Estimates of mean population salt intake based upon spot urine samples can provide countries with a good indication of mean population salt intake and whether action on salt consumption is required.

Objective: To understand factors influencing implementation of salt reduction interventions in low- and middle-income countries (LMICs). Design: Retrospective policy analysis based on desk reviews of existing reports and semi-structured stakeholder interviews in four countries, using Walt and Gilson’s ‘Health Policy Triangle’ to assess the role of context, content, process and actors on implementation of salt policy. Setting: Argentina, Mongolia, South Africa and Vietnam Results: Global targets and regional consultations were viewed as important drivers of salt reduction interventions in Mongolia and Vietnam in contrast to local research and advocacy, and support from international experts, in Argentina and South Africa. All countries had population-level targets and written strategies with multiple interventions to reduce salt consumption. Engaging industry to reduce salt in foods was a priority in all countries: Mongolia and Vietnam were establishing voluntary programs, while Argentina and South Africa opted for legislation on salt levels in foods. Ministries of Health, the World Health Organization and researchers were identified as critical players in all countries. Lack of funding and technical capacity/support, absence of reliable local data and changes in leadership were identified as barriers to effective implementation. No country had a comprehensive approach to surveillance or regulation for labelling, and mixed views were expressed about the potential benefits of low sodium salts. Conclusions: Effective scale-up of salt reduction programs in LMICs requires: 1) reliable local data about the main sources of salt; 2) collaborative multi-sectoral implementation; 3) stronger government leadership and regulatory processes; and 4) adequate resources for implementation and monitoring.

Little is known about factors influencing children's dietary intake in Mongolia, a country undergoing rapid nutrition transition. Using nationally representative data from the 2017 Mongolia National Nutrition Survey, we assessed the nutritional status of children aged <2 years and examined household, maternal, and child factors associated with feeding practices among children aged 6–23 months ( n = 938). Multivariable logistic regression models were used to identify predictors of minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). The prevalence of child stunting (length/height‐for‐age Z ‐score < −2 SD ) was 6.3%, and the prevalence of overweight (weight‐for‐height Z ‐score > +2 SD) was 16.8%. The prevalence of anaemia and iron deficiency was 39.0% and 32.2%, respectively, and 73.5% and 85.5% of children had inadequate vitamin A and vitamin D status, respectively. Of children aged 6‐23 months, 92.1% ( n = 864) had MMF, 49.6% ( n = 465) had MDD, and 43.8% ( n = 411) achieved MAD. Increased household wealth was positively associated with all three indicators, whereas severe food insecurity was not associated with MMF, MDD, or MAD. Older child age (odds ratio, 95% CI: 1.09 [1.06, 1.12]; p < .001) and maternal dietary diversity (odds ratio, 95% CI: 2.36 [1.67, 3.34]; p < .001) were positively associated with child MDD. Nutrition‐specific and nutrition‐sensitive efforts are needed to improve the dietary quality of infants and young children in Mongolia and reduce the high burdens of child micronutrient deficiency and overweight in the country.

Background Endothelium dependent vasodilatation is impaired after consumption of a high salt meal however the mechanisms of this effect are not well understood. It is unknown whether this observation is caused by decreased post-prandial nitric oxide bioavailability due to increased plasma sodium concentration. Our aim therefore was to determine postprandial sodium and nitrate/nitrite concentrations in response to salt loading.Methods Sixteen healthy, normotensive adults received a meal with added salt (HSM; 65mmol Na) and a control low-salt meal (LSM; 5mmol Na) on 2 separate occasions in a randomised order. Serum electrolytes and plasma osmolality, nitrate/nitrite, vasopressin and atrial natriuretic peptide (ANP) concentrations were measured while fasting and postprandially at 30, 60, 90, and 120 min. Blood pressure was also measured.Results HSM increased serum sodium concentration within 60minutes compared with LSM (HSM 141.00 Ϯ 1.26mmol; LSM 139.56 Ϯ 1.26 p ϭ 0.008). Serum chloride (HSM 106.69 Ϯ 2.7mmol; LSM 104.25 Ϯ 1.84mmol; p ϭ 0.002) and osmolality (HSM 294.25 Ϯ 3.91mOsmol; LSM 291.31 Ϯ 4.19; p ϭ 0.046) increased in response to the HSM. There were no signifi cant differences in plasma nitrate/nitrite, vasopressin, ANP or blood pressure variables observed between meals.

BackgroundMethods based on spot urine samples (a single sample at one time-point) have been identified as a possible alternative approach to 24-hour urine samples for determining mean population salt intake.ObjectiveThe aim of this study is to identify a reliable method for estimating mean population salt intake from spot urine samples. This will be done by comparing the performance of existing equations against one other and against estimates derived from 24-hour urine samples. The effects of factors such as ethnicity, sex, age, body mass index, antihypertensive drug use, health status, and timing of spot urine collection will be explored. The capacity of spot urine samples to measure change in salt intake over time will also be determined. Finally, we aim to develop a novel equation (or equations) that performs better than existing equations to estimate mean population salt intake.MethodsA systematic review and meta-analysis of individual participant data will be conducted. A search has been conducted to identify human studies that report salt (or sodium) excretion based upon 24-hour urine samples and spot urine samples. There were no restrictions on language, study sample size, or characteristics of the study population. MEDLINE via OvidSP (1946-present), Premedline via OvidSP, EMBASE, Global Health via OvidSP (1910-present), and the Cochrane Library were searched, and two reviewers identified eligible studies. The authors of these studies will be invited to contribute data according to a standard format. Individual participant records will be compiled and a series of analyses will be completed to: (1) compare existing equations for estimating 24-hour salt intake from spot urine samples with 24-hour urine samples, and assess the degree of bias according to key demographic and clinical characteristics; (2) assess the reliability of using spot urine samples to measure population changes in salt intake overtime; and (3) develop a novel equation that performs better than existing equations to estimate mean population salt intake.ResultsThe search strategy identified 538 records; 100 records were obtained for review in full text and 73 have been confirmed as eligible. In addition, 68 abstracts were identified, some of which may contain data eligible for inclusion. Individual participant data will be requested from the authors of eligible studies.ConclusionsMany equations for estimating salt intake from spot urine samples have been developed and validated, although most have been studied in very specific settings. This meta-analysis of individual participant data will enable a much broader understanding of the capacity for spot urine samples to estimate population salt intake.