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Kuukkanen, T., & Malkia, E. (2000). Effects of a three-month therapeutic exercise programme on flexibility in subjects with low back pain. Physiother Res Int, 5(1), 46-61.
Martins, C. O. (2000). Efeitos da Ginástica laboral em servidores da reitoria da UFSC. Dissertação (Mestrado em Engenharia de Produção), UFSC, Florianópolis.
Mesquita, C. C., Ribeiro, J. C., & Moreira, P. (2010). Portuguese version of the standardized Nordic musculoskeletal questionnaire:
cross cultural and reliability. J Public Health, 18(5), 461–466.
Moseley, L. (2002). Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother, 48(4), 297-302 O'Sullivan, P. B., Mitchell, T., Bulich, P., Waller, R., & Holte, J. (2006). The relationship beween posture and back muscle endurance in industrial workers with flexion-related low back pain. Man Ther, 11(4), 264-271.
Przysiezny, W. (2000). Distúrbios osteomusculares relacionados ao trabalho: um enfoque ergonômico. Dynamis, 8(31);19-34 Rainville, J., Hartigan, C., Martinez, E., Limke, J., Jouve, C., & Finno, M. (2004). Exercise as a treatment for chronic low back pain.
Spine J, 4(1), 106-115 Reis R.J., La Rocca P.F., Silveira A.M., Bonilla I.M., iGiné A.N., Martín M. (2003). Fatores relacionados ao absenteísmo por doença em profissionais de enfermagem. Rev. Saúde Pública 37(5): 616-23.
Rocha, A. S. (1999). A influência da ginástica laboral na postura dinâmica do trabalhador industrial. Dissertação de Mestrado em Ciências do Movimento Humano. ESEF/UFRGS, Porto Alegre Santos, J.B. (2003). Programa de exercício físico na Empresa. Dissertação de Mestrado em Engenharia de Produção da Universidade Federal de Santa Catarina, Florianópolis Silva M. (1998). Segurança, Higiene e Saúde no Trabalho - Escritórios e Serviços. Lisboa: Instituto do Emprego e da Formação Profissional.
Souza, I. Venditti, R. (2004). Ginástica laboral: contribuições para a saúde e qualidade de vida de trabalhadores da indústria de construção e montagem - Case TECHINT S.A. EF y Deportes, 77.
Waddell, G., & Burton, A. K. (2001). Occupational health guidelines for the management of low back pain at work: evidence review.
Occup Med (Lond), 51(2), 124-135.
Wewers M.E. & Lowe N.K. (1990). A critical review of visual analogue scales in the measurement of clinical phenomena. Research in Nursing and Health 13, 227-236.
Sodium Content in Vegetable Soups Prepared Outside the Home: Identifying the Problem Gonçalves, Carlaa, Silva, Gabrielaa, Pinho, Olíviaa, Camelo, Sandraa, Amaro, Luísa, Teixeira, Vitora,b, Padrão, Patríciaa,c, Moreira, Pedroa,b,c a Faculty of Nutrition and Food Sciences, University of Porto, Portugal email: firstname.lastname@example.org, b Research Centre in Physical Activity, Health and Leisure, University of Porto, Portugal, c Public Health Institute from the University of Porto, Portugal
1. INTRODUCTION Modern life leads consumers to eat out and away from home and this is a trend that does not appear to be declining. Since very young age, meals served in catering establishments and the number of meals eaten away from home may vary from one to all day meals.
Eating out is associated with an increased risk for higher energy intake and to obesity [Orfanos, 2007]. One important food consumed in Portugal, even when eating out, is “vegetable soup” which is strongly recommended, given its high nutritional value, and negative association with obesity [Moreira, 2006]. However, soup has been identified as a “food unit” with high levels of sodium [Conceição, 2011; Mano, 1983] and this is a matter of concern. The sodium part in kitchen salt (sodium chloride) can have harmful effects in the body.
The average salt intake in most countries is about 9 to 12 g/d [Brown, 2009], and in European countries the average intake levels range from 5.4 to 18 g/d [Webster, 2011]. The average daily intake of sodium is between 3500 and 4700 mg/d, well beyond the Food and Nutrition Board  and the 2010 U.S. Dietary Guidelines [USDA, 2010], set at 1500 mg/d (“adequate intake”) for elderly and children.
