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The protein structure, gel changes, and chewing properties of low‐sodium myofibrillar protein (MP) prepared by compound chloride salts (KCl/MgCl2, KCl/CaCl2, and KCl/MgCl2/CaCl2) and different substitution degrees (10%, 25%, and 40%) at same ionic strength (0.6 M) were investigated. The results revealed that the low‐sodium MP gels containing CaCl2 manifested more liquid loss and less moisture content accompanied by obvious morphological shrinkage, while KCl/MgCl2 contributed to the gel juiciness. At high substitution degree of 40%, KCl/CaCl2 substitution rendered the gel with dense structure and highest strength, but worse water retention capacity. Using other compound chloride salts influenced the chewing efficiency, and CaCl2 substitution made the gel relatively hard to chew. The inhomogeneous structure accompanied by cluster blocks in KCl/CaCl2‐substituted MP gel accelerated the overall fracture rate. During heating process, more proteins in CaCl2‐substituted MP did not participate in gel formation, intervening the final gel properties. The chloride salt mixtures containing MgCl2, rather than CaCl2, avoided or alleviated the liquid loss and shrinkage of low‐sodium MP gel within the substitution degree of 10%–40%, and substitution degree not exceeding 25% was more reasonable for the controlled qualities. [ABSTRACT FROM AUTHOR]

Abstract This study aimed to investigate the impact of reduction of salt content (from 1.5 to 0.75%), the technique of mixing half of the salt content with animal fat, and the salt particle size on the instrumental texture, cooking losses, diameter reduction, overall liking, and sensory characteristics of burgers. The results showed that regardless of the types of micronized salt (MS

BACKGROUND: Excessive NaCl intake in liquid and semi‐solid food (e.g. soup, hot pot base, sauce) poses a high risk to human health, and reducing NaCl intake is a major concern for global health. RESULTS: Using the generalized Labeled Magnitude Scale (gLMS) method, the study verified the possibility of sodium reduction through oil addition. The compromised acceptance threshold (CAT) and hedonic rejection threshold (HRT) were determined. The gLMS results showed that the saltiness intensity of samples containing 0.36% NaCl and 2.29% sunflower seed oil was significantly higher than that of samples containing only 0.36% NaCl (P < 0.05). CAT and HRT results indicated that by adding 3.59% sunflower oil, the NaCl content could be reduced to a minimum of 0.14% without causing sensory rejection in bone broth samples. The quantitative descriptive analysis method was used to determine the effects of NaCl and oil concentrations on the sensory attributes of bone broth samples. Furthermore, it was used to analyze the consumer acceptability drivers in combination with the hedonic scale to optimize the formulation of reduced‐salt bone broth products. Notably, sample E (0.36% NaCl, 2.29% fat) not only had a significant salt reduction effect with a 20% decrease in NaCl, but also had improved overall acceptability. CONCLUSION: This study provides theoretical guidance for designing salt‐reduction cuisine within the catering and food industries, including bone broth and hot pot bases. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Electric taste technology, which permits the adjustment of food flavors, has recently garnered attention as a method to reduce excessive salt intake. Electrical tongue stimulation, which modifies taste through electric cutlery, is user-friendly but only effective when the cutlery is in contact with the tongue via food. As transcutaneous electrical stimulation (TES) is expected to overcome the challenges of electrical tongue stimulation, this study investigated its usefulness. A time-intensity analysis was conducted to evaluate taste modification, specifically whether anodal TES (aTES)—where the anode was attached to the anterior part of the jaw and the cathode to the back of the neck—can enhance continuous saltiness during electric stimulation. Moreover, whether aTES could improve the perception of saltiness in NaCl solutions and five different foods for individuals on a low-sodium diet was investigated, utilizing a 9-point scale and paired comparison tests. The results indicated that aTES consistently enhanced the saltiness of the NaCl solution both during tasting and after swallowing. Notably, aTES at 3.0 mA significantly increased the saltiness perception of a 0.5 % NaCl solution in individuals on a low-sodium diet. aTES significantly enhanced the taste of somen noodles with dipping sauce, misosoup, simmered hijiki seaweed, potato chips, and Chinese rice bowls. These results suggest that aTES may further reduce the burden of salt reduction in individuals on a low-sodium diet and contribute to a reduction in excessive salt intake.

Background: Potassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse. Objectives: The objective of this study was to summarize the label features of potassium-enriched salt products available worldwide. Methods: A content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as “salt substitute” or “low sodium salt.” Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized. Results: A total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (n = 15), no potassium (n = 5), or that were duplicates (n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use. Conclusions: There was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.

Background: Guidance from the United States Food and Drug Administration (FDA) includes targets for the food industry to voluntarily reduce the sodium content (mg/100 g) of packaged, processed, and prepared foods sold by stores and restaurants. Assessments of sodium intake by the United States population are needed to inform sodium-reduction efforts. Objectives: The objectives of this study were to assess the sodium content and sodium intake contributions of categories and subgroups of foods obtained from stores and restaurants and determine sodium intake reductions that would be achieved by meeting FDA targets. Methods: Analyses used dietary data from the National Health and Nutrition Examination Survey, What We Eat in America (WWEIA), 2009–2018, to assess sodium in foods consumed by the United States population aged 2 y or older. Data describing where foods were obtained were used to identify store-bought and restaurant-prepared foods. Combination codes were used to group foods, such as separate salad ingredients, which were eaten together. Foods in their as-eaten form were then classified into WWEIA food categories and subgroups corresponding to FDA targets. Sample-weighted estimates generated by SUDAAN analyses were used to calculate projected sodium intake reductions. Results: Store-bought, restaurant-prepared, and other foods contributed 62%, 26%, and 12%, respectively, of sodium in United States diets. Top-ranked food category contributors of sodium included sandwiches, tortilla products, pizza, poultry, soups, and breads. Subgroups of these categories contributing the most sodium included store-bought lunchmeat sandwiches and hotdogs, restaurant-prepared burgers, store-bought and restaurant-prepared tacos/burritos, restaurant-prepared pizza with meat, and store-bought white/wheat bread. Meeting the FDA targets for these subgroups achieved the highest projected sodium intake reductions. Conclusions: Reductions of sodium in widely consumed foods, such as luncheon-meat sandwiches and restaurant-prepared pizza, have the greatest impact on reducing sodium intake by the United States population. These findings could be used by restauranteurs, food manufacturers, policymakers and regulators, and clinical practitioners to inform sodium-reduction efforts.

