Salt intake, blood pressure and cardiovascular disease mortality in England, 2003-2018.

OBJECTIVES: The aim of this study was to assess the changes in salt intake and concomitant changes in blood pressure (BP) and cardiovascular disease (CVD) mortality in England from 2003 to 2018. METHODS: National surveys and death registration data were used for the analysis of salt intake as measured by 24-h urinary sodium excretion (449-1069 participants per year), BP (2651-6738 participants per year) and CVD mortality. RESULTS: A decline in salt intake from 9.38 (SD 4.64) to 7.58 (3.41) g/d was observed between 2003 and 2014 ( P  < 0.01), followed by an increase to 8.39 (4.13) g/d in 2018 ( P  < 0.01). Similar trends in BP and CVD mortality were also observed between 2003 and 2018. SBP/DBP decreased from 125.3 (15.92)/74.48 (11.33) mmHg to 122.57 (14.92)/73.33 (10.75) mmHg between 2003 and 2014 ( P  < 0.01), followed by a plateau up to 2018 [122.04 (14.64)/73.84 (10.54) mmHg, P  > 0.05]. Likewise, a fall in stroke and ischaemic heart disease mortality rates was observed between 2003 and 2014, from 12.24 and 43.44 cases per 100 000, to 8.19 and 27.23 cases per 100 000 ( P  < 0.01), respectively, followed by a plateau afterwards ( P  > 0.05). CONCLUSION: The UK salt reduction programme was initially successful in reducing population salt intake by 19% (from 9.38 g/d in 2003 to 7.58 g/d in 2014). However, in recent years, the programme stalled and thus led to an interruption in the decline of salt intake. BP and CVD mortality reduction was also interrupted when salt reduction stalled. The changes in salt intake may have played an important role in the concomitant changes in BP and CVD mortality. Urgent action is needed to reinvigorate the UK's once world-leading salt reduction programme.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis.

Objective: To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods: A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results: Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions: These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis

[ABSTRACT]. Objective. To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods. A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random‐effects meta‐analysis model. Results. Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41- 69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions. These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the mini- mum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

[RESUMEN]. Objetivo. Determinar la excreción urinaria de sodio y potasio en 24 horas en la Región de las Américas. Métodos. Se realizaron una revisión sistemática y un metanálisis en busca de estudios realizados entre los años 1990 y 2021 con adultos residentes en cualquier Estado soberano de la Región publicados en Medline, Embase, Scopus, SciELO y Lilacs. La búsqueda se llevó a cabo por primera vez el 26 de octubre del 2020 y se actualizó el 15 de diciembre del 2021. De los 3941 resúmenes revisados, se incluyeron 74 estudios de 14 países, 72 estudios sobre excreción urinaria de sodio (27 387 adultos) y 42 estudios sobre excreción urinaria de potasio (19 610 adultos) realizados entre el 1990 y el 2020. Se agruparon los datos mediante un modelo de metanálisis de efectos aleatorios. Resultados. La excreción media de sodio fue de 157,29 mmol/24h (IC de 95%, 151,42-163,16); la de potasio, de 57,69 mmol/24 h (IC de 95%, 53,35-62,03). En los casos en que se consideraron únicamente mujeres, la excreción media de sodio fue de 135,81 mmol/24h (IC de 95%, 130,37-141,25); la de potasio, de 51,73 mmol/24h (IC de 95%, 48,77-54,70). En varones, la excreción media de sodio fue de 169,39 mmol/24h (IC de 95%, 162,14-176,64); la de potasio, de 62,67 mmol/24h (IC de 95%, 55,41-69,93). La excreción media de sodio fue de 150,09 mmol/24h (IC de 95%, 137,87-162,30) en la década de 1990 y de 159,79 mmol/24 h (IC de 95%, 151,63-167,95) en la década del 2010. La excreción media de potasio fue de 58,64 mmol/24h (IC de 95%, 52,73-64,55) en la década de 1990 y de 56,33 mmol/24h (IC de 95%, 48,65-64,00) en la década del 2010. Conclusiones. Estos resultados sugieren que la excreción de sodio casi duplica el nivel máximo recomen- dado por la Organización Mundial de la Salud y las excreción de potasio es 35% más baja que el requisito mínimo, por lo que se deben invertir grandes esfuerzos para reducir el consumo de sodio y aumentar la ingesta de potasio.

