventy-nine different brands identified. Allowing for loss of salt between manufacture and consumption, a full global switch from regular salt to potassium-enriched salt would require about 9·7 million tonnes of sodium chloride to be replaced with 9·7 million tonnes of potassium chloride annually.

Significant upscaling of the production of potassium chloride and the capacity of companies able to manufacture potassium-enriched salt, as well as a robust business case for the switch to potassium chloride, would be required.

Potassium-enriched low sodium salt substitutes (LSSS), which replace a proportion of sodium chloride (NaCl) with potassium chloride (KCl), have been shown to reduce blood pressure and offer a potential solution to address the high burden of hypertension in South Africa. However, it is unknown which proportions of KCl in LSSS are acceptable. We compared the taste and visual acceptability of various LSSS in South African adults.

Fifty-six adults underwent double-blind taste and visual tests of four LSSS (35%KCl/65%NaCl; 50%KCl/50%NaCl; 66%KCl/34%NaCl; 100%KCl) in comparison to 100%NaCl (common salt). Participants scored each product by taste ranking, taste perception and likeliness to use. Participants then visually inspected the five products and attempted to identify which was which. Almost half (45 %) of participants ranked the taste of 50%KCl/50 %NaCl as fantastic or really good. Furthermore, 62 % of participants liked and would be happy to use the 50 %KCl/50 %NaCl or felt this tasted like common salt. Only 12 % rated the 100%KCl highly for taste, and over half reported being unlikely to use this. Most participants (57.3 % and 36.4 %) were able to visually identify 100%NaCl and 100%KCl, while identification of other blends was generally poor. Responses were similar for 35%KCl/65%NaCl and 66%KCl/34%NaCl throughout.

Our findings suggest that the taste of the 50%KCl salt substitute would be well tolerated by South African adults, most of which could not visually differentiate between this salt substitute and common salt.

Excessive consumption of dietary sodium is a significant contributor to non-communicable diseases, including hypertension and cardiovascular disease. There is now a global consensus that regulating salt intake is among the most cost-effective measures for enhancing public health. More than half of the countries worldwide have implemented multiple strategies to decrease salt consumption. Nevertheless, a report on sodium intake reduction published by the World Health Organization revealed that the world is off-track to meet its targeted reduction of 30% by 2025. The global situation regarding salt reduction remains concerning. This review will center on domestic and international salt reduction policies, as well as diverse strategies, given the detrimental effects of excessive dietary salt intake and the existing global salt intake scenario. Besides, we used visualization software to analyze the literature related to salt reduction research in the last five years to explore the research hotspots in this field. Our objective is to enhance public awareness regarding the imperative of reducing salt intake and promoting the active implementation of diverse salt reduction policies.

High salt intake and compliance to low-sodium (LS) diets are critical in hypertension. Salt reduction in processed foods can help to achieve the target sodium intake. To verify the hypothesis that an innovative LS formulation of a traditional bread could result in a reduction of sodium intake and blood pressure, we performed a 6-month randomized controlled pilot trial on hypertensive patients. We additionally explored the effects of sodium restriction on blood pressure and fecal cultivable bacteria.Fifty-seven patients were randomized in three groups. Group A (n = 19) followed a free diet using standard bread (750 mg Na/100 g), group B (n = 18) followed a LS diet (2300 mg Na/die) using standard bread, group C (n = 20) followed a LS diet (2300 mg Na/die) using LS bread (280 mg Na/100 g). We measured 24-h urinary sodium, blood pressure, routine parameters, fecal microbial counts (26 patients).After 6 months, as compared to group A, group C showed a reduction of 24-h urinary sodium excretion (-908 mg/24 h), diastolic pressure (-9 mmHg) and microbial counts of Bacteroides, Porphyromonas, Prevotella, Enterobacteriaceae, Staphylococcus, Micrococcus. These results suggest that LS bread could increase the adherence to a LS diet, reducing sodium excretion, diastolic pressure and abundance of some fecal cultivable bacteria.Trial registration Registration nr. NCT03127553, on 25/04/2017.

