A study was conducted evaluating the effect of long-term Cu deficiency, with or without high Mn, on growth, gene expression and Cu status of beef cattle. Twenty-one Angus calves were born to cows receiving one of the following treatments: (1) 10 mg supplemental Cu/kg DM (+Cu); (2) no supplemental Cu and 2 mg Mo/kg DM ( − Cu); (3) − Cu diet plus 500 mg supplemental Mn/kg DM ( − Cu+Mn). Calves were weaned at approximately 183 d of age and individually fed throughout the growing and finishing phases. Plasma Cu was lower (P < 0·01) in − Cu calves compared with +Cu calves while high dietary Mn further depressed (P < 0·01) plasma Cu in − Cu+Mn calves v. − Cu calves. Liver Cu concentrations in +Cu calves were greater (P < 0·01) than in − Cu calves, with no differences between − Cu and − Cu+Mn calves. The daily body-weight gain of +Cu calves was greater (P < 0·01) than − Cu calves during the period from birth to weaning, but did not differ during the growing phase. − Cu+Mn calves gained less (P < 0·05) than − Cu calves during the growing phase. DM intake was lower (P < 0·01) in − Cu+Mn calves v. − Cu calves, and did not differ among +Cu and − Cu calves. The relative gene expression of cytochrome c oxidase in the liver was lower (P < 0·05) in − Cu calves compared with +Cu or − Cu+Mn calves. In conclusion, feeding a Cu − deficient diet in combination with high Mn negatively affected the growth and Cu status of beef cattle.

Poor nutritional status is a major concern for children being treated for an oncology condition. It is vital for optimal prognosis that nutritional concerns are recognised and treated promptly. The majority of oncology treatment centres only use simple methods to screen for poor nutritional status; however, it is unknown whether these simple methods accurately recognise poor nutritional status. We aimed to determine whether commonly used simple nutritional assessment variables could accurately identify poor nutritional status in children being treated for oncological conditions. This cross-sectional study measured height, weight, mid-upper arm circumference, triceps skinfold, albumin levels and body cell mass in forty children being treated for an oncological condition. To determine whether commonly used nutritional variables were suitable determinants, the variables were compared against the reference measure of body cell mass index (BCMI) Z-scores. Using the BCMI Z-score cut-off of − 1·65, 48 % of the study population were considered poorly nourished. Correlational analysis showed that there was no significant biological relationship between the BCMI Z-score and the simple parameters. When divided into two groups based on the nutritional status indicated by the BCMI Z-score, the independent t tests between the well-nourished and malnourished groups demonstrated that there was a significant difference in the BMI Z-score (P = 0·01) between the groups. No simple nutritional measures were found to accurately identify poor nutritional status in children being treated for oncological conditions.

We aimed to test the effects of three different weight maintenance diets on appetite, glucose and fat metabolism following an initial low-energy diet (LED) induced body weight loss. Following an 8-week LED and a 2–3-week refeeding period, 131 subjects were randomized to three diets for 6 months: MUFA, moderate-fat (35–45 energy percentage (E%) fat), high in MUFA with low glycaemic index; LF, low fat (20–30 E% fat) or CTR, control (35 E% fat). A meal test study was performed in a subgroup, before and after the 6-month dietary intervention, with forty-two subjects completing both meal tests. No difference in body weight, energy intake or appetite ratings were observed between diets. Both the LF and MUFA diets compared to CTR diet reduced postprandial glycaemia and insulinaemia and lowered fasting insulin from month 0 to month 6. Following the 8-week LED period lower levels of the appetite regulating peptides, pancreatic polypeptide, peptide YY, glucagon-like peptide-1 and glucagon-like peptide-2, along with increased appetite scores were seen in comparison to measurements performed after the 6-month dietary intervention. In conclusion, the two competing diets, MUFA and LF, were equally good with respect to glucose metabolism, whereas the CTR diet resembling the typical Western diet, high in SFA, sugar and high glycaemic carbohydrates, indicated associations to lowering of insulin sensitivity. Lower levels of appetite regulatory peptides along with increased appetite scores following an 8-week LED and 2–3-week refeeding period, suggest that strategies for physiological appetite control following a LED period are needed, in order to prevent weight regain.

