Salt Profile and Content in Foods Prepared in Restaurants and 1 Bakeries: Analysis of the 2 Main Urban Centers in Cape Verde

Abstract


ii. Analysis of sodium chloride content
The sodium chloride content was evaluated through titration by the Mohr method. After sample preparation, 99 approximately 5 g of Portuguese bread/ wheat bread and 10 g of meals were weighed in duplicate on an analytical 100 inside 250-ml cups. Then, 100 ml of warm distilled water (50-55°C) and 100 ml of boiling distilled water (~100 101°C ) were added to the cups containing bread and meal samples, respectively (Ward, R. E., & Carpenter, C. E., 102 2010). 103 The solution was vigorously homogenized (30 s) twice at an interval of 1 minute. After the solution had 104 cooled to room temperature, the pH was adjusted to 6.5-10.0, and the solution was filtered through sterile gauze. 105 Next, 15 ml of the filtered solution was transferred to a 250-ml Erlenmeyer flask, and 1.5 ml of 0.1 M potassium 106 chromate indicator (K2CrO4) was added. The solution was then titrated with 0.1 M silver nitrate (AgNO3) 107 until the first appearance of a brownish red color; the process was continued for another 30 s, and the volume of 108 titrant used was recorded. 109 10 iii. Calculations 110 The sodium chloride content in each replicate sample was calculated, and the mean, median, range and standard 111 deviation were calculated. 112 11 e) Statistical analysis 113 The data were analyzed using the Statistical Package for the Social Sciences (SPSS,v. 26). The data were 114 described using absolute and relative frequencies, and the chi-square test was used to compare the salt content 115 in food prepared by the establishments in Praia and Mindelo. All tests were two-sided, and P values less than 116 0.05 were considered to be statistically significant. 118 This study was approved by the National Committee on Ethics in Health Research (deliberation no. 33/2019, 119 31 May). All participants signed an informed consent form, which was filed under confidentiality at the National 120 Institute of Public Health of Cape Verde. Written informed consent for participation was obtained from managers 121 of restaurants and bakeries and their privacy and confidentiality were maintained. All personal identifiers were 122 excluded, and data was kept confidential and used for the proposed study only.

125
A total of 125 restaurants were evaluated. Regarding the origin of the salt used during food preparation in the 126 restaurants, 79% of restaurants used salt of national origin, 13.7% used salt of international origin, 4% used salt 127 of both origins, and 3.2% used salt of an unknown origin.

128
Of the restaurants in which the salt used in food preparation was of national origin, 62.6% used salt from the 129 island of Sal, and 25.3% used salt from the island of Maio; for 12.1%, the island of origin was unknown. Notably, 130 the island of Santiago does not produce salt.

131
Of the restaurants in which the salt used in food preparation was of international origin, 95% used salt from 132 Portugal, and 5% used salt from France.

133
Regarding the means used to transport salt, 61.1% of restaurants used a car, 18.2% used a car and boat, 7.1% 134 used a car and plane, and 13.5% did not use any means of transport.

135
Most restaurants (58.4%) did not have a specific location for salt storage. The salt was stored in its original 136 packaging (91.9%), protected from light (38.7%), exposed to heat in a nonventilated area (19.4%), stored in the 137 presence of chemicals (9.7%), and exposed to moisture (6.5%).

141
Among the restaurants that did not have a specific location for salt storage, in 79.6%, the salt was stored in 142 the kitchen; in 12.2%, the salt was stored in the pantry; in 4.1%, the salt was stored on a kitchen shelf; and in 143 2%, the salt was stored on a shelf or near the stove.

144
Regarding the lighting where the salt was stored, the location was well lit in 30.6% and lit in 26.5% of 145 restaurants, received natural light in 22.4%, low light in 12.2%, and no light in 4.1% of restaurants, and was 146 exposed to light and heat in 2% of restaurants.

