Temporal Trends in Cardiovascular Health Status Among Chinese School-Aged Children From 1989 to 2018: Multiwave Cross-Sectional Analysis.

BACKGROUND: Despite the release of updated metrics for Life's Essential 8 (LE8), key indicators for assessing cardiovascular health (CVH) status, there is currently no report on their distribution among Chinese children. OBJECTIVE: This study aimed to assess the nationwide distribution of CVH in Chinese school-aged children using LE8 scores and analyze temporal changes in these scores over time. METHODS: Participants aged 7 to 19 years from 11 waves (between 1989 and 2018) of the China Health and Nutrition Survey were included in this study. LE8 components were grouped into 2 domains of health behaviors (diet, physical activity, nicotine exposure, sleep) and health factors (BMI, blood lipids, blood glucose, blood pressure). Scores of overall CVH and each LE8 metric were calculated individually. Temporal changes were assessed with joint point regression models by rural and urban living residence. The causal relationships between health behaviors and health factors that changed the most over time were built with cross-lagged panel models. RESULTS: A total of 21,921 participants, 52.6% (n=11,537) of whom were male, who had data for at least 4 CVH components were included in the analysis. The mean age was 13 (SD 3.6) years. The overall CVH score remained stable in most regions, with the lowest found in Shandong from East China, which had a mean between 67 (SD 10.9) and 67.2 (SD 12.4). In contrast, the highest score was found in Guizhou from Southwest China, with a mean between 71.4 (SD 10.8) and 74.3 (SD 10.3). In rural areas, the diet score decreased significantly from 1997 onward with a speed of 0.18 (95% CI: 0.15-0.21; P<.001) per year, and the BMI score decreased significantly from 2005 onward with a speed of 0.56 (95% CI 0.44-0.68; P<.001) per year. In urban areas, the diet score decreased from 1994 onward with a speed of 0.03 (95% CI: 0.001-0.07; P=.04) per year, and the BMI score decreased from 2002 onward with a speed of 0.63 (95% CI 0.47-0.79; P<.001) per year. The sleep score dropped constantly in both urban and rural areas, with a speed of 0.69 (95% CI 0.58-0.80; P<.001) and 0.69 (95% CI: 0.52-0.86; P<.001) per year, respectively. A decline in the diet score led to a decline in the BMI score with a coefficient of 0.190 (95% CI 0.030-0.351; P=.02), while a decline in the BMI score led to a decline in sleep health with a coefficient of 0.089 (95% CI 0.010-0.168; P=.03). CONCLUSIONS: Chinese school-aged children and adolescents were generally of moderate CVH status, but mutual influences existed between CVH metrics. Dietary interventions should be prioritized for promoting overall CVH in the future.

Estimating impact of food choices on life expectancy: A modeling study.

