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Current Nutrition & Food Science

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ISSN (Print): 1573-4013
ISSN (Online): 2212-3881

Research Article

Salt Intake from Traditional Breads: A Public Health Challenge for Decreasing Non-communicable Diseases in Iran

Author(s): Zahra Hadian*, Ehsan Feizollahi, Kianoosh Khosravi, Vahid Mofid and Hamid Rasekhi

Volume 16, Issue 8, 2020

Page: [1278 - 1284] Pages: 7

DOI: 10.2174/1573401316666200309150947

Price: $65

Abstract

Background: In recent decades, a decrease of sodium chloride (NaCl) salt in diets such as breads has raised public attention for control of non-communicable diseases (NCDs) in developed and developing countries. Bread is an important food in public diets in Iran as well as many other countries.

Aim: The aim of this study was to assess salt (NaCl) content of the Iranian traditional breads and to estimate daily salt intake through consumption of these foodstuffs. The study was carried out in five major cities of Iran in 2016.

Methods: In total, 237 traditional bread samples (including Sangak, Taftoon, Lavash and Barbari) were collected and the sample NaCl content was assessed using published methods by the International Organization for Standardization (ISO) and Association of Official Analytical Chemists (AOAC). Values were compared to Iranian standard limit values.

Results: Salt content of the traditional breads ranged from 0.03 g to 2.99 g per 100 g of dry weight (D.W.). Overall, 49.2% of the traditional bread samples in Tehran and 47.2% of the traditional bread samples in other cities exceeded the standard limit. Since 93.8% of Sangak breads from Tehran met the salt limit criteria of national standards, this traditional bread includes a more favorable nutritional status compared to that other breads do.

Conclusion: Awareness of salt level in breads and monitoring salt use in bakeries can help update food policies and improve public lifestyle. A decrease in the ratio of salt is recommended as the major nutritional intervention for the prevention and control of NCDs.

Keywords: Bread, dietary intake, Iran, non-communicable diseases, salt, dietary patterns.

