The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Graham A Macgregor - One of the best experts on this subject based on the ideXlab platform.
-
impact of the 2003 to 2018 population Salt Intake reduction program in england a modeling study
Hypertension, 2021Co-Authors: Sergi Alonso, Graham A Macgregor, Monique Tan, Changqiong Wang, Seamus Kent, Linda J Cobiac, Borislava MihaylovaAbstract:The United Kingdom was among the first countries to introduce a Salt reduction program in 2003 to reduce cardiovascular disease (CVD) incidence risk. Despite its initial success, the program has stalled recently and is yet to achieve national and international targets. We used age- and sex-stratified Salt Intake of 19 to 64 years old participants in the National Diet and Nutrition Surveys 2000 to 2018 and a multistate life table model to assess the effects of the voluntary dietary Salt reduction program on premature CVD, quality-adjusted survival, and health care and social care costs in England. The program reduced population-level Salt Intake from 9.38 grams/day per adult (SE, 0.16) in 2000 to 8.38 grams/day per adult (SE, 0.17) in 2018. Compared with a scenario of persistent 2000 levels, assuming that the population-level Salt Intake is maintained at 2018 values, by 2050, the program is projected to avoid 83 140 (95% CI, 73 710–84 520) premature ischemic heart disease (IHD) cases and 110 730 (95% CI, 98 390–112 260) premature strokes, generating 542 850 (95% CI, 529 020–556 850) extra quality-adjusted life-years and £1640 million (95% CI, £1570–£1660) health care cost savings for the adult population of England. We also projected the gains of achieving the World Health Organization target of 5 grams/day per adult by 2030, which by 2050 would avert further 87 870 (95% CI, 82 050–88 470) premature IHD cases, 126 010 (95% CI, 118 600–126 460) premature strokes and achieve £1260 million (95% CI, £1180–£1260) extra health care savings compared with maintaining 2018 levels. Strengthening the Salt reduction program to achieve further reductions in population Salt Intake and CVD burden should be a high priority.
-
role of Salt Intake in prevention of cardiovascular disease controversies and challenges
Nature Reviews Cardiology, 2018Co-Authors: Graham A MacgregorAbstract:Strong evidence indicates that reduction of Salt Intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population Salt Intake from the current level of approximately 10 g daily to 85 categories of food; many other developed countries are following the UK’s lead. In developing countries where most of the Salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in Salt Intake across the whole population can lead to a major improvement in public health and cost savings. Reduction in Salt consumption has long been recommended to lower blood pressure (BP) and the risk of cardiovascular disease (CVD). A linear relationship between Salt Intake and CVD risk has recently been challenged in some cohort studies; however, methodological issues exist with these studies. In this Review, He and MacGregor discuss the relationship between Salt Intake, BP, and CVD risk, and describe the benefits and challenges of reducing the population Intake of Salt.
-
mean dietary Salt Intake in urban and rural areas in india a population survey of 1395 persons
Journal of the American Heart Association, 2017Co-Authors: Graham A Macgregor, Claire Johnson, Sailesh Mohan, Kris Rogers, Roopa Shivashankar, Sudhir Raj Thout, Priti Gupta, Jacqui WebsterAbstract:BackgroundThe scientific evidence base in support of population‐wide Salt reduction is strong, but current high‐quality data about Salt Intake levels in India are mostly absent. This project sought...
