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Reeve E, Bell C, Sacks G, Mounsey S, Waqa G, Peeters A, Thow AM. Lessons for strengthening policymaking for obesity and diet-related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region. Obes Rev 2024; 25:e13651. [PMID: 37905309 DOI: 10.1111/obr.13651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/28/2023] [Accepted: 09/09/2023] [Indexed: 11/02/2023]
Abstract
Obesity and diet-related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low- and middle- income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation challenges limit effective policy action. We undertook meta-narrative synthesis of the academic literature and used theories of policymaking and implementation to synthesize current knowledge of issues affecting the adoption and implementation of policies to prevent obesity and diet-related NCDs in LMICs in the Western Pacific Region. We found that political leadership and management of food and nutrition policies often diluted following policy adoption, and that nutrition and health advocates find it difficult to enforce policy compliance from actors outside their sectors. Opportunities for strengthening implementation of food and nutrition policies in the Western Pacific include (1) improved and earlier engagement between health policymakers and implementing agencies; (2) focusing on the need for increased accountability from governments, including through effective engagement and organization of actor networks, knowledge sharing, and in highlighting where stronger action is required; and (3) identifying and building the strategic capacities of policy actors in framing, advocacy, coalition-building, knowledge translation, and leadership.
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Affiliation(s)
- Erica Reeve
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Sarah Mounsey
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Patay D, Schram A, Friel S. The challenges in protecting public health interests in multisectoral governance in the context of small island developing states: the case of tobacco control in Fiji and Vanuatu. Global Health 2023; 19:31. [PMID: 37118741 PMCID: PMC10142426 DOI: 10.1186/s12992-023-00931-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, protecting public health interests can be challenging amidst industry interference and conflicting policy priorities, particularly in low and middle-income countries (LMICs) where the need for rapid economic development is pronounced. Small island developing states (SIDS) face even more challenges in regulating CDoH because their unique socioeconomic, political, and geographic vulnerabilities may weaken institutional conditions that could aid health sector actors in protecting health interests. This study aims to explore the institutional conditions that shape health sector actors' capability to protect public health interests in tobacco governance in Fiji and Vanuatu. METHODS We employed a qualitative, exploratory case study design. We applied the administrative process theory to inform data collection and analysis. Seventy interviews were completed in Fiji and Vanuatu from 2018 to 2019. RESULTS The findings show that the protection of health interests in tobacco governance were not supported by the institutional conditions in Fiji and Vanuatu. While the policy processes formally ensured a level playing field between actors, policies were often developed through informal mechanisms, and the safeguards to protect public interests from vested private interests were not implemented adequately. SIDS vulnerabilities and weak regulation of political parties contributed to the politicisation of government in both states, resulting in high-level government officials' questionable commitment to protect public health interests. The system of checks and balances usually embedded into democratic governments appeared to be muted, and policymakers had limited bureaucratic autonomy to elevate health interests in multisectoral policymaking amidst high-level government officials' frequent rotation. Finally, capacity constraints aggravated by SIDS vulnerabilities negatively impacted health sector actors' capability to analyse policy alternatives. CONCLUSIONS Health sector actors in Fiji and Vanuatu were not supported by institutional conditions that could help them protect public health interests in multisectoral governance to regulate CDoH originating from the tobacco industry. Institutional conditions in these states were shaped by SIDS vulnerabilities but could be improved by targeted capacity building, governance and political system strengthening.
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Affiliation(s)
- Dori Patay
- School of Regulation and Global Governance, College of Asia and the Pacific, The Australian National University, Canberra, Australia.
- The George Institute for Global Health, Sydney, Australia.
- Menzies Centre for Health Policy and Economy, Sydney School of Public Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Ashley Schram
- School of Regulation and Global Governance, College of Asia and the Pacific, The Australian National University, Canberra, Australia
| | - Sharon Friel
- School of Regulation and Global Governance, College of Asia and the Pacific, The Australian National University, Canberra, Australia
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Brown CR, Rocke K, Murphy MM, Hambleton IR. Interventions and policies aimed at improving nutrition in Small Island Developing States: a rapid review. Rev Panam Salud Publica 2022; 46:e33. [PMID: 36042710 PMCID: PMC9409607 DOI: 10.26633/rpsp.2022.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Objective. To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years. Methods. A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS. Results. A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions. Conclusions. There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.
