Early View: Salt (sodium chloride) content of retail samples of Nigerian white bread: implications for the daily salt intake of normotensive and hypertensive adults

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Salt (sodium chloride) content of retail samples of Nigerian white bread: implications for the daily salt intake of normotensive and hypertensive adults

B. C. Nwanguma and C. H. Okorie

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Background

Bread has been identified as a major contributor to the excessive salt (sodium chloride) intake of consumers in many countries, some of which have very high incidences of hypertension and related cardiovascular complications, such as stroke. This has prompted a global rise in interest in the salt content of breads produced and consumed in many other countries.

Methods

The sodium contents of retail samples of 100 brands of Nigerian white bread were determined by photometry with a view to estimating the relative contribution of bread to the recommended daily sodium intake of both normotensive and hypertensive adults in the country.

Results

The salt content of the bread samples varied extensively, ranging from 0.51 g per 100 g (0.51%) to 1.8 g per 100 g (1.8%). The average salt content was 1.36 g per 100 g. Based on an estimated consumption of six slices of bread (about 180 g) per meal of bread, this equates to a daily intake of between 0.99 g and 3.33 g of salt from bread alone. This represents between 19.8% and 66.6% of the recommended daily allowance of 5 g for normotensive adults, and between 24.75% and 83.25% of the recommended daily allowance of 4 g for hypertensive adults.

Conclusions

The consumption of some brands of bread by normotensive and hypertensive adults puts them at great risk of exceeding their recommended daily allowance for salt. Thus, there is an urgent need to regulate the amount of salt added to bread. In the interim, compelling bakers to declare the salt content of their products on the packaging could help consumers, especially hypertensive adults, avoid brands with a high salt content.

 

 

Life changing research

 

 

 

 

 

 

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I am celebrating an important anniversary this week. It is 20 years since I completed the data collection that led to the paper which changed my life. At the end of an experiment that had been under way for over 4 months I finally completed a set of blood pressure measurements, analysed the data and found, to my amazement, that feeding a protein restricted diet in rat pregnancy resulted in high blood pressure in their adult offspring. This was the first experimental confirmation of the Barker Hypothesis.

20 years…

 

I say that this work changed my life with utter sincerity. Research changes lives in many ways. In my case, this experiment was the start of it all. The production of my own small brick to add to the wall of human knowledge, launched my career, got me to where I am today and enabled me to lay perhaps a whole course of those knowledge bricks. Research may change lives directly by contributing to clinical treatments that improve the quality of life, ease suffering or perhaps cure disease. Everyone who is involved research hankers to do this at some level, and those of us who would think of ourselves as carrying out “basic science” strive to find the translational link that moves our work from the abstract but interesting, to a state where it impacts upon human health and wellbeing.

 In the shadow of these personal and more global effects of research, it is easy to overlook the impact that is perhaps most important of all. The research we do changes lives by inspiring others. We live in the information age, where access to research papers, research findings and ideas is easier than it has ever been. The work that we publish has the capacity to set new challenges to the new generation of scientists; to excite the imagination and; trigger innovation. Coupled with the rapid changes in technology, the clues that we leave sitting in that big wall of human knowledge may translate into impacts upon human health, societal change and the global good much faster than we can imagine.

 

The final measurements I made 20 years ago this week have led to another 90 papers of my own, spawned the studies of research collaborators and rivals the world over, formed the springboard for more than a dozen PhD students who have worked with me since, have informed undergraduate students learning and so much more. I don’t mind saying that I feel quite proud of myself.

 

How will your research change lives?

 

 

A response to Verrill et al: Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity

A few days ago I posted a link to a paper that is currently viewable on Early View,

Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity, by Linda Verrill and colleagues at the United States FDA. The following response to the paper has been provided by  Whitney Caudill of Manchester College of Pharmacy, Indiana. The views expressed are entirely those of Dr Caudill. I have invited Dr Verrill and colleagues to make a response to appear on this blog.

In Response: It is Time for Action by the United States Food and Drug Administration on Gluten-Free Labeling Rules

This commentary is in response to the research paper published in the Journal of Human Nutrition and Dietetics by researchers at The Center for Food Safety and Applied Nutrition at the United States Food and Drug Administration (the “FDA”). The FDA found, among other things, that the lack of rules in the United States regulating gluten-free labeling contributes to difficulty experienced by patients with coeliac disease and non-coeliac gluten sensitivities in adhering to a gluten-free diet. Yet, after being empowered in 2004 by the United States Congress, the FDA has been ineffective in enacting rules governing gluten-free claims on food labeling. The unsuccessful attempt is despite a statutory mandate under the Food Allergen Labeling and Consumer Protection Act of 2004 that such rules be in place no later than 2008.This commentary discusses the FDA rule-making history and lack of action on gluten-free labeling rules in the context of the FDA’s own research, which supports the need for final rules. The FDA agrees that final rules are necessary, but when will the FDA take action?