-
school based education programme to reduce Salt Intake in children and their families school eduSalt cluster randomised controlled trial
BMJ, 2015Co-Authors: Xiangxian Feng, Caryl Nowson, Jing Zhang, Haijun Wang, Jianhui Yuan, Chingping Lin, Graham A MacgregorAbstract:Objective To determine whether an education programme targeted at schoolchildren could lower Salt Intake in children and their families. Design Cluster randomised controlled trial, with schools randomly assigned to either the intervention or control group. Setting 28 primary schools in urban Changzhi, northern China. Participants 279 children in grade 5 of primary school, with mean age of 10.1; 553 adult family members (mean age 43.8). Intervention Children in the intervention group were educated on the harmful effects of Salt and how to reduce Salt Intake within the schools’ usual health education lessons. Children then delivered the Salt reduction message to their families. The intervention lasted for one school term (about 3.5 months). Main outcome measures The primary outcome was the difference between the groups in the change in Salt Intake (as measured by 24 hour urinary sodium excretion) from baseline to the end of the trial. The secondary outcome was the difference between the two groups in the change in blood pressure. Results At baseline, the mean Salt Intake in children was 7.3 (SE 0.3) g/day in the intervention group and 6.8 (SE 0.3) g/day in the control group. In adult family members the Salt Intakes were 12.6 (SE 0.4) and 11.3 (SE 0.4) g/day, respectively. During the study there was a reduction in Salt Intake in the intervention group, whereas in the control group Salt Intake increased. The mean effect on Salt Intake for intervention versus control group was −1.9 g/day (95% confidence interval −2.6 to −1.3 g/day; P Conclusions An education programme delivered to primary school children as part of the usual curriculum is effective in lowering Salt Intake in children and their families. This offers a novel and important approach to reducing Salt Intake in a population in which most of the Salt in the diet is added by consumers. Trial registration ClinicalTrials.gov NCT01821144.
-
high Salt Intake independent risk factor for obesity
Hypertension, 2015Co-Authors: Graham A MacgregorAbstract:High Salt Intake is the major cause of raised blood pressure and accordingly leads to cardiovascular diseases. Recently, it has been shown that high Salt Intake is associated with an increased risk of obesity through sugar-sweetened beverage consumption. Increasing evidence also suggests a direct link. Our study aimed to determine whether there was a direct association between Salt Intake and obesity independent of energy Intake. We analyzed the data from the rolling cross-sectional study-the UK National Diet and Nutrition Survey 2008/2009 to 2011/2012. We included 458 children (52% boys; age, 10±4 years) and 785 adults (47% men; age, 49±17 years) who had complete 24-hour urine collections. Energy Intake was calculated from 4-day diary and misreporting was assessed by Goldberg method. The results showed that Salt Intake as measured by 24-hour urinary sodium was higher in overweight and obese individuals. A 1-g/d increase in Salt Intake was associated with an increase in the risk of obesity by 28% (odds ratio, 1.28; 95% confidence interval, 1.12-1.45; P=0.0002) in children and 26% (odds ratio, 1.26; 95% confidence interval, 1.16-1.37; P<0.0001) in adults, after adjusting for age, sex, ethnic group, household income, physical activity, energy Intake, and diet misreporting, and in adults with additional adjustment for education, smoking, and alcohol consumption. Higher Salt Intake was also significantly related to higher body fat mass in both children (P=0.001) and adults (P=0.001) after adjusting for age, sex, ethnic group, and energy Intake. These results suggest that Salt Intake is a potential risk factor for obesity independent of energy Intake.
Bruce Neal - One of the best experts on this subject based on the ideXlab platform.
-
Dietary Salt Intake in the Australian population.
Public health nutrition, 2017Co-Authors: Joseph Alvin Santos, Mark Woodward, Jacqui Webster, Mary Anne Land, Victoria M. Flood, John Chalmers, Bruce Neal, Kristina S. PetersenAbstract:Objective To update the estimate of mean Salt Intake for the Australian population made by the Australian Health Survey (AHS). Design A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of Salt Intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily Salt Intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples. Setting Lithgow, New South Wales, Australia. Subjects Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll. Results Mean (95 % CI) Salt Intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of Salt Intake for Lithgow adults based upon the 24 h urine collections was 9·0 (8·6, 9·4) g/d. When the age- and sex-specific estimates of Salt Intake obtained from the 24 h urine collections in the Lithgow sample were weighted using Australian census data, estimated Salt Intake for the Australian population was 9·0 (8·6, 9·5) g/d. Further adjustment for non-urinary Na excretion made the best estimate of daily Salt Intake for both Lithgow and Australia about 9·9 g/d. Conclusions The dietary recall method used by the AHS likely substantially underestimated mean population Salt consumption in Australia.