Several studies have linked a high intake of salt with physiological and pathological changes such as increased blood pressure, left ventricular hypertrophy, increased cardiovascular diseases and renal diseases. There is also some evidence that excessive salt intake is associated with an increased risk of osteoporosis and stomach cancer [He, 2009].
Over the past twenty years, in Portugal cardiovascular disease accounted for 39% of deaths, and malignant tumours for 20% of deaths, being gastric cancer incidence and mortality the highest in European Union [Ferlay, 2006]. By this set of evidence, excessive salt intake is one of the main concerns by health professionals [INE, 2002] and from a public health perspective, reducing salt intake is one of the most upcoming strategies to put into practice. About 80% of salt intake can come from added salt in processed foods [Ferlay, 2006] and soup is no exception. However, given the high nutritional density of vegetable soup, it would be desirable to encourage its consumption at main meals, at home and when eating out, without concerns of increasing sodium intake at the same time.
This study aims to characterize the content of sodium present in soups served in several different Portuguese institutions, such as kindergartens, schools and nursing homes.
2. MATERIALS AND METHODS
2.1 Study Design This study encompasses data on sodium content in vegetable soup collected in 3 different institutions at lunch. At first, two samples of soup were collected in two geriatric institutions of the city of Barcelos for seven consecutive days, both before and after the addition of salt. Secondly, samples of soup were collected in eight kindergartens of the city of Vila Nova de Gaia for five consecutive days, also before and after adding salt. Lastly, samples were collected in ten elementary schools in the city of Porto and Bragança for three consecutive weeks, but only after the addition of salt. The total number of samples was 588, being 28 samples of nursing homes (14 before and 14 after salt addition), 110 of kindergartens (55 before and 55 after salt addition) and 450 of elementary schools.
2.2 Sample preparation The sample preparation procedure was adapted to soups from one validated method proposed to quantify sodium content in bread [Vieira, 2011]. All soup samples were stored in plastic containers at 4 °C until analysis. After homogenization of each soup, 2g were sampled and 2ml of nitric acid were added. The mixture was shaken during 90 minutes to allow the food matrix's complete hydrolysis. Then, 20 ml of water were added and the mixture was again homogenized using an electric homogenizer (Ultra Turrax model). Volume was completed up to 40 ml and shaken for 30 min, followed by centrifugation (4,000 rpm, 15 min). Finally, 1.00 ml of aqueous supernatant was diluted up to 40 ml of deionized water before reading in the flame photometer.
2.3 Chemicals and samples All reagents used were of analytical grade purity. Standard solution of sodium (1,000 mg/L) was supplied by JenWay, England. Calibration curves were constructed using 0.5, 1, 2.5, 5.0 and 7.5 μg/ml standards. The solutions were stored in a refrigerator. To avoid contamination of the samples, all PTFE materials were emerged in a freshly prepared solution
composed of 15% (v/v) proanalysis HNO3 (Merck) during 24 h, then rinsed thoroughly with doubly deionized water, and dried in a stove
2.4 Instrumentation A flame photometer (Model PFP7, JenWay, England) with filters for lithium, sodium, and potassium was used. Butane gas and air were supplied as the source of flame. The flow rate of fuel was adjusted to get a maximum sensitivity. Other apparatus used were a Seradest LFM 20 Water Purification System, a Heidolph REAX 2000 vortex, a Kern ALS 120–4 balance (Ziegelei), an Ultra Turrax homogenizer T25 (Sotel), a Heraeus stove D-6450 model and a Centrifuge Labofuge 6000 ®, from Heraeus.
2.5 Method validation For the evaluation of the instrumental precision, intensity emitted was determined in the same soup sample 20 times under the established instrumental conditions. Linearity was observed in the working ranges (in microgram per milliliter) from 0.5 to 7.5. Repeatability of the extraction procedure was evaluated by the coefficient variation using six aliquots of solutions that were submitted to extraction by direct dissolution of soup sodium in water. Recovery studies were carried out to determine the accuracy of the method. The samples were analyzed after the methods validation.
2.6 Statistical analysis Statistical analyses were carried out with SPSS (version 17, Chicago, USA). Data are presented as the mean ± standard deviation, and percentiles 5, 25, 50, 75 and 95; mode, maximum and minimum are also presented.
