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Background: Globally, cardiovascular diseases are the leading cause of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure is among the most effective and economical health promotion strategies. While school-based and mHealth-based salt reduction interventions have been proven effective in trial setting, their impact when scaled up in real-world contexts remains uncertain., Objective: This study aims to evaluate the effectiveness of the real-world implementation of an mHealth and school-based health education scale-up programme to reduce salt (EduSaltS)., Methods: A parallel, cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in two districts and two counties within Ganzhou City, Jiangxi Province, China. Schools were randomly assigned in a 1:1 ratio to either intervention or control group within each district or county. One third-grade class per school and twenty-six students from each class were selected using simple random sampling. Subsequently, one parent of each participating student was invited to join. If a parent was unavailable, an alternative family member aged 18-75 years and residing with the student was recruited. The EduSaltS intervention, which spanned over one academic year, incorporated both online health education courses and offline salt reduction activities, with participation being monitored through the backend management system. The effectiveness of the intervention was assessed by comparing changes in salt intake and blood pressure between the intervention and control groups from baseline to one-year follow-up, using data from surveys, physical examination, and 24-hour urine laboratory tests., Results: Of the 524 children (288 (54.96%) boys; mean age 9.16 (SD=0.35) years) and 524 adults (194 (37.02%) men; mean age 40.99 (SD=11.04) years) who participated and completed the baseline assessments in 10 intervention and 10 control schools, the loss to follow-up rate was 2.48% (13/524) for children and 8.97% (47/524) for adults. All schools and participants showed satisfactory adherence to the intervention. For schoolchildren, the measured difference in salt intake, SBP and DBP, between the intervention and the control schools, was -0.24g/day (95%CI:-0.77 to 0.65), -0.66mmHg (95%CI:-2.35 to 1.04), and -1.37mmHg (95%CI:-2.79 to 0.06) respectively. For adults, salt intake in the intervention group decreased from 9.0 (SE=0.2) g/day to 8.3 (SE=0.2) g/day after intervention. Compared with the control group, the adjusted change in the intervention group for salt intake, SBP, and DBP were -1.06g/day (95%CI:-1.81 to -0.30), -2.26mmHg (95%CI:-4.26 to -0.26), and -2.33mmHg (95%CI:-3.84 to -0.82), respectively., Conclusions: The EduSaltS comprehensive intervention programme, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and blood pressure control in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren., Clinicaltrial: Chinese Clinical Trial Registry ChiCTR2400079893, retrospectively registered on January 15, 2024 (embedded in an prospectively registered scale-up study, ChiCTR2000039767), https://www.chictr.org.cn/showproj.html?proj=199678.

Background: A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren's adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months., Methods: Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score., Results: The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was - 0.38 g/day at 24 months versus baseline (95% CI - 0.81 to 0.05, p = 0.09), following the - 0.83 g/day (95% CI - 1.25 to - 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was - 2.19 mm Hg (95% CI - 3.63 to - 0.76, p = 0.003) at 24 months versus baseline, following the - 1.80 mm Hg (95% CI - 3.19 to - 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children., Conclusions: The effect of the education program on adults' salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings., Trial Registration: ChiCTR1800017553. Registered on August 3, 2018., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Queen Mary (University of London) Ethics of Research Committee (QMERC2018/13) and the Peking University Institutional Review Board in China (IRB00001052-18051). Permissions were obtained from the local education authorities and school headteachers. All participants who took part in the outcome assessments gave written informed consent. For children, participant assent and parental written consent were obtained. Consent for publication: Not applicable. Competing interests: FJH is an unpaid member of Action on Salt and World Action on Salt, Sugar and Health (WASSH); no other relationships or activities that could appear to have influenced the submitted work. All other authors declare no competing interests., (© 2025. The Author(s).)