Reliance on animal foods must be reduced to improve planetary and human well-being. This research studied plant-based cheese alternatives (PBCA) relative to dairy cheese in a consumer taste test with 157 consumers in New Zealand. A case study approach used cream cheese (commercially available) as the focal product category (2 PBCA, 2 dairy) and implemented a multi-response paradigm (hedonic, sensory, emotional, conceptual, situational). "Beyond liking" insights were established, including drivers of liking (sensory, non-sensory) and sensory drivers of non-sensory product associations. Two consumer segments were identified, of which the largest (n = 111) liked PBCA and dairy samples equally (6.5-6.7 of 9). In this PBCA Likers cluster, the key sensory drivers of liking were 'creamy/smooth mouthfeel', 'dissolves quickly in mouth', and 'sweet', while a significant penalty was associated with 'mild/bland flavour'. The non-sensory data contributed additional consumer insights, including the four samples being perceived as differently appropriate for 9 of 12 use situations, with PBCA being regarded as less appropriate. In the limited confines of this case on cream cheese, the findings show that PBCA need not be inferior to their dairy counterparts despite a general narrative to the contrary. Of note, the results were obtained among participants who were open to eating a more PB diet but were not vegetarian or vegan.

Excess salt intake is the leading dietary risk factor for cardiovascular disease in most countries, including Italy. While the cost-effectiveness of interventions aimed to reduce salt intake has been proved, the WHO recommendation to reduce salt intake by 30 % at the global level by 2025 is far from being reached.

In Italy, two surveys of the general adult population have established that the average salt intake is still almost twice the WHO recommendation although it was reduced by 1.2 g/day between 2008-12 and 2018-19. Previous investigations had shown that non-discretionary salt added by the industry or by local craft producers represents at least 50 % of the total intake and indicated cereal-based products as the main source of non-discretionary salt. Two recent studies conducted by the Italian Society of Human Nutrition "Young Working Group" have provided updated information on the salt content of almost three thousand cereal-based products currently available on the Italian food market and shown that most of the items evaluated had a sodium content much higher than the sodium benchmarks recently proposed by WHO.

Italy has built the foundations of an effective population strategy for salt intake reduction: it is time however to proceed with full commitment to food reformulation if any substantial further progress has to be made. Salt benchmarks for Italy need to be defined for the food categories most relevant to population salt intake and their implementation should ideally be mandatory after consultation with food producers.

High sodium intake is one of the main risk factors for noncommunicable diseases, and its consumption should be reduced. This study aimed to simulate changes in the daily salt intake of the Italian adult population based on consumption scenarios of prepacked cereal-based foods sold in Italy.

Information on food packages was retrieved from 2893 cereal-based products. Potential changes in salt intake were simulated based on food consumption scenarios that consider the daily consumption of cereal-based products suggested in the Italian Dietary Guidelines and their current daily consumption by Italian adults. The highest salt content was retrieved in bread (median, 25th-75th percentile: 1.3, 1.1-1.4 g/100 g) and bread substitutes (1.8, 1.0-2.2 g/100 g). If the suggested daily amounts were consumed, bread would contribute to 44% of the 5 g salt/day target, whereas bread substitutes, breakfast cereals, biscuits and sweet snacks would marginally contribute (1-2%). Compared to bread with median salt content, a -44% and +10% salt intake would be observed if products within the first and the last quartile of salt content were chosen, respectively. However, considering the actual intake of Italian consumers, bread would cover 25% and bread substitutes 7% of the daily salt target.

Food labels have a pivotal role and efforts are required to encourage consumers to use them to make healthy choices. Moreover, these results may contribute to setting sodium benchmarks in cereal-based products and encourage the food industry to reduce the salt content in the products.