The objective of the present study was to evaluate the validity of a FFQ in the estimation of dietary amino acid intake. Amino acid intake was calculated using a composition database developed based on the Standard Tables of Food Composition for amino acids in Japan. Subjects were subsampled from two populations of the Japan Public Health Center-based Prospective Study who volunteered to participate in the validation study of the FFQ. The first group was from the population the FFQ was developed for (internal population; n 215) and the second was a separate population to confirm external validity (external population; n 350). The validity of the FFQ was evaluated using 28 d weighed dietary records (DR) as a reference method. Spearman's rank correlation coefficients (CC) between amino acid intake from the FFQ and DR were calculated. The dietary intake of amino acids was slightly underestimated by the FFQ. Deattenuated CC of energy-adjusted amino acid intake according to the FFQ and corresponding amino acid intake according to the DR ranged from 0·15 to 0·52. The median CC for twenty amino acids were 0·33 for men and 0·25 for women in the internal population, and 0·40 for men and 0·30 for women in the external population. In conclusion, the validity of the FFQ in estimating amino acid intake was low to moderate.

To assess energy balance in very sick medical patients requiring prolonged acute mechanical ventilation and its possible impact on outcome, we conducted an observational study of the first 14 d of intensive care unit (ICU) stay in thirty-eight consecutive adult patients intubated at least 7 d. Exclusive enteral nutrition (EN) was started within 24 h of ICU admission and progressively increased, in absence of gastrointestinal intolerance, to the recommended energy of 125·5 kJ/kg per d. Calculated energy balance was defined as energy delivered − resting energy expenditure estimated by a predictive method based on static and dynamic biometric parameters. Mean energy balance was − 5439 (sem 222) kJ per d. EN was interrupted 23 % of the time and situations limiting feeding administration reached 64 % of survey time. ICU mortality was 72 %. Non-survivors had higher mean energy deficit than ICU survivors (P = 0·004). Multivariate analysis identified mean energy deficit as independently associated with ICU death (P = 0·02). Higher ICU mortality was observed with higher energy deficit (P = 0·003 comparing quartiles). Using receiver operating characteristic curve analysis, the best deficit threshold for predicting ICU mortality was 5021 kJ per d. Kaplan–Meier analysis showed that patients with mean energy deficit ≧5021 kJ per d had a higher ICU mortality rate than patients with lower mean energy deficit after the 14th ICU day (P = 0·01). The study suggests that large negative energy balance seems to be an independent determinant of ICU mortality in a very sick medical population requiring prolonged acute mechanical ventilation, especially when energy deficit exceeds 5021 kJ per d.

We have previously shown that adult female rats exposed to intra-uterine malnutrition were normophagic, although obese and resistant to insulin-induced hypophagia. The present study aimed at examining aspects of another important catabolic component of energy homeostasis control, the hypothalamic serotonergic function, which inhibits feeding and stimulates energy expenditure. Pregnant dams were fed ad libitum or were restricted to 50 % of ad libitum intake during the first 2 weeks of pregnancy. Control and restricted 4-month-old progeny were studied. The restricted rats had increased body adiposity with normal daily food intake but failed to respond with hypophagia to an intracerebroventricular injection of serotonin (5-hydroxytryptamine; 5-HT). Stimulation, by food ingestion, of extracellular levels of serotonin in medial hypothalamus microdialysates was more pronounced and lasted longer in the restricted than in the control rats. In the restricted group, hypothalamic levels of 5-HT2C receptor protein tended to be reduced (P = 0·07) while the levels of 5-HT1B receptor and serotonin transporter proteins were significantly elevated (36 and 79 %, respectively). In conclusion, female rats undernourished in utero had normophagic obesity as adults but had an absence of serotonin-induced hypophagia and low hypothalamic levels of the 5-HT2C receptor. Compensatory adaptations for the functional serotonergic impairment were evidenced, such as an enhanced release of serotonin in response to a meal allied to up-regulated hypothalamic 5-HT1B and transporter expression. Whether these compensations will persist in later life warrants further investigation. Moreover, it cannot be ruled out that the serotonergic component of energy expenditure was already impaired, thus contributing to the observed body-fat phenotype.

