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Purpose: To develop and validate a tool to assess salt intake in the adult population of the Russian Federation.Material and Methods: Respondents filled out food diaries, where the type of food intake, its volume, and the fact of additional salting of the dish were taken into account. R language, version 4.2.1, RStudio development environment (packages ggplot2, ggpubr, dplyr, tidyverse, gtsummary, rstatix) were used for statistical processing of the obtained data.Results: A total of 271 respondents were included in the study, with a median age of 52 [20; 70] years. It was found that the main factors for high sodium intake were pre-salting, consumption of salty foods, lower intake in confectionery, low salt intake was characterized by higher consumption of dairy products. Cohen’s consistency test was κ = 0.48 95 % CI (0.08; 0.08), Cronbach’s alpha values α = 0.8. At a threshold score of ≥12 points on the questionnaire, the questionnaire had a sensitivity of 85 % compared with the median score from the 3-day food diary data. At a threshold score < 12 points, the questionnaire has a specificity of 74 % compared with the median score from a 3-day food diary.Conclusion: The SOLE questionnaire can be used to determine the estimated level of salt intake by the population, but for wider application in the territory of the Russian Federation additional validation by regions is required.

Salt consumption restriction has many advantages in patients on hemodialysis (HD), but it is also very challenging for them. Self-efficacy is a crucial aspect of successful disease management. Factors related to self-efficacy have been evaluated in many countries. However, the different demographic characteristics in Indonesia may show different significant results. Understanding this problem may contribute to the development of nursing interventions and the patients’ self-management ability while undergoing HD. Hence, the present study aimed to determine the factors associated with self-efficacy for restricting salt consumption among HD patients. Altogether, 98 HD patients participated in this cross-sectional study. The Self-efficacy for Restricting Dietary Sodium in Hemodialysis Scale questionnaire was completed to assess the patients’ self-efficacy. Linear regression was performed to evaluate the relationship between self-efficacy and patient characteristics. The participants’ mean age was 50.11 ± 1.29 years and the mean self-efficacy score was 73.56 ± 14.85. Mostly, participants were male (60.2%), married (82.7%), and had hypertension (85.7%). Age (p = 0.000; r = 0.384), HD duration (p = 0.004; r = −0.287), and interdialytic weight gain (IDWG) (p = 0.008; r = −0.267) significantly correlated with self-efficacy for restricting salt consumption. These three variables determined 21% of the variance of self-efficacy among HD patients. The present study provides primary evidence that age, HD duration, and IDWG are associated with self-efficacy for restricting salt consumption among HD patients. Thus, nurses could develop innovative interventions to enhance the self-efficacy among patients with younger age, longer HD duration, and more IDWG. Keywords: hemodialysis, salt consumption, self-efficacy Abstrak Efikasi Diri dalam Konsumsi Garam di Kalangan Pasien yang Menjalani Hemodialisis. Pembatasan asupan garam pasien hemodialisis (HD) bermanfaat bagi kondisi kesehatan sekaligus menjadi tantangan tersendiri bagi pasien. Efikasi diri merupakan aspek mendasar dalam keberhasilan manajemen penyakit. Faktor yang berhubungan dengan efikasi diri sudah diteliti di negara-negara lain, akan tetapi, perbedaan karakteristik demografi di Indonesia dapat memperlihatkan perbedaan hasil. Pemahaman terkait masalah ini berkontribusi pada peningkatan intervensi keperawatan dan manajemen diri pasien. Oleh karena itu, tujuan penelitian ini untuk mengetahui faktor-faktor yang berhubungan dengan efikasi diri dalam membatasi asupan garam pada pasien hemodialisis. Penelitian ini menggunakan desain cross-sectional dengan melibatkan sebanyak 98 pasien. Kuesioner The self-efficacy for Restricting Dietary Sodium in Hemodialysis Scale digunakan untuk mengukur efikasi diri pasien. Regresi linear dilakukan untuk melihat hubungan antara efikasi diri dengan data demografi. Rata-rata usia partisipan adalah 50,11 ± 1,29 tahun dengan rata-rata skor efikasi diri pasien adalah 73,56 ± 14,85. Sebagian besar partisipan adalah laki-laki (60,2%), sudah menikah (82,7%), dan memiliki hipertensi (85,7%). Ditemukan bahwa usia (p = 0,000; r = 0,384), durasi hemodialisis (p = 0,004; r = −0,287), dan IDWG (p = 0,008; r = −0,267) berhubungan signifikan dengan efikasi diri dalam membatasi asupan garam. Ketiga variabel tersebut berkontribusi sebesar 21% terhadap variansi efikasi diri pasien hemodialisis. Penelitian ini membuktikan bahwa usia, durasi hemodialisis, dan IDWG berhubungan dengan efikasi diri pembatasan asupan garam pasien hemodialisis. Oleh karena itu, perawat dapat mengembangkan intervensi peningkatan efikasi diri pada pasien dengan usia muda, pasien yang telah lama menjalani HD, dan pasien dengan IDWG lebih. Kata Kunci: asupan garam, efikasi diri, hemodialisis

