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BackgroundEarly nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. ObjectiveThis study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. MethodsAn interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. ResultsThe environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%). ConclusionsFoodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition.

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, HF patient perspectives regarding the use of apps for HF management in unknown. This data is critical for these tools to be successfully developed, implemented, and adopted to optimize adherence and improve HF outcomes. 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 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 a total of four key themes related to the use of mobile apps. The theme 'Factors impacting technology use by patients' identified motivations and challenges to app use, including access to credible information, easy and accessible user-interface. Three themes described patients' needs on the use of mobile apps to support HF management: 1) 'Providing patient support through access to information and self-monitoring', apps could provide education on HF-related content (e.g., diet, medication, symptoms); 2) 'Facilitating connection and communication', through information sharing with healthcare providers and connecting with other patients; 3) 'Patient preferences', app features such as reminders for medication, and visuals to show changes in HF symptoms were favoured. Conclusions: HF patients perceive several benefits and challenges to app use for HF self-management. Capitalizing on the benefits and addressing the challenges during the app development process may maximize adoption of such tools in this patient population. [ABSTRACT FROM AUTHOR]

Non-weight-focused approaches (NWFAs) may be used by some clinicians when working with higher-weight clients. In contrast to weight-focused approaches (WFAs), NWFAs de-emphasize or negate weight loss and emphasize overall diet quality and physical activity. The extent to which WFAs, NWFAs, or a combination of both WFAs and NWFAs are used by dietitians is unknown in Canada and globally. This study surveyed Canadian Registered Dietitians (RDs) who counsel higher-weight clients to assess which practice approaches are most commonly used, how they view the importance of weight, and how they define "obesity" for the study population. Five practice approaches were initially defined and used to inform the survey: solely weight-focused; moderately weight-focused; those who fluctuate between weight-focused/weight-inclusive approaches (e.g., used both approaches); weight inclusive and; weight liberated. Participants (n = 383; 94.8% women; 82.2% white) were recruited using social media and professional listservs. Overall, 45.4% of participants used NWFAs, 40.5% fluctuated between weight-focused/moderately weight-focused, and 14.1% used weight-focused approaches (solely weight focused and moderately weight focused). Many participants (63%) agreed that weight loss was not important for higher-weight clients. However, 81% of participants received no formal preparation in NWFAs during their education or training. More research is needed to understand NWFAs and to inform dietetic education in support of efforts to eliminate weight stigma and provide inclusive access to care. [ABSTRACT FROM AUTHOR]

Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016–2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations. [ABSTRACT FROM AUTHOR]

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

Objective: To assess the prevalence of partially hydrogenated oils (PHO), hydrogenated oils (HO) and/or both in Canadian packaged foods in 2013 and 2017 and to determine the mean trans-fatty acid (TFA) content of products declaring such oils.Design: Repeated cross-sectional study of the Food Label Information Program.Setting: Food labels (n 32 875) were collected from top Canadian grocery retailers in 2013 and 2017. Proportions of products declaring PHO, HO and/or both in the Ingredients List were calculated by year and food category. The percentage contribution of TFA (g) to total fat (g) was calculated and compared against the voluntary TFA limits, defined as <2 % of total fat content for fats and oils, and <5 % for all other foods. Foods exceeding limits were identified. The mean TFA content (in g/serving and per 100 g) was calculated for products with these oils.Results: The use of PHO, HO and/or both significantly decreased in Canadian foods from 2013 to 2017 (0·8 to 0·2 %, 5 to 2·4 % and 5·7 to 2·6 %, respectively, for PHO, HO and/or both). The mean TFA content of products containing PHO increased (0·34 to 0·57 g TFA/serving); although it was not statistically significant, it is still concerning that TFA content increased. The TFA content significantly decreased in foods with HO (0·24 to 0·16 g TFA/serving, P < 0·05) during 2013-2017.Conclusions: Products with PHO continue to be present in the Canadian marketplace, despite voluntary efforts to eliminate them. Products with HO should also be monitored, as they can also contribute to TFA content in foods. [ABSTRACT FROM AUTHOR]

