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Objective: Salt reduction is a public health priority because it is a leading contributor to the global burden of disease. As in Australia there is uncertainty about the current level of salt intake, we sought to estimate current levels.Study Design: Random effects meta-analysis of data from 31 published studies and one unpublished dataset that reported salt or sodium consumption by Australian adults on the basis of 24-hour urine collections or dietary questionnaires.Data Sources: MEDLINE (via Ovid) and EMBASE (to August 2016).Data Synthesis: Thirty-one published studies and one unpublished dataset (1989-2015; 16 836 individuals) were identified. The mean weighted salt consumption estimated from 24-hour urine collections was 8.70 g/day (95% CI, 8.39-9.02 g/day); after adjusting for non-urinary salt excretion, the best estimate of salt intake in Australia is 9.6 g/day. The mean weighted intake was 10.1 g/day (95% CI, 9.68-10.5 g/day) for men and 7.34 g/day (95% CI, 6.98-7.70 g/day) for women. Mean weighted consumption was 6.49 g/day (95% CI, 5.94-7.03 g/day) when measured with diet diaries, 6.76 g/day (95% CI, 5.48-8.05 g/day) when assessed with food frequency questionnaires, and 6.73 g/day (95% CI, 6.34-7.11) when assessed by dietary recall. Salt intake had not decreased between 1989 and 2015 (R2 = -0.02; P = 0.36).Conclusion: Salt intake in Australian adults exceeds the WHO-recommended maximum of 5 g/day and does not appear to be declining. Measuring salt intake with methods based on self-reporting can substantially underestimate consumption. The data highlight the need for ongoing action to reduce salt consumption in Australia and robust monitoring of population salt intake. [ABSTRACT FROM AUTHOR]

Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes.Research Design and Methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial.Setting and Participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months.Intervention: Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools.Main Outcome Measures: Adherence to CVD risk screening and prescribing guidelines.Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28).Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence-practice gaps.Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910. [ABSTRACT FROM AUTHOR]

Objective: To compare two front-of-pack nutrition labelling systems for the assessment of packaged foods and drinks with Australian Dietary Guidelines. Design: A cross-sectional nutrient profiling assessment. Food and drink products (n 20 225) were categorised into scoring levels using criteria for the Institute of Medicine (IOM) three-star system and the five-star Australian Health Star Rating (HSR). The effectiveness of these systems to categorise foods in accordance with Australian Dietary Guidelines was explored. Setting: The study was conducted in Australia, using a comprehensive food database. Subjects: Packaged food and drink products (n 20 225) available in Australia. Results: Using the IOM three-star system, the majority (55%) of products scored the minimum 0 points and 25·5% scored the maximum 3 points. Using HSR criteria, the greatest proportion of products (15·2%) scored three-and-a-half stars from a possible five and 12·5% received the lowest rating of a half-star. Very few products (4·1%) scored five stars. Products considered core foods and drinks in Australian Dietary Guidelines received higher scores than discretionary foods in all food categories for both labelling systems (all P<0·05; Mann-Whitney U test), with the exception of fish products using IOM three-star criteria (P=0·603). The largest discrepancies in median score between the two systems were for the food categories edible oils, convenience foods and dairy. Conclusions: Both the IOM three-star and Australian HSR front-of-pack labelling systems rated packaged foods and drinks broadly in line with Australian Dietary Guidelines by assigning core foods higher ratings and discretionary foods lower ratings. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the impact of the Food and Health Dialogue on the reduction of premature death and disability due to poor diet in Australia. A brief overview of the Dialogue is provided which was established by the Australian government in 2009 to raise the nutritional profile of foods. According to the authors, the mechanism for delivering the goals of the Dialogue has been inadequate.

The article presents a study which defined the effectiveness of the efforts by the Australian Division of World Action on Salt and Health, and the Heart Foundation in New Zealand to reduce sodium levels in breads in Australia and New Zealand between 2007 and 2010. Data on the sodium contents of packaged sliced bread products sold in the countries' supermarkets were obtained from the product labels. Results show that the efforts by the organizations have an impact on sodium levels in bread.

The author examines the challenges of implementing a population-wide salt-reduction program. He highlights several studies about the adverse impact of salt on human health, and explains why salt reduction presents a great public health opportunity. He discusses the average salt consumption in Australia, and details the results of a study that explored the short- and long-term implications of salt intake for blood pressure.

• Excess dietary sodium is a modifiable cause for high blood pressure. • International Food and Beverage Alliance (IFBA) members committed to lower sodium. • There was no difference in sodium reduction between IFBA and non-IFBA companies. • Sodium reduced in juice, processed meat/seafood, ready meals and savoury snacks. • Effective strategies are required to achieve widespread reduction in sodium. Excess dietary sodium is a modifiable cause of high blood pressure. The World Health Organization has targeted a 30 % reduction in mean population sodium consumption by 2025. In 2008, members of the International Food and Beverage Alliance (IFBA) made commitments to lower sodium content in their products. The aim of this study was to determine recent changes in sodium levels between 2013 and 2017 in foods and beverages produced by companies that are IFBA members (n = 10) and non-IFBA members (n = 6) that were included in the 2018 Global Access to Nutrition Index operating in Australia. Independent Samples t -tests and Mann Whitney U tests were used to test the differences in sodium levels. There was no clear difference in sodium content between 2013 and 2017 detectable for the IFBA members (mean difference 17 mg/100 g, 95 % confidence interval (CI), –82 to +48; p = 0.612; median difference 27 mg/100 g, p = 0.582). For the non-IFBA companies there was a decrease in median sodium content (−30 mg/100 g; P = 0.002) but not mean sodium content (−52 mg/100 g, 95 % CI −106 to +3; p = 0.064). Sodium reduction in IFBA companies appear to have had slow progress in Australia. Stronger implementation and monitoring programs are needed to drive industry action. [ABSTRACT FROM AUTHOR]