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[1]
Fallah Z, Qorbani M, Motlagh ME, Heshmat R, Ardalan G, Kelishadi R. Prevalence of prehypertension and hypertension in a nationally representative sample of Iranian children and adolescents: The CASPIAN-IV study. Int J Prev Med 2014; 5(Suppl. 1): S57-64.
[PMID: 24791193]
[2]
Kawamura A, Kajiya K, Kishi H, et al. The nutritional characteristics of the hypotensive WASHOKU-modified DASH diet: A sub-analysis of the DASH-JUMP study. Curr Hypertens Rev 2018; 14(1): 56-65.
[http://dx.doi.org/10.2174/1573402114666180405100430] [PMID: 29618312]
[3]
Passi SJ. Prevention of non-communicable diseases by balanced nutrition: population-specific effective public health approaches in developing countries. Curr Diabetes Rev 2017; 13(5): 461-76.
[http://dx.doi.org/10.2174/1573399812666160905105951] [PMID: 27593512]
[4]
Castro I, Waclawovsky G, Marcadenti A. Nutrition and physical activity on hypertension: implication of current evidence and guidelines. Curr Hypertens Rev 2015; 11(2): 91-9.
[http://dx.doi.org/10.2174/1573402111666150429170302] [PMID: 25921545]
[5]
Prater MR. Nutritional aspects relating to the developmental origins of health and disease. Curr Womens Health Rev 2008; 4(3): 143-52.
[http://dx.doi.org/10.2174/157340408785821827]
[6]
Gomez GB, Cappuccio FP. Dietary salt and disease prevention: a global perspective. Curr Med Chem Immunol Endocr Metab Agents 2005; 5(1): 13-20.
[http://dx.doi.org/10.2174/1568013053005445]
[7]
Nelson F, Nyarko KM, Binka FN. Prevalence of risk factors for non-communicable diseases for new patients reporting to Korle-Bu Teaching Hospital. Ghana Med J 2015; 49(1): 12-8.
[http://dx.doi.org/10.4314/gmj.v49i1.3] [PMID: 26339079]
[8]
Alwan A. Global status report on noncommunicable diseases 2010.World Health Organization 2011.http://whqlibdoc.who.int/publications
[9]
Ferrara LA, Pacioni D, Vitolo G, Staiano L, Riccio E, Gaetano G. Fast food versus slow food and hypertension control. Curr Hypertens Rev 2008; 4(1): 30-5.
[http://dx.doi.org/10.2174/157340208783497219]
[10]
Tokunaga M, Takahashi T, Singh RB, et al. Diet, nutrients and non-communicable diseases. Open Nutraceuticals J 2012; 5: 146-59.
[http://dx.doi.org/10.2174/1876396001205010146]
[11]
Al Jawaldeh A, Al-Khamaiseh M. Assessment of salt concentration in bread commonly consumed in the Eastern Mediterranean Region. East Mediterr Health J 2018; 24(1): 18-24.
[http://dx.doi.org/10.26719/2018.24.1.18] [PMID: 29658617]
[12]
Nwanguma BC, Okorie CH. Salt (sodium chloride) content of retail samples of Nigerian white bread: implications for the daily salt intake of normotensive and hypertensive adults. J Hum Nutr Diet 2013; 26(5): 488-93.
[http://dx.doi.org/10.1111/jhn.12038] [PMID: 23438149]
[13]
Israr T, Rakha A, Sohail M, Rashid S, Shehzad A. Salt reduction in baked products: Strategies and constraints. Trends Food Sci Technol 2016; 51: 98-105.
[http://dx.doi.org/10.1016/j.tifs.2016.03.002]
[14]
Hansen MM. Public health: promoting the health of populations and communities. Policy and Politics in Nursing and Health Care E-Book 2015; 24: 252.
[15]
Temme EHM, Hendriksen MAH, Milder IEJ, et al. Salt Reductions in some foods in the Netherlands: Monitoring of food composition and salt intake. Nutrients 2017; 9(7)E791
[http://dx.doi.org/10.3390/nu9070791]] [PMID: 28737692]
[16]
2015-2020 Dietary Guidelines for Americans. Washington, DC: USDA 2015.
[17]
Aghaei Meybodi HR, Khashayar P, Rezai Homami M, Heshmat R, Larijani B. Prevalence of hypertension in an Iranian population. Ren Fail 2014; 36(1): 87-91.
