Revista Panamericana de Salud Públicahttps://scielosp.org/feed/rpsp/2012.v32n4/2018-01-01T00:02:00ZVol. 32 No. 4 - 2012WerkzeugReducción de la ingesta de sodio en las Américas: un imperativo de salud públicaS1020-498920120010000012018-01-01T00:02:00Z2018-01-01T00:02:00ZBarquera, SimónAppel, Lawrence J.
<em>Barquera, Simón</em>;
<em>Appel, Lawrence J.</em>;
<br/><br/>
Iniciativas para reducir la sal alimentaria en la Región de las AméricasS1020-498920120010000022018-01-01T00:02:00Z2018-01-01T00:02:00ZCampbell, Norm R. C.Correa-Rotter, RicardoLegowski, BarbaraLegetic, Branka
<em>Campbell, Norm R. C.</em>;
<em>Correa-Rotter, Ricardo</em>;
<em>Legowski, Barbara</em>;
<em>Legetic, Branka</em>;
<br/><br/>
Conocimientos, percepciones y comportamientos relacionados con el consumo de sal, la salud y el etiquetado nutricional en Argentina, Costa Rica y EcuadorS1020-498920120010000032018-01-01T00:02:00Z2018-01-01T00:02:00ZSánchez, GermanaPeña, LorenaVarea, SoledadMogrovejo, PatriciaGoetschel, María LorenaMontero-Campos, María de los ÁngelesMejía, RaúlBlanco-Metzler, Adriana
<em>Sánchez, Germana</em>;
<em>Peña, Lorena</em>;
<em>Varea, Soledad</em>;
<em>Mogrovejo, Patricia</em>;
<em>Goetschel, María Lorena</em>;
<em>Montero-Campos, María De Los Ángeles</em>;
<em>Mejía, Raúl</em>;
<em>Blanco-Metzler, Adriana</em>;
<br/><br/>
OBJETIVO: Identificar los conocimientos, percepciones y comportamientos relacionados con el consumo de la sal y el sodio alimentarios y su relación con la salud y el etiquetado nutricional de los alimentos, en tres países de la Región. MÉTODOS: Estudio cualitativo-exploratorio basado en entrevistas semiestructuradas, según las categorías del modelo de creencias en salud. Se realizaron 34 entrevistas y 6 grupos focales con líderes comunales (71 informantes en total) en áreas rurales y urbanas de Argentina, Costa Rica y Ecuador. RESULTADOS: El consumo de sal varía en las áreas rurales y urbanas de los tres países. Para la mayoría de los entrevistados, los alimentos no se podrían consumir sin sal y solo las personas que consumen una cantidad excesiva de sal tendrían riesgos para la salud. Se desconoce que los alimentos procesados contienen sal y sodio. Aunque no medían la cantidad de sal agregada a las comidas, los participantes consideraban que consumían poca sal y no percibían su salud en riesgo. La mayoría de los informantes no revisaba la información nutricional y los que lo hacían manifestaron no comprenderla. CONCLUSIONES: Existe un conocimiento popular en relación con la sal, no así con el término "sodio". Se consume más sal y sodio de lo informado y no hay perspectivas de reducción. Aunque se sabe que el consumo excesivo de sal representa un riesgo para la salud, no se perciben en riesgo. El reemplazo de la palabra sodio por sal facilitaría la elección de los alimentos.Consumer attitudes, knowledge, and behavior related to salt consumption in sentinel countries of the AmericasS1020-498920120010000042018-01-01T00:02:00Z2018-01-01T00:02:00ZClaro, Rafael MoreiraLinders, HubertRicardo, Camila ZanchetaLegetic, BrankaCampbell, Norm R. C.
