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Objective International guidelines recommend that preterm infants should be supported to maintain their serum electrolytes within "normal" ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. Study Design We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. Results There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7 ± 1.1 mmol/L), while sodium, chloride, and creatinine increased over GA by 0.17, 0.14 mmol/L/week, and 1.07 µmol/L/week, respectively (p < 0.003). Average preterm cord potassium and chloride were higher than the term (p < 0.05). Compared with adult reference intervals, cord preterm reference intervals were higher for chloride (100–111 vs. 98–106 mmol/L), lower for creatinine (29–84 vs. 62–115 µmol/L), and more variable for potassium (2.7–7.9 vs. 3.5–5.0 mmol/L) and sodium (130–141 vs. 136–145 mmol/L). Cesarean section was associated with higher potassium and lower glucose, multiple births with higher chloride and creatinine and lower glucose, and SGA with lower glucose. Conclusion Cord blood values varied across the GA range with increases in sodium, chloride, and creatinine, while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults' reference values. The changes across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management. Key Points Cord blood electrolyte, creatinine, and glucose values vary across neonatal gestational age. Average preterm cord values of potassium and chloride were higher than term values. Cord reference values differ by delivery mode, growth, and multiple impacting neonatal care decisions. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the second leading cause of total deaths in Canada. High blood pressure is the main metabolic risk factor for developing CVDs. It has been well established that excess consumption of sodium adversely affects blood pressure. Canadians' mean sodium intakes are well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention, however, dietary sodium intake and the potential health impact of meeting recommended sodium intake levels due to food reformulation have not been determined in Canada. Objective: This study aimed to 1) obtain robust estimates of Canadians' usual sodium intakes, 2) model sodium intakes had foods been reformulated to align with Health Canada's sodium reduction targets, and 3) estimate the number of CVD deaths that could be averted or delayed if Canadian adults were to reduce their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d–driven by a reduction of sodium levels in packaged foods to meet Health Canada targets (reformulation); B) 2,000 mg/d to meet the World Health Organization (WHO) recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. Methods: Foods in the University of Toronto's Food Label Information Program 2017, a Canadian branded food composition database, were linked to nationally representative food intake data from the 2015 Canadian Community Health Survey–Nutrition to estimate sodium intakes (and intakes had Health Canada's reformulation strategy been fully implemented). The Preventable Risk Integrated ModEl (PRIME) was used to estimate potential health impact. Results: Overall, mean sodium intake was 2758 mg/day, varying by age and sex group. Based on 'reformulation' scenario A, mean sodium intakes were reduced by 459 mg/day, to 2299 mg/day. Reducing Canadians' sodium intake to recommended levels under scenarios A, B and C could have averted or delayed 2,176 (95% UI 869–3,687), 3,252 (95% UI 1,380–5,321), and 5,296 (95% UI 2,190–8,311) deaths due to CVDs, respectively, mainly from ischaemic heart disease, stroke, and hypertensive disease. This represents 3.7%, 5.6%, and 9.1%, respectively, of the total number of CVDs deaths observed in Canada in 2019. Conclusion: Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada's voluntary benchmark sodium reduction targets. [ABSTRACT FROM AUTHOR]

Clubroot, a damaging disease of canola (Brassica napus L.) caused by the soilborne parasite Plasmodiophora brassicae Woronin, is spreading across Alberta and other provinces of western Canada. The movement of infested soil on field machinery is the main mechanism of dispersal, with clubroot generally occurring first as localized patches near field entrances. In this study, the soil fumigant Vapam (metam sodium) was evaluated as a management option for foci of P. brassicae infestation. Replicated experiments at two field sites in central Alberta showed reductions in clubroot severity ranging from 9% to 51% following treatment with varying rates of Vapam. Decreases in clubroot severity of up to 28% were observed in the year following Vapam treatment, indicating some potential residual effects and (or) a reduction in the amount of inoculum returned to the soil in the previous year. While Vapam shows some promise as a clubroot management tool, an integrated approach will be required for the sustainable management of this disease on canola. [ABSTRACT FROM AUTHOR]

An oral, fixed-dose coformulation of sodium phenylbutyrate and ursodoxicoltaurine (ALBRIOZA™; hereafter denoted sodium phenylbutyrate/ursodoxicoltaurine) is being developed by Amylyx Pharmaceuticals for the treatment of neurodegenerative diseases. In June 2022, the coformulation received its first approval with conditions in Canada for the treatment of amyotrophic lateral sclerosis (ALS) in adults. The approval was based on results from the multicentre, phase II CENTAUR trial, in which slowing of ALS progression was demonstrated with sodium phenylbutyrate/ursodoxicoltaurine relative to placebo. This article summarizes the milestones in the development of sodium phenylbutyrate/ursodoxicoltaurine leading to this first approval. [ABSTRACT FROM AUTHOR]

The release of Canada's Food Guide (CFG) in 2019 by Health Canada prompted the development of indices to measure adherence to these updated dietary recommendations for Canadians. This study describes the development and scoring standards of the Healthy Eating Food Index (HEFI-2019), which is intended to measure alignment of eating patterns with CFG-2019 recommendations on food choices among Canadians aged 2 years and older. Alignment with the intent of each key recommendation in the CFG-2019 was the primary principle guiding the development of the HEFI-2019. Additional considerations included previously published indices, data on Canadians' dietary intakes from the 2015 Canadian Community Health Survey-Nutrition, and expert judgement. The HEFI-2019 includes 10 components: Vegetables and fruits (20 points), Whole-grain foods (5 points), Grain foods ratio (5 points), Protein foods (5 points), Plant-based protein foods (5 points), Beverages (10 points), Fatty acids ratio (5 points), Saturated fats (5 points), Free sugars (10 points), and Sodium (10 points). All components are expressed as ratios (e.g., proportions of total foods, total beverages, or total energy). The HEFI-2019 score has a maximum of 80 points. Potential uses of the HEFI-2019 include research as well as monitoring and surveillance of food choices in population-based surveys. Novelty: The Healthy Eating Food Index-2019 was developed to measure adherence to the 2019 Canada's Food Guide recommendations on healthy food choices. The HEFI-2019 includes 10 components, of which 5 are based on foods, 1 on beverages and 4 on nutrients, for a total of 80 points. [ABSTRACT FROM AUTHOR]