The long-chain (LC) n-3 PUFA content of pork, particularly DHA, can be increased by including 15 % PorcOmega® (a fortified tuna fishmeal product) in pig finisher diets. The aim of the present study was to see whether this enriched pork could deliver cardiovascular health benefits to consumers. In a double-blind intervention trial, thirty-three healthy adult volunteers (sixteen female and seventeen male) were randomised to consume either n-3-enriched or regular (control) pork (a selection of five fresh cuts totalling 1000 g/week) for 12 weeks. Fasting blood samples were collected every 4 weeks and analysed for serum lipids, maximally stimulated thromboxane production and erythrocyte fatty acid composition. The n-3-enriched pork provided subjects with 1·3 g LC n-3 PUFA per week. Erythrocyte DHA levels rose 15 % in the n-3 group and fell 5 % in the control group over 12 weeks (P = 0·001). Compared with the control group, serum TAG decreased to a greater extent in the n-3 group (P = 0·02) and serum thromboxane production increased to a lesser extent (P = 0·004). Changes in the latter were inversely associated with changes in incorporation of DHA into erythrocytes (r − 0·54; P < 0·05). Thus the modest increases in LC n-3 PUFA intake resulting from regular consumption of enriched pork can improve cardiovascular risk factors.

In the present study the relationship of sugar-sweetened beverage (SSB) consumption with the intake of single nutrients and total diet quality in German children and adolescents was evaluated using a repeated-measures regression analysis model. We used dietary data from 7145 three-day weighed records of 1069 subjects aged 2–19 years participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Intake of macronutrients as percentage of total energy intake (%En), intake of micronutrients as percentage of German reference values (intake quality score) and nutritional quality index (NQI) as an indicator of diet quality were chosen as separate dependent variables. SSB consumption was positively associated with %En from carbohydrates (boys v. girls: +4·00 v. +4·09 En%/MJ from SSB) and added sugars (boys v. girls: +7·36 v. +9·52 En%/MJ from SSB) and negatively with %En from protein (boys v. girls:  − 1·25 v.  − 1·31 En%/MJ from SSB) and fat (boys:  − 2·82 v.  − 2·73 En%/MJ from SSB). With respect to micronutrients, SSB consumption was negatively associated with folate and Ca intake, for which mean intake levels were inadequate in girls. Absolute diet quality was negatively associated with SSB consumption, whereas the effect was larger for girls (boys v. girls:  − 1·41 v.  − 2·63 points of NQI/MJ from SSB). Overall, results show a diluting effect of SSB consumption on micronutrient intake and diet quality. This effect might be relevant especially in girls as the association with diet quality was larger and mean NQI levels were lower in comparison with boys.

Despite the potential link between snack food intake and obesity and the reportedly high prevalence of snacking among adolescents, adolescent snack food patterns (types of foods consumed, frequency and portion size) have not been extensively examined. This study examines these issues using data on the snacking patterns of adolescents aged 13–16 years who took part in the 1997 National Diet and Nutrition Survey (NDNS) and that from a Northern Irish (NI) cohort of adolescents collected 8 years later, in 2005. Overall energy intake was significantly higher in the NI adolescents in 2005 compared with the NDNS adolescents in 1997 (P < 0·01). Consequently, energy intake from snacks was significantly higher in the NI cohort (P < 0·01) and a trend for a higher % energy intake from snacks compared with the NDNS group was observed (median 32·5 % v. 29·8 %, respectively). Sugar-sweetened carbonated and soft drinks remained the most popular choice of snack over this 8-year period; however, both the portion size consumed and frequency of consumption were significantly higher among the adolescents in 2005 compared with those in 1997 (P = 0·022 and P = 0·014, respectively). Despite the lower popularity, and correspondingly lower frequency of milks and beverages, the portion size of both food groups was significantly higher among the adolescents in 2005 compared with those in 1997 (P < 0·001 and P = 0·007, respectively). These findings may provide scope for policy interventions to place particular emphasis on reducing typical portion sizes consumed of popular snack choices, in particular high-energy carbonated and soft drinks, among UK adolescents.

