strategies to reduce salt or other selected …...2008/02/13 · lab analysis acta medica portug...
TRANSCRIPT
STRATEGIES TO REDUCE SALT or other selected nutrients in processed food STAKEHOLDER COLLABORATION – EXAMPLE FOOD SERVICE INDUSTRY
Sigrid Beer-Borst, applied Research & Development in Nutrition and Dietetics Funding: Federal Office of Public Health, Bern University of Applied Sciences
Joint Workshop, Tallinn, 8th February 2013
3
HEALTH Nutrition & Dietetics Nursing Physiotherapy Midwifery
What to expect
Communal catering / food service industry as target area
Self-regulation : Capacity building , Good Practice concept
Identification of critical control points
Areas of action – measures to take
Ongoing and future R&D activities
4
The National Programm of Nutrition & Physical Activity (BAG July 2008)
5
Switzerland offers health promoting environments that
allow individuals, families and communities to eat a
balanced diet and be active
Setting and target group specific activities
Improve ways of coaching, counseling and therapy
Establish & maintain health promoting environments
Encourage a well balanced diet (eating & drinking)
NCD (risk factor) prevention
Core action in the scope of the Swiss salt strategy
Creation of an enabling environment for reduction of sodium intake on a population level
Collaborating with the food and food service industry to reduce salt levels in processed foods and in the catering sector, whilst assuring quality and safety
6
Out-of-home eating, an area of public health action
7
At least 1/7th of the Swiss population takes at least one main meal per day in a Swiss communal catering establishment.
The Good Practice concept
8
a recognized instrument of continual quality improvement in health promotion considers and examines successful approaches for their potential in terms of
project or product improvement
Good Practice concept – Capacity building
9
Self regulation – health promoting activities
10
Exampels: www.gp-gemgastro.ch
Swiss quality standards for a health-promoting communal catering
11
… A main meal -such as a luncheon- should not contain more than 2.5 g salt or 1 g sodium per person.
Experimental study set-up Salt in communal catering: measures to reduce intake
12
Communal Catering Establishment
Production Side: Kitchen and Catering Team Consumption side: Restaurant and Consumer
Supply (purchase)Initial Products
Plate WasteWaste
Management
Consumer’s awareness
and behaviour
Seasoning to use (Offer)
Meal Deliver, Service
Meal Production(Menu plan
implementation)
CCP
Laboratory Analyses
Evaluate and weight CCPs
Derive measures M1 to Mx
CCPCCPCCP CCP CCP CCPCCP CCP CCP
Are
as o
f co
ntro
l
Aliquot sampling
Data Interpretation
Mai
n St
udy
Pilo
t Stu
dy
Crit
ical
con
trol
poin
ts
5 CC-establishments − 3 BUS, 1 CARE, 1 EDU − 3 Cook & Serve, 1 Cook & Chill,
1 combined
HACCP-based decision tree Identification of critical control points for salt in menus
13
1Is the specific menu relevant
in terms of salt intake, considering• menu composition• consumption frequency or sales ?
NO
2Is an instruction available on how
to prepare the menu, including• initial products to use• recipes ?
3Does the
responsible person comply
with the instruction ?
4Could the sodium content
in the menu be reduced as to • initial products used• preparation process/method ?
NO CCP
Menu Planning - Initial Products
Meal Production
Meal D
eliveryC
onsumption
5Is an instruction available on
how to serve the menu, including • combination of components• portion sizes ?
6Does the service
staff comply with given
instructions on portion sizes ?
7Could the sodium content of the
portioned/served menu be reduced as to • kind/combination of components• amounts of components ?
YES
Menu not considered
Communal catering establishment• Key characteristics• 1-week Menu plan
CCP
Menu considered
CCPNOYES
NO CCPYES
CCP
NO
NO CCP CCPYES
CCPNO
NO CCPYES
CCP
NO
8Could the sodium content of the served menu be controled as to
availability of salt shakers/other salt-containing condiments in the restaurant
for discretionary use ?
