Don't Take it With a Grain of Salt: The Effect of Global Sodium Reduction Strategies on the Sodium Intake of Canadians

Background: Currently, sodium consumption of Canadians (2760 mg/day) exceeds the 2300 mg/day tolerable upper level putting Canadians at risk for hypertension and cardiovascular disease. Voluntary sodium reformulation strategies have been implemented in Canada, the United Kingdom (UK), United States (US) to reduce sodium intake from processed foods. The potential for sodium reformulation to reduce sodium intake across socioeconomic position (SEP) is not well understood. The objective of this study was to evaluate the extent to which fully achieving sodium reformulation targets for processed foods outlined in the Canada, UK, US strategies would decrease population and social inequities in sodium intake in Canadian adults.   Design: A cross-sectional study was conducted using the 2015 Canadian Community Health Survey–Nutrition (n=13,519 participants aged ≥19 years, 53% females). Foods from the 24-hour dietary recall were matched to each country’s sodium reduction categories and target sodium levels were applied. Multivariable linear regressions were used to estimate mean sodium intake for the population and across SEP indicators (educational attainment, household food security, and household income adequacy quintiles).   Results: Achieving Canada’s targets would reduce average sodium intake by 228 mg/day (95%CI: 196,260) compared to baseline. UK’s sodium targets would achieve greater reductions, decreasing average sodium intake by 270 mg/day (95%CI: 242,299). The US sodium targets would increase average sodium intake by 98 mg/day (95%CI: 64,132). Achieving sodium reformulation targets resulted in greater reductions in sodium intake in men, and in lower SEP groups. For example, educational inequalities in sodium intake observed at baseline were reduced in men [Canada: (RD: 148 mg/day, 95%CI: -30,327); UK: (RD: 152 mg/day, 95%CI: -43,347)] and eliminated in women.   Conclusion: Achieving targets outlined in Canada and UK’s voluntary sodium reformulation strategies would significantly reduce mean sodium intake in Canadians. This study demonstrated the potential for reducing social inequities in sodium intake and health.&nbsp

Impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course: a systematic review

Background Disasters are events that disrupt the daily functioning of a community or society, and may increase long-term risk of adverse cardiometabolic outcomes, including cardiovascular disease, obesity and diabetes. The objective of this study was to conduct a systematic review to determine the impact of disasters, including pandemics, on cardiometabolic outcomes across the life-course.Design A systematic search was conducted in May 2020 using two electronic databases, EMBASE and Medline. All studies were screened in duplicate at title and abstract, and full-text level. Studies were eligible for inclusion if they assessed the association between a population-level or community disaster and cardiometabolic outcomes ≥1 month following the disaster. There were no restrictions on age, year of publication, country or population. Data were extracted on study characteristics, exposure (eg, type of disaster, region, year), cardiometabolic outcomes and measures of effect. Study quality was evaluated using the Joanna Briggs Institute critical appraisal tools.Results A total of 58 studies were included, with 24 studies reporting the effects of exposure to disaster during pregnancy/childhood and 34 studies reporting the effects of exposure during adulthood. Studies included exposure to natural (n=35; 60%) and human-made (n=23; 40%) disasters, with only three (5%) of these studies evaluating previous pandemics. Most studies reported increased cardiometabolic risk, including increased cardiovascular disease incidence or mortality, diabetes and obesity, but not all. Few studies evaluated the biological mechanisms or high-risk subgroups that may be at a greater risk of negative health outcomes following disasters.Conclusions The findings from this study suggest that the burden of disasters extend beyond the known direct harm, and attention is needed on the detrimental indirect long-term effects on cardiometabolic health. Given the current COVID-19 pandemic, these findings may inform public health prevention strategies to mitigate the impact of future cardiometabolic risk.PROSPERO registration number CRD42020186074

Late preterm birth and growth trajectories during childhood: a linked retrospective cohort study

Abstract Background Evidence suggests that accelerated postnatal growth in children is detrimental for adult cardiovascular health. It is unclear whether children born late preterm (34–36 weeks) compared to full term (≥ 39 weeks), have different growth trajectories. Our objective was to evaluate the association between gestational age groups and growth trajectories of children born between 2006–2014 and followed to 2021 in Ontario, Canada. Methods We conducted a retrospective cohort study of children from singleton births in TARGet Kids! primary care network with repeated measures of weight and height/length from birth to 14 years, who were linked to health administrative databases. Piecewise linear mixed models were used to model weight (kg/month) and height (cm/month) trajectories with knots at 3, 12, and 84 months. Analyses were conducted based on chronological age. Results There were 4423 children included with a mean of 11 weight and height measures per child. The mean age at the last visit was 5.9 years (Standard Deviation: 3.1). Generally, the more preterm, the lower the mean value of weight and height until early adolescence. Differences in mean weight and height for very/moderate preterm and late preterm compared to full term were evident until 12 months of age. Weight trajectories were similar between children born late preterm and full term with small differences from 84–168 months (mean difference (MD) -0.04 kg/month, 95% CI -0.06, -0.03). Children born late preterm had faster height gain from 0–3 months (MD 0.70 cm/month, 95% CI 0.42, 0.97) and 3–12 months (MD 0.17 cm/month, 95% CI 0.11, 0.22). Conclusions Compared to full term, children born late preterm had lower average weight and height from birth to 14 years, had a slightly slower rate of weight gain after 84 months and a faster rate of height gain from 0–12 months. Follow-up is needed to determine if growth differences are associated with long-term disease risk