[RESUMO]. Objetivo. Determinar as excreções urinárias de sódio e potássio em 24 horas na Região das Américas. Métodos. Revisão sistemática e metanálise de estudos realizados entre 1990 e 2021, em adultos vivendo em qualquer estado soberano da região, indexados nos bancos de dados MEDLINE, Embase, Scopus, Sci- ELO e LILACS. A pesquisa foi realizada pela primeira vez em 26 de outubro de 2020 e foi atualizada em 15 de dezembro de 2021. Dos 3.941 resumos revisados, foram incluídos 74 estudos de 14 países, 72 estudos relatando sódio urinário (27.387 adultos) e 42 estudos relatando potássio urinário (19.610 adultos), realizados entre 1990 e 2020. Os dados foram reunidos utilizando um modelo de metanálise de efeitos aleatórios. Resultados. A excreção média foi de 157,29 mmol/24h (IC95% 151,42-163,16) para o sódio e 57,69 mmol/24h (IC95% 53,35-62,03) para o potássio. Quando somente mulheres foram consideradas, a excreção média foi de 135,81 mmol/24h (IC95% 130,37-141,25) para o sódio e 51,73 mmol/24h (IC95% 48,77-54,70) para o potássio. Nos homens, a excreção média foi de 169,39 mmol/24h (IC95% 162,14-176,64) para o sódio e 62,67 mmol/24h (IC95% 55,41-69,93) para o potássio. A excreção média de sódio foi de 150,09 mmol/24h (IC95% 137,87-162,30) na década de 1990 e 159,79 mmol/24h (IC95% 151,63-167,95) na década de 2010. A excreção média de potássio foi de 58,64 mmol/24h (IC95% 52,73-64,55) na década de 1990 e 56,33 mmol/24/h (IC95% 48,65-64,00) na década de 2010. Conclusões. Estes achados sugerem que as excreções de sódio são quase o dobro do nível máximo recomendado pela Organização Mundial da Saúde e as excreções de potássio são 35% menores do que o mínimo exigido; portanto, será necessário envidar esforços importantes para reduzir a ingestão de sódio e aumentar a de potássio.

Spot urinary sodium to monitor relative changes in population salt intake during the UK salt reduction programme.

OBJECTIVES: The most accurate method to measure population salt intake is to collect the complete 24-h urinary sodium excretion (24-h UNa) but it is resource intensive and is rarely carried out frequently. We, therefore, assessed the use of spot urinary sodium concentration to monitor relative changes in population salt intake in between 24-h urine surveys. METHODS: We used 24-h (n = 2020) and spot urine (n = 21 711) samples drawn from adult participants in separate, cross-sectional, nationally representative surveys in England, repeated between 2006 and 2014. RESULTS: As population average 24-h UNa fell from 2006 to 2014 (from 8.7 to 7.6 g/day, i.e. by 12%) with the ongoing salt reduction programme, spot sodium concentration fell by a similar extent (from 106.1 to 93.1 mmol/l, i.e. by 13%). The regression slopes of 24-h UNa and spot sodium concentration ran parallel (P value = 0.1009) in a linear regression modelling the difference in their year-on-year changes [by regressing the 24-h UNa or sodium concentration values on time, estimation method (24-h versus spot), and their interaction term]. In contrast, when 24-h UNa was estimated by applying the Kawasaki, Tanaka, or INTERSALT formulas to spot sodium concentrations, almost no change was detected from 2006 to 2014 (±1%) and their regression slopes were significantly different from that of the measured 24-h UNa (all P values <0.0001). CONCLUSION: Spot urinary sodium concentration drawn from random and representative samples of the population accurately reflected relative changes in population average 24-h UNa, and can therefore, be used in between 24-h urine surveys to monitor population salt reduction programmes. Formulas commonly used to estimate 24-h UNa were unsuitable to do so.

Sodium content of restaurant dishes in China: a cross-sectional survey.

BACKGROUND: Sodium intake in China is extremely high and eating in restaurants is increasingly popular. Little research has explored the sodium level of restaurant dishes. The present study aims to assess the content and sources of sodium in Chinese restaurants. METHODS: Cross-sectional data were obtained from the baseline survey of the Restaurant-based Intervention Study (RIS) in 2019. A total of 8131 best-selling restaurant dishes with detailed recipes from 192 restaurants in China were included. Sodium content per 100 g and per serving were calculated according to the Chinese Food Composition Table. The proportion of restaurant dishes exceeding the daily sodium reference intake level in a single serving and the major sources of sodium were determined. RESULTS: Median sodium content in restaurant dishes were 487.3 mg per 100 g, 3.4 mg per kcal, and 2543.7 mg per serving. For a single serving, 74.9% of the dishes exceeded the Chinese adults' daily adequate intake for sodium (AI, 1500 mg per day), and 62.6% of dishes exceeded the proposed intake for preventing non-communicable chronic diseases (PI, 2000 mg per day). Cooking salt was the leading source of sodium in Chinese restaurant dishes (45.8%), followed by monosodium glutamate (17.5%), food ingredients (17.1%), soy sauce (9.4%), and other condiments/seasonings (10.2%). More types of salted condiments/seasonings use were related to higher sodium level. CONCLUSIONS: The sodium levels in Chinese restaurant dishes are extremely high and variable. In addition to cooking salt, other salted condiments/seasonings also contribute a large proportion of sodium. Coordinated sodium reduction initiatives targeting the main sources of sodium in restaurant dishes are urgently needed.

