Salt-related practices and its association with 24-hour urinary sodium excretion in an Uruguayan population cohort / Prácticas relacionadas con la sal y su asociación con la excreción urinaria de sodio en 24 horas en una cohorte de población en Uruguay / Práticas relacionadas ao uso do sal e sua associação com a excreção de sódio na urina de 24 horas em uma coorte populacional uruguaia

Abstract Objectives. To evaluate the association between knowledge, attitudes, and behavior (KAB) towards sodium use and sodium intake measured by 24-hour urinary collection in an adult cohort from Uruguay (Genotype Phenotype and Environment of Hypertension Study, GEFA-HT-UY). Methods. In a cross-sectional study (n = 159), a single 24-hour urinary sample, participants' physical, biochemical and blood pressure measurements and questionnaire data were collected. The association between KAB and 24-hour urinary sodium excretion was assessed using general linear models. Results. Mean age of participants was 49.8±15.5 years, 67.9% were women, and mean 24-hour urinary sodium excretion was 3.6±1.7 g/day. Although 90.6% of participants exceeded the maximum recommended intake as indicated by urinary sodium excretion, more than half misperceived their actual intake, reporting consuming "the right amount." Almost three-quarters of the participants reported being concerned about the amount of sodium in their diet, but only 52.8% reported taking action to control it. Lack of procedural knowledge was observed. There was no association between KAB and sodium use and intake assessed by 24-hour urinary sodium excretion. Conclusions. The lack of association between KAB towards the use of sodium and intake measured by 24-hour urinary excretion reflects the need to support people with opportunities and motivations to reduce sodium consumption. Structural actions to promote an adequate food environment, such as the effective implementation of the front-of-package nutrition labeling in Uruguay, are positive steps.

RESUMEN Objetivos. Evaluar la relación entre conocimientos, actitudes y comportamientos en lo relativo a la ingesta de sodio medida por la recolección de orina de 24 horas en una cohorte de adultos en Uruguay (GEnotipo, Fenotipo y Ambiente de la HiperTensión Arterial en UruguaY, GEFA-HT-UY). Métodos. En un estudio transversal (n = 159), se obtuvo una muestra urinaria de 24 horas y los datos de un cuestionario y de las mediciones físicas, bioquímicas y de presión arterial de los participantes. Se evaluó la asociación entre conocimientos, actitudes y comportamientos y la excreción urinaria de sodio en 24 horas con modelos lineales generales. Resultados. La edad media de los participantes fue 49,8±15,5 años, 67,9% eran mujeres y la excreción urinaria media de sodio en 24 horas fue de 3,6±1,7 g/día. Aunque 90,6% de los participantes excedieron la ingesta máxima recomendada de acuerdo con la excreción urinaria de sodio, más de la mitad percibió su ingesta real incorrectamente al señalar que consumía "la cantidad correcta". Casi tres cuartas partes de los participantes manifestaron estar preocupados por la cantidad de sodio en su dieta, si bien solo 52,8% declaró haber tomado medidas para controlarla. Se observó una falta de conocimiento sobre los procedimientos. No se encontró una asociación entre conocimientos, actitudes y comportamientos y la ingesta de sodio evaluada mediante la excreción urinaria de sodio en 24 horas. Conclusiones. La falta de relación entre conocimientos, actitudes y comportamientos respecto del consumo de sodio y su ingesta medida por excreción urinaria en 24 horas refleja la necesidad de apoyar a las personas con oportunidades y motivaciones para reducir el consumo de sodio. Adoptar medidas estructurales que promuevan unas condiciones alimentarias adecuadas, como la aplicación efectiva del etiquetado nutricional frontal en Uruguay, constituye un paso en la dirección correcta.

RESUMO Objetivos. Avaliar a associação entre conhecimento, atitudes e comportamento (KAB, sigla do inglês Knowledge, Attitudes, Behavior) e o uso e ingestão de sódio, medida pela coleta de urina de 24 horas em uma coorte de adultos do Uruguai (Estudo do Genótipo, Fenótipo e Ambiente da Hipertensão, GEFA-HT-UY). Métodos. Em um estudo transversal (n = 159), foi coletada uma única amostra de urina de 24 horas dos participantes, medidas físicas, bioquímicas e de pressão arterial, e dados de questionários. A associação entre KAB e excreção urinária de sódio nas 24 horas foi avaliada por meio de modelos lineares gerais. Resultados. A idade média dos participantes foi de 49,8±15,5 anos; 67,9% eram mulheres e a excreção média de sódio na urina de 24 horas foi de 3,6±1,7 g/dia. Embora 90,6% dos participantes excedessem a ingestão máxima recomendada, conforme indicado pela excreção urinária de sódio, mais da metade dos participantes não tinha percepção da real ingestão de sódio, relatando consumir "a quantidade correta". Quase três quartos dos participantes relataram estar preocupados com a quantidade de sódio na dieta, mas apenas 52,8% relataram ter implementado medidas para controlá-la. Observou-se falta de conhecimento de procedimentos. Não houve associação entre KAB e o uso e a ingestão de sódio avaliada pela excreção de sódio na urina de 24 horas. Conclusões. A falta de associação entre KAB e o uso e a ingestão do sódio avaliada pela excreção urinária de 24 horas reflete a necessidade de oferecer apoio aos indivíduos por meio de oportunidades e motivações para reduzir o consumo de sódio. Ações estruturais para promover um ambiente alimentar adequado, como a implementação efetiva de advertências na rotulagem frontal dos alimentos no Uruguai, são passos positivos.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis / Excreción de sodio y potasio en 24 horas en la Región de las Américas: revisión sistemática y metanálisis / Excreção de sódio e potássio em 24 horas na Região das Américas: revisão sistemática e meta-análise

ABSTRACT Objective. To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods. A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results. Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions. These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

