Science of Salt: A regularly updated systematic review of salt and health outcomes studies (April to October 2018)

Determining food industry compliance to mandatory sodium limits: successes and challenges from the South African experience

OBJECTIVE

To provide an update on the compliance to the Na reduction regulation (R.214) and to highlight some challenges and successes experienced by South Africa in the implementation of a mandatory Na regulation.

DESIGN

The study design was observational. Nutritional information of packaged food (specified in the R.214 regulation) was collected between February 2019 and September 2020, before and after the implementation date of the final Na targets in the regulation. Six supermarket chains that accounted for more than 50 % of the grocery retailer market share in South Africa were included. The Na content (per 100 g) of products was extracted from photographs. Products were classified according to the thirteen food categories included in R.214. The percentage of targeted food categories that met the pre and post-regulation targets as well as the percentage by which Na limits were exceeded was calculated.

SETTING

Low-and-middle-income suburbs in Cape Town, South Africa.

PARTICIPANTS

N/A.

RESULTS

A total number of 3278 products were analysed. After the final implementation date, none of the categories targeted by the R.214 regulation fully complied. However, nine out of the thirteen food categories targeted by R.214 were above the 70 % compliance mark.

CONCLUSIONS

The compliance to R.214 in South Africa is good, although not 100 % compliant. This research also highlights the complexities regarding the monitoring and evaluation of a national regulation. Findings from the current study could aid by providing valuable information to countries in the process of implementing a Na reduction strategy.

The World Hypertension League Science of Salt: a regularly updated systematic review of salt and health outcomes studies (Sept 2019 to Dec 2020)

The World Hypertension League Science of Salt health outcomes review series highlights high-quality publications relating to salt intake and health outcomes. This review uses a standardised method, outlined in previous reviews and based on methods developed by WHO, to identify and critically appraise published articles on dietary salt intake and health outcomes. We identified 41 articles published between September 2019 to December 2020. Amongst these, two studies met the pre-specified methodological quality criteria for critical appraisal. They were prospective cohort studies and examined physical performance and composite renal outcomes as health outcomes. Both found an association between increased/higher sodium intake and poorer health outcomes. Few studies meet criteria for high-quality methods. This review adds further evidence that dietary salt reduction has health benefits and strengthens evidence relating to health outcomes other than blood pressure and cardiovascular disease. We observe that most studies on dietary sodium do not have adequate methodology to reliably assess sodium intake and its association with health outcomes.

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.

Further evidence that methods based on spot urine samples should not be used to examine sodium-disease relationships from the Science of Salt: A regularly updated systematic review of salt and health outcomes (November 2018 to August 2019)

The aim of this eighth Science of Salt outcomes review is to identify, summarize, and critically appraise studies on dietary sodium and health outcomes published between November 1, 2018, and August 31, 2019, to extend this series published in the Journal since 2016. The standardized Science of Salt search strategy was conducted. Studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisal. The search strategy resulted in 2621 citations with 27 studies on dietary sodium and health outcomes identified. Two studies met the criteria for detailed critical appraisal and commentary. We report more evidence that high sodium intake has detrimental health effects. A post hoc analysis of the Dietary Approaches to Stop Hypertension (DASH) sodium trial showed that lightheadedness occurred at a greater frequency with a high sodium DASH diet compared to a low sodium DASH diet. In addition, evidence from a post-trial analysis of the Trials of Hypertension (TOHP) I and II cohorts showed that estimates of sodium intake from methods based on spot urine samples are inaccurate and this method alters the linearity of the sodium-mortality association. Compared to measurement of 24-hour sodium excretion using three to seven 24-hour urine collections, estimation of average 24-hour sodium excretion with the Kawasaki equation appeared to change the mortality association from linear to J-shaped. Only two high-quality studies were identified during the review period, both were secondary analyses of previously conducted trials, highlighting the lack of new methodologically sound studies examining sodium and health outcomes.

Trends in Adult Cooking Salt Intake - China, 1991-2018

What is already known about this topic? Sodium intake in China is among the highest in the world, the main source of which in adults is salt added during cooking. In 2012, the national average cooking salt intake was 10.5 g/d. What is added by this report? In 2018, median cooking salt intake was 6.3 g/d, which has decreased compared to that in 1991. The north-south gap in cooking salt intake was closing over time. What are the implications for public health practice? Effective policies and interventions need to be sustained and intensified to lower cooking salt intake, thus achieving the recommended level of sodium and total salt intake.