-
estimating mean change in population Salt Intake using spot urine samples
International Journal of Epidemiology, 2016Co-Authors: Kristina S. Petersen, Carley A. Grimes, Caryl Nowson, Mark Woodward, Jacqui Webster, Bruce NealAbstract:Background: Spot urine samples are easier to collect than 24-h urine samples and have been used with estimating equations to derive the mean daily Salt Intake of a population. Whether equations using data from spot urine samples can also be used to estimate change in mean daily population Salt Intake over time is unknown. We compared estimates of change in mean daily population Salt Intake based upon 24-h urine collections with estimates derived using equations based on spot urine samples. Methods: Paired and unpaired 24-h urine samples and spot urine samples were collected from individuals in two Australian populations, in 2011 and 2014. Estimates of change in daily mean population Salt Intake between 2011 and 2014 were obtained directly from the 24-h urine samples and by applying established estimating equations (Kawasaki, Tanaka, Mage, Toft, INTERSalt) to the data from spot urine samples. Differences between 2011 and 2014 were calculated using mixed models. Results: A total of 1000 participants provided a 24-h urine sample and a spot urine sample in 2011, and 1012 did so in 2014 (paired samples n = 870; unpaired samples n = 1142). The participants were community-dwelling individuals living in the State of Victoria or the town of Lithgow in the State of New South Wales, Australia, with a mean age of 55 years in 2011. The mean (95% confidence interval) difference in population Salt Intake between 2011 and 2014 determined from the 24-h urine samples was -0.48g/day (-0.74 to -0.21; P 0.058). Separate analysis of the unpaired and paired data showed that detection of change by the estimating equations was observed only in the paired data. Conclusions: All the estimating equations based upon spot urine samples identified a similar change in daily Salt Intake to that detected by the 24-h urine samples. Methods based upon spot urine samples may provide an approach to measuring change in mean population Salt Intake, although further investigation in larger and more diverse population groups is required.
-
mean population Salt Intake estimated from 24 h urine samples and spot urine samples a systematic review and meta analysis
International Journal of Epidemiology, 2016Co-Authors: Liping Huang, Mark Woodward, Jacqui Webster, Mary Anne Land, Bruce Neal, Michelle Crino, Federica Barzi, Rachael Mclean, Batsaikhan EnkhtungalagAbstract:BACKGROUND Estimating equations based on spot urine samples have been identified as a possible alternative approach to 24-h urine collections for determining mean population Salt Intake. This review compares estimates of mean population Salt Intake based upon spot and 24-h urine samples. METHODS We systematically searched for all studies that reported estimates of daily Salt Intake based upon both spot and 24-h urine samples for the same population. The associations between the two were quantified and compared overall and in subsets of studies. RESULTS A total of 538 records were identified, 108 were assessed as full text and 29 were included. The included studies involved 10,414 participants from 34 countries and made 71 comparisons available for the primary analysis. Overall average population Salt Intake estimated from 24-h urine samples was 9.3 g/day compared with 9.0 g/day estimated from the spot urine samples. Estimates based upon spot urine samples had excellent sensitivity (97%) and specificity (100%) at classifying mean population Salt Intake as above or below the World Health Organization maximum target of 5 g/day. Compared with the 24-h samples, estimates based upon spot urine overestimated Intake at lower levels of consumption and underestimated Intake at higher levels of consumption. CONCLUSIONS Estimates of mean population Salt Intake based upon spot urine samples can provide countries with a good indication of mean population Salt Intake and whether action on Salt consumption is required.