Background and objective: Food reformulation is a World Health Organization "best buy" intervention for supporting population-wide dietary sodium reduction, with the establishment of sodium reduction targets for foods as a key implementation strategy. In 2015 the Pan-American Health Organization (PAHO) led the development of regional sodium targets for the Americas, with planned, periodic monitoring and updating. Here, we describe the methodology for updating the PAHO Regional sodium targets that were released in 2021. Methods: Five successive stages were executed to update the targets: 1) Compile national targets set by Member States in the Region; 2) Synthesize and evaluate data on the sodium content of foods in Member States; 3) Consult with countries on the inclusion of new and/or revised food categories; 4) Draft new and/or revised regional targets considering the distribution of sodium in regional foods and best practices in target setting in other jurisdictions, and; 5) Seek feedback and endorsement from the PAHO Technical Advisory Group (TAG) on Cardiovascular Disease Prevention through Population-wide Salt Reduction through a series of meetings. Results: The updated targets were expanded from 18 food categories in 2015 to 75 sub-categories (in 16 food categories). Target levels for 2022 and 2025 were established for all sub-categories (mg sodium/100g and mg sodium/100kcal). The 2022 and 2025 targets were based on a 15% and 30% reduction, respectively, from the measured sodium levels at the 50th percentile. The calculated targets were assessed for feasibility and adjusted by comparing the calculated values to national targets in the region, to the United Kingdom targets, and to the 25th percentile which gave an indication of the overall distribution of sodium in a subcategory. Feasibility assessment also included the known proportion of regional foods meeting the 2015 PAHO sodium targets. Conclusions: The updated PAHO regional sodium targets are feasible and based on regional sodium data and best practices in target setting. The PAHO TAG reached consensus and endorsed the targets. The targets will support countries in the Americas in facilitating food reformulation, towards the achievement of population-wide sodium reduction goals. [ABSTRACT FROM AUTHOR]

The Science of Salt reviews identify, summarize, and critically appraise published studies on dietary salt and health outcomes according to pre-specified methods. This review covers the period April 3 to October 30, 2018. Here, nineteen studies that fit pre-specified criteria for review and summary are included. Three of these, one prospective cohort study, one randomized controlled trial, and a post hoc analysis of the Dietary Approaches to Stop Hypertension (DASH) sodium trial fulfilled the quality criteria for detailed critical appraisal, including risk of bias assessment, and commentary. Two trials demonstrated a positive association between salt intake and blood pressure. In a cohort of older Italians, increased risk of total mortality was observed with salt intake less than ~16 g/d (6300 mg sodium/d) at baseline; no association existed for incident cardiovascular disease (CVD) or CVD mortality. The paucity of published studies which met our criteria for methodological quality is of concern. [ABSTRACT FROM AUTHOR]

This review aims to summarize and synthesize studies reporting on changes in sodium levels in packaged food products, restaurant foods, and hospital or school meals, as a result of salt reduction interventions. Studies were extracted from those published in the Science of Salt Weekly between June 2013 and February 2018. Twenty-four studies were identified: 17 assessed the changes in packaged foods, four in restaurant foods, two in hospital or school meals, and one in both packaged and restaurant foods. Three types of interventions were evaluated as part of the studies: voluntary reductions (including targets), labeling, and interventions in institutional settings. Decreases in sodium were observed in all studies (n = 8) that included the same packaged foods matched at two time points, and in the studies carried out in hospitals and schools. However, there was little to no change in mean sodium levels in restaurant foods. The pooled analysis of change in sodium levels in packaged foods showed a decrease in sodium in unmatched food products (-36 mg/100 g, 95% CI -51 to -20 mg/100 g) and in five food categories-breakfast cereals, breads, processed meats, crisps and snacks, and soups. Twenty-two of the 24 studies were from high-income countries, limiting the applicability of the findings to lower resource settings. [ABSTRACT FROM AUTHOR]