Objective: To measure the costs of a polypill strategy and compare them with those of usual care in people with established cardiovascular disease (CVD) or at similarly high cardiovascular risk., Design: A within-trial cost analysis of polypill-based care versus usual care with separate medications, using data from the Kanyini Guidelines Adherence with the Polypill (GAP) trial and linked health service and medication administrative claims data., Participants: Kanyini GAP participants who consented to Australian Medicare record access., Main Outcome Measures: Mean health service and pharmaceutical expenditure per patient per year, estimated with generalised linear models. Costs during the trial (randomisation January 2010 - May 2012, median follow-up 19 months, maximum follow-up 36 months) were inflated to 2012 costs., Results: Our analysis showed a statistically significantly lower mean pharmaceutical expenditure of $989 (95% CI, $648-$1331) per patient per year in the polypill arm compared with usual care (P < 0.001; adjusted, excluding polypill cost). No significant difference was shown in health service expenditure., Conclusions: This study provides evidence of significant cost savings to the taxpayer and Australian Government through the introduction of a CVD polypill strategy. The savings will be less now than during the trial due to subsequent reductions in the costs of usual care. Nonetheless, given the prevalence of CVD in Australia, the introduction of this polypill could increase considerably the efficiency of health care expenditure in Australia., Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN126080005833347.

Unlabelled: OBJECTIVE To define the changes in sodium levels of Australian fast foods between 2009 and 2012 overall, in major food subcategories and by company., Design: A comparison of mean sodium content was made across 4 years using t tests and mixed models., Setting: Nutrient content data for fast-food menu items collected from company websites of six large Australian fast-food chains., Main Outcome Measures: Mean sodium values in mg/100 g and mg/serve., Results: There were between 302 and 381 products identified each year. Overall, the mean sodium content of fast-food products decreased between 2009 and 2012 by 43 mg/100 g (95% CI, - 66 to - 20 mg/100 g), from 514 mg/100 g in 2009 to 471 mg/100 g in 2012. Mean sodium content per serving was not significantly different at 654 mg in 2009 and 605 mg in 2012 (- 49 mg; 95% CI, - 108 to + 10 mg), reflecting wide variation in the serving sizes of items offered each year. There was a small decline in sodium content over the 4 years across most food categories and food companies., Conclusions: The observed reduction in the sodium content of fast foods during the 4-year study period is encouraging. However, the reductions are small, and fast-food companies should be encouraged to make further and larger reductions since many products still contain high levels of sodium.

Background: Processed foods are major contributors to population dietary salt intake. Parts of the Australian food industry have started to decrease salt in a number of products. A definitive baseline assessment of current sodium concentrations in foods is key to targeting reformulation strategies and monitoring progress., Objectives: Our objectives were to systematically collate data on the sodium content of Australian processed food products and compare sodium values against maximum target levels established by the UK Food Standards Agency (UK FSA)., Design: Categories of processed foods that contribute the majority of salt to Australian diets were identified. Food-composition data were sought for all products in these categories, and the sodium content in mg/100 g (or mg/100 mL for liquids) was recorded for each. Mean sodium values were calculated for each grouping and compared with the UK FSA benchmarks., Results: Sodium data were collected for 7221 products in 10 food groups, 33 food categories, and 90 food subcategories. The food groups that were highest in sodium were sauces and spreads (1283 mg/100 g) and processed meats (846 mg/100 g). Cereal and cereal products (206 mg/100 g) and fruit and vegetables (211 mg/100 g) were the lowest in sodium. Sixty-three percent of food categories had mean sodium concentrations above the UK FSA targets, and most had wide ranges between the most and least salty product., Conclusions: Many products, particularly breads, processed meats, and sauces, have salt amounts above reasonable benchmarks. The variation in salt concentrations between comparable products suggests that reformulation is highly feasible for many foods.

Asian Indians appear particularly susceptible to coronary heart disease compared with other ethnic groups. We compared the effects of vascular risk factors on carotid intima-media thickness (IMT) in a population of South Asians from Andhra Pradesh, India with a population of Caucasians from Perth, Australia. Cardiovascular risk factors and ultrasound-assessed carotid IMT were measured in randomly selected adults from two villages in rural India (n=303) and compared to those for randomly sampled adults from Australia (n=1111). Regression models with interaction terms were used to compare the strengths of associations between risk factors and carotid IMT, in these two populations. There were stronger associations of cholesterol (p for interaction=0.009) and diabetes (p=0.04) with carotid IMT in the Indian compared to the Australian population. Also, while increasing HDL-cholesterol was associated with decreasing carotid IMT in the Australian population the reverse was true for the Indian population (p<0.001). The associations with IMT of blood pressure, triglycerides, age, HDL to total cholesterol ratio, glucose, BMI, waist, waist to hip ratio and smoking were not different between the populations. Greater adverse effects of total cholesterol and diabetes on atherosclerosis and no protective effect of HDL-cholesterol amongst Asian Indians provide a novel possible explanation for observed excess rates of cardiovascular disease amongst these populations.