The relationship of health/food literacy and salt awareness to daily sodium and potassium intake among a workplace population in Switzerland

Winemaking by-products fortification of flour formulations based on corn and lentil

Formulations based on a mixture of corn: lentil flours (70:30) (93.75%), salt (1.25%), sugar (5%), 5 or 20% of Hylon® V, were fortified with 5 and 20% of fermented Cabernet Sauvignon grape skin or seed, and unfermented Chardonnay grape seed flours, and evaluated for their functional components. The incorporation of winemaking by-products increased the dietary fibre content. Soluble sugars and arabinoxylans content depended only on corn:lentil flours presence. The total starch content varied between 42 .55 g/100g to 58.41 g/100g and the highest concentrations of resistant starch were determined in formulations with 20% Hylon® V. Total phenols, total flavonoids, and anthocyanins, were higher in all formulations with 20% fermented Cabernet Sauvignon skin or unfermented Chardonnay seed flours, regardless the content of corn:lentil flours. Winemaking by-products represent potential functional and prebiotic novel ingredients for new functional food products.

Unraveling compound curing agent on protein characteristics and proteome changes of Nuodeng ham by TMT-labeled quantitative proteomics

To understand the effects of compound curing agent (60 % NaCl+40 % KCl + 90 mg/kg NaNO2) on the protein characteristics and proteome of Nuodeng ham, the protein structure, oxidation, degradation, and proteomic changes of Nuodeng ham were analyzed. The results showed that the hydrophobic and disulfide bonds were the main forces to maintain the stability of the ham protein. The compound curing agent reduced protein oxidation and promoted the transformation of the α-helix structure to the β-sheet structure. 13 differentially up-regulated and 9 differentially down-regulated proteins were screened by TMT-labeled quantitative proteomics. GO functional annotation and protein-protein interaction analysis showed that I3LQ79, Q4PS85, I3LUD1, and A0A2C9F3F0 were important differentially expressed proteins in Nuodeng ham. These results elucidate the intrinsic mechanism of action of the compound curing agent from the perspective of protein changes, providing a scientific theoretical basis for the development and utilization of the compound curing agent.

Community-level dietary intake of sodium, potassium, and sodium-to-potassium ratio as a global public health problem: a systematic review and meta-analysis

Background

Widespread adoption of a westernized diet represents a major lifestyle change characterized by substantially higher sodium consumption and lower potassium intake, which is related to cardiovascular morbidity.

Methods

We performed a systematic review and meta-analysis over published studies in accordance with quantifying the dietary intake of sodium and potassium of the universal population across the world. The PubMed, EMBASE, Cochrane Library, and Google Scholar databases were used to find research that pronounced 24-hour urinary sodium or potassium excretion (reference period: 2014-2021). The effect size was estimated using the fixed-effect model; sub-group analysis become accomplished to determine urinary sodium and potassium excretion disaggregated by geographical location. Publication bias became evaluated the usage of graphical funnel plot. Data analysis was performed using STATA 16.

Results

Forty-three studies (n= 62,940) qualified the selection criteria. The mean urinary excretion of sodium and potassium was 156.73 mmol/24h [95% confidence interval (CI), 148.98-164.47] and 48.89 mmol/24 h (95% CI, 43.61-54.17), respectively; the mean urinary sodium/potassium ratio was 3.68 (95% CI, 2.96-4.40).

Conclusions

This updated systematic review highlights excessively high dietary intake of sodium and low intake of potassium at the community level in most parts of the world. The urinary Na/K ratio exceeded the level recommended by the WHO guidelines.

The Mechanism of Quality Changes in Grass Carp (Ctenopharyngodon idella) During Vacuum-Assisted Salting Brining with Physicochemical and Microstructural View

This study investigated the effects of vacuum impregnation (V) and atmospheric pressure impregnation (C) on the quality and microstructure of grass carp (Ctenopharyngodon idella) fillets during a 120 min brining period under 5.8% NaCl (w/v) and 4 °C. Vacuum impregnation significantly enhanced brining efficiency, achieving higher salt content (2.01%) and accelerated mass transfer kinetics, as evidenced by Peleg model parameters. Both treatments improved the water-holding capacity (WHC), increasing from 80.16% to 91.47% (C) and 89.92% (V), while reducing free water proportion. A microstructural analysis revealed a reduction in extracellular space in fillets, which further affected the fillet WHC and texture. Vacuum brining also mitigated lipid oxidation, yielding lower thiobarbituric acid-reactive substances (TBARSs: 0.237 mg MDA/kg). Texture analysis indicated reduced hardness and increased springiness/cohesiveness in fillets. Despite a slight decrease in lightness, vacuum-assisted brining preserved sensory quality and aligned with low-salt dietary trends. These findings underscore vacuum technology's potential to optimize brining efficiency and product quality in industrial applications.

A policy package for socio-cultural factors of promoting healthy diet in Iran

Objectives

Non-communicable diseases (NCDs) cause 74% of global deaths annually, for which poor diet is the leading risk factor. Diet improvement could prevent 20% of global deaths. This paper presents a policy package for socio-cultural factors, strategies, and policies to promote a healthy diet in Iran.