AbstractSalt (sodium chloride) plays a key role in maintaining the textural, microbiological, and sensorial aspects of the foods. However high dietary salt intake in the population has led to a series of health problems. Currently manufacturers are under pressure to reduce the sodium levels in foods without compromising the consumer experience. Because of the clean salty taste produced by sodium chloride, it has been challenging for the food industry to develop a suitable salt substitute. Studies have shown that different components within a food matrix can influence the perception of saltiness. This review aims to comprehend the potential synergistic effect of compounds such as minerals and amino acids on the perception of saltiness and covers the mechanism of perception where relevant to taste resulting from sodium ions and other metallic ions (such as K, Mg, Ca), as well as various amino acids and their derivatives. Finally, the review summarizes various salt reduction strategies explored by researchers, government organizations and food industry, including the potential use of plant-based extracts. [ABSTRACT FROM AUTHOR]

Aim: Both excessive intake of sodium and inadequate intake of potassium are associated with blood pressure elevation and subsequent increase in the risk of cardiovascular disease, which accounts for the largest number of deaths in China and worldwide. Low sodium salt, a mixture of mainly sodium chloride and potassium chloride, has shown its great potential as a promising population strategy for sodium intake reduction through multiple large‐scale, multicenter, randomized controlled trials among populations including patients with cardiovascular disease, individuals with and without hypertension, older and younger adults, and men and women in China and other countries. This Guidelines aims to provide expert recommendations for promotion and use of low sodium salt in China, based on the current available scientific evidence regarding the effectiveness, safety, cost‐effectiveness, and acceptability of low sodium salts in various population groups and different application scenarios. The suggestions to key stakeholders are also made. Methods: A working group, an expert review committee and an advisory committee were established to be responsible for formulating the guidelines' scope and key questions to be addressed, for searching, synthesizing, and evaluating research evidence, proposing and reviewing the recommendations. The consensus on the final recommendations was reached using the GRADE grid method. Results: The working group summarized current available evidence of salt substitution regarding its effectiveness, safety, cost‐effectiveness, acceptability, availability, suitability, etc. The Guidelines provided six recommendations advising different populations how to use low sodium salt, four recommendations on the application of low sodium salts in different scenarios, and five suggestions for key stakeholders to promote salt substitution. Conclusion: The first evidence‐based guidelines on promotion and use of low sodium salts covers all key questions in relevance and would play a critical role in prevention and control of hypertension and cardiovascular disease in China and worldwide. [ABSTRACT FROM AUTHOR]

Bread can be a major contributor to sodium intake, but sodium chloride reduction poses difficulties since it influences the functional properties of dough and flavor of bread. This study evaluated dough and bread properties in reduced-sodium systems containing fermented or unfermented macroalgae Saccharina latissima or Alaria esculenta. Recipes contained equal amounts of sodium (4 mg Na+/g flour), where sodium chloride contributed 3 or 3.5 mg Na+/g flour and 8.9–33.3 mg macroalgae/g flour contributed the remaining 0.5 or 1 mg Na+/g flour. A full-salt and three salt-reduced controls (6, 4, 3.5, and 3 mg Na+/g flour) were used for comparison. Empirical dough rheology, stickiness, ratios of polymeric to monomeric proteins, and bread characteristics (specific volume, crumb structure, and firmness) were measured. A trained sensory panel conducted a descriptive sensory analysis. Macroalgae addition increased water absorption and decreased dough development time, dough stability, the polymeric to monomeric protein ratio, and specific volume in a dose-dependent manner. Macroalgae addition increased the perception of saltiness, but also algae flavor and odor. Bread with fermented S. latissima received lower scores for certain undesirable sensory attributes than other bread with algae. [ABSTRACT FROM AUTHOR]

This study aimed to reduce sodium content in pork coppa without affecting consumer acceptance. NaCl reduction, partial replacement with KCl, and reduction in salting process time were evaluated. Six treatments were performed: Standard - 100% NaCl with a 2-day salting process and a 5-day re-salting process; T1 - a mixture of 70% NaCl/30% KCl; T2, T3, T4 - mixtures of 85% NaCl/15% KCl; T5 - 100% NaCl. T1 to T5 applied a 2-day salting process and a 2-day re-salting process. All treatments complied with Brazilian sodium guidelines. No statistically significant difference in consumer acceptance was observed. A reduction of 4 days in salting and re-salting processes maintained sensory characteristics and reduced sodium content by 50%. Even with reduced salt content, no changes in physicochemical parameters or effects on product preservation and microbiological quality were observed. NaCl reduction and replacement up to 30% KCl did not affect coppa characteristics or acceptance.

The demand for low-sodium products is growing worldwide and is compelled by the growing number of related illnesses. However, the quality of these products could be improved, likened to products produced with common salt (NaCL), because the replacement of sodium compromises the flavor of the product. Reducing sodium salts also poses an essential challenge for the meat industry, since sodium chloride (NaCl) fulfills essential technological functions. High sodium consumption has harmful health implications for cardiovascular and hypertension disorders. As a result, this study aimed to analyze the effect of KCl with Glycine and AMP on the physicochemical and sensory characteristics, purchase intent, and consumer perception of roasted chicken. NaCl/KCl replacement levels (0%, 25%, 50%, 75%, and 100%) were established, and consumer perception, liking, emotions, and purchase intent were evaluated. The different KCl levels, except for firmness, did not impact the physicochemical attributes. Even though higher replacement levels of KCl (75–100%) impacted chicken tenderness, it had no notable impact on panelists’ liking scores and purchase intent. Health claims about the sodium content in roasted chicken have also been shown to significantly increase purchase intent, based on enhancing consumer’s emotional responses. Regarding emotional responses, feelings of being unsafe and worried decreased their scores among the highest KCl replacement levels (75% and 100%). Positive emotional responses (feeling satisfied and pleased) were decisive consumer purchase intent predictors.

