Abstract
Background
Processed foods are major contributors to excessive sodium intake in Western populations.
We investigated the effect of food reformulation on daily dietary sodium intake.
Objective
To determine whether uninformed consumers accept reduced-sodium lunches and to determine
the effect of consuming reduced-sodium lunches on 24-hour urinary sodium excretion.
Design
A single-blind randomized controlled pretest-posttest design with two parallel treatment
groups was used.
Participants/setting
Participants chose foods in an experimental real-life canteen setting at the Restaurant
of the Future in Wageningen, the Netherlands, from May 16 until July 1, 2011.
Intervention
After a run-in period with regular foods for both groups, the intervention group (n=36)
consumed foods with 29% to 61% sodium reduction (some were partially flavor compensated).
The control group (n=38) continued consuming regular foods.
Main outcome measures
Outcomes for assessment of acceptance were the amount of foods consumed, energy and
sodium intake, remembered food liking, and intensity of sensory aspects. Influence
on daily dietary sodium intake was assessed by 24-hour urinary sodium excretion.
Statistical analyses performed
Between and within-subject comparisons were assessed by analysis of covariance.
Results
Energy intake and amount consumed of each food category per lunch remained similar
for both groups. Compared with the control group, the intervention group’s sodium
intake per lunch was significantly reduced by –1,093 mg (adjusted difference) (95%
CI –1,285 to –901), equivalent to 43 mmol sodium. Remembered food liking, taste intensity,
and saltiness were scored similarly for almost all of the reduced-sodium foods compared
with the regular foods. After consuming reduced-sodium lunches, compared with the
control group, intervention participants’ 24-hour urinary sodium excretion was significantly
lower by –40 mEq (adjusted difference) (95% CI –63 to –16) than after consuming regular
lunches, and this reflects a decreased daily sodium intake of 1 g.
Conclusions
Comparing the two treatment groups, consumption of reduced-sodium foods over a 3-week
period was well accepted by the uninformed participants in an experimental real-life
canteen setting. The reduced-sodium foods did not trigger compensation behavior during
the remainder of the day in the intervention group compared with the control group,
as reflected by 24-hour urinary sodium excretion. Therefore, offering reduced-sodium
foods without explicitly informing consumers of the sodium reduction can contribute
to daily sodium intake reduction.
Keywords
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References
- Global, regional and national sodium intakes in 1990 and 2010: A systematic analysis of 24-hour urinary sodium excretion and dietary surveys worldwide.BMJ Open. 2013; 3: e003733
- Effect of longer term modest salt reduction on blood pressure: Cohrane systematic review and meta-analysis of randomized trials.BMJ. 2013; 345: f1325
- Global sodium consumption and death from cardiovascular causes.N Engl J Med. 2014; 371: 624-634
- Effect of lower sodium intake on health: Systematic review and meta-analyses.BMJ. 2013; 346: f1326
- Reducing population salt intake worldwide: From evidence to implementation.Prog in Cardiovasc Dis. 2010; 52: 363-382
- Monitoring salt and iodine intakes in Dutch adults between 2006 and 2010 using 24-hour urinary sodium and iodine excretions.Public Health Nutr. 2013; 5: 1-8
- Potential effect of salt reduction in processed foods on health.Am J Clin Nutr. 2014; 99: 446-453
- The dominance of salt in manufactured food in the sodium intake of affluent societies.Lancet. 1987; 329: 426-469
- Relative contributions of dietary sodium sources.J Am Coll Nutr. 1991; 10: 383-393
- Dutch National Food Consumption Survey 2007–2010: Diet of Children and Adults Aged 7 to 69 Years.National Institute for Public Health and the Environment, Bilthoven, the Netherlands2011
- Effect of longer-term modest salt reduction on blood pressure.Cochrane Database Syst Rev. 2004; 3: CD004937
- Effective population-wide public health interventions to promote sodium reduction.Can Medical Assoc J. 2009; 181: 605-609
- An Assessment of Dietary Sodium Levels Among Adults (Aged 19-64) in the UK General Population in 2008, Based on Analysis of Dietary Sodium in 24-Hour Urine Samples. Food Standards Agency, London, UK2008
- Sodium in the Finnish diet: 20-year trends in urinary sodium excretion among the adult population.Eur J Clin Nutr. 2006; 60: 965-970
- Sodium in the Finnish diet: II trends in dietary sodium intake and comparison between intake and 24-hour excretion of sodium.Eur J Clin Nutr. 2006; 60: 1160-1167
- Strategies to reduce sodium consumption: A food industry perspective.Crit Rev Food Sci Nutr. 2009; 49: 841-851
- Reducing sodium in foods: The effect on flavor.Nutrients. 2011; 3: 694-711
- Salt enhances flavour by suppressing bitterness.Nature. 1997; 387: 563
- Population strategies to decrease sodium intake and the burden of cardiovascular disease: A cost-effectiveness analysis.Ann Int Med. 2010; 152: 481-487
- Short- and long-term effects of changes in pleasantness on food intake.Appetite. 2000; 34: 253-260