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Affiliation(s)
- Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kern Rocke
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Madhuvanti M. Murphy
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ian R. Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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Win Tin ST, Kubuabola I, Snowdon W, Cash HL, Na’ati E, Waqa GD, Moadsiri A, Bertrand S, Ravuvu A. Assessing the progress on the implementation of policy and legislation actions to address the Non-Communicable Diseases crisis in the Pacific. PLoS One 2022; 17:e0272424. [PMID: 35951506 PMCID: PMC9371336 DOI: 10.1371/journal.pone.0272424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 07/19/2022] [Indexed: 11/19/2022] Open
Abstract
Aim
To assess the progress on the implementation of Non-Communicable Diseases (NCD) related policies and legislations in the Pacific Island Countries and Territories (PICTs).
Materials and methods
The Pacific Monitoring Alliance for NCD Action (MANA) Dashboard was used to assess the progress on the implementation. The MANA Dashboard includes 31 indicators across four different domains such as leadership and governance; preventative policies and legislations; health system response programs; and monitoring This progress assessment was conducted between 2019 and 2020 for all 21 PICTs. The data were analyzed and compared with the baseline status (2018) report and presented across four different domains of the MANA dashboard.
Results
This progress assessment found that PICTs overall have made advancements in a number of areas, particularly the establishment of a national multi-sectoral NCD taskforce; implementation of referenced approaches to restrict trans-fat in the food supply in national documents; and fiscal measures to affect access and availability to less healthy foods and drinks. However, the strengths of actions varied across PICTs, and most are categorised as low strengths. Measures which had the most limited progress in implementation include policy and legislation that restrict alcohol advertising; tobacco industry interference; marketing of foods and non-alcoholic beverages to children; and marketing for breast milk substitutes.
Conclusions
This progress assessment further highlights that while PICTs continue to make progress, NCD policy and legislation gaps still exist, both in terms of weaknesses of existing measures and areas that have had little attention to-date. These require urgent actions to scale up NCD related policies and legislation at regional and national level.
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Affiliation(s)
- Si Thu Win Tin
- Public Health Division, Pacific Community (SPC), Suva, Fiji
- * E-mail: ,
| | | | - Wendy Snowdon
- Division of Pacific Technical Support, World Health Organisation (WHO), Suva, Fiji
| | - Haley L. Cash
- Pacific Islands Health Officers’ Association (PIHOA), Honolulu, Hawaii
| | - Elisiva Na’ati
- Public Health Division, Pacific Community (SPC), Suva, Fiji
| | - Gade D. Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
| | - Ada Moadsiri
- Division of Pacific Technical Support, World Health Organisation (WHO), Suva, Fiji
| | - Solene Bertrand
- Public Health, Division, Pacific Community (SPC), Noumea, New Caledonia
| | - Amerita Ravuvu
- Public Health Division, Pacific Community (SPC), Suva, Fiji
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Reeve E, Lamichhane P, McKenzie B, Waqa G, Webster J, Snowdon W, Bell C. The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys. BMC Public Health 2022; 22:1521. [PMID: 35948900 PMCID: PMC9364577 DOI: 10.1186/s12889-022-13808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs). Methods Secondary analysis of data from 21,433 adults aged 25–69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2019. Outcomes of interest were changes in consumption of fruit and vegetables, hypertension, overweight and obesity, and hypercholesterolaemia over time. Also, salt intake and sugar sweetened beverage consumption for those countries that measured these. Results Over time, the proportion of adults consuming less than five serves of fruit and vegetables per day decreased in five countries, notably Tonga. From the most recent surveys, average daily intake of sugary drinks was high in Kiribati (3.7 serves), Nauru (4.1) and Tokelau (4.0) and low in the Solomon Islands (0.4). Average daily salt intake was twice that recommended by WHO in Tokelau (10.1 g) and Wallis and Futuna (10.2 g). Prevalence of overweight/obesity did not change over time in most countries but increased in Fiji and Tokelau. Hypertension prevalence increased in 6 of 8 countries. The prevalence of hypercholesterolaemia decreased in the Cook Islands and Kiribati and increased in the Solomon Islands and Tokelau. Conclusions While some Pacific countries experienced reductions in diet related NCD risk factors over time, most did not. Most Pacific adults (88%) do not consume enough fruit and vegetables, 82% live with overweight or obesity, 33% live with hypertension and 40% live with hypercholesterolaemia. Population-wide approaches to promote fruit and vegetable consumption and reduce sugar, salt and fat intake need strengthening. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13808-3.