Cardiovascular diseases (CVD) continue to be the leading cause of deaths and disability worldwide and the major contributor is hypertension. Despite all the improvements in detecting hypertension together with technological advances and affordable, efficacious and relatively free of adverse effects anti-hypertensive agents, we continue to struggle to prevent the onset of hypertension and to control blood pressure (BP) to acceptable targets. The poor control of hypertension is commonly due to non-adherence to medications. Another reason is the failure to adopt diet and lifestyle changes. Reduction of dietary salt intake is important for lowering BP but the role of potassium intake is also important. Globally the intake of sodium is double that of the recommended 2 gm per day (equivalent to 5 gm of sodium chloride/salt) and half that of the daily recommended intake of potassium of 3500 mg/day, giving a sodium-to-potassium ratio of >1, when ideally it should be <1. Many studies have shown that a higher potassium intake is associated with lower BPs, particularly when coupled concurrently with a lower sodium intake giving a lower sodium to potassium ratio. Most hypertension guidelines, while recommending reduction of salt intake to a set target, do not specifically recommend a target for potassium intake nor potassium supplementation. Here we review the role of potassium and salt substitution with potassium in the management of hypertension. Hence, the focus of dietary changes to lower BP and improve BP control should not be on reduction of salt intake alone but more importantly should include an increase in potassium intake., Competing Interests: Compliance with ethical standards. Conflict of interest: YCC has received Research grants from Pfizer and Omron, Speaker honorarium from Astra-Zeneca, Medtronic, MIMS, Omron, Xepa-Sol, Viatris, Duopharma and Unrestricted educational grants on behalf of HOPE-Asia Network from Viatris and on behalf of the Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH) from Medtronic. FJH is an unpaid member of Action on Salt and World Action on Salt, Sugar and Health (WASSH). All other authors report no potential conflicts of interest in relation to this article., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

Objectives: To test the hypothesis that the association of formula-estimated sodium intake from spot urine with cardiovascular disease is independent of spot urinary sodium concentration., Methods: We included 435 336 participants in the UK Biobank whose sodium intake was estimated from spot urine using INTERSALT, Kawasaki, and Tanaka formulas. Hazard ratios for cardiovascular disease (CVD) events and deaths were estimated using Cox proportional-hazard model adjusted for multiple covariates. Penalized Cox regression was used to assess nonlinear relations. Hazard ratios were recalculated after replacement of the sodium concentration term with sex-specific mean values (women: 67.5 mmol/l; men: 89.8 mmol/l) to assess how other components of the formulas influenced these associations., Results: Forty-four thousand two hundred and sixty-eight CVD events and 3251 CVD deaths occurred during a median follow-up of 12 years. The mean estimated sodium intake was 143 (SD = 35), 178 (52), and 147 (33) mmol/day based on INTERSALT, Kawasaki, and Tanaka formulas, respectively. For CVD incidence, linear inverse associations were observed for INTERSALT and Tanaka estimates [hazard ratios (95% CIs) for every 50 mmol increase in estimated sodium intake: 0.9 (0.83-0.97) and 0.93 (0.89- 0.97); P -linear = 0.0047 and 0.0021], and a U-shaped association for the Kawasaki estimates ( P -nonlinear = 0.0026). When the sodium concentration term was fixed, inverse associations were seen for all formulas [0.86 (0.77-0.95), 0.96 (0.93-0.99) and 0.94 (0.89-0.99) for INTERSALT, Kawasaki, and Tanaka; P linear = 0.0054, 0.0166 and 0.0188]. For CVD mortality, no association was observed, but a nonlinear association was identified for the INTERSALT equation ( P -nonlinear = 0.0287) after fixing the sodium concentration., Conclusion: These formula-estimated sodium intakes were associated with CVD incidence and mortality independently of spot urinary sodium concentration. We recommend these formulas not be used in studies associating sodium intake with CVD outcomes to avoid generating misleading evidence., (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Salt intake in China was high and a series of salt reduction measures were accordingly carried out recently. Our study aimed to assess the long-term effect of a scale-up community randomized controlled trial (RCT); Methods: Individuals between the ages of 18 and 75, from six provinces in China, were recruited and randomized into control ( n = 1347) and intervention ( n = 1346) groups. A one-year salt reduction intervention was first implemented in the intervention group, followed by a two-year scale-up intervention in both groups. The 24 h urine sample, anthropometric measurement, and knowledge, attitude, and practice (KAP) of salt reduction, as well as lifestyle information, were collected at baseline, after one-year RCT (mid-term evaluation, n = 2456), and two-year scale-up intervention (terminal evaluation, n = 2267); Results: Both control (351.82 mg/24 h, p < 0.001) and intervention (192.84 mg/24 h, p = 0.006) groups showed a decrease in 24 h urinary sodium excretion from baseline to terminal evaluation. Except for an increase in 24 h urinary potassium excretion (85.03 mg/24 h, p = 0.004) and a decrease in systolic blood pressure (SBP) (2.95 mm Hg, p < 0.001) in the intervention group at the mid-term assessment, no statistically significant differences in other indicators were found between two groups. The KAP of salt reduction in two groups was gradually improved; Conclusions: After one-year RCT and two-year scale-up, all participants showed a decreasing trend in 24 h urinary sodium excretion and an increase in salt reduction KAP. The community salt reduction intervention package has the potential for broader application across other regions in China.

