The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Abstract

This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available.None of the studies were conducted in low-or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries. | INTRODUCTIONHigh salt intake is one of the main contributors to premature death from cardiovascular diseases globally. of countries (China, Finland, France, England, and Ireland) had already achieved significant reductions in population salt intake. | METHODOLOGYA detailed description of the search strategy used to identify and screen studies in this review has been previously reported. In the current review, studies evaluating the impact of salt reduction interventions were appraised for risk of bias by two independent reviewers using a modified Cochrane risk of bias tool for nonrandomized trials of intervention studies. 4,7 Detailed appraisal and commentary were also performed on these studies. Other types of studies that provided information pertinent to the design, implementation, and assessment of salt reduction interventions were summarized in a table.These include (1) studies on monitoring and surveillance of salt intake;(2) salt content in foods; (3) consumers' knowledge, attitudes, and behaviors toward salt; (4) economic evaluation or modeling studies of salt reduction strategies; and (5) other studies related to implementation of salt reduction initiatives. | RESULTSThe MEDLINE search identified 3675 citations, of which 85 were considered potentially eligible for full review on the basis of their findings relevant to salt reduction interventions. Ultimately, a total of 40 studies met the inclusion criteria: four studies evaluated the impact of salt reduction interventions, 21 were surveillance or monitoring studies, five were modeling studies relating to salt reduction, and 10 other studies related to the implementation of salt reduction interventions (Figure 1). conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level. 9The method for evaluating the impact ...

The Science of Salt: A global review on changes in sodium levels in foods

“…Most studies (n = 22) came from just seven high‐income countries with two from two middle‐income countries. The low number of studies from low‐ and middle‐income countries is in line with our previous reviews and means that the applicability of findings generated from the current review may be limited in these settings. Further, compared to the 2015 review of salt reduction initiatives around the world which reported that 38 countries (28 high‐income and 10 middle‐income countries) have voluntary or mandatory sodium targets for foods, the current review shows that only eight of these countries (seven high‐income and one middle‐income countries) have available data on change to measure the food industry's progress to reduce the sodium content of products.…”

“…Most studies (n = 22) came from just seven high-income countries with two from two middle-income countries. The low number of studies from lowand middle-income countries is in line with our previous reviews [23][24][25][26][27] and means that the applicability of findings generated from the current review may be limited in these settings. Further, compared to the 2015 review of salt reduction initiatives around the world which interventions.…”

“…As part of this initiative, regularly updated systematic reviews on the relationship between salt and health outcomes, and the implementation of salt reduction interventions are being published in the Journal of Clinical Hypertension. 16 To date, 11 studies (six on the relationship of salt and health outcomes [17][18][19][20][21][22] and five related to the implementation of salt reduction interventions [23][24][25][26][27] ) have been published. The last implementation review was the first to employ a thematic approach focusing on studies that reported knowledge, attitudes, and behaviors relating to salt.…”

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (September 2016–February 2017)

“…5 Initially designed as a summarized MEDLINE search communicated through a weekly email newsletter, the Science of Salt Weekly, 6 alternating narrative summaries of the reviewed articles are periodically published focusing on: (1) the relationship between dietary salt and health outcomes, and (2) evaluating salt reduction initiatives in populations. [7][8][9][10][11] In addition, two annual systematic reviews incorporating studies published between 2013 and 2015 were published. 4,12 To date there have been five periodic systematic reviews published-three focused on evaluating the implementation of salt reduction strategies identified as part of the Science of Salt Weekly systematic review series, with a view to informing future implementation of interventions to lower population salt consumption, 7,8,11 and two summarizing the volume of studies reporting on the effects of salt intake on health outcomes.…”

“…[7][8][9][10][11] In addition, two annual systematic reviews incorporating studies published between 2013 and 2015 were published. 4,12 To date there have been five periodic systematic reviews published-three focused on evaluating the implementation of salt reduction strategies identified as part of the Science of Salt Weekly systematic review series, with a view to informing future implementation of interventions to lower population salt consumption, 7,8,11 and two summarizing the volume of studies reporting on the effects of salt intake on health outcomes. 9,10 The reviews evaluating intervention studies provide important recommendations for the implementation of salt reduction strategies including government commitment, the need for multicomponent interventions extending the focus beyond targeting consumer behavior, and using standardized methodologies to rigorously monitor the salt content of processed foods.…”