<em>Claro, Rafael Moreira</em>;
<em>Linders, Hubert</em>;
<em>Ricardo, Camila Zancheta</em>;
<em>Legetic, Branka</em>;
<em>Campbell, Norm R. C.</em>;
<br/><br/>
OBJECTIVE: To describe individual attitudes, knowledge, and behavior regarding salt intake, its dietary sources, and current food-labeling practices related to salt and sodium in five sentinel countries of the Americas. METHODS: A convenience sample of 1 992 adults (≥ 18 years old) from Argentina, Canada, Chile, Costa Rica, and Ecuador (approximately 400 from each country) was obtained between September 2010 and February 2011. Data collection was conducted in shopping malls or major commercial areas using a questionnaire containing 33 questions. Descriptive estimates are presented for the total sample and stratified by country and sociodemographic characteristics of the studied population. RESULTS: Almost 90% of participants associated excess intake of salt with the occurrence of adverse health conditions, more than 60% indicated they were trying to reduce their current intake of salt, and more than 30% believed reducing dietary salt to be of high importance. Only 26% of participants claimed to know the existence of a recommended maximum value of salt or sodium intake and 47% of them stated they knew the content of salt in food items. More than 80% of participants said that they would like food labeling to indicate high, medium, and low levels of salt or sodium and would like to see a clear warning label on packages of foods high in salt. CONCLUSIONS: Additional effort is required to increase consumers' knowledge about the existence of a maximum limit for intake and to improve their capacity to accurately monitor and reduce their personal salt consumption.Relación costo-utilidad de la disminución del consumo de sal y su efecto en la incidencia de enfermedades cardiovasculares en ArgentinaS1020-498920120010000052018-01-01T00:02:00Z2018-01-01T00:02:00ZFerrante, DanielKonfino, JonatanMejía, RaúlCoxson, PamelaMoran, AndrewGoldman, LeePérez-Stable, Elíseo J.
<em>Ferrante, Daniel</em>;
<em>Konfino, Jonatan</em>;
<em>Mejía, Raúl</em>;
<em>Coxson, Pamela</em>;
<em>Moran, Andrew</em>;
<em>Goldman, Lee</em>;
<em>Pérez-Stable, Elíseo J.</em>;
<br/><br/>
OBJETIVO: Estimar la relación costo-utilidad de una intervención dirigida a reducir el consumo de sal en la dieta de personas mayores de 35 años en Argentina. MÉTODOS: La intervención consistió en reducir entre 5% y 25% el contenido de sal en los alimentos. Se utilizó el modelo de simulación del impacto de las políticas sobre la enfermedad coronaria para predecir la evolución de la incidencia, la prevalencia, la mortalidad y los costos en la población de la enfermedad coronaria y cerebrovascular en personas de 35 a 84 años. Se modeló el efecto y los costos de una disminución de 3 g de sal en la dieta, mediante su reducción en alimentos procesados y en la añadida por los consumidores, por un período de 10 años. Se estimó el cambio en la ocurrencia de eventos en este período y la ganancia en años de vida ajustados por la calidad (AVAC) en un escenario de efecto alto y otro de efecto bajo. RESULTADOS: La intervención generó un ahorro neto de US$ 3 765 millones y una ganancia de 656 657 AVAC en el escenario de efecto alto y de US$ 2 080 millones y 401 659 AVAC en el escenario de efecto bajo. Se obtendrían reducciones en la incidencia de enfermedad coronaria (24,1%), infarto agudo de miocardio (21,6%) y accidente cerebrovascular (20,5%), y en la mortalidad por enfermedad coronaria (19,9%) y por todas las causas (6,4%). Se observaron beneficios para todos los grupos de edad y sexo. CONCLUSIONES: La implementación de esta estrategia de reducción del consumo de sal produciría un efecto sanitario muy positivo, tanto en AVAC ganados como en recursos económicos ahorrados.Need for coordinated programs to improve global health by optimizing salt and iodine intakeS1020-498920120010000062018-01-01T00:02:00Z2018-01-01T00:02:00ZCampbell, Norm R. C.Dary, OmarCappuccio, Francesco P.Neufeld, Lynnette M.Harding, Kim B.Zimmermann, Michael B.