[http://dx.doi.org/10.3109/0886022X.2013.832315 PMID: 24028502]
[18]
Colin-Ramirez E, Arcand J, Ezekowitz JA. Estimates of dietary sodium consumption in patients with chronic heart failure. J Card Fail 2015; 21(12): 981-8.
[http://dx.doi.org/10.1016/j.cardfail.2015.08.345] [PMID: 26386452]
[19]
McMahon E, Clarke R, Jaenke R, Brimblecombe J. Detection of 12.5% and 25% salt reduction in bread in a remote indigenous Australian community. Nutrients 2016; 8(3): 169.
[http://dx.doi.org/10.3390/nu8030169] [PMID: 26999196]
[20]
Carcea M, Narducci V, Turfani V, Aguzzi A. A survey of sodium chloride content in Italian artisanal and industrial bread. Foods 2018; 7(11)E181
[http://dx.doi.org/10.3390/foods7110181]] [PMID: 30400580]
[21]
Akpolat T, Kadi R, Utaş C. Hypertension, salt, and bread. Am J Kidney Dis 2009; 53(6): 1103.
[http://dx.doi.org/10.1053/j.ajkd.2009.03.005] [PMID: 19463766]
[22]
Erdem Y, Akpolat T, Derici Ü, et al. Dietary sources of high sodium intake in Turkey: SALTURK II. Nutrients 2017; 9(9)E933
[http://dx.doi.org/10.3390/nu9090933]] [PMID: 28837102]
[23]
Pérez Farinós N, Santos Sanz S, Dal Re MÁ, et al. Salt content in bread in Spain, 2014. Nutr Hosp 2018; 35(3): 650-4.
[http://dx.doi.org/10.20960/nh.1339] [PMID: 29974775]
[24]
Lloyd-Sherlock P, Gómez-Olivé FX, Ngobeni S, Wagner RG, Tollman S. Pensions and low sodium salt: a qualitative evaluation of a new strategy for managing hypertension in rural South Africa. Curr Aging Sci 2018; 11(2): 140-6.
[http://dx.doi.org/10.2174/1874609811666180718114250] [PMID: 30019655]
[25]
Menyanu E, Russell J, Charlton K. Dietary sources of salt in low-and middle-income countries: a systematic literature review. Int J Environ Res Public Health 2019; 16(12): 2082.
[http://dx.doi.org/10.3390/ijerph16122082] [PMID: 31212868]
[26]
Institute of Standards and Industrial Research of Iran Traditional Breads Specifications and Test Methods 2017.
[27]
World Health Organization A Comprehensive Global Monitoring Framework Including Indicators and a Set of Voluntary Global Targets for the Prevention and Control of Noncommunicable Diseases. Geneva: World Health Organization 2012.
[28]
Campbell NR, Lackland DT, Lisheng L, et al. The World Hypertension League challenges hypertension and cardiovascular organizations to develop strategic plans for the prevention and control of hypertension. J Clin Hypertens (Greenwich) 2015; 17(5): 325-7.
[http://dx.doi.org/10.1111/jch.12557] [PMID: 25865341]
[29]
Fahimi S, Pharoah P. Reducing salt intake in Iran: priorities and challenges Archives of Iranian Medicine 2012; 15(2): 110-2.
[30]
Karizaki VM. Ethnic and traditional Iranian breads: different types, and historical and cultural aspects. Journal of Ethnic Foods 2017; 4(1): 8-14.
[http://dx.doi.org/10.1016/j.jef.2017.01.002]
[31]
Abdollahi M, Salehi F, Kalantari N, Asadilari M, Khoshfetrat MR, Ajami M. A comparison of food pattern, macro- and some micronutrients density of the diet across different socio-economic zones of Tehran. Med J Islam Repub Iran 2016; 30: 340.
[PMID: 27390710]
[32]
Kimiagar M. National Comprehensive Study on Household Food Consumption Pattern and Nutritional Status IR Iran Tehran. National Nutrition and Food Technology Research Institute, Center of Agricultural Economic Studies and Planning 1996.
[33]
Cochran WG. Sampling Techniques. 3rd ed. New York: John Wiley and Sons 1977.
[34]
ISO 712, P N E N Cereals and cereal products-Determination of moisture content-Reference method. 2009.
[35]