Background: Both blood pressure-lowering medication and sodium reduction are effective in hypertension control, but whether the effect of sodium reduction differ across blood pressure-lowering medications is unclear. This study aims to evaluate the dose-response effect of sodium intake reduction on blood pressure in treated hypertensive individuals and the impact of different classes of blood pressure-lowering drugs., Methods: We searched multiple databases and reference lists up to July 9, 2024. Randomized controlled trials with a duration of ≥2 weeks comparing the effect of different levels of sodium intake (measured by 24-hour urinary sodium excretion) on blood pressure in hypertensive individuals treated with constant blood pressure-lowering medications were included. Instrumental variable meta-analyses based on random-effects models were conducted to evaluate the dose effect of sodium reduction on blood pressure. Subgroup analyses were performed based on the class of blood pressure-lowering drugs, age, baseline sodium and blood pressure levels, and study duration., Results: We included 35 studies (median duration of 28 days) with a total of 2885 participants. For every 100 mmol reduction in 24-hour urinary sodium excretion, systolic blood pressure decreased by 6.81 mm Hg (95% CI, 4.96-8.66), diastolic blood pressure decreased by 3.85 mm Hg (95% CI, 2.26-5.43), and mean arterial pressure decreased by 4.83 mm Hg (95% CI, 3.22-6.44). The dose-response effects varied across classes of blood pressure-lowering medications, with greater effects observed in the β-blockers, renin-angiotensin-aldosterone system inhibitors, and dual therapy groups. No significant subgroup differences were observed across subgroups defined by age, baseline 24-hour urinary sodium excretion, blood pressure levels, or study duration., Conclusions: Pooled evidence suggests a dose-response relationship between sodium reduction and blood pressure in treated individuals with hypertension, influenced by the class of blood pressure-lowering medications., Competing Interests: G.A. MacGregor is the unpaid Chair of Consensus Action on Salt, Sugar and Health (CASSH), World Action on Salt, Sugar and Health (WASSH) and Blood Pressure UK. F.J. He is an unpaid member of CASSH and WASSH. S. Pombo-Rodrigues is the campaign lead for CASSH. The other authors report no conflicts.