This study aimed to formulate burgers made from three Amazonian fish species: pacu (Pyaractus brachypomus), boquichico (Prochilodus nigricans), and bujurqui (Chaetobranchus flavescens), focusing on sodium reduction and fortification with fish oil microparticles (FOM) rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The proximal composition, sodium and calcium content, instrumental texture profile, fatty acid profile, sensory profile, and overall liking were evaluated. Differences in proximal composition and fatty acid profiles between the fillets were reflected in the burgers. Fortification with FOM increased EPA and DHA in the burgers; thus, they can be considered "high in omega-3 fatty acids" and reduced the n-6/n-3 ratio below 4. There were sensory attributes that could be related to lipid oxidation but reduced overall liking for less than 10% of consumers. Nevertheless, certain sensory attributes (grilled, characteristic, aromatic, tasty, tender, and juicy) had a positive impact on the overall liking of more than 20% of consumers, yielding adequate scores (between 5.60 and 5.71) on the 9-point hedonic scale. The production process must be optimized by knowing the fish fillet quality in depth, improving the FOM and burgers' oxidative stability, and achieving an adequate sensory and hedonic profile by employing consumers' vocabulary to characterize new products. [ABSTRACT FROM AUTHOR]

Background Hypertension is the leading risk factor for cardiovascular disease worldwide. Patients with blood pressure (BP) response to dietary sodium reduction are referred to as “salt sensitive.” Salt sensitivity (SS) might be due to differences in sodium storage capacity and the erythrocyte SS examines this capacity of the red blood cells. This study aimed to test the effect of a self‐performed sodium reduced diet on BP in patients with essential hypertension and examine whether erythrocyte SS predicts SS. Methods and Results Seventy‐two patients with hypertension were included and randomized 2:1 to either sodium reduction or a control group for 4 weeks. Blood samples, 24‐hour BP measurement, and 24‐hour urine collection were performed before and after. The intervention group received advice on how to lower sodium intake. Urinary sodium excretion decreased 66 mmol (95% CI, −96 to −37 mmol) in the intervention group compared with the control group. Systolic 24‐hour BP decreased 9 mm Hg after low‐sodium diet compared with the control group (95% CI, −13 to −4 mm Hg). Similarly, the difference in reduction in diastolic BP between the groups was 5 mm Hg (95% CI, −8 to −1 mm Hg). We found no correlation between erythrocyte SS at baseline and decrease in 24‐hour BP, neither systolic nor diastolic (P=0.66 and P = 0.84). Conclusions Self‐performed sodium reduction was feasible and led to decrease in 24‐hour BP of 9/5 mm Hg compared with a control group. The erythrocyte SS did not correlate to the change in BP after lowering sodium intake. Registration URL: https://clinicaltrials.gov; Unique Identifier: NCT05165823.

Glutamate is one of the most abundant amino acids in nature, accounting for up to 8-10% of most dietary proteins and peptides and most tissues. Only the free form of glutamate has taste-enhancing properties as a unique umami taste, and when glutamate is bound to proteins, it is tasteless with no umami taste. Fermentation, ageing, ripening and heat cooking are typical natural processes of protein hydrolysis during which free glutamate is released. The food industry most commonly uses it in the form of monosodium glutamate (MSG) in amounts between 0.1 and 0.8% as a flavour enhancer. Since the beginning of the 21st century, its use as a flavour enhancer in meat and meat products with reduced salt content has become more widespread. The sodium content of MSG (12.28 g/100 g) is one-third that of salt (39.34 g/100 g), making MSG a promising salt alternative in sodium reduction strategies. There is no one-sided and conclusive scientific information reporting adverse human health effects of MSG in the general population, and it is still considered safe. However, in the wake of "clean label" initiatives, many consumers would prefer not to have additives or flavour enhancers such as glutamates in their food. This can be overcome by the known synergistic effect of natural 5'-ribonucleotides and glutamates found in seaweed, cheese, fish sauce, yeast extract, soy sauce, fermented soybeans and tomatoes, as they enhance the overall perception of umami flavour.

Cold-smoked salmon are ready-to-eat products that may support the growth of pathogenic Listeria monocytogenes during their long shelf-life. Consumption of such contaminated products can cause fatal listeriosis infections. Another challenge and potential risk associated with CS salmon is their high levels of sodium salt. Excess dietary intake is associated with serious health complications. In the present study, anti-listerial bacteriocin (nisin), P100 bacteriophages (Phageguard L, PGL) and fermentates (Verdad N6, P-NDV) were evaluated as commercial bio-preservation strategies for increased control of L. monocytogenes in standard (with NaCl) and sodium-reduced (NaCl partially replaced with KCl) CS salmon. Treatments of CS salmon with nisin (1 ppm) and PGL (5 × 107 pfu/cm2) separately yielded significant initial reductions in L. monocytogenes (up to 0.7 log) compared to untreated samples. Enhanced additive reductions were achieved through the combined treatments of nisin and PGL. Fermentates in the CS salmon inhibited the growth of Listeria but did not lead to its eradication. The lowest levels of L. monocytogenes during storage were observed in nisin- and PGL-treated CS salmon containing preservative fermentates and stored at 4 °C, while enhanced growth was observed during storage at an abusive temperature of 8 °C. Evaluation of industry-processed standard and sodium-replaced CS salmon confirmed significant effects with up to 1.7 log reductions in L. monocytogenes levels after 34 days of storage of PGL- and nisin-treated CS salmon-containing fermentates. No differences in total aerobic plate counts were observed between treated (PGL and nisin) or non-treated standard and sodium-reduced CS salmon at the end of storage. The microbiota was dominated by Photobacterium, but with a shift showing dominance of Lactococcus spp. and Vagococcus spp. in fermentate-containing samples. Similar and robust reductions in L. monocytogenes can be achieved in both standard and sodium-replaced CS salmon using the bio-preservation strategies of nisin, PGL and fermentates under various and relevant processing and storage conditions. [ABSTRACT FROM AUTHOR]

Sodium intake from pre-packaged foods is increasing in China and is well above the WHO recommendation of 5 g per day. The purpose of this study is to analyze the sodium content of pre-packaged foods collected by the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention (NINH, China CDC) in 20 provinces of China from 2017 to 2022. The proportion of pre-packaged foods that meet or exceed the low-sodium, medium-sodium, and high-sodium classifications were analyzed. The proportion of pre-packaged foods that meet and do not meet the WHO global sodium benchmarks and the difference in sodium content between these foods was also calculated. High-sodium foods include sauces, dips, and dressings (3896 mg/100 g), convenience foods (1578 mg/100 g), processed fish products (1470 mg/100 g), processed meat products (1323 mg/100 g), processed poultry products (1240 mg/100 g), snack foods (750 mg/100 g), processed egg products (741 mg/100 g), and fine dried noodles (602 mg/100 g). A large number of pre-packaged foods currently collected in China have a sodium content above sodium benchmarks. This study provided data to support the assessment of sodium intake from pre-packaged foods in the Chinese population and the implementation of comprehensive salt reduction strategies. [ABSTRACT FROM AUTHOR]