Methods

This is a qualitative health policy analysis. We conducted 30 semi-structured, in-depth, and face-to-face interviews with purposefully identified key informants, i.e., experts, policy-makers, and high-level managers, during 2018-19 in Iran. All interviews were digitally recorded and transcribed verbatim. The MAXQDA 11 software was used to facilitate data analysis.

Results

We developed several recommendations for different stakeholders, including improving cultural habits, promoting the use of fruit and vegetables, establishing healthy taste from early childhood, enhancing people's health literacy, developing health-promoting schools, and implementing a healthy buffet.

Conclusions

In line with target 3.4 of the Sustainable Development Goals (SDG) and the World Health Organization (WHO) recommendations for the prevention and control of NCDs, since 2015, Iran has developed its national action plan, including several nutritional interventions to achieve the target of reducing 30% of premature death due to NCDs and related risk factors by 2030. Our evidence-based recommendations can assist the government and other stakeholders, as we envisage, boost their activities to combat unhealthy diets, the biggest risk factor of NCDs in Iran, and perhaps beyond.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01449-9.

Analysis of factors associated with public attitudes towards salt reduction: a multicountry cross-sectional survey

OBJECTIVE

This paper provides an in-depth examination of public attitudes towards salt reduction across seven culturally diverse countries: the USA, the UK, France, Japan, Indonesia, Thailand, and Brazil.

DESIGN

Cross-sectional regression analysis with questionnaire data.

SETTING

An analysis of questionnaire study in seven countries.

PARTICIPANTS

The study's questionnaire collected responses from 7090 participants across seven countries with the mean age of respondents being 46.06 years (SD 16.96). The gender distribution encompassed 3473 men (49.12%), 3582 women (50.66%), 24 non-binary individuals (0.34%) and 11 who identified as 'other' (0.16%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Attitudes toward sodium reduction were measured on a seven-point Likert scale.

RESULTS

Regression analysis revealed significant associations between attitudes towards sodium reduction and various factors across countries. Gender was a significant factor in France, with women showing less awareness than men (coefficient -0.123, 95% CI -0.237 to -0.008). Age was a significant factor in Japan and Thailand, with older generations exhibiting stronger awareness. Occupation was a significant factor in France (grocery, 0.678, 0.229 to 1.127) and Japan (food service, 0.792, 0.300 to 1.283). In France (0.090, 0.033 to 0.146) and Brazil (0.092, 0.040 to 0.144), attitudes towards reducing sugar intake were positively associated with sodium reduction attitudes. Government interventions showed varying impacts, with positive associations in Thailand (0.004, 0.001 to 0.008) and negative associations in France (-0.003 -0.005 to -0.000).

CONCLUSION

Our study reveals a complex array of factors shaping attitudes towards sodium reduction across seven countries. These findings support the need for nuanced, country-specific approaches in formulating sodium reduction strategies. Future research should validate these findings, explore further determinants and understand how attitudes translate into dietary behaviours.

Adaptation of the Food Literacy (FOODLIT) Tool for Turkish Adults: A Validity and Reliability Study

BACKGROUND

Food literacy is associated with sustainable food systems and encourages individuals to adopt healthy eating habits. However, there is no validated method that can be used to measure food literacy related to sustainable food systems of Turkish adults. This research aimed to assess the validity and reliability of the Turkish adaptation of the "Food Literacy (FOODLIT) Tool" for Turkish adults.

METHODS

The study involved 328 people aged 19 to 58 years. The FOODLIT-Tool is a five-point Likert-type scale consisting of 24 items and five factors ("culinary competencies", "production and quality", "selection and planning", "environmentally safe" and "origin").

RESULTS

The Cronbach's alpha coefficient was applied to assess internal consistency reliability, showing an excellent scale coefficient of 0.927. The model was evaluated with a confirmatory factor analysis (CFA). The findings of the CFA suggested that the fit indices were acceptable (χ2/df = 1.257, comparative fit index: 0.991, goodness-of-fit index: 0.977, normed fit index: 0.990 and root mean error of approximation: 0.028). Furthermore, there was a positive relationship between the FOODLIT-Tool score and the "Sustainable and Healthy Eating Behaviors Scale" (SHEB) score (r = 0.518, p < 0.001).

CONCLUSION

Our study shows that the Turkish version of the FOODLIT-Tool integrated with sustainable food systems is a valid and reliable measurement tool for assessing the food literacy of Turkish adults.

A Mediation Model of Food Literacy: A Potential Relationship between Body Image Dissatisfaction and Body Mass Index