147
The salt storage location was ventilated in 44.7% of the restaurants, well ventilated in 23.4%, poorly ventilated 148 in 12.8%, ventilated and exposed to heat in 6.4%, not ventilated in 4.3%, exposed to heat in 4.3% and exposed 149 to natural ventilation in 2.1%.

150
In 29.2% of the restaurants, the salt was stored in its own packaging; in 37.5%, the salt was stored in plastic 151 jars; in 12.5%, the salt was stored in a container with a lid; in 6.3%, the salt was stored in plastic bags; in 6.3%, 152 the salt was stored in jars; in 4.2%, the salt was stored in a random container; and in 4.2%, the salt was stored 153 in glass jars. In 82.1% of the restaurants, the salt was stored together with other products.

157
A total of 30 bakeries were evaluated. Most of the salt used in the preparation of bread was of national origin, 158 with 55.6% of bakeries using salt from the island of Sal and 37% using salt from the island of Maio; 7.4% reported 159 not knowing the provenance.

160
The car was the most commonly used means for transporting salt (76.7%), followed by boat and car (20.0%) 161 and plane and car (3.3%). Most bakeries purchased salt locally (76.7%) and stored it in a specific location (80%).

162
Of these, 78.3% stored the salt in its original container, 47.8% stored the salt protected from light, 30.4% stored 163 the salt in a location exposed to heat, 4.3% stored the salt in a nonventilated area, and 4.3% stored the salt in 164 the presence of chemicals.

165
Of the 6 bakeries that did not have a specific location for salt storage, 50% stored it in the pantry, 33.3% 166 stored it in the production area, and 16.7% stored it in a location with other products. In 66.7% of the bakeries, 167 the salt was stored away from light; in 50%, the salt was stored in its own container; in 33.3%; the salt was 168 exposed to heat; and in 16.7%; the salt was stored in an unventilated location.

c) Profile of the salt used in restaurants 172
Only 12% of the restaurant managers stated that they followed standard guidelines for the amount of salt to be 173 used in food preparation. Regarding the existence of a standard that regulates the amount of salt to be used in the preparation of bread, 184 83.3% of the bakeries reported that they followed a standard; for the remaining 16.7%, there was no compliance 185 with any standard.

186
Iodized salt was the most used salt type (90%), followed by sea salt, fleur de sel and others, with 3.3% each.

187
Most respondents (69%) stated that there were differences between types of salt; the remaining 31% responded 188 that no differences exist between different types. The most reported differences between the types of salt were 189 quality (41.2%), followed by texture (17.6%). Among the respondents, 11.8% considered iodized salt the best, 190 and differences were reported in terms of appearance, taste/aroma, presence of iodine, importance for health and 191 salt content in the recipe (5.9% each).

192
The amount of salt per kg of dough was greater than 14 g/kg in 3 bakeries, and in 2 bakeries, the amount 193 of salt was greater than 6 g per loaf ( Table 2). The majority of the bakery managers (96.7%) believe that salt 194 has an impact on the health of all individuals. Only 3.3% considered that it has an impact only on the health of 195 individuals with some disease.

196
Most respondents (66.7%) were unaware of the daily dose of salt recommended by the WHO (5 g/day); 6.7% 197 were aware of such a recommendation.

198
Regarding the relationship between salt and sodium, 36.7% of the respondents answered that salt contains 199 sodium; 53.3% did not know the relationship between the 2.

212
In the present study, the amount of Na varied between 0.26 g and 6.89 g per meal (Appendix II), with a 213 median of 2.01 g (table 3), indicating a high Na content based on the recommended daily intake of less than 2 214 g of Na established by WHO (World Health Organization, 2020). Bakeries and restaurants in Mindelo used a 215 mean of 1.50 ± 0.3 g of salt/100 g of bread and 1.4 ± 0.5g of salt/100 g of meal respectively. In Praia, the mean 216 salt content in bread was 1.35 ± 0.25g /100g, and that in meals was 1.3 ± 0.5 g/100 g respectively (Table 3 and   217   table 4). There were no significant differences between Praia and Mindelo regarding the salt content used in the 218 bakeries (?2 = 71,778; p = 0.419) and in the restaurants (?2 = 367,488; p = 0.641).