Objectives: Observational studies that assess the relationship between salt intake and long-term outcomes require a valid estimate of usual salt intake. The gold-standard measure in individuals is sodium excretion in multiple nonconsecutive 24-h urines. Multiple studies have demonstrated that random spot urine samples are not valid for estimating usual salt intake; however, some researchers believe that fasting morning spot urine samples produce a better measure of usual salt intake than random spot samples., Methods: We have used publicly available data from a PURE China validation study to compare estimates of usual salt intake from morning spot urine samples and three published formulae with mean of two 24-h urine samples (reference). We estimated the means and 95% confidence intervals of absolute and relative errors for each formula-led method and the degree to which estimates were able to be classified into the correct quartile of intake. Bland-Altman plots were used to test the level of agreement., Results: The results show that compared with the reference method, all formulae-led estimates from spot urine collections have high error rates: both random and systematic. This is demonstrated for individual estimates, as well as by quartiles of reference salt intake. This study conclusively demonstrates the unsuitability of morning spot urine formula-led estimates of usual salt intake., Conclusion: Our findings support international recommendations to not conduct, fund, or publish research studies that use spot urine samples with estimating equations to assess individuals' salt intake in association with health outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Previous studies have established a correlation between the pathogenesis of oxidative stress and sarcopenia. The Oxidative Balance Score (OBS) is an integrated measure that reflects the overall balance of antioxidants and pro-oxidants in dietary components and lifestyle. However, there are limited reports on the association between OBS and lean mass and the impact of protein intake on the association between OBS and lean mass., Methods: Using data from the National Health and Nutrition Examination Survey from 2011 to 2018, multivariate linear and logistic regression analyses were conducted to explore the associations between OBS and outcomes. The findings were then illustrated through fitted smoothing curves and threshold effect analyses., Results: This study included 2,441 participants, demonstrating that higher OBS is significantly associated with an increased ratio of appendicular lean mass to body mass index. Key inflection points at OBS 31 mark pronounced changes in these associations, with age and protein intake notably affecting the association. The effect of OBS on lean mass varies among populations with high and low protein intake., Conclusions: Our findings suggest that OBS is significantly and positively associated with lean mass. A high protein intake of more than 84.5 g/day may enhance the role of OBS in influencing muscle health to improve muscle outcomes., (© 2024. The Author(s).)

Background: The ratio between non-high-density lipoprotein cholesterol and high-density lipoprotein cholesterol (NHHR) is a reliable marker for assessing the risk linked to lipid metabolism disorders. Sarcopenia, characterized by age-related loss of muscle mass and strength/function, includes the assessment of muscle mass, muscle strength, and muscle-specific strength. However, research into NHHR's relationship with low muscle mass risk remains unexplored., Methods: Our study utilized a cross-sectional approach, examining data derived from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Through multivariable linear and logistic regression, we investigated the relationships of the NHHR with muscle mass and low muscle mass. We visualized the results using smoothing curves and assessed threshold effects. We also performed various subgroup and sensitivity analyses., Results: This research encompassed 9,012 participants and demonstrated significant nonlinear associations between NHHR and ALM BMI or low muscle mass risk in a generalized additive model (GAM), pinpointing critical NHHR values (3.328 and 3.367) where changes in NHHR significantly impacted ALM BMI and low muscle mass risk., Conclusions: The NHHR demonstrates a significant association with an increased risk of low muscle mass among middle-aged Americans. This ratio has potential as a predictive marker for low muscle mass. Further exploration of NHHR is expected to aid in advancing preventive and therapeutic measures for this condition., (© 2024. The Author(s).)