Condiments are a significant source of sodium in the diets of Chinese residents. This study aimed to analyze the nutrient content of China's major condiments and to provide support for setting the reference intake for condiments in order to take measures on salt reduction in China. Nutrition data for condiments were collected from the Database on Nutrition Labelling of Prepackaged Foods China in 2017–2022, and by online access to food composition databases from France, the UK, Belgium, and Japan. The analyses include 1510 condiments in China and 1565 related condiments in four countries, of which the descriptive indicators were examined such as median, IQR, and range. Cross-comparisons were made in terms of the difference between the content levels in five countries and the "WHO global sodium benchmarks". The results show that among the 15 types of condiments in China, sesame/peanut butter-based products have a relatively high content of energy, fat, and protein, namely, 2580 kJ/100 g, 50 g/100 g, and 22.2 g/100 g, respectively. In addition to salt, chicken extract/chicken powder, bouillon cubes, and soy sauce are also high in sodium. Furthermore, there were significant differences in the contents of energy and core nutrients across different products when benchmarking with similar condiments in the five countries (p < 0.001). The sodium content and fat content of some condiments are excessively high. Therefore, enhancing residents' consumption awareness and reducing the amount of condiments is of great significance for reducing China's per capita salt intake and promoting good health. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO)

Abstract The aim of this review was to address some alternatives that can be applied to turn chicken nuggets into healthier products. One of the alternatives is to reduce the sodium content in nuggets by replacing sodium chloride with other salts, without affecting their sensory and technological properties, and to balance the consumption of mineral salts in the body. The addition of fibres can improve nutritional and functional properties when incorporated into meat products because they increase water and oil retention capacities. Reformulation of meat products by adding vegetable oils with low saturated and high unsaturated fatty acids contents makes breaded meat products healthier. The oil absorption by foods during frying can be reduced by the use of coating systems that serve as a barrier to protect the product. Therefore, different strategies have been used with the aim of making chicken nuggets healthier, due to the addition of functional compounds, the reduction in the fat content, the improviment in the lipid profile, the reduction of the sodium content in the nuggets and the increasing in the consumption of minerals. It is expected that new studies can be evaluated and applied within the industrial scale that can serve the entire population, even though it is a fried meat product, but that has a reduced sodium content and high functional compounds.

Functional food is a term for food products fortified with ingredients that possess beneficial physiological effects. Meat products are characterized by relatively high salt, fat and saturated fatty acid contents. Moreover, phosphates and nitrites are also marked as potential harmful components. Designing meat products as functional food has been associated with replacement (and/or reduction) of these components with other, especially natural, ingredients that possess beneficial effects. The development of such products poses quite a challenge since it requires the creation of a product with improved functional properties and the same sensory quality as conventional ones. Results of numerous studies into improving the nutritional properties of meat products indicate that the meat industry has responded to the changes of lifestyle and perception of food. [ABSTRACT FROM AUTHOR]

Hypertension is among the most prevalent medical conditions globally and a major contributor to chronic kidney disease, cardiovascular disease, and death. Prevention through nonpharmacological, population-level interventions is critically needed to halt this worldwide epidemic. However, there are ongoing disagreements as to where public policy efforts should focus. Recently the Salt Substitute and Stroke Study demonstrated the efficacy of substituting table salt with potassium salt to reduce the risk of stroke, major cardiovascular events, and death. However, this sparked debate over whether sodium or potassium should be prioritized in countries where table salt substitution was less feasible. In this commentary, we summarize arguments in favor of either strategy: reduced sodium or increased potassium intake. Moreover, we discuss evidence and policy approaches related to either or combined approaches relevant to cultural context. Ultimately, there is an urgent need for policies that both reduce sodium and increase potassium intake; however, identifying a strategy that fits cultural context will be key to improve populationwide blood pressures. [ABSTRACT FROM AUTHOR]

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Abstract Background The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. Methods A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. Results Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. Conclusions Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.

Background: Cardiovascular diseases (CVD) represent the main cause of death in Mexico, while high blood pressure is suffered by about half of the adult population. Sodium intake is one of the main risk factors for these diseases. The Mexican adult population consumes about 3.1 g/day, an amount that exceeds what is recommended by the World Health Organization (WHO) < 2 g sodium/day. The objective of this study was to estimate the impact of reducing sodium intake on CVD mortality in Mexico using a scenario simulation model. Methods: The Integrated Model of Preventable Risk (PRIME) was used to estimate the number of deaths prevented or postponed (DPP) due to CVD in the Mexican adult population following the following sodium intake reduction scenarios: (a) according to the WHO recommendations; (b) an "optimistic" reduction of 30%; and (c) an "intermediate" reduction of 10%. Results: The results show that a total of 27,700 CVD deaths could be prevented or postponed for scenario A, 13,900 deaths for scenario B, and 5,800 for scenario C. For all scenarios, the highest percentages of DPP by type of CVD are related to ischemic heart disease, hypertensive disease, and stroke. Conclusions: The results show that if Mexico considers implementing policies with greater impact to reduce sodium/salt consumption, a significant number of deaths from CVD could be prevented or postponed. [ABSTRACT FROM AUTHOR]

Sodium intake is linked to multiple negative health outcomes, particularly hypertension, the leading cause of premature death globally. Sodium intake levels in human populations are high, due in part to our desire for palatable salty-tasting foods. Two leading salt replacement strategies are the use of potassium chloride (KCl) and monosodium glutamate (MSG), the latter of which still contains some sodium, but both of which can replace some salty taste in foods while reducing net sodium levels. In this report, we employed a trained descriptive sensory panel to optimize saltiness in sodium-reduced aqueous samples using various concentrations of KCl and MSG. Following this, we assessed consumer attitudes to sodium-reduction strategies in a model food, canned soup, known to typically be high in sodium. Finally, in a large consumer test, we verified that these optimized levels of KCl and MSG did not lead to a drop in liking for the reduced-sodium soups with saltiness subsidized in this manner. Our results showed that sodium can be readily reduced in soups by 18% while actually scoring higher in liking, and in some cases being perceived as even more salty tasting, but that consumers are more open to sodium reduction in this manner when sodium replacements are not specifically highlighted, and when percentage sodium reduction is stated over absolute levels. [ABSTRACT FROM AUTHOR]