Dietary guidelines recommend intake targets for some essential minerals, based on observational and experimental evidence relating mineral intake levels to health outcomes. For prevention of cardiovascular disease, reducing sodium intake and increasing potassium intake are the principal tools. While reducing sodium intake has received greatest public health priority, emerging evidence suggests that increasing potassium intake may be a more important target for cardiovascular prevention. Increased potassium intake reduces blood pressure and mitigates the hypertensive effects of excess sodium intake, and the recent large Phase III SSaSS trial reported that increasing potassium intake (and reducing sodium intake) in populations with low potassium intake and high sodium intake, through salt substitution (25% KCl, 75%NaCl), reduces the risk of stroke in patients at increased cardiovascular risk. As key sources of potassium intake include fruit, vegetables, nuts, and legumes, higher potassium intake may be associated with healthy dietary patterns. The current review makes the case that increasing potassium intake might represent a more advantageous dietary strategy for prevention of cardiovascular disease. Future research should focus on addressing the independent effect of potassium supplementation in populations with low or moderate potassium intake, and determine effective strategies to increase potassium intake from diet.

(1) Background: The best method to assess discretionary salt intake in population surveys has not been established. (2) Methods: This secondary analysis compared three different methods of measuring sodium intake from discretionary salt in a convenience sample of 109 adults in New Zealand. Participants replaced their household salt with lithium-tagged salt provided by researchers over eight days. Baseline 24 h urine was collected, and two further 24 h urine and 24 h dietary recalls were collected between days six and eight. Discretionary salt was estimated from the lithium-tagged salt, focused questions in the 24 h dietary recall, and the 'subtraction method' (a combination of 24 h urine and 24 h dietary recall measures). (3) Results: Around one-third of estimates from the 'subtraction method' were negative and therefore unrealistic. The mean difference between 24 h dietary recall and lithium-tagged salt estimates for sodium from discretionary salt mean were 457 mg sodium/day and 65 mg/day for mean and median, respectively. (4) Conclusions: It is possible to obtain a reasonable estimate of discretionary salt intake from careful questioning regarding salt used in cooking, in recipes, and at the table during a 24 h recall process to inform population salt reduction strategies.

South Asian individuals (SAs) face heightened risks of premature coronary artery disease (CAD) and early-onset type 2 diabetes mellitus (T2DM), with grave health, societal, and economic implications due to the region's dense population. Both conditions, influenced by cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity, manifest earlier and with unique thresholds in SAs. Epidemiological, demographic, nutritional, environmental, sociocultural, and economic transitions in SA have exacerbated the twin epidemic. The coupling of premature CAD and T2DM arises from increased obesity due to limited adipose storage, early-life undernutrition, distinct fat thresholds, reduced muscle mass, and a predisposition for hepatic fat accumulation from certain dietary choices cumulatively precipitating a decline in insulin sensitivity. As T2DM ensues, the β-cell adaptive responses are suboptimal, precipitating a transition from compensatory hyperinsulinemia to β-cell decompensation, underscoring a reduced functional β-cell reserve in SAs. This review delves into the interplay of these mechanisms and highlights a prediabetes endotype tied to elevated vascular risk. Deciphering these mechanistic interconnections promises to refine stratification paradigms, surpassing extant risk-prediction strategies.

Hypertension is highly prevalent in India; however, little is known about the dietary intakes of those living with hypertension, particularly in rural areas. The primary aim was to assess the dietary intakes of individuals living in rural India with self-reported history of hypertension. As secondary analyses, we explored the dietary impact of a salt substitute in this population group.

This study used data from a large randomised controlled trial conducted in seven villages across rural India. Participants received either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride) to replace all home salt use. Dietary intake at baseline and end-of-trial was assessed using 24-h dietary recalls. A range of dietary outcomes were assessed including energy intake, macronutrient intake and overall diet quality according to the Alternate Healthy Eating Index (AHEI).