Purpose: To assess any effects of a state-wide sodium reduction intervention on sodium intake, sources of dietary sodium and discretionary salt use at a population level. Methods: Data (24-h urinary sodium excretion, self-report survey, a 24-h dietary recall) were collected cross-sectionally at baseline (2016/2017) and follow-up (2020) from adults in Victoria, Australia. Intervention activities included consumer awareness advertising campaign, public debate generation via mass media, strengthening existing policy initiatives and supporting food innovation with industry. Results: There were 339 participants at baseline and 211 at follow-up, with 144 and 90 of participants completing a 24-h dietary recall, respectively. There was no difference in adjusted 24-h urinary sodium excretion between baseline and follow-up (134 vs 131 mmol/24 h; p = 0.260). There were no differences in the percentage of participants adding salt during cooking (63% vs 68%; p = 0.244), adding salt at the table (34% vs 37%; p = 0.400) or regularly taking action to control salt/sodium intake (22% vs 21%; p = 0.793). There were large differences in the quantity of dietary sodium sourced from retail stores (57% vs 77%, p < 0.001), and less sodium was sourced from foods at fresh food markets (13% vs 2%; p ≤ 0.001) at follow-up. No large differences were apparent for foods with different levels of processing or for food groups. Conclusion: There was no clear population-level effect of the 4-year multi-component Victorian Salt Reduction Intervention on sodium intake with Victorian adults continuing to consume sodium above recommended levels. The findings indicate that more intensive and sustained efforts aiming at the retail and food industry with national level support are likely to be required to achieve a measurable improvement in sodium intake at a state level. [ABSTRACT FROM AUTHOR]

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes a significant burden on Westernized regions. The Western diet, high in salt intake, significantly contributes to disease development. However, there are a lack of data on salt literacy and salt intake among MASLD patients in Germany. Our study aims to analyze daily salt intake and salt-intake-related behavior in MASLD patients. Methods: 234 MASLD patients were prospectively included. Daily salt intake and salt-intake-related behavior were assessed via a food frequency questionnaire (FFQ—DEGS) and a salt questionnaire (SINU). Statistical analyses were performed using SPSS. Results: Mean daily salt intake was higher in men than in women (7.3 ± 5 g/d vs. 5.3 ± 4 g/d; p < 0.001). There was significant agreement between increased daily salt intake (>6 g/d) and the behavioral salt index (SI) (p < 0.001). Men exhibited higher SI scores compared to women, indicating lower awareness of salt in everyday life. Multivariate analysis identified specific salt-intake-related behaviors impacting daily salt consumption. Conclusions: Our study reveals a strong link between daily salt intake and salt-intake-related behavior, highlighting sex-specific differences in an MASLD cohort. To enhance patient care in high-cardiovascular-risk populations, specific behavioral approaches may be considered, including salt awareness, to improve adherence to lifestyle changes, particularly in male patients. [ABSTRACT FROM AUTHOR]

There is little information describing how endurance athletes perceive sodium intake in relation to training and competition. Using an online questionnaire, this study assessed the beliefs, information sources, and intended practices regarding sodium ingestion for training and competition. Endurance athletes (n = 344) from six English-speaking countries completed the questionnaire and were included for analysis. The most cited information sources were social supports (63%), self-experimentation (56%), and media (48%). Respondents generally believed (>50% on electronic visual analog scale) endurance athletes require additional sodiumon a daily basis (median 67% [interquartile range: 40-81%]), benefit from increased sodium in the days preceding competition (60% [30-77%]), should replace sodium losses during training (69% [48-83%]) and competition (74% [54-87%]), and would benefit from sweat composition testing (82% [65-95%]). Respondents generally believed sodium ingestion during endurance exercise prevents exercise-associated muscle cramps (75% [60-88%]) and exercise-associated hyponatremia (74% [62-89%]). The majority (58%) planned to consciously increase sodium or total food intake (i.e., indirectly increasing sodium intake) in the days preceding competition. Most (79%) were conscious of sodium intake during competition, but only 29% could articulate a specific intake plan. A small minority (5%) reported using commercial sweat testing services, of which 75% believed it was beneficial. We conclude that endurance athletes commonly perceive sodium intake as important for their sporting activities. Many intend to consciously increase sodiumintake in the days preceding and during competition, although these views appear informed mostly by nonscientific and/or non-evidence-based sources. [ABSTRACT FROM AUTHOR]

The omnipresence of microplastics (MPs) in marine and terrestrial environments as a pollutant of concern is well established and widely discussed in the literature. However, studies on MP contamination in commercial food sources like salts from the terrestrial environment are scarce. Thus, this is the first study to investigate various varieties of Australian commercial salts (both terrestrial and marine salts) as a source of MPs in the human diet, and the first to detect MPs in black salt. Using Nile red dye, the MPs were detected and counted under light microscopy, further characterised using attenuated total reflectance Fourier transformed infrared spectroscopy (ATR-FTIR) and scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM–EDS). Of all the 90 suspected particles, 78.8% were identified as MPs with a size ranging between 23.2 µm and 3.9 mm. The fibres and fragments constituted 75.78% and 24.22% respectively. Among the tested samples, Himalayan pink salt (coarse) from terrestrial sources was found to have the highest MP load, i.e. 174.04 ± 25.05 (SD) particle/kg, followed by black salt at 157.41 ± 23.13 particle/kg. The average concentration of detected MPs in Australian commercial salts is 85.19 ± 63.04 (SD) per kg. Polyamide (33.8%) and polyurethane (30.98%) were the dominant MP types. Considering the maximum recommended (World Health Organization) salt uptake by adults daily at 5 g, we interpret that an average person living in Australia may be ingesting approximately 155.47 MPs/year from salt uptake. Overall, MP contamination was higher in terrestrial salts (such as black and Himalayan salt) than the marine salt. In conclusion, we highlight those commercial salts used in our daily lives serve as sources of MPs in the diet, with unknown effects on human health. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is the leading cardiovascular disease (CVD) risk factor in Haiti and is likely driven by poverty-related social and dietary factors. Salt consumption in Haiti is hypothesized to be high but has never been rigorously quantified. Methods: We used spot urine samples from a subset of participants in the population-based Haiti Cardiovascular Disease Cohort to estimate population mean daily sodium intake. We compared three previously validated formulas for estimating dietary sodium intake using urine sodium, urine creatinine, age, sex, height, and weight. We explored the association between dietary sodium intake and blood pressure, stratified by age group. Results: A total of 1,240 participants had spot urine samples. Median age was 38 years (range 18–93), and 48% were female. The mean dietary sodium intake was 3.5–5.0 g/day across the three estimation methods, with 94.2%–97.9% of participants consuming above the World Health Organization (WHO) recommended maximum of 2 g/day of sodium. Among young adults aged 18–29, increasing salt intake from the lowest quartile of consumption (5.88 g/day) was associated with a mean 8.71 mmHg higher systolic blood pressure (SBP) (95% confidence interval: 3.35, 14.07; p = 0.001). An association was not seen in older age groups. Among participants under age 40, those with SBP ≥120 mmHg consumed 0.5 g/day more sodium than those with SBP

