Objective: The Na content of bread is one of the most common targets of initiatives to reduce Na intake worldwide. Assessing the Na content of staple foods is of major relevance in Mozambique, given the high burden of hypertension in this setting. We aimed to estimate the Na content of white bread available in different bakeries and markets in Maputo. Design: A cross-sectional study of the Na content of white bread available for sale at twenty-five bakeries and markets in Mozambique. Flame photometry was used to quantify the Na content of the bread. The percentage of samples meeting manufacturer Na targets from South Africa and six countries from other regions, selected as benchmarks, was computed. Setting: Maputo, Mozambique. Subjects: Three loaves of white bread from each selected bakery/market. Results: The mean Na content of bread was 450·3 mg/100 g (range: 254·9-638·3 mg/100 g), with no significant differences between bakeries and traditional markets. Most samples (88 %) did not meet the regulation in South Africa (≤380 mg/100 g). When considering the targets from other countries (range: ≤ 360-550 mg/100 g), the prevalence of non-compliance varied between 8 % and 92 %. There were no significant differences in the price of bread with Na content below and above the targets. Conclusions: The content of Na in bread varies widely in Mozambique, reaching high values in a high proportion of the bakeries and markets in Maputo. Measures to regulate the Na content in bread may contribute to a reduction in Na intake and improved health at the population level.
Keywords
Sodium Bread Mozambique AfricaHigh Na intake is strongly associated with high blood pressure (1) and stroke, being responsible for an estimated 4·0 million deaths worldwide in 2010 (2) . The WHO recommends no more than 2 g Na/d (equivalent to 5 g salt (NaCl)/d) in adults, in order to reduce the burden of noncommunicable diseases (3) . However, in all countries with recent data available the dietary Na intake is much higher than recommended (4) . To our knowledge, no such data from Mozambique have been published, despite Na intake being of major relevance in this setting given the high prevalence of hypertension (25-64 years: 33·1 % in 2005), the low proportion of hypertensive individuals under pharmacological treatment (39·9 % from the 14·8 % who were aware of their condition) (5,6) and the increasing public health impact of CVD. It is estimated that the number of deaths due to CVD almost doubled in Mozambique in the last two decades (from nearly 9000 in 1990 to almost 17 000 in 2010) (7) . In 2005-2006, the incidence of stroke hospitalization in Maputo among those aged ≥ 25 years was estimated to be one of the highest in developing settings (adjusted incidence rate, world standard population: 260·1 per 100 000) (8) and the early case-fatality rate was also high (9) .