Estimation of the economic benefits for the public health system related to salt reduction in Costa Rica.

Excessive salt and sodium intake are strongly associated with high blood pressure and increased risk of cardiovascular disease. High blood pressure in turn is the main risk factor for the global burden of morbidity and mortality. The prevalence of this disease in the adult population of Costa Rica in 2018 was 37.2%. Costa Rica has limited information on the economic costs for the public health system and related of the prevalence of this type of disease mediated by dietary factors such as salt intake. OBJECTIVE: to estimate the economic benefits for the public health system related to salt reduction in Costa Rica for the year 2018. METHODOLOGY: estimation of the economic benefits for the public healthcare costs and productivity losses associated to reducing the per capita salt consumption of Costa Ricans to 5g/day, including the estimation of the Years of Life Productive Lost and of the direct costs on consultations, hospitalizations, and medications for the Costa Rica Social Security System. RESULTS: The total annual costs of hospitalization, consultations, and medications attributable to excessive salt intake in the population older than 15 years of age for the year 2018, were estimated at USD $15.1 million. The highest were in hospitalizations (53%), followed by consultations and medications (32% and 15%, respectively). CONCLUSION: NCDs caused by excessive salt intake represent important economic losses for the country, not only in terms of direct health costs, but also indirect due to the increase in years of potential life lost due to premature deaths because of CVD, which causes significant losses of human capital and, therefore, to the economy and the development of Costa Rica.

Nutritional Content According to the Presence of Front of Package Marketing Strategies: The Case of Ultra-Processed Snack Food Products Purchased in Costa Rica.

The industry uses nutrition and health claims, premium offers, and promotional characters as marketing strategies (MS). The inclusion of these MS on ultra-processed products may influence child and adolescent purchase behavior. This study determined the proportion of foods carrying claims and marketing strategies, also the proportion of products with critical nutrients declaration, and nutritional profile differences between products that carry or not claims and MS on the front-of-package (FoP) of ultra-processed food products sold in Costa Rica. Data were obtained from 2423 photographs of seven food groups consumed as snacks that were sold in one of the most widespread and popular hypermarket chains in Costa Rica in 2015. Ten percent of products lacked a nutrition facts panel. Sodium was the least reported critical nutrient. Energy and critical nutrients were significantly highest in products that did not include any nutrition or health claim and in products that included at least one MS. Forty-four percent and 10% of all products displayed at least one nutrition or at least one health claim, respectively, and 23% displayed at least one MS. In conclusion, regulations are needed to restrict claims and marketing on ultra-processed food packages to generate healthier food environments and contribute to the prevention of childhood and adolescent obesity in Costa Rica.

Baseline and Estimated Trends of Sodium Availability and Food Sources in the Costa Rican Population during 2004-2005 and 2012-2013.

In 2012, Costa Rica launched a program to reduce salt and sodium consumption to prevent cardiovascular disease and associated risk factors, but little was known about the level of sodium consumption or its sources. Our aim was to estimate the magnitude and time trends of sodium consumption (based on food and beverage acquisitions) in Costa Rica. Data from the National Household Income and Expenditure Surveys carried out in 2004-2005 (n = 4231) and 2012-2013 (n = 5705) were used. Records of food purchases for household consumption were converted into sodium and energy using food composition tables. Mean sodium availability (per person/per day and adjusted for a 2000-kcal energy intake) and the contribution of food groups to this availability were estimated for each year. Sodium availability increased in the period from 3.9 to 4.6 g/person/day (p < 0.001). The income level was inversely related to sodium availability. The main sources of sodium in the diet were domestic salt (60%) in addition to processed foods and condiments (with added sodium) (27.4%). Dietary sources of sodium varied within surveys (p < 0.05). Sodium available for consumption in Costa Rican households largely exceeds the World Health Organization-recommended intake levels (<2 g sodium/person/day). These results are essential for the design and implementation of effective policies and interventions.