The purpose of this study is to explore the historical background of edema as a prognostic sign in popes, a special category of medical subjects whose health status was closely monitored and chronicled because of their unique important status in the events of their times. Nine out of 51 popes, who reigned in the years 1555–1978, died edematous at a mean age of 75.5 years of age. The cause of edema was: heart failure for John Paul I, liver disease, obstructive nephropathy associated with anemia for Paul IV, who also suffered from deep vein thrombosis, and malnutrition for Innocent XIII. Chronic kidney disease due to renal stones of gouty origin caused edema in Clement VIII, Clement X, Clement XI, and Benedict XIV. Obstructive nephropathy due to renal stones of non-gouty origin caused edema in Clement XIII, whereas toxic nephropathy due to the use of mercurials caused edema in Clement XIV. Innocent XI, Benedict XIV, and Clement XIV were bled before death because of impending pulmonary edema. It is not surprising that chronic kidney disease was a significant cause of edema in popes with chronic kidney disease which is associated with impaired sodium excretion. The edema was likely aggravated by the excessive dietary salt intake of the period when the importance of sodium chloride restriction was still not discovered and effective diuretic agents were not available. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated., Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion., Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the Šidák correction applied for multiple comparisons., Results: Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01)., Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods., (©Gabriela Gutiérrez-Salmeán, Paola Vanessa Miranda-Alatriste, Patricio Benítez-Alday, Luis Enrique Orozco-Rivera, Nurit Islas-Vargas, Ángeles Espinosa-Cuevas, Ricardo Correa-Rotter, Eloisa Colin-Ramirez. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 18.11.2024.)

ntroduction. In Senegal, 29.8% of adults are known to have hypertension. Among all the dietary factors causing this disease, salt and its impact on blood pressure are by far the best documented. Objective. The objective of this study was to estimate the dietary salt intake of Senegalese populations on the basis of scenarios consumption. Material and methods. This was an estimate of the amount of salt that could be consumed by a resident of Dakar and Mékhé (Thiès). For that, the analytical data relating to the salt content of the most commonly consumed millet and rice dishes were correlated with those relating to the available food consumption habits. Results. The consumption scenarios revealed that Dakar as well as Thiès resident consumed between 8.81 and 32.34g of salt by day, i.e. 176.2 to 646.8% of the guide value of 5g of salt per day recommended by the World Health Organisation (WHO). Conclusion. Overconsumption of salt is noted in Senegalese, with sodium intakes higher than the guide value recommended by the WHO.

Abstract Background Sodium is an essential mineral needed by the human body that must be obtained from food. An excess intake, however, can lead to many diseases. As food is the main source of sodium, this study aims to provide information on high sodium food consumption patterns in the Malaysian adult population. Methods The Malaysian Community Salt Study (MyCoSS) was a nationwide cross-sectional study, conducted between October 2017 and March 2018. A multistage complex sample was applied to select a nationally representative sample of respondents aged 18 years and above. Face to face interview by a validated Food Frequency Questionnaire (FFQ) comprising 104 food items was used to gain information on high sodium food consumption patterns. Results A total of 1047 respondents were involved in this study, with 1032 (98.6%) answering the FFQ. From the number, 54.1% exceed the recommendation of sodium intake

High salt intake is an important risk factor for cardiovascular diseases (CVD), closely related to the level of blood pressure in the population. The purpose of the review: to study population-based interventions for CVD prevention, aimed at reducing salt intake; to assess the potential for their implementation in the Russian Federation. We presented population-based strategies for dietary salt intake reduction used in different countries. The main components of strategies aimed to correct this risk factor in the Russian Federation were identified. The main components of the population-based approach to reducing salt intake are: determining population salt consumption, identifying sources of salt in the diet, monitoring of salt content in products, engaging with the food industry, consumer awareness campaigns, changes in product labeling, tax measures. An integrated approach to the problem is the most successful. Measures which were highly effective have not yet been fully implemented in the Russian Federation. At the moment, taxation of high-salt foods and tax subsidies for healthy food are not applied. Food manufacturers are not sufficiently involved - there are no legislatively introduced measures to reduce salt through food reformulation. Firstly it has to be applied to diet-forming products that are consumed daily, such as bakery and dairy products, and meat products.

Abstract Background A high intake of salt is a major risk factor for cardiovascular diseases. Despite decades of effort to reduce salt consumption, the salt intake in China is still considerably above the recommended level. Thus, this study aims to design and implement an intelligent household added salt monitoring system (SALTCHECKER) to monitor and control added salt consumption in Chinese households. Methods A randomized controlled trial will be conducted among households to test the effect of a SALTCHECKER in Chongqing, China. The test modalities are the SALTCHECKER (with a smart salt checker and a salt-limiting WeChat mini programme) compared to a salt checker (with only a weighing function). The effectiveness of the system will be investigated by assessing the daily added salt intake of each household member and the salt consumption-related knowledge, attitude and practice (KAP) of the household’s main cook. Assessments will be performed at baseline and at 3 and 6 months. Discussion This study will be the first to explore the effect of the household added salt monitoring system on the reduction in salt intake in households. If the intelligent monitoring system is found to be effective in limiting household added salt consumption, it could provide scientific evidence on reducing salt consumption and preventing salt-related chronic diseases. Trial registration Chinese clinical trial registry (Primary registry in the World Health Organization registry network): ChiCTR1800018586 . Date of registration: September 25, 2018.