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Affiliation(s)
- Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Prabhat Lamichhane
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Briar McKenzie
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Colin Bell
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
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Bell C, Latu C, Na'ati E, Snowdon W, Moodie M, Waqa G. Barriers and facilitators to the introduction of import duties designed to prevent noncommunicable disease in Tonga: a case study. Global Health 2021; 17:136. [PMID: 34838081 PMCID: PMC8626938 DOI: 10.1186/s12992-021-00788-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/16/2021] [Indexed: 11/11/2022] Open
Abstract
Background In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks, dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to describe barriers to and facilitators of these import duties from a policy-maker perspective. Methods A case study was conducted to analyse implementation of policies originally modelled by the Pacific Obesity Prevention in Communities project to reduce mortality in the Kingdom of Tonga. Policymakers (n = 15) from the Ministries of Revenue, Health, Finance and Labour and Commerce involved in the development and implementation of Tonga’s food-related policies participated in key-informant interviews. Results The main facilitator of import duties were strong leadership and management, cross-sector collaboration, awareness raising and advocacy, nature of the policy, and the effective use of data to model policy impacts and inform the general public. The absence of clear lines of responsibility and a decline in collaboration over time were identified as barriers to implementation of the import duties. Conclusion In a small Island state implementing import duties to prevent non-communicable disease can be straight forward providing policymakers and the community have a shared understanding of the health and economic costs of NCDs.
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Affiliation(s)
- Colin Bell
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Catherine Latu
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, WHO Collaborating Centre for Obesity Prevention and Management, Fiji Institute of Pacific Health Research (FIPHR), Suva, Fiji
| | - Elisiva Na'ati
- Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | - Wendy Snowdon
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia.,Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases, WHO Collaborating Centre for Obesity Prevention and Management, Fiji Institute of Pacific Health Research (FIPHR), Suva, Fiji
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Chen YP, Wang M, Blank I, Xu J, Chung HY. Saltiness-Enhancing Peptides Isolated from the Chinese Commercial Fermented Soybean Curds with Potential Applications in Salt Reduction. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:10272-10280. [PMID: 34436886 DOI: 10.1021/acs.jafc.1c03431] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Salt is very important for human health and food seasoning. Recently, several peptides isolated from natural food products have been reported exhibiting a salty taste or a saltiness-enhancing function. In this investigation, taste-active peptides occurring in commercial Chinese fermented soybean curd were isolated and identified using ultrafiltration, gel permeation chromatography, ion-exchange chromatography, and nano-LC/Q-TOF MS/MS. The salty taste-enhancing function of the target fractions was confirmed by both a rat taste cell model and/or human sensory evaluation. Four decapeptides were found as taste-active compounds. Among them, peptide E (EDEGEQPRPF) was the most potent saltiness-enhancing peptide: 0.4 mg/mL in 50 mmol/L NaCl solution could increase its salty perception equivalent to the salt level of 63 mmol/L NaCl reference solution. The sequence of the peptide has been found in the α'-subunit of β-conglycinin [Glycine max]. The remaining peptides V (VGPDDDEKSW), DD (DEDEQPRPIP), and DG (DEGEQPRPFP) showed umami and kokumi tastes as well as a weak saltiness-enhancing sensation. These findings suggest that the decapeptide EDEGEQPRPF could be a possible alternative to partially reduce the amount of sodium intake without compromising for saltiness.
