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This research aims to develop an evidence-based classification for sodium-rich condiments (natremic index) based on their CVD-related risks. It is hypothesised that the acute cardiovascular and physiological response (effectively extrapolated to long-term CVD risks) to meals prepared with various sodium-rich condiments can be leveraged upon for the development of such an index that will systematically classify sodium-rich condiments based on the risk they present to cardiovascular health.
Hypertension is the leading risk factor for cardiovascular diseases (CVDs) in older adults. While absolute dietary sodium reductions remain vital for prevention, effective long-term management must take stock of sensorial efficacy and acceptance, alongside the corresponding impacts on health. In Asia, this phenomenon is distinct due to a genetic predisposition of the population to salt sensitivity (increased risk), and a distinct food culture characterised by regional condiments (e.g. soy sauce, fermented bean paste).
The aim of this research is to develop an evidence-based classification for sodium-rich condiments (natremic index) based on their CVD-related risks. Perceived saltiness intensity is influenced by factors beyond the total amount of sodium consumed (e.g. flavour enhancers like MSG, tastes synergism etc.).
Similarly, while hypertension is predisposed by excessive sodium intake, growing evidence also suggests the potential role of bioactive compounds and ingredients (including some identified from Asian-style condiments e.g. spices, soya-derived flavonoids) that may elicit cardiovascular protective properties.
Contrary to generic recommendations that focused solely on absolute sodium reduction, sustainable solutions must simultaneously address concerns surrounding long-term health and consumer acceptance.
Much like the well-established glycemic index, it is hypothesised that the development of a natremic index, designed to evaluate and classify sodium-rich condiments according to their risks to cardiovascular health will serve as a vital, first of its kind strategy that can reliably guide public health recommendations, and spearhead next-generation innovations in the food and nutrition industry. The proposed research is split into two main parts that will investigate in detail three sodium-rich condiments commonly used in Asia cuisines: light soy sauce (condiment 1), fermented bean paste (condiment 2), and table salt (control), from sensory and health perspectives
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control porridge with no condiments | Experimental | This arm will consist of plain porridge which participants will consume. |
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| Porridge with light soya sauce | Experimental | This arm will consist of plain porridge with light soya sauce which participants will consume. |
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| Porridge with fermented bean paste | Experimental | This arm will consist of plain porridge with fermented bean paste which participants will consume. |
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| Porridge with table salt | Experimental | This arm will consist of plain porridge with table salt which participants will consume. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Control porridge with no condiments | Other | To examine acute cardiovascular health response to plain porridge. |
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| Measure | Description | Time Frame |
|---|---|---|
| Endopat assessment | EndoPAT test which will measure endothelial health and function at baseline. The EndoPAT test is a non-invasive procedure that involves the placement of probes on each index finger, followed by blood pressure cuff inflation for measurements of the arterial tone and blood flow responses (e.g. EndoPAT index). | EndoPAT assessments which will serve as the primary outcome of interest will be measured at postprandial intervals (up to 3 measurements) over 4 hours. |
| Measure | Description | Time Frame |
|---|---|---|
| Ambulatory blood pressure | The ambulatory blood pressure monitor will be attached and programmed for blood pressure measurements at pre-determined intervals. Blood pressure measurements will be taken at 15 minutes interval during the postprandial study duration (4 hours), 30 minutes interval (after the 4 hours) when participant is awake, and hourly when the participants are asleep. During each measurement, participants must be standing, seated or lie still, stay relaxed and silent. If seated they should keep their feet flat on the floor (not crossed). |
| Measure | Description | Time Frame |
|---|---|---|
| Health and lifestyle relevant questionnaire to to assess eligibility for inclusion/exclusion criteria. | This is to evaluate the participants eligibility for the study. Section A: Participant information, Section B: Medical and Health History, Section C: Lifestyle and Diet. Section A, B and C are questions with "Yes" or "No" to be answered. Section D: Physical Acitvity where participants select only one description that best represents their usual physical activity for leisure over the past 3 months. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Darel Toh, PhD | Contact | 64074149 | darel_toh@a-star.edu.sg | |
| Bhupinder Kaur, MSc | Contact | 64074355 | bhupinder_kaur@a-star.edu.sg |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Nutrition Research Centre | Recruiting | Singapore | 117599 | Singapore |
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| ID | Term |