Background and Objectives: The global rise in obesity presents a significant public health challenge, with Turkey exhibiting one of the highest obesity rates in Europe. Body image dissatisfaction (BID) and lower food literacy (FL) have been associated with obesity, yet their interplay remains underexplored. This study aimed to investigate the relationship between body mass index (BMI), body image dissatisfaction, and FL in adults in Turkey. Materials and Methods: In total, 759 women and 419 men aged 18-64 years old were included in this study. The mean age was 31.34 ± 11.92. A total of 1178 participants completed an online questionnaire assessing anthropometric measurements, BID, using the Stunkard Figure Rating Scale, and FL, using a validated questionnaire. The data were analyzed using descriptive statistics, correlation analysis, and mediation analysis to explore the relationships between variables in SPSS 24.0. Results: Women desired to be thinner more frequently than men, and those with negative BID were predominantly individuals with overweight or obesity. Moreover, those with higher FL scores were more likely to be satisfied with their bodies. Correlation analysis demonstrated a negative relationship between BMI and FL (r = -0.94; p = 0.001) and a positive relationship between BMI and BID (r = 0.628; p < 0.001). Mediation analysis revealed that FL mediated the relationship between BID and BMI (β = -2.281; lower limit = -3.334, upper limit = -1.228). Conclusions: The findings highlight the importance of addressing BID and enhancing FL to mitigate obesity risk factors. This study contributes to understanding the complex interplay between BID, FL, and obesity, providing insights for public health interventions aimed at obesity prevention and management.

Self-perceived food literacy in relation to the quality of overall diet and main meals: A cross-sectional study in Japanese adults

This cross-sectional study aimed to assess the relationship between self-perceived food literacy (SPFL) and quality of overall diet and main meals in Japanese adults. In total, 5998 adults aged 20-79 years were included in this analysis. The SPFL was assessed using the Japanese version of the 29-item Dutch SPFL scale (score range 1-5). Using validated dietary information, the Healthy Eating Index-2015 (HEI-2015) was calculated (score range 0-100). The mean SPFL was 3.18; the internal consistency of the overall scale was considered good (Cronbach's alpha: 0.80). The mean HEI-2015 for overall diet was 50.4. The SPFL was significantly and positively associated with the HEI-2015. Using multiple linear regression, one point increase of SPFL corresponded to an increase in HEI-2015 by a point of 4.8 for overall diet, 6.2 for breakfast, 4.6 for lunch, and 3.6 for dinner (all P < 0.0001). Six of the eight domains of SPFL (i.e., food preparation skills, resilience and resistance, healthy snack styles, examining food labels, healthy budgeting, and healthy food stockpiling) were significantly associated with the HEI-2015 for overall diet. When the HEI-2015 for each meal was examined, the domains showing significant associations with all three meals included food preparation skills, healthy snack styles, and healthy budgeting. The healthy food stockpiling was associated with the HEI-2015 for breakfast and lunch, but not dinner. The social and conscious eating and daily food planning were associated with the breakfast HEI-2015 only, with the resilience and resistance associated with the dinner HEI-2015 only. In conclusion, the SPFL was cross-sectionally associated with the quality of overall diet and main meals in Japanese adults. Further observation and intervention studies are needed to confirm the associations observed here.

Salt content of prepacked cereal-based products and their potential contribution to salt intake of the Italian adult population: Results from a simulation study

BACKGROUND AND AIMS

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.

METHODS AND RESULTS

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.

CONCLUSION

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.

Novel NaCl reduction technologies for dry-cured meat products and their mechanisms: A comprehensive review

Sodium chloride (NaCl) confers a unique flavor and quality in meat products, however, due to growing concerns about the adverse effects of excessive NaCl consumption, how to reduce NaCl content while ensuring quality and safety has become a research hotspot in this field. This review mainly discusses the role of NaCl in dry-cured meat, as well as novel salt-reducing substances that can substitute for the effects of NaCl to achieve sodium reduction objectives. New technologies, such as vacuum curing, ultrahigh pressure curing, ultrasonic curing, pulsed electric field curing, and gamma irradiation, to facilitate the development of low-sodium products are also introduced. The majority of current salt reduction technologies function to enhance salt diffusion and decrease curing time, resulting in a decrease in NaCl content. Notably, future studies should focus on implementing multiple strategies to compensate for the deficiencies in flavor and safety caused by NaCl reduction.

Who has a high level of food literacy, and who does not?: a qualitative study of college students in South Korea

BACKGROUND/OBJECTIVES

Unhealthy food choices among young adults are common globally, and the incidence of chronic diseases, such as obesity, is rising. Food literacy (FL) is important for improving and maintaining individual health in a rapidly changing food environment and can form the basis for following a sustainable diet. Therefore, it is essential to improve FL among young adults, particularly college students, who are in the formative years of their lifelong food habits. This study examined the facilitators and barriers of FL and related dietary behavior among college students in South Korea.

SUBJECTS/METHODS

This study recruited 25 college students with different residence types using convenience and snowball sampling. In-person, telephone, and video interviews were conducted from March to November 2021. The interview data were analyzed using framework analysis based on the socio-ecological model.

RESULTS

At the individual level, prior good experiences with food were the most frequently mentioned facilitator. In contrast, the major barriers were a lack of knowledge, financial hardship, irregular schedules, and academic stress. At the interpersonal level, the influences of family and peers, such as early exposure to healthy eating habits and opportunities to have easy accessibility to farms and farming, are major facilitators, but the lack of a sense of community was the major barrier. At the environmental level, the major barriers were unfavorable food environments at home and in neighborhoods, such as the absence of kitchens in housing and large packaging of produce at markets.

CONCLUSIONS

Many factors affected the students' FL and related healthy eating practices. These findings suggest that a campus-based FL program should be developed by reflecting on these facilitators and barriers.