RESUMEN Objetivo. Determinar la excreción urinaria de sodio y potasio en 24 horas en la Región de las Américas. Métodos. Se realizaron una revisión sistemática y un metanálisis en busca de estudios realizados entre los años 1990 y 2021 con adultos residentes en cualquier Estado soberano de la Región publicados en Medline, Embase, Scopus, SciELO y Lilacs. La búsqueda se llevó a cabo por primera vez el 26 de octubre del 2020 y se actualizó el 15 de diciembre del 2021. De los 3941 resúmenes revisados, se incluyeron 74 estudios de 14 países, 72 estudios sobre excreción urinaria de sodio (27 387 adultos) y 42 estudios sobre excreción urinaria de potasio (19 610 adultos) realizados entre el 1990 y el 2020. Se agruparon los datos mediante un modelo de metanálisis de efectos aleatorios. Resultados. La excreción media de sodio fue de 157,29 mmol/24h (IC de 95%, 151,42-163,16); la de potasio, de 57,69 mmol/24 h (IC de 95%, 53,35-62,03). En los casos en que se consideraron únicamente mujeres, la excreción media de sodio fue de 135,81 mmol/24h (IC de 95%, 130,37-141,25); la de potasio, de 51,73 mmol/24h (IC de 95%, 48,77-54,70). En varones, la excreción media de sodio fue de 169,39 mmol/24h (IC de 95%, 162,14-176,64); la de potasio, de 62,67 mmol/24h (IC de 95%, 55,41-69,93). La excreción media de sodio fue de 150,09 mmol/24h (IC de 95%, 137,87-162,30) en la década de 1990 y de 159,79 mmol/24 h (IC de 95%, 151,63-167,95) en la década del 2010. La excreción media de potasio fue de 58,64 mmol/24h (IC de 95%, 52,73-64,55) en la década de 1990 y de 56,33 mmol/24h (IC de 95%, 48,65-64,00) en la década del 2010. Conclusiones. Estos resultados sugieren que la excreción de sodio casi duplica el nivel máximo recomendado por la Organización Mundial de la Salud y las excreción de potasio es 35% más baja que el requisito mínimo, por lo que se deben invertir grandes esfuerzos para reducir el consumo de sodio y aumentar la ingesta de potasio.

RESUMO Objetivo. Determinar as excreções urinárias de sódio e potássio em 24 horas na Região das Américas. Métodos. Revisão sistemática e metanálise de estudos realizados entre 1990 e 2021, em adultos vivendo em qualquer estado soberano da região, indexados nos bancos de dados MEDLINE, Embase, Scopus, SciELO e LILACS. A pesquisa foi realizada pela primeira vez em 26 de outubro de 2020 e foi atualizada em 15 de dezembro de 2021. Dos 3.941 resumos revisados, foram incluídos 74 estudos de 14 países, 72 estudos relatando sódio urinário (27.387 adultos) e 42 estudos relatando potássio urinário (19.610 adultos), realizados entre 1990 e 2020. Os dados foram reunidos utilizando um modelo de metanálise de efeitos aleatórios. Resultados. A excreção média foi de 157,29 mmol/24h (IC95% 151,42-163,16) para o sódio e 57,69 mmol/24h (IC95% 53,35-62,03) para o potássio. Quando somente mulheres foram consideradas, a excreção média foi de 135,81 mmol/24h (IC95% 130,37-141,25) para o sódio e 51,73 mmol/24h (IC95% 48,77-54,70) para o potássio. Nos homens, a excreção média foi de 169,39 mmol/24h (IC95% 162,14-176,64) para o sódio e 62,67 mmol/24h (IC95% 55,41-69,93) para o potássio. A excreção média de sódio foi de 150,09 mmol/24h (IC95% 137,87-162,30) na década de 1990 e 159,79 mmol/24h (IC95% 151,63-167,95) na década de 2010. A excreção média de potássio foi de 58,64 mmol/24h (IC95% 52,73-64,55) na década de 1990 e 56,33 mmol/24/h (IC95% 48,65-64,00) na década de 2010. Conclusões. Estes achados sugerem que as excreções de sódio são quase o dobro do nível máximo recomendado pela Organização Mundial da Saúde e as excreções de potássio são 35% menores do que o mínimo exigido; portanto, será necessário envidar esforços importantes para reduzir a ingestão de sódio e aumentar a de potássio.

Cut-Point for Satisfactory Adherence of the Dietary Sodium Restriction Questionnaire for Patients with Heart Failure / Ponto de Corte para Adesão Satisfatória do Questionário de Restrição de Sódio na Dieta em Pacientes com Insuficiência Cardíaca

Abstract Background: The low or non-adherence to reduction of sodium intake has been identified as one of the main precipitating factors of heart failure (HF). The Dietary Sodium Restriction Questionnaire (DSRQ) identifies factors that can interfere with adherence to this recommendation. However, there is still no cut-point to define adherence for this questionnaire. Objectives: To identify the cut-point for satisfactory adherence to the Brazilian version of the DSRQ, (the Questionário de Restrição de Sódio na Dieta, QRSD). Methods: Multicenter study. Patients with HF in outpatient treatment (compensated) and those treated in emergency departments due to acute HF (decompensated) were included. For the cut-point definition, the DSRQ scores were compared between groups. A ROC curve was constructed for each subscale to determine the best point of sensitivity and specificity regarding adherence. A 5% significance level was adopted. Results: A total of 206 compensated patients and 225 decompensated were included. Compensated patients exhibited scores that showed higher adhesion in all subscales (all p <0.05). Scores ≥ 40 points of a total of 45 for the subscale of Attitude and Subjective Norm; scores ≤ eight of a total of 20 for Perceived Behavioral Control; and ≤ three of a total of 15 for Dependent Behavior Control were indicative of satisfactory adherence. Conclusions: Based on the evaluation of patients in these two scenarios, it was possible to determine the cut-point for satisfactory adherence to the reduction of sodium in the diet of patients with HF. Countries with similar culture could use this cut-point, as other researchers could also use the results as a reference for further studies.

Resumo Fundamento: A baixa ou a não adesão à redução de sódio na dieta foi identificada como um dos principais fatores causais da insuficiência cardíaca (IC). O Questionário de Restrição de Sódio na Dieta (QRSD) do inglês Dietary Sodium Restriction Questionnaire (DSRQ) identifica fatores que possam interferir na adesão a essa recomendação. No entanto, anda não existe um ponto de corte que estabelece adesão segundo o QRSD. Objetivos: Identificar o ponto de corte para adesão satisfatória ao QRSD, versão brasileira do DSRQ. Métodos: Estudo multicêntrico. Foram incluídos pacientes com IC em tratamento ambulatorial (compensados) e aqueles tratados em serviços de emergência por IC aguda (descompensados). Para a definição do ponto de corte, os escores do QRSD foram comparados entre os grupos. A curva ROC foi construída para cada subescala para determinar o melhor ponto de sensibilidade e especificidade em relação à adesão. Adotou-se um nível de significância de 5%. Resultados: Foram incluídos 206 pacientes compensados e 225 pacientes descompensados. Os pacientes compensados apresentaram escores que indicaram maior adesão em todas as subescalas (p < 0,05). Escores ≥ 40 pontos de um total de 45 para a subescala "atitude e norma subjetiva"; escores ≤ 8 de um total de 20 para a subescala "controle comportamental percebido"; e escores 3 de um total de 15 para "comportamento dependente" foram indicativos de adesão satisfatória. Conclusões: A avaliação de pacientes com IC atendidos no ambulatório ou na emergência permitiu a determinação dos pontos de corte para adesão satisfatória à restrição dietética de sódio. Países de culturas similares poderiam usar esse mesmo ponto de corte, bem como outros pesquisadores poderiam utilizá-lo como referência para outros estudos.