|---|---|
| D006973 | Hypertension |
| ID | Term |
|---|---|
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D017673 | Sodium Chloride, Dietary |
| ID | Term |
|---|---|
| D012965 | Sodium Chloride |
| D017670 | Sodium Compounds |
| D007287 | Inorganic Chemicals |
| D012982 | Sodium, Dietary |
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| Porridge with light soya sauce | Other | To examine acute cardiovascular health response to plain porridge with saltiness-matched light soya sauce |
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| Porridge with fermented bean paste | Other | To examine acute cardiovascular health response to plain porridge with saltiness-matched fermented bean paste |
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| Porridge with table salt | Other | To examine acute cardiovascular health response to plain porridge with saltiness-matched table salt. |
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| 24 hour period consisting of: Postprandially 15 minutes intervals (over 4 hours), 30 minutes interval (after 4 hours) |
| Palatability questionnaire rated on a visual analogue scale "Good" to "Bad" | Palatability appetite questionnaire, rated on a visual analogue scale. To place a vertical mark on the thick line to indicate how person feels at that moment in response to various questions. At opposite ends of each line are descriptors which should be read carefully before placing the vertical line. | Test meal is consumed for 15 minutes. At the end of 15 minutes, palatibility questionnaire is completed. |
| Serum and Plasma sodium and potassium | Serum and plasma collected are for sodium and potassium assessment | Blood will be sampled at timepoints, t = 0 minute (Baseline) and at t = 30, 45, 60, 120, 180, 240 minute for each session |
| Subjective appetite questionnaire | Subjective appetite questionnaire, rated on a 0-100 visual analogue scale. 0 corresponds to "not at all" and 100 corresponds to "extremely".Questions usually used are "How hungry are you?" "How full are you?" "How strong is your desire to eat?" "How much food do you think you could eat?" | t=0 minute (Baseline), and t= 30, 45, 60, 120, 180, 240 minute for each session. |
| Taste acuity test | Sensory method to assess participant's recognition, detection and aversion threshold for sweet, salty, umami, sour and bitter taste. Up to 25 samples (approximately 10 milimetre each) will be evaluated per test session. | Test administered once at each session (5 sessions). Each test takes 20 minutes. |
| Ultrasound scan of carotid intima-media thickness | The ultrasound scan measures the thickness of the carotid intima-media layers on the side of the neck which is a marker for CVD risk | At baseline only |
| Evaluation | Participants will taste up to 25 test samples (undosed or dosed with various condiments with varying concentrations). A mandatory inter-stimulus break of one-minute is enforced between each sample to reduce possible fatigue and allow time for palate cleansing. The QDA method features participants rating pre-defined sensory attributes (e.g. salty taste intensity) on a 0-100 VAS scale. During sample evaluation, participants will be instructed to place the entire sample in their mouth, hold it in, swirl for 5 seconds before swallowing, then rate the taste intensity of the sample marked from 'low' (0) to 'high' (100) on a scale in Compusense | Administered during session4, 5 and 6. Each evaluation takes1 hour.There is a 1-minute inter-stimulus break between each sample for palate cleansing. |
| This is conducted at the Screening Visit, 1 time only. Takes 15 minutes to complete. |
| 3 day food records | Dietary intake will be assessed by documenting all foods and beverages consumed over 3 consecutive days, typically including 2 weekdays and 1 weekend day. Participants will record all foods and beverages consumed using household measures. | Administered once during whole study. Record 3 days of food intake (over 72 hours). Recording can range from 5-15 minutes for every meal recorded (recording duration depends on how many meals to be recorded for the day) |
| Gastrointestinal Symptom Rating Scale (GSRS) | The Gastrointestinal Symptom Rating Scale (GSRS) is a validated, self-administered questionnaire used to assess the severity of gastrointestinal symptoms. It consists of 15 items grouped into five symptom domains: reflux, abdominal pain, indigestion, diarrhoea, and constipation. Each item is rated on a 7-point Likert scale ranging from 1 (no discomfort) to 7 (very severe discomfort). Higher scores indicate greater gastrointestinal symptom severity. | Administered once over the course of the study. Takes about 1-2 minutes to complete each item. |
| Council on Nutrition Appetite Questionnaire (CNAQ)- Rate items like appetite quality, fullness, hunger, taste of food, and eating frequency on a 5-point Likert scale (e.g., from "very poor" to "very good"). A total score is often used. | An 8-item self-reported appetite assessment tool used in clinical research to evaluate appetite status. | Administered only once over the course of the study. Takes about 1-2 minutes to complete each item. |
| Pittsburgh Sleep Quality Index (PSQI)- Self-rated items,combined to generate 7 component scores to obtain a global PSQI score ranging from 0 to 21, with higher scores indicating poorer sleep quality | Validated, self-administered questionnaire used to assess subjective sleep quality and sleep disturbances over the previous 1 month. | Administered only once over the course of the study. Takes about 1-2 minutes to complete each item |