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Affiliation(s)
- Yan Ping Chen
- Department of Food Science and Technology, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China
- Food and Nutritional Sciences Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mengni Wang
- Department of Food Science and Technology, School of Agriculture and Biology, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Imre Blank
- Zhejiang Yiming Food Co, LTD, Jiuting Center, Huting North Street No.199, Shanghai 201600, China
| | - Jiaojiao Xu
- Food and Nutritional Sciences Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Hau Yin Chung
- Food and Nutritional Sciences Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Green TJ, Whitfield KC, Daniels L, Brown RC, Houghton LA. Modeling thiamine fortification: a case study from Kuria atoll, Republic of Kiribati. Ann N Y Acad Sci 2021; 1498:108-115. [PMID: 33438290 PMCID: PMC8451779 DOI: 10.1111/nyas.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
In 2014, there was an outbreak of beriberi on Kuria, a remote atoll in Kiribati, a small Pacific Island nation. A thiamine‐poor diet consisting mainly of rice, sugar, and small amounts of fortified flour was likely to blame. We aimed to design a food fortification strategy to improve thiamine intakes in Kuria. We surveyed all 104 households on Kuria with a pregnant woman or a child 0–59 months. Repeat 24‐h dietary recalls were collected from 90 men, 17 pregnant, 44 lactating, and 41 other women of reproductive age. The prevalence of inadequate thiamine intakes was >30% in all groups. Dietary modeling predicted that rice or sugar fortified at a rate of 0.3 and 1.4 mg per 100 g, respectively, would reduce the prevalence of inadequate thiamine intakes to <2.5% in all groups. Fortification is challenging because Kiribati imports food from several countries, depending on price and availability. One exception is flour, which is imported from Fiji. Although resulting in less coverage than rice or sugar, fortifying wheat flour with an additional 3.7 mg per 100 g would reduce the prevalence of inadequacy to under 10%. Kiribati is small and has limited resources; thus, a regional approach to thiamine fortification is needed.
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Affiliation(s)
- Tim J Green
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Lisa Daniels
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Rachel C Brown
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Lisa A Houghton
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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Farmery AK, Scott JM, Brewer TD, Eriksson H, Steenbergen DJ, Albert J, Raubani J, Tutuo J, Sharp MK, Andrew NL. Aquatic Foods and Nutrition in the Pacific. Nutrients 2020; 12:E3705. [PMID: 33266125 PMCID: PMC7761396 DOI: 10.3390/nu12123705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
National rates of aquatic food consumption in Pacific Island Countries and Territories are among the highest in the world, yet the region is suffering from extensive levels of diet-related ill health. The aim of this paper is to examine the variation in consumption patterns and in nutrient composition of aquatic foods in the Pacific, to help improve understanding of their contribution to food and nutrition security. For this examination we analysed nutrient composition data and trade data from two novel region-specific databases, as well as consumption data from national and village level surveys for two Melanesian case studies, Vanuatu and Solomon Islands. Results demonstrated that consumption depends on availability and the amount and type of aquatic food consumed, and its contribution to nutrition security varies within different geographic and socio-demographic contexts. More data is needed on locally relevant species and consumption patterns, to better inform dietary guidelines and improve public health both now and into the future. Advice on aquatic food consumption must consider the nutrient composition and quantity of products consumed, as well as accessibility through local food systems, to ensure they contribute to diverse and healthy diets.
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Affiliation(s)
- Anna K. Farmery
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
| | - Jessica M. Scott
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
| | - Tom D. Brewer
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
| | - Hampus Eriksson
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
- WorldFish, Honiara, Faculty of Agriculture, Fisheries and Forestry, C/O Solomon Islands National University, Ranadi, Solomon Islands;
| | - Dirk J. Steenbergen
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
| | | | - Jacob Raubani
- Fisheries, Aquaculture and Marine Ecosystems Division, The Pacific Community, Noumea Cedex 98849, New Caledonia;
| | - Jillian Tutuo
- WorldFish, Honiara, Faculty of Agriculture, Fisheries and Forestry, C/O Solomon Islands National University, Ranadi, Solomon Islands;
| | - Michael K. Sharp
- Statistics for Development Division, The Pacific Community, Noumea Cedex 98849, New Caledonia;
| | - Neil L. Andrew
- Australian National Centre for Ocean Resource and Security, Faculty of Business and Law, University of Wollongong, Wollongong 2522, Australia; (J.M.S.); (T.D.B.); (H.E.); (D.J.S.); (N.L.A.)