Nutrition and Food Literacy: Framing the Challenges to Health Communication

Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.

The level of food literacy and its association with food intake and obesity status among Seoul citizens: results from Seoul Food Survey 2021

BACKGROUND/OBJECTIVES

Food literacy (FL) is a crucial skill for selecting sustainable and healthy food options, necessitating the identification of vulnerable groups in the community using valid measurement tools. Identifying weak domains in FL is essential for enhancing the overall FL. This study examined the FL levels of Seoul citizens based on their sociodemographic characteristics and assessed the relationship between FL, food intake, and weight status.

SUBJECTS/METHODS

This study utilized the data from the Seoul Food Survey, a cross-sectional study employing representative samples of Seoul citizens. Data collection occurred from September to October 2021, with 4,039 citizens aged 18 yrs and above participating in face-to-face surveys. Thirty-three FL items were assessed, comprising 14 items in the nutrition and safety (NS) domain, eight items in the cultural and relational (CR) domain, and 11 items in the socio-ecological (SE) domain. In addition, data on food intake sufficiency and obesity status were collected. The descriptive statistics, t-tests, analysis of variance, and logistic regression analysis were used for analysis.

RESULTS

Men, students, young adults, older citizens, and people experiencing food insecurity had the lowest scores for all the FL domains. The highest quartile group of NS scores had a higher probability of consuming adequate servings of vegetables and fruits, with significant linear trends observed (P for trend < 0.05). In all three FL domains, the odds ratio for obesity was significantly lower in the groups with high FL scores (P < 0.05).

CONCLUSIONS

A close relationship was observed between low FL, obesity, and food intake, even after controlling for other covariates. Vulnerable groups with low FL were also identified. Therefore, it is essential to develop programs to improve FL and the health and well-being of these groups.

Salt-Intake-Related Behavior Varies between Sexes and Is Strongly Associated with Daily Salt Consumption in Obese Patients at High Risk for MASLD

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes a significant burden on Westernized regions. The Western diet, high in salt intake, significantly contributes to disease development. However, there are a lack of data on salt literacy and salt intake among MASLD patients in Germany. Our study aims to analyze daily salt intake and salt-intake-related behavior in MASLD patients.

METHODS

234 MASLD patients were prospectively included. Daily salt intake and salt-intake-related behavior were assessed via a food frequency questionnaire (FFQ-DEGS) and a salt questionnaire (SINU). Statistical analyses were performed using SPSS.

RESULTS

Mean daily salt intake was higher in men than in women (7.3 ± 5 g/d vs. 5.3 ± 4 g/d; p < 0.001). There was significant agreement between increased daily salt intake (>6 g/d) and the behavioral salt index (SI) (p < 0.001). Men exhibited higher SI scores compared to women, indicating lower awareness of salt in everyday life. Multivariate analysis identified specific salt-intake-related behaviors impacting daily salt consumption.

CONCLUSIONS

Our study reveals a strong link between daily salt intake and salt-intake-related behavior, highlighting sex-specific differences in an MASLD cohort. To enhance patient care in high-cardiovascular-risk populations, specific behavioral approaches may be considered, including salt awareness, to improve adherence to lifestyle changes, particularly in male patients.

Impact of Harvest Month and Drying Process on the Nutritional and Bioactive Properties of Wild Palmaria palmata from Atlantic Canada

The macroalga Palmaria palmata could be a sustainable and nutritional food resource. However, its composition may vary according to its environment and to processing methods used. To investigate these variations, wild P. palmata from Quebec were harvested in October 2019 and June 2020, and dried (40 °C, ≃5 h) or stored as frozen controls (-80 °C). The chemical (lipids, proteins, ash, carbohydrates, fibers), mineral (I, K, Na, Ca, Mg, Fe), potential bioactive compound (carotenoids, polyphenols, β-carotene, α-tocopherol) compositions, and the in vitro antioxidant activity and angiotensin-converting enzyme (ACE) inhibition potential of water-soluble extracts were determined. The results suggested a more favorable macroalgae composition in June with a higher content of most nutrients, minerals, and bioactive compounds. October specimens were richer only in carbohydrates and carotenoids. No significant differences in antioxidant or anti-ACE inhibitory activities were found between the two harvest months. The drying process did not significantly impact the chemical and mineral compositions, resulting in only small variations. However, drying had negative impacts on polyphenols and anti-ACE activities in June, and on carotenoids in October. In addition, a concentration effect was observed for carotenoids, β-carotene and α-tocopherol in June. To provide macroalgae of the highest nutritional quality, the drying process for June specimens should be selected.