The high incidence of sodium overconsumption in the general population has led sodium reduction in commercial food products to become a topic of importance in the food industry. In order to bridge the gap between sodium reduction understanding in the food industry and academia, focus groups and individual interviews of food industry professionals were conducted. Sodium reduction and influence from external entities such as federal regulations and consumer insight were prominent in the nutritional concerns of food industry professionals. A large variety of sodium reduction strategies were introduced with discussion on the many factors that contribute to their potential for success. Flavor modification methods were most prevalent in the discussion, with particular focus on potassium chloride and incorporating umami taste. Factors that frequently positively contributed to a strategy's success include maintaining functionality and/or important sensory attributes, inexpensive to implement, and being perceived as clean label. Conversely, factors that negatively affect success include adversely impacting flavor, being considered not clean label, and high costs of implementation. Foods important for future sodium reduction varied widely, although those were largely products with high sodium density. Future efforts toward reducing sodium overconsumption and sodium content in the food supply fell into three categories: consumer‐focused, industry‐focused, and research‐focused. Of particular importance for future efforts included greater regulatory pressure and more consumer nutritional education. Findings suggest that future efforts to reduce the incidence of sodium overconsumption should be carried out through multiple avenues rather than focusing on the agency of consumers, the food industry, or research alone. [ABSTRACT FROM AUTHOR]

The category of salted meat products is very diversified and are widely appreciated and consumed worldwide due to their unique sensory characteristics and high nutritional value. As some salted meat products are stable at ambient temperature, they are considered a safe strategy. However, they have been criticized due to some high levels of sodium, which if consumed in excess may increase the risk of developing certain health disorders. In this context, this work discusses in detail, the characteristics, processing, different strategies for sodium reduction and the effect of sodium chloride (NaCl) reduction in the category of salted meat products, as well as the main new technologies used in the salting and dehydration stages to optimize processes and improve the quality of final products. [ABSTRACT FROM AUTHOR]

Dry fermented sausage innovation trends are linked to consumer preferences for clean label and sodium-reduced foods. This study aims to evaluate the effect of the formulation and production process temperature on the dynamics of bacterial communities in fuet-type dry fermented sausages using metataxonomics. Six fuet batches were manufactured, including formulations without and with the addition of nitrifying salts (replaced or not by pork liver auto-hydrolysate as a colouring agent), processed at 3 to 12 °C, and a partial replacement of NaCl by KCl, processed at 12 °C. Fermentation was performed spontaneously or by a starter culture. Physicochemical characterisation and culture-dependent and independent bacterial analyses were performed at day 0, 4 and 12, at the end of ripening (aw < 0.90) and after storage. Temperature was the most important factor determining the change in pH, aw and lactic acid bacteria levels while the presence of a starter culture promoted a pH decrease. Metataxonomic analysis showed that low temperature processes and the absence of nitrifying salts allowed the growth of spoilage-related species, while sausages submitted to a mild temperature containing a starter culture and nitrifying salts showed less bacterial diversity. Liver auto-hydrolysate added putative probiotic species to the product. This study provides valuable information to manufacturers who want to innovate safely. [ABSTRACT FROM AUTHOR]

ABSTRACT: The prerigor salting effect is known to provide superior meat processing quality. Based on the urgent need for low salt meat products, the present study was undertaken to evaluate the prerigor salting effect when basic amino acids were introduced at 1% NaCl level. Ground chicken breast meat was salted with NaCl and basic amino acids at 30 min, 60 min, and 90 min postmortem for prerigor treatments. Compared to the 1% NaCl (w/w) treatment, the introduction of 0.06% basic amino acids (w/w) in the prerigor significantly led to an increase in myofibril fragmentation, myofibrillar protein solubility, emulsion activity, storage modulus change rate, gel water-holding capacity and hardness (P < 0.05). Furthermore, smaller and more uniformly sized droplets were produced in emulsion by basic amino acids. Individual basic amino acids had different prerigor salting effects, and it was indicated that basic amino acids could play a positive role in the prerigor salting effect when NaCl was reduced.

This study aimed to formulate burgers made from three Amazonian fish species: pacu (Pyaractus brachypomus), boquichico (Prochilodus nigricans), and bujurqui (Chaetobranchus flavescens), focusing on sodium reduction and fortification with fish oil microparticles (FOM) rich in eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The proximal composition, sodium and calcium content, instrumental texture profile, fatty acid profile, sensory profile, and overall liking were evaluated. Differences in proximal composition and fatty acid profiles between the fillets were reflected in the burgers. Fortification with FOM increased EPA and DHA in the burgers; thus, they can be considered “high in omega-3 fatty acids” and reduced the n-6/n-3 ratio below 4. There were sensory attributes that could be related to lipid oxidation but reduced overall liking for less than 10% of consumers. Nevertheless, certain sensory attributes (grilled, characteristic, aromatic, tasty, tender, and juicy) had a positive impact on the overall liking of more than 20% of consumers, yielding adequate scores (between 5.60 and 5.71) on the 9-point hedonic scale. The production process must be optimized by knowing the fish fillet quality in depth, improving the FOM and burgers’ oxidative stability, and achieving an adequate sensory and hedonic profile by employing consumers’ vocabulary to characterize new products.