<em>Campbell, Norm R. C.</em>;
<em>Dary, Omar</em>;
<em>Cappuccio, Francesco P.</em>;
<em>Neufeld, Lynnette M.</em>;
<em>Harding, Kim B.</em>;
<em>Zimmermann, Michael B.</em>;
<br/><br/>
High dietary salt is a major cause of increased blood pressure, the leading risk for death worldwide. The World Health Organization (WHO) has recommended that salt intake be less than 5 g/day, a goal that only a small proportion of people achieve. Iodine deficiency can cause cognitive and motor impairment and, if severe, hypothyroidism with serious mental and growth retardation. More than 2 billion people worldwide are at risk of iodine deficiency. Preventing iodine deficiency by using salt fortified with iodine is a major global public health success. Programs to reduce dietary salt are technically compatible with programs to prevent iodine deficiency through salt fortification. However, for populations to fully benefit from optimum intake of salt and iodine, the programs must be integrated. This review summarizes the scientific basis for salt reduction and iodine fortification programs, the compatibility of the programs, and the steps that need to be taken by the WHO, national governments, and nongovernmental organizations to ensure that populations fully benefit from optimal intake of salt and iodine. Specifically, expert groups must be convened to help countries implement integrated programs and context-specific case studies of successfully integrated programs; lessons learned need to be compiled and disseminated. Integrated surveillance programs will be more efficient and will enhance current efforts to optimize intake of iodine and salt. For populations to fully benefit, governments need to place a high priority on integrating these two important public health programs.Iniciativas desenvolvidas no Brasil para a redução do teor de sódio em alimentos processadosS1020-498920120010000072018-01-01T00:02:00Z2018-01-01T00:02:00ZNilson, Eduardo Augusto FernandesJaime, Patrícia ConstanteResende, Denise de Oliveira
<em>Nilson, Eduardo Augusto Fernandes</em>;
<em>Jaime, Patrícia Constante</em>;
<em>Resende, Denise De Oliveira</em>;
<br/><br/>
A construção de estratégias para a redução do teor de sódio em alimentos processados faz parte de um conjunto de iniciativas para diminuir o consumo desse nutriente no Brasil - dos atuais 12 g de sal por pessoa ao dia para menos de 5 g por pessoa por dia (2 000 mg de sódio) até 2020. Nesse processo, uma ação central é a pactuação, entre o governo e a indústria de alimentos, de metas de redução voluntária, gradual e sustentável dos teores máximos de sódio nos alimentos industrializados. Este artigo apresenta a experiência brasileira na construção e implementação de estratégias para a redução dos limites máximos de sódio nos alimentos processados e os atores sociais envolvidos.Reducing salt intake to prevent hypertension and cardiovascular diseaseS1020-498920120010000082018-01-01T00:02:00Z2018-01-01T00:02:00ZHe, Feng J.Campbell, Norm R. C.MacGregor, Graham A.
<em>He, Feng J.</em>;
<em>Campbell, Norm R. C.</em>;
<em>Macgregor, Graham A.</em>;
<br/><br/>
There is compelling evidence that dietary salt intake is the major cause of raised blood pressure (BP) and that a reduction in salt intake from the current level of ≈ 9 - 12 g/day in most countries to the recommended level of < 5 g/day lowers BP. A further reduction to 3 - 4 g/day has a greater effect and there needs to be ongoing consideration of lower targets for population salt intake. Cohort studies and outcome trials have demonstrated that a lower salt intake is related to a reduced risk of cardiovascular disease. Salt reduction is one of the most cost-effective measures to improve public health worldwide. In the Americas, a salt intake of > 9 g/day is highly prevalent. Sources of salt in the diet vary hugely among countries; in developed countries, 75% of salt comes from processed foods, whereas in developing countries such as parts of Brazil, 70% comes from salt added during cooking or at the table. To reduce population salt intake, the food industry needs to implement a gradual and sustained reduction in the amount of salt added to foods in developed countries. In developing countries, a public health campaign plays a more important role in encouraging consumers to use less salt coupled with widespread replacement of salt with substitutes that are low in sodium and high in potassium. Numerous countries in the Americas have started salt reduction programs. The challenge now is to engage other countries. A reduction in population salt intake will result in a major improvement in public health along with major health-related cost savings.Progress toward sodium reduction in the United StatesS1020-498920120010000092018-01-01T00:02:00Z2018-01-01T00:02:00ZLevings, JessicaCogswell, MaryCurtis, Christine J.Gunn, JanelleNeiman, AndreaAngell, Sonia Y.