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Mean Dietary Salt Intake in Vanuatu: A Population Survey of 755 Participants on Efate Island. Nutrients 2019; 11:nu11040916. [PMID: 31022856 PMCID: PMC6521272 DOI: 10.3390/nu11040916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/27/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022] Open
Abstract
Non-communicable diseases are responsible for 63% of global deaths, with a higher burden in low- and middle-income countries. Hypertension is the leading cause of cardiovascular-disease-related deaths worldwide, and approximately 1.7 million deaths are directly attributable to excess salt intake annually. There has been little research conducted on the level of salt consumption amongst the population of Vanuatu. Based on data from other Pacific Island countries and knowledge of changing regional diets, it was predicted that salt intake would exceed the World Health Organization’s (WHO) recommended maximum of 5 g per day. The current study aimed to provide Vanuatu with a preliminary baseline assessment of population salt intake on Efate Island. A cross-sectional survey collected demographic, clinical, and urine data from participants aged 18 to 69 years in rural and urban communities on Efate Island in October 2016 and February 2017. Mean salt intake was determined to be 7.2 (SD 2.3) g/day from spot urine samples, and 5.9 (SD 3.6) g/day from 24-h urine samples, both of which exceed the WHO recommended maximum. Based on the spot urine samples, males had significantly higher salt intake than females (7.8 g compared to 6.5 g; p < 0.001) and almost 85% of the population consumed more than the WHO recommended maximum daily amount. A coordinated government strategy is recommended to reduce salt consumption, including fiscal policies, engagement with the food industry, and education and awareness-raising to promote behavior change.
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Sparks E, Paterson K, Santos JA, Trieu K, Hinge N, Tarivonda L, Snowdon W, Johnson C, Webster J. Salt-Related Knowledge, Attitudes, and Behaviors on Efate Island, Vanuatu. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061027. [PMID: 30901868 PMCID: PMC6466123 DOI: 10.3390/ijerph16061027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 12/27/2022]
Abstract
In Vanuatu, mean salt intake exceeds the recommended maximum daily intake, and contributes to the high proportion of deaths attributable to cardiovascular diseases. Understanding salt-related knowledge, attitudes, and behaviors of the Vanuatu population can inform appropriate interventions. This cross-sectional study was conducted as part of the 2016–2017 Vanuatu Salt Survey. In total, 753 participants aged between 18 and 69 years from rural and urban communities on the Island of Efate were included. Demographic and clinical data were collected and a salt-related knowledge, attitudes, and behaviors survey was administered. Knowledge relating to the need to reduce salt consumption was high, but reported behaviors did not reflect this knowledge. A total of 83% of participants agreed that too much salt could cause health problems, and 86% reported that it was “very important” to lower the amount of salt in the diet. However, more than two-thirds of the population reported always/often adding salt to food during cooking/meal preparation and at the table, and always/often consuming processed foods high in salt. Strategic, targeted, and sustained behavior change programs in parallel with interventions to change the food environment to facilitate healthier choices should be key components of a salt reduction program. Actions should implemented as part of a comprehensive strategy to prevent and control non-communicable diseases in Vanuatu.
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Affiliation(s)
- Emalie Sparks
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | | | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Nerida Hinge
- Vanuatu Ministry of Health, Iatika Complex, Cornwall St, Port Vila, Vanuatu.
| | - Len Tarivonda
- Vanuatu Ministry of Health, Iatika Complex, Cornwall St, Port Vila, Vanuatu.
| | - Wendy Snowdon
- Division of Pacific Technical Support, South Pacific Office, World Health Organization, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji.
| | - Claire Johnson
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, NSW 2006 Sydney, Australia.
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Abstract
OBJECTIVE Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands. DESIGN Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies. RESULTS Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake. CONCLUSIONS Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.