Abstract Background Canadian sodium intakes remain high despite population-wide sodium reduction initiatives, highlighting the need for personal action in reducing dietary sodium. eHealth interventions support patients in dietary change and assist clinicians in decision-making and delivering care, including provision of advice. To date, impact of diet-focused eHealth tools, like the Sodium Calculator (SC) dietary screening tool, on clinical outcomes has received minimal examination. This study assessed feasibility of a randomized controlled trial (RCT) protocol to examine the impact of the SC, a physician-focused intervention, on the quality of dietary sodium reduction advice provided by physicians to their patients with hypertension. Methods Primary care physicians from community-based primary care clinics were randomized to one of two groups: (1) ‘usual care’ for dietary sodium counselling or (2) dietary sodium counselling using the SC (‘experimental group’). The primary endpoint was protocol feasibility defined by the following outcomes: process (e.g. recruitment, retention, protocol adherence, acceptability of intervention), resources (e.g. needs, impact on workflow), and management (e.g. staff requirements). Outcomes were assessed using direct observation, interviews, and questionnaires with patients, physicians, and clinic staff. Results Seven physicians (n = 4 in experimental group, n = 3 in usual care group) and 65 patients with hypertension (48.5% men, 69.8 ± 10.1 years) successfully participated. The main challenges identified is related to recruitment rate (48% for patients, 20% for physicians) and physician protocol adherence (76%). These improved with minor protocol modifications. There were several areas of protocol success such as no disruption to physician workflow, hiring clinic nurses as research staff, having a physician site lead to support physician recruitment, and a ‘Protocol Prompt Form’ to increase physician protocol adherence. Importantly, there was a high degree of acceptability of the SC intervention among experimental group physicians [n = 3 (75%)]. Conclusions The modified RCT protocol was considered feasible. The identified successes can be leveraged, and the risks can be mitigated, during implementation of a full-scale RCT. Assessment of this RCT protocol is an important step in understanding the effectiveness of diet-focused eHealth tools to supporting physician self-efficacy in assessing, monitoring, and implementing dietary advice in routine clinical practice and supporting patients in effective behaviour change.

Sodium overconsumption has become a serious health concern resulting in the Food and Drug Administration (FDA) publishing voluntary sodium reduction guidelines for a wide spectrum of packaged and processed foods. Reducing sodium through the removal of salt may decrease the palatability of foods, thus increasing the need for new approaches to prevent such palatability loss. The objective of this research was to characterize white and multigrain breads with either 43% or 60% reduction in sodium and with and without monosodium glutamate (MSG) using descriptive analysis methodology as well as to identify the drivers of liking for white and multigrain breads of varying sodium contents with and without MSG. Significant differences were identified in the attributes of salty taste and aftertaste, savory aftertaste, and chewy and firm textures in white bread and of salty taste and aftertaste, sweet taste, and density in multigrain bread. By regressing consumer test data of these breads onto their principal component analysis biplots, textural attributes and salty taste and aftertaste were identified as primary drivers of liking in white and multigrain breads. Flavor enhancers such as MSG show promise in mitigating palatability loss that occurs when the sodium content of bread is greatly reduced and thus provide a promising solution to produce breads with an improved nutritional profile. Future research on flavor enhancement in other food matrices would be valuable as well as in other bread and carbohydrate‐based food categories. Practical Application: The findings of our study suggest that texture and a salty taste and aftertaste drive consumer liking of reduced‐sodium white and multigrain breads and liking of breads could be improved with the addition of monosodium glutamate. Increasing the acceptance of reduced‐sodium food products could help to improve the health of the American population by resulting in a reduced risk of hypertension and subsequently heart attacks and stroke. [ABSTRACT FROM AUTHOR]

In many parts of the world, sodium consumption is higher than recommended levels, representing one of the most important food‐related health challenges and leading to considerable economical costs for society. Therefore, there is a need to find technical solutions for sodium reduction that can be implemented by food producers and within food services. The aims of this review are to discuss the barriers related to sodium reduction and to highlight a variety of technical solutions. The barriers relate to consumer perception, microbiology, processing, and physicochemistry. Existing technical solutions include inhomogeneous salt distribution, coated salt particles, changing particle sizes and forms, surface coating, multisensory combinations, sodium replacements, double emulsions, adapted serum release by microstructure design, and adapted brittleness by microstructure design. These solutions, their implementation and the associated challenges, and applicable product categories are described. Some of these solutions are ready for use or are in their early development stages. Many solutions are promising, but in most cases, some form of adaptation or optimization is needed before application in specific products, and care must always be taken to ensure food safety. For instance, further research and innovation are required in the dynamic evolution of saltiness perception, consumer acceptance, the binding and migration of sodium, juiciness, microbiological safety, and the timing of salt addition during processing. Once implemented, these solutions will undoubtedly support food producers and food services in reducing sodium content and extend the application of the solutions to different foods. [ABSTRACT FROM AUTHOR]

The plant-based products that are mainly produced by soy protein isolate (SPI) present significantly higher sodium (Na) content than the corresponding animal-based products. Accordingly, the production of low-sodium soy protein ingredients becomes a challenging task. For this purpose, alternative soy fractionation processes were investigated, and the use of KOH as the replacement for NaOH has been established to produce soy protein fractions (SPFs). The obtained MF-K contained 0.2 mg sodium and 24 mg potassium per 100 g of fraction, which was 3 % of the sodium content in the SPI, and the potassium content was over 10 times higher than SPI. Besides, using KOH increased the protein content of SPFs by almost 7 %, as well as their water holding capacity (WHC) and thermal stability; however, the yields of SPFs were dropped by around 4–8 % while the protein solubility of SPFs was reduced companied with the application of KOH. The fractionation processes mainly affected the protein composition, powder morphology, and viscosity of SPFs, while the sodium and potassium content showed limited impacts on the variations. Overall, the application of KOH during different fractionation procedures provided the possibility to produce low-sodium high‑potassium soy protein ingredients for the development of healthy soy-based foods. [Display omitted] • KOH can be used as an alternative to NaOH to produce low-Na soy protein. • K content significantly increased by applying KOH during the process. • The use of KOH in different process conditions alters the functionality of soy protein. • The ratio of Na/K can be selected to tailor soy proteins for food applications. [ABSTRACT FROM AUTHOR]