219
Most of the salt samples collected (97%) contained iodine. 220 19 IV. discussion 221 Most restaurants did not have a specific location for storing salt. It was stored in its own packaging, protected 222 from light, exposed to heat, stored in a nonventilated place, stored in the presence of chemicals, and exposed

234
In this study, 50% of the analyzed bread samples revealed a salt content greater than the limit recommended 235 by the Portuguese standard, which is 1.4 g/100 g of bread or 0.55 g of sodium/100 g of bread (Assembleia da 236 República, 2009). Bread is one of the most consumed foods in the world, accounting for an average of 30% of 237 daily salt intake (2,3). It contributes a significant percentage of salt to the diet of the Cape Verdean population.

238
Of the samples with salt contents greater than or equal to 1.4 g/100 g, 57.8% (n = 11) were collected in

242
The results of the present study indicate that the salt content in meals prepared in restaurants in Cape Verde 243 is high (? = 5.44 g/meal) based on the WHO recommendation (World Health Organization, Salt reduction, 244 2020).

245
A higher salt content was observed in meals that contained meat, french fries, chorizo or shellfish. This may 246 be due to some traditional preservation processes (use of salt as a preservative) (Ludwig, L. M., et al., 2021).

247
Conversely, the samples consisting essentially of salad had low salt contents (Nascimento RFd, et al., 2017).

248
In the present study, the amount of Na ranged from 780 mg to 4,330 mg/meal, with a median of 1,900 mg/meal, 249 which exceeds not only the recommendation for a meal (18,27,28) but also the WHO daily recommendation, which 250 establishes a maximum intake of 2,000 mg of Na/day (World Health Organization, Salt reduction, 2020).

251
The present findings draw attention to the greater sodium intake Approximately 59,3% (n=35) of the meal 252 samples collected in the restaurants in Praia and 42,4% in Mindelo had a NaCl greater than 5.0 g per meal, with a 253 median of 5.03 g, suggesting a much higher daily NaCl intake than the maximum limit (<5 g/day) recommended 254 by the WHO (World Health Organization, Hypertension, 2021; World Health Organization, Salt reduction, 2020).

255
An intake of less than 5 g of salt per day in adults helps to reduce blood pressure and the risk of cardiovascular 256 disease, stroke and heart attack (World Health Organization, Salt reduction, 2020).

257
The results should be interpreted considering that the data were collected only in the 2 main population 258 centers. Thus, it is possible that there are other bakeries and restaurants that were not taken into account.

265
Our study revealed unprecedented data on the profile and content of salt in the 2 main urban centers of Cape 266 Verde (Praia and Mindelo). Thus contributing to the redesign of salt intake reduction strategies in these cities 267 and in the country. It is imperative and urgent that national legislation regulates the unit weight of bread and 268 the amount of salt that ready-to-eat food, including bread, should contain. What is the amount of salt you use, 269 per person, to make a soup? ? <1 g (less than 1/2 teaspoon) ? 1 to 2 g (1/2 to 1 teaspoon) ? 2 to 4 g (1 to 2 270 teaspoons) ? 4 to 6 g (2 to 3 teaspoons) ? >6 g (more than 1 tablespoon) 14. How much salt do you use, per 271 person, to prepare a main dish? ? <1 g (less than 1/2 teaspoon) ? 1 to 2 g (1/2 to 1 teaspoon) ? 2 to 4 g (1 272 5 20 CONCLUSIONS to 2 teaspoons) ? 4 to 6 g (2 to 3 teaspoons) ? >6 g (more than 1 tablespoon) 15. Do you consider that salt 273 intake has an impact on health? ? Yes, for all individuals ? Yes, but only for individuals with some disease ? No