The objective of this study was to validate an automated self-administered 24-hour dietary recall web application (R24W) against recovery biomarkers for sodium, potassium and protein intakes and to identify individual characteristics associated with misreporting in a sample of 61 men and 69 women aged 20–65 years from Québec City, Canada. Each participant completed 3 dietary recalls using the R24W, provided two 24-hour urinary samples and completed questionnaires to document psychosocial factors. Mean reported intakes were 2.2%, 2.1% and 5.0% lower than the urinary reference values, respectively, for sodium, potassium and proteins (significant difference for proteins only (p = 0.04)). Deattenuated correlations between the self-reported intake and biomarkers were significant for sodium (r = 0.48), potassium (r = 0.56) and proteins (r = 0.68). Cross-classification showed that 39.7% (sodium), 42.9% (potassium) and 42.1% (proteins) of participants were ranked into the same quartile with both methods and only 4.8% (sodium), 3.2% (potassium) and 0.8% (proteins) were ranked in opposite quartiles. Lower body esteem related to appearance was associated with sodium underreporting in women (r = 0.33, p = 0.006). No other individual factor was found to be associated with misreporting. These results suggest that the R24W has a good validity for the assessment of sodium, potassium and protein intakes in a sample of French-speaking adults. Novelty: The validity of an automated self-administered 24-hour dietary recall web application named the R24W was tested using urinary biomarkers. According to 7 criteria, the R24W was found to have a good validity to assess self-reported intakes of sodium, potassium and proteins. [ABSTRACT FROM AUTHOR]

Some wetlands in the northern Great Plains support hundreds to thousands of late-stage tadpoles providing important sources of recruitment to the Wood Frog (Lithobates sylvaticus) population while many other wetlands produce none. Relationships between water quality and late-stage tadpole abundance were determined to identify the water quality parameters associated with tadpole abundance. Water samples were collected, and late-stage tadpole abundances were assessed once each year in late June for 12 years in 26 wetlands. Catch or abundance was the number of tadpoles captured in 30 min with a dip-net. The catch of tadpoles was variable both among wetlands and over the long-term for individual wetlands, and ranged from 0 to several hundred individuals. Wood Frog tadpoles were especially sensitive to sodium and chloride concentrations. At Cl concentrations less than 5 mg/L, occupancy for late-stage tadpoles was 84%, and declined by about 8% for each 5 mg/L increase in Cl to 40.1 mg/L Cl, the maximum concentration associated with the detection of tadpoles. Optimal water quality for late-stage Wood Frog tadpoles included low concentrations of Na (x ¯ = 8.1 mg/L), and Cl (x ¯ = 4.2 mg/L) relative to total dissolved solids and other ions, and high concentrations of phosphorus. In a landscape where ion concentrations in wetlands can range over 3 orders of magnitude, water quality analyses suggest that abundant Wood Frog tadpole populations occur in wetlands dominated by snow-melt runoff with its characteristic low ion concentrations. The present study highlights the importance to amphibian conservation of the water quality environment of tadpole habitat. [ABSTRACT FROM AUTHOR]

Dietary sodium is required in very small amounts to support circulating blood volume and blood pressure (BP). Available nutritional surveillance data suggest that most Canadian children consume sodium in excess of their dietary requirements. Approximately 80% of the sodium Canadians consume comes from processed and packaged foods. High sodium intakes in children may be an indicator of poor diet quality. Results from systematic reviews and meta-analyses have demonstrated that decreasing dietary sodium in children leads to small but clinically insignificant decreases in BP. However, population-level strategies to reduce sodium consumption, such as food product reformulation, modifying food procurement processes, and federal healthy eating policies, are important public health initiatives that can produce meaningful reductions in sodium consumption and help to prevent chronic disease in adulthood. [ABSTRACT FROM AUTHOR]

The governments of the United States and Canada have jointly undertaken the development of the Dietary Reference Intakes (DRIs) since themid-1990s. The Federal DRI committees from each country work collaboratively to identify DRI needs, prioritize nutrient reviews, advance work to resolve methodological issues that is necessary for new reviews, and sponsor DRI-related committees through the National Academies of Sciences, Engineering and Medicine. In recent years, the Joint Canada-US DRI Working Group, consisting of members from both Federal DRI committees, developed an open and transparent nomination process for prioritizing nutrients for DRI review, by which sodium, the omega-3 (n–3) fatty acids, vitamin E, and magnesium were identified. In addition, discussions during the nutrient nomination process prompted the Federal DRI committees to address previously identified issues related to the use of chronic disease endpoints when setting DRIs. The development of guiding principles for setting DRIs based on chronic disease risk reduction will be applied for the first time during the DRI review of sodium and potassium. In summary, the US and Canadian governments have worked collaboratively to adapt our approach to prioritizing nutrients for DRI review and to broaden the scope of the DRIs to better incorporate the concept of chronic disease risk reduction in order to improve public health. [ABSTRACT FROM AUTHOR]

Calcium levels are declining in eastern North American and western European lakes. This widespread issue is affecting the composition of crustacean zooplankton communities, as the presence and abundance of several calcium-rich daphniid species are declining, while two other daphniids, D. catawba and D. ambigua , that apparently tolerate low calcium environments, are prospering. The physiological basis for low calcium tolerance of these daphniids is unknown. In this study the presence of one Ca-rich ( D. pulicaria ) and one Ca-poor ( D. ambigua ) daphniid species in Canadian Shield lakes is assessed in relation to lake water Ca levels. The occurrence of D. ambigua was independent of Ca levels in Ontario lakes, whereas D. pulicaria was more likely to occur in lakes with relatively more Ca. In the laboratory, D. ambigua maintained lower levels of hemolymph Ca 2+ across a range of low Ca levels (0.7 to 7 mg l −1 ) compared with D. pulicaria . The hemolymph pH remained steady across this Ca gradient in D. ambigua while it was significantly more acidic in D. pulicaria in the two lowest Ca treatments. While Ca 2+ uptake was observed adjacent to the surface of D. ambigua individuals, Ca 2+ loss was observed for D. pulicaria assayed under moderately high Ca levels. Based on these observations we propose that D. ambigua is able to survive in low Ca lakes by maintaining low free ionic Ca 2+ levels in the hemolymph which minimizes the Ca gradient across the body wall in low Ca water thus limiting overall Ca loss and facilitating Ca 2+ uptake. [ABSTRACT FROM AUTHOR]