Dietary sodium intake of adult residents in 15 provinces of China in 2015 / 中华预防医学杂志

Objective@#To analyze the status of dietary sodium intake of Chinese adult residents in fifteen provinces in 2015.@*Methods@#Data were collected from 2015 China Nutrition Transition Cohort Study. This cohort study used a three consecutive 24-h retrospective method to record food intake and weighing method to record household condiment consumption. In this study, 14 847 residents aged 18 years and over with complete data from 15 provinces in 2015 were selected for the comparison of dietary sodium intake (median) with different characteristics.@*Results@#Among the 14 847 residents, 47.1% were males, and the rural and northern residents accounted for 60.1% and 37.7%, respectively. Median sodium intake was 3 960.0 mg/d among residents in 2015. The sodium intake of males (4 272.1 mg/d) was higher than that of females (3 716.6 mg/d). Across age subgroups, sodium intake was highest among residents aged 45-59 years (4 257.0 mg/d; 18-44 years old, 3 867.1 mg/d; ≥60 years old, 3 799.0 mg/d). Sodium intake was higher in rural area (4 042.9 mg/d) than in urban area (3 866.8 mg/d), higher in north (4 229.2 mg/d) than in south (3 806.8 mg/d) (all P values <0.05). 11.8% of residents with dietary sodium intake were below 2 000 mg/d. The main sources of dietary sodium were condiments (79.4%), regular cooking foods (11.9%) and processed foods (8.7%). Among the condiments, the salt and soy sauce accounted for 63.6% and 10.4%, respectively.@*Conclusion@#In 2015, Chinese adult residents had higher dietary sodium intake with gender and regional differences. Condiments were the main source of dietary sodium.

Inappropriate activity of local renin-angiotensin-aldosterone system during high salt intake: impact on the cardio-renal axis / Atividade inadequada do sistema renina-angiotensina-aldosterona local durante período de alta ingestão de sal: impacto sobre o eixo cardiorrenal

ABSTRACT Although there is a general agreement on the recommendation for reduced salt intake as a public health issue, the mechanism by which high salt intake triggers pathological effects on the cardio-renal axis is not completely understood. Emerging evidence indicates that the renin-angiotensin-aldosterone system (RAAS) is the main target of high Na+ intake. An inappropriate activation of tissue RAAS may lead to hypertension and organ damage. We reviewed the impact of high salt intake on the RAAS on the cardio-renal axis highlighting the molecular pathways that leads to injury effects. We also provide an assessment of recent observational studies related to the consequences of non-osmotically active Na+ accumulation, breaking the paradigm that high salt intake necessarily increases plasma Na+ concentration promoting water retention

RESUMO Apesar de haver uma concordância geral sobre a necessidade de redução na ingestão de sal como questão de saúde publica, o mecanismo pelo qual a alta ingesta de sal deflagra efeitos patológicos sobre o eixo cardiorrenal não está ainda completamente elucidado. Cada vez mais evidencias indicam que o sistema renina-angiotensina-aldosterona (SRAA) seja o principal alvo da alta ingesta de Na+. Uma ativação inadequada do SRAA tecidual pode causar hipertensão e dano ao órgão. Nós revisamos o impacto da dieta com alto teor de sódio sobre o eixo cardiorrenal, destacando as vias moleculares que causam a lesão. Também fizemos uma avaliação de recentes estudos observacionais relacionados às consequências do acúmulo de Na+ não osmoticamente ativo, quebrando assim o paradigma de que a alta ingestão de sódio necessariamente aumenta a concentração sérica de Na+, assim promovendo a retenção de água.

Psychometric Testing of the Indonesian Version of Dietary Sodium Restriction Questionnaire Among Patients with Hypertension

PURPOSE: The purpose of this research was to test the validity and reliability of the Indonesian version of the Dietary Sodium Restriction Questionnaire (DSRQ-I) among patients with hypertension. METHODS: The cross-sectional study enrolled hypertensive patients from a cardiac outpatient department in Indonesia using convenience sampling. Eligible patients received a demographic questionnaire and DSRQ-I during a one-month period of data collection. Content and construct analysis examined the validity, whereas internal consistency assessment checked reliability. Participation required 10–15 minutes on average. RESULTS: One hundred thirty-five patients participated: mostly females (54.1%) and married (82.9%) with mean age of 58.18 ± 10.44 years. The item of content validity index was .97, and subscale content validity index was .81 for DSRQ-I. The KaisereMeyereOlkin test gave a value of .83, indicating adequate sampling, and the Bartlett's test of sphericity reached significant result (p < .001). The principal component analysis indicated three components, with 64.2% explaining variance, including perceived behavioral control (35.5%), attitude (19.3%), and subjective norm (9.4%). Confirmatory factor analysis produced a parsimonious model on the three-factor outcome by removing a single item. The indices of good fit model was achieved at χ2/df = 2.17, goodness fit index = .85, root mean square error of approximation = .09, standardized root mean square means = .07, and Bentler comparative fit index = .90 (p < .001). Cronbach's alpha coefficients for attitude, subjective norm, and perceived behavioral control were .85, .87, and .85, respectively. All interitem and item-total correlations indicated adequate outcome and acceptable result. Consequently, 15 items were determined reliable measurement and included in the final version of DSRQ-I. CONCLUSION: The DSRQ-I is a valid and reliable instrument to measure facilitators and barrier of sodium restriction among hypertensive patients in Indonesia.

Formula to detect high sodium excretion from spot urine in chronic kidney disease patients / Fórmula para detectar elevada excreção de sódio a partir de amostra isolada de urina de pacientes com doença renal crônica pré-dialítica

Abstract Introduction: Excessive sodium intake is related to adverse renal and cardiovascular outcomes in patients with chronic kidney disease (CKD) and assessment of sodium intake is complex and not evaluated very often in clinical practice. Objective: To develop a new formula to estimate 24h sodium excretion from urine sample (second void) of patients with CKD. Methods: We included 51 participants with CKD who provided 24-hour urine collection and a sample of the second urine of the day to determine the sodium excretion. A formula to estimate the 24-hour sodium excretion was developed from a multivariate regression equation coefficients. The accuracy of the formula was tested by calculating the P30 (proportion of estimates within 30% of measured sodium exection) and the ability of the formula to discriminate sodium intake higher than 3.6 g/day was evaluated by ROC curve. Results: Correlation test between measured and estimated sodium was significant (r = 0.57; p < 0.001), but P30 test identified a low accuracy (61%) of the formula. Different cutoff points were tested by performance tests and a ROC curve was generated with the cutoff that showed better performance (3.6 g/day). An area under the curve of 0.69 with a sensitivity of 0.91 and specificity of 0.53 was obtained. Conclusion: A simple formula with high sensitivity in detecting patients with sodium consumption higher than 3.6 g/day from isolated urine sample was developed. Studies with a higher number of participants and with different populations are necessary to test formula´s validity.