-
Proposed Nomenclature for Salt Intake and for Reductions in Dietary Salt
Journal of clinical hypertension (Greenwich Conn.), 2014Co-Authors: Norm R C Campbell, Jacqui Webster, Bruce Neal, Francesco P Cappuccio, Ricardo Correa‐rotter, Daniel T. Lackland, Graham A MacgregorAbstract:There is considerable confusion about what ranges of dietary Salta could be considered low, normal, or high and also what ranges of reduction in dietary Salt are small or large. The World Hypertension League with other organizations involved in dietary Salt reduction have proposed a standardized nomenclature based on normal ancestral levels of Salt Intake and also on ranges of reduction in Salt Intake in clinical and population interventions. Low daily Salt (sodium) Intake where harm due to deficiency would be expected to occur is recommended to remain undefined because of inadequate research but likely 10 to 15 g (4000–6000 mg), and extremely high >15 g (6000 mg). Reductions in daily Salt (sodium) Intake are recommended to be called small if 5.0 g (2000 mg). Use of this nomenclature is likely to result in less confusion about Salt Intake and interventions to reduce dietary sodium.
-
new evidence relating to the health impact of reducing Salt Intake
Nutrition Metabolism and Cardiovascular Diseases, 2011Co-Authors: Norm R C Campbell, Bruce Neal, Ricardo Correarotter, Francesco P CappuccioAbstract:Abstract This paper is a Position Statement from an ‘ad hoc’ Scientific Review Subcommittee of the PAHO/WHO Regional Expert Group on Cardiovascular Disease Prevention through Dietary Salt Reduction. It is produced in response to requests from representatives of countries of the Pan-American Region of WHO needing clarification on two recent publications casting doubts on the appropriateness of population wide policies to reduce Salt Intake for the prevention of cardiovascular disease. The paper provides a brief background, a critical appraisal of the recent reports and explanations as why the implications have been mis-interpreted. The paper concludes that the benefits of Salt reduction are clear and consistent, and reinforces the recommendations outlined by PAHO/WHO and other organizations worldwide for a population reduction in Salt Intake to prevent strokes, heart attacks and other cardiovascular events.
Francesco P Cappuccio - One of the best experts on this subject based on the ideXlab platform.
-
Proposed Nomenclature for Salt Intake and for Reductions in Dietary Salt
Journal of clinical hypertension (Greenwich Conn.), 2014Co-Authors: Norm R C Campbell, Jacqui Webster, Bruce Neal, Francesco P Cappuccio, Ricardo Correa‐rotter, Daniel T. Lackland, Graham A MacgregorAbstract:There is considerable confusion about what ranges of dietary Salta could be considered low, normal, or high and also what ranges of reduction in dietary Salt are small or large. The World Hypertension League with other organizations involved in dietary Salt reduction have proposed a standardized nomenclature based on normal ancestral levels of Salt Intake and also on ranges of reduction in Salt Intake in clinical and population interventions. Low daily Salt (sodium) Intake where harm due to deficiency would be expected to occur is recommended to remain undefined because of inadequate research but likely 10 to 15 g (4000–6000 mg), and extremely high >15 g (6000 mg). Reductions in daily Salt (sodium) Intake are recommended to be called small if 5.0 g (2000 mg). Use of this nomenclature is likely to result in less confusion about Salt Intake and interventions to reduce dietary sodium.
-
socioeconomic inequality in Salt Intake in britain 10 years after a national Salt reduction programme
BMJ Open, 2014Co-Authors: Francesco P CappuccioAbstract:Objectives: The impact of the national Salt reduction programme in the UK on social inequalities is unknown. We examined spatial and socioeconomic variations in Salt Intake in the 2008–2011 British National Diet and Nutrition Survey (NDNS) and compared them with those before the programme in 2000–2001. Setting: Cross-sectional survey in Great Britain. Participants: 1027 Caucasian males and females, aged 19–64 years. Primary outcome measures: Participants’ dietary sodium Intake measured with a 4-day food diary. Bayesian geo-additive models used to assess spatial and socioeconomic patterns of sodium Intake accounting for sociodemographic, anthropometric and behavioural confounders. Results: Dietary sodium Intake varied significantly across socioeconomic groups, even when adjusting for geographical variations. There was higher dietary sodium Intake in people with the lowest educational attainment (coefficient: 0.252 (90% credible intervals 0.003, 0.486)) and in low levels of occupation (coefficient: 0.109 (−0.069, 0.288)). Those with no qualification had, on average, a 5.7% (0.1%, 11.1%) higher dietary sodium Intake than the reference group. Compared to 2000-2001 the gradient of dietary sodium Intake from south to north was attenuated after adjustments for confounders. Estimated dietary sodium consumption from food sources (not accounting for discretionary sources) was reduced by 366 mg of sodium (∼0.9 g of Salt) per day during the 10-year period, likely the effect of national Salt reduction initiatives. Conclusions: Social inequalities in Salt Intake have not seen a reduction following the national Salt reduction programme and still explain more than 5% of Salt Intake between more and less affluent groups. Understanding the socioeconomic pattern of Salt Intake is crucial to reduce inequalities. Efforts are needed to minimise the gap between socioeconomic groups for an equitable delivery of cardiovascular prevention.