Background: Approximately 2 in 3 US adults have prehypertension or hypertension that increases their risk of cardiovascular disease. Reducing sodium intake can decrease blood pressure and prevent hypertension. Approximately 9 in 10 Americans consume excess sodium (≥2300 mg/d). Voluntary sodium standards for commercially processed and prepared foods were established in North America, but their impact on sodium intake is unclear. Objective: We modelled the potential impact on US sodium intake of applying voluntary sodium standards for foods. Design: We used NHANES 2007-2010 data for 17,933 participants aged ≥1 y to model predicted US daily mean sodium intake and the prevalence of excess sodium intake with the use of the standards of the New York City's National Salt Reduction Initiative (NSRI) and Health Canada for commercially processed and prepared foods. The Food and Nutrient Database for Dietary Studies food codes corresponding to foods reported by NHANES participants were matched to NSRI and Health Canada food categories, and the published sales-weighted mean percent reductions were applied. Results: The US population aged ≥1 y could have reduced their usual daily mean sodium intake of 3417 mg by 698 mg (95% CI: 683, 714 mg) by applying NSRI 2014 targets and by 615 mg (95% CI: 597, 634 mg) by applying Health Canada's 2016 benchmarks. Significant reductions could have occurred, regardless of age, sex, race/ethnicity, income, education, or hypertension status, up to a mean reduction in sodium intake of 850 mg/d in men aged ≥19 y by applying NSRI targets. The proportion of adults aged ≥19 y who consume ≥2300 mg/d would decline from 88% (95% CI: 86%, 91%) to 71% (95% CI: 68%, 73%) by applying NSRI targets and to 74% (95% CI: 71%, 76%) by applying Health Canada benchmarks. Conclusion: If established sodium standards are applied to commercially processed and prepared foods, a significant reduction of US sodium intake could occur. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether higher intakes of Na, added sugars and saturated fat are prospectively associated with all-cause mortality and CVD incidence and mortality in a diverse population. The nationally representative Canadian Community Health Survey-Nutrition 2004 was linked with the Canadian Vital Statistics - Death Database and the Discharge Abstract Database (2004-2011). Outcomes were all-cause mortality and CVD incidence and mortality. There were 1722 mortality cases within 115 566 person-years of follow-up (median (interquartile range) of 7·48 (7·22-7·70) years). There was no statistically significant association between Na density or energy from saturated fat and all-cause mortality or CVD events for all models investigated. The association of usual percentage of energy from added sugars and all-cause mortality was significant in the base model with participants consuming 11·47 % of energy from added sugars having 1·34 (95 % CI 1·01, 1·77) times higher risk of all-cause mortality compared with those consuming 4·17 % of energy from added sugars. Overall, our results did not find statistically significant associations between the three nutrients and risk of all-cause mortality or CVD events at the population level in Canada. Large-scale linked national nutrition datasets may not have the discrimination to identify prospective impacts of nutrients on health measures.

Canada recently mandated front-of-pack (FOP) labelling regulations, where foods meeting and/or exceeding recommended thresholds for nutrients-of-concern (i.e., saturated fat, sodium, and sugars) must display a 'high-in' FOP nutrition symbol. However, there is limited research on the amounts and sources of foods consumed by Canadians that would require a FOP symbol. The objective was to examine the intakes of nutrients-of-concern from foods that would display a FOP symbol and to identify the top food categories contributing to intakes for each nutrient-of-concern. Using the first day 24-hour dietary recall from the nationally representative 2015 Canadian Community Health Survey-Nutrition (CCHS), Canadian adults' intakes of nutrients-of-concern from foods that would display a FOP symbol was examined. Foods were assigned to 1 of 62 categories to identify the top food categories contributing to intakes of energy and nutrient-of-concern that would display a FOP symbol for each nutrient-of-concern. Canadian adults (n = 13,495) consumed approximately 24% of total calories from foods that would display a FOP symbol. Foods that would display a FOP symbol for exceeding thresholds for nutrients-of-concern accounted for 16% of saturated fat, 30% of sodium, 25% of total sugar, and 39% of free sugar intakes among Canadian adults. The top food category contributing intakes of each nutrient-of-concern that would display a FOP symbol were nutrient-specific: Processed meat and meat substitutes for saturated fat; Breads for sodium; and Fruit juices & drinks for total and free sugars. Our findings show that Canadian FOP labelling regulations have the potential to influence the intakes of nutrients-of-concern for Canadian adults. Using the findings as baseline data, future studies are warranted to evaluate the impact of FOP labelling regulations., Competing Interests: MA, APN, and MRL received a competitive research grant from the Institute for the Advancement of Food and Nutrition Sciences (IAFNS) to analyze National Health and Nutrition Examination Survey (NHANES) data to determine sodium intakes and sources in diets of Americans. APN currently works at the Canadian Sugar Institute. However, none of the organizations had a role in this research. No other authors have competing interests to declare., (Copyright: © 2023 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In 2010, as part of a national sodium reduction strategy, Canada published sodium reduction benchmark targets for packaged foods; however, no evaluation of this policy has occurred. The objective was to evaluate changes in the sodium content of packaged foods, identify categories reduced in sodium, and determine the proportion meeting Health Canada's sodium reduction benchmarks. This was a cross-sectional analysis of Canadian packaged foods in 2010 and 2013 ( n = 10 487 and n = 15 394, respectively). Sodium content was obtained from the Nutrition Facts table. Overall, 16.2% of food categories had significantly reduced sodium levels. The greatest shifts in the distribution of sodium within food categories occurred in imitation seafood (mean ± SD, mg/100 g; 602 ± 50 to 444 ± 81, 26.2%, p = 0.002), condiments (1309 ± 790 to 1048 ± 620, 19.9%, p = 0.005), breakfast cereals (375 ± 26 to 301 ± 242, 19.7%, p = 0.001), canned vegetables/legumes (269 ± 156 to 217 ± 180, 19.3%, p < 0.001), plain chips (462 ± 196 to 376 ± 198, 18.6% p = 0.004), hot cereals (453 ± 141 to 385 ± 155, 15.0%, p = 0.011), meat analogues (612 ± 226 to 524 ± 177, 14.4%, p = 0.003), canned condensed soup (291 ± 62 to 250 ± 57, 14.1%, p = 0.003), and sausages and wieners (912 ± 219 to 814 ± 195, 10.7%, p = 0.012). The proportion of foods meeting at least 1 of the 3 phases of the sodium reduction benchmark targets slightly increased (51.4% to 58.2%) and the proportion exceeding maximum benchmark levels decreased (25.2% to 20.8%). These data provide a critical evaluation of changes in sodium levels in the Canadian food supply. Although progress in reducing sodium in packaged foods is evident, the food industry needs to continue efforts in reducing the sodium in the foods they produce. [ABSTRACT FROM AUTHOR]