3. RESULTS AND DISCUSSIONThe method’s limit of detection was 0.2μg/ml and the limit of quantification was 0.2μg/ml. These values show that the method is precise and sensitive, enabling the quantification of low levels of sodium. The instrumental precision was 1.46%. Recovery studies were carried out to determine the accuracy of the method and it was found that recoveries ranged between 93.8% and 97.5%.
Higher mean values of sodium after adding salt were found in soups served in nursing homes (mean 269.06mg/100g) and kindergardens (mean 213.16mg/100g). These results (Table 1) may be due to a lack of awareness of the cooks to limit sodium intake, the absence of specific control for added salt in food preparation, or adjust the salt content to consumer preferences (particularly in geriatric institutions). Moderate content in elementary schools may be due to greater control by the system of school meals, but further analysis should be carried on other institutions.
The sodium content in soups with added salt are considerably higher than for soups before adding salt, strongly suggesting that the main contribution for sodium intake from soup is from addition in the cooking process. Most of the soup sodium content (more than 90%) comes from the salt added during cooking.
The Portuguese traditional food habits include the consumption of soup, rich in vegetables, twice a day (lunch and dinner). In the cohort EPI Porto study, the frequency of daily consumption of vegetable soup was 58.8% in women, and 54.9% in men [Lopes, 2006]. As populations become more sedentary and able to access energy-dense foods, there is a need to maintain the healthy components of traditional diets, such as vegetable soup, that may protect against obesity and other chronic diseases [Flood, 2007; Maureen, 2011] being of most importance to determine the level of sodium added to soups in order to maintain its positive nutritional characteristics.
Considering the possibility of having 300 ml of soup served per meal, sodium intake per soup may be up to 459-850mg, representing 31 to 54% of the daily adequate sodium intake [He, 2009] for the elderly and children in a single dose during a meal. We should also be aware that to the salt consumed in the soup is only a part of the total sodium intake throughout the day, and recommended dietary intake values may be easily overcome.
Many workplaces, schools or social institutions are associated with meal systems, that may include own production of meals or catering business. It would be desirable that consumers exposed to the consumption of meals outside the home could make informed choices and take effective action about their own salt intake, and benefit from meals that reduce their health risks. Geaney and colleagues  shown that structured catering initiatives in public sector has potential to reduce dietary intakes of salt. These initiatives may be through increased consumer information and / or by providing healthy meals at the public institutions.
To solve this problem, it would be advisable to develop educational and legislation strategies about maximum sodium / salt content in different foods, and to raise awareness among chefs and food handlers on this topic. Future strategies should consider an integrated national approach to desirable sodium content in foods, and objectives to reduce intake in a given time frame, taking into account the hedonic evaluation of consumer.
The strengths of this work lie in the methodology used in the laboratory to be the same in all three studies, the accuracy of sample collection, the large number of samples and isolating the amount of sodium added from the salt introduced into the soup. The convenience sample used act as the main weakness of this study.
4. CONCLUSIONS Average sodium levels in soups may be considered high, particularly in nursing homes and in kindergartens. Sodium per soup reached 31 to 54% of the daily adequate intake for the elderly and children. The values were very heterogeneous, probably because the sodium added to soups varied according to intrapersonal and interpersonal food preparation practices.
In terms of public health it would be important to standardize and monitor the sodium content of food served outside the home, and provide nutrition education to food handlers about reducing salt consumption and global health.
5. ACKNOWLEDGMENTS The authors declare no conflict of interest in the writing of this article, and acknowledge the collaboration of staff and institutions to collect vegetable soup samples.
6. REFERENCES Brown IJ, Tzoulaki I, Candeias V, Elliott P. (2009). Salt intakes around the world: implications for public health. Int J Epidemiol.
38(3):791-813 Conceição R, Mendes E, Casal S. Salt amounts in Oporto ready-to-eat soups. (2011) Porto: REQUIMTE, Faculdade de Farmácia, Laboratório de Bromatologia e Hidrologia Ferlay, J., Autier P, Boniol M, Heanue M, Colombet M, Boyle P. (2006) Estimates of the cancer incidence and mortality in Europe in