BACKGROUND: Non-communicable illnesses are the leading reason for wide-reaching death. Reducing the burden of these illnesses is one of the significant objectives of the World Health Organization's action plan. In this respect, reducing salt consumption is one of the most cost-effective public health interventions. The present study aimed to adjust the Theory of Planned Behavior (TPB) in expecting salt consumption behavior in pregnant women visiting the health centers in Birjand. MATERIALS AND METHODS: In this cross-sectional study, 273 pregnant women who visited the health centers in Birjand were selected through Quota sampling method. The data were collected using a self-administered questionnaire based on the TPB constructs. The data analysis was done in SPSS 19 and AMOS 24. RESULTS: The mean age of participants was 27.33 ± 5.77 years, and their mean gestational age was 12.67 ± 4.11 weeks. The mean score of attitude construct was 86.54 ± 8.50, subjective norm construct 36.59 ± 4.47, perceived behavioral control construct 41.63 ± 7.01, intention construct 16.01 ± 2.65 and behavior construct 19.86 ± 2.57. There was a statistically significant relationship between attitude construct (p < 0.001), perceived behavioral control (p < 0.001), and intention (p < 0.001) with salt consumption behavior (p < 0.05). The goodness of fit indices showed a proper fit of data (χ2/df = 1.94, PNFI = 0.6, TLI = 0.9, CFI = 0.9 and RMSE = 0.06). CONCLUSION: The results of this study showed that the TPB is an appropriate model for reviewing the behavior of salt consumption. Hence, this model offers a suitable basis for designing an educational intervention to regulate the quantity of salt consumed by pregnant women and; thus, its usage in health promotion programs is suggested.

Resumen: Objetivo: Identificar el consumo de sal, actitudes, comportamiento y conocimientos de los pacientes que acuden durante un mes al centro de salud y del personal sanitario basado en la ingesta de sal según categoría de los alimentos. Material y métodos: Estudio observacional, descriptivo y transversal en una consulta de Atención Primaria mediante una encuesta multicomponente y autoadministrada con variables respecto a actitudes, comportamiento y conocimientos sobre el consumo de sal. Resultados: Muestra 330 pacientes y 48 profesionales sanitarios. Análisis estadístico: Programa SPSS versión 27. Descripción uni y bivariada. Contrastes bivariados entre variables cualitativas X2 de Pearson y U Mann-Whitney para las cuantitativas. Nivel de significación p< 0,05.El consumo de alimentos con alto y bajo contenido en sal es elevado en los dos colectivos, siendo mayor entre el personal sanitario (valor p = 0,000). Comportamientos y actitudes (valor p >0,05). Conocimientos: cantidad de sal recomendada (valor p= 0,001) y procedencia de la principal fuente de sal (valor p= 0,000). Conclusión: El consumo de sal es alto tanto en sanitarios como en pacientes con una autopercepción baja de su consumo. No hay diferencias en actitudes ni comportamiento entre los dos grupos, pero sí en cuanto a conocimientos. Más del 70% de pacientes desconoce la ingesta diaria máxima de sal recomendada y solo un 25% sabe que la principal fuente de consumo de sal está en los alimentos procesados.Estos resultados apoyan el importante papel del profesional sanitario en cuanto a la educación de los pacientes sobre el consumo de sal para la prevención de la enfermedad cardiovascular. Abstract: Aim: To identify the salt consumption, attitudes, behavior and knowledge of patients attending a health center and health care staff during a month, based on salt intake according to food category. Material and methods: Observational, descriptive and cross-sectional study carried out in a primary care clinic by means of a multicomponent, self-administered survey with several variables regarding attitudes, behavior and knowledge about salt consumption. Results: Sample of 330 patients and 48 health professionals.Statistical analysis: SPSS program version 27. Univariate and bivariate description. Bivariate contrasts between qualitative variables Pearson's Chi-square and Mann-Whitney U for quantitative variables. Significance level p< 0.05.The consumption of foods with high and low salt content is high in both groups, being higher among health personnel (p-value = 0.000). Behavior and attitudes (p-value >0.05). Knowledge: recommended amount of salt (p-value = 0.001) and origin of the main source of salt (p-value = 0.000). Conclusion: Salt consumption is high in both health professionals and patients with a low self-perception of salt consumption. There are no differences in attitudes or behavior between the two groups, but there are differences in knowledge. More than 70% of patients do not know the maximum recommended daily salt intake and only 25% know that the main source of salt consumption is in processed foods.These results support the important role of the health professional in educating patients about salt intake for the prevention of cardiovascular disease.

Background: Sodium is an essential mineral needed by the human body that must be obtained from food. An excess intake, however, can lead to many diseases. As food is the main source of sodium, this study aims to provide information on high sodium food consumption patterns in the Malaysian adult population.Methods: The Malaysian Community Salt Study (MyCoSS) was a nationwide cross-sectional study, conducted between October 2017 and March 2018. A multistage complex sample was applied to select a nationally representative sample of respondents aged 18 years and above. Face to face interview by a validated Food Frequency Questionnaire (FFQ) comprising 104 food items was used to gain information on high sodium food consumption patterns.Results: A total of 1047 respondents were involved in this study, with 1032 (98.6%) answering the FFQ. From the number, 54.1% exceed the recommendation of sodium intake <2000mg/day by FFQ assessment. The results also demonstrated that fried vegetables (86.4%) were the most common high sodium food consumed, followed by bread (85.9%) and omelet (80.3%). In urban areas, bread was the most common while fried vegetables took the lead in rural areas. By sex, bread was most commonly eaten by males and fried vegetables by females. The results also found that kolok mee/kampua mee contributed the highest sodium, 256.5mg/day in 9.0% adult population, followed by soy sauce 248.1mg/day in 33.2% adult population, and curry noodles 164.2mg/day in 18.5% adult population.Conclusion: Fried vegetables, bread, and soy sauce were the main source of sodium consumption among adult. Reducing the amount of sodium added to these foods should be the top priority to reduce population sodium intake and thereby prevent sodium-related diseases in Malaysia. [ABSTRACT FROM AUTHOR]