The average salt intake of people in Canada, the United States, and Europe is about 3,400mg of sodium per day, which exceeds the recommended intake levels set by various health organizations. The World Health Organization recommends a worldwide reduction of sodium intake to less than 2,000mg per day. Most research to date has focused on the negative effects of high-sodium intake; however, little information is available on the metabolic effects of low-sodium intakes. This review focuses on the hormonal changes associated with low-sodium diets, specially the hormones involved in metabolism and cardiovascular and renal function. Based largely on rodent studies, low-sodium diets have been associated with changes in glycemic control, energy metabolism, cardiovascular disease risk, cholesterol concentrations, inflammation, and functioning of the renin-angiotensin-aldosterone system. Overall, research has revealed mixed results regarding the impact of dietary sodium intake on various hormones. Further research is required to assess the effects of sodium reduction on hormones and their associated pathways in order to determine the likelihood of any unintended effects. [ABSTRACT FROM AUTHOR]

Background: Sodium fluctuations in very preterm neonates and their neurodevelopmental consequences are not well described., Methods: We assessed the changes in plasma sodium and glucose in the first days of life in very preterm neonates and studied the association of glucose-corrected plasma sodium fluctuations on neurodevelopmental outcomes. We included 147 consecutive neonates born before 29 weeks of gestation in our center and retrospectively obtained plasma sodium, glucose, and glucose-corrected sodium levels. Neurodevelopmental assessment was obtained from the Canadian Neonatal Follow-Up Network., Results: Mean ± standard deviation of plasma sodium changes within the first 10 days of life were 16.2 ± 6.0, 14.8 ± 5.3, and 11.1 ± 5.2 mmol/l in neonates born ≤25, 25-26, and 26-27 weeks of gestation, respectively (p < 0.001). Non-steroidal anti-inflammatory drug administration was associated with larger plasma sodium fluctuation. Eighty-six percent had a known neurological status at 18 months. Higher fluctuations in glucose-corrected plasma sodium were associated with death or neurodevelopmental impairment at 18 months corrected age (B = 3.19, 95% CI [1.24, 5.14]), and this association remained after adjustment for gestational age (B = 2.1, 95% CI [0.16, 4.04])., Conclusions: Neonates born very preterm show fluctuations in glucose-corrected plasma sodium during the first days of life, which may increase the risk of death or developmental impairment., Impact: Risk factors and neurodevelopmental consequences of plasma sodium changes in early neonatal life of preterm infants are not well characterized. This study shows for the first time that glucose-corrected plasma sodium fluctuations within the first days of life are more severe in preterm infants receiving non-steroidal anti-inflammatory drugs (NSAIDs) and are associated with death or neurodevelopmental impairment at 18 months corrected age. Large plasma sodium and glucose fluctuations should be expected more often in preterm infants receiving NSAIDs and should be avoided., (© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Background: Canada proposed the implementation of mandatory front-of-pack (FOP) labelling regulations, whereby foods meeting or exceeding thresholds for nutrients-of-concern (i.e., total sugars, saturated fat, sodium) must display a 'high-in' FOP symbol (FOP). The objective of the study was to evaluate the potential implications of the proposed regulations using Canadian generic and branded food composition databases., Methods: A generic food composition database of products consumed by Canadians, Canadian Nutrient File (CNF) 2015 (n = 3,677), and a branded food composition database of packaged foods and beverages, Food Label Information Program (FLIP) 2017 (n = 17,521), were used to evaluate the number and proportion of foods that would display a FOP symbol based on the details of the proposed FOP labelling regulations published in 2018., Results: Overall, 35.5% (n = 1,306) of products in CNF 2015 and 63.9% (n = 11,193) of products in FLIP 2017 would display a FOP symbol for at least one nutrient-of-concern exceeding proposed thresholds. Soups, Combination Dishes, and Desserts categories in CNF 2015 and Combination dishes, Soups, and Meats categories in FLIP 2017 would have the highest proportion of products that would display a FOP symbol. Although displaying a FOP symbol for one nutrient was most common in both CNF 2015 (n = 992; 27.0%) and FLIP 2017 (n = 7,296, 41.6%), the number (i.e., 0-3) and type (i.e., saturated fat, sodium, total sugar) of nutrients displayed varied by food category., Conclusion: While the generic database, containing both packaged and unpackaged foods, revealed a low prevalence of foods that would display a FOP symbol, the branded database showed that the proposed FOP labelling regulations would identify over 60% of packaged foods with excess contents of nutrients-of-concern. Considering the high prevalence of packaged foods in Canada that would meet or exceed the thresholds of nutrients-of-concern, the proposed FOP labelling regulations should be implemented in a timely manner to help consumers easily identify foods high in nutrients-of-concern and encourage manufacturer-driven product reformulations., (© 2022. The Author(s).)

Guidance from Health Canada to limit highly processed foods (HPF) seeks to ensure that Canadians remain within intake recommendations for nutrients of concern. However, HPF can contribute to dietary requirements of specific populations. The Canadian Nutrition Society and Institute for the Advancement of Food and Nutritional Sciences convened speakers for a Food for Health workshop in 2021 to provide evidence and perspectives from government, industry, and healthcare on reasons for advocating limits and potential unintended consequences of limiting HPF, and implications and necessity of HPF in clinical settings. This paper discusses advantages and disadvantages of HPF explored at this workshop.

Background: Characteristics of patients using newer 2 nd and 3 rd line antidiabetic drugs in a real-world setting are poorly understood. We described the characteristics of new users of sodium-glucose co-transporter-2 inhibitors (SGLT-2i), dipeptidyl peptidase-4 inhibitors (DPP-4i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in Canada and the United Kingdom (UK) between 2016 and 2018., Methods: We conducted a multi-database cohort study using administrative health databases from 7 Canadian provinces and the UK Clinical Practice Research Datalink. We assembled a base cohort of antidiabetic drug users between 2006 and 2018, from which we constructed 3 cohorts of new users of SGLT-2i, DPP-4i, and GLP-1 RA between 2016 and 2018., Results: Our cohorts included 194,070 new users of DPP-4i, 166,722 new users of SGLT-2i, and 27,719 new users of GLP-1 RA. New users of GLP-1 RA were more likely to be younger (mean ± SD: 56.7 ± 12.2 years) than new users of DPP-4i (67.8 ± 12.3 years) or SGLT-2i (64.4 ± 11.1 years). In Canada, new users of DPP-4i were more likely to have a history of coronary artery disease (22%) than new users of SGLT-2i (20%) or GLP-1 RA (15%)., Conclusion: Although SGLT-2i, DPP-4i, and GLP-1 RAs are recommended as 2 nd or 3 rd line therapy for type 2 diabetes, important differences exist in the characteristics of users of these drugs. Contrary to existing guidelines, new users of DPP-4i had a higher prevalence of cardiovascular disease at baseline than new users of SGLT2i or GLP-1RA., (© 2022. The Author(s).)