BACKGROUND: Interpreting and utilizing the findings of nutritional research can be challenging to clinicians, policy makers, and even researchers. To make better decisions about diet, innovative methods that integrate best evidence are needed. We have developed a decision support model that predicts how dietary choices affect life expectancy (LE). METHODS AND FINDINGS: Based on meta-analyses and data from the Global Burden of Disease study (2019), we used life table methodology to estimate how LE changes with sustained changes in the intake of fruits, vegetables, whole grains, refined grains, nuts, legumes, fish, eggs, milk/dairy, red meat, processed meat, and sugar-sweetened beverages. We present estimates (with 95% uncertainty intervals [95% UIs]) for an optimized diet and a feasibility approach diet. An optimal diet had substantially higher intake than a typical diet of whole grains, legumes, fish, fruits, vegetables, and included a handful of nuts, while reducing red and processed meats, sugar-sweetened beverages, and refined grains. A feasibility approach diet was a midpoint between an optimal and a typical Western diet. A sustained change from a typical Western diet to the optimal diet from age 20 years would increase LE by more than a decade for women from the United States (10.7 [95% UI 8.4 to 12.3] years) and men (13.0 [95% UI 9.4 to 14.3] years). The largest gains would be made by eating more legumes (females: 2.2 [95% UI 1.1 to 3.4]; males: 2.5 [95% UI 1.1 to 3.9]), whole grains (females: 2.0 [95% UI 1.3 to 2.7]; males: 2.3 [95% UI 1.6 to 3.0]), and nuts (females: 1.7 [95% UI 1.5 to 2.0]; males: 2.0 [95% UI 1.7 to 2.3]), and less red meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]) and processed meat (females: 1.6 [95% UI 1.5 to 1.8]; males: 1.9 [95% UI 1.7 to 2.1]). Changing from a typical diet to the optimized diet at age 60 years would increase LE by 8.0 (95% UI 6.2 to 9.3) years for women and 8.8 (95% UI 6.8 to 10.0) years for men, and 80-year-olds would gain 3.4 years (95% UI females: 2.6 to 3.8/males: 2.7 to 3.9). Change from typical to feasibility approach diet would increase LE by 6.2 (95% UI 3.5 to 8.1) years for 20-year-old women from the United States and 7.3 (95% UI 4.7 to 9.5) years for men. Using NutriGrade, the overall quality of evidence was assessed as moderate. The methodology provides population estimates under given assumptions and is not meant as individualized forecasting, with study limitations that include uncertainty for time to achieve full effects, the effect of eggs, white meat, and oils, individual variation in protective and risk factors, uncertainties for future development of medical treatments; and changes in lifestyle. CONCLUSIONS: A sustained dietary change may give substantial health gains for people of all ages both for optimized and feasible changes. Gains are predicted to be larger the earlier the dietary changes are initiated in life. The Food4HealthyLife calculator that we provide online could be useful for clinicians, policy makers, and laypeople to understand the health impact of dietary choices.

Adherence to the EAT-Lancet Diet and Risk of Stroke and Stroke Subtypes: A Cohort Study.

BACKGROUND AND PURPOSE: We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). METHODS: We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993-1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. RESULTS: Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76-1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64-0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12-0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64-0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36-0.93]). CONCLUSIONS: Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

Food system resilience thinking: from digital to integral.

The current food system is directly influenced by the increase in environmental problems and nutritional inequality globally. Financial and political collapses, health crises, excessive urbanization, and rapid industrialization are some of the principal factors threatening the food supply's security. The food system needs a profound transformation to avoid ecosystem destabilization and a global food crisis. Concerning this transformation, we are certain that the first step for a successful food system change is global resilience thinking. To reach an integrated food system, we proposed introducing the resilient concept linked with other known concepts, such as circular economy and sustainability. A resilient food system can recover over time, ensuring the supply of sustainable and quality food and access to all. This would mean redesigning the value chains in the food system, re-educating consumers to implement a healthier diet, and introducing technology such as digital innovation. Re-evaluating these relevant points, redesigning the focus of the food system, not only for economic efficiency but also including significant trade-offs, or valuing other services in the food system, are essential to reaching the desired resilience. © 2021 Society of Chemical Industry.

Sustainable food systems and nutrition in the 21st century: a report from the 22nd annual Harvard Nutrition Obesity Symposium.

Food systems are at the center of a brewing storm consisting of a rapidly changing climate, rising hunger and malnutrition, and significant social inequities. At the same time, there are vast opportunities to ensure that food systems produce healthy and safe food in equitable ways that promote environmental sustainability, especially if the world can come together at the UN Food Systems Summit in late 2021 and make strong and binding commitments toward food system transformation. The NIH-funded Nutrition Obesity Research Center at Harvard and the Harvard Medical School Division of Nutrition held their 22nd annual Harvard Nutrition Obesity Symposium entitled "Global Food Systems and Sustainable Nutrition in the 21st Century" in June 2021. This article presents a synthesis of this symposium and highlights the importance of food systems to addressing the burden of malnutrition and noncommunicable diseases, climate change, and the related economic and social inequities. Transformation of food systems is possible, and the nutrition and health communities have a significant role to play in this transformative process.

