Why salt in restaurant and processed food is a big public health risk
The American Heart Association’s recommended salt intake levels are being threatened by restaurant and processed food, a new study in the USA appears to show.
Such foods accounted for about 70 percent of dietary sodium intake in a study in three US regions, according to research in the American Heart Association's journal Circulation.
Sodium is an important contributor to high blood pressure, one of the leading causes of heart attack and stroke. The American Heart Association recommends a maximum of 2,300 milligrams (mg) of sodium a day, which is equivalent to one teaspoon of salt. For nearly 70 percent of US adults, the maximum sodium intake recommendation is even lower - 1500 mg/day - based on their age, race or ethnicity, or existing high blood pressure.
However, sodium can be difficult to avoid, especially when people eat a lot of processed food from grocery stores or restaurants. In fact, the average American adult consumes more than 3,400 mg of sodium per day. To address this serious health threat, in 2010 the Institute of Medicine recommended gradually decreasing sodium levels in commercially processed foods.
Between December 2013 and December 2014, researchers recruited 450 study participants in Palo Alto, California; Birmingham, Alabama; and Minneapolis, Minnesota; divided evenly among each location. Half of participants were female, and equal percentages, overall, were Hispanic, African American, Asian and white. They ranged in age from 18 to 74 years old.
Participants visited the clinic once at the beginning of the study and then kept records of daily food intake for four days, which they reported to researchers in four telephone interviews along with providing samples of salt replicating the amount they had added to food at home.
Across age groups, the level of dietary sodium was similar, with an average 3,501 mg consumed per day -- over 50 percent more than the recommended 2,300 mg.
- Sodium added to food outside the home was the leading source (70.9 percent) and sodium found naturally in food was the next highest (14.2 percent);
- Sodium from salt added in home food preparation (5.6 percent) and added to food at the table (4.9 percent) were next highest.
- Sodium in home tap water, dietary supplements and antacids contributed minimally (less than 0.5 percent).
"Telling patients to lay off the salt shaker isn't enough," said Lisa J. Harnack, Dr.PH., study lead author and professor at the University of Minnesota in Minneapolis. "Rather, commercially processed and restaurant foods should be the primary focus when educating patients on strategies for lowering sodium in the diet. Food manufacturers and restaurants should be encouraged to lower the sodium content in their food products to support Americans in consuming a diet consistent with sodium intake recommendations."
"If you're aiming to limit your sodium intake to the recommended level of less than 2,300 milligrams per day, you'll need to choose foods wisely when grocery shopping and dining out," Harnack said. "For packaged foods, the nutrition fact panel may be useful in identifying lower sodium products, and for menu items diners can request sodium content information. Also, if you frequently add salt to food at the table or in home food preparation, consider using less."
The study was limited in that it did not represent the overall U.S. population because participants were selected based on location and also may have changed their sodium consumption during the study because they knew that it was under watch.
According to the American Heart Association, restaurant and prepackaged food companies must be a part of the solution to reduce sodium and give Americans the healthy options they need and deserve. The American Heart Association encourages packaged food companies and restaurants to reduce the sodium in their products to help make meaningful impact on the health of all Americans. The association has developed a sodium reduction campaign to help.
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.