Search

Objective: To assess agreement between established methods of estimating salt intake from spot urine collections and 24 h urinary Na (24hUNa) and then to develop a valid formula that can be used in the Iranian population to estimate salt intake from spot urine samples., Design: A validation study. Three spot urine samples were collected (fasting second-void morning; afternoon; evening) on the same day as a 24 h urine collection. We estimated 24hUNa from spot specimens using the Kawasaki, Tanaka and INTERSALT equations. Two new formulas were developed, the Iran formula 1 (Iran 1) and Iran formula 2 (Iran 2), based on our population characteristics., Setting: Iranian adults recruited in 2014-2015., Participants: Healthy volunteer adults aged ≥18 years., Results: With all three spot urine specimens, predicted population 24hUNa was underestimated based on the INTERSALT equation (-469 to -708 mg/d; all P < 0·05) and conversely overestimation occurred with the Kawasaki equation (926 to 1080 mg/d; all P < 0·01). The Tanaka equation produced comparable estimates to measured 24hUNa (-151 to 86 mg/d; all P > 0·49). The newly derived formulas, Iran 1 and Iran 2, showed less mean bias than the established equations (Iran 1: 43 to 80 mg/d, all P > 0·55; Iran 2: 22 to 90 mg/d, all P > 0·50)., Conclusions: In this Iranian sample, the Tanaka equation and newly derived formulas produced group-level estimates comparable to measured 24hUNa. The newly developed formulas showed less mean bias than established equations; however, they need to be tested for generalization in a larger sample.

The 2013 Institute of Medicine report entitled "Sodium Intake in Populations: Assessment of Evidence" found inconsistent evidence of health benefit with dietary sodium intake <2300 mg/d. Different studies reported benefit and harm of population dietary intake <2300 mg/d. The Institute of Medicine committee, however, did not assess whether the methodology used in each of the studies was appropriate to examine dietary sodium and health outcomes. This review investigates the association of methodological rigor and outcomes of studies in the Institute of Medicine report. For the 13 studies that met all methodological criteria, nine found a detrimental impact of high sodium consumption on health, one found a health benefit, and in three the effect was unclear (P = .068). For the 22 studies that failed to meet all criteria, 11 showed a detrimental impact, four a health benefit, and seven had unclear effects from increasing dietary sodium (P = .42)., (©2018 Wiley Periodicals, Inc.)

The standard for population-based surveillance of dietary sodium intake is 24-hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24-hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para-aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted., (©2015 Wiley Periodicals, Inc.)

Introduction: In many countries including Canada, excess consumption of dietary sodium is common, and this has adverse implications for population health. Socio-economic inequities in sodium consumption seem likely, but research is limited. Knowledge of socio-economic inequities in sodium consumption is important for informing population-level sodium reduction strategies, to ensure that they are both impactful and equitable., Methods: We examined the association between socio-economic indicators (income and education) and sodium, using two outcome variables: 1) sodium consumption in mg/day, and 2) reported use of table salt, in two national surveys: the 1970/72 Nutrition Canada Survey and the 2004 Canadian Community Health Survey, Cycle 2.2. This permitted us to explore whether there were any changes in socio-economic patterning in dietary sodium during a time period characterized by modest, information-based national sodium reduction efforts, as well as to provide baseline information against which to examine the impact (equitable or not) of future sodium reduction strategies in Canada., Results: There was no evidence of a socio-economic inequity in sodium consumption (mg/day) in 2004. In fact findings pointed to a positive association in women, whereby women of higher education consumed more sodium than women of lower education in 2004. For men, income was positively associated with reported use of table salt in 1970/72, but negatively associated in 2004., Conclusions: An emerging inequity in reported use of table salt among men could reflect the modest, information-based sodium reduction efforts that were implemented during the time frame considered. However, for sodium consumption in mg/day, we found no evidence of a contemporary inequity, and in fact observed the opposite effect among women. Our findings could reflect data limitations, or they could signal that sodium differs from some other nutrients in terms of its socio-economic patterning, perhaps reflecting very high prevalence of excess consumption. It is possible that socio-economic inequities in sodium consumption will emerge as excess consumption declines, consistent with fundamental cause theory. It is important that national sodium reduction strategies are both impactful and equitable.

