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Validation of Preferred Salt Concentration in Soup Hypertension Research (2020) 43:525–533 https://doi.org/10.1038/s41440-020-0397-1 ARTICLE Validation of preferred salt concentration in soup based on a randomized blinded experiment in multiple regions in Japan— influence of umami (L-glutamate) on saltiness and palatability of low-salt solutions 1 2 2 2 3 3 Hitomi Hayabuchi ● Rieko Morita ● Masanori Ohta ● Akiko Nanri ● Hideki Matsumoto ● Shoji Fujitani ● 3 4,5 6 7 8 9 Shintaro Yoshida ● Sadayoshi Ito ● Atsushi Sakima ● Hiroyuki Takase ● Miho Kusaka ● Takuya Tsuchihashi Received: 21 October 2019 / Revised: 8 December 2019 / Accepted: 22 December 2019 / Published online: 29 January 2020 © The Author(s) 2020. This article is published with open access Abstract Sodium reduction is an important public health goal. Individual and population approaches are necessary for reducing the sodium content of processed foods and meals. The aim of the present study is to affirm the effect of monosodium L-glutamate (MSG), an umami substance, on the saltiness or palatability of low-salt solutions and to explore the preferred salt concentration in soup. Five hundred and eighty-four healthy participants from nineteen regions in Japan tasted 0.3, 0.6, 1234567890();,: 1234567890();,: and 0.9% NaCl solutions with or without 0.3% MSG. Evaluations of saltiness and palatability for each solution were conducted using a visual analog scale in a double-blinded randomized manner. Saltiness gradually increased depending on the concentration of NaCl. The saltiness of the 0.3% NaCl solution with MSG was rated significantly higher than that without MSG. The palatability ratings were higher for the solutions with MSG than for those without MSG for all NaCl concentrations. In particular, the palatability rating of the 0.3% NaCl solution with MSG was twice as high as that without MSG and was significantly higher than that of the other five test solutions. Furthermore, these results were observed to be approximately the same, irrespective of sex, age, region, etc. Salt reduction is believed to result in a loss of palatability. However, our results suggest that umami can compensate for the loss of palatability caused by salt reduction and that the addition of an appropriate amount of an umami substance can facilitate salt reduction from 0.9 to 0.3% without sacrificing palatability. Keywords Umami ● Glutamate ● Palatability ● Sodium reduction ● Randomized blind experiment Introduction Reducing salt intake is essential for preventing the onset and aggravation of hypertension [1–4] and improving healthy longevity [5–7]. Higher sodium intake is reported to – Supplementary information The online version of this article (https:// be associated with higher blood pressure [8 12]. According doi.org/10.1038/s41440-020-0397-1) contains supplementary to the Global Burden of Disease project [13], elevated blood material, which is available to authorized users. * Hitomi Hayabuchi 4 Division of Nephrology, Endocrinology and Hypertension, [email protected] Tohoku University Graduate Medicine, Sendai, Japan 5 Department of Medicine, Katta General Hospital, Miyagi, Japan 1 Department of Food Science and Nutrition, Faculty of Human Life and Environment, Nara Women’s University, Nara, Japan 6 Health Administration Center, University of the Ryukyus, Okinawa, Japan 2 Graduate School of Health and Environmental Sciences, Fukuoka Women’s University, Fukuoka, Japan 7 Enshu Hospital, Hamamatsu, Japan 3 Research Institute for Bioscience Products & Fine Chemicals, 8 Kusaka Clinic, Kure, Japan Ajinomoto Co., Inc, Kawasaki, Japan 9 Steel Memorial Yawata Hospital, Kitakyushu, Japan 526 H. Hayabuchi et al. pressure (systolic > 115 mmHg) continues to be the largest Consequently, it is essential to find an appropriate com- single contributor to disease burden and mortality world- pound to enhance palatability and determine its optimum wide, resulting in 9.4 million deaths each year. Moreover, levels to compensate for the palatability loss caused by salt the global prevalence of hypertension is predicted to reduction [1]. The addition of an umami substance increase from 26.4% in 2000 to 29.2% by 2025, meaning (monosodium L-glutamate (MSG) or calcium diglutamate that 1.56 billion people may be diagnosed with hyperten- (CDG)) has made it possible to lower the NaCl concentra- sion [14]. Another report also suggests that the number of tion without sacrificing the pleasantness, saltiness, or taste people suffering from high blood pressure and the pre- intensity of soups [29–36]. In Japan, miso soup is an valence of high blood pressure are expected to continue ordinary food item in the daily diet, and Takimoto et al. increasing worldwide over the next decade [15]. Therefore, suggested that miso, or fermented soybean