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Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events.

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

Objective: The aim of this study was to describe sugary drink (beverages with free sugars), sugar-sweetened beverage (beverages with added sugars, SSB) and 100% juice (beverages with natural sugars) consumption across socioeconomic position (SEP) among Canadians. Methods: We conducted a cross-sectional analysis of 19,742 respondents of single-day 24-h dietary recalls in the nationally representative 2015 Canadian Community Health Survey–Nutrition. Poisson regressions were used to estimate the prevalence of consuming each beverage type on a given day. Among consumers on a given day, linear regressions were used to estimate mean energy intake. Models included household education, food security and income quintiles as separate unadjusted exposures. Sex-specific models were estimated separately for children/adolescents (2–18 years) and adults (19 +). Results: Among female children/adolescents, the prevalence of consuming sugary drinks and, separately, SSB ranged from 11 to 21 and 8 to 27 percentage-points higher among lower education compared to ‘Bachelor degree or above’ households. In female adults, the prevalence of consuming sugary drinks and, separately, SSB was 10 (95% CI: 1, 19) and 14 (95% CI: 2, 27) percentage-points higher in food insecure compared to secure households. In males, the prevalence of consuming 100% juice was 9 (95% CI: − 18, 0) percentage-points lower among food insecure compared to secure households. Social inequities in energy intake were observed in female adult consumers, among whom mean energy from sugary drinks was 27 kcal (95% CI: 3, 51) higher among food insecure compared to secure and 35 kcal (95% CI: 2, 67) higher from 100% juice among ‘less than high school’ education compared to ‘Bachelor degree or above’ households. Conclusion: Social inequities in sugary drink consumption exist in Canada. The associations differed by SEP indicator. Equitable interventions to reduce consumption are warranted.

Hypertension Canada’s 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.

Patients with chronic kidney disease (CKD) are advised to limit their dietary intake of phosphorus and potassium as hyperphosphatemia and hyperkalemia are both associated with an increased risk of mortality. There is uncertainty concerning the actual content of these minerals in the Canadian food supply, as phosphorus and potassium are increasingly being used as food additives. This study aimed to determine the impact of food additives on the chemically analyzed content of phosphorus, potassium, sodium, and protein in commonly consumed meat, poultry, and fish products (MPFs).

Population-wide dietary sodium reduction is considered a priority intervention to address sodium-related chronic diseases. In 2010, the Canadian government adopted a sodium reduction strategy to lower sodium intakes of Canadians; however, there has been a lack of coordinated action in its implementation. Our objective was to evaluate Canadians' concern, actions, reported barriers, and support for government-led policy interventions aimed at lowering sodium intakes. We conducted a survey among Canadians about sodium knowledge, attitudes, and behaviours. Data were weighted to reflect the 2006 Canadian census. Among 2603 respondents, 67.0% were concerned about dietary sodium and 59.3% were currently taking action to limit sodium intake. Those aged 50-59 years (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.17-2.72) and 60-69 years (OR, 1.63; 95% CI, 1.05-2.55) were more likely to be concerned about sodium vs younger individuals (20-29 years), as were hypertensive patients vs normotensive patients (OR, 4.13; 95% CI, 3.05-5.59). Older age groups and those with hypertension (OR, 3.48; 95% CI, 2.58-4.69) were also more likely to limit sodium consumption. Common barriers to sodium reduction were limited variety of lower sodium processed (55.5%) and restaurant (65.8%) foods. High support for government-led actions was observed, including interventions for lowering sodium levels in processed (86.6%) and restaurant (72.7%-74.3%) foods, and in food served in public institutions (81.8%-82.3%), and also for public education (80.4%-83.1%). There was much less support for financial incentives and disincentives. In conclusion, these concerns, barriers, and high level of support for government action provide further rationale for multi-sectoral interventions to assist Canadians in lowering their sodium intakes.