Cunniff P. Official Methods of Analysis of AOAC International Association of Official Analytical Chemists 1996. Report No. 0935584544
[36]
Abdollahi M, Mohammadi-Nasrabadi F, Houshiarrad A, Ghaffarpur M, Ghodsi D, Kalantari N. Socio-economic differences in dietary intakes: The comprehensive study on household food consumption patterns and nutritional status of IR Iran. Nutr Food Sci Res 2014; 1(1): 19-26.
[37]
Rahmani MKA, Allahverdian S, Hedayati M. Comparison of dietary iodine intake and urinary excretion in urban and rural households of Ilam in 2000. Majallah-i Ghudad-i Darun/Riz va Mitabulism-i Iran 2000; 2(1): 31-7.
[38]
Azizi F, Rahmani M, Allahverdian S, Hedayati M. Effects of salted food consumption on urinary iodine and thyroid function tests in two provinces in the Islamic Republic of Iran 2001.Available From: http://www.who.int/iris/handle/10665/118997
[39]
Sadeghzadeh V, Ghasemi I, Kelachayeh SSR, Naserian J. Effects of a lifestyle-change program on cardiac risk factors after angioplasty. Int Res J Appl Basic Sci 2013; 1: 234-8.
[40]
Motlagh Z, Mazloomy S, Mozaffari Khosravi H, Morowati-sharifabad M, Askarshahi M. Salt intake among women referring to medical health centers, Yazd, Iran, 2011. J Shahid Sadoughi Univ of Medical Sciences 2011; 19(4): 550-60.
[41]
Sari AA, Bazargani-Gilani B, Pajohi-Alamooti MR, Choobkar N. Evaluating chemical properties of all bread types in Hamedan bakeries. Int Food Res J 2017; 24(5): 1963-6.
[http://dx.doi.org/10.3390/foods1010003]
[42]
Mirnalini K Jr, Zalilah MS, Safiah MY, et al. Energy and nutrient intakes: findings from the Malaysian Adult Nutrition Survey (MANS). Malays J Nutr 2008; 14(1): 1-24.
[PMID: 22691761]
[43]
Radhika G, Sathya RM, Sudha V, Ganesan A, Mohan V. Dietary salt intake and hypertension in an urban south Indian population--[CURES - 53]. J Assoc Physicians India 2007; 55(6): 405-11. [CURES-53]
[PMID: 17879493]
[44]
Khosravi A, Pourheidar B, Roohafza H, et al. Evaluating factors associated with uncontrolled hypertension: Isfahan cohort study, Iran. ARYA Atheroscler 2014; 10(6): 311-8.
[PMID: 25815021]
[45]
Rafiei M, Boshtam M, Sarraf-Zadegan N, Seirafian S. The relation between salt intake and blood pressure among Iranians. Kuwait Med J 2008; 40(3): 191-5.
[46]
Zibaeinezhad MJ, Houshangi M, Abtahi F, Heydari ST. A study of salt (sodium chloride) content in different bread consumed in Shiraz City in Spring/Summer 2009. Iranian Cardiovascular Research Journal 2010; 4(1): 17-21.
[47]
Dötsch M, Busch J, Batenburg M, et al. Strategies to reduce sodium consumption: a food industry perspective. Crit Rev Food Sci Nutr 2009; 49(10): 841-51.
[http://dx.doi.org/10.1080/10408390903044297] [PMID: 19960392]
[48]
He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009; 23(6): 363-84.
[http://dx.doi.org/10.1038/jhh.2008.144] [PMID: 19110538]
[49]
He FJ, MacGregor GA. Reducing population salt intake worldwide: from evidence to implementation. Prog Cardiovasc Dis 2010; 52(5): 363-82.
[http://dx.doi.org/10.1016/j.pcad.2009.12.006] [PMID: 20226955]
[50]
Toldrá F, Barat JM. Strategies for salt reduction in foods. Recent Pat Food Nutr Agric 2012; 4(1): 19-25.
[http://dx.doi.org/10.2174/1876142911204010019] [PMID: 22316270]
[51]
Durack E, Alonso-Gomez M, Wilkinson MG. Salt: a review of its role in food science and public health. Curr Nutr Food Sci 2008; 4(4): 290-7.
[http://dx.doi.org/10.2174/157340108786263702]
[52]
Pietinen P, Valsta LM, Hirvonen T, Sinkko H. Labelling the salt content in foods: a useful tool in reducing sodium intake in Finland. Public Health Nutr 2008; 11(4): 335-40.
[http://dx.doi.org/10.1017/S1368980007000249] [PMID: 17605838]