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Abstract
Objective: Salt reduction is one of the most cost-effective interventions for the prevention of noncommunicable diseases, but there are no studies evaluating the effectiveness of national strategies in low or lower middle income countries. This study aimed to examine the effect of an 18-month nation-wide salt reduction strategy in Samoa. Methods: Two nationally representative cross-sectional surveys of adults aged 18–64 years, measuring 24-h urinary salt excretion and salt-related knowledge, attitudes and behaviours, were conducted before (2013) and after (2015) the intervention. Results: There were 234 participants at baseline (response rate 47%) and 479 at 18 months (response rate 61%). There was no change in mean population salt intake between 2013 (7.31 g/day) and 2015 (7.50 g/day) (0.19, 95% confidence interval −0.50 to 0.88; P = 0.588). There were significant changes in the proportion of the population who always or often add discretionary salt when eating (−16.2%, P = 0.002), the proportion who understood the adverse effects of salt (+9.0%, P = 0.049) and the proportion using one or more methods to control their salt intake (+20.9%, P < 0.001). A total of 73% reported that they had heard or seen the salt reduction messages. Conclusion: With widespread awareness of the salt reduction message and some improvements in salt-related knowledge and behaviours following the intervention, Samoa is now well positioned to implement much-needed structural initiatives or policies to reduce salt in the food supply.
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Webster J, Pillay A, Suku A, Gohil P, Santos JA, Schultz J, Wate J, Trieu K, Hope S, Snowdon W, Moodie M, Jan S, Bell C. Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji. Nutrients 2018; 10:nu10020155. [PMID: 29385758 PMCID: PMC5852731 DOI: 10.3390/nu10020155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.
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MESH Headings
- Costs and Cost Analysis
- Cyclonic Storms
- Diet, Healthy/economics
- Diet, Healthy/ethnology
- Diet, Sodium-Restricted/economics
- Diet, Sodium-Restricted/ethnology
- Fast Foods/adverse effects
- Fast Foods/analysis
- Fast Foods/economics
- Fiji
- Focus Groups
- Food Industry/economics
- Food, Preserved/adverse effects
- Food, Preserved/analysis
- Food, Preserved/economics
- Health Knowledge, Attitudes, Practice/ethnology
- Health Plan Implementation/economics
- Health Promotion/economics
- Humans
- Hypertension/economics
- Hypertension/ethnology
- Hypertension/etiology
- Hypertension/prevention & control
- Information Dissemination
- Nutrition Surveys/economics
- Patient Compliance/ethnology
- Program Evaluation
- Public-Private Sector Partnerships/economics
- Sodium Chloride, Dietary/adverse effects
- Sodium Chloride, Dietary/analysis
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Arleen Suku
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Paayal Gohil
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Jillian Wate
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Silvia Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Colin Bell
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
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Assessment of a Salt Reduction Intervention on Adult Population Salt Intake in Fiji. Nutrients 2017; 9:nu9121350. [PMID: 29231897 PMCID: PMC5748800 DOI: 10.3390/nu9121350] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/15/2017] [Accepted: 12/07/2017] [Indexed: 11/17/2022] Open
Abstract
Reducing population salt intake is a global public health priority due to the potential to save lives and reduce the burden on the healthcare system through decreased blood pressure. This implementation science research project set out to measure salt consumption patterns and to assess the impact of a complex, multi-faceted intervention to reduce population salt intake in Fiji between 2012 and 2016. The intervention combined initiatives to engage food businesses to reduce salt in foods and meals with targeted consumer behavior change programs. There were 169 participants at baseline (response rate 28.2%) and 272 at 20 months (response rate 22.4%). The mean salt intake from 24-h urine samples was estimated to be 11.7 grams per day (g/d) at baseline and 10.3 g/d after 20 months (difference: -1.4 g/day, 95% CI -3.1 to 0.3, p = 0.115). Sub-analysis showed a statistically significant reduction in female salt intake in the Central Division but no differential impact in relation to age or ethnicity. Whilst the low response rate means it is not possible to draw firm conclusions about these changes, the population salt intake in Fiji, at 10.3 g/day, is still twice the World Health Organization's (WHO) recommended maximum intake. This project also assessed iodine intake levels in women of child-bearing age and found that they were within recommended guidelines. Existing policies and programs to reduce salt intake and prevent iodine deficiency need to be maintained or strengthened. Monitoring to assess changes in salt intake and to ensure that iodine levels remain adequate should be built into future surveys.
