Salt Reduction Programs from Around the World

This review consolidates the details of salt reduction programs and national initiatives across the world. The most important features of these efforts were chosen and analyzed in order to formulate better healthcare policies. Data on direct salt intake, as well as sodium levels consumed in food, was taken into account. Salt control measures, like altering food products, labeling on food containers and awareness modules, were studied in different countries. This review is the first of its kind to have “concisely summarized the most important elements of the many existing salt reduction programs and highlight the characteristics most likely to be important to program efficacy.”

Hypertension is known to be a major concern in healthcare due to its negative consequences on heart health. A balanced salt intake is critical for the management of hypertension. Reducing salt content in food could contribute greatly to the prevention of high blood pressure. Lowering salt intake is found to decrease the rate of strokes and mortality. The World Health Organization (WHO) supports salt control initiatives by governments, as this is an efficient and cost-effective proposition in the interest of public health. This study analyzes earlier programs, initiatives and literature reviews to draw out optimum strategies for reduction of salt consumption at national, and eventually, global levels. A selection of current programs across the world was done. The details were extracted and worked out to create an agenda on which future models of salt reduction initiatives can be based. A majority of the salt reduction initiatives were found to be in Europe.

The review comprised of 32 salt reduction programs initiated by governments, non-governmental organizations and industries, including data from the World Action on Salt and Health (WASH) website and the Medline database. Significant details like salt limits in food, baseline values, intermittent monitoring, control measures like reformulation, behavioral tuning and labeling, were recorded for analysis. The reasons for successful outcomes of these initiatives were examined to develop a concise framework for future salt reduction schemes.

Results/Key findings
* Of the 32 salt reduction programs, most were led by governments, while others were led by non-governmental organizations. Only one country reportedly had an industry-led salt reduction program.
* Seven countries had estimates of the average daily population salt intake, which were obtained through the analysis of 24-hour urine samples. Indirect methods of estimation like modeling of dietary data were used in most countries.
* Twenty-eight countries had set voluntary or mandatory reformulation of foods planned, nine countries had schemes for increasing consumer awareness through labeling on food packages and traffic lights, and by circulation of guidelines and warnings.
* Of all the countries assessed, Finland, France, Ireland, Japan and the UK were found to succeed in their salt reduction initiatives. These countries reported a significant reduction in population salt consumption, increase in consumer awareness and reduced salt levels in foodstuffs.

Next steps/Shortcomings
Most of the estimates on salt intake were obtained from food surveys and not from standard 24-hour urine assays, leading to an underestimation of the average salt intake. The studies reviewed came from varied sources, giving rise to the possibility of improper coverage and non-uniform analysis. Examination of each core feature individually is required for a better and comparative understanding of all programs included in this study.

Using less salt in the diet seems to be a simple and effective solution for the prevention of commonly occurring physiological disorders. The proof of the expected effect of salt reduction in control of hypertension is evident from the increasing number of these programs in different countries. The majority of these schemes are government-initiated, while non-governmental organization play a critical role, too. In an urban setting, processed food should be targeted to reduce dietary salt intake; while in rural settings, substitution of salt with other alternatives is a good option since most of the salt intake is added while cooking. Fixing predetermined targets for salt consumption and reformulation at the industry level, followed by effective monitoring, goes a long way in the implementation of salt reduction schemes.

For More Information:
Salt Reduction Initiatives around the World
Publication Journal: Journal of Hypertension, 2011
By Jacqueline L. Webster; Elizabeth K. Dunford; University of Sydney, Australia

*FYI Living Lab Reports Are Summaries of the Original Research.

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