Resumo Introdução: O consumo excessivo de sódio está relacionado a piores desfechos renais e cardiovasculares em pacientes com doença renal crônica (DRC), mas a avaliação deste consumo é complexa e mensurada com baixa frequência na prática clínica. Objetivo: Desenvolver uma nova fórmula para estimar a excreção de sódio de 24h a partir da concentração de sódio em amostra isolada da segunda urina do dia em pacientes com DRC pré-dialítica. Métodos: 51 participantes com DRC forneceram coleta de urina de 24h e uma amostra da segunda urina do dia para determinação da excreção de sódio. Uma fórmula para estimar a excreção de sódio de 24h foi desenvolvida a partir dos coeficientes da equação de regressão. A acurácia da fórmula foi testada por meio do cálculo do P30. A habilidade da fórmula em discriminar consumo de sódio superior a 3,6 g/dia foi avaliada pela curva ROC. Resultados: O teste de correlação entre sódio mensurado e estimado pela fórmula foi r = 0,57; p < 0,001, porém o resultado do P30 identificou baixa acurácia (61%). Diferentes pontos de corte foram testados por meio de testes de performance e uma curva ROC foi gerada com o ponto de corte de melhor performance (3,6 g/dia). Foi obtida uma área sob a curva de 0,69 com sensibilidade 0,91 e especificidade 0,53. Conclusão: Foi desenvolvida uma fórmula simples com elevada sensibilidade em detectar pacientes com consumo de sódio superior a 3,6 g/dia a partir de amostra de urina isolada. Estudos que testem a fórmula com um maior número de participantes e com outras populações são necessários.

Qualidade da dieta e consumo de sódio por pacientes em hemodiálise de uma clínica renal da fronteira oeste do Rio Grande do Sul / Quality of diet and sodium consumption by hemodialysis patients in a renal clinic of the border west of Rio Grande do Sul

Objetivo: Avaliar a qualidade da dieta e estado nutricional de pacientes submetidos à hemo- diálise em Clínica Renal de um município do sul do Brasil. Método: Neste estudo descritivo, observacional foram incluídos 15 pacientes. Dados sociodemográficos, clínicos e laboratoriais foram coletados dos prontuários de cada paciente. Para avaliação dos dados antropométricos, foram aferidas medidas de peso seco, peso pré e pós-diálise, altura e circunferência da cintura. Dados dietéticos foram coletados por meio de um recordatório de 24h e avaliados pelo Índice de Qualidade da Dieta Revisado. O consumo de alimentos ricos em sódio foi avaliado por meio de questionário de frequência específico. Resultados: Na população estudada, a média de idade foi de 57,3 anos, sendo a maioria dos pacientes do sexo masculino (60%). A classificação do índice de massa corporal foi de eutrofia para metade dos pacientes (53,3%). A média da circunferência da cintura foi de 89,67 cm, sendo que 73,3% dos pacientes apresentaram valores adequados. Conforme avaliação dos dados dietéticos, o consumo de sódio diário foi de 3,98 g e a pontuação média do Índice de Qualidade da Dieta foi de 63,33 pontos; 66,7% da população apresentaram necessidade de modificação da dieta. Conclusões: Os pacientes apresentaram hábitos alimentares que necessitam de modificações, principalmente no que diz respeito ao consumo de frutas, verduras e cereais integrais. Também se destaca o elevado consumo de sódio, sendo o sódio adicional o mais prevalente entre o consumo total diário. Desta maneira, tornam-se necessárias estratégias de educação nutricional para uma mudança efetiva dos hábitos alimentares destes pacientes.(AU)

Objective: To evaluate dietary quality and nutritional status of hemodialysis patients in a Renal Clinic of southern Brazil. Methods: Fifteen patients were included in the study. Sociodemo- graphic, clinical and laboratory data were collected from medical records. To evaluate the anthropometric measurements were measured dry weight, weight pre and post-dialysis, height, and waist circumference. Dietary data were collected using 24-hour recalls and evaluated by the Diet Quality Index - Revised. The consumption of foods high in sodium was assessed by a food frequency questionnaire. Results: In this study the mean age was 57.3 years and most patients were male (60%). Body mass index classification was eutrophic to half of patients (53.3%). The average waist circumference was 89.67 cm, and 73.3% of patients had appro- priate values. According to the assessment of dietary data, daily sodium intake was 3.98 g and the mean score of the Diet Quality Index was 63.33 points; 66.7% of the population was classified as "need a diet modification". Conclusions: Patients of the renal clinic need dietary changes, especially regarding to the consumption of fruits, vegetables and whole grains. Also highlights the high sodium intake, being the added sodium the most prevalent among total daily consumption. Therefore, become necessary nutritional education strategies for effective change in eating habits of these patients.(AU)

Dietary Sodium Intake in People with Diabetes in Korea: The Korean National Health and Nutrition Examination Survey for 2008 to 2010

BACKGROUND: Diabetics are likely to receive advice from their physicians concerning lifestyle changes. To understand how much sodium is consumed by diabetics in Korea, we compared the average daily sodium intake between diabetics and non-diabetics after controlling for confounding factors. METHODS: We obtained the sodium intake data for 13,957 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES), 2008 to 2010, which consisted of a health interview and behavioral and nutritional surveys. The KNHANES uses a stratified, multistage, probability-sampling design, and weighting adjustments were conducted to represent the entire population. RESULTS: Our analysis revealed that, overall, diabetics tended to have lower sodium intake (4,910.2 mg) than healthy individuals (5,188.2 mg). However, both diabetic and healthy individuals reported higher sodium intake than is recommended by the World Health Organization (WHO). Stratified subgroup analyses revealed that the sodium intake (4,314.2 mg) among newly diagnosed diabetics was higher among women when compared to patients with known diabetes (3,812.5 mg, P=0.035). Female diabetics with cardiovascular disease had lower average sodium intake compared to those without cardiovascular disease after adjusting for sex, age, body mass index, and total energy intake (P=0.058). Sodium intake among male diabetics with hypercholesterolemia (P=0.011) and female diabetics with hypertriglyceridemia (P=0.067) tended to be higher than that among those who without dyslipidemia. CONCLUSION: The average sodium intake of diabetics in Korea was higher than the WHO recommends. Sodium intake in newly diagnosed diabetics was significantly higher than that in non-diabetics and previously diagnosed diabetics among females. Prospective studies are needed to identify the exact sodium intake.