The International Society of Hypertension and the World Hypertension League have developed a policy statement calling for reducing dietary salt. The policy supports the WHO and the United Nations recommendations, which are based on a comprehensive and up-to-date review of relevant research. The policy statement calls for broad societal action to reduce dietary salt, thus reducing blood pressure and preventing hypertension and its related burden of cardiovascular disease. The hypertension organizations and experts need to become more engaged in the efforts to prevent hypertension and to advocate strongly to have dietary salt reduction policies implemented. The statement is being circulated to national hypertension organizations and to international nongovernmental health organizations for consideration of endorsement. Member organizations of the International Society of Hypertension and the World Hypertension League are urged to support this effort.

This review addresses the rationale for lowering dietary sodium intake in Canada and recent progress in this direction. Data from trials involving moderate and sustained (≥ 4 weeks) reductions in sodium intake demonstrated significant dose-dependent effects on blood pressure (BP) with larger effects in hypertensive individuals. Average sodium intake in Canada (approximately 3500 mg per day) is well above currently recommended intake targets (≤ 1500 mg per day). Approximately one-eighth of sodium intake is a natural component of food, with the remainder added by food industries (approximately 3/4) or at home (approximately 1/8). Modelling results suggest that lowering Canadian sodium intake to near recommended levels would reduce hypertension prevalence by approximately 30%, prevent approximately 15,500 cardiovascular events per year, and yield savings of approximately CAD$2 billion per year. These estimates do not include the potential additional benefits of long-term sodium restriction on BP, nor BP-independent effects. Actions to facilitate lower sodium intakes in Canada included dietary intake recommendations, mandatory nutritional labelling, a national intake survey, and recommendations of a Government-appointed Sodium Working Group (SWG) that aims to reduce Canadian intakes below 2300 mg per day by 2016. SWG strategies included voluntary reductions in sodium added by food industries, increased education, and research. However, the SWG has recently been disbanded, its responsibilities passed to a Federal-Provincial-Territorial Committee and to a new Food Regulatory Advisory Committee, and the significance for implementing recommendations is unclear. Health care practitioners are encouraged to promote lower dietary sodium intake in their patients and to advocate continued Government efforts to reduce the sodium content of the Canadian food supply., (Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Increases in dietary sodium increase blood pressure, whereas emerging evidence confirms that the reduction in dietary sodium results in reduced cardiovascular events., Objectives: To estimate the effect that reducing dietary sodium can have on cardiovascular events in Canada., Methods: Based on published meta-analyses of randomized controlled trials, blood pressure reductions associated with different levels of reduction in dietary sodium were used in the model. The RR for cardiovascular events associated with the blood pressure reduction was modelled based on a meta-analysis of diuretic trials. Assumptions were made that controlled hypertensive patients would or would not have similar reduction in blood pressure as the normotensive population. Cardiovascular events in Canada for 2002 were used to estimate the decrease in cardiovascular events., Results: A reduction in daily sodium intake of 1840 mg/day was estimated to prevent 11,550 cardiovascular disease events per year. This varied from about 7300 to 10,700 events per year when hypertension control rates were varied from 13% to 66%. Reduction in cardiovascular events ranged from 8300 to 16,800 per year for a reduction in dietary sodium from 1200 mg/day to 2400 mg/day., Conclusions: Reducing dietary sodium can substantially reduce cardiovascular disease events in Canada. This information can aid policy makers in assessing the importance of public health policy and to monitor the health impact of changes in dietary sodium in Canada.

Background: Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations., Objectives: To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives., Methods: Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey., Results: Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure., Conclusions: Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.