[53]
Braschi A, Gill L, Naismith DJ. Partial substitution of sodium with potassium in white bread: feasibility and bioavailability. Int J Food Sci Nutr 2009; 60(6): 507-21.
[http://dx.doi.org/10.1080/09637480701782118] [PMID: 18608540]
[54]
Bolhuis DP, Temme EH, Koeman FT, Noort MW, Kremer S, Janssen AM. 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(12): 2249-55.
[http://dx.doi.org/10.3945/jn.111.141366] [PMID: 22049293]
[55]
Kaur A, Bala R, Singh B, Rehal J. Effect of replacement of sodium chloride with mineral salts on rheological characteristics of wheat flour. Am J Food Technol 2011; 6(8): 674-84.
[http://dx.doi.org/10.3923/ajft.2011.674.684]
[56]
Bidlas E, Lambert RJ. Comparing the antimicrobial effectiveness of NaCl and KCl with a view to salt/sodium replacement. Int J Food Microbiol 2008; 124(1): 98-102.
[http://dx.doi.org/10.1016/j.ijfoodmicro.2008.02.031 PMID: 18423764]
[57]
Charlton KE, MacGregor E, Vorster NH, Levitt NS, Steyn K. Partial replacement of NaCl can be achieved with potassium, magnesium and calcium salts in brown bread. Int J Food Sci Nutr 2007; 58(7): 508-21.
[http://dx.doi.org/10.1080/09637480701331148] [PMID: 17852502]
[58]
Takano H, Kondou R. Sodium gluconate and potassium gluconate as substitutes for sodium chloride in bread making. Food Sci Technol Res 2002; 8(1): 75-9.
[http://dx.doi.org/10.3136/fstr.8.75]
[59]
Salovaara H. Sensory limitations to replacement of sodium with potassium and magnesium in bread. Cereal Chem 1982; 59: 427-30.
[60]
Hess SY, Zimmermann MB, Torresani T, Bürgi H, Hurrell RF. Monitoring the adequacy of salt iodization in Switzerland: a national study of school children and pregnant women. Eur J Clin Nutr 2001; 55(3): 162-6.
[http://dx.doi.org/10.1038/sj.ejcn.1601140] [PMID: 11305264]
[61]
Noort MW, Bult JH, Stieger M. Saltiness enhancement by taste contrast in bread prepared with encapsulated salt. J Cereal Sci 2012; 55(2): 218-25.
[http://dx.doi.org/10.1016/j.jcs.2011.11.012]
[62]
Miller RA, Jeong J. Sodium reduction in bread using low-sodium sea salt. Cereal Chem 2014; 91(1): 41-4.
[http://dx.doi.org/10.1094/CCHEM-05-13-0089-R]
[63]
Rafieifar S, Pouraram H, Djazayery A, et al. Strategies and opportunities ahead to reduce salt intake. Arch Iran Med 2016; 19(10): 729-34.
[PMID: 27743439]
[64]
Antúnez L, Giménez A, Ares G. A consumer-based approach to salt reduction: Case study with bread. Food Res Int 2016; 90(90): 66-72.
[http://dx.doi.org/10.1016/j.foodres.2016.10.015] [PMID: 29195892]
[65]
Colin-Ramirez E, Espinosa-Cuevas Á, Miranda-Alatriste PV, Tovar-Villegas VI, Arcand J, Correa-Rotter R. Food sources of sodium intake in an adult Mexican population: A sub-analysis of the SALMEX study. Nutrients 2017; 9(8): 810.
[http://dx.doi.org/10.3390/nu9080810] [PMID: 28749449]
[66]
Saavedra-Garcia L, Sosa-Zevallos V, Diez-Canseco F, Miranda JJ, Bernabe-Ortiz A. Reducing salt in bread: a quasi-experimental feasibility study in a bakery in Lima, Peru. Public Health Nutr 2016; 19(6): 976-82.
[http://dx.doi.org/10.1017/S1368980015001597] [PMID: 25990705]
[67]
Bertram MY, Steyn K, Wentzel-Viljoen E, Tollman S, Hofman KJ. Reducing the sodium content of high-salt foods: effect on cardiovascular disease in South Africa. S Afr Med J 2012; 102(9): 743-5.
[http://dx.doi.org/10.7196/SAMJ.5832] [PMID: 22958695]
[68]
Mohammadifard N, Fahimi S, Khosravi A, et al. Advocacy strategies and action plans for reducing salt intake in Iran. Arch Iran Med 2012; 15(5): 320-4.
[PMID: 22519384]

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