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Cardiovascular diseases (CVD) represent the leading cause of death in Costa Rica and high blood pressure was associated with a mortality rate of 29% in 2018. The average household sodium intake in the country is also two times higher than the World Health Organization recommendation. The objective of this study was to estimate the impact of reducing salt intake on CVD mortality in Costa Rica using a scenario simulation model. The Preventable Risk Integrated ModEl (PRIME) was used to estimate the number of deaths that would be averted or delayed in the Costa Rican population by following the national and the international guidelines to reduce salt consumption, according to two scenarios: A) 46% reduction and B) 15% reduction, both at an energy intake of 2171 kcal. The scenarios estimated that between 4% and 13%, respectively, of deaths due to CVD would be prevented or postponed. The highest percentages of deaths prevented or postponed by type of CVD would be related to Coronary heart disease (39% and 38%, respectively), Hypertensive disease (32% and 33%, respectively), and Stroke (22% in both). The results demonstrate that reducing salt consumption could prevent or postpone an important number of deaths in Costa Rica. More support for existing policies and programs urges.

The objectives of this study were to estimate sodium intake and to identify the main dietary sources of this nutrient in young people. Cross-sectional study performed in 2685 students from 64 schools and high-schools of Costa Rica. A food frequency survey was applied to study the food and beverage intake habits of the participants. The average daily sodium intake for children and adolescents 7 to 18 years of age was 3214 mg. Around 97% of the students had sodium intakes > 2300 mg per day with significant differences by age subgroup, sex and nutritional status due to excess body weight (p < 0.001). The average sodium density of the diet was 1698 mg sodium/1000kcal, and the average addition of salt to the food was 445 mg of sodium (1.1 grams of salt). Including the amount added to the served food, the average sodium intake for children and adolescents from 7 to 18 years of age increased to 3434 mg and the overall average sodium density increased to 1821 mg of sodium/ 1000kcal, maintaining significant differences by age subgroups (p < 0.001). These results justify carrying out social marketing campaigns that include educational processes with sense and meaning for children, adolescents and families, in such a way that these groups of the population become motivated to modify gradually their eating habits, such as reducing the use of sauces, seasonings and salt in food preparation and at the table. If the habit of adding salt to the served food is gradually reduced or avoided, the children and adolescents in Costa Rica could decrease the intake of salt per day from 1 to 2 grams. This decrease could be even more effective if youngsters additionally would remove the intake of sauces, contributing in this way to achieve the maximum salt intake recommendation (5 g per day). UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Centro de Investigación en Hematología y Trastornos Afines (CIHATA)

The industry uses nutrition and health claims, premium offers, and promotional characters as marketing strategies (MS). The inclusion of these MS on ultra-processed products may influence child and adolescent purchase behavior. This study determined the proportion of foods carrying claims and marketing strategies, also the proportion of products with critical nutrients declaration, and nutritional profile differences between products that carry or not claims and MS on the front-of-package (FoP) of ultra-processed food products sold in Costa Rica. Data were obtained from 2423 photographs of seven food groups consumed as snacks that were sold in one of the most widespread and popular hypermarket chains in Costa Rica in 2015. Ten percent of products lacked a nutrition facts panel. Sodium was the least reported critical nutrient. Energy and critical nutrients were significantly highest in products that did not include any nutrition or health claim and in products that included at least one MS. Forty-four percent and 10% of all products displayed at least one nutrition or at least one health claim, respectively, and 23% displayed at least one MS. In conclusion, regulations are needed to restrict claims and marketing on ultra-processed food packages to generate healthier food environments and contribute to the prevention of childhood and adolescent obesity in Costa Rica.

Dietary risks in aggregate are the leading risk for death globally. Among dietary risks, high dietary sodium (salt) is the leading risk.1 Globally, excess dietary sodium is estimated to have caused over 3 million deaths and over 70 million disability‐adjusted life‐years (DALYS) in 2017.1, 2 High dietary sodium is predominantly a risk as a result of increasing blood pressure (the leading single risk for death globally) but is also a probable pro‐carcinogen for gastric cancer, directly causes cardiovascular and renal damage independent of blood pressure, and is associated with several other diseases.1, 3-11 The recent National Academy of Medicine review of the evidence for dietary sodium consumption in United States and Canada concluded that excess dietary sodium increases blood pressure, that elevated blood pressure causes cardiovascular disease (CVD) and that there is moderately strong evidence that high dietary sodium directly increases total mortality and cardiovascular events.12 In addition, the World Health Organization (WHO) reported that increased dietary sodium increases blood pressure and is associated with CVD.13 Multiple other diseases have associations and biologically sound pathophysiological mechanisms for sodium causing harm, but clinical evidence is not substantive enough to prove causality.3 In addition, acute ingestion of sodium chloride (salt) in the range of 17 g or more in an adult, and 12.5 g or more in an infant can cause seizures, coma, and death. Although ingestions of large quantities of sodium are very distasteful and believed to be infrequent, both accidental and intentional deaths do occur.12, 14