Background: An mHealth-based school health education platform (EduSaltS) was promoted in real-world China to reduce salt intake among children and their families. This progress evaluation explores its implementation process and influencing factors using mixed methods., Methods: The mixed-methods process evaluation employed the RE-AIM framework. Quantitative data were collected from a management website monitoring 54,435 third-grade students across two cities. Questionnaire surveys (n = 27,542) assessed pre- and post-education effectiveness. Mixed-effects models were used to control cluster effects. Qualitative interviews (23 individuals and 8 focus groups) identified program performance, facilitators, and barriers. Findings were triangulated using the RE-AIM framework., Results: The program achieved 100% participation among all the third-grade classes of the 208 invited primary schools, with a 97.7% registration rate among all the 54,435 families, indicating high "Reach." Qualitative interviews revealed positive engagement from children and parents through the "small hands leading big hands" strategy. The high completion rate of 84.9% for each health cloud lesson and the significant improvement in salt reduction knowledge and behaviors scores from 75.0 (95%CI: 74.7-75.3) to 80.9 (95%CI: 80.6-81.2) out of 100 demonstrated the "Effect" of EduSaltS. The program's "Adoption" and "Implementation" were supported by attractive materials, reduced workload via auto-delivered lessons/activities and performance evaluation, and high fidelity to recommended activities, with medians 3.0 (IQR: 2.0-8.0)/class and 9.0 (IQR: 5.0-14.0)/school. Stable course completion rates (79.4%-93.4%) over one year indicated promising "Maintenance." Apart from the facilitating features praised by the interviewees, government support was the basis for the scaling up of EduSaltS. Barriers included the lack of smartphone skills among some parents and competing priorities for schools. Unhealthy off-campus environments, such as excessive use of salt in pre-packaged and restaurant foods, also hindered salt reduction efforts. The program's scalability was evident through its integration into existing health education, engagement of local governments and adaptation across various mobile devices., Conclusions: The mHealth-based school health education program is scalable and effective for public salt reduction in China. Identified barriers and facilitators can inform future health program scale-ups. The program's successful implementation demonstrates its potential for broader application in public health initiatives aimed at reducing dietary salt intake., (© 2024. The Author(s).)

The resected pⅢA-N2 non-small-cell lung cancer (NSCLC) patients who could benefit from postoperative radiotherapy (PORT) are not well-defined. The study explored the role of PORT on EGFR mutant and wild-type NSCLC patients. We retrospectively searched for resected pIIIA-N2 lung adenocarcinoma patients who underwent EGFR mutation testing. 80 patients with EGFR wild-type and 85 patients with EGFR mutation were included. 62 patients received PORT. In overall population, the median disease-free survival (DFS) was improved in PORT arm compared to non-PORT arm (22.9 vs. 16.1 months; p  = 0.036), along with higher 2-year locoregional recurrence-free survival (LRFS) rate (88.3% vs. 69.3%; p  = 0.004). In EGFR wild-type patients, PORT was associated with a longer median DFS (23.3 vs. 17.2 months; p  = 0.044), and a higher 2-year LRFS rate (86.8% vs. 61.9%; p  = 0.012). In EGFR mutant patients, PORT was not significantly correlated with improved survival outcomes. EGFR wild-type may a biomarker to identify the cohort that benefits from PORT., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