Abstract Background and Aim: Overuse of salt is one of the most important risk factors for cardiovascular disease and is the first cause of mortality worldwide. The aim of the present study was to extract the views and opinions of the people of Yasuj about salt intake in order to use its findings in designing and implementing a behavioral intervention to reduce salt intake. Methods: In the present qualitative study, which was done by content analysis approach, the data were collected through six sessions of centralized discussion with presence of 66 residents of Yasuj, Iran. The data collecting tool was grouped in semi-structured questions. The comments presented were fully recorded, implemented and analyzed with the help of the content analysis method manually. Finally, five main themes and 31 sub-themes were identified and after several readings, the main themes were grouped together with similar meanings. Results: Five main themes were self-assessment of the level of salt consumption (with 5 subfields), side effects of too much salt (with three subfields), low barriers salt intake (11 subfields), strategies to reduce salt intake (8 subfields), communication channels were identified for communicating with individuals and encouraging them to reduce salt intake (with four sub-topics). Most participants in the study were aware of their salt intake, knew the side effects of too much salt in hypertension, educational programs at home and with minimal time and for all members of the family, and offer alternatives healthy for salt offered, Physicians and health care providers in the service centers considered the most influential people to modify their behavior. Conclusion: To improve risk behaviors such as high salt intake in the community, it is important to know their views and opinions so that effective audience-based interventions can be designed and implemented

In Victoria, Australia, a statewide salt reduction partnership was launched in 2015. The aim was to measure Na intake, food sources of Na (level of processing, purchase origin) and discretionary salt use in a cross-section of Victorian adults prior to a salt reduction initiative. In 2016/2017, participants completed a 24-h urine collection (n 338) and a subsample completed a 24-h dietary recall (n 142). Participants were aged 41·2 (sd 13·9) years, and 56 % were females. Mean 24-h urinary excretion was 138 (95 % CI 127, 149) mmol/d for Na. Salt equivalent was 8·1 (95 % CI 7·4, 8·7) g/d, equating to about 8·9 (95 % CI 8·1, 9·6) g/d after 10 % adjustment for non-urinary losses. Mean 24-h intake estimated by diet recall was 118 (95 % CI 103, 133) mmol/d for Na (salt 6·9 (95 % CI 6·0, 7·8 g/d)). Leading dietary sources of Na were cereal-based mixed dishes (12 %), English muffins, flat/savoury/sweet breads (9 %), regular breads/rolls (9 %), gravies and savoury sauces (7 %) and processed meats (7 %). Over one-third (38 %) of Na consumed was derived from discretionary foods. Half of all Na consumed came from ultra-processed foods. Dietary Na derived from foods was obtained from retail stores (51 %), restaurants and fast-food/takeaway outlets (28 %) and fresh food markets (9 %). One-third (32 %) of participants reported adding salt at the table and 61 % added salt whilst cooking. This study revealed that salt intake was above recommended levels with diverse sources of intake. Results from this study suggest a multi-faceted salt reduction strategy focusing on the retail sector, and food reformulation would most likely benefit Victorians and has been used to inform the ongoing statewide salt reduction initiative. [ABSTRACT FROM AUTHOR]

Background: A high intake of salt is a major risk factor for cardiovascular diseases. Despite decades of effort to reduce salt consumption, the salt intake in China is still considerably above the recommended level. Thus, this study aims to design and implement an intelligent household added salt monitoring system (SALTCHECKER) to monitor and control added salt consumption in Chinese households.Methods: A randomized controlled trial will be conducted among households to test the effect of a SALTCHECKER in Chongqing, China. The test modalities are the SALTCHECKER (with a smart salt checker and a salt-limiting WeChat mini programme) compared to a salt checker (with only a weighing function). The effectiveness of the system will be investigated by assessing the daily added salt intake of each household member and the salt consumption-related knowledge, attitude and practice (KAP) of the household's main cook. Assessments will be performed at baseline and at 3 and 6 months.Discussion: This study will be the first to explore the effect of the household added salt monitoring system on the reduction in salt intake in households. If the intelligent monitoring system is found to be effective in limiting household added salt consumption, it could provide scientific evidence on reducing salt consumption and preventing salt-related chronic diseases.Trial Registration: Chinese clinical trial registry (Primary registry in the World Health Organization registry network): ChiCTR1800018586. Date of registration: September 25, 2018. [ABSTRACT FROM AUTHOR]

Complementary feeding practices are debated among pediatricians, primarily regarding whether nutritional needs or developmental readiness should be prioritized in recommendations for starting complementary feeding. The aim of the present study was to analyze the timing of the start of complementary feeding and the related motivations with an 8-item online survey administered to active members of the Italian Society of Primary Care Pediatricians. The participation rate was 43.3% (350 of 808), and 213 (60.9%) and 137 (39.1%) of the participants chose items related to developmental readiness and nutritional needs, respectively, as the criteria for starting complementary feeding. Approximately 74% of the participants reported that they recommended starting complementary feeding between 5 and 6 months of age, 17% recommended starting before 5 months, and 8% recommended starting after 6 months. Predefined schemes were proposed by 38% of the participants, and a responsive feeding modality was proposed by 13%, while the majority (49%) recommended both modalities depending on family characteristics. Regarding recommendations based on nutritional needs, 89% of pediatricians reported providing indications concerning the quantity of meat consumed during the first year of life, and 91% reported recommending introducing added salt only after 12 months of age. Compared with pediatricians who emphasized developmental readiness, those who prioritized nutritional needs suggested earlier complementary feeding start and a higher use of predefined schemes and were more likely to make recommendations regarding meat quantity and added salt (p < 0.0001).Conclusions: Pediatricians who used a developmental readiness criterion for starting complementary feeding may less frequently provide nutritional advice to parents, even if a trend to harmonize the different positions regarding complementary feeding start time is emerging.What is Known:• Pediatricians make suggestions for introducing complementary feeding based on scientific evidence, local traditions, and personal beliefs.• Either infants' nutritional needs or their developmental readiness currently is used as determinant for the timing of complementary feeding.What is New:• More than 60% of Italian pediatricians consider developmental readiness a priority for introducing complementary feeding.• Pediatricians following the criterion of developmental readiness may less frequently give detailed nutritional advice. [ABSTRACT FROM AUTHOR]