The International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) is a coalition of intentional and national health and scientific organizations formed because of concerns low-quality research methods were creating controversy regarding dietary salt reduction. One of the main sources of controversy is believed related to errors in estimating sodium intake with urine studies. The recommendations and positions in this manuscript were generated following a series of systematic reviews and analyses by experts in hypertension, nutrition, statistics, and dietary sodium. To assess the population's current 24-hour dietary sodium ingestion, single complete 24-hour urine samples, collected over a series of days from a representative population sample, were recommended. To accurately estimate usual dietary sodium at the individual level, at least 3 non-consecutive complete 24-hour urine collections obtained over a series of days that reflect the usual short-term variations in dietary pattern were recommended. Multiple 24-hour urine collections over several years were recommended to estimate an individual's usual long-term sodium intake. The role of single spot or short duration timed urine collections in assessing population average sodium intake requires more research. Single or multiple spot or short duration timed urine collections are not recommended for assessing an individual's sodium intake especially in relationship to health outcomes. The recommendations should be applied by scientific review committees, granting agencies, editors and journal reviewers, investigators, policymakers, and those developing and creating dietary sodium recommendations. Low-quality research on dietary sodium/salt should not be funded, conducted, or published. [ABSTRACT FROM AUTHOR]

The Global Burden of Disease (GBD) 2010 study estimated national salt intake for 187 countries based on data available up to 2010. The purpose of this review was to identify studies that have measured salt intake in a nationally representative population using the 24-hour urine collection method since 2010, with a view to updating evidence on population salt intake globally. Studies published from January 2011 to September 2018 were searched for from MEDLINE, Scopus, and Embase databases using relevant terms. Studies that provided nationally representative estimates of salt intake among the healthy adult population based on the 24-hour urine collection were included. Measured salt intake was extracted and compared with the GBD estimates. Of the 115 identified studies assessed for eligibility, 13 studies were included: Four studies were from Europe, and one each from the United States, Canada, Benin, India, Samoa, Fiji, Barbados, Australia, and New Zealand. Mean daily salt intake ranged from 6.75 g/d in Barbados to 10.66 g/d in Portugal. Measured mean population salt intake in Italy, England, Canada, and Barbados was lower, and in Fiji, Samoa, and Benin was higher, in recent surveys compared to the GBD 2010 estimates. Despite global targets to reduce population salt intake, only 13 countries have published nationally representative salt intake data since the GBD 2010 study. In all countries, salt intake levels remain higher than the World Health Organization's recommendation, highlighting the need for additional global efforts to lower salt intake and monitor salt reduction strategies. [ABSTRACT FROM AUTHOR]

The purpose of this review is to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from April 2017 to March 2018. The search strategy was adapted from a previous systematic review on dietary salt and health. Identified studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisals. Overall, 6747 citations were identified by the search strategy, and 42 health outcome studies were identified. Three of the 42 studies met the criteria for methodological quality and health outcomes and underwent detailed critical appraisals and commentary. In addition, a systematic review and meta-analysis was critically appraised, although it did not strictly meet our methodological criteria. All four of the studies critically appraised found that sodium reduction improved blood pressure, especially in individuals with hypertension. In addition, sodium reduction reduced albuminuria in patients with stage 1-3 chronic kidney disease. Examination of the time course of blood pressure responses to sodium reduction revealed lowering sodium in the context of an average American diet may not produce maximal blood pressure reductions within a 4-week intervention period. This review provides further evidence of the benefit of sodium reduction for blood pressure lowering and gives insights into the subgroups of the population that may derive the greatest benefit from sodium reduction and the time course required to see benefit. Only three high-quality studies were identified during this 12-month review period, highlighting the critical need for more well-conducted rigorous studies in this area. [ABSTRACT FROM AUTHOR]

The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from August 2016 to March 2017. The search strategy was adapted from a previous systematic review on dietary salt and health. Studies that meet standards for methodological quality criteria and eligible health outcomes are reported in detailed critical appraisals. Overall, 47 studies were identified and are summarized in this review. Two studies assessed all-cause or disease-specific mortality outcomes, eight studies assessed morbidity reduction-related outcomes, three studies assessed outcomes related to symptoms/quality of life/functional status, 25 studies assessed blood pressure (BP) outcomes and other clinically relevant surrogate outcomes, and nine studies assessed physiologic surrogate outcomes. Eight of these studies met the criteria for outcomes and methodological quality and underwent detailed critical appraisals and commentary. Five of these studies found adverse effects of salt intake on health outcomes (BP; death due to kidney disease and initiation of dialysis; total kidney volume and composite of kidney function; composite of cardiovascular disease (CVD) events including, and risk of mortality); one study reported the benefits of salt restriction in chronic BP and two studies reported neutral results (BP and risk of CKD). Overall, these articles confirm the negative effects of excessive sodium intake on health outcomes. [ABSTRACT FROM AUTHOR]