Updating evidence-based nutrient guidance is challenging. One set of recommendations for which a robust evidence base is essential is the DRIs. In the past 10 y, DRI values for 4 essential nutrients have been re-evaluated in 2 groups: vitamin D and calcium, and sodium and potassium. To support the work of the committees tasked with evaluating the available evidence, the federal agencies that sponsor the DRI reviews contracted with the Agency for Healthcare Research and Quality to perform systematic reviews on predefined questions for these nutrient groups. Our aims were to tabulate the studies included in these systematic reviews and then, within the context of prespecified outcomes, summarize the totality of the available evidence and identify areas for consideration to maximize the value of the end products for future DRI committees. For the outcomes of interest, the available studies did not tend to report age data consistent with the current DRI categories. For some life stage categories, particularly pregnancy and lactation, there is a dearth of data. A wide range of study interventions were used, making it challenging to combine data to accurately derive or re-evaluate DRI values. There is also an under-representation of data on race/ethnicity and overweight/obesity, which is of concern, given the shifting demographic in the US and Canadian populations. Moving forward, it may be advantageous to develop a process to prospectively target research funding for studies designed to generate data that will most closely support re-evaluation of DRI values., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Abstract: A recommendation for increased whole grain consumption was released in Canada in 2007 to promote adequate intakes of fibre and magnesium. Since then, a proliferation of ‘whole grain’ claims on food packaging has been observed, but whole grain labelling is voluntary and unregulated in Canada. Through a detailed survey of bread sold in three supermarkets, this study examined how the presence of front-of-package reference to whole grain relates to (i) the presence and nature of whole grain ingredients, (ii) nutrient content, and (iii) price of the product. Twenty-one percent of breads bore a reference to whole grain on the front-of-package and the front-of-package reference to whole grain was a better predictor of fibre content than any information that could be gleaned from the ingredient list. On average, breads with a whole grain reference were higher in fibre and magnesium and lower in sodium. Mean price did not differ by presence of a whole grain reference, but breads with whole grain labelling were less likely to be low in price. Voluntary nutrition labelling may be targeting a discrete market of health-conscious consumers who are willing to pay premium prices for more healthful options. [Copyright &y& Elsevier]

Background: 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., Methods: SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2-3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 100 mmol (ie, <1500 mg/day). The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual., Findings: Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58-74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653-3005) to 1658 mg/day (1301-2189) in the low sodium group and from 2119 mg/day (1673-2804) to 2073 mg/day (1541-2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63-1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73-2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54-1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60-2·41]; p=0·60). No safety events related to the study treatment were reported in either group., Interpretation: In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events., Funding: Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand., Competing Interests: Declaration of interests JAE reports research grants from American Regent, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb/Pfizer, eko.ai, US2.ai, Merck, Novartis, Otsuka, Sanofi, and Servier, and consulting fees from American Regent, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb/Pfizer, Merck, Novartis, Otsuka, Sanofi, and Servier. PM reports research grants from National Health & Medical Research Committee, New South Wales Department of Health, and St Vincent's Clinic Foundation; consulting fees from AstraZeneca, Boehringer Ingelheim, and Novartis; honoraria payments from Japanese Circulation Society; support for attending meetings or travel from Astellas; and stock or stock options from Infensa Biologics. RT reports research grants from Health Research Council of New Zealand; consulting fees from Merck and Roche Diagnostics; and honoraria payments from Roche Diagnostics. CS reports research grants from Medtronic; consulting fees from AstraZeneca, Bayer, Merck, and Boehringer Ingelheim; honoraria payments from AstraZeneca, Bayer, Merck, Boehringer Ingelheim, and Novartis; and fees for participation in advisory boards from Servier, AstraZeneca, Bayer, Merck, Boehringer Ingelheim, and Novartis. JAt reports consulting fees from AstraZeneca, Boehringer Ingelheim, and Eli Lilly and support for attending meetings from AstraZeneca, Novartis, and Shire. MG reports research grants from the University of Alberta. JH reports research grants from AstraZeneca; consulting fees from Servier, Otsuka, Alnylam, Boehringer Ingelheim, Lilly, Novo Nordisk, Bayer Canada, AstraZeneca, and Novartis; and honoraria payments from Servier, Otsuka, Alnylam, Boehringer Ingelheim, Lilly, Novo Nordisk, Bayer Canada, AstraZeneca, and Novartis. SJ reports research payments from the University of Alberta. ML reports consulting fees from New Zealand Formulary and honoraria payment from Novartis. JS reports consulting fees from Servier and Novartis; honoraria payments from Bayer; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Servier, Novartis, Bayer, and HLS Therapeutics. SZ reports consulting fees from Abbott, Akcea, AstraZeneca, Amgen, Alnylam, Bayer, Boehringer Ingelheim, Eli Lilly, Merck, Novartis, Otsuka, Pfizer, Servier, and Vifor; and honoraria payments from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS Therapeutics, Janssen, Novartis, Novo Nordisk, Servier, and Vifor. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective. To describe individual attitudes, knowledge, and behavior regarding salt intake, its dietary sources, and current food-labeling practices related to salt and sodium in five sentinel countries of the Americas. Methods. A convenience sample of 1 992 adults (≥ 18 years old) from Argentina, Canada, Chile, Costa Rica, and Ecuador (approximately 400 from each country) was obtained between September 2010 and February 2011. Data collection was conducted in shopping malls or major commercial areas using a questionnaire containing 33 questions. Descriptive estimates are presented for the total sample and stratified by country and sociodemographic characteristics of the studied population. Results. Almost 90% of participants associated excess intake of salt with the occurrence of adverse health conditions, more than 60% indicated they were trying to reduce their current intake of salt, and more than 30% believed reducing dietary salt to be of high importance. Only 26% of participants claimed to know the existence of a recommended maximum value of salt or sodium intake and 47% of them stated they knew the content of salt in food items. More than 80% of participants said that they would like food labeling to indicate high, medium, and low levels of salt or sodium and would like to see a clear warning label on packages of foods high in salt. Conclusions. Additional effort is required to increase consumers' knowledge about the existence of a maximum limit for intake and to improve their capacity to accurately monitor and reduce their personal salt consumption. [ABSTRACT FROM AUTHOR]

Abstract: Sodium (Na) and potassium (K) are essential nutrients. Like people in many Western societies, Canadians consume too much Na and not enough K, both of which contribute to hypertension. We analysed the Na and K content of 154 food composites, broadly representative of the foods most commonly consumed in Canada, from the Canadian Total Diet Study collection of 2007. Foods were prepared as if for home consumption before compositing. No salt was added during food preparation. Samples prepared by aqueous extraction were analysed by atomic emission (Na) or atomic absorption spectrometry (K). Processed foods and soups contained large amounts of Na per reference amount (serving) of the food, with 17 samples containing over 1/3 of the Adequate Intake (AI) for adults, or >500mg Na/serving. Fluid milk, unprocessed meats and several fruits and vegetables contained large amounts of K per reference amount, with 11 samples containing over 10% of the AI for adults, or >470mgK/serving. Na:K molar ratios were typically either high or low, with few values near unity. Thus, with few exceptions, foods high in Na were lower in K, and vice versa. Through judicious food selection it may be possible for consumers to decrease Na intake while increasing K, with associated health benefits. Such choices would be consistent with common nutrition advice to decrease consumption of processed foods, while increasing intakes of fresh fruits and vegetables. [Copyright &y& Elsevier]