• Previous opioid-dependency altered salt 'desire' in now abstinent individuals. • Opioid substitution therapy did not alter salt 'desire' or salt 'liking' in humans. • Chronic opioid treatment and withdrawal increased salt consumption in mice. The consumption of dietary salt (NaCl) is controlled by neuronal pathways that are modulated by endogenous opioid signalling. The latter is disrupted by chronic use of exogenous opioid receptor agonists, such as morphine. Therefore, opioid dependence may influence salt consumption, which we investigated in two complimentary studies in humans and mice. Human study: three groups were recruited: i. Individuals who are currently opioid dependent and receiving opioid substitution treatment (OST); ii. Previously opioid dependent individuals, who are currently abstinent, and; iii. Healthy controls with no history of opioid dependence. Participants tasted solutions containing different salt concentrations and indicated levels of salt 'desire', salt 'liking', and perceptions of 'saltiness'. Mouse study: preference for 0.1 M versus 0.2 M NaCl and overall levels of salt consumption were recorded during and after chronic escalating morphine treatment. Human study: Abstinent participants' 'desire' for and 'liking' of salt was shifted towards more highly concentrated salt solutions relative to control and OST individuals. Mouse study: Mice increased their total salt consumption during morphine treatment relative to vehicle controls, which persisted for 3 days after cessation of treatment. Preference for 'low' versus 'high' concentrations of salt were unchanged. These findings suggest a possible common mechanistic cross-sensitization to salt that is present in both mice and humans and builds our understanding of how opioid dependence can influence dietary salt consumption. This research may help inform better strategies to improve the diet and overall wellbeing of the growing number of individuals who develop opioid dependence. [ABSTRACT FROM AUTHOR]

High salt/sodium intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. This paper aims to examine the association between salt consumption and salt-related knowledge, attitudes, and practices (KAP) in Nepal. The cross-sectional data used in this study were collected as part of the community-based management of non-communicable diseases project (COBIN) to understand the amount and KAP related to salt consumption in Nepal. Multivariate hierarchical logistic regression was performed to assess the association of salt-related KAP and determinants of high salt consumption in Nepal. The mean per capita salt intake was 8.0 (±3.7) g/day, with 81.6% of the population reporting higher intake than the WHO recommendation of <5 g/day. People of upper castes [adjusted odds ratio (aOR) = 0.7; 95% confidence interval (CI): 0.5-0.9], people in large families (aOR = 0.6; 95% CI: 0.5-0.7), respondents who were advised to lower salt intake (aOR = 0.6; 95% CI: 0.4-0.9) and who checked salt/sodium labels in food (aOR = 0.6; 95% CI: 0.4-0.9) were less likely to consume higher amounts of salt. Similarly, people who added extra salt to their food at the table (aOR = 1.4; 95 CI: 1.1-1.9) and who reported consuming high amounts of salt (aOR = 1.5; 95% CI: 1.1-2.3) were more likely to have high salt intake. High salt intake was documented in this population. This study suggests the need for culturally tailored community-based behavior modification through health education and dietary counseling to effectively reduce salt consumption and thereby support a reduction in hypertension and cardiovascular diseases in Nepal. [ABSTRACT FROM AUTHOR]

High dietary sodium is recognized as a silent killer responsible for 2.3 million deaths worldwide in 2010 predominantly secondary to hypertension and its complications. Although high salt consumption is considered a worldwide public health problem, its magnitude is highly variable among different communities; therefore, it is important to study locally. This study aimed to evaluate habitual salt consumption, its important correlations, as well as the knowledge, attitude, and behavior of healthy Jordanian citizens. As potassium consumption is highly correlated and important we aimed to study both jointly. In this descriptive cross-sectional study we enrolled 103 healthy adult Jordanian citizens. All participants were interviewed for questionnaire filling, physical examination, and instructed on proper 24-hour urine collection procedure. We measured sodium and potassium concentration in the provided controlled 24-hour urine collection samples, as it is presently considered the gold standard for evaluating daily intake. The results showed an average sodium intake of 179 mmol (4.1 g) per day [higher in males at 186 mmol (4.3 g) vs. 173 mmol (4.0 g) for females], significantly above the current WHO recommendations, though only 8% regularly add salt to food. Ironically, most participants (82%) believe their salt consumption was appropriate and only 29% thought they may benefit from reducing salt intake. On the other hand, potassium intake is far below the current WHO recommendations. High sodium and low potassium intake have synergistic adverse effects on public health that is not currently addressed in Jordan. We conclude that Jordanian citizens currently consume high sodium and low potassium diet and are mostly unaware of its negative impact on their health. Hence, it is crucial for healthcare providers to intervene and adopt long-term strategies to control salt intake to reduce its negative effects in Jordan and elsewhere.