Background: With the rising prevalence of severe obesity, bariatric surgery has emerged as a crucial treatment option. As the number of surgeries performed worldwide increases, there has been growing interest in the impact of bariatric surgery on cancer incidence. While several studies have examined this relationship, the topic remains controversial., Objectives: We conducted this systematic review of cohort studies with meta-analysis to evaluate the effect of bariatric surgery versus nonsurgical treatment on overall cancer incidence. However, the effects may vary when focusing on specific cancer types, surgical procedures, or gender, so we conducted additional subgroup analyses., Setting: A meta-analysis. University hospital., Methods: The Cochrane, Embase, PubMed, and Web of Science databases were searched for studies from 1 January 2000 to 1 December 2022. Meta-analysis was conducted to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, operation type, and sex., Results: All cohort studies were included in this meta-analysis from 18,216 studies. The overall cancer incidence demonstrated a significant decrease in the group with bariatric surgery (odds ratios [OR] = .56, P = .000, 95% CI .46 to .68). In subgroup analysis, similar decrease effect was found in 9 cancers. Furthermore, the incidence of cancer decreased significantly in male (OR = .66, P = .001, 95% CI .51 to .85) and female patients (OR = .63, P = .000, 95% CI .57 to .69) and patients undergoing gastric bypass (OR = .46, P = .000, 95% CI .33 to .63) or sleeve gastrectomy (OR = .44, P = .001, 95% CI .27 to .70)., Conclusions: In the overall analysis, bariatric surgery could reduce the incidence of cancer significantly. Further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence., (Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Cardiovascular diseases (CVDs) are the major cause of death among Malaysians. Reduction of salt intake in populations is one of the most cost-effective strategies in the prevention of CVDs. It is very feasible as it requires low cost for implementation and yet could produce a positive impact on health. Thus, salt reduction initiatives have been initiated since 2010, and two series of strategies have been launched. However, there are issues on its delivery and outreach to the target audience. Further, strategies targeting out of home sectors are yet to be emphasized. Our recent findings on the perceptions, barriers and enablers towards salt reduction among various stakeholders including policy-makers, food industries, food operators, consumers and schools showed that eating outside of the home contributed to high salt intake. Foods sold outside the home generally contain a high amount of salt. Thus, this supplementary document is being proposed to strengthen the Salt Reduction Strategy to Prevent and Control Non-communicable Diseases (NCDs) for Malaysia 2021-2025 by focussing on the strategy for the out-of-home sectors. In this supplementary document, the Monitoring, Awareness and Product (M-A-P) strategies being used by the Ministry of Health (MOH) are adopted with a defined outline of the plan of action and indicators to ensure that targets could be achieved. The strategies will involve inter-sectoral and multi-disciplinary approaches, including monitoring of salt intake and educating consumers, strengthening the current enforcement of legislation on salt/sodium labelling and promoting research on reformulation. Other strategies included in this supplementary document included reformulation through proposing maximum salt targets for 14 food categories. It is hoped that this supplementary document could strengthen the current the Salt Reduction Strategy to Prevent and Control NCDs for Malaysia 2021-2025 particularly, for the out-of-home sector, to achieve a reduction in mean salt intake of the population to 6.0 g per day by 2025., (© 2024. The Author(s).)

Background: Due to the complex histological type and anatomical structures, there has been considerable debate on the classification of adenocarcinoma of the esophagogastric junction (AEG), especially Siewert II AEG. Furthermore, neither the American Joint Committee on Cancer (AJCC) 7th tumor-node-metastasis (TNM) [esophageal adenocarcinoma (E) or gastric cancer (G)] nor the AJCC 8th TNM (E or G) accurately predicted the prognosis of patients with Siewert II AEG., Objective: This study aimed to investigate the factors influencing the survival and prognosis of patients with Siewert II AEG and establish a new and better prognostic predictive model., Design: A retrospective study., Methods: Patients with Siewert II AEG, retrieved from the Surveillance, Epidemiology, and End Results (SEER) databases, were assigned to the training set. Patients retrieved from a single tertiary medical center were assigned to the external validation set. Significant variables were selected using univariate and multivariate Cox regression analyses to construct the nomogram. Nomogram models were assessed using the concordance index (C-index), a calibration plot, decision curve analysis (DCA), and external validation., Results: Age, tumor grade, and size, as well as the T, N, and M stages, were included in the nomograms. For the SEER training set, the C-index of the nomogram was 0.683 (0.665-0.701). The C-index of the nomogram for the external validation set was 0.690 (0.653-0.727). The calibration curve showed good agreement between the nomogram estimations and actual observations in both the training and external validation sets. The DCA showed that the nomogram was clinically useful., Conclusion: The new predictive model showed significant accuracy in predicting the prognosis of Siewert II AEG., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2024.)