Background: Globally, population‐wide sodium reduction strategies have been adopted and implemented to address the adverse health effects of excess dietary sodium. However, in Canada, minimal coordinated action by governments has occurred, including interventions aimed at food service operations in hospitals and long‐term care (LTC) centers. The objective of this study was to investigate actions, attitudes, barriers, and facilitators related to sodium reduction in these institutions. Methodology: A cross‐sectional survey was administered to food service administrators working in hospitals and LTC facilities in Ontario. Responses from key informants from 27 institutions, representing 9,823 patient/resident beds were included. Results: Overall, 63.0% of institutions had an established sodium target (900–4,000 mg/day). The reported sodium level on "regular" menus was 2,845 ± 1,025 mg/day. Sixty‐three percent believed it was important to reduce sodium on inpatient/resident menus. Top facilitators reported for sodium reduction included group purchasing organizations identifying lower sodium foods (85.2%), increased availability of pre‐packaged lower sodium products (77.8%), government prioritizing and providing support and resources (74.1%), and improved taste of lower sodium foods (74.1%). Only 37.0% believed that patient/resident satisfaction would decrease with sodium reduction. Sodium reduction practices were variable among food service operations. Conclusions: These data support the need for consistent and coordinated policies to facilitate sodium reduction in hospitals and long‐term care settings and for multi‐sectorial government, industry, and institutional support to ensure success. [ABSTRACT FROM AUTHOR]

The aim of the current review was to examine the scope of studies published in the Science of Salt Weekly that contained a measure of self-reported knowledge, attitudes, and behavior (KAB) concerning salt. Specific objectives were to examine how KAB measures are used to evaluate salt reduction intervention studies, the questionnaires used, and whether any gender differences exist in self-reported KAB. Studies were reviewed from the commencement of Science of Salt Weekly, June 2013 to the end of August 2017. Seventy-five studies had relevant measures of KAB and were included in this review, 13 of these were salt-reduction intervention-evaluation studies, with the remainder (62) being descriptive KAB studies. The KAB questionnaires used were specific to the populations studied, without evidence of a best practice measure. 40% of studies used KAB alone as the primary outcome measure; the remaining studies used more quantitative measures of salt intake such as 24-hour urine. Only half of the descriptive studies showed KAB outcomes disaggregated by gender, and of those, 73% showed women had more favorable KAB related to salt. None of the salt intervention-evaluation studies showed disaggregated KAB data. Therefore, it is likely important that evaluation studies disaggregate, and are appropriately powered to disaggregate all outcomes by gender to address potential disparities. [ABSTRACT FROM AUTHOR]

The purpose of this review is to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from April to July 2016. The search strategy was adapted from a previous systematic review on dietary salt and health. We have revised our criteria for methodological quality and health outcomes, which are applied to select studies for detailed critical appraisals and written commentary. Overall, 28 studies were identified and are summarized in this review. Four of the 28 studies met criteria for methodological quality and health outcomes and five studies underwent detailed critical appraisals and commentary. Three of these studies found adverse effects of salt on health outcomes (chronic kidney disease and blood pressure) and two were neutral (fracture risk/bone mineral density and cognitive impairment). [ABSTRACT FROM AUTHOR]