High blood pressure is a leading cause of death in Costa Rica, with an estimated mortality rate of 30%. The average household sodium intake is two times higher than the World Health Organization recommendation. The consumption of processed foods is an important and growing contributor to sodium intake. The objective of this study was to describe the sodium content of packaged foods (mg/100 g) sold in Costa Rica in 2015 (n = 1158) and 2018 (n = 1016) and to assess their compliance with the national sodium reduction targets. All 6 categories with national targets were analyzed: condiments, cookies and biscuits, bread products, processed meats, bakery products, and sauces. A significant reduction in mean sodium content was found in only 3 of the 19 subcategories (cakes, tomato-based sauces, and tomato paste). No subcategories had statistically significant increases in mean sodium levels, but seasonings for sides/mains, ham, and sausage categories were at least 15% higher in sodium. Compliance with the national sodium targets among all foods increased from 80% in 2015 to 87% in 2018. The results demonstrate that it is feasible to reduce the sodium content in packaged foods in Costa Rica, but more work is needed to continually support a gradual reduction of sodium in packaged foods, including more stringent sodium targets.

IntroductionCardiovascular diseases (CVDs) represent the main cause of death among non-communicable diseases (NCDs) in Brazil, and they have a high economic impact on health systems. Most populations around the world, including Brazilians, consume excessive sodium, which increases blood pressure and the risk of CVDs.ObjectiveTo model the estimated deaths and costs associated with CVDs, which are mediated by increased blood pressure attributable to excessive sodium consumption in adults from the perspective of the Brazilian public health system in 2017.MethodsWe employed two macrosimulation methods, using top-down approaches and based on the same relative risks. The models estimated the mortality and costs-of-illness attributable to excessive sodium intake and mediated by hypertension for adults aged over 30 years in 2017. Direct healthcare cost data (inpatient care, outpatient care and medications) were extracted from the Ministry of Health information systems and official records.ResultsIn 2017, an estimated 46,651 deaths from CVDs could have been prevented if the average sodium consumption had been reduced to 2 g/day in Brazil. Premature deaths related to excessive sodium consumption caused 575,172 Years of Life Lost and US$ 752.7 million in productivity losses to the economy. In the same year, the National Health System's costs of hospitalizations, outpatient care and medication for hypertension attributable to excessive sodium consumption totaled US$192.1 million. The main causes of death and costs associated with CVDs were coronary heart disease and stroke, followed by hypertensive disease, heart failure and aortic aneurysm.ConclusionExcessive sodium consumption is estimated to account for 15% of deaths by CVDs and to 14% of the inpatient and outpatient costs associated with CVD. It also has high societal costs in terms of premature deaths. CVDs are a leading cause of disease and economic burden on the global, regional and country levels. As a largely preventable and treatable conditions, CVDs require the strengthening of cost-effective policies, supported by evidence, including modeling studies, to reduce the costs relating to illness borne by the Brazilian public health system and society.

Population-wide sodium reduction is a cost-effective approach to address the adverse health effects associated with excess sodium consumption. Latin American and Caribbean (LAC) countries consume excess dietary sodium. Packaged foods are a major contributor to sodium intake and a target for sodium reduction interventions. This study examined sodium levels in 12 categories of packaged foods sold in 14 LAC (n = 16,357). Mean sodium levels and percentiles were examined. Sodium levels were compared to regional sodium reduction targets. In this baseline analysis, 82% of foods met the regional target and 47% met the lower target. The greatest proportion of products meeting the regional target were uncooked pasta and noodles (98%), flavored cookies/crackers (97%), seasonings for sides/main dishes (96%), mayonnaise (94%), and cured/preserved meats (91%). A large proportion of foods met the lower target among uncooked pasta and noodles (88%), cooked pasta and noodles (88%), and meat/fish seasonings (88%). The highest the highest median sodium levels were among condiments (7778 mg/100 g), processed meats (870 mg/100 g), mayonnaise (755 mg/100 g), bread products (458 mg/100 g), cheese (643 mg/100 g), and snack foods (625 mg/100 g). These baseline data suggest that sodium reduction targets may need to be more stringent to enable effective lowering of sodium intake.