The demand for salt generated by the dietary and domestic needs of most Greek city-states could be usually fulfilled by local resources given the general abundance of salt along the coasts of the ancient Mediterranean. The extremely rare references to interregional salt trade in literary and documentary sources corroborate this idea. As a bulky commodity with little economic value, salt was too expensive to be transported over long distances and was more conveniently obtainable from local resources. However, the situation was different when large-scale fish processing centers entered into the equation. The production and widespread distribution of processed fish required a steady supply of both fish and salt. Salt only was able to transform fish—which is otherwise extremely perishable—into a durable commodity, easy to store and trade. The strategic importance that salt assumed at these centers transformed its economic significance and made interregional trade both convenient and profitable. Also, it was through the medium of processed fish that the surplus of salt production available in certain regions was redistributed across the Mediterranean and came to play an important, albeit indirect, role in interregional trade. [ABSTRACT FROM AUTHOR]

The Brazilian endemic species Pyrrhura lucianii Deville, 1851, was found on private property in the municipality of Senador Guiomard in Acre State, Brazil. This is the first record of this parakeet species in the state, expanding its distribution in 219 km to the south of Pauini, the nearest location. The species was observed consuming salt, used as a cattle feed supplement. [ABSTRACT FROM AUTHOR]

The article concerns the review of different approaches to reduce table salt consumption by human beings. The levels for harmless consumption are reviewed those were recommended in terms of target organ damage prevention. The guidelines for salt consumption consuming regulation are presented, that are in use in various world countries. The foundations for personal, social aEnd state policy for practical implication of these guidelines are provided. The predicted outcomes for the realization of the policy in relation to decrease of general and cardiovascular mortality and also correction of arterial hypertension are given. The article can be in the field of interest of physicians — internists of broader profile, cardiologists, health managers.

The aim of the research was the study of changes in urine protein composition of healthy human under controlled living conditions during 105-day experiment (Mars-500 program) at different salt consumption levels. Modern proteomic methods based on chromatography-mass spectrometry, as well as different techniques of bioinformatics (including the opoSOM program), were used. Three time ranges with different dynamics of the protein detection were isolated: initial (weeks 1-6 of the experiment), intermediate (weeks 7-11), and final (weeks 12-15). About 10 different groups of jointly detectable proteins, directly associated with the periods of different salt consumption level, were identified during the work. In particular, their biological functions, tissue specificity, and signaling pathways, in which these proteins are involved in the human body, were determined. [ABSTRACT FROM AUTHOR]

The paper is focused in the salt consumption effects on renal system during the development and progression of arterial hypertension. The factors facilitating the transformation of normal hemodynamic profile into the hypertensive one are discussed. The author presents the results of experimental and clinical studies which confirm negative effects of excessive salt consumption on the morphology and function of kidneys as the key organ regulating blood pressure levels. These effects are due to both hemodynamic and non-hemodynamic mechanisms of the salt sensitivity phenomenon. The evidence of the low-salt diet effectiveness in the prevention of kidney pathology, as the target organ damage in arterial hypertension, is presented.

The review discusses the clinical impact of salt consumption on the cardiovascular system status. The therapeutic potential of reduced salt intake, in order to facilitate regression of cardiovascular disturbances, is also discussed. Daily consumption of standard or increased amounts of salt results in the complex multilevel changes of cardiac chambers, arterial and venous vessels, and microcirculation in individuals with normal and elevated blood pressure (BP). The underlying mechanisms, both hemodynamic and non-hemodynamic, are present even in normotensive people. Reduced salt consumption is associated with the regression of structural cardiovascular disturbances.

En la actualidad, las enfermedades cardiovasculares son la primera causa de muerte en el mundo. La presión arterial elevada es uno de los factores más importantes para su desarrollo, la cual está fuertemente relacionada con el consumo de sal. A nivel mundial el consumo de sal actual sobrepasa en más del doble la ingesta recomendada, lo que se ha asociado con el desarrollo de enfermedades cardiovasculares y de algunos cánceres. Los efectos beneficiosos demostrados al reducir su consumo (menor morbi-mortalidad y menores gastos en salud) han servido de aliciente para desarrollar diversas estrategias nacionales para lograr este efecto. Dentro de las estrategias más utilizadas se encuentran campañas educativas y la disminución paulatina de la sal agregada en los alimentos industrializados. Chile, se ha sumado a estas iniciativas con un acuerdo entre los productores de pan y el Ministerio de Salud con el fin de disminuir progresivamente la concentración de sal en el pan a nivel nacional. El objetivo de esta revisión es aportar información actualizada sobre las recomendaciones de ingesta de sal, ingesta real, efectos nocivos del exceso de consumo, beneficios atribuidos a su disminución y analizar las estrategias globales para reducir el consumo de sal en la población.Global strategies to reduce salt intake

To investigate excessive dietary salt intake as an independent risk factor of cognitive impairment and dementia in older adults. Prospective, population-based cohort study. Two thousand forty-one community residents aged ≥60 years were recruited between April 2007 and August 2009 from the Shandong area of China. Participants were classified into low, mild, moderate, and high salt intake groups according to urinary sodium measurements for 7 consecutive days. Global cognitive function was assessed at baseline and biennially thereafter using the Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Dementia Rating Scale (DRS), and Informant Questionnaire on Cognitive Decline in the Elderly. Demographics and apolipoprotein E (APOE) genotype were also obtained for each participant. Participants were monitored for 11.4 ± 2.0 years. During follow-up, MMSE, MoCA, and DRS scores decreased progressively faster with increasing salt intake (P adjustment < 0.05 among all intake groups). In total, 319 participants (13.74 per 1000 person-years) developed cognitive impairment. Compared with the low salt intake group, cognitive impairment risk was increased by 75% in the mild group (P adjustment = 0.027), 180% in the moderate group (P adjustment < 0.001), and 330% in the high group (P adjustment < 0.001) after adjustment for age, education, mean, and variability in visit-to-visit systolic and diastolic blood pressure, and APOE genotype. The hazard ratio for cognitive impairment increased by 1.59 (95% CI 1.40-1.79) with each 1-SD increment in salt intake after confounder adjustment (P adjustment < 0.001). Excessive dietary salt impairs cognitive function and increases cognitive impairment risk in older adults independently of known risk factors, including hypertension and APOE genotype. [ABSTRACT FROM AUTHOR]