App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial.

OBJECTIVE: To determine whether a smartphone application based education programme can lower salt intake in schoolchildren and their families. DESIGN: Parallel, cluster randomised controlled trial, with schools randomly assigned to either intervention or control group (1:1). SETTING: 54 primary schools from three provinces in northern, central, and southern China, from 15 September 2018 to 27 December 2019. PARTICIPANTS: 592 children (308 (52.0%) boys; mean age 8.58 (standard deviation 0.41) years) in grade 3 of primary school (about 11 children per school) and 1184 adult family members (551 (46.5%) men; mean age 45.80 (12.87) years). INTERVENTION: Children in the intervention group were taught, with support of the app, about salt reduction and assigned homework to encourage their families to participate in activities to reduce salt consumption. MAIN OUTCOME MEASURES: Primary outcome was the difference in salt intake change (measured by 24 hour urinary sodium excretion) at 12 month follow-up, between the intervention and control groups. RESULTS: After baseline assessment, 297 children and 594 adult family members (from 27 schools) were allocated to the intervention group, and 295 children and 590 adult family members (from 27 schools) were allocated to the control group. During the trial, 27 (4.6%) children and 112 (9.5%) adults were lost to follow-up, owing to children having moved to another school or adults unable to attend follow-up assessments. The remaining 287 children and 546 adults (from 27 schools) in the intervention group and 278 children and 526 adults (from 27 schools) in the control group completed the 12 month follow-up assessment. Mean salt intake at baseline was 5.5 g/day (standard deviation 1.9) in children and 10.0 g/day (3.5) in adults in the intervention group, and 5.6 g/day (2.1) in children and 10.0 g/day (3.6) in adults in the control group. During the study, salt intake of the children increased in both intervention and control groups but to a lesser extent in the intervention group (mean effect of intervention after adjusting for confounding factors -0.25 g/day, 95% confidence interval -0.61 to 0.12, P=0.18). In adults, salt intake decreased in both intervention and control groups but to a greater extent in the intervention group (mean effect -0.82 g/day, -1.24 to -0.40, P<0.001). The mean effect on systolic blood pressure was -0.76 mm Hg (-2.37 to 0.86, P=0.36) in children and -1.64 mm Hg (-3.01 to -0.27, P=0.02) in adults. CONCLUSIONS: The app based education programme delivered through primary school, using a child-to-parent approach, was effective in lowering salt intake and systolic blood pressure in adults, but the effects were not significant in children. Although this novel approach could potentially be scaled up to larger populations, the programme needs further strengthening to reduce salt intake across the whole population, including schoolchildren. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800017553.

Phase 2 Study of Dabrafenib Plus Trametinib in Patients With BRAF V600E-Mutant Metastatic NSCLC: Updated 5-Year Survival Rates and Genomic Analysis.

INTRODUCTION: Dabrafenib plus trametinib was found to have robust antitumor activity in patients with BRAF V600E-mutant metastatic NSCLC (mNSCLC). We report updated survival analysis of a phase 2 study (NCT01336634) with a minimum of 5-year follow-up and updated genomic data. METHODS: Pretreated (cohort B) and treatment-naive (cohort C) patients with BRAF V600E-mutant mNSCLC received dabrafenib 150 mg twice daily and trametinib 2 mg once daily. The primary end point was investigator-assessed overall response rate per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end points were duration of response, progression-free survival, overall survival, and safety. RESULTS: At data cutoff, for cohorts B (57 patients) and C (36 patients), the median follow-up was 16.6 (range: 0.5-78.5) and 16.3 (range: 0.4-80) months, overall response rate (95% confidence interval [CI]) was 68.4% (54.8-80.1) and 63.9% (46.2-79.2), median progression-free survival (95% CI) was 10.2 (6.9-16.7) and 10.8 (7.0-14.5) months, and median overall survival (95% CI) was 18.2 (14.3-28.6) and 17.3 (12.3-40.2) months, respectively. The 4- and 5-year survival rates were 26% and 19% in pretreated patients and 34% and 22% in treatment-naive patients, respectively. A total of 17 patients (18%) were still alive. The most frequent adverse event was pyrexia (56%). Exploratory genomic analysis indicated that the presence of coexisting genomic alterations might influence clinical outcomes in these patients; however, these results require further investigation. CONCLUSIONS: Dabrafenib plus trametinib therapy was found to have substantial and durable clinical benefit, with a manageable safety profile, in patients with BRAF V600E-mutant mNSCLC, regardless of previous treatment.