Coeliac disease, non-coeliac gluten sensitivity, and the adherence to a gluten-free diet are topics of increasing discussion in the scientific and lay media. The topic has been covered recently in the Journal of Human Nutrition and Dietetics by researchers at The Center for Food Safety and Applied Nutrition at the United States Food and Drug Administration (the “FDA”). (Verrill, et al., 2013).  (Verrill, et al., 2013).

The FDA researchers surveyed 1,583 adults with coeliac disease (“CD”) and 797 adults with non-coeliac gluten sensitivity (“NCGS”) all of whom adhere to a gluten-free diet (“GFD”) as treatment for their respective conditions. (Verrill, et al., 2013). The FDA researchers’ findings include that

  1. the United States’ lack of standards for use of gluten-free claims on food labels contributes to patients’ difficulty in adhering to a GFD;
  2. a “significant association between reading food labels and hav[ing] less difficulty following a GFD”; and
  3. a “positive association between using a [gluten-free] claim and difficulty following a GFD.” (Verrill, et al., 2013).

The FDA acknowledges that the lack of rules regarding gluten-free labeling contributes to patient difficulty in adhering to the GFD. (Verrill, et al., 2013).  It is observed that the “association between [gluten-free] claims and difficulty following a GFD could be explained by the potential confusion about the meaning of the claim or a mistrust of it.” (Verrill, et al., 2013).  The researchers state further that the “FDA’s rulemaking, which is underway to define the food labeling term [gluten-free], is expected to mitigate the confusion in this regard.” (Verrill, et al., 2013).

What the FDA does not state in this research paper is that the rules regarding gluten-free labeling on food products was required by the  United States Food Allergen Labeling and Consumer Protection Act of 2004 (“FALCP”) to be completed no later than 2008. Food Allergen Labeling and Consumer Protection Act of 2004, Pub. L. no. 108-282, 118 Stat. 910 (2004). Further, the FDA has not provided any indication that its rulemaking process will produce gluten-free standards in 2013 or the near future.

I have coeliac disease (“CD”). CD is a systemic autoimmune disorder caused by exposure to gluten in genetically susceptible people. (Fasano & Catassi, 2012). Gluten is a protein found in wheat, rye, and barley and the derivatives of each. The immune response activated in CD causes the body to attack gluten as if it is an antigen and cause symptoms including chronic diarrhea, weight loss, bloating, and chronic fatigue, among others. (Fasano & Catassi, 2012). Untreated CD can result in osteoporosis, neurologic disorders, and cancer. (Fasano & Catassi, 2012).

The only treatment for CD is adherence to a GFD. (Fasano & Catassi, 2012).

I learned quickly after my diagnosis that the easiest way to ensure that I am adhering to a GFD is to buy fresh food, rather than packaged food that is processed. I do occasionally purchase and consume processed foods out of convenience and necessity. When this happens I carefully examine the food label to determine if the food contains gluten. Often I contact manufacturers directly to inquire about the contents of the product or the company’s production practices to prevent cross-contamination. It is common for me to end those conversations and still wonder if the product is safe. When I am looking at products that claim on the label to be “gluten-free” I still have to wonder if the product is safely gluten-free.

 Why?

In the United States there is no legal definition for the phrase “gluten-free.” In the United States manufacturers can use that phrase as they choose without meeting any regulated standards. Manufacturers may use the term “gluten-free” as long as, according to the FDA, it is not “misleading.”

 How can this be?

The FDA has failed to accurately define the term “major food allergen,” establish safe gluten thresholds for food products, and meet its legal obligation under the FALCP to create and implement final rules for gluten-free food labeling.

The United States Federal Food, Drug and Cosmetic Act does not specifically regulate gluten as it affects patients with CD, an autoimmune disorder. Rather, it regulates wheat as an allergen. The phrase “major food allergen” under FALCP means “(1) Milk, egg, fish (e.g., bass, flounder, or cod), Crustacean shellfish (e.g. crab, lobster, or shrimp), tree nuts (e.g. almonds, pecans, or walnuts), wheat, peanuts and soybeans. (2) A food ingredient that contains protein derived from a food specified in paragraph (1), except the following: (A) Any highly refined oil derived from a food specified in paragraph (1) and any ingredient derived form such highly refined oil. . . . .” 21 U.S.C. § 321(qq) (2012). The FALCP requires that manufacturers identify these allergens by their common names (i.e. wheat, milk, or soy) on labeling for easy identification by consumers. 21 U.S.C. § 343(w) (2012).