We studied the activity of T138067-sodium in patients with malignant gliomas. T138067-sodium is a unique new chemotherapy agent that inhibits microtubule formation by binding irreversibly and specifically to β1, β2, and β4 isotypes of β-tubulin, causing cell arrest at G2/M and inducing apoptosis. Patients with recurrent anaplastic astrocytoma or glioblastoma multiforme were treated intravenously with 330 mg/m² of T138067-sodium weekly. Treatment was continued until the patient experienced either unacceptable toxicity or progressive disease. Patients had to have histologically proven glioma, have bidimensionally measurable disease at least 1 cm × 1 cm, and have received no more than one prior adjuvant chemotherapy. No chemotherapy or radiotherapy for recurrent disease was permitted. Nineteen patients entered the trial. One patient was found to be ineligible. There were two patients with anaplastic astrocytoma and 16 with glioblastoma multiforme. Only two patients had received prior adjuvant chemotherapy. The first seven patients had full pharmacokinetic sampling. No dose-limiting toxicity was seen, and pharmacokinetic results were consistent with those from nonglioma patients. The most common drug-related effects were fatigue (33%), nausea (28%), neutropenia (28%), and anorexia (17%). No patients stopped the study because of toxicity. No responses were seen in the 15 eligible patients who completed at least one cycle. Three patients had stable disease with a median duration of 2.6 months. Our results suggest that given in this dose and schedule T138067-sodium does not have activity in this population of anaplastic astrocytoma and glioblastoma multiforme. [ABSTRACT FROM AUTHOR]

The objective of this study is to decide if chemical concentrations measured during 1988-1997 in precipitation by the Canadian Air and Precipitation Monitoring Network (CAPMoN) indicate changes in the annual patterns. The inference is based on SO4, NO3, Cl, NH4, Na, Ca and K concentrations monitored daily with the rain water acidity pH. By pattern is understood the probability distribution of the annual sample at a particular location. Most of the annual data can be well described by means of a linear regression model with second order polynomial trend and autocorrelated noise. Statistical analysis based on the model shows luck of systematic significant year to year increases or declines of the concentrations. [ABSTRACT FROM AUTHOR]

The Sodium Reduction Strategy for Canada includes an identification of priority areas for future research, based on a workshop convened by the Canadian Institutes of Health Research (CIHR) and partners. A strong portfolio of research is essential to addressing current developments and controversies raised in relation to the health outcomes associated with dietary sodium. CIHR aims to provide leadership in working together with other funders and partners to catalyze a broad range of sodium research. [ABSTRACT FROM AUTHOR]

Using Canadian (CMZ), Bear River (BRZ), and St. Cloud (SCZ) zeolites, this study investigates the application of natural and pre-treated zeolites for Na + removal from salinised groundwater. Natural BRZ achieved better Na + removal for initial concentrations of 250-10,000 mg Na + /L and had the highest maximum adsorption capacity (14.3 ± 0.4 mg/g) compared to natural CMZ (5.8 ± 0.5 mg/g) and SCZ (5.6 ± 0.7 mg/g). Natural BRZ exhibited a higher cation exchange capacity (CEC), mineralogical purity, and natural abundance of exchangeable calcium. The natural abundance of Na + on CMZ and SCZ may have reduced Na + adsorption. H-form BRZ and H-form CMZ were also prepared through conventional acidic pre-treatment. Acid treatment improved zeolite properties for adsorption (surface area and CEC). Synchrotron-based X-ray scanning transmission microscopy (STXM) indicated that Na + adsorption sites in the H-form zeolites were associated with the mineral framework. However, sorption effluents were highly acidic (pH ∼2) and Al 3+ leached significantly due to the dealumination induced by acid treatment. Alternatively, hard water softening was cyclically integrated with sodium adsorption as a zeolite treatment to generate Ca/Mg-form CMZ. This integration suggested the feasibility of combining CMZ cycles for water softening and sodium reduction for an extended CMZ lifecycle. Natural CMZ was first used to treat hard water, which enriched the CMZ with Ca 2+ and Mg 2+ and increased its subsequent Na + removal rate by over 77%, without producing acidic effluents. The Canadian zeolite adsorbed more sodium when water softening was integrated with sodium removal, which is a repeatable dual-treatment.

• Reports of clozapine-induced gastrointestinal hypomotility (CIGH) in Canada have increased from 1993 to 2018, while the proportion of fatal reports during this period have remained relatively constant. • The odds of a fatal CIGH outcome increased with age. Clozapine-induced gastrointestinal hypomotility (CIGH) is poorly understood and potentially life-threatening. Herein, we present trends of CIGH annual reporting and explore factors associated with a fatal outcome using 25-years of pharmacovigilance data in Canada. Since 1993, the number of CIGH reports increased 22-fold but the proportion of fatal reports remained relatively stable. Fatal reports of CIGH were associated with older age but not sex, clozapine dose, or clozapine duration. Concomitant use of medications used to treat CIGH (lactulose, docusate sodium) and its associated pain/discomfort (acetaminophen, lorazepam) were more commonly reported in fatal cases. Confirmatory and prospective studies of CIGH are warranted. [ABSTRACT FROM AUTHOR]

Aim: To compare urosepsis rates in patients with type 2 diabetes treated using sodium-glucose co-transporter-2 inhibitors (SGLT2i) with dipeptidyl peptidase-4 inhibitors (DPP4i) in a real-world setting., Methods: We conducted a matched cohort study using a prevalent new-user design with time-conditional propensity scores. New users of SGLT2i from seven Canadian provinces and the UK were matched to DPP4i users. The primary outcome was hospitalization with a diagnosis of urosepsis and the secondary outcome was Fournier's gangrene. Site-specific hazard ratios for urosepsis comparing SGLT2i with DPP4i were estimated using Cox proportional hazards models and pooled using a random effects meta-analysis., Results: We included 208 244 users of SGLT2i and 208 244 users of DPP4i. Among SGLT2i users, 42% initiated canagliflozin, 31% dapagliflozin and 27% empagliflozin. During a mean follow-up of 0.9 years, patients initiating SGLT2i had a lower rate of urosepsis compared with those receiving DPP4i. The pooled adjusted hazard ratio was 0.58 (95% confidence interval [CI]: 0.42-0.80). The incidence rates of Fournier's gangrene were numerically similar in SGLT2i (0.08 per 1000 person-years; 95% CI: 0.05-0.13) and DPP4i users (0.14; 95% CI: 0.09-0.21)., Conclusions: In this large, multi-site study, we did not observe an increased risk for urosepsis associated with SGLT2i compared with DPP4i among patients with type 2 diabetes in a real-world setting., (© 2020 John Wiley & Sons Ltd.)