Reducing daily salt intake in China by 1 g could prevent almost 9 million cardiovascular events by 2030: a modelling study.

Introduction: In China, salt intake is among the highest in the world (~11 g/day) and cardiovascular disease (CVD) accounts for 40% of deaths. We estimated the potential impact of reducing salt intake on CVD events in China, via systolic blood pressure (SBP). Methods: To develop our model, we extracted the effect of salt reduction on SBP from a meta-regression of randomised trials and a population study, and that of SBP on CVD risk from pooled cohort studies. Results: Reducing population salt intake in China by 1 g/day could lower the risk for ischaemic heart disease by about 4% (95% uncertainty interval 1.8%-7.7%) and the risk for stroke by about 6% (2.4%-9.3%). Should this reduced salt level be sustained until 2030,~9 million (M) (7M-10.8M) CVD events could be prevented, of which ~4M (3.1M-4.9M) would have been fatal. Greater and gradual salt intake reductions, to achieve WHO's target of 30% reduction by 2025 or the Chinese government's target of ≤5 g/day by 2030, could prevent ~1.5 or 2 times more CVD events and deaths, respectively. Should the prolonged effect of salt reduction over several years be accounted for, all estimates of CVD events and deaths prevented would be 25% greater on average. Conclusion: Bringing down the high salt intake levels in China could result in large reductions in CVD. An easily achievable reduction of 1 g/day could prevent ~9M CVD events by 2030. Urgent action must be taken to reduce salt intake in China.

24-hour sodium and potassium excretion in the Americas: a systematic review and meta-analysis / Excreción de sodio y potasio en 24 horas en la Región de las Américas: revisión sistemática y metanálisis / Excreção de sódio e potássio em 24 horas na Região das Américas: revisão sistemática e meta-análise

ABSTRACT Objective. To determine the 24-hour urinary sodium and potassium excretions in the Americas. Methods. A systematic review and meta-analysis were performed seeking for studies conducted between 1990 and 2021 in adults living in any sovereign state of the Americas in Medline, Embase, Scopus, SciELO, and Lilacs. The search was first run on October 26th, 2020 and was updated on December 15th, 2021. Of 3 941 abstracts reviewed, 74 studies were included from 14 countries, 72 studies reporting urinary sodium (27 387 adults), and 42 studies reporting urinary potassium (19 610 adults) carried out between 1990 and 2020. Data were pooled using a random-effects meta-analysis model. Results. Mean excretion was 157.29 mmol/24h (95% CI, 151.42-163.16) for sodium and 57.69 mmol/24h (95% CI, 53.35-62.03) for potassium. When only women were considered, mean excretion was 135.81 mmol/24h (95% CI, 130.37-141.25) for sodium and 51.73 mmol/24h (95% CI, 48.77-54.70) for potassium. In men, mean excretion was 169.39 mmol/24h (95% CI, 162.14-176.64) for sodium and 62.67 mmol/24h (95% CI, 55.41-69.93) for potassium. Mean sodium excretion was 150.09 mmol/24h (95% CI, 137.87-162.30) in the 1990s and 159.79 mmol/24h (95% CI, 151.63-167.95) in the 2010s. Mean potassium excretion was 58.64 mmol/24h (95% CI, 52.73-64.55) in the 1990s and 56.33 mmol/24/h (95% CI, 48.65-64.00) in the 2010s. Conclusions. These findings suggest that sodium excretions are almost double the maximum level recommended by the World Health Organization and potassium excretions are 35% lower than the minimum requirement; therefore, major efforts to reduce sodium and to increase potassium intakes should be implemented.