The purpose of this study was to evaluate the effect of low Ca intake on the 10-year incidence of vertebral fractures in cohorts I and II of the Japan Public Health Centre-based Prospective Study. The baseline studies were conducted in 1990–1994, with the follow-up studies conducted after 10 years. We analysed 33 970 subjects aged 40–59 years in cohort I and 41 664 subjects aged 40–69 years in cohort II. At baseline, the intake of Ca was assessed as a predictor, using validated FFQ. A meta-analysis was performed to estimate a summary relative risk (RR) for the two cohort studies. The 10-year cumulative incidences of self-reported vertebral fractures were 0·38 % for cohort I and 0·56 % for cohort II. In women, lower Ca intake was associated with a higher incidence of vertebral fractures (P for trend = 0·001), with the lowest quartile of Ca intake having a significantly higher incidence (0·89/1000 persons per year or RR 2·10 (95 % CI 1·25, 3·55)) than that (0·42/1000 persons per year) of the highest. In addition, the RR calculated using energy-adjusted Ca intake (by the residual method) as an outcome was 1·92 (95 % CI 1·28, 2·88). However, no such association was observed in men. An increase of Ca intake should be considered as a preventive strategy for vertebral fractures in peri- and post-menopausal women with a low Ca intake.

The aim of the present study was to investigate the relationships of physical activity types and sedentary behaviour with BMI and waist circumference (WC). The sample comprised 6215 adults (2775 men, 3440 women) aged 16 years and over living in Scotland. Self-reported physical activity of moderate to vigorous intensity (MVIA) included domestic activity, walking, and sports and exercises. MVIA levels were classified as being inactive, being insufficiently active, being sufficiently active for general health benefits and being sufficiently active for obesity prevention. Sedentary time was defined as television and other screen-based entertainment time (TVSE). Dependent variables were BMI-defined obesity (BMI-OB) and WC-defined obesity (WC-OB). TVSE was positively related to both WC-OB (adjusted OR 1·69 (95 % CI 1·39, 2·05) for ≥ 4 h of TVSE per d compared with < 2 h/d) and BMI-OB (OR 1·88; 95 % CI 1·51, 2·35) independently of MVIA. Those classified as most active who reported ≥ 4 h/d of TVSE had higher prevalence of BMI-OB (18·9 v. 8·3 %; P < 0·05) and WC-OB (28·0 v. 10·0 %; P < 0·01) than those equally active with < 2 h/d of TVSE. Sports and walking were related inversely to WC-OB (OR for no time compared with ≥ 30 min/d: 1·55 (95 % CI 1·24, 1·94); 2·06 (95 % CI 1·64, 2·58)), but only walking was related to BMI-OB (OR 1·94; 95 % CI 1·58, 2·37). Domestic physical activity was not related to BMI-OB or WC-OB. In conclusion, physical activity and sedentary behaviour are independently related to obesity. Public health recommendations should both promote physical activity and discourage engagement in sedentary pursuits.

From the observation that fasting heat production includes the cost of body protein resynthesis and the evidence that protein resynthesis is included in the regression estimate of protein retention efficiency it is conjectured that the estimate of maintenance from fasting heat production must be conceptually equal to the regression intercept estimate of maintenance plus the cost of body protein resynthesis. Experimental evidence for comparable situations shows an approximate observational equality in agreement with the conjectured conceptual equality. This approximate equality implies that the theoretical (stiochiometric) efficiency of protein synthesis should be used in conjunction with the estimate of maintenance from fasting heat production for the prediction of growth energy requirements. The approximate maintenance equalities suggest furthermore approximate equality of theoretical fat synthesis efficiency and regression fat retention efficiency. This conjecture is also supported by experimental evidence. Some practical nutrition and pig breeding implications of the foregoing conclusions are indicated.

The accumulation of advanced glycation endproducts (AGE) due to non-enzymic glycation of proteins has been implicated in several pathophysiologies associated with ageing and diabetes. The formation of AGE is accelerated in hyperglycaemic conditions, which alter the structure and function of long-lived proteins. Thus inhibition of the formation of AGE is believed to play a role in the prevention of diabetic complications. In the present study we evaluated the antiglycating effect of aqueous extracts of various plant-based foods. The effect of aqueous extracts of these agents in terms of their ability to prevent the accumulation of AGE due to fructose-mediated in vitro glycation of eye lens soluble proteins was investigated. The degree of protein glycation in the absence and presence of dietary extracts was assessed by different complementary methods, i.e. non-tryptophan AGE fluorescence, AGE-induced cross-linking by SDS-PAGE and glyco-oxidative damage by carbonyl assay. Five out of the seventeen agents tested showed significant inhibitory potential against in vitro protein glycation in a dose-dependent manner. Prominent among them were ginger, cumin, cinnamon, black pepper and green tea, which inhibited in vitro AGE formation to lens proteins 40–90 % at 1·0 mg/ml concentration. Assessing their potential to reduce the amount of glycated protein using boronate affinity chromatography and also their ability to prevent the formation of specific antigenic-AGE structures by immunodetection further substantiated the importance of ginger, cumin and cinnamon in reducing AGE burden. These findings indicate the potential of some dietary components to prevent and/or inhibit protein glycation. Thus these dietary agents may be able to be exploited for controlling AGE-mediated diabetic pathological conditions in vivo.