- Interaction between bread and butter with varying NaCl contents: Hedonic responses and sensory characteristics.Food Qual Pref. 1990; 2: 167-176
- Effect of salt on bread flavor.Lebensm-Wiss Technol. 1982; 15: 270-274
- Failure to compensate decreased dietary-sodium with increased table salt usage.JAMA. 1987; 258: 3275-3278
- Limited compensation by table salt for reduced salt within a meal.Appetite. 1989; 13: 193-200
- A review of methods to measure dietary sodium intake.J Cardiovasc Nurs. 2006; 21: 63-67
- Demonstrations of the influence of the eating environment on food acceptance.Appetite. 2000; 35: 231-237
- The effects of contextual variables on food acceptability: A confirmatory study.Food Qual Pref. 2007; 18: 58-65
- A comparison between liking ratings obtained under laboratory and field conditions. The role of choice.Appetite. 2005; 44: 15-22
- Health labelling can influence taste perception and use of table salt for reduced-sodium products.Public Health Nutr. 2012; 15: 2340-2347
- Current salt reduction strategies and their effect on sensory acceptability: A study with reduced salt ready-meals.Eur Food Res Technol. 2011; 232: 529-539
- Salt reduction in foods using naturally brewed soy sauce.J Food Sci. 2009; 74: S255-S262
- Consumer acceptance of foods lower in sodium.J Am Diet Ass. 1995; 95: 447-453
- Salty taste in dairy foods: Can we reduce the salt?.J Dairy Sci. 2011; 94: 636-645
- Consumers' acceptance of innovations in dry-cured ham: Impact of reduced salt content, prolonged aging time and new origin.Food Qual Pref. 2011; 22: 31-41
- The influence of sodium on liking and consumption of salty food.J Food Sci. 2011; 76: S72-S76
- A one-quarter reduction in the salt content of bread can be made without detection.Eur J Clin Nutr. 2003; 57: 616-620
- A salt reduction of 50% in bread does not decrease bread consumption or increase sodium intake by the choice of sandwich fillings.J Nutr. 2011; 141: 2249-2955
- Effect of saltiness on the liking and consumption of bread and butter.Ecol Food Nutr. 1986; 18: 99-106
- Consumer acceptance of salt-reduced “soy sauce” foods over rapidly repeated exposure.Food Qual Pref. 2013; 27: 179-190
- Low-sodium dietary approaches to stop hypertension-type diet including lean red meat lowers blood pressure in postmenopausal women.Nutr Res. 2009; 29: 8-18
- Memory processes in the development of reduced-salt food.Appetite. 2014; 83: 125-134
- Two non-consecutive 24-hour recalls using EPIC-Soft software are sufficiently valid for comparing protein and potassium intake between five European centres—Results from the European Food Consumption Validation (EFCOVAL) study.Br J Nutr. 2011; 105: 447-458
- Para-aminobenzoic acid (PABA) used as a marker for completeness of 24-hour urine: Effects of age and dosage scheduling.Eur J Clin Nutr. 2003; 57: 138-142
- Reference values for analytes of 24-hour urine collections known to be complete.Ann Clin Biochem. 1988; 25: 610-619
Beckman Coulter (2010) Synchron LX System(s), chemistry information sheet. NA sodium. http://www.beckmancoulter.com/wrsportal/techdocs?docname=/cis/A18529/ AF/EN_NA.pdf. Accessed April 1, 2014.
- A method to compensate for incomplete 24-hour urine collections in nutritional epidemiology studies.Public Health Nutr. 1999; 2: 587-591
- Effect of salt intensity in soup on ad libitum intake and on subsequent food choice.Appetite. 2012; 58: 48-55
- Principles of Nutritional Assessment.Oxford University Press, Oxford, UK2005
- Salt substitute effect of flavorings and intensity rating of beef soup in different test settings.Food Sci Biotechnol. 2010; 19: 1421-1427
- Testing consumer preferences for iced-coffee: Does the drinking environment have any influence?.Food Qual Pref. 2007; 18: 161-172
- Validation of a buffet meal design in an experimental restaurant.Appetite. 2012; 58: 889-897
Biography
A. M. Janssen is a senior scientist of consumer science, Food and Biobased Research Department, Wageningen University and Research Centre, the Netherlands.
Biography
S. Kremer is a senior scientist of consumer science, Food and Biobased Research Department, Wageningen University and Research Centre, the Netherlands.
Biography
W. L. van Stipriaan is a clinical trial assistant, Julius Clinical, Zeist, the Netherlands; at the time of the study, she was a fifth-year student, Division of Human Nutrition, Wageningen University, the Netherlands.
Biography
M. W. J. Noort is a scientist of functional ingredients, TNO, Zeist, the Netherlands.
Biography
J. H. M. de Vries is a nutritionist and an assistant professor, Division of Human Nutrition, Wageningen University, the Netherlands.
Biography
E. H. M. Temme is a public health nutritionist, National Institute for Public Health and the Environment, Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands.
Article info
Publication history
Published online: March 11, 2015
Accepted:
January 20,
2015
Received:
May 20,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This research was supported by the Dutch Ministry of Economic Affairs, which had no role in the study design; the collection, analysis, and interpretation of the data; the writing of the report; or the decision to submit the report for publication. Also, no honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