RESUMEN Objetivo. Determinar la excreción urinaria de sodio y potasio en 24 horas en la Región de las Américas. Métodos. Se realizaron una revisión sistemática y un metanálisis en busca de estudios realizados entre los años 1990 y 2021 con adultos residentes en cualquier Estado soberano de la Región publicados en Medline, Embase, Scopus, SciELO y Lilacs. La búsqueda se llevó a cabo por primera vez el 26 de octubre del 2020 y se actualizó el 15 de diciembre del 2021. De los 3941 resúmenes revisados, se incluyeron 74 estudios de 14 países, 72 estudios sobre excreción urinaria de sodio (27 387 adultos) y 42 estudios sobre excreción urinaria de potasio (19 610 adultos) realizados entre el 1990 y el 2020. Se agruparon los datos mediante un modelo de metanálisis de efectos aleatorios. Resultados. La excreción media de sodio fue de 157,29 mmol/24h (IC de 95%, 151,42-163,16); la de potasio, de 57,69 mmol/24 h (IC de 95%, 53,35-62,03). En los casos en que se consideraron únicamente mujeres, la excreción media de sodio fue de 135,81 mmol/24h (IC de 95%, 130,37-141,25); la de potasio, de 51,73 mmol/24h (IC de 95%, 48,77-54,70). En varones, la excreción media de sodio fue de 169,39 mmol/24h (IC de 95%, 162,14-176,64); la de potasio, de 62,67 mmol/24h (IC de 95%, 55,41-69,93). La excreción media de sodio fue de 150,09 mmol/24h (IC de 95%, 137,87-162,30) en la década de 1990 y de 159,79 mmol/24 h (IC de 95%, 151,63-167,95) en la década del 2010. La excreción media de potasio fue de 58,64 mmol/24h (IC de 95%, 52,73-64,55) en la década de 1990 y de 56,33 mmol/24h (IC de 95%, 48,65-64,00) en la década del 2010. Conclusiones. Estos resultados sugieren que la excreción de sodio casi duplica el nivel máximo recomendado por la Organización Mundial de la Salud y las excreción de potasio es 35% más baja que el requisito mínimo, por lo que se deben invertir grandes esfuerzos para reducir el consumo de sodio y aumentar la ingesta de potasio.

RESUMO Objetivo. Determinar as excreções urinárias de sódio e potássio em 24 horas na Região das Américas. Métodos. Revisão sistemática e metanálise de estudos realizados entre 1990 e 2021, em adultos vivendo em qualquer estado soberano da região, indexados nos bancos de dados MEDLINE, Embase, Scopus, SciELO e LILACS. A pesquisa foi realizada pela primeira vez em 26 de outubro de 2020 e foi atualizada em 15 de dezembro de 2021. Dos 3.941 resumos revisados, foram incluídos 74 estudos de 14 países, 72 estudos relatando sódio urinário (27.387 adultos) e 42 estudos relatando potássio urinário (19.610 adultos), realizados entre 1990 e 2020. Os dados foram reunidos utilizando um modelo de metanálise de efeitos aleatórios. Resultados. A excreção média foi de 157,29 mmol/24h (IC95% 151,42-163,16) para o sódio e 57,69 mmol/24h (IC95% 53,35-62,03) para o potássio. Quando somente mulheres foram consideradas, a excreção média foi de 135,81 mmol/24h (IC95% 130,37-141,25) para o sódio e 51,73 mmol/24h (IC95% 48,77-54,70) para o potássio. Nos homens, a excreção média foi de 169,39 mmol/24h (IC95% 162,14-176,64) para o sódio e 62,67 mmol/24h (IC95% 55,41-69,93) para o potássio. A excreção média de sódio foi de 150,09 mmol/24h (IC95% 137,87-162,30) na década de 1990 e 159,79 mmol/24h (IC95% 151,63-167,95) na década de 2010. A excreção média de potássio foi de 58,64 mmol/24h (IC95% 52,73-64,55) na década de 1990 e 56,33 mmol/24/h (IC95% 48,65-64,00) na década de 2010. Conclusões. Estes achados sugerem que as excreções de sódio são quase o dobro do nível máximo recomendado pela Organização Mundial da Saúde e as excreções de potássio são 35% menores do que o mínimo exigido; portanto, será necessário envidar esforços importantes para reduzir a ingestão de sódio e aumentar a de potássio.

Impact of color-coded and warning nutrition labelling schemes: A systematic review and network meta-analysis.