The Connection between Non-Alcoholic Fatty-Liver Disease, Dietary Behavior, and Food Literacy in German Working Adults

(1) Background: German working adults are particularly at risk of non-alcoholic fatty-liver disease (NAFLD), which is connected to increased cardiovascular and overall morbidity and mortality. Dietary behavior (DB) and health knowledge are crucial factors in the conceptual NAFLD model, which can directly influence this disease. These two factors largely align with the concept of food literacy (FL), which deals with proficiency in food-related skills and knowledge to promote healthy DB and prevent NAFLD. However, the potential of FL for NAFLD prevention remains unknown, because FL has not been tested in connection with DB and NAFLD. Therefore, the current study examined the direct and indirect connections between FL, DB, and NAFLD in a mediation model. (2) Methods: A total of 372 working adults (38% female) participated in a cross-sectional study by completing self-report questionnaires on FL and DB. In addition, an independent physician assessed the fatty-liver index (FLI) as an indicator of NAFLD in an occupational health checkup. (3) Results: The mediation model revealed that FL had a direct moderate connection with DB (β = 0.25, p < 0.01), but no direct connection with the FLI (β = -0.05, p = 0.36). However, DB showed a small to moderate connection with the FLI (β = -0.14, p = 0.01), which could indicate the indirect-only mediation of the relationship between FL and NAFLD via DB. (4) Conclusion: These results confirm the value of DB for the prevention of NAFLD. In addition, FL might be a vital component for improving DB and thereby function as a resource in the prevention of NAFLD. However, future longitudinal research is needed to substantiate the value of FL with respect to NAFLD.

Validation of salt intake measurements: comparisons of a food record checklist and spot-urine collection to 24-hour-urine collection

Objective

Monitoring population salt intake is operationally and economically challenging. We explored whether a questionnaire assessment and a prediction of Na intake from spot-urine could replace or complement the recommended measurement of Na in 24-h urine (24-h U).

Design

Compare the agreement of a Na-specific food record checklist (FRCL) and a late-afternoon spot-urine measurement (PM-spot) with 24-h U measurement in estimating Na intake at group level. Each participant’s use of these methods extended over 3 d. Agreement was assessed using mean (95 % CI) differences, linear regression models and Bland−Altman plots.

Setting

The validation study was part of a 1-year workplace intervention trial to lower salt intake in Switzerland.

Participants

Seventy women and 71 men, aged 21−61 years, completed three FRCL, and acceptable PM-spot and 24-h U samples at baseline (April−October 2015).

Results

Mean Na intake estimates varied slightly across methods (3·5-3·9 g/d). Mean Na intake differences from 24-h U were 0·2 (95% CI (0, 0·5)) g/d for FRCL and 0·4 (95 % CI (0·2, 0·6)) g/d for PM-spot. Linear regression models and Bland-Altmann plots more clearly depicted differences by sex and discretionary salt use.

Conclusions

Although 24-h U remains the best reference method for monitoring Na intake at the population level, PM-spot and FRCL might be more practical instruments for frequent, periodic Na intake assessments. Population-specific prediction models to estimate 24-h U could be developed and evaluated.

Policy analysis of socio-cultural determinants of salt, sugar and fat consumption in Iran

Background

Noncommunicable diseases (NCDs) are the first reason for death worldwide, in which poor diet is the leading risk factor. It is estimated that 20% of all death is related to food. The Unhealthy diet includes many foods with excessive salt, sugar and fat. This paper reports a national study on the socio-cultural determinants affecting salt, sugar and fat consumption in Iran.

Methods

This is a qualitative study. We conducted semi-structured interviews with 30 various purposefully identified key stakeholders to collect data from December 2018 until August 2019 in Iran.

Results

We identified socio-cultural determents of salt, fat and sugar consumption as follows: Inadequate structure of traditional medicine and people’s desire for traditional foods, low health literacy, the global trend of nutritional transition and its impact on Iranian society, The progressive decline of people’s trust in NGOs, and Inappropriate media management. Worse still, the global trend of nutritional transition and people’s tendency towards fast foods, unhealthy diet and junk foods, partially due to establishing children’s taste mainly with salty, high-fat and sweet foods, has jeopardized their desire to eat healthily during adulthood.

Conclusion

Reducing salt, fat and sugar consumption is problematic in Iran, mainly due to multi-dimensional socio-cultural determinants. In line with sustainable development goal (SDG) 3.4 to reduce 30% of premature death due to NCDs and related risk factors by 2030 in Iran, various stakeholders from multiple sectors need to initiate coherent series of interventions to alter people’s approach to select food so that they may reduce the consumption of foods with excessive salt, fat and sugar.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00518-7.

Food Literacy and Its Associated Factors in Non-Dialysis Patients with Chronic Kidney Disease in China: A Cross-Sectional Study

PURPOSE

Nephrology professionals' understanding of food literacy (FL) and influencing factors is significant for nutrition management, which is key to controlling disease progress among non-dialysis patients with chronic kidney disease (CKD). However, few studies have explored FL in CKD patients. Hence, this study aimed to investigate the level of FL of non-dialysis patients with CKD and to analyze influencing factors in China.

PATIENTS AND METHODS

A total of 203 CKD patients without dialysis were recruited from August to December 2020 to participate in a cross-sectional study. Food literacy was assessed by a modified short food literacy questionnaire for adults. Related influencing factors were measured by the motivation for dietary self-control scale and the satisfaction with dietary behavior scale. Data were also collected regarding patients' health information-seeking behavior (four items), satisfaction and compliance with dietary advice from healthcare professionals (two items), and demographics and clinical diagnoses.