-
spatial variation of Salt Intake in britain and association with socioeconomic status
BMJ Open, 2013Co-Authors: Ngiangabakwin Kandala, Francesco P CappuccioAbstract:Objectives To evaluate spatial effects of variation and social determinants of Salt Intake in Britain. Design Cross-sectional survey. Setting Great Britain. Participants 2105 white male and female participants, aged 19–64 years, from the British National Diet and Nutrition Survey 2000–2001. Primary outcomes Participants’ sodium Intake measured both with a 7-day dietary record and a 24-h urine collection. By accounting for important linear and non-linear risk factors and spatial effects, the geographical difference and spatial patterns of both dietary sodium Intake and 24-h urinary sodium were investigated using Bayesian geo-additive models via Markov Chain Monte Carlo simulations. Results A significant north–south pattern of sodium Intake was found from posterior probability maps after controlling for important sociodemographic factors. Participants living in Scotland had a significantly higher dietary sodium Intake and 24-h urinary sodium levels. Significantly higher sodium Intake was also found in people with the lowest educational attainment (dietary sodium: coeff. 0.157 (90% credible intervals 0.003, 0.319), urinary sodium: 0.149 (0.024, 0.281)) and in manual occupations (urinary sodium: 0.083 (0.004, 0.160)). These coefficients indicate approximately a 5%, 9% and 4% difference in average sodium Intake between socioeconomic groups. Conclusions People living in Scotland had higher Salt Intake than those in England and Wales. Measures of low socioeconomic position were associated with higher levels of sodium Intake, after allowing for geographic location.
-
habitual Salt Intake and risk of gastric cancer a meta analysis of prospective studies
Clinical Nutrition, 2012Co-Authors: Lanfranco Delia, Francesco P Cappuccio, Gian Paolo Rossi, Renato Ippolito, Pasquale StrazzulloAbstract:Background & aims Systematic reviews of case–control studies evaluating the relationship between dietary Salt Intake and gastric cancer showed a positive association, however a quantitative analysis of longitudinal cohort studies is lacking. Therefore, we carried out a meta-analysis to assess the association between habitual Salt Intake and risk of gastric cancer in prospective studies. Methods We performed a systematic search of published articles (1966–2010). Criteria for inclusion were: original articles, prospective adult population studies, assessment of Salt Intake as baseline exposure and of gastric cancer as outcome, follow-up of at least 4 years, indication of number of participants exposed and events across different Salt Intake categories. Results Seven studies (10 cohorts) met the inclusion criteria (268 718 participants, 1474 events, follow-up 6–15 years). In the pooled analysis, “high” and “moderately high” vs “low” Salt Intake were both associated with increased risk of gastric cancer (RR = 1.68 [95% C.I. 1.17–2.41], p = 0.005 and respectively 1.41 [1.03–1.93], p = 0.032), with no evidence of publication bias. The association was stronger in the Japanese population and higher consumption of selected Salt-rich foods was also associated with greater risk. Meta-regression analyses did not detect specific sources of heterogeneity. Conclusions Dietary Salt Intake was directly associated with risk of gastric cancer in prospective population studies, with progressively increasing risk across consumption levels.