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Jackson SL, VanFrank BK, Lundeen E, Uncangco A, Alam L, King SMC, Cogswell ME. Sodium in Store and Restaurant Food Environments - Guam, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:510-3. [PMID: 27227418 DOI: 10.15585/mmwr.mm6520a2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Compared with the United States overall, Guam has higher mortality rates from cardiovascular disease and stroke (1). Excess sodium intake can increase blood pressure and risk for cardiovascular disease (2,3). To determine the availability and promotion of lower-sodium options in the nutrition environment, the Guam Department of Public Health and Social Services (DPHSS) conducted an assessment in September 2015 using previously validated tools adapted to include sodium measures. Stores (N = 114) and restaurants (N = 63) were randomly sampled by region (north, central, and south). Data from 100 stores and 62 restaurants were analyzed and weighted to account for the sampling design. Across the nine product types assessed, lower-sodium products were offered less frequently than regular-sodium products (p<0.001) with <50% of stores offering lower-sodium canned vegetables, tuna, salad dressing, soy sauce, and hot dogs. Lower-sodium products were also less frequently offered in small stores than large (two or more cash registers) stores. Reduced-sodium soy sauce cost more than regular soy sauce (p<0.001) in stores offering both options in the same size bottle. Few restaurants engaged in promotion practices such as posting sodium information (3%) or identifying lower-sodium entrées (1%). Improving the availability and promotion of lower-sodium foods in stores and restaurants could help support healthier eating in Guam.
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Christoforou A, Trieu K, Land MA, Bolam B, Webster J. State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact. J Epidemiol Community Health 2016. [DOI: 10.1136/jech-2015-206997\] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Christoforou A, Trieu K, Land MA, Bolam B, Webster J. State-level and community-level salt reduction initiatives: a systematic review of global programmes and their impact. J Epidemiol Community Health 2016; 70:1140-1150. [PMID: 27222501 DOI: 10.1136/jech-2015-206997] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/05/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND High-salt diets are linked to elevated blood pressure, a major risk factor for cardiovascular diseases, particularly stroke. State and community salt reduction strategies may complement nationally led initiatives and contribute to achieving global salt reduction targets. We aim to systematically review such interventions and document reported impact where programmes have been evaluated. METHODS Electronic databases were searched up to June 2015 using terms 'salt' or 'sodium' and 'state' and 'community' in combination with 'campaign', 'initiative', 'project', 'strategy', 'intervention' or 'programme'. Data from evaluated and unevaluated interventions were included. Studies were analysed in relation to intervention components and outcome measures and appraised for quality using a Cochrane Risk-of-Bias Tool. RESULTS 39 state and community programmes were identified. Settings varied from whole communities (n=23), state-owned buildings (n=5), schools (n=7), workplaces (n=3) and correctional facilities (n=1). Strategies included nutrition education programmes, public education campaigns, changes to the food environment, other 'novel' approaches and multifaceted approaches. Of the 28 studies that evaluated intervention effectiveness, significant reductions were observed in terms of salt intake from dietary assessment (n=7), urinary sodium excretion (n=8), blood pressure (n=11) and sodium in foods (n=9). Six studies reported positive changes in consumer knowledge, attitudes and behaviours. All but two studies had some methodological limitations. CONCLUSIONS State and community salt reduction programmes may be effective in a range of settings but more robust evaluation methods are needed. Scaling up these efforts in coordination with national initiatives could provide the most effective and sustainable approach to reducing population salt intake.