RESULTS

The mean age of patients was 44.5 years (range 18 to 75), and 42.5% were male. Most (50.2%) were in stages 1-2 of CKD. The mean FL score of these patients was 38.75±0.38. The multivariable linear regression analysis shows that secondary educational level (β=0.221, p=0.004), motivation for controlling diet (β=0.198, p=0.003), satisfaction with dietary behaviors (β=0.319, p<0.001), and health information-seeking behavior (β=0.146, p=0.019) were significant influencing factors.

CONCLUSION

Food literacy of Chinese CKD patients without dialysis should be improved. Patients with higher education levels exhibit more active information-seeking behaviors, have greater satisfaction with dietary behaviors, and their motivation for dietary self-control is more likely to be associated with better FL. Healthcare workers should be aware of factors influencing FL and attempt to integrate assessment of FL into routine food-related education for CKD patients.

Associations of Health Literacy with Blood Pressure and Dietary Salt Intake among Adults: A Systematic Review

Health literacy has been recognized as a significant social determinant of health, defined as the ability to access, understand, appraise, and apply health-related information across healthcare, disease prevention, and health promotion. This systematic review aims to understand the relationship between health literacy, blood pressure, and dietary salt intake. A web-based search of PubMed, Web of Science, CINAHL, ProQuest, Scopus, Cochrane Library, and Prospero was performed using specified search/MESH terms and keywords. Two reviewers independently performed the data extraction and analysis, cross-checked, reviewed, and resolved any discrepancies by the third reviewer. Twenty out of twenty-two studies met the inclusion criteria and were rated as good quality papers and used in the final analysis. Higher health literacy had shown to have better blood pressure or hypertension knowledge. However, the relationship between health literacy with dietary salt intake has shown mixed and inconsistent findings. Studies looking into the main four domains of health literacy are still limited. More research exploring the links between health literacy, blood pressure, and dietary salt intake in the community is warranted. Using appropriate and consistent health literacy tools to evaluate the effectiveness of salt reduction as health promotion programs is required.

Estimation of sodium consumption by novel formulas derived from random spot and 12-hour urine collection

The gold standard for estimating sodium intake is 24h urine sodium excretion. Several equations have been used to estimate 24h urine sodium excretion, however, a validated formula for calculating 24h urine sodium excretion from 12h urine collection has not yet been established. This study aims to develop novel equations for estimating 24h urine sodium excretion from 12h and random spot urine collection and also to validate existing spot urine equations in the Thai population. A cross-sectional survey was carried out among 209 adult hospital personnel. Participants were asked to perform a 12h daytime, 12h nighttime, and a random spot urine collection over a period of 24 hours. The mean 24h urine sodium excretion was 4,055±1,712 mg/day. Estimated urine sodium excretion from 3 different equations using random spot urine collection showed moderate correlation and agreement with actual 24h urine sodium excretion (r = 0.54, P<0.001, ICC = 0.53 for Kawasaki; r = 0.57, P<0.001, ICC = 0.44 for Tanaka; r = 0.60, P<0.001, ICC = 0.45 for INTERSALT). Novel equations for predicting 24h urine sodium excretion were then developed using variables derived from 12h daytime urine collection, 12h nighttime urine collection, random spot urine collection, 12h daytime with random spot urine collection, and 12h nighttime with random spot urine collection which showed strong correlation and agreement with actual measured values (r = 0.88, P<0.001, ICC = 0.87; r = 0.83, P<0.001, ICC = 0.81; r = 0.67, P<0.001, ICC = 0.62; r = 0.90, P<0.001, ICC = 0.90; and r = 0.83, p<0.001, ICC = 0.82 respectively). Bland-Altman plots indicated good agreement between predicted values and actual 24h urine sodium excretion using the new equations. Newly derived equations from 12h daytime and 12h nighttime urine collection with or without casual spot urine collection were able to accurately predict 24h urine sodium excretion.

Food Literacy Is Associated With Adherence to a Mediterranean-Style Diet in Kidney Transplant Recipients

OBJECTIVES

Adherence to a Mediterranean-style diet is associated with improved health outcomes in kidney transplant recipients (KTR). However, poor dietary habits, including excessive sodium intake, are common in KTR, indicating difficulties with incorporating a healthy diet into daily life. Food literacy is identified as potential facilitator of a healthy diet, but the precise relationship between food literacy and dietary intake in KTR has not been investigated. This study examined food literacy levels in KTR and its association with adherence to a Mediterranean-style diet and sodium intake.

METHODS

This cross-sectional study is part of the TransplantLines Cohort and Biobank Study. Food literacy was measured with the Self-Perceived Food Literacy (SPFL) questionnaire. Dietary intake assessment with food frequency questionnaires was used to calculate the Mediterranean Diet Score. Sodium intake was based on the 24-hour urinary sodium excretion rate. Associations of SPFL with Mediterranean Diet Score and sodium intake were assessed with univariable and multivariable linear regression analyses.

RESULTS

In total, 148 KTR (age 56 [48-66]; 56% male) completed the SPFL questionnaire with a mean SPFL score of 3.63 ± 0.44. Higher SPFL was associated with a higher Mediterranean Diet Score in KTR (β = 1.51, 95% confidence interval 0.88-2.12, P ≤ .001). Although KTR with higher food literacy tended to have a lower sodium intake than those with lower food literacy (P = .08), the association of food literacy with sodium intake was not significant in a multivariable regression analysis (β = 0.52 per 10 mmol/24-hour increment, 95% confidence interval -1.79 to 2.83, P = .66).

