Results of a National Survey Examining Canadians' Concern, Actions, Barriers, and Support for Dietary Sodium Reduction Interventions

Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
The Canadian journal of cardiology (Impact Factor: 3.94). 03/2013; 29(5). DOI: 10.1016/j.cjca.2013.01.018
Source: PubMed


Population-wide dietary sodium reduction is considered a priority intervention to address sodium-related chronic diseases. In 2010, the Canadian government adopted a sodium reduction strategy to lower sodium intakes of Canadians; however, there has been a lack of coordinated action in its implementation. Our objective was to evaluate Canadians' concern, actions, reported barriers, and support for government-led policy interventions aimed at lowering sodium intakes. We conducted a survey among Canadians about sodium knowledge, attitudes, and behaviours. Data were weighted to reflect the 2006 Canadian census. Among 2603 respondents, 67.0% were concerned about dietary sodium and 59.3% were currently taking action to limit sodium intake. Those aged 50-59 years (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.17-2.72) and 60-69 years (OR, 1.63; 95% CI, 1.05-2.55) were more likely to be concerned about sodium vs younger individuals (20-29 years), as were hypertensive patients vs normotensive patients (OR, 4.13; 95% CI, 3.05-5.59). Older age groups and those with hypertension (OR, 3.48; 95% CI, 2.58-4.69) were also more likely to limit sodium consumption. Common barriers to sodium reduction were limited variety of lower sodium processed (55.5%) and restaurant (65.8%) foods. High support for government-led actions was observed, including interventions for lowering sodium levels in processed (86.6%) and restaurant (72.7%-74.3%) foods, and in food served in public institutions (81.8%-82.3%), and also for public education (80.4%-83.1%). There was much less support for financial incentives and disincentives. In conclusion, these concerns, barriers, and high level of support for government action provide further rationale for multi-sectoral interventions to assist Canadians in lowering their sodium intakes.

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    • "The majority of participants in this study understood that there is a link between high salt intake and high blood pressure and stroke although the knowledge of the significance of high blood pressure in diabetes was not addressed. Studies from consumer populations suggest that consumers are generally aware that eating too much salt is not healthy and can raise blood pressure (Arcand et al., 2013; Grimes et al., 2009; Marshall, Bower, & Schroder, 2007); however, they may not fully understand the amount of salt in packaged foods from reading the food label or how much salt it would contribute to their daily intake (Arcand et al., 2013). The mean urinary sodium excretion in Australians has been found to be approximately 172 mmol/day for men and 127 mmol/day for women (Riedel et al., 2006). "
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    ABSTRACT: Background: Despite good evidence that reducing sodium intake can reduce blood pressure (BP), salt intake in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) remains high. The purpose of this study was to describe the knowledge and beliefs of health risks associated with a high salt diet in adults with diabetes. Methods: Men and women with T1DM (n = 27; age 38 ± 16 years) or T2DM (n = 124; age 60 ± 11 years) were recruited. Results: Nine (6.0%) respondents knew the correct maximum daily recommended upper limit for salt intake. Thirty-six (23.9%) participants were not concerned with the amount of salt in their diet. Most participants knew that a diet high in salt was related to high BP (88.1%) and stroke (78.1%) and that foods such as pizza (80.8%) and bacon (84.8%) were high in salt. Fewer than 30% of people knew that foods such as white bread, cheese and breakfast cereals are high in salt (white bread 28.5%, cheese 29.1%, breakfast cereals 19.9%) and 51.0% correctly ranked three different nutrition information panels based on the sodium content. Label reading and purchase of low salt products was used by 60-80% of the group. Estimated average 24 hour urinary sodium excretion was 169 ± 32 mmol/24 h in men and 115 ± 27 mmol/24 h in women. Conclusion: Label reading and purchase of low salt products was used by the majority of the group but their salt excretion was still high. Men who used label reading had a lower salt intake. Other strategies to promote a lower sodium intake such as reducing sodium in staple foods such as bread need investigation.
    Full-text · Article · Aug 2014 · Appetite
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    • "In a recent survey, 89% of consumers felt that the Canadian population, in general, consumes too much sodium, but only 41% believed their personal consumption was too high (Decima Research Inc. 2009). Despite knowing that processed foods contribute the most to dietary sodium (Decima Research, Inc. 2009), many also believe they consume low amounts of sodium because they do not add salt to their food at the table or during cooking (Arcand et al. 2013). This lack of self-awareness may impede personal motivation and the effective implementation of strategies to lower dietary sodium. "
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    ABSTRACT: Dietary sodium reduction is commonly used in the treatment of hypertension, heart and liver failure, and chronic kidney disease. Sodium reduction is also an important public health problem since most of the Canadian population consumes sodium in excess of their daily requirements. Lack of awareness about the amount of sodium consumed and the sources of sodium in diet is common, and undoubtedly a major contributor to excess sodium consumption. There are few known tools available to screen and provide personalized information about sodium in the diet. Therefore, we developed a Web-based sodium intake screening tool called the Salt Calculator ( ), which is publicly available for individuals to assess the amount and sources of sodium in their diet. The Calculator contains 23 questions focusing on restaurant foods, packaged foods, and added salt. Questions were developed using sodium consumption data from the Canadian Community Health Survey cycle 2.2 and up-to-date information on sodium levels in packaged and restaurant food databases from the University of Toronto. The Calculator translates existing knowledge about dietary sodium into a tool that can be accessed by the public as well as integrated into clinical practice to address the high levels of sodium presently in the Canadian diet.
    Full-text · Article · Mar 2014 · Applied Physiology Nutrition and Metabolism
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    ABSTRACT: OBJECTIVE: Initiatives promoting the reduction of high-salt food consumption by consumers need to be partly based on current levels of salt knowledge in the population. However, to date there is no validated salt knowledge questionnaire that could be used to assess population knowledge about dietary salt (i.e. salt knowledge). Therefore, the aim of the present study was to develop and validate a salt knowledge questionnaire. DESIGN: A cross-sectional study was conducted on an online web survey platform using convenience, snowball sampling. The survey questionnaire was evaluated for content and face validity before being administered to the respondents. SETTING: Online survey. SUBJECTS: A total of forty-one nutrition experts, thirty-two nutrition students and thirty-six lay people participated in the study. RESULTS: Item analyses were performed to evaluate the psychometric properties of the test items. Twenty-five items were retained to form the final set of questions. The total scores of the experts were higher than those of the students and lay people (P < 0·05). The total salt knowledge score showed significant correlations with use of salt at the table (ρ = -0·197, P < 0·05) and inspection of the salt content in food products when shopping (ρ = 0·400; P < 0·01). CONCLUSIONS: The questionnaire demonstrated sufficient evidence of construct validity and internal consistencies between the items. It is likely to be a useful tool for the evaluation and measurement of levels of salt knowledge in the general population.
    No preview · Article · Mar 2013 · Public Health Nutrition
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