Excessive dietary sodium intake increases blood pressure and cardiovascular risk. In Western diets, the majority of dietary sodium comes from packaged and prepared foods (≈75%); however, in Mexico there is no available data on the main food sources of dietary sodium. The main objective of this study was to identify and characterize the major food sources of dietary sodium in a sample of the Mexican Salt and Mexico (SALMEX) cohort. Adult male and female participants of the SALMEX study who provided a complete and valid three-day food record during the baseline visit were included. Overall, 950 participants (mean age 38.6 ± 10.7 years) were analyzed to determine the total sodium contributed by the main food sources of sodium identified. Mean daily sodium intake estimated by three-day food records and 24-h urinary sodium excretion was 2647.2 ± 976.9 mg/day and 3497.2 ± 1393.0, in the overall population, respectively. Processed meat was the main contributor to daily sodium intake, representing 8% of total sodium intake per capita as measured by three-day food records. When savory bread (8%) and sweet bakery goods (8%) were considered together as bread products, these were the major contributor to daily sodium intake, accounting for the 16% of total sodium intake, followed by processed meat (8%), natural cheeses (5%), and tacos (5%). These results highlight the need for public health policies focused on reducing the sodium content of processed food in Mexico. [ABSTRACT FROM AUTHOR]

This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available. None of the studies were conducted in low- or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries. [ABSTRACT FROM AUTHOR]

The purpose of this review was to identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from December 2015 to March 2016. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 13 studies were included in the review: one study assessed cardiovascular events, nine studies assessed prevalence or incidence of blood pressure or hypertension, one study assessed kidney disease, and two studies assessed other health outcomes (obesity and nonalcoholic fatty liver disease). Four studies were selected for detailed appraisal and commentary. One study met the minimum methodologic criteria and found an increased risk associated with lower sodium intake in patients with heart failure. All other studies identified in this review demonstrated positive associations between dietary salt and adverse health outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this review was to systematically identify, summarize, and critically appraise studies on dietary salt relating to health outcomes that were published from August to November 2015. The search strategy was adapted from a previous systematic review on dietary salt and health. Overall, 15 studies were included in the review: one study assessed cardiovascular events, five studies assessed blood pressure or hypertension incidence, six studies assessed surrogate outcomes for cardiovascular or kidney diseases, and three studies assessed other outcomes (age-related cataracts, rheumatoid arthritis, and bone mineral density, respectively). Four studies were selected for detailed appraisal and commentary. [ABSTRACT FROM AUTHOR]

Background: Reduced potassium excretion caused by angiotensinconverting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may increase the risk of hyperkalemia (serum potassium concentration >5 mmol/L) in the setting of increased potassium intake. Objective: The purpose of this study was to assess the effect of increasing dietary potassium on serum potassium concentration in hypertensive individuals with normal renal function treated with an ACEi or ARB. We hypothesized that an increase in dietary potassium would not provoke hyperkalemia in this population despite treatment with either an ACEi or ARB. Design: We conducted a controlled, parallel-design clinical trial in 20 hypertensive subjects with normal renal function treated with an ACEi or ARB, with random assignment to a usual diet or a high-potassium diet (HKD). Fruit and vegetable intake was used to increase potassium intake. Serum potassium concentration, 3-d food records, and 24-h urine collections were completed at baseline and 4 wk. Results: In the usual-diet group there were no statistically significant differences for potassium excretion, intake, or serum levels at end of study compared with baseline. The HKD group had significant differences in urinary potassium excretion (83 ± 26 mmol/d at baseline compared with 109 ± 35 mmol/d at 4 wk, P = 0.01) and dietary potassium intake (3775 ± 1189 mg/d at baseline compared with 5212 ± 1295 mg/d at 4 wk, P = 0.02). Despite increased potassium intake in the HKD group, serum potassium concentrations did not significantly increase from baseline at midpoint or end of study (4.1 ± 0.6, 4.3 ± 0.3, and 4.2 ± 0.4 mmol/L, respectively). Conclusion: This study demonstrates that an increase in dietary potassium over a 4-wk period is safe in hypertensive subjects who have normal renal function and are receiving ACEi and/or ARB therapy. [ABSTRACT FROM AUTHOR]

