Knowledge, Attitudes, Practices, and Perceptions for Salt/Sodium Reduction in the Gastronomic Sector of Costa Rica

Excess sodium intake is associated with high blood pressure and cardiovascular diseases. This study examined food services in Costa Rica as a major source of sodium. The research included six cafeterias, six fast food establishments, 13 restaurants, and 15 diners using non-probabilistic convenience sampling. Interviews were conducted with workers to assess knowledge, attitudes, and practices regarding salt reduction. The findings were analyzed to determine effective intervention strategies. Participants showed regular knowledge about salt/sodium. While they recognized the link with high blood pressure, understanding of other health problems was limited. Positive attitudes were observed toward healthy cooking and reducing sodium in pre-prepared food, especially in restaurants. Over 70% expressed a desire to reduce salt in food services, with more than 80% indicating a need for staff training, particularly in cafeterias lacking knowledge of low-salt preparations. High-sodium ingredients were prevalent, with saltshakers and sauces readily available. However, some individuals were reluctant to reduce salt/sodium intake, citing concerns about taste, food variety, and customer complaints. Obstacles to reducing salt/sodium levels included limited accessibility and the cost of low-sodium ingredients. The data collection tools and methodologies used in this study can serve as a foundation for future investigations and strategies to reduce salt consumption in food services. The study recommends government support for transforming the gastronomic sector and implementing regulations and knowledge enhancement. Collaboration with the productive sector is crucial for creating healthy environments. This research presents valuable evidence regarding the utilization of salt and sodium in the gastronomic sector, thereby assisting in the decision-making process for public health initiatives and the prevention of non-communicable chronic diseases. It highlights the significance of tackling sodium reduction in food services to encourage the adoption of healthy culinary practices and enhance the overall health of the population.

Design of a Social Marketing Plan on Salt Reduction for the Control and Treatment of Noncommunicable Diseases in Costa Rica

High blood pressure and other non-communicable diseases associated with excessive salt/sodium consumption represent a major challenge to the health of the world’s population. Consumption is a human behavior that is usually influenced by significant factors, internal and external to people. The design of a national social marketing intervention is described. The whole process was developed by a national interdisciplinary team over the course of a decade (2011-2022). Its purpose is to promote changes in this behavior, through gradual reduction of salt/sodium consumption in the target populations of Costa Rica, for the prevention and control of associated diseases. The process includes four phases: research, situation analysis, creation of a proposal for the social marketing strategy, and implementation and evaluation. Last phase was not developed by the research team. The main inputs used to design this intervention were the data generated in three qualitative researchers carried out by the national work team and the social marketing regional plan for salt consumption reduction in Latin America. By analyzing these research data, marketing mix components were determined for designing the intervention. The marketing strategy is promotional and is based on encouraging a natural diet with less sodium using natural seasonings and adding less discretional salt and industrialized products high in sodium, in the preparation of food and dishes. The primary key audience is the mother of the school-aged child, and the secondary is the adult caregivers of this child. It is expected that in the short term, health promoters from different government and non-state sectors will contribute to the implementation of the national social marketing plan, to achieve, in the medium or long term, a consumption that approaches five grams of salt per person per day. This plan is a country initiative to position the value of a natural diet with less sodium and to contribute to the prevention and treatment of HT and NCD associated diseases.

Salt/Sodium Intake Estimation in Children and Adolescents of Costa Rica

The objectives of this study were to estimate sodium intake and to identify the main dietary sources of this nutrient in young people. Cross-sectional study performed in 2685 students from 64 schools and high-schools of Costa Rica. A food frequency survey was applied to study the food and beverage intake habits of the participants. The average daily sodium intake for children and adolescents 7 to 18 years of age was 3214 mg. Around 97% of the students had sodium intakes > 2300 mg per day with significant differences by age subgroup, sex and nutritional status due to excess body weight (p < 0.001). The average sodium density of the diet was 1698 mg sodium/1000kcal, and the average addition of salt to the food was 445 mg of sodium (1.1 grams of salt). Including the amount added to the served food, the average sodium intake for children and adolescents from 7 to 18 years of age increased to 3434 mg and the overall average sodium density increased to 1821 mg of sodium/1000kcal, maintaining significant differences by age subgroups (p < 0.001). These results justify carrying out social marketing campaigns that include educational processes with sense and meaning for children, adolescents and families, in such a way that these groups of the population become motivated to modify gradually their eating habits, such as reducing the use of sauces, seasonings and salt in food preparation and at the table. If the habit of adding salt to the served food is gradually reduced or avoided, the children and adolescents in Costa Rica could decrease the intake of salt per day from 1 to 2 grams. This decrease could be even more effective if youngsters additionally would remove the intake of sauces, contributing in this way to achieve the maximum salt intake recommendation (5 g per day).