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Affiliation(s)
- Anthea Christoforou
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kathy Trieu
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Mary-Anne Land
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bruce Bolam
- The Victorian Health Promotion Foundation (VicHealth), Carlton, Victoria, Australia
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health (affiliated with the University of Sydney), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Charlton KE, Russell J, Gorman E, Hanich Q, Delisle A, Campbell B, Bell J. Fish, food security and health in Pacific Island countries and territories: a systematic literature review. BMC Public Health 2016; 16:285. [PMID: 27009072 PMCID: PMC4806432 DOI: 10.1186/s12889-016-2953-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/14/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pacific Island countries and territories (PICTs) face a double burden of disease, with a high prevalence of household food insecurity and childhood micronutrient deficiencies, accompanied by a burgeoning increase in adult obesity, diabetes and heart disease. Methods A systematic literature review was undertaken to assess whether increased availability of, and access to, fish improves a) household food security and b) individual nutritional status. Results A total of 29 studies were reviewed. Fourteen studies identified fish as the primary food source for Pacific Islanders and five studies reported fish/seafood as the primary source of dietary protein. Fish consumption varied by cultural sub-region and Pacific Island countries and territories. Fish consumption and nutritional status was addressed in nine studies, reporting moderate iodine deficiency in Vanuatu where only 30 % of participants consumed mostly fresh fish. Similarly, the degree to which Pacific Islanders depended on fishing for household income and livelihood varied between and within PICTs. For more economically developed countries, household income was derived increasingly from salaried work and dependency on fishing activities has been declining. Conclusions Fishing remains a major contributor to food security in PICTs, through subsistence production and income generation. However, there is a paucity of research aimed at assessing how maintaining and/or improving fish consumption benefits the diets and health of Pacific Islanders as they contend with the ongoing nutrition transition that is characterised by an increasing demand for packaged imported foods, such as canned meats, instant noodles, cereals, rice, and sugar-sweetened beverages, with subsequent decreased consumption of locally-produced plants and animals.
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Affiliation(s)
- Karen E Charlton
- School of Medicine, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Joanna Russell
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Emma Gorman
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Quentin Hanich
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Aurélie Delisle
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Brooke Campbell
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Johann Bell
- Australian National Centre for Ocean Resources and Security (ANCORS), University of Wollongong, Wollongong, NSW, 2522, Australia.,Betty and Gordon Moore Center for Science and Oceans, Conservation International, Arlington, VA, 22202, USA
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Webster J, Su'a SAF, Ieremia M, Bompoint S, Johnson C, Faeamani G, Vaiaso M, Snowdon W, Land MA, Trieu K, Viali S, Moodie M, Bell C, Neal B, Woodward M. Salt Intakes, Knowledge, and Behavior in Samoa: Monitoring Salt-Consumption Patterns Through the World Health Organization's Surveillance of Noncommunicable Disease Risk Factors (STEPS). J Clin Hypertens (Greenwich) 2016; 18:884-91. [PMID: 26843490 PMCID: PMC5067650 DOI: 10.1111/jch.12778] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/26/2022]
Abstract
This project measured population salt intake in Samoa by integrating urinary sodium analysis into the World Health Organization's (WHO's) STEPwise approach to surveillance of noncommunicable disease risk factors (STEPS). A subsample of the Samoan Ministry of Health's 2013 STEPS Survey collected 24‐hour and spot urine samples and completed questions on salt‐related behaviors. Complete urine samples were available for 293 participants. Overall, weighted mean population 24‐hour urine excretion of salt was 7.09 g (standard error 0.19) to 7.63 g (standard error 0.27) for men and 6.39 g (standard error 0.14) for women (P=.0014). Salt intake increased with body mass index (P=.0004), and people who added salt at the table had 1.5 g higher salt intakes than those who did not add salt (P=.0422). A total of 70% of the population had urinary excretion values above the 5 g/d cutoff recommended by the WHO. A reduction of 30% (2 g) would reduce average population salt intake to 5 g/d, in line with WHO recommendations. While challenging, integration of salt monitoring into STEPS provides clear logistical and cost benefits and the lessons communicated here can help inform future programs.
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.
| | | | | | - Severine Bompoint
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Claire Johnson
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Wendy Snowdon
- WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Mary-Anne Land
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Satu Viali
- Medical Specialist Clinic and Ministry of Health, Apia, Samoa
| | - Marj Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, VIC, Australia
| | - Colin Bell
- School of Medicine, Deakin University, Melbourne, VIC, Australia
| | - Bruce Neal
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Department of Epidemiology, Johns Hopkins University, Baltimore, MD
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Charlton KE, Langford K, Kaldor J. Innovative and Collaborative Strategies to Reduce Population-Wide Sodium Intake. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0138-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Cornélio ME, Godin G, Rodrigues RCM, de Freitas Agondi R, Alexandre NMC, Gallani MCBJ. Effect of a behavioral intervention of the SALdável program to reduce salt intake among hypertensive women: A randomized controlled pilot study. Eur J Cardiovasc Nurs 2015; 15:e85-94. [DOI: 10.1177/1474515115589275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 05/11/2015] [Indexed: 12/17/2022]
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