In order for a product to be gluten-free it must be safely free of all gluten: wheat, barley, and rye. Unfortunately, the current law does not meet that standard. The definition of major food allergen includes only wheat. 21 U.S.C. § 321(qq) (2012). It does not include rye and barley, and the derivatives, all of which contain gluten. The FDA’s definition of major food allergen must include the term “gluten” or the words “wheat, barley, and rye” to safely protect citizens with CD or NCGS.

Additionally, the FALCP charged the FDA to have final standards for gluten-free labeling in place by 2008, no later than four years after the enactment of FALCP. Food Allergen Labeling and Consumer Protection Act of 2004, Pub. L. no. 108-282, 118 Stat. 910 (2004).  In 2007, following up on the mandate from FALCP, the FDA issued a proposed rule: “Food labeling; Gluten-Free Labeling of Foods.” The proposed rule states that a food is gluten-free if the food does not contain any of the following:

  1. an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains;
  2. an ingredient derived from these grains and that has not been processed to remove gluten;
  3. an ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten; or
  4. 20 ppm or more gluten.

Food Labeling; Gluten-Free Labeling of Foods, 72 Fed. Reg. 2795 (proposed January 23, 2007) (to be codified at 21 CFR Part 101). These standards are consistent with those adopted in European in 2012. (Verrill, et al., 2013).

The FDA’s notice described the currently adopted analytical methods for gluten detection as being able to reliably and consistently detect gluten at levels of 20 parts per million or more in a variety of foods. Participation by food manufacturers would be voluntary if they wish to market products as gluten-free. The comment period for these rules passed with no action. No final rules were issued by the FDA.

In 2011, the FDA reopened the comment period on the same proposed regulations for “Food Labeling; Gluten-Free Labeling of Foods.” Food Labeling; Gluten-Free Labeling of Foods; Reopening of the Comment Period, 76 Fed. Reg. 46671 (proposed August 3, 2011) (to be codified at 21 CFR Part 101). That comment period closed and, again, no action was taken. No final rules were issued by the FDA regarding the labeling of gluten-free foods.

Over a year later, on December 14, 2012, the FDA issued a notice titled “Request for Comments and Information on Initiating a Risk Assessment for Establishing Food Allergen Thresholds; Establishment of a Docket.” This notice does not specifically include further comment or action on the proposed rules published on January 23, 2007 and again on December 12, 2012 to establish gluten-free labeling standards for food.

The comment period on the rule issued in December 2012 is open until February 12, 2013 and an advisory committee meeting of the FDA is scheduled for March 7, 2013 from 8:00 a.m. to 5:00 p.m. Request for Comments and Information on Initiating a Risk Assessment for Establishing Food Allergen Thresholds; Establishment of Docket, 77 Fed. Reg. 74485 (proposed December 14, 2012).

Today, nearly 1 in 133 people in the United States have CD. (Fasano, A. et al. 2003). It has been nearly a decade since the FDA was empowered by Congress to establish final rules on gluten-free labeling in the United States. The FDA has taken no final action. The FDA has acknowledged that the lack of standards for gluten-free labeling has created difficulty for patients with CD and NCGS to successfully adhere to the medically required GFD. The FDA has stated that “more research is needed in this area.” (Verrill, et al., 2013).  Yet, the FDA has not acted on rules it proposed over five years ago that could assist patients who must adhere to a GFD. It is time for the FDA to take action.

References:

  1. 21 U.S.C. § 321(qq) (2012).
  2. 21 U.S.C. § 343(w) (2012).
  3. Fasano A, Berti I, Gerarduzzi T, et al. (2003) Prevalence of celiac disease in at-risk and not-at-risk groups in the United States. Archives of Internal Medicine. 163, 268–292.
  4. Fasano, A., Catassi, C. (2012) Celiac Disease. N. Engl. J. Med. 367, 2419.
  5. Food Allergen Labeling and Consumer Protection Act of 2004, Pub. L. no. 108-282, 118 Stat. 910 (2004).
  6. Food Labeling; Gluten-Free Labeling of Foods, 72 Fed. Reg. 2795 (proposed January 23, 2007) (to be codified at 21 CFR Part 101).
  7. Food Labeling; Gluten-Free Labeling of Foods; Reopening of the Comment Period, 76 Fed. Reg. 46671 (proposed August 3, 2011) (to be codified at 21 CFR Part 101).
  8. Request for Comments and Information on Initiating a Risk Assessment for Establishing Food Allergen Thresholds; Establishment of Docket, 77 Fed. Reg. 74485 (proposed December 14, 2012).
  9. Verrill, L., Zhang, Y., Kane, R. (2013) Food label usage and reported difficulty with following a gluten-free diet among individuals in the USA with coeliac disease and those with noncoeliac gluten sensitivity. J. Hum. Nutr. Diet. doi:10.1111/jhn. 12032.