Ingestion of selected nutrients modulates dermal properties. In the present study, two groups of women ingested flaxseed or borage oil for 12 weeks. The control group received a placebo containing medium-chain fatty acids. Dose was 2·2 g total fatty acids/d with α-linolenic acid and linoleic acid as major constituents in the flaxseed oil group; in the borage oil group linoleic and γ-linolenic acid were predominant. In the flaxseed oil group, the contribution of α-linolenic acid to total fatty acids in plasma was significantly increased on weeks 6 and 12, whereas there was an increase in γ-linolenic acid in the borage oil group (P < 0·05). Skin irritation was performed by nicotinate treatment, and changes in skin reddening and blood flow were monitored. Compared to week 0, skin reddening was diminished in both groups; blood flow was also lowered. Skin hydration was significantly increased after 12 weeks of treatment compared to week 0, with flaxseed or borage oil (P < 0·05). Transepidermal water loss was decreased in both oil groups by about 10 % after 6 weeks of supplementation. A further decrease was determined after 12 weeks in the flaxseed oil group. Surface evaluation of living skin revealed that roughness and scaling of the skin were significantly decreased with flaxseed and borage oil comparing week 0 and week 12 (P < 0·05). Except for hydration, none of the parameters was affected in the placebo group. The present data provide evidence that skin properties can be modulated by an intervention with dietary lipids.

A randomised, double-blind, placebo-controlled study was conducted to determine whether probiotics might be effective in reducing the risk of infections in infancy. Infants requiring formula before the age of 2 months were recruited from community well-baby clinics. Infant formula supplemented with the probiotics Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb-12 or placebo was administered daily until the age of 12 months. Incidence of early infections (before the age of 7 months) and incidence of recurrent (three or more) infections during the first year of life were recorded as the main outcome measures of the study. During the first 7 months of life, seven out of thirty-two (22 %) infants receiving probiotics and twenty out of forty (50 %) infants receiving placebo experienced acute otitis media (risk ratio (RR) 0·44 (95 % CI 0·21, 0·90); P = 0·014) and antibiotics were prescribed for ten out of thirty-two (31 %) infants receiving probiotics and twenty-four out of forty (60 %) infants receiving placebo (RR 0·52 (95 % CI 0·29, 0·92); P = 0·015). During the first year of life, nine out of thirty-two (28 %) infants receiving probiotics and twenty-two out of forty (55 %) infants receiving placebo encountered recurrent respiratory infections (RR 0·51 (95 % CI 0·27, 0·95); P = 0·022). These data suggest that probiotics may offer a safe means of reducing the risk of early acute otitis media and antibiotic use and the risk of recurrent respiratory infections during the first year of life. Further clinical trials are warranted.

Maternal nutrition during pregnancy has a significant influence in establishing patterns of metabolism and postnatal behaviours in offspring, and therefore shapes their risk of developing disorders in later life. Although it is well established that a mismatch between food consumption and energy expenditure leads to obesity and metabolic dysregulation, little research has investigated the biological origin of such behaviour. We conducted the present experiments to investigate effects of early-life nutrition on preference between wheel running and lever pressing for food during adult life. To address this issue we employed a well-established experimental approach in the rat which has shown that offspring of mothers undernourished during pregnancy develop obesity and metabolic disorders when kept under standard laboratory conditions. Using this experimental approach, two studies were conducted where offspring of ad libitum-fed dams and dams undernourished throughout pregnancy were given the choice between wheel running and pressing a response lever for food. Across subsequent conditions, the rate at which the response lever provided food was varied from 0·22 to 6·0 (study 1) and 0·19 to 3·0 (study 2) pellets per min. Compared with the control group, offspring from dams undernourished during pregnancy showed a consistently greater preference for running over lever pressing for food throughout both experiments of the study. The results of the present study provide experimental evidence that a mother's nutrition during pregnancy can result in a long-term shift in her offspring's lifestyle choices that are relevant to obesity prevention. Such a shift, if endorsed, will have substantial and wide-ranging health consequences throughout the lifespan.

