Projected effects on salt purchases following implementation of a national salt reduction policy in South Africa.

OBJECTIVE: To assess the contribution of different food groups to total salt purchases and to evaluate the estimated reduction in salt purchases if mandatory maximum salt limits in South African legislation were being complied with. DESIGN: This study conducted a cross-sectional analysis of purchasing data from Discovery Vitality members. Data were linked to the South African FoodSwitch database to determine the salt content of each food product purchased. Food category and total annual salt purchases were determined by summing salt content (kg) per each unit purchased across a whole year. Reductions in annual salt purchases were estimated by applying legislated maximum limits to product salt content. SETTING: South Africa. PARTICIPANTS: The study utilised purchasing data from 344 161 households, members of Discovery Vitality, collected for a whole year between January and December 2018. RESULTS: Vitality members purchased R12·8 billion worth of food products in 2018, representing 9562 products from which 264 583 kg of salt was purchased. The main contributors to salt purchases were bread and bakery products (23·3 %); meat and meat products (19 %); dairy (12·2 %); sauces, dressings, spreads and dips (11·8 %); and convenience foods (8·7 %). The projected total quantity of salt that would be purchased after implementation of the salt legislation was 250 346 kg, a reduction of 5·4 % from 2018 levels. CONCLUSIONS: A projected reduction in salt purchases of 5·4 % from 2018 levels suggests that meeting the mandatory maximum salt limits in South Africa will make a meaningful contribution to reducing salt purchases

Changes in sodium levels of processed foods among the International Food and Beverage Association member companies in Australia: 2013-2017

Excess dietary sodium is a modifiable cause of high blood pressure. The World Health Organization has targeted a 30 % reduction in mean population sodium consumption by 2025. In 2008, members of the International Food and Beverage Alliance (IFBA) made commitments to lower sodium content in their products. The aim of this study was to determine recent changes in sodium levels between 2013 and 2017 in foods and beverages produced by companies that are IFBA members (n = 10) and non-IFBA members (n = 6) that were included in the 2018 Global Access to Nutrition Index operating in Australia. Independent Samples t-tests and Mann Whitney U tests were used to test the differences in sodium levels. There was no clear difference in sodium content between 2013 and 2017 detectable for the IFBA members (mean difference 17 mg/100 g, 95 % confidence interval (CI), –82 to +48; p = 0.612; median difference 27 mg/100 g, p = 0.582). For the non-IFBA companies there was a decrease in median sodium content (−30 mg/100 g; P = 0.002) but not mean sodium content (−52 mg/100 g, 95 % CI −106 to +3; p = 0.064). Sodium reduction in IFBA companies appear to have had slow progress in Australia. Stronger implementation and monitoring programs are needed to drive industry action

Effect of individualised dietary advice for weight loss supplemented with walnuts on blood pressure: the HealthTrack study

Background/objectives: In addition to weight-loss, healthy dietary patterns and lower sodium intakes can help reduce blood pressure (BP), but individualised dietary advice may be necessary to achieve these effects. This study aimed to examine the impact of individualised dietary advice on BP in the intensive phase of a weight-loss trial. Subjects/methods: Secondary analysis of baseline and 3-month data from the HealthTrack randomised controlled trial (n = 211). Participants were randomly assigned to one of three dietary advice groups: general advice (control), individualised advice (intervention group, I), or intervention group supplemented with 30 g walnuts/day (IW). Resting BP and 24-h urine sodium and potassium were measured. Dietary intake was evaluated through diet history interviews. Results: Unadjusted SBP reduced significantly in all groups (IW and I groups P \u3c 0.001; control group P = 0.002) and DBP in IW and I groups (P \u3c 0.001). Compared to controls, the reductions in BP were 3-4 mmHg greater in the I and IW groups, but this only reached significance for DBP in the I group (−3.3 mmHg; P = 0.041). After controlling for age, sex, medication, weight-loss, physical activity and smoking, only the IW group showed a significant association between SBP reduction and increased urinary potassium (β = −0.101, P = 0.044), decreased sodium:potassium ratio (β = 2.446, P = 0.037) and increased consumption of seed and nut products and dishes (β = −0.108, P = 0.034). Conclusions: Dietary patterns with distinctive foods and lower sodium:potassium ratios may enhance the effects of weight-loss on BP. The patterns were best achieved with individualised dietary advice and food supplements

An application of partial least squares for identifying dietary patterns in bone health

Financial support This work was supported by the Foods Standards Agency and the UK Department of Health (grant number N05086) and the Scottish Funding Council. We are grateful for funding from the Scottish Government’s Rural and Environmental Science and Analytical Services (RESAS) Food, Land and People Programme. Any views expressed are the authors’ own; none of the funders had a role in design, analysis or writing of the present study.Peer reviewedPublisher PD

Effectiveness of a patient-centered medical home model of primary care versus standard care on blood pressure outcomes among hypertensive patients

Patients with hypertension and other comorbidities have complex health care needs that are challenging to manage in primary care. However, there is strong evidence suggesting that patient-centered approaches in primary care are effective in managing complex multimorbidity. We aim to evaluate the effectiveness of a patient-centered medical home model called ‘WellNet’ versus that of standard care on blood pressure (BP) outcomes among hypertensive patients. We used a cohort study design with a comparison group and case-series design to assess the ‘between-group’ and ‘within-group’ effectiveness of the WellNet program delivered across six general practices in Sydney, Australia. The treatment group included 447 eligible patients who provided consent and who received general practitioner-led care with the integration of care coordinators. The comparison group included 5237 matched patients receiving usual care at four geographically comparable general practices. To assess changes over time, paired, and independent samples t-tests were used to determine significant differences. In addition, analysis of covariance (ANCOVA) was used to identify any significant differences after adjusting for potential covariates. The adjusted model showed significant reductions in systolic BP (−3.4 mmHg; 95% CI −5.1, −1.7; p value < 0.001) in the treatment group at follow-up. However, no significant mean change was observed in diastolic BP. The proportion of patients within the recommended range was found to be significantly higher in the treatment group than in the comparison group (13.6% versus 6.4%). WellNet patients experienced statistically significant and clinically meaningful improvement in BP during the follow-up. The findings of this study may be beneficial to both patients and providers in terms of improved health outcomes and delivery of care, respectively