BACKGROUND: Suboptimal diets are a leading risk factor for death and disability. Nutrition labelling is a potential method to encourage consumers to improve dietary behaviour. This systematic review and network meta-analysis (NMA) summarises evidence on the impact of colour-coded interpretive labels and warning labels on changing consumers' purchasing behaviour. METHODS AND FINDINGS: We conducted a literature review of peer-reviewed articles published between 1 January 1990 and 24 May 2021 in PubMed, Embase via Ovid, Cochrane Central Register of Controlled Trials, and SCOPUS. Randomised controlled trials (RCTs) and quasi-experimental studies were included for the primary outcomes (measures of changes in consumers' purchasing and consuming behaviour). A frequentist NMA method was applied to pool the results. A total of 156 studies (including 101 RCTs and 55 non-RCTs) nested in 138 articles were incorporated into the systematic review, of which 134 studies in 120 articles were eligible for meta-analysis. We found that the traffic light labelling system (TLS), nutrient warning (NW), and health warning (HW) were associated with an increased probability of selecting more healthful products (odds ratios [ORs] and 95% confidence intervals [CIs]: TLS, 1.5 [1.2, 1.87]; NW, 3.61 [2.82, 4.63]; HW, 1.65 [1.32, 2.06]). Nutri-Score (NS) and warning labels appeared effective in reducing consumers' probability of selecting less healthful products (NS, 0.66 [0.53, 0.82]; NW,0.65 [0.54, 0.77]; HW,0.64 [0.53, 0.76]). NS and NW were associated with an increased overall healthfulness (healthfulness ratings of products purchased using models such as FSAm-NPS/HCSP) by 7.9% and 26%, respectively. TLS, NS, and NW were associated with a reduced energy (total energy: TLS, -6.5%; NS, -6%; NW, -12.9%; energy per 100 g/ml: TLS, -3%; NS, -3.5%; NW, -3.8%), sodium (total sodium/salt: TLS, -6.4%; sodium/salt per 100 g/ml: NS: -7.8%), fat (total fat: NS, -15.7%; fat per 100 g/ml: TLS: -2.6%; NS: -3.2%), and total saturated fat (TLS, -12.9%; NS: -17.1%; NW: -16.3%) content of purchases. The impact of TLS, NS, and NW on purchasing behaviour could be explained by improved understanding of the nutrition information, which further elicits negative perception towards unhealthful products or positive attitudes towards healthful foods. Comparisons across label types suggested that colour-coded labels performed better in nudging consumers towards the purchase of more healthful products (NS versus NW: 1.51 [1.08, 2.11]), while warning labels have the advantage in discouraging unhealthful purchasing behaviour (NW versus TLS: 0.81 [0.67, 0.98]; HW versus TLS: 0.8 [0.63, 1]). Study limitations included high heterogeneity and inconsistency in the comparisons across different label types, limited number of real-world studies (95% were laboratory studies), and lack of long-term impact assessments. CONCLUSIONS: Our systematic review provided comprehensive evidence for the impact of colour-coded labels and warnings in nudging consumers' purchasing behaviour towards more healthful products and the underlying psychological mechanism of behavioural change. Each type of label had different attributes, which should be taken into consideration when making front-of-package nutrition labelling (FOPL) policies according to local contexts. Our study supported mandatory front-of-pack labelling policies in directing consumers' choice and encouraging the food industry to reformulate their products. PROTOCOL REGISTRY: PROSPERO (CRD42020161877).

Cross-sectional comparisons of sodium content in processed meat and fish products among five countries: potential for feasible targets and reformulation.

INTRODUCTION: Reducing sodium intake has been identified as a highly cost-effective strategy to prevent and control high blood pressure and reduce cardiovascular mortality. This study aims to compare the sodium content in processed meat and fish products among five countries, which will contribute to the evidence-base for feasible strategies of sodium reduction in such products. METHODS: Sodium content on product labels of 26 500 prepackaged products, 19 601 meat and 6899 fish, was collected in supermarkets from five countries using the FoodSwitch mobile application from 2012 to 2018. To be specific, it was 1898 products in China, 885 in the UK, 5673 in Australia, 946 in South Africa and 17 098 in the USA. Cross-sectional comparisons of sodium levels and proportions meeting 2017 UK sodium reduction targets were conducted using Kruskal-Wallis H and the χ2 test, respectively across the five countries. RESULTS: The results showed that processed meat and fish products combined in China had the highest sodium level (median 1050 mg/100 g, IQR: 774-1473), followed by the USA, South Africa, Australia, with the lowest levels found in UK (432 mg/100 g, IQR: 236-786) (p<0.001). Similar variations, that is, a twofold to threefold difference of sodium content between the highest and the lowest countries were found among processed meat and fish products separately. Large sodium content variations were also found in certain specific food subcategories across the five countries, as well as across different food subcategories within each country. CONCLUSION: Processed meat and fish products differ greatly in sodium content across different countries and across different food subcategories. This indicates great potential for food producers to reformulate the products in sodium content, as well as for consumers to select less salted food.

Efficacy and safety of valsartan in children aged 1-5 years with hypertension, with or without chronic kidney disease: a randomized, double-blind study followed by open-label phase.