<em>Levings, Jessica</em>;
<em>Cogswell, Mary</em>;
<em>Curtis, Christine J.</em>;
<em>Gunn, Janelle</em>;
<em>Neiman, Andrea</em>;
<em>Angell, Sonia Y.</em>;
<br/><br/>
The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of < 2 300 mg/day. A further reduction to 1 500 mg/day is advised for people 51 years or older; African Americans; and people with high blood pressure, diabetes, or chronic kidney disease. In the United States of America, the problem of excess sodium intake is related to the food supply. Most sodium consumed comes from packaged, processed, and restaurant foods and therefore is in the product at the time of purchase. This paper describes sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.Systematic review of studies comparing 24-hour and spot urine collections for estimating population salt intakeS1020-498920120010000102018-01-01T00:02:00Z2018-01-01T00:02:00ZJi, ChenSykes, LindsayPaul, ChristinaDary, OmarLegetic, BrankaCampbell, Norm R. C.Cappuccio, Francescp P.
<em>Ji, Chen</em>;
<em>Sykes, Lindsay</em>;
<em>Paul, Christina</em>;
<em>Dary, Omar</em>;
<em>Legetic, Branka</em>;
<em>Campbell, Norm R. C.</em>;
<em>Cappuccio, Francescp P.</em>;
<br/><br/>
OBJECTIVE: To examine the usefulness of urine sodium (Na) excretion in spot or timed urine samples to estimate population dietary Na intake relative to the gold standard of 24-hour (h) urinary Na. METHODS: An electronic literature search was conducted of MEDLINE (from 1950) and EMBASE (from 1980) as well as the Cochrane Library using the terms "sodium," "salt," and "urine." Full publications of studies that examined 30 or more healthy human subjects with both urinary Na excretion in 24-h urine and one alternative method (spot, overnight, timed) were examined. RESULTS: The review included 1 380 130 participants in 20 studies. The main statistical method for comparing 24-h urine collections with alternative methods was the use of a correlation coefficient. Spot, timed, and overnight urine samples were subject to greater intra-individual and interindividual variability than 24-h urine collections. There was a wide range of correlation coefficients between 24-h urine Na and other methods. Some values were high, suggesting usefulness (up to r = 0.94), while some were low (down to r = 0.17), suggesting a lack of usefulness. The best alternative to collecting 24-h urine (overnight, timed, or spot) was not clear, nor was the biological basis for the variability between 24-h and alternative methods. CONCLUSIONS: There is great interest in replacing 24-h urine Na with easier methods to assess dietary Na. However, whether alternative methods are reliable remains uncertain. More research, including the use of an appropriate study design and statistical testing, is required to determine the usefulness of alternative methods.Avances en la reducción del consumo de sal y sodio en Costa RicaS1020-498920120010000112018-01-01T00:02:00Z2018-01-01T00:02:00ZBlanco-Metzler, AdrianaMontero-Campos, María de los ÁngelesNúñez-Rivas, HildaGamboa-Cerda, CeciliaSánchez, Germana
<em>Blanco-Metzler, Adriana</em>;
<em>Montero-Campos, María De Los Ángeles</em>;
<em>Núñez-Rivas, Hilda</em>;
<em>Gamboa-Cerda, Cecilia</em>;
<em>Sánchez, Germana</em>;
<br/><br/>
En el presente artículo se describen los avances logrados en Costa Rica -así como los desafíos y limitaciones- en la reducción del consumo de sal. El establecimiento del Plan Nacional para la Reducción del Consumo de Sal/sodio en la Población de Costa Rica 2011 - 2021 se complementó con programas y proyectos multisectoriales específicos dirigidos a: 1) conocer la ingesta de sodio y el contenido de sal o sodio en los alimentos de mayor consumo; identificar los conocimientos, actitudes y comportamientos del consumidor respecto a la sal/sodio, su relación con la salud y el etiquetado nutricio-nal; evaluar la relación costo-efectividad de las medidas dirigidas a reducir la prevalencia de hipertensión arterial; 2) implementar estrategias para disminuir el contenido de sal/sodio en los alimentos procesados y los preparados en casa; 3) promover cambios de conducta en la población para reducir el consumo de sal en la alimentación; y 4) monitorear y evaluar las acciones dirigidas a reducir el consumo de sal o sodio en la población. Para alcanzar las metas propuestas se debe lograr una exitosa coordinación interinstitucional con los actores estratégicos, negociar compromisos con la industria alimentaria y los servicios de alimentación, y mejorar la regulación de los nutrientes críticos asociados con las enfermedades crónicas no transmisibles, en los alimentos. Se espera que a partir de los avances logrados durante la ejecución del Plan Nacional, Costa Rica logre alcanzar la meta internacional de reducción del consumo de sal.