Poster presented at the Nutrition 2014: III World Congress of Public Health Nutrition =   III Congresso Mundial de Nutrição e Saúde Pública. Las Palmas de Gran Canaria, Spain, 9-12 November 201

Jorge, R.

Santos, A.

English

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Analysis of sodium intake from bread in an institutionalized elderly populationJorge R.1* and Santos A.21-Egas Moniz Interdisciplinary Research Center;2-Faculty of Nutrition and Food Sciences of University of Oporto.*ruimfjorge@gmail.comIntroductionObjectives•The present investigation main purpose is to assess the impact of bread consumption• The Bread role in the total sodium intake (and consequently of salt) has beenconsidered significantly relevant in some populations1. Portugal’s bread annual percapita consumption was about 70 kg in 20092.• Portugal is one of the European countries with the highest rates of stroke mortality,in part because of a probable relationship with the high salt intake3.• Current guidelines on salt intake (5g/day) are almost always exceeded, with a higherrisk to senior hypertensive individuals who have even straighter recommendations(3,8 g/day), and usually show a much higher salt intake4,5.• It is possible to make a 25% salt reduction on the bread without causing a badacceptability or diminishing its consumption6.• On August 12th 2010, the law no.75/2009 took effect to establish an upper limit tobread’s salt addition (1,4g /100g of bread)7.• By analyzing Table 1, it’s possible to understand that the mean salt daily intakedue to bread consumption is 2,7 g with close maximum and minimum values (SD= 0,8). This can be explained by a patronized bread consumption in VFWSC, in partrelated to the bread offer at fixed meals.• The participants presented a mean daily salt intake of 12,7 g (SD = 5,6), with amean of 27,5% of the salt intake having its source on the daily bread consumption(Table 2).Participant ID No.Percentage of the salt consumed trough bread in the total urinary salt excretion1 35,89%2 45,47%Table 2. Percentage of the salt consumed trough bread in the total urinary salt excretion.•Total sodium excretion was assessed through a 24-hour urine samples, in order to estimate the participants daily sodium intake. An 24h-urine sample was collected from each participant to determine creatinuria (alkaline picrate and spectophotometric methods) and urinary sodium (ion-selective electrode).•Weight, height, age, waist circumference, creatinemia, pharmacological therapy andclinical information like current and chronic pathologies were assessed. The body massindex was determined and the glomerular filtration rate (GFR) was estimated by 3different methods (direct measurement of creatinine clearance, Cockcroft-Gault9equation and the Modification of Diet in Renal Disease equation10).•To determine the bread levels of sodium chloride was used the commonly knownCharpentier-Volhard method, with a protocol abide by a PN (Portuguese Norm) 1845 of198211. For each of the 12 bread samples, collected before and after the enforcement ofthe law no. 75/2009, 2 tests were realized and the mean and standard deviation werecalculated.• In order to evaluate the quantity and quality of bread consumed by the users of theVFWSC was developed a questionnaire applied to the study participants.• The same interviewer applied and filled all questionnaires. All written answers wereMaterial and methods•All participants were patients of the Vale de Figueira’s Wellness Social Center (VFWSC),and the first group was made of 27 participants.•After applying the only exclusion criteria, which was the impossibility of collecting a24hours urine sample, the participants were reduced to 19 to whom, was presented aninformed consent based on a model of the Portugal’s North Regional HealthAdministration, to consent the collection and analyze of the 24 hours urine sample.•Of the18 participants that signed the consent form , one passed away and other washospitalized reducing the final group to 16 participants.on the daily total sodium intake of a senior institutionalized population and also, toevaluate, in this institution, the potential effect and enforcement of the law nº 75/2009witch took effect on August 12th 2010.•A secondary objective is to assess the usefulness of creating a protocol with the localbread industry, that would improve salt intake rates of the individuals at the care centerof this study , by reducing the bread salt levels.ParticipantsAssessments• The salt intake through bread consumption, at the VFWSC, seems to havediminished after the law no. 75/2009, resulting in an average reduction of 19,4%(SD = 0,5) per participant.