paste, is a pro- strategies to prevent hypertension are urgently needed. minent contributor to reducing daily salt intake [37]. Soup is In 2019, the Japanese Society of Hypertension published well known to be a common food consumed not only in Guidelines for the Management of Hypertension [16]. The Japan but also throughout the world. It is therefore essential importance of lifestyle modifications for the management to control the NaCl concentration in soups to reduce daily and prevention of hypertension is discussed in this guide- salt consumption [30, 32, 35, 36]. In previous studies on the line, and it is proposed that a salt reduction goal of <6 g effects of MSG and NaCl concentration on palatability, per day should be set. However, according to the National broth made from dried bonito [29], chicken broth Health and Nutrition Survey Japan in 2017 [17], the average [30, 32, 34], vegetable soup [31, 33] or spicy chicken soup daily salt intake was 10.8 g/day and 9.1 g/day in adult men [35] were used as test objects, but limiting factors such as and women, respectively. These intake levels are extremely age and number of panelists were found. In this study, we far from the salt reduction goal proposed above and do not investigated the influence of an umami substance on the even approach the provisional dietary goal (daily salt intake: saltiness and palatability of a low-salt solution prepared <8.0 g/day in men and <7.0 g/day in women) declared in the with distilled water as a medium and clarified the most Dietary Reference Intakes for Japanese 2015, which was preferred NaCl and MSG concentrations in a randomized published with the aim of preventing noncommunicable blind experiment with participants from multiple regions in diseases, including stroke, and cardiovascular diseases [18]. Japan. The daily salt intake recommendation of the World Health Organization (WHO) for adults to reduce blood pressure and the risk of cardiovascular disease, stroke and coronary Methods heart disease is <5 g/day [19]. In addition, global targets established by the United Nations and the WHO for the Study procedure prevention of chronic diseases include a 30% relative reduction in population-level salt intake by 2025 [20]. This multicenter study was conducted from 2017 to 2018 in Many countries have initiated programs targeting salt Japan, and participants comprised students from the nutri- reduction [21]. tion departments of eight universities and attendees of 11 The positive correlation between sodium intake and health seminars. Sensory evaluations were performed at systolic blood pressure has been shown in randomized eight universities located in Aomori, Chiba, Kanagawa, controlled trials [22] and a meta-analysis [23]. To prevent Shizuoka, Hiroshima, Fukuoka, and Kagoshima Prefectures and control prehypertension and hypertension, major in June 2017 and in Nara Prefecture in April 2018. The reductions in the salt content of the food supply, including same general middle-aged and elderly subjects performed processed foods and restaurant meals, are needed. sensory evaluation tests at 11 health seminars held in The potential for a reduction in the NaCl content in foods Miyagi, Saitama, Tokyo, Shizuoka, Nara, Hiroshima, to diminish their palatability is well known [24, 25]. Fukuoka (Kitakyushu, Munakata, and Fukuoka City), Although salt reduction programs have been developed in Nagasaki, and Okinawa Prefectures from July to many countries, few people pay attention to these programs November 2018. and reduce their salt intake [26]. In addition, Kawamura This study was conducted according to the guidelines et al. described the difficulty in convincing subjects to presented in the Declaration of Helsinki, and all the subjects continue consuming a low-salt diet even after their partici- signed the informed consent form prior to participating in pation in dietary programs and nutritional education for salt the study. All sensory evaluations were performed under intake reduction [27]. Kubota et al. also indicated the pos- the same protocol, which was approved by the Research sibility that impairment of salty taste recognition was Ethics Committee of Fukuoka Women’s University associated with masked hypertension in women showing (Approval No: 2016-31) for students and the Research normal blood pressure during clinical examination [28]. Ethics Review Committee at Nara Women’s University Validation of preferred salt concentration in soup based on a randomized blinded experiment in multiple. 527 (Approval No: 18-02) for general adults. These sensory General adult parcipants Young adult parcipants evaluations were registered with the University Hospital in eleven areas at eight universies Medical Information Network Clinical Trials Registry Sys- N=392 N=259 tem (UMIN000035280
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