High Sodium Intake: Review of Recent Issues on Its Association with Cardiovascular Events and Measurement Methods

There has been a long-known association between high dietary sodium intake and hypertension, as well as the increased risk of cardiovascular disease. Reduction of sodium intake is a major challenge for public health. Recently, there have been several controversial large population-based studies regarding the current recommendation for dietary sodium intake. Although these studies were performed in a large population, they aroused controversies because they had a flaw in the study design and methods. In addition, knowledge of the advantages and disadvantages of the methods is essential in order to obtain an accurate estimation of sodium intake. I have reviewed the current literatures on the association between sodium intake and cardiovascular events, as well as the methods for the estimation of sodium intake.

Intake of protein, calcium and sodium in public child day care centers / Ingestión de proteínas, calcio y sodio en guarderías públicas / Ingestão de proteína, cálcio e sódio em creches públicas

To assess calcium, protein and sodium intake, of children that attend public day-care centers and to compare it with the recommended one. METHODS: Cross-sectional descriptive study in seven public day care centers of São Paulo city, Southeast Brazil, which enrolled 366 children between 12 and 36 months of age. The data collection occurred between September and December 2010. Each day care center was evaluated for three non-consecutive days, totaling 42 days and 210 meals. Dietary intake was assessed by a direct food weighing method. For the nutritional calculation, DietWin(r) Profissional 2.0 was used, and the adequacy was calculated according to the recommendations of the National School Feeding Program for energy, protein, calcium and sodium. The calcium/protein relation was also calculated, as well as calcium density (mg/1,000kcal). RESULTS: The energy (406.4kcal), protein (18.2g) and calcium (207.6mg) consumption did not reach the recommended values ​​in all the evaluated day care centers. Sodium intake exceeded up to three times the recommendation. The calcium/protein ratio of 11.7mg/g was less than the adequate one (20mg/g). CONCLUSIONS: There was inadequacy of calcium, protein and sodium dietary intake, in children attending public day-care centers...

Evaluar la ingestión de calcio, proteína y sodio y compararla con la recomendada. MÉTODOS: Estudio transversal descriptivo realizado en nidos de siete guarderías públicas del municipio de São Paulo, que atendían a 366 niños entre 12 y 36 meses, siendo el periodo de recolección de septiembre a diciembre de 2010. Se evaluó cada guardería durante tres días no consecutivos, totalizando 42 días y 210 comidas. El consumo alimentar fue evaluado por método de pesaje directa de alimentos. Para el cálculo nutricional, se utilizó el software DietWin Profissional 2.0(r) y la adecuación se calculó según las recomendaciones del Programa Nacional de Alimentación Escolar (PNAE) para energía, proteína, calcio y sodio. La relación calcio/proteína y la densidad de calcio (mg/1.000kcal) también fueron computados. RESULTADOS: Se constató que el consumo de energía (406,4kcal), de proteína (18,2g) y de calcio (207,6mg) no alcanzó los valores recomendados en todas las guarderías estudiadas, siendo que la ingestión de sodio sobrepasó en hasta tres veces la recomendación. La relación calcio/proteína de 11,7mg/g fue inferior a la adecuada (20mg/g). CONCLUSIONES: Los resultados de este estudio señalan la inadecuación del consumo alimentar de calcio, proteína y sodio, suministrando subsidios para el conocimiento sobre la ingestión de los nutrientes en la población infantil y para el primer paso de toma de conciencia y evaluación del consumo alimentar de niños insertados en el contexto de guarderías públicas...

Avaliar a ingestão de cálcio, proteína e sódio e compará-la com a recomendada, em crianças que frequentam creches públicas. MÉTODOS: Estudo transversal descritivo realizado em berçários de sete creches públicas do município de São Paulo, que atendiam 366 crianças entre 12 e 36 meses, com coleta entre setembro a dezembro de 2010. Avaliou-se cada creche durante três dias não consecutivos, totalizando 42 dias e 210 refeições. O consumo alimentar foi avaliado por método de pesagem direta de alimentos. Para o cálculo nutricional, utilizou-se o software DietWin Profissional 2.0 (r) e a adequação foi calculada segundo as recomendações do Programa Nacional de Alimentação Escolar (PNAE) para energia, proteína, cálcio e sódio. A relação cálcio/proteína e a densidade de cálcio (mg/1.000kcal) também foram computadas. RESULTADOS: Constatou-se que o consumo de energia (406,4kcal), de proteína (18,2g) e de cálcio (207,6mg) não atingiu os valores recomendados em todas as creches estudadas, sendo que a ingestão de sódio ultrapassou em até três vezes a recomendação. A relação cálcio/proteína de 11,7mg/g foi inferior à adequação (20mg/g). CONCLUSÕES: Há inadequação do consumo alimentar de cálcio, proteína e sódio, em crianças inseridas no contexto de creches públicas...

The Effects of Low-sodium Diet Education Program on Dietary Habits, Diet Quality and Obesity Index in Overweight and Obese Middle-aged Women / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to investigate the effect of low sodium diet education program on dietary habits, diet quality, and measures of obesity in overweight or obese middle-aged women. METHODS: Subjects were 81 individuals aged 45 years or over, who completed an 8-week nutrition education. The subjects were divided into a normal group (N = 30) and an overweight-obese group (N = 51) according to the BMI. The effects were evaluated by anthropometric measurement, biochemical analysis, questionnaire, and diet records before and after the program. RESULTS: Overweight-obese group showed significant decreases in weight (p < 0.0001), BMI (p < 0.0001), percent of body fat (p = 0.0087), waist circumference (p < 0.0001), systolic (p = 0.0003) and diastolic blood pressure (p = 0.0261). Nutrients intakes were not different between the two groups and only sodium intake was decreased after education. Total score of general dietary habits, dietary behavior related to sodium intake, dietary diversity score (DDS), diet variety score (DVS), and diet quality index-international (DQI-I) were improved in both groups compared to the baseline. Overweight-obese group showed significant improvement in 'having fruits everyday', 'having fish everyday', 'trying to eat many kinds of food', 'eating less broth when eating soup, stew, and noodles', 'eating less kimchi and salt-fermented vegetable', and 'propensity to think that dishes should be pretty seasoned'. In addition, moderation of empty calories food (p = 0.0064) and macronutrient ratio (p = 0.0004) were improved in the overweigh-obese group, but in the normal group, the results did not reach statistical significance. CONCLUSIONS: These results suggested that low sodium diet education program may contribute to obesity management by improving diet quality and dietary habits in middle-aged women.