Studies identified from an updated systematic review (from June 2014 to May 2015) on the impact of dietary salt intake on clinical and population health are reviewed. Randomized controlled trials, cohort studies, and meta-analyses of these study types on the effect of sodium intake on blood pressure, or any substantive adverse health outcomes were identified from MEDLINE searches and quality indicators were used to select studies that were relevant to clinical and public health. From 6920 studies identified in the literature search, 144 studies were selected for review, of which only three (n=233,680) met inclusion criteria. Between them, the three studies demonstrated a harmful association between excess dietary salt and all-cause mortality, noncardiovascular and cardiovascular disease mortality, and headache. None of the included studies found harm from lowering dietary salt. The findings of this systematic review are consistent with the large body of research supportive of efforts to reduce population salt intake and congruent with our last annual review from June 2013 to May 2014. [ABSTRACT FROM AUTHOR]

Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI) and Canada’s Food Guide (CFG) recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9-1.1 g/kg/day). Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality. [ABSTRACT FROM AUTHOR]

In 2015, the Pan American Health Organization (PAHO) published sodium targets for packaged foods, which included two distinct levels: one "regional" and one "lower" target. Changes to the sodium content of the food supply in Latin American Countries (LAC) has not been evaluated. A repeated cross-sectional study used food label data from 2015 (n = 3859) and 2018 (n = 5312) to determine changes in the proportion of packaged foods meeting the PAHO sodium targets and the distribution in the sodium content of foods in four LAC (Argentina, Costa Rica, Paraguay, Peru). Foods were classified into the 18 food categories in the PAHO targets. The proportion of foods meeting the regional targets increased from 82.9% to 89.3% between 2015 and 2018 (p < 0.001). Overall, 44.4% of categories had significant decreases in mean sodium content. Categories with a higher proportion of foods meeting the regional and lower targets in 2018 compared to 2015 (p < 0.05) were breaded meat and poultry, wet and dry soups, snacks, cakes, bread products, flavored cookies and crackers, and dry pasta and noodles. While positive progress has been made in reducing the sodium content of foods in LAC, sodium intakes in the region remain high. More stringent targets are required to support sodium reduction in LAC. [ABSTRACT FROM AUTHOR]

Background: High sodium intake is a leading modifiable risk factor for cardiovascular diseases. This study estimated full compliance to Canada's voluntary sodium reduction guidance (SRG) targets on social inequities and population sodium intake. Methods: We conducted a modeling study using n = 19,645, 24 h dietary recalls (Canadians ≥ 2 years) from the 2015 Canadian Community Health Survey—Nutrition (2015 CCHS-N). Multivariable linear regressions were used to estimate mean sodium intake in measured (in the 2015 CCHS-N) and modelled (achieving SRG targets) scenarios across education, income and food security. The percentage of Canadians with sodium intakes above chronic disease risk reduction (CDRR) thresholds was estimated using the US National Cancer Institute (NCI) method. Results: In children aged 2–8, achieving SRG targets reduced mean sodium intake differences between food secure and insecure households from 271 mg/day (95%CI: 75,468) to 83 mg/day (95%CI: −45,212); a finding consistent across education and income. Mean sodium intake inequities between low and high education households were eliminated for females aged 9–18 (96 mg/day, 95%CI: −149,341) and adults aged 19 and older (males: 148 mg/day, 95%CI: −30,327; female: −45 mg/day, 95%CI: −141,51). Despite these declines (after achieving the SRG targets) the majority of Canadians' are above the CDRR thresholds. Conclusion: Achieving SRG targets would eliminate social inequities in sodium intake and reduce population sodium intake overall; however, additional interventions are required to reach recommended sodium levels. [ABSTRACT FROM AUTHOR]

The interactive and engaging nature of serious games (i.e., video games designed for educational purposes) enables deeper learning and facilitates behavior change; however, most do not specifically support the dissemination of national dietary guidelines, and there are limited data on their impact on child nutrition knowledge. The Foodbot Factory serious game mobile application was developed to support school children in learning about Canada's Food Guide; however, its impacts on nutrition knowledge have not been evaluated. The objective of this study was to determine if Foodbot Factory effectively improves children's knowledge of Canada's Food Guide, compared to a control group (control app). This study was a single-blinded, parallel, randomized controlled pilot study conducted among children ages 8–10 years attending Ontario Tech University day camps. Compared to the control group (n = 34), children who used Foodbot Factory (n = 39) had significant increases in overall nutrition knowledge (10.3 ± 2.9 to 13.5 ± 3.8 versus 10.2 ± 3.1 to 10.4 ± 3.2, p < 0.001), and in Vegetables and Fruits (p < 0.001), Protein Foods (p < 0.001), and Whole Grain Foods (p = 0.040) sub-scores. No significant difference in knowledge was observed in the Drinks sub-score. Foodbot Factory has the potential to be an effective educational tool to support children in learning about nutrition. [ABSTRACT FROM AUTHOR]