In 2012, Costa Rica launched a program to reduce salt and sodium consumption to prevent cardiovascular disease and associated risk factors, but little was known about the level of sodium consumption or its sources. Our aim was to estimate the magnitude and time trends of sodium consumption (based on food and beverage acquisitions) in Costa Rica. Data from the National Household Income and Expenditure Surveys carried out in 2004–2005 (n = 4231) and 2012–2013 (n = 5705) were used. Records of food purchases for household consumption were converted into sodium and energy using food composition tables. Mean sodium availability (per person/per day and adjusted for a 2000-kcal energy intake) and the contribution of food groups to this availability were estimated for each year. Sodium availability increased in the period from 3.9 to 4.6 g/person/day (p < 0.001). The income level was inversely related to sodium availability. The main sources of sodium in the diet were domestic salt (60%) in addition to processed foods and condiments (with added sodium) (27.4%). Dietary sources of sodium varied within surveys (p < 0.05). Sodium available for consumption in Costa Rican households largely exceeds the World Health Organization-recommended intake levels (

This article describes the progress-as well as the challenges and limitations-in reducing salt intake in Costa Rica. The National Plan to Reduce Public Consumption of Salt/Sodium in Costa Rica 2011 - 2021 was complemented with multisectoral programs and projects specifically designed to: 1) determine sodium intake and the salt/sodium content of the most widely consumed foods; identify the consumer knowledge, attitudes, and behaviors with regard to salt/sodium, their relationship to health, and nutritional labeling; evaluate the cost-effectiveness of measures aimed at reducing the incidence of hypertension; 2) implement strategies to reduce the salt/sodium content of processed foods and foods prepared at home; 3) promote behavioral changes in the population to reduce salt in people's diets; and 4) monitor and evaluate action geared to reducing salt/sodium intake in the population. Meeting the proposed targets will require successful interinstitutional coordination among the strategic actors, the negotiation of commitments with the food industry and food services, and tighter regulation of critical nutrients in foods associated with chronic noncommunicable diseases. Given the progress made during the implementation of the National Plan, Costa Rica is expected to meet the international goal of reducing salt intake.

Background Smoke-free legislation eliminating tobacco smoke in all indoor public places and workplaces is the international standard to protect all people from exposure to secondhand smoke. Uruguay was the first country in the Americas and the first middle-income country in the world to enact a comprehensive smokefree national legislation in March 2006. Objective To compare air nicotine concentrations measured in indoor public places and workplaces in Montevideo, Uruguay before (November 2002) and after (July 2007) the implementation of the national legislation. Methods Air nicotine concentrations were measured for 7e14 days using the same protocol in schools, a hospital, a local government building, an airport and restaurants and bars. A total of 100 and 103 nicotine samples were available in 2002 and 2007, respectively. Results Median (IQR) air nicotine concentrations in the study samples were 0.75 (0.2e1.54) mg/m 3 in 2002 compared to 0.07 (0.0e0.20) mg/m 3 in 2007. The overall nicotine reduction comparing locations sampled in 2007 to those sampled in 2002 was 91% (95% CI 85% to 94%) after adjustment for differences in room volume and ventilation. The greatest nicotine reduction was observed in schools (97% reduction), followed by the airport (94% reduction), the hospital (89% reduction), the local government building (86% reduction) and restaurants/bars (81% reduction). Conclusion Exposure to secondhand smoke has decreased greatly in indoor public places and workplaces in Montevideo, Uruguay, after the implementation of a comprehensive national smoke-free legislation. These findings suggest that it is possible to successfully implement smoke-free legislations in low and middleincome countries.

The Costa Rican Food Composition Information System (SICA-COR) has been developed to address the increased demands for local food information by health workers, decision makers, food industry, international commerce, and consumers. It has a software application that allows updating and managing of information in a more versatile, cost-effective and accessible way than conventional food composition database systems. The purpose of this work is to present the development and current state of SICA-COR. The system was developed using four main steps, identification of available food composition data, sources and needs; data capture and quality evaluation; development of the SICA-COR software; and establishment of the database. SICA-COR has a validated, LATINFOODS-compatible information capture form which includes detailed descriptions of the data sources, food names, and quality parameters and allows for inclusion of data for more than 80 nutritional components per 100 g edible food. The software was developed using a Microsoft ® SQL Server database engine and Java™. Of 1200 completed compilation forms, 83% fulfilled LATINFOODS standards and were incorporated into the database. Most of the data consists of values for energy, water, carbohydrate, fat, protein and ash. Pre-designed reports are available for specific and general end users such as members of the LATINFOODS Regional Center. The current SICA-COR Version (0.9) is a stand-alone application intended to eventually evolve to a web application. Specific actions to test and improve the software are underway.