CONCLUSIONS

Higher levels of food literacy are associated with better adherence to a Mediterranean-style diet in KTR. No association between food literacy and sodium intake was found. Further studies are needed to determine if interventions on improving food literacy contribute to a healthier diet and better long-term outcomes in KTR.

Achieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education

Sodium-reduction initiatives have been a cornerstone of preventing hypertension and broader atherosclerotic cardiovascular disease (ASCVD) since the early 1970s. For nearly 50 years, public health and clinical guidelines have concentrated on consumer education, behavioral change, and, to a lesser extent, food policy to help reduce sodium intake among Americans. While these efforts undoubtedly helped improve awareness, average sodium consumption remains at approximately 4200 mg/day in men and 3000 mg/day in women, well above the United States Dietary Guidelines of 2300 mg/day. Culinary medicine is an emerging discipline in clinical and public-health education that provides healthcare professionals and community members with food-based knowledge and skills. With the hands-on teaching of kitchen education to individuals, culinary medicine provides eaters with tangible strategies for reducing sodium through home cooking. Here, we review opportunities for culinary medicine to help improve both individual- and population-level sodium-reduction outcomes through five main areas: increasing adherence to a plant-forward dietary pattern, food literacy, the enhancement of complementary flavors, disease-specific teaching-kitchen modules, and the delivery of culturally specific nutrition education. Through this process, we hope to further underline the value of formal, hands-on teaching-kitchen education among healthcare professionals and community members for ASCVD prevention.

Association between health literacy and dietary intake of sugar, fat and salt: a systematic review

Objectives:

To collect and summarise all current data from observational studies, generating evidence of the association between health literacy (HL) and the dietary intake of sugar, salt and fat, to analyse intervention studies on the promotion of an appropriate dietary intake of the above-mentioned nutrients and to ascertain whether HL moderates the efficacy of such intervention.

Design:

A systematic literature search of analytical observational studies on the association between HL and dietary intake of sugar, salt and fat was performed in Medline and Scopus databases. Intervention studies on the promotion of healthy nutrition that concerned the intake of sugar, salt and fat were also assessed.

Results:

Of the eight observational studies included in this review, five investigated dietary intake of sugar, one focused on salt, one assessed sugar and salt and one analysed the fat intake. The results of the five studies assessing sugar were mixed: three found an association between low levels of HL and a high sugar intake, one found this association only for boys and two found no evidence of any association. The two studies assessing salt and the one assessing fat found no evidence of any association with HL. One intervention study on the sugar intake concluded that HL was not a significant moderator of the intervention’s effectiveness.

Conclusion:

No evidence of any association between HL and salt and fat intake emerged, while for sugar, the results are mixed. More work is needed to better understand the moderating effects of HL on the outcomes of health promotion interventions.

On computing critical factors based healthy behavior index for behavior assessment

OBJECTIVE

Ubiquitous computing has supported personalized health through a vast variety of wellness and healthcare self-quantification applications over the last decade. These applications provide insights for daily life activities but unable to portray the comprehensive impact of personal habits on human health. Therefore, in order to facilitate the individuals, we have correlated the lifestyle habits in an appropriate proportion to determine the overall impact of influenced behavior on the well-being of humans.

MATERIALS AND METHODS

To study the combined impact of personal behaviors, we have proposed a methodology to derive the comprehensive Healthy Behavior Index (HBI) consisting of two major processes: (1) Behaviors' Weight-age Identification (BWI), and (2) Healthy Behavior Quantification and Index (HBQI) modeling. The BWI process identifies the high ranked contributing behaviors through life-expectancy based weight-age, whereas HBQI derives a mathematical model based on quantification and indexing of behavior using wellness guidelines.

RESULTS

The contributing behaviors are identified through text mining technique and verified by seven experts with a Kappa agreement level of 0.379. A real-world user-centric statistical evaluation is applied through User Experience Questionnaire (UEQ) method to evaluate the impact of HBI service. This HBI service is developed for the Mining Minds, a wellness management application. This study involves 103 registered participants (curious about the chronic disease) for a Korean wellness management organization. They used the HBI service over 12 weeks, the results for which were evaluated through UEQ and user feedback. The service reliability for the Cronbach's alpha coefficient greater than 0.7 was achieved using HBI service whereas the stimulation coefficient of the value 0.86 revealed significant effect. We observed an overall novelty of the value 0.88 showing the potential interest of participants.

CONCLUSIONS

The comprehensive HBI has demonstrated positive user experience concerning the stimulation for adapting the healthy behaviors. The HBI service is designed independently to work as a service, so any other wellness management service-enabled platform can consume it to evaluate the healthy behavior index of the person for recommendation generation, behavior indication, and behavior adaptation.

Salt and Health: Survey on Knowledge and Salt Intake Related Behaviour in Italy

BACKGROUND AND AIM

Excess sodium intake is a recognised causal factor of hypertension and its cardiovascular complications; there is however a lack of practical instruments to assess and monitor the level of knowledge and behaviour about dietary salt intake and to relate these factors to the population general dietary habits.