-
does reducing Salt Intake increase cardiovascular mortality
Kidney International, 2011Co-Authors: Lawrence J Appel, Francesco P Cappuccio, Hugh E De Wardener, Graham A MacgregorAbstract:Overwhelming evidence shows that reducing Salt Intake from 9–12 to 5–6g/d lowers blood pressure, thereby preventing cardiovascular disease. A recent paper claims that lower Salt Intake is associated with higher cardiovascular mortality despite lower blood pressure. The study is flawed and cannot refute the evidence for the benefits of Salt reduction. The WHO recommends Salt reduction as crucial in tackling the global non-communicable-disease crisis. A reduction in population Salt Intake remains a public-health priority.
Arthur D Loewy - One of the best experts on this subject based on the ideXlab platform.
-
sodium deprivation and Salt Intake activate separate neuronal subpopulations in the nucleus of the solitary tract and the parabrachial complex
The Journal of Comparative Neurology, 2007Co-Authors: Joel C Geerling, Arthur D LoewyAbstract:Salt Intake is an established response to sodium deficiency, but the brain circuits that regulate this behavior remain poorly understood. We studied the activation of neurons in the nucleus of the solitary tract (NTS) and their efferent target nuclei in the pontine parabrachial complex (PB) in rats during sodium deprivation and after Salt Intake. After 8-day dietary sodium deprivation, immunoreactivity for c-Fos (a neuronal activity marker) increased markedly within the aldosterone-sensitive neurons of the NTS, which express the enzyme 11-beta-hydroxysteroid dehydrogenase type 2 (HSD2). In the PB, c-Fos labeling increased specifically within two sites that relay signals from the HSD2 neurons to the forebrain--the pre-locus coeruleus and the innermost region of the external lateral parabrachial nucleus. Then, 1-2 hours after sodium-deprived rats ingested Salt (a hypertonic 3% solution of NaCl), c-Fos immunoreactivity within the HSD2 neurons was virtually eliminated, despite a large increase in c-Fos activation in the surrounding NTS (including the A2 noradrenergic neurons) and area postrema. Also after Salt Intake, c-Fos activation increased within pontine nuclei that relay gustatory (caudal medial PB) and viscerosensory (rostral lateral PB) information from the NTS to the forebrain. Thus, sodium deficiency and Salt Intake stimulate separate subpopulations of neurons in the NTS, which then transmit this information to the forebrain via largely separate relay nuclei in the PB complex. These findings offer new perspectives on the roles of sensory information from the brainstem in the regulation of sodium appetite.
-
sodium deprivation and Salt Intake activate separate neuronal subpopulations in the nucleus of the solitary tract and the parabrachial complex
The Journal of Comparative Neurology, 2007Co-Authors: Joel C Geerling, Arthur D LoewyAbstract:Salt Intake is an established response to sodium deficiency, but the brain circuits that regulate this behavior remain poorly understood. We studied the activation of neurons in the nucleus of the solitary tract (NTS) and their efferent target nuclei in the pontine parabrachial complex (PB) in rats during sodium deprivation and after Salt Intake. After 8-day dietary sodium deprivation, immunoreactivity for c-Fos (a neuronal activity marker) increased markedly within the aldosterone-sensitive neurons of the NTS, which express the enzyme 11-β-hydroxysteroid dehydrogenase type 2 (HSD2). In the PB, c-Fos labeling increased specifically within two sites that relay signals from the HSD2 neurons to the forebrain—the pre-locus coeruleus and the innermost region of the external lateral parabrachial nucleus. Then, 1–2 hours after sodium-deprived rats ingested Salt (a hypertonic 3% solution of NaCl), c-Fos immunoreactivity within the HSD2 neurons was virtually eliminated, despite a large increase in c-Fos activation in the surrounding NTS (including the A2 noradrenergic neurons) and area postrema. Also after Salt Intake, c-Fos activation increased within pontine nuclei that relay gustatory (caudal medial PB) and viscerosensory (rostral lateral PB) information from the NTS to the forebrain. Thus, sodium deficiency and Salt Intake stimulate separate subpopulations of neurons in the NTS, which then transmit this information to the forebrain via largely separate relay nuclei in the PB complex. These findings offer new perspectives on the roles of sensory information from the brainstem in the regulation of sodium appetite. J. Comp. Neurol. 504:379–403, 2007. © 2007 Wiley-Liss, Inc.