JCL Roundtable. Making prevention a priority.

Clinical lipidology belongs par excellence to the preventive mode of medical practice. This Roundtable brings two long-time advocates of cardiometabolic prevention and a newly minted preventive cardiologist into a discussion that expands their recent JCL editorial on this topic. Atherosclerosis is a single disease process that leads to approximately 25% of deaths in economically advanced nations and a growing fraction of mortality and morbidity in nations with developing and emerging economies. Our discussants suggest that at least 75% of atherosclerotic cardiovascular disease can be prevented. Diet and lifestyle including physical activity are the cornerstones for this effort. Public and private choices about diet-lifestyle are influenced by economics, education (especially in childhood), inequities, technology, misinformation, and trust. Lipid clinics perform well with pharmacologic treatment of lipid disorders and increasingly give attention to hypertension, obesity, and diabetes as needed. Cardiometabolic prevention in the clinic works best through provider teams. Business considerations and exemplary programs are highlighted.

Wikipedia, Google Trends and Diet: Assessment of Temporal Trends in the Internet Users' Searches in Italy before and during COVID-19 Pandemic.

We obtained data from Google Trends and Wikipedia in order to assess whether an analysis of Internet searches could provide information on the Internet users' behaviour/interest in diets. Differences in seasonality, year and before/during COVID-19 pandemic were assessed. From Wikipedia, we extracted the number of times a page is viewed by users, aggregated on monthly and seasonal bases. We also used Google Trends to evaluate the frequency of the users' web searches. The Mediterranean diet was the most frequently (33.9%), followed by the pescatarian diet (9.0%). Statistically, significant seasonal differences were found for the Mediterranean, vegetarian, Atkins, Scarsdale, and zone diets and pescetarianism. The most commonly searched diet and consequent diet-related queries on Google resulted to be: Dukan diet, Dukan and weight loss. Ketogenic, FODMAP and intermittent fasting diets were statistically more frequently searched during the pandemic compared with before. Our data show a different trend of searches based on the seasonality, year and the pandemic. These data could be useful for scientists, practitioners and policy makers because they can inform educational campaigns via the Internet, especially in periods when the population is more receptive.

Digital Food Retail: Public Health Opportunities.

For over two decades, digital food retail services have been emerging alongside advances in mobile technology and improved access to wi-fi. Digitalization has driven changes within the food environment, complicating an already complex system that influences food-related behaviors and eating practices. Digital food retail services support an infrastructure that enhances commercial food systems by extending access to and availability of highly processed foods, further escalating poor dietary intakes. However, digital food retail services are heterogeneous-food delivery apps, online groceries, and meal kits-and can be feasibly adapted to nutrition interventions and personalized to individual needs. Although sparse, new evidence indicates great potential for digital food retail services to address food insecurity in urban areas and to support healthy eating by making it easier to select, plan, and prepare meals. Digital food retail services are a product of the digital transformation that reflect consumers' constant need for convenience, which must be addressed in future research and interventions. This paper will discuss public health opportunities that are emerging from the global uptake of digital food retail services, with a focus on online groceries, food delivery apps, and meal kits.

Changes in the Global Diet Quality Score, Weight, and Waist Circumference in Mexican Women.