High Sodium Intake in Women with Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Metabolic syndrome and high sodium intake are associated with frequent cardiovascular events. Few studies have estimated sodium intake in subjects with metabolic syndrome by 24-hour urine sodium excretion. We evaluated sodium intake in individuals with metabolic syndrome. SUBJECTS AND METHODS: Participants were recruited by random selection and through advertisement. Twenty four-hour urine collection, ambulatory blood pressure measurements, and blood test were performed. Sodium intake was estimated by 24-hour urine sodium excretion. Participants receiving antihypertensive medications were excluded from analysis. RESULTS: Among the 463 participants recruited, subjects with metabolic syndrome had higher levels of 24-hour urine sodium excretion than subjects without metabolic syndrome (p=0.0001). There was a significant relationship between the number of metabolic syndrome factors and 24-hour urine sodium excretion (p=0.001). The proportion of subjects with metabolic syndrome was increased across the tertile groups of 24-hour urine sodium excretion (p<0.0001). The association of high sodium intake and metabolic syndrome was significant only among women. Among the factors related to metabolic syndrome, body mass index had an independent association with 24-hour urine sodium excretion (p<0.0001). CONCLUSION: Women with metabolic syndrome exhibited significantly higher sodium intake, suggesting that dietary education to reduce sodium consumption should be emphasized for women with metabolic syndrome.

Estimativa de consumo de sodio pela populacao brasileira, 2008-2009 / Estimativa de consumo de sodio por la poblacion brasilena, 2008-2009 / Estimated sodium intake for the Brazilian population, 2008-2009

OBJETIVO: Atualizar estimativas sobre consumo de sódio no Brasil. MÉTODOS: Foram utilizados dados da Pesquisa de Orçamentos Familiares 2008-2009. Realizou-se a conversão em nutrientes dos registros de aquisição de alimentos dos domicílios brasileiros por meio de tabelas de composição de alimentos. Foram calculadas a disponibilidade média de sódio/pessoa/dia e a disponibilidade média ajustada para um consumo energético diário de 2.000 kcal. Calculou-se a contribuição de grupos de alimentos selecionados para o total de sódio disponível para consumo no domicílio e comparou-se com aqueles da Pesquisa de Orçamentos Familiares 2002-2003. RESULTADOS: A quantidade diária de sódio disponível para consumo nos domicílios brasileiros foi de 4,7 g para ingestão diária de 2.000 kcal, mantendo-se mais de duas vezes superior ao limite recomendado de ingestão desse nutriente. A maior parte do sódio disponível para consumo provém do sal de cozinha e de condimentos à base de sal (74,4%), mas a fração proveniente de alimentos processados com adição de sal aumentou linear e intensamente com o poder aquisitivo domiciliar (12,3% do total de sódio no quinto inferior da distribuição da renda por pessoa e 27,0% no quinto superior). Observou-se redução na contribuição de sal e condimentos à base de sal (76,2% para 74,4%) e dos alimentos in natura ou processados sem adição de sal (6,6% para 4,8%) e aumento dos alimentos processados com adição de sal (15,8% para 18,9%) e dos pratos prontos (1,4% para 1,6%) na comparação com a Pesquisa de Orçamentos Familiares 2002-2003. CONCLUSÕES: O consumo de sódio no Brasil mantém-se em níveis acima da recomendação máxima para esse nutriente ...

OBJETIVO: Actualizar estimativas sobre consumo de sodio en Brasil. MÉTODOS: Se utilizaron datos de la Investigación de Presupuestos Familiares 2008-2009. Se realizó la conversión en nutrientes de los registros de adquisición de alimentos de los domicilios brasileños por medio de tablas de composición de alimentos. Se calcularon la disponibilidad promedio de sodio/persona/día y la disponibilidad promedio ajustada para un consumo energético diario de 2000 kcal. Se calculó la contribución de grupos de alimentos seleccionados para el total de sodio disponible para consumo en el domicilio y se comparó con los datos de la Investigación de Presupuestos Familiares 2002-2003. RESULTADOS: La cantidad diaria de sodio disponible para consumo en los domicilios brasileños fue de 4,7 g para ingestión diaria de 2000 kcal, manteniéndose más de dos veces mayor al límite recomendado de ingestión de dicho nutriente. La mayor parte del sodio disponible para consumo proviene de la sal de cocina y de condimentos a base de sal (74,4%), sin embargo, la fracción proveniente de alimentos procesados con adición de sal aumentó linear e intensamente con el poder adquisitivo domiciliar (12,3% del total de sodio en la quinta parte inferior de la distribución de renta por persona y 27,0% en la quinta parte superior). Se observó reducción en la contribución de sal y condimentos a base de sal (de 76,2% a 74,4%) y de los alimentos in natura o procesados sin adición de sal (de 6,6% a 4,8%) y aumento de los alimentos procesados con adición de sal (de 15,8% a 18,9%) y de las comidas listas (de 1,4% a 1,6%) en comparación con la Investigación de Presupuestos Familiares 2002-2003. CONCLUSIONES: El consumo de sodio en Brasil se mantiene en niveles por encima de la recomendación máxima para dicho nutriente ...

OBJECTIVE: To update estimates of sodium intake in Brazil. METHODS: We used data from the Brazilian Household Budget Survey of 2008-2009. Records of food purchases of households were converted into nutrients using food composition tables. Mean sodium availability per person per day and mean adjusted availability for a 2,000 kcal daily energy intake were calculated. The contribution of food groups to the total household sodium availability was calculated and compared to results estimated from the 2002-2003 Household Budget Survey. RESULTS: Mean daily sodium available for consumption in Brazilian households was 4.7 g per 2,000 kcal per day, thus still more than twice the recommended levels of intake for this nutrient. Although most of the sodium available for intake is derived from table salt or salt-based condiments (74.4%), the fraction derived from processed foods with added salt showed a strong linear increase with household income (12.3% of total sodium intake in the lower quintile of per capita income distribution and 27.0% in the upper quintile). There was a reduction in the contribution of salt and salt-based condiments (76.2% to 74.4%) and fresh or processed foods without added salt (6.6% to 4.8%) and an increase of processed foods with added salt (15.8% to 18.9%) and ready meals (1.4% to 1.6%), when compared to results estimated from the 2002-2003 Household Budget Survey. CONCLUSIONS: Sodium intake in Brazil remains at levels above the recommended maximum for this nutrient in all Brazilian macro regions and income strata. There was stability in the total household sodium availability, and an increase in the fraction from processed foods with addition of salt and ready meals, when comparing 2008-2009 with 2002-2003. .