Background: Lowering dietary salt intake reduces albuminuria, an early marker of renal damage and a sensitive predictor of adverse cardiovascular outcomes. The mechanisms underlying this effect are uncertain but small changes in serum sodium concentration may be important: this retrospective cohort study investigated the hypothesis that higher serum sodium concentration is a risk factor for albuminuria (defined as a urine albumin:creatinine ratio [UACR], ≥3 mg/mmol)., Methods: Primary care data from the Royal College of General Practitioners Research and Surveillance Centre were used to identify 47,294 individuals with a UACR result available between April 2010 and March 2015, and no known albuminuria prior to this. Exclusion criteria were missing or abnormal serum sodium concentration at baseline (&lt;135 or &gt;146 mmol/L); age &lt;18 years; diabetes mellitus; decompensated liver disease; heart failure; and stage 5 chronic kidney disease., Results: After adjustment for known risk factors, there was a significant "U-shaped" relationship between serum sodium concentration and albuminuria. The lowest risk was associated with a serum sodium of 138-140 mmol/L. In comparison, the risk of albuminuria was 18% higher with a serum sodium of 135-137 mmol/L and 19% higher with a serum sodium of 144-146 mmol/L. There was no association between serum sodium concentration and blood pressure., Conclusion: The finding of a positive association between higher serum sodium concentration and albuminuria is in support of the hypothesis, but the inverse relationship between serum sodium concentration and albuminuria at lower concentrations warrants further explanation., (© 2024 S. Karger AG, Basel.)

Inhibitor of apoptosis proteins (IAPs) are crucial components of apoptosis that perform vital roles in the regulation of caspase activity in organisms. In this study, two IAPs genes were identified from Cotesia chilonis , the dominant parasitic wasp of Chilo suppressalis . Cc IAP1 gene is a typical IAP and contains two BIR domains and a RING domain, whereas Cc IAP gene is an atypical IAP1 only containing two BIR domains. Phylogenetic analysis indicated that Cc IAP1 and Cc IAP were grouped with other Hymenopteran IAPs and IAP1 in C. suppressalis. Real-time quantitative PCR revealed that Cc IAP1 and Cc IAP genes were both highly induced at -6°C and 30°C, and expression was highest at the third instar stage. The expression of Cc IAP1 and Cc IAP genes were significantly induced during parasitism of C. suppressalis , and the 7-d time point resulted in the highest expression levels for both genes, in which was an advanced stage of larval development of C. chilonis . RNAi experiments showed that Cc IAP1 gene was the key IAP in the regulation of apoptosis of C. chilonis and its host. In conclusion, Cc IAP1 and Cc IAP correlate with the development of C. chilonis and their responses to temperature stress., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lu, He, Zhu and Du.)

Objective: To explore the perspectives, barriers and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers and consumers., Design: A qualitative study involving twenty-two focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyse the data., Setting: Two in-depth interviews and twenty-two focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online., Participants: Focus group discussions were conducted among twenty-three street food vendors, twenty-one caterers and seventy-six consumers of various eateries. In-depth interviews were conducted among two street food vendors and four caterers, individually., Results: Consumers and food operators perceived a high-salt intake within Malaysia's out-of-home food sectors. Food operators emphasised the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators and challenges in accessing affordable low-Na food products, whereas food operators faced the lack of standardised guidelines and effective enforcement mechanisms and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products and stricter enforcement targeting vendors. Consumers also suggested promoting and recognising health-conscious food premises, whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance and maintaining food quality., Conclusions: These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia's out-of-home sectors.

Introduction: Setting sodium targets for pre-packaged food has been a priority strategy for reducing population sodium intake. This study aims to explore the attitudes and considerations of researchers and key stakeholders toward implementing such policy in China., Methods: An exploratory study comprising a survey and a focus group discussion was conducted among 27 purposively selected participants including 12 researchers, 5 consumers, 4 administrators, 3 industry association representatives and 3 food producers. The survey/discussion covered the key questions considered when developing/promoting sodium targets. Free-text responses were manually classified and summarized using thematic analysis., Results: Two-thirds of the participants supported target-setting policy. Researchers and administrators were most supportive, and food producers and associations were least supportive. Adapted WHO food categorization framework was well accepted to underpin target-setting to ensure international comparability and applicability for Chinese products. Maximum values were the most agreed target type. The WHO benchmarks were thought to be too ambitious to be feasible given the current food supply in China but can be regarded as long-term goals. Initially, a reduction of sodium content by 20% was mostly accepted to guide the development of maximum targets. Other recommendations included implementing a comprehensive strategy, strengthening research, engaging social resources, establishing a systematic monitoring/incentive system, maintaining a fair competitive environment, and developing a supportive information system. Target-setting policy was acceptable by most stakeholders and should be implemented alongside strategies to reduce discretionary salt use., Discussion: Our findings provide detailed guidance for the Chinese government when developing a target-setting strategy. The methods and results of this study also provide meaningful references for other countries to set sodium targets for pre-packaged foods and implement other salt reduction strategies simultaneously., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Zhang, Rosewarne, Li, Dong, He, Brown, Pettigrew, Yamamoto, Nishida, Liu, Yang, Zhang, Ding and Wang.)