Background: Non-communicable illnesses are the leading reason for wide-reaching death. Reducing the burden of these illnesses is one of the significant objectives of the World Health Organization's action plan. In this respect, reducing salt consumption is one of the most cost-effective public health interventions. The present study aimed to adjust the Theory of Planned Behavior (TPB) in expecting salt consumption behavior in pregnant women visiting the health centers in Birjand., Materials and Methods: In this cross-sectional study, 273 pregnant women who visited the health centers in Birjand were selected through Quota sampling method. The data were collected using a self-administered questionnaire based on the TPB constructs. The data analysis was done in SPSS 19 and AMOS 24., Results: The mean age of participants was 27.33 ± 5.77 years, and their mean gestational age was 12.67 ± 4.11 weeks. The mean score of attitude construct was 86.54 ± 8.50, subjective norm construct 36.59 ± 4.47, perceived behavioral control construct 41.63 ± 7.01, intention construct 16.01 ± 2.65 and behavior construct 19.86 ± 2.57. There was a statistically significant relationship between attitude construct ( p < 0.001), perceived behavioral control ( p < 0.001), and intention ( p < 0.001) with salt consumption behavior ( p < 0.05). The goodness of fit indices showed a proper fit of data (χ2/df = 1.94, PNFI = 0.6, TLI = 0.9, CFI = 0.9 and RMSE = 0.06)., Conclusion: The results of this study showed that the TPB is an appropriate model for reviewing the behavior of salt consumption. Hence, this model offers a suitable basis for designing an educational intervention to regulate the quantity of salt consumed by pregnant women and; thus, its usage in health promotion programs is suggested., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Excessive salt consumption is one of the leading causes of high blood pressure. Worldwide salt intake largely exceeds the WHO recommended amount. This study aimed to evaluate the prevalence of high salt consumers and the effectiveness of a short-term workplace educational intervention among health workers. An online survey, assessing daily salt consumption through the MINISAL-SIIA questionnaire, was sent to the 4911 health workers employed by the University Hospital of Verona, Italy. Health workers who had a high (total score ≥ 10) or moderate (total score = 8/9) salt consumption associated with obesity or arterial hypertension were invited to undergo a medical examination and a short individual counselling session. A total of 1665 health workers (34.0%) completed the online questionnaire; 40.9% and 12.6% had moderate and high salt intake, respectively. High salt intake was more prevalent in men, current and past smokers, and obese and overweight subjects. In 95 participants completing the clinical phase, median daily salt consumption decreased from 10 (p25-p75 8-11) to 7 g (6-8) ( p < 0.001), systolic blood pressure from 130 (120-140) to 120 (120-130) mmHg and weight from 78 (62-87) to 75 (62-86) kg. More than half of health workers had an excessive salt intake. However, a brief educational intervention in the healthcare working setting can substantially reduce unhealthy dietary habits, fostering weight loss and blood pressure control. Studies with a longer follow-up are needed to evaluate the persistence over time of these effects.

Penelitian ini bertujuan untuk mengetahui proses pelaksanaan implementasi Peraturan Daerah Kabupaten Magelang Nomor 9 Tahun 2004 tentang Pelarangan Peredaran Garam Konsumsi Tidak Beriodium di Kabupaten Magelang. Penelitian ini menggunakan metode penelitian kualitatif dengan teknik pengambilan informan secara purposive sampling. Informan berjumlah 10 pedagang garam konsumsi di Kabupaten Magelang dan 2 petugas instansi terkait pelaksanaan perda. Teknik pengambilan data menggunakan teknik wawancara mendalam dengan analisis secara deskriptif. Hasil penelitian menunjukkan bahwa pelaksanaan implementasi kebijakan ini belum berjalan secara maksimal. Dari enam (6) hal yang berpengaruh dalam pelaksanaan implementasi kebijakan, terdapat tiga hal yang belum berjalan secara maksimal sehingga menghambat pelaksanaan implementasi perda ini. Tiga hal tersebut adalah sumber daya kebijakan yang belum sepenuhnya terpenuhi, komunikasi yang kurang lancar antar organisasi, dan badan pelaksana kebijakan yang belum berjalan dengan kuat. Saran bagi instansi terkait, memperbaiki komunikasi antar organisasi dalam pelaksanaan implementasi perda ini serta segera melakukan pemenuhan sumber daya yang berkaitan dengan perda (seperti gudang penyitaan garam). This research aimed to find out the implementation process of Local Regulation of Magelang District No. 9 Year 2004 about the Prohibition of Circulating Non-Iodized Salt Consumption in Magelang District. This research used qualitative research method with informant sampling technique by purposive sampling. Total of the informants were 10 (ten) sellers of salt consumption in Magelang District and 2 (two) officers agencies related to the implementation of local regulation. The data retrieval technique used in-depth interview technique with descriptive analysis. The result of the research showed that the implementation of this policy implementation was not running optimally. From six (6) things that affect the implementation of policy implementation, there were three (3) things that had not run optimally thus inhibiting the effective implementation of this regulation. Those three (3) things were resource policies that have not been fully met, substandard communication among the organizations, and agency of policy that had not been running strong. Suggestions for relevant agencies, to fix communication among the organizations in implementing the local regulation, and immediate fulfillment of the resources related to regulation (such as the warehouse of salt confiscation).

Objective: To estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool. Study design: Statistical disease modelling study. Methods: DYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. Turk- STAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012-2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025. Results: The gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively. Conclusion: This model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit. [ABSTRACT FROM AUTHOR]