NO CCP
NO
NOCCP
YES
NO CCP CCP
YES
NO YES
Identification of CCPs for sodium/salt entry
14
Salt content of luncheons in g per standard serving
15
Luncheon
NaCl g/standard serving
from to
Plated standard menu*, i.e. meat or fish component, with soup and bread
5.48 11.18
Plated vegetarian menu* with soup and bread 4.12 6.78
Salad dish from the free-flow buffet with soup and bread
3.24 7.38
*typically a protein component (meat, fish, soy product or legumes, etc.), a carbohydrate component (starchy foods, e.g. potatoes, pasta, rice etc.), vegetables and sauce
Salt content build-up (g/standard portion) of a meat luncheon vis-à-vis current Swiss recommendations
16
Salt content build-up (g/standard portion) of a vegetarian luncheon vis-à-vis current Swiss recommendations
17
Average salt content of meal components in g/100g ±SD
18
Salt content of meals prepared/consumed out-of-home International comparisons
Country Catering NaCl per seving (mean ± SD)
Data Reference
Belgium University: lunch 3.14g ± 0.48 (consumed) Calculated Public Health Nutr
2009;12:122-8
Portugal Public schools: lunch 3.4g [3.0;3.8] Lab analysis Acta Medica Portug 2011;24:215-22
Serbia Kindergarten: lunch 3.46g ± 1.59 Lab analysis Srp Arh Celok Lek 2010;138:619-23
Denmark Worksite: hot meal incl. bread, dessert 4.3g ± 1.9 Lab analysis
(Cl) Food & Nutr Res 2010;54:2100-
Switzerland Worksite, University, Home: lunch (soup + plated menu)
7.05g ± 1.79 Lab analysis Study Report 2011 MS in preparation
The Netherlands
Worksite: lunch (soup + plated non-vegi dish) 7.1g ± 0.2 (SE) Lab analysis BMJ
2011;343:d7352
Canada Hospital: regular patient menus 7.3g ± 1.54 Calculated Arch Intern Med
2012, July 16 online 19
Consumers’ general rating of the meals’ saltiness by gender and in total (N=330) (in%)
Frequency of answers in %
Saltiness rating Women
N= 99
Men
N=231 Total
N=330
Just right 37 49 46
Rather too salty 27 26 26
Much too salty 16 9 11
Rather not enough salty 9 11 11
Not enough salty 3 2 2
Don‘t know 5 2 3
Awareness of recommendations and attitudes towards salt intake (N=330)
Consumers‘ main decision factors at meal delivery
Multiple answers permitted, n=222; 2178 answers
Online survey „Good Practice – Communal catering“ www.gp-gemgastro.ch, Dec 2009- April 2012
Ongoing and future R&D activities
23
Catalogue of measures by areas of control
24
Communal Catering Establishment
Production Side: Kitchen and Catering Team Consumption side: Restaurant and Consumer
Supply (purchase)Initial Products
Plate WasteWaste
Management
Consumer’s awareness
and behaviour
Seasoning to use (Offer)
Meal Deliver, ServiceMeal Production
(Menu plan implementation)
Food reformulation
Salt alternatives
Product database
Recipe reformulationIngredients by kind & amount – also seasonings, preparation mode application
Provide portions of seasoning
Alternative seasonings , e.g. herbs
Sensory testing
Trainings on the job
Team internal control
Serving / scooping concept
Provide defined portions of e.g. dressing, grated cheese, bread
Trainings on the job
Central seasoning station with a variety of salt alternatives, e.g. fresh and dried herbs, pepper mill etc.
Standardise serving sizes at free-flow
Getting used to and accept stepwise salt reduction
Increase health literacy (know-how) through education
Reformulation of dishes / menus (recipes)
25
Environmental & Educational Intervention (2014/2015)
26