Jacqui Webster - One of the best experts on this subject based on the ideXlab platform.
-
Dietary Salt Intake in the Australian population.
Public health nutrition, 2017Co-Authors: Joseph Alvin Santos, Mark Woodward, Jacqui Webster, Mary Anne Land, Victoria M. Flood, John Chalmers, Bruce Neal, Kristina S. PetersenAbstract:Objective To update the estimate of mean Salt Intake for the Australian population made by the Australian Health Survey (AHS). Design A secondary analysis of the data collected in a cross-sectional survey was conducted. Estimates of Salt Intake were made in Lithgow using the 24 h diet recall methodology employed by the AHS as well as using 24 h urine collections. The data from the Lithgow sample were age- and sex-weighted, to provide estimates of daily Salt Intake for the Australian population based upon (i) the diet recall data and (ii) the 24 h urine samples. Setting Lithgow, New South Wales, Australia. Subjects Individuals aged ≥20 years residing in Lithgow and listed on the 2009 federal electoral roll. Results Mean (95 % CI) Salt Intake estimated from the 24 h diet recalls was 6·4 (6·2, 6·7) g/d for the Lithgow population compared with a corresponding figure of 6·2 g/d for the Australian population derived from the AHS. The corresponding estimate of Salt Intake for Lithgow adults based upon the 24 h urine collections was 9·0 (8·6, 9·4) g/d. When the age- and sex-specific estimates of Salt Intake obtained from the 24 h urine collections in the Lithgow sample were weighted using Australian census data, estimated Salt Intake for the Australian population was 9·0 (8·6, 9·5) g/d. Further adjustment for non-urinary Na excretion made the best estimate of daily Salt Intake for both Lithgow and Australia about 9·9 g/d. Conclusions The dietary recall method used by the AHS likely substantially underestimated mean population Salt consumption in Australia.
-
review of behaviour change interventions to reduce population Salt Intake
International Journal of Behavioral Nutrition and Physical Activity, 2017Co-Authors: Kathy Trieu, Joseph Alvin Santos, Emma Mcmahon, Adrian Bauman, Kellie Ann Jolly, Bruce Bolam, Jacqui WebsterAbstract:Excess Salt Intake is a major cause of raised blood pressure—the leading risk factor for death and disability worldwide. Although behaviour change interventions such as awareness campaigns and health education programs are implemented to reduce Salt Intake, their effectiveness is unclear. This global systematic review investigates the impact of population-level behaviour change interventions that aim to reduce Salt Intake. A search for published and grey literature was conducted using PubMed, Cochrane Library, Embase, Web of Science, Sage, Scopus, OpenGrey, Google Scholar and other relevant organizations’ websites. Studies were included if 1) published between 2005 and 2015; 2) the education or awareness-raising interventions were aimed at the population or sub-population and 3) Salt Intake and/or Salt-related behaviours were outcome measures. Study and intervention characteristics were extracted for the descriptive synthesis and study quality was assessed. Twenty two studies involving 41,448 participants were included. Most were conducted in high income countries (n = 16), targeting adults (n = 21) in the general population (n = 16). Behaviour change interventions were categorised as health education interventions (n = 14), public awareness campaigns (n = 4) and multi-component interventions (including both health education and awareness campaigns, n = 4). 19 of the 22 studies demonstrated significant reductions in estimated Salt Intake and/or improvement in Salt-related behaviours. All studies showed high risk of bias in one or more domains. Of the 10 higher quality studies, 5 found a significant effect on Salt Intake or Salt behaviours based on the more objective outcome assessment method. Based on moderate quality of evidence, population-level behaviour change interventions can improve Salt-related behaviours and/or reduce Salt Intake. However, closer analysis of higher quality studies show inconsistent evidence of the effectiveness and limited effect sizes suggest the implementation of education and awareness-raising interventions alone are unlikely to be adequate in reducing population Salt Intake to the recommended levels. A framework which guides rigorous research and evaluation of population-level interventions in real-world settings would help understand and support more effective implementation of interventions to reduce Salt Intake.