OBJECTIVE: To assess the dose-response relationship for reduction in mean systolic blood pressure (MSBP) with valsartan solution, in young children with hypertension with or without chronic kidney disease (CKD). METHODS: In this multicenter, randomized, double-blind, double-dummy study, 127 young children aged 1-5 years with hypertension (MSBP ≥95th percentile) were randomized (1:1) to receive valsartan 0.25 or 4 mg/kg/day for 6 weeks, followed by a 20 week open-label phase, where patients received valsartan 1 mg/kg/day for 4 weeks, and then optionally titrated to 2 mg/kg/day or up to 4 mg/kg/day. The primary endpoint was the change in MSBP from baseline at Week 6 during the double-blind phase. RESULTS: Overall, 120 patients (94.5%) completed the study; 63 had CKD. A clinically and statistically significant reduction in MSBP from baseline to Week 6 was observed with the valsartan 4 mg/kg group compared with the valsartan 0.25 mg/kg group (8.5 vs 4.1 mmHg; p = .0157). A positive dose-response relationship for MSBP reduction was observed between the 0.25 mg/kg and 4 mg/kg groups (p = .0012). In the CKD subgroup, a significant reduction in MSBP was observed with 4 mg/kg (9.2 mmHg) versus 0.25 mg/kg (1.2 mmHg; p = .0096). In the non-CKD subgroup, a numerically greater decrease in MSBP was observed with 4 mg/kg (7.8 mmHg) versus 0.25 mg/kg (6.9 mmHg; p = .6531). Incidence of adverse events was lower with valsartan 4 mg/kg than 0.25 mg/kg (41.9% vs 51.6%) and similar between CKD and non-CKD subgroups (48.4% vs 45.3%) irrespective of dose. Increase in serum potassium (>20% compared to baseline) was observed more frequently in patients with CKD compared to non-CKD patients. CONCLUSION: Valsartan was efficacious and well tolerated in children 1 to 5 years of age with hypertension, with or without CKD. Clinical trial registration: The study has been registered at ClinicalTrials.gov (Identifier: NCT01617681).

Impact of the 2003 to 2018 Population Salt Intake Reduction Program in England: A Modeling Study.

[Figure: see text].

App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation.

BACKGROUND: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. OBJECTIVE: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. METHODS: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. RESULTS: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. CONCLUSIONS: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19430.

Restaurant interventions for salt reduction in China: protocol for a randomised controlled trial.

INTRODUCTION: Salt intake in China is high, and most of it comes from that added by consumers. Nevertheless, recent years have seen a rapid increase in the frequency at which people eat out. The aim of this study is to evaluate the effectiveness of interventions designed for salt reduction in restaurants through a randomised controlled trial in China. METHODS AND ANALYSIS: As a randomised controlled trial with restaurants as study subjects, we recruited 192 restaurants from 12 counties of 6 provinces in China. After the baseline survey, restaurants were randomly assigned to intervention or control group. Using social cognitive theory, comprehensive intervention activities were designed to encourage salt reduction in all restaurant foods, and at the same time, to encourage consumers to choose lower salt options when eating out. The interventions will be conducted only in restaurants of the intervention group during the first year. The follow-up assessment will be conducted at the end of the trial. The primary outcome is the change in the average salt content of the five best-selling dishes of the restaurant, as measured by laboratory tests. Secondary outcomes include differences in the monthly use of salt and salty condiments between intervention and control restaurants, and the knowledge, attitude and practice on salt among restaurant consumers. ETHICS AND DISSEMINATION: The study was reviewed and approved by the Review Board of the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention and Queen Mary Research Ethics Committee. Results will be disseminated through presentations, publications and social media. TRIAL REGISTRATION NUMBER: ChiCTR1800019694; Pre-results.

Five-Year Analysis of Adjuvant Dabrafenib plus Trametinib in Stage III Melanoma.

BACKGROUND: In the previously reported primary analysis of this phase 3 trial, 12 months of adjuvant dabrafenib plus trametinib resulted in significantly longer relapse-free survival than placebo in patients with resected stage III melanoma with BRAF V600E or V600K mutations. To confirm the stability of the relapse-free survival benefit, longer-term data were needed. METHODS: We randomly assigned 870 patients who had resected stage III melanoma with BRAF V600E or V600K mutations to receive 12 months of oral dabrafenib (at a dose of 150 mg twice daily) plus trametinib (2 mg once daily) or two matched placebos. The primary end point was relapse-free survival. Here, we report 5-year results for relapse-free survival and survival without distant metastasis as the site of the first relapse. Overall survival was not analyzed, since the required number of events to trigger the final overall survival analysis had not been reached. RESULTS: The minimum duration of follow-up was 59 months (median patient follow-up, 60 months for dabrafenib plus trametinib and 58 months for placebo). At 5 years, the percentage of patients who were alive without relapse was 52% (95% confidence interval [CI], 48 to 58) with dabrafenib plus trametinib and 36% (95% CI, 32 to 41) with placebo (hazard ratio for relapse or death, 0.51; 95% CI, 0.42 to 0.61). The percentage of patients who were alive without distant metastasis was 65% (95% CI, 61 to 71) with dabrafenib plus trametinib and 54% (95% CI, 49 to 60) with placebo (hazard ratio for distant metastasis or death, 0.55; 95% CI, 0.44 to 0.70). No clinically meaningful between-group difference in the incidence or severity of serious adverse events was reported during the follow-up period. CONCLUSIONS: In the 5-year follow-up of a phase 3 trial involving patients who had resected stage III melanoma with BRAF V600E or V600K mutations, 12 months of adjuvant therapy with dabrafenib plus trametinib resulted in a longer duration of survival without relapse or distant metastasis than placebo with no apparent long-term toxic effects. (Funded by GlaxoSmithKline and Novartis; COMBI-AD ClinicalTrials.gov number, NCT01682083; EudraCT number, 2012-001266-15.).