BACKGROUND: Evidence on concurrent changes in overall diet quality and weight and waist circumference in women of reproductive age from low- and middle-income countries is limited. OBJECTIVES: We examined the associations of changes in the Global Diet Quality Score (GDQS) and each GDQS food group with concurrent weight and waist circumference change in Mexican women. METHODS: We followed prospectively 8967 nonpregnant nonlactating women aged 25-49 y in the Mexican Teachers' Cohort between 2006 and 2008. We assessed diet using an FFQ of the previous year and anthropometric measures were self-reported. Regression models were used to examine 2-y changes in the GDQS and each food group (servings/d) with weight and waist circumference changes within the same period, adjusting for demographic and lifestyle factors. RESULTS: Compared with those with little change in the GDQS (-2 to 2 points), women with the largest increase in the GDQS (>5 points) had less weight (ß: -0.81 kg/2 y; 95% CI: -1.11, -0.51 kg/2 y) and waist circumference gain (ß: -1.05 cm/2 y; 95% CI: -1.62, -0.48 cm/2 y); likewise, women with the largest decrease in the GDQS (<-5 points) had more weight (ß: 0.36 kg/2 y; 95% CI: 0.06, 0.66 kg/2 y) and waist circumference gain (ß: 0.71 cm/2 y; 95% CI: 0.09, 1.32 cm/2 y). Increased intake of dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, citrus fruits, and fish and shellfish was associated with less weight gain. In addition, deep orange vegetables, low fat and high fat dairy, whole grains, and fish were associated with less waist circumference gain within the 2-y period. CONCLUSIONS: Improvements in diet quality over a 2-y period reflected by an increase in the GDQS and changes in consumption of specific components of the GDQS were associated with less weight and waist circumference gain in Mexican women.

Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015.

BACKGROUND: Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities. OBJECTIVES: We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada. METHODS: Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. RESULTS: Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII = 2.09 (95% CI: 0.45, 3.73) to SII = 4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII = 8.06 (95% CI: 6.41, 9.71) to SII = 10.52 (95% CI: 8.73, 12.31)], increased in males. CONCLUSIONS: Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.

Special Issue "Mediterranean Diet and Metabolic Diseases".

The Mediterranean diet (MD) has been considered among the healthiest dietary patterns since a little over 50 years ago, Ancel Keys-as the key figure-provided evidence for the beneficial effects of the MD [...].

Assessing the Nutrient Adequacy in China's Food Supply from 1965 to 2018.

Nutritional intake has important impacts on human health. A sufficient supply of nutrients is required to ensure high-level nutrition in a population. Assessment of nutrient supply adequacy can help to develop evidence-based policies and thereby promote public health. This study estimates the supply adequacy of nutrients in China's food system from 1965 to 2018 at the national level, aiming to reveal whether the supply of nutrients meets the demand. The results show that the nutrient supply in China's food system has experienced a sharp increase in the past five decades, and the deficiency in nutrient supply has been greatly mitigated. Although most nutrients such as potassium are already sufficiently supplied in China's current food system, some nutrients, especially calcium and zinc, still need a further enlarged supply to improve the nutrition condition of the Chinese population. Besides encouraging a healthy diet, supply-side regulation, e.g., fortification and enrichment, is also needed to improve nutrient availability. This study helps people better understand the development and current situation of nutrient adequacy in China's food supply, thereby providing information and implications for policymakers.

Edible Plant Sprouts: Health Benefits, Trends, and Opportunities for Novel Exploration.

The consumption of plant sprouts as part of human day-to-day diets is gradually increasing, and their health benefit is attracting interest across multiple disciplines. The purpose of this review was to (a) critically evaluate the phytochemicals in selected sprouts (alfalfa, buckwheat, broccoli, and red cabbage), (b) describe the health benefits of sprouts, (c) assess the recent advances in sprout production, (d) rigorously evaluate their safety, and (e) suggest directions that merit special consideration for further novel research on sprouts. Young shoots are characterized by high levels of health-benefitting phytochemicals. Their utility as functional ingredients have been extensively described. Tremendous advances in the production and safety of sprouts have been made over the recent past and numerous reports have appeared in mainstream scientific journals describing their nutritional and medicinal properties. However, subjects such as application of sprouted seed flours in processed products, utilizing sprouts as leads in the synthesis of nanoparticles, and assessing the dynamics of a relationship between sprouts and gut health require special attention for future clinical exploration. Sprouting is an effective strategy allowing manipulation of phytochemicals in seeds to improve their health benefits.

Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating.

The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.

Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period.