Abstract Background Dietary patterns developed by the USDA provide modest levels of protein (14–18% energy) within the Acceptable Macronutrient Distribution Range (AMDR) of 10–35% for adults, though diets providing a higher percentage of energy may be beneficial for some individuals. The purpose of this study was to determine if it is feasible to modify the Healthy U.S.-Style Eating Pattern (“HEP”) to provide a higher percentage of energy from protein. Methods Using the framework implemented by the USDA in developing the HEP, energy from protein was set at 20%, 25%, and 30%. Amounts of protein foods were proportionally increased while amounts of other foods were adjusted iteratively within specified parameters. The models also disaggregated total meat/poultry into fresh and processed forms to develop patterns maintaining current proportions, current levels, reduced, or no processed meat/poultry. Nutrient intakes were compared with nutrient goals for representative U.S. populations with 2,000 kcal needs (females 19–30 years, males 51–70 years), with 90% of the Recommended Dietary Allowance or Adequate Intake regarded as sufficient. Results Dietary patterns with 20% energy from protein were constructed with minor deviations from the current 2,000 kcal HEP. Dietary patterns with 25% energy from protein were constructed for all levels of processed meat/poultry excluding the current proportion model, though relative to the current HEP the constructed patterns reflect substantial reductions in amounts of refined grains and starchy vegetables, and substantial increases in protein foods consumed as beans and peas, seafood, and soy products. It was not possible to develop a pattern with 30% energy from protein without reducing the percentage of energy from carbohydrate below the AMDR or non-compliance with other modeling constraints. Stepwise reductions in processed meat/poultry reduced sodium intake. Conclusions It is feasible to develop dietary patterns in a 2,000 kcal diet while mirroring the HEP that meet recommended intakes of nutrients with 20% or 25% energy from protein, though the pattern with 25% energy from protein may be more idealistic than realistic. Reduced levels of processed meat/poultry may translate to lower sodium intake.

This study investigated the effect of low-salt processing on the umami peptide profile of dry-cured hams. Peptidomics data showed 633 umami peptides in the low- and full-salt groups. Among them, 36.2% and 26.5% of shared umami peptides in the low-salt group were significantly down- and up-regulated in relative abundance. Multivariate statistical analysis showed 1011 significantly different umami peptides (SDUPs) in the low- and full-salt groups. Creatine kinase M-type (CKM) and fast skeletal muscle troponin T (TnTf) were the main precursor proteins of these SDUPs. At the end of processing, the relative expression of CKM was lower in the low-salt group than in the full-salt group (P < 0.05), but there was no significant difference in TnTf. More dipeptidyl peptidase cleavage sites were observed in CKM and TnTf proteins in the low-salt group. • Umami peptides in dry-cured hams were screened using peptidomics. • Low- and full-salt hams could be distinguished using 1011 SDUPs. • The 62.7% of shared umami peptides changed significantly in relative abundance. • Degradation of TnTf and CKM was closely associated with SDUPs formation. [ABSTRACT FROM AUTHOR]

Excessive dietary salt intake leads to health issues, while reducing NaCl content compromises flavor. Therefore, identifying methods to decrease salt levels without sacrificing flavor is crucial. This study investigated the sensory interaction between the saltiness of NaCl and the pungency of Litsea oleoresin. Glyceryl monostearate (6.6%) and soy lecithin (4.4%) were used as gelling agents to create oleogels, which were then employed to immobilize NaCl nanocrystals, optimizing sensory interactions. NaCl nanocrystals (427.73 ± 61.98 nm) were encapsulated in a Litsea oleoresin-sunflower seed oleogel system with uniform distribution. Sensory evaluation indicated that the NaCl nanocrystal/ Litsea oleoresin@oleogel system, with moderate pungency, significantly enhanced perceived saltiness intensity (29.00 ± 1.14, compared to the control, 18.48 ± 1.12) (P < 0.05). When applied to potato chips, this system noticeably increased saltiness perception. This research provides a promising approach for developing low-sodium yet flavorful foods. • A novel system for reducing salt by structuring oleogels has been developed. • Saltiness was enhanced through the use of sodium chloride nanocrystals. • The sensory interaction between saltiness and pungency was investigated. • The saltiness of potato chips was improved using this specific system. [ABSTRACT FROM AUTHOR]

The sodium consumption in many countries is too high, which results in increased risk for hypertension, cardiovascular diseases, stroke and premature death. Inhomogeneous sodium distribution using layering is a viable way to reduce sodium in bread that normally contains a lot of sodium. Prevention of sodium migration during production and storage is important for the function of this approach. Furthermore, the distribution of sodium between starch and gluten influences their properties. The spatial distribution of sodium was investigated at high resolution using combinations of X-ray fluorescence microscopy (XFM), scanning transmission X-ray microscopy (STXM), light microscopy (LM), scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM-EDX) and image analysis. Reference breads and layered bread samples were baked with one salt-free layer and one layer containing 3.6 wt% sodium chloride salt. The obtained results showed that the concentration of sodium is higher in the starch phase than in the gluten phase and that sodium migrates across the layer interface from the salt-containing to the salt-free layer. The ratios between the sodium concentration in the starch and gluten phases were dependent on the sodium concentration across the interfaces. Furthermore, magnesium and phosphor signals in bread yeast cells were observed using XFM. • New method to investigate the spatial distribution of sodium in bread using advanced microscopy. • High resolution maps of the spatial distribution of sodium between starch and gluten. • Sodium preferentially localises in the starch phase. • Identification of yeast cells in bread using magnesium and phosphor signals. [ABSTRACT FROM AUTHOR]

Cold-smoked salmon are ready-to-eat products that may support the growth of pathogenic Listeria monocytogenes during their long shelf-life. Consumption of such contaminated products can cause fatal listeriosis infections. Another challenge and potential risk associated with CS salmon is their high levels of sodium salt. Excess dietary intake is associated with serious health complications. In the present study, anti-listerial bacteriocin (nisin), P100 bacteriophages (Phageguard L, PGL) and fermentates (Verdad N6, P-NDV) were evaluated as commercial bio-preservation strategies for increased control of L. monocytogenes in standard (with NaCl) and sodium-reduced (NaCl partially replaced with KCl) CS salmon. Treatments of CS salmon with nisin (1 ppm) and PGL (5 × 107 pfu/cm2) separately yielded significant initial reductions in L. monocytogenes (up to 0.7 log) compared to untreated samples. Enhanced additive reductions were achieved through the combined treatments of nisin and PGL. Fermentates in the CS salmon inhibited the growth of Listeria but did not lead to its eradication. The lowest levels of L. monocytogenes during storage were observed in nisin- and PGL-treated CS salmon containing preservative fermentates and stored at 4 °C, while enhanced growth was observed during storage at an abusive temperature of 8 °C. Evaluation of industry-processed standard and sodium-replaced CS salmon confirmed significant effects with up to 1.7 log reductions in L. monocytogenes levels after 34 days of storage of PGL- and nisin-treated CS salmon-containing fermentates. No differences in total aerobic plate counts were observed between treated (PGL and nisin) or non-treated standard and sodium-reduced CS salmon at the end of storage. The microbiota was dominated by Photobacterium, but with a shift showing dominance of Lactococcus spp. and Vagococcus spp. in fermentate-containing samples. Similar and robust reductions in L. monocytogenes can be achieved in both standard and sodium-replaced CS salmon using the bio-preservation strategies of nisin, PGL and fermentates under various and relevant processing and storage conditions.