Objectives: The aim of this study was to assess the changes in salt intake and concomitant changes in blood pressure (BP) and cardiovascular disease (CVD) mortality in England from 2003 to 2018., Methods: National surveys and death registration data were used for the analysis of salt intake as measured by 24-h urinary sodium excretion (449-1069 participants per year), BP (2651-6738 participants per year) and CVD mortality., Results: A decline in salt intake from 9.38 (SD 4.64) to 7.58 (3.41) g/d was observed between 2003 and 2014 ( P  < 0.01), followed by an increase to 8.39 (4.13) g/d in 2018 ( P  < 0.01). Similar trends in BP and CVD mortality were also observed between 2003 and 2018. SBP/DBP decreased from 125.3 (15.92)/74.48 (11.33) mmHg to 122.57 (14.92)/73.33 (10.75) mmHg between 2003 and 2014 ( P  < 0.01), followed by a plateau up to 2018 [122.04 (14.64)/73.84 (10.54) mmHg, P  > 0.05]. Likewise, a fall in stroke and ischaemic heart disease mortality rates was observed between 2003 and 2014, from 12.24 and 43.44 cases per 100 000, to 8.19 and 27.23 cases per 100 000 ( P  < 0.01), respectively, followed by a plateau afterwards ( P  > 0.05)., Conclusion: The UK salt reduction programme was initially successful in reducing population salt intake by 19% (from 9.38 g/d in 2003 to 7.58 g/d in 2014). However, in recent years, the programme stalled and thus led to an interruption in the decline of salt intake. BP and CVD mortality reduction was also interrupted when salt reduction stalled. The changes in salt intake may have played an important role in the concomitant changes in BP and CVD mortality. Urgent action is needed to reinvigorate the UK's once world-leading salt reduction programme., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Conflict of interest: N.R.C.C. reports personal fees from Resolve to Save Lives (RTSL), the Pan American Health Organization, and the World Bank, outside the submitted work; and is an unpaid member of World Action on Salt, Sugar and Health and an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations. Dr Campbell chaired the International Consortium for Quality Research on Dietary Sodium/Salt (TRUE) which is an unpaid voluntary position. Dr Campbell was on the Medical Advisory Board of Switch Health and was a one-time reviewer of a joint Novartis Canada Alberta Health Services collaborative project to treat dyslipidemia. All the honoraria from Switch Health and Novartis Canada have been donated to the University of Calgary to support a community cardiovascular disease prevention recognition award. F.J.H. is an unpaid member of Action on Salt, and World Action on Salt, Sugar and Health (WASSH). F.P.C. is Past-President, British & Irish Hypertension Society (2017-9) (unpaid); Member, Action on Salt and World Action on Salt, Sugar and Health (unpaid); Head, World Health Organization (WHO) Collaborating Centre for Nutrition (unpaid); Senior Advisor, WHO (refunds for travel, accommodation, per-diem); OMRON Academy (speaker fees, travel, accommodation, expenses); Annual Royalties from Oxford University Press (OUP) for 2 books on topics unrelated to salt. G.A.M. is the unpaid Chair of Action on Salt, Action on Sugar (WASSH), and Blood Pressure UK.