This article describes efforts from the Pan American Health Organization (PAHO) that have supported progress in country-driven planning and implementing of actions to address noncommunicable diseases (NCD), as well as mechanisms that PAHO has supported for countries in the Americas to share and build on each other’s experiences. The Regional Strategy and Plan of Action for NCD, approved by all member states in 2006, is the major frame for this work. The strategy has 4 lines of action: policy and advocacy; surveillance; health promotion and disease prevention; and integrated management of NCD and risk factors. Cross-cutting strategies include resource mobilization, communication, training, and networks and partnerships. The strategy is operationalized through biannual work plans for which countries link and commit to achieving specific objectives. PAHO then provides technical support toward achieving these plans, and countries report progress annually. The CARMEN (Collaborative Action for Risk Factor Prevention and Effective Management of NCD [Conjunto de Acciones para la Reducción y el Manejo de las Enfermedades No transmisibles]) Network provides a major platform for sharing, and the multisector Pan American Forum for Action on NCD has been launched to extend the network to include business and civil society. PAHO also supported civil society capacity building. Almost all member states have made substantial progress in implementing their national chronic disease programs, in most instances reporting exceeding the indicators of the strategic plan related to chronic diseases. From the Caribbean countries, leadership has been provided to achieve the historic UN High-Level Meeting on NCD in September 2011. The region is on track to meet the mortality reduction target set for 2013, though much remains to be done to further increase awareness of and resources for scaling up NCD prevention and control programs, given the huge health and economic burden, increasing costs, and worrying increases of some conditions such as obesity. Major challenges include getting NCD into social protection packages, building the human resource capacity, strengthening surveillance, achieving true intersectoral and multipartner action, given that most determinants of the epidemic lie outside the health sector, and increasing investment in prevention.

Com o objetivo de conhecer o comportamento dos monócitos e mastócitos em peritônio livre na vigência de doença inflamatória do cólon, células que sabe-se participam ativamente do processo inflamatório, colite ulcerativa é induzida em ratos com ácido acético à 10%. Utilizaram-se 20 animais Wistar, 10 para controle e 10 para indução de colite. Os macrófagos são marcados com azul de Tripan e células são capturadas do peritônio livre após 5 dias de evolução. Observou-se que o número de monócitos/macrófagos era 3 vezes maior no líquido peritoneal obtido dos animais com doença inflamatória do que nos seus controles e o número dos mastócitos 2 vezes maior (p

Natural food antimicrobials are bioactive compounds that inhibit the growth of microorganisms involved in food spoilage or food-borne illness. However, stability issues result in degradation and loss of antimicrobial activity. Nanoencapsulation allows protection of antimicrobial food agents from unfavorable environmental conditions and incompatibilities. Encapsulation of food antimicrobials control delivery increasing the concentration of the antimicrobials in specific areas and the improvement of passive cellular absorption mechanisms resulted in higher antimicrobial activity. This paper reviews the present state of the art of the nanostructures used as food antimicrobial carriers including nanoemulsions, nanoliposomes, nanoparticles, and nanofibers.

Excess energy, saturated fat, sugar and salt from processed and fast foods are a major cause of chronic disease worldwide. In 2010 The Food Monitoring Group established a global branded food composition database to track the nutritional content of foods and make comparisons between countries, food companies and over time. A protocol for the project was agreed and published in 2011 with 24 collaborating countries. Standardised tools and a website have been developed to facilitate data collection and entry. In 2010 data were obtained from nine countries, in 2011 from 12 and in 2012 data are anticipated from 10 additional countries. This collaborative approach to the collation of food composition data offers potential for cross-border collaboration and support in developed and developing countries. The project should contribute significantly to tracking progress of the food industry and governments towards commitments made at the recent UN high level meeting on chronic disease.

Chronic diseases are the leading cause of premature death and disability in the world with overnutrition a primary cause of diet-related ill health. Excess energy intake, saturated fat, sugar, and salt derived from processed foods are a major cause of disease burden. Our objective is to compare the nutritional composition of processed foods between countries, between food companies, and over time.Surveys of processed foods will be done in each participating country using a standardized methodology. Information on the nutrient composition for each product will be sought either through direct chemical analysis, from the product label, or from the manufacturer. Foods will be categorized into 14 groups and 45 categories for the primary analyses which will compare mean levels of nutrients at baseline and over time. Initial commitments to collaboration have been obtained from 21 countries.This collaborative approach to the collation and sharing of data will enable objective and transparent tracking of processed food composition around the world. The information collected will support government and food industry efforts to improve the nutrient composition of processed foods around the world.