Twenty-Four-Hour Urinary Sodium and Potassium Excretion and Their Associations With Blood Pressure Among Adults in China: Baseline Survey of Action on Salt China.

This study aimed to assess current level of sodium and potassium intake and their associations with blood pressure (BP) using the 24-hour urinary data in a large sample of China. Data from participants aged 18 to 75 years were collected as the baseline survey of Action on Salt China in 2018. Of 5454 adults, 5353 completed 24-hour urine collection. The average sodium, potassium excretion, and sodium-to-potassium molar ratio were 4318.1±1814.1 mg/d (equivalent to 11.0±4.6 g/d of salt), 1573.7±627.1 mg/d, and 5.0±2.1, respectively. After adjusting for potential confounding factors and correcting for regression dilution, each 1000-mg increase in sodium excretion was associated with increased systolic BP (1.32 mm Hg [95% CI, 0.92-1.81]) and diastolic BP (0.34 mm Hg [95% CI, 0.09-0.60]). Each 1000-mg increase in potassium excretion was inversely associated with systolic BP (-3.19 mm Hg [95% CI, -4.38 to -2.20]) and diastolic BP (-1.56 mm Hg [95% CI, -2.29 to -0.90]). Each unit increase in sodium-to-potassium molar ratio was associated with an increase of systolic BP by 1.21 mm Hg (95% CI, 0.91-1.60) and diastolic BP by 0.44 mm Hg (95% CI, 0.24-0.64). The relationships between sodium and BP mostly increase with the rise of BP quantiles. Potassium shows the opposite trend. The current sodium intake in Chinese adults remains high and potassium intake is low. Sodium and sodium-to-potassium ratio were positively associated with BP, whereas potassium was inversely associated with BP. Registration- URL: https://tinyurl.com/vdr8rpr; Unique identifier: ChiCTR1800017553. URL: https://tinyurl.com/w8c7x3w; Unique identifier: ChiCTR1800016804. URL: https://tinyurl.com/s3ajldw; Unique identifier: ChiCTR1800018119.

Effectiveness and Feasibility of Taxing Salt and Foods High in Sodium: A Systematic Review of the Evidence.

Diets high in salt are a leading risk for death and disability globally. Taxing unhealthy food is an effective means of influencing what people eat and improving population health. Although there is a growing body of evidence on taxing products high in sugar, and unhealthy foods more broadly, there is limited knowledge or experience of using fiscal measures to reduce salt consumption. We searched peer-reviewed databases [MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] and gray literature for studies published between January 2000 and October 2019. Studies were included if they provided information on the impact on salt consumption of: taxes on salt; taxes on foods high in salt, and taxes on unhealthy foods defined to include foods high in salt. Studies were excluded if their definition of unhealthy foods did not specify high salt or sodium. We found 18 relevant studies, including 15 studies reporting the effects of salt taxes through modeling (8), real-world evaluation (4), experimental design (2), or review of cost-effectiveness (1); 6 studies providing information relevant to country implementation of salt taxes; and 2 studies reporting stakeholder perceptions toward salt taxation. Although there is some evidence on the potential effectiveness and cost-effectiveness of salt taxation, especially from modeling studies, uptake of salt taxation is limited in practice. Some modeling studies suggested that food taxes can have unintended outcomes such as reduced consumption of healthy foods, or increased consumption of unhealthy, untaxed substitutes. In contrast, modeling studies that combined taxes for unhealthy foods with subsidies found that the benefits were increased. Modeling suggests that taxing all foods based on their salt content is likely to have more impact than taxing specific products high in salt given that salt is pervasive in the food chain. However, the limited experience we found suggests that policy-makers favor taxing specific products.