-
mean dietary Salt Intake in urban and rural areas in india a population survey of 1395 persons
Journal of the American Heart Association, 2017Co-Authors: Graham A Macgregor, Claire Johnson, Sailesh Mohan, Kris Rogers, Roopa Shivashankar, Sudhir Raj Thout, Priti Gupta, Jacqui WebsterAbstract:BackgroundThe scientific evidence base in support of population‐wide Salt reduction is strong, but current high‐quality data about Salt Intake levels in India are mostly absent. This project sought...
-
estimating mean change in population Salt Intake using spot urine samples
International Journal of Epidemiology, 2016Co-Authors: Kristina S. Petersen, Carley A. Grimes, Caryl Nowson, Mark Woodward, Jacqui Webster, Bruce NealAbstract:Background: Spot urine samples are easier to collect than 24-h urine samples and have been used with estimating equations to derive the mean daily Salt Intake of a population. Whether equations using data from spot urine samples can also be used to estimate change in mean daily population Salt Intake over time is unknown. We compared estimates of change in mean daily population Salt Intake based upon 24-h urine collections with estimates derived using equations based on spot urine samples. Methods: Paired and unpaired 24-h urine samples and spot urine samples were collected from individuals in two Australian populations, in 2011 and 2014. Estimates of change in daily mean population Salt Intake between 2011 and 2014 were obtained directly from the 24-h urine samples and by applying established estimating equations (Kawasaki, Tanaka, Mage, Toft, INTERSalt) to the data from spot urine samples. Differences between 2011 and 2014 were calculated using mixed models. Results: A total of 1000 participants provided a 24-h urine sample and a spot urine sample in 2011, and 1012 did so in 2014 (paired samples n = 870; unpaired samples n = 1142). The participants were community-dwelling individuals living in the State of Victoria or the town of Lithgow in the State of New South Wales, Australia, with a mean age of 55 years in 2011. The mean (95% confidence interval) difference in population Salt Intake between 2011 and 2014 determined from the 24-h urine samples was -0.48g/day (-0.74 to -0.21; P 0.058). Separate analysis of the unpaired and paired data showed that detection of change by the estimating equations was observed only in the paired data. Conclusions: All the estimating equations based upon spot urine samples identified a similar change in daily Salt Intake to that detected by the 24-h urine samples. Methods based upon spot urine samples may provide an approach to measuring change in mean population Salt Intake, although further investigation in larger and more diverse population groups is required.
-
mean population Salt Intake estimated from 24 h urine samples and spot urine samples a systematic review and meta analysis
International Journal of Epidemiology, 2016Co-Authors: Liping Huang, Mark Woodward, Jacqui Webster, Mary Anne Land, Bruce Neal, Michelle Crino, Federica Barzi, Rachael Mclean, Batsaikhan EnkhtungalagAbstract:BACKGROUND Estimating equations based on spot urine samples have been identified as a possible alternative approach to 24-h urine collections for determining mean population Salt Intake. This review compares estimates of mean population Salt Intake based upon spot and 24-h urine samples. METHODS We systematically searched for all studies that reported estimates of daily Salt Intake based upon both spot and 24-h urine samples for the same population. The associations between the two were quantified and compared overall and in subsets of studies. RESULTS A total of 538 records were identified, 108 were assessed as full text and 29 were included. The included studies involved 10,414 participants from 34 countries and made 71 comparisons available for the primary analysis. Overall average population Salt Intake estimated from 24-h urine samples was 9.3 g/day compared with 9.0 g/day estimated from the spot urine samples. Estimates based upon spot urine samples had excellent sensitivity (97%) and specificity (100%) at classifying mean population Salt Intake as above or below the World Health Organization maximum target of 5 g/day. Compared with the 24-h samples, estimates based upon spot urine overestimated Intake at lower levels of consumption and underestimated Intake at higher levels of consumption. CONCLUSIONS Estimates of mean population Salt Intake based upon spot urine samples can provide countries with a good indication of mean population Salt Intake and whether action on Salt consumption is required.