Background: Sodium is an essential nutrient; however, excess dietary sodium is associated with increased blood pressure levels. The 2004 Canadian Community Health Survey - Nutrition (CCHS 2.2) concluded that most Canadians exceeded the Tolerable Upper Intake Level (UL) of 2300 mg/day. The 2015 CCHS indicated that Canadians were still consuming above the UL. To assess population sodium intakes, a Sodium AnaLysis Tool (SALT) was developed., Methods: We used data from CCHS 2.2 (2004) to group foods into types (e.g., popcorn, crackers) and general categories (e.g., snack foods) which formed the SALT questions. Portion sizes and sodium values were calculated for SALT questions. Over a one-month period, one hundred participants completed three, 24-h recalls (at beginning, middle, and end) and two SALT (SALT 1 & SALT 2 ) tools (at beginning and end). To assess both validity and reliability, statistical tests including Bland-Altman (B-A) plots, paired t-tests, differences between means, and correlations were conducted. The mean of the 3,24-h recalls (m24HR) was used for validation., Results: Validity testing between SALT 2 and the m24HR yielded variable results. A B-A plot between SALT 2 and m24HR depicted a small bias of 7 mg/day of sodium. The sodium intake for m24HR (2742 ± 980 mg/day) (mean ± standard deviation) versus SALT 2 (2735 ± 1174 mg/day) was not significantly different (p = 0.960). Pearson's correlation between methods, although significant (p = 0.02) was poor (r = 0.202; de-attenuated r = 0.400). There was a fair, significant agreement (κ = 0.236, p = 0.02) for the classification of sodium intake into two categories (above or below the UL). Test-retest reliability results were also variable. There was moderate, significant agreement (κ = 0.488, p = 0.001) for classification of sodium intake into two categories between SALT 1 and SALT 2 , a significant correlation (Pearson's r = 0.785, p < 0.001), and the B-A plot depicted good agreement. However, the values for sodium intake for SALT 1 (3185 ± 1424) vs SALT 2 (2735 ± 1174) were significantly different (p = 0.005)., Conclusions: Results indicate that the SALT has the potential to be a valid and reliable tool for assessing dietary sodium intake of Canadian adult populations. Despite some classification issues, there may be some value in using the SALT to categorize sodium intakes. Further refinement of the SALT may be required.

Saturated soil paste extracts indicate soluble ions in soil pore water that are available to vegetation. As such, they are thought to accurately describe the relationship between soil and groundwater salinity. To test this assumption, soil and groundwater samples were collected from 575 monitoring wells in saline regions of the Western Canadian Sedimentary Basin (WCSB). Samples were analyzed for electrical conductivity (EC) and Cl - , Na + , Ca 2+ , Mg 2+ , K + , SO 42- , and HCO - 3 content. We compared groundwater ionic concentrations to paste extracts derived from matching soils, finding that differences from in situ soil porosity cause saturated pastes to underestimate groundwater salinity. Therefore, we provide pedotransfer functions for accurately calculating groundwater quality from soil data. In addition, we discuss the effects of porosity and soil composition on the saturated paste method, as measured through hydraulic conductivity, saturation percent, and sample lithology. Groundwater salinity may also influence further leaching of salts from soil. As produced water (NaCl brine) spills are common across the sulfate-rich soils of the WCSB, we considered the effects of NaCl on leaching of other ions, finding that influx of Na + into groundwater is associated with increased sulfate leaching from soil. Therefore, considering the secondary effects of produced water on groundwater quality is essential to spill management.

Few studies have compared consumer sensory product attribute profiles and their influence on liking of regular and sodium-reduced foods. This study compared sensory profiles and overall liking between regular and sodium-reduced foods and examined the influence of consumption frequency of dietary sodium sources (DSS) on consumer sensory perception. One hundred adult consumers (70 women) assessed four pairs of commercially available regular and sodium-reduced products (potato chips, pickles, cooked ham, chicken noodle soup) that contribute substantial sodium to the Canadian diet. Products were assessed for overall liking (9-point hedonic scale), saltiness (5-point Just-About-Right scale) and defining sensory attributes (3-point Rate-All-That-Apply scale). Consumers indicated their consumption frequency of 13 groups of DSS on a DSS Food Frequency Questionnaire (DSS-FFQ). Sodium-reduced foods were perceived with reduced saltiness and intensity differences of other sensory attributes. Saltiness was a key driver of pickle liking; sodium-reduced pickles were liked more than regular pickles. However, decreased intensity in saltiness and several sensory attributes of sodium-reduced chips (oily, flavorful) and ham (seasoning, juicy) did not change liking. Decreased intensity in all evaluated attributes decreased liking of sodium-reduced soup. Penalty analysis revealed opposing sub groups within the study population whose liking decreased or increased with reduced product saltiness, confirming the challenge to please the taste preferences of every consumer. Hierarchical cluster analysis of DSS-FFQ data stratified participants into low (n = 27), moderate (n = 33) and high (n = 40) consumption frequency of DSS. Consumption frequency of DSS influenced sensory perception inconsistently across products and unique liking drivers were identified for each consumer segment. This knowledge can aid development of sodium-reduced foods for targeted consumer segments., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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., (©2019 Wiley Periodicals, Inc.)

Dietary factors are major contributors to morbidity and mortality, and significant attention is being paid to interventions to support healthy eating, including through the creation of a healthier food supply. The objective of this study was to inform interventions to support healthy eating by examining the top dietary sources of calories, sodium, sugars, and saturated fats among Canadians in relation to sex, age, and income. We drew upon data from the 2015 Canadian Community Health Survey, which collected interviewer-administered 24-h dietary recalls from Canadians who were 1 year of age and older ( n = 20 176), residing in the 10 provinces. Foods and beverages were grouped into 91 mutually exclusive categories (e.g., 100% fruit juice, fruit drinks). On the basis of the average proportion contributed, the top 20 sources of each dietary component were identified for all individuals and by sex-age and income groups. The mean amount of each dietary component contributed by each category (per capita and per consumer) and the proportions of persons consuming items in each category were also examined. Top sources included commonly consumed items (e.g., breads and flatbreads as sources of sodium), as well as those high in a given dietary component (e.g., soda as a source of sugars). Several food and beverage categories were top contributors to more than one dietary component examined, suggesting possible priorities for intervention and future analyses. The identification of major sources of calories and nutrients of concern can inform population health efforts, such as reformulation, to improve the health of Canadians.