Percepciones y conocimientos acerca de la sal, el sodio y la salud en adultos de clase media de la provincia de San José, Costa Rica / Perceptions and knowledge about salt, sodium and health in middle-class adults living in San José, Costa Rica

En el ámbito mundial se realizan acciones para desarrollar e implementar estrategias que permitan la reducción del consumo de sal/sodio y de esta manera disminuir la prevalencia de hipertensión arterial (HTA) y de enfermedades cardiovasculares (ECV). El objetivo de la investigación fue explorar las percepciones y los conocimientos acerca de la sal, el sodio y la salud de los adultos de clase media de la zona urbana de la provincia de San José; con el fin de proporcionar información para el desarrollo de estrategias educativas. Se realizaron entrevistas (formulario precodificado en el Anexo 1) a 400 personas entre 40 y 55 años de edad de clase media, subdividida en tres subestratos (alto, medio y bajo). Se analizaron frecuencias y se aplicó la prueba de Chi cuadrada. Se encontró que las personas no se sienten en riesgo de desarrollar HTA independientemente del subestrato socioeconómico (p>0,05) y 68% de éstas no consideró un exceso en el consumo de sal/sodio. Además, 70% no tenían conocimiento sobre la relación entre sal y sodio y hubo asociación (p<0,05) entre la subdivisión del estrato socioeconómico y el conocimiento de esta relación. Además, poseían un conocimiento calificado como medio acerca del riesgo del consumo excesivo de sal/sodio y de los beneficios de la disminución de su ingesta. Se concluyó que existen vacíos de conocimientos en la población de Costa-Rica y que es necesario desarrollar estrategias educativas basadas en la situación actual, acompañadas por intervenciones que impacten a las personas en riesgo y cambien sus hábitos de alimentación.

Organizations and governments globally are making great efforts to develop strategies to reduce population salt intake, and thus reduce the prevalence of hypertension and CVD. The objective of this study was to explore the perceptions and knowledge about salt, sodium and their effects on health of adults of middle income in the urban area of San José; in order to provide information for the development of educational strategies. Four hundred interviews to subjects between 40 to 55 years old, belonging to middle income socioeconomics strata, sub-divided into three levels (high, medium and low) were performed. Frequencies analyses were performed, and the Chi-square test was applied. We found that people felt that they are not at risk of developing hypertension regardless of the sub-middle socioeconomic strata (p> 0.05) and 68% of individuals did not consider that their consumption of salt and/or sodium was excessive. In addition, 70% of subjects had no knowledge about the relationship between salt and sodium, and an association (p <0.05) between the sub-division of the socioeconomic status and knowledge about this relationship was found. Individuals had an average knowledge about the risk of excessive salt/sodium consumption and the benefits of reduced intake. It was concluded that there is a knowledge gap in subjects and there is a need for developing initiatives to reduce salt/sodium intake, shocking enough to make people be more aware of their risk and change their eating habits.

Latin foo ds activities and challenges during the period of 2009-2012 / Actividades y desafíos de LATINFOODS durante el período 2009-2012

The Latin American Network of Food Composition Data System (LATINFOODS) is the regional data center of the global network “International Network on Food Data Systems” (INFOODS) co-sponsored by the Food and Agriculture Organization of the United Nations (FAO) and the United Nations University (UNU). The aim of this work is to provide information on the main activities held and challenges during the period 2009- 2012. The activities included: network organization, technological development, research, web site modification, database location, publication of new food composition tables, organization and participation in scientific activities, assistance and training. During this period, new strategic alliances where food composition is key were developed. This promoted more activities and strengthen working links in the region. The main challenges were: 1) to improve and update the regional database 2) to improve the national capacities for generating and compiling data to elaborate and update the national food composition tables 3) to establish and implement the database software in branches; 4) to reach technical and financial sustainability. Despite the fact that the network has a dynamic structure consolidated, trained and experienced members, a database of regional food composition, specialized tools and documents; more support for sustainability and progress is required.

La Red Latinoamericana de Composición de Alimentos (LATINFOODS) es el centro regional de datos de la red mundial “Red Internacional de Sistemas de Datos de Alimentos” (INFOODS), copatrocinada por la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO) y la Universidad de las Naciones Unidas (UNU). Este trabajo tiene por objeto proporcionar información sobre las principales actividades realizadas y los desafíos durante el período 2009-2012. Las actividades incluyeron: la organización de la red, el desarrollo tecnológico, la investigación, la modificación del sitio web, la ubicación de la base de datos, publicación de nuevas tablas de composición, la organización y la participación en actividades científicas, asistencia y capacitación. Se llevaron a cabo nuevas alianzas estratégicas donde la composición de alimentos es clave, que promovieron más actividades y fortalecieron los vínculos de trabajo en la región. Los principales desafíos fueron: 1) mejorar y actualizar la base de datos regional; 2) mejorar las capacidades nacionales para generar y recopilar datos para las tablas nacionales de composición de alimentos; 3) establecer y poner en práctica el software de base de datos en los capítulos; 4) llegar a contar con sostenibilidad técnica y económica. A pesar del hecho de que la red dispone de una estructura dinámica consolidada, miembros capacitados y experimentados, una base de datos regional de composición de alimentos, herramientas y documentos especializados; hace falta más apoyo para que sea sostenible y continúe progresando.

