Consumer acceptance of reformulated food products: A systematic review and meta-analysis of salt-reduced foods

<p>Food product reformulation is promoted as an effective strategy to reduce population salt intake and address the associated burden of chronic disease. Salt has a number of functions in food processing, including impacting upon physical and sensory properties. Manufacturers must ensure that reformulation of foods to reduce salt does not compromise consumer acceptability.</p> <p>The aim of this systematic review is to determine to what extent foods can be reduced in salt without detrimental effect on consumer acceptability.</p> <p>Fifty studies reported on salt reduction, replacement or compensation in processed meats, breads, cheeses, soups, and miscellaneous products. For each product category, levels of salt reduction were collapsed into four groups: <40%, 40–59%, 60–79% and ≥80%. Random effects meta-analyses conducted on salt-reduced products showed that salt could be reduced by approximately 40% in breads [mean change in acceptability for reduction <40% (−0.27, 95% confidence interval (CI) −0.62, 0.08; <i>p </i>= 0.13)] and approximately 70% in processed meats [mean change in acceptability for reductions 60–69% (−0.18, 95% CI −0.44, 0.07; <i>p</i> = 0.15)] without significantly impacting consumer acceptability. Results varied for other products.</p> <p>These results will support manufacturers to make greater reductions in salt when reformulating food products, which in turn will contribute to a healthier food supply.</p

Examination of Potential Sources of Heterogeneity between Studies of Proteinuria and CHD According to Study or Participant Characteristics

<div><p>Conventions as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-g002" target="_blank">Figure 2</a>.</p> <p>Footnote: (a) One study reported both risk estimates for individuals with and without diabetes.</p></div

Summary Risk Ratio (95% Confidence Intervals) for the Association of Proteinuria with the Risk of Coronary Heart Disease in Population-Based Cohort Studies

<p>The black squares are inversely proportional to the variance of the study and the horizontal lines represent the 95% CIs. Footnotes: Four studies reported estimates separated according to subgroups including (a) female, (b) male, (c) people without diabetes, (d) people with diabetes, (e) people with type 1 diabetes, and (f) people with type 2 diabetes. References: Culleton 2000 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b022" target="_blank">22</a>]; Fuller 2001 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b024" target="_blank">24</a>]; Irie 2006 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b026" target="_blank">26</a>]; Leelawattana 2003 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b030" target="_blank">30</a>]; Madison 2006 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b032" target="_blank">32</a>]; Miettinen 1996 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b034" target="_blank">34</a>]; Muntner 2002 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b035" target="_blank">35</a>]; Sasaki 1995 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b036" target="_blank">36</a>]; Shimozato 1996 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b037" target="_blank">37</a>]; Wagener 1994 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b042" target="_blank">42</a>].</p

Identification Process for Eligible Studies

<p>Identification Process for Eligible Studies</p

Summary Risk Ratio (95% Confidence Intervals) for the Association of Albuminuria with the Risk of Coronary Heart Disease in Population-Based Cohort Studies

<div><p>(A) Studies reporting risk estimate of microalbuminuria compared to normoalbuminuria.</p> <p>(B) Studies reporting risk estimate of macroalbuminuria compared to normoalbuminuria.</p> <p>(C) Studies reporting risk estimate of any level of albuminuria compared to normoalbuminuria.</p> <p>Conventions as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-g002" target="_blank">Figure 2</a>. Footnotes: Three studies reported separated estimates according to subgroups including (a) female, (b) male, (c) non-Asian people, and (d) Asian people. References: Beilin 1996 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b020" target="_blank">20</a>]; Borch-Johnsen 1999 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b021" target="_blank">21</a>]; Corona 2005 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b045" target="_blank">45</a>]; Florkowski 2001 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b023" target="_blank">23</a>]; Hu 2002 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b025" target="_blank">25</a>]; Jensen 2000 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b027" target="_blank">27</a>]; Klausen 2004 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b028" target="_blank">28</a>]; Lee 2006 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b029" target="_blank">29</a>]; Lempiainen 1999 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b031" target="_blank">31</a>]; Mattock 1998 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b033" target="_blank">33</a>]; Soedarnah-Muthu 2004 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b038" target="_blank">38</a>]; Tillin 2005 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b039" target="_blank">39</a>]; Torffvit 2005 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b040" target="_blank">40</a>]; Valmadrid 2000 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b041" target="_blank">41</a>]; Wang 2005 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b043" target="_blank">43</a>]; Yuyun 2004 [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050207#pmed-0050207-b044" target="_blank">44</a>].</p></div

Proportion of women with GDM on CR by diagnostic criteria <i>n</i>(<i>%)</i>.

<p>Proportion of women with GDM on CR by diagnostic criteria <i>n</i>(<i>%)</i>.</p

Improvements attributed to the clinical register.

<p>Communication: Increased communication; Knowledge: Improved understanding of the recommended clinical care required for women with DIP; Early detection: Improved awareness of early detection of DIP; Pre-pregnancy: Improved awareness of pre-pregnancy planning & contraception; Referrals: Improved awareness of who to contact in regards to women with DIP; Epidemiology: Improved awareness of how many women in the NT have DIP.</p

Open ended survey responses and focus group data.

<p>Open ended survey responses and focus group data.</p

Numbers of GDM and pre-existing diabetes in the NT as reported by NT Midwives Data Collection as compared to NT DIP Clinical Register.

<p>MDC did not report on pre-existing diabetes in 2010 and data not yet published 2015; Pre-existing diabetes includes Type 1. Total number of births on MDC for 201, 2012, 2013 and 2014 were as follows: 2011- Aboriginal <i>n</i> = 1349, non-Aboriginal <i>n = 2440</i>, 2012- Aboriginal <i>n</i> = 1348, non-Aboriginal <i>n</i> = 2556, 2013- Aboriginal <i>n</i> = 1232, non-Aboriginal <i>n</i> = 2687, and 2014- Aboriginal <i>n</i> = 1315, non-Aboriginal <i>n</i> = 2610. Based on these total births the prevalence of GDM among all pregnancies in Aboriginal women was 8.7% in 2011 and 15.7% in 2013; in non-Aboriginal women it was 6.0% in 2011 and 10.1% in 2013. The prevalence of pre-existing diabetes among all pregnancies in Aboriginal women was 3.9% in 2011 and 4.1% in 2013; in non-Aboriginal women it was 0.4% in 2011 and 0.6% in 2013.</p