Relación costo-utilidad de la disminución del consumo de sal y su efecto en la incidencia de enfermedades cardiovasculares en Argentina / The cost-utility ratio of reducing salt intake and its impact on the incidence of cardiovascular disease in Argentina

Objetivo. Estimar la relación costo-utilidad de una intervención dirigida a reducir el consumo de sal en la dieta de personas mayores de 35 años en Argentina. Métodos. La intervención consistió en reducir entre 5% y 25% el contenido de sal en los alimentos. Se utilizó el modelo de simulación del impacto de las políticas sobre la enfermedad coronaria para predecir la evolución de la incidencia, la prevalencia, la mortalidad y los costos en la población de la enfermedad coronaria y cerebrovascular en personas de 35 a 84 años. Se modeló el efecto y los costos de una disminución de 3 g de sal en la dieta, mediante su reducción en alimentos procesados y en la añadida por los consumidores, por un período de 10 años. Se estimó el cambio en la ocurrencia de eventos en este período y la ganancia en años de vida ajustados por la calidad (AVAC) en un escenario de efecto alto y otro de efecto bajo. Resultados. La intervención generó un ahorro neto de US$ 3 765 millones y una ganancia de 656 657 AVAC en el escenario de efecto alto y de US$ 2 080 millones y 401 659 AVAC en el escenario de efecto bajo. Se obtendrían reducciones en la incidencia de enfermedad coronaria (24,1%), infarto agudo de miocardio (21,6%) y accidente cerebrovascular (20,5%), y en la mortalidad por enfermedad coronaria (19,9%) y por todas las causas (6,4%). Se observaron beneficios para todos los grupos de edad y sexo. Conclusiones. La implementación de esta estrategia de reducción del consumo de sal produciría un efecto sanitario muy positivo, tanto en AVAC ganados como en recursos económicos ahorrados.

Objective. Estimate the cost-utility ratio of an intervention to reduce dietary salt intake in people over the age of 35 in Argentina. Methods. The intervention consisted of reducing salt content in food by 5% to 25%. A simulation model was used to measure the impact of policies on heart disease in order to predict incidence, prevalence, mortality, and cost trends for heart and cerebrovascular disease in the population aged 35–84. The intervention modeled the impact and costs of a 3-gram reduction in dietary salt intake by reducing the amount of salt in processed food and salt added to food by the participants themselves over a 10-year period. Changes in event occurrence during this period and gains in quality-adjusted life years (QALY) were estimated in high- and low-impact scenarios. Results. The intervention generated a net savings of US$ 3 765 million and a gain of 656 657 QALYs in the high-impact scenario and a savings of US$ 2 080 million and 401 659 QALY in the low-impact scenario. The result would be reductions in the incidence of heart disease (24.1%), acute myocardial infarction (21.6%), and stroke (20.5%), as well as in mortality from heart disease (19.9%) and all causes (6.4%). Benefits were observed for all age groups and both genders. Conclusions. Implementing this strategy to reduce salt intake would produce a very positive health impact, both in QALY gains and savings in economic resources.

Conocimientos, percepciones y comportamientos relacionados con el consumo de sal, la salud y el etiquetado nutricional en Argentina, Costa Rica y Ecuador / Knowledge, perceptions, and behavior related to salt consumption, health, and nutritional labeling in Argentina, Costa Rica, and Ecuador

Objetivo. Identificar los conocimientos, percepciones y comportamientos relacionados con el consumo de la sal y el sodio alimentarios y su relación con la salud y el etiquetado nutricional de los alimentos, en tres países de la Región. Métodos. Estudio cualitativo-exploratorio basado en entrevistas semiestructuradas, según las categorías del modelo de creencias en salud. Se realizaron 34 entrevistas y 6 grupos focales con líderes comunales (71 informantes en total) en áreas rurales y urbanas de Argentina, Costa Rica y Ecuador. Resultados. El consumo de sal varía en las áreas rurales y urbanas de los tres países. Para la mayoría de los entrevistados, los alimentos no se podrían consumir sin sal y solo las personas que consumen una cantidad excesiva de sal tendrían riesgos para la salud. Se desconoce que los alimentos procesados contienen sal y sodio. Aunque no medían la cantidad de sal agregada a las comidas, los participantes consideraban que consumían poca sal y no percibían su salud en riesgo. La mayoría de los informantes no revisaba la información nutricional y los que lo hacían manifestaron no comprenderla. Conclusiones. Existe un conocimiento popular en relación con la sal, no así con el término “sodio”. Se consume más sal y sodio de lo informado y no hay perspectivas de reducción. Aunque se sabe que el consumo excesivo de sal representa un riesgo para la salud, no se perciben en riesgo. El reemplazo de la palabra sodio por sal facilitaría la elección de los alimentos.

Objective. To identify the knowledge, perceptions, and behavior related to the consumption of salt and sodium in food and its relationship to health and the nutritional labeling of food in three countries of the Region. Methods. Qualitative-exploratory study based on semi-structured interviews, according to the categories of the Health Belief Model. Thirty-four interviews and six focus groups were conducted with community leaders (71 total respondents) in rural and urban areas of Argentina, Costa Rica, and Ecuador. Results. Salt consumption varies in the rural and urban areas of the three countries. Most interviewees felt that food could not be consumed unsalted and that only people who consume an excessive amount of salt would have health risks. They did not know that processed food contains salt and sodium. Although they did not measure the amount of aggregate salt in foods, the participants believed that they consumed little salt and did not perceive that their health was at risk. The majority of the participants did not review nutritional information, and those who did said that they did not understand it. Conclusions. There is public awareness about salt, but not about the term “sodium.” More salt and sodium are consumed than what is reported and there are no prospects of reducing that consumption. Although it is understood that excessive consumption of salt is a health risk, participants do not perceive that they are at risk. Replacing the word “sodium” with the word “salt” would facilitate food selection.

Avances en la reducción del consumo de sal y sodio en Costa Rica / Advances in reducing salt and sodium intake in Costa Rica

En el presente artículo se describen los avances logrados en Costa Rica —así como los desafíos y limitaciones— en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011–2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricional; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.