The salt content of products from popular fast-food chains in Costa Rica.

Salt is a major determinant of population blood pressure levels. Salt intake in Costa Rica is above levels required for good health. With an increasing number of Costa Ricans visiting fast food restaurants, it is likely that fast-food is contributing to daily salt intake. Salt content data from seven popular fast food chains in Costa Rica were collected in January 2013. Products were classified into 10 categories. Mean salt content was compared between chains and categories. Statistical analysis was performed using Welch ANOVA and Tukey-Kramer HSD tests. Significant differences were found between companies; Subway products had lowest mean salt content (0.97 g/100 g; p < 0.05) while Popeye's and KFC had the highest (1.57 g/100 g; p < 0.05). Significant variations in mean salt content were observed between categories. Salads had a mean salt content of 0.45 g/100 g while sauces had 2.16 g/100 g (p < 0.05). Wide variation in salt content was also seen within food categories. Salt content in sandwiches ranged from 0.5 to 2.1 g/100 g. The high levels and wide variation in salt content of fast food products in Costa Rica suggest that salt reduction is likely to be technically feasible in many cases. With an increasing number of consumers purchasing fast foods, even small improvements in salt levels could produce important health gains.

[Perceptions and knowledge about salt, sodium and health in middle-class adults living in San José, Costa Rica]. / Percepciones y conocimientos acerca de la sal, el sodio y la salud en adultos de clase media de la provincia de San José, Costa Rica.

Organizations and governments globally are making great efforts to develop strategies to reduce population salt intake, and thus reduce the prevalence of hypertension and CVD. The objective of this study was to explore the perceptions and knowledge about salt, sodium and their effects on health of adults of middle income in the urban area of San José; in order to provide information for the development of educational strategies. Four hundred interviews to subjects between 40 to 55 years old, belonging to middle income socioeconomics strata, sub-divided into three levels (high, medium and low) were performed. Frequencies analyses were performed, and the Chi-square test was applied. We found that people felt that they are not at risk of developing hypertension regardless of the sub-middle socioeconomic strata (p > 0.05) and 68% of individuals did not consider that their consumption of salt and/or sodium was excessive. In addition, 70% of subjects had no knowledge about the relationship between salt and sodium, and an association (p < 0.05) between the sub-division of the socioeconomic status and knowledge about this relationship was found. Individuals had an average knowledge about the risk of excessive salt/sodium consumption and the benefits of reduced intake. It was concluded that there is a knowledge gap in subjects and there is a need for developing initiatives to reduce salt/sodium intake, shocking enough to make people be more aware of their risk and change their eating habits.

LATINFOODS activities and challenges during the period of 2009-2012.

The Latin American Network of Food Composition Data System (LATINFOODS) is the regional data center of the global network "International Network on Food Data Systems" (INFOODS) co-sponsored by the Food and Agriculture Organization of the United Nations (FAO) and the United Nations University (UNU). The aim of this work is to provide information on the main activities held and challenges during the period 2009- 2012. The activities included: network organization, technological development, research, web site modification, database location, publication of new food composition tables, organization and participation in scientific activities, assistance and training. During this period, new strategic alliances where food composition is key were developed. This promoted more activities and strengthen working links in the region. The main challenges were: 1) to improve and update the regional database 2) to improve the national capacities for generating and compiling data to elaborate and update the national food composition tables 3) to establish and implement the database software in branches; 4) to reach technical and financial sustainability. Despite the fact that the network has a dynamic structure consolidated, trained and experienced members, a database of regional food composition, specialized tools and documents; more support for sustainability and progress is required.

Avances en la reducción del consumo de sal y sodio en Costa Rica / Advances in reducing salt and sodium intake in Costa Rica

En el presente artículo se describen los avances logrados en Costa Rica —así como los desafíos y limitaciones— en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011–2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricional; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.

This article describes the progress—as well as the challenges and limitations—in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011–2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people’s diets; and 4) monitor and evaluate action geared to reducing salt/ sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

[Advances in reducing salt and sodium intake in Costa Rica]. / Avances en la reducción del consumo de sal y sodio en Costa Rica.

This article describes the progress-as well as the challenges and limitations-in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011 - 2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people's diets; and 4) monitor and evaluate action geared to reducing salt/sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.