BACKGROUND: Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood. OBJECTIVE: To evaluate within-participant longitudinal changes in scores for nine a priori-defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the "Seguimiento Universidad de Navarra" (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up. DESIGN: In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ). PARTICIPANTS/SETTING: Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7). MAIN OUTCOME MEASURES: Main outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010. STATISTICAL ANALYSES PERFORMED: Adjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up. RESULTS: The comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices. CONCLUSIONS: In this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.

Global Trends (1961-2017) in Human Dietary Potassium Supplies.

BACKGROUND: Potassium (K) is an essential mineral and major intracellular electrolyte involved in the regulation of blood pressure, muscle contraction and nerve transmission in humans. Major dietary sources of K include fruits and vegetables, starchy roots and tubers, and whole grains. The aim of this study was to assess and report: (i) the sufficiency of K in national food systems globally, (ii) to quantify the contribution from food groups, and (iii) to explore spatial and temporal trends in the period of 1961-2017. METHODS: Food supply and demography (1961-2017), K composition and K requirement data were combined to estimate per capita human dietary supplies of potassium (DSK), adequate intake of K (AIK) and K sufficiency ratio (KSR) at national, regional, continental and global levels. RESULTS AND DISCUSSION: Globally, the mean ± SD. DSK (mg capita-1 d-1) increased from 2984 ± 915 in 1961 to 3796 ± 1161 in 2017. There was a wide range in DSK between geographical regions and across years, with particularly large increases in east Asia, where DSK increased from <3000 to >5000 mg capita-1 day-1. Roots and tubers contributed the largest dietary source of K, providing up to 80% of DSK in most regions. At the global level, throughout the 57-year period, the population-weighted KSR was <1 based on the 2006 Institute of Medicine AIK recommendation, while it was >1 based on the 2019 National Academies of Science and the 2016 European Union AIK recommendation. While KSR ≥ 1 shows sufficiency of DSK, KSR < 1 does not indicate K deficiency risk. CONCLUSION: Due to the absence of a Recommended Daily Allowance (RDA) for K, this study used the ratio of DSK:AIK (i.e., KSR) to assess dietary K sufficiency. Estimates of dietary K sufficiency are, therefore, highly sensitive to the AIK reference value used and this varied greatly based on different institutions and years. To quantify the risk of dietary K deficiency, bridging the data gap to establish an RDA for K should be a global research priority.

Trend of salt intake measured by 24-h urine collection in the Italian adult population between the 2008 and 2018 CUORE project surveys.

BACKGROUND AND AIMS: The WHO Global Action Plan for the Prevention of non-communicable diseases (NCDs) recommends a 30% relative reduction in mean population salt/sodium intake. The study assessed the trend in the habitual salt intake of the Italian adult population from 2008 to 2012 to 2018-2019 based on 24-h urinary sodium excretion, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU' SALUTE national surveys. METHODS AND RESULTS: Data were from cross-sectional surveys of randomly selected age and sex-stratified samples of resident persons aged 35-74 years in 10 (out of 20) Italian Regions distributed in North, Centre and South of the Country. Urinary sodium and creatinine measurements were carried out in a central laboratory. The analyses included 942 men and 916 women examined in 2008-2012, and 967 men and 1010 women examined in 2018-2019. The age-standardized mean daily population salt (sodium chloride) intake was 10.8 g (95% CI 10.5-11.1) in men and 8.3 g (8.1-8.5) in women in 2008-2012 and respectively 9.5 g (9.3-9.8) and 7.2 g (7.0-7.4) in 2018-2019. A statistically significant (p<0.0001) salt intake reduction was thus observed over 10 years for both genders, and all age, body mass index (BMI) and educational classes. CONCLUSIONS: The average daily salt intake of the Italian general adult population remains higher than the WHO recommended level, but a significant reduction of 12% in men and 13% in women has occurred in the past ten years. These results encourage the initiatives undertaken by the Italian Ministry of Health aimed at the reduction of salt intake at the population level.