This article describes the progress—as well as the challenges and limitations—in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011–2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people’s diets; and 4) monitor and evaluate action geared to reducing salt/ sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

Intervenciones para reducir el consumo de sal a través del etiquetado: [revisión] / Interventions to reduce SALT consumption through labeling: [review]

Objective. Determine the extent to which labeling of food products informs about salt consumption. Methods. A critical and systematic analysis was conducted of 9 studies selected outof a total of 133 studies. The studies were collected by reviewing the scientific literature on interventions conducted in the human population aimed towards reducing salt consumption through label messaging. All of the information was obtained bydirect consultation and by Internet from the scientific literature collected in several databases. Results. Out of the 133 articles recovered, after the inclusion and exclusion criteria were applied, 9 studies were selected for review. All of them took into account theability of the study population to interpret and understand salt content labeling in foods. Conclusions. Food consumers understand and value easily recognizable logos more than the information found on nutritional composition labels. Therefore, use ofalternative logos that facilitate this information and are also standardized could be justified. This situation is reinforced because the inclusion of symbols that are easily understandable favors the most adequate choice by consumers.

Objetivo. Determinar el grado en que el etiquetado de productos alimentarios informa acerca del consumo de sal.Métodos. Se realizó un análisis crítico y sistemático de 9 estudios —seleccionados de un total de 133— recogidos mediante revisión de la literatura científica sobre las intervenciones realizadas en población humana orientadas a reducir el consumo de sal a través de mensajes en el etiquetado. Toda la información se obtuvo mediante consulta directa y vía Internet a la literatura científica recogida en varias bases de datos.Resultados. De los 133 artículos recuperados, una vez aplicados los criterios de inclusión y exclusión, se seleccionaron para la revisión 9 trabajos: en todos ellos se planteaba a la población en estudio su conocimiento acerca de la interpretación de la etiqueta sobre el contenido de salde los alimentos. Conclusiones. Los consumidores de alimentos entienden y valoran más a los logotipos que ala composición nutricional que figura en la etiqueta. Se justificaría entonces el uso de logotipos alternativos que facilitaran esta información y que además fueran normalizados. Esta situación se ve reforzada porque la inclusión de símbolos fácilmente entendibles favorece la correcta elección por parte de los consumidores.

Mecanismos neuro-hormonais envolvidos na regulação do apetite ao sódio: alguns aspectos / Neuro-hormonal mechanisms involved within sodium appetite: some aspects

O sódio é o principal íon do líquido extracelular e tem primordial importância para diversas funções fisiológicas. Manter a concentração plasmática do sódio dentro dos limites fisiológicos é vital para diversas espécies de animais, inclusive os humanos. Portanto, é fundamental que hajam mecanismos responsáveis pela monitorização e manutenção de níveis adequados de sódio no plasma. O apetite ao sódio, o comportamento que comanda a ingestão de sal, é estimulado por situações de deficiência sistêmica de sódio. Ao longo de décadas, diversos estudos foram desenvolvidos a fim de compreender os mecanismos neurais e hormonais envolvidos no controle desse comportamento. No entanto, muitas questões relacionadas a esse assunto ainda permanecem desconhecidas e a cada dia surgem novas evidências. Neste trabalho, foram revistos os fatos históricos, mecanismos neurais, hormonais e os achados mais recentes envolvendo apetite ao sódio.

Sodium is the most important ion of the extracellular fluid and plays an important role for many physiological functions. Maintain the sodium concentration in the plasma around of its physiological values is vital for many species of animals, including humans. Therefore, it is important that have responsible mechanisms for monitorization and maintenance of appropriated levels of plasmatic sodium. Sodium appetite, the behavioral drive to ingest salt, is stimulated by systemic sodium deficiency. Over the past decades, several studies have been performed in order to understand the neural and hormonal mechanisms involved in the control of this behavior. However, many questions related to this issue are still unknown and everyday new evidences arise. Here, we review historical facts, neural and hormonal mechanisms and recent findings involving sodium appetite.

Feasibility of salt reduction in processed foods in Argentina / Factibilidad de reducir el contenido de sal de los alimentos procesados en la Argentina

OBJECTIVE: To assess an intervention to reduce salt intake based on an agreement with the food industry. METHODS: Salt content was measured in bakery products through a national survey and biochemical analyses. Low-salt bread was evaluated by a panel of taste testers to determine whether a reduced salt bread could remain undetected. French bread accounts for 25 percent of the total salt intake in Argentina; hence, reducing its salt concentration from 2 percent to 1.4 percent was proposed and tested. A crossover trial was conducted to evaluate the reduction in urinary sodium and blood pressure in participants during consumption of the low-salt bread compared with ordinary bread. RESULTS: Average salt content in bread was 2 percent. This study evaluated low-salt bread containing 1.4 percent salt. This reduction remained mostly undetected by the panels of taste testers. In the crossover trial, which included 58 participants, a reduction of 25 milliequivalents in 24hour urine sodium excretion, a reduction in systolic blood pressure of 1.66 mmHg, and a reduction in diastolic blood pressure of 0.76 mmHg were found during the low-salt bread intake. CONCLUSIONS: The study showed that dietary salt reduction was feasible and well accepted in the population studied through a reduction of salt content in bread. Although the effects on urinary sodium and blood pressure were moderate, a countrywide intervention could have a greater public health impact.

OBJETIVO: Evaluar una intervención destinada a reducir el consumo de sal a partir de un convenio con la industria alimentaria. MÉTODOS: Se midió el contenido de sal de los productos de panadería por medio de una encuesta nacional y análisis bioquímicos. Un grupo de catadores evaluó el pan con bajo contenido de sal para determinar si la disminución pasaba inadvertida. Dado que el pan francés representa 25 por ciento del consumo total de sal en la Argentina, se propuso someter a prueba este tipo de pan con una disminución de la concentración de sal de 2 por ciento a 1,4 por ciento. Se realizó un estudio cruzado con el fin de evaluar si los participantes presentaban una concentración urinaria de sodio más baja y una presión arterial menor durante el período en que consumieron pan con bajo contenido de sal respecto del período en que consumieron pan común. RESULTADOS: El pan común contiene un porcentaje promedio de sal de 2 por ciento. En este estudio, el pan con bajo contenido de sal contenía 1,4 por ciento, disminución que, en general, pasó inadvertida a los catadores. En el estudio cruzado, en el que participaron 58 sujetos, la eliminación urinaria de sodio disminuyó 25 miliequivalentes en 24 horas, la presión arterial sistólica bajó 1,66 mmHg y la presión arterial diastólica bajó 0,76 mmHg durante el período en que los participantes consumieron pan con bajo contenido de sal. CONCLUSIONES: El estudio demuestra que es factible reducir la ingesta de sal alimentaria y que la población estudiada considera aceptable que el pan contenga esta menor concentración de sal. Aunque los efectos sobre la concentración urinaria de sodio y la presión arterial fueron moderados, es probable que una intervención nacional tenga repercusiones más importantes para la salud pública.