METHODS AND RESULTS

A self-administered questionnaire was developed to assess the salt and health related knowledge and behaviour of the Italian population through an online survey. A sample of 11,618 Italian participants completed the questionnaire. The degree of knowledge and the reported behaviour about salt intake were both found to be related to age, gender, home region, level of education and occupation. There was a significant interrelation between salt knowledge and behaviour and both were significantly and directly related to the degree of adherence to a Mediterranean-like dietary pattern. A hierarchical evaluation was also made of the relevance of any single question to the overall assessment of knowledge and behaviour about salt intake.

CONCLUSIONS

The study population overall appeared to have a decent level of knowledge about salt, but a less satisfactory behaviour. Our findings point to social inequalities and young age as the main factors having a negative impact on knowledge and behaviour about salt intake as part of generally inadequate dietary habits. The degrees of knowledge and behaviour were significantly and directly interrelated, confirming that improving knowledge is a key step for behavioural changes, and suggesting that educational campaigns are crucial for the implementation of good practices in nutrition.

Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review

INTRODUCTION

The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data.

OBJECTIVE

This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland.

METHODS

Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization.

RESULTS

Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported.

CONCLUSION

This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.

RE-AIM evaluation of a one-year trial of a combined educational and environmental workplace intervention to lower salt intake in Switzerland

Reducing excessive dietary sodium may reduce cardiovascular disease risk. Environmental and behavioral interventions in workplaces may reduce salt consumption, but information on the effectiveness of workplace nutrition interventions is sparse. We used the RE-AIM framework to evaluate a one-year trial in 2015–2016 of an educational and environmental intervention to lower salt intake of employees in organizations with catering facilities in Switzerland. Five educational workshops for employees and assessments that included 24-hour urine collection were combined with five coaching sessions and food analyses in catering operations. We studied the adoption, reach, implementation, effectiveness, and maintenance of the intervention.

Eight of 389 candidate organizations participated in the trial in which 145 (50% men) out of 5794 potentially eligible employees consented to participate, and 138 completed the trial with 13 in the control group.

The overall mean change of daily salt intake was −0.6 g from 8.7 g to 8.1 g (6.9%). Though the mean daily salt intake of women was unaltered from 7 g, the mean intake of men declined by −1.2 g from 10.4 g to 9.2 g. Baseline salt intake, sex, and waist-to-height ratio were significant predictors of salt reduction. The analysis also highlighted pivotal determinants of low adoption and reach, and program implementation in catering operations. We conclude that a workplace program of nutrition intervention for employees and catering staff is feasible. The acceptance, effectiveness, and maintenance of nutrition interventions in the workplace require strong employer support. In a supportive food environment, interventions tailored to sex, age, and CVD risk inter alia could be successful.

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Leadership support is of vital importance to success of workplace nutrition trials.

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The observed overall salt intake reduction was not statistically significant.

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Baseline salt intake, sex, and waist-to-height ratio explained salt reduction.

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Habits and high-salt food environment were cited as barriers to reduced salt intake.

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Catering has not succeeded in strictly implementing a gradual salt reduction approach.

Study design and baseline characteristics of a combined educational and environmental intervention trial to lower sodium intake in Swiss employees

BACKGROUND

Blood pressure is a primary cardiovascular disease risk factor. Population-wide governmental strategies aim to reduce lifestyle and dietary risk factors for hypertension, one of which is an unbalanced diet with high sodium and low potassium intakes. Nutrition interventions in the workplace are considered a promising approach in encouraging health-promoting behaviors. We developed and conducted the health promoting sodium reduction trial "Healthful & Tasty: Sure!" in worksites in the German-speaking part of Switzerland from May 2015 to Nov 2016, for which we present the study protocol and baseline characteristics.

METHODS

Healthful & Tasty, a cluster nonrandomized single-arm trial with calibration arm, aimed to demonstrate the effectiveness of a combined educational and environmental intervention in the workplace in reducing employees' average daily sodium/salt intake by 15%. To this end, health and food literacy of employees and guideline compliance among the catering facility team needed to be improved. The primary outcome measure was sodium/salt intake estimated from sodium excretion in a 24-h urine sample. Secondary outcome measures included changes in the overall qualitative diet composition, blood pressure, anthropometric indices, and health and food literacy. Of eight organizations with catering facilities, seven organizations took part in the nutrition education and catering salt reduction interventions, and one organization participated as a control. Overall, 145 consenting employees were included in the staggered, one-year four-phase trial, of which 132 participated in the intervention group. In addition to catering surveys and food sampling, the trial included five follow-up health assessments including questionnaires, blood pressure measurements, anthropometrics, and sodium, potassium, and iodine intake measurements obtained from 24-h and spot urine samples, and a food record checklist. Exploratory and hypothesis generating baseline statistical analysis included 141 participants with adequate 24-h urine samples.

DISCUSSION

Despite practice-driven limitations to the study design and small cluster and participant numbers, this trial has methodological strength and will provide important insights into the effectiveness of a combined educational and environmental intervention to reduce salt intake among female and male Swiss employees.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00006790 . Registered 23 September 2014.