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., (©2019 Wiley Periodicals, Inc.)

Dietary sodium reduction is commonly used in the treatment of hypertension, heart and liver failure, and chronic kidney disease. Sodium reduction is also an important public health problem since most of the Canadian population consumes sodium in excess of their daily requirements. Lack of awareness about the amount of sodium consumed and the sources of sodium in diet is common, and undoubtedly a major contributor to excess sodium consumption. There are few known tools available to screen and provide personalized information about sodium in the diet. Therefore, we developed a Web-based sodium intake screening tool called the Salt Calculator (), which is publicly available for individuals to assess the amount and sources of sodium in their diet. The Calculator contains 23 questions focusing on restaurant foods, packaged foods, and added salt. Questions were developed using sodium consumption data from the Canadian Community Health Survey cycle 2.2 and up-to-date information on sodium levels in packaged and restaurant food databases from the University of Toronto. The Calculator translates existing knowledge about dietary sodium into a tool that can be accessed by the public as well as integrated into clinical practice to address the high levels of sodium presently in the Canadian diet. [ABSTRACT FROM AUTHOR]

Background and Objectives: Niacin downregulates intestinal sodium-dependent phosphate transporter 2b expression and reduces intestinal phosphate transport. Short-term studies have suggested that niacin lowers serum phosphate concentrations in patients with CKD and ESRD. However, the long-term effects of niacin on serum phosphate and other mineral markers are unknown., Design, Setting, Participants, & Measurements: The Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Trial was a randomized, double-blind, placebo-controlled trial testing extended release niacin in persons with prevalent cardiovascular disease. We examined the effect of randomized treatment with niacin (1500 or 2000 mg) or placebo on temporal changes in markers of mineral metabolism in 352 participants with eGFR<60 ml/min per 1.73 m 2 over 3 years. Changes in each marker were compared over time between the niacin and placebo arms using linear mixed effects models., Results: Randomization to niacin led to 0.08 mg/dl lower plasma phosphate concentrations per year of treatment compared with placebo ( P <0.01) and 0.25 mg/dl lower mean phosphate 3 years after baseline (3.32 versus 3.57 mg/dl; P =0.03). In contrast, randomization to niacin was not associated with statistically significant changes in plasma intact fibroblast growth factor 23, parathyroid hormone, calcium, or vitamin D metabolites over 3 years., Conclusions: The use of niacin over 3 years lowered serum phosphorous concentrations but did not affect other markers of mineral metabolism in participants with CKD., (Copyright © 2018 by the American Society of Nephrology.)

The article reports that the federal government of Canada has disposed its sodium reduction group. It states that the Sodium Working Group which was formed to create and impose strategy for cutting excessive sodium intake and has passed a report calling for voluntary reductions by industry was told that the said duty was reassigned to Health Canada's advisory body, Food Regulatory Advisory Committee. It adds that Health Canada also proposes a less rigorous sodium reduction targets.

The article reports that some restaurant chains in Canada have made voluntary commitments to lower sodium levels. Topics discussed include the disbanding of the expert panel Sodium Working Group, sodium reductions by voluntary industry in restaurant foods, and a table that outlines sodium levels in restaurant food items in the country from 2010 to 2013.

Background and Aim: Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatments from the same study to assess the effect over time on systolic, diastolic and mean arterial pressure (MAP), and the relation to sodium (Na(+)), potassium (K(+)), and portfolio components., Methods and Results: 241 participants with hyperlipidemia, from four academic centers across Canada were randomized and completed either a DASH-type diet (control n = 82) or a dietary portfolio that included, soy protein, viscous fibers and nuts (n = 159) for 24 weeks. Fasting measures and 7-day food records were obtained at weeks 0, 12 and 24, with 24-h urines at weeks 0 and 24. The dietary portfolio reduced systolic, diastolic and mean arterial blood pressure compared to the control by 2.1 mm Hg (95% CI, 4.2 to -0.1 mm Hg) (p = 0.056), 1.8 mm Hg (CI, 3.2 to 0.4 mm Hg) (p = 0.013) and 1.9 mm Hg (CI, 3.4 to 0.4 mm Hg) (p = 0.015), respectively. Blood pressure reductions were small at 12 weeks and only reached significance at 24 weeks. Nuts, soy and viscous fiber all related negatively to change in mean arterial pressure (ρ = -0.15 to -0.17, p ≤ 0.016) as did urinary potassium (ρ = -0.25, p = 0.001), while the Na(+)/K(+) ratio was positively associated (ρ = 0.20, p = 0.010)., Conclusions: Consumption of a cholesterol-lowering dietary portfolio also decreased blood pressure by comparison with a healthy DASH-type diet. CLINICAL TRIAL REG. NO.: NCT00438425, clinicaltrials.gov., (Copyright © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objective: Several provincial and federal bills have recommended various forms of menu labelling that would require information beyond just calories; however, the additional benefit of including sodium information is unknown. The objective of this study was to determine whether sodium information on menus helps consumers make lower-sodium choices and to understand what other factors influence the effect of menu labelling on consumers' meal choices., Methods: A total of 3,080 Canadian consumers completed an online survey that included a repeated measures experiment in which consumers were asked to select what they would typically order from four mock-restaurant menus. Subsequently, consumers were randomly allocated to see one of three menu-labelling treatments (calories; calories and sodium; or calories, sodium and serving size) and were given the option to change their order., Results: There was a significant difference in the proportion of consumers who changed their order, varying from 17% to 30%, depending on the restaurant type. After participants had seen menu labelling, sodium levels decreased in all treatments (p&lt;0.0001). However, in three of the four restaurant types, consumers who saw calorie and sodium information ordered meals with significantly less sodium than consumers who saw only calorie information (p&lt;0.01). Consumers who saw sodium labelling decreased the sodium level of their meal by an average of 171-384 mg, depending on the restaurant. In the subset of consumers who saw sodium information and chose to change their order, sodium levels decreased by an average of 681-1,360 mg, depending on the restaurant. Sex, intent to lose weight and the amount of calories ordered at baseline were the most important predictors of who used menu labelling. Eighty percent of survey panelists wanted to see nutrition information when dining out., Conclusion: Including sodium information alongside calorie information may result in a larger decrease in the amount of sodium ordered by restaurant-goers.