Summary: Background: While low sodium intake (40 years with stable blood pressure (BP), without heart failure or postural hypotension were randomised to intensive dietary counselling (target sodium intake

Sodium chloride (NaCl) is a key ingredient in the processing of traditional dry-cured meat products by improving microbial safety, sensory attributes and technological properties. However, increasing concern about the consumption of sodium and health has been supporting the development of low-sodium meat products. Several strategies to reduce sodium in dry-cured meat product have been tested, although the followed approaches sometimes result in undesirable characteristics concerning flavor, texture and mouthfeel. The use of halophytic plants such as glasswort (Salicornia herbacea) in food matrices has been suggested as a novel strategy to reduce sodium content, due its salty flavor. The main aim of the present study is to produce traditional dry-cured pork bellies from the Bísaro breed using glasswort as a NaCl partial replacer, and compare it with dry-cured bellies salted either with NaCl or a mix of NaCl + KCl. Control bellies (BC) were salted with 100% of NaCl, the second formulation (BK) had 50% of NaCl and 50% of KCl, and the third formulation (BG) had 90% of NaCl and 10% of glasswort powder (GP). After production, the bellies were evaluated for aw, pH, CIELab coordinates, weight loss, proximal composition, TBARS, collagen and chloride contents, fatty acid profile and sensory attributes. The use of BG in dry-cured pork bellies did not affect processing indicators such as weight loss, aw and pH. Concerning CIELab, only the coordinates L* and hue angle from the external surface color of BG were statistically different from BC and BK. As expected, ash and NaCl contents differed from BG to the other two formulations. SFA and indexes AI and TI were lower, whereas the MUFA and h/H ratio were higher in BG than other treatments, leading to a product with a healthier lipid profile. The sensory evaluation revealed differences in appearance, taste and flavor among treatments, but did not indicate any negative effects of BG in the product attributes. This study reinforces the potential of BG as a natural sodium reducer for the production of traditional dry-cured pork bellies. [ABSTRACT FROM AUTHOR]

Background: The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. Methods: A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. Results: Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. Conclusions: Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care. [ABSTRACT FROM AUTHOR]

The common use of sodium in different compositions, is as a preservative, for colouring, curing, flavouring and as a binding agent in processed meats, it is also used for improved shelf life and distinct palatability. Even with modern food processing methods, sodium is still essential in manufacturing of meat derivatives. Continuous consumption of high sodium diets is associated with adverse chronic health effects, such as cardiovascular diseases, hypertension, stroke, cancers, among others, which have been on the rise. As a result, there has been a global drive by organisations such as the World Health Organization (WHO) to advise member states to reduce dietary sodium levels in various foods, including processed meats. Consequently, South Africa promulgated the first sodium reduction regulations in Africa by 2013, intended to reduce sodium in certain foodstuffs, including processed meat products. The objectives of this study were to determine (1) the level of sodium in processed meats produced by local butcheries in the City of Tshwane (CoT), Gauteng, South Africa and (2) to compare the amount of sodium in processed meats, determined using the two South African legislated methods, namely Flame Atomic Absorption Spectroscopy (FAAS) and Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES). A crosssectional approach with qualitative and experimental dimensions approach was followed. Processed meat production records obtained from randomly selected butcheries in CoT (122) revealed that the top six commonly produced processed meats were boerewors (90.2 %), braaiwors (87.7 %), biltong (86.9 %), drywors (62.3 %), viennas (45.9 %) and burger patties (43.5 %). Subsequently, sampling (n=396) of the top six products from 66 randomly selected butcheries was done. The findings of the study revealed that processed meats analysed using ICP-AES and FAAS contained mean sodium levels of 1449 mg/100 g and 649 mg/100 g, respectively (p<0.0001), which were higher than the South African legal sodium limits. The concentration of sodium of products determined using ICP-AES (64.7 - 9201 mg/100 g) was significantly (p<0.0001) higher than in the same products analysed using FAAS (35.4 - 2351 mg/100 g). From the findings of this study, sodium reduction requires a concerted effort in enforcing the South African mandatory sodium limits in local butcheries in processed meats. The results of legislated sodium test methods must be comparable to ensure equal level of compliance. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to evaluate the quality of information and guidance on dietary sodium reduction available on consumer‐facing websites. Google Trends was used to identify the five most‐used search terms related to dietary sodium reduction. For each term, websites on the first two pages were collected (n = 18–20). Of 93 websites collected, 24 were excluded due to defective links, duplicate websites, or not being consumer‐focused. The remaining 69 websites were evaluated using a novel instrument, JHU‐SALT, that includes 14 questions on topics related to salt reduction. The questions are grouped into three domains ("information," "guidance," and "accuracy"). For each question, websites were scored using a 3‐step ordinal scale ("topic not addressed," "topic somewhat addressed," or "topic addressed adequately"). Only three of 14 JHU‐SALT questions were addressed adequately by a majority of websites. Many websites provided information on the adverse health effects of a high sodium diet (74%, n = 51) or mentioned intake recommendations (64%, n = 44). Information on fundamental concepts was largely missing. The majority of websites (80%, n = 55) provided information on lifestyle strategies to reduce blood pressure, but most did not provide guidance to help implement those strategies. While missing information was common, misinformation was uncommon. The DISCERN questionnaire was utilized as well. Consumers seeking information and guidance on dietary sodium reduction will find that most available websites provide accurate but limited information, and insufficient guidance on how to lower sodium intake. Websites that provide both relevant information and guidance are needed to help consumers effectively reduce dietary sodium. [ABSTRACT FROM AUTHOR]

Background: Potassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse., Objectives: The objective of this study was to summarize the label features of potassium-enriched salt products available worldwide., Methods: A content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as "salt substitute" or "low sodium salt." Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized., Results: A total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium ( n = 15), no potassium ( n = 5), or that were duplicates ( n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use., Conclusions: There was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed., (© 2024 The Authors.)