Conjugated linoleic acid (CLA) has anti-obesity effects, but induces fatty liver in mice. The present study investigated whether co-administration of arachidonic acid (ARA) attenuates fat accumulation in the mouse liver induced by CLA. Male mice (8 weeks old) were given diets with either no addition of dietary fat (control), 3 % linoleic acid (LA), 3 % CLA, 3 % CLA+1 % ARA, or 3 % CLA+2 % ARA for 4 weeks. The perirenal fat weight in ARA-treated groups decreased similarly as with CLA alone, when compared to control or LA. Plasma TAG concentration was significantly higher in the CLA group than in either CLA+ARA group, while plasma cholesterol and NEFA concentrations did not vary among the groups. In contrast to visceral fat, liver weight was significantly higher in the CLA group than in the control or LA groups, and the effects of CLA were attenuated by ARA. TAG and cholesterol were markedly accumulated in the liver with dietary CLA, whereas co-administration with ARA, at either concentration, suppressed CLA-induced lipid accumulation. Liver PGE2 was enhanced by a combination of CLA and ARA when compared with CLA alone, but PGE1 level was not significantly different among groups. In conclusion, fatty liver induced by CLA was attenuated by co-administration with ARA, furthermore, a combination of these fatty acids maintained the anti-obese effect of CLA.

The aim of the present study was to report the first reliability and validity tests of the remote food photography method (RFPM), which consists of camera-enabled cell phones with data transfer capability. Participants take and transmit photographs of food selection and plate waste to researchers/clinicians for analysis. Following two pilot studies, adult participants (n 52; BMI 20–35 kg/m2 inclusive) were randomly assigned to the dine-in or take-out group. Energy intake (EI) was measured for 3 d. The dine-in group ate lunch and dinner in the laboratory. The take-out group ate lunch in the laboratory and dinner in free-living conditions (participants received a cooler with pre-weighed food that they returned the following morning). EI was measured with the RFPM and by directly weighing foods. The RFPM was tested in laboratory and free-living conditions. Reliability was tested over 3 d and validity was tested by comparing directly weighed EI to EI estimated with the RFPM using Bland–Altman analysis. The RFPM produced reliable EI estimates over 3 d in laboratory (r 0·62; P < 0·0001) and free-living (r 0·68; P < 0·0001) conditions. Weighed EI correlated highly with EI estimated with the RFPM in laboratory and free-living conditions (r>0·93; P < 0·0001). In two laboratory-based validity tests, the RFPM underestimated EI by − 4·7 % (P = 0·046) and − 5·5 % (P = 0·076). In free-living conditions, the RFPM underestimated EI by − 6·6 % (P = 0·017). Bias did not differ by body weight or age. The RFPM is a promising new method for accurately measuring the EI of free-living individuals. Error associated with the method is small compared with self-report methods.

A potassium chloride-containing salt substitute lowers blood pressure levels, but its overall acceptability has been of concern due to its potential adverse effects on food taste. In a large-scale, blinded randomised trial evaluating the comparative effects of a salt substitute (65 % sodium chloride, 25 % potassium chloride and 10 % magnesium sulphate) and a normal salt (100 % sodium chloride) on blood pressure, we collected data on the saltiness, flavour and overall acceptability of food. We performed this at baseline, 1, 6 and 12 months post-randomisation using 100 mm visual analogue scales for assessments of both home-cooked foods and a standard salty soup. The mean age of the 608 participants from rural northern China was 60 years and 56 % of them were females. In the primary analyses, the changes in the saltiness, flavour and overall acceptability of both home-cooked foods and a standard salty soup were not different between the randomised groups (all P>0·08). In the secondary analyses, weighting each of the data points according to the lengths of the respective follow-up intervals, the flavour of both home-cooked foods (mean difference = − 1·8 mm, P = 0·045) and a standard salty soup (mean difference = − 1·9 mm, P = 0·03) was slightly weaker in the salt substitute group. We conclude that salt substitution is both an effective and an acceptable means of blood pressure control. Possible small differences in flavour did not importantly deter the use of the salt substitute in this study group, although the acceptability of the salt substitute by a more general population group would need to be confirmed.