Background:Adherence to diet and medical therapies are key to improving heart failure (HF) outcomes; however, nonadherence is common. While mobile apps may be a promising way to support patients with adherence via education and monitoring, little is known about HF patient opinions regarding adoption of apps for HF management; which is critical to understand for these tools to be successfully developed, implemented, and adopted.Objective:To determine patients’ needs, motivations and challenges on the use of mobile apps to support HF management.Methods:A qualitative descriptive study using focus groups (n=4,60 minutes) was conducted among HF patients (aged ≥18 yrs, smartphone/tablet users, on stable medical therapy without hospital admission for ≥ 6 months) from outpatient HF clinics in Toronto, Canada. The Diffusion of Innovation theory informed a ten-question interview guide. Interview transcripts were independently coded by two researchers and analyzed using content analysis.Results:Nineteen HF patients (65 ± 10 yrs, 12 men) identified technology and app use behaviours, opportunities and challenges across six main themes: 1)‘Patient usage of technology’, many patients already used technology for daily activities and monitoring health; 2) ‘Patient views on adopting new technology’, some patients reported being early adopters of technology, while others would wait; 3) ‘Factors impacting technology use by patients’, included access to accurate information, easy and accessible user-interface; 4) ‘Providing patient support through access to information and self-monitoring’, apps could provide education on HF-related content (e.g., diet, medication, exercise, symptoms); 5) ‘Facilitating connection and communication’, apps could help information sharing with healthcare providers and connect with other patients; 6) ‘Patient preferences of app features’, app features such as reminders for medication, and visuals to show changes in HF symptoms were favoured.Conclusions:HF patients perceive several benefits to app use for HF self-management. Capitalizing on the opportunities apps offer may maximize their adoption by patients and support adherence to diet and medical therapies to improve HF outcomes.

Both the US Institute of Medicine and the Canadian Standing Committee on Health have called for simple, standardized front-of-package (FOP) nutrition labelling systems on packaged foods. However, despite scientific evidence and expert consensus on the topic, Canada’s Minister of Health has dismissed these recommendations, stating that Canadian consumers already have “the tools they need to make healthy food choices when they shop for groceries”. This is relevant since existing evidence suggests that the current regulated nutrition labelling tools may not meet their intended objectives. Furthermore, Canada’s current FOP labelling environment — characterized by a variety of FOP labels with varying criteria — does not support the objectives of good nutrition labelling defined by Health Canada. Evidence suggests that well-designed FOP systems are capable of positively influencing consumer purchases as well as product reformulations by manufacturers. The US Institute of Medicine suggests a standardized, simple, interpretive, and ordinal FOP symbol as the ideal FOP labelling system. Although additional research is required, such a system should be considered in Canada, as it may be capable of addressing the shortcomings of existing nutrition labelling tools found in the Canadian marketplace. Tant l’Institute of Medicine des États-Unis que le Comité permanent de la santé du Canada ont réclamé des systèmes d’étiquetage nutritionnel «sur le devant de l’emballage» (SLDDE) simples et standardisés pour les aliments emballés. Toutefois, malgré les preuves scientifiques et le consensus des spécialistes sur le sujet, la ministre de la Santé du Canada a rejeté ces recommandations en disant que les consommateurs canadiens possèdent déjà «les outils dont ils ont besoin pour choisir des aliments sains quand ils font l’épicerie». C’est un élément pertinent, car les données existantes portent à croire que les outils actuels de réglementation de l’étiquetage nutritionnel pourraient ne pas respecter leurs objectifs prévus. De plus, l’environnement d’étiquetage SLDDE actuel du Canada — caractérisé par diverses étiquettes SLDDE choisies selon divers critères — n’appuie pas l’objectif d’un bon étiquetage nutritionnel défini par Santé Canada. Les faits montrent que des systèmes SLDDE bien conçus sont capables d’influencer positivement les achats des consommateurs ainsi que les reformulations de produits par les fabricants. Selon l’Institute of Medicine américain, le système d’étiquetage SLDDE idéal est un symbole SLDDE standardisé, simple, interprétatif et ordinal. Il faudrait pousser la recherche, mais un tel système mérite qu’on s’y intéresse au Canada, car il pourrait combler les carences des outils d’étiquetage nutritionnel que l’on trouve actuellement sur le marché canadien.