A total of 454 participants were included in the analysis. At baseline, mean (SE) energy intakes in regular salt group and salt substitute group were similar at 5240 (110) kJ/day and 5120 (106) kJ/day, respectively. This was largely attributable to intakes of carbohydrates (74.4% of total energy intakes for regular salt group vs 75.4% for the salt substitute group) followed by total fat (15.8% vs 15.4%) and protein (10.4% vs 10.3%). Both groups also had similar AHEI scores at baseline, with mean (SE) total scores equating to 33.0 (0.4) (out of a total 90) for the regular salt group and 32.7 (0.4) for the salt substitute group. Both groups received lowest AHEI scores across the following components: vegetables, fruit and wholegrains. At baseline, the mean (SE) intakes of sodium across the regular salt and salt substitute groups were similar at 2349 (67) mg/day and 2396 (64) mg/day, respectively. In the salt substitute group, there was a significant reduction in total sodium intakes over time (-264 mg/day, 95% CI, -442 to -85), driven by the use of the salt substitute.

This study found individuals with hypertension living in rural India had poor dietary intakes, including low intakes of fruits, vegetables and wholegrains, and high intakes of sodium. Salt substitutes may be an effective strategy for reducing sodium intake in this population group.

This Special Issue of Nutrients, "Reducing Dietary Sodium and Improving Human Health 2 [...].

Reducing dietary salt intake is an essential population strategy for cardiovascular disease (CVD) prevention, but evidence on healthcare costs and outcomes is limited in Japan. We aimed to conduct a pilot economic evaluation under hypothetical scenarios of applying the salt reduction policies of England to Japan.

We examined salt reduction policies in England: media health promotion campaigns, front-of-pack labeling, and voluntary and mandatory reformulation with best-case and worst-case policy cost scenarios. We assumed that these policies were conducted in Japan for 10 years from 2019. We used published data on epidemiology and healthcare expenditures in Japan and the costs and effects of salt reduction policies in England, and defined the benefits as a decrease in national medical expenditures on CVD. We developed a Markov cohort simulation model of the Japanese population. To estimate the annual net benefits of each policy over 10 years, we subtracted monitoring and policy costs from the benefits. We adopted a health sector perspective and a 2% discount rate.

The cumulative net benefit over 10 years was largest for mandatory reformulation (best case) at 2,015.1 million USD (with costs of USD 48.3 million and benefits of USD 2063.5 million), followed by voluntary reformulation (net benefit: USD 1,895.1 million, cost: USD 48.1 million, benefit: USD 1,943.2 million), mandatory reformulation (worst case, net benefit: USD 1,447.9 million, cost: USD 1,174.5 million, benefit: USD 2,622.3 million), labeling (net benefit: USD 159.5 million, cost: USD 91.6 million, benefit: USD 251.0 million), and a media campaign (net benefit: USD 140.5 million, cost: USD 110.5 million, benefit: USD 251.0 million). There was no change in the superiority or inferiority of policies when the uncertainty of model parameters was considered.

Mandatory reformulation with the best-case cost scenario might be economically preferable to the other alternatives in Japan. In future research, domestic data on costs and effects of salt reduction policies should be incorporated for model refinement.

High dietary salt consumption is a significant health issue in Chinese populations. This study identified the facilitators for and barriers to salt reduction for prevention of hypertension among Chinese Australians.

An inductive qualitative study with semi-structured interviews (n = 8) was conducted with convenience samples recruited from social media. Adults who a) were over 18 years old, b) were of Chinese ancestry and c) had lived in Australia for at least 6 months were eligible for participation. Interview transcripts were transcribed and analysed using content analysis.

Four facilitators for and eight barriers to reducing salt consumption were synthesised from the narrative materials. The facilitators were: 1) individual perceptions of health benefits, 2) salt alternatives, 3) digital information and 4) increased awareness of negative health impacts from a high-salt diet. The barriers identified were: 1) negative physical changes not apparent, 2) inadequate salt-related health education, 3) hidden salt in food products, 4) inadequate food literacy, 5) pricing, 6) busy lifestyle, 7) low perceived susceptibility and 8) individual food taste preference and cooking habits. Peer and family influence had positive and negative effects on participants' likelihood of reducing salt consumption.

The facilitators for and barriers to maintaining a low-salt diet in Chinese Australians were multifaceted and interrelated. Future salt-reduction strategies should focus on the health benefits of reduced salt consumption and practical interventions such as salt alternatives and education on low-salt food choices and cooking methods and changing perceptions about salt reduction to become a social norm in the Chinese community.