British Dietetic Association members- how to keep in touch

From early 2013 JHND has become an online only journal, which means that BDA members will no longer receive issues in paper form. This will undoubtedly change the way in which you access and experience research articles that are relevant to your own research and clinical practice.  Although the days of browsing through JHND may be over, there are a number of new ways of keeping in touch with what is being published. First of all the journal web page  gives access to published issues and includes the Early View section. Early View gives access to all papers that have been accepted, often 6 months before official publication. Through the JHND website you can sign up for email alerts which will provide you with tables of contents as each issue of the journal is published. You can also keep up with the journal by following us on Twitter (@JHNDEditor), connecting with me on LinkedIn, or of course by reading the Editor’s blog.

The first 40 days in the hot seat

 

 

                        

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I have now been the Editor-in-Chief of JHND for 40 days and contrary to the message conveyed by the picture, it has been a very enjoyable experience. Politicians often review what they have achieved after 100 days in office, but at JHND we are far more stringent, so I thought I would post a few words to convey the things that have been achieved so far.

 

 

  1. We now have a brand new Editorial Board, which gives JHND a firm presence through North America, Australasia, the UK and Europe.  
  2. There have been 64 submissions (34 original submissions, 30 resubmissions) since the 1st January, so it looks as though 2013 may see an increase in the number of submissions over previous years.
  3. The Associate Editors have worked wonders and our turnaround time is improving dramatically. We will soon be achieving the target of a first decision being provided to authors within 6 weeks. 
  4.  The hand-over of the Editor-in-Chief role also generated a backlog of accepted papers that could easily fill the journal page budget for the whole of 2013. This will be cleared by running a supplemental issue, in which all of the papers will be open access.
  5. I have been working hard to engage with social media in order to raise the profile of the journal. There is now, of course this JHND Editor’s blog and we also have a journal Twitter account (@JHNDEditor). The social media allow us to post up papers as they go on to Early View, giving readers more warning of the articles which will appear in the journal. 

 Overall, I think this has been a highly productive start to 2013 at JHND. As ever, if you have any comments or suggestions, please post them here.

Ethnic variation in meat consumption in the USA- impact on micronutrient intakes.

Contribution of meat to vitamin B12, iron and zinc intakes in five ethnic groups in the USA: implications for developing food-based dietary guideline 

S. Sharma, T

  • . Sheehy, 
  • L. N. Kolonel

Background

To describe the sources of meat and their contributions to vitamin B12, iron and zinc in five ethnic groups in the USA.

Methods

Dietary data for the Multiethnic Cohort, established in Hawaii and Los Angeles, were collected using a quantitative food frequency questionnaire from more than 215 000 subjects, aged 45–75 years at baseline (1993–1996). Participants included African American, Latino, Japanese American, Native Hawaiian and Caucasian men and women. Servings of meat items were calculated based on the US Department of Agriculture recommendations and their contributions to intakes of total meat, red meat, vitamin B12, iron and zinc were determined.

Results

Of all types of meat, poultry contributed the most to meat consumption, followed by red meat and fish among all ethnicities, except for Latino (born in Mexico and Central/South America) men who consumed more beef. Lean beef was the most commonly consumed red meat for all ethnic-sex groups (9.3–14.3%), except for Native Hawaiian and Japanese American men, and Japanese American women whose top contributor was stew/curry with beef/lamb and stir-fried beef/pork with vegetables, respectively. The contribution of meat was most substantial for zinc (11.1–29.3%) and vitamin B12 (19.7–40%) and, to a lesser extent, for iron (4.3–14.2%).

Conclusions

This is the first large multiethnic cohort study to describe meat sources and their contributions to selected nutrients among ethnic minorities in the USA. These findings may be used to develop ethnic-specific recommendations for meat consumption aiming to improve dietary quality among these groups.

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