• Participants of this study revealed an excessive salt intake, 3,35 times superior tothe 3,8 g/day recommendations for elderly and hypertensive patients of the2010’s Dietary Guidelines for Americans12.• Bread was an important vehicle of salt intake, reflecting more than a quarter ofthe total daily salt intake. This findings support the need for creating salt intakereduction measures like a protocol with the local bread industry in order toproduce a special kind of bread with lower salt levels• The law no. 75/2009 of August 12th 2010 was respected by the bread supplierKey findings3 11,40%4 54,88%5 32,62%6 19,12%7 9,08%8 16,38%9 32,88%10 65,97%11 25,32%12 20,80%13 9,40%14 19,27%15 14,51%Mean ± SD 27,53 ± 17,08%confirmed orally, with a careful and adequate language, with the participants, in order toconfirm the obtained data. This checking and confirmation was important due to theethnographic characteristics presented by the participants, well known andcomprehended by the interviewer, a local habitant.• All data used in this research was collected between July 26th 2010 and January 21th2011.Results• The 16 participants of this study were senior institutionalized individuals with agesbetween 69 and 89 years old (Mean = 80,4 years old; SD = 5,6 years), 4 males and12 females.• Of the 15 hypertensive participants, 7 were taking diuretics .• All participants presented a considered “normal” renal function according to theirage.• The users of VFWSC only consumed 2 different kinds of bread (carcaça andcortado), both refined, with wheat flower has key ingredient and with salt.• Table 1 shows the daily bread consumption, daily salt intake, and daily salt intakevalues due to bread consumption.company and contributed to lower the quantity of salt added to the breadacquired by VFWSC, lowering the salt intake .Daily intake (g/day)Mean (g/day)Standard Deviation (g/day)Minimum (g/day)Maximum (g/day)Bread (total) 204,1 59,2 114,0 306,0Salt (total 12,7 5,6 3,9 22,2Salt (trough bread) 2,7 0,8 1,6 4,1Table 1. daily bread consumption, daily salt intake, and daily salt intake values dueto bread consumption(n = 16).References1. Brown IJ, Tzoulaki I, Candeias V, Elliot P. Salt intakes around the world: implications forpublic health. Int J Epidemiol; 38(3):791-813; 20092. Neves JR, Pinheiro A, Neves A, Hasegawa D, Enomura M, Larotinda A et al. Relatório domercado em 2009. Panorama 2010 – Guia de fornecedores da indústria de panificaçãoe confeitaria. Fevereiro; 8:6-16; 20103. Polónia J, Maldonado J, Ramos R, Bertoquini S, Duro M, Almeida C et al. Determinaçãodo consume de sal numa amostra da população portuguesa adulta pela excreçãourinária de sódio. Sua relação com rigidez arterial. Rev Port Cardiol; 25(9):801-17; 20064. Elmadfa I, Meyer A, Nowak V, Hasenegger V, Putz P, Vertraeten R et al. EuropeanNutrition and Health Report; 62(1):1660-0347; 20095. Centers for Disease Control and Prevention (CDC). Application of lower sodium intakerecommendations to adults – United States, 1999-2006. MMWR Morb Mortal Wkly Rep;58(11):281-3; 20096. Girgis S, Neal B, Prescott J, Prendergast J, Dumbrell S, Turner C et al. A one-quarterreduction in salt of bread can be made without detection. Eur J Clin Nutr 2003;67(4):616-20; 20037. Lei n.º 75/2009 de 12 de Agosto que estabelece normas com vista à redução do teor desal no pão bem como informação na rotulagem de alimentos embalados destinados aoconsumo humano. Diário da República - 1ª série Agosto 2009; 155(1):5225-6; 20098. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidneydisease: evaluation, classification, and stratification. Guideline 4. Estimation of GFR AmJ Kidney Dis 2002 Feb; 39(2):S1-266.9. Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.Nephron 1976; 16(1):31-41.10.Levey AS, Bosch JP, Lewis JB, Greene T, Rodgers N, Roth D. A more accurate methodto estimate glomerular filtration rate from serum creatinine: a new prediction equation.Modification of Diet in Renal Disease Study Group. Ann Intern Med; 130(6):461-70.11.Norma Portuguesa. Determinação do teor de cloretos – Método Corrente. NP-1845,1982 Jun; 199912.US Department of Health and Human Services, US Department of Agriculture. Dietaryguidelines for Americans 2010. 7th ed. Washington, DC: US Department of Health andHuman Services, US Department of Agriculture; 2010.

Analysis of sodium intake from bread in an institutionalized elderly population

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Analysis of sodium intake from bread in an institutionalized elderly population

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