High blood pressure is a leading cause of death in Costa Rica, with an estimated mortality rate of 30%. The average household sodium intake is two times higher than the World Health Organization recommendation. The consumption of processed foods is an important and growing contributor to sodium intake. The objective of this study was to describe the sodium content of packaged foods (mg/100 g) sold in Costa Rica in 2015 (n = 1158) and 2018 (n = 1016) and to assess their compliance with the national sodium reduction targets. All 6 categories with national targets were analyzed: condiments, cookies and biscuits, bread products, processed meats, bakery products, and sauces. A significant reduction in mean sodium content was found in only 3 of the 19 subcategories (cakes, tomato-based sauces, and tomato paste). No subcategories had statistically significant increases in mean sodium levels, but seasonings for sides/mains, ham, and sausage categories were at least 15% higher in sodium. Compliance with the national sodium targets among all foods increased from 80% in 2015 to 87% in 2018. The results demonstrate that it is feasible to reduce the sodium content in packaged foods in Costa Rica, but more work is needed to continually support a gradual reduction of sodium in packaged foods, including more stringent sodium targets. [ABSTRACT FROM AUTHOR]

Despite public health efforts to reduce dietary sodium, sodium intakes in most countries remains high. The purpose of this study was to determine if using novel web-based tools that provide tailored feedback, the Sodium Calculator and Sodium Calculator Plus, improves users' sodium-related knowledge, attitudes, and intended behaviours (KAB). In this single arm pre- and post-test study, 199 healthy adults aged 18–34 years completed a validated questionnaire to assess changes to sodium-related KAB before and after using the calculators. After using the calculators, the proportion of participants who accurately identified the sodium adequate intake and chronic disease risk reduction level increased (19% to 74% and 23% to 74%, respectively, both p = 0.021). The proportion accurately self-assessing their sodium intake as 'high' also increased (41% to 66%, p = 0.021). Several intended behavioural changes were reported, i.e., buying foods with sodium-reduced labels, using the Nutrition Facts table, using spices and herbs instead of salt, and limiting eating out. Evidence-based eHealth tools that assess and provide personalized feedback on sodium intake have the potential to aid in facilitating sodium reduction in individuals. This study is an important first step in evaluating and optimizing the implementation of eHealth tools to help reduce Canadians' sodium intakes. [ABSTRACT FROM AUTHOR]

Population-wide sodium reduction is a cost-effective approach to address the adverse health effects associated with excess sodium consumption. Latin American and Caribbean (LAC) countries consume excess dietary sodium. Packaged foods are a major contributor to sodium intake and a target for sodium reduction interventions. This study examined sodium levels in 12 categories of packaged foods sold in 14 LAC (n = 16,357). Mean sodium levels and percentiles were examined. Sodium levels were compared to regional sodium reduction targets. In this baseline analysis, 82% of foods met the regional target and 47% met the lower target. The greatest proportion of products meeting the regional target were uncooked pasta and noodles (98%), flavored cookies/crackers (97%), seasonings for sides/main dishes (96%), mayonnaise (94%), and cured/preserved meats (91%). A large proportion of foods met the lower target among uncooked pasta and noodles (88%), cooked pasta and noodles (88%), and meat/fish seasonings (88%). The highest the highest median sodium levels were among condiments (7778 mg/100 g), processed meats (870 mg/100 g), mayonnaise (755 mg/100 g), bread products (458 mg/100 g), cheese (643 mg/100 g), and snack foods (625 mg/100 g). These baseline data suggest that sodium reduction targets may need to be more stringent to enable effective lowering of sodium intake. [ABSTRACT FROM AUTHOR]